Erin P. Hambrick

Using Multiple Informants to Assess Child Maltreatment: Concordance between Case File and Youth Self-Report

To understand the psychosocial implications of child maltreatment, methods used to document prevalence must be clear. Yet, rates of maltreatment found in child self-report are generally inconsistent with data found in case files from state social service agencies. Although it is known that self-reports and case file reports of abuse disagree on occurrence of specific events, it is unclear if reporters agree when overall categories of abuse are considered. This study investigated differences between case file and youth report of abuse by examining four types of abuse—physical, sexual, neglect, and psychological—in a within-subjects design using a sample of 97 youth in foster care aged 8 to 22. Case files were coded for the presence of any indication of each type of abuse. Self-report of abuse was also assessed for any indication of each type of abuse. Results indicated that, overall, youth reported more physical and psychological abuse, and younger youth reported more sexual abuse than documented in their file. Implications for research and service provision for maltreated youth are discussed.

The blind men and the elephant: identification of a latent maltreatment construct for youth in foster care

Child maltreatment is a major public health concern due to its impact on developmental trajectories and consequences across mental and physical health outcomes. Operationalization of child maltreatment has been complicated, as research has used simple dichotomous counts to identification of latent class profiles. This study examines a latent measurement model assessed within foster youth inclusive of indicators of maltreatment chronicity and severity across four maltreatment types: physical, sexual, and psychological abuse, and neglect. Participants were 500 foster youth with a mean age of 12.99 years (SD=2.95years). Youth completed survey questions through a confidential audio computer-assisted self-interview program. A two-factor model with latent constructs of chronicity and severity of maltreatment revealed excellent fit across fit indices; however, the latent constructs were correlated 0.972. A one-factor model also demonstrated excellent model fit to the data (χ2 (16, n=500)=28.087, p=0.031, RMSEA (0.012-0.062)=0.039, TLI=0.990, CFI=0.994, SRMR=0.025) with a nonsignificant chi-square difference test comparing the one- and two-factor models. Invariance tests across age, gender, and placement type also were conducted with recommendations provided. Results suggest a single-factor latent model of maltreatment severity and chronicity can be attained. Thus, the maltreatment experiences reported by foster youth, though varied and complex, were captured in a model that may prove useful in later predictions of outcome behaviors. Appropriate identification of both the chronicity and severity of maltreatment inclusive of the range of maltreatment types remains a high priority for future research.

Case file coding of child maltreatment: Methods, challenges, and innovations in a longitudinal project of youth in foster care

State social service agency case files are a common mechanism for obtaining information about a childs maltreatment history, yet these documents are often challenging for researchers to access, and then to process in a manner consistent with the requirements of social science research designs. Specifically, accessing and navigating case files is an extensive undertaking, and a task that many researchers have had to maneuver with little guidance. Even after the files are in hand and the research questions and relevant variables have been clarified, case file information about a childs maltreatment exposure can be idiosyncratic, vague, inconsistent, and incomplete, making coding such information into useful variables for statistical analyses difficult. The Modified Maltreatment Classification System (MMCS) is a popular tool used to guide the process, and though comprehensive, this coding system cannot cover all idiosyncrasies found in case files. It is not clear from the literature how researchers implement this system while accounting for issues outside of the purview of the MMCS or that arise during MMCS use. Finally, a large yet reliable file coding team is essential to the process, however, the literature lacks training guidelines and methods for establishing reliability between coders. In an effort to move the field toward a common approach, the purpose of the present discussion is to detail the process used by one large-scale study of child maltreatment, the Studying Pathways to Adjustment and Resilience in Kids (SPARK) project, a longitudinal study of resilience in youth in foster care. The article addresses each phase of case file coding, from accessing case files, to identifying how to measure constructs of interest, to dealing with exceptions to the coding system, to coding variables reliably, to training large teams of coders and monitoring for fidelity. Implications for a comprehensive and efficient approach to case file coding are discussed.

