Back to Primary Prevention of Child Maltreatment

A. MEDLINE search

• Part 1: Clinical, Comparative & Evaluative studies
• Part 2: Selected epidemiological and other papers dealing with statistics & numerical data
• Part 3: Selected review papers

• Book chapters
• Clinical, Comparative & Evaluative studies
• Dental Interventions
• Editorial
• Epidemiological Study
• Meta-analysis
• Randomised controlled trial
• Reviews

A. MEDLINE, 1993-November 1997 (Search engine = National Library of Medicine’s Internet PubMed)

Key:
MESH = Medical Subject Heading
MAJR = Major MESH topic
PTYP = Publication Type (clinical trials, reviews and meta-analyses)

"child abuse/prevention and control" [MAJR] AND ("clinical trial" [PTYP] OR "review" [PTYP] OR "meta-analysis" [PTYP])

"incest/prevention and control" [MESH] AND ("clinical trial" [PTYP] OR "review" [PTYP] OR "meta-analysis" [PTYP])

"battered child syndrome/prevention and control" [MESH] AND ("clinical trial" [PTYP] OR "review" [PTYP] OR "meta-analysis" [PTYP])

"child abuse/epidemiology" [MAJR] AND ("clinical trial" [PTYP] OR "review" [PTYP] OR "meta-analysis" [PTYP])

"child abuse/statistics and numerical data" [MAJR] AND ("clinical trial" [PTYP] OR "review" [PTYP] OR "meta-analysis" [PTYP])

Also searched articles related to the Macmillan et al 1993 CTF CMAJ update.

Part 1: Clinical, Comparative & Evaluative studies

Ref ID : 2

Bruening CC, Wagner WG, Johnson JT. Impact of rater knowledge on sexually abused and nonabused girls' scores on the Draw-A-Person: Screening Procedure for Emotional Disturbance (DAP:SPED). J Pers Assess. 1997;68:665-677.

Notes : Human figure drawings collected from a clinical sample of 20 sexually abused and 20 nonsexually abused girls were randomly assigned to 1 of 2 case descriptions: Actual, in which raters were told the girls' actual abuse status, or Pretend, in which raters were told that drawings were made by girls with the opposite abuse status. Using the Draw-A-Person: Screening Procedure for Emotional Disturbance (DAP:SPED) scoring system developed by Naglieri, McNeish, and Bardos (1991), three raters independently scored 44 randomly ordered protocols, 4 of which were commonly rated as checks for rater accuracy and observer drift. Results revealed no significant effect for girls' abuse status or the case description given to raters, thereby suggesting that the DAP:SPED is sufficiently objective to withstand the confounding influence of varying case descriptions.

Ref ID : 15

Olds DL, Eckenrode J, Henderson CR, Jr., Kitzman H, Powers J, Cole R, Sidora K, Morris P, Pettitt LM, Luckey D. Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial [comment]. JAMA. 1997;278:637-643.

Notes : CONTEXT: Home-visitation services have been promoted as a means of improving maternal and child health and functioning. However, long-term effects have not been examined. OBJECTIVE: To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women's life course and child abuse and neglect. DESIGN: Randomized trial. SETTING: Semirural community in New York. PARTICIPANTS: Of 400 consecutive pregnant women with no previous live births enrolled, 324 participated in a follow-up study when their children were 15 years old. INTERVENTION: Families received a mean of 9 home visits during pregnancy and 23 home visits from the child's birth through the second birthday. DATA SOURCES AND MEASURES: Women's use of welfare and number of subsequent children were based on self-report; their arrests and convictions were based on self-report and archived data from New York State. Verified reports of child abuse and neglect were abstracted from state records. MAIN RESULTS: During the 15-year period after the birth of their first child, in contrast to women in the comparison group, women who were visited by nurses during pregnancy and infancy were identified as perpetrators of child abuse and neglect in 0.29 vs 0.54 verified reports (P<.001). Among women who were unmarried and from households of low socioeconomic status at initial enrollment, in contrast to those in the comparison group, nurse-visited women had 1.3 vs 1.6 subsequent births (P=.02), 65 vs 37 months between the birth of the first and a second child (P=.001), 60 vs 90 months' receiving Aid to Families With Dependent Children (P=.005), 0.41 vs 0.73 behavioral impairments due to use of alcohol and other drugs (P=.03), 0.18 vs 0.58 arrests by self-report (P<.001), and 0.16 vs 0.90 arrests disclosed by New York State records (P<.001). CONCLUSIONS: This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies, the use of welfare, child abuse and neglect, and criminal behavior on the part of low-income, unmarried mothers for up to 15 years after the birth of the first child University of Colorado Health Sciences Center, Denver 80203, USA DavidOlds@uchscedu.

Ref ID : 1

Telljohann SK, Everett SA, Price JH. Evaluation of a third grade sexual abuse curriculum. J Sch Health. 1997;67:149-153.

Notes : This paper presents results from a third grade sexual abuse prevention program. A 24-item questionnaire was administered as a pretest and post-test to an experimental group (n = 236) and a control group (n = 195) of third grade students. Those receiving the sexual abuse prevention program significantly increased their sexual abuse knowledge scores from pretest to post-test. In addition, differences in knowledge were significantly higher in the experimental compared to the control group. Students who received the sexual abuse curriculum significantly improved from pretest to post-test on their behavioral intention scores. Results from this evaluation indicated a modest improvement can be obtained through use of this two-hour sexual abuse prevention curriculum.

Ref ID : 21

Whipple EE, Richey CA. Crossing the line from physical discipline to child abuse: how much is too much? Child Abuse Negl. 1997;21:431-444.

Notes : OBJECTIVE: The aim of this paper was to better differentiate physical discipline, corporal punishment, and physical child abuse based on samples drawn from the United States. METHODOLOGY: The American literature was examined to differentiate these three constructs, first on such dimensions as severity, intention, and child effects; and second on key contextual or environmental factors empirically associated with higher rates of violent behavior in families. Third, normative data on parental spanking frequencies were summarized to better operationalize patterns of physical discipline among abusive and nonabusive parents. RESULTS: Five articles that met selection criteria revealed that abusive parents spanked their children more often than did nonabusive parents. Aggregated data from nonabusive parents were used to compute a continuum or "normal range" of daily spanking frequencies from 0 to 5.73 (M = 2.5) times in 24 hours. CONCLUSION: While further research is needed to address spanking intensity, severity, and context, results of the research suggest that "relative exposure" to spanking may be an additional risk marker for abuse when considered with other known indicators or risk factors School of Social Work, Michigan State University, East Lansing 48824- 1118, USA.

Ref ID : 75

Wonderlich SA, Brewerton TD, Jocic Z, Dansky BS, Abbott DW. Relationship of childhood sexual abuse and eating disorders. J Am Acad Child Adolesc Psychiatry. 1997;36:1107-1115.

Notes : OBJECTIVE: To review the literature that has examined the relationship between childhood sexual abuse and the eating disorders. METHOD: Each of the five authors reviewed all identified empirical studies to be certain that inclusion/exclusion criteria were met. Two teams of raters then independently reviewed each study to determine whether it supported any of a series of six hypotheses that had been tested in this literature. RESULTS: This review indicates that childhood sexual abuse is a nonspecific risk factor for bulimia nervosa, particularly when there is psychiatric comorbidity. There is some indication that childhood sexual abuse is more strongly associated with bulimic disorders than restricting anorexia, but it does not appear to be associated with severity of the disturbance. CONCLUSION: Childhood sexual abuse is a risk factor for bulimia nervosa with significant comorbidity. Further study of the nature of this relationship is warranted Department of Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo 58102, USA stephenw@mailmedundnodakedu.

Ref ID : 16

Wurtele SK, Owens JS. Teaching personal safety skills to young children: an investigation of age and gender across five studies. Child Abuse Negl. 1997;21:805-814.

Notes : OBJECTIVE: To determine the extent to which preschool-aged boys and girls can benefit from instruction in personal safety. METHOD: Data compiled from five previous studies were employed. Four hundred and six preschoolers were pretested and participated in either the Behavioral Skills Training program (BST; Wurtele, 1986) or a control program. Children were posttested on skill and knowledge gains. RESULTS: Preschoolers who had participated in the BST program demonstrated greater knowledge and higher levels of personal safety skills compared with controls. Boys and girls reacted similarly to the program, as did children from younger and older age groups. CONCLUSIONS: These results provide support for the assertion that most preschool-aged children can benefit from participating in a developmentally appropriate personal safety program. Suggestions for expanding the efforts to prevent child sexual abuse are offered, so that children do not shoulder the full responsibility for prevention Department of Psychology, University of Colorado at Colorado Springs, 80933-7150, USAPMID- 9280384.

Ref ID : 31

Gray J, Bentovim A. Illness induction syndrome: paper I--a series of 41 children from 37 families identified at The Great Ormond Street Hospital for Children NHS Trust. Child Abuse Negl. 1996;20:655-673.

Notes : At the hospital 41 children from 37 families were identified as having had illness induced by a parent who in all but three cases was the mother. Their case records were reviewed. Four patterns of presentation occurred; failure-to-thrive through the active withholding of food; allegation of allergy and withholding of food; allegation and fabrication of medical symptoms; and active interference by poisoning or disrupting medical treatment. Four of the children died, two as a result of the illness induction. In 35% of the families a sibling had been previously subjected to some type of abuse. All the children had been presented with potentially serious symptoms, but post- identification only five were found to have serious medical problems requiring ongoing treatment. There were no specific characteristics of either the child or family associated with each type of presentation. Seventeen children had previously presented with failure-to-thrive, feeding problems or food allergies. All the mothers had suffered at least one of the following: privation, child abuse, psychiatric illness, or significant loss or bereavement, whereas only half the fathers had grown up in a deprived family situation and/or had earlier or current health difficulties. Forty percent of the parents had serious marital problems. A combined medical/psychosocial team identified the abuse and attempted to understand the family's belief system regarding the illness. The process of Illness Induction was conceptualized as being initiated by the parents perceiving the child to be ill and using this focus on illness as a way of solving major personal, marital, and/or family difficulties Social Work Department, Great Ormond Street Hospital for Children NHS Trust, London, England.

Ref ID : 6

Kolko DJ. Clinical monitoring of treatment course in child physical abuse: psychometric characteristics and treatment comparisons. Child Abuse Negl. 1996;20:23-43.

Notes : Weekly reports of high-risk indicators designed to monitor the course of treatment were obtained from physically abused, school-aged children and their parents/guardians who were randomly assigned to Individual Child and Parent Cognitive-Behavioral Treatment (CBT) or Family Therapy (FT). Measures of parental anger and physical discipline/force, and family problems were obtained each session. The measures showed moderate stability and parent-child correspondence. Between 20% and 23% of the two informant's reports acknowledged high levels of physical discipline/force during the early and late phases of treatment, respectively, and an even higher percentage of cases reported heightened parental anger and family problems. Early treatment reports from both informants predicted late period reports, but only parent reports were related to validity measures. The overall levels of parental anger and physical discipline/force were lower in CBT than FT families, though each group showed a reduction on these items from the early to late treatment sessions. The importance of routine monitoring of clinical course during intervention, especially in the identification of cases at-risk of reabuse, is discussed.

Ref ID : 5

Mulder MR, Vrij A. Explaining conversation rules to children: an intervention study to facilitate children's accurate responses [see comments]. Child Abuse Negl. 1996;20:623-631.

Notes : In the past few years there has been increased concern over the role of social influences on children's reports during interviews. It is argued that the number of wrong answers can be reduced by explaining a set of social rules of conversation to children at the beginning of an interview. In the present experiment, the effects of two conversation rules were tested. Children were informed that (a) "I-don't-know" is an acceptable answer, and (b) the interviewer would not be able to help them in answering the questions. A total of 114 children, aged 4 to 10, watched a staged event and were interviewed afterwards. The two factors were systematically varied in the experiment by utilizing a 2 x 2 factorial design. The results supported the hypotheses that introduction of these rules would reduce suggestibility. Our findings have implications for interviewing child witnesses.

