Escala para evaluar indicadores de reparación en niños, niñas y adolescentes que han vivido maltrato grave (I-REPARACIÓN): estructura factorial en Chile / Scale to evaluate the recovery process in children and adolescents exposed to serious abuse (I-REPARACION): factorial structure in Chile

En este estudio se ofrece un análisis psicométrico de un instrumento que evalúa la reparación de las consecuencias del maltrato infantil en una muestra de adolescentes chilenos/as. La reparación es un concepto controvertido y complejo que requiere de instrumentos que logren capturar sus distintas dimensiones. En total participaron 491 adolescentes (M = 14,32; DT = 1,70; 74,7% de sexo femenino y 25,3% de sexo masculino) que fueron evaluados/as con el I-REPARACIÓN. Los resultados del análisis factorial exploratorio y confirmatorio apoyan la validez del instrumento ya que este reconoce tres dimensiones de la reparación coherentes con la teoría y evidencia previa: fortalecimiento de la identidad, integración de la experiencia y ausencia de sintomatología. A su vez los análisis de consistencia interna (alfa de Cronbach) apoyan la fiabilidad del instrumento dado que sus ítems miden el constructo de forma consistente. Se considera que, aunque se trata de resultados preliminares, los resultados ofrecen garantías psicométricas para el uso I-REPARACIÓN en el monitoreo del avance de las intervenciones en adolescentes expuestos/as a maltrato infantil.

This study offers a psychometric analysis of an instrument that assesses the recovery process of the consequences of child abuse in a sample of Chilean adolescents. Recovery is a controversial and complex concept that requires instruments that can capture its different dimensions. In total, 491 adolescents (M = 14,32; SD = 1,70; 74,7% girls, 25,3% boys) participated and were evaluated with the I-REPARACIÓN. The exploratory and confirmatory factor analysis results support the instrument's validity since it recognizes three dimensions of recovery consistent with theory and previous evidence: identity strengthening, integration of the traumatic experience, and absence of symptoms. In turn, internal consistency (Cronbach's alpha) analyses support the instrument reliability since its items measure the construct consistently. Although preliminary research, it is considered that the results offer psychometric guarantees for the use of I-REPARACIÓN in monitoring the progress of interventions in adolescents exposed to child abuse.

Short term outcomes of children with abusive head trauma two years post injury: A retrospective study.

PURPOSE: Abusive head trauma (AHT) can have debilitating sequelae for children who survive. A retrospective medical record review was used to describe short-term developmental outcomes of children with AHT and identify predictors of poorer outcomes. METHOD: Children with AHT who received follow up by the hospital's rehabilitation department for 12 to 24 months post-injury were included in this review. Data for 85 children were collected on hearing, vision, gross motor, fine motor, speech and language, cognition, play, adaptive functioning, behaviour and personal-social skills. RESULTS: Global assessment found 42% of children had a good recovery, 34% had a moderate disability and 24% had a severe disability. For whom there was data, more than half had abnormal cognition, behaviour and personal-social skills, whilst more than a third had abnormal speech and language, neurological signs on last assessment, vision, play skills, and gross and fine motor skills. Factors that predicted poorer prognosis across all developmental domains included paediatric intensive care unit admission, longer length of hospital stay, breathing difficulty and lower Glasgow Coma Scale on presentation. CONCLUSION: This study highlights the substantial number of children who have abnormal development in the short-term post-AHT and assists in identifying those who require extensive long-term follow up.

A comparison between a Neuro-Physiological Psychotherapy (NPP) treatment group and a control group for children adopted from care: Support for a neurodevelopmentally informed approach to therapeutic intervention with maltreated children.

