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Lessons learned from LONGSCAN Presented by Diana English, PhD

Lessons learned from LONGSCAN Presented by Diana English, PhD Child Welfare Research Group University of Washington, School of Social Work Desmond K. Runyan, MD, DrPH University of North Carolina at Chapel Hill. Acknowledgments. U.S. Department of Health and Human Services

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Lessons learned from LONGSCAN Presented by Diana English, PhD

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  1. Lessons learned from LONGSCAN Presented by Diana English, PhD Child Welfare Research GroupUniversity of Washington, School of Social Work Desmond K. Runyan, MD, DrPH University of North Carolina at Chapel Hill

  2. Acknowledgments • U.S. Department of Health and Human Services • Administration for Children, Youth, and Families • Children's Bureau • Office on Child Abuse and Neglect • National Institutes of Health • National Institute of Child Health and Human Development  

  3. LONGSCAN Background • 1990 NCCAN funded consortium • Focus on child abuse & neglect • Need for theory-based longitudinal studies • Address CAUSES & CONSEQUENCES of abuse and neglect • Implications for… • Preventing maltreatment (initial or reoccurrence) • Preventing negative effects of maltreatment • Promote recovery

  4. Overview of LONGSCAN • LONGitudinal Studies of Child Abuse & Neglect • 5 distinct studies (East, South, Midwest, Northwest , & Southwest) • Measurement & data coordinated at UNC coordinating center • Common measures, coding, training, data entry • Consortium governance agreement • Committees for governance, measurement, analysis, and publications/dissemination • For more information, see Runyan et al. 1998

  5. Current Status • Data collection on-going - Youth now 14 - 22 years old • Data summarized & updated 4 times a year - Data are distributed to sites twice a year • Data archived with the National Data Archive on Child Abuse and Neglect (NDACAN) - Age 4, 6, 8, and 12 interviews - Contact interviews through age 11 - Includes CPS record reviews

  6. Data Collected (Baseline to age 18) Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18.

  7. Data Collected (Baseline to age 18) Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18. 8

  8. Sample Demographics (Baseline to Age 16) Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14 and 16.

  9. Caregiver Demographics (Baseline to Age 16) Notes. + Data collection on-going at age 14 and 16. 10

  10. Measurement • Guided by Social-Developmental-Ecological Theory(NRC, 1993; Bronfenbrenner, 1989; Hawkins & Catalano, 1996). • Domains assessed: • Child/Youth: Characteristics, functioning • Caregiver: Characteristic, functioning • Family microsystem: Home environment, functioning • Macrosystem: Neighborhood, school, support

  11. Measurement • Multiple sources & methods • Reports/ratings/questionnaires (Child/Youth, Caregiver, and Teacher) • Performance (Child/Youth) • Situational tests/samples • Official records (CPS) • Presentation of measures • Interview & Audio-Computer Assisted Self Interview (A-CASI)

  12. LONGSCAN Publications to Date Note. Publications as of February ’09.

  13. Exposure of LONGSCAN To Maltreatment

  14. Maltreatment History • Expand definitions & methods • Look at maltreatment • Physical & sexual abuse, neglect, emotional, witnessed violence (home and community) • Beyond just the occurrence: yes/no • Multidimensional (focus on degree or extent - CAN special issue May, 2005) • Beyond CPS report • Age 12 youth self-report

  15. # of Maltreatment Records/Referrals per Child (birth through age 14) 7 Records (3%) 6 Records (4%) 8-22 Records (12%) 5 Records (5%) 4 Records (7%) 3 Records (9%) 1 Record (16%) 2 Records (12%) Total N = 1354

  16. Age of First Record/Referral (birth through age 14) Descriptive Stats (0-14): Total N of kids with record = 916 Mean Age = 2.2 years (SD = 2.9) Range of Ages = 0 – 14.4 Median Age = 1.2 # of Children Age of First Record/Referral

  17. # of Allegations by Maltreatment Type (birth through age 14) # of Allegations Based on Baseline Sample (N = 1354) Age

