The home inventory of dangers and safety precautions-2: addressing critical needs for prescriptive assessment devices in child maltreatment and in healthcare

Parent training interventions for parents with intellectual disability

BACKGROUND

Research suggests that the number of intellectually disabled people with children is increasing. Intellectual disabilities do not inevitably cause parenting difficulties, but it may impact on an individual's capacity to parent a child effectively. Children of parents with intellectual disabilities may be at increased risk of neglectful care, which could lead to health, developmental and behavioural problems, or increased risk of intellectual disability. Compared with other parents, those with intellectual disabilities are more likely to be involved in care proceedings.

OBJECTIVES

To assess the effectiveness of parent training interventions for parents with intellectual disabilities designed to support parenting, parent-child relations, safe parenting or family environments, or to develop parenting skills.

SEARCH METHODS

In July 2017, we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL and six other databases as well as two trials registers. We also searched reference lists of included studies and contacted experts in the field to identify additional ongoing and unpublished studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs comparing parent training interventions for parents with intellectual disabilities with treatment as usual or a control group.

DATA COLLECTION AND ANALYSIS

We used standardised Cochrane methods.

MAIN RESULTS

As of July 2017, we identified four trials with 192 participants that met the review inclusion criteria. Participating parents were mostly mothers (seven fathers were included in two studies), and children's ages ranged from one month to six years and five months.One study was conducted in Australia, one in Canada, one in the Netherlands, and one in the USA. Each studied a different intervention and considered different outcomes. Three interventions were delivered at home, and one in a community venue (e.g. a church). Interventions varied in duration from seven weeks to 12 months. They included a range of practical childcare skills, home safety and developing parents' ability to respond sensitively to their children. Parents in the comparison groups included in the review received treatment as usual and most of these received the index intervention after the study was complete.One study was funded by the Ontario Mental Health Foundation and the Ontario Ministry of Community and Social Services Research Grants Program; one by the Alabama Development Disabilities Council; one by the Best Practice Parenting Education Initiative of the Commonwealth Department of Family and Community Services and the New South Wales Aging and Disability Department; and one by ZonMw, The Netherlands Organisation for Health Research and Development.It was not possible for us to conduct a meta-analysis. The GRADE quality assessment varied from very low to moderate across the studies.Primary outcomesNo study reported on the 'attainment of specific parenting skill targets'.'Safe home practices' and 'understanding of child health': one study (30 parents, very low-quality evidence) reported some improvements in parents' knowledge of life-threatening emergencies, ability to recognise dangers, and identify precautions, in favour of the intervention group. It also found limited, very low-quality evidence that parent training improved parents' ability to understand child health, implement precautions, use medicines safely, recognise child illness and symptoms, and seek medical advice (i.e. visit the doctor). Another study (22 mothers, very low-quality evidence) reported improved attainment of skills related to childcare and safety, in favour of the intervention group.Secondary outcomes'Parent-child interaction': one study (40 mothers, very low-quality evidence) reported improved maternal-child interaction following parent training at 12 months follow-up. Another study (83 mothers, 2 fathers, moderate-quality evidence) reported that inclusion in the intervention group led to a steeper decline in parenting stress related to the child compared to the control group.'Parents' retention of child': one study (22 participants; very low-quality evidence) reported that before joining the programme nine of 11 (82%) families with a previous child had had the child removed from their care by child protection authorities due to maternal maltreatment, compared with only four of 22 (19%) families after participating in the programme (only one of these four mothers had also had a previous child removed).No study reported data on: 'return to independent care of child' or 'lifting of child-related court order'.

AUTHORS' CONCLUSIONS

There is some very low-quality evidence that some parents, mainly mothers, with intellectual disabilities are able to provide adequate parenting if they are given appropriate training and support to learn the parenting skills they need. However, there are few studies exploring how interventions might work, for whom and in what circumstances. In particular, there have been few studies that include fathers with intellectual disabilities, or that explore the views of parents themselves.There is a need for larger RCTs of parenting interventions, with longer follow-up, before conclusions can be drawn about the effectiveness of parent training for this group of parents.

