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Joskowitz K, Patwardhan UM, Floan GM, Heflinger M, Cruz S, David M, Jadhav P, Nienow S, Thangarajah H, Ignacio RC. Evaluating Outcomes of Nonaccidental Trauma in Military Children. J Am Coll Surg 2024; 238:801-807. [PMID: 38372360 DOI: 10.1097/xcs.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Nonaccidental trauma (NAT), or child abuse, is a leading cause of childhood injury and death in the US. Studies demonstrate that military-affiliated individuals are at greater risk of mental health complication and family violence, including child maltreatment. There is limited information about the outcomes of military children who experience NAT. This study compares the outcomes between military-dependent and civilian children diagnosed with NAT. STUDY DESIGN A single-institution, retrospective review of children admitted with confirmed NAT at a Level I trauma center was performed. Data were collected from the institutional trauma registry and the Child Abuse Team's database. Military affiliation was identified using insurance status and parental or caregiver self-reported active-duty status. Demographic and clinical data including hospital length of stay (LOS), morbidity, specialty consult, and mortality were compared. RESULTS Among 535 patients, 11.8% (n = 63) were military-affiliated. The median age of military-associated patients, 3 months (interquartile range [IQR] 1 to 7), was significantly younger than civilian patients, 7 months (IQR 3 to 18, p < 0.001). Military-affilif:ated patients had a longer LOS of 4 days (IQR 2 to 11) vs 2 days (IQR 1 to 7, p = 0.041), increased morbidity or complication (3 vs 2 counts, p = 0.002), and a higher mortality rate (10% vs 4%, p = 0.048). No significant difference was observed in the number of consults or injuries, trauma activation, or need for surgery. CONCLUSIONS Military-affiliated children diagnosed with NAT experience more adverse outcomes than civilian patients. Increased LOS, morbidity or complication, and mortality suggest military-affiliated patients experience more life-threatening NAT at a younger age. Larger studies are required to further examine this population and better support at-risk families.
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Affiliation(s)
- Katie Joskowitz
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Utsav M Patwardhan
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA (Patwardhan, Floan)
| | - Gretchen M Floan
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA (Patwardhan, Floan)
| | - Megan Heflinger
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Sheena Cruz
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Maya David
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Priyanka Jadhav
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
| | - Shalon Nienow
- Division of Child Abuse Pediatrics, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, CA (Nienow)
- Division of Child Abuse Pediatrics, Rady Children's Hospital-San Diego, San Diego, CA (Nienow)
- Chadwick Center for Children and Families at Rady Childrens Hospital, San Diego, CA (Nienow)
| | - Hari Thangarajah
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA (Thangarajah, Ignacio)
| | - Romeo C Ignacio
- From the Division of Pediatric Surgery, Rady Children's Hospital-San Diego, San Diego, CA (Joskowitz, Patwardhan, Heflinger, Cruz, David, Jadhav, Thangarajah, Ignacio)
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA (Thangarajah, Ignacio)
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Shinyemba TW, Shiode S, Devries K. Application of geospatial analysis in health research: A systematic review of methodological aspects of studies on violence against children and young people. CHILD ABUSE & NEGLECT 2024; 151:106730. [PMID: 38461708 DOI: 10.1016/j.chiabu.2024.106730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/20/2024] [Accepted: 03/02/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Geographical variation exists in violence experienced by children and young people; however, there is limited research applying geospatial techniques to study this variation, and the methodological quality of this body of work is unclear. OBJECTIVE This study aimed to review the application of geospatial analysis in research on violence against children (VAC) and evaluate how essential methodological aspects are reported. METHODS Twelve databases were searched for studies on VAC using geospatial techniques. Two independent reviewers screened the papers for eligibility. Findings were narratively synthesised. RESULTS Sixty studies were included. Six studies estimated the prevalence of VAC and 54 investigated the associations between VAC and covariates. Most studies were conducted in the US (68 %), and the broad definition of 'child maltreatment' (53 %) was the most common form of violence explored. Most studies (83 %) used administrative data, whereas 23 % used an ecological study design to estimate the associations between risk factors and official reports of VAC. Frequentist modelling approaches were used in 54 % of the studies, and 47 % investigated VAC at census tract level. Model fit metrics were reported in 69 % of studies. CONCLUSIONS Current knowledge of the geographical distribution of VAC is severely limited because of the reliance on administrative data, which vastly underestimates the prevalence of VAC compared with self-reports and poor reporting of quality characteristics. There is a huge opportunity for applying geospatial methods in VAC research in diverse geographic contexts. Future research must adopt rigorous and standardised approaches to model fitting and validation and make better use of self-reported data.
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Affiliation(s)
- Tobias Willem Shinyemba
- Department of Geography, Birkbeck, University of London, London, UK; Department of Computing, Mathematical and Statistical Sciences, University of Namibia, Windhoek, Namibia.
| | - Shino Shiode
- Department of Geography, Birkbeck, University of London, London, UK
| | - Karen Devries
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Vidal-Sánchez MI, Cantero-Garlito PA, Gasch-Gallén Á. Professional Perspectives on Children's Health Assets: A Delphi Study. Healthcare (Basel) 2024; 12:506. [PMID: 38470616 PMCID: PMC10930817 DOI: 10.3390/healthcare12050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
This study aims to describe a local community expert's perspective on the identification of and access to children's health assets and to gather proposals to promote children's health and well-being within their community. The health asset approach is essential for health promotion, and there is evidence of its benefits to individuals' or communities' health when this approach is observed. Children's health assets are gaining increasing interest, but the literature that captures the perception of professionals working with children is scarce. Qualitative research designed with Delphi methodology was carried out with the participation of 25 professionals working in a neighbourhood with children and families. The participants stated that this neighbourhood was a good environment for the healthy and happy growth of children but pointed out that there were inequities. They emphasised the importance of economic and physical security and feeling loved. The absolute best aspects of the neighbourhood according to these experts were its support networks, mutual help, educational and health services, and green spaces, and the most deficient aspects were the possibility of a hopeful future and emotional support within the family unit. Poverty and/or the scarcity of economic resources were identified as the main barriers to accessing health assets. Special difficulties in access to health for migrant and Roma children were also identified. The panel of experts made concrete action proposals. It was recommended to support resources and services that already exist in their community. The experts prioritised work with families, education, working in conjunction with vulnerable groups, community participation, and networking.
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Affiliation(s)
- María Isabel Vidal-Sánchez
- Physiatrist and Nursing Department, Health Science Faculty, Zaragoza University, 50009 Zaragoza, Spain; (M.I.V.-S.); (Á.G.-G.)
- GIIS104-Wellbeing, Occupation, Participation and Health Research Group (IBiOPS), Institute for Health Research Aragón, Zaragoza University, 50009 Zaragoza, Spain
| | - Pablo A. Cantero-Garlito
- Nursing, Physiotherapy and Occupational Therapy Department, Health Science Faculty, Castilla La Mancha University, 45600 Talavera de la Reina, Spain
| | - Ángel Gasch-Gallén
- Physiatrist and Nursing Department, Health Science Faculty, Zaragoza University, 50009 Zaragoza, Spain; (M.I.V.-S.); (Á.G.-G.)
- GIIS094-Research Group Nursing Research in Primary Care in Aragón (GENIAPA), Institute for Health Research Aragón, Zaragoza University, 50009 Zaragoza, Spain
- GIIS011-Aragonese Research Group in Primary Care (GAIAP), Institute for Health Research Aragón, Zaragoza University, 50009 Zaragoza, Spain
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4
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Scaggs SJA, Starseed SC, Kluckman M, Tueller S, Yu L. A state-wide analysis of characteristics and predictors of dual system involvement among child victims of human trafficking. CHILD ABUSE & NEGLECT 2024; 147:106530. [PMID: 37979486 DOI: 10.1016/j.chiabu.2023.106530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND The child welfare system is pivotal in identifying and responding to child (younger than age 18) human trafficking victims. Children who have experienced human trafficking-or are at risk of victimization-are increasingly recognized as also being served in the juvenile justice system. Yet little is known about human trafficking victimization among children in the juvenile justice population or among children with child welfare and juvenile justice involvement. OBJECTIVE Building on previous research with child welfare-and juvenile justice-involved children, we investigated characteristics and system experiences among children who have experienced a human trafficking abuse allegation in Florida. PARTICIPANTS AND SETTING The overall study population included all children born on or after January 1, 1993, who had at least one DCF-documented maltreatment allegation before March 1, 2020. This study examined a total of 12,167 allegations in the first set of analyses and the first human trafficking allegation for each child (N = 9300) in the second set of analyses. METHODS Analyses are based on linked administrative data for a cohort of children involved with Florida's Departments of Juvenile Justice (DJJ) and/or Children and Families (DCF). We used descriptive and multivariate logistic regression analyses to document the characteristics of single and dual system-involved children and examine predictors of child welfare, juvenile justice, and dual system involvement. RESULTS (1) Nearly half of children with a human trafficking abuse allegation are involved in DCF at the time of the allegation, (2) females who experienced trafficking are more likely to be involved in DCF (with or without DJJ involvement) than involved in no system, (3) Black children with an alleged trafficking incident were more likely than White children to be involved in both systems compared with DCF only, and (4) children who experienced labor trafficking abuse allegations were less likely than those who experienced sex trafficking to be involved with either system. CONCLUSIONS This study depicts child victims of sex and labor trafficking who are involved with one or both systems in one state.
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Affiliation(s)
- Samuel J A Scaggs
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States.
| | - Stacey Cutbush Starseed
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States
| | - Marianne Kluckman
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States
| | - Stephen Tueller
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States
| | - Lilly Yu
- RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States
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5
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Jones MU, Banaag A, Nafea SS, Koehlmoos TP. Evaluation of Racial Disparities in Suspected Child Abuse among Insured Children with Head Injury. CHILD MALTREATMENT 2023; 28:713-722. [PMID: 36571822 DOI: 10.1177/10775595221148424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Previous studies demonstrate racial disparities in child abuse evaluations even after controlling for health insurance coverage. We conducted a cross-sectional study using the Military Health System Data Repository (MDR) of Military Health System (MHS) beneficiaries born between fiscal years 2016 and 2018 to evaluate racial disparities and other factors in the suspicion of child abuse. We observed beneficiaries for 2.5 years after birth and assessed the incidence of head injury using diagnostic codes. Among children with head injury codes, we performed a multivariable logistic regression analysis to measure the association between race and the concurrent use of the diagnostic code for suspected child abuse (SCA) or for the performance of a skeletal survey. There were 195,893 infants included and 45,269 (23.1%) underwent evaluations for head injury. Less than one percent (n = 424) concurrently had the diagnostic code for SCA or a skeletal survey performed within 2 weeks of the head injury evaluation. When controlling for other factors, race was not associated with SCA. Higher military rank was independently associated with decreased odds of SCA. Racial disparities in SCA may be mitigated in the MHS, and further evaluation is needed. Military rank could be a factor in SCA disparities and warrants further study.
