Predictors of re-entry into the child protection system in Singapore: a cumulative ecological-transactional risk model

Disruptive behaviors, antisocial attitudes, and aggression in young offenders: Comparison of Adverse Childhood Experience (ACE) typologies

BACKGROUND

Adverse Childhood Experiences (ACE) are associated with many deleterious outcomes in young offenders. There is a dearth of studies examining its effects on young offenders' antisocial attitudes, disruptive behaviors and aggression, risk factors for delinquency and reoffending.

OBJECTIVE

This study examined ACE patterns and their association with the above factors in young offenders.

PARTICIPANTS AND SETTING

1130 youth offenders (964 males; M_age = 17.57 years), provided self-reports on ACEs, antisocial attitudes, disruptive behavior ratings and aggression.

METHOD

Latent Class Analysis was performed on 12 self-reported ACEs, followed by Analyses of Covariance on each of the measures.

RESULTS

Four classes - Low ACE, Indirect Victims, Abusive Environment, and Polyvictimized - were identified. Polyvictimized youths had the highest levels of conduct problems (M = 70.35, ps < .05) and proactive aggression (M = 0.45, ps < .05) but did not differ from youths in Abusive Environment in reactive aggression (M = 1.02, p = .69), oppositional problems (M = 65.15, p = .18), and antisocial attitudes (M = 26.95, p = .21). Indirect Victims had lower levels of conduct problems (M = 64.80, p < .05) and antisocial attitudes (M = 24.35, p < .05) than Polyvictimized youths but higher levels of these outcomes than the Low ACE group.

CONCLUSIONS

Our findings showed that ACEs patterns vary in their effects on antisociality and disruptive behaviors. The novel finding was that childhood victimization does not have to be direct, as indirect victimization significantly impacted factors important to delinquency and reoffending.

Driving for Success in Family Reunification-Professionals' Views on Intervention

Family reunification is a complex process and is consensually considered the best solution for children in care, as soon as the family has changed the dysfunctional patterns that prevent child safety and well-being. Intervention throughout the entire process is crucial to the success of family reunification. This study aimed to explore and understand child protection professionals' views on factors influencing (un)successful family reunification trajectories. Using a qualitative design, 33 Portuguese child protection professionals participated in five focus groups. The thematic analysis revealed a set of influential factors within three different systemic levels: child, family, and child welfare system. The latter level was clearly predominant, pointing to the powerful role of the intervention as a vehicle for successful family reunification. The results showed the relevance attributed by the professionals to some main intervention guidelines, children-professionals' relationships, multisystemic assessment and intervention, coordinated work of intervention teams, and sufficient time between the court decision and the child's re-entry into the family home. The need for early intervention and its continuity after the child's reintegration into the home also emerged as relevant factors. This study provides in-depth knowledge of professionals' views on the intervention process, thus contributing to a comprehensive understanding of (un)successful family reunification trajectories.

A Systematic Literature Review of the Contribution Accumulation Makes to Psychological and Physical Trauma Sustained through Childhood Maltreatment

The pervasive effects of cumulative harm resulting from adverse childhood experiences influence all aspects of an individual’s life course. Research highlights a relationship between accumulation and trauma symptomology across all domains of harm and risk. A systematic literature review was conducted to explore and synthesize the current evidence base for the contribution accumulation makes to psychological and physical injury of childhood trauma. A search was conducted relevant to two areas of interest: (a) “cumulative harm” or “cumulative trauma” and (b) “consequences and outcomes”. Database searches and further manual searches yielded a total of 1199 articles, and 12 studies satisfied all the inclusion criteria. Only studies that were peer-reviewed and published between January 2011 and January 2022 were included. The evidence from the review indicated that multiplicity and polyvictimization, parental history and intergenerational transmission of trauma, systemic cumulative harm, and developmental lifespan outcomes were associated with the likelihood and impact of the accumulation of physical and psychological injury. The findings of this review contribute valuable knowledge to allow for a better understanding of the physical and psychological impact of accumulated and chronic childhood trauma. This knowledge will improve intervention, prevention, and management strategies for helping professionals working with traumatized or vulnerable children and adults.

