Risk Factors for the Occurrence of Child Abuse and Neglect

SUMMARY

A large, nationally representative database of child abuse and neglect cases was analyzed to identify demographic risk factors for the occurrence of different types of abuse and neglect. The analyses used the data collected in the second National Incidence Study of Child Abuse and Neglect (the NIS-2) concerning children who were harmed by abuse or neglect. Multiple-factor logistic models were developed to identify risk factors for the occurrence of abuse or neglect in six categories of maltreatment: physical abuse, sexual abuse, emotional maltreatment, physical neglect, educational neglect, and multiple maltreatment. A key finding was that children in families with incomes under $15,000 per year were at far greater risk in every category of maltreatment. Also, older children were generally at greater risk in every category, and risk was related to family structure, family size, child's sex and race/ethnicity, and metropolitan status of the county. However, these relationships applied to only certain types of abuse or neglect or took different forms in different maltreatment categories. Interactions among risk factors were the rule rather than the exception. Findings emphasize the need for better coordination between human services and income support services to families. The results imply that risk assessment would be appreciably advanced by going beyond simple matrix approaches that independently consider different factors by developing assessment models that include interactions between different risk factors.     

Use of Services Prior to and Following Intensive Family Preservation Services

A goal of short-term intensive family preservation services (IFPS) is to facilitate access to other services. However, service use following IFPS has rarely been studied. I describe the types of aftercare services that IFPS therapists recommended and use of these services in the two months following IFPS termination. Since families were using services that were not on the recommended aftercare plans, use of these services is also described. Primary caregivers of families who received family preservation through either child welfare or mental health were interviewed at two months after family preservation for the purpose of ascertaining service use. Different types of services were recommended and used based on whether families received IFPS through child welfare or mental health. However, there were also differences in the presenting problems and demographics between families in child welfare and mental health. Future research should include an independent assessment of need in order to determine the relationship between need and the types of services recommended and used. Even though families used services prior to IFPS, the findings indicated that IFPS facilitated use of new services. More research is needed on the process of how therapists decide what services to recommend and what they do to help families access services. It is also important to examine whether use of less restrictive services helps prevent out-of-home placements and the relationship between informal support and use of formal services.     

Physical Abuse in U.S. Children: Risk Factors and Deficiencies in Referrals to Support Services

More than 600,000 U.S. children are reported for physical abuse annually. Risk factors are proposed in the literature, but a comprehensive, national assessment of risk factors and support services has not been conducted. An analysis of national data from the National Child Abuse and Neglect Dataset revealed that domestic violence, parental alcohol and drug use, prior child abuse and neglect, public assistance receipt, and child behavior problems are associated with higher odds of substantiated physical abuse reports, compared to unsubstantiated reports. Most families, however, failed to receive relevant support services for any of these risk factors. Screening by physicians, child protection workers, and others for these risk factors could help identify children at increased risk for physical abuse and inform prevention efforts and support-service provision.     

The child abusing family: I. Methodological issues and parent-related characteristics of abusing families

Abstract

The physical abuse of children by their parents is a family matter and should be viewed within the context of the family unit. Unfortunately, few child abuse studies have directly examined the family unit. Rather, most studies focus on characteristics of individual members of abusing families or on dyadic relationships within abusing families. Therefore, the present paper examines the family-related variables that might contribute to child abuse. This review is divided into two parts. Part I discusses methodological considerations and parent-related aspects of abusing families, including: characteristics of abusing parents, childhood experiences of abusing parents, marital relationships of abusing parents and the perceptions and expectations that abusing parents have of their abused children. Part II of this review, which will appear in a later issue, will cover child-related aspects of abusing families, parent-child interactions in these families, environmental conditions associated with child abuse and typologies of abusing families.     