Development and initial psychometric examination of the Home Safety and Beautification Assessment in mothers referred to treatment by child welfare agents

Unintentional injury is the leading cause of death among children, with approximately 45% of injuries occurring in and around the home. Rates of home injury are particularly high in the homes of caregivers who are referred for intervention services by child welfare agents. However, there are few validated methods of home safety assessment available. The Home Safety and Beautification Assessment (HSBA) was developed to assist intervention planning specific to home safety and appearance in a sample of 77 mothers who were referred to treatment by Child Welfare Services. Exploratory factor analysis of HSBA items indicated that safety and appearance factors emerged across rooms in the home, and internal consistencies were good. For each room, the sums of assessors' safety and appearance intervention priority item scores were correlated with the assessors' global safety and appearance ratings of the entire home, respectively. The participants' overall room attractiveness scores were correlated with the assessors' overall room appearance intervention priority scores, whereas the participants' ratings of overall room safety were not correlated with the assessors' overall room safety intervention priority scores. Participants' scores on the Abuse subscale of the Child Abuse Potential Inventory, personal income, and education level were not associated with the assessors' home safety and appearance intervention priority ratings, suggesting the HSBA is assessing constructs that are distinct from child abuse potential and socioeconomic status. The results support the HSBA in a sample referred to treatment by child welfare agents. (PsycINFO Database Record

Practices Changes in the Child Protection System to Address the Needs of Parents With Cognitive Disabilities

Parents with cognitive disabilities (PCD) are over-represented in the child protection system. However, the current state of the child protection system is not well prepared for working with them. Biases that exist against their parenting, the need for accommodations in assessment and intervention practices, and specific training in staff and cross systems barriers need to be addressed. This paper argues for changes that will ensure such parents are more effectively served and that child protection staff and contract providers are better equipped to work with them. Specific changes are discussed in assessment and intervention practices. These changes will require human capacity building and organizational restructuring. Although empirically based behavioral approaches with PCD will be emphasized, recent empirical work suggests that social information processing and neurocognitive problems occur in PCD. Approaches to working with such problems are emerging and must also be considered and integrated into a blueprint for change.

Caregiver reports of serious injuries in children who remain at home after a child protective services investigation

The study objectives were to examine serious injuries requiring medical attention among children who remain at home after a child welfare/child protective services (CPS) maltreatment investigation in the US and to determine whether child/caregiver characteristics and ongoing CPS involvement are related to injuries requiring medical attention. Using the National Survey of Child and Adolescent Well-being, we analyzed data on the subsample of children who remained at home (N = 3,440). A multivariate logistic regression model included child characteristics, chronic illness and disability in the child, level of CPS involvement, subsequent foster care placement, caregiver characteristics, and caregiver/family psychological variables. Injuries requiring medical attention were identified in 10.6% of the in-home population over a 15-month period, with no differences in rates by age. Children with a chronic medical condition (OR = 2.07; 95% CI, 1.20-3.58) and children with depressed caregivers (OR = 2.28; 95% CI, 1.45-3.58) were more likely to have an injury that required medical care. Older caregivers (>54 years) were less likely (OR = 0.15; 95% CI, 0.03-0.69) to have a child with an injury requiring care. Injuries were not related to further involvement with CPS after the initial maltreatment investigation. Children with chronic medical conditions who remained in their biological homes or whose caregivers were depressed were likely to experience an injury requiring medical attention. Older caregivers were less likely to report a child injury. Extending existing health policies for foster children to children who remain at home following referral to CPS may encourage more comprehensive injury prevention for this population.

Parent training support for intellectually disabled parents

BACKGROUND

Intellectual disability may impact on an individual's capacity to parent a child effectively. Research suggests that the number of intellectually disabled people with children is increasing. Children of parents with intellectual disabilities may be at increased risk of neglectful care which could lead to health, developmental and behavioural problems, or increased risk of intellectual disability.However, there is some indication that some parents with intellectual disabilities are able to provide adequate child care if they are given appropriate training and support to do so.

OBJECTIVES

To assess the effectiveness of parent training interventions to support the parenting of parents with intellectual disabilities

SEARCH STRATEGY

We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO, ASSIA, Sociological Abstracts, Dissertation Abstracts International, MetaRegister of Controlled Trials, and ZETOC.

SELECTION CRITERIA

Randomised controlled trials comparing parent training interventions for parents with intellectual disabilities with usual care or with a control group. Outcomes of interest were: the attainment of parenting skills specific to the intervention, safe home practices and the understanding of child health.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed risk of bias and undertook data extraction.

