Risk Factors For Child Maltreatment Research Articles

Randomized trial of a statewide home visiting program to prevent child abuse: impact in reducing parental risk factors

Objectives: To assess the impact of a home visiting program in reducing malleable parental risk factors for child abuse in families of newborns identified, through population-based screening, as at-risk of child abuse. Methods: This randomized trial focused on Healthy Start Program (HSP) sites operated by three community-based organizations on Oahu, HI, USA. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Mothers in both groups were interviewed annually for 3 years (88% follow-up each year) to measure mental health, substance use, and partner violence. HSP records were reviewed to measure home visiting services provided. Home visitors were surveyed annually to measure their perceived competence. Results: Malleable parental risks for child abuse were common at baseline. There was no significant overall program effect on any risk or on at-risk mothers’ desire for and use of community services to address risks. There was a significant reduction in one measure of poor mental health at one agency and a significant reduction in maternal problem alcohol use and repeated incidents of physical partner violence for families receiving ≥75% of visits called for in the model. Home visitors often failed to recognize parental risks and seldom linked families with community resources. HSP training programs were under-developed in preparing staff to address risks and to link families with community resources. Conclusions: Overall, the home visiting program did not reduce major risk factors for child abuse that made families eligible for service. Research is needed to develop and test strategies to improve home visiting effectiveness in reducing parental risks for child abuse.

Risk Factors for Child Abuse and Neglect Among Former TANF Families: Do Later Leavers Experience Greater Risk?

Risk Factors for Child Abuse and Neglect Among Former TANF Families: Do Later Leavers Experience Greater Risk?

Emotion-focused coping as a mediator of maternal cocaine abuse and antisocial behavior.

A great deal of data implicate parental drug use as a potential risk factor for child abuse; however, theories for understanding the links between maternal drug use and antisocial behavior have yet to be examined empirically. This case-control study investigated correlates of adult antisocial behavior among 279 inner-city mothers in 3 comparison groups: drug abusers (n = 112), depressed mothers (n = 73), and nonsubstance abusing controls (n = 94). Using hierarchical regression techniques and mediational analyses controlling for ethnicity, current depression, and family history of substance abuse, support was provided for an emotion-focused coping style as a link between addictive and antisocial behavior. These results highlight the importance of focusing on emotion regulation models in the prevention and treatment of violence in drug-abusing women.

External hydrocephalus: a probable cause for subdural hematoma in infancy

Subdural hemorrhage is common in infancy, particularly in the first year of life. The most common cause is nonaccidental (child abuse), with accidental in second place. We present three healthy infants, ages 4, 5, and 7 months that, during an evaluation for macrocephaly, were found to have frontal subdural hematoma in association with prominent extracerebral cerebrospinal fluid spaces (external hydrocephalus). There was no history of trauma or risk factors for child abuse. Skull surveys and ophthalmologic examinations were normal. All infants were neurologically intact and achieved normal developmental milestones in one-year follow-up. We suggest that some infants with external hydrocephalus may be at risk for development of subdural hematoma with minimal or no trauma, most likely secondary to stretching of the bridging veins in the unusually widened subarachnoid spaces. Child abuse, although it should always be kept in mind and should be excluded, may not be the most common cause in this specific context. Ravid S, Maytal J. External hydrocephalus: A probable cause for subdural hematoma in infancy.

Child maltreatment in the “Children of the Nineties:” deprivation, class, and social networks in a UK sample