The Impact of Family Unification Housing Vouchers on Child Welfare Outcomes

This study addresses whether providing housing vouchers through the Family Unification Program (FUP) to families involved in the child welfare system reduces child maltreatment and the need for child welfare services. The study uses child welfare administrative data on 326 children in Portland, Oregon, and 502 children in San Diego, California from the point at which their families were referred to the program through 18 months post‐referral. Using a quasi‐experimental waitlist comparison design, probit regressions show little impact of FUP on preventing child removal from home, but some positive impact on reunification among children already placed out of home. Hazard estimations show receipt of FUP speeds up child welfare case closure. Impacts on new reports of abuse and neglect are mixed, but point toward reduced reports. Low rates of removal among intact comparison families and high rates of reunification for children in out‐of‐home care suggest poor targeting of housing resources. Housing vouchers are being given to families not bearing the risks the program is intended to address. The presence of some positive findings suggests that housing vouchers might help reduce child welfare involvement if better targeting were practiced by child welfare agencies.     

Palm Beach County Child Abuse and Neglect System Redesign: Initial Process Evaluation

For the families in Palm Beach County who entered the child abuse and neglect system as a result of having a child placed into emergency shelter, their experience was that the system was frequently intimidating, confusing, and fragmented. The reaction of the children and their families to this system was often defensiveness and resistance. To increase the system's effectiveness, it was redesigned and privatized. The redesigned system included centralized shelter placement, a comprehensive assessment, independent service coordination, and treatment service provision within a managed care model. By emphasizing family involvement and quality service provision, the goal was to increase voluntary participation and improve family outcomes. Based on initial data, it appears that the redesigned system has been successfully implemented and has made notable progress toward meeting its system flow timeframes. The initial data also indicate that high percentages of families are participating in and are satisfied with the system, that children are spending less time in shelter placements, and that only one family has reentered the system.     

Children with Disabilities

Abstract

Children in out-of-home care due to abuse and neglect are at disproportionately high risk for disabling conditions. The reasons for the over-representation of children with disabilities in the child welfare system are reviewed and discussed in this chapter. Factors discussed include impact of abuse and neglect, the impact risk factors such as exposure to community and domestic violence and poverty, risk of abuse or neglect associated with disability, and child welfare system factors. In addition, the need for greater efficacy in identification of disability, identification of service needs, and linkage with and delivery of services to serve the needs of children with disabilities in out-of-home care is addressed. Recommendations for policy review at State and Federal levels are offered along with direction for future research.     

Externalizing problems and problematic sexual behaviors: same etiology?

The study sought to determine whether maltreatment subtypes, family sexuality, and personal characteristics predicted and distinguished child problematic sexual behaviors (PSB) and externalizing problems (EP). Participants were families of 188 children, 6–11 years old, referred by child welfare services in four Quebec districts. Caregivers completed interviews and questionnaires. Results suggested that family environment and maltreatment subtypes had partially different impacts on PSB and EP. When EP and gender were controlled, younger children in a sexualized family environment and those verbally victimized were more likely to exhibit PSB. When PSB and gender were controlled, verbal abuse and neglect emerged as predictors of EP. Potential implications for child PSB research and interventions are discussed. Aggr. Behav. 36:358–370, 2010. © 2010 Wiley‐Liss, Inc.     

Preventing Maltreatment with a Community-Based Implementation of Parent–Child Interaction Therapy

The purpose of this study was to examine rates of child abuse and neglect reports following a community implementation of Parent–Child Interaction Therapy (PCIT), an evidence-supported intervention for the prevention of maltreatment. Among a group of families receiving PCIT, predictors of reports were examined including family demographics, course of treatment, changes in clinical measures, and caregiver report for prior maltreatment victimization and perpetration. Participants (n = 120) included families at-risk for future maltreatment with and without prior maltreatment history. Agency case records were linked with state administrative records of child welfare reports. Time to follow-up ranged from 13 to 40 months. Bivariate and multivariate survival analyses were used to model risk for a later report. During the follow-up period, 12.5 % of families had a report for physical abuse or neglect. Reports of prior victimization as a child and prior perpetration as an adult were strong predictors of a report of perpetration after PCIT. Dosage of PCIT and change in clinical measures did not increase risk for a later report. PCIT can be an effective intervention for preventing maltreatment. Family history of child welfare involvement is a prominent factor in assessing risk for future involvement.     

