Poverty and Child Maltreatment

Childcare Subsidy Employment and Copayment Requirements and Child Maltreatment

Economic support programs for low-income families may play an important role in preventing child abuse and neglect. In the United States, childcare subsidies are provided to low-income families who meet certain requirements to offset the high cost of childcare. States have flexibility in setting many policies related to the provision of childcare subsidies, which results in a great deal of variation in how the programs operate between states. One policy dimension on which states vary is the number of employment hours required to receive childcare subsidies. A small body of work has begun to investigate the ways in which these state policy variations might relate to child maltreatment. Using 11 years of administrative data from the United States, the current study sought to estimate the relationship between two sources of variation in childcare subsidy policies: employment requirements and copayment size; and child neglect, physical abuse, and emotional abuse substantiations. The study found a nuanced relationship between required employment and neglect substantiations. Specifically, requiring some level of work was not associated with neglect substantiations, but requiring 30 hours of employment was associated with higher rates. The study did not find a relationship between copayment size and maltreatment substantiations.

Revictimization Risk Factors Following Childhood Maltreatment: A Literature Review

Revictimization research, to date, has primarily focused on sexual revictimization (i.e., child sexual abuse and adult sexual assault), which has resulted in a lack of understanding of trauma revictimization more generally. Specifically, it is unclear what factors are placing individuals with a history of child maltreatment (i.e., sexual abuse, physical abuse, and witnessing intimate partner violence [IPV]) at greater risk for subsequent adult victimization (i.e., sexual assault and IPV). Existing theoretical and empirical work on revictimization suggest that multiple risk factors are likely present within this framework (e.g., posttraumatic stress symptoms [PTSS], emotion dysregulation, and risk-taking behaviors). Prior research has suggested that PTSS are often linked with these other risk factors, and it is possible that the development of PTSS following child maltreatment may be related to the development or maintenance of additional factors that increase the likelihood of revictimization. The purpose of this review was to synthesize findings regarding risk factors that place maltreated individuals at greater risk for adult revictimization. Approximately 228 studies were identified following a thorough search of the peer-reviewed literature using multiple databases (PsycINFO, PILOTS, and Google Scholar). Each study was critically analyzed for relevance. The included studies were used in our review of prevalence, specific risk factors that have been identified, and unanswered questions in this literature. PTSS were noted to be particularly important in the revictimization framework, and thus, a novel model of revictimization was also proposed where PTSS are illustrated as being associated with the development and maintenance of other factors within the revictimization framework.

Creating an Interdisciplinary Collaborative Network of Scholars in Child Maltreatment Prevention: A Network Analysis of the Doris Duke Fellowships for the Promotion of Child Well-Being

Background

Child maltreatment is a complex problem requiring interdisciplinary collaborative research to generate innovative solutions. The Doris Duke Fellowships for the Promotion of Child Well-Being were designed to identify and nurture emerging scholars committed to child maltreatment prevention and create a supportive interdisciplinary learning network.

Objective

This paper examines connectivity within the collaborative network created by the fellowships program using longitudinal social network data.

Participants and Setting

Participants were 120 individuals selected as Doris Duke Fellows during their doctoral training at universities in the United States.

Methods

Fellows completed annual, voluntary web-based surveys to assess their interactions with other fellows during the past year. Social network analysis methods were used to assess the strength and quality of the learning network over a four-year period.

Results

Across four years of data, there were increases in the number of connections, proportion of cross-cohort connections, and proportion of interdisciplinary connections. Network analyses showed a highly connected network consisting of primarily medium- and high-quality connections between fellows from different disciplines. The number of scientific journal articles authored by two or more fellows grew substantially over time.

Conclusions

Findings indicate the collaborative network created by the fellowships program is growing and strengthening over time. The new Child Well-Being Research Network extends the fellowships network to a broader group of scholars and professionals to advance diversity, equity, inclusion, and justice in the field of child well-being research.

County-Level Relationships Between Foreign-Born Residents, Latinos, Immigration Enforcement, and Child Maltreatment Report Rates in the United States, 2015-2018

U.S. Latino and foreign-born populations show lower child maltreatment report (CMR) rates despite their low socioeconomic positions, perhaps due to protective cultural factors within these populations. However, discriminatory Immigration and Customs Enforcement (ICE) activities may attenuate such protection. We examined how ethnic and foreign-born compositions and local ICE activities were associated with community CMR rates, overall and within racial/ethnic groups (i.e., White, Black, Latino), and how these associations changed over time. We used national county-level data linking multiple administrative/archival data sources (i.e., CMR, Census, and ICE data) longitudinally for 2015 to 2018 across the United States. Multilevel (county-years, counties, and states) models estimated how percentages of Latino, percentages of foreign-born, and ICE arrest rates were related to overall and race/ethnicity-specific CMR rates among counties while adjusting for a range of demographic, socioeconomic, child care burden, health insurance, residential mobility, and urbanicity factors. Higher percentages of foreign-born residents within counties were significantly associated with lower CMR rates, both overall and within all racial/ethnic groups. These protective associations became significantly stronger over the study period. Higher percentages of Latino residents were significantly associated with lower total and White CMR rates but not with Black or Latino CMR rates. The interaction between the percentage of Latino residents and year was not significant. ICE arrest rates showed no significant associations with CMR rates. Our findings suggest that communities with more foreign-born and Latino residents may be more protective against CMRs. While the foreign-born and Latino concentrations were both independently predictive of decreased CMR rates, the protective associations of the foreign-born concentration were more consistent within racial/ethnic groups and grew stronger over time. These findings suggest the need to investigate community-level protective mechanisms that may explain these results. The null findings for ICE activity also require further research with alternative measures of discriminatory state action.

Applying the Integrative Model to Predict Intention to Use Corporal Punishment Among Low-income Parents

Child corporal punishment (CP) is associated with child physical abuse, which is a public health problem in the United States. Informed by the integrative model of behavioral prediction, this study surveyed low-income Black, Hispanic, and White parents who had children younger than 6 years old (N = 260) to identify major risk factors that determined intention to use CP to discipline children. Structural equation modeling revealed that attitudes, descriptive norms, and perceived efficacy of alternative discipline strategies were associated with intention to use CP. Additionally, parents' childhood CP frequency and past use of CP with their own children were influential distal variables that indirectly predicted CP intention. Results indicated the utility of the model in this behavioral context. Communication intervention programs targeting low-income parents should leverage perceived norms, perceived efficacy of alternative discipline strategies, and attitudes to change CP behavior.

Neighborhood Poverty, Family Economic Well-Being, and Child Maltreatment

This study sought to understand the relationships between neighborhood poverty, family monetary well-being, and child maltreatment. The specific research questions were as follows: (1) Is neighborhood poverty at age 1 related to child physical abuse, psychological abuse, and neglect at age 5? (2) Are these relationships mediated by family monetary well-being? The study relied on data from three waves (child ages 1, 3, and 5) of the Fragile Families and Child Wellbeing Study, a longitudinal birth-cohort study of 4,898 children from 20 large U.S. cities. Structural equation modeling was employed to examine mediational effects. The study found a lasting impact of neighborhood poverty on child neglect only, and this relationship was fully mediated by family monetary well-being. There was not a significant longitudinal relationship between neighborhood poverty and physical abuse or psychological abuse. Implications from the study suggest that neighborhood disadvantage impacts a families' economic well-being, and that individual-level economic supports may interrupt the pathway from neighborhood poverty to child neglect.

