Students Review the Extent of Evidence for Interventions that may increase safety for children November 14, 2007
Posted by dianedepanfilis in Child Safety.trackback
Students in the School’s Child Welfare Research class have each conducted reviews of evidence about interventions that may increase child safety for children. These reports range in focus from primary prevention programs (like education to prevent incidents of shaken baby to interventions that might address the consequences of child maltreatment and prevent the recurrence of child maltreatment, to interventions that focus on helping adolescents in foster care prevent future maltreatment of their children). They will each post a brief version of their reports by replying to this post. I hope you join in the discussion about what “might” work to decrease the risk of child abuse and neglect and increase safety for children.
Abuse-Focused Cognitive-Behavioral Therapy
Research in child welfare is both necessary and overlooked. Often a program or therapeutic technique is implemented and advertised without proper research and support for the efficacy of the intervention. The following report is concentrating on Abuse-Focused Cognitive-Behavioral Therapy (AF-CBT), a therapeutic intervention aimed at physically abused children and their offending parents. This program is unique in that is has components aimed at parents, children and the family interaction. It is that particular layout that makes this program an effort at increasing child safety by lowering recidivism of physical child abuse. Many programs only have elements for the traumatized children. As important as that is for child well-being, in order to properly address the safety of the children, it is necessary to also have treatment aimed at the offending parents and their families.
There is a plethora of research available on risk factors for physical abuse of children. In an effort to make logical connections between the risk factors and AF-CBT, I chose to concentrate on one salient risk factor. Research indicates that many parents physically abuse their children because they do not process information from their children correctly. Abusive parents tend to view their children more negatively, have poor conceptual ability, have problem- solving difficulty and have a lack of cognitive flexibility, which makes it difficult for abusive parents to respond appropriately to the needs of their children and places them at high risk to abuse (Milner, 1993; Mammen, Kolko, & Pilkonis, 2002; Montes, de Paul, & Milner, 2001).
The purpose of AF-CBT is to increase the ability of parents to understand and relate to their children and to decrease angry and destructive behavior towards children. Addressing these cognitive needs is accomplished through intensive cognitive-behavioral therapy from a trained therapist with the offending parent. As mentioned previously, AF-CBT also targets children and the family unit. The therapist conducts therapy privately with the children and does family therapy as well.
AF-CBT is a relatively new intervention and there have not been any randomized controlled trials as a result. However, AF-CBT is largely based on cognitive-behavioral therapy (CBT) and there is significant research on the efficacy of CBT in working with physically abused children. David Kolko is the founder of AF-CBT and has researched CBT as a form of treating physically abused children and their families. The results of his work indicate that CBT is an efficacious way to treat this population. As AF-CBT relies heavily on the components of CBT, the research on CBT can be used in support of AF-CBT.
The research indicates that AF-CBT has the potential to be a promising practice for reducing recidivism of physical abuse, but it is too early and not enough evidence is available to know the effectiveness with certainty. Therefore this writer recommends future research be conducted which investigates the implementation of AF-CBT specifically, with a child welfare population. David Kolko is currently running a study called “Partnership for Families” through funding from the National Institute of Mental Health, which is investigating AF-CBT with families that have been involved with the child welfare system because of physical abuse allegations. These results will be extremely useful in determining the efficacy of the intervention, but more research is needed.
To reach a point where AF-CBT can be promoted, there must be a plethora of published studies showing success. This writer believes AF-CBT has tremendous promise to reduce recidivism of child physical abuse in a child welfare population. This intervention combines the essential ingredients of treating the child and the parents, as well as focusing efforts on the cognitive improvement of the parents.
For more information, please examine the following websites and journal articles:
Abuse-Focused Cognitive Behavioral Therapy (AF-CBT)-Detailed Report from The California Evidence-Based Clearinghouse for Child Welfare. Retrieved September 21 from http://www.cachildwelfareclearinghouse.org/program/9/detailed
Abuse-Focused Cognitive Behavioral Therapy for Child Physical Abuse from the Child Welfare Information Gateway. (2007, March). Retrieved September 21, 2007 from http://www.Childwelfare.gov/pubs/cognitive/
Kolko, D. J. (1996). Clinical monitoring of treatment course in child physical abuse:psychometric characteristics and treatment comparisons. Child Abuse and Neglect, 20(1), 23-43.
Mammen, O.K., Kolko, D.J. & Pilkonis, P.A. (2002). Negative affect and parental aggression in child physical abuse. Child abuse and Neglect, 26(4), 407-424.
Milner, J.S. (1993). Social information processing and physical child abuse. Clinical Psychology Review,13, 275-294.
Montes, M.P., de Paul, J. & Milner, J.S. (2001). Evaluations, attributions, affect, and disciplinary choices in mothers at high and low risk for child physical abuse. Child Abuse and Neglect, 25,1015-1036.
Partnerships for Families. (2007 September 1). Retrieved October 7, 2007 from http://www.wpic.pitt.edu/research/aft/abstract.html
Treatment for Mothers of Addicted Newborns
A key child welfare outcome is the safety of children, (i.e. preventing the future serious maltreatment of children who have been reported to Child Protective Services). It has been estimated that parental substance abuse is the major factor for 40% to 80% of families involved with child welfare services (Child Welfare League of America, 2004); however, there are relatively few empirically sound studies or nationally representative data on this issue (Young, Boles, & Otero, 2007). Parental substance abuse impacts children in multiple ways.
A study conducted by Scannapieco and Connell-Carrick (2007) found that maltreating substance users were more likely than non-maltreaters to have an impoverished home environment; more stressors in their home; fewer parental resources; less knowledge of children and child development; fewer parental skills; less parental capacity; provided poorer quality of care to their children; provided poorer emotional care; and had poorer connections to their children (including attachment problems and lack of empathy for the child). Scannapieco and Connell-Carrick also indicated that families who used drugs or alcohol had a more serious and chronic pattern of maltreatment (2007). As shown by the above risk factors, parenting ability is greatly impacted with the use of a substance as it jeopardizes the child’s basic needs of receiving nurturance, supervision, and nutrition; hence, creating potentially neglectful situations. To increase safety for children, it is important that we understand what interventions are most effective for keeping children safe, particularly when their parents have substance abuse problems.
One particular program developed to serve the child welfare population in Maryland is the Treatment for Mothers of Addicted Newborns, better known as TMAN. The purpose of TMAN is to prevent future child maltreatment in the drug-addicted population by offering supportive services and treatment. TMAN is a three tiered program that begins at the hospital utilizing the Health Department’s Infants at Risk (IAR) program. The IAR utilize the SB 512 Drug-Exposed Newborn Report to make referral decisions regarding drug dependency. If a woman or child meets criteria based on the report then the LDSS is contacted for an investigation. All drug-exposed newborns are referred directly to the TMAN unit, which is comprised of specialized CPS caseworkers who complete an initial assessment and provide home-visits, case management services, and support to the families. TMAN’s third tier of service is the Health Department’s Children and Parents (CAP) program. CAP consists of intensive outpatient services offering substance abuse treatment and mental health services that include: group, individual, and family counseling; psychiatric care; and specialty classes for parenting and anger management. Although not yet widespread or clearly documented, TMAN has been successful at identifying drug-addicted mothers and newborns and getting women into treatment as indicated by their 2004 fiscal year results. TMAN received 61 referrals, 31 of which subsequently entered into treatment (DHR, n.d.).
TMAN currently lacks research on its effectiveness in increasing core child welfare outcomes (i.e. child safety, child well-being, and permanency). The information that is available from the Department of Human Resources is in raw data format and only measures the number of referrals made to the program and the number of women who enter treatment. Since there has been no research conducted to date, TMAN would benefit from a True Experimental Randomized Controlled Trial, to assess whether this specialized intervention achieves any better outcomes for drug affected families than traditional child welfare services alone. More information about what works best with these families is needed to promote programmatic and policy changes so that effective services to addicted mothers and newborns become a standard of care.
To learn more about TMAN:
Department of Human Resources. (undated). Report on the Senate Bill 512/House Bill 1209 pilot program children in need of assistance-drug addicted babies. Unpublished raw data.
Maryland General Assembly. (1997). Senate Bill 512, fiscal note. Retrieved October 1st, 2007 from http://mlis.state.md.us/1997rs/billfile/sb0512.htm.
Project SUPPORT
quoted Holden et al. (1998), who “found that children exhibited fewer problem behaviors postshelter”. Therefore, after being removed from their violent home and having both an emergency shelter stay and second-stage aid, these children were at a reduced risk for child abuse.
Project SUPPORT is a useful program in relation to domestic violence victims and their children who have externalizing behavior problems, such as a conduct disorder. Domestic violence is extremely prevalent in our society. Every year approximately 600,000 children are physically abused in the United States (Black, Heyman, & Slep, 2000, p.121). “Approximately 15.5 million American children were estimated to live in families in which partner violence had occurred at least once in the previous year, with 7 million estimated to live in families in which severe partner violence had occurred” (McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006 (a), p. 137). Although these children may benefit from the removal of the violent partner, these mothers are often under a great deal of stress and lack social support. For example, research suggests that a change in life events may cause these mothers to become physically abusive mothers (Black et al., 2000, p. 129). “Three studies (Conger, Burgess, & Barrett, 1979; Rosenberg & Reppucci, 1983; Coohey & Braun, 1997) found that CPA [child physical abuse] parents, compared to non-CPA parents reported more stressful life changes,” (Black et al., 2000, p. 155). CPA children also “emitted more non-compliant behaviors” and “had more observed physically aggressive behaviors toward their mothers than did children from non-CPA families” (Black et al., 2000, p. 175). In a study completed by Jarvis and Novaco (2006) it was stated that, “children who received only emergency shelter intervention had higher internalizing and externalizing behaviors than those who received emergency and second-stage” (p. 1059). Jarvis and Novaco (2006, p. 104
Project SUPPORT is an intervention that has been implemented in Texas. The program selected women who were exiting a battered women’s shelter and had at least one child between the ages of 4 and 9 with a conduct disorder. The intervention lasted for 16 months and consisted of weekly counseling sessions which included providing the mother with instrumental and emotional support, as well as child management and nurturing skills. During these sessions, mentors interacted with the children. The purpose of the program was to aid the mothers in treating and reducing their children’s externalizing behavior problems.