Ref ID : 4

Oldfield D, Hays BJ, Megel ME. Evaluation of the effectiveness of Project Trust: an elementary school-based victimization prevention strategy. Child Abuse Negl. 1996;20:821-832.

Notes : This study employed a Posttest-Only Control Group Design to assess the effects of a victimization prevention program, Project TRUST, on elementary school students' knowledge of general prevention concepts, knowledge of difficult-to-acquire prevention concepts, anxiety, and reporting of abuse. A selected subgroup of experimental subjects was also assessed for retention of acquired concepts over time. Students exposed to Project TRUST demonstrated significantly greater knowledge of maltreatment prevention information, as well as difficult-to-acquire concepts, than control group students. A 3-month delayed reassessment of the experimental subgroup showed no loss in acquired prevention information. No differences in anxiety scores existed between experimental and control groups. First-time student abuse disclosures were greater in the experimental than in the control group. These findings support the effectiveness of Project TRUST as a strategy to increase prevention knowledge and generate abuse disclosures without creating student anxiety.

Ref ID : 36

Roberts I, Kramer MS, Suissa S. Does home visiting prevent childhood injury? A systematic review of randomised controlled trials. BMJ. 1996;312:29-33.

Notes : OBJECTIVE--To quantify the effectiveness of home visiting programmes in the prevention of child injury and child abuse. DESIGN--Systematic review of 11 randomised controlled trials of home visiting programmes. Pooled odds ratios were estimated as an inverse variance weighted average of the study specific odds ratios. SETTING--Randomised trials that were available by April 1995. SUBJECTS--The trials comprised 3433 participants. RESULTS--Eight trials examined the effectiveness of home visiting in the prevention of childhood injury. The pooled odds ratio for the eight trials was 0.74 (95% confidence interval 0.60 to 0.92). Four studies examined the effect of home visiting on injury in the first year of life. The pooled odds ratio was 0.98 (0.62 to 1.53). Nine trials examined the effect of home visiting on the occurrence of suspected abuse, reported abuse, or out of home placement for child abuse. Because of the potential for bias in outcome reporting in these studies, pooled effect estimates were not calculated. CONCLUSIONS--Home visiting programmes have the potential to reduce significantly the rates of childhood injury. The problem of differential surveillance for child abuse between intervention and control groups precludes the use of reported abuse as a valid outcome measure in controlled trials of home visiting Department of Community Paediatric Research, Montreal Children's Hospital, McGill University Faculty of Medicine, Quebec, CanadaPMID- 8555855.

Ref ID : 3

Samra J, Yuille JC. Anatomically-neutral dolls: their effects on the memory and suggestibility of 4- to 6-year-old eyewitnesses [see comments]. Child Abuse Negl. 1996;20:1261-1272.

Notes : The purpose of this investigation was to compare the amount and accuracy of details provided in the eyewitness accounts of preschool-aged children interviewed exclusively with a verbal interview against those interviewed with anatomically-neutral dolls in addition to a verbal interview. Forty-four children, aged 4 to 6 years, were paired up and assigned as participants or observers for an event they engaged in with a confederate. Children's memory was assessed afterwards by (a) The Step-Wise Interview (Yuille, Hunter, Joffe, & Zaparniuk, 1993); (b) the Step-Wise Interview and big dolls; or (c) The Step-Wise Interview and small, detailed dolls and props. Three leading questions were incorporated into the interviews. Results indicated no main effect of interview type on the overall amount or accuracy of the children's accounts. No main effects for interview type or participant versus observer condition were observed for the leading questions. Relative to 4-year-olds, 5-year-olds recalled a greater number of overall details and were more accurate in their accounts with both types of dolls. Females were more accurate than males in their accounts with the small detailed toys and props. Implications for the use of anatomically-neutral dolls in child sexual abuse investigations are discussed.
 

Ref ID : 94

Gracia E. Visible but unreported: a case for the "not serious enough" cases of child maltreatment. Child Abuse Negl. 1995;19:1083-1093.

Notes : This study examined the psychosocial characteristics of cases of child maltreatment labelled as "not serious enough." The sample consisted of cases of suspected physical abuse (N = 48), neglect (N = 13), and psychological maltreatment (N = 8) identified by teachers, and a nonabused comparison group (N = 283). Characteristics of children and their parents were evaluated at three ecological levels: individual, family, and social. Results indicated a poor personal and social adjustment of the children in the maltreatment groups, and suggest that the definition of cases of maltreatment as not serious enough does not represent the psychological reality of these children. Discriminant analysis indicated that the most important variables for discriminating between all maltreatment groups and the nonabuse group were parents and children's perceptions of parental behavior, children's behavioral problems and personal adjustment, parents integration and satisfaction in the community, and the importance and direction of personal growth emphasized in the family. The importance of other variables such as socioeconomic status, stress, psychological symptoms or number of children appeared to be a function of the different types of child maltreatment. The importance of prevention and intervention efforts before the maltreatment reaches a serious stage is discussed Facultad de Psicologia, Universidad de Valencia, SpainPMID-8528815.

Ref ID : 8

Olds D, Henderson CR, Jr., Kitzman H, Cole R. Effects of prenatal and infancy nurse home visitation on surveillance of child maltreatment. Pediatrics. 1995;95:365-372.

Notes : OBJECTIVE. To examine the effects of prenatal and infancy nurse home visitation on the surveillance of child abuse and neglect by examining differences in the health, living conditions, and maltreatment characteristics of nurse-visited and comparison children who had been identified as maltreated in the first 4 years of life. DESIGN. Randomized controlled trial. SETTING. Carried out in a semirural community in upstate, New York. Families dispersed throughout 14 other states during 2-year period after children's second birthdays. PARTICIPANTS. 400 primiparous women registered before 30th week of pregnancy, 85% of whom were either teenaged (< 18 years at registration), unmarried, or from Hollingshead social class IV or V. Maltreated subsample consisted of 56 families in which children had a state-verified report of child abuse or neglect during the first 4 years of the children's life. INTERVENTION. Nurse home visitation from pregnancy through the second year of the child's life. MAIN RESULTS. During the two-year period after the program ended, nurse-visited maltreated children lived in homes with fewer observed safety hazards for children; their homes contained more intellectually stimulating toys, games, and reading materials; their mothers were less controlling; and the children paid 87% fewer visits to the physician for injuries or ingestions, and 38% fewer visits to the emergency department. CONCLUSIONS. Children who were identified as maltreated and who were visited by nurses during pregnancy and the first two years of life had less serious expressions of caregiving dysfunction. This is likely to be a reflection, in part, of earlier and more comprehensive detection of child maltreatment on the part of nurse-visited families.

Ref ID : 7

Palusci VJ, McHugh MT. Interdisciplinary training in the evaluation of child sexual abuse. Child Abuse Negl. 1995;19:1031-1038.

Notes : To increase their knowledge of the medical evaluation and reporting of child sexual abuse, medical students, pediatric resident physicians, fellows and attendings participated in an interdisciplinary team-based training program consisting of didactic lectures, case discussions, videotapes and direct participation in patient evaluation. Content focused on the medical knowledge and skills needed for an assessment of the child's interview, anogenital examination and the indications for case reporting to child protection authorities. We evaluated the results of this training in our outpatient child abuse clinic located in a university-affiliated, municipal hospital using a survey which assesses knowledge of female genital anatomy, sexually-acquired diseases and case reporting in a nonrandomized control trial. Fifteen medical students and pediatric physicians participated and were compared to a reference group of 127 participants who did not receive this training and 15 others who randomly repeated the survey instrument during the study period. The results showed that resident physicians demonstrated increased mean total scores in the survey instrument. We conclude that an interdisciplinary team using patient care exposure increases physician knowledge in the evaluation of child sexual abuse.

Ref ID : 10

Barton K, Baglio CS, Braverman MT. Stress reduction in child-abusing families: global and specific measures. Psychol Rep. 1994;75:287-304.

Notes : This study compared in-home treatment to traditional county services for their ability to reduce stress in child-abusing families. 47 families who were at risk for having at least one child removed from the home for child abuse were referred to Families First for an intensive 6-wk., in-home therapy program. A comparison group of 29 families who were also at risk for having at least one child removed for abuse received traditional county services but no in-home therapy. Stress scores used were derived from a factor analysis of the Family Inventory of Life Events and Changes (FILE) that had identified 10 stress factors. The stress data were analyzed by a series of 2 x 2 analyses of variance, group and time being the independent variables and the stress factors the dependent variables. Total stress was significantly reduced over time for both groups, and several specific stress factors were also significantly reduced over time. In secondary analyses, 2 x 3 (group by time) analyses identified interactions for total stress and three of the individual stress factors. In-home treatment was effective in reducing stress, but traditional services were also effective. Some possible explanations were discussed. A major finding was that, by including analyses using the specific stress factors (rather than just the Total Stress score), a much richer understanding of the role stress plays in abusive families is provided. It was concluded that, although global stress may be reduced by different methods, some specific types of stress are more likely to be reduced than others.

Ref ID : 11

Marcenko MO, Spence M. Home visitation services for at-risk pregnant and postpartum women: a randomized trial. Am J Orthopsychiatry. 1994;64:468-478.

Notes : A randomized trial tested the psychosocial efficacy of a home visitation model for women at risk of out-of-home placement of their newborns. After an average of ten months of exposure, the experimental group reported significantly increased social support, greater access to services, and decreased psychological distress. Implications of the findings for interventions with at-risk families are discussed.

Ref ID : 13

McLeer SV, Callaghan M, Henry D, Wallen J. Psychiatric disorders in sexually abused children. J Am Acad Child Adolesc Psychiatry. 1994;33:313-319.

Notes : OBJECTIVE: This study was designed to compare the prevalence of psychiatric disorders in a clinical sample of sexually abused children referred for outpatient evaluation. Two a priori hypotheses were tested: (1) the sexually abused group would have more post-traumatic stress disorder than the non-sexually abused group and (2) non-sexually abused children referred for evaluation would have more diagnoses than the sexually abused group. METHODS: Twenty-six sexually abused children and 23 non-sexually abused children referred for psychiatric outpatient evaluation at a medical school center were matched by age, sex, race, and socioeconomic status and compared to determine differences in prevalence of Axis I, DSM-III-R disorders. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version was used for systematic diagnosis. RESULTS: Groups did not differ significantly in the number of diagnoses and, in both groups, attention-deficit hyperactivity disorder was the most frequent diagnosis. However, the prevalence of post-traumatic stress disorder among sexually abused children was significantly greater (p < .02), with 42.3% of sexually abused children and 8.7% of non-sexually abused children meeting full criteria. There were no significant differences between groups in other diagnostic categories. CONCLUSIONS: This study, using structured interviews and comparison groups, confirmed earlier findings suggesting that sexually abused children are at heightened risk for the development of post-traumatic stress disorder.

Ref ID : 12

Oates RK, O'Toole BI, Lynch DL, Stern A, Cooney G. Stability and change in outcomes for sexually abused children. J Am Acad Child Adolesc Psychiatry. 1994;33:945-953.

