Do Maltreated Children who Remain at Home Function Better than Those who Are Placed?

Lifetime poly-victimization and later bullying victimization: Associations with internalizing problems and out-of-home care

BACKGROUND

Many youth in out-of-home care (OOHC) have experienced victimization in their lifetime making them vulnerable to mental health problems and further victimization. However, little is known about mechanisms behind this continuing victimization, e.g. in the form of bullying victimization, and about possible mediating and moderating factors.

OBJECTIVE

This study examined the association between lifetime poly-victimization and later bullying victimization, as well as mediation by internalizing problems, and moderation by OOHC.

PARTICIPANTS AND SETTING

In total n = 226 youth (n = 117 OOHC, n = 109 biological families) participated, with one of their social/biological caregivers when possible, resulting in subsamples of n = 159 participants (11-21 years) for self-report, and n = 210 participants (8-21 years) for caregiver report.

METHODS

An online survey assessed self-report of bullying victimization in the past six months, as well as self-report and caregiver report of lifetime poly-victimization and internalizing problems.

RESULTS

Based on both self-report and caregiver report, youth in OOHC showed higher levels of poly-victimization and internalizing problems than youth in biological families. In self-report, a conditional direct effect of lifetime poly-victimization on bullying victimization was found for youth in OOHC, c' = 0.18, SE = 0.07, p = .007, while the association was mediated by internalizing problems for youth in biological families, ab = 0.13, 95 % CI [0.020; 10.805]. In the caregiver report, there was neither a direct nor a mediated effect of lifetime poly-victimization on bullying victimization.

CONCLUSIONS

The results stress the importance of considering the high impact of poly-victimization in predicting bullying victimization, particularly for youth in OOHC. For youth in biological families, a mediating effect of internalizing problems was found.

Longitudinal trajectories of depressive symptoms among sexually abused adolescents involved in child protection services

BACKGROUND

Childhood sexual abuse (CSA) contributes to depression in several populations. However, there is a significant lack of longitudinal research on depressive symptoms among sexually abused adolescents involved in Child Protection Services (CPS). Given the systemic challenges in CPS research, it is also unclear as to whether depressive symptoms vary according to CSA severity.

OBJECTIVE

The research aimed to determine whether depressive symptoms increased over time and to assess whether CSA severity predicted the variation of change in depressive symptoms over time.

PARTICIPANTS AND SETTING

The study included 135 sexually abused adolescents (M = 16.01, 71.9 % female) from the Maltreatment and Adolescent Pathways (MAP) Longitudinal Study who were involved in three densely populated urban CPS agencies in Ontario, Canada.

METHODS

The project involved the collection of self-report questionnaires to be completed every six-months for three years. The questionnaires encompassed measures on psychological outcomes, selected resiliency factors, and abuse and neglect history. Hierarchical Linear Modeling (HLM) via mixed model analyses were used to estimate depressive symptom trajectories.

RESULTS

We found that depressive symptoms significantly reduced over time (β. = -3.62, p < .001). Furthermore, the results showed that CSA severity significantly predicted depressive symptoms over time (β = 0.19, p < .001).

CONCLUSIONS

The findings contrast previous longitudinal research in community-based samples, suggesting a different trajectory for depressive symptoms among sexually abused adolescents involved in CPS. Moreover, the results reveal a strong association between depressive symptoms and CSA severity, further supporting early mental health screening practices.

Out-of-home placement, sleep problems, and later mental health and crime: A prospective investigation

Previous research suggests that out-of-home placement experiences increase the risk for mental health problems and criminal involvement. However, few studies have examined the mechanisms whereby out-of-home placement increases the risk for these outcomes. The present study examines whether sleep problems in part explain the relationship between childhood placement experiences and depression and anxiety and criminal arrests in adulthood. Data are from a prospective longitudinal study of 531 children with documented cases of childhood maltreatment (14% with no out-of-home placement, 68% placed solely for abuse and/or neglect, and 18% placed for maltreatment and delinquency) who were followed up into adulthood. Cases are from 1967 to 1971 from a metropolitan county in the Midwest. Sleep problems were assessed in young adulthood (M_age = 29 years). Depression and anxiety symptoms and arrest records were assessed in middle adulthood (M_age = 40 years). Structural equation modeling was used to test hypotheses. Both types of out-of-home placement experiences (for maltreatment only and for maltreatment and delinquency) predicted more sleep problems in adulthood across all models. Sleep problems in young adulthood predicted higher levels of anxiety and depression in middle adulthood, but not criminal arrests. Sleep problems mediated the relationship between placement only and internalizing symptoms and results differed for male, female, White, and Black individuals examined separately. Using court-substantiated cases of childhood abuse and neglect, this study demonstrates the long-term negative consequences of out-of-home placement experiences for sleep problems and anxiety and depression in adulthood. More attention is needed to insure adequate sleep for maltreated children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The accrual of parent reported adverse childhood experiences following a child protective services investigation: A prospective approach

