Lil Tonmyr

Methodological Challenges in Measuring Child Maltreatment.

OBJECTIVE This article reviewed the different surveillance systems used to monitor the extent of reported child maltreatment in North America. METHODS Key measurement and definitional differences between the surveillance systems are detailed and their potential impact on the measurement of the rate of victimization. The infrastructure requirements, quality of information, timely access to data and the usefulness for child welfare policy are compared and contrasted and a summary table of the type of information by each system is presented. RESULTS Two studies collect data regarding the extent and nature of child maltreatment using survey methodology reported to professionals: the United States National Incidence Study of Child Abuse and Neglect (NIS) and the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS), and the United States National Child Abuse and Neglect Data System (NCANDS) uses administrative data methods to collect annual case-level and state data. PRACTICE IMPLICATIONS The purpose of this comparison is to assist researchers and policy analysts with interpreting data from these studies as well as to help officials from other countries in developing surveillance systems that are appropriately adapted to their needs.

A Review of Childhood Maltreatment and Adolescent Substance Use Relationship

Adolescence is a period of heightened exploration, emotional and physical change. During this time, engagement in risk behaviours occurs often, affecting physical, mental and social health and well-being. Risk factors can include experimentation with substances and may lead to social and legal problems, disability and accidental death. We searched CINAHL, PsycINFO, ERIC, Medline, Social Policy & Practice and PubMed to identify studies that measured child maltreatment (witnessing domestic violence, emotional maltreatment, neglect, physical and sexual abuse) and the use/abuse of substances (nicotine (cigarette smoking) alcohol and a variety of drugs) in community and school samples. Thirty-five articles comprising 31 studies met inclusion criteria. The majority of included studies identified an association, with increased risk of substance use/abuse among youth with history of child maltreatment. Physical and sexual abuse and alcohol use/abuse were most often measured. The magnitude of the association varied by type of maltreatment and type of substances: sexual abuse and (a) nicotine (odds ratio (OR) 0.9-4.2); (b) alcohol (OR 1.4-5.2) and (c) drugs (OR 1.0-8.6); physical abuse and (a) nicotine (OR 1.8-6.1); (b) alcohol (OR 0.8-8.9) and (c) drugs (OR 1.8-20.4); neglect and alcohol (OR 1.2-21.2); emotional maltreatment and (a) nicotine (OR 1.4); (b) alcohol (OR 1.5) and (c) drugs (OR 1.4); and witnessing domestic violence and (a) nicotine (OR 1.4-2.2); (b) and alcohol (OR 1.4-1.9). The results are examined and implications for research and intervention are discussed.

The utility and challenges of using ICD codes in child maltreatment research: A review of existing literature

OBJECTIVE The objectives of this article are to explore the extent to which the International Statistical Classification of Diseases and Related Health Problems (ICD) has been used in child abuse research, to describe how the ICD system has been applied, and to assess factors affecting the reliability of ICD coded data in child abuse research. METHODS PubMed, CINAHL, PsychInfo and Google Scholar were searched for peer reviewed articles written since 1989 that used ICD as the classification system to identify cases and research child abuse using health databases. Snowballing strategies were also employed by searching the bibliographies of retrieved references to identify relevant associated articles. The papers identified through the search were independently screened by two authors for inclusion, resulting in 47 studies selected for the review. Due to heterogeneity of studies meta-analysis was not performed. RESULTS This paper highlights both utility and limitations of ICD coded data. ICD codes have been widely used to conduct research into child maltreatment in health data systems. The codes appear to be used primarily to determine child maltreatment patterns within identified diagnoses or to identify child maltreatment cases for research. CONCLUSIONS A significant impediment to the use of ICD codes in child maltreatment research is the under ascertainment of child maltreatment by using coded data alone. This is most clearly identified and, to some degree, quantified, in research where data linkage is used. PRACTICE IMPLICATIONS The importance of improved child maltreatment identification will assist in identifying risk factors and creating programs that can prevent and treat child maltreatment and assist in meeting reporting obligations under the CRC.

Placement Decisions and Disparities among Aboriginal Children: Further Analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect Part A: Comparisons of the 1998 and 2003 Surveys.