The majority of the research on the subject of domestic violence related to conduct disorder and child abuse, has been done specifically on reducing conduct disorder, while only a few studies show the relation to child abuse reduction. There is little research on Project Support, especially due to the fact that Project SUPPORT appears to be the only program of its kind. However, the available research is important in proving Project SUPPORT’s assumptions and findings. For example, in a study by McDonald, Jouriles, and Skopp (2006 (b)),
“The results indicated that at 2 years posttreatment, 15% of children in families in the Project SUPPORT condition exhibited clinical levels of conduct problems compared with 53% of those in the existing services condition. In addition, mothers of children in the Project SUPPORT condition reported their children to be happier, to have better social relationships, and to have lower levels of internalizing problems, relative to children in the comparison condition. Mothers in the Project SUPPORT condition were less likely to use aggressive child management strategies and were less likely to have returned to their partners during the follow-up period (p. 127).
Thus, Project SUPPORT is shown to reduce the child’s behavior problems by intervening in the mother’s parenting and support. Although, there is little available research linking Project SUPPORT to the reduction of child abuse, other research suggests that the reduction of externalizing behavior problems and parental stress reduces child abuse (Black et al., 2000, p. 175). Therefore, additional research is needed for this topic and this program in order to show its true relevance to child abuse reduction. Research is also lacking in the long-term arena, as well as a variety of populations, especially in areas without domestic violence resources, such as Carroll County, Maryland. Jarvis and Novaco (2006) suggest that, “research on postshelter success of abused woman has been sparse, and even less is known about the psychosocial adjustment of their children following shelter residence” (p. 1047). Additional research will need to be conducted in order to assess the impact of shelter residence and domestic violence in children with developed conduct disorders as well as their mothers. It is also recommended that additional research concerning Project SUPPORT and its effectiveness with family victims of domestic violence with at least one child with a conduct disorder is needed. The lack of this needed research may explain why this program has not been implemented in other states, because sufficient research has been conducted to suggest it is needed.
References
Black, D. A., Heyman, R. E., & Slep, A. M. S. (2000). Risk factors for child physical abuse. Aggression and Violent Behavior, 6, 121-188.
Jarvis, K. L., & Novaco, R. W. (2006). Postshelter adjustment of children from violent families [Electronic Version]. Journal of Interpersonal Violence, 21 (8), 1046-1062.
Jouriles, E.N., McDonald, R., Spiller, L., Norwood, W. D., Swank, P. R., Stephens, N., et al. (2001). Reducing conduct problems among children of battered women [Electronic Version]. Journal of Consulting and Clinical Psychology, 69 (5), 774-785.
McDonald, R., Jouriles, E. N., Ramisetty-Mikler, S., Caetano, R., & Green, C. E. (2006 (a)). Estimating the number of American living in partner-violent families [Electronic Version]. Journal of Family Psychology, 20 (1), 137-142.
McDonald, R., Jouriles, E. N., & Skopp, N. A. (2006 (b)). Reducing conduct problems among children brought to women’s shelters: Intervention effects 24 months following termination of services [Electronic Version]. Journal of Family Psychology, 20 (1), (p. 127- 136).
For more information on Project SUPPORT:
The California Evidenced-Based Clearinghouse for Child Welfare (2007). Project SUPPORT- Detailed Report. Retrieved September 12, 2007 from http://www.cachildwelfareclearinghouse.org/program/50/detailed
Review of Evidence for Pathways Program for Teen Mothers to Increase Child Safety
Child safety is one of three outcomes related to Child Welfare services. In an attempt to reduce the risk of neglect and increase child safety, Pathways Program for Teen Mothers was implemented. Pathways Program aims to lower risk behaviors and increase protective factors. Pathways Program is an intervention that seeks to assist pregnant and parenting teens through the trials and tribulations of raising a child by helping the teen and her child achieve positive outcomes.
Pathways Program was administered to pregnant and teen mothers in South Carolina for a 24 month trial (McDonell, J.R., Limber, S.P., & Conner-Godbey, J., 2007). There were five specific types of services provided to teens which include case management, family group decision making, mutual assistance groups, life skills education, and leadership development. Participants involved were given the opportunity to participate in all services provided in the hopes the information and services provided would help improve the overall quality of life of the teens and their children. The Pathways Program’s purpose is to reduce and/or eliminate substance use among teen mothers, increase academic success, and prevent future pregnancies of teen mothers involved in the intervention.
The research conducted on Pathways program was limited to the study by McDonell, et al. Due to Pathways being a program provided only to African Americans in a rural setting, it is unknown as to how effective Pathways would be if provided to populations in various demographics and of different races. Pathways took into consideration that teens may be resistant to treatment, and therefore, creative ways to gain the teens interest in attempt to maintain the teens’ ongoing involvement in the program were implemented.
More research for this intervention is needed to draw concrete conclusions about the effectiveness of the Pathways Program. It is recommended that for future research that (1) the research is a randomized design and (2) the intervention is implemented with populations that are in urban areas, as well as with different populations of minorities such as Asians, Latinos, etc. or with the majority population, Caucasians. By providing the interventions to teens that Pathways has to offer, there may be a better understanding of the intervention to different populations.
More information on the Pathways Program and related programs can be found in the following journals:
Britner, P.A. & Reppucci, N.D. (1997). Prevention of child maltreatment: Evaluation of a parent education program for teen mothers. Journal of Child and Family Studies, 6(2), 165-175.
Feijoo, A.N. (1999). Teenage pregnancy, the case for prevention: An updated analysis of recent trends & federal expenditures associated with teenage pregnancy. 2nd ed. Advocates for Youth.
McDonell, J.R., Limber, S.P., & Connor-Godbey, J. (2007). Pathways teen mother support project: Longitudinal findings. Children and Youth Services Review, 29, 840-855.
Introduction
Maternal substance abuse is one of the most frequent causes of contact with the child welfare system for child abuse and neglect (Suchman, Pajulo, DeCoste, and Mayes, 2006 and Child Welfare League of America 1998). Comprehending the connection between parental substance abuse and child maltreatment is imperative in supplying family assessments, and in building improved intervention and prevention guidelines. Prevalence rates of substantiated cases of child maltreatment, including physical abuse and neglect that is directly related to substance abuse is roughly 50%-78% (Besinger, Garland, Litrownik, and Landsverk, 1999; Famularo, Kinschertt, and Fenton, 1992; and Murphy, Jellinek, Quinn, Smith, Poitrast, and Goshko, 1991). Additionally, 25% of childhood fatality cases from child abuse or neglect were due to maternal substance abuse (Albert, Klein, Noble, Zahand, and Holtby 2000).
Program Description
The Baltimore Family Recovery Program (FRP) is a fairly new program that addresses the increasing need for parental substance abuse treatment and management in Baltimore, Maryland The purpose of the FRP intervention is to decrease the length of stay for children in foster care whose parents are in the FRP and decrease substance abuse for families in the ERP. The FRP works in a collaborative effort with Child in Need of Assistance (CINA), the Department of Social Services, and the juvenile court to support the recovery for parental substance abuse. The program services up to 250 families currently in the child welfare system and who have at least one child in foster care between the ages of birth-5 years due to parental substance abuse.
Research Review
There has been no evidence based research conducted to date on the FRP. It is a new program to Baltimore that has been modeled after a similar program in San Diego, California, called Substance Abuse Recovery Management System (SARMS). The California Evidence-Based Clearinghouse has reviewed the program for relevance to child welfare and a scientific rating. Based on these findings the program received a 4 for scientific rating, which is acceptable, emerging practice, but the effectiveness and efficacy is unknown at this point. The program received a 1, demonstrating high relevance to child welfare (California Clearinghouse for Child Welfare 2004). After reviewing this program it is evident that more research is needed to accurately demonstrate that the effects of the interventions prevent child abuse and neglect.
Future Research Recommendations
With the limited research that has been done on both the FRP and the SARMS, it is unclear if the interventions are successful at reducing future child maltreatment. Further research is needed to ascertain if the overall services that the FRP does provide, with specialized case management, immediate access to substance abuse treatment programs, multi-disciplinary collaboration among the court, judge, mental health systems and department of social services, reduces not only substance abuse among parents, but future maltreatment.
Currently there is no website for Baltimore’s Family Recovery Program. However, the California Clearinghouse website does include information on the Substance Abuse Recovery Management System (SARMS).
References
Albert, V., Klein, D., Noble, A., Zahand, E., and Holtby, S. (2000). Identifying substance abusing
delivering women: Consequences for child maltreatment reports. Child Abuse and Neglect, 24, 173- 183
Besinger, B.A., Garland, A. F., Litrownik, A. J. and Landsverk, J. A. (1999). Caregiver substance abuse
among maltreated children placed in out-of-home care. Child Welfare, 78, 221-239.
