Child Maltreatment

虐待儿童
  • 文章类型: Journal Article
    这项研究的目的是检查患病率,预测因子,以及预期看护者和儿童身体和情感虐待的回顾性儿童报告之间分歧的后果。该设计是对雅芳父母和子女纵向研究数据的二次分析,为期30年的英国出生队列。前瞻性照顾者报告与儿童身体和情感虐待暴露的回顾性报告相差无几。护理人员倾向于低估暴露。记者之间的分歧与抑郁症状和物质使用严重程度的风险增加有关,但降低了心理健康诊断的风险。儿童虐待暴露的筛查措施应谨慎使用来自不同报告者的措施(即,来自母亲与孩子)。报告中的分歧可能表明对心理健康评估的需求未得到满足。
    The purpose of this study was to examine the prevalence, predictors, and consequences of disagreement between prospective caregiver and retrospective child reports of childhood physical and emotional maltreatment. The design was a secondary analysis of data from the Avon Longitudinal Study of Parents and Children, a three-decade long UK-based birth cohort. Prospective caregiver reports were in poor to fair agreement with retrospective child reports for physical and emotional maltreatment exposure, with caregivers tending to underreport exposure. Disagreement between reporters was associated with increased risk of depressive symptoms and substance use severity, but decreased risk for mental health diagnoses. Screening measures of childhood maltreatment exposure should take caution against using measures from different reporters interchangeably (i.e., from mother versus child). Disagreement in reports may indicate unmet need for mental health evaluation.
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  • 文章类型: Journal Article
    背景:虽然过去的研究表明,非正式的社会支持和幼儿计划对儿童福利监督的家庭和儿童的福祉的重要性,关于这些机制是否作为儿童福利涉及家庭的保护因素,并调解重复虐待儿童的可能性,人们知之甚少。
    目的:该研究调查了非正式社会支持和幼儿计划参与在调解儿童忽视初始报告对随后的儿童虐待报告的影响中的作用。
    方法:0-6岁儿童(N=1963)的研究样本来自NSCAW-II数据集,5872儿童福利监督儿童及其家庭的全国代表性纵向数据集。
    方法:结构方程模型用于检查直接和间接途径:从最初的忽视报告到所有随后的儿童虐待报告,以及从最初的忽视报告到所有随后的儿童虐待报告,通过中介变量,例如非正式的社会支持和幼儿计划。
    结果:结果表明,非正式的社会支持在降低后续报告的可能性方面起着重要作用(b=-0.00,p=0.005)。非正式社会支持的增加一个单位,使儿童虐待重新报告的几率降低了0.3%(非正式社会支持的几率OR=0.997)。
    结论:重要的是,支持儿童福利监督的家庭加强与家人和朋友的非正式网络,并扩大社区中的非家庭非正式网络。
    While past research has suggested the importance of informal social support and early childhood programs for the well-being of child welfare supervised families and children, little is known about whether or not these mechanisms function as protective factors for child welfare involved families and mediate the likelihood of repeat child maltreatment.
    The study examined the role of informal social support and early childhood program participation in mediating the effects of initial report of child neglect on subsequent child maltreatment reports.
    The study sample of children ages 0-6 (N = 1963) was drawn from the NSCAW-II dataset, a nationally representative longitudinal dataset of 5872 child welfare supervised children and their families.
    Structural Equation Modeling was used to examine the direct and indirect pathways: from initial report of neglect to all subsequent child maltreatment reports and from initial report of neglect to all subsequent child maltreatment reports through mediating variables such as informal social support and early childhood programs.
    Results showed that informal social support plays an important role in reducing the likelihood of subsequent reports (b = -0.00, p = 0.005). One unit increase in informal social support reduced the odds of a child maltreatment re-report by 0.3 % (odds ratio for informal social support OR = 0.997).
    It is important that child welfare supervised families are supported in enhancing their informal networks with their family members and friends and expanding non-familial informal networks in the community.