OBJECTIVE Fluke et al. (2010) analyzed Canadian Incidence Study on Reported Child Abuse and Neglect (CIS) data collected in 1998 to explore the influence of clinical and organizational characteristics on the decision to place Aboriginal children in an out-of-home placement at the conclusion of a child maltreatment investigation. This study explores this same question using CIS data collected in 2003 which included a larger sample of Aboriginal children and First Nations child and family service agencies. METHODS The decision to place a child in an out-of-home placement was examined using data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2003 and a reanalysis of CIS-1998 data (Fluke et al., 2010). The CIS-2003 dataset includes information on nearly 12,000 child maltreatment investigations from the time of report to case disposition. The CIS-2003 also captures information on the characteristics of investigating workers and the child welfare organizations for which they work. Multi-level statistical models were developed to analyze the influence of clinical and organizational variables using MPlus software. MPlus allows the use of dichotomous outcome variables, which are more reflective of decision-making in child welfare and facilitates the specific case of the logistic link function for binary outcome variables under maximum likelihood estimation. RESULTS Final models revealed the proportion of investigations conducted by the child welfare agency involving Aboriginal children was a key single agency level predictor of the placement decision. Specifically, the higher the proportion of investigations of Aboriginal children, the more likely placement was to occur. Contrary to the findings in the first paper (Fluke et al., 2010), individual Aboriginal status also remained significant in the final model at the first level. CONCLUSIONS Further analysis needs to be conducted to further understand individual and organizational level variables that may influence decisions regarding placement of Aboriginal children. There is also a need for research that is sensitive to differences among, and between, Métis, First Nations and Inuit communities. Results are not generalizable to Québec because data from this province were excluded.

Measurement of emotional/psychological child maltreatment: A review

BACKGROUND Emotional/psychological child maltreatment (ECM) is a major public health problem with serious consequences including emotional and behavioral problems. Nevertheless, ECM is an understudied area. OBJECTIVES The aims of this review are to identify measures of ECM and to evaluate their psychometric properties and utilities. We provide a summary of ECM measures that have been tested for their reliability and validity, evaluate the quality of these assessments and suggest directions for future research. METHODS We searched PsycINFO and Medline databases from 2000 to 2010 in addition to a hand search of retrieved references; 2344 were identified and the abstracts reviewed independently by two authors to identify relevant articles. Using pre-established criteria, 144 of those articles were selected and reviewed in full to assess whether the instruments included a separate measure of ECM and its psychometric properties. RESULTS Forty-five articles examining 33 measures met the inclusion criteria and were selected for further review. The majority of measures demonstrated acceptable reliability; fewer measures had evaluated one or more types of validity. CONCLUSION Both reliability and validity testing are required in order to establish more accurate measures of ECM. PRACTICE IMPLICATIONS Reliable and valid measures are necessary to enhance our limited knowledge about the distribution, determinants and consequences of ECM.

Sex Differences in Childhood Sexual Abuse and Suicide-Related Behaviors

Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.

The Relation between Childhood Adverse Experiences and Disability Due to Mental Health Problems in a Community Sample of Women

Objective: The objective of this study was to examine the association between selected childhood adverse experiences and disability due to mental health problems in a community sample of women. Variables of interest included childhood physical and sexual abuse, parental psychiatric and substance abuse history, and sociodemographic factors. Method: Girls and women (aged 15 to 64 years) from a province-wide community sample (n = 4239) were asked about disability and most childhood adverse experiences through interview; a self-administered questionnaire inquired about child abuse. Logistic regression (crude and adjusted odds ratios) was used to test the associations between childhood adversity and disability due to mental health problems. Results: Approximately 3% of the women had a disability due to mental health problems. Among women with a disability, about 50% had been abused while growing up. After controlling for income and age, we found that disability showed the strongest association with childhood sexual abuse, physical abuse, and parental psychiatric disorder. Conclusion: Disability due to mental health problems was experienced by women with and without exposure to abuse in childhood. However, childhood sexual abuse and physical abuse were important correlates of disability. Disability creates suffering and loss for the individual and society; this issue merits more research in relation to child abuse.

