Shifting definitions of emotional maltreatment: an analysis child welfare investigation laws and practices in Canada

Current issues and challenges in the definition and operationalization of child maltreatment: A scoping review

BACKGROUND

Studies show considerable variability in the definitions and operationalization of child maltreatment (CM), which limits research, policy formation, surveillance, and cross-country and cross-sector comparisons.

OBJECTIVE

To review the recent literature (2011-2021) to understand current issues and challenges in defining CM, to assist in the planning, testing and implementing of CM conceptualizations.

METHODS

We searched eight international databases. Articles were included if the substantive content was related to issues, challenges, and debates in defining CM, and the article was an original study, review, commentary, report, or guideline. The review followed methodological guidance for the conduct of scoping reviews and was reported in accordance with the PRISMA-ScR checklist. Four experts in CM conducted a thematic analysis to summarize findings. Methodological rigor of the included studies was not formally assessed.

RESULTS

We identified 7372 potentially relevant articles; 55 full-text studies were assessed for eligibility, 25 satisfied the inclusion criteria. We identified three themes: 1) strategies to define CM, including the integration of child and victim perspectives; 2) difficulties in defining specific CM types; and 3) real-world implications for research, prevention and policy.

CONCLUSIONS

Despite longstanding concerns, challenges regarding the definitions of CM persist. A small minority of studies have tested and implemented CM definitions and operationalizations in practice. The findings will inform international multi-sectoral processes to develop uniform definitions of CM, for example by highlighting the need to acknowledge challenges in defining some CM types and emphasizing the importance of considering the perspectives of children and CM survivors.

Mechanisms of Inequity: The Impact of Instrumental Biases in the Child Protection System

The structural risk perspective conceptualizes the causes of inequities in child protection system contact as unequal exposure to the structural causes of child abuse risk, combined with biases in the responses of child welfare workers and reporters. This conceptual article proposes a third mechanism of inequity: instrumental biases. It is proposed that instrumental biases operate as a third group of mechanisms that inequitably increase the involvement of some groups and not others. Instrumental biases operate through institutional structures, interpretive concepts and risk proxies that affect how risk is coded and becomes attached to particular people. Against the background of the notify-investigate model that creates poor conditions for decision making, and shapes institutional structures, instrumental biases include the miscalibration of the demand and supply of services (an institutional cause); family-specific surveillance bias and a reliance on prior case histories (a risk proxy cause); widening legal definitions of serious harm (an interpretive concept cause); and complex responses to intimate partner violence that minimize theories of IPV and the social context it occurs within (concept and risk proxy causes). It is argued that within the decision-making context of the child protection system, how services are structured and risk becomes codified has disproportionate impacts on some communities compared to others. Examples from Aotearoa New Zealand, with reference to Māori and people living in high-deprivation areas, are used to illustrate these concepts.

Fathers, mothers and family violence: Which risk factors contribute to the occurrence of child maltreatment and exposure to intimate partner violence in early childhood? Findings in a German longitudinal in-depth study

BACKGROUND

Family violence, especially child maltreatment and intimate partner violence, in early childhood has a strong impact on negative developmental outcomes. There is evidence of child, parental, and family risk factors. Less is known about paternal than maternal risk factors.

OBJECTIVE

To identify maternal and paternal predictors of family violence and predictive constellations of risk factors.

PARTICIPANTS AND SETTING

According to psychosocial adversity in a larger study, families were stratified into low-, medium- and high-risk groups. Both, mothers and fathers (n = 197/191), were investigated longitudinally across seven months using self-report questionnaires and ratings of the IFEEL Pictures.

METHODS

χ²-tests, logistic regression models, and prediction configural frequency analysis (P-CFA) were employed.

