Barbara L. Bonner

Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports

A randomized trial was conducted to test the efficacy and sufficiency of parent-child interaction therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Physically abusive parents (N=110) were randomly assigned to one of three intervention conditions: (a) PCIT, (b) PCIT plus individualized enhanced services, or (c) a standard community-based parenting group. Participants had multiple past child welfare reports, severe parent-to-child violence, low household income, and significant levels of depression, substance abuse, and antisocial behavior. At a median follow-up of 850 days, 19% of parents assigned to PCIT had a re-report for physical abuse compared with 49% of parents assigned to the standard community group. Additional enhanced services did not improve the efficacy of PCIT. The relative superiority of PCIT was mediated by greater reduction in negative parent-child interactions, consistent with the PCIT change model.

Family Preservation and Family Support Programs: Child Maltreatment Outcomes across Client Risk Levels and Program Types.

OBJECTIVES This study evaluated client-level outcomes among an entire statewide group of Family Preservation and Family Support (FPFS) programs funded under PL 103-66. METHOD A total of 1,601 clients (primarily low income, moderate to high risk with no current involvement in the child protection system) were assessed and followed over time for future child maltreatment events reported to Child Protective Services. The study compared program completers with program dropouts, compared recipients of more lengthy full-service programs with recipients of one-time services, and examined the effects of program duration, intensity, service site (center-based vs. home based) and service model/content. Effects were modeled using survival analysis and variable-exposure Poisson hierarchical models, controlling for initial client risk levels and removing failure events because of surveillance bias. Changes in lifestyle, economic and risk factors were also examined. RESULTS A total of 198 (12.2%) participants had at least one defined failure event over a median follow-up period of 1.6 years. Controlling for risk and receipt of outside services, program completers did not differ from program dropouts or from recipients of one-time services, and there was no relationship between program intensity or duration and outcomes. Program types designed to help families meet basic concrete needs and programs using mentoring approaches were found to be more effective than parenting and child development oriented programming, and center-based services were found to be more effective than home-based services, especially among higher risk parents. CONCLUSIONS The findings did not support the effectiveness of these services in preventing future maltreatment cases, and raised questions about a number of common family support assumptions regarding the superiority of home-visiting based and parent training services. A number of possible reasons for this are explored.

Empirical Research on Child Abuse Treatment: Report by the Child Abuse and Neglect Treatment Working Group, American Psychological Association

Reviewed empirical research on the short- and long-term effects of four major types of child maltreatment (physical abuse, sexual abuse, psychological abuse, and neglect). Outcome research for a variety of treatments for child victims of abuse and for adults abused as children suggests that treatment is effective; however, comprehensive and carefully designed studies have not been done. Likewise, outcome research for treatment efforts with parents and caregivers who engage in child maltreatment is limited, but evidence supports treatment efficacy. Thirteen recommendations are offered pertaining to improvement of conceptualization, treatment, and research in the area of child maltreatment.

Fatal child maltreatment: characteristics of deaths from physical abuse versus neglect.

This study examined victim, family, and alleged perpetrator characteristics associated with fatal child maltreatment (FCM) in 685 cases identified by child welfare services in the state of Oklahoma over a 21-year period. Analyses also examined differences in child, family, and alleged perpetrator characteristics of deaths from abuse versus neglect. Case information was drawn from child welfare investigation records for all FCM cases identified by the state Department of Human Services. Fatal neglect accounted for the majority (51%) of deaths. Children were primarily younger than age 5, and parents were most frequently the alleged perpetrators. Moreover, most victims had not been the subject of a child welfare report prior to their death. A greater number of children in the home and previous family involvement with child welfare increased childrens likelihood of dying from neglect, rather than physical abuse. In addition, alleged perpetrators of neglect were more likely to be female and biologically related to the victim. These results indicate that there are unique family risk factors for death from neglect (versus physical abuse) that may be important to consider when selecting or developing prevention efforts.

Women's alcohol consumption and risk for alcohol-exposed pregnancies in Russia.

AIMS Alcohol-exposed pregnancies (AEP) are the direct cause of fetal alcohol spectrum disorders (FASD). This study examines drinking patterns among pregnant and non-pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world. DESIGN Cross-sectional survey. SETTING Seven public womens clinics in two locations: St Petersburg (SPB) and the Nizhny Novgorod region (NNR). PARTICIPANTS A total of 648 pregnant and non-pregnant childbearing-age women. MEASUREMENTS A face-to-face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition. FINDINGS Eighty-nine per cent of non-pregnant women reported consuming alcohol and 65% reported binge drinking in the past 3 months; 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at risk for AEP. There was a significant decline in drinking after pregnancy identification. Twenty per cent of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive. CONCLUSIONS Russian women substantially reduce drinking after pregnancy recognition compared to pre-pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The pre-conception period presents a risk window and, therefore, a prevention opportunity.

