Nationwide efforts for trauma-informed care implementation and workforce development in healthcare and related fields: a systematic review

There is building evidence that Adverse Childhood Experiences without early and proper intervention leads to subsequent short- and long-term behavioral, social, physical and mental health problems. Practitioners, researchers, and healthcare systems have been implementing trauma-informed care (TIC) in a variety of health and human services settings, resulting in improvements in clinical care and prevention of illness by identifying high risk populations. This has led to positive health outcomes including improved compliance, better access to mental health services and reduced health care costs. A systematic review was conducted of studies that focused on TIC implementation in healthcare settings, statewide TIC implementation, impact of adverse childhood experiences on health outcomes, impact of TIC on health outcomes, and evaluation of TIC implementation. A search was conducted in March 2019 to identify studies in PubMed, Medline, and other online literature. We limited our search to articles published in English after 2000. This article aims to review the components of TIC phases of implementation in healthcare settings, success stories across the nation to help the readers understand the importance of a paradigm shift to improve healthcare delivery and health outcomes and to prevent illness starting from childhood with a family centered care perspective.

Assessing Crisis Chat Visitors' Capacity to Regulate Thoughts Related to Suicide

Background: Regulation of suicidal thoughts may be defined as a person's beliefs about their capacity to control affective and cognitive processes related to suicide. The inability to regulate suicidal thoughts is related to persistent suicidal thoughts, intentions, attempts, and suicide. Aims: The purpose of this study was to validate a scale that counselors could use to assess chat visitors' capacity to regulate suicidal thoughts. Method: The validity and reliability of the Regulation of Suicidal Thoughts Scale (RSTS) was evaluated using two different samples (n = 1,162, n = 241). Results: All items correlated with the theoretical construct regulation of suicidal thoughts, and the structural model showed the RSTS predicted perceived certainty to attempt suicide. Construct and criterion validity were inferred from a decrease in visitors' ability to control their thoughts of suicide from pre-chat to post-chat (Cohen's d = 91). Greater regulation in thoughts was also related to less certainty to attempt suicide. Limitations: Additional evidence is needed to validate the RSTS, especially among diverse populations. Conclusion: Counselors could use RSTS pre-chat scores to match counseling skills with specific affective and cognitive processes related to visitors' suicidal thoughts.

Trends, Diagnoses, and Hospitalization Costs of Child Abuse and Neglect in the United States of America

We conducted a secondary analysis of the National Inpatient Sample (NIS) to examine child abuse and neglect hospitalization from 1998-2016. The NIS is the largest all-payer, inpatient care database in the United States and is maintained by the Health Care Utilization Project. Participants were youth 18 years and younger with discharged diagnoses of child abuse and neglect from hospitals. The rate of child abuse or neglect hospitalizations did not vary significantly over the study period (1998-2016), which on average was 6.9 per 100,000 children annually. Males (53.0%), infants (age < 1; 47.3%), and young children (age 1-3; 24.2%) comprised most of the child maltreatment cases. Physical abuse was the most frequent type of maltreatment leading to hospitalization. Government insurance was the most common payer source, accounting for 77.3% of all child maltreatment hospitalizations and costing 1.4 billion dollars from 2001-2016. Hospitalizations due to child abuse and neglect remain steady and are costly, averaging over $116 million per year. The burden on government sources suggests a high potential for return on investment in effective child abuse prevention strategies.

Validation of the Suicide Counseling Skills Inventory

Background: The self-report measures used in evaluations of the Applied Suicide Intervention Skills Training (ASIST) program have tended not to detect an improvement in a broad range of suicide counseling skills from pre- to posttraining or among trainees with better skills at pretraining. Aims: The purpose of this study was to develop and validate the Suicide Counseling Skills Inventory (SCSI), which included ten brief counselor-client scenarios and three counselor responses to each scenario. Method: Data were collected from several samples to develop and evaluate the SCSI. Trainee scores were subtracted from criterion expert scores to create discrepancy scores. Results: The SCSI detected an improvement in skills from pre- to posttraining across samples, including among trainees with better skills at pretraining. Internal consistency and test-retest reliability were good. Limitations: The results may not generalize across different training models. Conclusion: Trainee scores were more like expert scores at posttraining. The SCSI may be useful in evaluating suicide counseling competency.