MAIN RESULTS

Three trials met the inclusion criteria for this review but no meta-analysis was possible. One study reported improved maternal-child interaction following group parent training compared with the control group. The second study reported some improvements in parents knowledge of life threatening emergencies, ability to recognise dangers and identify precautions and smaller improvements in their ability to implement precautions, use medicines safely and recognise child illness and symptoms. The third study reported improvement in child care and safety skills following the intervention.

AUTHORS' CONCLUSIONS

There is some risk of bias in the included studies, with limited information available to assess possible bias and to fully assess the findings of one included study. Whilst the evidence presented here does seem promising with regard to the ability of such interventions to improve parenting knowledge and skill in this population, there is a need for larger RCTs of interventions before conclusions can be drawn about the effectiveness of parent training for this group of parents.

The role of care neglect and supervisory neglect in childhood obesity in a disadvantaged sample

OBJECTIVE

Assess the roles of care neglect and supervisory neglect, and the moderating influence of child age on childhood obesity. Study Design Child BMI, parental care neglect, and supervisory neglect were assessed in an ethnically diverse sample of 571 young children from two Midwestern States. Hierarchical linear regression was used to assess the influence of both forms of neglect and the moderating role of age.

RESULTS

Fifteen percent of the children were overweight and 16.3% were obese. Care neglect significantly correlated with child BMI for younger but not older children, while supervisory neglect significantly correlated with child BMI for older but not younger children.

CONCLUSIONS

The impact of two types of neglect on obesity varied across age, highlighting the importance of differentiating between types of neglectful parenting when addressing the high rate of childhood obesity in disadvantaged children.

Care neglect, supervisory neglect, and harsh parenting in the development of children's aggression: a replication and extension

To understand the effects of neglectful parenting, poor supervision, and punitive parenting in the development of children's aggression, 218 children ages 4 to 8 years who were disadvantaged and their mothers were recruited from two states to develop a sample that was diverse with respect to degree of urbanization and ethnicity. Multimethod and multisource indices of the predictive constructs (Social Disadvantage, Denial of Care Neglect, Supervisory Neglect, and Punitive Discipline) and the criterion construct (Aggression) were used in a test of a theoretical model using structural equation modeling. The results established the role of care neglect, supervisory neglect, and punitive parenting as mediators of the role of social disadvantage in the development of children's aggression, the importance of distinguishing between two subtypes of neglect, and the need to consider the role of discipline in concert with neglect when attempting to understand the parenting in the development of aggression.

¿Qué se puede hacer para prevenir la violencia y el maltrato de los niños con discapacidades?

Children with physical, psychological and sensorial disabilities are known to be more vulnerable to violence and maltreatment, or to be at a greater risk of these forms of abuse. Violence and maltreatment of children with disabilities is part of the general problem of child maltreatment, which is still under-researched and little known as a whole; prevention, in particular, has received little attention. Preventing violence and maltreatment against children with disabilities means preventing physical pain, emotional suffering, difficulties in integration and sequelae additional to those already experienced by children due to their disability, in addition to avoiding great expense to the community. This article presents a review of the literature published in the last 10 years on the various primary and secondary prevention strategies that have taken place in developed countries, with the aim of bringing the subject to public attention, especially that of health professionals, and of serving as a basis for the planning of future research lines and prevention strategies.

The development of an instrument measuring unintentional injuries in young children in low-income settings to serve as an evaluation tool for a childhood home injury prevention program

PROBLEM

Responding to the lack of standardized instrumentation, especially as applied in low-income contexts, the researchers decided that an instrument should be developed to serve as an evaluation tool for a childhood (unintentional) injury prevention program as well as a tool from which injury risks (poisonings, burns and falls) could be identified within households.

METHODS

Cross-sectional samples of 521 households in four low-income sites in Cape Town and Johannesburg, South Africa, participated in the three phases of the study. The generation of an item pool based on a table of specifications, subsequent scientific item reduction procedures, reviews from experts and pilot tests were used to develop the scales for measuring the injury risks.

RESULTS

The developed instrument complies with all the requirements for a valid and reliable measurement instrument.

CONCLUSION

The instrument allows valid comparison of risks between communities, as well as before and after comparisons for an intervention program.

IMPACT

The provision of this instrument may bring enormous benefits to research studies. It can also provide proactive, rather than reactive, information about injury risks before they develop into injuries and thus allows focusing of safety efforts for improvement of problematic areas in the households.