Higher Risk Of Maltreatment Research Articles

A new protocol for screening adults presenting with their own medical problems at the Emergency Department to identify children at high risk for maltreatment

Identifying child abuse and neglect solely on the grounds of child characteristics leaves many children undetected. We developed a new approach (Hague protocol) based on characteristics of parents who attend the Emergency Department (ED) because they have the following problems: (1) intimate partner violence, (2) substance abuse, or (3) suicide attempt or other serious psychiatric problems. The goal of this protocol is to enable the Reporting Center for Child Abuse and Neglect (RCCAN) to rapidly assess family problems and offer voluntary community based support to these parents. The aim of this study is to assess whether this protocol for screening adults presenting for care in the Emergency Department can identify children at high risk for maltreatment. A before and after study was conducted at 9 EDs in 3 regions in the Netherlands (one intervention region and 2 control regions). During the period January 2006 to November 2007, prior to the introduction of the Hague protocol, from a total of 385,626 patients attending the ED in the intervention region 4 parents (1 per 100,000) were referred to the RCCAN. In the period after introduction of the protocol (December 2007 to December 2011), the number rose to 565 parents from a total of 885,301 patients attending the ED (64 per 100,000). In the control region, where the protocol was not implemented, these figures were 2 per 163,628 (1 per 100,000) and 10 per 371,616 (3 per 100,000) respectively (OR=28.0 (95 CI 4.6–170.7)). At assessment, child abuse was confirmed in 91% of referred cases. The protocol has a high positive predictive value of 91% and can substantially increase the detection rate of child abuse in an ED setting. Parental characteristics are strong predictors of child abuse. Implementing guidelines to detect child abuse based on parental characteristics of parents attending the adult section of the ED can increase the detection rate of child abuse and neglect allowing appropriate aid to be initiated for these families.

Enhancing Attachment Organization Among Maltreated Children: Results of a Randomized Clinical Trial

Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.

Childhood maltreatment in subjects with male-to-female gender identity disorder

Childhood maltreatment (CM) is quite common and constitutes a nonspecific risk factor for a range of different psychiatric symptoms during lifespan. It has been demonstrated that sexual minorities are at higher risk of maltreatment and abuse, and a high proportion of transsexual subjects report CM. The aim of this study is to evaluate the prevalence of reported CM in a clinical sample of patients with male-to-female Gender Identity Disorder (MtF GID), and to explore the relationship between these early life events, body image and different psychopathological and clinical variables. A consecutive series of 162 patients with male genotype was evaluated from July 2008 to May 2010. A total of 109 subjects (mean age 36 ± 10 years) meeting the criteria for MtF GID and giving their informed consent were considered. The occurrence of CM experiences was evaluated through a face-to-face clinical interview. Patients were asked to complete the Body Uneasiness Test and Symptom Checklist-90 Revised. More than one-fourth of patients reported CM. Maltreated subjects reported a higher body dissatisfaction and display a worse lifetime mental health. The presence of reported CM in these patients has relevant psychopathological implications, and therefore should be carefully investigated.

WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders.

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.

Non-accidental fractures in child maltreatment syndrome

Non-accidental fractures are the second most common injuries in maltreated children presenting to the emergency department. It is estimated that 30% of maltreated children evaluated have either acute or healing fractures. The hallmarks of these injuries are multiple fractures at different stages of healing. However, certain isolated fracture patterns are also observed. The determination of the non-accidental nature of injury remains a challenge, and a delay in diagnosis may place the child at increased risk of sustaining further injuries or death. In this article we will review the historical and physical characteristics, common fractures, and radiographic findings of non-accidental fractures in maltreated children. Careful evaluation of historical data, identification of children at high risk for maltreatment, accurate interpretation of radiographs, and a timely referral to social services may result in reduced morbidity and mortality.