Notes : OBJECTIVE: To evaluate sexually abused children and their families at intake and 18 months later, in comparison with a control group. METHODS: Eighty-four sexually abused children aged 5 to 15 years were assessed at intake, with 64 being able to be reassessed at 18 months, the assessment using measures of self-esteem relevant to their age; the Children's Depression Inventory, and the Achenbach Child Behavior Checklist. Parents were assessed with the McMaster Family Assessment Device and the General Health Questionnaire. Control children and families were similarly assessed. Additional measures at follow-up were a structured interview with the parents, the Indices of Coping Responses, and the Newcastle Child and Family Life Events Schedule. Therapists were contacted to obtain information on type and duration of therapy. RESULTS: While the control children's self-esteem, depression, and behavior scores showed little change over time, the abused children's scores were more likely to move toward the normal range although 56% remained in the dysfunctional range for self-esteem, 48% for behavior, and 35% for depression. Improvement in child behavior was related to improvement in family function. While there was no direct relationship between child outcome and the relationship of the abuser to the child, family dysfunction, which was related to child outcome, did correlate with the closeness of the abuser to the child. Sixty-five percent of abused children had received therapy for an average of 9 months. No relationship was found between therapy and outcome. CONCLUSIONS: The major variable relating to improvement in sexually abused children appears to be adequacy of family functioning. There is a need for increased emphasis on the evaluation of treatment.

Ref ID : 93

Bath HI, Haapala DA. Intensive Family Preservation Services with abused and neglected children: an examination of group differences. Child Abuse Negl. 1993;17:213-225.

Notes : Intensive Family Preservation Services (IFPS) have emerged as one of the most widely-employed placement prevention models in the field of Family-Based Services. Most IFPS evaluations have reported positive outcomes, but some results have been mixed. The use of heterogeneous client samples may explain some of the equivocal findings, so a study was designed to assess maltreatment group differences in a relatively large sample of families referred by Child Protective Service (CPS) agencies. It was found that: (a) Neglectful families, in contrast to abusive ones, were poorer, more reliant on public income, more likely to be headed by a single parent, had more children at imminent risk of placement, and were more likely to have medical, mental health, and substance abuse problems; (b) families referred for both abuse and neglect were more similar to the neglect-only group than the abuse-only one; and (c) although the majority of all children avoided placement, children from neglectful families were almost twice as likely to be placed than children from abusive ones, with those from multiple maltreatment families being at highest risk. The implications for research methodology and service delivery are discussed Behavioral Sciences Institute, Federal Way, WA 98003-6796PMID-8472174.

Ref ID : 66

Bogat GA, McGrath MP. Preschoolers' cognitions of authority, and its relationship to sexual abuse education. Child Abuse Negl. 1993;17:651-662.

Notes : This study investigated preschoolers' perceptions of authority in sexual and benign situations and how these might influence acquisition of concepts presented in a sexual abuse prevention program. Participants were 117 children, ages 36-84 months, at four day-care centers. Children were randomly assigned to either an experimental or delayed treatment control group. Measures of authority and prevention skills were administered prior to and following the first administration of the curriculum. Preschoolers reasoned at a higher level of authority in sexually abusive encounters as compared to benign ones. For experimental children, this capability increased after participating in the prevention program. At pretest, sexual abuse authority scores predicted scores on one of two prevention skills; pretest authority scores did not predict either posttest prevention skill. Results are discussed in relation to children's understanding of moral versus social-conventional rules, and future directions for research are indicated Department of Psychology, Michigan State University, East Lansing 48824.

Ref ID : 89

Brayden RM, Altemeier WA, Dietrich MS, Tucker DD, Christensen MJ, McLaughlin FJ, Sherrod KB. A prospective study of secondary prevention of child maltreatment. J Pediatr. 1993;122:511-516.

Notes : This study sought (1) to retest an approach to the prediction of risk of child maltreatment and (2) to test the effect of a comprehensive prenatal and pediatric health services program on the rate of maltreatment. Of 2585 women screened at their first prenatal visit, 1154 qualified for the study. Risk assignment was determined by a structured interview. High-risk women (n = 314) were assigned to receive standard (high-risk control group; n = 154) or intervention (high-risk intervention group; n = 160) services throughout the prenatal period and during the first 2 years of their infants' life. A third group (low-risk control group; n = 295) was selected among low- risk women and received standard care without intervention services. State records were searched for substantive reports of child maltreatment up to 36 months after birth. Physical abuse was found for 5.1% of the study population; neglect was substantiated for 5.9%. Prediction efforts were effective in identifying risk of physical abuse but not of neglect. Comprehensive health services did not alter the reported abuse rate for high-risk parents and was associated with an increased number of neglect reports. Intervention reduced subject attrition and appeared to serve as a bias for detection of maltreatment. Thus this long-term, prospective approach was ineffective for child abuse prevention, perhaps because of detection biases and societal changes Department of Pediatrics, Vanderbilt University, Nashville, TennesseePMID- 8463893.

Ref ID : 98

Ewigman B, Kivlahan C, Land G. The Missouri child fatality study: underreporting of maltreatment fatalities among children younger than five years of age, 1983 through 1986. Pediatrics. 1993;91:330-337.

Notes : Estimates of the incidence of child maltreatment fatalities vary widely; most experts believe they are underreported. To investigate the suspicion that fatal maltreatment was underreported in Missouri preschool children, a statewide, population-based study was conducted using nine data sources. The study cases included the 384 children younger than age 5 who died from 1983 through 1986 and whose death certificates were coded with an external cause (injury) or whose deaths were substantiated as abuse or neglect fatalities by the Missouri Division of Family Services. Each fatality was categorized as one of the following: definite maltreatment, probable maltreatment, possible maltreatment, non-maltreatment, or inadequate information. Of the 121 cases classified as definite maltreatment, only 47.9% had codes consistent with maltreatment on their death certificates. The Division of Family Services had substantiated 79.3% of definite maltreatment cases as abuse or neglect fatalities. The Federal Bureau of Investigation Uniform Crime Reports database reported only 38.8% of these cases as homicides. In 37.2% of the cases, there was at least one criminal conviction. Child maltreatment fatalities are drastically underreported as such in Missouri because of inadequate investigations, lack of information-sharing between investigators and agencies, and reporting systems that fail to capture the contribution of maltreatment as a cause of death. Missouri has created a statewide system of child fatality review panels and a child fatality surveillance system to address the problems documented in this study Department of Family and Community Medicine, University of Missouri- Columbia 65212PMID- 8424006.

Ref ID : 63

Huxley P, Warner R. Primary prevention of parenting dysfunction in high-risk cases. Am J Orthopsychiatry. 1993;63:582-588.

Notes : Evaluation of high-risk cases treated via a tri-agency, interdisciplinary, early-intervention program suggests that a better outcome was achieved in the treatment program than in a control group of similar high-risk families receiving standard care. The number of treated cases requiring child protection services decreased during treatment, and confirmed episodes of child abuse were fewer in the treated group than in the control group Department of Psychiatry, Manchester University, EnglandPMID-8267098.

Ref ID : 91

MacMillan HL, Thomas BH. Public health nurse home visitation for the tertiary prevention of child maltreatment: results of a pilot study. Can J Psychiatry. 1993;38:436-442.

Notes : The purpose of this pilot study was to assess the feasibility of using public health nurse home visitation for the tertiary prevention of child maltreatment. The intervention was designed to provide support to the parents, education about child-rearing and child development and to assist families obtaining help from other services. Eighteen families referred from the Hamilton-Wentworth child protective agencies participated in the intervention. Enrolment criteria included first episode of suspected or verified child physical abuse or neglect, ongoing involvement with a child protective agency, index child less than 12 years of age and remaining in the home, and agreement to participate in the study. Home visits were provided weekly on average over a period of six months and the nurses were available by telephone. Pilot assessment included review of medical records, semi-structured interviews to gather background information, checklists of child- rearing attitudes, child behaviour and development. The participants were interviewed about their response to the intervention. The high degree of mobility of the families posed a problem in recruitment. Nevertheless, the public health nurses were able to develop a working alliance with 14 of the 18 families (77%) who participated. The participants gave permission for review of their medical records and reported that the methods of assessment were acceptable. The authors conclude that the intervention and assessment procedure are feasible and acceptable for preventing the recurrence of child maltreatment. Any decision about effectiveness of the intervention awaits a longitudinal, controlled trial Hamilton-Wentworth Department of Public Health Services, OntarioPMID- 8402438.

Ref ID : 65

Walton E, Fraser MW, Lewis RE, Pecora PJ, Walton WK. In-home family-focused reunification: an experimental study. Child Welfare. 1993;72:473-487.

Notes : Intensive, in-home family-based services were employed in reunifying families separated by the placement of a child in out-of-home care. After a 90-day service period, 93% of the 57 families randomly assigned to receive the intensive treatment were reunited-compared to 28% of the 53 families in a control group who received routine out-of-home care services. Follow-up data were collected six and 12 months after the end of treatment. Estimates of outcomes suggest that the experimental treatment had a substantial impact on families and that treatment effects endured for upwards of 12 months following cessation of direct intervention services College of Social Work, Ohio State University, ColumbusPMID-8404251.

Part 2: Selected epidemiological and other papers dealing with statistics & numerical data (there are more, I chose the most recent in more major journals)

Ref ID : 76

Haskett ME, Marziano B, Dover ER. Absence of males in maltreatment research: a survey of recent literature. Child Abuse Negl. 1996;20:1175-1182.

Notes : This paper provides a review of research in the area of physical maltreatment with respect to the degree to which males are represented in research samples. The systematic, comprehensive review includes 126 articles published between the years 1989 and 1994 in nine primary journals. Results show that adult males are dramatically underrepresented in this research. Specifically, males were included in fewer than one-half (47.7%) of the 77 articles reviewed and the total number and percentage of males in research samples was significantly less than the number and percentage of females. Only three studies included males exclusively, yet 40 studies involved solely female participants. Of the studies that did include men, only 37.5% provided an evaluation of gender differences. Research involving abused children showed a much greater representation of male subjects than research with adult participants. Only four of 49 studies of abused children were based exclusively on girls; a full 62.8% included an equal representation of boys and girls Department of Psychology, North Carolina State University, Raleigh 27695, USA.

Ref ID : 80

Bertolli J, Morgenstern H, Sorenson SB. Estimating the occurrence of child maltreatment and risk-factor effects: benefits of a mixed-design strategy in epidemiologic research. Child Abuse Negl. 1995;19:1007-1016.

Notes : Despite the large volume of literature on child abuse and neglect generated over the past two decades, there has been relatively little comprehensive discussion of the limitations of different study designs for achieving major epidemiologic research goals. Although some improvements have been made in conventional research designs, there have been few efforts to develop new approaches. This article discusses the methodologic limitations of four observational study designs-- ecologic, case-control, cross-sectional, and cohort--that dominate the child abuse and neglect literature; identifies key features of an "ideal" study of child maltreatment; and proposes a new mixed-design research strategy. The major advantage of the proposed strategy is that it greatly improves the ability to identify cases of child maltreatment from a well-defined population at risk representing diverse segments of the US population Department of Epidemiology, UCLA School of Public Health, USA.

Ref ID : 92

Whetsell-Mitchell J. Indicators of child sexual abuse: children at risk. Issues Compr Pediatr Nurs. 1995;18:319-340.

Ref ID : 50

English DJ, Pecora PJ. Risk assessment as a practice method in child protective services. Child Welfare. 1994;73:451-473.

Notes : This article offers an overview of the development of risk assessment and its purpose and goals, a summary of research on risk assessment to date, and suggestions regarding future research. This overview indicates that the use of risk assessment is a widespread phenomenon, with differing goals and purposes. Research on risk assessment confirms the lack of conceptual clarity and the difficulty of incorporating it into a child protective services system that emphasizes findings of abuse and/or neglect as the key to continuing involvement in the system Office of Children's Administration Research, Washington State Department of Social and Health Services, Olympia.

Ref ID : 84

Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child. 1994;4:31-53.