Is Household Unemployment Associated With Increased Verbal and Physical Child Abuse During the COVID Pandemic?

PURPOSE

The economic downturn due to the Coronavirus Disease 2019 (COVID-19) pandemic initially led to a large increase in the US unemployment rate. Being laid-off or losing a job could cause financial stress and have an impact on the relationship between parents or other adults in the home and children. We aimed to assess the effect of household unemployment on child physical and emotional abuse during the early part of the COVID-19 pandemic, with an older population of children.

METHODS

Data were from a sample of 7,555 students from 51 schools that participated in a survey administered from October to December 2020. We conducted weighted multivariable logistic regression models and report adjusted odds ratio to estimate associations between recent household unemployment and emotional and physical abuse.

RESULTS

Having a parent or other adult in the home with a job loss was associated with higher odds of emotional or physical abuse.

CONCLUSIONS

The findings are consistent with child maltreatment prevention strategies focused on alleviating economic hardship.

Community Food Insecurity and Child Maltreatment Reports: County-Level Analysis of U.S. National Data From 2009 to 2018

Current literature suggests that food insecurity increases child maltreatment risk. Yet, existing evidence is limited to individual-level associations among low-income, high-risk populations based on local, mostly urban data. This study aims to generalize prior findings to community-level associations in general populations, using national data including all urban-rural areas. We examined, for the first time, if food insecurity rates increase child maltreatment report (CMR) rates at the county level after controlling for potential confounders. We examined both within-community longitudinal changes (i.e., within-effects) and inter-community differences (i.e., between-effects) of food insecurity rates and their associations with CMR rates. We also examined differences by age, sex, race/ethnicity, maltreatment type, and urbanicity. We constructed longitudinal county-level data by linking multiple national databases, including all substantiated and unsubstantiated CMR records, the Map the Meal Gap's community food insecurity estimates, and Census data. The data covered over 96% of U.S. counties from 2009 to 2018. For analysis, we used within-between random effects models. Regarding between-effects, we found that in inter-community comparisons, higher food insecurity rates were significantly associated with increased CMR rates. This association was consistent by age, sex, maltreatment type, and urbanicity. For within-effects, we found that the association between longitudinal changes of food insecurity rates and CMR rates significantly differed by urbanicity. Specifically, longitudinal increases of food insecurity rates significantly increased CMR rates among large urban counties, but not among small urban and rural counties. Study findings highlight the importance of conducting further research to better understand the mechanisms through which food insecurity impact child maltreatment at both individual and community levels. Our community-level findings from general populations especially have significant implications for community-based programs and large-scale policies to achieve population-level impact on child well-being.

Understanding the interconnected relationships between intimate partner violence and child maltreatment: The role of maternal material hardship

BACKGROUND

Evidence indicates an association between intimate partner violence (IPV) and child maltreatment (CM). Although research shows mothers' IPV victimization is a risk factor for CM, the specific elements within IPV and CM are not well understood. Some studies suggest material hardship plays a role in the relationships between IPV and CM. However, the relationship between different typologies of IPV and CM considering material hardship has rarely been examined.

OBJECTIVE

This study fills this gap by assessing the direct effects of IPV victimization on material hardship and CM, direct effects of material hardship on CM, and indirect effects of IPV victimization on CM via material hardship with attention to typologies of IPV and CM.

METHODS

Data included responses by 3086 mothers in the Fragile Families Child Wellbeing Study.

RESULTS

Structural equation modeling showed that material hardship predicted higher risk of CM regardless of the presence of IPV or what type (child physical assault: β = 0.11, p < 0.001; child psychological aggression: β = 0.12, p < 0.001; child neglect: β = 0.06, p < 0.01). However, mothers who experienced controlling and emotional IPV had a higher risk of material hardship, and this increased their children's risk of CM (child physical assault: β = 0.02, p < 0.01; child psychological aggression: β = 0.02, p < 0.01; child neglect: β = 0.01, p < 0.05). This was the only type of IPV associated with CM through its association with material hardship.

CONCLUSIONS

The varied findings suggest that intervention efforts in families with co-occurring IPV and CM should mobilize economic support to IPV survivors with consideration of the varied effects of different types of IPV.

Associations Between State TANF Policies, Child Protective Services Involvement, And Foster Care Placement

The Temporary Assistance for Needy Families (TANF) program, which was established in 1996 and renewed in 2005, constituted a major reform of the US welfare system. Since its renewal, few studies have examined its effects on children. We used instrumental variables, two-way fixed effects, and event studies to examine the associations between state-level TANF policies, Child Protective Services involvement, and foster care placement during the period 2004-16. We found that each additional TANF policy that restricted access to benefits was associated with a 13 percent reduction in TANF caseloads. Using TANF policies as an instrument, we found that increases in TANF caseloads were associated with significant reductions in numbers of neglect victims and foster care placements. In two-way fixed effects models, restrictions on TANF access were associated with more than forty-four additional neglect victims per 100,000 child population and between nineteen and twenty-two additional children per 100,000 placed in foster care. Our findings suggest that additional research using data that capture the nuances of maltreatment should be used to investigate the relationships among TANF policies, child maltreatment, and foster care placement.

Adverse Childhood Experiences and Intimate Partner Violence; Findings From a Community Sample of Hispanic Young Adults

In the United States, a substantial proportion of the adult population (36% of women and 34% of men) from all socioeconomic and ethnic backgrounds report experiencing intimate partner violence (IPV) over the life course. Family risk factors have been linked to adolescent and young adult IPV involvement, yet few studies have examined the effect of multiple, co-occurring adverse childhood experiences (ACEs) in the stability and change of IPV behaviors over young adulthood-the period of highest risk for IPV. We investigated the relationship between the degree of ACE exposure and IPV victimization and perpetration at age 22 and two years later at age 24 among a sample of Hispanic young adults (N= 1,273) in Southern California. Negative binomial regression models compared the incident rate ratio (IRR) of past-year verbal and physical IPV victimization and perpetration of respondents with 1-3 ACE and with ≥4 ACE to their peers who reported no history of ACE cross-sectionally (age 22) and longitudinally (age 24). At age 22, participants with 1-3 and ≥4 ACE were overrepresented in all IPV behaviors and had higher IRRs of verbal and physical victimization and perpetration compared to their peers with no ACE. By age 24, respondents with a history of ≥4 ACE were at significantly greater risk for escalating IPV behaviors over this time period than their peers with 1-3 ACE and no ACE. These findings highlight the importance of investing in coordinated efforts to develop strategies that help young people cope with the downstream effects of early life adversity. Research should continue to identify what individual, community, and cultural assets that promote resilience and are promising foci of IPV prevention approaches among vulnerable populations.

Community food insecurity predicts child maltreatment report rates across Illinois zip codes, 2011-2018

PURPOSE

We examined how longitudinal changes and inter-community differences of food insecurity rates were associated with child maltreatment report (CMR) rates at the zip code level. We assessed these associations overall, by urbanicity, and within subgroups of age, sex, and maltreatment type.