RESULTS

Univariate predictors (p < .05) were anxiety and stress in mothers, and insensitivity in recognizing negative child emotions in fathers. Within high-risk levels, paternal adverse childhood experiences (ACE) were a predictor (z = 2.92, p > .01), proven by P-CFA. Logistic regression models including family violence at baseline, sociodemographic variables, univariate predictors, and ACE of both parents revealed maternal anxiety (OR = 1.22, p < .05) and low paternal recognition of negative IFEEL Pictures (OR = 6.00, p < .05) as predictors. P-CFA identified socioemotional problems in children and low paternal recognition of negative child emotions as a predictive risk constellation (z = 2.58, p > .01).

CONCLUSION

Analysis of both caregivers in small population samples with oversampled at-risk families leads to a systemic perspective of family violence. The identified risk constellation is highly relevant for early childhood intervention.

Psychological Mediators of the Association Between Childhood Emotional Abuse and Depression: A Systematic Review

Background: A number of existing meta-analyses and narrative reviews have already addressed the relation between childhood adversity and depression, yet none of them has examined the specific link between emotional abuse and depression highlighted by previous research. It is no longer appropriate to regard childhood maltreatment as a unitary concept when considering its effects on subsequent depression; instead, subtypes of childhood maltreatment need to be scrutinized separately. This review addresses this significant gap by critically evaluating empirical studies examining psychological mediators of the relationship between childhood emotional abuse and subsequent depression. Methods: A systematic search of nine electronic databases was conducted to identify eligible studies published in English between January 1980 and January 2020. Given the heterogeneous outcomes of eligible studies and the inconsistent reporting of indirect effects, a narrative synthesis, rather than a quantitative meta-analysis, was conducted. An appraisal of methodological quality was also included. Results: We identified 34 papers, comprising 18,529 adults and 3,434 adolescents, including 888 clinical participants. Our synthesis suggests that studies on mediators in the emotional abuse-depression link have focused on five clusters of intervening variables: early maladaptive schemas, cognitive-personality variables, emotion dysregulation, interpersonal styles, and stressful negative events. Only 11 studies identified the unique contribution of emotional abuse to depression by controlling for other forms of childhood maltreatment. Conclusions: Our findings support several routes with relative consistency (e.g., early maladaptive schemas, hopelessness, negative cognitive styles, brooding rumination, overall emotion dysregulation). Because psychological mediators function as a complex interrelated system, controlling for the interrelation between them is important. The evidence for the purported mediating role of the factors identified in this review should be considered with caution given the relative dearth of large-scale, adequately powered longitudinal studies. This review proposes a comprehensive multilevel theoretical framework as a basis for future research.

Adolescent friendships predict later resilient functioning across psychosocial domains in a healthy community cohort

BACKGROUND

Adolescence is a key time period for the emergence of psychosocial and mental health difficulties. To promote adolescent adaptive ('resilient') psychosocial functioning (PSF), appropriate conceptualisation and quantification of such functioning and its predictors is a crucial first step. Here, we quantify resilient functioning as the degree to which an individual functions better or worse than expected given their self-reported childhood family experiences, and relate this to adolescent family and friendship support.

METHOD

We used Principal Component and regression analyses to investigate the relationship between childhood family experiences and PSF (psychiatric symptomatology, personality traits and mental wellbeing) in healthy adolescents (the Neuroscience in Psychiatry Network; N = 2389; ages 14-24). Residuals from the relation between childhood family experiences and PSF reflect resilient functioning; the degree to which an individual is functioning better, or worse, than expected given their childhood family experiences. Next, we relate family and friendship support with resilient functioning both cross-sectionally and 1 year later.

RESULTS

Friendship and family support were positive predictors of immediate resilient PSF, with friendship support being the strongest predictor. However, whereas friendship support was a significant positive predictor of later resilient functioning, family support had a negative relationship with later resilient PSF.

CONCLUSIONS

We show that friendship support, but not family support, is an important positive predictor of both immediate and later resilient PSF in adolescence and early adulthood. Interventions that promote the skills needed to acquire and sustain adolescent friendships may be crucial in increasing adolescent resilient PSF.

