Child Maltreatment

Research suggests children from non-White and Hispanic/Latinx communities are at higher risk for child maltreatment. This study identified in which states children from specific non-White communities were overrepresented in child protective services reports for child physical, sexual, and emotional/psychological abuse through exploratory mapping. Reports on child maltreatment originated from the 2018 National Child Abuse and Neglect Data System and state-level population estimates from the U.S. Census Bureau. Racial disparities were identified in states with unequal proportions of reported child maltreatment among a non-White child population compared to the proportion among the White child population. We found disparities for children from non-White communities in many states, especially for Black communities (Disparity Ratio [DR]: 15.10 for child physical abuse, DR: 12.77 for child sexual abuse in Washington DC, and DR: 5.25 for child emotional/psychological abuse in California). The ability to identify high disparities among Pacific Islanders highlights one of the study’s strengths, given we separately examined Asian Americans, Pacific Islanders and multiracial communities. Results from our exploratory mapping provide insight into how preventive resources might be differentially allocated to non-White communities with higher child protective services reporting compared with White communities, and manifest states with multiple non-White communities overrepresented across maltreatment types.

Recent changes to federal legislation created a requirement for states to address the needs of infants with prenatal substance exposure. Understanding clinical outcomes among substance exposed infants prior to these changes is important for establishing a baseline of risk and informing systems-level responses. Using North Carolina, Georgia, and Texas Medicaid data, we examined the incidence of inpatient and outpatient diagnoses for injury, maltreatment, and developmental disorders prior to age 12 months and compared types of diagnoses among substance exposed and unexposed infants. The cumulative incidence of maltreatment (1.2% vs. 0.2%) and developmental disorder (10.7% vs. 1.5%) diagnoses prior to age 12 months was significantly higher among substance exposed compared to unexposed infants. The incidence of injury diagnoses was similar (3.7% vs. 3.4%). We observed differences in types of maltreatment and injury diagnoses. For example, diagnoses for neglect were more common among substance exposed infants while diagnoses for physical abuse were more common among unexposed infants. Results provide insight for informing monitoring and intervention by medical and public health professionals.

This study investigated child protection decision-making practices of healthcare-professionals in community-health-services. We examined the effect of heuristics in professional judgments regarding suspected maltreatment, as affected by the child’s ethnicity, gender, and family socioeconomic-status, as well as the healthcare-worker’s workload-stress, and personal and professional background. Furthermore, we examined how these variables influence judgments regarding suspected maltreatment and intentions to consult and report child-maltreatment. We used an experimental survey design including vignettes manipulating the child’s characteristics. Data was collected from 412 professionals employed at various community-health-service-clinics of the largest health-management organization in northern Israel. Findings show that all subjective factors have a significant effect on suspected child-maltreatment assessment, which appears as a significant predictor of later decisions regarding consultation and reporting. This study lends support to prior research indicating that healthcare-professionals’ decisions may incorporate biases, and suggests how the effects of these biases’ are mediated through a sequence of decisions. Recommendations focus on providing regular consultation opportunities for practitioners.

Children in foster care face disproportionate rates of biopsychosocial challenges but social and extracurricular activities (SEAs) may support their healthy development. The Reasonable and Prudent Parenting Standard (RPPS), a 2014 federal policy, aims to increase access to these opportunities for children in foster care. Analyses of statutes from 50 US states and the District of Columbia (n = 51) revealed similarities and differences in state-level RPPS policy implementation. Building on these findings, researchers conducted semi-structured retrospective telephone interviews with foster parents across one southeastern state (n = 20) to identify local retrospective perspectives on RPPS implementation. Using thematic inductive coding two unique themes emerged about SEAs prior to RPPS: 1) negative social impacts and 2) complicated activity approval processes. Three unique themes emerged after RPPS: 1) empowerment, 2) implementation disparities and 3) resource recommendations. Policy implications include the need to support foster parents by increasing resources (funding, transportation, access), clarifying liability and clarifying motivation expectations.

There is growing consensus that outpatient health services for young people (aged 12–25 years) need to deliver trauma-informed care to ameliorate the effects of trauma, offer safe treatments, and avoid retraumatization. Trauma-informed care has become a familiar term for many professionals; however, its operating definition lacks clarity. MEDLINE, Embase, and PsycINFO were systematically searched to clarify what trauma-informed care is, and what it should achieve in these settings. We reviewed 3,381 unique records, of which 13 met criteria for inclusion. Content analysis identified 10 components of trauma-informed care as it has been operationalized in practice: seven of these occurred at the system-level (interagency collaboration; service provider training; safety; leadership, governance and agency processes; youth and family/carer choice in care; cultural and gender sensitivity; youth and family/carer participation), and three involved trauma-specific clinical practices (screening and assessment; psychoeducation; therapeutic interventions). There is a need for greater consensus regarding an operating definition of trauma-informed care and further research into outcomes for young people and their families/carers.

Child maltreatment is associated with elevated risk of post-traumatic stress disorder (PTSD), which can often present alongside comorbidities. While evidence-based treatments for PTSD in young people already exist, there remains ongoing clinical and academic debate about the suitability of these approaches, particularly cognitive-behavioral approaches, for young people who have been exposed to more complex traumatic experiences, such as maltreatment. We conducted an updated systematic review of the evidence-base for psychological treatments for PTSD, specifically for maltreated young people. Fifteen randomized controlled trials and five non-randomized controlled clinical trials satisfied the inclusion criteria. Trials included treatments ranging from trauma-focused CBT to creative-based therapies. Trauma-focused CBT remained the best supported treatment for children and adolescents following child maltreatment, with new evidence that symptom improvements are maintained at longer-term follow up. The evidence for other therapies remained limited, and there were concerns regarding methodological quality. Implications for treatment decision-making are discussed.