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Affiliation(s)
- Milissa U Jones
- Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Amanda Banaag
- Department of Pediatrics, Tripler Army Medical Center, Tripler Army Medical Center, HI, USA
| | - Shamim S Nafea
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
| | - Tracey Perez Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
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Drake B, Jones D, Kim H, Gyourko J, Garcia A, Barth RP, Font SA, Putnam-Hornstein E, Duerr Berrick J, Greeson JKP, Cook V, Kohl PL, Jonson-Reid M. Racial/Ethnic Differences in Child Protective Services Reporting, Substantiation and Placement, With Comparison to Non-CPS Risks and Outcomes: 2005-2019. CHILD MALTREATMENT 2023; 28:683-699. [PMID: 36990447 DOI: 10.1177/10775595231167320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
We used National Child Abuse and Neglect Data System and Census data to examine Black-White and Hispanic-White disparities in reporting, substantiation, and out-of-home placement both descriptively from 2005-2019 and in multivariate models from 2007-2017. We also tracked contemporaneous social risk (e.g., child poverty) and child harm (e.g., infant mortality) disparities using non-child protective services (CPS) sources and compared them to CPS reporting rate disparities. Black-White CPS reporting disparities were lower than found in non-CPS risk and harm benchmarks. Consistent with the Hispanic paradox, Hispanic-White CPS reporting disparities were lower than risk disparities but similar to harm disparities. Descriptive and multivariate analyses of data from the past several years indicated that Black children were less likely to be substantiated or placed into out-of-home care following a report than White children. Hispanic children were slightly more likely to be substantiated or placed in out-of-home care than White children overall, but this difference disappeared in multivariate models. Available data provide no evidence that Black children were overreported relative to observed risks and harms reflected in non-CPS data. Reducing reporting rates among Black children will require addressing broader conditions associated with maltreatment.
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Affiliation(s)
- Brett Drake
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
| | - Dylan Jones
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
| | - Hyunil Kim
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - John Gyourko
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Antonio Garcia
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Richard P Barth
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Sarah A Font
- Department of Sociology and Criminology, Penn State University, University Park, PA, USA
| | - Emily Putnam-Hornstein
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jill Duerr Berrick
- School of Social Welfare, University of California at Berkeley, Berkeley, USA
| | - Johanna K P Greeson
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Cook
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Patricia L Kohl
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
| | - Melissa Jonson-Reid
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
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7
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Abdul Rahim R, Pilkington R, Procter AM, Montgomerie A, Mittinty MN, D'Onise K, Lynch J. Child protection contact among children of culturally and linguistically diverse backgrounds: A South Australian linked data study. J Paediatr Child Health 2023; 59:644-652. [PMID: 36744551 PMCID: PMC10946611 DOI: 10.1111/jpc.16364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
AIM To describe the cumulative incidence of child protection (CP) system contact, maltreatment type, source of reports to age 7 years, and socio-demographic characteristics for culturally and linguistically diverse (CALD) Australian children. METHODS We used CP, education, health, and birth registrations data for children followed from birth up to age 7 from the South Australian Better Evidence, Better Outcomes, Linked Data (SA BEBOLD) platform. PARTICIPANTS SA born children enrolled in their first year of school from 2009 to 2015 (n = 76 563). CALD defined as non-Aboriginal or Torres Strait Islander, spoken language other than English, Indigenous or Sign, or had at least one parent born in a non-English speaking country. OUTCOMES MEASURES For CALD and non-CALD children, we estimated the cumulative incidence (risk) of CP contacts up to age 7, relative risk and risk differences for all levels of CP contact from notification to out-of-home care (OOHC), primary maltreatment type, reporter type, and socio-economic characteristics. Sensitivity analyses explored different population selection criteria and CALD definitions. RESULTS By age 7, 11.2% of CALD children had 'screened-in' notifications compared to 18.8% of non-CALD (risk difference [RD] 7.6 percentage points (95% confidence interval: 6.9-8.3)), and 0.6% of CALD children experienced OOHC compared to 2.2% of non-CALD (RD 1.6 percentage points (95% confidence interval: 1.3-1.8)). Emotional abuse was the most common substantiated maltreatment type for CALD and neglect for non-CALD. Among both groups, the most common reporter sources were police and education sector. Socio-economic characteristics were broadly similar. Sensitivity analyses results were consistent with primary analyses. CONCLUSION By age 7, CALD children had lower risk of contact with all levels of CP. Estimates based on primary and sensitivity analyses suggested CALD children were 5-9 percentage points less likely to have a report screened-in, and from 1.0 to 1.7 percentage points less likely to have experienced OOHC.
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Affiliation(s)
- Razlyn Abdul Rahim
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Rhiannon Pilkington
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Alexandra M Procter
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Alicia Montgomerie
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Murthy N Mittinty
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Katina D'Onise
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Prevention and Population HealthWellbeing SAAdelaideSouth AustraliaAustralia
| | - John Lynch
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
- Robinson Research InstituteThe University of AdelaideAdelaideSouth AustraliaAustralia
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
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Gartner RE, Whitfield DL, Sterzing PR. Ethnoracial Differences in Past Year Victimization Rates for a National Sample of Gender and Sexual Minority Adolescents. VIOLENCE AND VICTIMS 2023; 38:234-249. [PMID: 37011951 DOI: 10.1891/vv-2021-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Little research exists on victimization for gender and sexual minority adolescents (GSMA) of color. This study identifies differences in past year rates across six victimization types for GSMA by ethnoracial identification. Descriptive analyses were conducted on 1,177 GSMA (14-19 years old), with victimization types stratified by ethnoracial identification and multiple logit regression was used to identify differences. Compared to White (non-Hispanic) peers, Black (non-Hispanic) GSMA reported lower victimization rates across multiple categories with two exceptions. Higher rates of racially biased physical assault were noted among Black (non-Hispanic) and bi/multi-ethnoracial GSMA. Higher rates of witnessing community violence were reported by Black (non-Hispanic), bi/multi-ethnoracial, and Latinx GSMA. To address GSMA's needs, we need to understand the differential risk so that our interventions are responsive to the diversity within this community.
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Affiliation(s)
| | | | - Paul R Sterzing
- School of Social Welfare, University of California, Berkeley, CA
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9
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Thomas MMC, Waldfogel J, Williams OF. Inequities in Child Protective Services Contact Between Black and White Children. CHILD MALTREATMENT 2023; 28:42-54. [PMID: 35081781 PMCID: PMC9325927 DOI: 10.1177/10775595211070248] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Child protective services (CPS) contact occurs at substantially higher rates among Black than White families. The present study considers systemic racism as a central driver of this disparity and emphasizes racialized poverty as a possible mechanism. We used data from the Fragile Families and Child Wellbeing Study and logistic regression analyses to assess the associations between income poverty, a racialized experience, and CPS contact, separately among Black and White families. Results indicated that income poverty was a significant predictor of CPS contact among White families, who were protected by higher income. In contrast, income per se was not a significant predictor of CPS contact among Black families, who were instead impacted by racialized family regulation and consequences of poverty, such as poor health and depression. Refundable state Earned Income Tax Credit (EITC) policies were protective for Black families, and more expansive Temporary Assistance for Needy Families (TANF) programs decreased CPS contact for Black and White families. Implications include centering systemic racism and specifically racialized poverty as causes of racial inequities in CPS contact and rethinking the role of CPS in protecting children.
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10
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Day E, Tach L, Mihalec-Adkins B. State Child Welfare Policies and the Measurement of Child Maltreatment in the United States. CHILD MALTREATMENT 2022; 27:411-422. [PMID: 33832331 DOI: 10.1177/10775595211006464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
State-level child welfare policies and practices affect what can be referred, investigated, and substantiated as child maltreatment, and these institutional factors vary across states and over time. Researchers typically have not accounted for these factors in analyses, confounding institutional features with the underlying construct they seek to study. The present study addresses this limitation by demonstrating how changes in specific state child welfare policies and practices influence reported and substantiated maltreatment in the National Child Abuse and Neglect Data System (NCANDS). Using negative binomial models with state and year fixed-effects to analyze data from 2005 to 2018, we found significant influence of state policy and practice changes on state-level rates of reported and substantiated maltreatment over time. If a state implemented three of the most common policy changes-adding mandated reporters, centralized intake, and staff-its maltreatment reports were an estimated 32% higher than they would have been in the absence of these changes. By contrast, most state policy changes decreased the number of reports that were substantiated-by 24% if they implemented both differential response and higher standards of proof. Implications for future research and policy are discussed.
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11
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Zhang L, Simmel C, Nepomnyaschy L. Income inequality and child maltreatment rates in US counties, 2009-2018. CHILD ABUSE & NEGLECT 2022; 130:105328. [PMID: 34538657 DOI: 10.1016/j.chiabu.2021.105328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 08/04/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Studies have confirmed that income inequality is associated with compromised health and well-being. However, much less is known about the effects of county-level income inequality on risk of perpetrating child maltreatment, particularly for distinct types of child maltreatment. By utilizing recent national data over 10 years (2009-2018), our study explored the associations of county-level income inequality (i.e., Gini index and income quantile ratios) with child maltreatment rates, including both overall and specific types of maltreatment rates (i.e., physical, psychological, and sexual abuse and neglect) in the US. PARTICIPANTS AND SETTING We utilized data from approximately 902 US counties by linking the National Child Abuse and Neglect Data System with the American Community Survey. METHODS Ordinary Least Squares regression models were estimated to examine the relationship between county-level income inequality and child maltreatment rates and the moderating role of poverty rates. RESULTS Higher scores on county-level Gini index were significantly associated with higher overall child maltreatment rates and neglect, after controlling for county-level characteristics. Income quantile ratios were significantly associated with overall child maltreatment, physical abuse, and neglect. We also found significant interaction effects between income inequality and poverty rates in the associations with physical and psychological abuse rates, suggesting that the effects of inequality were exacerbated by county-level poverty. CONCLUSIONS Given the tremendous increases in inequality in the US over recent decades, this research sheds light on the mechanisms through which inequality impacts parents' caregiving abilities in highly unequal counties.
