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1.

Objective

Child maltreatment constitutes a strong risk factor for violent delinquency in adolescence, with cumulative experiences of maltreatment creating increasingly greater risk. Our previous work demonstrated that a universal school-based violence prevention program could provide a protective impact for youth at risk for violent delinquency due to child maltreatment history. In this study we conducted a follow-up to determine if participation in a school-based violence prevention program in grade 9 continued to provide a buffering effect on engaging in acts of violent delinquency for maltreated youth, 2 years post-intervention.

Methods

Secondary analyses were conducted using data from a cluster randomized controlled trial of a comprehensive school-based violence prevention program. Students (N = 1,722; 52.8% female) from 20 schools participated in 21 75-min lessons in grade 9 health classes. Individual data (i.e., gender, child maltreatment experiences, and violent delinquency in grade 9) and school-level data (i.e., student perception of safety averaged across students in each school) were entered in a multilevel model to predict violent delinquency at the end of grade 11.

Results

Individual- and school-level factors predicting violent delinquency in grade 11 replicated previous findings from grade 9: being male, experiencing child maltreatment, being violent in grade 9, and attending a school with a lower perceived sense of safety among the entire student body increased violent delinquency. The cross-level interaction of individual maltreatment history and school-level intervention was also replicated: in non-intervention schools, youth with more maltreatment in their background were increasingly likely to engage in violent delinquency. The strength of this relationship was significantly attenuated in intervention schools.

Conclusions

Follow-up findings are consistent with the buffering effect of the prevention program previously found post-intervention for the subsample of youth with maltreatment histories.

Practice implications

A relative inexpensive school-based violence prevention program that has been shown to reduce dating violence among the whole student body also creates a protective effect for maltreated youth with respect to lowering their likelihood of engaging in violent delinquency.  相似文献   

2.

Objective

The aim of the study was to examine caregiver management strategies for child sexual abuse (CSA) when presented with hypothetical scenarios that vary in physical invasiveness.

Methods

One hundred fifty three caregivers were given 3 scenarios of CSA with 7 management strategies presented in the 21-item Taking Action Strategies (TAS) scale. Caregivers were asked to rate strategies according to their willingness to carry out each action with rating of 5 = greater likelihood of carrying out the action specified while a rating of 1 = a lower likelihood of carrying out that action. CSA scenarios included exposure to pornography/masturbation, fondling, and penetration while management strategies including fighting the accused, blaming the child, and outreaching to the authorities. Repeated measures ANOVA was used to compare mean TAS scores for the management strategies across CSA scenarios.

Results

The difference between TAS scores across the abuse scenarios was statistically significant (p < .001). Mean TAS scores reflected greater preference for taking action if the abusive act was perceived as more physically intrusive (exposure to pornography/masturbation-TAS 3.5, fondling-TAS 3.7, penetration-TAS 3.8). Caregivers reported being less willing to handle a disclosure of CSA without outreach (TAS 2.5 and 2.0 for fighting and blaming the child, respectively) and more willing to manage a disclosure with outreach to authorities (TAS 3.8, 4.5, and 4.7 for outreaching to Child Protective Services [CPS], to the child's healthcare provider and police, respectively). A predictor of caregiver outreach to authorities identified was the caregiver having past interactions with CPS.

Conclusion

Perception of the physical invasiveness of CSA and demographic factors can impact caregiver management strategies after a disclosure.

Practice implications

Results suggest that several factors influence caregiver management of sexual abuse. These factors warrant further study, as they are potential contributors to declining trends in CSA cases observed. Other implications include the need for educational efforts targeting caregivers. These interventions should focus on dispelling myths about the perceived physical invasiveness of CSA. These perceptions should not mitigate a caregiver's decision to involve the authorities in their management after a disclosure. Lastly, despite criticisms of the child protective systems, caregivers with past encounters with CPS view these related agencies as valuable resources.  相似文献   

3.

Objectives

To present a detailed confession from a perpetrator of Shaken Baby syndrome.

Methods

Case study.

Results

We present a confession of Shaken Baby syndrome describing how the perpetrator severely injured a 3 year old with repeated bursts of acceleration-deceleration (shaking). The child sustained retinal and intracranial hemorrhage. Details of the confession and circumstances by which it was obtained lead us to believe its accuracy.

