Reduce Child Maltreatment Research Articles

The economic burden of child maltreatment in the United States, 2015.

Child maltreatment incurs a high lifetime cost per victim and creates a substantial US population economic burden. This study aimed to use the most recent data and recommended methods to update previous (2008) estimates of 1) the per-victim lifetime cost, and 2) the annual US population economic burden of child maltreatment. Three ways to update the previous estimates were identified: 1) apply value per statistical life methodology to value child maltreatment mortality, 2) apply monetized quality-adjusted life years methodology to value child maltreatment morbidity, and 3) apply updated estimates of the exposed population. As with the previous estimates, the updated estimates used the societal cost perspective and lifetime horizon, but also accounted for victim and community intangible costs. Updated methods increased the estimated nonfatal child maltreatment per-victim lifetime cost from $210,012 (2010 USD) to $830,928 (2015 USD) and increased the fatal per-victim cost from $1.3 to $16.6 million. The estimated US population economic burden of child maltreatment based on 2015 substantiated incident cases (482,000 nonfatal and 1670 fatal victims) was $428 billion, representing lifetime costs incurred annually. Using estimated incidence of investigated annual incident cases (2,368,000 nonfatal and 1670 fatal victims), the estimated economic burden was $2 trillion. Accounting for victim and community intangible costs increased the estimated cost of child maltreatment considerably compared to previous estimates. The economic burden of child maltreatment is substantial and might off-set the cost of evidence-based interventions that reduce child maltreatment incidence.

Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities.

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed.

Perspectives from Community-Based Organizational Managers on Implementing and Sustaining Evidence-Based Interventions in Child Welfare

ABSTRACTThe managers of community-based organizations that are contracted to deliver publicly funded programs, such as in the child welfare sector, occupy a crucial role in the implementation and sustainment of evidence-based interventions to improve the effectiveness of services, as they exert influence across levels of stakeholders in multitiered systems. This study utilized qualitative interviews to examine the perspectives and experiences of managers in implementing SafeCare®, an evidence-based intervention to reduce child maltreatment. Factors influencing managers’ abilities to support SafeCare® included policy and ideological trends, characteristics of leadership in systems and organizations, public–private partnerships, procurement and contracting, collaboration and coopetition, and support for organizational staff.

Recruitment and Retention in a Parenting Intervention: A Case Study with Parents Aging Out of the Child Welfare System

ABSTRACTParenting interventions are efficacious in reducing child maltreatment and negative child behaviors, yet the recruitment and retention of parents, especially vulnerable parents, in such interventions can be challenging. Prior research identifies several ways to improve recruitment and retention including laying the foundation for the intervention, fostering relationships with parents, ensuring fit of the intervention with the intended population, and identifying barriers to parents’ participation. This case study presents a process of recruiting and retaining a vulnerable group of parents, specifically parenting youth aging out of the child welfare system. In addition to outlining the strategies used, lessons learned are highlighted. Parents expressed interest in the parenting intervention, experienced significant needs, negotiated great instability in their lives, and valued the social connections facilitated by the group intervention. Despite the research team following best practices and investing significant time and resources, recruitment and retention remained challenging. Implications for future work in this area are presented.

Maternal intimate partner violence victimization and child maltreatment

There is some limited evidence of an association between maternal intimate partner victimization (IPV) and children’s experience of maltreatment. Using data from a longitudinal study, we examine whether this relationship is independent of range of potential confounders including socio-economic, familial and psychological factors. Data were taken from the 14 and 30-year follow-ups of the Mater-University of Queensland Study of Pregnancy (MUSP) in Australia. A subsample of 2064 mothers and children (59.0% female) whose data on maternal IPV and child maltreatment was available, were analysed. In families with maternal IPV, two in five children reported being maltreated, compared to one in five children maltreated in families without maternal IPV. Except for sexual maltreatment which was consistently higher in female offspring, there was no gender differences in experiencing different types of maltreatment in families manifesting maternal IPV. Although both males and females were at increased risk of child maltreatment in families where mothers were victimized by their male partners, male children were more likely to be emotionally maltreated. The main associations were substantially independent of measured confounders, except for father’s history of mental health problems which attenuated the association of maternal IPV victimization and male offspring’s physical abuse. Our findings confirm that there is a robust association between maternal IPV and child maltreatment. Both maternal IPV victimization and child maltreatment co-occur in a household characterized by conflict and violence. Consequences of IPV go beyond the incident and influence all family members. Efforts to reduce child maltreatment may need to address the greater level of IPV associated with the cycle of family violence.

