Family dynamics and child abuse and neglect in three Finnish communities

The purpose of this study was to describe family dynamics of Finnish families in which there is abuse or neglect of a child in that family. One adult from 41 families with recognized child abuse/neglect completed the Family Dynamics Measure II (FDM II) consisting of six dimensions of family life, and answered questions about problems, changes and illnesses. Nurses and social workers in community health care and social agencies identified potential subjects in their agencies and collected data. Four of the six dimensions of the FDM II reached statistical significance (p =.05) with child age and number of children, education, marital status, and age of respondent. They are: Flexibility vs. rigidity, Stability vs. disorganization, Clear vs. distorted communication, and Role reciprocity vs. role conflict. FDM II is useful in identifying several of the less positive family dynamics dimensions in abuse:neglect families. Conclusions for clinical management cannot be drawn at this time.     

Family dynamics in the United States, Finland and Iceland

Scand J Caring Sci; 2010; 24; 84–93
Family dynamics in the United States, Finland and Iceland
Understanding the dynamics of contemporary, postmodern families and how these relate to health is critically important to nurses and other health care providers throughout the world. Much can be learned by studying not only one's own culture but also other countries. Thus, the purpose of this study was to compare family dynamics of families in the United States, Finland and Iceland. To date relatively little has been published related to families in these Nordic countries. Six family dimensions in Barnhill's Family Health Cycle served as the theoretical framework. Adult respondents (n = 567) purposively selected from varied community groups, completed the Family Dynamics Measure II (FDM II) and a sociodemographic questionnaire. Main findings from the three countries were positive family dynamics, with mutuality contributing the strongest factor to partially confirm the theoretical propositions in Barnhill's Family Health Cycle. Respondents from all countries reported (1) clear communication and flexibility that contribute to mutuality; (2) younger age of respondents and increased education that were associated with more positive family dynamics; and (3) larger families associated with more negative dynamics. Mixed reports occurred according to gender, with Nordic men tending to perceive some negative dimensions. Marriage was important for more positive family dynamics only in the United States. Families in the United States and in Iceland had in common more negative family dynamics during illnesses. Problems and changes affected mostly families in the United States. In general, families in Finland and Iceland had greater strengths than in the United States. This benchmark study offers information for health practitioners to assist families, as well as contribute to the improvement of family social policies, especially in the United States.     

Risk factors of child maltreatment within the family: towards a knowledgeable base of family nursing

The purpose of this study was to compare family dynamics in child maltreating families (n=42) with that in ordinary families with children (n=77), and to ascertain risk factors of child maltreatment within the family. Child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child by a parent. Data were collected using questionnaires (Family Dynamics Measure 2, FMD 2) (N=119) basing on Barnhill's conceptual framework of healthy family systems and analysed by forming sum variables and logistic regression. The study results indicate that family functioning in child maltreating families is lower on all dimensions of family dynamics (individuation, mutuality, flexibility, stability, communication and roles) than that in ordinary families with children. Furthermore, it seems that specific risk factors, detected with logistic regression analysis, are related to whether child maltreatment occurs in the family or not. These include the parent's low educational background, many children in the family, unemployment of a parent, low individuation of the family members, and poor stability and security within the family. The results of this study provide guidelines for detecting and preventing child maltreatment as well as for recognising its existence, although no generalizations can be made due to the small sample size and complexity of the phenomenon under study.     

Relationships between infant temperament, demographic variables, and family dynamics of childrearing families

Relationships between infant temperament, demographic variables, and family dynamics of child-rearing families were investigated in this study. The revised Infant Temperament Questionnaire (RITQ), the Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were sent to 118 families who had participated in the first stage of the study as child-bearing families. About 8 months after childbirth 96 mothers and 95 fathers completed the questionnaires. The characteristics of infant temperament and demographic variables related to the variance of dimensions of family dynamics. Characteristics of the temperamentally easy baby related to more positive family dynamics perceived by child-rearing parents. Fathers rearing their first child reported that their families functioned better than fathers with their second infant. In child health clinics families rearing their second child should also be supported, especially families with arhythmic and negative mood infants.     