Conclusions

Accurate perpetrator confessions offer useful windows into realities and pathophysiology of abusive head trauma.  相似文献   

4.

Objectives

Previous research suggests that women's early sexual victimization experiences may influence their parenting behaviors and increase the vulnerability of their children to being sexually victimized. The current study considered whether mother's sexual victimization experiences, in childhood and after age 14, were associated with the sexual victimization experiences reported by their adolescent daughters, and if so, whether these effects were mediated via parenting behaviors.

Methods

The proposed model was examined using a community sample of 913 mothers and their college-bound daughters, recruited by telephone at the time of the daughter's high school graduation. Daughters reported on their experiences of adolescent sexual victimization and perceptions of mothers’ parenting in four domains: connectedness, communication effectiveness, monitoring, and approval of sex. Mothers provided self-reports of their lifetime experiences of sexual victimization.

Results

Consistent with hypotheses, mothers’ victimization was positively associated with their daughters’ victimization. The effect of mothers’ childhood sexual abuse was direct, whereas the effect of mothers’ victimization after age 14 was mediated via daughters’ perceptions of mothers’ monitoring and greater approval of adolescent sexual activity. Comparison of the prevalence of specific victimization experiences indicated that mothers were more likely to report forcible rape over their lifetimes; however, daughters were more likely to report unwanted contact and incapacitated rape.

Conclusions

Findings suggest that even in a highly functional community sample, mothers’ sexual victimization experiences are significantly associated with aspects of their parenting behavior and with their daughters’ own experiences of adolescent sexual victimization.  相似文献   

5.
6.

Objective

This study investigated the long-term effects of exposure to intimate partner violence in the home on adolescent violence and drug use and gender differences in these relationships. Although the general relationship between exposure to IPV and negative outcomes for youth has been demonstrated in past research, gender differences in the effects of IPV on adolescents have been rarely assessed using longitudinal data.

Methods

Longitudinal data was obtained from 1,315 adolescents and their primary caregivers participating in the Project on Human Development in Chicago Neighborhoods (PHDCN). The sample was 51% female and ethnically diverse (45% Hispanic, 37% African-American, and 14% Caucasian). Two waves of data were assessed to examine the effects of exposure to IPV, reported by caregivers when their children were aged 12 and 15, on violence and drug use, reported by adolescents 3 years later. Multivariate statistical models were employed to control for a range of child, parent, family, and neighborhood risk factors.

Results

Exposure to IPV did not significantly predict subsequent violence among males or females in multivariate analyses. IPV exposure was significantly related to the frequency of drug use for females but did not predict drug use among males. This gender difference was not statistically significant, however, which suggests more similarities than differences in the relationship between exposure to IPV and subsequent violence and drug use.

Conclusions

This study supports prior research indicating that exposure to IPV can negatively impact adolescent development, but it suggests that these effects may be more likely to influence some outcomes (e.g., drug use) than others (e.g., interpersonal violence). The findings also emphasize the need for additional research examining the overall impact of IPV on adolescent problem behaviors and gender differences in these relationships, including longitudinal studies and investigations that control for a range of other important predictors. A better understanding of these relationships can help inform intervention efforts aimed at ensuring that adolescents living in violent households receive timely and appropriate services to help prevent the occurrence of future problem behaviors.  相似文献   

7.
8.

Objective

The present study was designed to determine whether parents at high risk for physical child abuse, in comparison with parents at low risk, show deficits in emotion recognition, as well as to examine the moderator effect of gender and stress on the relationship between risk for physical child abuse and emotion recognition.

Methods

Based on their scores on the Abuse Scale of the CAP Inventory (Milner, 1986), 64 parents at high risk (24 fathers and 40 mothers) and 80 parents at low risk (40 fathers and 40 mothers) for physical child abuse were selected. The Subtle Expression Training Tool/Micro Expression Training Tool ( [Ekman, 2004a] and [Ekman, 2004b]) and the Diagnostic Analysis of Nonverbal Accuracy II (Nowicki & Carton, 1993) were used to assess emotion recognition.

Results

As expected, parents at high risk, in contrast to parents at low risk, showed deficits in emotion recognition. However, differences between high- and low-risk participants were observed only for fathers, but not for mothers. Whereas fathers at high risk for physical child abuse made more errors than mothers at high risk, no differences between mothers at low risk and fathers at low risk were found. No interaction between stress, gender, and risk status was observed for errors in emotion recognition.

