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.     

Predictors of re-referral to child protective services: a longitudinal follow-up of an urban cohort maltreated as infants

Decades of research has identified several psychosocial risk factors for child maltreatment, only some of which are modifiable. The relative importance of the most modifiable psychosocial variables, as compared to more static variables such as demographic characteristics, is not well understood, particularly among children maltreated at a very young age. This study examined predictors of re-referral among 149 urban children originally referred for maltreatment as infants. Of these children, 42.3% were re-referred over a period of 11 to 15 years. Cox regression analyses with time-varying covariates revealed that modifiable psychosocial risk factors failed to predict risk for re-referral in a multivariate model. Demographic characteristics and characteristics of the index incident of maltreatment were the strongest predictors of re-referral. Existing services may not be addressing the underlying reasons for maltreatment, particularly in families with young children. A clearer understanding of the underlying causes of maltreatment is needed.     

Infant Health and Development Program for low birth weight, premature infants: program elements, family participation, and child intelligence.

The Infant Health and Development Program was an eight-site randomized controlled trial testing the efficacy of early intervention to enhance the cognitive, behavioral, and health status of low birth weight, premature infants. The 377 intervention families received for the first 3 years of life: (1) pediatric follow-up, (2) home visits, (3) parent support groups, and (4) a systematic educational program provided in specialized child development centers. The control group (n = 608) received the same pediatric follow-up and referral services only. This paper describes the delivery of the intervention and its outcomes. A Family Participation Index that was the sum of participation frequencies in each of the program modalities unique to the intervention revealed that program implementation was not different across the eight sites. Index scores did not vary systematically with mother's ethnicity, age, or education or with child's birth weight, gender, or neonatal health status; but they were positively related to children's IQ scores at age 3. Only 1.9% of children of families in the highest tercile of participation scored in the mentally retarded range (IQ less than or equal to 70), whereas 3.5% and 13% of children in the middle and lowest participation terciles, respectively, scored in the retarded range. Similar findings were obtained for borderline intellectual functioning. These findings are consistent with previous research linking intensity of intervention services with degree of positive cognitive outcomes for high-risk infants. The determinants of variations in individual family participation remain unknown.     

Ponderal index of large-for-gestational age infants: comparison between infants of diabetic and non-diabetic mothers

Ponderal index (PI) is a weight-height related parameter that is mainly used to assess the pattern of fetal growth in small-for-gestational age infants. We aimed to use PI for large-for-gestational age (LGA) infants who were born to diabetic or non-diabetic mothers, in order to predict the fetal growth pattern. One hundred sixty-six LGA infants born at the Department of Obstetrics, Hacettepe University Hospital, Ankara, Turkey were included in the study. The PI was calculated by using the following formula: PI = weight (g) x 100/(height, cm)3. Sixty-seven (40%) of these infants were born to diabetic mothers. Maternal age, maternal weight and maternal weight gain during pregnancy were similar in the diabetic and non-diabetic groups. Mean birthweight, height and head circumference were similar in both groups, but median PI of infants of diabetic mothers was significantly higher than of infants of non-diabetic mothers (3.02 and 2.89, respectively, p < 0.05). Fetal growth was different between LGA infants of diabetic and non-diabetic mothers, and PI provided useful information on the proportionality of fetal growth in LGA infants.     

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.     

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.     

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.     

Children of substance-using mothers: child health engagement and child protection outcomes

Aim: Maternal substance use has been associated with a range of child risk factors. The study investigated the relationship between engagement with child health services and child protection outcomes for children of substance‐using mothers. Methods: The sample comprised 119 children of mothers who disclosed opiate, amphetamine or methadone use during a maternity admission between 2000 and 2003. Statutory child protection agency and child health engagement information for the first 2 years of life was obtained. The relationship between type of maternal substance use, child health engagement and child protection outcomes was examined. Results: Of study group infants, 72% were engaged with child health services during the first 2 years of life. Chi‐squared analysis showed no significant relationship between child health engagement and child protection reports. Child health engagement was associated with decreased substantiated child protection notifications for children of methadone using mothers, but not for children of illicit substance users. Conclusions: Almost a quarter of identified children of substance‐using mothers are not accessing standard child health services in their first 2 years of life. This study provides support for increased attention to the provision of child health services for children of methadone using mothers. Further research into effective intervention strategies for children of illicit substance‐using mothers is indicated.     

Evaluation of a sick child day care program: lack of detected increased risk of subsequent infections

A day care center for the short term care of mildly ill children opened in Minneapolis in October, 1985. We conducted a prospective study to evaluate the risk for study participants of acquiring subsequent infections as a result of possible exposure to other infectious agents while at the center. Between June, 1986, and August, 1987, we determined the rates of subsequent infections for 118 children attending the day care center (center-based children) and compared them with rates of subsequent infections for children participating in a home-based sick child care program (home-based children). Of 105 center-based children potentially exposed to respiratory illness while at the center, 24 (23%) developed subsequent respiratory illness compared with 17 (16%) of the matched home-based children (odds ratio, 1.5; 95% confidence interval, 0.7, 3.1). Of 17 center-based children potentially exposed to gastrointestinal illness, 1 (6%) developed subsequent gastrointestinal illness compared with one (6%) of the matched home-based children (odds ratio, 1.0; 95% confidence interval, 0.06, 16.0). Of 12 pairs of children, where the center-based child was potentially exposed to chickenpox while at the center and both were susceptible to chickenpox, 1 center-based child (8%) developed chickenpox compared with 2 home-based children (17%) (odds ratio, 0.5; 95% confidence interval, 0.04, 5.5). We were not able to demonstrate that children who attended the sick child day care center were at significantly increased risk of developing subsequent infections when compared with a matched group of children who did not attend the center.     

