Paula Kienberger Jaudes

Association of Drug Abuse and Child Abuse.

OBJECTIVE To show that children born to mothers who used drugs during pregnancy were at a higher risk of subsequent abuse or neglect than were children from the general population. METHODOLOGY This is a retrospective-prospective study of abuse experiences of children born at an urban medical center between January 1985 and December 1990 to women who used illicit drugs during pregnancy. Children exposed in-utero to drugs were identified using results of toxicology screens from birth and maternal records. Evidence of abuse was obtained from the State Central Registry of Abuse and Neglect. The registry contained information on all reported abuses or neglects, the types, findings, and outcomes of the investigations of reported cases. The outcome measure was whether the children had been abused or not during the study period. RESULTS One hundred and fifty-five (30.2%) of the 513 children exposed in-utero to drugs were reported as abused or neglected and 102 (19.9%) had substantiated reports giving a rate of 84 abuse and neglect cases per 1,000 years of exposure. The yearly substantiated abuse rates varied, the lowest being 30 cases per 1,000 years of exposure in 1986 and the highest 107 cases per 1,000 in 1987. This rate was two to three times that of children living in the same geographic area in the south side of Chicago. Neglect was reported in 72.6% of cases, with the toddlers being the most vulnerable to abuse and neglect. Natural parents were responsible for maltreatment 88% of the time. On logistic regression analysis, the risk of abuse of children increased 1.56-fold (Confidence Interval = 1.25-2.01) that of nonabusing parents among women who had completed high school education or had some college education and 1.80-fold among women with previous planned abortion, after controlling for confounding variables. Other sociodemographic variables of the child or mother did not significantly increase the odds of abuse. CONCLUSIONS Infants exposed in-utero to drugs have a higher than expected risk of subsequent abuse compared to children in the general population.

The medical and psychosocial needs of children entering foster care

The estimated three to four hundred thousand children in foster care represent a population at high risk for medical and psychosocial problems. Their problems are compounded by the lack of adequate resources available to them while in foster care. This study provided a medical and psychosocial screening of 149 abused and neglected children entering the foster care system. The goal was to generate a profile of the medical and psychosocial needs of children entering the foster care system as a first step toward development of a better health care delivery system. Results indicated that these children have a much greater incidence of chronic medical conditions, are likely to weigh significantly less and be significantly shorter than the general population, require significant amounts of medical sub-specialty care, have a high incidence of developmental delays, and major deficits in adaptive behavior and have a large number of behavioral problems often associated with psychiatric disorders. Results are discussed in terms of the development of a regional model to effectively manage the health care needs of children entering foster care.

The Health of Children in Foster Care

Using Medicaid claims data, we compare the health service use and the prevalence of reported conditions among three groups of Medicaid‐eligible Illinois children: those receiving Aid to Families with Dependent Children (AFDC) who do not enter foster care, those receiving AFDC who subsequently enter foster care, and children in foster care. We find that the two groups of children receiving AFDC differed in their health service use and reported conditions. Once in foster care, children used more health services than children receiving AFDC. Children in kinship foster care also had similar patterns of service use and reported conditions.

Child Abuse in a Cerebral-palsied Population

Of 86 cerebral‐palsied children seen in one care center over a 12‐month period, 17 had been subject to child abuse. Eight of these Childrens cerebral palsy was a result of abuse. The findings suggest that there is a high incidence of child abuse among children with cerebral palsy. There is a ‘double indication’ for abuse, both as a cause and a result of cerebral palsy.

Criminal Prosecution of Child Sexual Abuse Cases.

To describe the outcome of prosecuting alleged intrafamilial/caretaker child sexual abuse, the authors evaluated charts for 1986-1988 at La Rabida Childrens Hospital and Research Center in Chicago, plus police records for Area V, Chicago for 1986-1987. The states attorneys office provided data on outcome of legal proceedings. Of 451 allegations, 324 (72%) were formally designated as probable sexual abuse cases, and 269 (83%) alleged perpetrators were identified. Complaints (77 felonies, 29 misdemeanors, and 30 juvenile charges) were initiated by the police for preliminary hearings against 136 (51%) persons. Of the felony charges, 66 (85.7%) resulted in indictments, and 11 (14.3%) in dismissal of charges by judge or grand jury. Thirty-two (48.5%) of those indicted pleaded guilty, 24 (36%) went to trial; 16 (67%) were found guilty, and 8 (12%) had charges dismissed. Therefore, of the 77 felony complaints initiated, 48 (62%) ended in convictions and 29 (38%) in dismissals or not-guilty verdicts. Only 24 (5%) of the original allegations resulted in trials. Although 30% of allegations and 51% of alleged perpetrators ended up in court, only 17% of the original 451 allegations were prosecuted for a felony. For felony indictments, 36% of victims appeared in court. Forty-three of 48 persons found guilty served time (mean sentencing time, 6.8 years). The mean time from initial hearing to final disposition was 321 days and was significantly longer if the accused either went to trial (501 vs. 236 days) or was found guilty or pleaded guilty (353 vs. 254 days for not-guilty verdicts). The authors conclude that very few children (5%) have to appear as witnesses in court, as most cases are resolved by plea bargaining, and that resolution by trial can take 12 to 16 months.

The handicapped child and child abuse

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.

Sexual Abuse Evaluations in the Emergency Department: Is the History Reliable?.

The authors assessed agreement on perpetrator identification obtained at two interviews of child victims of sexual abuse. We reviewed charts for 141 children who had undergone both a screening interview by an emergency department physician and an investigative interview by an interdisciplinary team specializing in child sexual abuse evaluation. For 107 (76%) cases, information was consistent; for instance, identification occurred at both interviews or at neither interview. Of the 38 children not identifying the perpetrator at the screening interview, 17 (45%) made disclosure at the investigative interview. Children who made disclosure only at the investigative interview were more likely to have refused to speak to the physician in the emergency department (p = .001). No significant differences were found when data for interview site and perpetrator identification were analyzed by gender of child, time interval between assault and screening interview, time interval between the two interviews, relationship of the alleged perpetrator to the child, performance of the investigative interview on an inpatient versus outpatient basis, and report of genital contact. In conclusion, perpetrator identification obtained during emergency department screening interviews usually agreed with information obtained at the subsequent investigative interview. The investigative interview was most helpful in identification of perpetrators when the child was not the source of the history obtained in the emergency department.

Child Sexual Abuse: Who Goes Home?.

The purpose of this study was to ascertain the factors which influence custody change in cases of children who have been sexually abused. Of 180 children admitted to La Rabida Childrens Hospital and Research center with a suspicion of having been sexually abused, 138 met the states criteria for proven sexual abuse, and 30% of those children had a sexually transmitted disease. One-third of the children with proven abuse were under 4 years of age. Of the children with proven abuse, ultimately 40% had a custody change. Only an initial outcry of abuse was associated with an increased probability of a change in custody. A change in custody was not found to be related to the patients age, sex, the perpetrators relation to the child or access to the home, the presence of sexually transmitted disease, whether the child was also physically abused, or whether the child had had developmental delay. These data suggest an absence of any discernible guidelines in the juvenile courts decision concerning custody change of a sexually abused child.