Child maltreatment investigations: Comparing children, families, and reasons for referral in three European countries.

BACKGROUND: Almost all countries have developed measures to ensure that children do not suffer from violence in their families. However, the legal framework, definitions of maltreatment, and institutional structures differ. Whereas in other areas of social policy comparative research is very common, child protection research falls behind. RESEARCH QUESTIONS: The article examines the differences between cases referred to local child and youth welfare authorities due to concerns about abuse or neglect in Germany, England and the Netherlands, comparing the characteristics of the child, the family, the person reporting the suspected maltreatment, and the type of maltreatment. METHOD: 1207 case files on children investigated due to suspected child maltreatment from the Netherlands, England, and Germany were analyzed using a standardized coding scheme. RESULTS: The family backgrounds of the children reported differed substantially, with more lone parents in England and more children living in two households in the Netherlands. The persons and institutions reporting their concerns to the local child and youth welfare authorities also differed, with more reports from children and family members in Germany and more from health services in England. In England, physical abuse, sexual abuse, and sexual exploitation were more frequently the reason for referral than in the Netherlands and Germany. DISCUSSION: Differences between countries can partially be explained based on differences in policies and relations of other systems to the child protection system.

Antenatal risk factors for child maltreatment: Linkage of data from a birth cohort study to child welfare records.

BACKGROUND: Understanding the risk factors for child maltreatment is critical to efforts to reduce its prevalence. OBJECTIVE: This study investigated the association between characteristics and circumstances of mothers during pregnancy and the subsequent identification of concerns about child maltreatment. PARTICIPANTS AND SETTING: The study drew on two data sets: (i) data from questionnaires administered to the expectant mothers of 11,332 children born in a deprived multi-ethnic local authority in England between 2007 and 2011, for a birth cohort study, and (ii) administrative data on children referred to child welfare services. METHODS: The linkage of these two pre-existing data sets enabled the prospective study of risk factors for child maltreatment. RESULTS: A range of factors captured during the antenatal period were associated with an increased likelihood of subsequent recorded child maltreatment concerns, including: younger maternal age (HR=0.96; p < .001), lower maternal education level (HR=1.36; p < .001), maternal mental illness (HR=1.17; p = .001), maternal smoking in pregnancy (HR=1.69; p < .001), single motherhood (HR=1.41; p = .022), larger family size (HR=1.13; p < .001), multiple deprivation (HR=1.01; p = .011), social housing (HR=1.72; p < .001), paternal unemployment (HR=1.79; p < .001), and the receipt of means-tested welfare benefits (HR=1.43; p < .001). A greater total number of risk factors during pregnancy also increased the risk of subsequent maltreatment concerns (HR=1.45; p < .001). CONCLUSIONS: The identification of multiple risk factors in this study supports claims that single targeted interventions are unlikely to be successful in preventing or reducing child maltreatment due to its multifactorial nature, and that multidimensional interventions are required.

Disentangling the effect of out-of-home care on child mental health.

BACKGROUND: Children in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children's mental health outcomes from the effects of the adverse circumstances that led to their admission to care. OBJECTIVE: This research investigated the association between care placement and the presence of child mental health problems after controlling for children's pre-care experiences. It also identified factors associated with mental health problems among children in care. PARTICIPANTS AND SETTING: The sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159). METHODS: The mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers. RESULTS: The odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032). CONCLUSIONS: These findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.

Mind-mindedness in parents of looked-after children.

The studies reported here aimed to test the proposal that mind-mindedness is a quality of personal relationships by assessing mind-mindedness in caregiver-child dyads in which the relationship has not spanned the child's life or in which the relationship has been judged dysfunctional. Studies 1 and 2 investigated differences in mind-mindedness between adoptive parents (ns = 89, 36) and biological parents from the general population (ns = 54, 114). Both studies found lower mind-mindedness in adoptive compared with biological parents. The results of Study 2 showed that this group difference was independent of parental mental health and could not fully be explained in terms of children's behavioral difficulties. Study 3 investigated differences in mind-mindedness in foster carers (n = 122), parents whose children had been the subject of a child protection plan (n = 172), and a community sample of biological parents (n = 128). The level of mind-mindedness in foster carers and parents who were involved with child protection services was identical and lower than that in the community sample; children's behavioral difficulties could not account for the difference between the 2 groups of biological parents. In all 3 studies, nonbiological carers' tendency to describe their children with reference to preadoption or placement experiences was negatively related to mind-mindedness. These findings are in line with mind-mindedness being a relational construct. (PsycINFO Database Record

Multi-dimensional Treatment Foster Care in England: differential effects by level of initial antisocial behaviour.

Multi-dimensional Treatment Foster Care (MTFC), recently renamed Treatment Foster Care Oregon for Adolescents (TFCO-A) is an internationally recognised intervention for troubled young people in public care. This paper seeks to explain conflicting results with MTFC by testing the hypotheses that it benefits antisocial young people more than others and does so through its effects on their behaviour. Hard-to-manage young people in English foster or residential homes were assessed at entry to a randomised and case-controlled trial of MTFC (n = 88) and usual care (TAU) (n = 83). Primary outcome was the Children's Global Assessment Scale (CGAS) at 12 months analysed according to high (n = 112) or low (n = 59) baseline level of antisocial behaviour on the Health of the Nation Outcome Scales for Children and Adolescents. After adjusting for covariates, there was no overall treatment effect on CGAS. However, the High Antisocial Group receiving MTFC gained more on the CGAS than the Low group (mean improvement 9.36 points vs. 5.33 points). This difference remained significant (p < 0.05) after adjusting for propensity and covariates and was statistically explained by the reduced antisocial behaviour ratings in MTFC. These analyses support the use of MTFC for youth in public care but only for those with higher levels of antisocial behaviour. Further work is needed on whether such benefits persist, and on possible negative effects of this treatment for those with low antisocial behaviour.Trial Registry Name: ISRCTNRegistry identification number: ISRCTN 68038570Registry URL: www.isrctn.com.

Reunifying abused or neglected children: Decision-making and outcomes.

Little is known about decision-making regarding the reunification of children in care, or about the consequences of these decisions for the children concerned. This study compared decision-making and outcomes for 149 maltreated children in seven English authorities (68 reunified, 81 who remained in care). Children were followed up six months after their return home or, for those who were not reunified, six months after the 'effective decision' that they should remain in care. They were followed up again four years (on average) after the return or effective decision. Data were extracted from case files at baseline and six month follow-up and were gathered from surveys of social workers and teachers at final follow-up. The two key predictors of reunification were assessments that parental problems had improved and that risks to the child were not unacceptably high. Two-thirds returned to improved family circumstances, sometimes due to a change in the household they returned to, but others were reunified despite persisting concerns. However 35% re-entered care within six months and 63% re-entered at some point during the four-year follow-up period, often due to recurring abuse or neglect. At final follow-up remaining in care was the strongest predictor of positive outcomes on a range of dimensions, even once children's characteristics and histories were taken into account. Outcomes were especially poor for neglected children who were reunified, irrespective of whether reunification was stable or unstable. Results show the potential of the care system to produce positive outcomes for maltreated children.