Preface

Abstract

Child victimization is a serious and on-going problem in the United States and throughout the world. In 2000, an estimated 900,000 children were victims of abuse and neglect in the United States. New and different responses to child maltreatment will have to be developed and implemented in response to the increasingly diverse contexts and situations within which maltreatment occurs. Emerging trends in adult-child boundary violations are explored within this volume from a cross-section of disciplines, including law, sociology, criminal justice, psychology, and health services. The selections analyze issues critical to child maltreatment and offer intriguingly different perspectives of present and future issues related to child abuse.     

Preface

Summary

Child victimization is a serious and on-going problem in the United States and throughout the world. In 2000, an estimated 900,000 children were victims of abuse and neglect in the United States. New and different responses to child maltreatment will have to be developed and implemented in response to the increasingly diverse contexts and situations within which maltreatment occurs. Emerging trends in adult-child boundary violations are explored within this volume from a cross-section of disciplines, including law, sociology, criminal justice, psychology, and health services. The selections analyze issues critical to child maltreatment and offer intriguingly different perspectives of present and future issues related to child abuse.     

The Strengths and Limitations of Case Record Reviews in Examining Family Preservation Outcome Formulation and Treatment Planning

Much debate has centered on what are reasonable outcomes of the short-term intensive family preservation services (IFPS). However, little attention has been given to how therapists actually formulate outcomes in their practices. The files of 98 families who used IFPS were reviewed to determine how therapists formulated outcomes and whether formulated outcomes varied by service sector (child welfare or mental health) and child age. It was found that formulated outcomes in mental health were more likely than those in child welfare to have a child focus and an interpersonal locus. Variation in outcome formulation in child welfare by child age was found, with outcomes of younger children more likely to be parent-focused than were outcomes of older children. The issues pointed out by these findings are discussed. Since case records are a potential data source for researchers, the paper concludes with a discussion of the strengths and limitations of case record reviews for research purposes.     

Religion-Related Child Physical Abuse

Abstract

Religious beliefs can foster, encourage, and justify child abuse, yet religious motivations for child abuse and neglect have been virtually ignored in social science research. In this paper, we compare victims' retrospective reports of religion-related child physical abuse to other reported cases of child physical abuse. We describe in statistical detail the nature and circumstances of the abuse, characteristics of victims and perpetrators, and the spiritual and psychological impact of the abuse. Results indicate that although the basic characteristics of religion-related physical abuse are similar to non-religion-related physical abuse, religion-related abuse has significantly more negative implications for its victims' long-term psychological well-being.     

Permanent Housing for Child Welfare‐Involved Families: Impact on Child Maltreatment Overview

A longitudinal randomized controlled trial tested whether access to permanent housing reduces child maltreatment among inadequately housed families under investigation for child abuse and neglect. The study followed homeless and child welfare‐involved families randomly assigned to receive a referral for housing subsidies plus housing case management (n = 75, 196 children) or housing case management alone (n = 75, 186 children). Latent growth models examined change in caregiver‐reported frequencies of psychological aggression, physical abuse, and neglect toward children at five time points across 2.5 years. Intent‐to‐treat analyses suggested treatment differences for minor assault and neglect that approached significance; families randomly assigned to permanent housing plus case management exhibited marginally greater declines compared to families referred for housing case management only. Caregiver psychological aggression remained high over time, regardless of treatment condition. No evidence indicated higher risk families benefitted more from permanent housing. Results show some promise of permanent housing and highlight the complex needs of homeless families under investigation for child maltreatment. Findings emphasize the importance of continued involvement from the child welfare system to connect families with important resources.     

Mother-child separations among homeless and housed families receiving public assistance in New York City

We examined the incidence, characteristics, and predictors of separations of children from mothers in 543 poor families receiving public assistance, 251 of whom had experienced homelessness during the previous 5 years. Forty-four percent of the homeless mothers and 8% of housed mothers were separated from one or more children. A total of 249 children were separated from 110 homeless families and 34 children from 23 housed families. Children were placed with relatives and in foster care but were rarely returned to their mothers. Maternal drug dependence, domestic violence, and institutionalization predicted separations, but homelessness was the most important predictor, equivalent in size to 1.9 other risk factors. We infer that policies regarding child welfare and substance abuse treatment should be changed to reduce unnecessary placements. Studies of homeless children who remain with families may be biased if separated children are excluded.     

