Borderline personality disorder features and history of childhood maltreatment in mothers involved with child protective services

This study examines the history of childhood maltreatment and Borderline Personality Disorder (BPD) symptoms in mothers whose children were removed from the home by Child Protective Services (CPS) to identify potential targets for future intervention efforts. Forty-one mothers of children removed from the home due to abuse and/or neglect and 58 community-control mothers without CPS involvement were assessed for history of childhood maltreatment, alcohol and drug use, and BPD features. CPS-involved mothers scored significantly higher on measures of childhood maltreatment history and BPD features than did control mothers. The highest BPD scores were associated with the most severe histories of mothers' childhood maltreatment. In total, 50% of CPS-involved mothers reported elevated BPD features, compared with 15% of control mothers. Further, 19% of CPS-involved mothers had self-reported scores consistent with a BPD diagnosis, compared with 4% of control mothers. BPD features rather than maltreatment history per se predicted maternal involvement with CPS, controlling for alcohol and drug use predictors. The present data suggest that evidence-based treatments to address BPD symptoms may be indicated for some CPS-involved parents.     

Reducing recurrence in child protective services: impact of a targeted safety protocol

Statewide implementation of a child safety assessment protocol by the Illinois Department of Children and Family Services (DCFS) in 1995 is assessed to determine its impact on near-term recurrence of child maltreatment. Literature on the use of risk and safety assessment as a decision-making tool supports the DCFS's approach. The literature on the use of recurrence as a summative measure for evaluation is described. Survival analysis is used with an administrative data set of 400,000 children reported to DCFS between October 1994 and November 1997. An ex-post facto design tests the hypothesis that the use of the protocol cannot be ruled out as an explanation for the observed decline in recurrence following implementation. Several alternative hypotheses are tested: change in use of protective custody, other concurrent changes in state policy, and the concurrent experience of other states. The impact of the protocol to reduce recurrence was not ruled out.     

Predictors of client engagement and attrition in home-based child maltreatment prevention services

High rates of program attrition in home-based family support and child maltreatment prevention services are common. Researchexamining factors related to family engagement (i.e., enrollment and completion rates) may help program developers increase theimpact of child abuse prevention services by reducing attrition. The present study examined the relative influence of provider,program, and individual factors from the Integrated Theory of Parent Involvement (ITPI) as well as maternal and family demo-graphic and risk variables in predicting service enrollment and completion in a home-based child maltreatment prevention service(SafeCaret) and a standard community care program (Services as Usual [SAU]). Participants were 398 female caregivers ofchildren ages 5 and below. Support was found for the primary role of program and provider factors in client enrollment andcompletion of services. Specifically, participants in SafeCaret were 4 times more likely to enroll in services and 8.5 times morelikely to complete services than those in SAU. Family risk variables including intimate partner psychological aggression, substanceabuse, and depression were also significant predictors. Recommended next steps include integration of risk-related factors in theITPI framework and disentangling specific provider and program factors related to service engagement.     

The relation between child death and child maltreatment

The death of a child is a sentinel event in a community, and a defining marker of a society's policies of safety and health. Child death as a result of abuse and neglect is a tragic outcome that occurs in all nations of the world. The true incidence of fatal child abuse and neglect is unknown. The most accurate incidence data of such deaths have been obtained from countries where multi-agency death review teams analyse the causes of child fatalities, as is done in the United States and Australia.     

The relation between child death and child maltreatment.

The death of a child is a sentinel event in a community, and a defining marker of a society's policies of safety and health. Child death as a result of abuse and neglect is a tragic outcome that occurs in all nations of the world. The true incidence of fatal child abuse and neglect is unknown. The most accurate incidence data of such deaths have been obtained from countries where multi-agency death review teams analyse the causes of child fatalities, as is done in the United States and Australia.     