  18. # of Substantiations by Maltreatment Type (birth through age 14) Descriptive Stats (0-14): Total # of substantiations (0-14) = 2282 Total # of physical abuse substantiations (0-14) = 369 Total # of sexual Abuse substantiations (0-14) = 99 Total # of neglect substantiations (0-14) = 1456 Total # of emotional abuse substantiations (0-14) = 358 Frequencies (0-14): 49% have 1 or more substantiations 14% have 1 or more physical abuse substantiations 6% have 1 or more sexual abuse substantiations 41% have 1 or more neglect substantiations 17% have 1 or more emotional abuse substantiations # of Substantiations Based on Baseline Sample (N = 1354) Age

  19. Findings: Maltreatment Dimensions – Substantiation Status • Are there outcome differences for children reported & substantiated compared to those who are reported and NOT substantiated? • No differences on 10 developmental, social, emotional and behavioral outcomes for substantiated vs. not substantiated (Hussey et al., 2005).

  20. Maltreatment Allegations by Severity (birth through age 14) Note. Only includes participants who have an allegation.

  21. Findings: Maltreatment Dimensions - Severity • Severity construction: • Maximum severity within type • Maximum severity across type • Total or sum of maximum severity • Mean severity • Maximum severity by type best predictor of outcomes including adaptive functioning and anger (Litrownik et al., 2005).

  22. Chronicity of Maltreatment(birth through age 14) 16.4% 34.5% 20.3% 13.1% 15.7% N = 903

  23. Findings: Maltreatment Dimensions - Chronicity • Developmental vs. Calendar to examine consequences over time. • The developmental approach across a child’s lifespan was the most sensitive – as well as looking at extent (across developmental stages) and continuity (whether there are any gaps) (English et al., 2005).

  24. Findings: Maltreatment Dimensions -Type • Hierarchical Type – prioritized abuse vs. neglect • Severity/Frequency Type – based on highest severity or frequency • Expanded Hierarchical – differentiated multiple vs. single sub-types • All three types predicted child social/emotional and behavioral functioning, however, differentiating multiple vs. single sub-types was the more outcomes (Lau et al., 2005).

  25. Findings: Maltreatment Dimensions - Combined • Type, severity, chronicity and age at first report. • Individual maltreatment dimensions have distinct effects on child functioning. • Type (based on maximum severity of each type) most consistent predictor across outcomes, however different types predicted different outcomes (English et al., 2005).

  26. Findings: Maltreatment Dimensions - Combined • A comprehensive assessment of a child’s maltreatment experience (not just the presenting incident) including type and severity. • Age of onset • Pattern (extent and continuity) • All are important in understanding the outcome of maltreatment on children’s growth and development. (see Child Abuse & Neglect Volume 29: 2005)

  27. Self Report of Abuse (birth through age 12) * Indicators are NOT mutually exclusive (N = 881) (N = 874) (N = 883)

  28. Comparing Substantiations to Child Self-Report (birth through age 12) 3.2% 4.3% Psychological Abuse (N = 883) 18.6% 14.2% 7.8% 80.9% 7.7% 33.0% 51.2% 8.1%

  29. Concordance between Child Self-Report and CPS Substantiations • Classifying children/youth with profiles improves ability to identify antecedents and consequences of maltreatment: • No PA/SA • High PA, Low SA • No PA/Moderate SA • High PA, High SA • (35% Youth did not endorse CPS reports) • Agreement between CPS report and self-report not high (Everson et al., 2008).

  30. Concordance between Child Self-Report and CPS Substantiations • A-CASI interview rates of abuse 4-6 X higher than in CPS records (Everson et al., 2008). • Adolescent psychological adjustment (measured by TSCC & YSR) more strongly associated with self-report than with CPS determination (Everson et al., 2008).

  31. Discussion • Implications of LONGSCAN findings on maltreatment for policy and practice

  32. Foster Care in LONGSCAN

  33. Foster Care: First 18 months • Examined number of placements during first 18 months following removal (N = 415) • 1-15 placements : Mean = 4.23 placements • Child behavior problems at time of initial placement predicted subsequent # placements. • # prior placements predicted later behavior problems for those who did not have problems initially (Newton et al., 2000).

  34. Long-Term Placement and Violence Exposure • Children placed in out of home care before 3.5 • At age 6 Reunified children: • Had more exposure to family violence • Experienced more adverse life events • Evidenced increased internalizing problems • Received fewer mental health services • However, felt less isolated • Parents of adoptive kids used more minor violence than foster parents for discipline • Adoptive kids report witnessing less violence in the home (Lau et al., 2003; Litrownik et al., 2003).