Distal Stressors and Depression among Homeless Men

Depression is a common problem among homeless men that may interfere with functional tasks, such as securing stable housing, obtaining employment, and accessing health services. Previous research on depression among homeless men has largely focused on current psychosocial resources, substance abuse, and past victimization. Guided by Ensel and Lin's life course stress process model, the authors examined whether distal stressors, including victimization and exposure to parent problems in childhood, contributed to men's depression above and beyond current (or proximal) stressors, such as substance abuse and health problems, and social resources. The sample consisted of 309 homeless men who had entered a federally funded emergency shelter. Using the Burns Depression Checklist, the authors found that one out of three men met the threshold for moderate to severe depression during the past week. The logistic regression showed that past exposure to parent problems was related to depression after accounting for current stressors and social resources (number of close adult relationships and whether their emotional support needs were met). Past victimization was not related to depression. To address men's depression, workers should concurrently provide services that meet men's basic needs (for example, housing) and address their relationship needs, including their need for emotional support.

Adverse childhood experiences and trauma informed care: the future of health care

Adverse childhood experiences (ACEs) are related to short- and long-term negative physical and mental health consequences among children and adults. Studies of the last three decades on ACEs and traumatic stress have emphasized their impact and the importance of preventing and addressing trauma across all service systems utilizing universal systemic approaches. Current developments on the implementation of trauma informed care (TIC) in a variety of service systems call for the surveillance of trauma, resiliency, functional capacity, and health impact of ACEs. Despite such efforts in adult medical care, early identification of childhood trauma in children still remains a significant public health need. This article reviews childhood adversity and traumatic toxic stress, presents epidemiologic data on the prevalence of ACEs and their physical and mental health impacts, and discusses intervention modalities for prevention.

Sources of psychological pain and suicidal thoughts among homeless adults

Homeless adults experience problems in multiple areas of their lives. It was hypothesized that adults who were troubled by problems in more areas of their lives would be more likely to report suicidal thoughts. The sample included 457 homeless men and women who resided in three emergency shelters. The number of sources of psychological pain, past suicide attempts, and being a man predicted current suicidal thoughts, but being diagnosed with a depressive disorder did not. Shelter workers should ask adults whether they have attempted suicide in the past and how troubled they are by each area of their lives.

Strain, depressed mood and suicidal thoughts among maltreated adolescents in the United States

Almost one-fourth of maltreated adolescents report they have thought about killing themselves in the last two weeks. We draw on Agnew's strain theory to develop a model to account for variability in suicidal thoughts among this high-risk group. We used data from a nationally representative sample of 572 maltreated adolescents, aged 11-15. One dimension of relational strain (poorer relationship with peers) and greater depressed mood were directly related to whether adolescents did or did not think about suicide. Depressed mood mediated the relationship between two strain variables (relationship with caregiver and with school) and suicidal thoughts. Child maltreatment strain (being severely harmed) and substance use were not directly related to suicidal thoughts; however, depressed mood appeared to mediate the relationship between drug use and suicidal thoughts. Adolescents who experience child maltreatment and who appear to be disconnected from caregivers, friends and school should be screened for depression and suicidal thoughts.

Posttraumatic growth among men with histories of child sexual abuse

Despite an increased risk of long-term mental health problems, many survivors of child sexual abuse (CSA) experience positive changes in areas such as appreciation for life, personal strength, and interpersonal relationships. Drawing on life course theory, this study examined factors related to posttraumatic growth among a sample of men with CSA histories (N = 487). Using multiple linear regression (i.e., ordinary least squares), we found that men who had a better understanding of the sexual abuse experience, who ascribed to less traditional masculine norms, and who experienced a turning point reported greater growth. To promote growth, practitioners can help survivors understand the meaning and impact of the abuse on their lives and deconstruct rigid gender norms. More research on growth is needed with male survivors, especially on the nature of turning points in the recovery process.

Multiple victimization experiences, resources, and co-occurring mental health problems among substance-using adolescents

This study examined the relationship between multiple types of victimization experiences, psychological and social resources, and co-occurring mental health problems among substance-using adolescents. Data for this cross-sectional study were obtained from a multisite research project in which adolescents ages 11-18 years participated in a comprehensive screening program for substance misuse. Multiple types of victimization, low self-efficacy beliefs, lack of support for victimization issues, and available sources of emotional support were positively related to co-occurring mental health problems. These findings suggest that treatment planning and interventions may focus on helping adolescents cope effectively with their victimization experiences and addressing their mental health needs. Particular emphasis may be placed on enhancing self-efficacy and social skills so that adolescents may benefit from their available sources of social support.

