Diane DePanfilis

The effect of services on the recurrence of child maltreatment

OBJECTIVE Building on a previous model of recurrence, this study examined the relationship of services on the hazard of child maltreatment recurrence during CPS intervention for families who were provided continuing intervention following a confirmed index report of physical abuse or neglect. METHOD This nonconcurrent prospective study selected 434 subject families who met study eligibility requirements from 1181 families randomly selected from the 2902 families who had experienced a substantiated report of child abuse or neglect during the sampling year. Data were collected and coded from archival sources for 5 years following the index report. Each record was coded by two research analysts to increase inter-rater reliability. Data were analyzed with the Cox Proportional Regression Model. RESULTS Case characteristics that predicted recurrence were: child vulnerability, family stress, partner abuse, and social support deficits. After examining the potential effect of nine service-related variables only attendance at services predicted recurrence while controlling for other variables in the model. Families who were noted to attend the services identified in their service plans were 33% less likely to experience a recurrence of child maltreatment while their case was active with CPS. CONCLUSIONS Implications of this and other research suggests that actively engaging families in a helping alliance and helping them accept and receive services may reduce the likelihood of future maltreatment.

Predicting child maltreatment recurrences during treatment

UNLABELLED The primary purpose of the child protective services system is to protect children from the recurrence of child maltreatment. Understanding more about what predicts recurrence may help us more adequately target interventions to reduce the risk of future maltreatment. OBJECTIVE The specific objective of this study was to identify correlates of recurrence during CPS intervention for families who were provided continuing intervention following a confirmed index report of physical abuse or neglect. METHOD This nonconcurrent prospective study selected 446 subject families who met study eligibility requirements from 1,181 families randomly selected from the 2,902 families who had experienced a substantiated report of child abuse or neglect during the sampling year. Data were collected and coded from archival sources for 5 years following the index report. Each record was coded by two research analysts to increase inter-rater reliability. Data were analyzed with survival analysis methods: (1) Kaplan Meier and (2) the Cox Proportional Regression Model. RESULTS Predictors of recurrence were child vulnerability, family stress, partner abuse, social support deficits, and an interaction between family stress and social support deficits. CONCLUSIONS Implications of this and earlier research suggest that increasing social supports may help families cope with life events that increase stress and the risk of continued child maltreatment; that collaborations between CPS and domestic violence agencies are needed; and that screening maltreated children for mental health problems and other disabilities and assuring that children with these needs and their families get effective treatment may reduce the likelihood of continued maltreatment.

The Intergenerational Cycle of Child Maltreatment Continuity Versus Discontinuity

Few studies have focused on identifying characteristics that discriminate between parents who break versus those who perpetuate intergenerational cycles of child maltreatment. Both the dose and the attachment hypotheses were examined in this study of 213 mothers maltreated as children in one of three ways (beatings, neglect, or sexual abuse). Maltreatment continuity versus discontinuity was assessed through substantiated reports to a Child Protective Services (CPS) agency over a 7-year period. Findings were consistent with the attachment hypothesis. Poorer quality attachment relationships in childhood increased the probability of transmission. Findings were consistent with the dose hypothesis for only one conceptualization of dose. Those mothers who had experienced severe forms of sexual abuse (experienced coitus vs. did not) were more likely to have a maltreated child. These findings are discussed in terms of current theory and research on intergenerational maltreatment.

family connections: A program for preventing child neglect

Family Connections was a demonstration program specifically designed to prevent child neglect. This article describes the development of prevention strategies and the assessment of outcomes for families who received two versions of the intervention. The sample included 154 families (473 children) in a poor, urban neighborhood who met risk criteria for child neglect and who were randomly assigned to receive either a 3- or 9-month intervention. Self-report and observational data were analyzed using analyses of variance (ANOVA) with repeated measures. Results for the entire sample indicated positive changes in protective factors (parenting attitudes, parenting competence, social support); diminished risk factors (parental depressive symptoms, parenting stress, life stress); and improved child safety (physical and psychological care of children) and behavior (decreased externalizing and internalizing behavior). Results further reflected no advantage of the 9-month intervention for improving parenting adequacy. Further testing of the intervention with other target populations is being conducted.