Child Welfare League of America (2007). State Fact Sheet. Retrieved September 29th, 2007 from
http://www.cwla.org/advocacy/statefactsheets/2007/maryland.htm
Falmalaro, R., Kinschertt, R. and Fenton, T. (1992). Parental substance abuse and the nature of child
maltreatment. Child Abuse and Neglect, 16, 475-483
Murphy, J. M., Jellinek. M., Quinn, D., Smith, G., Poitrast, F. G. and Goshko, M. (1991) Substance abuse
and serious child maltreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and
Neglect, 15, 197-211
Suchman, N., Pajulo, M., DeCoste, C., and Mayes, L (2006). Parenting Interventions for Drug-Dependent
Mothers and Their Young Children: The Case for an Attachment-Based Approach. Family Relations,
55, (2) 211-226.
The California Evidenced-Based Clearinghouse for Child Welfare (2007). Substance Abuse Recovery
Management System (SARMS) - Detailed Report. Retrieved September 29, 2007 from
http://www.cachildwelfareclearinghouse.org/program/50/detailed.
Nationally in 2003 there were over half a million children in foster care and more than half of these same children exiting the system were reunified with their parents (Child Welfare Information Gateway, 2005). Having worked as a case manager in child welfare, I experienced that reunification is a main focus of the child welfare system. Although it may be the main focus of child welfare, there are many risk factors associated with reunification. Whether the case worker is preparing the family for reunification or maintaining a child in a placement, it is important to focus on child safety. There are many programs that families and caseworkers can choose from match their nedds. One program, Family Visitation Centers (FVC) is a practice that the California Evidence-Based Clearinghouse has identified as an Acceptable/Emerging Practice. FVC’s focus on two main risk factors that contribute to future indicated reports of abuse. First, the parent and child have a safe place to visit in which promotes positive parent/child relationships. Second parenting skills are addressed through classes and group support. The theory that FVC’s reduce the future amount of abuse after reunification has not been tested. It is important for future researchers to look at the effect FVC’s have on recidivism rates, if any. Currently, the only research study I was able to locate on FVC’s is based on the Florida system. Perkins & Ansay found that with an increase in number of visits, the likelihood of reunification has increased (1998). While concrete research on FVC’s is lacking, there have been numerous studies that link the amount of visits with reunification in general. Davis, Landsverk, Newton and Ganger (1996) looked at cases in San Diego California in hopes to find correlation between parental visiting and reunification. They concluded that parents that participated in the visiting plans as recommended were more likely to achieve reunification while mothers who participated less than recommended were significantly less likely to be reunified with their children. Other studies researched the amount of impact the caseworker and foster parents have on the likelihood of visitation happening. Future research needs to focus on other areas of concern with FVC’s. There is no research on the effectiveness of the parent skills component or on the impact FVS’s has on reentry into the system. Research on FVC’s is limited which makes it difficult to properly asses the effectiveness of the program. While many programs may exist without research, it is important for the social work profession to begin to value the amount of evidence available and incorporate the process of using programs that are validated through credible research.
Additional information on FVC’s and related research can be found at:
Child Welfare Information Gateway (2005). Foster care numbers and trends.
Retrieved October 5, 2007, from
http://www.childwelfare.gov/pubs/factsheets/foster.pdf
Davis, I., Landsverk, J., Newton, R., & Ganger, W. (1996). Parental visiting and foster
care reunification. Children and Youth Services Review, 18, 363-382.
Perkins, D., & Ansay, S. (1998). The effectiveness of a visitation program in fostering visits with noncustodial parents. Family Relations, 47, 253-258.
The California Evidence-Based Clearinghouse (n.d.). Family visitation center - detailed report. Retrieved October 8, 2007, from http://www.cachildwelfareclearinghouse.org/program/70
Brief Report: Triple P-Positive Parenting Program
Introduction: Reviewing the evidence for the Triple P-Positive Parenting Program is important to consider for it’s relevance to child safety. This program focuses on parent training (increasing parental knowledge, self-sufficiency, skills, and confidence) as a preventative measure to child maltreatment.
Describe the program, theory, and it’s purpose: According to the Triple P-America website, the aims of the Triple P-Positive Parenting Program are to promote the independence and health of families by enhancing parents competence, resourcefulness, self-sufficiency knowledge and skills and to reduce the incidence of child abuse, mental illness, behavioral problems, delinquency, and related problems. The evidence suggests that poor parenting, family conflict, marriage breakdown, a lack of a warm positive relationship with parents, harsh, rigid, or inconsistent discipline practices are factors that potentially put a child at risk for emotional or physical abuse. In addressing the risk and protective factors the program incorporates five levels of intervention of increasing strength. The levels range from increasing community awareness regarding the parenting program through electronic media and print (commercials, etc.) to intensive (8-10) sessions which incorporates causes of children’s behavior problems, strategies for encouraging children’s development, and strategies for managing misbehavior (http://www.triplep-america.com/). The theoretical basis of the Triple P is a form of behavioral family intervention based on social learning principles (Sanders, 1999)
Review of the Research: The research that was reviewed reported significantly lower levels of parent-reported child behavior problems, significantly less observed child negative behavior; lower levels of dysfunctional parenting and greater parental competence at post intervention. Furthermore, the gains achieved were maintained at the one year follow up (Bor, Sanders, Markie-Dadds, C., 2002). Other studies also confirmed the efficacy the Triple P-Positive Parenting Program (Leung, et. al., 2003) (Plant & Sanders, 2006). It was also found to be effective in diverse populations (Sanders, Cann, Markie-Dadds, 2003).
Recommendation for future research and why?:
Based on my review, more research is needed specifically targeting child welfare populations. In July of 2007, the National Center for Injury Prevention a component of the Centers for Disease Control and Prevention was soliciting research applications to expand the implementation and evaluation of the Triple P-Positive Parenting Program (http://grants.nih.gov/grants/guide/rfa-files/RFA-CE-07-011.html).
The Triple P-Positive Parenting Program appears to be a good fit for a diverse population; however, I did not find research that specifically targeted families who entered into the public child welfare population. However, research trials are currently underway evaluating the efficacy of the Triple P system with populations of families notified for child maltreatment, specifically levels 4 and 5 (Sanders, Cann, Markie-Dadds, 2003).
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Where you find out more:
http://www.triplep-america.com
Bor, W., Sanders, M.R., & Markie-Dadds, C. (2002). The effects of the triple p-positive parenting program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties. (Electronic Version). Journal of Abnormal Child Psychology, Vol. 30 (6), 371-387.
Leung, C., Sanders, M.R., Leung, S., Mak, R., & Lau, J., (2003). An outcome evaluation of the implementation of the triple p-positive parenting program in Hong Kong. (Electronic Version). Family Process, Vol. 42 (4).
Sanders, M.R. (1999). Triple p-positive parenting program: towards an empirically validated multilevel parenting and family support strategy for the prevention of behavior and emotional problems in children. (Electronic Version). Clinical Child and Family Psychology Review. Vol.2 (2).
Sanders, M.R., Cann, W., & Markie-Dadds,C. (2003). The triple p positive parenting program: a universal population level approach to the prevention of child abuse. (Electronic Version). Child Abuse Review. Vol. 12 (3) 155-171.
Sanders, M.R. & Glynn, E.L. (1981). Training parents in behavioural self-management: an analysis of generalization and maintenance. (Electronic Version). Journal of Applied Behavior Analysis, Vol. 14 (3), 223-237.
Sanders, M.R., Markie-Dadds, C., & Turner, K. (2003). Theoretical, scientific and clinical foundations of the triple p-positive program: a population approach to the promotion of parenting competence. (Electronic Version). The Family and Parenting Support Centre, The University of Queensland.
United States Department of Health and Human Services. Multi-level parent training effectiveness trial. Part I Overview Information. Retrieved October 9, 2007 from the World Wide Web. http://grants.nih.gov/grants/guide/rfa-files/RFA-CE-07-011.html.
The Incredible Years Parenting, Teacher and Child Training Program
An evidence-based parent training program has emerged that may be relevant to the prevention of child abuse and neglect. This intervention program, if found effective with child welfare populations, could be implemented as an alternative to current, less researched parenting classes currently used in public agencies.
The Incredible Years is an evidence-based parent, teacher and child training program that is intended to prevent conduct problems in children. It is implemented in twelve to twenty weekly two-hour group separate sessions with parents, teachers and children. It uses innovative techniques to teach positive parenting and classroom management techniques as well as pro-social child behaviors.
The research behind The Incredible Years is strong. This program has been the focus of several randomized controlled trials in diverse populations in Seattle, New York and abroad. The studies have implemented well-researched tools for measurement of client outcomes. Studies have found that participation in The Incredible Years has resulted in significant and ongoing improvement in child behavior and parenting techniques, particularly in reducing harsh parenting styles and child aggression and externalizing behaviors (Linares et al., 2006 & Webster-Stratton et al., 2001).
One study used the parent training component of this intervention with foster parents and biological parents simultaneously and found that it lead to, “significant gains in positive parenting and collaborative co-parenting for both biological and foster parents at the end of the intervention” (Linares, et al., 2006).
I recommend this intervention for further randomized controlled trials with child welfare populations, particularly as a mandated parent education program for parents who have been indicated for child physical abuse.
If you would like to find out more about The Incredible Years program, check out the program’s website at http://www.incredibleyears.com and/or view the following research:
Linares, L., Montalto, D., Li, M. & Oza, V. (2006). A promising parenting intervention in foster care. Journal of Counseling and Clinical Psychology, 74, 32-41.
