Treatment of co-occurring child maltreatment and substance abuse

Despite high prevalence and severe negative consequences of child maltreatment (e.g., Brown, G. R., & Anderson, B., (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55–61; Jaudes, P. K., Ekwo, E., & Van Voorhis, J.V., (1995). Association of drug abuse and child abuse. Child Abuse and Neglect, 19, 1065–1075; Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., & Goshkom, M., (1991). Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15, 197—211), the treatment of perpetrators and victims of child abuse and neglect remains grossly understudied (Behl, L. E., Conyngham, H. A., & May, P. F., (2003). Trends in child maltreatment literature. Child Abuse and Neglect, 27, 215–229). More than half of parentes founded for the abuse and neglect of their children have evidenced drug abuse, yet no treatments have been validated that concurrently address these problems. The reciprocal interaction between substance abuse and child maltreatment supports the need to concurrently treat these problems. This article illustrates the relationship between child maltreatment and parental substance abuse and proposes a behavioral model to explain the reciprocal influence of drug abuse and child maltreatment. A behavioral treatment plan that is designed to concurrently address drug abuse and child abuse is proposed and suggestions are made for future directions in this area.     

Examination of the Extent to which Employment Factors are Associated with Reduced Child Maltreatment Potential and Drug Use

Job assistance programs are commonly recommended for parents of children who have been victimized by child maltreatment, particularly when illicit drugs are indicated. However, the relationship between employment factors, substance abuse, and risk of child maltreatment has received limited empirical attention. Therefore, the current study examines employment factors in a sample of 72 mothers, who were referred by child protective services for treatment of substance abuse and child neglect. Child maltreatment potential was found to be negatively associated with number of hours employed and self-reported happiness with employment. The association between child abuse potential and personal income of participants approached significance (p?=?.057), and the results were not influenced by social desirability. Employment satisfaction significantly contributed to the prediction of child maltreatment potential over and above other employment factors and control variables. These findings suggest that when mothers are involved in child protective services their risk of perpetrating child maltreatment may be reduced when they are assisted in gainful employment that is personally satisfying. Happiness with employment was the only employment factor correlated (inversely) with substance use (biological testing, self-report of participants). Future directions are discussed in light of the results, including the importance of considering employment satisfaction when conducting vocational assistance programs in this population.     

Childhood maltreatment, emotional distress, and early adolescent sexual intercourse: multi-informant perspectives on parental monitoring

This prospective investigation used multi-informant models to examine whether parental monitoring moderated associations between child maltreatment and either emotional distress or sexual intercourse. Data included 637 youth in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Child maltreatment was determined by lifetime Child Protective Service records and youth self-report and included sexual, physical, psychological abuse, and neglect (age 12). The moderating variable was youth- and caregiver-reported parental monitoring (age 12). Outcome variables were emotional distress (age 12) and sexual intercourse (age 14). Analyses included multi- and individual-informant models, adjusting for age, ethnicity/race, family income, and study site. Rates of parental monitoring did not differ by gender, but gender-specific analyses found that among girls, but not boys, youth-reported parental monitoring buffered the effect of maltreatment on emotional distress. Subtype analyses found that the buffering effects of monitoring on emotional distress were strongest for sexual and physical abuse and when youth experienced multiple subtypes of maltreatment. Caregiver-reported monitoring was not associated with reduced emotional distress. Youth and caregiver reports of parental monitoring were inversely associated with sexual intercourse, regardless of maltreatment history. Findings suggest that promoting parental monitoring among caregivers, and perceptions of monitoring among youth, may prevent early sexual intercourse regardless of maltreatment history. Promoting parental monitoring among youth with a history of maltreatment, especially girls or those who have experienced sexual or physical abuse or multiple subtypes of abuse, may reduce the likelihood of emotional distress.     

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.     

Intervention in child neglect: an applied behavioral perspective

Child maltreatment in the forms of abuse and neglect is a serious social problem, affecting over 1.5 million children in the US annually. Abuse has generally received more public and professional attention than other forms of child maltreatment. Given that more than one type of child maltreatment frequently occurs in families, there are few behavioral studies that have specifically addressed techniques for the reduction of child neglect. Only recently have researchers begun to regard child neglect as a phenomenon that may be conceptually different from other forms of child maltreatment, thereby warranting specific attention. Described here are intervention strategies for parents at-risk for or referred for child neglect. We review these strategies, along with commentary on the difficulties of conducting applied research in this field. Suggestions are offered for improved intervention research in child neglect.     