Flawed reports of immunization complications: consequences for child health

Flawed studies about complications in vaccination programmes may have serious consequences for community health, as illustrated by a previous report on the adverse effect of pertussis vaccination and a more recent report about a suspected link between MMR vaccination and autistic spectrum disorders.

Conclusion: The Editorial Board of The Lancet has apologized for having published a paper which has misled its readers about the risk of MMR vaccination. Due to the important role of TV and newspapers in giving information about health promotion, these media should also be willing to correct false information.     

High human immunodeficiency virus-free survival of infants born to human immunodeficiency virus-positive mothers in an integrated program to decrease child mortality in rural Rwanda

We retrospectively examined infant mortality and human immunodeficiency virus (HIV)-free survival among 211 infants who received a comprehensive package of health services, including breast milk substitution and clean water access, to prevent maternal-to-child transmission of HIV and improve child survival. The cumulative 12-month infant survival probability was 0.97 (95% confidence interval: 0.94-0.99). The cumulative 12- to 18-month HIV-free survival probability was 0.95 (confidence interval: 0.91-0.97).     

乙型肝炎病毒DNA定量在母婴传播中的意义

目的　探讨孕妇不同血清HBV DNA含量对HBV母婴传播的影响。方法　应用荧光定量PCR技术检测 6 9对母婴血清HBV DNA含量 (所测数据经对数转换 ) ,对孕妇不同血清HBV DNA含量进行分组。结果　孕妇HBV DNA含量为 (6 3± 1 9)拷贝 /ml,婴儿为 (4 8± 2 0 )拷贝 /ml,两者之间呈正相关 (r=0 310 ,P <0 0 1)。 6 9例婴儿中 ,45例HBV DNA定性和 (或 )HBV血清学检查异常 ,提示HBV母婴垂直传播 ,传播率为 6 5 %;HBV母婴传播率随孕妇血清HBV DNA浓度增高而增高 ;根据孕妇血清HBV DNA含量分别向下和向上累计分析 ,显示孕妇HBV DNA含量在 5 0、6 0和 7 0拷贝 /ml三个界面的上下浓度区域 ,HBV母婴传播率差异有显著性 ,其差值分别为 32 %、34 %和 2 8%。本组资料中 ,孕妇HBeAg阳性 19例 ,HBsAb阳性 17例 ,HBeAg阳性组HBV DNA[(7 6± 1 3)拷贝 /ml]明显高于阴性组 [(5 8± 1 9)拷贝 /ml],其HBV母婴传播率 (90 %)明显高于阴性组 (5 6 %) ;HBsAb阳性组HBV DNA含量 [(5 3± 1 6 )拷贝 /ml]明显低于阴性组 [(6 6± 1 9)拷贝 /ml],HBV母婴传播率 (2 9%)也明显低于阴性组 (77%)。同时 ,HBeAg阳性主要分布在HBV DNA测定值较高的孕妇中 ,HbsAb阳性主要分布在HBV DNA测定值较低的孕妇组。结论　HBV母婴传播率受孕妇血清H     

Evaluating a statewide home visiting program to prevent child abuse in at-risk families of newborns: fathers' participation and outcomes

This study sought to describe fathers' participation in a statewide home-visiting program to prevent child abuse and to assess program impact on their parenting. This randomized trial followed 643 at-risk families for 3 years. Data were collected through program record review, staff surveys, and annual maternal interviews. Participation in visits varied by the parents' relationship and paternal employment, violence, and heavy drinking at baseline. Overall, the program had no apparent impact on fathers' accessibility to the child, engagement in parenting activities, and sharing of responsibility for the child's welfare. The program promoted parenting involvement for nonviolent fathers in couples who lived together but also for violent fathers in couples with little contact at baseline; it decreased the father's accessibility to the child in couples who lived apart but saw each other frequently at baseline. Infrequent participation in visits and differential program impact on violent versus nonviolent fathers demonstrate the need to consider family context in developing, implementing, and studying home-visiting models.     

The potential for child neglect: the case of adolescent mothers and their children

The present study examines the role of neglect potential in adolescent mother-child dyads, both in terms of antecedents and its consequences for children's development. Participants were 100 adolescent mother-child dyads who were part of a larger, longitudinal study. Data were collected from the third trimester of pregnancy until the children's 10th year. Histories of maternal neglect and the quality of mother-child interactions during early childhood were found to predict neglect potential during middle childhood. Mothers with high neglect potential had children who exhibited more externalizing problems and fewer adaptive behaviors, with neglect potential mediating the effects of both early abuse potential and the quality of parenting on children's later externalizing behaviors. Results suggest that neglect potential may be a mechanism through which early potential for child abuse and insensitive maternal interactions affect later externalizing problems in children of adolescent mothers.     

母婴乙型肝炎病毒DNA定量的相关性研究

目的　探讨母婴之间HBV -DNA含量的关系。方法　应用荧光定量PCR技术检测 2 2对母婴HBV -DNA。结果　胎儿脐血HBV -DNA含量与孕妇HBV -DNA含量呈线性相关 (r =0 .4984,P <0 .0 5 )。结论　提示孕妇HBV -DNA含量的高低反映HBV垂直感染的强弱