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1.
Objective
The current study was designed to explore the prevalence of child sexual abuse (CSA) and its association with health risk behaviors (i.e., smoking, alcohol use, binge drinking, suicidal ideation, and suicide attempt) among rural children and adolescents in China.Methods
A sample of 683 rural children and adolescents (8 to 18 years of age) completed an anonymous questionnaire which assessed experiences of CSA and 5 health risk behaviors. Data on several potential confounding factors were also collected.Results
A total of 123 (18%) respondents reported experiencing at least 1 kind of CSA before 16 years of age, with more boys reporting CSA than girls (21.5% vs. 14.2%). In addition, attending non-boarding schools, lower levels of self-esteem, and higher levels of perceived peer pressure for engagement in health risk behaviors were associated with higher rates of CSA. Multivariate logistic regression analyses revealed that CSA experience was significantly associated with cigarette smoking (aOR = 2.14), binge drinking (aOR = 2.68), suicidal ideation (aOR = 1.69), and suicide attempt (aOR = 2.69) after controlling for several demographic and psychological factors.Conclusion
More attention should be paid to the issues of CSA among rural children and adolescents in China. Effective CSA prevention intervention needs to address the vulnerabilities of the population, increase children's and parents’ awareness of CSA and ability of self-protection. 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.
Objective
To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect.Method
The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models.Results
Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01-1.49, p = .04), maternal education ≤ high school (RR = 1.55, CI = 1.01-2.38, p = .04), maternal drug use (RR = 1.71, CI = 1.01-2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09-1.51, p < .01), and more children in the family (RR per additional child = 1.26, CI = 1.07-1.47, p < .01).Conclusions
Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment. 相似文献4.
Objective
To examine whether Chinese studies of child sexual abuse (CSA) in the general population show lower prevalence rates than other international studies, and whether certain features of these studies may help to account for variation in estimates.Methods
A meta-analysis and meta-regression were conducted on 27 studies found in the English and Chinese language peer reviewed journals that involved general populations of students or residents, estimated CSA prior to age 18, and specified rates for males or females individually.Results
Estimates for Chinese females were lower than the international composites. For total CSA for females, the Chinese pooled estimate was 15.3% (95% CI = 12.6–18.0) based on the meta-analysis of 24 studies, lower than the international estimate (Stoltenborgh, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011) but not significantly. For contact CSA for females, the pooled estimate was 9.5% (95% CI = 7.5–11.5), based on 16 studies, significantly lower than the international prevalence. For penetrative CSA for females, the pooled estimate was 1% (95% CI = 0.7–1.3), based on 15 studies, significantly lower than the international estimate of 15.1%. Chinese men reported significantly less penetrative CSA but significantly more total CSA than international estimates; while contact CSA reported by Chinese and international males appeared to be roughly equivalent. Chinese CSA prevalence estimates were lower in studies from urban areas and non-mainland areas (Hong Kong and Taiwan), and in surveys with larger and probability samples, multiple sites, face-to-face interview method and when using less widely used instruments.Conclusions
The findings to date justify further research into possible cultural and sociological reasons for lower risk of contact and penetrative sexual abuse of girls and less penetrative abuse of boys in China. Future research should examine sociological explanations, including patterns of supervision, sexual socialization and attitudes related to male sexual prowess.Practice implications
The findings suggest that future general population studies in China should use well validated instruments, avoid face-to-face interview formats and be careful to maintain methodological standards when sampling large populations over multiple sites. 相似文献5.
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6.
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7.
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9.
Johnson WL 《Child abuse & neglect》2011,35(1):18-28
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10.
11.
Leslie LK Raghavan R Hurley M Zhang J Landsverk J Aarons G 《Child abuse & neglect》2011,35(5):333-342
Objectives
Public Law (P.L.) 110-351, the “Fostering Connections to Success Act,” calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors.Methods
Cross-sectional analysis of Wave 1 data for the 92 child welfare catchment areas participating in the National Survey of Child and Adolescent Well-being, a random probability sample of 2,504 children ages 2-15 years undergoing investigation for abuse and neglect. We employed multilevel regression modeling to examine the impact of catchment-level variables on medication use, controlling for child-level variables.Results
Fifteen percent of children reported taking psychotropic medications. Rates of medication use across catchment areas ranged widely from 0 to 40%, a 40-fold difference. On multi-level logistic regression modeling, older age (p < .001), male gender (p < .001), emotional and behavioral problems (p < .001), and insurance (p = .05) were associated with psychotropic medication use at the child-level. At the catchment-level, stressful environment within the child welfare system was negatively associated with medication use. No other catchment-level variables examined were found to explain use.Conclusions
Striking disparities in medication use exist across catchment areas in this national sample. Of the catchment variables examined, only stressful environment was related to medication use.Practice implications
These findings highlight significant geographic variation in medication use that most likely reflect both under-use and over-reliance on psychotropic medication. The link between child welfare environment and medication use suggests the influence of systemic, as opposed to clinical, causes of variation in medication use. This requires greater implementation of organizational processes governing quality of care for this highly vulnerable population. 相似文献12.