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Affiliation(s)
- Liwei Zhang
- Rutgers, The State University of New Jersey, School of Social Work, 390 George Street, New Brunswick, NJ 08901, United States of America.
| | - Cassandra Simmel
- Rutgers, The State University of New Jersey, School of Social Work, 390 George Street, New Brunswick, NJ 08901, United States of America.
| | - Lenna Nepomnyaschy
- Rutgers, The State University of New Jersey, School of Social Work, 390 George Street, New Brunswick, NJ 08901, United States of America.
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12
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Schneider W, Brooks-Gunn J. Geography of mobility and parenting behavior in low income families. CHILD ABUSE & NEGLECT 2022; 130:105142. [PMID: 34112526 DOI: 10.1016/j.chiabu.2021.105142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 05/05/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The geographic location of birth has implications for low-income children's upward economic mobility, as Chetty, Hendren, Kline, and Saez (2014) found in an examination of millions of income tax records from each county in the US. Additional work indicates that low income children in higher economic mobility counties have higher language scores and fewer behavioral problems (Donnelly et al., 2017). However, the processes by which the geography of opportunity influences parenting are less well-understood. OBJECTIVE This study examines whether living in higher intergenerational mobility counties is associated with less harsh parenting, material hardship, household violence and substance use, and low child supervision - parenting behaviors that increase the risk for child maltreatment - for low-income families. DATA Data come from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort of low income families in 20 cities in the U.S (N ~, 2841; 76% lower (household income of $41,994 or less) and 24% higher-income) linked to county level data on intergenerational mobility from the Equality of Opportunity Project. METHODS We estimate OLS and Linear Probability regressions of the association between (1) exposure to county-level intergenerational mobility and (2) number of waves of exposure to county intergenerational mobility 1 standard deviation above the mean and maternal parenting behaviors. RESULTS A 1 standard deviation increase in county level intergenerational mobility is associated with decreases in harsh parenting, but not indicators of neglect. Longer exposure to high intergenerational mobility areas was associated with decreased maternal harsh parenting and risk for child maltreatment. CONCLUSIONS For low-income children, higher intergenerational mobility is associated with decreased risk of harsh parenting, particularly at younger ages, as is longer exposure to high intergenerational mobility areas. That lower-income families are less likely to live in economically mobile geographies may exacerbate inequalities among income groups.
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Affiliation(s)
- William Schneider
- University of Illinois at Urbana-Champaign, United States of America.
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Putnam-Hornstein E, Prindle JJ, Rebbe R. Community disadvantage, family socioeconomic status, and racial/ethnic differences in maltreatment reporting risk during infancy. CHILD ABUSE & NEGLECT 2022; 130:105446. [PMID: 35144838 DOI: 10.1016/j.chiabu.2021.105446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children are reported for maltreatment during infancy at elevated rates; research has established persistent racial/ethnic differences in the likelihood of reporting to the child protection system (CPS). OBJECTIVE To model the influence of race/ethnicity and community disadvantage in CPS reporting during infancy. PARTICIPANTS/SETTING A population-based dataset consisting of more than 1.2 million children born in California between 2012 and 2014. Vital birth records were probabilistically linked to administrative CPS records. American Community Survey data were used to measure community disadvantage. METHODS For each child, we coded sociodemographic information from the birth record, assigned the child to a community using their residential address at birth, and captured maltreatment reports from child protection records. We employed a modified Poisson regression model to examine an infant's likelihood of being reported to CPS by race/ethnicity across levels of community disadvantage and after adjusting for individual-level covariates. RESULTS Infants born in neighborhoods with the most concentrated disadvantage were reported to CPS at 7 times the rate of children born in the most advantaged neighborhoods (12.3% vs. 1.8%). After adjusting for individual-level covariates, we found that both Black and Hispanic infants born on public insurance were significantly less likely than White infants to be reported for maltreatment overall - and Black and Hispanic infants had a statistically equivalent or lower likelihood of reporting at the two extremes of neighborhood disadvantage. Among privately insured families, Hispanic infants continued to have a lower likelihood of reporting, but Black infants were reported at higher rates than White infants. This Black-White difference persisted in the most advantaged neighborhoods, but disappeared in the most disadvantaged neighborhoods. CONCLUSIONS Capturing individual-level differences in socioeconomic status and associated risk factors is critical to understanding sources of racial/ethnic differences in CPS reporting, including when there is unwarranted variation or disparate treatment. Our findings suggest an elevated likelihood of maltreatment reporting among privately insured Black infants not explained by differences in observed risk or neighborhood, but no such differences were documented for Black or Hispanic infants on public insurance.
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Affiliation(s)
- Emily Putnam-Hornstein
- School of Social Work, University of North Carolina at Chapel Hill, United States of America; Suzanne Dworak-Peck School of Social Work, University of Southern California, United States of America.
| | - John J Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, United States of America
| | - Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, United States of America
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Maguire-Jack K, Yoon S, Hong S. Social Cohesion and Informal Social Control as Mediators Between Neighborhood Poverty and Child Maltreatment. CHILD MALTREATMENT 2022; 27:334-343. [PMID: 33853354 DOI: 10.1177/10775595211007566] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Neighborhoods have profound impacts on children and families. Using structural equation modeling and data from 4,898 children in the Fragile Families and Child Wellbeing Study, the current study examines the direct and indirect effects of neighborhood poverty on the likelihood of being maltreated at age 5. Two neighborhood social processes, social cohesion and informal social control, were examined as mediators. The study found that neighborhood poverty was indirectly related to physical assault and psychological aggression through its impact on social cohesion, and indirectly related to neglect through its impact on informal social control. The results highlight the need to reduce poverty across communities and increase social cohesion and social control as potential pathways for interrupting the impact of neighborhood poverty on maltreatment.
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Affiliation(s)
| | - Susan Yoon
- 2647The Ohio State University College of Social Work, Columbus, OH, USA
| | - Sunghyun Hong
- 1259University of Michigan School of Social Work, Ann Arbor, MI, USA
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Walsh K, Eggins E, Hine L, Mathews B, Kenny MC, Howard S, Ayling N, Dallaston E, Pink E, Vagenas D. Child protection training for professionals to improve reporting of child abuse and neglect. Cochrane Database Syst Rev 2022; 7:CD011775. [PMID: 35788913 PMCID: PMC9301923 DOI: 10.1002/14651858.cd011775.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed. OBJECTIVES To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list. SELECTION CRITERIA All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect). DATA COLLECTION AND ANALYSIS We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence. MAIN RESULTS We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants' self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants' responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence). We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals' knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence). AUTHORS' CONCLUSIONS The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.
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Affiliation(s)
- Kerryann Walsh
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Eggins
- School of Social Science, University of Queensland, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Lorelei Hine
- School of Social Science, University of Queensland, Brisbane, Australia
| | - Ben Mathews
- School of Law, Queensland University of Technology, Brisbane, Australia
| | - Maureen C Kenny
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Sarah Howard
- Library Services Directorate, Queensland University of Technology, Brisbane, Australia
| | - Natasha Ayling
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | | | - Elizabeth Pink
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Debelle G, Efstathiou N, Khan R, Williamson A, Summan M, Taylor J. The Typology and Topography of Child Abuse and Neglect: The Experience of a Tertiary Children's Centre. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138213. [PMID: 35805871 PMCID: PMC9266617 DOI: 10.3390/ijerph19138213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Abstract
Effective child protection systems and processes require reliable and accurate data. The aim of this study was to determine what data could be extracted from hospital records in a single site that reflected a child’s journey from admission with suspected abuse to the decisions regarding substantiation made by the multidisciplinary child protection team. A retrospective study of the case records of 452 children referred to a major UK children’s tertiary centre for suspected child maltreatment was undertaken. Child maltreatment was substantiated in 65% of referred cases, with the majority of referrals coming from children living in the most deprived neighbourhoods in the country. Domestic violence and abuse and the child’s previous involvement with statutory bodies were associated with case substantiation. Physical abuse predominated, with soft tissue injuries, including dog bites and burns, most frequent. Burns were related almost exclusively to supervisory neglect. There were also cases of medical neglect. Emotional abuse was associated with exposure to domestic violence and abuse and to self-harm. The strengths and limitations for single-centre data systems were explored, concluding with a recommendation to establish an agreed national and international minimum data set to protect children from maltreatment.
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Affiliation(s)
- Geoff Debelle
- Birmingham & Solihull NHS Clinical Commissioning Group, Birmingham B4 6AR, UK
- Correspondence: (G.D.); (J.T.); Tel.: +44-121-4148671 (J.T.)
| | - Nikolaos Efstathiou
- School of Nursing, University of Birmingham, Birmingham B15 2TT, UK; (N.E.); (R.K.)
| | - Rafiyah Khan
- School of Nursing, University of Birmingham, Birmingham B15 2TT, UK; (N.E.); (R.K.)
| | - Annette Williamson
- Birmingham Women and Children’s Hospital Foundation NHS Trust, Birmingham B15 2TG, UK; (A.W.); (M.S.)
| | - Manjit Summan
- Birmingham Women and Children’s Hospital Foundation NHS Trust, Birmingham B15 2TG, UK; (A.W.); (M.S.)
| | - Julie Taylor
- School of Nursing, University of Birmingham, Birmingham B15 2TT, UK; (N.E.); (R.K.)
- Birmingham Women and Children’s Hospital Foundation NHS Trust, Birmingham B15 2TG, UK; (A.W.); (M.S.)
- Correspondence: (G.D.); (J.T.); Tel.: +44-121-4148671 (J.T.)
