Assessment Of Child Abuse Research Articles

Die deutsche Version des Childhood Trauma Questionnaire (CTQ) – psychometrische Eigenschaften in einer bevölkerungsrepräsentativen Stichprobe

The Childhood Trauma Questionnaire (CTQ) has become internationally accepted as an assessment of traumatic childhood experiences. The short version assesses aspects of childhood abuse and neglect. In order to check the psychometric properties of the German short form, the CTQ was used within a representative sample of the German population (N=2 500). The five factor structure of the original version showed only a sufficient model fit, because of high intercorrelations and weak internal consistency of the scale "physical neglect". The internal consistency of the other subscales was high with α≥0.80. Construct validity was supported by positive correlations with measures of anxiety/depression and negative correlations with life satisfaction. The German short form of the CTQ is a reliable and valid self rating instrument to assess childhood maltreatment retrospectively. The subscale "physical neglect" should be applied with caution.

Improving accuracy and consistency in child maltreatment severity assessment in child protection services in Spain: New set of criteria to help caseworkers in substantiation decisions

This article describes the work carried out to develop a new instrument/set of criteria aimed at increasing Spanish Child Protection Services (CPS) caseworkers' accuracy and consistency in judgments leading to maltreatment substantiation and eligibility for CPS action decisions. A preliminary test on some of the instrument scales was conducted and presented. The new instrument was developed based upon a review of the literature, extended discussions with an expert group, and a three-month pilot application. Studies conducted on the instrument used case vignettes and focused on four scales: Physical Abuse, Supervisory Neglect, Emotional Maltreatment, and Parental Incapacity to Control Child/Adolescent Behavior. Three groups of the Basque Region CPS caseworkers participated in the studies: a first group of 515 caseworkers who attended a five-hour session for a general overview of the instrument, and a second and third groups of 137 and 94 caseworkers who attended, respectively, ten- and twenty-hour training sessions about the instrument. A booklet containing four case vignettes was given to each participant. Caseworkers of the first group were asked to rate severity of the assigned case vignettes firstly before the general overview session with their prior criteria, and secondly after the session with the instrument. Caseworkers of the second and third groups were asked to rate the assigned case vignettes after the training sessions with the instrument. When caseworkers used their prior criteria to rate case vignettes severity, only 20% of them accurately rated all four, or three out of the four, assigned vignettes. This percentage increased significantly to 44.9% after receiving a 5-hour general overview session of the instrument, approaching the percentage achieved by the caseworkers who received 10 h of training (45.5%). The highest percentage of caseworkers who accurately rated all four, or three out of the four, assigned vignettes was found in the group that received 20 h of training (61.7%). The instrument did not allow caseworkers to reach adequate percentages of accurate ratings or inter-worker agreement in most of the case vignettes with moderate levels of severity and in emotional maltreatment vignettes. No significant relationships were found between accuracy of severity ratings and caseworkers' professional discipline, gender, degree of dedication to CPS, and years of experience. Conclusions and implications for practice Present findings suggest high levels of inaccuracy and inconsistency in Basque Region CPS caseworkers' assessment of child maltreatment severity. Results support the hypothesis that availability of specific instruments and intensive professional training can contribute to increase accuracy and consistency, and improve substantiation in decision-making processes. ► A new instrument to assess child maltreatment severity was tested in Spain. ► Increase of caseworkers' accurate ratings of vignettes severity was observed. ► Low accuracy persisted for emotional abuse and moderate vignettes. ► More training with the instrument was related to higher levels of accuracy. ► More studies are needed to test all the scales of the instrument.