BACKGROUND: Little evidence exists regarding outcomes of therapeutic interventions for maltreated children who are removed from their birth families and then adopted. This study follows on from a previous evaluation of the Neuro-Physiological Psychotherapy (NPP) model, which found significant, positive and sustained post-treatment change. OBJECTIVE: To compare the outcomes for the NPP intervention group to those of a control group. PARTICIPANTS AND SETTING: Participants were families who received the NPP intervention and families who, following assessment, did not receive the NPP intervention as recommended. METHODS: Groups were matched in terms of demographics and presentation at assessment. A comparison of outcomes took place using ANCOVA. RESULTS: Significant differences were found between group measures of Behavioral Regulation Index (moderate effect size, Cohen's d = .435; F(1, 1505) = 14.476, p = .000) and Global Executive Functioning (BRIEF) (small effect size, Cohen's d = .147; F(1, 3506) = 7.771, p = .008); mental health difficulties common in maltreated children (ACC/ACA) (small effect size, Cohen's D = .212; F(1, 1100) = 6.197, p = .020) and externalizing behavior (CBCL) (small effect size, Cohen's D = .025; F(1, 686) = 5.420, p = .025). A comparison of parent responses on quantitative aspects of a structured interview using chi-square analysis revealed significant differences between the groups on relationship quality (x2 (2, N = 53) = 10.453, p = .005 with a medium effect size, Cramer's V = .444), disruption (x2 (1, N = 54) = 4.998, p = .025. The effect size was medium with Cramer's V = .304), parental separation rates (x2 (1, N = 45) = 9.474, p = .002. The effect size was moderate with Cramer's V = .459) and several indicators for longer-term social inclusion. The results are discussed in the light of the model's neurodevelopmental and sequential approach, which focuses on sensory integration, affect regulation and therapeutic life story work alongside parent and school support. CONCLUSIONS: Implications regarding current treatment guidelines for this population are discussed; and a call is made for interventions which actively consider and address the neurodevelopmental impact of maltreatment.

[Mental health of children in foster care, a literature review]. / La santé mentale des enfants placés. Une revue de la littérature.

In France more than 140 000 children live in foster homes under the responsibility of the French Child Protection Agency. These children have lived in environments that cannot be good for their development and have been separated from their families which have to have consequences on their mental development. A literature review in France and abroad was made to identify the profiles of these children, their risk factors, and the mental disorders they can present. French child protection is handled by smaller territories, called Départements of which there are more than 90 and count around 1 000 000 people each. The number of foster children differ byDépartement, as do the placement types and meaning of the placement. More than half of these children have suffered maltreatment prior to placement. Comparing them to children of the same age, they present more internalizing and externalizing disorders, more addiction problems and suicidal behaviors. Protection factors have nonetheless been identified, such as early age of placement and placement stability. The main inhibitors of good health care are the absence of a common regulatory framework, source of organization difficulties, and the lack of collaboration between health and social services. French cohort studies using validated tools are necessary to precise and confirm these results. They could then lead to national recommendations for mental health screening and care organization, as well as validation of protocols for specific therapies for foster children.

Unpacking the Influence of Abuse and Depression on Grades among Urban Ethnic Minority Adolescents and Young Adults.

BACKGROUND: Both depression and a history of abuse have known negative consequences on the overall health of adolescents and young adults (AYAs). Research is not clear, however, on the interactive influence of abuse and depression on academic achievement, especially among AYAs of color. OBJECTIVE(S): This study aims to assess the interactive influence of abuse and depression on academic grades among African American and Latino AYAs. METHODS: The study sample was made up of 476 predominantly urban African American and Latino youth ages 14 to 24. Study participants completed a demographic questionnaire (which included self-reported grades) and the Beck Depression Inventory for Primary Care-Fast Screen. Screenings for abuse were done through three structured methods using the Childhood Maltreatment Interview Schedule-Short Form, a short-structured questionnaire, and a face-to-face unstructured interview with a clinical provider. FINDINGS: Depression had a significant main effect on grades, while abuse did not. Abuse and depression had a significant interactive effect on grades in that non-depressed adolescents who reported abuse had an almost four point higher average grade score than their non-depressed counterparts who did not report abuse. CONCLUSIONS: Our findings highlight an unexpected effect in AYAs of color with a history of abuse but no history of depression, suggesting that perhaps there is something intrinsic to this group's resilience or their support systems that protects both against depression and supports their academic achievement. In conclusion, abuse alone does not serve as a predictor of grade achievement. Further work should be done to determine influential factors behind this relationship, with recommendations for school-based counselors and medical providers to screen for depression along with abuse in AYAs in order to determine how best to support this population.