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Thomas MM, Waldfogel J. What kind of "poverty" predicts CPS contact: Income, material hardship, and differences among racialized groups. CHILDREN AND YOUTH SERVICES REVIEW 2022; 136:106400. [PMID: 35462724 PMCID: PMC8972944 DOI: 10.1016/j.childyouth.2022.106400] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND PURPOSE Child protective services (CPS) contact is consistently linked with poverty in the US, and empirical evidence is mounting to indicate that disparate exposure to income poverty explains a substantial portion of racial inequities in CPS involvement. Evidence about the different distributions of income poverty and material hardship also suggests that income poverty may not sufficiently capture economic wellbeing among families. This paper assessed whether differences in exposure to income poverty and/or material hardship explain racial inequities in CPS contact and further examined whether income poverty and material hardship predict CPS contact differently within racialized groups. METHODS We used data from the Fragile Families and Child Wellbeing Study (FFCWS), an urban cohort representative of births in large US cities in 1998–2000. The FFCWS data are ideal for this study in capturing each of the key constructs: racialized group membership, income, material hardship, and CPS contact. We measured income poverty and material hardship when children were age 1 and measured any CPS contact by age five. Our final sample included 3,517 families, including 1,848 Black, 614 white, and 1,055 Latinx families. We employed logistic regression to assess the associations between income poverty and material hardship, independently and jointly, and CPS contact. We conducted analyses in our full analytic sample and among subsamples of the Black, white, and Latinx families. RESULTS We found that differences in income-to-poverty ratio account for differences in CPS contact between Black and white families. Differences in CPS contact between Black and Latinx families were not explained by economic wellbeing measures alone but were ameliorated when differences in income poverty, material hardship, and a full set of family characteristics were considered. Additionally, we found that material hardship was a consistent predictor of CPS contact in the full sample and within each of the Black, white, and Latinx subsamples, even accounting for differences in income and other family characteristics. CONCLUSIONS The clear role of income poverty in explaining inequities in CPS contact between Black and white families and the consistent importance of material hardship in predicting CPS contact across all families underscore the critical importance of reducing income poverty and hardship and of distinguishing material need from maltreatment in the context of CPS. Our findings offer clear implications for policy intervention to reduce income poverty and material hardship. Such interventions might include extending the temporarily expanded Child Tax Credit and expanded food and housing assistance benefits, toward the ends of supporting child and family wellbeing and reducing economic and racial inequities in CPS contact.
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Affiliation(s)
| | - Jane Waldfogel
- Columbia University School of Social Work, United States
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Flemington T, Fraser J, Gibbs C, Shipp J, Bryant J, Ryan A, Wijetilaka D, Marks S, Scarcella M, Tzioumi D, Ramanathan S, Clague L, Hartz D, Lonne B, Lock (Ngiyampaa) M. The Daalbirrwirr Gamambigu (Safe Children) Model: Embedding Cultural Safety in Child Protection Responses for Australian Aboriginal Children in Hospital Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5381. [PMID: 35564775 PMCID: PMC9102959 DOI: 10.3390/ijerph19095381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023]
Abstract
The aim of this paper is to describe the development of a model of care to embed cultural safety for Aboriginal children into paediatric hospital settings. The Daalbirrwirr Gamambigu (pronounced "Dahl-beer-weer gum-um-be-goo" in the Gumbaynggirr language means 'safe children') model encompasses child protection responses at clinical, managerial and organisational levels of health services. A review of scholarly articles and grey literature followed by qualitative interviews with Aboriginal health professionals formed the evidence base for the model, which then underwent rounds of consultation for cultural suitability and clinical utility. Culturally appropriate communication with children and their families using clinical yarning and a culturally adapted version of ISBAR (a mnemonic for Identify, Situation, Background, Assessment and Recommendation) for interprofessional communication is recommended. The model guides the development of a critical consciousness about cultural safety in health care settings, and privileges the cultural voices of many diverse Aboriginal peoples. When adapted appropriately for local clinical and cultural contexts, it will contribute to a patient journey experience of respect, dignity and empowerment.
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Affiliation(s)
- Tara Flemington
- Nursing, Midwifery and Service Reform, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
- Faculty of Medicine and Health, Susan Wakil School of Nusing and Midwifery, University of Sydney, Camperdown, NSW 2006, Australia
| | - Jennifer Fraser
- Faculty of Medicine and Health, Susan Wakil School of Nusing and Midwifery, University of Sydney, Camperdown, NSW 2006, Australia
- Nursing, Midwifery and Education, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia
| | - Clinton Gibbs
- Health Reform, Opportunities and Transition, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Joanne Shipp
- Integrated Child, Youth and Family Wellbeing, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Joe Bryant
- Aboriginal Health Strategy Unit, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
| | - Amanda Ryan
- Aboriginal Health Strategy Unit, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia;
| | - Devika Wijetilaka
- Paediatrics, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia;
| | - Susan Marks
- Child Protection Unit, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia;
| | - Mick Scarcella
- Aboriginal Health, The Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia;
| | - Dimitra Tzioumi
- Child Protection Unit, The Sydney Children’s Hospitals Network, Randwick, NSW 2031, Australia;
- Child Protection and Wellbeing, Ministry of Health, St Leonards, NSW 2065, Australia
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW 2052, Australia
| | - Shanthi Ramanathan
- Health Research Economics, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia;
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Liesa Clague
- School of Nursing, Midwifery, Health Science and Physiotherapy, The University of Notre Dame, Darlinghurst, NSW 2010, Australia;
| | - Donna Hartz
- School of Nursing and Midwifery, College of Medicine Health & Wellbeing, University of Newcastle, Gosford, NSW 2250, Australia;
| | - Bob Lonne
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | - Mark Lock (Ngiyampaa)
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
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Suresh S, Heineman E, Meyer L, Richichi R, Conger S, Young S, Coombs C, Berger R. Improved Detection of Child Maltreatment with Routine Screening in a Tertiary Care Pediatric Hospital. J Pediatr 2022; 243:181-187.e2. [PMID: 34929244 DOI: 10.1016/j.jpeds.2021.11.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To evaluate the impact of layering routine child abuse screening on top of a preexisting electronic health record-embedded Child Abuse Clinical Decision Support System (CA-CDSS) in a pediatric emergency department. STUDY DESIGN The Pittsburgh Child Abuse Screening Tool (P-CAST) was performed in all children aged <13 years and in nonverbal children aged ≥13 years who presented to a pediatric tertiary care center over a 6-month period. The P-CAST was layered on top of a preexisting CA-CDSS that included passive triggers, alerts, and abuse-specific order sets. RESULTS Of the 28 797 screens performed, 1.8% were positive in children aged <13 years and 1.6% were positive in nonverbal children aged ≥13 years. One-half of the children with a positive P-CAST also triggered the CA-CDSS; the other one-half triggered only because of the P-CAST. Nineteen percent of the patients with a positive P-CAST were reported to Child Protective Services (CPS). There was no relationship between race and the odds of a positive P-CAST or between race and the likelihood of a report being made to CPS. CONCLUSIONS Active routine child abuse screening improves identification of suspected child maltreatment in a children's hospital above and beyond what is identified with a CA-CDSS, which depends on passive triggers. The lack of a relationship between race and a positive P-CAST or a report to CPS suggest that systematic child abuse screening may mitigate well-recognized racial disparities in identifying and reporting suspected child maltreatment.
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Affiliation(s)
- Srinivasan Suresh
- Division of Health Informatics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA; Division of Emergency Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Emily Heineman
- Division of Child Advocacy, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Lisa Meyer
- Division of Health Informatics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Rudolph Richichi
- Statistical Analysis and Measurement Consultants, Inc, Williamsburg, VA
| | - Scott Conger
- Division of Child Advocacy, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Shanon Young
- Division of Emergency Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Carmen Coombs
- Division of Emergency Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA; Division of Child Advocacy, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Rachel Berger
- Division of Child Advocacy, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
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Yuma P, Orsi R, Pena AA. Adult mental health and child maltreatment: An ecological study across rural-urban and economic continua with implications for post-pandemic human services. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1773-1786. [PMID: 34820851 DOI: 10.1002/jcop.22752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 10/22/2021] [Indexed: 06/13/2023]
Abstract
This ecological, county-level, cross-sectional study examines relationships between the mental health of adults (IV) and child maltreatment report rates (DV), as they vary by socioeconomic distress and rurality (n = 3015 counties), using the most recent available data from several linked sources. In a two-way model, maltreatment reports increased 20.1% for each additional half day of poor mental health in metro counties, 11.7% in nonmetro counties, and 13% in rural counties. Our zero-inflated negative binomial model, moderated by rurality and economic distress, showed a significant relationship between the number of poor mental health days and increased child maltreatment report rates in counties (χ2 = 145.52, p < 0.0001). Investment in prevention and treatment of adult mental health concerns is imperative, especially in light of the increase in mental health problems caused by the coronavirus disease 2019 pandemic and increased tension within national political debate. Our results indicate successful support of adult mental health will prevent child maltreatment and reduce the cyclical financial burden of child maltreatment and mental health concerns.
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Affiliation(s)
- Paula Yuma
- Colorado School of Public Health, Colorado State University, Fort Collins, Colorado, USA
| | - Rebecca Orsi
- Department of Pediatrics, The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anita A Pena
- Department of Economics, Colorado State University, Fort Collins, Colorado
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Sumetsky N, Burke JG, Mair C. Relationships Between Opioid-Related Hospitalizations and Intimate Partner Violence and Child Maltreatment Hospitalizations in Pennsylvania Across Space and Time. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP3474-NP3491. [PMID: 32799738 PMCID: PMC7887118 DOI: 10.1177/0886260520948525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intimate partner violence (IPV) and child maltreatment outcomes are markedly associated with substance abuse disorders. However, few studies have explored these serious family violence outcomes in connection to the opioid epidemic or population-level geographic connections between these variables. This study assesses associations of ZIP code-level IPV and child maltreatment hospitalization outcomes with opioid- and alcohol-related diagnoses as well as economic and demographic neighborhood characteristics. We used 11 years (2004-2014) of ZIP code-level Pennsylvania hospital discharge data and U.S. Census neighborhood characteristics data. As nearby ZIP codes are more likely to be similar than those that are distant, we incorporated spatial autocorrelation using conditionally autoregressive Bayesian hierarchical space-time models. There was a positive relationship between ZIP code-level opioid-related diagnoses and both IPV (relative risk 1.061; 95% credible interval [1.015, 1.106]) and child maltreatment (relative risk 1.055; 95% credible interval [1.035, 1.070]) hospitalizations. There was a positive relationship between alcohol-related diagnoses and IPV but not child maltreatment. Higher median household incomes were associated with lower counts of both IPV and child maltreatment hospitalizations. To illustrate geographic heterogeneity of model estimates, posterior distributions were used to compare variability of effects across ZIP codes. Our findings emphasize the secondary implications of the opioid epidemic in the form of family violence within communities.
