J. Christopher Graham

Toward a Definition of Neglect in Young Children

This study examined the relationship between child experiences identified conceptually as “neglectful” prior to age 4 and child outcomes at age 4. This was done using measures from two sites collected as part of LONGSCAN. Child needs were included within categories of physical and psychological safety and security. Problems with residence safety or cleanliness and untreated behavioral problems predicted child impairments in language. CPS reports of failure to provide shelter predicted impairments in several developmental outcomes. A stimulating home environment predicted less impairment in cognitive development. Multiple changes in residence predicted externalizing behavior problems. Exposure to verbally aggressive discipline predicted more behavioral problems overall. Conversely, some indicators (such as caregiver transitions and lack of medical care) predicted less developmental impairment or fewer behavior problems in certain domains. The approach supports a conceptualization of neglect based on child developmental needs. Implications for practice and future research are discussed.

Unexplained Gastrointestinal Symptoms After Abuse in a Prospective Study of Children at Risk for Abuse and Neglect

PURPOSE Unexplained gastrointestinal symptoms are more common in adults who recall abuse as a child; however, data available on children are limited. The aim of this study was to investigate the association of childhood maltreatment and early development of gastrointestinal symptoms and whether this relation was mediated by psychological distress. METHODS Data were obtained from the Longitudinal Studies of Child Abuse and Neglect, a consortium of 5 prospective studies of child maltreatment. The 845 children who were observed from the age of 4 through 12 years were the subjects of this study. Every 2 years information on gastrointestinal symptoms was obtained from parents, and maltreatment allegations were obtained from Child Protective Services (CPS). At the age of 12 years children reported gastrointestinal symptoms, life-time maltreatment, and psychological distress. Data were analyzed by logistic regression. RESULTS Lifetime CPS allegations of sexual abuse were associated with abdominal pain at age 12 years (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.1–2.47). Sexual abuse preceded or coincided with abdominal pain in 91% of cases. Youth recall of ever having been psychologically, physically, or sexually abused was significantly associated with both abdominal pain and nausea/vomiting (range, OR = 1.5 [95% CI, 1.1–2.0] to 2.1 [95% CI, 1.5–2.9]). When adjusting for psychological distress, most effects became insignificant except for the relation between physical abuse and nausea/vomiting (OR = 1.5; 95% CI, 1.1–2.2). CONCLUSION Youth who have been maltreated are at increased risk for unexplained gastrointestinal symptoms, and this relation is partially mediated by psychological distress. These findings are relevant to the clinical care for children who complain of unexplained gastrointestinal symptoms.

At-risk and maltreated children exposed to intimate partner aggression/violence: what the conflict looks like and its relationship to child outcomes

Despite increasing research on childrens exposure to intimate partner aggression/violence (IPAV), and co-occurrence of IPAV and maltreatment, little is known about IPAV in at-risk and maltreating families. We explored the nature of IPAV in 554 homes where children were identified as at risk or reported for maltreatment and examined differences between emotional and behavioral outcomes for children in homes where one or both intimate partners is the alleged perpetrator of IPAV. We found in this sample that IPAV primarily took the form of verbal aggression with differences in perpetrator gender for verbal, minor, and severe violence. There were few child outcomes predicted by perpetrator gender: Significant child behavior problems were found with all types of IPAV and both genders as perpetrators. Results suggest the need for comprehensive assessments of IPAV when assessing risk, safety, and harm issues for children reported as being at risk or victims of maltreatment.

The impact of drugs, infants, single mothers, and relatives on reunification: A Decision-Making Ecology approach.

Using a Decision-Making Ecology (DME) approach and proportional hazards models, the study isolated four case factor profiles that interacted strongly with race and resulted in disparate reunification outcomes for African American children compared with Anglos. The four interrelated factors were drug involvement, a solo infant case, single mothers, and relative placements. A cohort of 21,763 children from the Texas Department of Family and Protective Services who were placed for the first time in care, who were under 13 and either Anglo or African American were followed for 20 months or more post entry into care. Starting with an initial model consisting of main effects only and consistent with other studies, African American children had a 12% lower hazard rate of reunification compared to Anglo children. However, when a set of case profiles involving combinations of single parents, single infants, drug involvements and kinship placements were crossed with race, the magnitude of the effect of race on hazard rates fanned out from no difference to as much as 68% that of Anglo children. The results show that racial disparities in outcomes resulting from complex, contextual decision making cannot be modeled well with simple main effects models.

Intervention with substance-abusing mothers: are there rural-urban differences?

OBJECTIVE The purpose of this study was to examine rural-urban differences among substance-abusing mothers enrolled in the Parent-Child Assistance Program (PCAP) from 1998 to 2008 in Washington State. METHODS This was a longitudinal study utilizing PCAP data reports of 773 women enrolled from 1998 to 2008. Differences across urban-rural PCAP participants were examined. RESULTS Rural participants were more likely to report alcohol use and binge drinking at program intake and at the 3-year program exit. In addition, throughout the program, rural women were less likely to complete outpatient substance abuse treatment compared to urban participants. Rural women also used less services during the last year including alcohol/drug support and mental health provider services. Findings are troubling when we consider that at program exit, rural participants also reported higher use of alcohol and more suicidal thoughts than those residing in urban areas. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Data presented indicate there are important differences between urban and rural residing participants. Findings highlight the importance of considering the barriers that rural or remote locations might create. Identifying community-specific needs of substance abusing pregnant or parenting women in both rural and urban settings is crucial for the successful development and improvement of treatment and intervention programs for this vulnerable population of women. (Am J Addict 2014;XX:1-9).

Intervention with substance-abusing mothers

OBJECTIVE The purpose of this study was to examine rural-urban differences among substance-abusing mothers enrolled in the Parent-Child Assistance Program (PCAP) from 1998 to 2008 in Washington State. METHODS This was a longitudinal study utilizing PCAP data reports of 773 women enrolled from 1998 to 2008. Differences across urban-rural PCAP participants were examined. RESULTS Rural participants were more likely to report alcohol use and binge drinking at program intake and at the 3-year program exit. In addition, throughout the program, rural women were less likely to complete outpatient substance abuse treatment compared to urban participants. Rural women also used less services during the last year including alcohol/drug support and mental health provider services. Findings are troubling when we consider that at program exit, rural participants also reported higher use of alcohol and more suicidal thoughts than those residing in urban areas. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Data presented indicate there are important differences between urban and rural residing participants. Findings highlight the importance of considering the barriers that rural or remote locations might create. Identifying community-specific needs of substance abusing pregnant or parenting women in both rural and urban settings is crucial for the successful development and improvement of treatment and intervention programs for this vulnerable population of women.