A reporting and response model for culture and child maltreatment

Decision-Making Factors in the Mandatory Reporting of Child Maltreatment

The goal of this exploratory study was to investigate the factors that may impact a social worker's decision to report suspected child maltreatment. A volunteer sample of social workers (n = 439) from Ontario, Canada completed an online survey where they reviewed three hypothetical vignettes of potential child maltreatment (exposure to intimate partner violence, physical, emotional). Social workers responded to questions regarding their decision-making and the factors which would impact their reporting decision (legal requirements, ethnicity of caregivers, circumstances around disclosure, reporting history, consultation or supervision, field of practice). A series of multiple logistic regression analyses were performed for each version of the three vignettes. The study found that consultation or supervision were significant predictors in social worker's decision to report suspected child maltreatment. Peer consultation may assist with emotional regulation and provide an outside perspective to guide decision-making.

Asian-Canadian children and families involved in the child welfare system in Canada: A mixed methods study

OBJECTIVE

The purpose of the study is to understand the similarities and differences in child welfare involvement for Asian- Canadian (East and Southeast Asian) versus White-Canadian children and families involved in the child welfare system in Canada, and to consider the implications and recommendations for service. This mixed methods study began by replicating this author's previous study that found significant differences in the case characteristics and services used by Asian compared to non-Asian families in the child welfare system. The present study used a mixed method approach to further build a comprehensive descriptive understanding of Asian-Canadian children and families involved in the child welfare system at national and local levels.

METHODS

Secondary data analysis of the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) was conducted to identify the case characteristics (such as referral source, investigation type, and primary maltreatment type) and short-term service outcome (such as substantiation decision and decision to transfer to ongoing child protection services) of child maltreatment investigations involving Asian-Canadian children and families in the child welfare system. The results were presented to focus group participants in a workshop, and a semi-structured interview guide was used to document child welfare workers' experience with and perception of Asian-Canadian service users.

RESULTS

The results indicated substantial differences between Asian- Canadian and White-Canadian children and families investigated by child welfare agencies in respect to the household composition, maltreatment type, substantiation decision and decision to transfer to ongoing child protection services. Child welfare workers validated the results from secondary data analysis of the CIS-2008 and offer a broader cultural and structural context for understanding child welfare involvement with Asian-Canadians.

CONCLUSION

Asian-Canadian children and families bring a diversity of cultural values and family norms. This study prompts further consideration for social work practice and policies in working with Asian-Canadian children and families involved in the child welfare system.

Examining Child Welfare Decisions and Services for Asian-Canadian Versus White-Canadian Children and Families in the Child Welfare System

Using administrative child welfare data from the Ontario Child Abuse and Neglect Data System (OCANDS), this study compared the profiles of Asian-Canadian and White-Canadian children and families that experienced a case closure after an investigation instead of being transferred to ongoing child protection services (CPS). Child protection investigations involving Asian-Canadian and White-Canadian children and families that were transferred to ongoing CPS presented a different profile of case characteristics and caregiver and child clinical needs. Asian-Canadian children and families received ongoing CPS for over a month longer than White-Canadian children and families and were less likely (odds ratio [ OR] = 0.39) to be reinvestigated for any form of maltreatment-related concerns within 1 year after case closure. It appears that child protection investigations involving Asian-Canadian children and families are less likely to be closed prematurely than White-Canadian children and families, and the child protection system may be meeting the needs of Asian-Canadian communities. Alternatively, it is possible there is unaccounted biases that may be reflective of systemic problem of discriminative practices in the child protection system. Further research is needed to explore this phenomenon.

Cultural considerations and child maltreatment: in search of universal principles

Cultural diversity poses challenges within the health care setting, particularly regarding the question of how health professionals can resolve the tension between respecting cultural norms or child-rearing practices and the importance of determining what constitutes harm and child maltreatment. Cultural competency and respect for cultural diversity does not imply universal tolerance of all practices. The United Nations provides a standard of universal child rights, protecting them from harmful practices. Pediatric providers must respect cross-cultural differences while maintaining legal and ethical standards of safety and wellbeing for children, promoting evidence-based prevention of maltreatment, and advocating for child wellness across all cultures.

"Who can you tell?" Features of Arab culture that influence conceptualization and treatment of childhood sexual abuse

The literature on child sexual abuse reflects growing recognition of the manner in which culture impacts the conceptualization, experience, and treatment of such cases. Despite heightened visibility of Arab Americans within the United States, population due to recent media attention, little empirical research exists on the occurrence of child sexual abuse within this population. Arab culture is often characterized by an emphasis on collectivism and familial obligations, and such features may prove to either facilitate or impede assessment and treatment of child sexual abuse, depending on how they are manifested. In terms of reporting child sexual abuse, cultural values pertaining to shame and honor as well as the stigma attached to mental health problems may influence the response to abuse. As such, enhancing the cultural competence of the therapist is key to facilitating effective cultural practice. Empirical research is required to investigate and substantiate these concepts as they relate to child sexual abuse in Arab-American populations.