METHODS

We used Illinois statewide zip code-level data from 2011 to 2018. We measured CMR rates based on Illinois child protective services records and food insecurity rates from Feeding America's Map the Meal Gap. We conducted spatial linear modeling to account for spatial dependence with controls for various socioeconomic, demographic, care burden, and instability conditions of communities.

RESULTS

Both longitudinal changes and inter-community differences of food insecurity rates were significantly associated with increased CMR rates overall and within all subgroups. These associations were significant among all large urban, small urban, and rural areas, while longitudinal changes of food insecurity rates had significantly stronger associations among small urban areas compared with other areas.

CONCLUSIONS

Communities experiencing higher food insecurity had higher CMR rates. Increases in food insecurity over time were associated with increases in CMR rates. These associations were reproduced within subgroups of child age, sex, maltreatment type, and urbanicity. Attention and collaborative efforts are warranted for high food insecure communities.

Income inequality and child maltreatment rates in US counties, 2009-2018

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.

Public policy and parent-child aggression: Considerations for reducing and preventing physical punishment and abuse

Parent-child physical aggression, including both physical punishment and abuse, remains a prevalent problem in the United States. In this paper, we briefly review the prevalence and harms of parent-child aggression and discuss changes in social norms and policies over the past several decades. Then, we discuss broad social policies influencing risk for parent-child physical aggression, policies relevant to reducing and preventing physical abuse, and policies relevant to reducing and preventing physical punishment. We close by considering future directions to strengthen research and evaluation and accelerate progress toward ending parent-child physical aggression.

Implementing Triple P during the COVID-19 pandemic with families at risk for substance use

BACKGROUND

Many studies have examined the Positive Parenting Program (Triple P), yet few have considered its effectiveness during the twin challenges of the opioid crisis and COVID-19 pandemic.

OBJECTIVE

This study examines the implementation of, and parenting outcomes associated with the Positive Parenting Program (Triple P) in 13 counties in central Ohio.

PARTICIPANTS AND SETTING

The program was provided to parents who were at heightened risk for substance use. From July 2020 through June 2021, 890 parents received services from Triple P.

METHODS

Parents completed pre- and post-test assessments of protective factors within their families and parenting behaviors. Parents also participated in qualitative interviews regarding their experiences in the program.

CONCLUSIONS

Overall, the results were promising, with improvements seen in family functioning/resilience, nurturing and attachment, parental laxness, and parental over-reactivity. Parents reported positive experiences participating in the program and felt that their relationship with their child had improved. Despite the profound, recent challenges to parenting and service provision, Triple P continues to show promise as an approach to reducing child maltreatment. Expansion of Triple P to other areas may improve parenting behaviors and reduce child maltreatment among parents at risk for substance use.

The Relative Influence of Family and Neighborhood Factors on Child Maltreatment at Critical Stages of Child Development

This study examines the impact of family and neighborhood factors on physical and psychological abuse across three developmental stages of children: early childhood (age 3), young school age (age 5), and middle childhood (age 9). Data from the Fragile Families and Child Wellbeing Study, a longitudinal national cohort study of children from 20 urban U.S. cities, are used. Path analysis is employed to investigate the longitudinal relationships between family and neighborhood context variables and abuse risk, as well as the importance of different factors at key developmental stages. Economic hardship, maternal substance use, intimate partner violence, and exposure to community violence are found to be related to child abuse risk regardless of developmental stage, while maternal depression and neighborhood informal social control are found to have impacts only within certain child development stages. Findings suggest the need for early intervention and prevention strategies that specifically target economic hardship, poverty, intimate partner violence, and exposure to community violence.

Child Maltreatment and the Child Welfare System as Environmental Factors in the International Classification of Functioning

The WHO defines child maltreatment as any form of neglect, exploitation, and physical, emotional, or sexual abuse, committed against children under the age of 18. Youth involved in the child welfare system report more maltreatment experiences and environmental turbulence (e.g., number of moves, caseworkers), placing them at greater risk for poorer physical and mental health. The International Classification of Functioning, Disability, and Health (ICF) provides a framework to describe health conditions and severity of disabilities for an individual and/or group in the context of environmental factors. The Maltreatment and Adolescent Pathways (MAP) study is a longitudinal study, assessing self-reports on variables (e.g., child maltreatment history, trauma symptoms, dating violence, and substance use) of youth in an urban child protection service system. This study focuses on 11 of the 24 MAP publications that pertain to health and functioning, which can be considered applicable to the ICF framework, following established linking rules. The purpose of this study is to analyze these MAP sub-studies, with maltreatment and involvement in the child welfare system as environmental factors that impact the functioning of child welfare-involved youth. Findings indicate significant relationships across environmental factors (i.e., child maltreatment histories, child welfare system involvement), health conditions (i.e., trauma symptomatology, psychological distress, intellectual disabilities), and functioning problems (i.e., substance use, adolescent dating violence, sexual risk-taking, coping motives, sleep problems). The interrelated nature of these factors in the MAP sub-studies suggests the value of the ICF model to a holistic health view of use to practitioners supporting system-involved youth, clarifying unattended environmental factors in guiding service provision for foster care and/or maltreated youth.

Intergenerational trauma: Parental PTSD and parent-reported child abuse subtypes differentially relate to admission characteristics in the autism inpatient collection

Autistic youth experience high rates of maltreatment. Little research has considered how distinct abuse dimensions differentially relate to meaningful outcomes, nor taken an intergenerational approach to consider how caregiver trauma and child maltreatment are related. This study sought to identify how parent-reported child abuse subtypes and parent posttraumatic stress disorder (PTSD) relate to each other and to admission characteristics upon inpatient service entry. Autistic youth (N = 527; 79% White, 21.3% girls, mean age = 12.94 years) participated in the autism inpatient collection. Parents reported on child abuse subtypes (physical, sexual, emotional) and their own PTSD, child behavior and emergency services, and parenting stress. Youth of parents with PTSD were nearly three times more likely to have parent-reported physical and emotional abuse. Autistic girls were more likely to experience parent-reported sexual abuse and a higher number of subtypes. Lower income related to higher rates of parent-reported child emotional abuse and parent PTSD. Emotional abuse associated with child behavior whereas both child physical and emotional abuse related to emergency services. Reported parent PTSD associated with child behavior and parental distress. When considered jointly, parent PTSD and number of parent-reported child abuse subtypes differentially related to child behavior and interacted to predict psychiatric hospitalizations. Intergenerational continuity of trauma is important to consider among autistic youth, and both parent-reported child abuse and parent PTSD relate to admission characteristics. Critical limitations include reliance on binary parent reports of child abuse and parent PTSD and the low representation of youth of minoritized identities. Implications for trauma-informed care are discussed.

Enhancing Early Engagement (E3) in mental health services training for children's advocacy center's victim advocates: feasibility protocol for a randomized controlled trial

Background

Child maltreatment is a major public issue in the United States, yet most children affected by abuse or neglect never engage in evidence-based practices (EBP) for child mental health. Children’s Advocacy Centers (CACs’) are uniquely situated to serve as Family Navigators who connect children impacted by maltreatment to appropriate EBPs. In fact, the CAC position of Victim Advocate mirrors the Mental Health Family Navigator national initiative.