Family violence in the military: a review of the literature

Family violence, including both child maltreatment and spouse abuse, is a public health concern in both military and civilian populations. However, there is limited knowledge concerning violence in military families relative to civilian families. This literature review critically reviews studies that examine child maltreatment and spouse abuse among military families and compares family violence in military versus nonmilitary populations. Physical abuse and neglect compose the majority of the reported and substantiated cases of child maltreatment in military families, followed by sexual abuse and emotional abuse. On the other hand, physical abuse represents more than 90% of all substantiated cases of spouse abuse in military families, followed by emotional abuse, neglect, and sexual abuse. Mixed results were found when comparing military and nonmilitary families in terms of child maltreatment and spouse abuse, in part because of a lack of consistency in policies and practices between military and civilian agencies.     

Child abuse. When to be suspicious and what to do then

The abuse of children may be physical, sexual, or emotional or may take the form of neglect. Primary care physicians are in an excellent position to recognize abuse and to respond with the proper intervention. In order to act appropriately, physicians must have a high degree of suspicion and a working knowledge of the governmental agencies in their area that may be utilized to intervene in abuse cases. Physicians should also be attuned to the family dynamics that may predispose to incidents of child abuse.     

Family dynamics and postnatal depression

Research has shown that postnatal depression (PND) affects 10-15% of mothers in Western societies. PND is not easily identified and therefore it often remains undetected. Untreated depression has a detrimental effect on the mother and child and the entire family. The purpose of this study was to ascertain the state of family dynamics after delivery and whether the mother's PND was associated with family dynamics. The study used a survey covering the catchment area of one Finnish university hospital. Both primi- and multiparas took part and data were collected using the Edinburgh Postnatal Depression Scale (EPDS) for mothers and the Family Dynamics Measure II (FDM II) for both mothers and fathers. The data were analysed using SPSS statistical programme and frequency and percentage distributions, means and standard deviations were examined. Correlations were analysed using Spearman's correlation coefficients. The significance of any differences between mothers' and fathers' scores was determined with a paired t-test. Of the families participating in the study (373 mothers and 314 partners), 13% of the mothers suffered from PND symptoms (EPDS score of 13 or more). As a whole, family dynamics in the families participating in the study were reported to be rather good. However, mothers having depressive symptoms reported more negative family dynamics compared with other families. With the exception of individuation, mothers having depressive symptoms reported more negative family dynamics than their partners. With the exception of role reciprocity, non-depressed mothers reported more positive family dynamics than their partners. Knowledge of the association of mothers' PND with family dynamics could help to develop nursing care at maternity and child welfare clinics and maternity hospitals. Depressed mothers and their families need support to be able to make family dynamics as good as possible.     

Screening families with young children for child maltreatment potential

The incidence of child maltreatment in the United States is increasing. According to the third National Incidence Study of Child Abuse and Neglect (NIS-3), the number of abused and neglected children doubled between the years 1986 and 1993 to 2.8 million (Sedlak & Broadhurst, 1996). This same study found that the number of children who were seriously injured quadrupled during this period of time to nearly 570,000. Conservative estimates suggest that 10% to 20% of children under 12 years of age experience physical or sexual abuse or neglect. In over 80% of these circumstances, the perpetrator is a family member. Risk indicators have been identified that significantly increase the likelihood of abuse or neglect of children. Interventions that reduce these risk factors have been found to be associated with a decreased incidence of abuse and neglect (Andrews, 1994; Barber-Madden, Cohn, & Scholesser, 1988; Garbarino, 1986; Helfer, 1987). However, existing risk assessment or intervention guides for use with families of children under the age of 3 years are not concise enough for use in a busy primary care setting. For this reason, the Parenting Maltreatment Risk and Intervention Protocol was designed to aid in the identification of families with children under the age of 3 who are at risk for child abuse and neglect and to guide initial intervention, referral, and follow-up care.     

Multidisciplinary approach to working with burn victims of child abuse

Successful outcomes in abuse cases are dependent upon close coordination of professional hospital staff with referring agencies including child protective services and the legal and judicial systems. A four-year retrospective study of 369 pediatric burn patients admitted to our Burn/Trauma Center was completed to: (1) assess demographic factors of patients and families that differentiate cases of child abuse from cases of children burned as a result of accidental injury, and (2) determine the impact of a multidisciplinary team approach to working with abused children and their families during the course of hospitalization. When medical evaluation reveals the possibility of child abuse, a social work assessment, including a developmental history of the child and psychosocial assessment of the family, is crucial. In addition, physicians must be well versed in the gathering of evidence for potential utilization by the legal system. This includes the obtainment of photographs and detailed documentation of the burn injury. A plan of evaluation and the effective coordination of services during hospitalization and following discharge have proven essential to meeting the best interests of the child.     

