Populations at Risk Across the Lifespan: Case Studies: Psychological and Physical Abuse Among Pregnant Women in a Medicaid‐Sponsored Prenatal Program

ABSTRACT Objectives: To document psychological and physical abuse during pregnancy among women enrolled in enhanced prenatal services (EPS); explore the associations between maternal risk factors and type of abuse; and examine the relationship between abuse and EPS participation. Design and Sample: Cross‐sectional study utilizing screening data collected between 2005 and 2008. Convenience sample of Medicaid‐insured pregnant women enrolled in EPS selected from urban and rural providers. Measures: A prenatal screening tool that included measures such as Cohen's Perceived Stress Scale‐4, Patient Health Questionnaire‐2, and Abuse Assessment Screen was used. Results: Logistic regressions showed that high perceived stress and lack of father support were associated with all types of abuse and abuse history. Women with risk factors, such as a positive depression screen (odds ratio [OR]=2.36), were associated with psychological abuse but not with physical abuse during pregnancy. Less than a 12th‐grade education was associated with physical abuse (OR=1.64) but not psychological abuse during pregnancy. The amount or the timing of EPS participation was not significantly associated with abuse history or abuse during pregnancy. Conclusions: Risk factors, such as high perceived stress and lack of father support, may alert nurses to further explore abuse during pregnancy. Additional research is needed for understanding the relationship between abuse and EPS participation.     

Relationships Between Attribution Style, Child Abuse History, and PTSD Symptom Severity in Vietnam Veterans

Relationships between learned helplessness, locus of control, child abuse histories, adult trauma exposure and subsequent PTSD symptom severity in a clinical sample of male Vietnam veterans were examined. Learned helplessness and external locus of control were not only reliably associated with each other, but also differentially associated with childhood abuse and PTSD symptom severity. Learned helplessness, in particular, evidenced significant relationships with both childhood trauma and current distress. Contrary to expectations, child abuse history was not reliably associated with combat-related PTSD. Overall results suggested that learned helplessness and external locus of control are correlated, but independent constructs with compelling links to adult psychopathology.

Identification of child maltreatment while caring for them in a university hospital

The purpose of the study was to look at how nurses and physicians of a university hospital rated their ability to identify child maltreatment while caring for those children. In this study, child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child under the age of 18 by parents or caregivers. The total population of staff caring for children (N=513) in a university hospital were surveyed. Data were collected with a questionnaire developed for this study with reference to the literature. Altogether 317 questionnaires were returned, which yielded a response rate of 62%. The data were analysed using statistical methods and quantitative content analysis. Forty per cent of the respondents estimated that they had never cared for a maltreated child. Two-thirds of the respondents believed that they would be able to identify a child maltreatment case. The most distinct signs by which maltreatment could be identified were fractures, multiple bruises and the fact that the child had frequent injuries. The child's or parent's behaviour often aroused suspicion of maltreatment. Seventy-one per cent of the respondents rated the identification of maltreatment as rather difficult or difficult. Awkwardness of the phenomenon, the staff's pressure of work and relative unfamiliarity with the phenomenon were assessed as things that make the identification difficult. The fact that no jointly agreed guidelines were available for handling the matter was seen as a particular weakness. The respondents had fairly much theoretical knowledge about child maltreatment. However, child maltreatment is a multi-dimensional phenomenon that calls forth emotions. The development and improvement of practical nursing and medical care and of staff collaboration require that education be provided to different occupational groups and parties caring for children and that jointly agreed hospital-specific and regional models for operation be developed.     

Forensic nurses' experiences of receiving child abuse disclosures

Purpose. A child's self‐disclosure of abuse is a critical component in initiating intervention to stop abuse and decrease the likelihood of long‐term negative outcomes. This study described the context in which child abuse victims disclosed to forensic nurses. Design and Methods. Thirty interviews were conducted at the International Forensic Nurses Scientific Assembly 2007 and then analyzed using narrative inquiry methodology. Results. Five themes emerged: child‐friendly environment, building rapport, engaged listening, believing unconditionally, and the potential for false disclosures. Practice Implications. Nurses can provide an environment that allows a child the perception of limitless time to share their unique stories.     

Family-Centered Care When Abuse or Neglect is Suspected

Ask the Expert provides answers to clinical questions for nurses in practice settings. Where possible, evidence from research is used to support the experts' recommendations.     