Aim: To determine risk factors for child maltreatment within the socio-economic environment of a contemporary UK child population. Methods: The research is based on a large cohort study, the Avon Longitudinal Study of Parents and Children. Out of 14,256 children participating in the study, 115 have been identified as having been placed on local child protection registers prior to their 6th birthday. Data on the socio-economic environment of the families have been obtained from a series of questionnaires administered during pregnancy and the first 3 years of life. Risk factors have been analyzed using logistic regression analysis. Results: Four indicators of deprivation all showed significant relationships with registration. Adjusted odds ratios were 2.33 for paternal unemployment; 7.65 for council housing; 2.16 for overcrowding; and 2.33 for car ownership. There was a strong relationship between the number of indicators of deprivation and the risk of maltreatment. In a second model, maternal unemployment, high mobility (> 3 house moves in the previous 5 years) and a poor social network were also significant with odds ratios of 2.82, 2.81, and 3.09, respectively. Conclusions: This study confirms the importance of social factors in the etiology of child maltreatment. Social deprivation is an important determinant of child maltreatment, and encompasses a number of different aspects, including financial security, housing situation and material benefits; in addition, the job situation of the parents and the stability and richness of their social networks all have a significant impact on risk of maltreatment. Interventions at both an individual and a community level are important to support families and reduce the risk of maltreatment.

Malos tratos infantiles: representaciones sociales de la población general y de los profesionales del ámbito de la infancia en el caribe colombiano

Objective: The main objective was to know social representations about child maltreatment (severity, etiology, and intervention strategies) of the general population and the professionals working with children in the Caribbean area of Colombia. Method: Sample was composed for 402 participants. From this pool of participants, 111 of them were working in child protection, 95 worked with children but not in the child protection system and 196 pertained to the general population. All participants answered to a questionnaire composed by 86 items. The questionnaire was developed to assess (1) the perceived severity of different typologies of child abuse, (2) opinions about risk factors for child maltreatment and sexual abuse, and (3) opinions about the most adequate ways of intervention with perpetrator of child abuse. Results: Sexual abuse is considered as the most severe typology of child maltreatment and emotional abuse is considered as more severe than physical abuse. No differences between groups were found in perceived severity of typologies of child maltreatment. Differences in the social representation about the etiology of child maltreatment were found. Professionals working in the child protection system give more value to characteristics of parents and to the socio-economic and familiar environment in the etiology of child maltreatment than participants from the general population. Prevention and treatment programs for abusers were considered as the more relevant strategies against child maltreatment. Discussion: Findings of present study suggest that social representations about child maltreatment of general population and professionals from the Caribbean area of Colombia are similar than social representation observed in other regions and countries. It is important to take into account that child labor and child poverty were considered as non-severe typologies of child maltreatment. Moreover, findings suggest that people from general population in the Caribbean area of Colombia have a relevant knowledge about agencies working for child protection.

Household composition and risk of fatal child maltreatment.

Approximately 2000 children die annually in the United States from maltreatment. Although maternal and child risk factors for child abuse have been identified, the role of household composition has not been well-established. Our objective was to evaluate household composition as a risk factor for fatal child maltreatment. Population-based, case-control study using data from the Missouri Child Fatality Review Panel system, 1992-1994. Households were categorized based on adult residents' relationship to the deceased child. Cases were all maltreatment injury deaths among children <5 years old. Controls were randomly selected from natural-cause deaths during the same period and frequency-matched to cases on age. The main outcome measure was maltreatment death. Children residing in households with adults unrelated to them were 8 times more likely to die of maltreatment than children in households with 2 biological parents (adjusted odds ratio [aOR]: 8.8; 95% confidence interval [CI]: 3.6-21.5). Risk of maltreatment death also was elevated for children residing with step, foster, or adoptive parents (aOR: 4.7; 95% CI: 1.6-12.0), and in households with other adult relatives present (aOR: 2.2; 95% CI: 1.1-4.5). Risk of maltreatment death was not increased for children living with only 1 biological parent (aOR: 1.1; 95% CI: 0.8-2.0). Children living in households with 1 or more male adults that are not related to them are at increased risk for maltreatment injury death. This risk is not elevated for children living with a single parent, as long as no other adults live in the home.

Are father surrogates a risk factor for child maltreatment?

Most research on the effect of father figures in the home on the incidence of child maltreatment has been cross-sectional and has focused on sexual abuse. This prospective study's purpose is to determine if the presence of a father surrogate in the home affects the risk of a subsequent child maltreatment report. In a longitudinal sample of at-risk children, North Carolina's Central Registry for Child Abuse and Neglect was used to determine the maltreatment history of children from birth to age 8 years. Children who had a father surrogate living in the home were twice as likely to be reported for maltreatment after his entry into the home than those with either a biological father (odds ratio = 2.6, 95 % confidence interval = 1.4-4.7) or no father figure in the home (odds ratio = 2.0, 95% confidence interval = 1.1-3.5).