Conclusions and practice implications

The present findings, if confirmed with physical abusers, could be helpful to further our understanding of deficits in processing information of physically abusive parents and to develop treatment strategies specifically focused on emotion recognition. Moreover, if gender differences can be confirmed, the findings could be helpful to develop specific treatment programs for abusive fathers.  相似文献   

9.

Objective

The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community.

Study design

Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were coded and each ACE criterion endorsed by a traumatic event received a score of 1 (range = 0-9). This study reports on the prevalence of various ACE categories in this population, as well as the association between ACE score and two pediatric problems: learning/behavior problems and body mass index (BMI) ≥ 85% (i.e., overweight or obese).

Results

The majority of subjects (67.2%, N = 471) had experienced 1 or more categories of adverse childhood experiences (ACE ≥ 1) and 12.0% (N = 84) had experienced 4 or more ACEs (ACE ≥ 4). Increased ACE scores correlated with increased risk of learning/behavior problems and obesity.

Conclusions

There was a significant prevalence of endorsed ACE categories in this urban population. Exposure to 4 or greater ACE categories was associated with increased risk for learning/behavior problems, as well as obesity.

Practice implications

Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models.  相似文献   

10.

Objective

To examine whether depressed mood and anger mediate the effects of sexual abuse and family conflict/violence on self-injurious behavior and substance use.

Methods

A cross-sectional national survey was conducted including 9,085 16-19 year old students attending all high schools in Iceland in 2004. Participants reported frequency of sexual abuse, family conflict/violence, self-injurious behavior, substance use, depressed mood, and anger.

Results

Sexual abuse and family conflict/violence had direct effects on self-injurious behavior and substance use among both genders, when controlling for age, family structure, parental education, anger, and depressed mood. More importantly, the indirect effects of sexual abuse and family conflict/violence on self-injurious behavior among both males and females were twice as strong through depressed mood as through anger, while the indirect effects of sexual abuse and family conflict/violence on substance use were only significant through anger.

Conclusions

These results indicate that in cases of sexual abuse and family conflict/violence, substance use is similar to externalizing behavior, where anger seems to be a key mediating variable, opposed to internalizing behavior such as self-injurious behavior, where depressed mood is a more critical mediator.

Practice implications

Practical implications highlight the importance of focusing on a range of emotions, including depressed mood and anger, when working with stressed adolescents in prevention and treatment programs for self-injurious behavior and substance use.  相似文献   

11.
12.

Objectives

Adolescents often experience different types of victimization across a specified period of time in different situations. These multiple victimization experiences can have a number of deleterious effects on psychosocial well-being. To expand on research gathered primarily from US samples, the current study estimated the prevalence of multiple victimization in a nationally representative sample of Canadian adolescents. We also expanded on past research by adopting an ecological approach to identify correlates of multiple victimization.

Methods

Cross-sectional data from the 2000-2001 cycle of the National Longitudinal Survey of Children and Youth (NLSCY) were used to estimate the prevalence of multiple victimization (verbal harassment, threat of and actual physical assault, school social exclusion, discrimination) in 1,036 13-16 year olds. We also examined household (e.g., parental education), family (e.g., parenting practices), and adolescent (e.g., friendship quality) correlates of multiple victimization for the whole sample and separately by sex.

Results

Among the 6 in 10 adolescents who reported at least 1 victimization experience, 30.5% reported 2 types of victimization whereas 23.7% reported 3 or more types. There was an increased probability of multiple victimization (2 or more types) in adolescents who reported greater parental rejection, who engaged in more frequent out-of-school activities, and who experienced non-victimization adversity. The probability decreased if adolescents reported greater friendship quality.

Conclusions

The clustering of different types of victimization is common among adolescents. For both males and females, a difficult parent-child relationship characterized as rejecting is important when considering risk for multiple victimization, as is the adolescent's functioning outside of the home in the context of friendship quality and involvement in out-of-school activities. Non-victimization adversity (e.g., death of a loved one) also emerged as a significant multiple victimization correlate.