Role of childhood traumatic experience in personality disorders in China

BackgroundThere has been no large-scale examination of the association between types of childhood abuse and personality disorders (PDs) in China using standardized assessment tools and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Hence, this study aimed to explore the relationship between retrospective reports of various types of childhood maltreatments and current DSM-IV PDs in a clinical population in China, Shanghai. MethodOne thousand four hundred two subjects were randomly sampled from the Shanghai Psychological Counselling Centre. PDs were assessed using the Personality Diagnostic Questionnaire, Fourth Edition Plus. Participants were also interviewed using the Structured Clinical Interview for DSM-IV axis II. The Child Trauma Questionnaire (CTQ) was used to assess childhood maltreatment in 5 domains (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). ResultsAccording to Pearson correlations, childhood maltreatment had a strong association with most PDs. Subsequently, using partial correlations, significant relationships were also demonstrated between cluster B PDs and all the traumatic factors except physical neglect. A strongest positive correlation was found between cluster B PD and CTQ total scores (r = .312, P < .01). Using the Kruskal-Wallis rank sum test, significant differences in 4 groups of subjects (clusters A, B, and C PD and non-PD) in terms of emotional abuse (χ2 = 34.864, P < .01), physical abuse (χ2 = 14.996, P < .05), sex abuse (χ2 = 9.211, P < .05), and emotional neglect (χ2 = 17.987, P < .01) were found. Stepwise regression analysis indicated that emotional abuse and emotional neglect were predictive for clusters A and B PD, and sexual abuse was highly predictive for cluster B PD; only emotional neglect was predictive for cluster C PD. ConclusionEarly traumatic experiences are strongly related to the development of PDs. The effects of childhood maltreatment in the 3 clusters of PDs are different. Childhood trauma has the most significant impact on cluster B PD.

Childhood maltreatment and psychiatric disorders among detained youths.

This study examined the prevalence of childhood maltreatment and its relationship with current psychiatric disorders among detained youths. Clinical research interviewers assessed history of childhood maltreatment with the Child Maltreatment Assessment Profile and psychiatric diagnosis with the Diagnostic Interview Schedule for Children, version 2.3, in a stratified, random sample of 1,829 youths detained at the Cook Country Juvenile Temporary Detention Center (final sample, N=1,735). History of maltreatment was also ascertained from Cook County Court Child Protection Division records. More than three-quarters of females and more than two-thirds of males had a history of physical abuse (moderate or severe). More than 40% of females and 10% of males had a history of sexual abuse. Females and non-Hispanic whites had the highest prevalence rates of childhood maltreatment. Among females, sexual abuse was associated with every type of psychiatric disorder. Females who experienced various types of abuse were 2.6 to 10.7 times as likely as females with no maltreatment to have any disorder. Among males, maltreatment was associated with every disorder except anxiety disorders (range of odds ratios, 1.9-7.9). Among youths who were sexually abused, abuse with force was associated with anxiety and affective disorders among females and attention-deficit hyperactivity or disruptive behavior disorders and substance use disorders among males. Childhood maltreatment is common among detained youths and is also highly associated with psychiatric disorders. The mental health, child welfare, and juvenile justice systems must collaborate to ensure that youths receive protection and care when they return to their communities.

High prevalence of childhood emotional, physical and sexual trauma among a Canadian cohort of HIV-seropositive illicit drug users

Background . The psychosocial impacts of various types of childhood maltreatment on vulnerable illicit drug-using populations remain unclear. We examined the prevalence and correlates of antecedent emotional, physical and sexual abuse among a community-recruited cohort of adult HIV-seropositive illicit drug users. Methods . We estimated the prevalence of childhood abuse at baseline using data from the Childhood Trauma Questionnaire, a 28-item validated instrument used to retrospectively assess childhood maltreatment. Logistic regression was used to estimate relationships between sub-types of childhood maltreatment with various social-demographic, drug-using and clinical characteristics. Results . Overall, 233 HIV-positive injection drug users (IDU) were included in the analysis, including 83 (35.6%) women. Of these, moderate or severe emotional childhood abuse was reported by 51.9% of participants, emotional neglect by 36.9%, physical abuse by 51.1%, physical neglect by 46.8% and sexual abuse by 41.6%. In multivariate analyses, emotional, physical and sexual abuses were independently associated with greater odds of recent incarceration. Emotional abuse and neglect were independently associated with a score of ≥16 on the Centre for Epidemiologic Studies Depression Scale. There was no association between any form of childhood maltreatment and clinical HIV variables, including viral load, CD4+ count and history of antiretroviral therapy use. Conclusion . These findings underscore the negative impact of childhood maltreatment on social functioning and mental health in later life. Given the substantial prevalence of childhood maltreatment among this population, there is a need for evidence-based resources to address the deleterious effect it has on the health and social functioning of HIV-positive IDU.