Methods

The feasibility study protocol is to develop, implement, and evaluate web-based and consultative training for Victim Advocates to enhance early engagement in services (E3 training). The interactive web-based training embeds key targets of knowledge and skills related to family engagement, trauma, and EBP services. Participating CACs were randomized to E3 webinar-based training, E3 webinar plus consultation, or delayed training. The project will test the E3 training’s impact on key mechanisms of change (e.g., knowledge, skills) to improve rates of screening, referral, and access to EBP services. The feasibility of implementing the training program and differential impact and costs by level of training will be examined.

Discussion

The overarching goal of this project is to test the feasibility of training that is readily implemented through CACs and examine the mechanisms for improving early engagement and, ultimately, child, and adolescent mental health outcomes. Results and cost findings will be used to plan a large-scale comprehensive, mixed-methods hybrid type II effectiveness-implementation and cost-effectiveness trial of family navigator E3 training. If outcomes are positive, considerable infrastructure exists to support the scale-up and sustainability of E3 training nationwide, by embedding the training in national CAC training protocols.

Trial registration

NCT04221633

Date and version identifier

March 25, 2021; Vers. 1.0 (original); September 11, 2021; Vers 2.0 (revision); October 29, 2021; Vers. 3.0 (revision)

The association between early reports to Child Protective Services and developmental trajectories through middle childhood

BACKGROUND

Longitudinal studies on resilience among children who have experienced maltreatment indicate that resilience is multi-dimensional. However, most research consolidates diverse developmental domains comprising resilience into a single score, which does not allow for detection of potentially heterogeneous associations between risk factors and outcomes of resilience processes.

OBJECTIVE

This study seeks to improve our understanding of the association between early child maltreatment and development through middle childhood (6-12 years) using individual domains considered to be outcomes of resilience processes.

PARTICIPANTS AND SETTING

Participants are 499 children from the Longitudinal Studies of Child Abuse and Neglect.

METHODS

We used latent growth curve models to explore patterns of socialization and daily living skills, and internalizing and externalizing behaviors - outcomes of resilience processes - across three time points in middle childhood, and their association with early maltreatment, defined as referral to Child Protective Services (CPS) before age 6.

RESULTS

In fully adjusted models, children experiencing early maltreatment had poorer baseline scores in activities of daily living (-4.22, 95% CI [-7.38, -1.46]) and externalizing behavior (2.95, 95% CI [1.05, 4.86]), but maltreatment was not associated with change over time in these domains. However, maltreatment was associated with increases in internalizing behavior over time (0.42, 95% CI [0.06, 0.77]).

CONCLUSION

Heterogeneity in patterns of association between maltreatment and outcomes of resilience processes support the utility of examining developmental domains individually, versus as a composite, to identify specific targets for intervention.

Multimorbidity and polyvictimization in children - An analysis on the association of children's disabilities and long-term illnesses with mental violence and physical violence

BACKGROUND

Children's disabilities and long-term illnesses (DLTIs) are a significant risk factor in the development of maltreatment.

OBJECTIVE

The study is focused on the association of children's DLTIs with child maltreatment and poly-victimization perpetrated by parents.

PARTICIPANTS AND SETTING

The study is based on a 2013 Child Victim Survey (N = 11,364), which is a cross-sectional survey. This nationally representative survey focused on the life situation of Finnish children aged 12-17 years, as well as on experiences of violence, crime, and bullying.

METHODS

Multinomial logistic regression analysis was used to examine the association of children's DLTIs and child maltreatment.

RESULTS

Poly-victimization played a significant role in child maltreatment. Children's hearing impairment (OR 5.68, 95% Cl 2.25-14.35), physical disability (OR 3.32, 95% Cl 1.61-6.88), and mental health problems (OR 4.37, 95% Cl 1.63-11.72) increased the odds of poly-victimization more than other forms of abuse. The situation was similar with both somatic diseases (OR 1.59, 95% Cl 1.14-2.21) and psychiatric illnesses (OR 2.12, 95% Cl 1.36-2.47) in children. Further, somatic and psychiatric multimorbidity in children increased the odds of poly-victimization (OR 4.17, 95% Cl 2.25-7.75) slightly more than risk of physical abuse (OR 3.57, 95% 1.11-11.49). As control variables, child's gender and age, the family financial situation, and the parent's intimate partner violence were adjusted in all of the analyses.

CONCLUSION

Clinical professionals should consider children's multimorbidity as a potential risk factor of maltreatment. The results of the study can be used to support families and children with DLTIs.

Are Children With a Number of Disabilities and Long-Term Illnesses at Increased Risk of Mental Violence, Disciplinary Violence, and Serious Violence?

The focus of this study was on the question of whether or not children with a number of disabilities and long-term illnesses are at increased risk of child maltreatment (mental violence, disciplinary violence, and serious violence). This study was based on the Child Victim Survey of 2013 (FSD2943). The data consist of a nationally representative sample of pupils in Finland in sixth grade (12-13 years of age) and ninth grade (15-16 years of age). The sampling was undertaken as a stratified cluster by province, municipality type, and school size. The total number of respondents was 11,364. According to the logistic regression analyses, the children with at least three disabilities or long-term illnesses had an increased risk of violence compared with children with no disability: The risk of mental violence increased by 2.96 times, the risk of disciplinary violence by 4.30 times, and the risk of serious violence by 3.53 times. The effect of the category of at least three disabilities and illnesses remained statistically significant, although the analysis also accounted for several confounding factors. Thus, a child's multiple morbidity (in the case of three or more disabilities and illnesses) can be categorized as one of the major risk factors for child maltreatment. The study complements the results of previous studies concerning the effect of children's disabilities and long-term illnesses and their impact on child maltreatment. The results underline the importance of employees of health and social care having knowledge of multiple morbidity and its importance as a key factor regarding child maltreatment.

Material hardship and child neglect risk amidst COVID-19 in grandparent-headed kinship families: The role of financial assistance

BACKGROUND

COVID-19 has exacerbated material hardship among grandparent-headed kinship families. Grandparent-headed kinship families receive financial assistance, which may mitigate material hardship and reduce child neglect risk.

OBJECTIVE

This study aims to examine (1) the association between material hardship and child neglect risk; and (2) whether financial assistance moderates this association in a sample of kinship grandparent-headed families during COVID-19.

PARTICIPANTS AND SETTING

Cross-sectional survey data were collected from a convenience sample of grandparent-headed kinship families (not necessarily child welfare involved) (N = 362) in the United States via Qualtrics Panels online survey.

METHODS

Descriptive, bivariate, and negative binomial regression were conducted using STATA 15.0.

RESULTS

Experiencing material hardship was found to be associated with an increased risk of child neglect, and receiving financial assistance was associated with a decreased risk of child neglect in the full sample and a subsample with household income > $30,000. Receiving financial assistance buffered the negative effect of material hardship on child neglect risk across analytic samples, and receiving SNAP was a significant moderator in the full sample. Among families with a household income ≤ $30,000, receiving SNAP and foster care payments was associated with a decreased risk of child neglect, while receiving TANF and unemployment insurance was associated with an increased risk of child neglect. Among families with household income > $30,000, only receiving SNAP was associated with a decreased risk of child neglect.

CONCLUSIONS

This study suggests the potential importance of providing concrete financial assistance, particularly SNAP and foster care payments, to grandparent-headed kinship families in efforts to decrease child neglect risk during COVID-19.

