The Temporal Impact of Economic Insecurity on Child Maltreatment: A Systematic Review

Longitudinal Impacts of Housing Cost Burden on Physical and Psychological Aggression of Children From Age 3 to 15

Housing cost burden is stressful for families, interfering with healthy, positive parenting. The present study uses data from the Future of Families and Child Wellbeing Study to examine the relationship between housing cost burden and aggressive parenting with children age 3 to age 15. Latent growth curve modeling finds that both types of aggressive parenting behaviors decline on average, but that housing cost burden contributes to significant ongoing risk. Results indicate within-time associations between housing cost burden and psychological aggression and associations both within- and across-time between housing cost burden and physical aggression. Housing cost burden poses a significant risk factor for families, and child maltreatment prevention approaches must incorporate strategies for addressing housing cost burden.

Perpetrator characteristics and firearm use in pediatric homicides: Supplementary Homicide Reports - United States, 1976 to 2020

BACKGROUND

Describe trends in perpetrator characteristics and firearm use in pediatric homicides across the United States.

METHODS

Multiply-imputed data from the Federal Bureau of Investigation's 1976-2020 Supplementary Homicide Reports were used to estimate perpetrator characteristics (sex, age, and relationship to victim) and firearm use in pediatric homicides. Descriptive analyses were stratified by victim age group, sex, race, and five-year time periods.

RESULTS

Family members were the most common perpetrator of infant and toddler (ages 0-4) and child (ages 5-12) homicides, whereas acquaintances accounted for the majority of adolescent (ages 13-19) homicides. Perpetrator characteristics vary across victim sex and race, particularly among adolescents. Despite overall stability, there were changes in perpetrator characteristics from 1976 to 2020. There was a sustained increase in the proportion of homicides committed with a firearm. In 2016-2020, the proportion of firearm-involved homicides was an all-time high for infant and toddler (14.8%), child (53.1%), and adolescent victims (88.5%).

CONCLUSIONS

Policy interventions that improve family stability and well-being may be most effective at preventing infant, toddler, and child homicides, whereas programs that target peer and community relationships, as well as policies that focus on firearm access, may be more crucial for preventing adolescent homicides.

Reliability and validity of the short version of the childhood abuse self report scale in Chinese college students

BACKGROUND

The reliability and validity of the current scale for measuring childhood abuse in China are worrying. The development of the Short Version of the Childhood Abuse Self Report Scale (CASRS-12) helps to change this situation, but the effectiveness of the tool has not yet been tested in Chinese participants. This study aims to test the reliability and validity of the CASRS‑12 in Chinese college students.

METHODS

A total of 932 college students were investigated, of whom 418 were investigated for the first time, and only the CASRS‑12 was filled out. In the second survey, 514 participants filled out the CASRS‑12, Depression Scale, Self-esteem Scale and Subjective Well-being Scale in turn. After 4 weeks, 109 participants were selected for retest.

RESULTS

Each item of the CASRS‑12 had good discrimination. Exploratory factor analysis and confirmatory factor analysis (χ2/df = 4. 18, RMSEA = 0. 079, CFI = 0. 95, TLI = 0. 94, IFI = 0. 95, NFI = 0. 94) all supported the four-factor structure of the scale, and the cumulative contribution rate of variance was 76.05%. Cronbach's α coefficient and retest reliability were 0.86 and 0.65, respectively. Childhood abuse was positively correlated with depression (r = 0. 42, p < 0.01), and negatively correlated with self-esteem (r=-0. 33, p < 0.01) and subjective well-being (r=-0. 32, p < 0.01).

CONCLUSION

The Chinese version of CASRS‑12 meets the measurement standard and could be used to measure the level of childhood abuse of Chinese college students.

Making a way out of no way: The importance of improving financial instability among African American kinship care families

Close attention should be given to the increased reliance on kinship care to provide out-of-home care for vulnerable children and youth because although these families have various strengths, they also frequently face financial instability and experience material hardship. Living in poverty and experiencing material hardship are linked to an array of negative outcomes, including physical and mental health problems, elevated parental stress, and children's academic difficulties and social and behavioral problems. This study examined African American families who are providing informal kinship care with the aim of developing a nuanced understanding of the financial characteristics, challenges, and coping strategies of these families. Data for this study were obtained from two sources: (1) an exploratory sequential mixed-method pilot study and (2) the National Financial Capability Study. It was found that most caregivers in the pilot reported their family resources were only seldom or sometimes adequate to cover their household's basic needs. Some caregivers reported being unaware of public benefits and community resources available for kinship care families, and they had difficulties navigating the system. Additionally, family members' love and support for each other helped them to cope with financial instability. Using a nationally representative dataset, predicted probabilities for three types of financial instability were higher among households with demographic characteristics of kinship care families including difficulty covering expenses, having income that exceeds expenses, and having emergency savings. Implications for practice, policy, and future research are discussed.

Childcare Subsidy Employment and Copayment Requirements and Child Maltreatment

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

Material hardship in the postpartum year: Links to child maltreatment

BACKGROUND

Millions of mothers with young children in the U.S. struggle to afford basic needs. Material hardships such as inadequate food, housing, and medical care increase risk for child maltreatment as mothers face heightened physical and emotional strain.

OBJECTIVE

The present study applied a person-centered approach to understand unique subtypes of material hardship experienced by at-risk mothers in the postpartum year, and links from hardship subtypes to subsequent child maltreatment.

PARTICIPANTS AND SETTING

The sample included at-risk mothers who gave birth in one of 20 large American cities 1998-2000 and retained custody of their children at age 1 and 3 (N = 3966).

METHOD

Latent class analysis (LCA) identified subtypes of material hardship; mean maltreatment scores were estimated across classes.

RESULTS

LCA identified four hardship subtypes with differential risks for maltreatment. Compared to "Stable" mothers, "Cost-Burdened" mothers - who displayed high levels of missed rent and utility payments - were significantly more likely to psychological abuse (χ2 = 5.04, p < 0.05) or neglect (χ2 = 4.46, p < 0.05) their children. "Severely Housing Insecure Mothers" - characterized by elevated rates of doubling up, eviction, and homelessness - were significantly more likely to engage in physical assault (χ2 = 16.25, p < 0.001), psychological aggression (χ2 = 11.15, p < 0.01), and neglect (χ2 = 17.55, p < 0.001).

CONCLUSIONS

Difficulty maintaining stable and affordable housing is associated with elevated risk of child maltreatment. Efforts to prevent child maltreatment must incorporate access to housing screening and supports, particularly among families with infants.

The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters

OBJECTIVE

To assess the counts of infant maltreatment-related medical encounters at a large medical system during a 21-month span of the COVID-19 pandemic.

METHODS

Retrospective data for this study came from all inpatient and emergency department medical encounters for infants from January 1, 2016, through November 30, 2021, at a single children's hospital system in California. Distributions of medical encounters were tabulated and plotted over time. Interrupted time series models were used to evaluate changes in child maltreatment medical encounters.

RESULTS

Medical encounters for infants with child maltreatment diagnoses increased following the onset of COVID-19. Monthly counts of encounters with indicated maltreatment trended upward following the start of the pandemic. Interrupted time series models showed that the count of maltreatment encounters increased 64% with the onset of COVID-19.

