Health and home environments of caregivers of children investigated by child protective services

Kinship Care and Child Protection in High-Income Countries: A Scoping Review

Kinship care is a global phenomenon with a long history, which in high-income countries (HICs) at least, is being increasingly formalized through legislation and policy. There are many benefits to kinship care, including improved child mental health and well-being when compared to other types of out-of-home care. Despite this, kinship care is not without its risks with a lack of support and training for kinship carers putting children at an increased risk of abuse and neglect. This scoping review was conducted across 11 databases to explore the breadth and depth of the literature about abuse and neglect within kinship care in HICs and to provide initial indications about the relationship between kinship care and abuse. Of the 2,308 studies initially identified, 26 met the inclusion criteria. A majority of studies were from the United States, and most used case review methods. From the included studies, rates of re-abuse, and particularly rates of physical and sexual abuse, appear to be lower in kinship care settings when compared to other out-of-home care settings, but rates of neglect are often higher. This review has demonstrated that a small but significant number of children living in kinship care experience neglect or abuse.

Do county mental health, physical health, and care provider availability predict child maltreatment report rates?

BACKGROUND

Research on community-level relationships between mental/physical health and child maltreatment is sparse.

OBJECTIVE

We examined how rates of mental distress, physical distress, mental health professionals, and primary care physicians were related to child maltreatment report rates at the county level.

PARTICIPANTS AND SETTING

U.S. counties from 2014 to 2017.

METHODS

Within-between random effects models estimated both within-effects (i.e., longitudinal changes) and between-effects (i.e., inter-county differences) of mental distress rates, physical distress rates, mental health professional rates, and primary care physician rates and their associations with overall and age-specific maltreatment report rates, while adjusting for potential confounders.

RESULTS

Longitudinal increases of mental distress rates marginally significantly (p < .10) increased overall maltreatment report rates (β = 0.50) and significantly (p < .05) increased age 0-5 maltreatment report rates (β = 0.84). Conversely, longitudinal increases of mental health professional rates significantly decreased overall (β = -0.38), age 0-5 (β = -0.59), and age 6-11 (β = -0.31) maltreatment report rates and marginally significantly decreased age 12-17 maltreatment report rates (β = -0.13). Between-effects of metal distress rates and mental health professional rates were mostly not significant. Neither within-effects nor between-effects of physical distress rates and primary care physician rates were significant.

CONCLUSIONS

Our findings suggest that community mental distress is a risk factor for child maltreatment reports and that community availability of mental health professionals is a protective factor. Community-based strategies to address mental distress and human resource approaches to supply sufficient mental health professionals in communities may help reduce maltreatment report rates in communities. Further research is required to confirm our findings and to better understand underlying mechanisms.

Trauma-Informed Care

Most children will experience some type of trauma during childhood, and many children suffer from significant adversities. Research in genetics, neuroscience, and epidemiology all provide evidence that these experiences have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the life span. Trauma-informed care translates that science to inform and improve pediatric care and outcomes. To practically address trauma and promote resilience, pediatric clinicians need tools to assess childhood trauma and adversity experiences as well as practical guidance, resources, and interventions. In this clinical report, we summarize current, practical advice for rendering trauma-informed care across varied medical settings.

Does Kinship vs. Foster Care Better Promote Connectedness? A Systematic Review and Meta-Analysis

Internationally, there is an increasing trend toward placing children in kinship vs. foster care. Prior research suggests that children in kinship care fare better compared to children in foster care; however, the reasons for this remain unclear. We conducted a systematic review and meta-analysis to examine the hypothesis that kinship care better preserves children's connectedness to caregiver, birth family, culture, and community; which, in turn, is associated with more optimal child outcomes. Thirty-one studies were reviewed that compared children aged 0-18 years in kinship care vs. foster care on levels of connectedness, three of which had outcomes that permitted meta-analysis. Findings indicated that children in kinship vs. foster care were more likely to feel connected to family in general; however, there was not a clear advantage for kinship vs. foster care for caregiver, birth parent, cultural, and community connectedness. While levels of connectedness were generally associated with more adaptive child outcomes for children in both kinship and foster care, no reviewed studies examined the hypothesis that children's connectedness may mediate the relationship between placement type and child well-being and placement outcomes. Results are discussed with respect to limitations and policy implications of the current evidence-base and the need for more rigorous research to help identify how to improve child well-being in home-based care.

Maternal Depression and Child and Adolescent Problem Behaviors: a Propensity Score Matching Approach

Prior studies have consistently revealed that maternal depression is significantly associated with children exhibiting higher levels of internalizing problem behaviors and externalizing problem behaviors. However, there is reason to believe that prior research may have suffered from model misspecification and confounding that biased the conclusions drawn from these studies. We use this possibility as the foundation for our analyses that examine the potential association between maternal depression and child internalizing and externalizing problem behaviors while addressing the methodological limitations of previous research. To do so, we analyzed data from the National Survey of Child and Adolescent Well-Being and used propensity score matching. The analyses revealed significant differences between depressed and non-depressed mothers that, once accounted for, significantly impacted the revealed associations between maternal depression and child internalizing and externalizing problem behaviors. Although the significant relationship with child internalizing problem behaviors remained in all of the cross-sectional and longitudinal models post-matching, once the mothers were properly matched, the significant relationship between maternal depression and child externalizing problem behaviors disappeared at Wave 3. We conclude by discussing the implications and limitations of our study as well as considerations for future research.