INTRODUCTION

Most studies on adverse childhood experiences (ACEs) have largely employed retrospective measures from adults, eschewing prospective measures in child samples. In this paper, we tracked the accrual of ACEs during childhood in a sample of children left in-home following a Child Protection Services investigation.

METHODS

Data from three waves of the 2010 National Survey of Child and Adolescent Well-Being were used (n = 1880). ACEs included 5 forms of child maltreatment and parental domestic violence, mental health problems, substance or alcohol abuse, separation, and arrest. At each wave, parents reported child ACE exposure for the previous year. ACE accrual over three years was traced as mean scores, discrete events, and compounding risk. OLS regression predicted accrual of ACEs over time controlling for important covariates.

RESULTS

At baseline, children experienced an average of 2.2 ACEs, which increased by 3.2 by W3 (5.4 total ACEs). The predicted number of ACEs over time increased by 0.58 with each increase of 1 ACE at baseline (t = 11.74, p < .001). As compound risk, children with 0 ACE at baseline accrued an additional 1.7 by W3, while those experiencing 6 ACEs at baseline accrued 5.9 by W3. Children who experienced emotional neglect and psychological aggression accumulated a greater number of ACEs.

CONCLUSION

The average number of ACEs for in-home children increased precipitously over 3 years, and higher ACE scores at baseline were associated with greater accumulation. This indicates that retrospective measurements may not convey the unremitting nature of ACE accrual.

Self-esteem in adolescents with reactive attachment disorder or disinhibited social engagement disorder

BACKGROUND

Low self-esteem predicts negative outcomes and mediates the association between childhood adversity and mental health problems in adolescence. Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are presumably caused by early insufficient care, but their association with self-esteem is unknown.

OBJECTIVE

Investigate global and domain-specific self-esteem in adolescents with RAD or DSED.

PARTICIPANTS AND SETTING

All adolescents living in Norwegian residential youth care (RYC) (N = 306; age 12-20) were compared with a sample from the general Norwegian adolescent population (N = 10,480; age 12-20).

METHODS

Self-esteem for scholastic competence (SC), social acceptance (SA), athletic competence (AC), physical appearance (PA), romantic appeal (RA), close friendship (CF), and self-worth (SW) was investigated using the revised version of the Self-Perception Profile for Adolescents.

RESULTS

Compared to the general population, adolescents with RAD diagnosis had lower SC (mean difference, MD = -0.30, p = .020) and higher CF (MD = 0.25, p = .021), whereas adolescents with DSED diagnosis had lower SC (MD = -0.42, p = .005), SA (MD = -0.40, p = .015), AC (MD = -0.22, p = .038), PA (MD = -0.33, p = .048), and SW (MD = -0.37, p = .013). Compared to adolescents in RYC without RAD/DSED diagnoses, adolescents with DSED diagnoses had lower SA (MD = -0.42, p = .012) and SW (MD = -0.32, p = .037). More RAD symptoms were associated with lower SA (B = -0.051, p = .013), AC (B = -0.048, p = .028), RA (B = -0.053, p = .007), and CF (B = -0.052, p = .005). More DSED symptoms were associated with lower SC (B = -0.125, p = .038).

CONCLUSION

Both global and domain-specific self-esteem in adolescents with RAD or DSED should be assessed; developmental support and treatment plans should be adjusted accordingly.

Locating Infant and Early Childhood Mental Health at the Heart of Social Work

Infant and early childhood mental health (IECMH)-an interdisciplinary field dedicated to advancing understanding of early relationships, socioemotional development, and cultural and contextual influences on caregiving-offers essential tools for social workers to support the well-being of infants, toddlers, preschoolers, and their families. Even though social worker Selma Fraiberg was a founder of the field, and social workers are central to the work of assessment and intervention with young children and their caregivers in many settings, few schools of social work offer training in IECMH, and few social workers are familiar with its core principles, scholarship, and intervention approaches. In this article, faculty members from four U.S. social work programs address the vital role of IECMH in social work training, research, and practice as well as issue a call to the field to recover and renew commitment to a practice perspective and knowledge base with roots in social work. Twenty-five years ago, Social Work published a similar call, but the request has gone largely unheeded. The authors examine the changing landscape and argue that it is more important and timelier than ever for social workers to learn and integrate the relationship-based approach to promotion, prevention, intervention, and treatment offered by IECMH.