Child Abuse Perpetrators of Iranian Adolescents

Background: Child abuse is a main health problem all over the world. Objectives: The aim of this study was to extend our understanding about offenders of child abuse in different domains. Methods: The study was designed as a cross-sectional survey on 700 students in secondary schools using multiple cluster sampling in Yazd, Iran in 2013. We applied 2 self-reported questionnaires: a standard self-reported valid and reliable questionnaire for recording child abuse and DASS (depression anxiety stress scales)-42 for assessing mental disorders and another part about perpetrators (parents, relatives, friends or classmates, school teachers and coaches, strangers). The collected data was analyzed using SPSS software. P values < 0.05 were considered as significant. Results: School parents, more than the other groups were guilty in severe forms of all domains. Parents neglected totally 97 (26.7 %) students in a variety of intensity, abused psychologically 90 (28.3%), physically 58 (25.6%) and even sexually in 29 (15.3%) cases. Moreover, parents were also responsible for severe physical abuse of 69 (30.4%) and strangers in severe sexual of 105 (55.5%) students (P value < 0.05). Psychological abuse was more probable in girls (OR: 2.3, P value < 0.001) and physical in boys (OR: 1.5, P value: 0.01). The students who had parents with substance abuse problem reported neglect 3.1, psychological 2.1, physical 2.07 and sexual abuse 2.04 more than other adolescents (P value < 0.05). Conclusions: Understanding about offenders of child abuse would reveal findings that could be an alarm for decision makers’ intervention programming aimed at reducing child abuse.

DNA methylome variation in a perinatal nurse-visitation program that reduces child maltreatment: a 27-year follow-up

This study reveals the influence of child maltreatment on DNA methylation across the genome and provides the first evidence that a psychosocial intervention program, the Nurse Family Partnership (NFP), which targets mothers at risk for abusive parenting, associates with variation in the DNA methylome in adult offspring. The 188 participants were born to women randomly assigned to control (n = 99) or nurse-visited intervention groups (n = 89) and provided blood samples and a diagnostic interview at age 27 years. Interindividual variation in the blood DNA methylome was described using principal components (PC) scores derived from principal component analysis and showed that the NFP program (PC10: p = 0.029) and a history of abuse/neglect (PC1: p = 0.029, PC2: p = 0.009) significantly associated with DNA methylome variation at 27 years of age independent of gender, ancestry, cellular heterogeneity, and a polygenic risk index for major psychiatric disorders. The magnitude of the association between child maltreatment and DNA methylation was reduced when accounting for lifestyle factors, including smoking. These findings reflect the sustained impact of both childhood adversity as well as intervention programs that target such adversity on the epigenome but highlight the need for prospective longitudinal studies of DNA methylome variation in the context of early intervention programs.

“It Has Changed”: Understanding Change in a Parenting Program in South Africa

BackgroundPoor parenting that leads to child maltreatment during adolescence presents a major public health burden. Research from high-income countries indicates that evidence-based parenting program interventions can reduce child maltreatment. Much less is known, however, about how beneficiaries of these programs experience this process of change. Understanding the process that brings about change in child maltreatment practices is essential to understanding intervention mechanisms of change. This is particularly important given the current scale-up of parenting programs across low- and middle-income countries. ObjectivesThis study aimed to provide insight into how caregivers and adolescents attending a parenting program in South Africa perceived changes associated with abuse reduction. MethodsSemi-structured interviews were conducted with caregivers and adolescents (n = 42) after the intervention, as well as observations of sessions (n = 9) and focus group discussions (n = 240 people). Participants were adolescents between the ages of 10-18 and their primary caregiver residing in peri-urban and rural program clusters in the Eastern Cape Province of South Africa. Data were coded in Atlas.ti, and thematic content analysis was conducted. FindingsBased on participant perceptions, the Sinovuyo Teen parenting program workshops catalyzed change into practice by creating an environment that was conducive to learning alternatives. It did so through prioritizing a process of mutual respect, openness, and being valued by others, giving legitimacy to a respectful reciprocity and new ways of spending time together that enabled caregivers and teenagers to shift and normalize more positive behaviors. This in turn led to reductions in physical and verbal abuse. ConclusionsThis study's findings may be of use to policymakers and practitioners who need to understand how parenting programs support parents and teenagers in increasing positive parenting approaches and changing potentially harmful practices. It additionally highlights the importance of assessing the experiences of both parents and teenagers attending such programs.