Academic achievement despite child maltreatment: a longitudinal study

PURPOSE

Although researchers have concluded that child maltreatment has a negative effect on children's learning and academic achievement, not all children are negatively affected by maltreatment, and some children seem to succeed academically despite being maltreated. Drawing on risk and resilience theory, we examined a broad range of potential risk, promotive, and protective factors within children and their environments along with characteristics of the maltreatment to account for variability in test scores.

METHODS

A national longitudinal probability sample of 702 maltreated school-aged children, ages 6-10, and their caregivers was used to predict reading and math scores among maltreated children over three years.

RESULTS

We found that chronic maltreatment, poorer daily living skills, and lower intelligence explained a substantial proportion of the variance in maltreated children's math scores (39%), whereas type of maltreatment, poorer daily living skills and lower intelligence explained a substantial proportion of the variance in reading scores (54%) over time. Contrary to our prediction, having a behavior problem seemed to protect chronically maltreated children from poorer performance in math over time.

CONCLUSIONS

To increase academic achievement among maltreated children, it is imperative that we prevent chronic maltreatment and help children increase their competency on daily living skills.

Gender differences in internalizing problems among sexually abused early adolescents

OBJECTIVE

The purpose of this study was twofold. First, we determined whether sexually abused adolescent boys or girls were more likely to have internalizing behavior scores in the clinical range. Second, after determining boys were more likely than girls to have an internalizing behavior problem, we tested whether this relationship would persist after several other variables were accounted for: characteristics of the sexual abuse, exposure to domestic violence, self-efficacy, and their peer and caregiver relationships.

METHODS

A national probability sample of children investigated by child protective services for child maltreatment was used. The sample consisted of 127 girls and 31 boys, ages 11-14.

RESULTS

Sexually abused boys were more likely than girls to have an internalizing behavior problem in the clinical range even after controlling for several variables. Exposure to domestic violence, more severe sexual abuse, sexual abuse by a non-relative, and the amount of autonomy support provided by caregivers also increased the likelihood internalizing problem.

CONCLUSIONS

During early adolescence, sexually abused boys may be more likely than sexually abused girls to have a clinically significant internalizing behavior problem. Researchers need to continue to investigate whether sexually abused boys are as likely as girls or more likely than girls to have an internalizing behavior problem in later adolescence.

PRACTICE IMPLICATIONS

Internalizing symptoms warrant careful screening and assessment with sexually abused boys and girls who experience more intrusive sexual abuse, who are sexually abused by a non-relative, who are exposed to domestic violence, and who receive lower autonomy support from their caregivers.

The effect of severe child sexual abuse and disclosure on mental health during adulthood

This study examined the relationship among severe child sexual abuse, disclosure, and mental health symptoms during adulthood. The sample consisted of 172 adults who were sexually abused in childhood. The multivariate model showed that respondents in their 30s and 40s who were abused by more than one abuser, who were injured by their abusers, who were abused by a biological relative, who told someone about the abuse when it occurred, and who did not discuss their abuse in depth within one year of the abuse had a greater number of mental health symptoms. Abuse severity and disclosure history should be assessed by professionals to identify clients who are at higher risk of mental health symptoms and to focus therapy.

Mothers' protection of their children after discovering they have been sexually abused: an information-processing perspective

OBJECTIVE

The purpose of this study was to understand why some non-offending mothers did not protect their children consistently after they knew they were sexually abused.

METHODS

The sample included 85 mothers who were involved with child protective services: 48 mothers who protected their children consistently were compared to 37 mothers who did not.

RESULTS

Several variables explained 47% of the variance in the multivariate analysis. If the mother did not ask the abuser whether the abuse occurred, attributed responsibility to the abuser, believed consistently that the abuse occurred, and was not a victim of domestic violence, then she was more likely to protect her child consistently.

CONCLUSIONS

Some maternal characteristics believed to affect protectiveness, such as mothers' mental health and substance abuse, were not related to whether they protected their children consistently, whereas other variables, such as domestic violence, were. Researchers need to continue to examine these and other variables simultaneously, so that practitioners can better understand which children are most likely to receive inadequate protection.