Maltreatment Clusters Among Youth in Outpatient Substance Abuse Treatment: Co-Occurring Patterns of Psychiatric Symptoms and Sexual Risk Behaviors

The purpose of the current study was to describe the use of a brief maltreatment assessment instrument to classify adolescents receiving alcohol or other drug (AOD) treatment services based on the extensiveness and severity of prior maltreatment. This goal is significant because maltreatment reduces the effectiveness of AOD treatment and is associated significantly with co-occurring patterns of psychiatric symptoms and sexual risk behaviors. Structured interviews were administered to 300 adolescent treatment clients (202 males, 98 females; M=16.22 years; SD=1.13 years) to assess childhood maltreatment experiences, past year psychiatric symptoms, and sexual risk behaviors during the past 180 days. Cluster analysis classified adolescents into unique groups via self-reported sexual abuse, physical punishment, and parental neglect/negative home environment. Significant between-cluster differences in psychiatric symptoms and sexual risk behaviors were documented using MANOVA and chi-square analyses. More severe maltreatment profiles were associated with higher scores for psychiatric symptoms and unprotected intercourse. Significant heterogeneity and distinct types within this treatment sample of adolescents supports the adaptation of selected prevention efforts to promote HIV/STI risk reduction.

The Relation Between Dimensions of Normal and Pathological Personality and Childhood Maltreatment in Incarcerated Boys

The relation between subtypes of maltreatment and dimensions of personality and personality pathology was investigated in a representative sample of 142 incarcerated Dutch male juveniles. Normal personality dimensions were assessed with the Big Five Inventory, the Dimensional Assessment of Personality Pathology-Basic Questionnaire for Adolescents was used to measure pathological personality dimensions, and the Childhood Trauma Questionnaire was used to assess childhood maltreatment. The five maltreatment subtypes were found to be differentially and uniquely related to the normal and pathological personality dimensions in juvenile delinquents. The association between the abusive subtypes and Emotional Dysregulation depended on the co-occurrence of neglect. It was concluded that subtypes of maltreatment are distinctively related to dimensions of personality and personality pathology, possibly due to specific gene-environment interactions. Further research on this interplay is needed to be able to recognize genetic vulnerability. Early identification of children at risk could aid to limit the long-term consequences of maltreatment.

Differences in Legal Outcomes for Male and Female Children Who Have Been Sexually Abused

The goal of the present study was to determine whether or not there were sex differences in legal outcomes for children who were sexually abused. Using the methodology of Joa and Edelson (2004), the results indicated that males who were sexually abused had poorer legal outcomes than females. Specifically, it was found that cases involving male victims were less likely to be filed with the District Attorney (DA) than cases involving female victims and had fewer criminal counts charged. For those children seen at a Child Abuse Assessment Center, cases involving female victims were significantly more likely to be filed by the DA's office than were cases involving male victims. Finally, there were differences in whether guilty defendants pled guilty or were found guilty at trial depending on whether the defendant sexually abused a male or female. The implications of the findings are discussed.

Child Maltreatment and Women’s Adult Sexual Risk Behavior: Childhood Sexual Abuse as a Unique Risk Factor

This study investigated (a) whether childhood sexual abuse (CSA) was uniquely associated with adult sexual risk behavior, after controlling for other types of childhood maltreatment and (b) whether there were additive or interactive effects of different types of maltreatment on adult sexual risk behavior. Participants were 414 women (M age = 28 years) attending a publicly funded STD clinic. All women completed a computerized survey assessing childhood maltreatment (sexual, physical, psychological abuse, and neglect) and sexual risk behavior. Analyses showed that sexual abuse, physical abuse, psychological abuse, and neglect were associated with adult sexual risk behavior. Multivariate analyses that controlled for all other forms of child maltreatment showed that only CSA was uniquely associated with adult sexual risk behavior (i.e., percentage of episodes of unprotected sex in the past 3 months and number of lifetime partners). The authors found little support for an additive or an interactive model of the effects of different types of childhood maltreatment on adult sexual risk behavior; CSA alone was the best predictor of adult sexual risk behavior. Sexual risk reduction interventions are needed for women who were sexually abused as children. Continued research on the effects of multitype maltreatment on adult sexual risk behavior is needed.