Child maltreatment and onset of emergency department presentations for suicide-related behaviors

OBJECTIVES To determine whether the rates of a first presentation to the emergency department (ED) for suicide-related behavior (SRB) are higher among children/youth permanently removed from their parental home because of substantiated maltreatment than their peers. To describe the health care settings accessed by these children/youth before a first SRB presentation to help design preventive interventions. METHODS A population-based (retrospective) cohort of 12-17-year-olds in Ontario, Canada was established. Children/youth removed from their parental home because of the above noted maltreatment (n=4683) and their population-based peers (n=1,034,546) were individually linked to administrative health care records over time to ascertain health service use and subsequent ED presentations for SRB during follow-up. Person-time incidence rates were calculated and Cox regression models used to estimate adjusted hazard ratios (HR) and corresponding 95% confidence intervals (CI). RESULTS After controlling for demographic characteristics and prior health service use, maltreated children/youth were about five times more likely to have a first ED presentation for SRB compared to their peers, in both boys (HR: 5.13, 95% CI: 3.94, 6.68) and girls (HR: 5.36, 95% CI: 4.40, 6.54). CONCLUSIONS Children/youth permanently removed from their parental home because of substantiated child maltreatment are at an increased risk of a first presentation to the ED for SRB. The prevention of child maltreatment and its recurrence and the promotion of resilience after maltreatment has occurred are important avenues to study toward preventing ED SRB presentations in children/youth. Provider and system level linkages between care sectors may prevent the need for such presentations by providing ongoing environmental support.

A commentary on national child maltreatment surveillance systems: Examples of progress

a Medical and Social Affairs, The National Family Safety Program, Saudi Arabia b Child Protection Research Center, American Humane Association, USA c PICU and Pediatric Emergencies, Hotel-Dieu Hospital, Beirut, Lebanon d Department of Child and Adolescent Psychiatry/Psychotherapy, University, Ulm, Germany e Department of Children, Schools and Families, England, United Kingdom f Child and Youth Welfare Unit, Australian Institute of Health and Welfare, Australia g Child Protection Unit Department of Pediatrics, University of the Philippines, Philippines h Kind & Gezin, Belgium i Child, Youth and Family, New Zealand j Surveillance and Epidemiology Division, Public Health Agency of Canada, Canada

A systematic review of childhood maltreatment assessments in population-representative surveys since 1990

Background Population-representative surveys that assess childhood maltreatment and health are a valuable resource to explore the implications of child maltreatment for population health. Systematic identification and evaluation of such surveys is needed to facilitate optimal use of their data and to inform future research. Objectives To inform researchers of the existence and nature of population-representative surveys relevant to understanding links between childhood maltreatment and health; to evaluate the assessment of childhood maltreatment in this body of work. Methods We included surveys that: 1) were representative of the non-institutionalized population of any size nation or of any geopolitical region ≥ 10 million people; 2) included a broad age range (≥ 40 years); 3) measured health; 4) assessed childhood maltreatment retrospectively; and 5) were conducted since 1990. We used Internet and database searching (including CINAHL, Embase, ERIC, Global Health, MEDLINE, PsycINFO, Scopus, Social Policy and Practice: January 1990 to March 2014), expert consultation, and other means to identify surveys and associated documentation. Translations of non-English survey content were verified by fluent readers of survey languages. We developed checklists to abstract and evaluate childhood maltreatment content. Results Fifty-four surveys from 39 countries met inclusion criteria. Sample sizes ranged from 1,287-51,945 and response rates from 15%-96%. Thirteen surveys assessed neglect, 15 emotional abuse; 18 exposure to family violence; 26 physical abuse; 48 sexual abuse. Fourteen surveys assessed more than three types; six of these were conducted since 2010. In nine surveys childhood maltreatment assessments were detailed (+10 items for at least one type of maltreatment). Seven surveys’ assessments had known reliability and/or validity. Conclusions and Implications Data from 54 surveys can be used to explore the population health relevance of child maltreatment. Assessment of childhood maltreatment is not comprehensive but there is evidence of recent improvement.