Primary Prevention Programs for Children in the Social Service System

Providing effective social services for children and their families at high risk for substance abuse problems is a national concern. The paper presents the prevalence and incidence of children in need of social services due to child maltreatment, child poverty, parental incarceration, parental substance abuse, juvenile justice problems, child mental health and substance abuse problems, and homelessness. Next, the paper examines early childhood family education and family support approaches in primary prevention designed to meet the needs of these children. New research to understand developmental pathways that lead to substance abuse problems in these children is recommended.     

Mental Health Problems in Teens Investigated by U.S. Child Welfare Agencies

PurposeTo examine prevalence and correlates of five mental health (MH) problems among 12–17.5 year olds investigated by child welfare.MethodsData from the National Survey on Child and Adolescent Well-being (NSCAW II) were analyzed to examine depression, anxiety, substance use/abuse, suicidality, and attention deficit hyperactivity disorder (ADHD) as reported by teens and their caregivers. In a sample of 815 adolescents, prevalence for each MH problem and correlates (e.g., age, placement location) were identified using bivariate and multivariable logistic analyses.ResultsAfter investigation for maltreatment, 42.7% of teens reported at least one MH problem, regardless of placement. Nine percent reported depression, 13.9% reported suicidality, 23% had substance use/abuse, 13.5% reported anxiety, and 18.6% had ADHD. Of 332 teens with any MH problem, 52.1% reported only one problem, 28.3% had two problems, and 19.6% had ≥ three problems. Teens with prior out-of-home placement had odds 2.29 times higher of reporting a MH problem and odds 2.12 times higher of reporting substance use/abuse. Males were significantly less likely to report depression. Older teens were more likely to report substance use/abuse. Black teens were significantly less likely to report suicidality and ADHD and almost half as likely to report anxiety. Teens with a chronic health condition and teens whose caregiver reported depression had more than twice the odds of reporting anxiety.ConclusionsThis study highlights high rates of MH problems in teens of all ages and placement locations and suggests that all teens involved with child welfare should be screened for MH problems, regardless of initial placement status.     

When Should Programs for Teen Parents and Babies Begin? Longitudinal Evaluation of a Teen Parents and Babies Program

Confirmed child abuse and neglect rates were assessed for a group of 204 low-income, low-education adolescent mothers several years after identification of the teens either as low-risk or as high risk/low-support and eligible for 18 to 27 months of home-visitation by trained child development specialists. Three groups were studied: Low-risk Contrast Group, High-risk Program Graduates, and a Dropout Comparison Group—the last group being formed unintentionally when some participants dropped out of the high risk program. The major finding of this study is that acceptance of high-risk mothers into program prior to the infant's birth made a significant difference in preventing later child abuse/neglect. Child abuse/neglect rates and subsequent parity rates were not different between high-risk program graduates and low-risk contrast group members. Both of these groups differed significantly on these two rates with the Dropout Comparison Group. However, due to the unknown nature of this comparison group, more research is needed to understand this finding. Program costs were significantly lower than county foster care costs for children placed because of child abuse. Thus, prenatal initiation of program for high-risk pregnant adolescents may provide a cost-effective boost for family mental health and prevent child abuse and neglect by at-risk families.     

Child abuse and neglect — is it time for a public health approach?

Australia is seeing an unprecedented increase in the rate of child protection notifications and children being taken into care. The burden of such high levels of notifications and removals impact not only the children and families but also the system which is trying to resource them. The concern is that these increases are unsustainable and overloaded child protection systems can be dangerous for the vulnerable families and children they are trying to protect and support.
This paper hopes to raise some alternative thinking as to the overall approaches to child abuse and neglect with a greater focus on prevention. Is it time to consider a public health approach, using population-based measures of child abuse and neglect to accurately describe the epidemiology of population risk and protective factors? Should we investigate the potential of universal health, welfare and education services as platforms for prevention? And should we investigate whether the provision of secondary prevention for vulnerable families which address major contributing factors, such as parental substance dependence and mental health issues are effective in reducing abuse of children in these families?     

Child abuse and neglect--is it time for a public health approach?

