Decision-making in child abuse and neglect

Social attachment theory can be of value in examining the wide variety of abuse and neglect situations that come to the attention of authorities. We consider evaluation of the parent-child relationship as a crucial part of the judicial process. We have suggested parameters that can be used to evaluate the relationship. We have outlined some of the more common distortions in this relationship that have, in our experience, been associated with the mistreatment of children. The use of social attachment theory has been of great help in understanding the emotional reactions of the many children we have seen for evaluation and treatment. The theory also serves as a potential guide for improvements in social policy. If we are more sensitive to the psychological world of these children, we will be better able to truly protect them.     

History of interpersonal violence, abuse, and nonvictimization trauma and severity of psychiatric symptoms among children in outpatient psychiatric treatment

In a clinical sample of child psychiatry outpatients, chart review data were collected for 114 consecutive admissions over a 1-year period at a Child and Adolescent Outpatient Psychiatry Clinic. Data included history of documented maltreatment, potentially traumatic domestic or community violence, neglect or emotional abuse, and noninterpersonal stressors as well as demographics, psychiatric diagnoses, and parent-rated child emotional and disruptive behavior problems. On a bivariate and multivariate basis, any past exposure to interpersonal violence-but not to noninterpersonal traumas-was related to more severe disruptive behavior problems, independent of the effects of demographics and psychiatric diagnoses. Noninterpersonal trauma and psychiatric diagnoses were associated with emotional problems; exposure to interpersonal violence appeared to partially account for this relationship despite not being independently associated with emotional problem severity. History of exposure to interpersonal violence warrants clinical and research attention as a severity marker and potential treatment focus in psychiatric outpatient services for children, particularly those with disruptive behavior problems.     

An integrated understanding of elder abuse and neglect

In the past three decades, society has developed interest in what has come to be called elder abuse. Since interest initially appeared, concern about elder abuse has gone through different cycles regarding the conceptualization of the problem, appropriate responses, and explanations. A recent trend has witnessed a call for an interdisciplinary and integrated understanding of, and response to, elder abuse. This article describes what is meant by an integrated response to elder abuse. Ways to promote a broader response to the problem are suggested.     

Intimate partner violence perpetration by court-ordered men: distinctions among subtypes of physical violence, sexual violence, psychological abuse, and stalking

This study continues previous work documenting the structure of violence perpetrated by males against their female intimate partners. It assesses the construct validity of a measurement model depicting associations among eight subtypes of perpetration: moderate physical violence, severe physical violence, forced or coerced sexual violence, sexual violence where consent was not possible, emotional/verbal psychological abuse, dominance/isolation psychological abuse, interactional contacts/surveillance related stalking, and stalking involving mediated contacts. Data were obtained from a sample of 340 men arrested for physical assault of a female spouse or partner, and court ordered into batterer intervention programs. Men were surveyed before starting the intervention. Confirmatory factor analyses (CFA) supported the validity of model as evidenced by good model to data fit and satisfaction of requirements for fit statistics. In addition, the eight factor solution was characterized by a slightly better model to data fit than a four factor higher order solution described in the author's previous work. Latent variable correlations across the broader categories of intimate partner violence (IPV) revealed that the violence subtypes were mostly moderately positively correlated and ranged from .381 (emotional/verbal psychological abuse with interactional contacts/surveillance related stalking) to .795 (dominance/isolation psychological with abuse with forced sex). Future studies should determine whether there are distinct risk factors and health outcomes associated with each of the eight IPV perpetration subtypes and identify possible patterns of co-occurrence.     

Mandatory reporting by nurses of child abuse and neglect

Most Australian jurisdictions have mandatory reporting legislation to compel members of selected professional groups, including nurses, to report suspicions that a child has been or is likely to be subjected to abuse or neglect. This article details the legal obligations of nurses in each jurisdiction, and highlights differences between jurisdictions. Problematic features of the laws are identified, including the use of ambiguous concepts like "reasonable" suspicion and "significant" harm. Literature is reviewed to identify what is known about nurses' legal knowledge, actual reporting practice, and the practical problems that arise for nurses in this context. It is concluded that empirical research needs to be conducted, because it is not known if the laws are practically effective, whether nurses have sufficient training in, and knowledge of, their reporting duties, or what factors influence sound reporting. Such research can inform both the development of sound training systems and recommendations for legal reform.     