Child abuse consultations initiated by child protective services: the role of expert opinions

ObjectiveTo describe consultations provided by child abuse pediatricians for cases referred by child protective services (CPS); compare the opinions of the likelihood of child maltreatment of the initial physician, CPS, and the child abuse pediatrician; and examine predictors of the experts’ opinions.MethodsCases were referred by CPS for consultations between March 1, 1998, and June 30, 2005, to 2 child abuse pediatricians at Yale–New Haven Children’s Hospital. We abstracted demographic and clinical information and the opinions of the initial physician, CPS, and the child abuse expert, each coded using a 5-point scale from definite maltreatment to definite benign cause (eg, accident).ResultsOf 187 cases, 50.3% occurred in children younger than 1 year of age. Children’s most serious injuries were fractures (50.8%), burns (16.6%), and bruises/abrasions (15.0%). The child abuse experts’ opinions were 47.6% definite or probable maltreatment, 8.6% uncertain, and 43.9% definite or probable benign. Of the 119 cases with opinions from all 3 assessors, the expert agreed with the physician in 57.1% of cases (κ = 0.34) and with CPS in 64.7% (κ = 0.42). The best predictor of the expert’s opinion that the injury was due to maltreatment was agreement between the physician and CPS that maltreatment had occurred.ConclusionsLevels of agreement were fair to poor between the child abuse expert and either the physician or CPS. Child abuse experts’ opinions have important value in selected cases to confirm previous assessments by the physician and/or CPS, or to change the opinion of the case.     

An intentional opiate intoxication of an infant: when medical toxicology and child maltreatment services merge

We present an instructive case of a 5-week-old infant seen in the emergency department with acute inspiratory stridor and depressed level of consciousness. His emergency department course identified an acute opiate intoxication. The child also developed chest wall rigidity, a rare complication of narcotic use. We discuss the emergency department management, as well as the toxicologic and child protection investigations.     

The relation of child maltreatment to shame and guilt among adolescents: psychological routes to depression and delinquency

In a longitudinal study of children followed for 8 years into adolescence, the authors investigated how different forms of maltreatment (i.e., harsh parenting, sexual abuse, witnessing domestic violence) in childhood and parenting during adolescence influenced adolescents' shame- and guilt-proneness. Furthermore, the authors examined whether diminished feelings of guilt or heightened feelings of shame were related to delinquent behavior or depression in late adolescence. Results showed that whereas harsh parenting in childhood was related to shame proneness in adolescence, this relationship was mediated by parental rejection in adolescence. Findings confirmed that youth with rejecting parents were more shame-prone and less guilt-prone than other youth. Furthermore, shame-proneness was associated with higher depression when measured 2 years later and guilt-proneness was linked to less delinquent behavior. Results suggest that, as mediators, shame and guilt may provide useful focal points for intervention and prevention efforts in reducing adolescent depression and delinquency.     

Comprehensive services for mothers of drug-exposed infants: relations between program participation and subsequent child protective services reports

It is unclear whether intensive services for women using drugs during pregnancy can reduce child maltreatment. Within-subjects, dose-response analyses can be conducted using Child Protective Services (CPS) reports. Dose of services received can indicate either engagement or higher need for services. Using data from an intensive intervention program for mothers of drug-exposed infants, the authors examined associations between CPS reports and (a) dose of services received and (b) a termination status variable combining dose of services received with duration of service involvement and progress on treatment plan goals. Cox regression revealed no association between dose of services and follow-up CPS reports. The termination status variable was strongly related to follow-up CPS reports, such that higher ratings were associated with significantly lower risk of re-report, even after controlling for baseline motivation. Findings suggest that program effects may be detectable using a treatment process-- based index that combines dose, duration, and quality of program involvement.     

Corporal punishment and child maltreatment in New Zealand

On 2 May, 2007, the New Zealand Parliament passed a law repealing Section 59 of the Crimes Act. In so doing, New Zealand became the first English‐speaking nation in the world to make corporal punishment of a child illegal. The passage of this legislation was surrounded by intense and persistent public debate, and supporters of corporal punishment continue to advocate against the law change to the present day. In Sweden, where the first stage of similar repeal took place in 1957, it may be difficult for many to understand the strength of the public opposition to this change in New Zealand. This article will present a viewpoint on the evolution of the debate in New Zealand, review the wider context of child maltreatment and family violence in New Zealand and summarize a range of attempts to prevent or intervene effectively in the cycle of dysfunction. Conclusion: Child maltreatment and family violence are public health issues of great importance, and a stain on all societies. While corporal punishment may be a significant contributing factor, there is no single ‘solution’. Change must occur on multiple levels (political, economic, cultural, familial and professional) before the tide will turn.     