CONCLUSIONS

We found an increase in infant maltreatment medical encounters during a 21-month period following the onset of COVID-19. These findings suggest that the pandemic may have adversely affected the safety of infants and ongoing work is needed to understand better the pandemic impacts on child maltreatment.

"The pandemic only gave visibility to what is invisible": a qualitative analysis of structural violence during COVID-19 and impacts on gender-based violence in Brazil

BACKGROUND

The COVID-19 pandemic produced alarming rates of disease and mortality globally, yet few nations were as severely impacted as Brazil. The pandemic also exposed and exacerbated persistent forms of structural violence across Brazil, which complicated gender-based violence (GBV) prevention and response efforts. While structural violence is not new, the systemic pressure and uncertainty introduced by COVID-19 intensified the detrimental impact of structural violence on the lives of Brazilians impacted by GBV. This work qualitatively investigated how the COVID-19 pandemic amplified structural violence and GBV in Brazil.

METHODS

We analyzed key informant interviews (KII) conducted with 12 service providers working in sectors related GBV prevention and response in Roraima, Boa Vista, and Rio de Janeiro. Interviews were audio-recorded, transcribed, and translated from Portuguese or Spanish into English, before applying deductive and inductive coding approaches through a collaborative data reduction process. The theoretical lens of structural violence outlined by Farmer and Rylko-Bauer guided the thematic development.

RESULTS

Analyses identified three themes. First, structural violence manifests as policies of inaction and erasure, which reduce the opportunity for upward social mobility among GBV survivors including Black women, trans persons, and people who live in the favelas. Policies of inaction and erasure fail to acknowledge/adequately respond to the significant health and safety needs of these communities. Second, structural violence is a fundamental cause of violence against women and children. Finally, service providers described community driven responses that address the dire survival needs (i.e., food insecurity) imposed by COVID-19, within a context of structural violence. These community driven responses were innovative, agile, and based on dire needs expressed to, and observed by, the service providers interviewed.

CONCLUSION

This analysis highlights how the COVID-19 pandemic exacerbated existing forms of structural violence prevalent throughout Brazil. Findings stress the urgency with which the Brazilian government and international organization must act to support community driven programs that strive to address the most basic human needs.

Has the relationship between community poverty and child maltreatment report rates become stronger or weaker over time?

BACKGROUND

Poverty is among the most powerful predictors of child maltreatment risk and reporting. To date, however, there have been no studies assessing the stability of this relationship over time.

OBJECTIVE

To examine whether the county-level relationship between child poverty rates and child maltreatment report (CMR) rates changed over time in the United States in 2009-2018, overall and across of child age, sex, race/ethnicity, and maltreatment type.

PARTICIPANTS AND SETTING

U.S. Counties in 2009-2018.

METHODS

Linear multilevel models estimated this relationship and its longitudinal change, while controlling for potential confounding variables.

RESULTS

We found that the county-level relationship between child poverty rates and CMR rates had intensified almost linearly from 2009 to 2018. Per one-percentage-point increase in child poverty rates, CMR rates significantly increased by 1.26 per 1000 children in 2009 and by 1.74 per 1000 children in 2018, indicating an almost 40 % increase in the poverty-CMR relationship. This increasing trend was also found within all subgroups of child age and sex. This trend was found among White and Black children, but not among Latino children. This trend was strong among neglect reports, weaker among physical abuse reports, and not found among sexual abuse reports.

CONCLUSIONS

Our findings highlight the continued, perhaps increasing importance of poverty as a predictor of CMR. To the degree that our findings can be replicated, they could be interpreted as supporting an increased emphasis on reducing child maltreatment incidents and reports through poverty amelioration efforts and the provision of material family supports.

Maltreatment, harsh parenting, and parent-adolescent relationships during the COVID-19 pandemic

The COVID-19 pandemic disrupted multiple aspects of family life, including normative tendencies for adolescents to establish independence from the family. This disruption has had profound, but variable impacts on parent-adolescent relationships, strengthening them in some circumstances and increasing the risk for harsh parenting and maltreatment in others. Factors that moderated this influence include a family's financial situation and pandemic-related job loss, pre-existing characteristics of the parent-child relationship, and parent and adolescent mental health. Further research is needed to examine the mechanisms through which the pandemic continues to influence parent-adolescent relationships, with attention to policy-related impacts.

Prolonged school closure during the pandemic time in successive waves of COVID-19- vulnerability of children to sexual abuses - A case study in Tamil Nadu, India

Objectives

The Tamil Nadu government mandated several stay-at-home orders, with restrictions of varying intensities, to contain the first two waves of the COVID-19 pandemic. This research investigates how such orders impacted child sexual abuse (CSA) by using counterfactual prediction to compare CSA statistics with those of other crimes. After adjusting for mobility, we investigate the relationship between situational factors and recorded levels of cases registered under the Protection of Children from Sexual Offences Act (POCSO). The situational factors include the victims' living environment, their access to relief agencies, and the competence and responsiveness of the police.

Methods

We adopt an auto-regressive neural network method to make a counterfactual forecast of CSA cases that represents a scenario without stay-at-home orders, relying on the eight-year daily count data of POCSO cases in Tamil Nadu. Using the insights from Google's COVID-19 Community Mobility Reports, we measure changes in mobility across various community spaces during the various phases of stay-at-home orders in both waves in 2020 and 2021.

Results

The steep falls in POCSO cases during strict stay-at-home periods, compared with the counterfactual estimates, were -72% (Cliff's delta -0.99) and -36% (Cliff's delta -0.65) during the first and second waves, respectively. However, in the post-lockdown phases, there were sharp increases of 68% (Cliff's delta 0.65) and 36% (Cliff's delta 0.56) in CSA cases during the first and second waves, with concomitantly quicker reporting of case registration.

Conclusions

Considering that the median delay in filing CSA complaints was above 30 days in the mild and post-intervention periods, the upsurge of cases in the more relaxed phases indicates increased occurrences of CSA during strict lockdowns. Overall, higher victimization numbers were observed during the prolonged lockdown-induced school closures. Our findings highlight the time gap between the incidents and their registration during the strict lockdown phases.

The Impact of Increased Minimum Wage on Child Neglect Varies by Developmental Age of Child

Children in poverty are at significantly greater risk of experiencing child maltreatment. Family economic security policies, such as minimum wage laws, offer a promising prevention strategy to support low-income families. This study utilized data from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study, to examine the effect of changes in state-specific minimum wage laws on maternal self-reported child maltreatment and material hardship as it varies by developmental age of the child. A series of fixed effects models with an interaction between the minimum wage and the age of the focal child were used to estimate if there was variation by developmental period of the impact of minimum wage laws on the following outcome variables: all domains of child maltreatment, maternal work-related stress, reported material hardship, aggravation in parenting, and maternal depression. Results revealed significant effects of increased minimum wage on maternal self-reported child neglect and material hardship when children are 3 years of age, and this relationship became non-significant as children aged. No effect was observed by age for other forms of child maltreatment nor any other outcome variables. Study findings suggest minimum wage laws may have differential effects on child neglect depending on the developmental period in which they are received.