Preventing the recurrence of maltreatment

In the context of the federal child welfare performance measurement system, recurrence of maltreatment refers to circumstances in which children that have previously been substantiated as victims of abuse or neglect experience another incident of substantiated maltreatment. Multiple episodes of maltreatment can lead to: (1) more serious short and long term negative consequences, (2) entry into the juvenile justice system, and (3) juvenile delinquency. In this literature review the authors summarize the research on child, family, and systemic factors related to maltreatment recurrence and promising practices for improving performance. Promising practices aimed at preventing recurrence of maltreatment include interventions at multiple levels (e.g., the child, caregiver, family, and agency) and include a range of service modalities.

Childhood maltreatment among Hispanic women in the United States: an examination of subgroup differences and impact on psychiatric disorder

Prevalence rates of childhood maltreatment among Hispanic women in the United States are presented separately for nativity status and ethnic origin subgroups, and the associations between different types of maltreatment and the development of anxiety and depressive disorders are examined. Analyses used self-report data from 1,427 Hispanic women who participated in the National Latino and Asian American Survey. Foreign-born Hispanic women compared to U.S.-born Hispanic women reported significantly lower rates of sexual assault and witnessing interpersonal violence, and a significantly higher rate of being beaten. Ethnic subgroups reported similar rates of maltreatment, with the exception of rape. Bivariate analyses were remarkably consistent in that regardless of nativity status or ethnic subgroup, each type of maltreatment experience increased the risk of psychiatric disorder. In multivariate models controlling for all types of victimization and proxies of acculturation, having been beaten and witnessing interpersonal violence remained significant predictors of both disorders, but sexual abuse increased risk of anxiety only. A significant interaction effect of family cultural conflict and witnessing violence on anxiety provided very limited support for the hypothesis that acculturation moderates the influence of maltreatment on mental health outcomes. Implications for culturally relevant prevention and intervention approaches are presented.

Ethnic/racial differences in the prevalence of injurious spanking and other child physical abuse in a National Survey of Adolescents

Limited research has examined whether similar patterns in injurious spanking and other forms of child physical abuse (CPA) exist across specific ethnic/racial groups. The authors examined and compared differences in the lifetime prevalence of injurious spanking and CPA in two national samples of adolescents across ethnic/racial groups and over time. Participants were 4,023 youth (12-17 years) and 3,614 youth (12-17 years) who participated in the 1995 National Survey of Adolescents (NSA) and 2005 National Survey of Adolescents-Replication (NSA-R), respectively. Adolescents, who were identified through random digit dial procedures, completed a telephone interview assessment. Results indicated significant ethnic/racial variation across groups in reports of injurious spanking in the NSA and the NSA-R samples; however, significant differences were not observed within groups between the two samples over time. Ethnic/racial differences also were found between groups in reports of CPA in the NSA-R sample. Limitations and future directions of this research are discussed.

Cutaneous signs of child abuse

Maltreatment of children is a major public health crisis, and it is estimated that each year more than 3 million children are victims of abuse. Safeguarding the welfare of children is a priority, and it is the moral and ethical responsibility of healthcare professionals to detect cases of abuse and intervene appropriately to prevent further harm. Clinicians are often challenged to differentiate signs of child abuse from skin conditions that mimic maltreatment. Because cutaneous injury represents the most recognizable and common form of abuse, dermatologists are often called upon to help distinguish signs of intentional injury from skin conditions that mimic maltreatment. However, few resources specific to dermatologic signs of abuse exist to aid in diagnosis. A review of the literature will provide an educational resource to assist dermatologists and other clinicians in differentiating cutaneous signs of child abuse, including physical and sexual abuse, from mimickers of inflicted injury.

LEARNING OBJECTIVE

After completing this learning activity, participants should be able to distinguish signs of intentional injury from skin conditions that mimic maltreatment and understand the clinician's role in the diagnosis and reporting of cases of suspected child abuse.

The Effect of Gua Sha Treatment on the Microcirculation of Surface Tissue: A Pilot Study in Healthy Subjects

CONTEXT

Gua Sha, therapeutic surface frictioning that intentionally raises transitory petechiae and ecchymosis, is a traditional East Asian healing technique also known as cao gio, coining, scraping, and spooning. There are case reports in Western literature but no studies on the physiological effects of Gua Sha.

OBJECTIVE

To study the microcirculatory effects of Gua Sha on the skin and subcutis in humans to elucidate physiological mechanisms responsible for the clinically observed pain-relieving effect of this treatment

DESIGN

Laser Doppler imaging (LDI) was used to make sequential measurements of the microcirculation of surface tissue before and after Gua Sha treatment in 11 healthy subjects. The effect of Gua Sha treatment on the microcirculation of surface tissue was expressed as changes from baseline in arbitrary perfusion units (PU).

SETTING

The study was conducted at the Department of Nephrology, Unit of Circulation Research, University Hospital of Essen, Germany.

SUBJECTS

Subjects were volunteers from the nursing and physician staff of the Kliniken Essen.

INTERVENTION

A single Gua Sha treatment was applied to an area of each subject's back.

OUTCOME MEASURES

Change in microcirculation was measured in PUs. Change in myalgia was subjectively reported and confirmed by manual palpation.

