Rebecca T. Leeb

Child maltreatment fatalities in children under 5: Findings from the National Violence Death Reporting System ☆

OBJECTIVE To describe the distribution of child maltreatment fatalities of children under 5 by age, sex, race/ethnicity, type of maltreatment, and relationship to alleged perpetrator using data from the National Violent Death Reporting System (NVDRS). STUDY DESIGN Two independent coders reviewed information from death certificates, medical examiner and police reports corresponding to all deaths in children less than 5 years of age reported to NVDRS in 16 states. RESULTS Of the 1,374 deaths for children under 5 reported to NVDRS, 600 were considered attributable to child maltreatment. Over a half of the 600 victims of child maltreatment in this age group were under 1 year old, 59% were male, 42% non-Hispanic Whites, and 38% were non-Hispanic Blacks. Two thirds of child maltreatment fatalities in children under 5 were classified as being due to abusive head trauma (AHT), 27.5% as other types of physical abuse, and 10% as neglect. Based on these data, fathers or their substitutes were significantly more likely than mothers to be identified as alleged perpetrators for AHT and other types of physical abuse, while mothers were more likely to be assigned responsibility for neglect. CONCLUSIONS Among children under 5 years, children under 1 are the main age group contributing to child maltreatment fatalities in the NVDRS. AHT is the main cause of death in these data. These findings are limited by underascertainment of cases and fair inter-rater reliability of coding. PRACTICE IMPLICATIONS The findings suggest the need to develop and evaluate interventions targeting AHT to reduce the overall number of child maltreatment deaths in young children. These interventions should make special efforts to include fathers and their substitutes.

A Review of Physical and Mental Health Consequences of Child Abuse and Neglect and Implications for Practice

This article provides an overview of mental and physical health outcomes of child maltreatment to help health care providers identify the consequences of maltreatment and consider treatment options. Child maltreatment is associated with a variety of negative physical and mental health outcomes that affect the individual throughout the lifespan and place a substantial burden on both victims and the population as a whole. The review begins with an overview of the role of physicians in identifying abuse and neglect in the clinic setting. Next, current research findings on physical and mental health outcomes in children, adolescents, and adults are reviewed. Finally, opportunities for primary prevention of abuse and neglect are discussed. Primary prevention strategies can avoid risk for maltreatment, and subsequent interventions for victims have the potential to greatly improve their health.

Concordance Between Self-Reported Maltreatment and Court Records of Abuse or Neglect Among High-Risk Youths

OBJECTIVES We examined the concordance between measures of self-reported maltreatment and court records of abuse or neglect in a sample of detained youths. METHODS Data were collected by the Northwestern Juvenile Project and include interviews from 1829 youths aged 10-18 years. Participants were newly detained youths in the Cook County Juvenile Temporary Detention Center in Illinois between 1995 and 1998. Self-reported cases of child maltreatment were compared with court records of abuse or neglect in the Cook County judicial system. RESULTS We found that among detained youths, 16.6% of those who reported any maltreatment, 22.2% of those who reported the highest level of maltreatment, and 25.1% of those who reported that they required medical treatment as a result of maltreatment had a court record of abuse or neglect. Among those with any self-reported maltreatment, girls (vs boys) and African Americans (vs Whites) were more likely to have a court record (adjusted odds ratio [AOR]=2.18; 95% confidence interval [CI]=1.53, 3.09; and AOR=2.12; 95% CI=1.23, 3.63, respectively). CONCLUSIONS Official records seriously underestimate the prevalence of maltreatment, which indicates that multiple data sources are needed to document the true prevalence of maltreatment.

Maltreatment History and Weapon Carrying Among Early Adolescents

This study examines the role of maltreatment in weapon carrying among 12-year-old youth (N = 797) interviewed as part of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), an ongoing study of the antecedents and consequences of child maltreatment. Participants reported their physical and sexual abuse history and provided responses to items assessing perceived need for a weapon and weapon carrying. There were no gender differences in rates of self-reported physical or sexual abuse. Males were more likely than females to report weapon carrying and perceived need for a weapon. A mediation analysis was conducted to examine the mediating effect of perceived need for a weapon on the association between abuse and weapon carrying. Results indicated that perceived need for a weapon fully mediated the effect of physical abuse and partially mediated the effect of sexual abuse. Results are discussed in the context of self-protection theory.