A study on stress and resilience among hearing-impaired people during the COVID-19 pandemic

AIM

The aim of the study is to determine the acute stress and psychological resilience level of people with hearing impairment during the COVID-19 pandemic and to investigate the relationship between the grade of hearing impairment, psychological resilience and perceived stress level in this period.

METHODS

A cross-sectional study. A total of 135 hearing-impaired individuals using hearing aids (study group) and 125 healthy individuals (control group) participated. The Turkish versions of the Acute Stress Symptoms Scale (ASSS) and Brief Resilience Scale (BRS) were applied to all participants. The Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (T-AIADH) was also applied to the study group in addition to other scales. The presence of any difference between the groups in terms of ASSS and BRS scores was investigated.

RESULTS

There was a statistically significant difference between the control group and the study group in terms of ASSS results (Z = -4.4, P = .00). No statistically significant difference was found between the control group and the study group in terms of BRS scores (Z = -0.248, P = .804). Furthermore, T-AIADH scale was observed not to correlate either with ASSS or BRS (P > .05). In the study group, the change in income level after the pandemic, age and sex variables were determined as a significant predictor of ASSS.

CONCLUSION

Identifying risks and protective factors for hearing-impaired individuals at the early stage of the epidemic is considered to be of critical importance to predict the psychological impact of both the epidemic and the response to the COVID-19 health crisis and to reduce stress.

Cascades of Risk Linking Intimate Partner Violence and Adverse Childhood Experiences to Less Sensitive Caregiving During Infancy

This study evaluated if maternal intimate partner violence (IPV) had indirect effects on sensitive parenting in infancy through prenatal depressive symptoms and postpartum parenting stress and if maternal adverse childhood experiences (ACEs) moderated these indirect effects. We hypothesized that: (a) IPV would be associated with greater prenatal depressive symptoms, which would predict greater postpartum parenting stress, and ultimately less sensitive parenting and (b) the link between IPV and depressive symptoms would be strongest for mothers with high ACEs. Participants included 295 mothers and their infants who were assessed prenatally and at 12 months postpartum. Path analyses indicated that mothers with higher IPV endorsed greater prenatal depressive symptoms, which was in turn associated with postpartum parenting stress, and ultimately less sensitive parenting behavior. Moderation analyses revealed that these indirect effects varied as a function of maternal ACEs, with the link between IPV and depressive symptoms only present for mothers who reported high ACEs. Because less sensitive caregiving is often an early indicator of child maltreatment risk, understanding precursors to sensitivity is critical to increase precision in parenting interventions designed to reduce risk for maltreatment. Results may inform evidence-based preventive interventions for mothers and infants at high-risk for child abuse and neglect.

The roles of attachment and emotion dysregulation in the association between childhood maltreatment and PTSD in an inner-city sample

BACKGROUND

Most people will experience a traumatic event in their lifetime, but only a subset (<10%) will develop posttraumatic stress disorder (PTSD).

OBJECTIVE

To facilitate prevention and intervention of PTSD, it is important to understand how risk and resilience factors interact with one another to explain individual differences in risk for PTSD, especially in underprivileged groups, who often experience greater burden of trauma and PTSD.

METHOD

The current study utilized multiple and moderated regression to examine the relation between childhood maltreatment and adulthood PTSD risk in the context of various attachment patterns and emotion dysregulation in a sample (n = 856) of mostly low-income, African American participants.

RESULTS

Moderation analysis indicated that the strongest association between self-reported childhood maltreatment and PTSD symptoms was manifest in participants reporting the highest levels of both attachment anxiety and attachment avoidance (b = 0.22, 95% CI [0.15, 0.29], p < .001), whereas, among those low on both these dimensions (i.e., more securely attached participants), there was no significant association between childhood maltreatment and current PTSD (b = 0.07, 95% CI [-0.01, 0.14], p = .07). Separately, multiple regression predicting current PTSD symptoms revealed an effect size for the two attachment dimensions similar to that of emotion dysregulation, while controlling for childhood maltreatment.

CONCLUSIONS

These findings suggest more secure attachment may buffer against the deleterious effects of childhood maltreatment, and both attachment difficulties and emotion dysregulation serve as robust correlates of adulthood PTSD.

Community-Level Prevention of Childhood Maltreatment: Next Steps in a World with COVID-19

Maltreatment of children continues to be a major public health concern, with high social, economic and health burdens. Rates vary by a number of factors that can be categorized into different levels of the social ecology. Research and theory in this field point to the importance of community-level factors that can contribute to either risk or prevention of child maltreatment. The COVID-19 pandemic context creates additional risks and concerns related to child maltreatment and exacerbates risk factors that existed before: e.g., families and communities are in much worsened states of poverty, unemployment, and food insecurity; losses and grief are affecting mental health; and limitations and safety concerns are affecting in-person child protection work and more. Central to recovery from this pandemic will be the mobilization of community-level resources and the building back up of the social fabric that can support vulnerable children and caregivers. Key to this mobilization will be a better intersectional understanding of structural inequities in the child welfare system and in our communities. Efforts to dismantle structural biases and discrimination are critical to provide safety and support for families and vital for effective child maltreatment prevention. In this context, we discuss the state of the science of community-level prevention of childhood maltreatment, highlighting evidence-based community-level prevention programs and how these types of efforts may be impacted by the current COVID-19 global pandemic.

Integrating a Sport-Based Trauma-Sensitive Program in a National Youth-Serving Organization

There is a pressing need to equip youth-serving community organizations to respond to the unique needs of trauma-exposed children. Early prevention measures can be an effective means of redirecting children to self-regulatory healing, while facilitating their transition toward strength-based thriving. Sport can offer a powerful opportunity to reach these children; however there remains little information on how to effectively develop, deliver, evaluate, and sustain trauma-sensitive sport programs in a community context. The purpose of this paper is to outline a case study of integrating sport-based trauma-sensitive practices with BGC Canada's national Bounce Back League program. An interdisciplinary partnership of academic, community, and practice experts used a community-based participatory action research approach, paired with a knowledge translational approach, to guide the process of program development. Mixed methods (e.g., surveys, logbooks, interviews, focus groups, online communications) were used to generate ongoing insights of staff's training experiences, successes and challenges of program implementation, and potential impact of program on club members. Several stages of program development are described, including: (a) collaboratively planning the program; (b) piloting the program to three clubs; (c) adapting the program using pilot insights; (d) expanding the adapted program to ten clubs; and (e) creating opportunities to maintain, sustain, and scale-out practices throughout grant duration and beyond. Lessons learned regarding the leadership team's experiences in terms of developing, adapting, and integrating trauma-sensitive practices in this community context are shared.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10560-021-00776-7.

Stress and parenting during the global COVID-19 pandemic

BACKGROUND

Stress and compromised parenting often place children at risk of abuse and neglect. Child maltreatment has generally been viewed as a highly individualistic problem by focusing on stressors and parenting behaviors that impact individual families. However, because of the global coronavirus disease 2019 (COVID-19), families across the world are experiencing a new range of stressors that threaten their health, safety, and economic well-being.

OBJECTIVE

This study examined the impacts of the COVID-19 pandemic in relation to parental perceived stress and child abuse potential.

PARTICIPANTS AND SETTING

Participants included parents (N = 183) with a child under the age of 18 years in the western United States.