Trauma-Informed Care: Essential Elements for Pediatric Health Care.

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Therapeutic interventions with child survivors of sibling sexual abuse: The professionals' perspective.

BACKGROUND: Sibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit age-appropriate curiosity. SSA may be the most prevalent, longest lasting form of intrafamilial sexual abuse - and the least reported, studied and treated. OBJECTIVE: This exploratory qualitative study examined the experience of intervention with SSA survivors from the perspective of mental health professionals, and explored their major therapeutic challenges. PARTICIPANTS AND SETTING: The sample consisted of 20 Jewish Israeli mental health professionals working in private clinics or public social welfare services who had experience with SSA. METHODS: Semi-structured interviews focusing on the characteristics of SSA events, perceptions about the effects of abuse, intervention priorities and therapeutic challenges compared to other types of child abuse. RESULTS: Professionals working with SSA survivors are preoccupied with the need to provide them with physical and emotional protection, as well as to help them process the abuse narrative. They also find themselves dealing with survivors who do not experience themselves as victims despite external evidence of abuse, or with the need to reconcile their perception of the sexual relationship as mutual, as opposed to the formal requirement to differentiate between "offender" and "victim". In either case, the reality of these survivors can be just as painful as in other SSA cases. CONCLUSIONS: The complexity of SSA calls for unique intervention skills, including working with survivor narratives that do not fit the victim/offender dichotomy on one hand and that do not minimize the potentially harsh consequences of SSA on the other.

Empowering young people who experienced domestic violence and abuse: The development of a group therapy intervention.

This article describes the development of a group-based therapeutic intervention for young people (YP) who have lived with domestic violence and abuse. The intervention was informed by interviews with 107 YP, focused on their experiences of coping, resilience and agency. The intervention draws on resources from systemic, creative and narrative approaches to group work, and aims to facilitate YP's expression of distress in a way that recognizes that it is embodied, contextual and relational. The intervention also explores YP's existing strategies for coping and maintaining a sense of agency, and works to harness, enhance and further develop those skills. We report on the pilot of this intervention, and its development and application across four European countries (the United Kingdom, Greece, Italy and Spain). We outline the goals, strengths and limitations of this group intervention, as well as the main challenges, hindrances and ethical dilemmas experienced by the research and intervention team. Implications for therapeutic practice and training are addressed.

Risks, strengths, gender, and recidivism among justice-involved youth: A meta-analysis.

OBJECTIVE: Debate ensues regarding female-specific risk and strength factors among adolescent offenders. Using meta-analysis, we examined whether risk and strength factors predicted recidivism differentially between male and female youth. METHOD: Database searches identified 22 studies, representing 50,601 justice-involved youth (11,952 females and 38,649 males) and a total of 584 effect sizes. RESULTS: For the global risk domains, there is some evidence for gender neutrality (i.e., risk factors predict to the same degree for both males and females) among most domains (e.g., antisocial peer relations, problematic family circumstances and parenting, substance abuse, antisocial personality/behavior, and antisocial attitudes/orientation). Although the global domains of mental health and child abuse were not significantly predictive for either gender, the global child abuse results trended in favor of predicting recidivism for females. When global risk domains were broken into indicators, some evidence for gender differences emerged (e.g., chronic alcohol use and family substance abuse predicted more strongly for females than for males). Last, gender comparisons among the global strength domains revealed that prosocial peers and the absence of substance abuse predicted success (i.e., no recidivism) for both genders, though a stronger effect emerged for males. In addition, education/employment strengths predicted success for males, whereas prosocial values predicted success for females. Limitations such as the lack of studies that defined constructs from the female experience, and the small number of primary studies are discussed. CONCLUSIONS: Advancing the future of gender informed practice with justice-involved youth will require careful consideration of both gender similarities and differences. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

EARLY MALTREATMENT AND CURRENT QUALITY OF RELATIONAL CARE PREDICT SOCIOEMOTIONAL PROBLEMS AMONG INSTITUTIONALIZED INFANTS AND TODDLERS.

