Treatment of Concurrent Substance Dependence,Child Neglect and Domestic Violence: A Single Case Examination Involving Family Behavior Therapy

Although child neglect and substance abuse co-occur in greater than 60% of child protective service cases, intervention outcome studies are deplorably lacking. Therefore, a home-based Family Behavior Therapy is described in the treatment of a woman evidencing child neglect, substance dependence, domestic violence and other co-occurring problems. Treatment included contingency management, self control, stimulus control, communication and child management skills training exercises, and financial management components. Results indicated improvements in child abuse potential, home hazards, domestic violence, and drug use, which were substantiated by objective urinalysis testing, and tours of her home. Validity checks indicated the participant was being truthful in her responses to standardized questionnaires, and assessors were “blind” to study intent. Limitations (i.e., lack of experimental control and follow-up data collection) of this case example are discussed in light of these results.     

Examination of Illicit Drug Use Frequency Using Multiple Drug Assessment Methods in Mothers Referred to Treatment by Child Protective Services

It has long been established that illicit drug use contributes to child maltreatment. However, investigators have yet to comprehensively examine illicit drug use in mothers referred to treatment by Child Protective Services (CPS). In this study, 77 mothers who were referred to treatment by CPS for co-existing drug abuse and child neglect were administered the Timeline Follow-Back measure to assess their substance use frequency during the four months preceding treatment. Reports of the mothers’ substance use were obtained for the same time period from the mothers’ significant others and CPS caseworkers, and mothers were administered urinalysis testing. The purpose of this study was to examine the concordance of these multiple reports, and identify unique predictors of different drug use reporting patterns. The practice of using urinalysis results as a prompt during the mothers’ Timeline Follow-Back administration may have contributed to greater frequency of drug use reporting in mothers. Mothers reported progressively more drug use for more distant time periods, as compared with caseworkers. Findings also suggested mothers’ reports of drug use were influenced by CPS investigatory case status (i.e., open or closed), ethnicity, and defensive responding. Implications of these findings for clinical practice and future research are discussed.     

Caffeine toxicity: a case of child abuse by drug ingestion

The case of a 14-month-old child who died of caffeine toxicity is presented. The evidence for prolonged toxicity associated with inappropriate delay in the seeking of medical care and the presence of various recent and healing injuries are diagnostic of child abuse. Fatal caffeine toxicity and child abuse by drug/substance administration are uncommonly reported. Relevant medical literature is reviewed.     

Child abuse potential and parenting stress within maltreating families

This study examined the relationship between child abuse potential and parenting stress in mothers and fathers receiving services for child maltreatment. Significant differences were found between perpetrating and nonperpetrating parents. Nonperpetrating parents reported more problems with family, greater total parenting stress and child-related stress, and greater stress from child demandingness, adaptability, acceptability, and distractibility. No significant gender differences in child abuse potential and parenting stress were found. Aspects of parent related stress moderated the relationship between child related stress and abuse potential. Perceived stress from parenting sense of competence was isolated as a variable that significantly increased abuse potential at medium and high levels of child-related stress.     

Attempted Drug‐facilitated Sexual Assault—Xylazine Intoxication in a Child

There are only a few cases of drug‐facilitated sexual assaults on children reported in the literature so far. Here, a case of a four‐year‐old boy is presented. He was unconscious, and the accompanying adults reported that the child had been at a playground on his own. Returning home, he complained of having been stung and collapsed immediately. Urine and serum samples of the child were investigated. In the toxicological analysis, xylazine, a sedative and muscle relaxant used in animals, was detected. Subsequent quantification by GC/MS after solid‐phase extraction revealed 0.053 mg/L xylazine in serum and approximately 0.63 mg/L in urine. Furthermore, the child was examined by a forensic medical specialist. Police investigations revealed that the godfather, who had been previously accused of sexual abuse of children, had injected the child with the drug, possibly in preparation for a shared bath.     

Incarcerated Mothers of Minor Children: Physical Health,Substance Use,and Mental Health Needs

Mothers of minor children serving sentences in a large Midwestern jail were screened for potential substance use problems and asked to report their physical and mental health status and treatment experiences. Of mothers screened for substance use problems, 72.1% had positive findings on the AUDIT-12, 56.7% reported at least one serious physical health problem, and 67.1% had received mental health treatment. More than two-thirds (68.8%) of the 240 mothers reported a co-occurring condition, and a third (33.8%) reported problems in all three spheres (substance use, mental health, and physical health). The relationship among the three health-related problems is examined as well as the characteristics of mothers related to having co-occurring health conditions. Given that the overwhelming majority of mothers reported more than one health-related problem, the changes to policy and practice need to avoid simplistic solutions.     