Development of a Child Abuse Checklist to Evaluate Prehospital Provider Performance

Objectives: To develop and provide validity evidence for a performance checklist to evaluate the child abuse screening behaviors of prehospital providers. Methods: Checklist Development: We developed the first iteration of the checklist after review of the relevant literature and on the basis of the authors' clinical experience. Next, a panel of six content experts participated in three rounds of Delphi review to reach consensus on the final checklist items. Checklist Validation: Twenty-eight emergency medical services (EMS) providers (16 EMT-Basics, 12 EMT-Paramedics) participated in a standardized simulated case of physical child abuse to an infant followed by one-on-one semi-structured qualitative interviews. Three reviewers scored the videotaped performance using the final checklist. Light's kappa and Cronbach's alpha were calculated to assess inter-rater reliability (IRR) and internal consistency, respectively. The correlation of successful child abuse screening with checklist task completion and with participant characteristics were compared using Pearson's chi squared test to gather evidence for construct validity. Results: The Delphi review process resulted in a final checklist that included 24 items classified with trichotomous scoring (done, not done, or not applicable). The overall IRR of the three raters was 0.70 using Light's kappa, indicating substantial agreement. Internal consistency of the checklist was low, with an overall Cronbach's alpha of 0.61. Of 28 participants, only 14 (50%) successfully screened for child abuse in simulation. Participants who successfully screened for child abuse did not differ significantly from those who failed to screen in terms of training level, past experience with child abuse reporting, or self-reported confidence in detecting child abuse (all p > 0.30). Of all 24 tasks, only the task of exposing the infant significantly correlated with successful detection of child abuse (p < 0.05). Conclusions: We developed a child abuse checklist that demonstrated strong content validity and substantial inter-rater reliability, but successful item completion did not correlate with other markers of provider experience. The validated instrument has important potential for training, continuing education, and research for prehospital providers at all levels of training.     

The Relationship Between Respite Care and Child Abuse Potential in Parents of Children with Developmental Disabilities: A Preliminary Report

This study longitudinally examined the impact of respite care services on child abuse potential and family relations in a sample of parents (N = 14) whose children were admitted for respite care to a center for developmental disability. A sample of parents (N = 18) whose children were admitted for short-term hospitalization (STH) was used as a contrast group. In addition, we examined the interrelationships between child abuse potential, family relations, and parenting stress at 3 time points. Parents completed measures of child abuse potential, family relations, and parenting stress at time of admission, discharge, and at a 2-month follow-up. Results indicated that neither respite care nor STH resulted in significant effects on child abuse potential or family relations although trends were found in the expected direction. Strong interrelationships were found between child abuse potential, family relations, and parenting stress at each of the 3 time points. These preliminary results suggest that respite care may be insufficient to directly impact child abuse potential; however, interventions that target variables related to abuse (e.g., quality of family relations, parenting stress) might be beneficial.     

The use of the Brief Child Abuse Potential Inventory in the general population in Finland

Objective: The purpose of this research was to analyze psychometric information in the Brief Child Abuse Potential Inventory (BCAP) in a Finnish general population sample.

Design: A self-report survey of parents in a primary health care setting and a hospital setting was used to evaluate the use of the BCAP.

Setting: The study population consisted of parents who were visiting one of the following contexts: a primary maternity health care clinic, a child health care clinic, and the maternity outpatient clinic, various pediatric outpatient clinics, the general pediatric ward, the pediatric surgical ward, or the neonatal intensive care unit in a hospital setting.

Subjects: The BCAP was given to parents at the 30–34th week of pregnancy, when the child was 5 months old or all parents depending on the context. The BCAP was delivered to 759 parents. The final size of the sample was 453 respondents.

Main outcome measure: The BCAP, which consisted of 25 items to screen child abuse potential and nine items for evaluation of respondent validity.

Results: The internal consistency of the Abuse Risk Scale was good (.770), and the validity scales worked well. The factor structure mirrors with the original factors structure.

Conclusion: The psychometric properties of the BCAP reported in the analysis suggest that the BCAP could be a valid instrument to detect child abuse potential in the general population in Finnish health care settings. However, among Finnish respondents there is very little variation in some parts of the measure, which suggests that further research should assess the validity of the instrument in representative samples. Further analysis is also needed to evaluate the correct classification rate of the BCAP.

• Key points

• Identification of families at risk of child maltreatment requires valid tools to recognize risk within the general population, as part of child and family needs and risk assessments in family services.

• 1. The BCAP is valid, reliable, and useful in bringing parental worries under discussion in child and family services.

• 2. Results of this study can be used for a more systematic and valid child maltreatment risk assessment for identifying families who need help managing their everyday lives.

     

Parent Education: An Evaluation of STEP on Abusive Parents''Perceptions and Abuse Potential

PROBLEM: To examine the effects of a structured, time-limited parent training group on abusive or potentially abusive parents. METHODS: A pretest-posttest control group design was used with consenting parents (N = 18) to examine the effects of Systematic Training for Effective Parenting (STEP) on abusive parents' perceptions of their children's behaviors and on the parents' potential to physically abuse. The Adlerian Parental Assessment of Child Behavior Scale and the Child Abuse Potential Inventory were used to measure treatment effects. FINDINGS: After participating in STEP, abusive parents had significantly more positive perceptions of their children and were significantly less potentially abusive. Using volunteers, the project cost an average of $100 for each parent. CONCLUSIONS: The research lends empirical support to individual psychology and family systems theory. Future research is indicated using larger samples to examine lay vs. professional leadership of the groups, as well as comparisons of different parenting programs with abusive parents.     