Family and social factors associated with substantiation of child abuse and neglect reports

One hundred fifty-nine families who were reported for child abuse or neglect to a country social services agency in a single fiscal year were studied empirically to test the ecological model of child abuse and neglect. Several family and social factors were studied. Only two, size of family and stage in family developmental cycle, were significantly associated with an increased risk of substantiation of the report. Two potential sources of social support, the use of regular child care and the presence of an extended family member, were tested for their effect on substantiation in those cases where risk factors such as the two mentioned above and combinations of risk factors such as single parenthood and unemployed head of household were associated with higher rates of substantiation. In every case, these two examples of social support reduced the substantiation rate. The influence of the use of regular child care was especially strong in mitigating the effect of the family and social risk factors.     

Advancing prevention research on child abuse, youth violence, and domestic violence: emerging strategies and issues

Prevention research on the related problems of child abuse, youth violence, and domestic violence has grown at an accelerating pace in recent years. In this context, a set of shared methodological issues has emerged as investigators seek to advance the interpersonal violence prevention knowledge base. This article considers some of the persistent methodological issues in these areas and points out emerging research strategies that are forging advances in garnering valid, rigorous, and useful knowledge to prevent interpersonal violence. Research issues and emerging strategies in three key domains of prevention research are considered, including complexities in validly conceptualizing and measuring varying forms of violence as specific targets for preventive intervention, research issues and strategies designed to reliably predict and identify future violence risk to be targeted by preventive intervention, and research issues and emerging strategies in the application of empirical methods to forge specific advances in preventive intervention strategies themselves.     

The development of a sexual abuse severity score: characteristics of childhood sexual abuse associated with trauma symptomatology, somatization, and alcohol abuse

Childhood sexual abuse (CSA) is common and is associated with both mental and physical health problems in adulthood. Using data from an age- and sex-stratified population survey of 600 Olmsted County, Minnesota, residents, a Sexual Abuse Severity Score was developed. The abuse characteristics of 156 CSA respondents were associated with self-reported trauma, somatization, and alcohol use. Characteristics included age of first sexual abuse, more than one perpetrator, degree of coercion, severity of abuse (i.e., attempted intercourse is more severe than fondling), and the number of occurrences. This is one of the few reports to develop a risk summary that quantifies the severity of CSA.     

Elder abuse and neglect cases reviewed by appellate courts

With increasing attention focused on abuse and neglect of the elderly in domestic and institutional settings, nearly every state has passed legislation to protect these vulnerable adults. While the legal system has become involved at the trial court level, the appellate courts have not yet been very active. Only ten reported cases in the United States during 1981–1993 were appealed to a higher court. This article documents these few cases and explores the reasons for their ultimate dispositions.     

The correlates of child physical abuse and neglect by adolescent mothers

Theoretical and empirical knowledge about the link between adolescent motherhood and child maltreatment is in an early stage of development. Research has produced contradictory findings as to a relationship between the two and has not focused on identifying correlates. To fill gaps in the knowledge base and generate hypotheses for future tests, this secondary analysis of data on a subset of 119 mothers who gave birth prior to their 18th birthday focused on identifying characteristics that discriminate among low-income adolescent mothers with maltreated children and comparable mothers whose children were not known to be maltreated. Bivariate analyses of 18 characteristics from several theoretically justified domains revealed that 11 were associated with neglect and four with abuse. Step-sise discriminant analysis identified six correlates of neglect that correctly classified 85% of the mothers and four for abuse that correctly classified 79% of the mothers. Discussion focuses on implications for future research and hypothesis generation.     

Child abuse and neglect prevention and treatment program--HHS. Final rule

This rule contains a new basic State grant requirement to implement the Child Abuse Amendments of 1984 (Pub. L. 98-457). As a condition of receiving State grants under the Child Abuse Prevention and Treatment Act, States must establish programs and/or procedures within the State's child protective service system to respond to reports of medical neglect, including reports of the withholding of medically indicated treatment for disabled infants with life-threatening conditions. Other changes in regulations required by these Amendments will be published as a separate NPRM at a later date.     