Men\u2019s Involvement in a Parenting Programme to Reduce Child Maltreatment and Gender-Based Violence: Formative Evaluation in Uganda

Parenting programmes involving fathers can reduce child maltreatment and gender-based violence. However, most parenting programmes find it difficult to recruit fathers. We piloted a 21 session parenting intervention, ‘Parenting for Respectability’, with fathers and mothers near Kampala, Uganda. Sixty-one fathers and 83 mothers were recruited initially and 52 fathers and 76 mothers retained to the end. We interviewed with 24 fathers and 16 mothers. Data were analysed thematically. Success in involving fathers was probably due to (a) the first 10 sessions being father-only, allowing them to share experiences before participating in mixed-sex sessions; (b) exploiting men’s pre-existing motivation to improve their children’s behaviour, thereby enhancing family respectability; and (c) the interactive, participatory delivery. Mixed sessions enabled couples to clarify conflicting perspectives regarding spousal relationships and gendered norms. However, men experienced social pressure to conform to conventional masculinity, suggesting the need to instil intervention values at community level.

A scoping review of evidence-based interventions available to parents of maltreated children ages 0-5 involved with child welfare services

Parents referred to child welfare services for child maltreatment often struggle against chronic risk factors including violence, substance abuse, mental health concerns, and poverty, which impinge upon their ability to be sensitive caregivers. The first line of intervention within the child welfare context is to modify parenting behavior. This scoping review comprehensively surveyed all available literature to map the extent and range of research activity around the types of interventions available within a child welfare context to parents of infants and toddlers (0–5 years of age), to identify the facilitators and/or barriers to the uptake of interventions, and to check that interventions match the risk factors faced by parents. This scoping review engaged in stringent screening of studies based upon inclusion/exclusion criteria. Sixty-five articles involving forty-two interventions met inclusion criteria. Interventions generally aimed to improve parenting practices, the relationship between parent and child, and/or attachment security, along with reducing child abuse and/or neglect. A notable finding of this scoping review is that at present, interventions for parents of children ages 0–5 involved with the child welfare system are most frequently measured via case study and quasi-experimental designs, with randomized control trials making up 26.2% of included study designs.

A Qualitative Study of Mechanisms Underlying Effects of a Parenting Intervention in Rural Liberia

Parenting interventions can reduce child maltreatment and improve child outcomes in high-risk settings, but little is known about mechanisms underlying effects. This study presents qualitative findings on mechanisms of change from a randomized trial of a parenting intervention in Liberia. Participants (N = 30) completed semi-structured interviews, and thematic content analysis was conducted from transcripts. Results suggest that learning about effects of violence on child development and discussing the value of empathy for children strengthened caregivers’ sense of identity as nurturers and protectors. This in turn drove efforts to decrease harsh discipline. As a result, children expressed less fear, increasing opportunities for positive interactions; shared enjoyment maintained reduced harsh treatment. Caregivers also described recognizing that physical punishment was often ineffective and using new non-violent discipline skills alongside emotion regulation skills to facilitate behavior change. Participants also described reduced couples conflict and more peaceful home environments associated with increased self-identification as role models.

Early Childhood Home Visiting.

High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home.

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 2.5years. 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.

Will prohibiting the use of physical punishment reduce child abuse deaths among New Zealand children?

The Amendment Act (Crimes (Substituted Section 59) Amendment Act, 2007) came into force on 22 June 2007. The changes in the Act amended the right of parents to use force by way of correction toward a child. The purpose of this amendment was to provide children with a safer and more secure environment to live in that is free from violence. Such a move also has the potential to provide a clearer mandate for social workers in regard to issues of child safety. While planned, reviews to determine how effective the amendment has been have not yet been undertaken.This paper presents some key findings from a larger study exploring the issue of child abuse deaths in New Zealand. In doing so a comparison of legislation and policy between New Zealand and Sweden is presented. Sweden was used as the main focus for this comparison as it introduced a ban on use of corporal punishment of children in 1979.

Will prohibiting the use of physical punishment reduce child abuse deaths among New Zealand children?

Will prohibiting the use of physical punishment reduce child abuse deaths among New Zealand children?