PRACTICE IMPLICATIONS

Practitioners should ask mothers whether they believe the abusers' behavior was sexual and abusive. If mothers do not perceive sexual abuse, then they will not believe abuse occurred or attribute responsibility to the abusers. Helping mothers understand the nature of sexual abuse may change their beliefs and attributions. If the abuser is the mother's partner and he has physically assaulted her, practitioners need to assess her willingness and ability, with adequate services and support, to restrict his access to her child.

The nature of parental supervisory neglect

The primary purpose of this study is to determine whether different types of supervision problems such as leaving a child alone and leaving a child with an inadequate caregiver have different correlates and consequences for children. A case-comparison design was used to compare four types of supervision problems. Data were extracted from child protective services investigative reports. The results showed that each type of supervision problem had a distinct set of characteristics. Recommendations for assessing and treating different types of supervision problems are addressed.

Social networks, informal child care, and inadequate supervision by mothers

The purpose of this study is to determine whether less informal child care support from family and friends is related to supervisory neglect and, if there is a relationship, to test several explanations for why some mothers receive less child care. Thirty-two low-income mothers who did not adequately supervise their children were matched to 32 mothers who provided adequate supervision. The results showed the mothers who provided inadequate supervision received less child care support from their partners and relatives, but not their friends. These differences appear to be linked to several properties of the mothers' social networks. For example, the majority of the mothers who provided inadequate supervision either did not have a partner or knew them for less than one year. They had fewer family members living nearby and more negative relationships with them than the mothers who provided adequate supervision. To reduce chronic supervisory neglect, mothers may need assistance with both informal and formal child care support.

What criteria do child protective services investigators use to substantiate exposure to domestic violence?

The primary purpose of this study is to determine whether child protective services investigators apply a recognizable set of criteria to substantiate batterers and victims of battering for exposing their children to domestic violence. Although domestic violence occurred in 35% of the 1,248 substantiated incidents of child maltreatment, only 31 (7.1%) couples were investigated for exposing a child to domestic violence or failing to protect a child from domestic violence. All of the batterers investigated and in the caregiver role when their children were exposed to domestic violence were substantiated. The unsubstantiated victims of battering tended to use more protective behaviors (M=3.82) than the substantiated victims (M=2.00); yet, at the case level, using more than one protective behavior did not seem to be a criterion used to substantiate the victims. Instead, it appears that investigators were discriminating between those protective behaviors by the victims that ended contact between the batterers and the children--for a substantial amount of time--and those that did not in both the substantiation and removal decision. Key issues related to applying criteria in incidents involving domestic violence are discussed along with recommendations to further refine and document them.

The relationship between mothers' social networks and severe domestic violence: a test of the social isolation hypothesis

To understand the relationship between characteristics of mothers' social networks and domestic violence, battered mothers who were severely assaulted were compared to battered mothers who were not severely assaulted and mothers who were not assaulted. The results showed that all three groups of mothers had several family members in their social networks with whom they had frequent contact during the past month. No differences were found between the groups on the number of family members who gave emotional support. However, the mothers who were severely assaulted had fewer friends, fewer contacts with their friends, fewer long-term friendships, and fewer friends who really listened to them than did the nonbattered mothers and the battered mothers who were not severely assaulted. Batterers may be more successful in disrupting friendship ties than family ties.

Physically abusive fathers and risk assessment

OBJECTIVE

The purpose of this study is to identify factors that predict recidivism among families in which the father is the perpetrator of physical abuse and to compare these factors to the factors that investigators believe are related to higher risk.

METHOD

A case-comparison design was used to understand risk among 137 predominantly Caucasian families in which a father had injured a child.

RESULTS

The multivariate analysis showed that families in which the father was unemployed (greater time at risk), had younger children, was not the biological father of all of the children, did not take responsibility for his behavior, seriously injured a child, and maltreated a child in the past were more likely to re-abuse. These factors, along with whether the mother had a criminal history, correctly predicted recurrence for 83% of the families. The investigators correctly predicted recurrence for 70% of the families.

CONCLUSIONS

The investigators placed too much emphasis on some variables that were not related to recurrence, such as the mother's mental health and whether she tried to protect her children. These results may be useful in adapting assessment systems that do not take into consideration the gender of the perpetrator.

The role of men in chronic supervisory neglect

This study investigates whether parents' child care demand and resources, their capacity to provide adequate supervision, and their understanding of the supervision problem predict chronic supervisory neglect. A case-comparison design was used to compare families who had one isolated incident of supervisory neglect, who were involved with child protective services (CPS) because of a persistent supervision problem (2 years or less), and who were involved with CPS because of a chronic supervision problem (more than 2 years). When the mother's partner was not the father of her children or had a drug, alcohol, or mental health challenge, and when no one understood that there was a supervision problem or took responsibility for it, the problem was more likely to persist or become chronic. Therefore, when predicting whether a family will continue to provide inadequate supervision, it is important to also assess the mother's partner.