How common is abuse in Greece? Studying cases with femoral fractures

AIMSTo examine the extent of undiagnosed child abuse in Greece by studying young children with femoral fractures, which may be associated with abuse.METHODSFifty seven consecutive cases of children under 6...

Assessment of Maltreatment of Children With Disabilities

Widespread efforts are continuously being made to increase awareness and provide education to pediatricians regarding risk factors of child abuse and neglect. The purpose of this statement is to ensure that children with disabilities are recognized as a population that is also at risk for maltreatment. The need for early recognition and intervention of child abuse and neglect in this population, as well as the ways that a medical home can facilitate the prevention and early detection of child maltreatment, should be acknowledged.

Risk factors of child maltreatment within the family: towards a knowledgeable base of family nursing

The purpose of this study was to compare family dynamics in child maltreating families ( n=42) with that in ordinary families with children ( n=77), and to ascertain risk factors of child maltreatment within the family. Child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child by a parent. Data were collected using questionnaires (Family Dynamics Measure 2, FMD 2) ( N=119) basing on Barnhill's conceptual framework of healthy family systems and analysed by forming sum variables and logistic regression. The study results indicate that family functioning in child maltreating families is lower on all dimensions of family dynamics (individuation, mutuality, flexibility, stability, communication and roles) than that in ordinary families with children. Furthermore, it seems that specific risk factors, detected with logistic regression analysis, are related to whether child maltreatment occurs in the family or not. These include the parent's low educational background, many children in the family, unemployment of a parent, low individuation of the family members, and poor stability and security within the family. The results of this study provide guidelines for detecting and preventing child maltreatment as well as for recognising its existence, although no generalizations can be made due to the small sample size and complexity of the phenomenon under study.

Identified spouse abuse as a risk factor for child abuse

Context: There are limited data on the extent to which spouse abuse in a family is a risk factor for child abuse. Objective: To estimate the subsequent relative risk of child abuse in families with a report of spouse abuse compared with other families. Design: Cohort study. Setting: Analysis of a centralized US Army database Participants: Married couples with children with at least one spouse on active duty in the US Army during 1989–95. Main Outcome Measures: The US Army Family Advocacy Program’s Central Database was used to identify child and spouse abuse. The exposure was an episode of identified spouse abuse and the main outcome was a substantiated episode of subsequent child abuse. Results: During the study period of an estimated 2,019,949 person years, 14,270 incident child abuse cases were substantiated. Families with an incident case of spouse abuse identified during the study period were twice as likely to have a substantiated report of child abuse compared with other military families, rate ratio, 2.0, (95% confidence interval [CI] 1.9–2.1). Young parental age had the highest rate ratio, 4.9 (95% CI 4.5–5.3) in the subgroup analysis controlling for rank. Identified spouse abuse was associated with physical abuse of a child, rate ratio 2.4 (95% CI 2.2–2.5), and with sexual abuse of a child, rate ratio 1.5 (95% CI 1.3–1.7). Identified spouse abuse was not associated with child neglect or maltreatment, rate ratio, 1.0 (95% CI 0.9–1.1). Conclusion: An identified episode of spouse abuse in a family appears to be associated with an increased risk of subsequent child abuse and serves as an independent risk factor. Therefore, care providers should consider the potential risk to children when dealing with spouse abuse.

Child maltreatment

Child maltreatment has become a major concern in countries throughout the world. This article presents a study conducted among 164 Arab social workers in Israel. The study asked the following questions: How do Arab social workers define child maltreatment? What signs are used to identify potential cases? What are the risk factors for child maltreatment as perceived by the social workers? How do social workers perceive their role in reporting maltreatment? The results reveal that the respondents’ definitions of maltreatment focus more on abuse than on neglect.