Relationship between Adverse Childhood Experiences and substance use in youth offenders in Singapore

BACKGROUND

Adverse Childhood Experiences are associated with worse outcomes in delinquency and substance use.

OBJECTIVE

Current research is overwhelmingly from Western perspectives, leaving a gap in non-Western, low crime-rate jurisdictions. Moreover, there exists a gap in characterizing the effect of ACE frequency on delinquency. We extend existing research by examining relationships between ACE and substance use in youth offenders in Singapore.

PARTICIPANTS AND SETTING

The study included 790 youth offenders (669 males, M_age = 17.59 years) from a longitudinal study on youth offending.

METHODS

Multiple regression was performed to examine relationships between self-reported ACEs and substance use. Latent Class Analysis was conducted to identify classes of substance use onset. The relationship between these classes and cumulative ACEs and ACE frequency were then tested using multiple regression.

RESULTS

Youth offenders who consume alcohol (B = 0.66, p = .002) and illicit drugs (B = 0.38, p = .02) had more cumulative and more frequent ACEs than those who do not. Moreover, we found a positive relationship between ACEs and substance use frequency. Those who started taking substances in childhood had significantly more ACEs and had worse drug dependency problems than those who started later (t = 5.93, p < .0001). Additionally, there was a positive relationship between ACEs and drug use dependency (B = 0.11, p = .03).

CONCLUSIONS

Our findings highlight the importance of ACEs as risk factors for substance use. This underscores the need for comprehensive screening and treatment of ACEs and substance use in the rehabilitative context.

Validation and further development of a risk assessment instrument for child welfare

BACKGROUND

Although many child maltreatment risk assessment instruments have been implemented in child welfare organizations, thorough studies on their predictive validity are scarce.

OBJECTIVE

To examine (1) the predictive validity of a risk assessment instrument that has been widely implemented in the Netherlands, and to examine (2) whether the actuarial risk estimation could be improved and simplified to widen the instrument's applicability to different organizations serving different populations.

PARTICIPANTS AND SETTING

The sample comprised risk assessments (N = 3,681) performed for families enrolled at one of five child welfare agencies in the Netherlands between January 2015 and December 2017.

METHODS

In a follow-up period of at least one year, child maltreatment was operationalized as whether or not child protection orders, residential care, or hotline reports occurred. Area Under the Curve values were calculated to determine the predictive accuracy of the risk classifications. Chi-square Automatic Interaction Detection was used to develop a new risk classification based on a new cumulative risk variable.

RESULTS

The original risk classification and the newly developed and simplified risk classification showed a similar discriminative accuracy for the different outcome measures: Area Under the Curve values were .68 and .69 for child protection orders, .62 and .63 for residential care, and .58 and .60 for hotline reports, respectively.

CONCLUSIONS

The original and new risk classification of the instrument had a medium predictive validity with the latter being simpler, more widely applicable, and based on more valid risk factors.

Exploring the interrelatedness of risk factors for child maltreatment: A network approach

BACKGROUND

Theories on the etiology of child maltreatment generally focus on the interaction between multiple risk and protective factors. Moreover, the quadratic model of cumulative risk describes a threshold at which the risk of child maltreatment increases exponentially, suggesting a synergistic effect between risk factors.

OBJECTIVE

This study explored the interrelatedness of risk factors for child maltreatment.

PARTICIPANTS AND SETTING

The sample consisted of risk assessments performed for both high-risk families (n = 2,399; child protection services) and lower risk families (n = 1,904; community outreach services).

METHODS

Network analyses were performed on parental risk factors. Three networks were constructed: a cross-sample network, a high-risk network, and a lower risk network. The relations between risk factors were examined, as well as the centrality of each risk factor in these networks. Additionally, the networks of the two samples were compared.