Definition and identification of child abuse by Finnish public health nurses

The purpose of this study was to determine how public health nurses in Finland defined child abuse and how they assessed their capability to identify child abuse in the family. Public health nurses described child abuse as consisting of physical and emotional abuse. They described physical abuse as consisting of two categories, direct physical abuse towards children and other acts causing children physical harm. Emotional abuse included neglect, teasing the child, frightening the child, rejecting the child in the family, and forcing the child to assume an adult role. The nurses divided the identification of child abuse into two categories: tools for identifying child abuse and markers indicating child abuse. The tools for identifying abuse included knowledge acquisition and interactive skills, intuition, and the capacity of the nurse to handle problematic situations. Public health nurses identified child abuse in the child's behavior and appearance and in family behaviors. Public health nurses seem to be aware of child abuse, but further research is needed if they need more-specific skills regarding how to apply their theoretical knowledge to nursing practice to provide nursing care for abused children and their families.     

Relationships between demographic variables and family dynamics of childbearing families

Hakulinen T, Paunonen M, Laippala P. International Journal of Nursing Practice 1997; 3: 247–254
Relationships between demographic variables and family dynamics of childbearing families
In this study relationships between demographic variables and family dynamics of childbearing families in Finland were studied. The sample was 160 urban families expecting their first or second child in the third trimester of pregnancy. One-hundred and eighteen families participated in the study. The Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were used in this study. Most expectant parents reported their family was well-functioning. Mothers of higher socioeconomic status found more flexibility in their families than mothers of lower socioeconomic status. Fathers in families expecting their first baby reported more mutuality, role reciprocity and more stability than second-time fathers. The findings contribute cues for public health nurses and midwives regarding parity, socioeconomic status and family dynamics to provide more specific family guidance during the transition to parenthood. Realistic information on the changes in family dynamics after childbirth should be given to pregnant parents.     

Abuse and neglect of elderly persons by family members. A special communication

Abuse and neglect of elderly persons, particularly by adult family members, is a serious social and health phenomenon that cannot be ignored. Physical therapists who deal with elderly persons must prepare themselves to recognize signs of abuse and neglect and to become familiar with existing intervention agencies and outlets for prevention. Awareness that the problem exists and improved detection and intervention procedures are needed to prevent abuse and neglect of elderly persons from becoming more widespread.     

Adopted children from the former Soviet Union: Are they at risk of fetal alcohol spectrum disorder?

Question One of the families in my practice is considering adoption of a 2-year-old child from the former Soviet Union. The family has been reassured by the agency that a doctor will examine the child to rule out developmental delays. However, my understanding from your previous articles is that one cannot rule out fetal alcohol spectrum disorder (FASD) at that age. Are these children at increased risk of developing FASD?Answer You are correct: FASD cannot be ruled out at 2 years of age. The risk of FASD, neglect, and abuse among children in orphanages in the former Soviet Union is high. While adoption of children with known developmental delays should be encouraged and supported, most families seek to adopt with the assumption that these children will be healthy.     

Family dynamics in families of severe COPD patients

Aim and objectives. The purpose of this study was to describe family dynamics in families with severe chronic obstructive pulmonary disease (COPD) on the basis of Barnhill's framework for healthy family systems. The sample consisted of 35 severe COPD patients and 30 family members at Tampere University Hospital, Finland or in the neighbouring regions. Background. Chronic obstructive pulmonary disease is a public health problem worldwide. It is a slowly progressive airway disease, producing a decline in lung function which is not fully reversible. Design. The sample included the families of patients without oxygen therapy and the families of patients who had long-term oxygen therapy (LTOT). The data were collected using the Family Dynamics Measure 2 (FDM2) and the Family Dynamics Questionnaire (FDQ). Method. A quantitative research method was employed in the study. Frequency and percentage distributions, as well as cross-tabulations, were used to describe the data. Mean values and standard deviations were calculated for the sum variables of six dimensions of the FDM2. Results. In the dimensions of individuation, mutuality and flexibility, dynamics in the families of patients with LTOT was significantly better than of the patients without oxygen therapy. Especially in the dimension of mutuality, the families of LTOT patients functioned very well, while in the dimensions of communication and roles, family dynamics in these families was notably worse, although still good. Conclusion. Poor self-identity – enmeshment, isolation from others and lack of flexibility to varying conditions – in families with severe COPD can weaken the ability of the families to manage in everyday life. Relevance to clinical practice. Families need family nursing to adapt to alterations occurring when a family member has severe COPD. Nurses can give support and help for these families for their roles of patient and caregiver, as well as opportunities to speak with someone about their situation.     