The Young Adolescent Project: A longitudinal study of the effects of maltreatment on adolescent development

The Young Adolescent Project (YAP) is an ongoing longitudinal study investigating the effects of abuse and neglect on adolescent development. It is a multidisciplinary study guided by a developmental, ecological perspective, and designed to consider the physical, social, and psychological effects of childhood maltreatment through the transition from childhood to adolescence. Four waves of data collection have been completed, ranging from early (Mean age = 10.95) to late adolescence (Mean age = 18.24). Members of the maltreated group (n = 303) were selected from new cases that had been opened by the Department of Child and Family Services, whereas the comparison group (n = 151) were not involved with child welfare but lived in the same neighborhoods as the maltreated group. The study assessed a wide variety of domains including physical development (e.g., height, weight, body mass, pubertal development); physiological reactivity (e.g., cortisol); cognitive abilities; mental health (e.g., symptoms of depression, anxiety, trauma, and aggression); risk behavior (e.g., sexual activity, delinquency, or substance use); social development (e.g., self-esteem, competence, and social support); family environment; and exposure to community violence. Overall, our findings demonstrated the pervasive and persistent adverse effects of child maltreatment both within and across domains, but they also identified maltreated youth with positive functioning. Our hope is that this work will help move us toward identifying targets for intervention to cultivate resilience and positive adaptation after early maltreatment experiences.

Adverse Childhood Experiences Associated with Children's Patterns of Out of Home Placement Over Time and Subsequent Negative Outcomes During Adolescence

Background

Out of home placement (OOHP) of welfare involved children is a critical problem associated with child abuse and neglect and household dysfunction. Few studies have also implicated greater instability in OOHP with more negative outcomes. However, several gaps remain.

Objectives

Objectives were twofold. To identify combinations of adverse childhood experiences that are associated with OOHP - based on both duration of OOHP and change in actual placement during each time point, among welfare involved youth. The second objective was to understand long-term negative outcomes during adolescence that are associated with greater placement instability.

Methods

Data come from the National Survey of Child and Adolescent Wellbeing (n = 1,657). Multinomial logistic regression was used to evaluate adverse childhood experiences that were associated with specific patterns of OOHP. Multivariate regression models were estimated to evaluate delinquency, aggression as well as depressive and trauma symptoms during adolescence that were associated with specific patterns of OOHP.

Results

There were six categories of OOHP found in the sample: 1) no OOHP, 2) OOHP one time, 3) OOHP two times, 4) OOHP two times with change in placements, 5) OOHP three times, and 6) OOHP three times with change in placement. Longer duration of OOHP was associated with more adversity exposure. Longer duration and more change in placement were associated with the most negative outcomes.

Conclusions

Findings demonstrate the need for future testing of these findings in prevention trials.

Harsh physical punishment as a mediator between income, re-reports and out-of-home placement in a child protective services-involved population

Poverty is consistently associated with a higher risk of experiencing child maltreatment, and children from poor families are the majority of children involved in child protective services (CPS). However, the mediators in the relationship from income to CPS involvement are not entirely understood. Using theoretically-informed mediating path models and data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), this study tests the role of harsh physical punishment as a mediator between family income and CPS involvement. CPS involvement was measured by subsequent report of maltreatment and removal to out-of-home care. The direct paths from income to re-report and to removal were significant; with higher income associated with lower risk of report and removal. Lower income was significantly associated with higher rates of harsh physical punishment. However, harsh punishment did not mediate the relationship between income and the outcomes. These results suggest that even within a population primarily comprised of low-income families, lower income is a risk for subsequent reports and removals as well as a risk for higher rates of harsh physical punishment. However, in this sample harsh physical punishment is not the mechanism that results in higher subsequent-reports or removal rates.

Disentangling the effect of out-of-home care on child mental health

BACKGROUND

Children in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children's mental health outcomes from the effects of the adverse circumstances that led to their admission to care.

OBJECTIVE

This research investigated the association between care placement and the presence of child mental health problems after controlling for children's pre-care experiences. It also identified factors associated with mental health problems among children in care.

PARTICIPANTS AND SETTING

The sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159).

METHODS

The mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers.

RESULTS

The odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032).

CONCLUSIONS

These findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.