Australia is seeing an unprecedented increase in the rate of child protection notifications and children being taken into care. The burden of such high levels of notifications and removals impact not only the children and families but also the system which is trying to resource them. The concern is that these increases are unsustainable and overloaded child protection systems can be dangerous for the vulnerable families and children they are trying to protect and support. This paper hopes to raise some alternative thinking as to the overall approaches to child abuse and neglect with a greater focus on prevention. Is it time to consider a public health approach, using population-based measures of child abuse and neglect to accurately describe the epidemiology of population risk and protective factors? Should we investigate the potential of universal health, welfare and education services as platforms for prevention? And should we investigate whether the provision of secondary prevention for vulnerable families which address major contributing factors, such as parental substance dependence and mental health issues are effective in reducing abuse of children in these families?     

Childhood maltreatment and the risk of substance problems in later life

This paper examines the risk of developing problems in adolescence and adulthood, particularly those associated with substance use, as a consequence of experiencing physical or sexual abuse during childhood. We review both retrospective and prospective research, conducted with both adolescent and adult respondents. Although there are some marked discrepancies in the findings from retrospective and prospective studies, these are probably due to differences in methodology, particularly between using official records and self-report to identify cases of abuse. Despite the wide range of methodologies and samples used in these studies, most indicate that the experience of childhood abuse is a risk factor for a number of common mental disorders in adolescence and adulthood, including alcohol and drug-related problems. In many cases, the experience of abuse appears to lead in later life to increased feelings of depression and anxiety which, while not sufficient to result in the diagnosis of a mental health disorder, place the victims at greater risk of developing substance problems. Multivariate studies indicate that this positive association remains even when controlling for important variables such as the presence of parental alcohol problems. The paper concludes with a number of recommendations for future research, so that it can be established whether the risk arises specifically from child abuse or neglect, or from the more general impact on child development of adverse family relationships.     

Promoting Children’s Mental Health in Family Supportive Housing: A Community–University Partnership for Formerly Homeless Children and Families

Emerging research indicates that significant numbers of formerly homeless families residing in permanent supportive housing have caregivers with substance use and mental health disorders, and children with histories of exposure to violence, abuse, and out-of-home placement. These factors place children at risk for adverse psychosocial outcomes, including later homelessness, providing a strong rationale for embedding child-focused prevention and intervention services in supportive housing contexts. This article describes a developing community-university partnership whose goal is to advance practice and research in the adaptation and dissemination of mental health prevention and early intervention for children in supportive housing.     

Maltreatment and Behavioral Characteristics of Youth Who Are Deaf and Hard-of-Hearing

This paper summarizes the available literature on child abuse and neglect among children with disabilities in general and considers children who are deaf and hard-of-hearing within this larger rubric given the low prevalence rates of children who are deaf and hard-of-hearing among the disabled population. This procedure allows for comparisons between disabilities as well as abused and non-abused children who are deaf and hard-of-hearing. Maltreatment data on children who are deaf and hard-of-hearing in a large epidemiological study of the prevalence of child maltreatment among children with disabilities are summarized. Children who are deaf and hard-of-hearing comprised 6.1% of the disabled population who were identified as victims of maltreatment. Their most prevalent form of maltreatment was neglect, followed by physical abuse and sexual abuse. Although children who are deaf and hard-of-hearing are significantly more likely to be maltreated by immediate family members, placement in a residential school is a risk factor for sexual and physical abuse. Maltreated children who are deaf and hard-of-hearing exhibit significantly more behavior problems including Post Traumatic Stress Disorder related behaviors than nonmaltreated peers.     

The relationship between childhood adverse experiences and disability due to physical health problems in a community sample of women

The goal of this study was to examine the association of physical and sexual abuse in childhood, poverty, parental substance abuse problems and parental psychiatric problems with disability due to physical health problems in a community sample of women. We included 4,243 women aged 15-64 years from the Ontario Mental Health Supplement in the analysis. The associations were tested by multiple logistic regression. Ten percent of women had a disability due to physical health problems. Among women with a disability, approximately 40% had been abused while growing up. After controlling for income and age, disability showed the strongest association with childhood physical abuse, parental education less than high school and parental psychiatric disorder. The association with child sexual abuse was not significant. Given the high correlation between abuse and disability due to physical health problems, it is important to investigate approaches to identify women who are at increased risk of subsequent impairment.     

