COLLABORATION IN PRACTICE: Experiences from a Multidisciplinary Research Project on Child Abuse and Neglect

Abstract. Gustafsson, L. H., Lagerberg, D., Larsson, B. and Sundelin, C. (Department of Paediatrics, University Hospital, Uppsala, Sweden). Collaboration in practice. Experiences from a multidisciplinary research project on child abuse and neglect. This paper describes experiences from a three-year research project concerning questions of child abuse and neglect. The emphasis is placed on an attempt to define the real difficulties that have arisen during the course of this work, e.g. group pressure, breaks in continuity, goal heterogeneity, role conflicts and differences in frames of reference. Collaboration problems must be taken seriously and deserve systematic investigation. Multidisciplinary collaboration in different connections within medical, health and social care is of particular importance at this time when the care resources are limited. At the same time it is of decisive importance that the members of the team clarify their attitudes towards certain fundamental questions.     

Child Neglect: Assessment and Intervention

Neglect is often a neglected form of child maltreatment even though it is the most common and deadliest form of child maltreatment. Pediatric nurse practitioners (PNPs) will most likely encounter neglected children in their practice. It is crucial that PNPs recognize child neglect in a timely manner and intervene appropriately. This continuing education article will help PNPs understand and respond to child neglect. Neglect will be defined and risk factors will be discussed. Children who are neglected can experience serious and lifelong consequences. The medical assessment and plan of care for children with concerns of suspected neglect will be discussed.     

Quality Improvement to Immunization Coverage in Primary Care Measured in Medical Record and Population-Based Registry Data

Objectives

Despite the proven benefits of immunizations, coverage remains low in many states, including Vermont. This study measured the impact of a quality improvement (QI) project on immunization coverage in childhood, school-age, and adolescent groups.

Childhood neglect: a clinical perspective and introducing the Graded Care Profile 2

Neglect has serious consequences for children in terms of their health, growth, and development. Neglect may even directly cause or contribute to child deaths. In common with other forms of abuse and exposure to adverse childhood experiences, neglect is linked with health risks in adulthood that lead to diseases that cause premature death. Healthcare professionals working with children and young people must be skilled in identifying and dealing with it. Early recognition is vital but whilst neglect is the most prevalent form of abuse it remains difficult to identify and assess. This review examines how neglect can impact on the developmental process and how this can be identified. Clinically discernible features are described, along with advice about how best to address them. It also introduces a tool which can help overcome some of the difficulties associated with the assessment of neglect: The Graded Care Profile 2 (GCP2).     

Child protection contact among children of culturally and linguistically diverse backgrounds: A South Australian linked data study

Aim

To describe the cumulative incidence of child protection (CP) system contact, maltreatment type, source of reports to age 7 years, and socio-demographic characteristics for culturally and linguistically diverse (CALD) Australian children.

Methods

We used CP, education, health, and birth registrations data for children followed from birth up to age 7 from the South Australian Better Evidence, Better Outcomes, Linked Data (SA BEBOLD) platform. Participants: SA born children enrolled in their first year of school from 2009 to 2015 (n = 76 563). CALD defined as non-Aboriginal or Torres Strait Islander, spoken language other than English, Indigenous or Sign, or had at least one parent born in a non-English speaking country. Outcomes measures: For CALD and non-CALD children, we estimated the cumulative incidence (risk) of CP contacts up to age 7, relative risk and risk differences for all levels of CP contact from notification to out-of-home care (OOHC), primary maltreatment type, reporter type, and socio-economic characteristics. Sensitivity analyses explored different population selection criteria and CALD definitions.

Results

By age 7, 11.2% of CALD children had ‘screened-in’ notifications compared to 18.8% of non-CALD (risk difference [RD] 7.6 percentage points (95% confidence interval: 6.9–8.3)), and 0.6% of CALD children experienced OOHC compared to 2.2% of non-CALD (RD 1.6 percentage points (95% confidence interval: 1.3–1.8)). Emotional abuse was the most common substantiated maltreatment type for CALD and neglect for non-CALD. Among both groups, the most common reporter sources were police and education sector. Socio-economic characteristics were broadly similar. Sensitivity analyses results were consistent with primary analyses.

Conclusion

By age 7, CALD children had lower risk of contact with all levels of CP. Estimates based on primary and sensitivity analyses suggested CALD children were 5–9 percentage points less likely to have a report screened-in, and from 1.0 to 1.7 percentage points less likely to have experienced OOHC.     

Child abuse and child abuse studies in Japan

Medical research on child abuse has a short history of only 20 years. However, the social and familial changes that have occurred since the Second World War have resulted in an increasing number of abused children throughout Japan. Reported cases represent only the tip of the iceberg, with many cases being ignored. This article discusses the history, definition, incidence, and social, familial, and psychopathology factors in the etiology of child abuse based on clinical experience and research surveys undertaken during the past 20 years. Suggestions for improving child abuse preventive and reactive services are also made.     

