Diana J. English

Longscan: A consortium for longitudinal studies of maltreatment and the life course of children

The National Research Council (1993) has issued an urgent call for theory-based, longitudinal research to examine the antecedents and consequences of child maltreatment. Many of the concerns raised by the National Research Council are addressed by LONGSCAN (LONGitudinal Studies of Child Abuse and Neglect), a consortium including a coordinating center and five independent prospective longitudinal investigations sharing common protocols for data collection, entry, and management. The children in the five investigations vary by their level of risk, ranging from a community sample with no identified risk beyond low income status, to children placed in foster care. The longitudinal study has been designed with six age-specific data collection points extending from 4 through 20 years of age. The conceptual model, organization, and analytic strategy for LONGSCAN are described.

Characteristics of repeated referrals to child protective services in Washington state

This study replicates and extends prior research on the characteristics and correlates of child maltreatment recurrences based on an ecological model of child maltreatment. The use of a very large sample with a large number of risk factors avoids methodological shortcomings based on small samples size and sample selection bias. The risk and other characteristics of 12,329 referrals were studied to determine which factors related to recidivism within an 18-month period. Rereferral rates increase with the increasing number of prior referrals and of placements in foster care (followed by reunification), but there is little difference in rates of rereferral by substantiation. Several of the risk factors associated with an increased likelihood of rereferral, history of domestic violence, history of caregiver child abuse/neglect (CA/N) as a child, and substance abuse, are the risk factors least often assessed by socialworkers. Rates of rereferral vary by ethnicity, type of abuse, and population type (rural, urban).

Importance of Early Neglect for Childhood Aggression

OBJECTIVE. The goal was to examine the association between early childhood neglect (birth to age 2 years) and later childhood aggression at ages 4, 6, and 8 years, compared with aggressions associations with early childhood abuse and later abuse and neglect. METHODS. A prospective cohort of 1318 predominantly at-risk children, recruited from 4 US cities and 1 southern state, were monitored from birth to 8 years of age. Maltreatment was determined through review of local child protective services records. A hierarchical, linear model approach, a special case of general, linear, mixed modeling, was used to predict aggressive behavior scores, as reported by the childs primary caregiver at ages 4, 6, and 8 years. RESULTS. Only early neglect significantly predicted aggression scores. Early abuse, later abuse, and later neglect were not significantly predictive in a controlled model with all 4 predictors. CONCLUSION. This longitudinal study suggests that child neglect in the first 2 years of life may be a more-important precursor of childhood aggression than later neglect or physical abuse at any age.

Effects of Family Violence on Child Behavior and Health During Early Childhood

Looking at families where children have been abused/neglected in early childhood, this study examined measures of child behavior and health to see if they tended to be worse when domestic violence is or has been present in a family. Further, caregiver and family characteristics as well as other case factors were examined, as possible moderators or mediators of the effects of domestic violence. Results indicate that domestic violence, of the type and severity occurring in our sample, does not have a direct effect on child outcomes by Age 6, when other associated variables are taken into account, but has considerable indirect effects. There is a pronounced impact of domestic violence on family functioning, the caregivers general health and well being, and the quality of the caregivers interaction with the child, which in turn are significantly associated with decrements of child functioning related to behavior problems and health. Some implications of this study for research in the area of domestic violence and child maltreatment are discussed.

Residential treatment and its alternatives: A review of the literature

This review summarizes the literature for residential treatment, family preservation services, treatment foster care, and individualized services and evaluates characteristics of each model, methodological limitations of outcome studies, and treatment effectiveness with children. Although residential care is often viewed negatively, empirical evidence does not suggest differential levels of effectiveness compared to nonresidential alternatives. The results of some nonresidential outcome studies are promising, but efficacy claims should be viewed critically due to the absence of methodologically rigorous evaluations for both residential and nonresidential approaches. Future research should focus on establishing empirically grounded placement criteria, identifying what presenting problems are most amenable to each form of treatment, and maximizing the maintenance of treatment gains in the postdischarge environment.

Concordance Between Adolescent Reports of Childhood Abuse and Child Protective Service Determinations in an At-Risk Sample of Young Adolescents

This study examines the concordance between adolescent reports of abuse and abuse determinations from Child Protective Service (CPS) agencies. It also compares the utility of adolescent reports of abuse, relative to CPS determinations in predicting adolescent psychological adjustment. The sample included 350 early adolescents, ages 12 to 13 years, who were initially identified prior to age 2 years as being at elevated risk of maltreatment. An Audio-Computer Assisted Self Interview (A-CASI) was used to assess lifetime experiences of physical, sexual, and psychological abuse. The A-CASI interview elicited prevalence rates of abuse 4 to 6 times higher than those found in CPS records. However, 20 of 45 adolescents with CPS determinations of abuse failed to report abuse during the study interview. Adolescent psychological adjustment was more strongly associated with self-reports than with CPS determinations. The implications of these findings are discussed for validity of adolescent self-reports of childhood abuse and for the ongoing debate about disclosure patterns among victims of child sexual abuse.