Notes : Approximately 150,000 confirmed cases of child sexual abuse were reported to child welfare authorities in the United States during 1993. This number represents about 15% of the more than one million confirmed cases of all child abuse and neglect. But the true scope of this problem is better reflected in retrospective surveys of adults, and this article summarizes data from 19 of these surveys. Considerable evidence exists to show that at least 20% of American women and 5% to 10% of American men experienced some form of sexual abuse as children. The rates are somewhat lower among people born before World War II, but there is little evidence of a dramatic increase for recent generations. The studies provide little evidence that race or socioeconomic circumstances are major risk factors. They do show elevated risk for children who experienced parental inadequacy, unavailability, conflict, harsh punishment, and emotional deprivation. Adult retrospective studies are also good sources of information about the characteristics of abuse. Most sexual abuse is committed by men (90%) and by persons known to the child (70% to 90%), with family members constituting one- third to one-half of the perpetrators against girls and 10% to 20% of the perpetrators against boys. Family members constitute a higher percentage of the perpetrators in child protective agency cases because the mandate of these agencies generally precludes their involvement in extrafamily abuse. Around 20% to 25% of child sexual abuse cases involve penetration or oral-genital contact. The peak age of vulnerability is between 7 and 13. Studies of the criminal justice processing of sexual abusers suggest that, compared with other violent criminals, slightly fewer are prosecuted, but of those prosecuted, slightly more are convicted. Studies conducted in the 1980s also showed that, once convicted, relatively few sexual abusers receive sentences longer than one year, while 32% to 46% serve no jail time. Overall, there is little evidence to suggest that either the child welfare system or the criminal justice system abandons its usual standards of operation and acts hysterically when confronted with sexual abuse Family Research Laboratory, University of New Hampshire.

Ref ID : 70

Finkelhor D. The international epidemiology of child sexual abuse. Child Abuse Negl. 1994;18:409-417.

Notes : Surveys of child sexual abuse in large nonclinical populations of adults have been conducted in at least 19 countries in addition to the United States and Canada, including 10 national probability samples. All studies have found rates in line with comparable North American research, ranging from 7% to 36% for women and 3% to 29% for men. Most studies found females to be abused at 1 1/2 to 3 times the rate for males. Few comparisons among countries are possible because of methodological and definitional differences. However, they clearly confirm sexual abuse to be an international problem Family Research Laboratory, University of New Hampshire, Durham 03824.

Ref ID : 71

Gibbons M, Vincent EC. Childhood sexual abuse. Am Fam Physician. 1994;49:125-136.

Notes : Childhood sexual abuse is a common problem. Patients with subacute and nonacute injuries may be treated in the physician's office. Patients with acute injuries are usually best managed in an emergency department where forensic testing can be performed efficiently. Physicians need to know how to appropriately interview children with signs of acute and subacute trauma. The physical examination should be thorough, nontraumatic and well documented. Evidence of inflammation, infection, and acute or healed trauma should be sought. Attention should be paid to sexually transmitted diseases, pregnancy prevention and mental health needs. Coordination with child welfare services, mental health professionals and law enforcement officers is often indicated. Awareness of the various presentations of sexual abuse and familiarity with normal and abnormal genital findings are necessary for the initial evaluation of these children Sexual Assault Center, Harborview Medical Center, Seattle.

Ref ID : 85

Carty HM. Fractures caused by child abuse. J Bone Joint Surg Br. 1993;75:849-857.
Notes : Department of Radiology, Royal Liverpool Children's NHS Trust, Alder Hey, UK.

Ref ID : 98

Ewigman B, Kivlahan C, Land G. The Missouri child fatality study: underreporting of maltreatment fatalities among children younger than five years of age, 1983 through 1986. Pediatrics. 1993;91:330-337.

Notes : Estimates of the incidence of child maltreatment fatalities vary widely; most experts believe they are underreported. To investigate the suspicion that fatal maltreatment was underreported in Missouri preschool children, a statewide, population-based study was conducted using nine data sources. The study cases included the 384 children younger than age 5 who died from 1983 through 1986 and whose death certificates were coded with an external cause (injury) or whose deaths were substantiated as abuse or neglect fatalities by the Missouri Division of Family Services. Each fatality was categorized as one of the following: definite maltreatment, probable maltreatment, possible maltreatment, non-maltreatment, or inadequate information. Of the 121 cases classified as definite maltreatment, only 47.9% had codes consistent with maltreatment on their death certificates. The Division of Family Services had substantiated 79.3% of definite maltreatment cases as abuse or neglect fatalities. The Federal Bureau of Investigation Uniform Crime Reports database reported only 38.8% of these cases as homicides. In 37.2% of the cases, there was at least one criminal conviction. Child maltreatment fatalities are drastically underreported as such in Missouri because of inadequate investigations, lack of information-sharing between investigators and agencies, and reporting systems that fail to capture the contribution of maltreatment as a cause of death. Missouri has created a statewide system of child fatality review panels and a child fatality surveillance system to address the problems documented in this study Department of Family and Community Medicine, University of Missouri- Columbia 65212PMID- 8424006.

Ref ID : 73

Oliver JE. Intergenerational transmission of child abuse: rates, research, and clinical implications. Am J Psychiatry. 1993;150:1315-1324.

Notes : OBJECTIVE: The author reviews current wisdom concerning the rates and mechanisms of intrafamilial components of intergenerational transmission of child abuse and illustrates the unreliability of basic data and of assumptions made by reviewers and partisan advocates, most of whom underestimate the importance of intrafamilial factors in child abuse. METHOD: The information in the report was derived from original research plus a recently prepared compilation of 60 studies, mainly from the United States and the United Kingdom. RESULTS: The crude rates of intergenerational transmission of child abuse according to the studies reviewed are as follows: one-third of child victims grow up to continue a pattern of seriously inept, neglectful, or abusive rearing as parents. One-third do not. The other one-third remain vulnerable to the effects of social stress on the likelihood of their becoming abusive parents. Intrafamilial factors appear to be the cause of personally directed, as opposed to culturally condoned, child abuse. Broad social factors, and some medical and psychiatric conditions, lower or raise thresholds in which family and personal vulnerabilities and propensities operate. CONCLUSIONS: There is no justification for any extremist advocacy in apportioning responsibility between the "sins of the parents" and the failings of society. The contention that clinical research on abuse is inferior to, and must give way to, large- scale or statistically balanced self-report and questionnaire surveys is plausible, popular, convincing, and wrong Wessex Regional Health Authority, Lockeridge near Marlborough, Wiltshire, United Kingdom.

Part 3: Selected review papers (there are many more, I chose the most recent in more major journals)

Ref ID : 23

Lumley VA, Miltenberger RG. Sexual abuse prevention for persons with mental retardation. Am J Ment Retard. 1997;101:459-472.

Notes : The problem of sexual abuse among persons with mental retardation, skills for preventing sexual abuse, and methods for assessing prevention skills were discussed. Because very little research on teaching sexual abuse prevention skills exists, research on abduction prevention programs for persons with mental retardation as well as on sexual abuse prevention programs for children, was reviewed. Suggestions for future research in the area of sexual abuse prevention for persons with mental retardation were discussed North Dakota State University, USA.

Ref ID : 77

Arellano CM. Child maltreatment and substance use: a review of the literature. Subst Use Misuse. 1996;31:927-935.

Notes : In this article the author reviews current literature that investigates the connection between a history of childhood physical and/or sexual abuse and subsequent substance use. In general, current research findings have found a link between child maltreatment and substance use. However, the number of studies focusing on the connection between child abuse and substance use and misuse are limited, and many are plagued with a number of methodological weaknesses. Methodological weaknesses are reviewed and implications for future research are discussed Tri-Ethnic Center for Prevention Research, Colorado State University, Fort Collins 80523, USA.

Ref ID : 37

Block SS. Analysis of child abuse and neglect. Optom Clin. 1996;5:125-160.

Notes : Child abuse and neglect is a problem that has existed for many years. Federal guidelines and state laws make it necessary for the optometrist to be aware of the definitions that describe abuse and neglect. In addition, it is necessary to review the characteristics of the child and caregiver to ascertain who may be at risk. Physical signs, such as specific types of fractures, burns, scalds, and bruises, should act as a key to suspected abuse. The most frequent ocular sign of abuse is intraocular hemorrhage. Other ocular manifestations include periorbital edema, ecchymosis, and retinal detachment, to name a few. Sexual abuse is also of concern. If a sexually transmitted disease is present in a young child, abuse should not be ruled out. It is the responsibility of the health care provider to report any suspected episodes of child abuse and neglect Illinois College of Optometry, Chicago, USA.

Ref ID : 38

Alexander RC. Current and emerging concepts in child abuse. Compr Ther. 1995;21:726-730.

Notes : Within the three decades since Henry Kempe first popularized the concept of "the battered child syndrome," much has been learned not only about physical abuse but also neglect and sexual abuse. More recently, physicians with an interest in child abuse have expanded their focus to include child death review and other prevention strategies. Despite the increasing specialization of child abuse evaluation and management, all physicians working with children are likely to encounter child abuse in their practice. In 1994, more than 3.1 million reports of child abuse were made, of which more than 1 million had enough evidence to substantiate the allegations. Approximately one-half of all substantiated child abuse reports were for neglect. Physical abuse was involved in 21% and sexual abuse in about 11%. In 3% of the cases, the newer category of mental injury (emotional abuse/neglect) also was present. Despite the increase in the reporting of child abuse, the percentage of adults who have experienced child maltreatment (approximately 25% to 33%) probably has not changed significantly during this century. Most people who are victims of child abuse still never come to the overt attention of physicians, social workers, or other professionals, but the hidden emotional consequences have a considerable impact on the mental and medical health care systems. This article will briefly review the following three major categories of child abuse to highlight some of the thinking behind recent advances: Neglect; Physical Abuse; and Sexual Abuse. We will also discuss Prevention Department of Pediatrics, University of Iowa, Iowa City 52242, USA.

Ref ID : 44

Botash AS, Fuller PG, Blatt SD, Church CC, Weinberger HL. Child abuse, sudden infant death syndrome, and attention-deficit hyperactivity disorder. Curr Opin Pediatr. 1995;7:235-239.

Notes : A review of recent literature helps to clarify normal variations in the physical examination of children who are thought to have been sexually abused. In many instances, no abnormal physical findings are discovered. Clinicians must continue to pay careful attention to the history and work with other professionals to implement appropriate management, despite the lack of physical findings. Guidelines for evaluating sudden and unexpected infant deaths are reviewed. The current recommendations of the American Academy of Pediatrics for infant sleep positions are discussed in light of epidemiologic studies in the United States and other countries. Attention-deficit hyperactivity disorder appears to respond best to a combination of stimulant medication, parent training in coping with behavior of affected children, and social skill training for the affected children themselves. A review of recent research failed to reach consistent correlations between resistance to thyroid hormone and attention- deficit hyperactivity disorder State University of New York Health Science Center, Department of Pediatrics, Syracuse, NY 13210, USA.

Ref ID : 81

Cicchetti D, Toth SL. A developmental psychopathology perspective on child abuse and neglect. J Am Acad Child Adolesc Psychiatry. 1995;34:541-565.

Notes : OBJECTIVE: The purpose of this review is to conceptualize child abuse and neglect within a developmental psychopathology perspective. Toward this end, issues of definition and epidemiology, etiology, and sequelae are addressed. METHOD: Research and theory on child abuse and neglect with relevance to a developmental perspective is reviewed. RESULTS: Considerable progress has been made in our understanding of the etiology and consequences of child abuse and neglect. Less progress has been made in utilizing this knowledge to inform treatment efforts. CONCLUSIONS: Incorporation of a developmental psychopathology perspective into efforts to understand and ameliorate the adverse effects of child abuse and neglect holds considerable promise for advancing research and intervention in the area of child maltreatment. The importance of providing comprehensive and coordinated services that incorporate knowledge of how maltreated youngsters negotiate stage- salient issues of development is stressed. The provision of child- focused treatment, parent-based models of intervention, and ecologically driven approaches to prevention all can benefit from an understanding of the adverse effects that maltreatment exerts on the process of development Mt Hope Family Center, University of Rochester, NY 14608, USA.