Non-infant adoption from care: lessons for safeguarding children

Aim To explore use of adoption in remedying abuse and neglect, to inform child protection practice and to identify professional responsibilities to adoptive families. Method A cohort of 130 children was identified for whom adoption was recommended in 1991–1996 at a mean age of 5.7 years (range 3–11). All were in local authority care for child protection reasons. Background information was gathered from social work records. The children were traced between 6 and 11 years later and their adopters interviewed. The Strengths and Difficulties Questionnaire and the Parent–Child Communication Scale were completed. Results All but three birth parents had traumatic childhoods involving abuse, neglect and/or time in care. Eighty‐six per cent had violent adult relationships. Mental illness, learning difficulties and substance abuse were prominent. Sixty‐seven per cent of families were known to social services when children were born, but 98% experienced abuse or neglect. Most adopters found the first year challenging, though rewarding. Depression, anxiety and marital problems were common. Children's learning difficulties, conduct problems, emotional ‘phoniness’ and rejection affected closeness. At follow‐up 28% described rewarding, happy placements, and 62% described continuing difficulties tempered by rewards. However, 10% reported no rewards. Hyperactivity and inattention frequently persisted despite stable adoption and were associated with conduct and attachment difficulties. Use of professional services was substantial. Thirty‐eight per cent of children failed to achieve stable adoption. Later entry to care correlated with poorer outcome. Conclusions This study highlights the importance in safeguarding children of considering the implications of parental childhood experiences, and indicates the risk of delay. The high prevalence of domestic violence in birth families indicates the need for better resources for managing emotional dysregulation. Adoption is a valuable therapeutic tool, but professional responsibilities in supporting it need to be acknowledged and adequately resourced. Dysfunctional hypothalamus‐pituitary‐adrenal axis programming may contribute to persisting difficulties. Supporting substitute care should be considered integral to safeguarding children.     

父母外出打工对留守儿童危险行为和心理因素影响

目的 了解父母外出打工对留守儿童危险行为以及心理因素的影响。方法 选取安徽省六安市2所全日制初中2 139名年龄≤14岁学生进行危险行为和心理因素问卷调查。结果 留守儿童810名(37.87%),其中父亲外出打工334人(42.47%),母亲外出打工146人(18.02%),父母均外出打工320(39.51%);母亲外出打工留守儿童吸烟行为比例为8.22%,高于父亲外出打工的3.80% 及父母均未外出打工的3.23%,差异有统计学意义(χ²=9.117,P=0.003;χ²=10.504,P=0.001);父母均外出打工留守儿童每周饮酒≥1次比例为11.25%,高于父亲外出打工的6.4% 及父母未外出打工的7.67,差异有统计学意义(χ²=4.850,P=0.028;χ²=4.315,P=0.038);母亲外出打工的留守儿童因饮酒打架≥1次/学期的比例为9.59%,高于父亲外出打工的4.65及父母均未外出打工的6.24%,差异有统计学意义(χ²=4.312,P=0.038;χ²=4.127,P=0.042);父母均未外出打工的留守儿童上网行为比例为17.08% 低于父母均外出打工的28.44%,差异有统计学意义(χ²=24.283,P=0.000);多因素非条件logistic回归分析显示,年龄(OR=1.129)、年级(OR=0.646)、性别(OR=0.146)是留守儿童吸烟行为的影响因素。结论 父母外出打工对留守儿童的危险行为和心理产生一定影响,其中母亲外出打工影响明显。     

Parental Incarceration as a Risk Factor for Children in Homeless Families

The current study aimed to describe the prevalence of children of incarcerated parents (COIP) in a sample of homeless/highly mobile children, examine the relationship between parental incarceration and other risk factors, and investigate the effect of parental incarceration on child academic and mental health outcomes. The authors compared COIP (n = 45) to children whose parents were never incarcerated (n = 93) within a sample of 138, 4‐ to 7‐year‐old ethnically diverse children residing in emergency homeless shelters. Children's caregivers provided information about children's history of parental incarceration and other family experiences. Children's teachers reported academic and mental health outcomes in the subsequent school year. Compared to children with no history of parental incarceration, COIP experienced more negative life events. Regression models revealed that a history of parental incarceration was a significant predictor of teacher‐reported internalizing problems. These results have implications for the identification and treatment of the highest risk homeless/highly mobile children.     