Hawaii's Healthy Start Program of Home Visiting for At-Risk Families: Evaluation of Family Identification, Family Engagement, and Service Delivery

To describe family identification, family engagement, and service delivery in a statewide home visiting program for at-risk families of newborns. Six target communities of Hawaii's Healthy Start Program (HSP), which incorporates 1) early identification of at-risk families of newborns via population-based screening and assessment, and 2) paraprofessional home visiting to improve family functioning, promote child health and development, and prevent child maltreatment. Cross-sectional study: describes early identification process and family characteristics associated with initial enrollment. Longitudinal study: describes home visiting process and characteristics associated with continued participation. Cross-sectional study: civilian births in 6 communities (n = 6553). Longitudinal study: at-risk families in the intervention group of a randomized trial of the HSP (n = 373). completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk. Early identification staff determined risk status for 84% of target families. Families with higher risk scores, young mothers with limited schooling, and families with infants at biologic risk were more likely to enroll in home visiting. Half of those who enrolled were active at 1 year with an average of 22 visits. Families where the father had multiple risk factors and where the mother was substance abusing were more likely to have >/=12 visits; mothers who were unilaterally violent toward the father were less likely. Most families were linked with a medical home; linkage rates for other community resources varied widely by type of service. Half of families overall, but >/=80% of those active at 1 year, received core home visiting services. Performance varied by program site. It is challenging to engage and retain at-risk families in home visiting. Service monitoring must be an integral part of operations.

Neighborhoods and child maltreatment: a multi-level study

Objective: To better understand how neighborhood and individual factors are related to child maltreatment. Method: Using an ecological framework, a multi-level model (Hierarchical Linear Modeling) was used to analyze neighborhood structural conditions and individual risk factors for child abuse and neglect. Parents ( n = 400) of children under the age of 18 were systematically selected from 20 randomly selected census-defined block groups with different risk profiles for child maltreatment report rates. Parents were administered the Neighborhood Environment for Children Rating Scales, the Child Abuse Potential Inventory, the Zimet measure of social support, and the Conflict Tactics Scales as a measure of childhood experience with violence. Results: Neighborhood factors of impoverishment and child care burden significantly affect child abuse potential after controlling for individual risk factors. However, neighborhood effects are weaker than they appear to be in aggregate studies of official child maltreatment reports. Variation in child abuse potential within neighborhoods is greater than between neighborhoods. However, adverse neighborhood conditions weakened the effects of known individual risk and protective factors, such as violence in the family of origin. Conclusions: If individual potential for child maltreatment is more evenly distributed across neighborhoods than reported maltreatment, then neighborhood and community play an important, if as yet unspecified, role in child maltreatment. Multi-level models are a promising research strategy for disentangling the complex interactions of individual and contextual factors in child maltreatment.

A longitudinal analysis of risk factors for child maltreatment: findings of a 17-year prospective study of officially recorded and self-reported child abuse and neglect

Objective: To identify demographic, family, parent, and child factors prospectively associated with risk for child abuse and neglect among families in the community, using data on child maltreatment obtained from both official records and youth self-reports. Method: Surveys assessing demographic variables, family relationships, parental behavior, and characteristics of parents and children were administered to a representative sample of 644 families in upstate New York on four occasions between 1975 and 1992. Data on child abuse and neglect were obtained from New York State records and retrospective self-report instruments administered when youths were ≥ 18 years old. Results: Logistic regression analyses indicated that different patterns of risk factors predicted the occurrence of physical abuse, sexual abuse, and neglect, although maternal youth and maternal sociopathy predicted the occurrence of all three forms of child maltreatment. In addition, the prevalence of child abuse or neglect increased from 3% when no risk factors were present to 24% when ≥ 4 risk factors were present. State records and self-reports of child maltreatment did not correspond in most cases when maltreatment was reported through at least one data source, underlining the importance of obtaining data from both official records and self-reports. Conclusions: Assessment of a number of risk factors may permit health professionals to identify parents and children who are at high risk for child maltreatment, facilitating appropriate implementation of prevention and treatment interventions.