Early childhood maltreatment and profiles of resilience among child welfare-involved children

Given the high burden of child maltreatment, there is an urgent need to know more about resilient functioning among those who have experienced maltreatment. The aims of the study were to: 1) identify distinct profiles of resilience across cognitive, emotional, behavioral, and social domains in young children involved in the child welfare system; and 2) examine maltreatment characteristics and family protective factors in relation to the identified resilience profiles. A secondary analysis was conducted using data from the National Survey of Child and Adolescent Well-Being (NSCAW-II). Latent profile analysis was performed on a sample of 827 children aged 3-5 years (46% girls, Mean age = 3.96). Three distinct resilience profiles were identified: 1) low cognitive resilience (24%); 2) low emotional and behavioral resilience (20%); and 3) multidomain resilience (56%). Caregiver cognitive stimulation, no out-of-home placement, higher caregiver education level, older child age, and being a girl were associated with the multidomain resilience profile. The findings provide empirical support for the multifaceted nature of resilience and suggest that practitioners need to help children achieve optimal and balanced development by assessing, identifying, and targeting those domains in which children struggle to obtain competence.

Heterogeneous effects of spanking on child protective services involvement in early childhood: A propensity score stratification analysis

Background

Extant literature has primarily employed linear models to estimate the average effect of spanking on children. Less is known about child and parent characteristics that may predict differential risks of children's exposure to spanking (i.e., pre-treatment heterogeneity) and the effect of spanking on child outcomes that may differ by the propensity for spanking (i.e., post-treatment heterogeneity).

Objective

The present study examines pre- and post-treatment heterogeneity in the association between maternal spanking at child age 3 and subsequent household Child Protective Services (CPS) involvement that were reported by mothers between child ages 3 to 5.

Methods

The sample consisted of 2,422 families from the Fragile Families and Child Wellbeing Study, a birth cohort study that oversampled children born to unmarried families. A propensity score stratification analysis procedure examined pre- and post-treatment heterogeneity in the association between spanking and subsequent household CPS involvement. Children were stratified into three strata depending on their propensity for experiencing spanking. Subsequently, the association between spanking and household CPS involvement was examined for each stratum.

Results

Disadvantaged socio-economic characteristics, negative psychosocial conditions of the mother, and dysregulated temperament of the child were associated with elevated risk of spanking. The odds of subsequent household CPS involvement increased by 2.4 times (β = 0.869, p <.01) for children in the stratum with the lowest propensity for experiencing spanking.

Conclusions

Results emphasize the importance of promoting alternative disciplinary strategies to families who would be considered low-risk before they may come into contact with the child welfare system.

Father-Mother Co-Involvement in Child Maltreatment: Associations of Prior Perpetration, Parental Substance Use, Parental Medical Conditions, Inadequate Housing, and Intimate Partner Violence with Different Maltreatment Types

The current study applied a family systems approach to examine dyadic parental risk factors linked with mother-father co-involved physical abuse, neglect, sexual abuse, and emotional abuse. Parental substance use, mental health problems, disability and medical conditions, inadequate housing, economic insecurity, intimate partner violence, and prior maltreatment history were investigated as key risk factors at the dyadic parental level. Logistic regression analysis was conducted using national child welfare administrative data from the National Child Abuse and Neglect Data System. The results showed differential associations between risk factors and four child maltreatment types: physical abuse, neglect, emotional abuse, and sexual abuse. Intimate partner violence was associated with higher odds of mother-father co-involved neglect and emotional abuse. Parental substance use, inadequate housing, and prior maltreatment history were all associated with higher odds of mother-father co-involved neglect, but lower odds of physical abuse. Parental disability and medical conditions were associated with higher odds of mother-father co-involved sexual abuse, whereas parental substance use was associated with lower odds of sexual abuse. Implications include more nuanced ways of addressing multiple risk factors within the family to prevent future occurrences of child maltreatment involving both mothers and fathers.

Emerging Adults' Adverse Life Events and Psychological Functioning: A Comparison Based on Intergenerational Trajectories of Child Maltreatment

Intergenerational continuity of child maltreatment (CM) is a well-documented phenomenon of concern; however, its effects on the child's level of exposure to CM, as well as subsequent trauma exposure and adult functioning remain undocumented. The present study aimed to further explore the intergenerational effects of CM by comparing emerging adults (EA; ages 18-25) on their exposure to CM, adult victimization, and psychological functioning according to their mother's CM histories. One hundred and eighty-five mothers and their EA completed independently an online survey measuring sociodemographics, material deprivation, CM, adult victimization, and psychological functioning. The participating dyads (primarily White and female-identifying) were recruited online through social media, universities, and advertisements in non-profit organizations throughout Canada. Findings revealed that maternal histories of CM were associated with increased neglectful and physically abusive acts endured in childhood for maltreated EA. Maternal histories of CM, regardless of the EA' victimization status, were associated with a higher EA' number of adulthood interpersonal-but not non-interpersonal-traumas experienced. While a maternal history of CM was a risk factor for intimate partner violence (IPV) in maltreated EA, it was protective for non-maltreated EA. Maltreated EA with maltreated versus non-maltreated mothers presented more psychological difficulties, but only if they also reported material deprivation. Practitioners working with children at-risk or exposed to CM should document parents' histories of CM and take that into account in their assessments and intervention practices. This study also provides further evidence to support social policies targeting the family system as a whole.

Child Maltreatment During COVID-19: Key Conclusions and Future Directions Based on a Systematic Literature Review

The COVID-19 pandemic has had a far-ranging impact. As societies struggled to minimize infection, questions arose regarding the consequences for children. Initial research reported the urgent need for child protective services worldwide to adapt existing policies and practices to protect children from maltreatment during this time, which is the rationale for the current systematic literature review. This review examined studies published in peer-reviewed journals from March 2020 to October 2020 on child maltreatment (CM) in the context of COVID-19. Twenty-five manuscripts met the inclusion criteria and were predominantly from the United States, with three international studies. The majority of the studies included CM reports during COVID-19 based on official data. The results clearly demonstrated an increased risk for children alongside a worrisome international decrease in CM reports. Only two studies addressed interventions during the pandemic. The current review highlights that, along with the obligation of scholars to advance the protection of children during COVID-19, there is much that is unknown. Future studies should examine the impact of the pandemic on children and their surrounding systems as well as child protective services' responses, which face enormous challenges during a pandemic. An additional conclusion is that, since children were not identified as a health risk group during the pandemic, their protection rights may have been jeopardized. Furthermore, the variance identified in the policies of different countries pinpoints the urgent need to establish an international protocol for protecting children from maltreatment during COVID-19, a protocol that will hopefully be a basis for policymakers worldwide.

Prevalence and correlates of child maltreatment among mothers in the Kurdistan province, Western Iran

OBJECTIVE

Parental child maltreatment is a serious public health issue worldwide. As mothers take on a significant proportion of parenting duties in two-parent families, knowledge of maternal risk factors for child maltreatment is essential.

METHODS

In this cross-sectional study, 135 mothers with their last child below 18 years old in Kurdistan province were enrolled. A validated Persian version of the ISPCAN Child Abuse Screening Tool-Parent version, Beck Anxiety Inventory, and Beck Depression Inventory were administered.