Foster care and the earned income tax credit

Foster care is a source of significant costs to both governments and foster children. Policies that provide income support to households potentially reduce entry into foster care via reducing child maltreatment and improving child behavior. As part of the American Recovery and Reinvestment Act in 2009 (ARRA2009), the federal government expanded the earned income tax credit (EITC), which is an important income support program for low-income working households. Using state-level data, we investigate the impact of this EITC expansion on state-level foster care entry rates. Typically, states with state-level EITC match federal EITC spending at a specific rate, meaning that increases in federal EITC spending increase state-level spending as well. We find that expansion of EITC decreased foster care entry rates by 7.43% per year in states with a state-level EITC, relative to those without. In models that separately examine foster care entry rates by age of the child, we find that the ARRA2009 had different effects on foster care entry based on the child’s age. We find that ARRA2009 decreased foster care entry rates for children age 11–15 by nearly 12% in states with a state EITC and it decreased foster care entry rates for children age 16–20 by roughly 17% in states with a state EITC, relative to states without a state EITC.

Effect of the Earned Income Tax Credit on Hospital Admissions for Pediatric Abusive Head Trauma, 1995-2013.

Policies that increase household income, such as the earned income tax credit (EITC), have shown reductions on risk factors for child maltreatment (ie, poverty, maternal stress, depression), but evidence is lacking on whether the EITC actually reduces child maltreatment. We examined whether states' EITCs are associated with state rates of hospital admissions for abusive head trauma among children aged <2 years. We conducted difference-in-difference analyses (ie, pre- and postdifferences in intervention vs control groups) of annual rates of states' hospital admissions attributed to abusive head trauma among children aged <2 years (ie, using aggregate data). We conducted analyses in 14 states with, and 13 states without, an EITC from 1995 to 2013, differentiating refundable EITCs (ie, tax filer gets money even if taxes are not owed) from nonrefundable EITCs (ie, tax filer gets credit only for any tax owed), controlling for state rates of child poverty, unemployment, high school graduation, and percentage of non-Latino white people. A refundable EITC was associated with a decrease of 3.1 abusive head trauma admissions per 100 000 population in children aged <2 years after controlling for confounders ( P = .08), but a nonrefundable EITC was not associated with a decrease ( P = .49). Tax refunds ranged from $108 to $1014 and $165 to $1648 for a single parent working full-time at minimum wage with 1 child or 2 children, respectively. Our findings with others suggest that policies such as the EITC that increase household income may prevent serious abusive head trauma.

Drug Use, the Drug Environment, and Child Physical Abuse and Neglect.

Although drug use is considered a risk factor for child maltreatment, very little work has examined how the drug environment may affect physical abuse and neglect by parents. Utilizing information from a telephone survey with 2,597 respondents from 43 cities with valid police data on narcotics incidents, we analyzed the relationship between drug use, drug availability, and child maltreatment using multilevel models. City-level rates of drug abuse and dependence were related to more frequent physical abuse. Parents who use drugs in areas with greater availability of drugs reported more physical abuse and physical neglect. Emotional support was protective of all types of maltreatment. While most child welfare interventions focus on reducing parental drug use in order to reduce child abuse, these findings suggest environmental prevention or neighborhood strengthening approaches designed to reduce the supply of illicit drugs may also reduce child abuse through multiple mechanisms.

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.

Summary of comparison between FFT-CW® and Usual Care sample from Administration for Children's Services

This evaluation compared the efficiency and effectiveness of Functional Family Therapy-Child Welfare (FFT-CW®, n=1625) to Usual Care (UC: n=2250) in reducing child maltreatment. FFT-CW® is a continuum of care model based on the family's risk status. In a child welfare setting, families received either UC or FFT-CW® in a quasi-experimental, stepped wedge design across all five boroughs of New York City. The families were matched using stratified propensity scoring on their pre-service risk status and followed for 16 months. The ethnically diverse sample included African American (36%), Asian (4%); Hispanic (49%), and Non-Hispanic White (6%) or Other (6%) participants. Referral reasons included abuse or neglect (57.4%), child service needs (56.9%) or child health and safety concerns (42.8%). Clinical process variables included staff fidelity, service duration, and number of contacts. Positive outcomes included whether all clinical goals were met and negative outcomes included transfers, outplacement, recurring allegations and service participation within 16 months of the case open date. Families receiving FFT-CW® completed treatment more quickly than UC and they were significantly more likely to meet all of the planned service goals. Higher treatment fidelity was associated with more favorable outcomes. Fewer FFT-CW® families were transferred to another program at closing, and they had fewer recurring allegations. FFT-CW® had fewer out-of-home placements in families with higher levels of risk factors. The FFT-CW® program was more efficient in completing service, and more effective than UC in meeting treatment goals while also avoiding adverse outcomes.