Identification during the postpartum period of infants who are at high risk of child maltreatment

To determine whether clinicians correctly identify newborn infants who are at high risk of child maltreatment, we examined the outcomes of high-risk and non-high-risk children. Infants who were born at Yale-New Haven Hospital from 1979 to 1981 and who were referred by clinicians during the postpartum period to the hospital's child abuse registry because they were considered at high risk of child abuse or neglect became the high-risk group. For each high-risk infant, a comparison infant was selected and matched according to date of birth, gender, race, and method of payment for the hospitalization. For both groups, the occurrence of maltreatment was ascertained by reviewing the medical records until the child's fourth birthday. Each injury for which medical care was sought was classified into one of seven categories (from definite child abuse to accident) by a pediatrician who was unaware of the child's risk status. Information also was recorded about nonorganic failure to thrive and changes in the child's caretaker. Maltreatment (defined as abuse or neglect) occurred more frequently in the high-risk group than the comparison group (adjusted matched odds ratio = 4.3; 95% confidence interval = 1.41, 6.93; p less than 0.001), as did poor weight gain from a nonorganic cause (matched odds ratio = 7.0; 95% confidence interval = 1.59, 30.79; p less than 0.01) and changes in the child's caretaker (matched odds ratio = 9.0; 95% confidence interval = 3.80; 20.55; p less than 0.001). We conclude that as early as the postpartum period, clinicians can identify some families who are at high risk of maltreatment and other major adverse outcomes resulting from poor parenting.

Children of migrant farm work families are at high risk for maltreatment: New York State study.

Utilizing a crosstabulation between data collected by the Migrant Student Records Transfer System and the New York State Central Register, it was determined that 298 of the 7,408 migrant children, age 18 years or younger, censused in 1982 were on file as having been maltreated in 1982. This rate, 40.2 per 1,000, is substantially higher than the rate found for upstate New York children (5.5). Maltreatment rates also varied by migrant status and household composition.

Can child maltreatment be predicted during the perinatal period: Evidence from longitudinal cohort studies?

Abstract The early identification of children who are at high risk for maltreatment would help clinicians direct scarce preventive resources towards families with the greatest needs. This report reviews 11 longitudinal studies in which subjects were categorized during the perinatal period into high-risk and non-high-risk children and then followed over time to determine the occurrence of at least one adverse outcome: maltreatment, non-organic failure-to-thrive, or relinquishment of the child by the parent. Three aspects of these studies are presented: (1) methodological issues in design, (2) statistical terms used in predictive studies, and (3) details of the 11 studies and a meta-analysis to determine whether accurate predictions of adverse outcomes were made. The results of the meta-analysis suggest that prediction is feasible; improvements, however, in the approach to the assessment of risk are necessary, including further development and use of a standardized clinical assessment.

Maltreatment of children and adolescents with multiple handicaps: Five case examples

Little attention has been directed toward abuse and neglect in children and adolescents with multiple handicaps. This population, however, may be at especially high risk for maltreatment. Factors contributing to added risk include: (a) disruption in mother-infant attachment, (b) greater stress related to care needs and difficult to manage behavior problems, and (c) increased vulnerability due to communication and/or cognitive limitations. Five cases are presented involving abuse and neglect in psychiatrically referred children with multiple handicaps. Cases are discussed in terms of: (a) difficulties in identifying maltreatment in those with multiple handicaps, (b) the need for multidisciplinary intervention with families who engage in maltreatment, and (c) suggestions for future directions that research might take.

A hospital program for the detection and registration of abused and neglected children.

To facilitate early identification of abused and neglected children, a program has been developed in our medical center that includes a registry of such patients and a committee of staff members who are particularly qualified to deal with such problems. During the 18 months since the inception of the registry, 183 patients have been referred for evaluation. One hundred and eighteen patients have been listed in the registry: 37 have evidence of abuse, 69 of neglect, and 12 are thought to be at high risk of maltreatment. The program appears to have increased the level of staff awareness of these problems, promoted early identification and led to thorough investigation, active intervention and follow-up observation. A report to the Committee does not replace the mandatory formal report to the State Health or Welfare Department, and the Committee's tasks include assistance to the house officer in fulfillment of this responsibility.