Reid, M., Webster-Stratton, C. & Beauchaine, T. (2001). Parent training in Head Start: A comparison of program response among African American, Asian American, Caucasian, and Hispanic mothers. Prevention Science, 2, 209-227.
Webster-Stratton, C., Reid, M., & Hammond, M. (2001). Preventing conduct problems, promoting social competence: a parent and teacher training partnership in Head Start. Journal of Clinical Child Psychology, 30, 283-302.
The purpose of this report is to give information about the degree of evidence on the Hospital-Based, Parent Education Program that is designed to address the issue of Shaken Baby Syndrome. Each year, it is estimated that 1,200 to 1,400 infants and small children experience Shaken Baby Syndrome (“National Center,” n.d.), a form of physical abuse, due to forceful shaking which can result in death or leave permanent severe brain damage. Experts recognize that the infants’ behavior (inconsolable crying due to illness/colic) is a catalyst for Shaken Baby Syndrome by increasing the parents’ level of frustration and exhaustion while trying to cope with personal and environmental stressors. The Hospital-Based, Parent Education Program is a primary prevention program which aims to educate parents about the dangers of shaking infants and safe methods for responding to persistent infant crying. The program is designed to be implemented at local hospitals where the clinical and floor nurses on each maternity ward can easily have access to all parents of all newborn infants shortly after the infants’ birth and prior to being discharged from the hospital. The mother, father or father figures (if the mother is single) are provided a one-page leaflet/brochure (something short and a quick reference) to read and take home and an 11-minute videotape which is shown to the parents at the hospital.
The research on this program is quite limited; as of to date there is only one published article about the study conducted in Western New York (WNY) by Mark Dias et al. (2005) that gives specifics of the components of the program’s protocol and a description of how it should be administered. For this study/program, there is no evidence to indicate that a meta-analyses or rigorous randomized control trial was performed based on my search; however, the study in itself consists of several components of measuring the effectiveness of the program. For example, both the mother and father/father figure were asked to voluntarily sign a commitment statement affirming their receipt and understanding of the materials and if they would recommend this information to be given to others. The commitment statements allowed an analysis of the parents’ initial response to the materials and a randomized follow-up interview (using a 10% subset of parents, seven months after the infant’s birth) to survey the parents’ recollection and usefulness of the information on SBS received on that day. To determine if there was a reduction of incidence of deaths and injuries and if any incidence occurred among the study group, several reports were accessed and cross-referenced with the signed commitment statements received from the parents in the study group: (1) report of births and injuries relating to SBS/abusive head trauma (2) report of deaths relating to SBS/abusive head trauma from the Medical Examiner’s office (3) reports from the adjacent 9-county regions of upstate New York (outside of WNY) were cross-referenced to the commitment statements to ensure accuracy in numbers. It was revealed that there was a 47% reduction of SBS cases over the 66 months study period compared to the historical control group with incidence of SBS during the six years preceding the study. Also, there was half the amount of cases with the signed commitment statements from parents in the study group (15.3) than cases without the signed statements (35.3) (Dias et al., 2005). These findings were published in Pediatrics, a peer-reviewed literature and the program’s module has since been duplicated in other States.
The Hospital-Based Parent Education Program is an intervention that can be utilized with families to increase safety for infants/children. However, because this is a primary prevention program that simply provides information about Shaken Baby Syndrome and tips for appropriate alternative responses to the infant’s/child’s behavior, it does not include the components to provide extended postnatal support to families that may need such services. Such services could include parenting classes to offer coping skills, stress management, and respite care (some aspects of secondary prevention efforts). Therefore, further research is recommended to do a study to determine if it is possible to collaborate with a secondary prevention program (i.e., home visiting program) in order to increase support with families (especially, single and young mothers, and male figures). Also, as more States began to publish their findings, it is my recommendation to perform a systematic review to include meta analysis of the findings from Western New York and such States as Arizona and Pennsylvania, which may publish their findings in the near future.
For more information on Shaken Baby Syndrome and the prevention program:
Dias, M. S., Smith, K., DeGuehery, K., Mazur, P., Li, V., & Shaffer, M.L. (2005). Preventing abusive head trauma among infants and young children: A hospital-based, parent education program. Pediatrics, 115, 470-477. Retrieved September 18, 2007, from http://pediatrics.aappublications.org/cgi/reprint/115/4/e470.pdf
National Center on Shaken Baby Syndrome. (n.d.). Retrieved September 5, 2007, from http://www.dontshake.com/
National Institute of Neurological Disorders and Stroke. (n.d.). Retrieved September 10, 2007, from http://www.ninds.nih.gov/disorders/shakenbaby/shakenbaby.htm
Brief Report: Good-Touch/Bad-Touch Program
Sexual abuse prevention programs have been taught in school settings for several decades. However, there is still controversy about the effectiveness of such programs. Arguments against include that children are not able to understand and implement what is taught, lack of empirical evidence, children are unable to prevent sexual abuse from occurring, and that there may be harmful effects for the children, despite some research studies showing positive results (Finkelhor, 2007).
The Good-Touch/Bad-Touch program aims to prevent childhood sexual abuse through an in school educational program. The program trains instructors to use curriculum, DVDs, and other materials to teach children in elementary and middle schools. The goals are to teach children the difference between good touches and sexual abusive touches, diminish the negative effects of abuse, provide skills for saying no and reporting abuse, reducing bullying and sexual harassment, and build self esteem (Childhelp, Inc., 2007). The program uses instruction, modeling, social reinforcement, and rehearsal to achieve its objectives.
Harvey, Forehand, Brown, and Holmes (198
studied the Good-Touch/Bad-Touch program to see how well kindergarten aged children could retain the information they were taught in the prevention classes. Using an experimental and control group, the researchers compared the children’s knowledge and skills regarding sexual abuse and reporting three weeks and again at seven weeks following the intervention. The children in the experimental group demonstrated more knowledge and skills regarding sexual abuse than did the children in the control group.
The program and related research were evaluated using rating scales from the California Evidence-Based Clearinghouse on Child Welfare (2007). It was determined that the Good-Touch/Bad-Touch program should be rated as a promising practice (level 3) with a medium relevance (level 2) to child welfare.
Further empirical research of the Good-Touch/Bad-Touch program is needed. Future studies should look at the ability of children to retain skills and knowledge over a longer period of time and the ability to use the knowledge in a potentially dangerous situation. Another long-term study should be considered to better understand the how effective the program is at reducing the number of children that are sexually abused. This would likely be a sizeable and extensive study that would have ethical considerations, such as withholding preventative information from children who could be sexually abused. Moreover, the most recent study available was published in 1988, so more current research is needed.
References
California Evidenced-Based Clearinghouse for Child Welfare. (2007a). Child welfare relevance scale. Retrieved October 11, 2007 from http://www.cachildwelfareclearinghouse.org/scientific-rating/child-welfare-relevance-ratings.
California Evidenced-Based Clearinghouse for Child Welfare. (2007b). Scientific Rating Scale. Retrieved October 11, 2007 from http://www.cachildwelfareclearinghouse.org/scientific-rating/scale.
Childhelp, Inc. (2007). Good-Touch/Bad-Touch. Retrieved October 4, 2007 from http://www.goodtouchbadtouch.com/index.php.
Finkelhor, D. (2007). Prevention of sexual abuse through educational programs directed towards children. Pediatrics, 120(3), 640-645.
Harvey, P., Forehand, R., Brown, C., & Holmes, T. (1988). The prevention of sexual abuse: Examination of the effectiveness of a program with kindergarten-age children. Behavior Therapy, 19, 429-435.
Domestic Violence and Child-Parent Psychotherapy
Plenty of research documents the connection between child physical abuse and domestic violence. Families that experience domestic violence are at risk for many things, and children especially are at risk of physical abuse if there are a lack of appropriate interactions or relationship between mother and child, and child externalizing behaviors, aggression, and violence. These make it more likely that the child will be physically abused and that the cycle of violence and abuse will continue into the child’s adult life.
Child-Parent Psychotherapy for Family Violence (CPP-FV) is an intervention designed to basically rebuild or repair the mother-child relationship in families that have experienced domestic violence. It is theoretically based, and draws on many theories like cognitive-behavioral, trauma, social learning, and attachment. CPP-FV is therapy that lasts 50 weeks (or about a year) with weekly hour to hour and a half sessions with mother and child. It is designed to help the mother and child interact so that the child can continue normal development and attachment which was interrupted by the trauma of violence at home; the mother can understand and be educated on the child’s behaviors and development. It helps the mother and child master the trauma and focuses on safety and prosocial interactions between the mother and child. It can be practiced in a variety of settings (in and out of the home.) It was designed and implemented to work with diverse client populations
There is not a lot of research done on this particular therapy. One study done by Lieberman, Van Horn, & Ghosh-Ippen (2005) uses CPP with mothers and toddlers with anxious attachment (and they extend it to domestic violence) and focuses on improving the quality of the mother-child relationship with the mother helping the child cope with trauma. Measurements showed that CPP reduced the number of Traumatic Stress disorder symptoms in children and a decrease in avoidance in mothers (Lieberman et al., 2005). Another study done by Lieberman, Weston, & Pawl (1991) used CPP with infants (12 month olds) who were anxiously attached and mothers believing that early intervention would alleviate the anxious attachment. Mothers and children who received CPP were more adaptive scores on assessments than the control group; mothers increased in empathic responsiveness and initiation whereas toddlers had lower scores with angry behaviors. There was not a lot of research done specifically on CPP but the few studies that there are showed the effectiveness of CPP . More research should be done with continued diverse populations (perhaps not primarily with Latino or Spanish-speaking populations as these studies were) and in different areas besides California so that more validity is established, especially working with the mainstream culture and other minority populations.