Child abuse in children living with special guardians, a service evaluation of child protection medical examinations

OBJECTIVE

To determine difference in frequency of referral for child protection medical examination (CPME) in children subject to special guardianship order (SGO), subject to child protection plan (CPP) or neither.

DESIGN

Service evaluation analysing data from CPME reports.

SETTING

Acute and community healthcare providers in Birmingham UK, during 2018.

PATIENTS

All children aged 0-18 years requiring CPME.

MAIN OUTCOME MEASURES

Details were obtained from CPME reports on: age, SGO status, CPP status, reason for CPME, injuries sustained, presence of non-accidental injury.Population data were obtained from the local children's safeguarding board and national statistics.

RESULTS

Reports were available for 292/298 (98%) CPME, relating to 288 children. 5 children were subject to SGO, 39 were subject to CPP, none subject to both. Non-accidental injury was substantiated in 189/288 (66%). The child population was 288 000. 1665 children were subject to CPP and approximately 750 subject to SGO. The relative risk (RR) for children subject to SGO requiring a CPME compared with children not subject to SGO or CPP is 7.86, p<0.0001 with 95% CI (3.26 to 19.02). The RR for children subject to a CPP requiring CPME compared with children not subject to SGO or CPP is 27.65, p<0.0001 with 95% CI (19.78 to 38.63).

CONCLUSIONS

This is a small study and findings need interpreting cautiously. Children subject to SGO may potentially be at higher risk of abuse than the general population despite living with carers who have passed social care parenting assessments. There is no register of children subject to SGO so professionals may be unable to offer families additional support. SGO families should be offered enhanced support and monitoring routinely. Children subject to CPP are not being adequately protected from further abuse.

Identifying families with complex needs after an initial child abuse investigation: A comparison of demographics and needs related to domestic violence, mental health, and substance use

Families with complex needs related to domestic violence, mental health, and substance use have some of the worst child protective services (CPS) outcomes. Although many of these families are identified during a CPS investigation and subsequently referred to home-based postinvestigation services (HBPS), many are re-reported to CPS, so it is important to understand the postinvestigation experiences of this vulnerable group. Therefore, this study compared families with and without complex needs to understand their uniquedemographics, needs, and postinvestigation outcomes. The sample consisted of 2008 caregivers who received HBPS following an initial CPS investigation. The Family Assessment Form (FAF) was used to measure family functioning in eight domains using a 1-5 scale with higher ratings representing worse functioning. Complex needs were indicated by a mean FAF score of 3 or higher for either domestic violence, mental health, or substance use. Using Pearson chi-square analyses and two-sample t-tests, comparisons were made between families with (n=836) and without (n=1172) complex needs. Half of caregivers with complex needs had a history of abuse, 25% had three to five needs, and nearly half had six to eight needs; 90% of caregivers without complex needs had zero to two needs. Furthermore, caregivers with complex needs had higher mean scores for concrete, educational, and clinical needs. These findings highlight the importance of recognizing variation among families referred to HBPS and accurate screening to ensure that families with complex needs are offered and receive services matched to their unique characteristics and needs.

Maltreated and comparison adolescents' recollections of lifetime residences: Relationship to delinquency and marijuana use

Both childhood maltreatment and frequent childhood residence changes are associated with poor behavioral outcomes including drug use and delinquency. It is not clear whether a higher number of residences results in poorer outcomes for maltreated adolescents compared to adolescents living in the same community but without child welfare-documented maltreatment. Our study of child welfare-affiliated maltreated youth (n=216) and comparison youth (n=128) from the same community (age M = 18.21, SD = 1.42) examined: 1. whether child/caregiver characteristics and maltreatment status were associated with lifetime number of residences and 2. whether child/caregiver characteristics, residences, and maltreatment status were associated with delinquency and marijuana use. The outcomes of this study, number of residences, delinquency, and marijuana use, were all skewed, and consequently negative binomial regressions were used. Maltreatment status, ever living with a non-parent caregiver, and being older are associated with more residence changes during childhood. More residences and male sex are associated with person offense delinquency and marijuana use. In lower income neighborhoods, such as where the adolescents in this study lived, residence changes are not unusual, but in this study maltreated youth moved more often than youth from the same community. It is important to help caregivers who live in disadvantaged neighborhoods, especially families with child welfare involvement, understand the behavioral consequences of residence changes and provide support for stable long-term housing.

Update on child maltreatment: toward refining the evidence base

PURPOSE OF REVIEW

This review is designed to aid general pediatricians as they assess cases of possible child maltreatment. The authors have selected salient articles that inform the daily practice of any professional involved in assessing child abuse.

RECENT FINDINGS

The incidence of child abuse continues to decline in the United States, although a large number of children still suffer from abuse and neglect, and many are subject to more than one type of maltreatment. Clinicians are encouraged to be vigilant about the subtle indicators of physical abuse, with many authors adding to our understanding about how children present after inflicted abdominal or skeletal trauma. Clinicians are also cautioned to watch for signs of Munchausen syndrome by proxy, which may be elusive and difficult to discern.

SUMMARY

The field of child abuse pediatrics is still young, with the first board certification in 2009. The volume of research in the field is exploding and there is a greater level of awareness and data collection occurring throughout the world. Pediatric clinicians are encouraged to play a role in preventing abuse and neglect, as well as addressing intimate partner violence, and to maintain vigilance about child maltreatment and its subtle clinical presentations.