Evaluation of a Child Sexual Abuse Prevention Program

A half-million children are believed to be sexually abused each year in the United States. In 1995, the American Medical Association declared sexual assault a silent violent epidemic. The majority of efforts to stop child sexual abuse have focused on punishing abusers and treating victims and their families; prevention programs are uncommon and rely on educating children to report sexual abuse. This case study describes the evaluation of the first public health campaign designed to target adults for prevention. A baseline assessment of attitudes, awareness, knowledge, and policies was conducted in Vermont to identify facilitators and barriers to adult prevention of child sexual abuse. These included predisposing factors (50% of Vermont residents did not know the characteristics of an abuser), enabling factors (60% of Vermont residents did not know where to refer someone who may have sexual behavior problems), and reinforcing factors (when focus group participants knew an abuser, they were less likely to take action). This process guided the intervention, which included a broad-based media campaign targeting adults; a one-to-one communications strategy that provided information to agencies working with families at risk and a toll-free helpline for adults in an abuse situation; and a systems change strategy designed to educate decision-makers and leaders. Program evaluation measures included a random-digit dial survey, focus groups, a survey of Vermont decision-makers, and other data sets. The successes and limitations of these interventions, both as strategies in themselves and as data sources for evaluation, are discussed.     

Preventing Sexual Abuse and Assault

This article reviews prevention of sexual abuse and assault from a public health approach. The public health approach identifies three levels of prevention: primary, secondary, and tertiary. Several programs are reviewed in the area of primary prevention. The article discusses the efficacy of different approaches. Information from offenders and victims is reviewed to gain insight into primary prevention approaches. Review of innovative approaches to secondary prevention are introduced. This section focuses on changing the behavior of potential offenders rather than changing the behavior of potential victims. Special consideration is given to the role of alcohol in abuse and possible prevention strategies to reduce abuse risk by reducing high-risk alcohol use. Discussion of intervention strategies and offender characteristics are reviewed to address tertiary prevention.     

Assessment of Tapentadol API Abuse Liability With the Researched Abuse,Diversion and Addiction-Related Surveillance System

Tapentadol, a Schedule II opioid with a combination of µ-opioid activity and norepinephrine reuptake inhibition, is used for the management of moderate to severe acute and chronic pain. Its dual mechanism of action is thought to reduce opioid-related side effects that can complicate pain management. Since approval, tapentadol has been tracked across multiple outcomes suggesting abuse liability, and a pattern of relatively low, although not absent, abuse liability has been found. This retrospective cohort study further details the abuse liability of tapentadol as an active pharmaceutical ingredient (API) when immediate-release as well as extended-release formulations were on the market together (fourth quarter of 2011 to second quarter of 2016). Tapentadol (API) was compared with tramadol, hydrocodone, morphine, oxycodone, hydromorphone, and oxymorphone across Poison Center, Drug Diversion, and Treatment Center Programs Combined data streams from the Researched Abuse, Diversion and Addiction-Related Surveillance system. Findings suggest the public health burden related to tapentadol to date is low, but present. Event rates of abuse per population-level denominators were significantly lower than all other opioids examined. However, when adjusted for drug availability, event rates of abuse were lower than most Schedule II opioids studied, but were not the lowest. Disentangling these 2 sets of findings further by examining various opioid formulations, such as extended-release and the role of abuse-deterrent formulations, is warranted.

Randomized Prospective Study to Evaluate Child Abuse Documentation in the Emergency Department

Objectives:  The objective was to determine whether an educational intervention for health care providers would result in improved documentation of cases of possible physical child abuse in children <36 months old treated in the emergency department (ED) setting.
Methods:  This study had a statewide group-randomized prospective trial design. Participating EDs were randomized to one of three intervention groups: no intervention, partial intervention, or full intervention. Medical records for children <36 months of age were abstracted before, during, and after the intervention periods for specific documentation elements. The main outcome measure was the change in documentation from baseline. Generalized estimating equations (GEEs) were used to test for intervention effect.
Results:  A total of 1,575 charts from 14 hospitals EDs were abstracted. Hospital and demographic characteristics were similar across intervention groups. There were 922 (59%) injury visits and 653 (41%) noninjury visits. For each specific documentation element, a GEE model gave p-values of >0.2 in independent tests, indicating no evidence of significant change in documentation after the intervention. Even among the 26 charts in which the possibility of physical abuse was noted, documentation remained variable.
Conclusions:  The educational interventions studied did not improve ED documentation of cases of possible physical child abuse. The need for improved health care provider education in child abuse identification and documentation remains. Future innovative educational studies to improve recognition of abuse are warranted.     

儿童虐待性颅脑外伤研究进展

虐待性颅脑外伤(AHT)是一种严重的虐待形式,是所有类型的儿童虐待中最严重的致命伤害,占儿童虐待死亡人数的30.00％.AHT常见于1岁以内儿童,其发病率在1～4月龄大时达到峰值,平均患病年龄为5月龄.AHT的发病率为(12.7～38.8)/10万,病死率为20.00％～30.00％.患者常患有认知、行为、智力等发育障...