Child Maltreatment Training in Doctoral Programs in Clinical, Counseling, and School Psychology: Where do we go from Here?:

The American Psychological Association (APA) has called for improving knowledge regarding child abuse and neglect among psychologists by increasing training. The present study examined the extent of child abuse training provided by APA-accredited doctoral programs in clinical, counseling, and school psychology by surveying the training directors in 1992 and 2001. The survey assessed available coursework, practica, and research experience in the area of child maltreatment. Findings indicated that more than half of all programs cover child maltreatment in three or more courses, and most programs discuss child maltreatment in ethics/professional seminars. Most students have some exposure to clients with abuse-related problems, and some have opportunities to participate in maltreatment research. Nonetheless, training falls short of APA recommendations for minimal levels of competence in child maltreatment, with no change in training in the past decade. Recommendations for improving training include more discussion among program faculty, attention to essential competencies, and specific suggestions for developing interdisciplinary training.

State Efforts to Identify Maltreated Children with Disabilities: A Follow-Up Study

Child abuse and neglect state liaison officers representing 50 states and 7 U.S. territories were surveyed regarding data collection procedures, accuracy of reporting, state assistance to local agencies, and training for child welfare workers in the area of maltreated children with disabilities. The current study is a replication of a similar survey conducted by Camblin in 1982. Results indicate that (a) more states provided assistance to local child welfare agencies than was reported in 1982, (b) the number of states that routinely collected disability information in child maltreatment cases had declined, (c) seven states documented specific disabilities in children, (d) two states reported on the number of children disabled as a result of abuse, (e) fewer states reported having accurate information on the incidence of disabled children reported for maltreatment, and (f) seven states required training in disabilities for child welfare workers, with an average of four hours required. Implications of the results for identifying and serving maltreated children with disabilities are discussed and recommendations for child welfare agencies are presented.

Fatal child neglect: Characteristics, causation, and strategies for prevention

Research in child fatalities because of abuse and neglect has continued to increase, yet the mechanisms of the death incident and risk factors for these deaths remain unclear. The purpose of this study was to systematically examine the types of neglect that resulted in childrens deaths as determined by child welfare and a child death review board. This case review study reviewed 22 years of data (n=372) of child fatalities attributed solely to neglect taken from a larger sample (N=754) of abuse and neglect death cases spanning the years 1987-2008. The file information reviewed was provided by the Oklahoma Child Death Review Board (CDRB) and the Oklahoma Department of Human Services (DHS) Division of Children and Family Services. Variables of interest were child age, ethnicity, and birth order; parental age and ethnicity; cause of death as determined by child protective services (CPS); and involvement with DHS at the time of the fatal event. Three categories of fatal neglect--supervisory neglect, deprivation of needs, and medical neglect--were identified and analyzed. Results found an overwhelming presence of supervisory neglect in child neglect fatalities and indicated no significant differences between children living in rural and urban settings. Young children and male children comprised the majority of fatalities, and African American and Native American children were over-represented in the sample when compared to the state population. This study underscores the critical need for prevention and educational programming related to appropriate adult supervision and adequate safety measures to prevent a childs death because of neglect.

Assessment of adolescent sexual offenders

Mental health professionals are asked increasingly to conduct assessments of sexually abusive youth. A comprehensive assessment procedure is necessary to develop an appropriate treatment plan, and this article reviews the psychological tests and psychophysiological procedures currently used to evaluate adolescent sexual offenders. The present knowledge on the assessment of risk for recidivism, future directions in the assessment of adolescent sexual offenders, and suggestion for research are presented. This review can serve as a guide for clinicians who are requested to conduct an evaluation of adolescent sexual offenders.

University-based interdisciplinary training in child abuse and neglect

This article presents an overview of the 10 university-based interdisciplinary training programs in child maltreatment funded in 1987 by the National Center on Child Abuse and Neglect. The organizational structure, student composition, and academic requirements of the program are described. A more detailed description of one of the programs based in a medical school is presented as a model for replication. The specific clinical and didactic components of the programs curriculum are included. Additionally, recommendations for replicating an interdisciplinary graduate training program in child abuse and neglect are discussed.