Practice implications

Non-physically invasive types of victimization (although adolescents also endorsed physical assault) are a reality for a number of adolescents. As such, we need to inquire about such experiences as school social exclusion, discrimination, and verbal threats in applied contexts. Moreover, in order to better identify adolescents who may be vulnerable to multiple forms of victimization, we need to adopt an ecological approach that considers individual, family, and household functioning.  相似文献   

13.

Purpose

Empirical research regarding potential risks and benefits of children's participation in the legal system generally, and in the child dependency legal system in particular, is sparse and mostly characterized by small studies without comparison groups. The current study was designed to address the following questions regarding children's participation in dependency court hearings: (1) Is attending court harmful to children? (2) Is attending court beneficial to children? (3) Is judicial behavior with the child in the courtroom related to potential harms or benefits? and (4) Are there age differences in children's reactions?

Method

The authors measured children's reactions to attending dependency review hearings (n = 43) and compared them to a sample of children who did not attend their hearings (n = 50). One to 2 weeks following review hearings, both groups of children were interviewed about their reactions to the court process.

Results

Children who attended their hearings reported more positive feelings about the dependency process (e.g., trust in judge, perceived fairness, and more comfort with their guardians ad litem and caseworkers). For children who attended, there was no evidence of high distress immediately preceding or following their hearings. Court observations revealed that more active engagement by judges was related to positive responses from the children. Most children, including both children who attended hearings and those who did not, believed that all children should be able to attend their hearings.

Conclusion

Overall, the findings suggest that policies encouraging children's attendance at dependency hearings are viewed positively by and not harmful to children.  相似文献   

14.

Objectives

To describe health-related problems across placement types (unrelated foster, kin foster, in-home with birth parent); to examine the association of placement and demographic/child welfare variables (child gender, age, race/ethnicity; caregiver language; type of maltreatment, and length of time receiving services from child welfare) with health-related problems.

Methods

This study utilized a retrospective medical chart review of children less than 6 years old (n = 449) seen at an outpatient child welfare pediatric clinic. Logistic regression modeling was used to estimate odds of having a weight, medical, or provisional developmental delay problem by placement and demographic/child welfare characteristics.

Results

Almost 13% of children in the sample were obese (≥95% age-gender specific percentile) and more than a quarter were overweight/obese (≥85%) while only 7% were underweight (≤5%). Most children (78%) had a physical health diagnosis and 25% were provisionally identified with a developmental delay. No differences between weight diagnoses, type of medical diagnoses, and provisional developmental delay by placement type were found, although children with 3 or more medical diagnoses were more likely to be with kin (p < .05). Children 2 years old or older were more likely to be overweight/obese than children under 2 years old (p < .05) and Hispanic children were more likely to be overweight/obese than non-Hispanic children (p < .01). Length of stay in child welfare was positively related with a medical diagnosis or provisional developmental delay (p < .01).

Conclusions

Results argue for careful assessment of weight, medical, and developmental problems in children active to child welfare, whether residing in their home of origin, with kin, or with unrelated foster parents. The increasing problem of obesity among young children in child welfare warrants further investigation and intervention.

Practice implications

The comprehensive health examination and enhanced health maintenance schedule for children in foster care should be extended to children who remain at home with child welfare services as child welfare involvement rather than placement is related to health-related problems.  相似文献   

15.

Objectives

The present investigation reports on the development and initial validation of a new analog task, the Parent-Child Aggression Acceptability Movie Task (P-CAAM), intended to assess respondents’ acceptance of parent-child aggression, including both physical discipline and physical abuse.

Methods

Two independent samples were utilized to develop and evaluate the P-CAAM: an undergraduate sample to initially pilot the task and a separate sample of normative parents for additional assessment of validity. Scores from the P-CAAM were compared to related measures, including measures of self-reported disciplinary attitudes, child abuse potential, harsh parenting style, and use and escalation of physical discipline practices on another analog parenting task.

Results

Across the studies, the P-CAAM demonstrated acceptable internal consistency and construct validity, evidencing mild to moderate associations with both self-report and analog measures. Participants demonstrating increased acceptance of physical discipline and physical abuse on the P-CAAM analog task also reported greater approval of physical discipline, greater use of and escalation of physical discipline, harsher parenting styles, and higher child abuse potential on two separate measures.