RESULTS

The networks revealed that risk factors for child maltreatment were highly interrelated, which is consistent with Belsky's multi-dimensional perspective on child maltreatment. As expected, risk factors were generally stronger related to each other in the high-risk sample than in the lower risk sample. Centrality analyses showed that the following risk factors play an important role in the development of child maltreatment: "Caregiver was maltreated as a child", "History of domestic violence", and "Caregiver is emotionally absent".

CONCLUSIONS

We conclude that studying the interrelatedness of risk factors contributes to knowledge on the etiology of child maltreatment and the improvement of both risk assessment procedures and interventions for child maltreatment.

Responding to the accumulation of adverse childhood experiences in the wake of the COVID-19 pandemic: implications for practice

In early 2020, the world as we knew it began to change dramatically and rapidly with the COVID-19 outbreak. Social distancing restrictions and lockdown measures have been the most effective course of action and an inarguably imperative approach at this time. However, in trying to keep the global population safe, social distancing measures unwittingly placed children already experiencing maltreatment and disadvantage in harm’s way. This paper will consider the evidence base which attests to the importance of considering the accumulation of adversity when seeking to understand risk and impact of child maltreatment and disadvantage. Given the unique and unprecedented circumstances which have accompanied the COVID-19 outbreak, and the dearth of research pertaining to the impact of pandemics on child welfare, the paper draws on an emerging body of literature about the effect of natural disasters, conflict and significant global events on child maltreatment. The paper synthesises the research to date in order to call attention to the cumulative impact of the COVID-19 pandemic on children already experiencing abuse and neglect. The paper concludes with an outline of the implications for practice in the helping professions.

Five-Year Review of Patients Presenting with Non-Accidental Injury to a Children’s Emergency Unit in Singapore

Introduction: There is an increasing trend of physical child abuse cases reported in Singapore. Children presenting to the Emergency Department with injuries require a high index of suspicion for clinicians to distinguish those that are abusive in nature. Materials and Methods: A retrospective study of children with diagnosis of NAI presenting to KK Women’s and Children’s Hospital (KKH) from June 2011 to May 2016 was conducted. Results: There were 1917 cases reported from 1730 subjects, of  which: 8.8% of subjects had repeat visits; 55.2% of cases were male; and mean age was 7.69 years. Racial demographics were: Chinese 45.5%, Malay 33.4%, Indian 15.4% and Others 5.9%. The most frequent injuries sustained were head and neck (50.8%), limbs (32.2%), and chest (5.7%). Of the type of injuries, 55% had contusions, 21% had cane marks, 16% had lacerations, 4.4% had burn marks and 1% sustained fractures. Males were more likely to be caned (P <0.001); 54.9% of cases were admitted and 38.9% were discharged. Cases that presented without a parent (P <0.001), were known to Child Protective Service (P <0.001), or had a history of  parental substance abuse (P = 0.038), mental illness in caregiver (P = 0.021), or domestic violence (P <0.001) were more likely to require admission. Conclusion: Analysing these factors provide a better understanding of  the presentation of  NAI cases, including 'red flags' and vulnerable groups who should have better protection. Key words: Physical abuse, Presentation of child abuse, Risk factors of child abuse

Factors associated with child protection recurrence in Australia

The aim of the current research was to advance understanding of child protection in Australia by examining the factors associated with recurrence of child protection notifications to the formal child protection system. Extant research has been primarily undertaken in the USA and it is important to understand whether similar factors associated with recurrence actually hold in the Australian context. Administrative data were obtained for a sample of 9608 children first subject to a screened-in report in 2011-12. Children were followed for 12 months. Cox Proportional Hazard models were used to measure associations between 26 independent variables and four types of recurrence: subsequent reports, subsequent investigations, subsequent substantiations, and subsequent intervention. Factors associated with recurrence in Australia were broadly similar to those identified in other jurisdictions, including reports and substantiation for neglect, younger age, prior child protection involvement in the household, and parental characteristics including drug use, mental health problems, and history of maltreatment as a child. As in previous studies, post-investigative service provision was positively associated with recurrence. In prior US research, race did not predict recurrence. However, in the present study, Indigenous Australian children were significantly more likely to be subject to all types of recurrence measured. Future research on recurrence should aim to disentangle the complex relationships between child protection recurrence, child maltreatment, and service delivery. Recurrence is not a good proxy indicator of child safety. The findings have implications for the equity of recurrence-based risk assessment tools as they are applied to indigenous populations.