Ref ID : 45

Oates RK, Bross DC. What have we learned about treating child physical abuse? A literature review of the last decade. Child Abuse Negl. 1995;19:463-473.

Notes : A literature review of articles on treatment of physically abused children and treatment of physically abused parents was undertaken. Only articles that had more than five subjects in the sample, at least 15% of the children in the sample having been physically abused and either pretest, posttest; comparison group; or randomization between different treatments used in the design were selected. Twelve papers meeting these criteria for abusive parents and 13 for treatment of abused children were found. Treatment duration ranged from 4 weeks to 12 months for parents and 4 weeks to 24 months for children. A wide range of treatments were used, the most popular for children being therapeutic daycare, with emphasis on improving developmental skills. While most programs showed some improvement with treatment, many had no, or very short, follow-up to see if improvement was sustained. More emphasis needs to be placed on rigorous evaluation and longer-term follow-up of children in physical abuse treatment programs Department of Pediatrics and Child Health, University of Sydney, Australia.

B. PsycINFO, 1993 - 1997 (Search engine = OVID CD)

Search terms = "child abuse" and "child neglect", limited to "experimental design" or "meta-analysis" or "literature review", "english", "human", "journal article"

Ref ID : 107

Foa, Meadows. Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology. 1997;48:449-480.

Notes : Discusses the literature on the prevalence, diagnostic criteria, assessment measures, and treatment of trauma and posttraumatic stress disorder (PTSD). The literature on the treatment outcomes of hypnotherapy and psychodynamic and cognitive-behavioral treatment is reviewed, using a model of an ideal treatment outcome study for PTSD. Issues specific to various trauma populations (such as veterans, sexual assault victims, and childhood abuse victims) and factors that may influence treatment efficacy across types of trauma are also examined. (PsycINFO Database Copyright 1997 American Psychological Assn, all rights reserved).

Ref ID : 106

de Jong T, L., Gorey K, M. Short-term versus long-term group work with female survivors of childhood sexual abuse: A brief meta-analytic review. Social Work with Groups. 1996;19:19-27.

Notes : This meta-analytic review synthesizes the findings of 7 published independent studies dealing with group work with female survivors of childhood sexual abuse and compares the effectiveness of short-term vs long-term methods. Six of the studies were 15 wks or less, and 1 was 50 wks long. Results of the meta-analysis indicate that, generally, group work had large beneficial effects on female survivors' affect and self-esteem such that three-quarters of the group participants improved. No extant empirical evidence supports the differential effectiveness of either short-term or long-term groups, because only 1 study reported the size of long-term methods' clinical effect. Thus, the question of the differential effectiveness of short- vs long-term group work with female survivors is not yet answerable. (PsycINFO Database Copyright 1997 American Psychological Assn, all rights reserved).

Ref ID : 108

Finkelhor D, Berliner L. Research on the treatment of sexually abused children: A review and recommendations. Journal of the American Academy of Child & Adolescent Psychiatry. 1995;34:1408-1423.

Notes : Evaluates research (1987-1995) findings on effectiveness of treatments for sexually abused children. 29 studies were categorized into 3 groups based on their designs: pre- and posttest designs with or without comparison groups and treatment, and quasi-experimental designs with comparisons and no treatment. Five studies substantially prove that recovery is due to therapy. Aggressiveness and sexualized behavior are resistant to change, and some children do not improve. Future sexual abuse therapy outcome research needs to be identified, such as the diversity of sexually abused children, the problem of children with no symptoms, the existence of serious "sleeper" effects, the importance of family context on recovery, the utility of abuse focused therapy and targeted interventions, the optimal length of treatment, the problem of treatment dropouts, and the development and use of abuse-specific outcome measures. (PsycINFO Database Copyright 1996 American Psychological Assn, all rights reserved).

Ref ID : 110

Silovsky J, F., Hembree-Kigin T, L. Family and group treatment for sexually abused children: A review. Journal of Child Sexual Abuse. 1994;3:1-20.

Notes : Provides a critical discussion of current research on the efficacy of family and group interventions for children who are survivors of sexual abuse, integrating treatment information from a variety of sources as guidelines for family and group interventions. Treatment goals and components are described, followed by a review of relevant empirical studies. Suggestions are made for improving the methodology of future sexual abuse intervention research. General guidelines for family and group treatment are offered based on anecdotal and empirical evaluations of treatment outcome for sexually abused preadolescent children. It is suggested that controlled outcome research is necessary to document effectiveness of current family and group interventions and to optimize available services; alternatives to waiting-list control designs are recommended. Outcome studies must assess treatment impact on documented short-and long-term effects. (PsycINFO Database Copyright 1995 American Psychological Assn, all rights reserved).

Ref ID : 105

Sturkie K. Group treatment for sexually abused children: Clinical wisdom and empirical findings. Child & Adolescent Psychiatric Clinics of North America. 1994;3:813-829.

Notes : Examines the development and current status of the group approaches for the treatment of child sexual abuse. A group model that integrates the clinical wisdom and empirical findings from the field, and a number of therapeutic guidelines for working with this population of children and adolescents and their caretakers, are also provided. (PsycINFO Database Copyright 1997 American Psychological Assn, all rights reserved).

Ref ID : 102

White J, Allers C, T. Play therapy with abused children: A review of the literature. Journal of Counseling & Development. 1994;72:390-394.

Notes : Reviews play therapy (PT) literature related to abused and neglected children, and discusses 7 characteristic play behaviors of maltreated children along with 2 common play themes. The play behaviors include developmental immaturity, opposition and aggression, withdrawal and passivity, self-deprecation and self-destruction, hypervigilance, sexuality, and dissociation. The 2 play themes identified are (1) unimaginative and literal play and (2) repetition and compulsion. Upon reviewing 22 published PT articles, the authors identify problems in the definition of abuse and neglect, along with 4 additional research deficits, including inconsistent definitions of PT. (PsycINFO Database Copyright 1995 American Psychological Assn, all rights reserved).

Ref ID : 104

Wekerle C, Wolfe D, A. Prevention of child physical abuse and neglect: Promising new directions. Clinical Psychology Review. 1993;13:501-540.

Notes : Reviews 34 intervention studies (1977-1990) targeting risk factors to child physical abuse and neglect. Programs that addressed parental competency enhancement with at-risk individuals, including new parents and teen parents, formed the principal database. Maternal global adjustment and childrearing skills were principal intervention targets, and significant gains were shown in these areas across studies. More modest gains were found in the promotion of child cognitive development and child behavioral competencies. Programs that provided an individualized approach were most successful, especially with parents considered to be at greater risk of maltreatment. Evidence of long-term benefits is limited, and indicators of actual maltreatment (e.g., child abuse reports) are rare and unreliable. Needed are adequate evaluation studies, male participants, and focus on specific at-risk groups. (PsycINFO Database Copyright 1994 American Psychological Assn, all rights reserved).

Part C: ERIC (OVID CD) 1993 – June 1997

Search terms = "child abuse" and "child neglect", limited to "literature review", "english", (there were no hits for any of the research design parameters I tried)

Ceci,-Stephen-J.; Bruck,-Maggie

Child Witnesses: Translating Research into Policy.

Social-Policy-Report; v7 n3 Fall 1993

AVAILABILITY: SRCD Executive Office, University of Michigan, 300 North Ingalls, 10th Floor, Ann Arbor, MI 48109-0406 ($3.50 for single issue; subscriptions available to nonmembers of SRCD at $12.50).

ABSTRACT: This report provides an overview of the research on the testimony of young children in cases of sexual abuse, focusing on preschoolers' presumed suggestibility and the role of researchers and mental health professionals as expert witnesses in such cases. It does so in light of the McMartin preschool case, in which seven defendants were acquitted, after 7 years of legal proceedings, of having sexually abused a large number of preschoolers. The report examines the prevalence of child sexual abuse and the increasing acceptance by the courts of uncorroborated testimony by young children. Research is reviewed on the degree to which very young children are prone to suggestion, concluding that the most recent studies are more often ambivalent about the reliability of children's reports than earlier studies. However, recent studies suggest that there are reliable age differences in suggestibility, with preschoolers' reports more influenced by erroneous suggestions than older children's reports. Policy implications of suggestibility research are also discussed, including what expert witnesses should tell the court, the qualifications of expert witnesses, the relationship of research to clinical practice, and the role of professional organizations. (Contains 98 references.) (MDM)

Briere,-John-N.; Elliott,-Diana-M. Immediate and Long-Term Impacts of Child Sexual Abuse. Future-of-Children; v4 n2 p54-69 Sum-Fall 1994

ABSTRACT: Summarizes what is currently known about the potential, immediate, and long-term impact of child sexual abuse. The various problems and symptoms described in the literature on child sexual abuse are reviewed in a series of broad categories including posttraumatic stress, cognitive distortions, emotional pain, avoidance, an impaired sense of self, and interpersonal difficulties. (GLR)

D. August 1998 Update - Including "Table of Contents" searches of recent online journals in addition to same search strategies as above.

Book Chapters

Ref ID : 19

1. Brown, D. and Peterson, L.,T.I. Unintentional injury and child abuse and neglect. Ammerman, Robert T.(Ed), Hersen, Michel (Ed), et al.(1997).Handbook of prevention and treatment with children and adolescents: Intervention in the real world context (Ed):John Wiley & Sons-356). New York, 1998.
Keywords : Child; Prevention; Child abuse; Child Neglect; Injuries; Literature Review; Adolescents; Children; Etiology
Notes : Chapter: 1997-36402-012 (from the chapter) One purpose of this chapter will be to review evidence that suggests other etiologies (e.g., characteristics of the caregiver, the child, and the environment) contribute to unintentional injuries, thereby marking potential points for intervention. This chapter will also review current prevention strategies, offer suggestions for future prevention strategies, and list important obstacles faced in implementing those strategies in the real world context. Because of the blurred boundaries of definition and commonalities in etiology, this chapter will consider child injury as a whole when reviewing the literature, unifying the fields of child maltreatment and unintentional injury and presenting the consequent advantages. ((c) 1998 APA/PsycINFO, all rights reserved).

Ref ID : 21

14. Milner, J.,S. and Dopke, C.,T.I. Child physical abuse: Review of offender characteristics. Wolfe, David A.(Ed), McMahon, Robert Joseph (Ed), et al.(1997).Child abuse: New directions in prevention and treatment across the lifespan.Banff international behavioral science series, Vol.4.(pp.27-54).Thousand Oaks, CA, USA: Sage Publications, (Ed)-54). Thousand Oaks, 1998.
Keywords : Child; Child abuse; Demographic Characteristics; Perpetrators; Literature Review; Physical Abuse; Behavior; Cognitive Processes; Biology
Notes : Chapter: 1997-30225-002 (from the chapter) Provides an overview of child physical abuse offender characteristics as described in controlled studies published in the literature. Although the review is not guided by any particular etiological model, the offender characteristics described in the various sections of the review can be viewed as supporting different theoretical perspectives within the framework of the organizational models of child physical abuse described by J. Belsky (1980, 1993) and D. Cicchetti and R. Rizley (1981). Consequently, the initial part of each section contains a brief description of the models, theoretical perspectives, and/or general hypotheses that guided the associated research. Topics discussed include: biological factors (psychophysiological factors, neuropsychological factors), cognitive/affective factors (self-esteem/ego-strength, perceptions of child behavior, attributions, expectations of child behavior, stress/distress, psychopathology/emotional problems, negative affectivity, empathy), behavioral factors (isolation and loneliness, problematic parent-child interactions, coping skills, attachment, alcohol and drug use). ((c) 1997 APA/PsycINFO, all rights reserved).
 