Conclusions

The P-CAAM analog appears to offer a promising alternative and/or supplement to conventional self-report measures, assessing attitudes regarding the acceptability of parent-child aggression in a way that is less likely to be influenced by social desirability. Suggestions for future evaluations with alternative samples, as well as possible implications of the data for disciplinary reactions are discussed.

Practice implications

The development of alternatives to self-report measurement may lead to clarification of theoretical models of abuse in ways that lead to improvements in intervention programming; analogs may also provide a useful means to assess intervention programming outcomes.  相似文献   

16.

Objective

Many children in the US who are court-ordered to live in out-of-home care are placed with kinship caregivers. Few studies have examined the impact of living with kin on child well-being. This study examined the relationship between length of time living with kin and indices of adolescent well-being in a cohort of children who were initially court-ordered into out-of-home care.

Methods

Prospective cohort design with 148 youth, ages 7-12, who entered out-of-home care between May, 1990, and October, 1991. Seventy-five percent of those interviewed at T1 (6 months following placement) were interviewed at T2 (5 years later).

Results

Bivariate analyses did not demonstrate significant relationships between length of time living with kin and the outcome variables. In multivariate analyses, longer length of time living with kin was related to: (1) greater involvement in risk behaviors including: delinquency (β = .22, p < .05), sexual risk behaviors (β = .31, p < .05), substance use (β = .26, p < .05), and total risk behaviors (β = .27, p < .05), and (2) poorer life-course outcomes including: Tickets/Arrests (OR = 1.4, p < .05) and lower grades (β = −.24, p < .05). Time living with kin was not related to total competence, or self-destructive, internalizing, externalizing, or total behavior problems. There were trends (p < .10) for time living with kin to predict greater trauma symptomatology (β = .17) and suspensions (OR = 1.1).

Conclusions

There were no significant bivariate findings. The multivariate findings suggested a pattern of poorer functioning for youth who spent more time living with kin. No differences were found in current symptomatology.

Practice implications

Although findings from a single study should not dictate changes in practice or policy, the current study's findings do suggest that the field needs to conduct more methodologically sophisticated research on the impact of kinship care.  相似文献   

17.

Objective

The aim of this study was to describe how sexually abused children experience the legal process, a process that includes being questioned by the police during the preliminary investigation and by lawyers and the prosecutor in the courtroom, and meeting other professionals from various agencies.

Method

Face-to-face in-depth interviews were conducted with 10 children—9 girls and 1 boy between 9 and 15 years old—who had experienced child sexual abuse (CSA). The interviews were semi structured and carried out and analyzed by interpretative phenomenological analysis (IPA). The aim of IPA is to explore the participants’ views of the world and to adopt as far as possible an “insider perspective.” IPA draws on a tradition of phenomenology and symbolic interactionism in attempting to understand how people make sense of their experiences.

Results

Five major themes emerged through the analysis: not being believed, making CSA visible, need for support, sanctions for offenders, and lack of respect for the child's integrity. Almost all the children had a feeling of not being believed. They described feelings ranging from anxiety to dread and even terror when they had to describe the CSA they had experienced. Even though the importance of support for such children is already well understood, the children stated that the support they were given was not sufficient. The children said that they wanted support from a single professional who was well informed about both the legal process and CSA. When the children were asked to reflect on sanctions against the abusers, they said that it was important that the perpetrator got treatment/therapy but they also said that imprisonment was desirable. Financial compensation was not as important to them; the damage had been done and money could not compensate for that damage. The children also said that both the lawyers and the media had treated them with disrespect.

Conclusions

It is valuable for children who have been exposed to CSA to learn that they can take part in the legal process as equal partners with the other participants, and it is evident that the quality of psychological care and support needs to be improved. The children want to be participants in the legal process rather than passive objects of that process.  相似文献   

18.

Objective

We examined (1) the prevalence of childhood sexual abuse (CSA) experiences as a function of cohort and gender, (2) the prevalence of factors associated with CSA as a function of cohort and whether the association of these factors with CSA remained the same irrespective of cohort, and (3) whether any cohort differences could be explainable by cohort differences in reporting bias.

Method

We used the responses of 4,561 men (M = 29, SD = 7 years) and 8,361 female (M = 29, SD = 7 years) Finnish participants who responded to the Childhood Trauma Questionnaire-Short Form as well as questions regarding family structure.

