Daniel J. Whitaker

Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial

The prevention of child maltreatment necessitates a public health approach. In the U.S. Triple P System Population Trial, 18 counties were randomly assigned to either dissemination of the Triple P—Positive Parenting Program system or to the services-as-usual control condition. Dissemination involved Triple P professional training for the existing workforce (over 600 service providers), as well as universal media and communication strategies. Large effect sizes were found for three independently derived population indicators: substantiated child maltreatment, child out-of-home placements, and child maltreatment injuries. This study is the first to randomize geographical areas and show preventive impact on child maltreatment at a population level using evidence-based parenting interventions.

Parent-adolescent discussions about sex and condoms: impact on peer influences of sexual risk behavior.

This research examined how parent-adolescent communication about initiating sex and condoms influenced the relationship between peer norms and behavior. African American and Hispanic adolescents reported on parent-adolescent discussions about initiating sex and condoms, perceived peer norms about sex and condom use, and their own behavior. Communication about sex and perceived peer norms about sex were each related to sexual behavior, and communication about condoms and peer norms about condoms were related to condom use behavior. For both sex and condom use, the peer norm–behavior relationship was moderated by parental communication: Peer norms were more strongly related to behavior among adolescents who had not discussed sex or condoms with a parent. Communication was also related to teens naming a parent as their best source of information about sex. Results suggest that a lack of communication may cause adolescents to turn to peers and that peers may then influence their behavior.

Differences in Frequency of Violence and Reported Injury Between Relationships With Reciprocal and Nonreciprocal Intimate Partner Violence

OBJECTIVES We sought to examine the prevalence of reciprocal (i.e., perpetrated by both partners) and nonreciprocal intimate partner violence and to determine whether reciprocity is related to violence frequency and injury. METHODS We analyzed data on young US adults aged 18 to 28 years from the 2001 National Longitudinal Study of Adolescent Health, which contained information about partner violence and injury reported by 11,370 respondents on 18761 heterosexual relationships. RESULTS Almost 24% of all relationships had some violence, and half (49.7%) of those were reciprocally violent. In nonreciprocally violent relationships, women were the perpetrators in more than 70% of the cases. Reciprocity was associated with more frequent violence among women (adjusted odds ratio [AOR]=2.3; 95% confidence interval [CI]=1.9, 2.8), but not men (AOR=1.26; 95% CI=0.9, 1.7). Regarding injury, men were more likely to inflict injury than were women (AOR=1.3; 95% CI=1.1, 1.5), and reciprocal intimate partner violence was associated with greater injury than was nonreciprocal intimate partner violence regardless of the gender of the perpetrator (AOR=4.4; 95% CI=3.6, 5.5). CONCLUSIONS The context of the violence (reciprocal vs nonreciprocal) is a strong predictor of reported injury. Prevention approaches that address the escalation of partner violence may be needed to address reciprocal violence.

Master of One’s Psychological Domain? Not Likely if One’s Self-Esteem is Unstable

The authors examined the extent to which self-esteem (SE) stability relates to self-regulatory styles, self-concept clarity (SCC), and goal-related affect. The results supported the notion that individuals with unstable SE are not likely to possess a strong sense of self. Specifically, unstable as compared to stable SE was associated with (a) self-regulatory styles reflecting lower levels of self-determination, (b) lower SCC, and (c) goal-related affect characterized by greater tenseness and less interest. Theoretical implications are discussed.

Risk factors for the perpetration of child sexual abuse : A review and meta-analysis

OBJECTIVES Since the late 1980s, there has been a strong theoretical focus on psychological and social influences of perpetration of child sexual abuse. This paper presents the results of a review and meta-analysis of studies examining risk factors for perpetration of child sexual abuse published since 1990. METHOD Eighty-nine studies published between 1990 and April of 2003 were reviewed. Risk factors were classified into one of the following six broad categories: family factors, externalizing behaviors, internalizing behaviors, social deficits, sexual problems, and attitudes/beliefs. Sex offenders against children (SOC) were compared to three comparison groups identified within the 89 studies: sex offenders who perpetrated against adults (SOA), non-sex offenders, and non-offenders with no history of criminal or sexual behavior problems. RESULTS Results for the six major categories showed that SOC were not different from SOA (all d between -.02 and .14) other than showing lower externalizing behaviors (d=-.25). Sex offenders against children were somewhat different from non-sex offenders, especially with regard to sexual problems and attitudes (d=.83 and .51). Sex offenders against children showed substantial differences from non-offenders with medium sized effects in all six major categories (ds range from .39 to .58). CONCLUSION Child sex offenders are different from non-sex offenders and non-offenders but not from sex offenders against adults. PRACTICE IMPLICATIONS This study suggests that the presence of general risk factors may lead to a variety of negative behavioral outcomes, including the perpetration of child sexual offending. Family factors were strongly related to the perpetration of child sex offending (vs. non-sexual offending or non-offending) and may be valuable intervention points for interrupting the development of child sex offending, as well as other negative behaviors. Other potential points for intervention may focus on the development of appropriate social and emotional skills that contribute to sexual offending.