How child protective services investigators decide to substantiate mothers for failure-to-protect in sexual abuse cases

The purpose of this study was to determine how Child Protective Services (CPS) investigators decide to substantiate mothers for failure-to-protect from sexual abuse. A case-comparison study was used to compare 31 mothers who were and 62 mothers who were not substantiated for failure-to-protect by CPS. The multivariate analysis showed that mothers who did not consistently believe the sexual abuse occurred and who did not consistently act protectively were more likely to be substantiated. In addition, if they knew about the abuse from more than one source were less supportive of the children; and had a substance abuse problem, a mental health problem or were being battered, then they were more likely to be substantiated. Investigators appear to apply criteria consistently to substantiate mothers. doi:10.1300/J070v15n04_04.

Battered mothers who physically abuse their children

The purpose of this study is to understand why some battered mothers physically abuse their children. Mothers who were battered and physically abused their children (the co-occurrence group) were compared with mothers who were neither battered nor physically abused, who were only battered, and who only abused (N = 184). The mothers in the co-occurrence group were more likely than the mothers who did not physically abuse their children to have been severely assaulted by their own mothers as children, have had poorer quality relationships with and receive less support from their mothers, have more stressors, and have known their partners for less time. These differences were not found between the mothers in the co-occurrence and abuse-only groups. In the multivariate analysis, having been assaulted by one's own mother as a child--not being battered by one's partner--was the most potent predictor for whether a mother physically abused her child.

Making judgments about risk in substantiated cases of supervisory neglect

OBJECTIVE

The purpose of this study was to determine which factors were used by investigators to determine level of risk among substantiated cases of supervisory neglect. The conceptual model included three sets of factors-the severity of the supervision problem, characteristics of the mother (e.g., prior involvement with child protective services (CPS), motivation, substance use) and characteristics of the investigator-as potential explanations for increased risk.

METHODS

A case-control design was used to compare 113 mothers whose names were placed on the child abuse registry for substantiated supervisory neglect (higher risk) with 45 mothers whose names were not placed on the registry but who had a substantiated report of supervisory neglect (lower risk). Two readers coded every investigative report.

RESULTS

Five out of 14 of the predictors had a unique effect on the investigator's assessment of higher risk in the multivariate analysis: a child was harmed, the mother did not take responsibility for the problem, there was no extenuating circumstance, she was being battered, and she had prior involvement with CPS. There was also an interaction between being battered and the type of supervision problem. When a mother failed to protect her child from a third party, being battered decreased the likelihood that the investigator would place the mother's name on the state's registry.

CONCLUSION

More research is needed on specific types of supervision problems to develop a risk assessment instrument for supervisory neglect. Without one, it is difficult to see how investigators and others can be expected to know whether a child is likely to be harmed in the future.

Defining and classifying supervisory neglect

The purpose of this study is to develop and test a classification system for different types of supervision problems. Several prominent child maltreatment typologies were reviewed to determine the level of definitional agreement between systems; identify strengths and weaknesses within systems; and derive a consensual definition of child neglect, its major subcategories (physical, supervisory, and emotional), and 10 types of supervisory neglect. Six hundred two substantiated child abuse and neglect reports were used to test the systems interrater reliability. The interrater reliability was excellent for most types of problems. Not watching a child closely enough (29.8% of the reports) made up the largest single type of supervisory neglect, followed by leaving a child alone without a caretaker (24.5%) and leaving a child with an unsuitable caretaker (19.7%). The article concludes with a discussion on how and in what context the system can be used.

The relationship between familism and child maltreatment in Latino and Anglo families

Familism, or familismo, refers to attitudes, behaviors, and family structures operating within an extended family system and is believed to be the most important factor influencing the lives of Latinos. Because of the complexity of the construct, this article begins by separating out and defining each dimension of familism, and then clarifies its relationship to the broader literature on social networks, social support, and child maltreatment. The analysis tests whether each dimension of familism is related to child maltreatment within and between 35 abusive Latino, 35 nonabusive Latino, 51 abusive Anglo, and 51 nonabusive Anglo families. Nonabusing Latinas appear to have a higher level of familism than the other three groups of mothers. However; when intraethnic comparisons were made, nonabusive Anglos, compared with abusive Anglos, had higher levels of familism on several variables. Hence, familism seems to characterize families--Latino and Anglo--who do not maltreat their children.