Neil B. Guterman Jiyoung K. Tabone George M. Bryan Catherine A. Taylor Cynthia Napoleon-Hanger Aaron Banman 《Child abuse & neglect》2013
Objective
This study set out to carry out a feasible, real-world, randomized clinical trial to examine the benefits of home-based paraprofessional parent aide services in reducing physical abuse and neglect risk in high-risk parents.Methods
Families were randomly assigned to receive either parent aide plus case management services (n = 73) or case management services only (n = 65), collecting in-home data on physical child abuse and neglect and proximal risk and protective factors, just prior to service initiation, and again after six months of services.Results
Mothers receiving parent aide and case management services reported significant improvements from baseline to six-month follow-up in self-reported indicators of physical child abuse risk, as well as improvements on parental stress, mastery, depression, and anxiety, whereas mothers receiving only case management services did not. The slopes of such observed changes across groups, however, were not found to be statistically significantly different. No discernable improvements were found with regard to indicators of risk for child neglect.Conclusions
As the first randomized clinical trial examining the effectiveness of parent aide services, this study provides the first controlled evidence examining the potential benefits of this service modality. This study suggests promising trends regarding the benefit of parent aide services with respect to physical child abuse risk reduction and related predictors, but evidence does not appear to suggest that such services, as they are presently delivered, reduce child neglect.Practice implications
These findings support the continued use of parent aide services in cases of physical child abuse and also suggest careful consideration of the ways such services may be better configured to extend their impact, particularly with respect to child neglect risk. 相似文献13.
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14.
Cuijpers P Smit F Unger F Stikkelbroek Y Ten Have M de Graaf R 《Child abuse & neglect》2011,35(11):937-945
Objectives
There is much evidence showing that childhood adversities have considerable effects on the mental and physical health of adults. It could be assumed therefore, that the disease burden of childhood adversities is high. It has not yet been examined, however, whether this is true.Method
We used data of a large representative sample (N = 7,076) of the general population in the Netherlands. We calculated the disability weight (DW) for each respondent. The DW is a weight factor that reflects the severity of a disease or condition on a scale from 0 (perfect health) to 1 (equivalent to death). We used an algorithm based on the SF-6D to estimate DW. Because the DW indicates the proportion of a healthy life year that is reduced by the specific health state of the individual, it also possible to calculate the total number of years lost due to disability (YLD) in the population. We calculated the years lived with disability (YLD) for 9 different childhood adversities (in the areas of parental psychopathology; abuse and neglect; major life events), as well as for major categories of mental disorders and general medical disorders.Results
All 9 adversities resulted in a significantly increased DW, except death of a parent before the age of 16. Adversities in the category of abuse and neglect are associated with the highest DWs (0.057), followed by parental psychopathology (0.031) and life events during childhood (0.012). All adversities (46.4% of the population reports one or more adversity) are associated with 20.7 YLD/1,000, which is more than all mental disorders together (12.9 YLD/1,000). The category of abuse/neglect has the highest YLD/1,000 (15.8), which is also higher than all mental disorders together. Adjustment for the presence of mental and general medical disorders resulted in comparable outcomes.Conclusions
Childhood adversities are more important from a public health point of view than all common mental disorders together, and should be a priority for public health interventions. 相似文献15.
Yin S 《Child abuse & neglect》2011,35(11):924-929
Objective
The objective of this study was to describe malicious nonpharmaceutical exposures in children reported to US poison centers.Methods
We performed a retrospective study of all nonpharmaceutical exposures involving children 7 years old reported to the US National Poison Data System (NPDS) from 2000 to 2008 for which the reason for exposure was coded as “malicious”. The American Association of Poison Control Centers definition and categorization of nonpharmaceuticals was used. Data collected for each case included age, gender, month and year of the exposure, the exposed substance or substances, intent, and poison center outcome designation. Fatality abstracts (summaries of the facts reported to the poison center) were reviewed.Results
Out of approximately 21.4 million exposures reported to NPDS during the study period, 4,053 cases involving 4,232 nonpharmaceuticals were identified. The mean number of cases per year was 450 (range 409-546) with no linear annual trend (p = 0.28). The median age was 3 years (1.5, 5) with boys constituting 57%. 4.5% of the cases resulted in moderate or worse outcomes in which the outcome was known. The most commonly reported major categories were household cleaning substances (23%), cosmetics/personal care products (13%), pesticides (8%), other/unknown nondrug substances (6%), foreign bodies/toys/miscellaneous (5%), alcohols (5%), hydrocarbons (4%), lacrimators (4%), chemicals (4%), and deodorizers (3%). Four children died and 18 others had lifethreatening injuries. Among these 22 children, cleaning substances (7) were the most common major category followed by chemicals (4), alcohols (3), fumes/gases/vapors (2) and six other categories with 1 each. In the only case where the presence or absence of associated physical injuries was described, the child had multiple injuries consistent with physical abuse.Conclusion
Malicious administration of nonpharmaceuticals is an important component of child maltreatment with cases being reported consistently to poison centers.Practical implications
Clinicians should consider the possibility of child abuse when presented with these exposures. 相似文献16.