Urban Communities as a Social Space for Child Abuse

AbstractStatement of problem: The rate at which children are maltreated is one of the most sensitive measures of demographic, social, and economic conditions. Maltreatment may differ markedly in terms of an area’s socio-demographic and economic makeup and this phenomenon needs to be studied in a structural context. This study employs a social disorganization perspective to identify the most reliable structural factors of child maltreatment for children aged 10 to 18 years in Valcea County. Method: ICAST-CH, an instrument developed by the International Society for Prevention Child Abuse and Neglect in order to assess child maltreatment’s rates in a unitary way in different countries. It was applied to 1142 children in Valcea’s urban areas. Results: child abuse is positive correlated to high rates of community violence and negative correlated with community resources. The parents’ education and occupation status is involved in explaining high rates of child abuse in different manners. Conclusion: the urban areas are diverse spaces in terms of variables that influence child abuse. Future studies in the subject of structural child abuse would need to be done in more urban areas in order to find some additional patterns of the phenomenon.

3D finite compartment modeling of formation and healing of bruises may identify methods for age determination of bruises

Simulating the spatial and temporal behavior of bruises may identify methods that allow accurate age determination of bruises to assess child abuse. We developed a numerical 3D model to simulate the spatial kinetics of hemoglobin and bilirubin during the formation and healing of bruises. Using this model, we studied how skin thickness, bruise diameter and diffusivities affect the formation and healing of circular symmetric bruises and compared a simulated bruise with a natural inhomogeneous bruise. Healing is faster for smaller bruises in thinner and less dense skin. The simulated and natural bruises showed similar spatial and temporal dynamics. The different spatio-temporal dynamics of hemoglobin and bilirubin allows age determination of model bruises. Combining our model predictions with individual natural bruises may allow optimizing our model parameters. It may particularly identify methods for more accurate age determination than currently possible to aid the assessment of child abuse.

Die deutsche Version des Childhood Trauma Questionnaire (CTQ): Erste Befunde zu den psychometrischen Kennwerten

Given the relevance of child maltreatment for the development and treatment of many mental disorders, the objective of our study was the psychometric evaluation of the German version of the Childhood Trauma Questionnaire (CTQ). In a sample of psychiatric patients (N=1 524) the established factor structure (i.e. sexual, physical and emotional abuse as well as physical and emotional neglect) was replicated by means of confirmatory factor analysis. The internal consistency of all scales (apart from physical neglect) was high (Cronbachs α ≥ 0.89). Correlations between the CTQ and self-report measures for posttraumatic stress, dissociation and general psychopathology were low to moderate. The psychometric properties of the German version of the CTQ were similar to the American original; it proved to be a reliable and valid screen for the retrospective assessment of child maltreatment.

Child maltreatment, alcohol use and drinking consequences among male and female college students: An examination of drinking motives as mediators

Although the relationship between child maltreatment and alcohol use and drinking problems is well established, the mechanisms involved in this relationship remain largely unknown and research has focused primarily on women. Using the Modified Drinking Motives Questionnaire-Revised (M-DMQ-R; Grant, Stewart, O'Connor, Blackwell & Conrod, 2007), drinking motives were examined as mediators in the relationship between childhood maltreatment and alcohol consumption and consequences among male and female college student drinkers ( N = 218, 60.6% women). Participants completed questionnaires assessing child maltreatment, drinking motives, alcohol consumption and alcohol consequences. Enhancement motives in particular mediated the relationship between childhood abuse and alcohol consequences for men, whereas coping-depression motives mediated this relationship for women. Implications of these findings for alcohol interventions and future research are discussed, along with limitations of the present study.