Maternal partiality in attachment with multiple birth children and the related factors

Multiple births are associated with an increased risk of child abuse and neglect. It is reported that only one child is abused in almost cases, and most abusers are the mothers. Maternal partiality regarding attachment has been suggested as the reason for this tendency. This study investigated the prevalence of this phenomenon in families with multiple birth children and identified factors associated with increased risk. The subjects were 231 mothers of multiple birth children. The following results were obtained. 1. Overall, 10.0% of mothers with multiple birth children reported that they didn't equally attach themselves to all their offspring. 2. Mothers who didn't equally attach themselves exhibited significantly poor health conditions and a higher frequency of upper respiratory infections, compared with mothers who demonstrated no partiality. Moreover, they were more likely to complain of severe fatigue (physical and mental) and poor sleeping conditions. 3. The mothers who didn't equally attach themselves to all their multiple birth children had a higher rate of handicapped children. CONCLUSION: Mothers who do not equally attach themselves to all their multiple birth children show poor health conditions and a higher frequency of upper respiratory infections, and complain of severe fatigue and poor sleeping conditions. They also have a higher rate of handicapped children.     

Child abuse and neglect--a public health concern

OBJECTIVE: To review the phenomenon of child abuse and neglect from a public health perspective. DATA SOURCES: Literature review before the publication of the landmark article by the pediatrician C. Henry Kempe and coworkers in 1962, "The battered-child syndrome", and selected publications until the end of 1999. STUDY SELECTION: Studies published in the period before the discovery of the battered-child syndrome, studies after that publication dealing with the definition of child abuse and neglect, epidemiology of child abuse, fatal child abuse, child sexual abuse, emotional abuse, and domestic violence. DATA EXTRACTION: Studies or data linked to child physical abuse, neglect, psychological abuse, sexual abuse, structural abuse, other forms of abuse and domestic violence. DATA SYNTHESIS: In the 19th century more understanding for children's rights was acknowledged and in the 20th century child abuse was discovered in 1962 after many years of "looking with the blind eye". The number of reported cases of child abuse world wide has ever since exploded into a public health epidemic with a ten times higher incidence than cancer (child abuse rate: 40 per 1,000 population; cancer 3.9 per 1,000 population. CONCLUSIONS: Child abuse and neglect is complex, involving many professionals and agencies, which can be one of the reasons why the field has not been able to attract enough resources for prevention, treatment, education, and research. Child abuse must be looked upon as a major public health problem, and professionals must enter the new century with an effort to really make it a "century for the child."     

Impact of Parental Substance Use Disorder and Child Neglect Severity on Substance Use Involvement in Male Offspring

Two child self-report scales were developed to measure parental neglect (emotional distance and parental involvement) in a sample of 344 boys between 10 and 12 years of age. Psychometric analyses of the parental emotional distance and involvement scales demonstrated their unidimensionality; construct, concurrent, and predictive validity; and reliability. Cross-sectional analyses indicated that neglect was more severe among boys who had a parent with a DSM-III-R lifetime substance use disorder (SUD) compared to youth whose parents had no Axis I psychiatric disorder. In addition, children reported more severe neglect by the mother than the father. Longitudinal analyses of a subsample (n = 99) revealed that child neglect at ages 10–12 predicted significant variance on a composite measure of substance use involvement and severity of substance use as well as increased the risk for SUD at age 19.     

Psychiatric disorders among American Indian and white youth in Appalachia: the Great Smoky Mountains Study.