Child Protection and Psychology Education in Australian Universities

Child maltreatment is a significant problem in Australia. Psychologists in a wide range of occupations play an important role in the identification and prevention of child abuse and neglect, the provision of interventions to children and families, and the development and conduct of research in related areas. Psychology graduates must be adequately prepared to work in this field; however, little is known about the extent to which child abuse and neglect related contents are taught in current university curricula. A purpose‐developed curriculum‐mapping survey was used to examine Australian undergraduate, fourth year, and postgraduate Australian Psychology Accreditation Council‐accredited programmes available in 2008. Results showed that students in the majority of programmes were exposed to child protection‐related content; however, the extent of exposure was limited. Three postgraduate units specifically addressed the prevention, identification, and response to child abuse and neglect. Course coordinators reported that child maltreatment content was mostly integrated into general units throughout the programme, typically within developmental psychology units in the undergraduate curriculum and in ethics, research, or professional issues units in the fourth year and postgraduate programmes. Results suggest the need for child protection content to be included in minimum national standards and accreditation guidelines for universities.     

儿童虐待与问题行为：基因与环境的作用

当前预防虐待之所以成为儿童保护的重要内容,不仅是法理上的儿童权益保护,也因虐待关联的基因与环境作用对人发展的长期影响。儿童虐待与问题行为关系复杂,已有研究显示,虐待特征、受害者特点是其关联因素,但其内在机制并不清楚。随着分子遗传学的兴起,MAOA、COMT、5-HTT等基因为解释儿童虐待与问题行为的机制提供新视角,重要候选基因可能调节这一关系。未来研究可从动物模型和纵向追踪角度去探究儿童虐待与问题行为关系的易感期、保护因子,完善儿童虐待与个体发展关系的研究图谱。     

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.     

Fighting for children

Child abuse is a problem of national importance. Nationwide, billions of dollars are spent on the child welfare system, but child abuse rates remain high. At the federal level, new laws, such as the Child Abuse Prevention and Enforcement Act, the Foster Care Independence Act, and the Adoption and Safe Families Act, represent steps toward addressing the problem. However, increased efforts are needed to raise awareness of the problem of child abuse and to prevent it. Furthermore, more attention is needed to address the need for reform of the child welfare system and to involve the private sector in helping abused children.     

Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism

We examined the relation between child maltreatment and non-suicidal self-injury (NSSI). Participants were 86 adolescents who completed measures of child maltreatment, self-criticism, perceived criticism, depression, and NSSI. Analyses revealed significant, small-to-medium associations between specific forms of child maltreatment (physical neglect, emotional abuse, and sexual abuse) and the presence of a recent history of NSSI. Emotional and sexual abuse had the strongest relations with NSSI, and the data supported a theoretical model in which self-criticism mediates the relation between emotional abuse and engagement in NSSI. Specificity for the mediating role of self-criticism was demonstrated by ruling out alternative mediation models. Taken together, these results indicate that several different forms of childhood maltreatment are associated with NSSI and illuminate one mechanism through which maltreatment may be associated with NSSI. Future research is needed to test the temporal relation between maltreatment and NSSI and should aim to identify additional pathways to engagement in NSSI.     

Child Maltreatment,Problem Behaviors,and Neighborhood Attainment

Using data from a prospective cohort design study of a group of children with documented histories of abuse and neglect (n = 908) and matched controls (n = 667), this paper examines whether problem behaviors (e.g., prostitution, crime, school problems, and homelessness) in young adulthood explain the link between maltreatment in childhood and living in high‐risk neighborhoods in middle adulthood. Problem behaviors were assessed at mean age of 29 and neighborhood characteristics were assessed at mean age of 40. Child maltreatment predicted living in less desirable neighborhoods in middle adulthood. Problem behaviors in young adulthood partially mediated the relationship between childhood maltreatment and residence in less desirable neighborhoods in middle adulthood. The direct paths from child maltreatment to neighborhoods were not significant for Black children. For White children, there was a direct relationship between child maltreatment and living in an economically disadvantaged neighborhood. Problem behaviors were a stronger mediator between child maltreatment and living in more disordered and less socially cohesive neighborhoods for Black children, while the problem behaviors were a stronger mediator for living in more economically disadvantaged and less socially cohesive neighborhoods for White children. Further research is needed to understand these racial differences. Interventions should focus on preventing problem behaviors to minimize the risk of residency in high‐risk neighborhoods.     