The role of friends, in-laws, and other kin in father-perpetrated child physical abuse

Thirty-five physically abusive fathers were matched with a comparison sample to test multiple systemic explanations for child physical abuse, using an ecological perspective, and to show the relationship between the structure of social ties and the function of those ties. The physically abusive fathers were found to have received significantly fewer emotional and instrumental supports from their friends, in-laws, and other kin than the comparison fathers, and were only weakly linked to members of their social networks--members who might have discouraged the fathers' aggressive impulses or provided additional support to them and to their families.

Home alone and other inadequately supervised children

This study examined the relationship between a mother's motivation, capacities, and opportunities, and how much supervision her children received. Ninety-five mothers who adequately supervised their children were compared with a demographically comparable sample of 37 mothers who did not. Mothers who provided inadequate supervision were less motivated, had fewer problem-solving and social skills, and were more likely to move, be homeless, and have inadequate housing. No differences were found between the groups on perceived social support. Families with supervision problems tended to have an adult or child in the family with one or more problems. A discriminant analysis showed that less education and poorer problem-solving skills made the largest contribution to the function.

Toward an integrated framework for understanding child physical abuse

OBJECTIVES

The article constructed an integrated conceptual framework for understanding child physical abuse based on a content analysis of different theories. Three major determinants of physical abuse were identified: exposure to aggression, exposure to stressors, and access to resources. To test the framework, we included variables from all three major categories in the analyses.

METHODOLOGY

Data from a case-comparison study that included 81 physically abusive and 148 nonabusive mothers was used. Logistic regression determined the relative importance of the predictors.

RESULTS

The probability of child physical abuse varied in the expected direction with the number of emotional resources received (listening, help with decision-making, companionship), the number of stressors experienced, and the mothers exposure to physical abuse by their own mothers, current partners, and former partners. The estimation results showed that exposure to aggression in one's own childhood (abused by one's own mother) and exposure to domestic violence in one's adult life (abused by one's previous and current partners) were the most potent factors for predicting whether a mother physically abused her child.

CONCLUSION

The results suggest further research on the interdependencies between domestic violence and child physical abuse.

Child maltreatment: testing the social isolation hypothesis

Several barriers limit our attempts to untangle the social context of child maltreatment. One major barrier is our inability to agree on or effectively communicate what social isolation is. In an attempt to clarify this construct, the introductory section traces the evolution of the social isolation construct over the last three decades and concludes it is not one etiologic factor for child maltreatment, but rather, a large set of variables linked to the parent's perception of support, and their informal and formal networks. The empirical section examines each component of the social isolation construct by comparing 300 maltreating and nonmaltreating low-income mothers. Considerable variation is found between the networks of different types of maltreating mothers and nonmaltreating mothers on structural network properties, perception of support, and the types of resources they do and do not receive. For example, neglectful mothers had fewer network members, fewer contacts, fewer members living within 1 hour, and received fewer emotional and instrumental resources. Despite these findings, the label "social isolation" may not accurately describe the networks of mothers who maltreat their children, since all three types of maltreaters had at least eight important network members and more than 100 contacts with these members in the month before completing the questionnaire.

Neglectful mothers, their mothers, and partners: the significance of mutual aid

Those who work to prevent the conditions that lead to child neglect need to know which supportive resources parents lack and why. The goals of this paper are to: (a) determine if mothers who neglect their children exchange (i.e., give and receive) fewer resources with two network members: their mothers and partners; and (b) identify a set of relationship characteristics that create barriers to the receipt of resources. Sixty-nine neglectful mothers were compared to a demographically comparable sample of 138 mothers. The results support the conclusion that neglectful mothers exchange fewer resources with both their partners and mothers, but the deficit varied depending on the network member and the type of support. Several additional relationship characteristics differentiated neglectful mothers from comparison mothers. Neglectful mothers were more likely to state their mothers had fewer positive attributes (e.g., was not warm and caring), their relationship was less positive, and they were less interested in receiving resources from their mothers. Partners of neglectful and comparison mothers did not differ on any of these characteristics. Instead, neglectful mothers and their partners knew each other for less time, were likely to be living with each other, and saw each other less frequently.