RESULTS

The prevalence of severe and moderate physical punishment was 78.5% and 71.9%, respectively. Psychological punishment was reported by 99.3% of respondents, and 48.9% reported neglect. A relationship was found between child physical and emotional abuse and low maternal education (P < 0.01), domestic violence (P = 0.02), maternal exposure to maltreatment during childhood (P = 0.03), maternal depression (p < 0.01), and maternal anxiety (P < 0.01). A relationship was found between neglect and residence in rural areas (P < 0.01), domestic violence, and low maternal education (P = 0.02).

CONCLUSION

Maternal child maltreatment in Iran is increased in mothers with psychological disorders and those with certain demographic characteristics. Clinicians should be alert to these potential risk factors.

Association of State Expansion of Supplemental Nutrition Assistance Program Eligibility With Rates of Child Protective Services-Investigated Reports

Importance

States in the US have the option to eliminate the asset test and/or increase the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility under a policy called broad-based categorical eligibility (BBCE). Given associations of economic hardships, including food insecurity, with child protective services (CPS) involvement, state adoption of these policies may be associated with changes in rates of CPS-investigated reports.

Objective

To examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility under BBCE with rates of CPS-investigated reports.

Design, Setting, and Participants

This cross-sectional ecologic study used data from 2006 to 2019 obtained from the SNAP Policy Database and the National Child Abuse and Neglect Data System Child Files and difference-in-differences analyses. The data were analyzed from March to September 2022. The study used CPS-investigated reports for suspected child abuse and neglect from 37 US states to examine elimination of the asset test, from 36 states to examine increases in the income limit, and from 26 states to examine adoption of both policies.

Exposures

State elimination of the asset test, increases in the income limit, and adoption of both policies to expand SNAP eligibility.

Main Outcomes and Measures

Number of CPS-investigated reports, overall and specifically for neglect and physical abuse, per 1000 child population.

Results

From 2006 to 2019 for all 50 states and the District of Columbia, there were a total of 29 213 245 CPS-investigated reports. By race and ethnicity, 19.8% of CPS-investigated reports were among non-Hispanic Black children and 45.7% among non-Hispanic White children (hereafter referred to as Black and White children). On average, there were 8.2 fewer CPS-investigated reports (95% CI, -12.6 to -4.0) per 1000 child population per year in states that eliminated the asset test, 5.0 fewer CPS-investigated reports (95% CI, -10.8 to 0.7) per 1000 child population per year in states that increased the income limit, and 9.3 fewer CPS-investigated reports (95% CI, -15.6 to -3.1) per 1000 child population per year in states that adopted both SNAP policies than there would have been if these states had not adopted these policies. There were decreases in CPS-investigated reports for neglect in states that adopted either or both policies, and small decreases in CPS-investigated reports for physical abuse in states that increased the income limit or adopted both policies. There were decreases in CPS-investigated reports among both Black and White children. For example, there were 6.5 fewer CPS-investigated reports among Black children (95% CI, -14.6 to 1.6) and 8.7 fewer CPS-investigated reports among White children (95% CI, -15.8 to -1.6) in states that adopted both SNAP policies than there would have been if these states had not adopted these policies.

Conclusions and Relevance

Results from this cross-sectional study suggest that state expansion of SNAP eligibility through elimination of the asset test and increases in the income limit may contribute to decreases in rates of CPS-investigated reports. These results can inform ongoing debates regarding SNAP policy options, specifically BBCE, and prevention efforts for child abuse and neglect.

Economic Hardship and Violence: A Comparison of County-Level Economic Measures in the Prediction of Violence-Related Injury

Economic hardship may lead to a wide range of negative outcomes, including violence. However, existing literature on economic hardship and violence is limited by reliance on official reports of violence and conflation of different measures of economic hardship. The goals of this study are to measure how violence-related injuries are associated with five measures of county-level economic shocks: unemployment rate, male mass layoffs, female mass layoffs, foreclosure rate, and unemployment rate change, measured cross-sectionally and by a 1-year lag. This study measures three subtypes of violence outcomes (child abuse, elder abuse, and intimate partner violence). Yearly county-level data were obtained on violence-related injuries and economic measures from 2005 to 2012 for all 87 counties in Minnesota. Negative binomial models were run regressing the case counts of each violence outcome at the county-year level on each economic indicator modeled individually, with population denominator offsets to yield incidence rate ratios. Crude models were run first, then county-level socio-demographic variables and year were added to each model, and finally fully-adjusted models were run including all socio-demographic variables plus all economic indicators simultaneously. In the fully-adjusted models, a county's higher foreclosure rate is the strongest and most consistently associated with an increase in all violence subtypes. Unemployment rate is the second strongest and most consistent economic risk factor for all violence subtypes. Lastly, there appears to be an impact of gender specific to economic impacts on child abuse; specifically, male mass-lay-offs were associated with increased rates while female mass-lay-offs were associated with decreased rates. Understanding the associations of different types of economic hardship with a range of violence outcomes can aid in developing more holistic prevention and intervention efforts.

Did the COVID-19 pandemic lead to increased pediatric musculoskeletal nonaccidental trauma? A cross-sectional study

Lockdowns due to COVID-19 increased known risk factors for nonaccidental trauma (NAT), including economic instability and parental stress. We sought to evaluate potential changes in the frequency and types of fractures associated with NAT during the COVID-19 pandemic. A retrospective cross-sectional study was conducted using de-identified data obtained from the IBM Watson Health Explorys Cohort Discovery database. Systematized Nomenclature of Medicine-Clinical Terms were used to query the database for victims of NAT in 2019 and 2020. Within this cohort of patients, we then identified those who were also diagnosed with a fracture within 21 days of the NAT event. Demographic data were compared between 2019 and 2020 where possible using chi-squared testing, and relative risks for various fracture diagnoses were calculated with 95% confidence intervals. There were 9500 records overall of pediatric NAT in 2019 compared to 9350 in 2020. Of those, in 2019 550 were associated with a diagnosis of fracture versus 570 in 2020. The relative risk of fracture due to NAT in 2020 when compared to 2019 was not significantly higher [relative risk, 1.05 (95% confidence interval, 0.94-1.17)]. The relative risk for each category of fracture diagnosis in 2020 was slightly higher, but not to a statistically significant degree. Despite increasing known risk factors, the frequency of NAT remained unchanged as the result of the COVID-19 pandemic. We also did not identify significant changes in the risk of fracture due to NAT, nor any changes in the associated types of fractures.

Breaking the Cycle of Intergenerational Childhood Maltreatment: Effects on Offspring Mental Health

This study evaluated how continuities and discontinuities in the intergenerational transmission of maltreatment affect offspring psychopathology. Data from a multigenerational prospective, longitudinal study were used to compare the severity of offspring psychopathology in families with no history of maltreatment (controls) and those in which parents, offspring, or both experienced childhood maltreatment (cycle breakers, initiators, and maintainers, respectively). Participants included 454 parents (M_age = 47.1, SD_age = 3.4) and their 697 offspring (M_age = 22.3, SD_age = 6.3). Offspring of cycle breakers reported less psychopathology than offspring of cycle maintainers and did not report more psychopathology than offspring of controls. Offspring of cycle initiators and maintainers reported comparable levels of psychopathology. Results suggest that breaking the cycle of maltreatment buffers offspring from risk for psychopathology associated with parental maltreatment, with no enduring or additive effects of maltreatment across generations. Our findings highlight the need for maltreatment prevention programs and further research to identify conditions and characteristics that reduce the probability of intergenerational transmission.