The development and piloting of the ISPCAN Child Abuse Screening Tool—Parent version (ICAST-P)

Objective Child maltreatment is a problem that has longer recognition in the northern hemisphere and in high-income countries. Recent work has highlighted the nearly universal nature of the problem in other countries but demonstrated the lack of comparability of studies because of the variations in definitions and measures used. The International Society for the Prevention of Child Abuse and Neglect has developed instrumentation that may be used with cross-cultural and cross-national benchmarking by local investigators. Design and sampling The instrument design began with a team of expert in Brisbane in 2004. A large bank of questions were subjected to two rounds of Delphi review to develop the fielded version of the instrument. Convenience samples included approximately 120 parent respondents with children under the age of 18 in each of six countries (697 total). Results This paper presents an instrument that measures parental behaviors directed at children and reports data from pilot work in 6 countries and 7 languages. Patterns of response revealed few missing values and distributions of responses that generally were similar in the six countries. Subscales performed well in terms of internal consistency with Cronbach's alpha in very good range (0.77–0.88) with the exception of the neglect and sex abuse subscales. Results varied by child age and gender in expected directions but with large variations among the samples. About 15% of children were shaken, 24% hit on the buttocks with an object, and 37% were spanked. Reports of choking and smothering were made by 2% of parents. Conclusion These pilot data demonstrate that the instrument is well tolerated and captures variations in, and potentially harmful forms of child discipline. Practice implications The ISPCAN Child Abuse Screening Tool – Parent Version (ICAST-P) has been developed as a survey instrument to be administered to parents for the assessment of child maltreatment in a multi-national and multi-cultural context. It was developed with broad input from international experts and subjected to Dephi review, translation, and pilot testing in six countries. The results of the Delphi study and pilot testing are presented. This study demonstrates that a single instrument can be used in a broad range of cultures and languages with low rates of missing data and moderate to high internal consistency.

Childhood maltreatment linked to greater symptom severity and poorer quality of life and function in social anxiety disorder

There is a paucity of data examining the prevalence and impact of childhood maltreatment in patients presenting with a primary diagnosis of social anxiety disorder (SAD). We thus examined the presence of a broad spectrum of childhood maltreatment, including physical, sexual, and emotional abuse and neglect, in treatment-seeking individuals with the generalized subtype of SAD (GSAD). We hypothesized that a history of childhood maltreatment would be associated with greater SAD symptom severity and poorer associated function. One hundred and three participants with a primary diagnosis of GSAD (mean age 37+/-14; 70% male) completed the well-validated, self-rated Childhood Trauma Questionnaire (CTQ), as well as measures of SAD symptom severity and quality of life. Fully 70% (n=72) of the GSAD sample met severity criteria for at least one type of childhood abuse or neglect as measured by the CTQ subscales using previously established thresholds. CTQ total score adjusted for age and gender was associated with greater SAD severity, and poorer quality of life, function, and resilience. Further, the number of types of maltreatment present had an additive effect, with specific associations for emotional abuse and neglect with SAD severity. Despite the use of validated assessments, our findings are limited by the retrospective and subjective nature of self-report measures used to assess childhood maltreatment. Nonetheless, these data suggest a high rate of childhood maltreatment in individuals seeking treatment for GSAD, and the association of maltreatment with greater disorder severity suggests that screening is clinically prudent.

Multidisciplinary assessment of child maltreatment: A multi-site pilot descriptive analysis of the Florida Child Protection Team model

The Florida Child Protection Team (CPT) program is a statewide assessment model that was developed to provide objective multidisciplinary evaluations of complex cases of alleged child maltreatment. However, only limited research has examined the content and quality of CPT assessment practices. In fact, the limited research on the quality and content of child protection assessments in relation to child protection assessment “best practices” is a system wide problem. In the current study, we sought to systematically evaluate the assessment practices of a pilot sample of CPTs. Specifically, we were interested in gaining a better understanding of the population served by CPTs, the types of evaluations offered, the content of the assessments, clinical interpretations and findings, and recommendations. The results show areas in which CPT functions as an effective multidisciplinary assessment team and relative weaknesses in assessment practices that may require changes in CPT policy and/or additional training.