The present study is focused on child socioemotional problems 6 months after institutionalization, by considering the putative predictive role of child maltreatment, of developmental functioning at admission and the following months, and of the quality of institutional relational care. Fifty institutionalized infants and toddlers participated in this study. Child developmental functioning (i.e., cognitive, language, and motor development) was assessed at admission to the institution (Wave 0), and 3 (Wave 1) and 6 months (Wave 2) thereafter. The quality of institutional relational care-operationalized in terms of caregivers' sensitivity and cooperation-was measured at Wave 2. Caregivers reported on the presence of disturbed socioemotional behaviors at Wave 2. Child gestational age, birth weight, age, and stunted growth at admission to the institution served as covariates. Results revealed significant associations between socioemotional difficulties and lower levels of motor development at Waves 0 and 1, child maltreatment, and less sensitive caregiving. A logistic regression showed that child maltreatment and caregiver insensitivity were the only significant predictors of disturbed socioemotional functioning by the end of 6 months of institutionalization.

Children hospitalized due to maltreatment in the ICU of a Public Health Service.

OBJECTIVE: to characterize children hospitalized due to violence in a pediatric ICU in 2011; to relate violence and the mechanisms of trauma with death; to know the contextualization of violence, from the records in the medical records. METHOD: retrospective cohort, performed in a first aid hospital, Porto Alegre city, in the records of 22 children hospitalized in the ICU due to violence. Quantitative analysis was performed by absolute and relative frequency rates, chi-square and relative risk. RESULTS: 54.5% were boys, 81.8% were white and 50% were up to three years old. Physical violence 50% and neglect 36.4%, family of children (77.3%), highlighting the mother (35.3%). Mechanisms of aggression: fall (22.7%), burns (18.2%). Burns were at high risk for death. Discharge to go home after ICU admission (59.1%). CONCLUSION: It is considered that the characterization of the cases of violence reflects the complexity of the theme, mainly, in face of the life histories that surround each case of children hospitalized by this aggravation.

Responding to Adverse Childhood Experiences: It Takes a Village.

In working to improve the health of North Carolinians, a broader emphasis has been placed on determinants of health, or non-medical drivers of health. Critical examples of health determinants are adverse childhood experiences, or ACEs, that affect early brain development and lifelong health and function. Multiple organizations and communities have come together to acknowledge the importance of prevention, address toxic stress and trauma in childhood, promote resiliency and trauma-informed care, and invest in the future of North Carolina through its children. This issue of the NCMJ highlights the prevalence and magnitude of ACEs in North Carolina and the effects on our children and the impact into adulthood, and how people and communities can come together to improve public health over the life course by addressing ACEs.

Protection of children and adolescents victims of violence: the views of the professionals of a specialized service.

OBJECTIVES: To know the obstacles faced by the professionals to work in network and challenges of the work of the professionals in the Reference Center Specialized in Social Assistance (CREAS) of a municipality in the extreme south of Brazil. METHODS: It is a qualitative study, developed with twelve professionals of a CREAS. Data collection was performed through a semi-structured interview, from April to May 2016. The interviews were submitted to content analysis. RESULTS: The fragmentation among the various services that make up the victim assistance network is an obstacle for professionals as they are unable to continue the recovery and health promotion actions of these families. The professionals point out the bureaucratic procedures, the accumulation of functions and the lack of human and financial resources as a routine problem and that seriously hinders the progress of the service. CONCLUSIONS: For the professionals, the protection network presents weaknesses that compromise the guarantee of the rights of children and adolescents.

Identifying Effective Components of Child Maltreatment Interventions: A Meta-analysis.

