Bolstering gun injury surveillance accuracy using capture-recapture methods.

Using a single source of data, such as police records, or combining data from multiple sources results in an undercount of gun-related injuries. To improve gun-related injury surveillance accuracy by using capture-recapture methods, data were culled from law enforcement, emergency departments, emergency medical services, media, and medical examiner records. The data overlap was operationalized using capture-recapture to generate estimates of uncounted gun incidents. Dependencies between data sources were controlled using log-linear modeling for accurate estimates. New Haven, Connecticut. The study population included subjects injuried/killed from a gun projectile. Incidence was measured using capture-recapture. 49 gun injuries occurred within the defined geography. No single source recorded more than 43 gun-related injuries/deaths. Log-linear modeling estimated the actual number of injuries to be 49.1 (95% CI 49-49.9). Capture-recapture may be less useful in large metropolitan areas that cross state geographical boundaries because of how government agency data are aggregated within each state. No single data source achieves complete gun-related case ascertainment. Log-linear and capture-recapture methods significantly improve gun-related injury estimates.

We Are Family: Specifying the Unique Contribution of Abuse and Neglect of Siblings on the Prevalence, Severity, and Chronicity of Maltreatment in the Household.

Prior research typically focuses on a single child ("index" victim) when measuring child abuse and neglect (CAN) using Child Protective Services (CPS) records. However, excluding siblings has the potential to underestimate estimates of the prevalence, severity, and chronicity of CAN in the household, which includes all children in the family. CPS maltreatment records were searched in 2005 for 366 "index" victims who were surveyed for 5 consecutive years (from 1998 to 2002) for the Mobile Youth Survey (MYS) as well as other siblings in the household. The estimate of prevalence of CAN in the household increased by 10% when sibling(s) in the household were included in the CPS search. In addition, prevalence of sexual abuse in the household increased by 38% when siblings were included in the broader search of CPS records. More importantly, including sibling victims of CAN uncovered incidents of maltreatment that occurred before the birth of the targeted MYS "index" victim. In short, the inclusion of abuse and neglect of siblings is a straightforward and intuitive way to improve estimates of abuse and neglect in the household. More importantly, the age of onset of CAN of sibling victims provides a wider window of opportunity to identify at-risk families for targeted interventions and may represent a critical stepping stone toward the primary prevention of CAN in the household.

Family Matters: Examining Child Abuse and Neglect as Family Dysfunction for Minority Youth Living in Extreme Poverty.

Two competing models of child abuse and neglect (scapegoat vs. family dysfunction) are used to illustrate how the specification of victims ("index" victim vs. all children in household) from incidents of child abuse and neglect can be used to improve estimates of maltreatment for at-risk minority youth. Child Protection Services records were searched in 2005 for 366 "index" victims who were surveyed for 5 consecutive years (from 1998 to 2002) for the Mobile Youth Survey as well as other siblings in the household. The findings indicate that the baseline estimate of any maltreatment, sexual abuse, physical abuse, and neglect increased by 68%, 26%, 33%, and 74%, respectively, after adjusting for incidents that involved multiple victims (i.e., maltreatment as family dysfunction). In addition, the baseline estimate of more severe (indicated) incidents of physical abuse and neglect increased by 67% and 64%, respectively, after accounting for incidents that involved multiple victims, but there were no incidents of more severe (indicated) sexual abuse that involved multiple victims. Similarly, baseline estimates of age of onset (or chronicity) of maltreatment during childhood and adolescence increased by 62% and 26%, respectively. Baseline estimates for youth with 3 or more years of maltreatment and youth with 3 or more incidents of maltreatment both increased by about 71%. The implications of these findings for policy and practice as well as areas for future research are also discussed.

Multidisciplinary team perspectives on older adult hoarding and mental illness.

This qualitative study examined multidisciplinary team members' perspectives of their involvement in older adult hoarding cases. Fifteen informants, as representatives of four hoarding teams, described cases in which teams did or did not work well together. Specifically, informants described their (a) team characteristics, (b) awareness of hoarding as a mental health illness, (c) barriers to providing mental health services for older adults who hoard, and (d) components of successful teamwork within the team and with the older adult as hoarder. Implications include research to better guide interventions, team training to develop common perspectives, and policy development that supports mental health representation on teams and in-home mental health treatment.