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  • 文章类型: Journal Article
    案例概念化,正式称为案例制定,是一种工具,有助于为遭受家庭暴力的儿童和家庭确定最佳行动方案,但在儿童福利中没有得到充分利用。在本文中,我们介绍了一个考虑儿童福利背景的逐步案例概念化过程。然后,我们提出了一个假设的案例示例,该案例是由儿童福利工作者转介的10岁儿童接受心理健康和行为关注的循证治疗。心理健康服务对孩子没有帮助,需要进一步咨询。为了更有效地指导干预和治疗计划,并最终改善儿童的预后,我们将案例概念化作为一个包含儿童和家庭历史和情况的相关方面的过程。最后,我们提出了一个简洁的病例概念化和治疗计划,以说明采用病例概念化后如何改善儿童的预后。
    Case conceptualization, formally known as case formulation, is one tool that assists in determining the best course of action for children and families experiencing family violence that has been under-utilized in child welfare. In this article we present a step-by-step case conceptualization process that considers the child welfare context. We then present a hypothetical case example of a 10-year-old child referred by a child welfare worker to evidence-based treatment for mental health and behavioural concerns. Mental health services are not helpful for the child and further consultation is enlisted. To more effectively guide intervention and treatment planning and ultimately improve outcomes for the child, we present case conceptualization as a process that incorporates relevant aspects of the child and family\'s history and circumstance. We conclude with a succinct case conceptualization and treatment plan to show how the prognosis of the child can be improved when case conceptualization is employed.
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  • 文章类型: Journal Article
    背景:在安大略省,涉及儿童接触亲密伴侣暴力(IPV)的儿童福利调查的增加可能是三个因素的结果:1)立法的变化,政策,和评估工具;2)提高对儿童接触IPV风险的认识,和3)专业人士的推荐(例如,警察)。
    目的:使用安大略省报告的儿童虐待和忽视发生率研究(OIS)的6个周期的数据(1993、1998、2003、2008、2013和2018),本文将研究IPV暴露发生率的变化,为安大略省尚未很好理解的一种调查提供了重要的背景。
    方法:得出调查人员主要关注的是IPV的调查发生率,并在OIS周期中进行比较。使用发生率计数对各个周期的调查进行比较。
    结果:在1998年至2003年间,安大略省所有虐待类型的调查增加了近2倍之后,IPV调查是唯一继续增加的类型。这些调查与证实虐待儿童之间的差距越来越大。随着时间的推移,安置率没有变化,保持低。转移和转介的比率有所增加,但幅度不大。
    结论:涉及IPV暴露的儿童福利调查率的持续增长,以及对IPV暴露的压倒性认可,同时保持向正在进行的儿童福利服务的转移比例和较低的安置率,是安大略省的一个重要问题。
    Increases in child welfare investigations involving children\'s exposure to intimate partner violence (IPV) in Ontario are likely the result of three factors: 1) changes to legislation, policy, and assessment instruments; 2) increased awareness of the risks of exposure to IPV for children, and 3) referrals from professionals (e.g., police).
    Using data from 6 cycles of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) (1993, 1998, 2003, 2008, 2013, and 2018), this paper will examine the changes of the incidence rates of IPV exposure, providing important context for a type of investigation that is not well understood in Ontario.
    The incidence of investigations where the primary concern of the investigating worker is IPV was derived and compared across OIS cycles. Investigation were compared across cycles using incidence counts.
    After the nearly 2-fold increase of investigations for all maltreatment types in Ontario between 1998 and 2003, IPV investigations are the only type that continue to increase. There is a growing gap between these investigations and substantiating child maltreatment. Rates of placement have not changed over time, remaining low. Rates of transfers and referrals have increased but not significantly.
    The continued growth in the rate of child welfare investigations involving exposure to IPV as well as the overwhelming endorsement of substantiated exposure to IPV, while maintaining the same proportion of transfers to ongoing child welfare services and low placement rates, is a significant concern for Ontario.
