Assessment Issues in Child Abuse Evaluations

Concurrent Treatment of Substance Abuse, Child Neglect, Bipolar Disorder, Post-Traumatic Stress Disorder, and Domestic Violence: A Case Examination Involving Family Behavior Therapy

High rates of co-occurrence between substance abuse and child neglect have been well documented and especially difficult to treat. As a first step in developing a comprehensive evidence-based treatment for use in this population, the present case examination underscores Family Behavior Therapy (FBT) in the treatment of a mother who evidenced Substance Dependence, child neglect, Post-Traumatic Stress Disorder, Bipolar I Disorder, and domestic violence. Utilizing psychometrically validated self-report inventories and objective urinalysis, treatment was found to result in the cessation of substance use, lower risk of child maltreatment, improved parenting attitudes and practices, and reduced instances of violence in the home. The importance of utilizing validity scales in the assessment of referrals from child welfare settings is discussed, and future directions are reported in light of the results.

Child maltreatment prevention priorities at the Centers for Disease Control and Prevention

The Division of Violence Prevention at Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control has had a long-standing interest in the prevention of child maltreatment. The nation's public health agency, CDC, seeks to focus the public health perspective on the problem of child maltreatment and to promote science-based practice in the field. Since 1999, CDC has developed research priorities to address the prevention of child maltreatment. Described here is a brief rationale for applying a public health approach to child maltreatment and a discussion of the priority-setting process, priorities in each of four areas of the public health model, and some of CDC's current child maltreatment prevention activities.

A scale for home visiting nurses to identify risks of physical abuse and neglect among mothers with newborn infants

OBJECTIVE

The aim was to construct and test the reliability (utility, internal consistency, interrater agreement) and the validity (internal validity, concurrent validity) of a scale for home visiting social nurses to identify risks of physical abuse and neglect in mothers with a newborn child.

METHOD

A 71-item scale was constructed based on a literature review and focus group sessions with social nurses and paraprofessionals who had experience with underprivileged families. This scale was applied in a random sample of 40 home visiting social nurses, who collected data in a sample of 373 nonabusive and 18 abusive/neglectful mothers with a newborn child.

RESULTS

Items with prevalence rates below 5% and items making no significant difference between maltreating and non-maltreating mothers were omitted. The final version contained 20 items. This scale showed high internal consistency (alpha = .92) and high interrater reliability (r = .97). Exploratory factor analysis yielded a three-factor solution: Isolation (8 items, explaining 62.17% of the common variance), Psychological complexity (6 items, 18.86%), and Communication problems (6 items, 8.41%). Scores on Communication problems and Isolation significantly predicted scores on a social deprivation scale, which significantly distinguished maltreating from non-maltreating mothers. Mothers scoring high on Communication problems or Isolation obtained higher scores for social deprivation than low-scoring mothers.

CONCLUSIONS

Home visiting nurses can identify risks for physical abuse and neglect among mothers with a newborn infant by focusing on signs of social isolation, distorted communication and psychological problems.

Dynamic prediction characteristics of the Child Abuse Potential Inventory

OBJECTIVES

Risk measures are commonly used to evaluate outcomes in child abuse prevention and intervention programs. This study examined whether pre-intervention to post-intervention changes on the Child Abuse Potential Inventory (CAP) Abuse Scale corresponded to actual changes in risk for future reports of maltreatment and evaluated the validity of several algorithms for classifying clinically significant change.

METHOD

Participants in the study were 459 parents participating in any one of 27 community-based family preservation and family support programs. Most parents were low-income mothers with a variety of social risk indicators, about a third of whom would be classified as high-risk by the CAP Abuse Scale. Participants were administered the CAP at program enrollment, then at completion of the intervention (median time=150 days), then followed for an average of approximately 2 years for future official maltreatment reports. Dynamic predictive validity of the CAP Abuse Scale was modeled by comparing survival models using a time-dependent structure of pre- and post-intervention scores to identically structured models using only a pre-intervention score.

RESULTS

Pre-intervention CAP Abuse Scale scores demonstrated incremental future predictive validity. However, score changes failed to correspond to changes in likelihood of future abuse. Models using pre-intervention scores only were more predictive than time-dependent score models, and pre-intervention scores were better predictors than post-intervention scores of post-intervention CPS referrals. Common algorithms for classifying clinically significant change yielded results that could be counter-intuitive and misleading. For example, participants classified as improved on these algorithms were actually at similar or even higher risk than those classified as unchanged or worse.

CONCLUSIONS

The results strongly supported the static predictive validity of the CAP and the use of the CAP for screening purposes. The results did not support the dynamic predictive validity of the CAP. Results of exploratory analyses suggested the possibility that the changes observed on the CAP Abuse Scale reflected changes in subscales assessing subjective distress or parenting attitudes, which may be markers for initial risk but when changed, do not necessarily translate into actual changes in future maltreatment behavior. Although replication and extension are needed before drawing firm conclusions, the current study raises questions about the common practice of using risk instruments as proxy measures for child maltreatment risk in intervention and prevention programs.

Verfahren zur Einschätzung von Mißhandlungs- und Vernachlässigungsrisiken

Zusammenfassung. Strukturierte und empirisch fundierte Verfahren zur Einschätzung von Mißhandlungs- und Vernachlässigungsrisiken können einen Beitrag zur Qualifizierung von Jugendhilfe leisten. Anhand verschiedener, teilweise aus dem angloamerikanischen Raum übertragener Verfahren werden drei Ansätze vorgestellt. Risikofaktoren-Checklisten sollen vor allem eine systematische Erhebung und Verwertung relevanter Informationen sicherstellen. Verfahren basierend auf einem empirischen Prädiktormodell bieten eine zusätzliche Risikoeinschätzung zum klinischen Urteil. Spezielle psychodiagnostische Verfahren erschließen ergänzende standardisierte Informationen. Für die Aussagekraft aller drei Vorgehensweisen liegen empirische Belege vor. Möglichkeiten und Grenzen der Anwendbarkeit in der Bundesrepublik werden erörtert.