For more information on Child-Parent Psychotherapy for Family Violence, you can go to the California Evidence-Based Clearinghouse for Child Welfare’s website at: http://www.cachildwelfareclearinghouse.org/program/49 or you can visit the National Child Traumatic Stress Network’s website for CPP at: http://www.nctsn.org/nccts/nav.do?pid=ctr_top_trmnt_prom . Or you can revisit the research articles done :
Lieberman, A.F., Van Horn, P., & Ghosh-Ippen, C. (2005). Toward Evidence-Based Treatment: Child-Parent Psychotherapy with Preschoolers Exposed to Marial Violence. Journal of the American Academy for Child and Adolescent Psychiatry, 44, 1241-1248.
Lieberman, A.F., Weston, D.R., & Pawl, J.H. (1991). Preventive Intervention and Outcome with Anxiously Attached Dyads. Child Development, 62, 199-209.
Brief Report: Project SafeCare and Parenting Adolescents in Foster Care
The birth rate for adolescents in foster care is more than twice that of their peers without foster care experience (Love, McIntosh, Rosst, & Tertzakian, 2005). Furthermore, young mothers who have had foster care experience are more likely to demonstrate parenting problems. Research has demonstrated a connection between maternal neglect and repeat neglect; parents who were maltreated as children are more likely to maltreat (Lounds, Borkowski, & Whitman, 2006). No specific prevention or education programs are in place for parenting adolescents in care of the Baltimore City Department of Social Services. Given the unique challenges of adolescents in care, their level of parenting skills should be carefully evaluated and, if necessary, those adolescents should have access to structured intervention to ensure the safety of their children.
Project SafeCare is an in-home ecobehavioral model that provides direct skill training to parents in child behavior management using planned activities training, home safety training, and teaching child health care skills to prevent child maltreatment (Gershater-Molko, Lutzker, & Wesch, 2002). Implementation is carried out by a trained worker who visits the family in the home for 1.5 – 3 hour sessions per month for at least 15 weeks.
Research indicates Project SafeCare is an effective intervention that reduces reports of child abuse and neglect. In a comparison study among families that received Project SafeCare services and those that received Family Preservation services, those that completed Project SafeCare training were less likely to be involved in recidivistic child abuse and neglect than the other families (Gershater-Molko et al., 2002). An additional study with families who were at risk for child maltreatment and those with histories of maltreatment concluded that each intervention was effective in improving parenting skills, child health-care skills, and the safety of the homes for the children of those families (Gershater-Molko, Lutzker, & Wesch, 2003). A parental satisfaction evaluation of the consumers of the services reported high satisfaction with all program components (Taban & Lutzker, 2001). The California Evidence Based Clearinghouse has given Project SafeCare a Scientific Rating of 3, indicating it is a “Promising Practice” and rates its relevance to child welfare as high, with a score of 1.
Further exploratory research should be conducted on the effectiveness of this program in reducing and preventing reports of child neglect among teen mothers in foster care. Research might also be implemented on the project’s success at enhancing personal self-efficacy; because Project SafeCare utilizes individual parental capacity for implementing proper parenting skills, it might serve as a bridge for enhancing other self-efficacy skills among young mothers.
For additional information, see the following:
Budd, K., Holdsworth, M., & HoganBruen, K. (2006). Antecedents and concomitants of parenting stress in adolescent mothers in foster care. Child Abuse and Neglect, 30, 557-574.
California Evidence Based Clearinghouse:
http://www.cachildwelfareclearinghouse.org/program/6
Gershater-Molko, R., Lutzker, J., & Wesch, D. (2002). Using recidivism data to evaluate Project SafeCare: teaching bonding, safety, and health care skills to parents. Child Maltreatment, 7, 277-285.
Gershater-Molko, R., Lutzker, J., & Wesch, D. (2003). Project SafeCare: improving health, safety, and parenting skills in families reported for, and at-risk for child maltreatment. Journal of Family Violence, 18, 377-386.
Lounds, J., Borkowski, J., & Whitman, T. (2006). The potential for child neglect: the case of adolescent mothers and their children. Child Maltreatment, 11, 281-294.
Love, L.T., McIntosh, J., Rosst, M., & Tertzakian, K. (2005). Fostering hope: preventing teen pregnancy among youth in foster care. Washington, DC: National Campaign to Prevent Teen Pregnancy.
Taban, N., & Lutzker, J. (2001). Consumer evaluation of an ecobehavioral program for prevention and intervention of child maltreatment. Journal of Family Violence,16, 323-330.
Brief Report: Parent-child Interaction Therapy
Introduction
Review of the evidence about Parent-child interaction therapy shows that it is a relevant intervention for increasing child safety. The use of this intervention in child welfare enables families to decrease instances of physical child abuse to their child/children with behavioral problems and/or disorders (Chaffin,2004).
Purpose of the Program
Parent –child interaction therapy(PCIT) is a family center treatment model with specified steps to direct parents by using techniques to train positive interactions between parents/caregivers and children. PCIT was designed to treat children with serious behavior problems such as conduct and oppositional defiant disorders .It has also been adjusted to treat children and families in which physical abuse has occurred. The goal of the intervention is to change negative parent/caregiver –child patterns in order to increase child safety. The intervention was designed to work with children ages 3-6, but has been adapted to work with kids 4-12 years of age, who have been physically abused. (The California Evidence –Based Clearinghouse, 2006)
Review of Research
One study (Chaffin, 2004) looked at the Parent-Child Interaction Therapy with physically abusive parents and the likelihood of reducing future abuse reports. This study looked at the relationship between children and parents who were classified as “physically abusive parents” because of multiple child welfare reports. The parents were separated into three groups; one group that offered just PCIT, a second group offered PCIT and individualized enhanced services, and the last group that offered a standard community-based parenting group .The study confirmed that “The reduction of abuse reoccurrence rates among families receiving PCIT was substantiated to less than half the reoccurrence rates of a standard parenting group program” (Chaffin,Silovsky,Funderburk,Valle,Brestan,Balachova,Jackson,Lensgraf and Bonner,2004).
Recommendations
Parent –child interaction therapy is an intervention that is successful for increasing child safety. It should be more widely used in child welfare programs because it does increase positive parent child interaction which prevents the increased risk of physical child abuse of children with behavioral disorders. Parents/Caretakers are equipped with skills and knowledge necessary to provide children with a safe environment. The research strongly suggested that significant change occurs after treatment has been fully completed and that oppositional behaviors decrease.
Although research suggested that tailoring is not completely necessary for treating racial /ethnic/cultural groups, I think that more research should be done in this area. I have concern about the delivery of the treatment and how it is received from these groups.
Key Citations
Chaffin,M.,Silovsky,J.F.,Funderburk,B.,Valle,L.A.,Brestan,E.V.,Balachova,T.,Jackson,
S.,Lensgraf,J.,&Bonner,B.L., (2004). Parent –child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Counseling and Clinical Psychology, 3(72), 500-510.
Parent –child interaction therapy (2006) Detailed Report: Retrieved September 21, 2007 from The California Evidence –Based Clearinghouse for Child Welfare. Website: http://www.cachildwelfareclearinghouse.org/program/5/detailed
The Nurturing Parenting Program
Programs that provide services to low-income family in an effort to prevent abuse and neglect are important because research shows that children who are raised in poverty are more likely to experience numerous negative effects such as poor health, low educational attainment, teenage pregnancy, and physical and emotional violence (Brooks-Gunn and Duncan). Further, research suggests that low-income parents are more likely to employ corporal punishment or the threat or use of physical punishment to influence children’s behavior that parents with more available income (Straus and Donnelly, 1993).
The Nurturing Parenting Program (NPP) is a program that seeks to identify the provision of services and target them to address the needs of a particular family. NPPs are evidenced-based parenting programs that are intended to decrease the number of child abuse cases in children age 12 and younger by improving parenting skills.
(Bavolek and Dellinger-Bavolek,1985)performed a study of NPP and the results of the program’s initial validation found that parents who participated and completed this program developed a more healthy self-esteem and self-awareness, as well as developed greater empathy for their child’s needs This particular outcome is important because Bavolek, et al. note, “When parental empathy increases, violence towards children and family dysfunction decreases (p.6).” A similarly, study by (Wagner 2001) of parents with active child abuse cases, found that NPP graduates were at lower risk for repeated child abuse, and that they appear to use less physical violence when recidivism does occur. Comparable to the results produced by Warner, (Matlak 2003) and (Cowen 2001) found that participants demonstrate increased knowledge and awareness of children’s capabilities, growth and development after participating in NPP.
The Nurturing Parenting Program is very effective at assisting families with reunification by helping parents develop empathy for their child, and develop a more comprehensive understanding of the child’s development and abilities, and practice better, less violent, parenting skills. While this program could be implemented on a national level, prior to implementation more large-scale studies should be performed. More specifically, group participants should include individuals from more diverse racial backgrounds. One critical aspect of NPP is that it can be tailored to meet specific groups’ needs however most of the literature and research do not focus on the minority groups. Being that the rates of abuse are higher for African American children, future research should include African Americans and other racial minorities.
For additional information: http://www.nurturingparenting.com, http://www.futureofchildren.org,
Citations:
Bavolek, and Dellinger-Bavolek J. (1985). “Increasing the Nurturing Parenting
Skills of Families in Head Start”: Validation of the Nurturing Program for
Parents and Children Birth to Fiver Years.” Retrieved October 11, 2007
from http://nurturingparenting.com/research_validation/validation_b-
5_program.pdf..