OBJECTIVES: This study examined prevalence of psychiatric disorders, social and family risk factors for disorders, and met and unmet needs for mental health care among Appalachian youth. METHODS: All 9-, 11-, and 13-year-old American Indian children in an 11-county area of the southern Appalachians were recruited, together with a representative sample of the surrounding population of White children. RESULTS: Three-month prevalences of psychiatric disorders were similar (American Indian, 16.7%; White, 19.2%). Substance use was more common in American Indian children (9.0% vs 3.8% in White children), as was comorbidity of substance use and psychiatric disorder (2.5% vs 0.9%). American Indian poverty, family adversity (e.g., parental unemployment, welfare dependency), and family deviance (parental violence, substance abuse, and crime) rates were higher, but the rate of family mental illness, excluding substance abuse, was lower. Child psychiatric disorder and mental health service use were associated with family mental illness in both ethnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian children used fewer mental health services. CONCLUSIONS: This study suggests that poverty and crime play different roles in different communities in the etiology of child psychiatric disorder.     

Quality of life among women living with HIV: the importance violence, social support, and self care behaviors

This paper describes the relationship between psychosocial factors and health related quality of life among 287 HIV-positive women using items from the Medical Outcomes Study HIV Health Survey to measure physical functioning, mental health and overall quality of life. Multivariate models tested the relative importance of sociodemographic characteristics, HIV-related factors and psychosocial variables in explaining these quality of life outcomes. A history of child sexual abuse and adult abuse, social support and health promoting self-care behaviors were the psychosocial factors studied. Women in the sample were on average 33 years old and had known they were HIV-positive for 41 months; 39% had been hospitalized at least once due to their HIV; 83% had children; 19% had a main sex partner who was also HIV-positive. More than one-half of the women (55%) had a history of injection drug use and 63% reported having been physically or sexually assaulted at least once as an adult. A history of childhood sexual abuse. reported by 41% of the sample, was significantly related to mental health after controlling for sociodemographic and HIV-related characteristics. Women with larger social support networks reported better mental health and overall quality of life. Women who practiced more self-care behaviors (healthy diet and vitamins, adequate sleep and exercise, and stress management) reported better physical and mental health and overall quality of life. The high prevalence of physical abuse and child sexual abuse reported by this sample underscores the importance of screening for domestic violence when providing services to HIV-positive women. That such potentially modifiable factors as social support and self care behaviors are strongly associated with health-related quality of life suggests a new opportunity to improve the lives of women living with HIV.     

Physicians' attention to parents' concerns about the psychosocial functioning of their children.

BACKGROUND: Epidemiological data indicate that approximately 20% of children have psychosocial problems, yet less than 2% of children are seen by mental health specialists each year. Primary care physicians tend to identify children with psychosocial problems when parents discuss concerns with them. OBJECTIVE: To examine factors related to physicians' attention to parental disclosures. DESIGN: Parents reported the psychosocial functioning of themselves and their children. Physicians reported the psychosocial functioning of 75 children and whether the parent disclosed psychosocial concerns to them. SETTING: Ambulatory care clinic of a community-based, university-affiliated, residency training program. PARTICIPANTS: Seventy-five parents of children aged 2 to 16 years who presented for routine primary care, and 26 physicians. MAIN OUTCOME MEASURES: Beck Depression Inventory (parental distress), Eyberg Child Behavior Inventory (child behavior problems), physician and parent report. RESULTS: Physicians identified 50.0% of children with clinically significant behavior problems. Logistic regression indicated that parental disclosure was the only significant predictor of physician identification (P < .002). When children had clinically significant behavior problems, physicians were more likely to report disclosures by parents (45.0% vs 5.7% for parents of children with and without behavior problems, respectively). Physicians were more likely to report parental disclosure when parents reported personal psychosocial distress (38.9% for distressed vs 5.7% nondistressed parents). CONCLUSIONS: Parental disclosure of concerns was a better predictor of physician identification of child psychosocial problems than was the presence of child behavior problems. Physicians responded more frequently to the disclosures of potential problems by parents of children with clinically significant psychosocial problems. They also attended more frequently to disclosures about behavior problems when the parent was also experiencing psychosocial distress.