Child welfare workers satisfaction and wellbeing during the COVID-19 pandemic: Perspectives of agency staff in Ohio

BACKGROUND

The COVID-19 pandemic has impacted the lives of children and families, created additional stressors, and increased risks for maltreatment. The pandemic has changed the way child welfare agencies operate, requiring changes to policies and practice. Minimal research has considered the effects of the COVID-19 pandemic on child welfare workers wellbeing and job satisfaction.

OBJECTIVE

This mixed-methods research study seeks to understand CPS staff satisfaction, variables impacting satisfaction, and challenges that increased since the pandemic began for child welfare workers in Ohio.

PARTICIPANTS AND SETTING

A sample of staff members (n = 267) from 50 CPS agencies across Ohio participated in the study.

METHODS

This mixed-methods study used logistic regression, chi square analyses, and thematic analysis to analyze the data from a survey sent to child welfare agencies in Ohio.

RESULTS

Caring for minor children, primary role at work, and years in child welfare were significantly associated with job satisfaction. Those working in foster care/placement, adoption/permanency, family support/visitation, kinship were 7.57 times more likely than those doing intake/investigation work to be satisfied with their job (p = .007). Thematic analysis of staff issues that increased during the pandemic resulted in six themes: Stress and Anxiety, Feeling Overwhelmed, Burnout, All, Motivation, and Isolation and Disconnection.

CONCLUSIONS

The COVID-19 pandemic has created additional stressors for child welfare staff. Practice implications are discussed to help increase job satisfaction, staff wellbeing, and mitigate turnover.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The prevalences, changes, and related factors of child maltreatment during the COVID-19 pandemic: A systematic review

BACKGROUND

The impact of the COVID-19 pandemic has been extensive and drastic during the twenty-first century. The increasing phenomenon of child maltreatment during the pandemic is a significant public health concern.

OBJECTIVE

This study is the first systematic review to analyze and summarize the prevalence rates, risk factors, and protective factors related to child maltreatment during the COVID-19 pandemic.

METHODS

Four electronic databases (PubMed, Web of Science, Scopus, Embase) were systematically searched. Some potential studies were also identified from the reference lists of previously included articles. The quality of the included studies was assessed by the National Institutes of Health (NIH) Quality Assessment Tool and Critical Appraisal Skills Program (CASP) Quality Assessment Tool.

RESULTS

A total of 35 articles were included in the analysis, with 16 having prevalence information and 22 having factor information. Sixteen studies were conducted in the US, the other 17 studies were from 12 countries, and only two studies contained mixed countries. The prevalences of child maltreatment during the pandemic varied widely in different types and measurements. The pandemic rates of physical abuse, psychological abuse, neglect, and sexual abuse were 0.1 %-71.2 %, and 4.9 %-61.8 %, 7.3 %-40 % and 1.4 %-19.5 %, respectively. There was a decline in allegations of child maltreatment and an increase in severe cases of child maltreatment during the COVID-19 pandemic. Lockdown measures and their side effects were the main risk factors contributing to child maltreatment.

CONCLUSIONS

This review calls for targeted measures to prevent child maltreatment during the COVID-19 pandemic and current and future lockdowns and more future replication studies conducted in countries other than the US.

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

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

The Occurrence and Co-Occurrence of Harsh Parenting and Family Conflict in Hong Kong

The violation of children's right to a safe home environment is a major public health problem in need of serious attention. Evidence has been limited about the family characteristics that go with the co-occurrence of harsh parenting and family conflict. By using a representative community sample of Hong Kong families, this study aims to examine the prevalence and risk factors of harsh parenting and family conflict. This study was conducted using a secondary analysis obtained from the 2017 Hong Kong Family Survey with a sample size of 1926 respondents who have children. Results showed that participants' ages are negatively related to the occurrence and co-occurrence of harsh parenting and/or family conflict. Married mothers reported less family conflict. Fathers with lower education levels reported more experiences of family violence. Mothers reporting a higher level of family satisfaction were less associated with harsh parenting. This study provides insights into the unique and shared familial elements that prevent harsh parenting and family conflict and help facilitate the development of effective intervention strategies for family violence co-occurrence. Family-based prevention for family violence may screen for the presence of harsh parenting and family conflict and take into consideration these signals to better support families in need.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Impact of COVID-19 on children

Background

The COVID-19 global pandemic has spread throughout the world, posing an extremely dangerous health risk for almost everyone. While dealing with such a large-scale viral disease, the healthcare infrastructure is under strain. Young adults who were thought to have been clinically affected fared better than their older counterparts. This pandemic has affected millions of children, especially those from low-economic backgrounds, who are otherwise highly susceptible and underprivileged. Children of frontline workers and single parents face particular challenges. Children from disadvantaged backgrounds are more vulnerable to infection and may experience long-lasting negative effects of the pandemic, such as child labor, child trafficking, child marriage, sexual exploitation, and even death. To lessen the psychological negative effects of COVID-19 on children and adolescents, parents, physicians, psychologists, social workers, and hospital administrators, government and non-governmental organizations have essential responsibilities to play. Priority one is to ensure that all children from all socioeconomic strata have access to the necessities of life, including social security, health care, and education. Moreover, some positive changes may result from the global crisis. This research paper discusses the potential consequences of this pandemic. 

Summary

Some of the hypotheses being investigated while looking at the low case fatality rate among pediatric age groups include the peak of immunity and differences in immune system response. The vulnerability of the comorbid pediatric age group, on the other hand, is comparable to that of their older counterparts. During the severe acute respiratory syndrome and Middle Eastern respiratory syndrome outbreaks, similar results were observed. The inoculation of a mother during pregnancy was found to be effective in protecting her progeny.

Results

This is a review article, thus not applicable.

Conclusions

Children are quite discouraged when school is abruptly stopped, when planned outings are canceled, when they are confined to the house, and when they are afraid of the unknown with regard to the continuing epidemic. Even though almost all studies suggest that COVID-19 has a relatively mild clinical manifestation in children, one must be cautious due to the novel coronavirus’s rapid mutation rate. More research is needed to determine the relationship between COVID-19 and pediatric age groups.

An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here?

BACKGROUND AND OBJECTIVES

A wealth of research has identified adverse childhood experiences (ACEs; abuse, neglect, violence or disorder in the home) as a strong risk factor for substance misuse. Synthesis of the existing evidence is critical to shape policy and inform directions for future research. Existing reviews have focused on specific substances or substance use outcomes (eg, disorder), and do not include discussion of the mechanisms that operate between ACEs and substance misuse. The current umbrella review aims to synthesize reviews on the relationship between ACEs and substance misuse, review the evidence on the mechanisms linking these, identify existing gaps in our knowledge, and discuss critical directions for future research, practice, and public policy.