Matlak, S. (2003). “A Quantitative Analysis of Poles Peal Family Connections Nurturing
Parenting Program.” Retrieved October 11, 2007 from
http://www.nurturingparenting.com/research_validation/research%20pikes%20peak%202002.pdf
The Nurturing Parenting Programs have been established to prevent and treat child abuse and neglect in a variety of populations by promoting parent knowledge, positive interaction, and empathic understanding of children’s needs. The programs decrease the risk factors of lack of parent knowledge of child development and needs and the absence of empathy in the parent-child relationship. One group that the program has been tailored to address is teen parents. I performed research in order to determine the program’s efficacy in preventing neglect in this population.
The Nurturing Parenting Programs are based on the idea that parenting is learned. They deliver knowledge and model behavior through the use of DVD’s, manuals, home visits, and group sessions. Time is set aside for parent education as well as guided parent-child nurturing and interaction. The program hopes to increase the amount of knowledge that parents hold, their empathy towards their children, and their nurturing interactions. (Family Development Resources, Inc., 2007).
There have been multiple studies of the Nurturing Parenting Programs which demonstrate its positive effects. The NurtingParenting.com website details eleven pre- post design studies, one comparative program design study, and six pre-post and longitudinal follow-up design studies (Family Development Resource, Inc., 2006) which show a positive change in the attitude of parents following the program. A multi-site study compared the Nurturing Parenting Programs to three other family-focused model programs in the areas of family resilience, family cohesion, family conflict, and family attachment. Nurturing Parenting was found to have the greatest effect in the areas of family attachment and cohesion (Matthew, Wang, Bellamy, & Copeland, 2005). There have been limited studies of the program in teen populations, though two mentioned on the program website demonstrate a positive change in participants (Family Development Resource, Inc., 2006).
Though the research on the Nurturing Parenting Programs does show positive outcomes, there are many shortfalls in the studies. The majority of the studies were pre-post design and thus not as indicative of a relationship between the program and its outcomes as a randomized controlled trial would be. Some of the larger evaluations include multiple testing sites, and the implementation and testing may not have been consistent. Additionally, most of the research makes conclusions based on changes in a scale or self-report, such as the Adult-Adolescent Parenting Inventory. Self-reports may not be a true representation of home conditions. Also, relying on scales that measure parents’ attitudes to determine whether an intervention effectively prevents child maltreatment may be a stretch. The results leave questions about the actual relationship between parenting skills and child abuse and neglect. Changes in attitude only indirectly show a change in maltreating behavior (Cowen, 2001).
Based on the evidence, I would recommend further testing of the Nurturing Parenting Program, especially with teen parents, in a more controlled setting with a random assignment of participants to experimental and control groups. A measure of further referrals to child protective services would also add to the evidence. A clearer picture of the relationship between the Nurturing Parenting Programs and a reduction in child maltreatment would be beneficial to both those responsible for the program and for those in the field of child welfare.
For more information:
http://www.nurturingparenting.com
http://www.cachildwelfareclearinghouse.org/program/3/detailed
Key Citations:
Cowen, P. (2001). Effectiveness of a parent education intervention for at-risk families
[Electronic Version]. JSPN, 6, 73-82.
Family Development Resources, Inc. (2006). Nurturing parenting program validation studies 1983-2005. Retrieved Oct. 3, 2007 from http://www.nurturingparenting.com/research_validation/a9_np_validation_studies.pdf
Family Development Resources. (2007). What are nurturing programs. Retrieved October 10, 2007 from http://www.nurturingparenting.com/what_are_np.php.
Matthew, Wang, Bellamy & Copeland. (2005). Test of efficacy of model family
strengthening programs [Electronic Version]. American Journal of Health Studies, 20, 164-170. Retrieved October 3, 2007 from Academic Search Premier database.
Brief Report: Can the Family Connections Model Work in Anne Arundel County?
Introduction
The Family Connections model for the prevention of child neglect in low socioeconomic areas exhibits promising evidence-based results (Leicht, Hughes, Madigan, & Dowell, 2003). On-going research of replication sites and the expansion of research to new populations provide Family Connections with the potential to become a national model for child neglect prevention.
Description
This paper focuses on the feasibility of applying the Family Connections model for the prevention of child neglect to at-risk populations in a geographic area different from the original boundaries used.
Family Connections began as a grant-funded program in a West Baltimore neighborhood characterized by extreme poverty, high unemployment, and economic distress. The program used in-home services, monetary and in-kind resources, referrals to services, and multi-family activities to decrease risk factors and increase protective factors intending to prevent child physical neglect of children ages 5-11 and their families (DePanfilis & Dubowitz, 2005).
Review of Research
Research from the original study demonstrated promising results (DePanfilis & Dubowitz, 2005). According to the Emerging Practices report from the U.S. Department of Health and Human Services, the Family Connections program received the distinction of being deemed a “Demonstrated Effective” program. This distinction is reserved for programs that show positive outcomes in prevention using rigorous evaluation methods. The study concluded that Family Connection is capable of increasing protective factors, decreasing risk factors, reducing incidents of child neglect, and increasing child safety (Leicht, Hughes, Madigan, & Dowell, 2003).
Limitations to the original research included small sample size, absence of a control group, and limited follow-up time. These limitations are being addressed in replication programs that are now underway in eight different urban centers (DePanfilis & Dubowitz, 2005).
Future Research
The target population of this study differs from the original West Baltimore population in that the geographic area is larger but contains pockets of populations that experience risk factors including poverty and social isolation. Future research should focus on the ability to identify appropriate participants for the Family Connections program and the feasibility of providing neglect prevention services to a dispersed geographic area. A study that includes a larger sample size, a control group that does not receive services, and longer follow-up times would contribute to the growing body of Family Connections’ evidence-based research.
The Family Connections program also expanded its target population when it created a program specifically for intergenerational families with grandparents as primary caregivers facing a unique set of risk factors. Grandparent Family Connections is another area where future research would be valuable to determine the programs ability to prevent child neglect (University of Maryland, Baltimore, 2003).
Find Out More
For more information on Family Connections and Grandparent Family Connections, visit their website at http://www.family.umaryland.edu.
References
DePanfilis, D., & Dubowitz,H. (2005). Family Connections: A program for preventing child neglect. Child Maltreatment, 10, 108-123.
Thomas, D., Leicht, C., Hughes, C., Madigan, A., & Dowell, K. (2003). Emerging practices in the prevention of child abuse and neglect. Washington, DC: US Department of Health and Human Services.
University of Maryland, Baltimore (2003). Family Connection. Retrieved October 1, 2007, from http://www.family.umaryland.edu/
Brief report: Child Neglect Prevention in Baltimore City, Md
In 2005, 899,000 children were found to be victims of child abuse or neglect nationwide. Of this number, 62.8 percent suffered neglect (U.S. Department of Health and Human Services, Children’s Bureau, 2005). In 2005, within the state of Maryland, Baltimore City ranked as the highest reported neglect cases, which was 3,644 (Maryland Department of Human Resources, 2007). The second highest report was Montgomery County, Which has 1,371 (Maryland Department of Human Resources, 2007). As of now, our governmental system is not geared towards preventative services. However, research has proven that preventative services can increase protective factors, and decrease risk factors. Neglect is the highest report of child maltreatment and it is imperative that we now turn our focus onto ways to prevent neglect.
Family Connections (FC) is located in West Baltimore, MD, and was nominated by the Children’s Bureau as a program effective in preventing child maltreatment. FC is designed to increase protective factors and decrease risk factors. FC was developed with a strong theoretical basis, incorporating empirical evidence pertaining to the prevention of child neglect and the promotion of healthy parenting and family functioning (DePanfilis & Dubowitz, 2005). The sample included 154 families (473 children) in a poor, urban neighborhood who met risk criteria for child neglect and who were randomly assigned to received either a 3- or 9-month intervention (DePanfilis & Dubowitz, 2005). In the Family Connections article, the sample showed evidence of improvements. Results for the entire sample indicated positive changes in protective factors (parenting attitudes, parenting competence, social support); diminished risk factors (parental depressive symptoms, parenting stress, life stress); and improved child safety (physical and psychological care of children) and behavior (decreased externalizing and internalizing behavior) (DePanfilis & Dubowitz, 2005).
Further research should be conducted in other Maryland counties. This would provide a larger sample size throughout the counties to in Maryland that are not just limited to Baltimore City, MD. Then the research from different counties could be pieced together to show a sample size to show larger results. The research design should be similar to Baltimore City FC. Such as assigning random 3 or 9 month interventions. More information on Family Connections can be found on their website: http://www.family.umaryland.edu
DePanfilis, D., & Dubowitz, H. (2005). Family connections: A program for preventing
child neglect. Child Maltreatment, 10, 674-685.
Maryland Department of Human Resources (2007). State of Maryland Department of
Human Resources (DHR Child Protective Services (CPS) Data Tables SFY’2005. Retrieved 10/05/2007 at http://www.dhr.state.md.us/cps/pdf/cpsstat.pdf.
U.S. Department of Health and Human Services, Children’s Bureau (2005). Child
Maltreatment. Washington, DC: U.S. Government Printing Office. Retrieved 10/01/2007 at http://www.acf.dhhs.gov/programs/cb/pubs/cm05/index.htm
I am cutting and pasting brief reports from 3 students who posted their reports in the wrong place on the blog.
Christina Law - November 16, 2007[Edit]
Reducing the number of children entering the foster care system continues to be a challenge for child welfare agencies. Research shows that Intensive Family Preservation Services provide families with services that reduce long-term involvement in the child welfare system (Frazier, Nelson, & Rivard, 1997).