There is a lack of knowledge about specific components that make interventions effective in preventing or reducing child maltreatment. The aim of the present meta-analysis was to increase this knowledge by summarizing findings on effects of interventions for child maltreatment and by examining potential moderators of this effect, such as intervention components and study characteristics. Identifying effective components is essential for developing or improving child maltreatment interventions. A literature search yielded 121 independent studies (N = 39,044) examining the effects of interventions for preventing or reducing child maltreatment. From these studies, 352 effect sizes were extracted. The overall effect size was significant and small in magnitude for both preventive interventions (d = 0.26, p < .001) and curative interventions (d = 0.36, p < .001). Cognitive behavioral therapy, home visitation, parent training, family-based/multisystemic, substance abuse, and combined interventions were effective in preventing and/or reducing child maltreatment. For preventive interventions, larger effect sizes were found for short-term interventions (0-6 months), interventions focusing on increasing self-confidence of parents, and interventions delivered by professionals only. Further, effect sizes of preventive interventions increased as follow-up duration increased, which may indicate a sleeper effect of preventive interventions. For curative interventions, larger effect sizes were found for interventions focusing on improving parenting skills and interventions providing social and/or emotional support. Interventions can be effective in preventing or reducing child maltreatment. Theoretical and practical implications are discussed.

Children hospitalized due to maltreatment in the ICU of a Public Health Service / Niños hospitalizados por maltrato en UTI de servicio público de salud / Crianças hospitalizadas por maus-tratos em UTI de serviço público de saúde

ABSRACT Objective: to characterize children hospitalized due to violence in a pediatric ICU in 2011; to relate violence and the mechanisms of trauma with death; to know the contextualization of violence, from the records in the medical records. Method: retrospective cohort, performed in a first aid hospital, Porto Alegre city, in the records of 22 children hospitalized in the ICU due to violence. Quantitative analysis was performed by absolute and relative frequency rates, chi-square and relative risk. Results: 54.5% were boys, 81.8% were white and 50% were up to three years old. Physical violence 50% and neglect 36.4%, family of children (77.3%), highlighting the mother (35.3%). Mechanisms of aggression: fall (22.7%), burns (18.2%). Burns were at high risk for death. Discharge to go home after ICU admission (59.1%). Conclusion: It is considered that the characterization of the cases of violence reflects the complexity of the theme, mainly, in face of the life histories that surround each case of children hospitalized by this aggravation.

RESUMEN Objetivo: caracterizar a los niños hospitalizados por violencia, en una UTI pediátrica, en 2011; relacionar la violencia y los mecanismos de trauma con el óbito; conocer la contextualización de la violencia, a partir de los registros en los prontuarios. Método: el corte retrospectivo, realizado en un hospital de pronto socorro, ciudad de Porto Alegre/RS, en los registros de 22 niños internados en la UTI por violencia. Se realizó un análisis cuantitativo por índices frecuenciales absolutos y relativos, qui-cuadrado y riesgo relativo. Resultados: 54,5% eran niños; 81,8% raza/etnia blanca y 50% tenían hasta tres años. Violencia física 50% y la negligencia 36,4%; familiar del niño (77,3%), destaque para la madre (35,3%). Mecanismos de agresión: caída (22,7%), quemaduras (18,2%). Las quemaduras presentaron un alto riesgo de muerte. Alta para el hogar después de la internación en UTI (59,1%). Conclusión: Se considera que la caracterización de los casos de violencia refleja la complejidad del tema, principalmente ante las historias de vida que envuelve cada caso de los niños hospitalizados por este agravio.

RESUMO Objetivo: caracterizar as crianças hospitalizadas por violência, em uma UTI pediátrica, em 2011; relacionar violência e os mecanismos de trauma com o óbito; conhecer a contextualização da violência, a partir dos registros nos prontuários. Método: coorte retrospectivo, realizado em um hospital de pronto socorro, Porto Alegre/RS, nos registros de 22 crianças internadas na UTI, por violência. Realizou-se análise quantitativa por índices frequenciais absolutos e relativos, qui-quadrado e risco relativo. Resultados: 54,5% eram meninos, raça/etnia branca 81,8% e 50% tinham até três anos. Violência física 50% e a negligência 36,4%, familiar da criança (77,3%), destaque para a mãe (35,3%). Mecanismos de agressão: queda (22,7%), queimaduras (18,2%). As queimaduras apresentaram risco elevado para óbito. Alta para casa após internação em UTI (59,1%). Conclusão: Considera-se que a caracterização dos casos de violência reflete a complexidade do tema, principalmente, diante das histórias de vida que envolve cada caso de criança hospitalizada por este agravo.