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Affiliation(s)
- Natalie Sumetsky
- University of Pittsburgh Graduate School of Public Health, PA, USA
| | - Jessica G. Burke
- University of Pittsburgh Graduate School of Public Health, PA, USA
| | - Christina Mair
- University of Pittsburgh Graduate School of Public Health, PA, USA
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Hoyle ME, Chamberlain AW, Wallace D. The Effect of Home Foreclosures on Child Maltreatment Rates: A Longitudinal Examination of Neighborhoods in Cleveland, Ohio. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2768-NP2790. [PMID: 32723140 DOI: 10.1177/0886260520943725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Foreclosure rates have been linked to increased levels of neighborhood stress. Neighborhood stressors can impact a number of interpersonal and familial dynamics, including child maltreatment. Despite this, little research has examined the relationship between neighborhood foreclosure rates and aggregate trends in child maltreatment. Using substantiated child maltreatment cases, foreclosure, and census data at the neighborhood level in Cleveland, Ohio we find that home foreclosures are a significant predictor of neighborhood rates of child maltreatment. Importantly, this effect is durable and is not impacted by the housing crisis. Furthermore, this is a direct effect and is not shaped by other neighborhood conditions like poverty, as found in prior research. From a policy perspective, this suggests that policy makers need to be cognizant of the effect of foreclosures on child maltreatment regardless of the historical and economic contexts of the neighborhood.
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Abstract
Despite sufficient evidence to conclude that maltreatment exposure affects the risk of crime and delinquency, we conclude that the unique effects of child maltreatment on crime and delinquency, and the mechanisms through which those effects operate, remain poorly identified. Key challenges include insufficient attention to the overlap of child maltreatment with various forms of family dysfunction and adversity and a lack of comprehensive measurement of the multiple, often comorbid, forms of child maltreatment. We then consider potential impacts of the child welfare system on the maltreatment-crime link. Because the child welfare system typically provides voluntary, short-term services of unknown quality, it likely neither increases nor reduces risks of delinquency and crime for most children who encounter it. For the comparatively small subset of children experiencing foster care, impacts on delinquency and crime likely vary by the quality of environments within and after their time in care - issues that, to date, have received too little attention.
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Affiliation(s)
- Sarah A Font
- Pennsylvania State University, Department of Sociology and Criminology, 612 Oswald Tower, University Park, PA 16802
| | - Reeve Kennedy
- Pennsylvania State University, Department of Sociology and Criminology
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Maguire-Jack K, Jespersen B, Korbin JE, Spilsbury JC. Rural Child Maltreatment: A Scoping Literature Review. TRAUMA, VIOLENCE & ABUSE 2021; 22:1316-1325. [PMID: 32274967 DOI: 10.1177/1524838020915592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
TOPIC OF REVIEW The current study sought to review the state of existing knowledge on rural maltreatment. METHOD OF REVIEW We conducted a scoping literature review to answer two research questions: (1) Is maltreatment higher in rural areas compared to urban areas? and 2) Are there unique correlates of maltreatment in rural areas? NUMBER OF RESEARCH STUDIES MEETING THE CRITERIA FOR REVIEW This review included studies that compared child maltreatment in rural and urban areas in the United States (9) and predictors of maltreatment in rural areas (7). CRITERIA FOR INCLUSION Studies that compared child maltreatment in rural and urban areas in the United States were included. For our second research question, related to understanding maltreatment in rural areas, we included those studies that exclusively examined rural areas, when maltreatment was the outcome variable. HOW RESEARCH STUDIES WERE IDENTIFIED Studies were reviewed from relevant databases (Annual Reviews, PsychINFO, PubMed, Web of Science) between 1975 and 2019. MAJOR FINDINGS Findings were mixed on whether rates of maltreatment were higher or lower in rural areas. While five studies reported higher rates of maltreatment in rural areas, four reported higher rates in urban areas. Overall, child maltreatment rates tended to be higher in urban areas among people of color and higher in rural areas among White people. One study found that community economic factors were not related to maltreatment in a rural area, in stark contrast to robust findings from urban areas.
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Luken A, Nair R, Fix RL. On Racial Disparities in Child Abuse Reports: Exploratory Mapping the 2018 NCANDS. CHILD MALTREATMENT 2021; 26:267-281. [PMID: 33729016 PMCID: PMC8328863 DOI: 10.1177/10775595211001926] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Research suggests children from non-White and Hispanic/Latinx communities are at higher risk for child maltreatment. This study identified in which states children from specific non-White communities were overrepresented in child protective services reports for child physical, sexual, and emotional/psychological abuse through exploratory mapping. Reports on child maltreatment originated from the 2018 National Child Abuse and Neglect Data System and state-level population estimates from the U.S. Census Bureau. Racial disparities were identified in states with unequal proportions of reported child maltreatment among a non-White child population compared to the proportion among the White child population. We found disparities for children from non-White communities in many states, especially for Black communities (Disparity Ratio [DR]: 15.10 for child physical abuse, DR: 12.77 for child sexual abuse in Washington DC, and DR: 5.25 for child emotional/psychological abuse in California). The ability to identify high disparities among Pacific Islanders highlights one of the study's strengths, given we separately examined Asian Americans, Pacific Islanders and multiracial communities. Results from our exploratory mapping provide insight into how preventive resources might be differentially allocated to non-White communities with higher child protective services reporting compared with White communities, and manifest states with multiple non-White communities overrepresented across maltreatment types.
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Affiliation(s)
- Amanda Luken
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Reshmi Nair
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Rebecca L. Fix
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
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Lombera A, Lee AH, Sharma-Patel K, Brown EJ. Threat-specific maltreatment exposure: Comparison of measurement models and associations with internalizing, externalizing, and PTSD symptoms. CHILD ABUSE & NEGLECT 2021; 115:105010. [PMID: 33639557 DOI: 10.1016/j.chiabu.2021.105010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/26/2021] [Accepted: 02/13/2021] [Indexed: 05/23/2023]
Abstract
BACKGROUND Child maltreatment is associated with short- and long-term mental health sequelae. Extant research has demonstrated that exposure characteristics (i.e., severity, frequency, duration, onset) are important in the measurement of maltreatment experiences. Emerging research has highlighted the contributions of these characteristics on symptom outcomes. OBJECTIVE The current study used multiple exposure characteristics of threat-specific types of maltreatment (i.e., physical abuse, sexual abuse, witnessing domestic violence) to examine three distinct measurement models of maltreatment and their relation to symptoms. PARTICIPANTS AND SETTING A racially and ethnically diverse sample of treatment-seeking youth (74 % female) ages 4-17 (N = 348) participated in the study. The majority of the youth (61 %) endorsed experiencing more than one type of threat-specific maltreatment. METHOD Using Structural Equation Modeling, we tested one-factor, three-factor, and bifactor models of maltreatment characteristics, and hypothesized that the bifactor model would yield the best fitting model based on prior studies supporting family violence as an underlying factor for child physical abuse and domestic violence. RESULTS The bifactor measurement model fit the data better than the three- and one-factor models. In the bifactor structural model that included symptom outcomes, physical abuse was significantly and positively associated with child internalizing and externalizing symptoms, whereas sexual abuse and witnessing domestic violence were associated with externalizing symptoms and PTSD. CONCLUSION Our findings support the inclusion of multiple exposure characteristics in the measurement of maltreatment and suggest that specific types of threat-specific maltreatment may have distinct associations with mental health sequelae.
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Affiliation(s)
| | - Amy Hyoeun Lee
- Child HELP Partnership, St. John's University, United States
| | | | - Elissa J Brown
- Child HELP Partnership, St. John's University, United States
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Rebbe R, Bishop AS, Ahn J, Mienko JA. Opioid overdose events and child maltreatment indicators: Differential county-level associations. CHILDREN AND YOUTH SERVICES REVIEW 2020; 119:105671. [PMID: 33384462 PMCID: PMC7771646 DOI: 10.1016/j.childyouth.2020.105671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Suite 1400, Los Angeles CA USA 90015
| | - Asia S. Bishop
- School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
| | - Jooree Ahn
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
| | - Joseph A. Mienko
- Center for Social Sector Analytics & Technology, School of Social Work, University of Washington, 4101 15 Ave NE Seattle WA USA, 98105
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Lotspeich SC, Jarrett RT, Epstein RA, Shaffer AM, Gracey K, Cull MJ, Raman R. Incidence and neighborhood-level determinants of child welfare involvement. CHILD ABUSE & NEGLECT 2020; 109:104767. [PMID: 33049663 DOI: 10.1016/j.chiabu.2020.104767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Child maltreatment is a global public health issue that has been linked with multiple negative health and life outcomes. OBJECTIVE This study evaluates the association between children placed in out-of-home care and neighborhood-level factors using eight years of administrative data. PARTICIPANTS AND SETTING Between 2011-2018, 33,890 unique instances of child welfare involvement were captured in a department of child and family services database in a southern state in the United States. METHODS Removal addresses were geocoded and linked to the U.S. Census Bureau's American Community Survey to obtain census tract socioeconomic factors. Incidence overall and stratified by individual and neighborhood-level factors was computed. Rate ratios, relative indexes of inequality, and concentration curves quantified disparities in incidence of child welfare involvement by neighborhood-level factors. RESULTS Incidence of children less than 19 years old placed into out-of-home care was 255 per 100,000 person-years (95 % CI: 252, 258). At the individual level, incidence was highest among children <5 and 15-17 years old, comparable between male and female children, and higher among Black children. At the neighborhood level, incidence was highest in census tracts with lower median household incomes, higher percentages of households below poverty or of female-headed or single-parent households, higher unemployment rates, and fewer residents with some college education or health insurance. CONCLUSIONS Incidence of children placed into out-of-home care is disproportionally higher for those who live in disadvantaged communities. Understanding neighborhood-level risk factors that may be linked to child welfare involvement can help inform policy and target prevention efforts.