The Intensive Family Preservation Services began in 1989 and provides comprehensive, concentrated, and short-term in-home services that are intended to prevent out-of-home placement for children at imminent risk of removal and assist in strengthening the family unit as a whole. The services are intended to protect children in homes where alleged neglect and abuse have occurred and prevent recidivism of abuse and neglect within the home (Kirk & Griffith, 2004).
Research of the effectiveness of Intensive Family Preservation Services has found that these programs were successful in preventing foster care placement. These services were found to reduce but not eliminate long-tem involvement in the child welfare system (Little, 2001). Programs that may reduce child maltreatment provide short term, home-based services that focus on stabilizing families and reducing further risk to out of home placement, such as case management, parenting classes, family therapy, and financial assistance (Henegan, Horowitz, & Leventhal, 1996)
Recommendations for further research include the measurement of other outcomes, such as child development, maternal-child interactions, and repeated episodes of maltreatment or intentional injury, as these outcomes may demonstrate more conclusively that children and families benefit from Intensive Family Preservation Services. Also needing to be considered is that there are few standardized methods of measuring these outcomes, which may lead to inconsistent definitions of success. Addressing whether or not an overburdened, under funded child welfare system can indeed provide an adequate response to child maltreatment is also important for future research.
More information regarding Intensive Family Preservation Services can be found by visiting the Child Welfare League of America’s website at http://www.cwla.org or to review the Evaluation of the Maryland Family Preservation Program, visit http://www.bonhamresearch.com.
Baltimore City Health Department Date Snap (2006). Retrieved October 10, 2007
from http://www.baltimorehealth.org.
DePanfilis, D., & Dubowitz, H. (2005). Family Connections: A program for
preventing child neglect. Child Maltreatment, 10, 108-123.
Fraser, M.W., Nelson, K.E., & Rivard, J.C. (1997). Effectiveness of Family
Preservation Services. Social Work Research, 21, 138-153.
Heneghan, A.M., Horwitz, S.M., & Leventhal, J.M. (1996). Evaluating Intensive
Family Preservation Programs: A Methodological Review. Pediatrics,
97, 535-542.
Kirk, R.S. & Griffith, D.P. (2004). Intensive family preservation services:
Demonstrating placement prevention using event history analysis.
Social Work Research, 28, 5-16.
Littell, J.H. (2001). Client participation and outcomes of intensive family
preservation services. Social Work Research, 25, 103-113.
Wells, K. & Tracy, E. (1996). Reorienting Intensive Family Preservation
Services in relation to Public Welfare Practice. Child Welfare,
5. Kala Campbell - November 16, 2007[Edit]
Child maltreatment is the general term used to describe all forms of child abuse and neglect. Antisocial behavior is one of the leading factors of child maltreatment. It is crucial to understand how antisocial behavior develops and provide possible solutions and programs to deter the behavior. Early childhood home visitation programs would not only help to prevent anti social behavior, but also monitor the safety of the child at risk (Moffitt, 1993). The Prenatal and Early Childhood Nurse Program helps to recognize anti social behavior early on and provide services to the expecting mother during the onset of her pregnancy. Several studies show that nurse home visitation programs reduce the risks for early antisocial behavior and prevents problems associated with juvenile delinquency such as child abuse, maternal substance abuse and maternal criminal involvement (Olds, Kitzman et al., 1997).
Risk factors include low income, first time mothers who are likely to deliver premature, neurological impaired babies. Protective factors include prenatal care, parenting classes and on call support (Olds and Korfmacher, 1997).
The purpose of the Prenatal and Early Childhood Nurse Home Visiting program is to prevent child abuse and neglect, promote positive parenting, promote resiliency in children and promote a healthy beginning for every child. Throughout the entire pregnancy until the child reaches the age of two, trained professionals help encourage improved quality of care for the infants and toddlers, ultimately preventing child maltreatment, childhood injuries, developmental delay, and behavioral problems. The program also focuses on preventing unintended subsequent pregnancies, preventing school drop out and reducing ongoing welfare dependency (Olds, Eckenrode et al., 1998).
Research shows the early home visitation programs to be very effective and beneficial.
Research has proven home visitation programs to be effective in the ability to reduce the development of antisocial behavior, reduce adverse maternal/prenatal health-related behaviors, reduce child abuse and neglect as well as welfare dependence. Common problems associated with home visitation programs included target families not accepting initial enrollment into the programs, families not engaging and completing the program and funds financing these programs. Home visiting programs are more effective when they employ highly trained visitors such as licensed nurses and social workers, are based on theories of development and behavioral change, and target at risk population (Olds, Henderson, Kitzman, 1994).
Although extensive research has been done on the implementation of home visiting programs, I believe more research should be done on the follow up of these women in the United States as well as their children when they reach child bearing ages. This could possibly show how effective the program truly is based on the children’s parenting. Future research should also focus on a multiple disciplinary approach involving not only nurses and social workers, but also teachers, counselors and therapists. This suggestion is based on studies that show the multidiscipline approach can make a significant difference because all team members contribute core skills with unique contributions (Schuetze, 2004).
To Find Out More Visit:
http://www.ncjrs.gov/pdffiles/172875.pdf.
http://www.excellence-earlychildhood.ca/documents/Zercher-SpikerANGxp.pdf
Key Citations to Research
-Prenatal and early home visitors
-Home Visitation Programs
-Protecting Children
-Programs that reduce child abuse and neglect
Resources
Moffitt, T.1993. Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review 100(4):674–701
Olds, D., Henderson, C., Kitzman, H. 1994. Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental care giving and child health at 25 to 50 months of life? Pediatrics 93 (1):89-98.
Olds, D., Kitzman, H., Cole, R., and Robinson, J. 1997. Theoretical foundations of a program of home visitation for pregnant women and parents of young children. Journal of Community Psychology 25 (1):1-7.
Olds, D., and Korfmacher, J. 1997. The evolution of a program of research on prenatal and early childhood home visitation: Special issue introduction. Journal of Community Psychology 25 (1):1-7.
Olds, D., Eckenrode, J., Pettitt, L., Robinson, J., Kitzman, H., Cole, R., and Powers, J. 1998. Reducing the risks for antisocial behavior with a program of prenatal and early childhood home visitation. Journal of Community Psychology 26(1):65–83.
Schuetz, K. 2004. Social Workers –Vital to multidisciplinary hospital teams. Social Work Today 4 (3):32-34.
Keith S. Howard - November 16, 2007[Edit]
Differential Response
It is important for child welfare agencies to be able to effectively engage the families they serve. Many families view CPS investigations as adversarial and do not fully participate in services. With the growing number of reports of child maltreatment, (www.childtreandsdatabank.org) child welfare agencies must develop new strategies to assess and engage families. This will allow for more productive case management of maltreatment referrals and result in overall better outcomes for children and families.
Differential response is a fairly new model of engaging families that are reported to child welfare agencies for child maltreatment. There are several variations of differential response and it has been implemented in over 20 states and other areas throughout the world (Holguin, 2006). Differential response utilizes a comprehensive assessment done during the initial investigation of a case to streamline the response by the child welfare agency. A case that is substantiated for more serious categories of child maltreatment (i.e. sexual abuse, physical abuse etc.) receives the traditional approach to CPS investigations. Other cases are screened out after this assessment and the families are offered community based services. These services are tailored to the individual needs of each family.
After searching the California Evidence Based Clearinghouse, the University of Maryland Evidence Based Practice Blog, and the Campbell Collaboration, I could not find ratings for any child welfare agencies that employ differential response. However, there is much research written on the effectiveness of differential response. In fact, according to the Institute of Applied Research, differential response is rated as a promising child welfare initiative.
Evaluation of Minnesota and Missouri’s programs has shown that children and families have better outcomes when a differential response is used in comparison to traditional CPS investigations. A study evaluated cases reported in 2002 to the National Child Abuse and Neglect Data System (NCANDS) from states that offered a differential response and a traditional investigation of its’ child welfare cases. The outcomes of children who received a differential response were compared to those who received a traditional CPS investigation. Children who received an alternative response were less likely to have a subsequent report or investigation.
References
Child Trends Data Bank (2003). http://www.childtrendsdatabank.org/indicators/40ChildMaltreatment.cfm
Lohman and Siegel (2005). Alternative Response in Minnesota: Findings of the Program Evaluation. Protecting Children, 20 (2-3), 78-92.
Loman, L. A., (2005). Differential response improves traditional investigations: Criminal arrests for severe physical and sexual abuse. St. Louis: Institute of Applied Research.
Merkel-Holguin (2005). Differential Response: A Common Sense Reform in Child Welfare. Protecting Children, 20 (2-3), 2-4.
Minnesota Department of Human Services (2004). Minnesota Alternative Response evaluation: A review of pilot project findings from 2001-2004. St. Louis Institute of Applied Research.
Shusterman, G., Fluke, J., Hollinshead, D., & Yuan, Y. T.Alternative Responses to Child Maltreatment: findings from NCANDS. Protecting Children, 20 (2-3), 32-43.
Brief Report of Parent-Child Interactive Therapy
Parent-Child Interactive Therapy (PCIT) is an important intervention when working with children who have behavioral issues. These children are subject to abuse due to stressors that families deal with and the lack of knowledge on how to appropriately discipline their children.