Elder abuse and neglect: challenges and directions for legal reform

The last two decades have heralded an increased community and professional awareness of the phenomenon of elder abuse and the challenges it poses to the enjoyment of the human rights of some older people. The contemporary Australian legal system provides many of the components of a framework required to assist in the promotion of the rights of the elderly and in the prevention and remedy of elder abuse. This framework acts in concert with health and community services dedicated to the advancement of health and wellbeing into old age. In the future, the acknowledgment and adoption of international legal principles which are directed to the needs of the elderly, the reform of existing domestic legislation and the development of new elder-specific statutes may all impact upon the incidence and consequences of elder abuse. To date, no Australian jurisdiction has adopted a legislative regime targeted specifically at the issues confronting older Australians who may be vulnerable to abuse and neglect. This column looks at some of the options for legal reform in this area.     

Child abuse and neglect:A National Summary Of State Statutes

Effective court improvements must be based on comprehensive, baseline analysis of state child abuse and neglect statutes. This information will provide policy makers with improved tracking and evaluation opportunities as significant statutory changes are contemplated in pending federal initiatives and state court improvement activities. This article provides excerpts of a comprehensive national study undertaken to determine the level of uniformity or variance in statutes since the initiation of federal legislation attempting to improve state practice in the handling of child abuse and neglect cases. The state-by-state information is designed to provide diverse jurisdictions with an opportunity for comparative statutory analysis. The complete, 50 state Matrix of State Statutes Pertaining to Child Abuse, Neglect and Dependency is scheduled for publication later this year.     

Examining the links between animal abuse and human violence

Empirical research has increasingly found evidence for the coexistence of animal abuse and various forms of interpersonal violence. Some researchers have even argued for a specific version of this relationship, namely, that individuals tend to move from violence toward animals, particularly in childhood, to subsequent violence toward humans. Others have suggested that the evidence for this graduation or progression hypothesis is weak and inconsistent, and that an approach to animal abuse that focuses on the link is misguided. This article begins by reviewing the research on the connections between animal abuse and interhuman violence. Then it critically assesses the evidence for and against the link, and discusses the issues and challenges facing future research in this area.     

Preventing violence and trauma in the next generation

Research in recent times has clearly demonstrated that violence is predictable and preventable; however, the primary prevention of abusive and violent behavior will not occur without personal, interpersonal, and social change. This article reviews the empirical research supporting hypotheses for primary prevention of many risks associated with children becoming abusive.     

Child abuse and neglect prevention and treatment program--HHS. Notice of proposed rulemaking

This rule proposes a new basic State grant requirement to implement the Child Abuse Amendments of 1984 (Pub. L. 98-457). As a condition of receiving State grants under the Child Abuse Prevention and Treatment Act, States must establish programs and/or procedures within the State's child protective service system to respond to reports of medical neglect, including reports of the withholding of medically indicated treatment for disabled infants with life-threatening conditions. Other changes in regulations required by these Amendments will be published as a separate NPRM at a later date.     

Knowledge of child abuse and neglect in nursing students: Assessment and perspectives

Misdiagnosis of child abuse and neglect can delay early treatment. Some authors have pointed out that nurses can miss child abuse and neglect diagnoses due to a lack of knowledge. It is unclear whether the lack of knowledge is due to students' insufficient preparation in nursing school and/or a deficiency in continuing education. An 18-item questionnaire was administered to final-year nursing students to assess their degree of knowledge on child abuse and neglect and to evaluate if the lack of knowledge was due to insufficient teaching/training during nursing school. The students were also asked to evaluate themselves by assigning a score to their knowledge. A statistical comparison was performed to define whether sufficient/insufficient results were associated with the following variables: sex, pediatric or general nursing student, attending pediatric lectures, training in pediatric wards/ambulatories, and attending specific lectures on child abuse and neglect. The study population comprised 175 students (154 females, 20 males, 1 unknown). Exactly 66.3% of the participants had ≤9/18 correct answers. Of all students, 77.7% self-evaluated their level of knowledge as ≤5/10. The comparisons yielded statistically significant differences between the groups with sufficient objective knowledge and those unrelated to training in pediatric wards/ambulatories or pediatric nursing students. Overall, there was little objective knowledge on the subject, which may be related to insufficient teaching/training in nursing schools. Useful corrective strategies include further teaching on child abuse and neglect, preferably using a practical approach. Further, common teaching/training programs should be conducted by both pediatric and general nursing schools.