Child Maltreatment最新文献

Child maltreatment (CM) is associated with negative health outcomes in adulthood, including deliberate self-harm (DSH), suicidal behaviours, and victimisation. It is unknown if associations extend to emergency department (ED) presentations for non-DSH related injuries. Birth cohort study data was linked to administrative health data, including ED presentations for non DSH related injuries and agency-reported and substantiated notifications for CM. Adjusted analyses (n = 6087) showed that any type of agency-reported notification for CM was significantly associated with increased odds of ED presentation for injuries (aOR = 1.57; 95% CI 1.32-1.87). In moderation analyses, women yielded significantly higher odds of notified and substantiated physical abuse, substantiated emotional abuse, and being subject to more than one type of substantiated abuse than males. ED presentations for injuries could be a proxy for risky behaviours, disguised DSH/suicidal behaviours, or physical abuse. The consistent findings in women may point to victimisation via interpersonal violence.

The Multidisciplinary Pediatric Education and Evaluation Consortium (MPEEC) is a medically directed program that mandates real-time interagency collaboration among child abuse pediatricians (CAPs), child protective services (CPS) investigators, and law enforcement. MPEEC provides consultation resulting in a definitive medical opinion regarding manner of injury when allegations of serious harm involving children less than three years old living in Chicago are reported to Illinois Department of Children and Family Services (DCFS). This study is the first to link data from a medically directed, inter-agency program with CPS investigations data to specifically examine the duration of CPS investigations and the level of concordance between the manner of injury as determined by CAPs and the investigation's outcome when CPS investigators and medical professionals are required to formally collaborate. On average, MPEEC produced a written opinion 16 days from the time of referral and DCFS made a finding 45 days after receiving the MPEEC report for the 690 cases referred to MPEEC over a 3-year period. The concordance level ranged from 75-90%. Our results highlight the need for more analysis of linked data to promote efficiency and proficiency in CPS investigations.

People exposed to childhood maltreatment (CM) are thought to emerge as "resilient" or "non-resilient" in adulthood, with the implication that resilient adults eluded the negative consequences of CM. However, adults with CM who are classified as "resilient" may still face negative outcomes in areas of life not captured by resilience criteria. To test this hypothesis, the present study examined whether higher levels of CM were associated with worse psychological, social, and physical health outcomes even in "resilient" adults. Using data at all three survey waves spanning two decades from the Midlife in the United States (MIDUS) longitudinal study, resilience was defined as healthy functioning across seven domains: psychiatric disorders, substance use, education, employment, homelessness, crime, and social isolation. Results showed that in both the "resilient" and "non-resilient" groups, higher CM exposure was significantly associated with worse outcomes on measures of stress reactivity, perceived stress, number of chronic conditions, self-esteem, life satisfaction, relationship quality with friends and family, and positive relations with others (measured at wave 3; all p-values <.033). These findings suggest that CM has enduring and overlooked psychological, social, and physical health consequences not captured by comprehensive resilience criteria, highlighting the need for intervention even in seemingly resilient adults.

The Philadelphia Alliance for Child Trauma Services III (PACTS III): Fortifying the Future is designed to change the trajectory of trauma experiences for children and youth and build an effective and sustainable trauma system for Philadelphia children, youth and their families. The initiative is led by the City of Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) and Community Behavioral Health (CBH) and has been implemented in community behavioral health agencies in Philadelphia, PA. Here, we provide an update on the program's progress and outcomes. Since 2012, 601 clinicians and supervisors have been trained in trauma-focused cognitive behavioral therapy (TF-CBT), approximately 23,000 youth were screened for trauma, and 8,420 youth received TF-CBT. Access expanded as the provider network grew from 3 to 21 agencies. An ongoing evaluation will determine the client-level impact of these efforts. Altogether, this system overhaul has greatly enhanced trauma identification and intervention.

Although maltreatment of children living in substitute care has significant negative consequences for both the children who experience it and for child welfare agencies, research examining this outcome is underdeveloped and has focused on a limited number of risk factors. Using administrative data from one Midwestern state and a social ecological framework, the current study examined the impact of multiple child, caseworker, case, and agency-level factors on the occurrence of maltreatment among children placed in foster homes. The results highlighted the importance of several agency-level factors. Foster home licensing was a significant predictor of substantiated maltreatment in substitute care, with children in unlicensed kinship and unlicensed fictive kinship foster homes at elevated risk of maltreatment compared to those in licensed placements. A majority of kinship and fictive kinship homes were unlicensed, which suggests that increasing licensure may improve child safety in substitute care. Other factors that increased the risk of maltreatment included larger caseworker caseloads, larger number of unrelated children in the foster home, and child mental health needs.

