"A rising tide floats all boats": The role of neighborhood collective efficacy in responding to child maltreatment

BACKGROUND

Nearly one-quarter of the approximately 400,000 reports to child protective services originating from non-mandated reporters come from neighbors. Understanding factors leading non-mandated reporters to contact authorities is important because if modifiable, they might serve as intervention targets to promote reporting of suspected maltreatment.

OBJECTIVE

Investigate associations between neighbors' reported responses to scenarios involving children in need, child/teen misbehavior, and suspected maltreatment with individual and neighborhood characteristics, including neighborhood collective efficacy, fear of victimization, and fear of retaliation.

HYPOTHESIS

Increased collective efficacy would be associated with increased likelihood of neighbors taking action in response to the situation.

PARTICIPANTS & SETTING

400 caregivers of minors in Cleveland, OH, USA living in 20 census tracts.

METHODS

Generalized linear mixed-effects modeling.

RESULTS

Analyses adjusted for covariates confirmed our primary hypothesis: a 1-unit increase in the collective efficacy measure was associated with a 64% increase in the odds of neighbors taking action compared to doing nothing (odds ratio = 1.64, 95th percentile confidence interval 1.41-1.92). Also, participants with less than a high-school education had 36% greater odds of reporting their neighbors taking action compared to more educated participants. An interaction effect between participants' fear of victimization in their neighborhood, but not fear of retaliation, was also observed: the effect of collective efficacy on the odds of neighbors taking action was substantially greater among residents expressing moderate and high fear of victimization.

CONCLUSION

Enhancing collective efficacy may be an effective strategy for fostering community response to suspected child maltreatment and other situations of a child in need because it may catalyze a variety of positive responses to these situations.

"Asylum is the Most Powerful Medicine": Navigating Therapeutic Interventions in Limbo

Drawing on ethnographic research among asylum seekers in the Midwestern United States, this article investigates how a profound sense of limbo informed the use, meaning, and experiences of psychotherapeutic interventions, namely psychiatric medication and psychotherapy. In doing so, the article brings into dialogue a consideration of temporal and spatial uncertainty as a key feature of refugee distress, on the one hand, and attention to the subjective experiences of mental health care, on the other. Asylum seekers used therapeutic interventions and found them meaningful in the multiple ways these modalities help claimants endure the asylum process. Yet, ultimately, because they identified the unjust, protracted asylum system as the primary locus of their distress, asylum seekers perceived therapeutic interventions to be limited in their ability to assuage their suffering. In this context, legal status was often understood as the most effective form of healing. Thus, a sense of limbo was often both the impetus for using mental health care and the reason for its perceived limitations. My analyses have implications beyond the context of political asylum, underscoring how attention to temporality is important to better understanding the use and experience of mental health care more broadly.

Why Does Child Maltreatment Occur? Caregiver Perspectives and Analyses of Neighborhood Structural Factors Across Twenty Years

Research on caregivers' views of factors that contribute to child maltreatment and analyses of neighborhood structural factors offer opportunities for enhancing prevention and intervention efforts. This study compared explanations of the factors that contribute to child maltreatment in a neighborhood-based sample of adult caregivers at two-time points: 1995-1996 and 2014-2015 along with analyses of neighborhood structural conditions during the same period. The study sample consisted of two cross-sectional subsamples: 400 adult caregivers in 20 census tracts in Cleveland, Ohio from a 1995-1996 study, and 400 adult caregivers of the same 20 census tracts surveyed in 2014-2015. At each time point, residents were asked to rate how much each of 13 factors contributes to child abuse and neglect. Median regression analyses adjusted for individual and neighborhood characteristics showed that "lack of religion" decreased somewhat in importance over time, while that of "single parents" increased slightly. Otherwise, there was substantial consistency in caregivers' perceptions of factors contributing to maltreatment over the two study points. In terms of overall ranking, at each time point the most important contributors to child maltreatment were "drugs," "alcohol," and "psychological or emotional problems," while the least important were "divorce," "single parents," and "lack of religion." Differences in ratings of contributing factors were associated with individual and neighborhood characteristics, most consistently by participant race and age and by neighborhood maltreatment investigation rate. Despite these differences, for any maltreatment prevention or intervention effort using or planning to use maltreatment etiology in some way in its activities, etiology seems to represent a fairly stable platform for programming.