Effects of enhanced foster care on the long-term physical and mental health of foster care alumni

CONTEXT Child maltreatment is a significant risk factor for adult mental disorders and physical illnesses. Although the child welfare system routinely places severely abused and/or neglected children in foster care, no controlled studies exist to determine the effectiveness of this intervention in improving the long-term health of maltreated youth. OBJECTIVE To present results of the first quasi-experimental study, to our knowledge, to evaluate the effects of expanded foster care treatment on the mental and physical health of adult foster care alumni. DESIGN We used a quasi-experimental design to compare adult outcomes of alumni of a model private foster care program and 2 public programs. The latter alumni were eligible for but not selected by the private program because of limited openings. Propensity score weights based on intake records were adjusted for preplacement between-sample differences. Personal interviews administered 1 to 13 years after leaving foster care assessed the mental and physical health of alumni. SETTING/ PARTICIPANTS A representative sample of 479 adult foster care alumni who were placed in foster care as adolescents (14-18 years of age) between January 1, 1989, and September 30, 1998, in private (n = 111) or public (n = 368) foster care programs in Oregon and Washington. More than 80% of alumni were traced, and 92.2% of those traced were interviewed. INTERVENTION Caseworkers in the model program had higher levels of education and salaries, lower caseloads, and access to a wider range of ancillary services (eg, mental health counseling, tutoring, and summer camps) than caseworkers in the public programs. Youth in the model program were in foster care more than 2 years longer than those in the public programs. RESULTS Private program alumni had significantly fewer mental disorders (major depression, anxiety disorders, and substance use disorders), ulcers, and cardiometabolic disorders, but more respiratory disorders, than did public program alumni. CONCLUSION Public sector investment in higher-quality foster care services could substantially improve the long-term mental and physical health of foster care alumni.

Adverse Childhood Experiences and Child Health in Early Adolescence

IMPORTANCE Child maltreatment and other adverse childhood experiences, especially when recent and ongoing, affect adolescent health. Efforts to intervene and prevent adverse childhood exposures should begin early in life but continue throughout childhood and adolescence. OBJECTIVES To examine the relationship between previous adverse childhood experiences and somatic concerns and health problems in early adolescence, as well as the role of the timing of adverse exposures. DESIGN Prospective analysis of the Longitudinal Studies of Child Abuse and Neglect interview and questionnaire data when target children were 4, 6, 8, 12, and 14 years old. SETTING Children with reported or at risk for maltreatment in the South, East, Midwest, Northwest, and Southwest United States Longitudinal Studies of Child Abuse and Neglect sites. PARTICIPANTS A total of 933 children who completed an interview at age 14 years, including health outcomes. EXPOSURES Eight categories of adversity (psychological maltreatment, physical abuse, sexual abuse, neglect, caregivers substance use/alcohol abuse, caregivers depressive symptoms, caregiver treated violently, and criminal behavior in the household) experienced during the first 6 years of life, the second 6 years of life, the most recent 2 years, and overall adversity. MAIN OUTCOMES AND MEASURES Child health problems including poor health, illness requiring a doctor, somatic concerns, and any health problem at age 14 years. RESULTS More than 90% of the youth had experienced an adverse childhood event by age 14 years. There was a graded relationship between adverse childhood exposures and any health problem, while 2 and 3 or more adverse exposures were associated with somatic concerns. Recent adversity appeared to uniquely predict poor health, somatic concerns, and any health problem. CONCLUSIONS AND RELEVANCE Childhood adversities, particularly recent adversities, already show an impact on health outcomes by early adolescence. Increased efforts to prevent and mitigate these experiences may improve the health outcome for adolescents and adults.

Survival Analysis of Risk Factors for Recidivism in Child Abuse and Neglect

The objective of this study was to examine, in an ecological context, the relative importance of risk factors for chronic recidivism in child abuse/neglect (CA/N). Survival analysis of multiple referrals to Child Protective Services (CPS), supplemented by neural network analysis, shows that a constellation of risk and other factors are associated with the likelihood of recidivism of CA/N. Caregivers distinguish families with multiple referrals by their history of abuse or neglect as children, abuse or neglect that began at an early age, having children with developmental delays, and having multiple victims in the family. Time to rereferral decreases with an increasing number of prior referrals, and there is a marked difference in the time to the first rereferral when compared to subsequent rereferrals. This indicates that referral to CPS reflects conditions that increase the likelihood of additional referrals to CPS. Administrative factors account for some of the variance in multiple referrals.

Examination of a Conceptual Model of Child Neglect

This study attempted to provide empirical support for conceptual definitions of child neglect. We identified 12 types of needs, conceptualizing neglect as occurring when children’s basic needs are not adequately met. We examined measures administered to 377 children and caregivers at ages 4 and 6 years participating in longitudinal studies on child mal-treatment to identify potential indicators of these needs. Indicators were found for latent constructs, operationalizing three of the basic needs (emotional support and/or affection, protection from family conflict and/or violence, and from community violence). These latent constructs were used in a measurement model; this supported the conceptual definitions of neglect. A structural equation model then assessed whether the latent constructs were associated with child adjustment at age 8 years. Low level of perceived support from mother was associated with internalizing and externalizing behavior problems. Exposure to family conflict was also linked to these problems, and to social difficulties. Finally, children’s sense of experiencing little early affection was associated with subsequent externalizing behavior and social problems. The approach of conceptualizing neglect in terms of unmet child needs, developing a measurement model to define latent neglect constructs, and relating these constructs to subsequent adjustment can build our understanding of neglect.