Restraint and Critical Incident Reduction Following Introduction of the Neurosequential Model of Therapeutics (NMT)

ABSTRACT Children with developmental trauma are at risk for severe and complex behavioral problems, often requiring long-term residential and day treatment. The Neurosequential Model of Therapeutics (NMT) is a developmentally sensitive approach to clinical work with a capacity-building component focusing on attachment, the impact of maltreatment and trauma, and emerging concepts in developmental psychology, neuroscience and traumatology. Research has demonstrated its effectiveness with trauma-exposed populations. NMT training may help providers working with trauma-exposed youth prevent critical incidents and reduce restraints. Restraint and critical incident data were obtained from 10 organizations providing residential and/or day-treatment services following exposure to, or certification in, the NMT. Data from the Pre-NMT Introduction period through to the Maintenance phase of NMT Certification were used to examine changes in restraints and critical incidents across phases of NMT exposure/certification. Multilevel logistic regression models suggested that NMT exposure and/or certification was associated with significant reductions in restraints and critical incidents. Reductions were sustained throughout the Maintenance phase. Estimates of potential staff hour and financial savings associated with these reductions are discussed. Implementation of the NMT in residential and day-treatment settings may result in staff, behavioral health provider, and organization-level changes that reduce critical incidents and restraint use.

Interview and recollection-based research with child disaster survivors: participation-related changes in emotion and perceptions of participation

Research suggests that some types of trauma research can be conducted safely with children ages 10 and older. The aim of this project was to learn more about potential risks or benefits of conducting research with younger children and with child disaster survivors, specifically about research that includes children providing trauma recollections. Fifty 8- to 12-year-old children who experienced a devastating tornado participated in an in-person interview that included both individual and joint (mother-child) recollections of their tornado experiences 1 year after exposure. These 50 children also rated 3 emotions at 3 time points and rated their perceptions (e.g., benefit and regret) of research post-participation. Children (N = 28) also participated in phone surveys 3 months later to assess persistent participation-related emotions and perceptions. Child reported that emotions worsened from pre- to during participation; however, reports of emotions returned to preparticipation levels post-participation and remained so at the 3-month follow-up. Sixty-four percent of children reported at least some participation benefit and no participation regret immediately postparticipation, as did 89.3% at the 3-month follow-up. Four percent of children reported some participation regret (no benefit) postparticipation, and 0% 3 months later. No children requested to stop participating, and none required postresearch connection with crisis services. Posttraumatic stress symptom severity, tornado exposure, and age were largely unrelated to child-reported emotions and perceptions of research. Results indicate that carefully planned and executed disaster-related research that includes children providing recollections can be conducted with preadolescents with little risk and some benefit.

Towards Successful Dissemination of Psychological First Aid: A Study of Provider Training Preferences

Dissemination of Psychological First Aid (PFA) is challenging considering the complex nature of disaster response and the various disaster mental health (DMH) trainings available. To understand challenges to dissemination in community mental health centers (CMHCs), interviews were conducted with nine DMH providers associated with CMHCs. Consensual qualitative analysis was used to analyze data. Interviews were targeted toward understanding organizational infrastructure, DMH training requirements, and training needs. Results clarified challenges to DMH training in CMHCs and factors that may promote buy-in for trainings. For example, resources are limited and thus allocated for state and federal training requirements. Therefore, including PFA in these requirements could promote adoption. Additionally, a variety of training approaches that differ in content, style, and length would be useful. To conclude, a conceptual model for ways to promote buy-in for the PFA Guide is proposed.

A Meta-Analysis of the Impact of Natural Disasters on Internalizing and Externalizing Problems in Youth: Natural Disasters and Mental Health in Youth

Abstract Although exposure to natural disasters can lead to diverse mental health (MH) outcomes in youth, most child disaster MH research has focused on posttraumatic stress symptoms (PTSS). To highlight the likelihood of other MH outcomes, we meta‐analyzed studies that have examined other (non‐PTSS) internalizing and externalizing behavior problems in youth exposed to natural disasters. We used PRISMA guidelines to systematically gather studies that have examined the association between natural disaster exposure and non‐PTSS internalizing and/or externalizing problems in samples of children and adolescents. Analyses of random effects models of 62 studies examining non‐PTSS internalizing problems and 26 studies examining externalizing problems showed exposure to natural disasters was significantly associated with non‐PTSS internalizing, r mean = .18, k = 70, and externalizing problems, r mean = .08; k = 31, in youth. Moderator analyses revealed a stronger association between disaster exposure and non‐PTSS internalizing problems in countries with a “medium” Human Development Index (HDI) ranking, r = .56, than in countries with “high,” r = .15, and “very high,” r = .16, HDI rankings. We also found a stronger association between disaster exposure and externalizing problems in countries with a medium HDI ranking, r = .54, versus high, r = .05, and very high, r = .04, HDI rankings, and based on parent, r = .16, compared to child, r = −.01, report. Results support the need for assessment of multiple postdisaster MH outcomes to inform comprehensive interventions. We also include a discussion of the state of the disaster MH research.