Howard Dubowitz

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.

Physical abuse and neglect of children

Child maltreatment includes physical abuse and neglect, and happens in all countries and cultures. Child maltreatment usually results from interactions between several risk factors (such as parental depression, stress, and social isolation). Physicians can incorporate methods to screen for risk factors into their usual appointments with the family. Detection of physical abuse is dependent on the doctors ability to recognise suspicious injuries, such as bruising, bite marks, burns, bone fractures, or trauma to the head or abdomen. Neglect is the most common form of child maltreatment in the USA. It can be caused by insufficient parental knowledge; intentional negligence is rare. Suspected cases of child abuse should be well documented and reported to the appropriate public agency which should assess the situation and help to protect the child.

Children in kinship care: How do they fare?

Abstract The placement of children in need of out-of-home care with relatives (i.e., kinship care) has been an increasing trend. The study summarized in this paper represents the first comprehensive assessment of the physical and mental health and educational status of children in kinship care. The anticipated high risk status of these children was supported by study findings in all areas of assessment. These findings are discussed and recommendations are offered for policy, practice and future research.

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.

Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model

CONTEXT. Effective strategies for preventing child maltreatment are needed. Few primary care–based programs have been developed, and most have not been well evaluated. OBJECTIVE. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment. METHODS. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0–5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. RESULTS. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. CONCLUSIONS. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.

School performance of children in kinship care

This study represents the first comprehensive assessment of the school performance of children placed in the care of a relative, an arrangement termed kinship care. The educational programs, academic achievement, and cognitive and language skills of the children were assessed with a teacher questionnaire and standardized tests. Compared to their peers, high rates of grade retention and participation in special and remedial education, as well as significant academic achievement, cognitive, and language deficits were found. Most teachers, however, reported that educational services were appropriate and several interventions had proven successful. Analyses of predictor variables showed that placement at a later age and fewer children in the home were associated with higher academic achievement. Results are reviewed in the context of other foster care studies, and recommendations are made regarding future research and educational needs of children in kinship care.

Identifying children at high risk for a child maltreatment report

OBJECTIVE To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect. METHOD The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models. RESULTS Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: childs low performance on a standardized developmental assessment (RR=1.23, 95% CI=1.01-1.49, p=.04), maternal education≤high school (RR=1.55, CI=1.01-2.38, p=.04), maternal drug use (RR=1.71, CI=1.01-2.90, p<.05), maternal depressive symptoms (RR per one standard deviation higher score=1.28, CI=1.09-1.51, p<.01), and more children in the family (RR per additional child=1.26, CI=1.07-1.47, p<.01). CONCLUSIONS Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.

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.

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.

Behavior problems of children in kinship care.

ABSTRACT. An increasing number of children needing out-of-home care are being placed with relatives. Despite this pervasive policy, there has been scant research on children in this arrangement called kinship care. The objectives of this study were (1) to assess the behavior of children in kinship care and (2) to identify predictors of their behavior. The caregivers of 346 children in kinship care completed the Child Behavior Checklist (CBCL). Background information was obtained from caregivers and caseworkers. Forty-two percent of boys and 28% of girls had overall CBCL scores in the clinical range, compared with an expected 10% in the general population. Logistic regressions revealed several variables significantly associated with behavior problems including: reason for placement, gender, race, caregivers perception of the child, caregivers educational level, number of contacts between caregiver and caseworker, long-term plan, and childs age. The frequent behavior problems among these high-risk children in kinship care suggest they all deserve mental health evaluations; at a minimum, periodic screening is indicated. J Dev Behav Pediatr 14:386–393, 1993. Index terms: kinship care, foster care, behavior.