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  • 文章类型: Journal Article
    背景:报告儿童虐待(CM)的机制在COVID-19大流行爆发后立即受到服务提供变化的影响。
    目的:检查COVID-19发病前后CM医疗遭遇的计数和CPS报告的变化。
    方法:在圣地亚哥雷迪儿童医院的研究期间,所有急诊科和住院医疗遇到至少一个CM诊断,2016年至2021年11月期间,加州最大的儿科医院。
    方法:使用链接的病历和CPS管理数据,中断的时间序列模型测试了随着COVID-19的发作向CPS报告的每月计数和CM医疗遭遇百分比的变化。Logistic回归测试CPS报告与CM相遇相关的可能性。
    结果:在COVID-19发作后,CM医疗遭遇总计2528次,包括793次。随着大流行的开始,中断的时间序列模型表明,CM接触计数增加了18%(RR:1.18,95%CI1.03-1.34),报告给CPS的百分比增加了10%(RR:1.10,95%CI:1.05-1.17).在COVID-19大流行发作后发生的CM遭遇增加了CPS报告的几率(完全调整模型:OR:1.08;95%CI:1.05-1.12)。
    结论:这项研究发现,大流行发作后,每月计数增加,与CPS报告的CM医疗接触百分比更高。
    Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic.
    To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19.
    All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children\'s Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021.
    Using linked medical record and CPS administrative data, interrupted time series models tested for changes in monthly counts and percentages of CM medical encounters reported to CPS with the onset of COVID-19. Logistic regression tested for the likelihood of a CPS report being associated with a CM encounter.
    CM medical encounters totaled 2528, including 793 after the onset of COVID-19. Interrupted time series models indicated with the onset of the pandemic, the counts of CM encounters increased 18 % (RR: 1.18, 95 % CI 1.03-1.34) and the percentages reported to CPS increased 10 % (RR: 1.10, 95 % CI: 1.05-1.17). CM encounters that occurred after the onset of the COVID-19 pandemic had increased odds of a CPS report (fully adjusted model: OR: 1.08; 95 % CI: 1.05-1.12).
    This study found increases in monthly counts and a higher percentage of CM medical encounters with CPS reports after the pandemic onset.
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  • 文章类型: Journal Article
    背景:儿童虐待在整个生命周期中有许多后果。全科医生(GP)与家庭有纵向联系,可以在识别处于危险中的儿童并向社会服务机构报告方面发挥重要作用。
    目的:探讨全科医生如何处理对儿童虐待的怀疑,并调查丹麦全科医生报告行为中潜在的人口统计学和地理差异。
    方法:从Medcom检索到的所有在丹麦注册的GP,国家资助的非营利组织。
    方法:我们向所有注册的全科医生邮寄了一份调查问卷,经验,知识,和虐待儿童的态度。
    结果:我们收到了1252份完整的问卷(回复率:38%)。大多数参与者在他们的职业生涯中怀疑虐待儿童(90%),并做出了强制性报告(85%)。超过一半的人在报告后收到反馈(56%),并表示他们的报告导致了行动(56%)。大多数全科医生报告说,他们对处理虐待儿童有信心(79%),并愿意在怀疑的情况下参与其中(0-10分为8.9分)。我们观察到,无论是在丹麦地区还是在农村和城市实践之间,报告都没有地理差异,但在单一实践中工作的全科医生对社会服务机构的报告较少。
    结论:这项研究的参与者全科医生意识到他们在儿童保护中的作用,有强制性报告的经验,并愿意参与其中。可能需要注意的领域包括不同环境之间的协作和支持,特别是在GP实践之间,医院,司法部门,和社会服务。
    Child maltreatment has many consequences through the lifespan. The general practitioners (GPs) are in longitudinal contact with the family and can play an important role in identifying children in danger and reporting to the social services.