Violence and abuse in psychiatric in-patient institutions: a South African perspective

Institutionalisation of psychiatric patients was a prevalent treatment approach in the apartheid era of South Africa. Allegations of violence and abuse towards patients frequently arose during this time. The post-apartheid Department of Health prioritised improvements in mental health care by recommending, inter alia, deinstitutionalisation and reintegration of patients into the community. Ten years later, these interventions have proved difficult to institute and many patients are still hospitalised. The present study investigated whether currently hospitalised patients continued to experienced violence and abuse. This was an exploratory naturalistic study in which both qualitative and quantitative data were collected. Of the 127 who completed the study, more than 50% reported experiences of abuse. The main perpetrators were other patients, although violence by staff was reported. Reasons for the tardiness of implementation of deinstitutionalisation and the prevalence of ongoing violence and abuse in psychiatric hospitals are complex. Factors inherited from the pre-democratic system coupled with increased urban violence and financial constraints appear to be some of the major causes of ongoing dependency upon hospitalisation of mental health care users. The present study highlighted the urgency of implementing mental health care improvements.     

Training Parents Reported for or at Risk for Child Abuse and Neglect to Identify and Treat Their Children's Illnesses

Parents at-risk or reported for child abuse or neglect may demonstrate deficits in infant and child health care skills, placing their children at greater risk for health problems. Research assistants, caseworkers, and a nurse provided health care skills training to parents at risk or reported for child abuse or neglect. A health reference guide and other training materials were validated by health care professionals. Training involved teaching parents to follow a series of steps to identify symptoms, use reference and record-keeping materials, determine the best form of treatment, and either treat the illness at home, consult a physician, or seek emergency treatment. Skill acquisition was assessed through observations of parent behavior in simulated health care scenarios. A series of multiple baselines across parents demonstrated effectiveness of this training in the context of these scenarios. Six out of seven parents met the 100% mastery criterion. All parents provided positive ratings of the content of the training program, the training strategies, and the counselors who provided training.     

Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health

This study examined the association between officially recorded child abuse and neglect and adult mental health, substance use, and physical health outcomes. Data are from a longitudinal study of more than 30 years in which individuals were interviewed most recently in their mid—30s. Analyses consisted of group comparisons using chi-square tests for categorical variables and independent samples t-tests for continuous measures. Logistic and linear regressions controlled for gender and childhood SES, adult age, marital status, and education. Adults maltreated in childhood reported more symptoms of adult depression, anxiety, and more impairment due to mental and physical health problems. A higher percentage of those with maltreatment histories reported lifetime alcohol problems and appear at greater risk for substance abuse. Most findings of these bivariate analyses remained significant after accounting for gender and childhood socioeconomic status. Somewhat fewer significant results were observed after controlling for adult age, marital status, and education.     

Examination of the Relationship Between Parental Satisfaction and Child Maltreatment Potential While Considering Social Desirability

Parental dissatisfaction with children appears to be associated with child maltreatment. However, little is known regarding the specific domains of parental dissatisfaction that may increase child maltreatment potential, particularly in perpetrators of child maltreatment where substance abuse is present. In this study, responses to the Child Abuse Potential Inventory (CAPI) and a scale measuring parental satisfaction in 11 domains were examined in a sample of 82 mothers who were referred for treatment of substance abuse and child neglect by the local child protective service agency. Results indicated that mothers were relatively most satisfied with their children overall, and least satisfied in domains that were relevant to discipline (i.e., following house rules, compliance, reaction to redirection and punishment, completion of chores). Five of the 11 areas of parental satisfaction that were assessed evidenced negative correlations with child abuse potential, indicating that as satisfaction increased, abuse potential decreased. However, when correlation analyses excluded participants with elevated CAPI Lie scale scores (a measure of social desirability), only overall happiness demonstrated a significant negative correlation with child abuse potential. These results suggest that while associations are present among measures of parental satisfaction and child abuse potential, these associations are moderated to some extent by social desirability, which may help explain some of the inconsistencies reported in prior studies of parental satisfaction and child maltreatment potential.     