Epidemiology of Child Maltreatment Recurrences

The recurrence of child maltreatment following a report to Child Protective Services is one index of the effectiveness of the public child welfare system. This article reports on the analysis of the patterns and frequency of recurrences of substantiated instances of maltreatment in an urban child welfare system. Results from survival analyses indicated that risk of recurrence was greatest during the first 30 days following a report, that risk declined with time and remained relatively low for 2 years following the termination of services, and that recurrence was dependent on the type of maltreatment. Most recurrence families experienced only one recurrence, but a clustering effect was apparent for families that experienced multiple recurrences.

Rates, patterns, and frequency of child maltreatment recurrences among families known to CPS

Child maltreatment is a widespread and costly social problem. A primary purpose of child maltreating reporting is to prevent its recurrence. Despite the widespread belief that the system designed to prevent its recurrence is failing miserably, little empirical data are actually compiled to support this contention. This article reviews available research on the rates, patterns, and frequency of child maltreatment recurrences. Findings are difficult to interpret and integrate because of differences in definitions, units of analysis, follow-up intervals, and data analysis strategies. Rates of recurrence range from 1% or 2% for cases deemed low-risk to over 50% for families followed more than 5 years. Findings from studies that have used survival analysis techniques seem to indicate that the risk of recurrence declines with intervention. Future research should be prospective, document definitions and methods, and use survival analysis so that this possible encouraging trend can be further examined.

Social Isolation of Neglectful Families: A Review of Social Support Assessment and Intervention Models

Child neglect is the most common form of child maltreatment reported to public Child Protective Services. Sufficient evidence exists that families who are socially isolated, experience loneliness, and lack social support in both rural and urban settings may be more prone to neglect than matched comparison groups. This article reviews the relationship between neglect and these factors and contrasts models for assessing and intervening with neglectful families. Results suggest that modest improvements in the parenting behavior of neglectful parents can be achieved through the following: (a) differential assessment; (b) a multiservice approach; (c) intense social contacts with a volunteer, lay therapist, or parent aide; (d) use of modeling, coaching, rehearsing, and feedback to improve social interaction skills; (e) development of personal networks; and (f) structured parenting and support groups for socialization, support, and social and parenting skill building.

Predicting Program Completion Among Families Enrolled in a Child Neglect Preventive Intervention

Objective: An exploratory analysis of self-report data gathered by the Family Connections program is used to build a predictive model of program completion. Method: The sample includes 136 families in a poor, urban neighborhood who meet risk criteria for child neglect. Families are randomly assigned to receive 3- or 9-month interventions. Bivariate analyses compare families who did and did not complete services. Logistic regression analysis identifies service-completion predictors for 136 families for whom pre- and post-data are available. Results: More caregivers in the 3-month group complete services. Completers have more children and report a more positive alliance with their workers. Depressive symptoms, worker alliance, and treatment-group status predict service completion in the final model. Conclusions: Findings and implications for practice are discussed.

Assessing the cost-effectiveness of Family Connections.

OBJECTIVE To assess the cost-effectiveness of two alternate forms of Family Connections (FC), a child neglect prevention program, in relation to changes in risk and protective factors and improvements in child safety and behavioral outcomes. METHODS In the original FC study, a sample of 154 families (473 children) in a poor, urban neighborhood, who met risk criteria for child neglect, were randomly assigned to receive either a 3- or 9-month intervention. CPS reports and self-report and observational data on risk and protective factors, safety, and behavioral outcomes were collected prior to, at the end of, and 6-months post intervention. The current study compared the costs of delivering the 3- or 9-month intervention in relation to reported improvements in risk and protective factors, safety, and behavioral outcomes for each group. RESULTS The 3-month intervention was more cost effective than the 9-month intervention in relation to positive changes in risk and protective factors and child safety. However, cost-effectiveness analysis indicated that the 9-month intervention was more cost effective (CE ratio=

The neglect scale: confirmatory factor analyses in a low-income sample

276) than the 3-month intervention (CE ratio=