    To explore how GPs manage suspicions of child maltreatment and to investigate potential demographic and geographic differences in reporting practices among Danish GPs.
    All registered GPs in Denmark retrieved from Medcom, a state-financed non-profit organization.
    We mailed a questionnaire to all registered GPs with demographics, experiences, knowledge, and attitudes in the context of child maltreatment.
    We received 1252 completed questionnaires (response rate: 38 %). Most of the participants had suspected child maltreatment during their professional life (90 %) and had made a mandatory report (85 %). More than half had received feedback after the report (56 %) and said that their report led to action (56 %). Most GPs reported feeling confident in dealing with child maltreatment (79 %) and being willing to get involved in case of suspicion (8.9 on a 0-10 scale). We observed no geographical differences in reporting neither across the Danish regions nor among rural and urban practices, but GPs working in single practices made fewer reports to the social services.
    Participant GPs in this study are aware of their role in child protection, have experiences with mandatory reports, and are willing to get involved. Possible areas for attention include collaboration and support between different settings, especially between GP practice, hospitals, justice sector, and social services.
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  • 文章类型: Journal Article
    目的:确定不同的患者特征,损伤类型,以及台湾住院虐待儿童与非虐待儿童伤害之间的治疗结果。方法:利用国家健康保险研究数据库中的数据,我们选择了1525名18岁以下被诊断为虐待儿童的患者,以及另外6100名患者作为对照组。卡方检验,Fisher精确检验,和独立样本t检验用于比较受虐待儿童和非虐待相关受伤儿童之间的差异。采用多因素条件logistic回归分析受伤儿童虐待的危险因素。结果:虐待儿童组的颅内损伤发生率高于非虐待儿童组(35.0%vs.8.2%;p<0.001)。虐待儿童组的儿童往往在医院停留更长的时间,并产生更高的医疗费用(8.91天与4.41天和2564美元vs.分别为880美元)。在多变量分析中,低收入家庭中虐待导致儿童受伤的调整后几率(调整后OR)比非低收入家庭高1.965倍(p<0.001)。生活在高城市化地区的儿童被虐待的概率明显高于生活在低城市化地区的儿童(p<0.001)。结论:1岁以下儿童因严重颅内损伤住院,儿童虐待的风险很高。此外,在虐待儿童案件中观察到许多高风险环境因素,包括生活在城市地区,低收入家庭,和季节性,由于儿童虐待案件在秋季更频繁发生。
    Objective: To identify the differential patient characteristics, injury types, and treatment outcomes between hospitalized child abuse and non-child abuse injuries in Taiwan. Methods: Using the data from the National Health Insurance Research Database, we selected a total of 1525 patients under the age of 18 that were diagnosed with child abuse, as well as an additional 6100 patients as a comparison group. Chi-square test, Fisher exact test, and independent samples t-test were used to compare the differences between the abused children and the non-abuse-related injured children. The multivariate conditional logistic regression was performed to measure the risk factor of child maltreatment in injured children. Results: Intracranial injury was more frequent in the child abuse group than it was in the non-child abuse group (35.0% vs. 8.2%; p < 0.001). Children in the child abuse group tended to stay longer in the hospital and incur higher medical expenses (8.91 days vs. 4.41 days and USD 2564 vs. USD 880, respectively). In multivariate analysis, the Adjusted Odds Ratio (Adjusted OR) of abuse resulting in an injury for children in low-income families is 1.965 times higher than those in non-low-income families (p < 0.001). Children living in high urbanization areas had a significantly higher probability of being abused than those living in low urbanization areas (p < 0.001). Conclusion: Children under the age of 1 who were hospitalized with severe intracranial injuries are highly at risk for child maltreatment. Moreover, numerous high-risk environmental factors were observed in child abuse cases, including living in urban areas, families with low income, and seasonality, as child maltreatment cases occur more frequently in autumn.