RESULTS

Gua Sha caused a fourfold increase in microcirculation PUs at the treated area for the first 7.5 minutes following treatment and a significant increase in surface microcirculation during the entire 25 minutes of the study period following treatment (P < .001). Females showed significantly higher rates of response than males (P = .003). Each subject experienced immediate decrease in myalgia in both the site treated, in the related distal control site, and in some cases, other distal sites. Pain relief persisted to some extent up to the follow-up visit. There were no adverse reactions.

CONCLUSION

Gua Sha increases microcirculation local to a treated area, and that increase in circulation may play a role in local and distal decrease in myalgia. Decrease in myalgia at sites distal to a treated area is not due to distal increase in microcirculation. There is an unidentified pain-relieving biomechanism associated with Gua Sha.

Cultural factors in decision-making about child physical abuse: identifying reporter characteristics influencing reporting tendencies

OBJECTIVE

This study examined cultural factors that may influence child physical abuse reporting. Relevant cultural factors such as the respondents' ethnic identity and corporal punishment acceptability were investigated as proximal variables of ethnicity that affect child physical abuse reporting tendencies.

METHOD

Participants consisted of 378 Caucasian, Hispanic, and African American college students. Participants read 12 vignettes that varied the ethnicity of the child and described a parent using physical punishment with the child. Participants' level of ethnic identity and their acceptance of different discipline practices were also assessed. Data were analyzed using multiple regression procedures.

RESULTS

The ethnicity of the respondent was a significant predictor of reporting tendencies for African American respondents only. For African Americans, higher levels of ethnic identity and acceptance of corporal punishment were significant mediators of reporting tendencies, which influenced the relationship between ethnicity and likelihood to report a child of the same ethnicity.

CONCLUSION

The results of this study indicate that ethnic minorities may not share similar cultural values and may differ in their degree of adherence to certain cultural variables. These results demonstrate how cultural variables that influence reporting tendencies may not apply across ethnic groups. Therefore, specifying relevant cultural variables is essential to understanding the relationship between ethnicity and reporting tendencies.

Racial variation in self-labeled child abuse and associated internalizing symptoms among adolescents who are high risk

One thousand and ten Non-Hispanic White, African American, Hispanic, and Asian Pacific Islander youth who were high risk and receiving public sector services were interviewed regarding history of child emotional and physical abuse and current internalizing symptoms. The study examined whether race moderated the association between adolescents' reports of specific parent behaviors and their self-labeling as victims of abuse. The study also examined whether reports of parental behaviors or self-labeled abuse better predicted internalizing symptoms, and whether these associations differed by race. When reporting punitive parent behavior, Non-Hispanic White youth were more likely to describe themselves as abused compared to Asian Pacific Islanders. Reported punitive parental behaviors accounted for more variance in internalizing symptoms than did self-labeled abuse. Reports of parent behaviors were more strongly related to concurrent internalizing symptoms among ethnic minority youth than among Non-Hispanic White youth. Results are discussed in the context of cultural competence in identification of child abuse.

An event history analysis of recurrent child maltreatment reports in Florida

OBJECTIVE

The purpose of this study was to (a) describe the timing of maltreatment recurrence and (b) measure associations between child demographics and characteristics of initial reports with recurrent maltreatment.

METHOD

Using administrative data from the Florida Department of Children and Families, case histories of 189,375 children with an initial maltreatment report in 1998 or 1999 were examined using event history techniques, also known as survival analysis, to assess the relationship between predictor variables and the likelihood and timing of recurrence. Specifically, data were analyzed using descriptive and multivariate analytic methods, including life-table analysis and logistic regression analysis.

RESULTS

Over 26% of the sample had a maltreatment recurrence during the 2-year follow-up period, and the risk of recurrence was greatest in the first 4 months after the initial incident. Results also suggest the presence of unique associations between recurrence and a child's race/ethnicity and age, as well as indication level, maltreatment type, and service disposition as specified in the initial report.

CONCLUSIONS

Results indicate that recurrent reports are more likely for young and White children whose first report resulted in a substantiation of neglect and the provision of in-home preventive services. This research highlights the importance of further investigating the relationship between chronic maltreatment and other influential variables.

Perceptions of child maltreatment by parents from the Indian subcontinent: challenging myths about culturally based abusive parenting practices

Clinicians and researchers emphasize the importance of recognizing differential cross-cultural definitions of child maltreatment, cautioning awareness that some ethnic groups may use harsher methods to discipline their children. Using a mixed-method research approach, based on questionnaire and focus group data, 29 parents of South Asian descent provided input on their attitudes toward child discipline, maltreatment, and neglect. Study findings suggest that South Asian parents do not differ significantly from other populations in their judgment of appropriate parenting approaches; that is, persistent and excessive use of physical discipline was considered to be inappropriate, behaviors of parents that may have negative emotional consequences for children were recognized as inappropriate, and lack of proper supervision of children was seen as a concern. Notably, though, participants voiced their reluctance to contact child protective services should they encounter families struggling with abuse. Implications for practice and directions for future research are suggested.