Gender-Specific Mental and Behavioral Outcomes Among Physically Abused High-Risk Seventh-Grade Youths

Objective. Research has shown that physical abuse during childhood (early PA) is associated with various mental and behavioral problems in adolescence. However, there is little research on the differences in these associations by gender among youths residing in high-risk communities. This study investigated gender differences in the relationship between early PA and various internalizing (e.g., thoughts of suicide or victimization) and externalizing (e.g., perpetration of violence) behaviors. Methods. A cross-sectional study was conducted using survey data (collected in 2004) provided by 1,484 seventh-grade youths residing in a high-risk community (83% participated). Students were considered victims of early PA if they reported experiencing abuse prior to age 10 years. Prevalence ratios (PRs) were calculated to estimate the association between early PA and various outcomes (e.g., suicidality, victimization, violence, and illegal drug use), adjusting for race/ethnicity and other forms of abuse. Poisson regression with robust variance estimates was used to estimate the PRs and test for early PA-gender interaction. Results. Early PA was positively associated with suicidality, illegal drug use, and victimization with no significant differences by gender. The association between early PA and criminal behavior was significantly higher for females; the association between early PA and peer violence perpetration was significantly higher for males (interaction term PA*gender was significant at the p≤0.005 level). Conclusions. Young high-risk adolescents who experienced early PA may need counseling or other services (e.g., home visitation) to help prevent suicidality, victimization, violence perpetration, criminal behavior, and illegal drug use. Furthermore, male victims may need more attention in the area of violence prevention; female victims may need particular attention with regard to preventing criminal behavior.

Examining the Role of Safe, Stable, and Nurturing Relationships in the Intergenerational Continuity of Child Maltreatment—Introduction to the Special Issue

This special issue is the result of a successful collaboration between the Centers for Disease Control and Prevention (CDC) and researchers leading four important longitudinal studies on intergenerational patterns of violence: The Environmental Risk Longitudinal TwinStudy (E-Risk) [1]; theFamilyTransitionsProject (FTP) [2]; the Lehigh Longitudinal Study [3]; and the Rochester Youth Development Study [4]. The papers that follow investigate the role of safe, stable, and nurturing relationships and social contexts in the lives of children and their caregivers, provide insight into complex relationship factors that influence the intergenerational continuity of child maltreatment, and point to a number of important avenues to improve the lives of children and families by preventing violence and promoting health and well-being. Child maltreatment is a significant public health problem that requires a multifaceted approach to prevention. It is estimated that one out of every ten children in the United States experiences one or more forms of physical, sexual, or emotional abuse or neglect by a parent or other caregiver at some point during their lifetime [5e7]. In 2011, social service workers identified 681,000 children1 in the United States as substantiated victims of maltreatment. This equates to an overall victimization rate of 9.1 per 1,000 children in the U.S. population [8]. It is well-established that experiencing child maltreatment is associated with a variety of negative physical, emotional, and psychological outcomes, including subsequent harsh and/or neglectful parenting in adulthood [9e13]. Yet, it is also clear that not all maltreated children grow up to become maltreating parents [14,15]. Thus, identifying factors that distinguish families in which the cycle of violence is maintained from families in which it is interrupted is critical for violence prevention and optimal child development. The CDC has identified the promotion of safe, stable, nurturing relationships (SSNRs) as a key strategy for the public health approach to child maltreatment prevention [16]. The three dimensions of SSNRs (i.e., safety, stability, and nurturance) each represent significant aspects of the social and physical environments that

Tests of the Mitigating Effects of Caring and Supportive Relationships in the Study of Abusive Disciplining Over Two Generations