How might neighborhood built environment influence child maltreatment? Caregiver perceptions

RATIONALE

Child maltreatment remains a serious but potentially preventable public health concern in the United States. Although research has examined factors associated with child maltreatment at the neighborhood level, few studies have explicitly focused on the role of the neighborhood built environment in maltreatment.

OBJECTIVE

We begin to address these gaps by investigating caregivers' own perceptions of mechanisms by which neighborhood built environments may affect child maltreatment.

METHOD

Utilizing a grounded theory approach, we examined open-ended interview data from 400 adult residents residing in 20 different Cleveland, Ohio neighborhoods (census tracts) and caring for at least one child under 18 years of age.

RESULTS

Our analysis revealed three primary pathways through which caregivers linked the neighborhood built environment to potential child maltreatment: housing density, physical neighborhood space as shaping family relations, and the internalization of the surrounding neighborhood-built environment.

CONCLUSIONS

Our findings suggest that aspects of the neighborhood built environment, such as the presence of abandoned houses or the lack of recreational centers, can be stressors themselves and may also critically alter families' thresholds for navigating other everyday pressures. Conversely, aspects of the neighborhood built environment, such as housing density, may work to mitigate the risk of maltreatment, either by promoting social support or by increasing the likelihood that maltreatment is reported to authorities. Additional research, both qualitative and quantitative, is integral to building and testing models of these separate but related pathways by which the neighborhood built environment may link to child maltreatment.

Change and consistency in descriptions of child maltreatment: A comparison of caregivers' perspectives 20 years apart

Although approximately one-fifth of child maltreatment reports originate with family members, friends, neighbors, or community members, their efforts to identify and report child maltreatment are still not well understood. Nor is it well understood how these individuals' perceptions of what constitutes maltreatment may change over time. This study examined descriptions of behavior perceived as maltreatment by caregivers of minors in Cleveland, Ohio, USA neighborhoods. Data were obtained from two neighborhood-based cross-sectional surveys of caregivers of minors: one conducted in 1995-1996 and the other in 2014-2015. The sample consisted of 400 caregivers living in 20 census tracts with varying profiles of maltreatment risk in the 1995-1996 study, and 400 caregivers living in the same 20 census tracts surveyed in 2014-2015. Each time point, participants were asked to provide three examples of behaviors they considered to be child abuse and neglect. All responses were categorized using the 1995-1996 coding scheme. Logistic regression analyses including all 800 participants, adjusted for individual and neighborhood characteristics, and accounting for residential clustering in neighborhoods, showed that participating in the 2014-2015 survey was associated with 51% increased odds of mentioning an act of neglect and a 39% decreased odds of mentioning an act of physical abuse. No significant temporal changes were observed for inadequate supervision, emotional or verbal abuse, sexual abuse, and parental misbehavior. Associations between specific types of maltreatment and individual and neighborhood characteristics were observed. Potential practice implications and future research directions include seeking greater familiarity with caregivers' perceptions of maltreating behaviors to better understand how these perceptions might "translate" into child maltreatment reports and investigations.

Two sides of the same neighborhood? Multilevel analysis of residents' and child-welfare workers' perspectives on neighborhood social disorder and collective efficacy

Neighborhood processes have been shown to influence child maltreatment rates, and accordingly neighborhood-based strategies have been suggested as helpful in intervening in and preventing child maltreatment. Although child-welfare workers are at the forefront of child maltreatment work, little is known about the extent to which their perspectives on neighborhood processes related to child maltreatment align with those of neighborhood residents. The current study examined the views of neighborhood residents (n = 400) and neighborhood-based child-welfare workers (n = 260) on 2 neighborhood process measures: social disorder and collective efficacy. Because social disorder is viewed as a risk factor for child maltreatment and collective efficacy is viewed as a protective factor, child-welfare workers and residents of neighborhoods need to reach a common understanding of these factors in order to reach agreement on the safety of children in these neighborhoods. The samples of neighborhood residents and child-welfare workers were nested within 20 neighborhoods in Cleveland, Ohio. Multilevel modeling taking into account individual and neighborhood characteristics indicated that child-welfare workers consistently tended to perceive higher social disorder and lower collective efficacy compared to residents. Neighborhood characteristics were associated with residents' and child-welfare workers' perspectives on social disorder in different ways. Differences between residents and child-welfare workers concerning perceptions of neighborhood processes have implications for better understanding the context and improving the effectiveness of neighborhood-based interventions to prevent child maltreatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Validity of weight distribution and sway measurements of the Balance Performance Monitor