Childhood emotional maltreatment and mental disorders: Results from a nationally representative adult sample from the United States

Child maltreatment is a public health concern with well-established sequelae. However, compared to research on physical and sexual abuse, far less is known about the long-term impact of emotional maltreatment on mental health. The overall purpose of this study was to examine the association of emotional abuse, emotional neglect, and both emotional abuse and neglect with other types of child maltreatment, a family history of dysfunction, and lifetime diagnoses of several Axis I and Axis II mental disorders. Data were from the National Epidemiological Survey on Alcohol and Related Conditions collected in 2004 and 2005 (n=34,653). The most prevalent form of emotional maltreatment was emotional neglect only (6.2%), followed by emotional abuse only (4.8%), and then both emotional abuse and neglect (3.1%). All categories of emotional maltreatment were strongly related to other forms of child maltreatment (odds ratios [ORs] ranged from 2.1 to 68.0) and a history of family dysfunction (ORs ranged from 2.2 to 8.3). In models adjusting for sociodemographic characteristics, all categories of emotional maltreatment were associated with increased odds of almost every mental disorder assessed in this study (adjusted ORs ranged from 1.2 to 7.4). Many relationships remained significant independent of experiencing other forms of child maltreatment and a family history of dysfunction (adjusted ORs ranged from 1.2 to 3.0). The effects appeared to be greater for active (i.e., emotional abuse) relative to passive (i.e., emotional neglect) forms of emotional maltreatment. Childhood emotional maltreatment, particularly emotionally abusive acts, is associated with increased odds of lifetime diagnoses of several Axis I and Axis II mental disorders.

On the incidence and prevalence of child maltreatment: a research agenda

Research on child maltreatment epidemiology has primarily been focused on population surveys with adult respondents. Far less attention has been paid to analyzing reported incidents of alleged child maltreatment and corresponding agency responses. This type of research is however indispensable to know how well a child protection system works and if the most vulnerable are identified and served. Notable findings of child maltreatment epidemiological research are summarized and directions for future studies discussed.

Prevalence, co-occurrence and decennial trends of family violence toward children in the general population

OBJECTIVES

In Quebec, three population-based surveys have documented the prevalence of psychological aggression, and minor and severe physical violence toward children. This paper aims to present 1) the results of the 2012 survey with regard to the frequency and annual prevalence of violence, and 2) the trends in all three forms of violence between 1999 and 2012 according to children's age.

METHODS

The three independent surveys were all conducted through telephone interviews in 1999, 2004 and 2012 by the Institut de la Statistique du Québec and reached a total sample of 9,646 children living with a mother figure. Psychological aggression, and minor and severe physical violence were measured using the Parent Child Conflict Tactics Scales.

RESULTS

The results show that repeated psychological aggression, after having increased between 1999 (48%) and 2004 (53%), slightly decreased in 2012 (49%). Minor physical violence decreased steadily between 1999 and 2012, from 48% to 35%, and severe physical violence remained stable (6%). These three forms of violence varied by the age category of the children. Finally, the results show that the co-occurrence of the use of physical and psychological violence remained high in all three surveys.

CONCLUSION

The results are consistent with trends in North America and are discussed in terms of services to support families.

Québec Incidence Study on the situations investigated by child protective services: Major findings for 2008 and comparison with 1998

OBJECTIVE

The Québec Incidence Study on situations investigated by child protective services (QIS) has been conducted in 5-year cycles since 1998 in collaboration with all 16 Québec child protection agencies. It provides reliable estimates of the incidence and characteristics of investigated children. The aim of this paper is to discuss major findings from the QIS-2008 and to compare them with the findings from QIS-1998.

METHODS

Two representative samples of children who were investigated by child protection services during the same three-month time frame in 1998 (N = 4,771) and in 2008 (N = 3,079) were constituted. Caseworkers were asked to complete the QIS data collection form for each sampled child. Annual estimates of the number of children investigated with different characteristics were computed and compared across both cycles. Statistical tests were performed to identify significant differences.