The Legal System and Child Sex Abuse—Ross Cheit's The Witch‐Hunt Narrative: Politics,Psychology, and the Sexual Abuse of Children

Cheit, Ross E. 2014 . The Witch‐Hunt Narrative: Politics, Psychology, and the Sexual Abuse of Children . New York: Oxford University Press. Pp. xvii + 508. $49.95 cloth. The prosecution of child sex abuse in cases involving very young children presents difficult problems for the justice system. Ross Cheit's book The Witch‐Hunt Narrative: Politics, Psychology, and the Sexual Abuse of Children (2014) addresses these problems in the context of the 1980s cases involving daycare centers. While the conventional conclusion drawn from these cases is that young children are not credible witnesses, Cheit's examination of the trial records in these cases reveals credible evidence of abuse in many, as well as evidence of injustice attributable to untrained and/or overenthusiastic interviewers. Cheit's examination of this litigation provides an opportunity to evaluate the legal system's treatment of child witnesses in sex abuse cases, as well as to discuss the appropriate use of social scientific evidence in litigation, the impact of mass media accounts on public policy, and the respective merits of criminal versus civil lawsuits in child sex abuse cases.     

The long-term effects of child sexual abuse by female perpetrators: a qualitative study of male and female victims

Although the long-term effects of sexual abuse by men have been studied extensively, minimal research has explored the effects of sexual abuse by women. This qualitative study explores the experience and long-term impact of sexual abuse by women. The data were derived from in-depth interviews with 14 adult victims (7 men, 7 women) of child sexual abuse by females. Most respondents reported severe sexual abuse by their mothers. The vast majority of participants reported that the experience of female-perpetrated sexual abuse was harmful and damaging. As a result of the sexual abuse, male and female respondents reported long-term difficulties with substance abuse, self-injury, suicide, depression, rage, strained relationships with women, self-concept and identity issues, and a discomfort with sex. In light of the popular and professional perceptions that sexual abuse by women is relatively harmless as compared to sexual abuse by men, the implications of these long-term effects are discussed, particularly in relation to professionals working in the area of child sexual abuse.     

Child abuse and chronic pain in a community survey of women

This study examined the relationship between a self-reported history of child physical and sexual abuse and chronic pain among women (N = 3,381) in a provincewide community sample. Chronic pain was significantly associated with physical abuse, education, and age of the respondents and was unrelated to child sexual abuse alone or in combination with physical abuse, mental disorder (anxiety, depression, or substance abuse), or low income. Number of health problems and mental health disorders did not mediate the relationship between physical abuse and chronic pain. Despite considerable evidence from the clinical literature linking exposure to child maltreatment and chronic pain in adulthood, this may well be the first population-based study to investigate this relationship for child physical and sexual abuse independently. The significant association between childhood history of physical abuse and pain in adulthood calls for a greater awareness of the potential for chronic pain problems associated with this type of maltreatment. Further research is needed to understand the mechanism for this complex relationship.     

The Interrelationship Between Substance Abuse and the Likelihood of Arrest,Conviction, and Re-offending in Cases of Intimate Partner Violence

The nexus between substance abuse and intimate partner violence has been studied in depth. The interrelationship between substance abuse, intimate partner violence, and the criminal justice system response and subsequent offending has not received as much attention. In this article, the authors examine the impact of substance abuse on the likelihood of an officer’s decision to make an arrest, conviction in that case, and subsequent re-offending. The authors find that while official decision-making remains unaffected by the fact that the offender has been drinking and/or using drugs, substance abuse and subsequent re-offending are inextricably interlinked. These findings highlight the need to screen domestic violence offenders for alcohol/drug abuse, and provide offenders manifesting these problems with alcohol/drug treatment in addition to batterer treatment.     

Safety, Health Care, and Bonding Within an Ecobehavioral Approach to Treating and Preventing Child Abuse and Neglect

This paper describes Project SafeCare, an ecobehavioral research and treatment project with families reported or at risk for child abuse or neglect. Preliminary demographic data are reviewed along with indirect assessment data. Four case studies are described to exemplify the effects of training provided to families. The implications for the current assessment data, treatment, and outcome are discussed.     