Clinical, Comparative & Evaluative studies

Britner, Preston A;  Reppucci, N. Dickon.
Title: Prevention of child maltreatment: Evaluation of a parent education program for teen mothers.
Source: Journal of Child & Family Studies. Vol 6(2), Jun 1997, 165-175.
Language: English
Abstract: Conducted an evaluation of a parent education program for the prevention   of child maltreatment that served urban teen, unmarried mothers at risk   for child maltreatment. The state's computer database on abuse and neglect   was searched for positive matches using the name and date of the birth of   the child and the name of the mother (as perpetrator or co-perpetrator).   Ss were 535 mothers (aged 11-20 yrs) and children (aged 3-5 yrs).   Information was provided separately for hospital, home visit, and program   groups. Three to 5 yrs after the birth of their children, the 125 program   graduates were significantly less likely than the 410 controls to have   founded reports of maltreatment in the state database. On the basis of a   follow-up phone call to a subset of 80 program graduates and 40 controls,   mothers who enrolled in the 12-wk parent education/support program showed   trends toward being more likely to have completed high school, taken some   college courses, and delayed subsequent pregnancies until after age 21. ((c) 1997 APA/PsycINFO, all rights reserved)
Key Phrase Identifiers: evaluation of parent education program for prevention of child   maltreatment, 11-20 yr old mothers & their 3-5 yr old children, 3-5 yr followup
Publication Type: Journal Article

Ref ID : 30

7. Finkelhor, D., Asdigian, N., and Dziuba-Leatherman, J. Victimization prevention programs for children: a follow-up. American Journal of Public Health 85(12):1684-1689, 1995.
Keywords : Family; Prevention; Children; Behavior; Incidence; Injuries; Sexual Abuse; Trends; Adolescence; Child; Child Abuse/pc [Prevention & Control]; Child Abuse/px [Psychology]; Child Abuse/sn [Statistics & Numerical Data]; Child Behavior; Female; Follow-Up Studies; Health Education/og [Organization & Administration]; Human; Knowledge,Attitudes,Practice; Male; Preventive Health Services/og [Organization & Administration]; Program Evaluation; Questionnaires; School Health Services/og [Organization & Administration]; Support,Non-U.S.Gov't; United States/ep [Epidemiology]
Notes : 96101330 Family Research Laboratory, University of New Hampshire, Durham 03824, USA OBJECTIVE. This study examined whether victimization prevention instruction in school has any impact on children's behavior in situations of real victimization threat. METHODS. Telephone interviews were conducted in 1992 with a nationally representative sample of youths aged 10 to 16 and their caretakers, and the experience of 1457 of these children was followed up more than a year later. RESULTS. Exposure to a more comprehensive prevention program was not associated with reduced incidence of victimization, injury, or upset. However, some of the exposure conditions were associated with an increased likelihood that the children would disclose victimizations, an increased likelihood that they would see themselves as having successfully protected themselves, and a decreased likelihood that they would blame themselves for the episode. Exposed children acquired some knowledge about sexual abuse and, when actually confronted by a threat, an ability to do the things they had been taught. A nonsignificant trend was also noted toward increased injury for exposed children during sexual assaults. CONCLUSION. These mixed findings suggest that prevention educators need to plan programs based on realistic goals for what can be accomplished. (Abstract by: Author).

Ref ID : 32

8. Finkelhor, D., Asdigian, N., and Dziuba-Leatherman, J. The effectiveness of victimization prevention instruction: an evaluation of children's responses to actual threats and assaults. Child Abuse & Neglect. (2):141-153, 1998.
Keywords : Family; Prevention; Behavior; Children; Injuries; Adolescence; Adult; Child; Child Abuse/pc [Prevention & Control]; Child Abuse/px [Psychology]; Child Abuse,Sexual/pc [Prevention & Control]; Child Abuse,Sexual/px [Psychology]; Female; Health Education; Human; Knowledge,Attitudes,Practice; Male; Parents/px [Psychology]; Program Evaluation; Self Disclosure; Support,Non-U.S.Gov't; Treatment Outcome; United States; Wounds and Injuries/pc [Prevention & Control]; Wounds and Injuries/px [Psychology]
Notes : 95299909 University of New Hampshire, Family Research Laboratory, Durham 03824, USA This study examined whether instruction in school and at home about how to prevent victimization has any impact on children's behavior in situations of real victimization threat. Telephone interviews were conducted in 1992 with a nationally representative sample of 2,000 youths age 10 to 16 and their caretakers. More comprehensive school programs had mixed, small but overall positive effects. Children exposed to such school-based prevention programs performed better on a short test of knowledge about sexual victimization; when victimized or threatened were more likely to use the self-protection strategies recommended by prevention educators; were more likely to feel that they had been successful in protecting themselves; and were more likely to disclose to someone about the victimization attempts. They were not better able to limit the seriousness of the assaults and, in fact, they experienced more injuries in the course of sexual assaults. Comprehensive parental instruction also had positive effects on knowledge, the use of preferred self-protection strategies and the likelihood of disclosure. Children with comprehensive parental instruction were more likely to limit the seriousness of assaults. (Abstract by: Author).
 

Hebert, Martine;  Lavoie, Francine;  Piche, Christiane;  Poitras, Michele.
Institution
Title: Assessment of a sexual abuse prevention program for elementary school students. [French].
Original Title: Evaluation d'un programme de prevention des abus sexuels chez les eleves du primaire.
Source: Revue Quebecoise de Psychologie. Vol 18(3), 1997, 37-58.
Language: French
Abstract: Studied the effectiveness of the Quebec adaptation of the Child Assault Prevention Project (S. J. Cooper, 1991). Human Ss: 30 normal Canadian   school-age children (1st graders and 3rd graders) (experimental group). 36   normal Canadian school-age children (1st graders and 3rd graders) (control   group). 38 normal male and female Canadian adults (children's parents). A   pretest-posttest design with a delayed intervention control group was used. The Oral Questionnaire on Skills was used to measure the preventive   skills of the experimental Ss, who were shown hypothetically abusive,   potentially abusive, or nonabusive videotaped situations. Their   satisfaction with the program was measured with another questionnaire. Parents' observations of children's behavioral reactions after the program were assessed with an adaptation of the Parent Perception Questionnaire   (S. K. Wurtele et al, 1992), which was administered 2 wks after the end of   the program. The children's preventive skills were reassessed at 2-mo   follow-up. Repeated measures ANOVAs were performed. (English abstract)   ((c) 1998 APA/PsycINFO, all rights reserved)
Key Phrase Identifiers: Quebec adaptation of Child Assault Prevention Project, preventive skills & perceptions of program, 1st & 3rd graders & parents, Canada, 2 mo follow-up
Publication Type: Journal Article

Ref ID : 22

9. Hohman, M.M. Motivational interviewing: an intervention tool for child welfare case workers working with substance-abusing parents. Child Welfare 77(3):275-289, 1998.
Keywords : Human; Child; Child Welfare; Adult; Case Report; Child of Impaired Parents; Child Abuse/pc [Prevention & Control]; Female; Interview,Psychological/mt [Methods]; Motivation; Parents/px [Psychology]; Professional-Patient Relations; Social Work,Psychiatric/mt [Methods]; Substance-Related Disorders/pc [Prevention & Control]
Notes : 98261794 San Diego State University School of Social Work, College of Health and Human Services, CA, USA Child welfare case workers have long known that abuse of alcohol and drugs is a major problem with many parents on their caseloads. This article discusses motivational interviewing, an intervention technique used with substance abusers. Motivational interviewing, which is based on the principles of motivational psychology, postulates that motivation is created in an interaction between the client and worker. Principles of motivational interviewing are discussed and illustrated in a case example. (Abstract by: Author).

Ref ID : 29

12. Logan, S. Home visiting reduces the rates of childhood injuries. Child: Care, Health & Development 23(1):101-102, 1997.
Keywords : Childhood; Injuries; Child; Child Abuse/pc [Prevention & Control]; Home Care Services; Human
Notes : 97273920.
Ref ID : 17
13. Mandel, U., Bigelow, K.,M., Lutzker, J.,R., and Loar, L.,T.I. Using video to reduce home safety hazards with parents reported for child abuse and neglect. Journal of Family Violence.Vol 13(2), Jun (Ed):Accelerated Developm-174). Bristol, 1998.
Keywords : Safety; Child; Child abuse; Family; Accident Prevention; Prevention; Home Visiting Programs; Parent Training; Videotape Instruction; Child Neglect; Child Welfare; Role; Advocacy; Child Abuse Reporting; Educational Personnel; Government Policy Making; Laws
Notes : Journal Article: 1998-04270-003 The effectiveness of a videotape intervention with two families involved with child abuse and neglect was examined, using a replicated multiple probe design across settings. Family A consisted of a 34-yr old mother, and three children (aged 12, 5, and 3 yrs). Family B had been involved with the Department of Children and Family Services due to drug abuse by the mother and father. The family consisted of a 32-yr-old father, his 2-yr-old daughter, and the father's mother. A series of four videotapes, viewed in the homes of the families, was used to guide parents in improving home safety. Data on the reduction of home hazards were collected using the Home Accident Prevention Inventory-Revised, and the Checklist for the Video-Trained Parent's Behavior. Follow-up observations were conducted at 1 mo and 3-4 mo following the last training session in order to evaluate the maintenance of training effects. Results indicate that a reduction in hazards occurred as a function of videotape intervention. In Family B, this reduction was maintained at the 4 mo follow-up. In Family A, the reduction in the number of hazards in the kitchen clearly followed the intervention. Social validation and expert validation data are also presented. ((c) 1998 APA/PsycINFO, all rights reserved)

Ref ID : 28

18. Mulroy, E.A. Building a neighborhood network: interorganizational collaboration to prevent child abuse and neglect. Social Work 42(3):255-264, 1997.
Keywords : Social Work; Child; Child abuse; Human; Poverty; Family; Child Abuse/pc [Prevention & Control]; Child,Preschool; Community Networks; Infant; Infant,Newborn; Social Work/og [Organization & Administration]; Support,Non-U.S.Gov't
Notes : 97297625 School of Social Work, University of Hawaii, Honolulu 96822, USA. mulroy:hawaii.edu Policymakers have identified the community-based human services network as a promising model for restructuring services in neighborhoods affected by poverty, but researchers have found this approach complex and difficult to implement. An increase in networks and partnerships among service providers suggests that organizations are learning to work together, yet little is known about the processes of their collaboration. This article reports findings from an organizational analysis of one interorganizational collaboration in which executive directors and frontline practitioners from seven agencies worked for five years to create, implement, and institutionalize a community-based service network of informal and formal family support programs to help prevent child abuse and neglect. This article presents a theoretical framework for understanding community-based networks and interorganizational collaboration and describes and analyzes how collaboration was used as a method to build a new service network, the characteristics of the network, and factors that facilitated the collaborative processes. (Abstract by: Author).

Ref ID : 15

24. Song L, Singer M, and Anglin TM Violence Exposure and Emotional Trauma as Contributors to Adolescents' Violent Behaviors. Arch Pediatrics and Adolescent Med 152(6):531-536, 1998.
Keywords : Female; Regression Analysis; Male
Notes : Objective: To investigate the degree to which violence exposure and symptoms of psychological trauma are related to adolescents' own violent behaviors.
Design and Setting: Anonymous self-report questionnaire administered to students in 6 public high schools (grades 9-12). Participants: Sixty-eight percent of the students attending the participating schools during the survey participated in the study (N=3735). Ages ranged from 14 to 19 years; 52% were female; and 35% were African American, 33% white, and 23% Hispanic.
Results: Multiple regression analysis determined that violence exposure and symptoms of psychological trauma together explained more than 50% of the variance in both male and female self-reported violent behavior. The independent effects of exposure to violence explained about one quarter of the variance in both male and female adolescents' violent behaviors. Anger was found to be the leading trauma symptom.
Conclusion: Our findings suggest that health clinicians and other professionals who encounter adolescents should routinely screen them for both exposure to violence and symptoms of anger.