Treating Parents and Children Together

SUMMARY

In this paper I look at two traditions of psychotherapy with children: family therapy {here considered in its common paradigm of systems theory and not in its diversity of approaches) and individual psychodynamically oriented child therapy. The author examines how, in these two modalities of treatment, the real world of the parent-child relationship, which remains mostly a world of women and children, tends to be left out in practice. Many family therapists “exclude” children from their sessions and concentrate on the marital relationship while child therapists “exclude” parents from the core of the therapeutic process. The issues for therapists and the consequences for adults and children in families in this com-partmentalization of services are examined within a feminist framework. The development which is advocated is for therapists to expose themselves fully to the world of the parent-child relationship as a fust step in reexamining their stereotypical views of motherhood and fatherhood which trap women in conflicted and potentially exploitative situations and do not consider that children actively construct their own relationships.     

Differentiating between child protection and family support in the Canadian child welfare system's response to intimate partner violence,corporal punishment,and child neglect

Rates of reported child maltreatment nearly doubled in Canada over the period 1998–2003, an increase that reflects growing awareness of the harmful effects of an expanding array of parental behaviors, including corporal punishment, lack of supervision, and exposure to intimate partner violence (IPV). Some of these situations may benefit from voluntary family support programs outside of the child welfare system. Analyzing a sample of 11,807 investigations, this paper compares cases where the sole concern is exposure to IPV, or hitting a child, or neglect, or other forms of investigated maltreatment. Situations where exposure to IPV or potentially abusive hitting were the sole reason for investigation presented with fewer risk factors and were less likely to lead to ongoing child welfare interventions compared to other maltreatment investigations. While situations involving alleged neglect presented a higher risk profile and elicited a more intensive child welfare response than did exposure to IPV or hitting, opportunities for alternative services were nevertheless identified. The study also found that visible minority families were overrepresented in cases involving hitting and that Aboriginal families were overrepresented in cases involving neglect. Overall the findings support the development of alternative response programs in Canada.     

Where do we go from here? Moving toward an integrated approach to family violence

This article discusses patterns across reviews of the risk and protective factors for each of seven forms of family violence: partner physical, psychological, and sexual abuse; child physical, psychological, and sexual abuse and child neglect. We note that both child and partner literatures have large research bases on risk factors for physical abuse, but relatively few articles on psychological or sexual abuse (or child neglect). In addition, co-occurrence of forms of maltreatment within families is high, but little integrative work has been conducted. We argue that the overlap of both occurrence and risk factors across forms of maltreatment suggests that both etiological and intervention models would be improved by considering all forms of maltreatment more explicitly in a family (rather than dyadic) context.     

Intrafamilial physical victimization and externalizing behavior problems: Who remain the ‘forgotten’ children?

Over the past few decades, researchers have documented positive associations between direct child maltreatment and exposure to interpersonal violence (including intimate partner violence, community violence, school violence, and media violence) and children's externalizing behavior problems. However, current family violence literature largely ignores the effects of child abuse on other children in the family. A handful of studies have focused on exposure to child abuse and documented the behavioral effects on siblings, and these studies lend support for broadening scholarship focused on this type of family violence. This article presents empirical research and theories that focus on the relationships between child physical abuse and exposure to intimate partner violence and children's externalizing behavior problems. Using this literature as a foundation, an argument is made for the need to focus on children's exposure to child physical abuse. This article presents information from the few studies that have focused on children who were exposed to the physical abuse of a sibling and offers theoretical frameworks, including social learning theory and psychological proximity, as a foundation for future research. The article concludes with a discussion of services that may be necessary for children who have been exposed to the physical abuse of a sibling, including services focused on safety and mental health.