Prevention of Child Abuse and Neglect in the Primary Care Setting

The number of cases of child abuse and neglect has risen steadily since reporting began in the 1960s. Today, child abuse and neglect is a major cause of injury and death in those ages 0 to 5. Studies have identified certain factors that increase the risk of maltreatment. The primary care practitioner is in an ideal position to assess for the presence of risk factors and to provide primary prevention interventions. This article defines child abuse and neglect and reviews its epidemiology; the risk factors of child abuse and neglect are also summarized. The concept of attachment as a theoretical framework is discussed; its significance in the attainment of a positive adjustment to the maternal role should drive the clinician's thought process. Suggested interventions are aimed at strengthening the parent-child relationship, reducing stress, and providing support. A protocol is presented that may be a useful guide for the practitioner.

The Rate of Physical Child Abuse in Chinese Families: A Community Survey in Hong Kong

Objective: This study aimed to describe the extent and pattern of parental child battering in Chinese families in Hong Kong. It was hypothesized that the unique feature of filial piety in Chinese culture will create a different pattern of child abuse in Hong Kong when compared to Western societies. Method: A telephone survey of 1,019 households randomly selected from the local residential telephone directory was completed. Three hundred and fifty-nine fathers and 660 mothers of a child at or under the age of 16 participated in the study. The occurrence of child abuse was assessed by the Chinese version of the Conflict Tactics Scale ( Straus 1979). Results: The base rate of physical child abuse was 526 per 1,000 children for minor violence and 461 per 1,000 children for severe violence. Minor violence was most likely directed at children aged 3–6 years or children without siblings in the family; and committed by mothers, parents aged 19–37 years, or housewives/unemployed fathers. The highest rate of severe violence occurred among boys or children aged 3–6 years; and was committed by mothers, parents aged 19–37 years, or housewives/unemployed fathers. Common risk factors of child abuse were identified for Chinese and US families. Conclusions: When compared to US families, Chinese families showed slightly lower rates of minor violence but higher rates of severe violence toward children. Children aged 3–6 years were the most vulnerable victims and female caregivers the most likely abusers in both US and Chinese families. Our findings also suggested that it cannot be assumed that results based on local official statistics and clinical samples regarding the extent of child abuse and characteristics of the victims and abusers can be accurately extended to community samples.

Beyond parenting skills: Battling barriers and building bonds to prevent child abuse and neglect

The grave physical and emotional consequences of childhood abuse and neglect are undisputed. Although the risk factors for child maltreatment are well established, implementing effective treatment methods remains a challenge. This paper describes three treatment challenges and solutions for replacing potentially abusive or neglectful parenting with child-appropriate parenting. The treatment challenges include: (a) conflict between participants' cultural and religious beliefs and our treatment goals, (b) cognitive limitations including inaccurate developmental expectations for the child, and, (c) an excess of negative affect and a deficit of tender feelings for the child. Solutions for these challenges evolved from clinical investigation of participant barriers to treatment, and include Socratic dialogue during treatment regarding culture and religion, use of visual metaphor in explaining abstract parenting concepts, perspective-taking exercises, techniques for anger awareness and management, and activities to increase shared positive affect and maternal emotional awareness. Policy implications and caveats concerning the limited empirical support for these techniques are discussed.

Facilitating Healthy Parenting Among Mothers with Substance Abuse or Dependence Problems:

More than one and one-half million children in the United States experience abuse or neglect. Research has identified parental substance abuse or dependence as one of the primary risk factors for child abuse. Along with this recognition, there are increased efforts to provide appropriate treatment to maltreating, substance-abusing or dependent parents. Parenting interventions may be required or recommended in conjunction with their treatment for substance abuse or dependence. However, current parenting programs, which tend to emphasize child management skills, may be less effective for parents with substance abuse or dependence issues. Traditional parenting programs may be rendered less potent for these parents with: multiple and chronic life problems, insufficient supports, poor coping skills, already damaged relationships with their children, and repetitive patterns of relating to their children sometimes based upon their past traumas. Parenting outcomes may be improved through comprehensive parenting p...