METHOD

Tests of group differences and hierarchical multiple regression analyses were employed to assess the relationships among demographic characteristics, COVID-19 risk factors, mental health risk factors, protective factors, parental perceived stress, and child abuse potential.

RESULTS

Greater COVID-19 related stressors and high anxiety and depressive symptoms are associated with higher parental perceived stress. Receipt of financial assistance and high anxiety and depressive symptoms are associated with higher child abuse potential. Conversely, greater parental support and perceived control during the pandemic are associated with lower perceived stress and child abuse potential. Results also indicate racial and ethnic differences in COVID-19 related stressors, but not in mental health risk, protective factors, perceived stress, or child abuse potential.

CONCLUSION

Findings suggest that although families experience elevated stressors from COVID-19, providing parental support and increasing perceived control may be promising intervention targets.

Longitudinal Understanding of Child Maltreatment Report Risks

BACKGROUND

Child maltreatment reports (CMR) are both common and strongly associated with various negative outcomes.

OBJECTIVE

To examine CMR risks by child age, early childhood context, current/cumulative economic status (welfare receipt), race, and other risk factors with a longitudinal dataset.

PARTICIPANTS AND SETTING

The CAN sample included 2,111 children having a CMR ≤ age 3, suggestive of a harmful early childhood context. The AFDC sample included 1,923 children having AFDC but no CMR ≤ age 3, suggestive of early childhood protective factors despite poverty.

METHODS

We estimated the CMR likelihood at each age from 1-17 years based on various risk factors while following up children from 1995-2009.

RESULTS

During follow-up, CMR likelihoods were substantially higher for the CAN sample than for the AFDC sample. The age-CMR relationship was strongly negative for the CAN sample (OR = 0.87, 95% CI = 0.86-0.88). This relationship was weaker for the AFDC sample (OR = 0.92, 0.89-0.95) and became non-significant for children who exited welfare. Current welfare receipt remained a strong predictor of CMR likelihoods for both CAN (OR = 2.32, 1.98-2.71) and AFDC (OR = 2.08, 1.61-2.68) samples. Prior welfare receipt moderately increased CMR likelihoods among those not currently on welfare. Controlling for other risk factors, White children had the highest likelihood of CMR. Other child and parent level vulnerabilities also increased CMR risk over time.

CONCLUSIONS

This study highlights the importance of longitudinal analytic approaches and the utility of cross-sector administrative data in improving our ability to understand and predict CMRs over time.

Sex Differences in Associations between Early Adversity, Child Temperament, and Behavior Problems

Early adversity is associated with both internalizing and externalizing problems among children, and effects of adversity on dimensions of child temperament may underlie these links. However, very little is known about the role of child sex in these processes. The current study examined if there are indirect effects of early adversity on behavior problems through dimensions of child temperament and if these indirect effects vary across child sex. Participants in this multimethod (parent-report survey, semi-structured interview, child protection records) study included 274 preschool-aged children (M _age = 50.86 months; 52% with documented case of moderate-severe maltreatment) and their primary caregivers assessed at two time-points spaced 6 months apart. Results of multi-group path analyses revealed that while anger mediated associations between lifetime stress and behavior problems for the full sample, inhibitory control and appropriate attentional allocation were significant intermediary mechanisms of lifetime stress for boys, but not for girls. Inhibitory control mediated associations between maltreatment and behavior problems for the full sample, but appropriate attentional allocation mediated these associations for boys only. Results suggest that early adversity influences child behavior problems through child temperament, particularly for boys. This work supports the perspective that temperament is influenced by characteristics of the early rearing environment, and the indirect effects of adversity on behavior problems through temperament vary across sex.

Supporting disabled parents and their families: perspectives and recommendations from parents, attorneys, and child welfare professionals

While it is well-established that parents with disabilities and their families are over-represented in the child welfare system, no known research has described the parents,' child welfare professionals,' and attorneys' perspectives on the system's capacity to support them or their recommendations for improvement. This qualitative phenomenological study involved semi-structured interviews with 15 disabled parents, 15 child welfare professionals, and 15 parent attorneys. Respondents agreed that the child welfare system lacks expertise on disability and adequate services for disabled parents, and holds negative attitudes about them. Respondents recommended robust training for professionals on parents with disabilities, and individually-tailored services for disabled parents.

Association between Maltreatment, Positive Parent-Child Interaction, and Psychosocial Well-Being in Young Children

OBJECTIVES

To explore the prevalence of maltreatment and the combined effect of maltreatment and frequency of positive parent-child interaction on psychosocial well-being in young children in China.

STUDY DESIGN

A retrospective study was conducted in 2016 in a representative sample of 20 324 children aged 3-4 years who were newly enrolled in kindergartens in Shanghai, China. All data were collected through online platforms. Parents reported the maltreatment history of their children and completed the Strengths and Difficulties Questionnaire and the Chinese Parent-Child Interaction Scale.

RESULTS

The prevalence of parent-reported child maltreatment in Shanghai was 2.70% (95% CI, 2.38-3.05). A history of maltreatment increased the risk of total difficulties (aOR, 2.36; 95% CI, 1.39-4.03) and prosocial problems (aOR, 2.31; 95% CI, 1.37-3.91). A high frequency of positive parent-child interaction had a moderating effect on the correlation between maltreatment and prosocial problems.

CONCLUSIONS

Maltreated children had an increased risk of developing psychosocial problems, particularly those with a low frequency of positive parent-child interactions. A higher frequency of positive parent-child interactions may be associated with fewer adverse outcomes in maltreated children.

Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample

BACKGROUND

Children with developmental disabilities are at heightened risk for maltreatment. However, little is known regarding the prevalence of maltreatment among specific groups, such as autism spectrum disorder (ASD) and/or intellectual disability (ID). Information about maltreatment in these groups can aid in the development of supports and prevention strategies for vulnerable children and their families.

METHODS

Using record linkage between the Department of Social Services (DSS) and the Autism and Developmental Disabilities Monitoring (ADDM) network, this study compares the prevalence and characteristics of maltreatment among children with ASD-only (n = 316), ASD and comorbid ID (ASD+ID; n = 291), ID-only (n = 1,280), and controls (n = 3,101). Behavioral correlates of maltreatment are examined.

RESULTS

Controlling for demographic factors, this study found significantly higher odds of reported and substantiated maltreatment among children with ASD-only (odds ratio = 1.86 for reported, 1.51 for substantiated), ASD+ID (odds ratio = 2.35 for reported, 1.97 for substantiated), and ID-only (odds ratio = 2.45 for reported, 2.49 for substantiated) relative to a population control group, with large effects. In particular, children with ASD+ID and ID-only were between two and three times more likely to experience maltreatment. All groups were more likely to experience physical neglect, and children in the ASD+ID and ID-only groups were more likely to experience all forms of abuse. Children in the ASD-only group were more likely to experience physical abuse. Maltreated children in the ASD-only and ID-only groups experienced more cases of physical abuse and neglect, and were victimized by more perpetrators compared to other maltreated youth. Maltreatment was associated with higher likelihood of aggression, hyperactivity, and tantrums for children with ASD.

CONCLUSIONS

Children with ASD and/or ID are at heightened risk for maltreatment. Empirically-supported assessment and intervention approaches for identifying and addressing traumatic stress related to maltreatment in ASD are urgently needed.