METHODS

Two electronic databases (PsycINFO and Medline) were searched for reviews published between 1998 and 2022 on the link between ACEs and substance misuse. Twenty articles met eligibility criteria and were qualitatively synthesized.

RESULTS

Results overwhelmingly demonstrated an elevated risk of substance misuse or disorder, among adolescents and adults exposed to ACEs. Research on the mechanisms that explain this link highlights a multitude of potential intervention targets, with childhood stress propelling a cascade of effects across neurobiological, endocrine, immune, metabolic, and nervous systems, impacting psychosocial and cognitive functioning. Nonetheless, the literature is subject to limitations surrounding potential unmeasured cofounders and causality, as well as decontextualizing childhood adversity from broader structural issues that influence the link between ACEs and substance misuse. Research, policy, and practice that seek to holistically understand and address the relationship between ACEs and substance misuse within the broader social determinants of health is crucial.

Associations Between Mothers' Adverse Childhood Experiences, Material Hardship, and Breastfeeding Challenges in the United States

BACKGROUND

Breastfeeding is the biological norm and is associated with numerous superior health outcomes for children and mothers when compared to human milk substitutes. Yet, breastfeeding difficulties and the inability to meet one's breastfeeding goals are common in the United States and maybe more common among mothers who have experienced trauma.

RESEARCH QUESTIONS

(1) Are mothers' adverse childhood experiences, and current experiences of discrimination, material hardship, and decreased social support associated with breastfeeding challenges; and (2) are these experiences associated with the number of breastfeeding challenges reported?

METHODS

A prospective, non-probability, cross-sectional study design with a diverse sample who had delivered a live baby within the previous year (N = 306) was conducted.

RESULTS

Over 70% of participants reported breastfeeding challenges and 45.2% reported material hardship. Among those who attempted breastfeeding (n = 286), 74.1% had at least one adverse childhood experience; 30.3% had four or more. Logistic and negative binomial regression models determined that adverse childhood experiences, experiences of discrimination, material hardship, and decreased social support were not associated with experiencing any breastfeeding challenges. However, adverse childhood experiences were associated with the number of breastfeeding challenges reported. (The adjusted rate ratio was 1.05; 95% CI [1.00, 1.09], p = .034).

CONCLUSION

We recommend further research on adverse childhood experiences and potential relationships with discrimination, material hardship, and social support to prevent and intervene in cases of breastfeeding challenges to maximize infant, maternal, and public health.

Violence in the Great Recession

Substantial evidence suggests that economic hardship causes violence. However, a large majority of this research relies on observational studies that use traditional violence surveillance systems that suffer from selection bias and over-represent vulnerable populations, such as people of color. To overcome limitations of prior work, we employed a quasi-experimental design to assess the impact of the Great Recession on explicit violence diagnoses (injuries identified to be caused by a violent event) and proxy violence diagnoses (injuries highly correlated with violence) for child maltreatment, intimate partner violence, elder abuse, and their combination. We used Minnesota hospital data (2004-2014), conducting a difference-in-differences analysis at the county level (n = 86) using linear regression to compare changes in violence rates from before the recession (2004-2007) to after the recession (2008-2014) in counties most affected by the recession, versus changes over the same time period in counties less affected by the recession. The findings suggested that the Great Recession had little or no impact on explicitly identified violence; however, it affected proxy-identified violence. Counties that were more highly affected by the Great Recession saw a greater increase in the average rate of proxy-identified child abuse, elder abuse, intimate partner violence, and combined violence when compared with less-affected counties.

Empowering Elementary and Middle School Youth to Speak Up and Be Safe: Advancing Prevention of Child Maltreatment with a Universal School-Based Curriculum

Child maltreatment is a global public health problem, and school-based universal prevention programs such as the Speak Up Be Safe (SUBS) curriculum can be an effective solution to help address child violence. This randomized control study employed a pre-, post-, and six-month follow-up design for students in kindergarten to grade 8, approximately ages 5-13 (n = 2797). Surveys measured the efficacy of the curriculum in increasing students' knowledge of safety rules and self-protection strategies. The analyses explored the differences at follow-up between the conditions for each index/scale for each grade using an analysis of covariance, which controlled for the pre-survey scores. The SUBS group had significantly higher scores at follow-up than the students in the control group. This study showed that the students learned new knowledge and skills to act upon and identify child abuse and neglect in keeping themselves and others safe. Policy- and decision makers now know that as a child maltreatment prevention program, SUBS can be implemented universally in schools at a low cost, delivering an essential evidence-based safety curriculum that protects students from child maltreatment.

Victimization by Caregivers: Prevalence and Risk Factors in Chilean Children and Adolescents

This study examined the prevalence and risk factors associated to victimization by caregivers in a national large sample of Chilean children and adolescents. 19,687 children and adolescents aged 12-17, selected by random probability sampling of 699 public schools in Chile who were surveyed by trained interviewers. Victimization by Caregivers was evaluated through a module of the Juvenile Victimization Questionnaire (JVQ). The prevalence (12 months) for physical abuse were (12.9%), for emotional abuse (27.9%), neglect (5.3%) and parental interference (3.5%). The results suggest as risk factors, sex, age, migration status, disability, geographical location, and type of school. The findings highlight the urgent need to address the issue of child maltreatment and victimization by caregivers in Chilean society and minimize its impact.

Prevalence Versus Evidence: A Closer Look at the Research Available for Serving Children Exposed to Maltreatment and a Response to Hyter's Call for Trauma-Informed Care

PURPOSE

In an October 2021 post of The ASHA LeaderLive, Dr. Yvette Hyter emphasized the need for trauma-informed services for children exposed to maltreatment in the wake of the COVID-19 pandemic. Inspired by her call, we discuss how the pandemic created a high-risk context for maltreatment, the speech-language pathologists' (SLPs') role in prevention and intervention, reflect on the gap in evidence for maltreatment within empirical journals aimed at the speech-language pathology audience, and reiterate Hyter's call for trauma-informed care as a guide for clinicians serving children exposed to maltreatment.

METHOD

We searched for empirical evidence within journals aimed at SLPs focused on maltreatment to get an estimate of the available research. For comparison, we consulted the same journals for the number of publications covering other risk factors or conditions with similar impacts on communication skills but with lower prevalence rates.

RESULTS

Compared to other risk factors or conditions with lower prevalence rates, the disparity between the evidence aimed at SLPs and the prevalence of childhood maltreatment was difficult to ignore.

CONCLUSION

Given the current circumstances, we encourage clinicians to seek information about the communicative effects of exposure to maltreatment beyond journals aimed specifically at speech-language pathologists, stress the need for trauma-informed care instruction during graduate schooling, increase awareness of our role in preventative care, and call for more research on intervention services tailored specifically for children exposed to maltreatment.