Dynamic adaptation process to implement an evidence-based child maltreatment intervention

BackgroundAdaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings.MethodsThis project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

Primary prevention of child physical abuse and neglect: gaps and promising directions

Reviews on primary prevention have identified effective strategies to prevent child maltreatment but have ignored potentially promising interventions that have not yet been evaluated as well as gaps in the development of programs. The goal of this review was to identify these gaps and recommend future directions for developing interventions from a public health perspective. To this end, a systematic review of the literature for 1980-2004 utilizing existing databases and found 188 primary prevention interventions that addressed a broad range of risk factors was conducted. However, few had been rigorously evaluated, and only a handful demonstrated impact on child maltreatment or its risk factors. From a public health perspective, interventions that target prevalent and neglected risk factors such as poverty, partner violence, teenage pregnancy, and social norms tolerating violence toward children need to be developed and evaluated. In addition, more attention should be given to low cost interventions delivered to the public, by society, or that require minimal effort from recipients.

Child maltreatment prevention priorities at the Centers for Disease Control and Prevention

The Division of Violence Prevention at Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control has had a long-standing interest in the prevention of child maltreatment. The nation’s public health agency, CDC, seeks to focus the public health perspective on the problem of child maltreatment and to promote science-based practice in the field. Since 1999, CDC has developed research priorities to address the prevention of child maltreatment. Described here is a brief rationale for applying a public health approach to child maltreatment and a discussion of the priority-setting process, priorities in each of four areas of the public health model, and some of CDC’s current child maltreatment prevention activities.

Concordance Between Self-Reported Maltreatment and Court Records of Abuse or Neglect Among High-Risk Youths

OBJECTIVES We examined the concordance between measures of self-reported maltreatment and court records of abuse or neglect in a sample of detained youths. METHODS Data were collected by the Northwestern Juvenile Project and include interviews from 1829 youths aged 10-18 years. Participants were newly detained youths in the Cook County Juvenile Temporary Detention Center in Illinois between 1995 and 1998. Self-reported cases of child maltreatment were compared with court records of abuse or neglect in the Cook County judicial system. RESULTS We found that among detained youths, 16.6% of those who reported any maltreatment, 22.2% of those who reported the highest level of maltreatment, and 25.1% of those who reported that they required medical treatment as a result of maltreatment had a court record of abuse or neglect. Among those with any self-reported maltreatment, girls (vs boys) and African Americans (vs Whites) were more likely to have a court record (adjusted odds ratio [AOR]=2.18; 95% confidence interval [CI]=1.53, 3.09; and AOR=2.12; 95% CI=1.23, 3.63, respectively). CONCLUSIONS Official records seriously underestimate the prevalence of maltreatment, which indicates that multiple data sources are needed to document the true prevalence of maltreatment.

Persistence and Desistance of the Perpetration of Physical Aggression Across Relationships Findings From a National Study of Adolescents

This study examined the persistent perpetration of physical intimate partner violence (IPV) across relationships. Based on the National Longitudinal Study on Adolescent Health, data were analyzed on 6,446 young adults, who reported on two recent relationships. Frequency and logistic regression analyses were used to examine the persistence of physical IPV perpetration across relationships and the predictors of persistent perpetration. Among individuals who perpetrated physical violence in their first relationship, 29.7% persisted in their perpetration in the second relationship and 70.3% desisted. Significant predictors of persistent physical IPV in the final multi-variate model were as follows: IPV frequency in the first relationship, age, living together versus apart in the subsequent relationship, respondent being better educated than the partner, and being an IPV victim in second relationship. The persistence of physical IPV across relationships was relatively low, with desistance being much more common. Factors specific to the second relationship were the strongest predictors of persistence.