Family profiles of maltreated children in Singapore: A latent class analysis

Children who enter the child protection system often have complex family problems and have experienced early adverse experiences. Using latent class analysis, this study aimed to identify family classes of child protection cases in Singapore, to ascertain the prevalence of these family classes, and to test the association of family class membership to subsequent recurrence of harm. A sample of 440 cases who entered the Child Protective Service in Singapore was analyzed based on eight familial factors on the household and caregiver levels. A four-class solution was found to demonstrate the best fit: (a) the large household group was intergenerational and majority lived with extended family members, (b) the harsh parenting group showed high levels of parenting problems and the caregiver justifying his abuse/neglect, (c) the high criminality group had high levels of caregiver substance abuse and caregiver arrest and incarceration history, and (d) the low disadvantage group rated low on all the familial factors. A Cox Regression revealed that in comparison to the low disadvantage group, the harsh parenting group was twice as likely to have recurrence of harm. There were also differences across family classes with regard to age at entry into child protection, gender composition and abuse types. The findings and practice implications are discussed.

Cumulative risk effect of household dysfunction for child maltreatment after intensive intervention of the child protection system in Japan: a longitudinal analysis

Background

Building an effective casework system for child maltreatment is a global issue. We estimated the effect of household dysfunction (i.e., interparental violence, caregiver mental health problems, and caregiver substance abuse) on child maltreatment to understand how to advance the current framework of child welfare.

Methods

The sample comprised 759 children (1- to 17-year-old; mean age was 10.6; 404 boys and 355 girls) placed in temporary custody units (one of the strongest intervention of the Japanese child protection system). Caseworkers from 180 units across 43 prefectures completed questionnaires on children and their family and were asked whether a child maltreatment report had been made after cancelation of custody in a 15-month follow-up period. The relations of household dysfunction and maltreatment reports were assessed using the Cox proportional hazard model.

Results

About half (48.4%) of the children had been placed in the unit because of maltreatment, and 88.3% had a history of victimization. Seventy-six cases had maltreatment reports after cancelation. We entered household dysfunction variables individually into the model, and each had a significant relationship with maltreatment reports (hazard ratios for interparental violence, caregiver mental health problem, and substance abuse were 1.69, 1.69, and 2.19, respectively) after covariate adjustment. When treating these three variables as cumulative risk score model of household dysfunction, the hazard ratio increased with increasing number of score (1.96 for score two; 2.35 for score three; score 0 as reference).

Conclusions

Greater household dysfunction score is a risk of maltreatment after intensive intervention. It is imperative to construct systems facilitating cooperation between child and adult service sectors and to deliver seamless services to children and families. Our findings provide child protect services with risk-stratified interventions for children at victimization risk and promote adult-focused services to be proactive in prevention or intervention for adults with perpetration risk.

Electronic supplementary material

The online version of this article (10.1186/s12199-018-0703-6) contains supplementary material, which is available to authorized users.