Household Food Insecurity and Parent-to-Child Aggression

Nearly 13 million children in the United States live in households struggling with food insecurity. Although biosocial theories suggest a strong link between the lack of food and child maltreatment, and a handful of studies have established a correlation between nutritional deficits and family violence, it is unclear if household food insecurity itself is associated with physical and psychological child abuse apart from other issues related to poverty. The current study examines this possibility by analyzing data from the Fragile Families and Child Wellbeing Study ( n = 2,330). Sixteen percent of households were food insecure, and food insecurity at Wave 3 was associated with an increased use of parent-to-child psychological and physical aggression at the follow-up interview. This relationship held even after controlling for important covariates, such as maternal depression and impulsivity. We conclude by discussing what additional research is required, as well as how our findings might intersect with social policy on this topic.

Additive Contributions of Social Information Processing and Economic Stress to Maltreatment Risk in Disadvantaged Rural Fathers

Child maltreatment is a critical concern in rural communities. Fathers perpetrate a substantial proportion of maltreatment cases and are overrepresented as perpetrators of severe physical abuse and fatalities. Despite this heightened risk, little research has examined risk of abuse and neglect among fathers in rural areas. The current study examined the contributions of social information processing (SIP) factors and economic stress to multiple indicators of maltreatment risk in a sample of 61 disadvantaged rural fathers of 2- to 6-year-old children. Results for the SIP model of maltreatment risk provide some support for its extension to fathers. Considered all together, SIP factors were associated with more inconsistent parenting and maladaptive injury prevention beliefs. Specific SIP factors of unrealistic expectations for children and poorer executive functioning were associated with more maladaptive injury prevention beliefs. With regard to economic stress, fewer economic resources were associated with greater child abuse potential, more inconsistent parenting, and poorer quality home environments, while less economic security was associated with greater child abuse potential. Analyses found evidence for independent additive effects of SIP and economic stress. Findings highlight the importance of fathers' cognition and economic stress in children's risk of physical abuse, neglect, and unintentional injuries.

Intergenerational continuity/discontinuity of child maltreatment among low-income mother–child dyads: The roles of childhood maltreatment characteristics, maternal psychological functioning, and family ecology

Despite evidence of some intergenerational continuity of maltreatment, a notable proportion of parents maltreated in childhood do not perpetuate the cycle of maltreatment. The aim of this study was to identify factors that would distinguish mother–child dyads where intergenerational continuity was present from dyads characterized by intergenerational discontinuity. The sample included 193 children and their mothers, drawn from two populations: 74 maltreated children recruited through Child Protection Services and 119 nonmaltreated children recruited among low-income families. Factors investigated included maternal childhood maltreatment, psychological functioning, and family ecology. Compared to maltreated mothers who broke the cycle of maltreatment, those who perpetuated the cycle were more likely to have experienced childhood physical neglect and multitype maltreatment, and to experience sociodemographic risk, intimate partner violence, and lack of family support. Compared to nonmaltreated mothers who maintained a nonmaltreating child-rearing environment: (a) maltreated mothers who broke the cycle were more likely to experience residential instability and lack of family support, and (b) nonmaltreated mothers whose child was maltreated were more likely to experience sociodemographic risk and lack of family support. Maternal psychological functioning did not discriminate maltreatment groups. Lending empirical support to a diathesis-stress model of poor parenting, these findings suggest that family-ecology related stress, but not maternal psychological difficulties, may create additional burden that will precipitate the risk of maltreatment intergenerational continuity.

An evaluation of welfare and child welfare system integration on rates of child maltreatment in Colorado

Policies that improve the socioeconomic conditions of families have been identified as one of the most promising strategies to prevent child maltreatment, particularly neglect. In this study, we examined the impact of integrated Temporary Assistance for Needy Families (TANF) and child welfare (CW) systems on child maltreatment-related hospitalizations and Child Protective Services investigations and substantiations in nine counties in Colorado from 1996 to 2014. Regression analyses showed TANF-CW integration was associated with subsequent year, but not second-year, increases rates of substantiated child maltreatment overall and neglect specifically (that is, there was no longer a difference in the rate two years after the change in integration). Neither unemployment nor the one- or two-year lagged effect of integration were significant for investigations or child maltreatment-related hospitalizations. Increased opportunities to interact with a family in crisis using an integrated case management model may help explain these findings. Implications for future research are discussed.

Adverse Childhood Experiences, Ethnicity, and Substance Use among College Students: Findings from a Two-State Sample

Objectives: Despite college students reporting high rates of substance use and adverse childhood experiences (ACE), few studies have examined ACE-related substance use patterns with diverse student samples. We estimated the prevalence of ACE and substance use and investigated ethnic differences in the relationship between ACE and substance use among college students from two states. Design: Data are responses (N = 7,148) on the National College Health Assessment (in California) and the College Student Health Survey (in Minnesota). Multivariable regression models assessed the associations between individual and accumulated ACE and alcohol, tobacco, marijuana, and illicit substance use and binge drinking (adjusting for age, gender, depression, and state) among non-Hispanic White, Hispanic, African American/Black, Asian Pacific Islanders, multiracial, and other students. Interaction terms were calculated to test for ethnic differences. Results: In the month preceding the survey, 22% of students used marijuana, 28% used tobacco, 75% drank alcohol; 6% used an illicit drug in the past year and 30% acknowledged past 2-week binge drinking. Although ACE were associated with all substance use behaviors (AORs ranged from 1.19 to 1.54, p < .001), there was significant ethnic variation in ACE exposure (40-52%) and the dose-response relationship between ACE and marijuana and tobacco use and binge drinking. Conclusions: The variability in ACE-related substance use patterns across ethnic groups highlights the need for research that advances our understanding of sociocultural influences in trauma response and the role that campus communities could have in the development of culturally sensitive services that address this issue.

Parents' use of physical and verbal punishment: cross-sectional study in underprivileged neighborhoods

OBJECTIVE

To estimate the past-year prevalence of parental use of verbal and physical discipline in an urban sample.

METHOD

A cross-sectional study was conducted in two underprivileged neighborhoods with nearly 80,000 inhabitants. Complex sampling was used. The households were selected by applying two-stage probabilistic sampling with stratification. A total of 401 households (sample error=0.1) were selected by maximizing the variance (p=0.5). The cluster sampling indicated 33 census units (sample error=0.05). The Brazilian Portuguese version of the WorldSAFE Core Questionnaire was used to assess parental use of moderate verbal discipline, harsh verbal discipline, moderate physical discipline, and harsh physical discipline. This questionnaire asks how often mothers (respondent) and/or their husband or partner use specific disciplinary tactics.

RESULTS

The mean age of children and adolescents was 9 years (SD: 4.5). The prevalence of harsh verbal discipline was approximately 37% (28.3% [95% CI: 23.4-33.3%] for more than three times). The prevalence of harsh physical discipline was approximately 30% (21.8% [CI: 18.2-25.4%] for more than three times). Boys had higher odds of receiving harsh physical discipline [OR: 1.56, p<0.05]. Children and adolescents with learning problems and developmental delays had higher odds of being exposed to harsh discipline than their peers without these problems. Children and adolescents with chronic health conditions (e.g., asthma) had lower odds of receiving harsh physical discipline (OR: 0.4; p<0.05).