Risk factors of parents abused as children: a mediational analysis of the intergenerational continuity of child maltreatment (Part I)

BACKGROUND: This study provides an exploration of factors implicated in the intergenerational cycle of child maltreatment. Families with newborns where at least one of the parents was physically and/or sexually abused as a child (AP families) were compared in terms of risk factors to families where the parents had no childhood history of victimization (NAP families). The mediational properties of risk factors in the intergenerational cycle of maltreatment were then explored. METHODS: Information was collected by community nurses as a part of the 'health visiting' service. Data was collated across 4351 families, of which 135 (3.1%) had a parent who self-reported a history of abuse in childhood. The health visitor visited each family at home when the child was 4 to 6 weeks of age to assess the presence of risk factors. RESULTS: Within 13 months after birth, 9 (6.7%) AP families were referred for maltreating their own child in comparison to 18 (.4%) NAP families. Assessments found a significantly higher number of risk factors for AP families. Mediational analysis demonstrated that the presence of three significant risk factors (parenting under 21 years, history of mental illness or depression, residing with a violent adult) provided partial mediation of the intergenerational continuity of child maltreatment, explaining 53% of the total effect. CONCLUSION: Prevention may be possible, once a history of parental childhood abuse has been identified, by offering services in priority to those families where a parent is under 21 years, has a history of mental illness/depression and/or there is a violent adult residing in the household. However, it must also be acknowledged that these factors do not provide a full causal account of the intergenerational transmission and consideration should be given to additional factors, such as parenting styles (see Part II of this mediational model, Dixon, Hamilton-Giachritsis, and Browne, 2004).     

Memories of Childhood Neglect and Abuse: Corroboration in a Series of Sisters

Reports from 87 community-based sister-pairs, selected for high rates of neglect or abuse in childhood, have been used to establish validity of the CECA, a retrospective interview measure of childhood experience. Corroboration was based on independent assessments of sisters accounts of what happened to each other in childhood. Corroboration of scales assessing parental neglect, physical abuse in the household and sexual abuse either household or nonhousehold I was satisfactory, with a mean correlation for the three experiences of.60 (weighted kappa [kw]).
Concordance reflected the degree to which experience was shared and was judged by comparing the sisters' accounts of their own experience. Among sisters with shared (concordant) experience for neglect or abuse, corroboration was high (mean of 74), but for those with nonshared (nonconcordant) experience it was largely absent (mean of .011. The degree to which I he experiences of neglect or abuse were concordant was related to whether the perpetrator was a member of the household. Neglect and physical abuse were by definition from household members i mainly parents I and involved high concordance of experience. Sexual abuse occurred from many sources and in practice was commonly from an adult living outside the household and such experiences were less likely to be shared by sisters. An overall index indicating the presence of at least one abusive experience before the age of 17 showed a concordance of .64 with corroboration between sisters as high as 70, Issues involving retrospective recall and measurement are discussed.     

Attributions and behaviours of parents abused as children: a mediational analysis of the intergenerational continuity of child maltreatment (Part II)

BACKGROUND: This study extends previous research (Dixon, Browne, & Hamilton-Giachritsis, 2004) by exploring the mediational properties of parenting styles and their relation to risk factors in the intergenerational cycle of child maltreatment. Families with newborns where at least one of the parents was physically and/or sexually abused as a child (AP families) were compared, in terms of parents' attributions and behaviour, to families where the parents had no childhood history of victimization (NAP families). METHODS: Information was collected from 4351 families (135 AP families) by community nurses as part of the 'health visiting' service. The same health visitor visited each family twice at home when the child was 4 to 6 weeks and 3 to 5 months of age, to assess behavioural indicators of positive parenting. RESULTS: Within 13 months after birth, 9 (6.7%) AP families were referred for maltreating their own child in comparison to 18 (.4%) NAP families. Assessments found a significantly higher number of risk factors and measures indicating poor parenting for AP families. Mediational analysis found that intergenerational continuity of child maltreatment was explained to a larger extent (62% of the total effect) by the presence of poor parenting styles together with the three significant risk factors (parenting under 21 years, history of mental illness or depression, residing with a violent adult). The three risk factors alone were less explanatory (53% of the total effect). CONCLUSION: This study provides an explanation for why a minority of parents abused in childhood go on to maltreat their own infant, evidencing poor parenting styles and mediating risk factors. Hence, prevention may be enhanced in AP families by the promotion of 'positive parenting' in addition to providing additional support to young parents, tackling mental illness/depression and domestic violence problems.     

892名卫校女生儿童期性虐待经历及其对心理健康的影响

目的 了解卫校女生儿童时期性虐待发生情况,探讨性虐待经历对学生心理健康的影响,为卫生、教育及其他相关部门制定预防儿童性虐待对策提供参考依据。方法 用自填式问卷,对一所卫校892名女生就有关儿童时期受性虐待经历进行不记名回顾性调查。结果 在被调查的892名女生中,有25．6％(2128／892)报告16岁以前经历过或非身体接触或身体接触的性虐待(身体接触的性虐待中包括被试图性交和被强行性交)。其中129人经历过身体接触的性虐待,占14．5％。52．6％的儿童首次性虐待经历发生在12岁及以下。与没有儿童期性虐待经历的女生比较,有儿童期性虐待经历的女生抑郁情绪量表得分高;健康状况自我感觉评价得分低;有性交行为比例高;在调查的近12个月里有自杀意念或自杀企图、参与或卷入斗殴、以及在调查近30天里曾吸烟饮酒的发生率均明显偏高。结论 儿童性虐待问题在我国并非少见。儿童期性虐待经历是影响受害者心理健康的一个重要因素。