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  • 文章类型: Journal Article
    为了确定婴儿是否接受身体虐待评估,婴儿窘迫的医疗遭遇与身体虐待或前哨损伤史有关。
    这次回顾展,对年龄<12个月的婴儿进行病例对照分析,评估其身体虐待确定的人口统计学特征,先前受伤,和婴儿痛苦的医疗遭遇。比较了受虐待婴儿和没有前哨损伤的未受虐待婴儿之间的变量。非参数递归分类树分析评估了变量之间的相互作用。
    婴儿窘迫与虐待相关(67.9%vs44.7%;P=.008;OR,2.6;95%CI,1.3-5.2)。有前哨损伤的婴儿有更高的婴儿困扰率(74.1%vs42.4%;P≤0.001)和哭闹率(81.5%vs62.7%;P=.012)。以前的跌倒(32.6%vs18.1%;P=.03)和非哨兵伤害(18.2%vs5.4%;P=.002)也与虐待有关,尽管哨兵受伤是虐待的最重要预测因素,其次是婴儿的痛苦。
    因痛苦和受伤而遭遇医疗的婴儿可能面临更高的虐待风险,并可能受益于为其照顾者提供的强化教育和支持服务。需要进行其他研究,以评估对挑剔婴儿的照顾者的最有效干预措施。
    To determine whether in infants evaluated for physical abuse, medical encounters for infant distress are correlated with physical abuse or a history of sentinel injuries.
    This retrospective, case-control analysis of infants aged <12 months evaluated for physical abuse identified demographic characteristics, prior injuries, and medical encounters for infant distress. Variables were compared between abused infants and nonabused infants with and without sentinel injuries. A nonparametric recursive classification tree analysis assessed interactions between variables.
    Infant distress was associated with abuse (67.9% vs 44.7%; P = .008; OR, 2.6; 95% CI, 1.3-5.2). Infants with sentinel injuries had higher rates of infant distress (74.1% vs 42.4%; P ≤ .001) and crying (81.5% vs 62.7%; P = .012). Previous falls (32.6% vs 18.1%; P = .03) and nonsentinel injuries (18.2% vs 5.4%; P = .002) also were associated with abuse, although sentinel injuries were the most important predictor of abuse, followed by infant distress.
    Infants with medical encounters for distress and injury may be at higher risk for abuse and may benefit from intensive educational and support services for their caregivers. Additional research evaluating the most effective interventions for caregivers of fussy infants is needed.
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  • 文章类型: Journal Article
    目前的文献表明,粮食不安全增加了儿童虐待的风险。然而,现有的证据仅限于低收入人群中的个人层面的关联,基于当地的高危人群,主要是城市数据。这项研究旨在将先前的发现推广到一般人群中的社区一级协会,使用包括所有城乡地区在内的国家数据。我们检查了,第一次,如果在控制潜在的混杂因素后,食品不安全率增加了县级儿童虐待报告(CMR)率。我们检查了社区内的纵向变化(即,效应内)和社区间差异(即,之间的影响)粮食不安全率及其与CMR率的关联。我们还检查了年龄的差异,性别,种族/民族,虐待类型,和城市化。我们通过链接多个国家数据库来构建纵向县级数据,包括所有经证实和未经证实的CMR记录,膳食缺口地图对社区粮食不安全的估计,和人口普查数据。从2009年到2018年,数据涵盖了超过96%的美国县。为了进行分析,我们使用了中间随机效应模型。关于中间效应,我们发现在社区间比较中,较高的粮食不安全率与CMR率增加显著相关.这种关联在年龄上是一致的,性别,虐待类型,和城市化。对于内部影响,我们发现,粮食不安全率的纵向变化与CMR率之间的关联因城市化而显著不同。具体来说,粮食不安全率的纵向上升显著增加了大城市县的CMR率,但不是在小的城市和农村县。研究结果强调了进行进一步研究以更好地了解粮食不安全在个人和社区层面影响儿童虐待的机制的重要性。我们来自普通人群的社区层面的发现尤其对基于社区的计划和大规模政策具有重要意义,以实现对儿童福祉的人口层面影响。
    Current literature suggests that food insecurity increases child maltreatment risk. Yet, existing evidence is limited to individual-level associations among low-income, high-risk populations based on local, mostly urban data. This study aims to generalize prior findings to community-level associations in general populations, using national data including all urban-rural areas. We examined, for the first time, if food insecurity rates increase child maltreatment report (CMR) rates at the county level after controlling for potential confounders. We examined both within-community longitudinal changes (i.e., within-effects) and inter-community differences (i.e., between-effects) of food insecurity rates and their associations with CMR rates. We also examined