FOOD NEGLECT AND INFANT DEVELOPMENT

The impact of food insecurity on child development in the general U.S. population is well‐established, yet little is known about the harm of food neglect relative to other types of maltreatment. Due to the harmful physiological impact of inadequate nutrients and the social impact of food‐related stress, it was hypothesized that food neglect would be more likely to impair infant cognitive and language development than physical abuse, sexual abuse, and other forms of neglect. Families of infants (N = 1,951) investigated by Child Protective Services were studied using the second cohort of the National Survey of Child and Adolescent Well‐Being (NSCAW II; NSCAW Research Group, 2002). Results from multivariable logistic regression models that controlled for likely confounding variables showed that the odds of impairment in cognition and language were significantly greater when food neglect was the most serious form of maltreatment. Considering that both food insecurity and child neglect are associated with poverty and parental mental health problems, it will be important for child welfare and mental health professionals to work collaboratively to better the health of these vulnerable children.     

The distressed family and wounded children

This article addresses the issue of the need for clergy to be better informed regarding the assessment of child abuse and neglect. It provides a quick reference guide to assist clergy in assessing the risk factors in the abusive family with guidelines for the recognition of child maltreatment. In a society that is marked by unprecedented levels of child maltreatment reporting and an ever increasing shortage of mental health services, clergy are increasingly being confronted by situations involving potential child maltreatment that require expert crisis intervention skills. This article provides specific, concrete guidelines for clergy confronted with situations that call for the recognition of child maltreatment.Andrew J. Weaver, Ph.D., United Methodist minister and a licensed marriage, family, and child therapist. He holds a doctorate in clinical psychology and serves as the director of the Pacific Center, Community Counseling Service, sponsored by 11 churches in Central Los Angeles.This article is dedicated to the staff of Alameda County Child Protective Services in Oakland, California, with appreciation for their courage and devotion to the grievous and demanding task of caring for distressed parents and their wounded children.     

The Role of Parenting Programmes in the Prevention of Child Maltreatment

Child maltreatment is a major worldwide concern and continuing high rates of abuse demand action. This article examines the role of parenting programmes as a strategy to prevent child maltreatment in the population as a whole and also as a targeted intervention for parents who have abused, or are at risk of abusing, their children. We argue that a blend of universal and targeted interventions is needed to reduce the prevalence of child maltreatment. Parenting interventions that concurrently target positive parenting and effective child management skills, dysfunctional parental attributions, and increasing parents' capacity to regulate their emotions are particularly useful. A variant of the Triple P—Positive Parenting Program, known as Pathways Triple P, is discussed to illustrate the value of this approach. Contextual factors that need to be addressed in working with child protection cases are also discussed. The role of training and supervision is discussed in the context of disseminating evidence‐based parenting programmes, and future directions for research are presented.     

Relations Between Emotion Regulation, Parenting, and Psychopathology in Young Maltreated Children in Out of Home Care

Young maltreated children, birth to three years, represent the age group with the highest rates of maltreatment in the United States (ACYF 2007). There are few studies to date that have investigated early childhood maltreatment and its effects on emotion regulatory processes and psychopathology. In response, the current investigation uses a dyadic assessment procedure to examine the relationship between parenting, emotion regulation, and symptoms of psychopathology among maltreating and non-maltreating parent–child interactions. The participants in this study were 123 children (66 maltreated and 57 nonmaltreated) from ages 1–3. Child and parent affect and child effortful control were observed during a parent–child interaction task. Symptoms of psychopathology were measured using the Child Behavior Checklist. The maltreated children exhibited more anger, more internalizing symptomatology, and less positive affect compared to non-maltreated children. Among maltreated children, emotion dysregulation was associated with internalizing symptomatology. Moreover, these data reveal parental positive affect was associated with lower child internalizing symptomatology and parental anger was associated with higher child internalizing symptomatology in the entire sample. This investigation offers evidence that emotion dysregulation subsequent to poor dyadic interactions is associated with early child maltreatment. These data suggest that maltreated children experience difficulties in emotion regulation which may be related to their higher levels of behavioral symptomatology.     