PCIT is an intervention program used with children age three through twelve years old who have behavioral issues. Sheila Eyberg, PCIT developer, wanted to combine behavior therapy, play therapy, family systems, and social learning to form an intervention program. The purpose of PCIT is to allow parents and children to interact together through therapy to prevent child abuse. The abusive parent and abused child interact or play in a room by themselves. There are two phases in the PCIT process. The first phase is to rebuild the relationship between the child and parent. The second phase is to teach the parent how to appropriately discipline the child when he or she is misbehaving. The parent wears an ear bug while the counselor assists the parent in what to do and say to the child. PCIT is a 22-24 week intervention that meets once a week for about an hour.
There have been studies on PCIT conducted in many different agencies, organizations, and universities. The University of Oklahoma Health Sciences Center is the most well known. All of the children participants had behavioral issues whose worker felt that they are at risk of being abused. The study included 110 participants, which were divided into three groups. Each group received different kind of services. The participants received PCIT, enhanced PCIT (receiving PCIT and other services to help the family), or standard community group. This study proved that PCIT is more effective than a standard community group. PCIT was also more effective than the enhanced PCIT. More research should be done with more diverse participants such as different regions, ethnicities, family structures, and social economic status.
For more information:
University of Oklahoma, Norman, Departmental and Behavioral Pediatrics. (2002). Parent Child Interaction Therapy. http://devbehavpeds.ouhsc.edu/pcit.asp
Parent-child interaction therapy (PCIT)- Detailed report. (2006, March). Retrieved October 5, 2007, from The California Evidence-Based Clearinghouse for Child Welfare Web site:
http://www.cachildwelfareclearinghouse.org/program/5
Review of the Evidence for Healthy Families America
Healthy Families America (HFA) has been gaining support throughout America regarding its ability to increase positive relationships between mothers and their children along with reducing child abuse among participating families (Donnelly, 1992). HFA provides home visits to new and expecting parents with an emphasis on at-risk families. A main focus of HFA is on child health and well being, as well as connecting the family to the community and other social supports. It is believed that families that receive social support and education about child development and parenting skills they will be less likely to abuse their children(Donnelly).
Studies have begun to evaluate Healthy Families America (HFA) programs around the United States. Mother-infant interaction was found to improve at a four months, when families received home visits. At the one-year evaluation, the data shows that there was less significance between the HFA mothers and the mothers in the control group (Dawson & Robinson, 1991). It was also found that there was an increase of parental knowledge of child development (Hammond-Ratzlaff & Fulton, 2001). Both mother-child interaction and parental knowledge of child development are believed to reduce the risk of child abuse. It appears that the home visiting services provided through Healthy Families America (HFA) reduces the occurrence of child abuse based on percentage of CPS reports and unnecessary Emergency Room visitations by families participating in HFA (Duggan, A. K., McFarlane, E. C., Windham, A. M., Rohde, C. A., Salkever, D. S., Fuddy, L., et al., 1991).
However, many of the studies were done in specific populations and had small participating groups. Some studies lacked control groups for comparison of data. These aspects make it hard to apply the data findings to the general public.
In conclusion, HFA should continue to be used based on the data that supports the reduction of child abuse. However, more research should be done to provide more evidence to support HFA’s effectiveness.
For more information:
Dawson, Peter M., Robinson, JoAnn L. (Winter, 1991). Supporting new parents through home visits: Effects on mother-infant interaction. Topics in Early Childhood Special Education, 10, 4, 29-45.
Donnelly, Anne C. (1992). Healthy families America. Children Today, 21, 2.
Duggan, A. K., McFarlane, E. C., Windham, A. M., Rohde, C. A., Salkever, D. S., Fuddy, L., et al. (1999). Evaluation of Hawaii’s Healthy Start Program. The Future of Children, 9, 1.
Hammond-Ratzlaff, Amy, & Fulton, Arlene. (Fall, 2001). Knowledge gained by mothers enrolled in home visitation program. Adolescence, 36, 143.
Or visit their website http://www.healthyfamiliesamerica.org
Differential Response: Can It Keep More Children Safe?
The following information comes from my research on Differential Response and its utility in Child Protective Service work, as a best practice in keeping children safe.
Differential Response (DR) has been recognized as an innovative and family centered intervention in Child Protective Service (CPS) work (Connolly, 2005). The hope is that Differential Response will assist in decreasing all forms of child maltreatment. The implementation of Differential Response represents a shift in practice and policy; away from traditional investigations toward a more family centered and needs based approach (Schene, 2001).
A Differential Response model of CPS practice “allows CPS to respond differently to accepted reports of child abuse and neglect” (Merkel, Kaplan, Kwak, 2006 p. 10). The Alternative Response is one that allows certain less severe screened-in cases to be handled devoid of a formal investigation. In the past CPS would investigate reports and make a finding; which often did little to help families or ensure safety (Schene, 2001). With AR, services are offered to families who under the traditional model would not have received services; making AR a more preventative practice (Connolly, 2005).
The Minnesota Alternative Response Evaluation Final Report 2004 is a great resource for research on Differential Response. The Institute of Applied Research (2004) authored this final report of data compiled in 20 localities in Minnesota from 2000-2004, that provides evidence of Differential/Alternative Response being a promising practice, which may ultimately lead to better outcomes for children. The study was conducted in 14 of 20 counties in Minnesota that agreed to permit AR screened-in families to be randomly assigned experimental or control conditions. The control group received traditional CPS investigations and the experimental group got an AR response. The experiences of these families and their outcomes were analyzed. Highlights from the findings of this evaluation include: child safety not being compromised by Alternative Response, that AR families were less likely to have new maltreatment reports, that AR families received more services than control families, that families responded better to the AR approach, and that workers liked AR and saw it as more effective. The analysis of AR in Minnesota indicates that AR does little to harm families and may actually allow more families to be assisted after a report of child abuse or neglect than achieved in the traditional CPS system. Only time will provide more opportunity to evaluate Alternative Response as an evidenced based practice to ensure child safety. The following paragraph is dedicated to an area where I think improvement or enhancement could be achieved in evaluating AR as a best practice.
It’s important to consider both risk and protective factors that lead to child maltreatment when assessing any intervention’s ability to keep children safe; in doing my research it became apparent that CPS cases which are put on an assessment track represent families in need of protective factors. I found the 5 protective factors outlined by The Center for the Study of Social Policy to be relevant to child protection and a possibly preventative action to reduce maltreatment. I think that a future area of study on Differential Response and its effectiveness would be to assess how effective the services provided were at building protective factors in caregivers. All sources are listed below along with helpful websites.
American Humane Association, Child Welfare League of America. (2006). National
Study on Differential Response in Child Welfare. Retrieved from: http://www.americanhumane.org/site/DocServer/National_Study.pdf?docID=4761
Center for the Study of Social Policy. (2003). Protective factors literature review: Early
care and education programs and the prevention of child abuse and neglect.
Washington, DC: Retrieved from: http://www.cssp.org/uploadFiles/horton.pdf.
Chipley, M., Sheets, J., Baumann, D., Robinson, D. & Graham, J.C. (1999). Flexible
response evaluation. Texas Department of Protective and Regulatory Services.
Connolly, M. (2005). Differential Responses in Child Care and Protection: Innovative
Approaches in Family-Centered Practice. In Protecting Children (Vol. 20, 2 nd
ed., pp. 8-20). Englewood, CO: American Humane Association
Institute of Applied Research. (2004). Minnesota Alternative Response evaluation: Final
Report. Retrieved from: http://www.iarstl.org/papers/ARFinalEvaluationReport.pdf
Loman, A., & Siegel, G. (2005). Alternative Response in Minnesota: Findings of the Program Evaluation. In Protecting Children (Vol. 20, 2 & 3rd ed., pp. 78-92). Englewood, CO: American Humane Association.
Office on Child Abuse and Neglect. (2005). A Coordinated response to child abuse and
neglect: The foundation for practice (Vol. 3). Fairfax, VA: Caliber Associates. Retrieved from: http://www.childwelfare.gov/pubs/usermanuals/foundation/foundationo.cfm
Schene, P. (2001). Meeting Each Families Needs Using Differential Response in Reports of Child Abuse and Neglect. In Best Practice Next Practice. Washington, D.C: Learning Systems Group.
Shusterman, G.R., Hollinshead, D., Fluke, J.D., & Yuan, Y.T. Alternative responses to
child maltreatment: Findings from NCANDS (Washington, DC: U.S. Department
of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, 2005).
Siegel, G. & Loman, A. (2000). The Missouri Family Assessment and Response impact
assessment: Digest of findings and conclusions. St. Louis, MO: Institute of
Applied Research.
U.S. Department of Health and Human Services. (1999). Blending perspectives and
building common ground: A report to Congress on substance abuse and child
protection. Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services, Administration for Children and
Families/Children’s Bureau and Office of the Assistant Secretary for Planning and
Evaluation. (2003). National Study of Child Protective Service Systems and
Reform Efforts: Findings on Local CPS Practices. (Washington, DC: U.S.
Government Printing Office).
I am a bit concerned by the conclusion of the review of alternative response programs completed by Sarah Butts. Although I believe that her review acccurately captures the preponderant view of alternative response I have a particular quarrel with the interpretation of the data regarding “safety.”
It is not possible to tell if children are safe by determining whether the number of child abuse reports went up or down. This is the technique that evaluators have used but is isn’t sound. That only tells you how many detected and reported cases there are. Some cases are not detected and some are not reported–they still occur and still indicate lack of safety. The typical AR evaluation has not done anything to try to get under these reports and get information from children or parents about their rates of abusive parenting. This is more than a quibble becuase the very nature of AR–which sends children and family away from CWS–would seem to increase the likelihood that abuse detection would not continue or be extended to other children in the family. I can’t prove that, but neither can the evaluators who count child abuse reports and claim that they are an acceptable indication of safety.