Objective
To explore whether adults possess implicit attitudes toward children and whether those attitudes are especially negative among respondents who are high in child physical abuse (CPA) risk.Methods
The present study used an implicit evaluative priming procedure. In this procedure, participants were instructed to make decisions about the evaluative implications of target words. These words were preceded by photographs of child faces or adult faces displaying positive, neutral, or negative expressions. Reaction times for the evaluative decisions were used as an index of the extent to which photos invoked negative or positive evaluative reactions.Results
Results from 2 studies, the first conducted on a student sample (N = 90) and the second on a parent sample (N = 95), demonstrated that evaluative congruence between the facial expressions displayed in photographs and the target words facilitated responses. Furthermore, the results suggested that regardless of CPA risk, child faces, relative to adult faces, facilitated responses to negative target words, suggesting an out-group bias. This implicit out-group bias was not moderated by respondents’ CPA risk status.Conclusions
Faces of children, relative to faces of adults, appear to activate negative information structures that facilitate evaluative decisions of negative stimuli, suggesting an out-group bias. Given that out-group biases typically lead to less favorable treatment of out-group members, additional research is needed to examine the pervasiveness of negative evaluative biases towards children and the potential implications of such biases on children's lives. Further, research examining whether high CPA risk parents and low CPA risk parents differ in how they manage initial negative evaluative reactions is needed. 相似文献17.
Objective
Children of mothers with mental illness are at risk for multiple untoward outcomes, including child maltreatment and foster care placement. The purpose of this analysis was to determine the association between maternal mental illness and children's long term safety and stability.Methods
A multi-sector administrative dataset from the Department of Social Services (DSS) and Department of Mental Health (DMH) was analyzed. The sample was 4,895 low income families (mother and child dyads) first reported to child welfare in 1993 or 1994. Families were followed until March of 2009. Dates of new report and foster care placement were obtained from DSS data. ICD-09 or ICD-10 diagnostic codes were obtained from Department of Mental Health data. Schizophrenic disorders, episodic mood disorders, anxiety disorders and personality disorders were examined.Results
New reports were more likely for children of mothers with mental illness, regardless of diagnosis. While overall 67% of children had a new report over the course of their childhood, rates ranged from 80 to 90% for children of mothers with mental illness and occurred within a shorter time frame than for other children. In the multivariate models, mood (HR = 1.41, p < .001) and anxiety disorders (HR = 1.32, p < .05) placed children at greater risk for new reports. The proportion of children with foster placements was more than double for children of mothers with mental illness than for other children. In the multivariate model, anxiety disorders were strongly associated with the risk of placement (HR = 1.75, p < .001).Conclusions and Practice implications
Important differences in safety and stability were found between children of mothers with and without mental illnesses, as well as some variability across diagnoses. Since these mothers had already received services our findings suggest that access is not enough. The services they are receiving or have received may be an ineffective approach to helping them parent safely. 相似文献18.
Objective
While the relationship between abusive parenting and violent delinquency has been well established, the cognitive and emotional processes by which this occurs remain relatively unidentified. The objective of this work is to apply a conceptual model linking abusive parenting to the conversion of shame into blaming others and therefore to violent delinquency.Methods
A retrospective study of 112 adolescents (90 male; 22 female; ages 12-19 years; M = 15.6; SD = 1.4) who were incarcerated in a juvenile detention facility pending criminal charges, completed measures of exposure to abusive and nonabusive discipline, expressed and converted shame, and violent delinquency.Results
Findings tend to confirm the conceptual model. Subjects who converted shame (i.e., low expressed shame, high blaming others) tended to have more exposure to abusive parenting and showed more violent delinquent behavior than their peers who showed expressed shame. Subjects who showed expressed shame (i.e., high expressed shame, low blaming others) showed less violent delinquency than those who showed converted shame.Conclusions
Abusive parenting impacts delinquency directly and indirectly through the effects of shame that is converted. Abusive parenting leads to the conversion of shame to blaming others, which in turn leads to violent delinquent behavior.Practice implications
For juvenile offenders, the conversion of shame into blaming others appears to contribute to pathological outcomes in relation to trauma. Translation of this work into clinical practice is recommended. 相似文献19.
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20.