Hardship in the Heartland: Associations Between Rurality, Income, and Material Hardship

One in three U.S. households has experienced material hardship. The inadequate provision of basic needs, including food, healthcare, and transportation, is more typical in households with children or persons of color, yet little is known about material hardship in rural spaces. The aim of this study is to describe the prevalence of material hardships in Iowa and examine the relationship between rurality, income, and material hardship. Using data from the 2016 State Innovation Model Statewide Consumer Survey, we use logistic regression to examine the association between rurality, income, and four forms of material hardship. Rural respondents incurred lower odds than non-rural respondents for all four hardship models. All four models indicated that lower income respondents incurred greater odds for having material hardship. Material hardship was reported across all groups, with rurality, income, race, and age as strong predictors of material hardship among our sample.

Child protective services during COVID-19 and doubly marginalized children: International perspectives

BACKGROUND

Alongside deficits in children's wellbeing, the COVID-19 pandemic has created an elevated risk for child maltreatment and challenges for child protective services worldwide. Therefore, some children might be doubly marginalized, as prior inequalities become exacerbated and new risk factors arise.

OBJECTIVE

To provide initial insight into international researchers' identification of children who might have been overlooked or excluded from services during the pandemic.

PARTICIPANTS AND SETTING

This study was part of an international collaboration involving researchers from Brazil, Canada, Colombia, Israel, South Africa, Uganda, the UK and the USA. Researchers from each country provided a written narrative in response to the three research questions in focus, which integrated the available data from their countries.

METHOD

Three main questions were explored: 1) Who are the children that were doubly marginalized? 2) What possible mechanisms may be at the root? and 3) In what ways were children doubly marginalized? The international scholars provided information regarding the three questions. A thematic analysis was employed using the intersectional theoretical framework to highlight the impact of children's various identities.

RESULTS

The analysis yielded three domains: (1) five categories of doubly marginalized children at increased risk of maltreatment, (2) mechanisms of neglect consisting of unplanned, discriminatory and inadequate actions, and (3) children were doubly marginalized through exclusion in policy and practice and the challenges faced by belonging to vulnerable groups.

CONCLUSION

The COVID-19 pandemic can be used as a case study to illustrate the protection of children from maltreatment during worldwide crises. Findings generated the understanding that child protective systems worldwide must adhere to an intersectionality framework to protect all children and promote quality child protection services.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Adolescent Mental Health and Family Economic Hardships: The Roles of Adverse Childhood Experiences and Family Conflict

Rising and economically disproportionate rates of adverse mental health outcomes among children and youth warrant research investigating the complex pathways stemming from socioeconomic status. While adverse childhood experiences (ACEs) have been considered a possible mechanism linking socioeconomic status (SES) and child and youth psychopathology in previous studies, less is understood about how family environments might condition these pathways. Using data from a longitudinal, multiple-wave study, the present study addresses this gap by examining the direct relationships between family economic status and youth internalizing and externalizing symptoms, if ACEs mediate these relationships, and if conflictual family environments moderate these direct and indirect relationships. The data were obtained from 5510 youth participants [mean age at baseline = 9.52 (SD = 0.50), 47.7% female, 2.1% Asian, 10.3% Black, 17.6% Hispanic, 9.8% Multiracial/Multiethnic, 60.2% White] and their caretakers from the baseline, 1-year, and 2-year follow up waves. Conditional process analysis assessed the direct, indirect, and moderated relationships in separate, equivalent models based on youth- versus caregiver-raters of ACEs and youth psychopathology to capture potential differences based on the rater. The results of both the youth- and caregiver-rated models indicated that lower family economic status directly predicted higher levels of externalizing symptoms, and ACEs indirectly accounted for higher levels of internalizing and externalizing symptoms. Additionally, family conflict moderated some, but not all, of these relationships. The study's findings highlight that lower family economic status and ACEs, directly and indirectly, contribute to early adolescent psychopathology, and conflictual family environments can further intensify these relationships. Implementing empirically supported policies and interventions that target ACEs and family environments may disrupt deleterious pathways between SES and youth psychopathology.

Change in Incidence and Severity of Abusive Head Trauma in the Paediatric Age Group Pre- and During COVID-19 Lockdown in the North East of England

Background:

Abusive head trauma (AHT) is currently the accepted terminology that encompasses previously used terms such as non-accidental injury (NAI) or non-accidental head injury (NAHI) and shaken baby syndrome (SBS). It is AHT and its ocular manifestations that ophthalmologists are vital in identifying and reporting.

Objectives:

To investigate whether there is a change in the incidence or severity of AHT pre- and during COVID-19 lockdown.

Participants and Settings:

AHT cases reported between March–June 2019 and March–June 2020. Data will be collected from ***** **** ********* NHS Foundation Trust.

Methods:

A retrospective comparative study.

Main Outcome Measures:

Results:

Of the pre-lockdown safeguarding referrals, 5/61 (8.19%) had confirmed AHT, and 4/40 (10%) of the during lockdown group were confirmed AHT. The absence of teachers was evident, as in the pre-lockdown group 40% (2) of referrals originated from schools compared to none during the lockdown period. Ophthalmic involvement was not present in any of the pre-lockdown cases and only 50% (2) of the during lockdown cases, with the appropriate proforma only used in one of these cases. Unfortunately, no further statistical testing was meaningful in light of the small sample size.

Conclusions:

The loss of the early warning detection mechanism provided by schools and health visitors may have contributed to both the change in presentation and severity of cases during the lockdown. There is also a need for ophthalmology and paediatrics to collaborate to ensure AHT cases are thoroughly investigated and documented.

Child Maltreatment in Asian American and Pacific Islander Families: The Roles of Economic Hardship and Parental Aggravation

Parents face various stressors in their daily lives, and their child discipline practices are likely to be affected by the stressors. Existing research suggests that parental stress is a significant contributor to child maltreatment, but more research is needed, particularly among Asian American and Pacific Islander (AAPI) families. This study examined the relationship between economic hardship and aggravation in parenting and three types of child maltreatment (i.e., psychological aggression, physical assault, and neglect) in AAPI families through secondary data analysis of a longitudinal de-identified data set. This study analyzed a sample size of 146 AAPI children, with mothers as the primary caregiver. Economic hardship was positively associated with psychological aggression (β = 3.104, p < .01) and physical assault (β = 1.803, p < .05). Aggravation in parenting was positively associated with neglect (β = 0.884, p < .05). The findings suggest that AAPI parents are more likely to use certain child maltreatment methods when they experience specific stressors. Researchers and practitioners should consider the various stressors that AAPI families face and how other social or economic challenges can compound these stressors.

Prenatal Substance Exposure and Child Maltreatment: A Systematic Review

State and federal policies regarding substance use in pregnancy, specifically whether a notification to child protective services is required, continue to evolve. To inform practice, policy, and future research, we sought to synthesize and critically evaluate the existing literature regarding the association of prenatal substance exposure with child maltreatment. We conducted a comprehensive electronic search of PubMed, Web of Science, PsycInfo, CHINAL, Social Work Abstracts, Sociological Abstracts, and Social Services Abstracts. We identified 30 studies that examined the association of exposure to any/multiple substances, cocaine, alcohol, opioids, marijuana, and amphetamine/methamphetamine with child maltreatment. Overall, results indicated that substance exposed infants have an increased likelihood of child protective services involvement, maternal self-reported risk of maltreatment behaviors, hospitalizations and clinic visits for suspected maltreatment, and adolescent retrospective self-report of maltreatment compared to unexposed infants. While study results suggest an association of prenatal substance exposure with child maltreatment, there are several methodological considerations that have implications for results and interpretation, including definitions of prenatal substance exposure and maltreatment, study populations used, and potential unmeasured confounding. As each may bias study results, careful interpretation and further research are warranted to appropriately inform programs and policy.