Developmental Outcomes of Foster Children: A Meta-Analytic Comparison With Children From the General Population and Children at Risk Who Remained at Home

Foster care is often preferred to other placement options for children in the child welfare system. However, it is not clear how the developmental outcomes of foster children relate to children in other living arrangements. In this study, a series of meta-analyses are performed to compare the cognitive, adaptive, and behavioral functioning of children placed in foster care (n = 2,305) with children at risk who remained with their biological parents (n = 4,335) and children from the general population (n = 4,971). A systematic literature search in PsycINFO, Medline, ERIC, and ProQuest identified 31 studies suitable for inclusion (N = 11,611). Results showed that foster children had generally lower levels of functioning than children from the general population. No clear differences were found between foster children and children at risk who remained at home, but both groups experienced developmental problems. Improving the quality of foster care and future research to identify which children are best served by either foster care or in-home services are recommended.

Self-Report of Health Problems and Health Care Use among Maltreated and Comparison Adolescents

The study aims were to compare maltreated and comparison adolescents' health problems and to identify how individual, family and home characteristics and maltreatment status affect adolescents' self-report of health status and health care use. The sample was 224 maltreated adolescents (mean age = 18.3 years) and 128 comparison adolescents (mean age = 18.15 years). Comparison adolescents reported more cold and pain symptoms during the previous 30 days but no differences in other physical health problems, self-assessment of their physical and mental health or health care use compared to maltreated adolescents. Girls were more likely to have had a dental checkup, to have seen a psychological counselor, and to self-identify their physical health as poor compared to boys. Older adolescents were less likely to have had a medical checkup or seen a psychological counselor than younger adolescents. A history of maltreatment was not related to health or health care disparities for adolescents growing up in the same low-income environment as adolescents without a maltreatment report. The environmental context and geographical location in which these adolescents grew up may be the primary driver in their health behaviors and health problems and not the experience of maltreatment.

Behavior problems of children in foster care: Associations with foster mothers' representations, commitment, and the quality of mother-child interaction

This study investigated different environmental and contextual factors associated with maltreated children's adjustment in foster care. Participants included 83 children (52 boys), ages 1-7 years, and their foster caregivers. Quality of interaction with the foster caregiver was assessed from direct observation of a free-play situation; foster caregiver attachment state of mind and commitment toward the child were assessed using two interviews; disruptive behavior symptoms were reported by foster caregivers. Results showed that quality of interaction between foster caregivers and children were associated with behavior problems, such that higher-quality interactions were related to fewer externalizing and internalizing problems. Foster caregivers' state of mind and commitment were interrelated but not directly associated with behavior problems of foster children. Type of placement moderated the association between foster caregiver commitment and foster child behavior problems. Whereas greater foster caregiver commitment was associated with higher levels of adjustment for children in foster families (kin and non-kin), this was not the case in foster-to-adopt families. Finally, the associations between foster child behavior problems and history of maltreatment and placement related-risk conditions fell below significance after considering child age and quality of interaction with the foster caregiver. Findings underscore the crucial contribution of the foster caregiver-child relationship to fostering child adjustment and, thereby, have important implications for clinical services offered to this population.

Differences in caregiver-reported health problems and health care use in maltreated adolescents and a comparison group from the same urban environment

Maltreated youth have a high prevalence of acute and chronic mental and physical health problems, but it is not clear whether these problems are related to maltreatment or to a disadvantaged environment. To compare health status and health care use of maltreated youth who had an open case with child protective services to comparison youth living in the same community, we conducted a secondary analysis of caregiver reports for 207 maltreated adolescents (mean age 11.9 years) and 142 comparison adolescents (mean age 12.3 years) living in urban Los Angeles, using questionnaire data from a larger longitudinal study framed in a socio-ecological model. Caregivers included biological parents, relatives, and unrelated caregivers. Analyses included t-test, MANOVA, chi-square, and multivariable logistic regression. Caregivers reported similar rates of physical health problems but more mental health problems and psychotropic medicine use in maltreated youth than in the comparison youth, suggesting that maltreated youths' higher rates of mental health problems could not be attributed to the disadvantaged environment. Although there were no differences in health insurance coverage, maltreated youth received preventive medical care more often than comparison youth. For all youth, having Medicaid improved their odds of receiving preventive health and dental care. Attention to mental health issues in maltreated adolescents remains important. Acceptance of Medicaid by neighborhood-based and/or school-based services in low-income communities may reduce barriers to preventive care.