BACKGROUND AND PURPOSE

The Balance Performance Monitor (BPM) is a device which provides auditory and visual feedback on weight distribution and the magnitude of lateral and anterior-posterior sway during quiet standing. This study investigated the validity of the measurements provided by the BPM using a Kistler force plate (KFP) as the gold standard.

METHOD

Percentage weight distribution between the BPM foot plates was validated using both a series of calibration weights and the vertical component of ground reaction force, measured by the KFP, during normal standing in 18 young normal subjects. The lateral and anterior-posterior sway indices from the BPM were validated against the standard deviation of the position of the centre of pressure, again obtained using the KFP, during normal standing with eyes open and eyes closed and standing with feet together with eyes open. Concurrent validity of the percentage weight distribution measurements was assessed by calculating the 'limits of agreement' between the corresponding measurements from the BPM and KFP and the 95% confidence intervals for these 'limits'. Differences in the units of measurement obtained from the BPM and KFP resulted in the concurrent validity of the sway indices being assessed using correlation and regression.

RESULTS

Excellent agreement was found between the percentage weight distribution values provided by the BPM and the KFP, which showed that the BPM may read only 3% of body weight above or below that given by the KFP. High correlations (r = 0.61-0.99) were found between both the lateral and anterior-posterior sway indices from the BPM and the motion of the centre of pressure from the KFP in the respective direction. Despite this, further analysis of regression equations and the 95% prediction intervals showed poor concurrent validity of the BPM sway indices in relation to KFP measurements. This was thought to be due to the different methods by which the sway indices and the motion of the centre of pressure were calculated.

CONCLUSIONS

The BPM may be used to provide a valid measure of the symmetry aspect, but not necessarily the steadiness aspect of postural control.

Inter- and intra-tester reliability of the Balance Performance Monitor in a non-patient population

BACKGROUND AND PURPOSE

There is a growing interest in the measurement and evaluation of balance deficits and a number of instruments for measurement are now available. However, few data exist that accurately describe the reliability when using these measurement tools. This study was designed to evaluate the inter- and intra-tester reliability of using the Balance Performance Monitor (BPM) (SMS Healthcare) in a non-patient population.

METHODS

A total of 58 subjects (mean age 29.83 years (+/- 9.44 years)) and three testers participated in two separate experiments. Intra Class Correlation Coefficients (ICCs) and coefficients of variation were used to describe the reliability of two different protocols for positioning subjects on the footplates of the BPM.

RESULTS

Measurements of weight distribution showed high and significant inter- and intra-tester reliability for both protocols (ICCs ranging from 0.720 to 0.868). Sway measurements showed more limited reliability (ICCs ranging from 0.183 to 0.775). Coefficients of variation were low for weight distribution measurements and high for sway measurements.

CONCLUSIONS

Taking the mean of three measurements is recommended for both the weight distribution and the sway measurements as it has shown to produce acceptable measurement results.

The inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in patients with spinal cord injury

Thirty patients with spinal cord injury (SCI) were randomly selected to participate in this study which evaluated the inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in the lower limbs. A doctor and a physiotherapist rated the muscle tone of hip adductors, hip extensors, hip flexors and ankle plantarflexors according to the original and to the modified Ashworth scale. The results were analyzed using a Cohen's Kappa statistical test and showed varying levels of reliability for different muscle groups and limbs. Kappa values ranged between 0.21 and 0.61 (mean 0.37). The original scale was slightly more reliable than was the modified scale. However, this difference was not significant (P > 0.05), and was not consistent between the two limbs and between different muscle groups. It was concluded that the Ashworth scale is of limited use in the assessment of spasticity in the lower limb of patients with SCI. Further work is required to establish a standardised speed of muscle stretching during the test, or to find more appropriate grades and descriptions of spasticity for this patient group. The effects of training of the raters in the use of the scales also warrants further investigation.