Ref ID : 14

1. Southall DP, Plunkett MCB, Banks MW, Falkov AF, and Sanuels MP Covert Video Recordings of Life-threatening Child Abuse: Lessons for Child Protection. Pediatrics 100(5):735-760, 1997.
Keywords : Child; Infant; Child abuse; SIDS
Notes : DESCRIPTIVE, RETROSPECTIVE, PARTIALLY CONTROLLED CASE STUDY Objective. To describe historic markers and clinical observations of life-threatening child abuse as diagnosed using covert video surveillance (CVS).
Design. A descriptive, retrospective, partially controlled case study.
Setting. Two hospitals (in London and North Staffordshire, UK) receiving referrals for the investigation of apparent life-threatening events (ALTE), with the availability of CVS.
Patients. A total of 39 children (age range at CVS, 2 to 44 months; median, 9 months) in whom hospital CVS was used to investigate suspicions of induced illness. Thirty-six were referred for investigation of ALTE, one with suspected epilepsy, one with failure to thrive, and one with suspected strangulation. A control group consisted of 46 children with recurrent ALTE proven on physiologic recordings to be attributable to a natural medical cause (9 attributable to epileptic seizures, and 37 attributable to respiratory problems).
Intervention. Collection of historic details from medical, social service, and police records; interagency collaboration in planning, investigations, and management; development and use of CVS as a clinical tool in the investigation of patients in whom there was suspicion of induced illness.
Outcome. Confirmation of attempted suffocation or other child abuse from CVS.
Results. CVS revealed abuse in 33 of 39 suspected cases, with documentation of intentional suffocation observed in 30 patients. Poisonings (with disinfectant or anticonvulsant), a deliberate fracture, and other emotional and physical abuse were also identified under surveillance. The first ALTE occurred at a median age corrected for the expected date of delivery of 3.6 months in the CVS patients and of 0.3 months in controls. Three CVS patients and 27 of the control children (including 20 at <32 weeks' gestation) were born prematurely. Bleeding from the nose and/or mouth was reported in 11 of the 38 patients with ALTE undergoing CVS but in none of the 46 controls. Four patients who had been subjected to recurrent suffocation before CVS had permanent neurologic deficits and/or required anticonvulsant therapy for epileptic seizures resulting from hypoxic cerebral injury. The 39 patients undergoing CVS had 41 siblings, 12 of whom had previously died suddenly and unexpectedly. Eleven of the deaths had been classified as sudden infant death syndrome but after CVS, four parents admitted to suffocating eight of these siblings. One additional sibling who had died suddenly with rotavirus gastroenteritis was reinvestigated after CVS of her sister revealed poisoning, and death was found to be caused by deliberate salt poisoning. Other signs of abuse were documented in the medical, social, and police records of an additional 15 of the siblings. In the 52 siblings of the 46 controls, 2 had died: one from hypoplastic left heart at 5 days and the other suddenly and unexpectedly (classified as sudden infant death syndrome) at 7 weeks. Twenty-three of the abusive parents were diagnosed by a psychiatrist as having personality disorders.
Conclusions. Induced illness is a severe form of abuse that may cause death or permanent neurologic impairment. It may be accompanied by other severe forms of abuse, may result in behavioral disorders, and may be accompanied by immeasurable suffering. Detection of this abuse requires careful history-taking; thorough examination of the health, social, and police records; and close and focused collaboration between hospital and community child health professionals, child psychiatrists, social workers, and police officers. CVS may help investigate suspicions and ensure that children are protected from additional abuse. When parents have failed to acknowledge that they have deceived health professionals, partnership with them in seeking to protect their children may be neither safe nor effective.

Ref ID : 31

29. Williams-Burgess, C., Vines, S.W., and Ditulio, M.B. The Parent-Baby Venture Program: prevention of child abuse. Journal of Child & Adolescent Psychiatric Nursing.8(3):15-23, 95(3)-23, 1995.
Keywords : Prevention; Child; Child abuse; Adolescents; Role; Risk; Behavior; Adolescence; Child Abuse/pc [Prevention & Control]; Community Health Nursing/og [Organization & Administration]; Female; Human; Mothers/ed [Education]; Mothers/px [Psychology]; Mothers; Postnatal Care/og [Organization & Administration]; Pregnancy; Pregnancy in Adolescence/px [Psychology]; Program Evaluation
Notes : 95384526 TOPIC. The overwhelming obstacles adolescents face to successful achievement of the maternal role. PURPOSE. To describe an innovative, community-based program to support high risk adolescents during the early postpartum period. SOURCE. A review of the literature related to programs designed to promote maternal-role attainment and prevent child abuse/neglect. CONCLUSION. Interviews with participants indicate a positive response to the intervention but regression to maladaptive behavior in some following termination. (Abstract by: Author).

 

Dental Interventions

Ref ID : 4

16. Mouden, L.D. The role Tennessee's dentists must play in preventing child abuse and neglect. J Tenn Dent Assoc 94(2):17-21, 1994.
Keywords : Child; Child Abuse/legislation & jurisprudence/prevention & control/psychology/statistics & numerical data; Dental Care for Children/legislation & jurisprudence; Ethics,Dental; Human; Mandatory Reporting; Physician's Role; Tennessee
Notes : 98181381 JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 0040-3385 D K7D 199808 Dentistry must become more aware of its moral, legal and ethical responsibilities in recognizing and reporting child abuse and neglect. All dental professionals must be aware of the seriousness of the problems of child maltreatment, and understand that children do not just get hurt in abuse and neglect, they often die as a direct result of their maltreatment. Unfortunately, as was pointed out by Warnick, victims of child abuse and neglect fall into only two categories--those who lived through it and those who did not.

Ref ID : 3

17. Mouden, L.D. The role Kentucky's dentists must play in preventing child abuse & neglect. Ky Dent J 97(6):10-Dec;49:6):10, 1997.
Keywords : Child; Child Abuse/diagnosis/legislation & jurisprudence/prevention & control; Child,Preschool; Dental Care for Children/legislation & jurisprudence/standards; Human; Kentucky; Mandatory Reporting; Social Responsibility
Notes : 98234852 JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 0744-396X D KVA 199809 Dentistry must become more aware of its moral, legal, and ethical responsibilities in recognizing and reporting child abuse and neglect. All dental professionals must be aware of the seriousness of the problems of child maltreatment, and understand that children do not just get hurt in abuse and neglect, they often die as a direct result of their maltreatment. Unfortunately, victims of child abuse and neglect fall into only two categories--those who lived through it and those who did not.

Ref ID : 24

20. Murphy, J.M. and Welbury, R.R. The dental practitioner's role in protecting children from abuse. 1. The child protection system. British Dental Journal 184(1):7-10, 1998.
Keywords : Child; Role; Children; Child Abuse/hi [History]; Child Abuse/pc [Prevention & Control]; Child Advocacy/hi [History]; Child Advocacy/lj [Legislation & Jurisprudence]; Child Advocacy/td [Trends]; Child Advocacy; Child Care/hi [History]; Child Care/lj [Legislation & Jurisprudence]; Child Care/td [Trends]; Child Welfare/hi [History]; Child Welfare/lj [Legislation & Jurisprudence]; Child Welfare/td [Trends]; Dentists; Great Britain; History of Medicine,20th Cent. Human; Parenting; Public Opinion; Public Policy; Social Justice; Social Work
Notes : 98140431 Child Protection Unit, Raby Cross, Newcastle upon Tyne The last British Dental Journal article on child protection was in 1986. Since then there have been major changes in both legislation and approaches to child protection. A local authority child protection specialist and a consultant in paediatric dentistry outline the development of child protection and the dental practitioner's role in the inter-agency child protection system in this, the first of three inter-related articles. (Abstract by: Author).

Ref ID : 26

28. Welbury, R.R. and Murphy, J.M. The dental practitioner's role in protecting children from abuse. 2. The orofacial signs of abuse. [Review] [31 refs]. British Dental Journal 184(2):61-65, 1998.
Keywords : Role; Children; Prevalence; Injuries; Child; Child abuse; Bites,Human/di [Diagnosis]; Burns/di [Diagnosis]; Child Abuse/cl [Classification]; Child Abuse/di [Diagnosis]; Child Abuse/pc [Prevention & Control]; Child,Preschool; Contusions/di [Diagnosis]; Dentists; Ear,External/in [Injuries]; Eye Injuries/di [Diagnosis]; Facial Bones/in [Injuries]; Facial Injuries/di [Diagnosis]; Female; Human; Infant; Male; Mouth/in [Injuries]; Skull Fractures/di [Diagnosis]; Tooth Injuries/di [Diagnosis]
Notes : 98150469 Dental Hospital and School, Newcastle upon Tyne The types of prevalence of the various orofacial injuries that may be sustained in child abuse have been presented. Table 2 gives the dental practitioner a summary check-list of five questions they must ask themselves and five observations they must make whenever doubts and suspicions of child abuse arise. (31 Refs) (Abstract by: Author).

Ref ID : 23

27. Welbury, R.R. and Murphy, J.M. The dental practitioner's role in protecting children from abuse. 3. Reporting and subsequent management of abuse. British Dental Journal 184(3):115-119, 1998.
Keywords : Role; Children; Child; Risk; Adolescence; Child Abuse/di [Diagnosis]; Child Abuse/lj [Legislation & Jurisprudence]; Child Abuse/pc [Prevention & Control]; Child Abuse/th [Therapy]; Child Abuse,Sexual/di [Diagnosis]; Child Abuse,Sexual/lj [Legislation & Jurisprudence]; Child Abuse,Sexual/pc [Prevention & Control]; Child Abuse,Sexual/th [Therapy]; Child Welfare/cl [Classification]; Child Welfare/lj [Legislation & Jurisprudence]; Dentists; Family Characteristics; General Practice,Dental; Great Britain; Human; Infant; Mandatory Reporting; Referral and Consultation; Registries; Social Work
Notes : 98185055 Dental Hospital and School, Newcastle upon Tyne The third and final article of the series covers the mechanism a general dental practitioner should follow when alerting the authorities to a child at risk, and the subsequent investigations and actions that follow such a report. (Abstract by: Author).
 

