From Science to Practice: Findings from the LONGSCAN studies

1. From Science toPractice: Findings from the LONGSCAN studies The LONGSCAN Investigators April 19, 2013

2. Acknowledgements LONGSCAN was funded for two decades by the Children’s Bureau Office of Child Abuse and Neglect, with additional funding received from NIH and CDC. From Science to Practice is funded by a grant from the Doris Duke Charitable Foundation to the Injury Prevention Research Center of The University of North Carolina at Chapel Hill,

3. Why Are We Here? • To translate 20 years of longitudinal research on child abuse and neglect into actionable practice and policy recommendations. • To build upon the recommendations gathered from five similar meetings that included LONGSCAN graduates, held in LONGSCAN sites throughout the country. • To share select findings and recommendations with practitioners and policy.

4. What is LONGSCAN? • LONGitudinalStudies of Child Abuse and Neglect • Funded in 1991 by the Office on Child Abuse and Neglect of the Administration on Children and Families to follow families for 18 years. • Five sites across the country, a total of 1354 families studied. • Variety of research disciplines: Pediatrics, Public Health, Psychology, Social Work, Epidemiology.

5. Safety

6. Safety We can identify children who are at risk for abuse and neglect from the moment they are born using a combination of risks which often persist from early childhood through adolescence.

7. Safety • For children who come into contact with CPS at an early age, maltreatment is only one of a multitude of adversities (e.g., family dysfunction, drug use, involvement in the criminal justice system, homelessness) that they are exposed to. • A report of child abuse & neglect, whether substantiated or not, is a sign that families are under stress, probably from some combination of adversities, and abuse and neglect may be just one of them.

8. Safety • Neglect is more difficult to identify than physical abuse, yet in children four and under, neglect is more likely than physical abuse to lead to aggression in later childhood. • Early neglect is especially harmful to children. • Neglect is more likely when fathers feel less effective in parenting. Some fathers may feel intimidated or inadequate as providers of child care.

9. Safety • Violence in the home, including verbal aggression and female-to-male aggression, has negative consequences for children even if not directed at them. • The risk of aggression, anger, and depression for an eight-year old who witnesses violence is similar to that for a child who actually experiences abuse. • Early problems with aggression often persist into adolescence.

10. Safety • Maltreated children are typically exposed to multiple forms of maltreatment over their lifetimes. • No one type of maltreatment or witnessed violence definitively predicts worse outcomes for children. • Psychological maltreatment, alone or in combination with other forms of maltreatment, can be just as detrimental to children.

11. Safety • Maltreated children may not be safe from themselves. • Thoughts of suicide are relatively common in abused and neglected children and are seen in children as young as 8 years of age.

12. Recommendations • Identify highest risk infants prior to birth. • Consider cumulative risk as an indicator of need for services. • Assessment of a broad range of experiences—including witnessed violence and psychological maltreatment—is necessary to better match services to needs. • Train all professionals dealing with children in recognizing and responding to psychological abuse and witnessed violence.

13. Recommendations • Consider a federal data sharing policy recommendation to promote sharing between agencies servicing at-risk and maltreated children and families. • Find ways to provide more integrated multi-agency services to high risk and maltreated children and their families. • Devote more attention during both assessment and related interventions for early neglect (<2 years). • Assess children who are victims of maltreatment for risk of suicidal thoughts.

14. Recommendations • Broaden our view of intimate partner aggression and violence to include verbal aggression and intimate partner violence perpetrated by women to better identify child witnesses. • Increase screening for intimate partner aggression and violence by asking children directly. • Access mental health assessment and treatment for children who have been exposed to violence in the home.

15. Permanency

16. Quotes • I know what I went through personally (that) no one should have to go through. You know, like, being in 29 different homes from 3 to 18; unacceptable, absolutely unacceptable. • I think it’s interesting how they are, like, not supposed to give you back to the parent if they are still using drugs, like they are supposed to being given a drug test just to make sure. Like she’s clean and sober now, but trust me, in a month she will be back to what she was doing. Like she’ll only get clean for the sake of trying to get us. They don’t do a follow-up, like oh, are you still sober? It was like, it really sucks.

17. Permanency • For the majority of youth served by CPS, foster care does not result in a permanent stable physical or emotional caregiving environment. • Early permanent placement types differ with regard to the mental and physical health of the caregiver and household income. • Adoptive parents and non-kin caregivers tend to be healthier and wealthier than relative caregivers, who in turn are healthier and have higher incomes than biological (i.e., reunified) parents.

18. Permanency • In the short term, adopted children have fewer behavior problems than those in other placements, with reunified children having more problems but feeling more socially connected. But: • The fact that foster children are adopted or reunified does not mean they are necessarily in a stable environment, and • Foster children who move into permanent placement need to continue to receive services.

19. Permanency • In the long term, • A history of instability is associated with more subsequent problems, and • Some youth (i.e., adopted youth) who appeared to have fewer problems initially may evidence more problems later on.

20. Recommendations • Take a long-term perspective—follow children who enter foster care beyond exit. • Expand our understanding of stability. • Determine services according to a child’s maltreatment risk or status, not according to a child’s official placement.

21. Recommendations • Develop policies that address both formal and informal kinship/foster family living situations. • Make services, such as financial support and support in navigating medical care, available to parents, families and children living in both formal and informal kinship care.

22. Well-being

23. Well-being • Social Support • Social Support of caregivers reduces the risk for and the consequences of abuse and neglect in children. • Children who report more support from fathers showed less depression, greater social competence, and were more socially accepted. .

24. Well-being • Fathers • Father presence is associated withbetter cognitive development and children’s perceived competence. • However, the presence of a live-in boyfriend increases the risk for maltreatment relative to a biological father or no father

25. Recommendations • Remove barriers to fathers’ involvement with their children. • Convey to fathers and father figures how their children can benefit from their involvement. • Help fathers feel competent in parenting.

26. Recommendations • Take a public health approach to preventing child maltreatment. • Primary prevention ofall types of maltreatment should lead to • Fewer emotional, behavioral, and school problemsamong children and youth, and • Less youth violence.