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Affiliation(s)
| | | | | | | | - Kathy Gracey
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Rameela Raman
- Vanderbilt University Medical Center, Nashville, TN, USA
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Adverse Childhood Experiences and Health Indicators in a Young Adult, College Student Sample: Differences by Gender. Int J Behav Med 2020; 27:660-667. [DOI: 10.1007/s12529-020-09913-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Holbrook HM, Hudziak JJ. Risk factors that predict longitudinal patterns of substantiated and unsubstantiated maltreatment reports. CHILD ABUSE & NEGLECT 2020; 99:104279. [PMID: 31791009 DOI: 10.1016/j.chiabu.2019.104279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Substantiated and unsubstantiated reports of maltreatment are associated with similar risk of emotional and behavioral problems. However, substantiation status often determines service provision. OBJECTIVE We examined substantiated and unsubstantiated reports to identify patterns of recurrence over a five-year period and identified family risk factors that predicted recurrence patterns. PARTICIPANTS AND SETTING We studied a subsample (N = 246,021) of the National Child Abuse and Neglect Data System from 2011-2015. METHODS Measures included child, caregiver, and child protective services case characteristics obtained in 2011. We used latent class analysis to identify heterogeneous classes, then entered class membership as the outcome variable in a multinomial logistic regression to identify risk factors. RESULTS Four latent classes emerged: (1) initial unsubstantiation and moderate recurrence, (2) initial unsubstantiation and low recurrence, (3) initial substantiation and moderate recurrence, and (4) initial substantiation and low recurrence. Domestic violence (relative risk ratio (RRR) = 2.56, β = 0.94, SE = .02, p < .001), caregiver substance abuse (RRR=2.23, β=0.80, SE=.02, p < .001), and Native Hawaiian/Pacific Islander race (RRR=1.67, β=0.52, SE=.11, p < .001), predicted initial substantiation status but were not meaningful predictors of long-term recurrence. Prior substantiated report and poverty predicted initial substantiation status (report RRR=1.50, β=0.41, SE=.02, p < .001; poverty RRR=1.50, β=0.41, SE=.02, p < .001) and long-term recurrence (report RRR=2.60, β=0.96, SE=.02, p < .001; poverty RRR = 1.35, β=0.30, SE=.02, p < .001). Asian American race predicted low recurrence rates (RRR=2.09, β=0.74, SE=.12, p < .001). CONCLUSIONS Similar recurrence patterns between substantiated and unsubstantiated reports emphasize the importance of providing services regardless of substantiation status. Integrating administrative databases may reveal more variables that predict long-term recurrence.
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Affiliation(s)
- Hannah M Holbrook
- Vermont Center for Children, Youth and Families, University of Vermont Medical Center, 1 South Prospect Street, Burlington, VT, United States.
| | - James J Hudziak
- Vermont Center for Children, Youth and Families, University of Vermont Medical Center, 1 South Prospect Street, Burlington, VT, United States.
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Jackson BM. Clinical Trials Not Causing Harm With Potential for Realizing Benefit Should Continue. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:112-114. [PMID: 31557104 DOI: 10.1080/15265161.2019.1654015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Modeling the Spatial Formation Mechanism of Poverty-Stricken Counties in China by Using Geographical Detector. SUSTAINABILITY 2019. [DOI: 10.3390/su11174752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The poverty-stricken counties in China follow a spatial pattern of regional poverty. Examining the influential factors of this spatial pattern can provide an important reference that can guide China in its implementation of a poverty alleviation policy. By applying a geographical detector and using a sample of poverty-stricken counties in China, this study explores the spatial relationship of county distribution with spatial influential factors, including terrain relief, cultivated land quality, water resource abundance, road network density, and the locational index. These poverty-stricken counties are then classified, and the main factors that restrict their economic development are determined. The results highlight that the selected poverty-stricken counties suffer a severe condition in each of the spatial factors mentioned above. Most of these counties are classified under the location index, terrain relief, and road network density constraint types. Each of the aforementioned spatial influential factors has unique controlling mechanisms on the distribution of these poverty-stricken counties. Most of these counties are constrained by two or multiple spatial influential factors, except for some counties located in South and Central China, which are mainly constrained by a single spatial influential factor. Therefore, these single factor-constrained poverty-stricken counties warrant more attention when a developmental policy for poverty alleviation is to be implemented. The various aspects of poverty-stricken counties constrained by multiple factors must be comprehensively considered with a special focus on their development. The differentiated policies must be designed for these poverty-stricken counties on the basis of their spatial influential factors.
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Maguire-Jack K, Font SA, Dillard R. Child protective services decision-making: The role of children's race and county factors. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2019; 90:48-62. [PMID: 31081655 PMCID: PMC7430035 DOI: 10.1037/ort0000388] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study investigates the role of race and county characteristics in substantiation and out-of-home placement decisions in the United States. Using multilevel models, we analyzed data from counties in the United States available through the National Child Abuse and Neglect Data Systems and Adoption and Foster Care Analysis and Reporting System to investigate the interactions between children's race and the context in which they live. Our sample consisted exclusively of children whose cases had been investigated; therefore, we were able to focus on the role played by race and county characteristics in substantiation and out-of-home placement decisions made by Child Protective Services, net of the heightened risk factors (or potential biases) that lead to disparate rates of reporting. Adjusting for state and county of investigation, Black, American Indian/Alaskan Native, and multiracial children were more likely than White (non-Hispanic) children to be substantiated or placed out of home, whereas Asian children were less likely to be substantiated or placed out of home. Notably, differences across groups are far smaller in magnitude when demographic and geographic differences are taken into account. Higher county-level poverty, percentages of Black residents, and juvenile arrest rates were associated with lower odds of substantiation and out-of-home placement among investigated children, whereas an elevated percentage of single-headed households was associated with higher odds of both outcomes. We also found that living in a rural county was associated with greater odds of substantiation but lower odds of out-of-home placement. Important differences by race were found for these associations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Sarah A Font
- Department of Sociology and Criminology, The Pennsylvania State University
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Fluke JD, Harlaar N, Brown B, Heisler K, Merkel-Holguin L, Darnell A. Differential Response and Children Re-Reported to Child Protective Services: County Data From the National Child Abuse and Neglect Data System (NCANDS). CHILD MALTREATMENT 2019; 24:127-136. [PMID: 30522344 DOI: 10.1177/1077559518816381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Child protection systems that implement differential response (DR) systems screen to route referrals to an investigation response (IR) or alternative response (AR). AR responses emphasize family engagement, assessment of family needs, and service linkage. Usually, AR state-level policy does not require child welfare staff to make a maltreatment determination. Jurisdictions implement DR systems differently, leading to variations in the proportion of AR cases, risk levels of cases served, and the ways families access and use services. County data from the National Child Abuse and Neglect Data System were analyzed for six states from 2004 to 2013 that implemented DR. Variation in county-level AR rates were associated with county-level re-report rates using regression models with risk adjustments for socioeconomic and other county characteristics. Counties had 3% fewer re-reports overall for each percentage increase in AR use; higher levels of AR use are related to lower levels of re-reporting. When county AR and IR cases were analyzed separately, increasing rates of AR were associated with lower re-report rates for IR cases, but higher re-report rates for AR cases. Findings for the AR and IR subgroup must be interpreted with caution as a number of technical factors may be driving these results.
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Affiliation(s)
- John D Fluke
- 1 Department of Pediatrics, The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Harlaar
- 1 Department of Pediatrics, The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brett Brown
- 2 U.S. Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research, and Evaluation, Washington, DC, USA
| | - Kurt Heisler
- 3 Kurt Heisler Consulting, LLC, Alexandria, VA, USA
| | - Lisa Merkel-Holguin
- 1 Department of Pediatrics, The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO, USA
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Morris MC, Marco M, Maguire-Jack K, Kouros CD, Im W, White C, Bailey B, Rao U, Garber J. County-level socioeconomic and crime risk factors for substantiated child abuse and neglect. CHILD ABUSE & NEGLECT 2019; 90:127-138. [PMID: 30776738 PMCID: PMC6422336 DOI: 10.1016/j.chiabu.2019.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 12/28/2018] [Accepted: 02/11/2019] [Indexed: 05/11/2023]
Abstract
Rates of substantiated child abuse and neglect vary significantly across counties. Despite strong cross-sectional support for links between social-contextual characteristics and abuse and neglect, few longitudinal studies have tested relations between these risk factors and substantiated rates of abuse/neglect. The goal of this study was to identify county-level socioeconomic and crime factors associated with substantiated abuse/neglect rates over 13 years (2004-2016). Annual county-level data for Tennessee, obtained from the KIDS COUNT Data Center, included rates of substantiated child abuse and neglect, children's race and ethnicity, births to unmarried women, teen birth rate, children in families receiving Supplemental Nutrition Assistance Program (SNAP) benefits, and children in families receiving Temporary Assistance for Needy Families. Annual county-level crime report data, obtained from the Tennessee Incident Based Reporting System, included sexual offenses, non-sexual assaults, stalking incidents, thefts, property damage, and drug-related offenses. Bayesian spatio-temporal models indicated that substantiated child abuse and neglect rates were independently and positively associated with teen birth rates, percentages of births to unmarried mothers, drug-related offenses, and percentages of children receiving SNAP benefits. In contrast, substantiated child abuse and neglect rates were negatively associated with percentages of African-American youth. The findings highlighted distinct demographic, socioeconomic, and crime factors associated with substantiated child abuse and neglect rates and have the potential to enhance identification of high-risk counties that could benefit from targeted abuse and neglect prevention efforts.
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Affiliation(s)
- Matthew C Morris
- Department of Family and Community Medicine, Meharry Medical College, United States; Center for Molecular and Behavioral Neuroscience, Meharry Medical College, United States; Department of Psychology, Vanderbilt University, United States.
| | - Miriam Marco
- Department of Social Psychology, University of Valencia, Spain
| | | | - Chrystyna D Kouros
- Department of Psychology at Southern Methodist University, United States
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, United States
| | - Codi White
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Brooklynn Bailey
- Department of Family and Community Medicine, Meharry Medical College, United States
| | - Uma Rao
- Department of Psychiatry & Human Behavior, University of California, Irvine, United States
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, United States
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Kokaliari ED, Roy AW, Taylor J. African American perspectives on racial disparities in child removals. CHILD ABUSE & NEGLECT 2019; 90:139-148. [PMID: 30780009 DOI: 10.1016/j.chiabu.2018.12.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND African American children are overrepresented in foster care at twice to three times the rate of white children. Scholars argue that racism and oppression underlie disproportionality (Križ & Skivenes, 2011). OBJECTIVE This study explored disproportionality as seen through the eyes of African American parents in the child welfare system. The aim was to understand why African American families are over-represented in child custody statistics and to improve family and parenting support for African American communities. PARTICIPANTS & SETTING Participants included twenty-one African Americans--12 women and 9 men, two of whom were foster parents and 19 of whom were parents involved with child welfare services. All participants reside in two impoverished areas in southern United States. Focus groups were used to collect data and were conducted at a community center. METHODS The method of analysis was constant comparison analysis (Strauss) and thematic analysis of the focus group discussions in the context of institutional policy. FINDINGS Six themes (profound lack of trust; overwhelming trauma; severe and persistent poverty; health and mental health; socio-economic conditions; and sense of social isolation were identified, along with three participant suggestions to improve child welfare services (family support services, economic revival, and better communication). CONCLUSIONS In the current study we note the strong link between poverty, child maltreatment, and child removal and conclude with an exploration of practice and policy implications with recommendations for a way forward. The need for culturally competent and trauma informed child welfare services is also discussed.