Specifying the interrelationship between exposure to violence and parental monitoring for younger versus older adolescents: a five year longitudinal test.

Five waves of longitudinal data collected from 349 African American youth living in extreme poverty were used to examine the interrelationship between exposure to violence and parenting during adolescence. Semi-parametric group based modeling was used to identify trajectories of parental monitoring and exposure to violence from T1 to T5. Results from these analyses revealed: (1) a trajectory of declining parental monitoring for 48% of youth; and (2) four distinct trajectories of exposure to violence. Multivariate findings were largely consistent with the ecological-transactional model of community violence. Youth with stable and/or increasing trajectories of exposure to violence were more likely than youth with stable-low exposure to violence to have declining parental monitoring, but additional analyses revealed a similar pattern of findings for younger adolescents (age 9-11 T1), but no evidence of linkages between trajectories of exposure to violence and parental monitoring for older adolescents (age 12-16 T1). The theoretical and policy implications of these findings as well as areas for future research are also discussed.

Specifying the role of exposure to violence and violent behavior on initiation of gun carrying: a longitudinal test of three models of youth gun carrying.

Two waves of longitudinal data from 1,049 African American youth living in extreme poverty are used to examine the impact of exposure to violence (Time 1) and violent behavior (Time 1) on first time gun carrying (Time 2). Multivariate logistic regression results indicate that (a) violent behavior (Time 1) increased the likelihood of initiation of gun carrying (Time 2) by 76% after controlling for exposure to violence at Time 1, which is consistent with the stepping stone model of youth gun carrying, and (b) youth who were both exposed to violence at Time 1 and engaged in violent behavior at Time 1 were more than 2.5 times more likely to initiate gun carrying at Time 2 compared to youth who had neither of these characteristics, which supports the cumulative risk model of youth gun carrying. The authors discuss the implications of these findings in clarifying the role of violence in the community on youth gun carrying and the primary prevention of youth gun violence.

Does parenting shield youth from exposure to violence during adolescence? A 5-year longitudinal test in a high-poverty sample of minority youth.

Five waves of longitudinal data collected from 349 African American youth living in extreme poverty were used to determine if parental monitoring shielded youth from exposure to violence during adolescence. Semiparametric group- based modeling was used to identify trajectories of parental monitoring and exposure to violence from T1 to T5. Results from these analyses revealed (a) about 52% of youth had a trajectory of hypervigilant parental monitoring and (b) two out of the five distinct trajectories of exposure to violence were low and/or declining over the 5-year time period. Multivariate findings indicated that (a) youth with a trajectory of hypervigilant parenting were 109% more likely to have middle-declining exposure to violence, but hypervigilant parenting was unrelated to stable and low exposure to violence T1 to T5. The theoretical and policy implications of these findings as well as areas for future research are also discussed.

Using multidisciplinary teams to address ethical dilemmas with older adults who hoard.

Multidisciplinary teams, representing professionals from diverse disciplines, are often involved in addressing difficult ethical dilemmas as they work with older adults who hoard (e.g., resolving conflicts between the older adult's freedom to engage in hoarding behaviors versus individual or public safety). The purpose of this article is threefold: (a) to explore the current use of hoarding task force or team interventions to address ethical dilemmas that occur within hoarding cases; (b) to propose an ethical decision making framework for use by teams and others; and (c) to discuss practice implications for hoarding teams in implementing this ethical decision making framework.

Does parenting mediate the effects of exposure to violence on violent behavior? An ecological-transactional model of community violence.

Three waves of longitudinal data from a high poverty sample of 1544 African American youth were used to test an ecological-transactional model of violence. SEM analyses were conducted to determine whether parenting (Time 2) mediated the effects of exposure to violence (Time 1) on violent behaviors (Time 3). Findings supported the specified model. Multigroup SEM analyses indicated that neither family structure nor developmental stage (early versus middle/late adolescence) moderated these effects. However, exposure to violence had a larger effect on violent behaviors in female versus male youth, although the difference was simply in magnitude, not direction. A final model that predicted change scores also provided support for the hypothesized ecological-transactional model of violence.