PURPOSE To examine evidence of the continuity in abusive discipline across two generations (G1 and G2) and the role of safe, stable, and nurturing relationships (SSNRs) as protective factors. METHODS Data are from the Lehigh Longitudinal Study, a prospective investigation of the causes and consequences child maltreatment that began in the 1970s with a sample of 457 children and their parents. Data were most recently collected in 2008-2010 from 80% of the original child sample (N = 357) when they were adults age 36 years on average. Of those assessed as adults, 268 participants (G2s) were parenting children and thus comprise the analysis sample. Analyses examined the association between harsh physical discipline practices by G1 parents and G2s reports of similarly severe discipline practices used in parenting their own children. Analyses also investigated the direct and interactive (protective) effects of SSNR variables that pertain to the care, warmth, and support children received from their mothers, fathers, and siblings over their lifetimes. A measure of an adult partners warmth and support was also included. A case-level examination of G2 harsh discipliners was included to investigate other forms of past and more recent forms of abuse exposure. RESULTS Results show a significant predictive association between physical discipline by G1 and G2 parents (β = .30; p < .05; odds ratio, 1.14; confidence interval, 1.04-1.26), after accounting for childhood socioeconomic status and gender. Whereas being harshly disciplined as a child was inversely related to reports of having had a caring relationship with ones mother (r = -.25; p < .01), only care and support from ones father predicted a lower risk of harsh physical discipline by G2s (β = -.24; p < .05; odds ratio, .74; confidence interval, .59-.92). None of the SSNR variables moderated the effect of G1 discipline on G2 discipline. A case-level examination of the abusive histories of G2 harsh discipliners found they had in some instances been exposed to physical and emotional abuse by multiple caregivers and by adult partners. CONCLUSIONS There is continuity in physical disciplining over two generations. SSNRs measured in this study did not mediate or moderate the effect of G1 on G2 harsh physical discipline, although care and support from fathers was inversely related to the likelihood of G2 harsh physical discipline. This relationship is independent of abuse in childhood. Research is needed to identify factors that interrupt the intergenerational continuity of harsh physical (abusive) disciplining so that promising interventions can be developed and implemented.

Does Childhood Disability Increase Risk for Child Abuse and Neglect

In this article we review the empirical evidence for the presumptions that children with disabilities are at increased risk for child maltreatment, and parents with disabilities are more likely to perpetrate child abuse and neglect. Challenges to the epidemiological examination of the prevalence of child maltreatment and disabilities are discussed. We conclude that the evidence for the relationship between child maltreatment victimization of children with disabilities and perpetration by caregivers with disabilities remains equivocal due to variability in research samples, key definitions, and study methodology. Future research examining the link between disability and child maltreatment would benefit from more rigorous methodology and inclusion of a theoretical framework, such as the ecological model of child maltreatment. One potential pathway from disability to child maltreatment is presented. Knowing and understanding the link between disability and child abuse and neglect is an important step toward planning targeted and appropriate prevention and intervention activities.

Mediating and moderating effects of social support in the study of child abuse and adult physical and mental health

A number of cross-sectional and a few longitudinal studies have shown a developmental relationship between child abuse and adult physical and mental health. Published findings also suggest that social support can lessen the risk of adverse outcomes for some abused children. However, few studies have investigated whether social support mediates or moderates the relationship between child abuse and adult physical and mental health. Structural equation modeling was used to examine data on these topics from a longitudinal study of more than 30 years. While a latent construct of physical and emotional child abuse did not predict adult health outcomes directly, child abuse did predict outcomes indirectly through social support. A test of variable moderation for child abuse and social support was nonsignificant. Results suggest that social support may help explain the association between child abuse and health outcomes at midlife. Implications of the findings for prevention and treatment are discussed. (PsycINFO Database Record

Public health efforts to build a surveillance system for child maltreatment mortality: lessons learned for stakeholder engagement.

CONTEXT Reducing the number of largely preventable and tragic deaths due to child maltreatment (CM) requires an understanding of the magnitude of and risk factors for fatal CM and targeted research, policy, and prevention efforts. Public health surveillance offers an opportunity to improve our understanding of the problem of CM. In 2006, the Centers for Disease Control and Prevention (CDC) funded state public health agencies in California, Michigan, and Oregon to implement a model approach for routine and sustainable CM surveillance and evaluated the experience of those efforts. OBJECTIVE We describe the experiences of 3 state health agencies in building collaborations and partnerships with multiple stakeholders for CM surveillance. DESIGN Qualitative, structured key informant interviews were carried out during site visits as part of an evaluation of a CDC-funded project to implement a model approach to CM surveillance. PARTICIPANTS Key informants included system stakeholders from state health agencies, law enforcement, child protective services, the medical community, and child welfare advocacy groups in the 3 funded states. RESULTS Factors that facilitated stakeholder engagement for CM surveillance included the following: streamlining and coordinating the work of Child Death Review Teams (CDRTs); demonstrating the value of surveillance to non-public health partners; codifying relationships with participating agencies; and securing the commitment of decision-makers. Legislative mandates were helpful in bringing key stakeholders together, but it was not sufficient to ensure sustained engagement. CONCLUSIONS The engagement process yielded multiple benefits for the stakeholders including a deeper appreciation of the complexity of defining CM; a greater understanding of risk factors for CM; and enhanced guidance for prevention and control efforts. States considering or currently undertaking CM surveillance can glean useful insights from the experiences of these 3 states and apply them to their own efforts to engage stakeholders.