differences by age, sex, race/ethnicity, maltreatment type, and urbanicity. We constructed longitudinal county-level data by linking multiple national databases, including all substantiated and unsubstantiated CMR records, the Map the Meal Gap\'s community food insecurity estimates, and Census data. The data covered over 96% of U.S. counties from 2009 to 2018. For analysis, we used within-between random effects models. Regarding between-effects, we found that in inter-community comparisons, higher food insecurity rates were significantly associated with increased CMR rates. This association was consistent by age, sex, maltreatment type, and urbanicity. For within-effects, we found that the association between longitudinal changes of food insecurity rates and CMR rates significantly differed by urbanicity. Specifically, longitudinal increases of food insecurity rates significantly increased CMR rates among large urban counties, but not among small urban and rural counties. Study findings highlight the importance of conducting further research to better understand the mechanisms through which food insecurity impact child maltreatment at both individual and community levels. Our community-level findings from general populations especially have significant implications for community-based programs and large-scale policies to achieve population-level impact on child well-being.
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  • 文章类型: Journal Article
    利用虐待儿童和忽视儿童的纵向研究数据集,比较了127名低收入残疾父母和254名无残疾父母的倾向评分匹配样本,以了解反复证实的儿童虐待指控的发生率以及证实的儿童虐待复发的潜在明显风险。低收入残疾父母(M=1.17,SD=1.83)得到证实的儿童虐待指控数量并未显着高于其匹配样本(M=.93,SD=1.44)(t=-1.29,p=.197)。负二项回归的结果表明,在控制其他危险因素后,父母残疾也不是低收入父母重复证实儿童虐待指控的重要预测因素(Exp(B)=1.16,p<.353)。在这两组中,黑人父母比白人父母更有可能重复有证据的虐待。对于有残疾的父母,作为一个年长的父母,接收SNAP的好处,有个女儿,有一个孩子在持续的家庭外护理显着增加了重复证实的风险,而具有GED或更高的教育程度并与更多的家庭生活在一起则降低了风险。对于没有残疾的父母,家庭不稳定是重复虐待证据的唯一额外危险因素.
    Using the Longitudinal Studies of Child Abuse and Neglect dataset, 127 low-income parents with disabilities and a propensity score matched sample of 254 parents without disabilities were compared for the rates of repeated substantiated child maltreatment allegations and potentially distinct risks for substantiated child maltreatment recurrence. The number of substantiated child maltreatment allegations was not significantly higher for low-income parents with disabilities (M = 1.17, SD = 1.83) than their matched sample (M = .93, SD = 1.44) (t = -1.29, p = .197). Findings from the negative binomial regression indicated that parental disability was also not a significant predictor for repeated substantiated child maltreatment allegations among low-income parents after controlling other risk factors (Exp(B) = 1.16, p < .353). In both groups, black parents were more likely to have repeated substantiated maltreatments than white parents. For parents with disabilities, being an older parent, receiving SNAP benefits, having a daughter, and having a child in continued out-of-home care significantly increased the risk for repeated substantiations while having a GED or higher education degree and living with a larger number of family decreased the risk. For parents without disabilities, family instability was the only additional risk factor for repeated maltreatment substantiations.
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