  35. Long-Term Stability of Early Foster Care Sample • Examine caregiver stability for children age 6 to 8 who were removed prior to age 3.5 (N = 285). • 1 in 7 unstable • Adoption most stable (compared to reunified, kin care, and non-kin care) • Other predictors of stability: father involvement; child intellectual functioning • Predictors of instability: Child behavior; expressive family (Randazzo et al., under review).

  36. Foster Care – Discipline Practices and Child Aggression, Kin & Non-Kin • Kin use more harsh disciplinary practice (N = 80). • Parents who use aggressive problem solving strategies have more aggressive youth (DeRobertis & Litrownik, 2004).

  37. Discussion • Implications of foster care findings on policy/practice.

  38. Family Context • Caregiver violence exposure as a child/adult • Current and/or recent domestic violence/family conflict • Caregiver depressive symptomatology • Parenting

  39. Neglect – A Different Conceptualization • Definition of neglect as psychological and physical safety and security. • Unsafe or dirty home & untreated behavioral problems predicted language impairments & developmental problems (Dubowitz et al., 2005). • A stimulating home environment predicted less impairment in cognitive development (Dubowitz et al., 2005).

  40. Neglect – A Different Conceptualization • Multiple changes in residence predicted externalizing behavior problems (Dubowitz et al., 2005). • Exposure to verbally aggressive discipline predicted more behavior problems (Dubowitz et al., 2005). • Conclusion: Important to conceptualize neglect in terms of child’s developmental needs (safety and security).

  41. Neglect • Examined individual and cumulative relationship among physical, psychological and environmental neglect and development (Age 3-5, N =136 - FTT & HIV Risk). • Psychological neglect associated with increased internalizing/externalizing problems. • Cumulative neglect index associated with internalizing problems

  42. Influence of Early and Later Maltreatment on Childhood Aggression at ages 4, 6 & 8

  43. Influence of Early and Later Maltreatment on Childhood Aggression at ages 4, 6 & 8 • This study suggests that early neglect may be a more important precursor of youth violence than is physical abuse (Kotch et al., 2008). • Limitations: • not a representative probability sample • the possibility of false negatives cannot be ruled out • site is a potential confounder

  44. Caregiver’s History of Violence Exposures as a Child and/or Adult (age 4) • Of those assaulted (n = 608): • 52% experienced some form of physical assault/abuse as a child or teenager. • 44% experienced some form of sexual assault /abuse before age 13. • 36% experienced some form of sexual assault/abuse as a teen. • 75% experienced some form of physical assault as an adult. • 22% experienced some form of sexual assault as an adult. Caregiver Report at Age 4 Interview (N = 923)

  45. Caregiver’s History of Violence Exposures as a Child and/or Adult • Maternal child victimization more powerful indicator of child behavior problems at age 4 than caregiver adult victimization (Thompson, 2007). • Caregivers victimized during childhood and adulthood had worse outcomes than if victimized either as an adult or child, or no victimization (Dubowitz et al., 2001).

  46. Caregiver’s History of Violence Exposure as a Child and/or as an Adult • Chronic victimization in childhood and adulthood more common than victimization in childhood alone or as an adult alone (Dubowitz et al., 2001). • Women who were physically and/or sexually abused had worse outcomes than those with only one type of abuse (Dubowitz et al., 2001).

  47. Caregiver’s History of Violence as a Child and/or as an Adult • Caregivers victimized in childhood and adulthood had: • More depressive symptomatology; • Used harsher parenting behaviors; • Children had higher internalizing and externalizing scores on the CBCL (Dubowitz et al., 2001).

  48. Caregiver’s History of Violence Exposure as a Child and/or as an Adult • Caregivers with a history of CSA at increased likelihood of a violent adult relationship (English et al., 2003). • Caregivers with a history of child physical abuse at increased risk of a violent adult relationship (English et al., 2003).

  49. Caregiver’s History of Violence Exposures as a Child and/or as an Adult • Caregivers with a history of CSA more depressed (Thompson, 2006). • Adult victimization and depression predicted maltreatment (Thompson, 2006). • Adult sexual victimization predicted problem drinking but not maltreatment (Thompson, 2006). • Maternal adult physical victimization predicted a 2-3 fold increase in risk of maltreatment (Thompson, 2006).

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