Family crisis care: a home-based intervention program for child abuse

Community awareness of child abuse and neglect has greatly increased. The documentation of an upward trend in the number of reported and confirmed child abuse and neglect cases in Hawaii reflects the need for additional programs to respond to this growing concern. Clinical nurse specialists in psychiatric and mental health nursing have developed an intensive home-based crisis interaction and family education program, Family Crisis Care. The program accepts only families referred by Child Protective Services in which at least one child is in imminent danger of being placed in foster, group, or institutional care. The goal of Family Crisis is to prevent the out-of-home placement of children through intensive, in-home intervention and to teach families new problem-solving skills to prevent future crises. The program has been effective in maintaining the child within the home, reducing physical punishment and other problem factors in the family, improving communication and problem-solving skills, and increasing use of community resources.     

六年级学生童年期遭受虐待经历与创伤后应激障碍状况的关联性研究

目的了解童年期遭受虐待的六年级学生创伤后应激障碍(post-traumatic stress disorder,PTSD)的现状,并进一步探讨童年期遭受虐待与PTSD的关系,为青少年心理健康发展提供科学的指导意见。方法采用随机分层抽样方法,抽取哈尔滨市某个区的四所学校的991名在校六年级学生进行童年期遭受虐待经历与PTSD的问卷调查。结果本次调查的虐待、情感虐待、躯体虐待、性虐待、情感忽视、躯体忽视的发生率分别为48.05%、3.80%、5.53%、7.48%、16.27%、37.96%。除情感虐待维度外,男生的遭受虐待总分及其他维度的得分均高于女生(P<0.05)。PTSD阳性检出率为7.48%。PTSD平均得分及各维度得分在不同的人口学特征(性别、户籍、是否为独生子女)上的比较无统计学差异(P>0.05)。童年期遭受过虐待的学生的PTSD平均得分及各维度得分均高于未遭受过虐待的(P<0.05)。相关分析显示PTSD平均得分及各维度得分与遭受虐待总分及各维度得分均呈正相关关系(P<0.05);Logistic回归分析结果显示情感虐待(OR=1.303,P<0.001)、躯体忽视(OR=1.120,P<0.05)是PTSD的危险因素。结论哈尔滨市在校六年学生的童年期遭受虐待与PTSD状况不容忽视。男生虐待得分高于女生。遭受虐待的群体PTSD得分高于未遭受虐待的群体,同时虐待得分与PTSD呈正相关关系,情感虐待、躯体忽视是PTSD的危险因素。预防童年期遭受虐待对于提高青少年身心健康至关重要。     

Preventing child maltreatment through community nursing

The role of community nurses, such as health visitors, in the prevention of child abuse and neglect by home visits is reviewed The paper evaluates the potential of community nurses for predicting and identifying families at high risk for child maltreatment in order to support them through the promotion of positive parental knowledge, attitudes, skills and behaviour The success of health visitor interventions to prevent family problems is also evaluated The review concludes that accurate prediction of child-maltreating families requires more than one screening procedure to reduce the number of false alarms, and suggests that health visitors might be trained in the objective assessment of parent-child interaction Few health visitor interventions were deemed a success, indicating that greater support and training is required for community nurses if they are to be used to prevent child abuse and neglect However, recent changes in the community nursing services and the purchaser-provider split in health care has reduced this possibility     

Functioning of child maltreating families: lack of resources for caring within the family

The purpose of this study was to develop a preliminary theoretical model of functioning of child maltreating families. Child maltreatment was defined as physical, psychological or sexual abuse or neglect caused by the child's primary caregivers. The aim was to generate knowledge needed in developing understanding and the care of these families. Data were collected using interviews with open-ended questions from child maltreating families (n = 20). Transcribed interviews were analysed by using grounded theory and its constant comparative method. The categories of family functioning included structural factors of the family, relationships between family members, relationships outside the family, family strengths, and risk factors and manifestations of maltreatment. The relationships that emerged between these categories included conflicts and negative circles of family life and the effects of child maltreatment on the family. Lack of resources for caring within the family emerged as the core category which described the phenomenon in general and was connected to all other categories of family functioning. The findings can be useful in developing the care of child maltreating families, in nursing education and in preventing child maltreatment.