The role of strengths in anger and conduct problems in maltreated adolescents

Despite multi-type maltreatment, some individuals demonstrate positive adaptation and continue to develop in a healthy way. A multitude of strength factors have been linked to adaptive functioning and resilience, but this has not been adequately examined in maltreated adolescent's psychosocial functioning. This study sought to examine the role of strengths such as having talents/interests, family relationships, educational support, the role of the recognition and application of these strengths, and the role of multi-type maltreatment on anger control and conduct problems. One hundred and thirty participants (61 males; 69 females) aged 13-19 years old were rated using the Singapore version of Child and Adolescent Needs and Strengths (CANS) tool. The results revealed that certain strengths were associated with anger and conduct problems, but the recognition and application of strengths emerged as a consistently significant predictor for both outcomes. Hence, to understand and apply one's strengths may be equally as important as merely possessing those strengths. This study extends current understanding of the importance of strengths with a group of maltreated adolescents in an Asian context. Adopting a person-centered and strength-based approach will further enhance the effectiveness of interventions and improve outcomes for maltreated adolescents living in residential care.

The complexity of child protection recurrence: The case for a systems approach

OBJECTIVE

Research on child protection recurrence has found consistent child, family, and case characteristics associated with repeated involvement with the child protection system. Despite the considerable body of empirical research, knowledge about why recurrence occurs, and what can be done to reduce it, is limited.

METHOD

This paper reviews the empirical literature and analyses the approaches of prior recurrence research. Four related conceptual challenges are identified: (1) a tendency to conflate child protection recurrence with repeated child maltreatment; (2) uncertainty about how best to operationalize and measure child protection recurrence in research; (3) inconsistency between prevailing explanations for the most frequently observed patterns of recurrence; and (4) difficulty in developing coherent strategies to address child protection recurrence based on research.

RESULTS

Addressing these challenges requires a greater consideration of the effects of decision-making in the child protection system on recurrence. This paper proposes a methodology based in systems theory and drawing on existing administrative data to examine the characteristics of the child protection system that may also produce recurrence.

Cumulative risk hypothesis: Predicting and preventing child maltreatment recidivism

Although Child Protective Services (CPS) and other child welfare agencies aim to prevent further maltreatment in cases of child abuse and neglect, recidivism is common. Having a better understanding of recidivism predictors could aid in preventing additional instances of maltreatment. A previous study identified two CPS interventions that predicted recidivism: psychotherapy for the parent, which was related to a reduced risk of recidivism, and temporary removal of the child from the parent's custody, which was related to an increased recidivism risk. However, counter to expectations, this previous study did not identify any other specific risk factors related to maltreatment recidivism. For the current study, it was hypothesized that (a) cumulative risk (i.e., the total number of risk factors) would significantly predict maltreatment recidivism above and beyond intervention variables in a sample of CPS case files and that (b) therapy for the parent would be related to a reduced likelihood of recidivism. Because it was believed that the relation between temporary removal of a child from the parent's custody and maltreatment recidivism is explained by cumulative risk, the study also hypothesized that that the relation between temporary removal of the child from the parent's custody and recidivism would be mediated by cumulative risk. After performing a hierarchical logistic regression analysis, the first two hypotheses were supported, and an additional predictor, psychotherapy for the child, also was related to reduced chances of recidivism. However, Hypothesis 3 was not supported, as risk did not significantly mediate the relation between temporary removal and recidivism.

Impact of Childhood Maltreatment on Recidivism in Youth Offenders: A Matched-Control Study

The purpose of the study is to examine the impact of childhood maltreatment on youth offender recidivism in Singapore. The study used case file coding on a sample of 3,744 youth offenders, among whom about 6% had a childhood maltreatment history. The results showed that the Youth Level of Service/Case Management Inventory 2.0 (YLS/CMI 2.0) ratings significantly predicted recidivism for nonmaltreated youth offenders, but not for maltreated youth offenders. Using propensity score matching, the result from a Cox regression analysis showed that maltreated youth offenders were 1.38 times as likely as their nonmaltreated counterparts to reoffend with a follow-up period of up to 7.4 years. The results implied that the YLS/CMI 2.0 measures were insufficient for assessing the risk for recidivism for the maltreated youth offenders, and that other information is needed to help assessors use the professional override when making the overall risk ratings.