Intimate partner violence (IPV) is prevalent in families with young children and increases risk for trauma-related symptoms, making comprehensive assessment of IPV important for research and clinical purposes. The reliability, validity, and incremental value of the partner conflict section of the semi-structured Family Socialization Interview - Revised 2.0 (FSI-R2) were examined in a sample of children at-risk for IPV exposure (N = 246, M age = 5.4 years, SD = 0.9). Data analyzed were from a study investigating the effects of IPV on young children. Interrater reliability was acceptable. Supporting convergent validity, FSI-R2 severity correlated positively with mother-reported partner conflict (Conflict Tactics Scale-2) and child-reported perceived threat (Berkeley Puppet Interview). The FSI-R2 severity codes correlated positively with children's PTSD and trauma-related symptoms. Supporting incremental value, FSI-R2 severity explained unique variance in children's symptoms beyond the CTS2. Finally, findings underscored the importance of comprehensively assessing IPV that has occurred not only with current partners, but also ex-partners, and across children's lifetimes.

Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) has been shown to effectively reduce social worker-assessed child neglect and child problems. However, no research has examined the effects of MST-CAN on parenting behaviors or identified which intervention targets are associated with reductions in child problems. This study examined changes in child internalizing and externalizing problems, parental psychological control, neglectful parenting, and social worker-assessed neglect, accounting for therapist effects, and assessed how parenting and neglect predict child outcomes in 143 parent-child dyads in Switzerland (mean child age = 10.5 years, 54.1% boys). Multilevel regression showed significant reductions in social worker-assessed neglect (b = 14.10, SE = 3.49, p < .001) and child problems (b = 4.97, SE = 0.88, p < .001) with low intraclass correlation coefficients (ICC = .049, ICC = .017). Neglectful parenting (b = 0.03, SE = 0.05, p = .640) and psychological control (b = 0.10, SE = 0.07, p = .140) were not significantly reduced. Parenting and social worker assessed neglect did not affect changes in child problems. Findings demonstrate MST-CAN's effectiveness in reducing social worker-assessed neglect and child problems but highlight the need for targeting psychological control and multi-method and multi-informant assessments of parenting behaviors.

In Australia, infants have the highest rate of child protection involvement. Many jurisdictions in Australia and internationally have introduced policies for prenatal planning and support, however little is known about outcomes of infants reported prenatally. This study is the first to use cross-jurisdictional, individual-record data to examine child protection pathways associated with prenatal and infant reports. Australian Institute of Health and Welfare data covering 2012-2018 was used. Cox regression analyses examined factors associated with removal into out-of-home care and reunification. Removals were significantly more likely for children with prenatal reports (HR = 2.29, 95% CI: 2.17-2.41). Earlier-in-pregnancy reports were not associated with reduced removals. There was significant variation across jurisdictions in removals and reunifications. Aboriginal children were significantly more likely to have prenatal reports and removals and less likely to be reunified. Examining the effectiveness and potential improvement of prenatal interventions and support could increase children's opportunity to safely remain at home.

Studies have linked maternal childhood maltreatment to altered infant brain volumes, but none have examined infant hypothalamic-pituitary-adrenal (HPA) axis function as a mechanism linking the two domains. Further, studies among older children suggest that childhood abuse and neglect may be associated with different developmental outcomes and thus should be studied separately. Study participants were N = 57 mother-infant dyads, stratified for maternal childhood maltreatment. At 4 months, infant cortisol total output (AUCg) and change (AUCi) were assessed across the Still-Face Paradigm. Under natural sleep, infants completed T1-weighted MRI scans (M age = 12.28 months). Whole brain, amygdala, and hippocampal volumes were extracted via automated segmentation. Maternal childhood neglect, but not abuse, was directly associated with higher infant AUCg and AUCi, and was indirectly associated with larger amygdala and hippocampal volumes through infant AUCg. Results suggest that infant cortisol may be particularly influenced by maternal childhood neglect and may be one mechanism further influencing brain development.