Evaluation of Bikers Against Child Abuse (BACA) program: A community intervention for child abuse victims.

Children who have experienced physical abuse benefit from a multitude of community interventions including support programs to address emotional and behavioral stability. This pilot study evaluated the services of Bikers Against Child Abuse (BACA), a community of bikers lending intervention to abused children, using a pre/post exploratory design. Participants (N=154) were children who had been referred by parents/guardians for current or past physical and/or sexual abuse. Parents/guardians of children were interviewed four times over a course of one year. Results indicated children demonstrated substantial improvements in their overall levels of emotional distress, conduct concerns, hyperactivity, and behavioral and emotional functioning. Overall, results support the premise that services provided by BACA may serve as a unique intervention for children who have experienced abuse.

Taking culture seriously: Can we improve the developmental health and well-being of Australian Aboriginal children in out-of-home care?

BACKGROUND: Children in out-of-home care have well-documented health and developmental needs. Research suggests that Aboriginal children in care have unmet health and intervention needs. In metropolitan Sydney, Kari Aboriginal Resources Inc. (KARI), an Aboriginal organization, provides support to indigenous children in care, including clinical assessment and intervention. We wanted to determine the health and developmental needs of a subset of children in out-of-home care with KARI, who had been in stable care for at least a year. We wanted to identify child, carer, and intervention characteristics that contributed to children doing well. We also wanted to identify enablers and barriers to providing culturally competent intervention. METHODS: We used mixed methods. From the KARI clinic database over the past 3 years, we identified children who had been in stable care with KARI for >12 months. We compared clinical measures and outcomes for these children with results from previous audits. We carried out a group discussion and key informant interviews with therapists and caseworkers to identify risk and resilience factors for each child, as well as enablers and barriers to culturally competent intervention. RESULTS: The health and developmental profile of the 26 children identified as being in stable care was similar to that of previous audits. Most (88%) were getting speech pathology intervention; one third were getting occupational therapy and psychological intervention; most children and their carers attended cultural programmes. The majority of children (25/26) improved in their developmental health. Caseworkers and therapists identified risk and resilience factors related to child, carer, and home characteristics. They also identified elements of good practice; systemic issues prevented some interventions from being carried out. CONCLUSIONS: There are challenges delivering a trauma-informed, culturally respectful service to Aboriginal children in out-of-home care in an urban setting, but it can be done if attention is paid to culture and the enablers and barriers are identified.

Difficulties with emotion regulation moderate the association between childhood history of maltreatment and cortisol reactivity to psychosocial challenge in postpartum women.

Exposure to child maltreatment can lead to long-term emotional difficulties and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. However, no prior work has examined emotion regulation as a moderator of the association between childhood history of maltreatment and cortisol response to psychosocial challenge. Amongst a sample of 140 postpartum women, associations between childhood maltreatment, emotion regulation, and cortisol response to a computerized Emotional Stroop paradigm were examined using structural equation modeling. Three saliva samples (baseline, 20- and 40-min post-challenge) were collected and later assayed for cortisol. Stepwise regression analyses revealed that difficulties with emotion regulation significantly moderated the association between maternal history of child maltreatment and cortisol reactivity (ß=-0.17, CI.95=-0.31, -0.04, t=-2.51, p=0.01). Specifically, women with higher child maltreatment scores and greater difficulties with emotion regulation displayed reduced cortisol reactivity. This finding suggests that diminished emotion regulation capacity may uniquely contribute to blunted physiological reactivity in postpartum women exposed to higher levels of child maltreatment. As the postpartum period has significant implications for maternal well-being and infant development, these findings are discussed in terms of adaptive responsivity, maternal behaviour, and clinical practice.