Editorial

Ref ID : 13
10. Jones D and Lynch M Diagnosing and responding to serious child abuse: Confronting deceit and denial is vital if children are to be protected. BMJ 317:484-485, 1998.
Keywords : Child
Notes : EDITORIAL; http://www.bmj.com/cgi/content/full/317/7157/484.
Publishing recently in Pediatrics, Southall et al described their experience of using covert video recordings to diagnose life threatening abuse.1 Of 39 children (median age 9 months) referred to two UK hospitals for investigation of suspicion of induced illness, including 36 with apparent life threatening events, the authors filmed evidence of abuse in 33. This included suffocation in 30, poisoning in two, and the breaking of an arm. The transcripts of the recordings make distressing, yet essential, reading. Risk of abuse extended to other children within these families: 12 out of 41 siblings had died suddenly and unexpectedly (suffocation was subsequently admitted for 8, and reinvestigation of another revealed salt poisoning), and abuse was documented in a further 15.
Southall et al have revealed the grim world which has been intermittently explored over the past 100 or so years.2-4 Now, however, the filmed evidence concretely exposes what was previously available only to professional imagination. These children were not damaged during bouts of anger but harmed coolly and callously by parents who appeared concerned and caring, yet when left alone with their children seriously harmed them. The added deception of the health professional increases the feeling of betrayal, not just on behalf of the child but also in relation to the trust doctors and nurses are accustomed to placing in the parent as the child's representative. What are the lessons from these disturbing data?
A crucial issue for doctors is the ability to distinguish cases of abuse from other causes of an acute life threatening event. Compared with controls, Southall et al found that the abused children were less likely to be prematurely born, more likely to present with bleeding from the nose or mouth, and more likely to have a history of sudden and unexpected death or abuse in siblings. In addition, 23 of the abusive parents were diagnosed as having personality disorders.
Intrafamilial child maltreatment is not a unitary, or easily definable, phenomenon but covers a wide range of ways in which parents harm their children. It ranges from neglect (the most common) through physical and emotional harm, to life threatening assault and rape of children. Most cases identified are not life threatening, and death from abuse is unusual. Professionals concerned with the majority can therefore be lulled into a sense of false optimism and assume circumstances will improve, even for the more problematic cases. Additionally, our training and professional calling to help the sick can encourage professional denial of such acts of harm.3 By contrast, those working in specialised units have to appreciate that milder, non-life threatening forms of maltreatment comprise most cases. Systems of child protection must be able to cope with the full range of child maltreatment.
The variety of child abuse that is factitious illness by proxy also incorporates a range of seriousness.5 In an epidemiological study in the United Kingdom McClure et al identified 128 cases.6 In 23 the perpetrator gave only a false history of illness and in a further 21, although both history and signs were fabricated, the parents did not inflict direct physical harm on the child. Thus, for a third of children harm resulted from the subsequent medical investigations. Of the remaining 84 children, 44 were poisoned and 32 suffered deliberate suffocation (3 children experienced both); 8 children died.
Southall et al suggest that "partnership" may not be feasible in cases of life threatening or serious harm. The term partnership has acquired a range of meaning, including professional style (mutual respect, communicative openness), sharing of power, as well as parental involvement in planning and decision making.7 Partnership as avoiding confrontation, or mere togetherness, is always dangerous in serious abuse. However, partnership is still possible, provided it is made explicit that the focus of all work is the child's welfare.8 A joint acknowledgment of maltreatment is mandatory, not merely desirable, and family reunification is not automatic. Indeed, partnership can exist around relinquishment of parental carethis being just as legitimate a therapeutic goal as reunification.8 Professional style should be mutually respectful and as inclusive of parents as possible while still maintaining the child's safety. Some interprofessional discussion must, however, remain confidential when parents are devious or seriously harmful.
What implications are there from this work for practitioners? Firstly, all professionals must remain alert to the possibility of serious, life threatening abuse. Secondly, the nature of the working partnership with abusive parents needs to be moulded by the requirements of child safety and welfare. Thirdly, child protection systems must encompass a range of responses, from family support to an ability to respond vigorously to prevent fatal abuse. One way of ensuring deaths from abuse are not overlooked would be the universal introduction of local child death reviews. 9 10 Covert video surveillance needs to be available as a tool for diagnosing some forms of factitious illness, though it must not replace a full child and family assessment, on which intervention should be based. Southall et al's work reveals important clues which may help to distinguish cases of acute life threatening events caused by abuse. Finally, the work which follows recognition is all important, for herein lies the potential for preventing further harm to children, and stopping escalation in less serious cases.
 

Epidemiological Study

Ref ID : 20

4. DePanfilis, D. and Zuravin, S.,J. Rates, patterns, and frequency of child maltreatment recurrences among families known to CPS. Child Maltreatment.Vol 3(1), Feb 98,(1)-42. 1998.
Keywords : Child; Family; Risk; Child abuse; Epidemiology; Literature Review; Recidivism; Trends
Notes : Journal Article: 1997-39106-003 Reviews available research on the rates, patterns, and frequency of child maltreatment recurrences. Findings are difficult to interpret and integrate because of differences in definitions, units of analysis, follow-up intervals, and data analysis strategies. Rates of recurrence range from 1% or 2 % for cases deemed low-risk to over 50 % for families followed more than 5 yrs. Findings from studies that have used survival analysis techniques seem to indicate that the risk of recurrence declines with intervention. Future research should be prospective, document definitions and methods, and use survival analysis so that this possible encouraging trend can be further examined. ((c) 1998 APA/PsycINFO, all rights reserved).
 

Meta-analysis

Ref ID : 7
23. Rispens, J., Aleman, A., and Goudena, P.P. Prevention of child sexual abuse victimization: a meta-analysis of school programs. Child Abuse Negl 97(10):975-987, 1997.
Keywords : Child; Child Abuse,Sexual/prevention & control; Child,Preschool; Confidence Intervals; Follow-Up Studies; Human; Program Evaluation; Regression Analysis; Research Design; School Health Services/standards; Time Factors; Treatment Outcome; Western World
Notes : 97471857 JOURNAL ARTICLE META-ANALYSIS 0145-2134 M CAN 199803 OBJECTIVE: The aim of this article was to provide data about the effects of child sexual abuse prevention programs. A more specific aim was to estimate the contribution of potential moderator variables such as age, program duration, or sample size to effect size. METHOD: A meta- analytic approach was used to calculate post-test and follow-up effect sizes of 16 evaluation studies of school programs aimed at the prevention of child sexual abuse victimization. Tests of categorical models were used in the analysis of moderator variables. Multiple regression analysis was used to determine their association with effect sizes. RESULTS: Significant and considerable mean post-intervention (d = .71) and follow-up (d = .62) effect sizes were found, indicating that victimization prevention programs are successful in teaching children sexual abuse concepts and self-protection skills. Intervention characteristics such as duration and content of the program, and child characteristics such as age and SES were important moderators of effect size. CONCLUSIONS: Our findings corroborate and refine the positive conclusions of traditional narrative reviews. Programs that focus on skill training, allowing sufficient time for children to integrate self-protection skills into their cognitive repertoire, are to be preferred. Future evaluation research should focus on transfer of training.
 

Randomised Controlled Trial

Ref ID : 9
21. Olds, D.L., Eckenrode, J., Henderson, C.R.,Jr., Kitzman, H., Powers, J., Cole, R., Sidora, K., Morris, P., Pettitt, L.M., and Luckey, D. Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial [comment]. JAMA 97(8):637-643, 1997.
Keywords : Child; Adolescence; Child Abuse/prevention & control; Child,Preschool; Community Health Nursing; Crime; Female; Follow-Up Studies; House Calls; Human; Infant; Infant,Newborn; Maternal Behavior; Maternal Health Services; Maternal Welfare; Models,Statistical; New York/epidemiology; Poverty; Pregnancy; Single Parent; Support,Non-U.S.Gov't; Support,U.S.Gov't,P.H.S. Treatment Outcome
Notes : 97417522 CLINICAL TRIAL COMMENT JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL 0098-7484 A M X KFR 199711 CONTEXT: Home-visitation services have been promoted as a means of improving maternal and child health and functioning. However, long-term effects have not been examined. OBJECTIVE: To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women's life course and child abuse and neglect. DESIGN: Randomized trial. SETTING: Semirural community in New York. PARTICIPANTS: Of 400 consecutive pregnant women with no previous live births enrolled, 324 participated in a follow-up study when their children were 15 years old. INTERVENTION: Families received a mean of 9 home visits during pregnancy and 23 home visits from the child's birth through the second birthday. DATA SOURCES AND MEASURES: Women's use of welfare and number of subsequent children were based on self-report; their arrests and convictions were based on self-report and archived data from New York State. Verified reports of child abuse and neglect were abstracted from state records. MAIN RESULTS: During the 15-year period after the birth of their first child, in contrast to women in the comparison group, women who were visited by nurses during pregnancy and infancy were identified as perpetrators of child abuse and neglect in 0.29 vs 0.54 verified reports (P<.001). Among women who were unmarried and from households of low socioeconomic status at initial enrollment, in contrast to those in the comparison group, nurse-visited women had 1.3 vs 1.6 subsequent births (P=.02), 65 vs 37 months between the birth of the first and a second child (P=.001), 60 vs 90 months' receiving Aid to Families With Dependent Children (P=.005), 0.41 vs 0.73 behavioral impairments due to use of alcohol and other drugs (P=.03), 0.18 vs 0.58 arrests by self-report (P<.001), and 0.16 vs 0.90 arrests disclosed by New York State records (P<.001). CONCLUSIONS: This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies, the use of welfare, child abuse and neglect, and criminal behavior on the part of low-income, unmarried mothers for up to 15 years after the birth of the first child.
 

Reviews

Ref ID : 1

3. Chiocca, E.M. The nurse's role in the prevention of child abuse and neglect: Part II. J Pediatr Nurs 98(3):194-195, 1998.
Keywords : Child; Child Abuse/prevention & control; Child Health Services; Human; Pediatric Nursing; United States
Notes : JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 0882-5963 N JNS 199809.

Ref ID : 11

6. Drake, B. and Zuravin, S. Bias in child maltreatment reporting: revisiting the myth of classlessness. Am J Orthopsychiatry 98(2):295-304, 1998.
Keywords : Child; Bias (Epidemiology); Child Abuse/legislation & jurisprudence/statistics & numerical data; Child Welfare/statistics & numerical data; Human; Mandatory Reporting; Poverty/statistics & numerical data; Risk; Social Class; United States
Notes : 98251678 JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 0002-9432 M 3R6 199810 Data on the degree of class bias in child protective services databases are reviewed, along with recent empirical findings on the class distribution of child maltreatment. The evidence suggests high levels of child abuse and neglect among the poor and, despite debate on the question, there is no body of empirical data suggesting that these findings are a product of bias predisposing toward overestimates of child maltreatment among the poor. Implications for research, practice, and policy are offered.

Ref ID : 12

15. Morales, J.M., Zunzunegui Pastor, V., and Martinez Salceda, V. [Conceptual models of child mistreatment: a biopsychosocial approach]. Gac Sanit 97(5):231-Oct;11:5):231, 1997.
Keywords : Child; Child Abuse/prevention & control/statistics & numerical data; Developmental Disabilities/epidemiology; English Abstract; Family; Human; Incidence; Prevalence; Risk Factors; Risk
Notes : 98155392 JOURNAL ARTICLE REVIEW REVIEW LITERATURE 0213-9111 GSZ 199807 INTRODUCTION: Currently, the concept of child maltreatment extends over any dysfunction in the parent-child relationship, including in its diagnosis all different forms in which parental dysfunction takes place (from the classic child abuse to subtle types of psychological maltreatment). METHODOLOGY: Review of original articles of Child Abuse and Neglect in 1991-1996, and of other articles cited in this period in that journal. Search of documents in the Spanish literature on this topic. RESULTS: Several studies carried out in Spain have shown a prevalence rate of 1.5%, although it is widely recognized that this figure is an underestimate. The view of child maltreatment as a psychosocial phenomenon which causes severe consequences in the child's integrated development, has produced conceptual models which explore the relationships among risk and protective factors involved in the occurrence of child maltreatment. The main risk factors are younger parents, anxiety and depression symptoms, monoparental family, and economic stress. Social support has a protective effect. CONCLUSION: A better understanding of the dynamics of protective and risk factors for child abuse is needed in order to carry out effective interventions in prevention and intervention programs against child maltreatment.

Ref ID : 8

19. Mulroy, E.A. and Shay, S. Nonprofit organizations and innovation: a model of neighborhood-based collaboration to prevent child maltreatment. Soc Work 97(5):515-524, 1997.
Keywords : Child; Child Abuse/prevention & control; Human; Interinstitutional Relations; Models,Organizational; Organizations,Nonprofit/organization & administration; Public Policy; Social Work/organization & administration; Support,Non-U.S.Gov't
Notes : 97457498 JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL 0037-8046 UUD 199801 Public policymakers increasingly are contracting with nonprofit organizations (NPOs) for innovations in the creation of new service systems in low-income communities. Interorganizational collaboration and cooperation are essential to such innovation. Neighborhood-based institutional arrangements require social work practitioners to work across multiple systems simultaneously--skills that most are not trained to possess. This article develops a theoretical and conceptual framework for neighborhood-based collaboration by NPOs; analyzes the main concepts of innovation in the design and implementation of a collaboration to prevent child maltreatment in an undervalued neighborhood; and draws implications for social policy, social work practice, and social work research.

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