The present state of chid abuse in Korea and its system for child protection

An act of children's welfare was made in 1961 for the first time in Korea but it had been nothing but the name in view of practical impact to prevention of child abuse. Real undertakings of Child Abuse Prevention were commenced overtly since 2000 in Korea, when the law for children's welfare was revised to put protective settings for the victims and to establish criterion for children's safety. The history of Child Abuse Prevention is very short in Korea but the reporting cases increased very fast from 4,133 cases in 2001 up to 9,570 cases in 2008 with the enthusiastic activities from people of the associated organizations along with the national supports. But the portion reported by the mandated reporters such as teachers or doctors is still low compared to those of the developed countries. The National Child Protection Agency (NCPA) was founded in 2001 by the Ministry of Health and Welfare to prevent child abuse and to aid recovery of abused and neglected children including their families, through the cooperation of related organizations. NCPA refers reported cases of child abuse to appropriate local centers, operates a computer database system for case management, publicizes national reports of child abuse on a yearly basis and technically supports the Local Child Protection Agency (LCPA) by developing scales for assessment of child abuse and neglect and distributing programs for the education of mandatory reporters. LCPAs operate 24-hour telephone hotline, investigate and visit homes and provide in home services networking with local resources, and operate multidisciplinary teams for screening child abuse victims and supervising case management through multimodal systems. We summarized the present state of child abuse in Korea and reviewed the operating systems for child protection in this country. Through this article, we hope that medical peoples are to be informed on the seriousness of child abuse and to be able to devote themselves for the prevention of child abuse. (Korean J Pediatr 2009;52:1185-1193

CARE OR CONTROL? THE EFFECTS OF INVESTIGATIONS AND INITIAL ASSESSMENTS ON THE SOCIAL WORKER–PARENT RELATIONSHIP

At a time of increasing calls for a return to relationship‐based practice, this paper presents qualitative research findings regarding the effects of more coercive and less coercive interventions on relationships between social workers and parents. Its context is the use, in England, of investigations of alleged child abuse (more coercive) versus initial assessments (less coercive, and potentially leading to family support services). Methods were based on 23 case studies involving interviews of both parent and social worker. The paper concludes that the less coercive initial assessments, combined with child welfare concerns that were perceived as less serious, provided the context for good working relationships between parent and worker. However, it is suggested that these conditions were not a prerequisite for good relationships. Worker skill was of significant importance, and good relationships were seen to be possible in a variety of procedural contexts. Comparisons are made with accounts of the therapeutic alliance in the counselling and psychotherapy literature.

The Use of TeleCAM as a Remote Web-Based Application for Child Maltreatment Assessment, Peer Review, and Case Documentation

Approximately 1 million children are physically or sexually abused each year in the United States. Accurate diagnosis of these children and subsequent extensive legal intervention requires a thorough clinical assessment as well as legal documentation. A Web-based application developed for the remote sharing of child maltreatment assessment among multiple child protection providers is presented. Usability data was collected from medical personnel at three remote Utah Children's Advocacy Centers (CACs) and one urban tertiary children's hospital. Qualitative findings are summarized and satisfaction differences are reported between remote sites and their referral tertiary center.

Variability in Expert Assessments of Child Physical Abuse Likelihood

In the absence of a gold standard, clinicians and researchers often categorize their opinions of the likelihood of inflicted injury using several ordinal scales. The objective of this protocol was to determine the reliability of expert ratings using several of these scales. Participants were pediatricians with substantial academic and clinical activity in the evaluation of children with concerns for physical abuse. The facts from several cases that were referred to 1 hospital's child abuse team were abstracted and recorded as in a multidisciplinary team conference. Participants viewed the recording and rated each case using several scales of child abuse likelihood. Participants (n = 22) showed broad variability for most cases on all scales. Variability was lowest for cases with the highest aggregate concern for abuse. One scale that included examples of cases fitting each category and standard reporting language to summarize results showed a modest (18%-23%) decrease in variability among participants. The interpretation of the categories used by the scales was more consistent. Cases were rarely rated as "definite abuse" when likelihood was estimated at < or = 95%. Only 7 of 156 cases rated < or = 15% likelihood were rated as "no reasonable concern for abuse." Only 9 of 858 cases rated > or = 35% likelihood were rated as "reasonable concern for abuse." Assessments of child abuse likelihood often show broad variability between experts. Although a rating scale with patient examples and standard reporting language may decrease variability, clinicians and researchers should be cautious when interpreting abuse likelihood assessments from a single expert. These data support the peer-review or multidisciplinary team approach to child abuse assessments.