Child maltreatment types and risk behaviors: Associations with attachment style and emotion regulation dimensions

Child maltreatment is a robust psychosocial risk factor linked to the development of a wide range of risk behaviors among young adults. Adult attachment style and emotion dysregulation are two potential mechanisms through which maltreatment leads to risk behaviors. Yet, less is known about the specificity of the relations among different maltreatment types, attachment styles, emotion regulation strategies, and risk behaviors. The present study examined the relations among various forms of maltreatment and risk behaviors (e.g., substance use; risky sex) among 361 undergraduate students and tested whether attachment styles and emotion dysregulation might underlie these relations. Emotional, and sexual but not verbal abuse (although verbal abuse was directly related to alcohol use), were related to anxious and avoidant attachment styles, emotion dysregulation, and a variety of risk behaviors. Among the emotion regulation dimensions, impulsivity showed the strongest indirect effect from child maltreatment to risk behaviors. Results support a cross-sectional link between child maltreatment and risk behavior outcomes via attachment styles and emotion regulation. Implications for treatment and prevention of these risk behaviors in young adults are discussed.     

Family Assisted Contingency Management within the Context of Evidence-Supported Treatment for Child Neglect and Drug Abuse

Contingency management (CM) has extensively been shown to be effective in reducing substance use disorders, but its effects in reducing child maltreatment have yet to be determined. The current study provides preliminary support for the utilization of an innovative family-assisted CM component in 18 mothers who were referred to an evidence-supported behavioral treatment for concurrent child neglect and drug abuse by Child Protective Service caseworkers. In the examined CM, participants were invited to indicate from a list of common actions incompatible with child neglect (i.e. positive parenting actions), the extent to which these actions had been experienced utilizing a 3-point scale (almost never, sometimes, almost always). For each item that was indicated to be almost never or sometimes experienced, the participants were queried to indicate if the neglect incompatible action should be targeted as a therapeutic goal. Contingencies were subsequently established in which the participants were rewarded by involved family members for their completion of therapeutic goals. At baseline, results indicated that there was a negative association between the number of neglect incompatible parenting actions that were infrequently experienced and child abuse potential. A hierarchical multiple regression analysis showed that the number of neglect incompatible actions targeted as therapeutic goals at baseline, but not the number of positive parenting actions experienced infrequently at baseline, predicted reduced child maltreatment potential following treatment. These findings suggest the examined CM may assist evidence supported behavioral treatment specific to child neglect and drug abuse.     

Impact of substance abuse and child maltreatment training on service utilization in a rural setting

Substance abuse and child maltreatment have been recognized as co-morbid problems encountered in families presenting in the child protective services (CPS) system. Nonetheless, utilization rates of substance abuse treatment services have generally lagged well behind what the research would suggest are prevalence rates for substance abuse disorders in this population, suggesting problems in recognition and referral practices among CPS workers. In response to this, 25 training programs were funded by the National Center on Child Abuse and Neglect. This study reports data from one program. Trainees indicated a high level of satisfaction and demonstrated significant knowledge gains. More importantly, utilization of substance abuse services increased significantly across time in a multi-county region receiving training relative to a comparison region receiving none. The gain was limited, suggesting that while increased knowledge may translate into increased service utilization, additional barriers to accessing needed services must also be addressed.     

What kind of society permits child abuse?

Child maltreatment is conceptualized as a social welfare problem inevitably created by the isolation that individualistic culture creates. The „defective parent”︁ model for detecting abusive persons is described as inconsistent, unfeasible and contradictory. Attention must be focused on basic institutional and social forces which permit abuse. The social and economic context for families is seen as the setting that transforms risk for abuse into actual abuse. It is strongly suggested that integration of formal and informal systems of child protective services is needed to protect and enhance the welfare of children and families.