Spouse Abuse and Child Abuse by Army Soldiers

This study analyzed data collected by the U.S. Army’s Family Advocacy Program, the group primarily responsible for family violence prevention, identification, evaluation, treatment, and follow-up on Army installations. Patterns of spouse abuse and child abuse perpetrated within a five year period (2000–2004) were examined in a sample of 10,864 Army Soldiers who were substantiated for family violence offenses. Three groups of family violence offenders were compared: (1) those who perpetrated spouse offenses only; (2) those who perpetrated child offenses only; and (3) those who perpetrated both spouse and child offenses. Results showed that the majority of substantiated family violence offenders were spouse offenders who had not committed child abuse (61%), followed by child offenders who had not committed spouse abuse (27%), and finally those who committed both spouse and child offenses (12%). The three groups of family violence offenders differed in terms of the types of abuse they perpetrated (neglect of children, emotional abuse, physical abuse, and sexual abuse), their experiences of being a spouse abuse victim, and sociodemographic characteristics. Twelve percent of all spouse abusers committed multiple spouse abuse incidents, and 10% of all child abusers committed multiple child abuse incidents.     

Examining the relationship among substance abuse, negative emotionality and impulsivity across subtypes of antisocial and psychopathic substance abusers

Growing evidence suggests that individuals with Antisocial Personality Disorder (ASPD) can be categorized into theoretically meaningful subtypes. This study builds on earlier cluster-analytic research (Poythress et al., 2010) that identified four subtypes of ASPD in a large sample of prison inmates and offenders ordered into mandatory substance abuse treatment. These four subtypes (primary, secondary, and “fearful” psychopathic and non-psychopathic ASPD) differed in theoretically important ways on various criterion measures. Of those participants in substance abuse treatment (N = 571), we compare the four clusters, as well as non-ASPD substance abusers, in terms of (a) the severity of their self-reported alcohol and drug problems and (b) whether the severity of their substance abuse is predicted by similar etiologically important correlates (i.e., negative emotionality, impulsivity). There were modest subgroup differences in abuse, although as expected secondary psychopaths reported more severe misuse than primary psychopaths. Associations between impulsivity and negative emotionality and drug use for the total sample were in the expected direction, though relatively modest in magnitude. Unexpectedly, these associations were weaker among psychopathic subtypes relative to the non-psychopathic subgroups. These findings suggest that the etiology of drug use may differ across subgroups of chronically antisocial individuals.     

Legal responses to child sexual abuse cases in the Children’s Court of Victoria: study findings on a case-management approach

Child sexual abuse cases present Children’s Courts with distinctive challenges. The highly conflictual nature of child sexual abuse cases means they do not lend themselves to the usual adversarial court processes that characterise the conduct of Magistrate Court matters in Australia. With this in mind, the Children’s Court in Victoria established for 12 months in 2013 a pilot specialised judicial list (known as the ‘D’ List) which offered an intensive Magistrate-led case management approach to child sexual abuse cases in the Family (child protection) Division of the Court. The operation of the List was evaluated to assess the suitability and effectiveness of this approach, and to investigate the challenges associated with managing and deciding this class of cases. The findings confirmed that the List provided better management of cases and reduced delay. Given this, the Court is continuing the judicially proactive intensive case management approach and dedicated list for child sexual abuse matters and extending it to regional courts; believing it to be a more effective approach to managing and deciding this complex class of cases.     

Significance of Family Risk Factors in Development of Childhood Animal Cruelty in Adolescent Boys with Conduct Problems

The literature suggests that physical child abuse, sexual child abuse, paternal alcoholism, paternal unavailability, and domestic violence may be significant in development of childhood animal cruelty. Two groups of early- to late adolescent boys (CTA and N-CTA) in residential treatment for conduct disorder were compared in the current study on histories of these family risk factors. The adolescents in Group 1 were comprised of boys who had conduct problems with documented histories of animal cruelty (n = 50; CTA). Group 2 consisted of adolescent boys (n = 50; N-CTA) with conduct problems, but without documented histories of animal cruelty. Results showed that children in the CTA group had significantly greater histories of physical and/or sexual child abuse and domestic violence in comparison to children in the N-CTA group. These results suggest that physical and/or sexual abuse to a child, and exposure to domestic violence, may be significant in the development of childhood animal cruelty.     

The Impact of Trauma on Child Development

A growing body of research links childhood experiences of abuse and neglect with serious life‐long problems including depression, suicide, alcoholism and drug abuse, and major medical problems such as heart disease, cancer, and diabetes. Two basic processes, neurodevelopment and psychosocial development, are affected by early abuse and neglect. Scientists have begun to understand the mechanisms through which these adverse experiences alter child development and produce pernicious mental, medical, and social outcomes. These insights have opened opportunities to intervene to prevent maltreatment and to mitigate its effects. Future success depends on the greater dissemination and refinement of these interventions.