Kinship care for the safety, permanency, and well-being of children removed from the home for maltreatment

BACKGROUND

Every year a large number of children around the world are removed from their homes because they are maltreated. Child welfare agencies are responsible for placing these children in out-of-home settings that will facilitate their safety, permanency, and well-being.However, children in out-of-home placements typically display more educational, behavioural, and psychological problems than do their peers, although it is unclear whether this results from the placement itself, the maltreatment that precipitated it, or inadequacies in the child welfare system.

OBJECTIVES

To evaluate the effect of kinship care placement compared to foster care placement on the safety, permanency, and well-being of children removed from the home for maltreatment.

SEARCH METHODS

We searched the following databases for this updated review on 14 March 2011: the Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE, PsycINFO, CINAHL, Sociological Abstracts, Social Science Citation Index, ERIC, Conference Proceedings Citation Index-Social Science and Humanities, ASSIA, and Dissertation Express. We handsearched relevant social work journals and reference lists of published literature reviews, and contacted authors.

SELECTION CRITERIA

Controlled experimental and quasi-experimental studies, in which children removed from the home for maltreatment and subsequently placed in kinship foster care were compared with children placed in non-kinship foster care for child welfare outcomes in the domains of well-being, permanency, or safety.

DATA COLLECTION AND ANALYSIS

Two review authors independently read the titles and abstracts identified in the searches, and selected appropriate studies. Two review authors assessed the eligibility of each study for the evidence base and then evaluated the methodological quality of the included studies.Lastly, we extracted outcome data and entered them into Review Manager 5 software (RevMan) for meta-analysis with the results presented in written and graphical forms.

MAIN RESULTS

One-hundred-and-two quasi-experimental studies,with 666,615 children are included in this review.The 'Risk of bias' analysis indicates that the evidence base contains studies with unclear risk for selection bias, performance bias, detection bias, reporting bias, and attritionbias, with the highest risk associated with selection bias and the lowest associated with reporting bias. The outcome data suggest that children in kinship foster care experience fewer behavioural problems (standardised mean difference effect size -0.33, 95% confidence interval (CI) -0.49 to -0.17), fewer mental health disorders (odds ratio (OR) 0.51, 95% CI 0.42 to 0.62), better well-being (OR 0.50,95% CI 0.38 to 0.64), and less placement disruption (OR 0.52, 95% CI 0.40 to 0.69) than do children in non-kinship foster care. For permanency, there was no difference on re unification rates, although children in non-kinship foster care were more likely to be adopted(OR 2.52, 95% CI 1.42 to 4.49), while children in kinship foster care were more likely to be in guardianship (OR 0.26, 95% CI 0.17 to 0.40). Lastly, children in non-kinship foster care were more likely to utilise mental health services (OR 1.79, 95% CI 1.35 to 2.37).

AUTHORS' CONCLUSIONS

This review supports the practice of treating kinship care as a viable out-of-home placement option for children removed from the home for maltreatment. However, this conclusion is tempered by the pronounced methodological and design weaknesses of the included studies.

Parenting Attitudes, Family Environments, Depression, and Anxiety in Caregivers of Maltreated Children

This study evaluated parenting attitudes, family environments, depression, and anxiety in a sample of primarily minority urban mothers to better understand maltreating mothers (n = 83), who retain custody of their children and how they are similar to and different from foster mothers (n = 50), kin caregivers (n = 52) of maltreated children, and comparison mothers (n = 100) from the same communities. Maltreating mothers were distinguished by their much higher levels of depression and anxiety from other mothers. In addition, like foster mothers, maltreating mothers were less likely to approve of corporal punishment. Foster mothers were higher in organization and lower in empathy than other groups. There were no differences by race/ethnicity on study dimensions. Higher education, however, was related to more favorable parenting attitudes and family environments. Practice implications related to appropriate services are suggested.

Parenting Attitudes, Family Environments, Depression, and Anxiety in Caregivers of Maltreated Children

This study evaluated parenting attitudes, family environments, depression, and anxiety in a sample of primarily minority urban mothers to better understand maltreating mothers (n = 83), who retain custody of their children and how they are similar to and different from foster mothers (n = 50), kin caregivers (n = 52) of maltreated children, and comparison mothers (n = 100) from the same communities. Maltreating mothers were distinguished by their much higher levels of depression and anxiety from other mothers. In addition, like foster mothers, maltreating mothers were less likely to approve of corporal punishment. Foster mothers were higher in organization and lower in empathy than other groups. There were no differences by race/ethnicity on study dimensions. Higher education, however, was related to more favorable parenting attitudes and family environments. Practice implications related to appropriate services are suggested.