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Affiliation(s)
- Effrosyni D Kokaliari
- School of Social Work Springfield College, 263 Alden Street, Springfield 01109 MA, United States.
| | - Ann W Roy
- School of Social Work Springfield College, 263 Alden Street, Springfield 01109 MA, United States
| | - Joyce Taylor
- School of Social Work Springfield College, 263 Alden Street, Springfield 01109 MA, United States
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Puls HT, Bettenhausen JL, Markham JL, Walker JM, Drake B, Kyler KE, Queen MA, Hall M. Urban-Rural Residence and Child Physical Abuse Hospitalizations: A National Incidence Study. J Pediatr 2019; 205:230-235.e2. [PMID: 30392871 DOI: 10.1016/j.jpeds.2018.09.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/24/2018] [Accepted: 09/28/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if child physical abuse hospitalization rates vary across urban-rural regions overall and after accounting for race/ethnicity and poverty demographics. STUDY DESIGN This was a retrospective cross-sectional study of black, Hispanic, and non-Hispanic white children <5 years of age living in all US counties. US counties were classified as central metro, fringe/small metro, and rural. Incidence rates were calculated using child physical abuse hospitalization counts from the 2012 Kids' Inpatient Database and population statistics from the 2012 American Community Survey. Counties' race/ethnicity demographics and percent of children living in poverty were used to adjust rates. RESULTS We identified 3082 child physical abuse hospitalizations occurring among 18.2 million children. Neither crude nor adjusted overall rates of child physical abuse hospitalizations varied significantly across the urban-rural spectrum. When stratified by race/ethnicity, crude child physical abuse hospitalization rates decreased among black children 29.1% (P = .004) and increased among white children 25.6% (P = .001) from central metro to rural counties. After adjusting for poverty, only rates among black children continued to vary significantly, decreasing 34.8% (P = .001) from central metro to rural counties. Rates were disproportionately higher among black children compared with white children and their disproportionality increased with population density, even after poverty adjustment. Rates among Hispanic children were disproportionately lower compared with white children in nearly all urban-rural categories. CONCLUSIONS Our results suggest that urban black children have unique exposures, outside of poverty, increasing their risk for child physical abuse hospitalization. Identifying and addressing these unique urban exposures may aid in reducing black-white disproportionalities in child physical abuse.
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Affiliation(s)
- Henry T Puls
- Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
| | - Jessica L Bettenhausen
- Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Jessica L Markham
- Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Jacqueline M Walker
- Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Brett Drake
- Brown School of Social Work, Washington University, St Louis, MO
| | - Kathryn E Kyler
- Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Mary Ann Queen
- Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Matthew Hall
- Division of Hospital Medicine, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO; Children's Hospital Association, Lenexa, KS
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Ezell JM, Richardson M, Salari S, Henry JA. Implementing Trauma-Informed Practice in Juvenile Justice Systems: What can Courts Learn from Child Welfare Interventions? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:507-519. [PMID: 32318172 PMCID: PMC7163902 DOI: 10.1007/s40653-018-0223-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Many youth entering juvenile court systems show manifestations of psychological trauma. Focusing on rural juvenile courts, systems with greatly underserved and under-researched populations, we assessed practices, barriers, and recommendations around trauma-informed practice, an evidence-based approach for addressing trauma and reducing delinquent behavior and recidivism. As part of a pilot trauma-informed practice initiative at four rural Michigan juvenile courts, semi-structured qualitative interviews were conducted with 15 court staff, including probation officers, referees, judges, and on-site clinical therapists. Respondents expressed an ideological affinity for trauma-informed practice, describing growing inclinations to rely on referral-making around mental health treatment in lieu of traditional (punitive) sentencing. Key implementation barriers included limited access to local mental health resources, insufficient buy-in from K-12 schools, government, and police, and concerns over professional abilities/boundaries. Respondents recommended additional technical trainings on trauma-informed practice and cross-disciplinary education for clients' families and external stakeholders.
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Affiliation(s)
- Jerel M. Ezell
- Department of Sociology and Department of Medicine, University of Chicago, 1126 E. 59th St., Chicago, IL 60637 USA
- Children’s Trauma Assessment Center, Unified Clinics, Western Michigan University, Kalamazoo, MI USA
| | - Margaret Richardson
- Children’s Trauma Assessment Center, Unified Clinics, Western Michigan University, Kalamazoo, MI USA
| | - Samira Salari
- University of Illinois Hospital and Health Sciences System, Chicago, IL USA
| | - James A. Henry
- Children’s Trauma Assessment Center, Unified Clinics, Western Michigan University, Kalamazoo, MI USA
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Hsin YC, Chang YC, Lee EP, Chiu CH, Chou I.J, Hsia SH, Lin KL, Lee J, Huang JL, Wang CJ, Wu HP. Risk factors for child maltreatment by the utilization of medical service and socioeconomic environment in Taiwan. Medicine (Baltimore) 2018; 97:e13728. [PMID: 30593145 PMCID: PMC6314714 DOI: 10.1097/md.0000000000013728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Child maltreatment is complicated by cultural, welfare, and socioeconomic factors. However, the relationship between child maltreatment and socioeconomic factors has not been completely understood. We investigated risk factors for child abuse and neglect in Taiwan.The data in our study was obtained from Taiwan National Statistics at county level from 2004 to 2015. We included 4 areas (eastern, western, southern, northern) involving 20 cities and counties. The trends of child maltreatment rate based on different years and different areas were surveyed. In addition, panel data analysis was used to analyze the links between child maltreatment rate and socioeconomic factors.An increasing trend of child maltreatment rate in Taiwan was observed. During the past decade, child maltreatment rate increased from 14.5 in 2004 to 23.4 cases per 10000 children in 2014. The peak, which was 43 cases per 10000 children, occurred in 2012. Significant geographical differences were observed, and the highest child maltreatment rate was seen in eastern Taiwan. Panel data analysis revealed a lag effect of the unemployment rate on child maltreatment rate at the county level: the child maltreatment rate increased by 7 percent, while the prior unemployment rate increased by one percent. In addition, the medical personnel density was related to the child maltreatment rate within the county.Previous unemployment rate had a lag impact on child maltreatment occurrence. Unemployment rate has not only a direct impact on the economy but also sequential effects on child maltreatment.
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Affiliation(s)
- Yi-Chen Hsin
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
- Division of Pediatric Allery, Asthma, and Rheumatology, Department of Pediatrics
| | - Yu-Ching Chang
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - En-Pei Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
- Division of Pediatric Critical Care Medicine
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University
- Division of Pediatric Infectious Diseases
| | - I.-.Jun Chou
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology
| | - Shao-Hsuan Hsia
- College of Medicine, Chang Gung University
- Division of Pediatric Critical Care Medicine
| | - Kuang-Lin Lin
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology
| | - Jung Lee
- Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan
- College of Medicine, Chang Gung University
| | - Jing-Long Huang
- College of Medicine, Chang Gung University
- Division of Pediatric Allery, Asthma, and Rheumatology, Department of Pediatrics
| | - Chao-Jan Wang
- College of Medicine, Chang Gung University
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan
| | - Han-Ping Wu
- Department of Pediatric Emergency Medicine
- Department of Medical Research, Children's Hospital
- Department of Medicine, College of Medicine, China Medical University, Taichung
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Orsi R, Yuma-Guerrero P, Sergi K, Pena AA, Shillington AM. Drug overdose and child maltreatment across the United States' rural-urban continuum. CHILD ABUSE & NEGLECT 2018; 86:358-367. [PMID: 30166067 DOI: 10.1016/j.chiabu.2018.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 06/08/2023]
Abstract
This national study of US counties (n = 2963) investigated whether county-level drug overdose mortality is associated with maltreatment report rates, and whether the relationship between overdose mortality and maltreatment reports is moderated by a county's rural, non-metro or metro status. Data included county-level 2015 maltreatment reports from the National Child Abuse and Neglect Data System, modeled drug-overdose mortality from the Centers for Disease Control, United States Department of Agriculture Rural-Urban Continuum Codes, US Census demographic data and crime reports from the Federal Bureau of Investigation. All data were linked across counties. Zero-inflated negative binomial (ZINB) regression was used for county-level analysis. As hypothesized, results from the ZINB model showed a significant and positive relationship between drug overdose mortality and child maltreatment report rates (χ = 101.26, p < .0001). This relationship was moderated by position on the rural-urban continuum (χ=8.76, p = .01). For metro counties, there was a 1.9% increase in maltreatment report rate for each additional increment of overdose deaths (IRR=1.019, CI=[1.010, 1.028]). For non-metro counties, the rate of increase was 1.8% higher than for metro counties (IRR=1.018, CI=[1.006, 1.030]); for rural counties, the rate of increase was 1.2% higher than for metro counties (IRR=1.012, CI=[0.999, 1.026]). Additional research is needed to determine why the relationship between drug overdose mortality and maltreatment reports is stronger in non-metro and rural communities. One potential driver requiring additional inquiry is that access to mental and physical health care and substance use treatment may be more limited outside of metropolitan counties.