Results

The prevalence of CSA experiences varied between 0.7-4.6% for men and 1.8-7.5% for women depending on the item. Younger cohorts reported less CSA as well as less of the risk factors (physical neglect and abuse, emotional neglect and abuse, parental substances abuse, not growing up with both biological parents) that were positively associated with the likelihood of CSA. The effects of these risk factors did not vary as a function of the cohort. Also, the declining trend was not explainable by social desirability being higher in the younger cohorts.

Conclusions

The results suggest that there is a real decline in the prevalence of CSA and it is associated with a simultaneous decline in factors associated with CSA.  相似文献   

19.

Objective

In order to be reimbursed for the care they provide, hospitals in the United States are required to use a standard system to code all discharge diagnoses: the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9). Although ICD-9 codes specific for child maltreatment exist, they do not identify all maltreatment-related hospital and emergency department discharges. To increase the usefulness of medical data for public health surveillance of child maltreatment, this project sought to identify ICD-9 codes that are suggestive of child maltreatment.

Methods

After review of the literature and discussions with experts, injuries and conditions that should raise suspicion of child maltreatment (physical or sexual abuse or neglect) were identified and a list of corresponding ICD codes was compiled. Using a statewide electronic database of hospital discharges and emergency department (ED) visits for the year 2000, visits by children assigned these ICD codes were identified, a sample of visits was selected, and medical records were reviewed to assess the circumstances of the injury or illness that led to the visit. Based on information in the medical record, the injury or illness was classified as maltreatment-related, or not.

Results

There were 3,684 visits selected for review. Of these, 2,826 records were reviewed and classified; 1,200 (43%) records met the criteria for being maltreatment-related, 1,419 (50%) contained adequate information indicating the injury/condition was not likely maltreatment-related, and 207 (7%) records did not contain enough information to classify. Sixty-eight ICD codes had >66% of visits classified as maltreatment-related, the a priori criteria for a code to be considered suggestive of maltreatment. Codes suggestive of maltreatment include specific fractures, burns, and injuries of undetermined intent, among others.

Conclusion

Several ICD codes were found that, when used with age restrictions and other specific exclusion criteria, are suggestive of maltreatment. This information may increase the usefulness of hospital discharge data for public health surveillance of child maltreatment.

Practice implications

Use of these suggestive codes facilitates identifying conditions and injuries that are likely maltreatment-related in hospital discharge and ED visit data. When used in conjunction with ICD maltreatment-specific codes, these suggestive codes may enhance the use of medical data for monitoring child maltreatment trends.  相似文献   

20.

Objective

Analysis of the validity and implementation of a child maltreatment actuarial risk assessment model, the California Family Risk Assessment (CFRA).

Questions addressed

(1) Is there evidence of the validity of the CFRA under field operating conditions? (2) Do actuarial risk assessment results influence child welfare workers’ service delivery decisions? (3) How frequently are CFRA risk scores overridden by child welfare workers? (4) Is there any difference in the predictive validity of CFRA risk assessments and clinical risk assessments by child welfare workers?

Method

The study analyzes 7,685 child abuse/neglect reports originating in 5 California counties followed prospectively for 2 years to identify further substantiated child abuse/neglect. Measures of model calibration and discrimination were used to assess CFRA validity and compare its accuracy with the accuracy of clinical predictions made by child welfare workers. The extent of use of an override feature of the CFRA and child welfare worker reliance on CFRA risk scores for making service decisions were analyzed.

Results

Imperfect but better-than-chance predictive validity was found for the CFRA on a range of measures in a large temporal validation sample (n = 6,543). For 114 cases where both CFRA risk assessments and child welfare worker clinical risk assessments were available, the CFRA exhibited evidence of imperfect but better-than-chance predictive validity, while child welfare worker risk assessments were found to be invalid. Child welfare workers overrode CFRA risk assessments in only 114 (1.5%) of 7,685 cases and provided in-home services in statistically significantly larger proportions of higher- versus lower-risk cases, consistent with heavy reliance on the CFRA.

Conclusions/practice implications

Until research identifies actuarial models exhibiting superior predictive validity when applied in every-day practice, the CFRA is, and will be a valuable tool for assessing risk in order to make in-home service-provision decisions.  相似文献   

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