RESULTS

While the rate of children investigated increased between 1998 and 2008, the rate of substantiated cases remained stable at 12 and 11 per 1,000 children in the population respectively. Furthermore, substantiated cases in 2008 were less severe than in 1998 along several dimensions, such as co-occurrence, emotional harm and duration.

CONCLUSION

Combined with the stability in the rate of substantiated cases, the decline in the severity of the situations seems encouraging but questions the necessity of a CPS intervention for some of these families. These findings are consistent with the ones reported in other countries, but Québec rates are below the rates estimated for Canada, where substantiated maltreatment almost doubled during the same time frame. Aspects of social policies in Québec may play a role in this situation and need to be examined in future research.

Differentiating between child protection and family support in the Canadian child welfare system's response to intimate partner violence, corporal punishment, and child neglect

Rates of reported child maltreatment nearly doubled in Canada over the period 1998-2003, an increase that reflects growing awareness of the harmful effects of an expanding array of parental behaviors, including corporal punishment, lack of supervision, and exposure to intimate partner violence (IPV). Some of these situations may benefit from voluntary family support programs outside of the child welfare system. Analyzing a sample of 11,807 investigations, this paper compares cases where the sole concern is exposure to IPV, or hitting a child, or neglect, or other forms of investigated maltreatment. Situations where exposure to IPV or potentially abusive hitting were the sole reason for investigation presented with fewer risk factors and were less likely to lead to ongoing child welfare interventions compared to other maltreatment investigations. While situations involving alleged neglect presented a higher risk profile and elicited a more intensive child welfare response than did exposure to IPV or hitting, opportunities for alternative services were nevertheless identified. The study also found that visible minority families were overrepresented in cases involving hitting and that Aboriginal families were overrepresented in cases involving neglect. Overall the findings support the development of alternative response programs in Canada.

A review of findings from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS)

OBJECTIVE

This article critically assesses and reviews analyses derived from three cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) published between 2001 and October 2011.

METHODS

Articles were retrieved from the Public Health Agency of Canada's data request records, which tracked database access and ensuing publications. The included articles were reviewed and appraised independently by the authors.

SYNTHESIS

Overall, 37 peer-reviewed articles using CIS data were included in the review. These articles revealed an increased likelihood of substantiation or placement if investigations 1) uncovered the presence of emotional or physical harm in a child, 2) involved older children, 3) identified the presence of risk indicators in caregivers, or 4) documented unstable or unsafe housing. A similar proportion of articles used a descriptive or multivariate approach to analyze CIS data, and strengths and limitations were identified.

CONCLUSION

Researchers have analyzed and interpreted the CIS extensively, although several issues are understudied - such as neglect and emotional maltreatment - especially using multivariate approaches. We hope this review will contribute to helping address gaps in the CIS literature.

Services and recurrence after psychological maltreatment confirmed by child protective services

Recurrence rates of psychological maltreatment (PM) and the services that may reduce those rates have not been systematically evaluated. The National Child Abuse and Neglect Data System was used for 2003-2007 to study a cohort of children in 18 states with PM reports first confirmed by child protective services (CPS) during 2003. PM recurrence rates after counseling and other referrals were assessed while controlling for factors associated with service referral and other maltreatment. A total of 11,646 children had a first CPS-confirmed report with PM, and 9.2% of them had a second-confirmed PM report within 5 years. Fewer than one fourth of families were referred for services after PM, with service referrals being more likely for families with poverty, drug or alcohol problems, or other violence. Controlling for these factors, counseling referral was associated with a 54% reduction in PM recurrence, but other services were not associated with statistically significant reductions. Few families in which PM was confirmed receive any services, and most services provided were not associated with reductions in PM recurrence. Clarification of key services associated with efficacious prevention of PM is needed.