CONCLUSIONS

Parental abuse was embedded within children and adolescents rearing practices in these two underprivileged neighborhoods.

A Randomized Trial of Home Visitation for CPS-Involved Families: The Moderating Impact of Maternal Depression and CPS History

Home visitation (HV) interventions may hold promise to improve parenting and prevent child maltreatment recidivism in families reported to child protective services (CPS) with young children, but this has rarely been studied. Findings are presented from an 18-month randomized controlled trial in which intact families ( N = 122) with at least one CPS report were provided with a facilitated connection to a paraprofessional evidence-based HV program or usual care services from child protection. Results are reported for changes in maternal stress, depression, and social support outcomes and repeat reports to CPS. No significant changes were found in maternal outcomes by group. Among nondepressed mothers or families without multiple CPS reports prior to study enrollment, HV was associated with a significantly lower likelihood of CPS report recidivism. These results indicate potential for HV to prevent maltreatment recidivism but suggest that higher intensity intervention is warranted for mothers exhibiting significant depressive symptoms or families with extensive CPS histories.

The Impact of Housing Instability on Child Maltreatment: A Causal Investigation

More than a half million children are confirmed as victims of maltreatment by the child welfare system each year. Children from unstably housed families are over-represented in child mal-treatment reports, and a growing body of evidence links housing problems to maltreatment and Child Protective Services (CPS); investigation. The present study applies two propensity score analysis approaches-greedy matching and propensity score weighting-to data from the Fragile Families and Child Well-being Study to move toward a causal explanation of child mal-treatment behaviors among mothers in low-income households. Utilizing two separate methods to correct for overt selection bias, the present study finds that housing instability leads to a small increase in maltreatment behaviors, yet this small positive net impact on child maltreatment does not fully explain the over-representation of unstably housed families in the child welfare system. Families experiencing housing problems likely have a range of needs that require earlier, targeted intervention to mitigate consequences of poverty, domestic violence, and maternal depression. Child welfare services should invest resources in housing assistance programs in-house as well as through partnerships with local public housing authorities to stabilize families, reduce housing-related strain on caregivers, and promote family preservation.

Maternal alcohol use disorder and subsequent child protection contact: A record-linkage population cohort study

We examined the relationship between a maternal alcohol-use diagnosis, and the timing of diagnosis, and child protection outcomes in a Western Australian population cohort. This analysis made use of routinely collected linked administrative health and child protection data. Those in scope for the study were women who had a birth recorded on the Western Australian Midwives Notification System (1983-2007). Women with an alcohol related diagnosis (ICD 9/10) on relevant datasets formed the exposed group. The comparison cohort were frequency matched to the exposed cohort. Generalized linear mixed models and a proportional hazards model were used to examine the relationship between a maternal alcohol-use diagnosis and subsequent child protection contact. Children of women with an alcohol-use diagnosis were at significantly increased risk of a substantiated child protection allegation (OR=2.92, 95%CI=2.71-3.14) and entry into out-of-home care (OR: 3.78, 95% CI=3.46-4.13). The highest risk of child protection contact was associated with diagnoses received during pregnancy, and in the years immediately pre- or post-pregnancy. Children whose mothers have an alcohol-use diagnosis are at increased risk of contact with child protection services. Despite current public health recommendations, some women continue to drink heavily during pregnancy. Additional work is required to identify effective strategies to reduce heavy alcohol use in this population. Further, women who have been identified to have alcohol use issues require additional support, from multiple agencies, to reduce the potential negative impacts on their child.

Community and Individual Risk Factors for Physical Child Abuse and Child Neglect: Variations by Poverty Status

Families are impacted by a variety of risk and protective factors for maltreatment at multiple levels of the social ecology. Individual- and neighborhood-level poverty has consistently been shown to be associated with higher risk for child abuse and neglect. The current study sought to understand the ways in which individual- and neighborhood-level risk and protective factors affect physical child abuse and child neglect and whether these factors differed for families based on their individual poverty status. Specifically, we used a three-level hierarchical linear model (families nested within census tracts and nested within cities) to estimate the relationships between physical child abuse and child neglect and neighborhood structural factors, neighborhood processes, and individual characteristics. We compared these relationships between lower and higher income families in a sample of approximately 3,000 families from 50 cities in the State of California. We found that neighborhood-level disadvantage was especially detrimental for families in poverty and that neighborhood-level protective processes (social) were not associated with physical child abuse and child neglect for impoverished families, but that they had a protective effect for higher income families.

Less money, more problems: How changes in disposable income affect child maltreatment

A number of research studies have documented an association between child maltreatment and family income. Yet, little is known about the specific types of economic shocks that affect child maltreatment rates. The paucity of information is troubling given that more than six million children are reported for maltreatment annually in the U.S. alone. This study examines whether an exogenous shock to families' disposable income, a change in the price of gasoline, predicts changes in child maltreatment. The findings of a fixed-effects regression show that increases in state-level gas prices are associated with increases in state-level child maltreatment referral rates, even after controlling for demographic and other economic variables. The results are robust to the manner of estimation; random-effects and mixed-effects regressions produce similar estimates. The findings suggest that fluctuations in the price of gas may have important consequences for children.

Duration in Poverty-Related Programs and Number of Child Maltreatment Reports

This study examined the relationship of a family's duration in poverty-related programs (i.e., Aid to Families with Dependent Children/Temporary Assistance for Needy Families and Medicaid) to the subject child's number of maltreatment reports while considering race and baseline neighborhood poverty. Children from a large Midwestern metropolitan area were followed through a linked cross-sector administrative database from birth to age 15. Generalized multilevel models were employed to account for the multilevel structure of the data (i.e., nesting of families within neighborhoods). The data showed a unique and significant contribution of duration in poverty-related programs to the number of maltreatment reports. The predicted number of maltreatment reports increased by between 2.5 and 3.7 times, as duration in poverty-related programs increased from 0 to 9 years. This relationship was consistent between Whites and non-Whites (over 98% Black), but non-Whites showed a significantly lower number of total maltreatment reports while controlling for duration in poverty-related programs. We were unable to find a significant association between child maltreatment reports and baseline neighborhood poverty.

Responsiveness-informed multiple imputation and inverse probability-weighting in cohort studies with missing data that are non-monotone or not missing at random

Population-based cohort studies are invaluable to health research because of the breadth of data collection over time, and the representativeness of their samples. However, they are especially prone to missing data, which can compromise the validity of analyses when data are not missing at random. Having many waves of data collection presents opportunity for participants’ responsiveness to be observed over time, which may be informative about missing data mechanisms and thus useful as an auxiliary variable. Modern approaches to handling missing data such as multiple imputation and maximum likelihood can be difficult to implement with the large numbers of auxiliary variables and large amounts of non-monotone missing data that occur in cohort studies. Inverse probability-weighting can be easier to implement but conventional wisdom has stated that it cannot be applied to non-monotone missing data. This paper describes two methods of applying inverse probability-weighting to non-monotone missing data, and explores the potential value of including measures of responsiveness in either inverse probability-weighting or multiple imputation. Simulation studies are used to compare methods and demonstrate that responsiveness in longitudinal studies can be used to mitigate bias induced by missing data, even when data are not missing at random.