What kind of "poverty" predicts CPS contact: Income, material hardship, and differences among racialized groups

•Differences in income explain some racial inequities in child welfare contact. •Differences in hardship do not explain racial inequities in child welfare contact. •Material hardship predicts child welfare contact across racialized groups.

Background and Purpose

Child protective services (CPS) contact is consistently linked with poverty in the US, and empirical evidence is mounting to indicate that disparate exposure to income poverty explains a substantial portion of racial inequities in CPS involvement. Evidence about the different distributions of income poverty and material hardship also suggests that income poverty may not sufficiently capture economic wellbeing among families. This paper assessed whether differences in exposure to income poverty and/or material hardship explain racial inequities in CPS contact and further examined whether income poverty and material hardship predict CPS contact differently within racialized groups.

Methods

We used data from the Fragile Families and Child Wellbeing Study (FFCWS), an urban cohort representative of births in large US cities in 1998–2000. The FFCWS data are ideal for this study in capturing each of the key constructs: racialized group membership, income, material hardship, and CPS contact. We measured income poverty and material hardship when children were age 1 and measured any CPS contact by age five. Our final sample included 3,517 families, including 1,848 Black, 614 white, and 1,055 Latinx families. We employed logistic regression to assess the associations between income poverty and material hardship, independently and jointly, and CPS contact. We conducted analyses in our full analytic sample and among subsamples of the Black, white, and Latinx families.

Results

We found that differences in income-to-poverty ratio account for differences in CPS contact between Black and white families. Differences in CPS contact between Black and Latinx families were not explained by economic wellbeing measures alone but were ameliorated when differences in income poverty, material hardship, and a full set of family characteristics were considered. Additionally, we found that material hardship was a consistent predictor of CPS contact in the full sample and within each of the Black, white, and Latinx subsamples, even accounting for differences in income and other family characteristics.

Conclusions

The clear role of income poverty in explaining inequities in CPS contact between Black and white families and the consistent importance of material hardship in predicting CPS contact across all families underscore the critical importance of reducing income poverty and hardship and of distinguishing material need from maltreatment in the context of CPS. Our findings offer clear implications for policy intervention to reduce income poverty and material hardship. Such interventions might include extending the temporarily expanded Child Tax Credit and expanded food and housing assistance benefits, toward the ends of supporting child and family wellbeing and reducing economic and racial inequities in CPS contact.

Role of maternal emotion in child maltreatment risk during the COVID-19 pandemic

Purpose

Preliminary research early in the COVID-19 pandemic suggested children appeared to be at increased risk for child maltreatment, particularly as parents struggled with mental health and economic strains. Such strains were likely to influence parental emotions about their children, affecting their parent-child interactions to contribute to elevated maltreatment risk. To identify the potential affective elements that may contribute to such increased maltreatment risk, the current study focused on whether maternal worry about children's behavior specifically as well as maternal anger were related to increased risk for neglect or physical or psychological aggression six months into the pandemic.

Method

The racially diverse sample included 193 mothers who completed an online survey during the COVID-19 pandemic in late September-early October 2020.

Results

Mothers' reported increases in neglect and physical and psychological aggression during the pandemic were significantly related with established measures of maltreatment risk. Furthermore, path models indicated that maternal anger and worry about children's behavior, as well as their interaction, were significantly related to indicators of physical aggression risk and neglect during the pandemic, but only maternal anger related to increased psychological aggression during the pandemic.

Conclusions

Maternal worry and anger about children's behavior may have exacerbated risk for maltreatment under the stressful conditions of the COVID-19 pandemic. Findings suggest affective reactions of both parental worry and anger focused on child behavior warrants greater empirical attention and consideration in intervention efforts both during the pandemic and potentially post-pandemic.

Association of Housing Stress With Child Maltreatment: A Systematic Review

Child maltreatment is a significant public health issue in the United States. Understanding key risk factors for child maltreatment is critical to informing effective prevention. Poverty is an established risk factor for child maltreatment. However, recent research indicates that material hardship (i.e., difficulties meeting basic needs) may serve as a more direct measure of the way in which poverty affects daily life. One form of material hardship that is common among families is housing stress. Previous reviews have summarized the existing literature regarding the association of economic insecurity with child maltreatment, but no reviews have synthesized and critically evaluated the literature specific to the association of various types of housing stress with child maltreatment. We conducted a systematic search of multiple electronic databases to identify peer-reviewed studies conducted in the U.S. regarding the association of housing stress with child maltreatment. We identified 21 articles that used nine distinct measures of housing stress including homelessness or eviction, homeless or emergency shelter stays, foreclosure filing, housing instability, inadequate housing, physical housing risk, living doubled-up, housing unaffordability, and composite housing stress indicators. Overall, results from this body of literature indicate that housing stress is associated with an increased likelihood of caregiver or child self-reported maltreatment, child protective services (CPS) reports, investigated and substantiated CPS reports, out-of-home placements, and maltreatment death. Additional theory-driven research is needed to further our understanding of the contribution of specific types of housing stress to risk for specific types of maltreatment.

Fair comparisons: Life course selection bias and the effect of father absence on US children

Studies have shown that father absence in opposite-gender couples has detrimental effects on children's wellbeing, net of selection bias. However, life course informed research suggests that the problem of selection bias may be more complex than currently thought. This paper shows the importance of nonparametrically adjusting for the trajectory of confounder covariates for the estimation of these effects. This paper uses data from the Fragile Families and Child Wellbeing Study to estimate the total effect of the departure of the biological father on children's wellbeing, as well as delayed or fade-out effects of this transition. The paper employs Bayesian additive regression trees, a machine learning and causal inference method suited for statistical models involving high-dimensional data sets. After adjusting for multiple time-invariant and -varying confounder covariates, as well as their history, estimates of father absence's effect on children's wellbeing are reduced substantially, a finding which may be referred to as life course selection bias. Results suggest early and middle childhood are not negatively affected by the departure of the biological father. Life course selection bias mostly affects estimates of this effect on adolescence, which is explained by children directly experiencing changes inparent's socioeconomic trajectories that lead to divorce or separation. This would not be the case when father absence is experienced in early childhood. Results suggest father absence is mostly a marker of life course cumulative socioeconomic disadvantage, not a cause of negative effects.

Changed for the Better: The Modifiable Maltreatment Factors Framework

Rates of child maltreatment in the U.S. have been relatively stagnant since the 1990s. This lack of progress suggests that prevention efforts, which have primarily focused on individual behaviors, have been unsuccessful. Building on existing research, this conceptual paper identifies the need to refocus prevention efforts on changeable and causal risk factors. The Modifiable Maltreatment Factors (MMF), a new framework to classify risk factors for maltreatment, is introduced. Use of the MMF in social work education and child protective services work could increase the understanding of macro factors in child maltreatment and the possibilities of policy change and community organizing in maltreatment prevention.