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Affiliation(s)
- Rebecca Orsi
- School of Social Work and School of Public Health, Colorado State University, Campus Delivery 1586, Fort Collins, CO, United States.
| | - Paula Yuma-Guerrero
- School of Social Work and School of Public Health, Colorado State University, Fort Collins, CO, United States
| | - Kristen Sergi
- School of Public Health, Colorado State University, Fort Collins, CO, United States
| | - Anita Alves Pena
- Department of Economics, Colorado State University, Fort Collins, CO, United States
| | - Audrey M Shillington
- School of Social Work and School of Public Health, Colorado State University, Fort Collins, CO, United States
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Rumball-Smith J, Fromkin J, Rosenthal B, Shane D, Skrbin J, Bimber T, Berger RP. Implementation of routine electronic health record-based child abuse screening in General Emergency Departments. CHILD ABUSE & NEGLECT 2018; 85:58-67. [PMID: 30170921 DOI: 10.1016/j.chiabu.2018.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Routine child abuse screening is an approach to early identification of abuse. Previous studies evaluated paper-based screens; the widespread use of electronic health records suggests that screening is more likely to succeed if integrated into the electronic record. OBJECTIVE To implement an electronic health record-based child abuse screen in a diverse hospital system and to evaluate the screening rate, rate of positive screens, and number of reports to Child Protective Services and assess whether hospital and patient characteristics are associated with these rates. PARTICIPANTS AND SETTING Children <13 years of age evaluated at one of 13 Emergency Departments within University of Pittsburgh Medical Center Health System. METHODS A previously validated child abuse screen was slightly modified and integrated into Cerner. Multivariable logistic regression models were used to estimate the odds of the outcomes of interest, controlling for key covariates. RESULTS Of 17,163 eligible children: 68% received the screen of which 1.9% were positive. The rate of reports to Child Protective Services was higher among children who were screened (p < 0.0001). Younger children were more likely to be screened, have a positive screen, and have a report filed. There was no difference in the odds of being screened according to hospital teaching status, size or urban vs rural location. CONCLUSIONS A child abuse screening tool can be integrated into the electronic health record in a large health-care network. The increased number of reports among children who were screened suggests that screening facilitates detection of suspected maltreatment.
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Affiliation(s)
- Juliet Rumball-Smith
- RAND Corporation, Health, Santa Monica, CA, United States; Ministry of Health, Wellington, New Zealand
| | - Janet Fromkin
- Departments of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Bruce Rosenthal
- Department of Emergency Medicine, UPMC Mercy Hospital, Pittsburgh, PA, United States
| | - Debra Shane
- Departments of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Janet Skrbin
- Department of Emergency Medicine, UPMC Hamot, Erie, PA, United States
| | - Tammy Bimber
- Department of Emergency Medicine, UPMC Horizon, Greenville, PA, United States
| | - Rachel P Berger
- Departments of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.
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Perrigo JL, Berkovits LD, Cederbaum JA, Williams ME, Hurlburt MS. Child abuse and neglect re-report rates for young children with developmental delays. CHILD ABUSE & NEGLECT 2018; 83:1-9. [PMID: 29940307 DOI: 10.1016/j.chiabu.2018.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 06/08/2023]
Abstract
The study objective was to examine the likelihood and magnitude of child abuse and neglect (CAN) re-reports for young children (0-71 months) with delays in cognitive, language, and adaptive development, compared to typically developing children. The National Survey of Child and Adolescent Well-Being (NSCAW II), a nationally representative and longitudinal survey, was used to examine CAN re-reports at two follow-up waves, 18- and 36-months post baseline assessments. Logistic regression models were employed to determine the correlation between number of developmental delays and a CAN re-report at waves 2 and 3. Results indicate that children with three or more domains of delays had odds 4.73 times higher than children without developmental delays of re-report to CPS at wave 2 but not at wave 3. In this study, children with multiple developmental delays have elevated rates of CAN re-reports when compared to typically developing children. Allocation of child welfare resources should include strategies for preventing maltreatment risk among children with developmental delays.
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Affiliation(s)
- Judith L Perrigo
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, Department of Children, Youth, and Families, 669 W 34th Street, Los Angeles, CA 90089, USA.
| | - Lauren D Berkovits
- Children's Hospital Los Angeles, 4650 Sunset Blvd., MS#53, Los Angeles, CA 90027, USA
| | - Julie A Cederbaum
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, Department of Children, Youth, and Families, 669 W 34th Street, Los Angeles, CA 90089, USA.
| | - Marian E Williams
- USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS#53, Los Angeles, CA 90027, USA
| | - Michael S Hurlburt
- University of Southern California (USC), Suzanne Dworak-Peck School of Social Work, Department of Children, Youth, and Families, 669 W 34th Street, Los Angeles, CA 90089, USA.
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Hodel AS. Rapid Infant Prefrontal Cortex Development and Sensitivity to Early Environmental Experience. DEVELOPMENTAL REVIEW 2018; 48:113-144. [PMID: 30270962 PMCID: PMC6157748 DOI: 10.1016/j.dr.2018.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Over the last fifteen years, the emerging field of developmental cognitive neuroscience has described the relatively late development of prefrontal cortex in children and the relation between gradual structural changes and children's protracted development of prefrontal-dependent skills. Widespread recognition by the broader scientific community of the extended development of prefrontal cortex has led to the overwhelming perception of prefrontal cortex as a "late developing" region of the brain. However, despite its supposedly protracted development, multiple lines of research have converged to suggest that prefrontal cortex development may be particularly susceptible to individual differences in children's early environments. Recent studies demonstrate that the impacts of early adverse environments on prefrontal cortex are present very early in development: within the first year of life. This review provides a comprehensive overview of new neuroimaging evidence demonstrating that prefrontal cortex should be characterized as a "rapidly developing" region of the brain, discusses the converging impacts of early adversity on prefrontal circuits, and presents potential mechanisms via which adverse environments shape both concurrent and long-term measures of prefrontal cortex development. Given that environmentally-induced disparities are present in prefrontal cortex development within the first year of life, translational work in intervention and/or prevention science should focus on intervening early in development to take advantages of this early period of rapid prefrontal development and heightened plasticity.
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Smith BD, Kay ES, Pressley TD. Child maltreatment in rural southern counties: Another perspective on race, poverty and child welfare. CHILD ABUSE & NEGLECT 2018; 80:52-61. [PMID: 29567457 DOI: 10.1016/j.chiabu.2018.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/04/2018] [Accepted: 03/10/2018] [Indexed: 06/08/2023]
Abstract
Building on research that has identified community characteristics associated with child maltreatment, this study investigates the adequacy and equity of the child welfare response at the county level. The study focuses on states in the U.S. south with demographic characteristics that make it possible to disentangle county racial composition from county rurality. County-level child maltreatment data were merged with data from the U.S. Census and other publicly-available sources for the 354 counties in four southern states. Results from multiple regression models indicated that, despite a greater preponderance of risk factors typically associated with child maltreatment, rural, majority African-American counties had lower rates of reported and substantiated child maltreatment compared to other southern counties. Cross-sectional results were consistent across three years: 2012, 2013, and 2014. The findings suggest that children and families in rural, majority African-American counties in the South may not be receiving adequate or equitable responses from the formal child welfare system.
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Affiliation(s)
- Brenda D Smith
- University of Alabama, School of Social Work, Box 870314, Tuscaloosa, AL 35487, United States.
| | - Emma Sophia Kay
- University of Alabama, School of Social Work, Box 870314, Tuscaloosa, AL 35487, United States
| | - Tracy D Pressley
- University of Alabama, School of Social Work, Box 870314, Tuscaloosa, AL 35487, United States
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45
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Bell MF, Bayliss DM, Glauert R, Ohan JL. School readiness of maltreated children: Associations of timing, type, and chronicity of maltreatment. CHILD ABUSE & NEGLECT 2018; 76:426-439. [PMID: 29245140 DOI: 10.1016/j.chiabu.2017.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 11/15/2017] [Accepted: 12/01/2017] [Indexed: 06/07/2023]
Abstract
Children who have been maltreated during early childhood may experience a difficult transition into fulltime schooling, due to maladaptive development of the skills and abilities that are important for positive school adaptation. An understanding of how different dimensions of maltreatment relate to children's school readiness is important for informing appropriate supports for maltreated children. In this study, the Australian Early Development Census scores of 19,203 children were linked to information on child maltreatment allegations (substantiated and unsubstantiated), including the type of alleged maltreatment, the timing of the allegation (infancy-toddlerhood or preschool), and the total number of allegations (chronicity). Children with a maltreatment allegation had increased odds of poor school readiness in cognitive and non-cognitive domains. Substantiated maltreatment was associated with poor social and emotional development in children, regardless of maltreatment type, timing, or chronicity. For children with unsubstantiated maltreatment allegations, developmental outcomes according to the type of alleged maltreatment were more heterogeneous; however, these children were also at risk of poor school readiness irrespective of the timing and/or chronicity of the alleged maltreatment. The findings suggest that all children with maltreatment allegations are at risk for poor school readiness; hence, these children may need additional support to increase the chance of a successful school transition. Interventions should commence prior to the start of school to mitigate early developmental difficulties that children with a history of maltreatment allegations may be experiencing, with the aim of reducing the incidence of continuing difficulties in the first year of school and beyond.
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Affiliation(s)
- Megan F Bell
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
| | - Donna M Bayliss
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Rebecca Glauert
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Jeneva L Ohan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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Spano R, David MA, Jeffries SR, Bolland JM. Family Matters: Examining Child Abuse and Neglect as Family Dysfunction for Minority Youth Living in Extreme Poverty. VIOLENCE AND VICTIMS 2017; 32:1063-1078. [PMID: 29017641 DOI: 10.1891/0886-6708.vv-d-16-00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Two competing models of child abuse and neglect (scapegoat vs. family dysfunction) are used to illustrate how the specification of victims ("index" victim vs. all children in household) from incidents of child abuse and neglect can be used to improve estimates of maltreatment for at-risk minority youth. Child Protection Services records were searched in 2005 for 366 "index" victims who were surveyed for 5 consecutive years (from 1998 to 2002) for the Mobile Youth Survey as well as other siblings in the household. The findings indicate that the baseline estimate of any maltreatment, sexual abuse, physical abuse, and neglect increased by 68%, 26%, 33%, and 74%, respectively, after adjusting for incidents that involved multiple victims (i.e., maltreatment as family dysfunction). In addition, the baseline estimate of more severe (indicated) incidents of physical abuse and neglect increased by 67% and 64%, respectively, after accounting for incidents that involved multiple victims, but there were no incidents of more severe (indicated) sexual abuse that involved multiple victims. Similarly, baseline estimates of age of onset (or chronicity) of maltreatment during childhood and adolescence increased by 62% and 26%, respectively. Baseline estimates for youth with 3 or more years of maltreatment and youth with 3 or more incidents of maltreatment both increased by about 71%. The implications of these findings for policy and practice as well as areas for future research are also discussed.
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