The affective and cognitive sequelae of child maltreatment

This article discusses the affective and cognitive sequelae of child maltreatment. It provides a brief historical overview and various definitional issues in the field. The tasks of childhood are identified, and developmental processes are discussed. A review of the literature of the sequelae of maltreatment is presented, followed by a discussion of the impact of these sequelae and the implications for the child's development.     

Shame in child maltreatment: contributions and caveats

This special section is a collection of papers that investigates the role of shame in children with abuse histories. Relationships are found between abuse-specific shame or general shame proneness and a variety of outcomes. However, the relationships are not consistent. The utility of these findings will be enhanced by studies that use common measurement approaches and address similar outcomes, as well specific tests of intervention approaches that target shame.     

Police involvement in child protective services investigations: literature review and secondary data analysis

This article examines the relationship of police and child protective services (CPS) coinvolvement to the outcomes of child maltreatment investigations. It reviews practice and empirical literature and conducts a secondary analysis of a national CPS data set. Most sources argue that coordination of the two agencies improves investigations and benefits children and families. Yet, sources also report friction between these agencies, interference with each other's job, and concerns that police involvement increases child removal. In the CPS case data, allegations were more likely to be judged credible when police also investigated and families were also more likely to receive various services. For neglect cases, multi-disciplinary decision making, but not police involvement per se, was linked to child removal. Across studies, police do not appear to hinder CPS effectiveness and may actually promote it. Their investigations should be coordinated in every community.     

The geography of drug market activities and child maltreatment

This study examines how drug market activities place children at risk of maltreatment over space and time. Data were collected for 95 Census tracts in Sacramento, California, over 7 years and were analyzed using Bayesian space-time models. Referrals for child maltreatment investigations were less likely to occur in places where current drug market activity was present. However, past-year local and spatially lagged drugs sales were positively related to referrals. After the investigative phase, Census tracts with more drug sales had higher numbers of substantiations, and those with more possessions also had more entries into foster care. The temporal delay between drug sales and child maltreatment referrals may indicate that the surveillance systems designed to protect children may not be responsive to changing neighborhood conditions or be indicative of the time it takes for the detrimental effects of the drug use to appear.     

Cultural evidence, child maltreatment, and the law

This article addresses child maltreatment law's use of cultural evidence. Such evidence, offered by immigrant and nonmainstream parents accused of child maltreatment, serves to mitigate intervention in families or to minimize punishment for the offense. The article explores how the two areas of law that currently regulate child maltreatment--criminal and child welfare law--approach the use of such evidence. Civil, child welfare law tends to formally accept and allow for the use of cultural evidence. Criminal law rejects cultural evidence to mount a formal cultural defense that would automatically exempt individuals from punishment for criminal acts, but the system still allows cultural evidence to affect legal decisions. How both systems actually use cultural evidence in practice, however, remains to be determined. The article offers an approach to encourage both legal systems to evaluate and consider cultural evidence more systematically and critically. The analysis also addresses likely objections to the proposed alternatives.     

Maternal psychological control and child internalizing symptoms: vulnerability and protective factors across bioregulatory and ecological domains

Background: We examined ecological (family socioeconomic status (SES)) and bioregulatory (sleep duration, sleep efficiency) moderators of the link between maternal psychological control and children’s vulnerability to internalizing symptoms. Method: A large socioeconomically diverse sample of third graders (N = 141) and their mothers participated. Sleep was examined via actigraphy for one week. Psychological control and internalizing symptoms (depressive symptoms, anxiety symptoms, pre‐sleep arousal) were examined through children’s reports. Results: For children with poorer sleep, lower SES, or a combination of the two, maternal psychological control was positively related to depressive symptoms; this association was not evident for children with both better sleep and higher SES. Further, maternal psychological control, sleep efficiency, and SES interacted to predict both anxiety symptoms and pre‐sleep arousal. Children were protected from the negative effects of psychological control when they were from higher SES families and had higher sleep efficiency; for all other groups of children, psychological control was associated with anxiety symptoms. A similar but less robust pattern of results was found for pre‐sleep arousal. Conclusions: Findings highlight the importance of children’s bioregulatory processes within the socioeconomic context for an enhanced understanding of children’s vulnerability to internalizing problems in the context of maternal psychological control.