Title: Maltreated Infants: Identifying Factors Associated with Poorer Outcomes
1Maltreated Infants Identifying Factors
Associated with Poorer Outcomes
Anita Scarborough, Ph.D. Frank Porter Graham
Child Development Institute University of North
Carolina Julie McCrae, MSW, Ph.D. University of
Pittsburgh, School of Social Work Child Welfare
Education and Research Programs
- The research for this presentation was funded by
the Administration on Children, Youth, and
Families of the U.S. Department of Health and
Human Services, Award 90PH0014.
2007 OSEP National Early Childhood
Conference Marriott Crystal Gateway Hotel
2Organization of Presentation
- Data Source
- Research Questions
- Findings
- Discussion
- Implications for Service Provision
3Source of Information
- The Administration for Children and Families
(ACF), funded the National Survey of Child and
Adolescent Well-Being, the first national
probability study of children and adolescents
investigated by Child Welfare Services. - Baseline data was collected in 1999 and 2000.
- This session will present the developmental
characteristics of a nationally representative
sub-sample of 1,196 infants, representing 149,398
maltreated infants shortly after investigation
and again, 3 and 4½ years later.
4Long-term Outcomes of Abused and Neglected
Children
- More likely to be arrested as juveniles, to
become pregnant during adolescence, use drugs,
have lower grade point averages, and experience
mental health problems. - 16 of males and 57 of females in State prisons
experienced childhood physical or sexual abuse. - Research has become quite conclusive regarding
the negative impact of the experience of child
maltreatment on adult outcomes in cognitive,
economic and mental health domains.
5Growing Public Awareness and Policy Change
- Amendment of the Child Abuse and Prevention
Treatment Act (CAPTA, 2003) requires referral of
a child under the age of 3 who is involved in a
substantiated case of child abuse or neglect to
early intervention services funded under Part C
(section 106(b)(2)(A)(xxi)). - The Individuals with Disability Education Act
(IDEA, 2004), requires state Part C programs to
have a description of their policy and procedures
that require the referral for early intervention
services for children under the age of 3 who are
involved in a substantiated case of child abuse
or neglect. Eligibility requirements for Part C
are determined by individual states.
6Definition of Substantiation
- Where the allegation of maltreatment was
supported or founded by state law or state policy
(US Department of Health and Human Services,
2006). - Each state requires a specific standard of proof
to substantiate maltreatment.
7Part C Services
- The goal of Part C is to provide services to
children from birth through two years of age with
disabilities. - Children in this age range experiencing
developmental delays, as defined by the
individual states, are entitled to services. - States vary according to the agency serving as
the lead agency, the eligibility definition for
delay, if services are provided to children at
risk for developmental delays (currently 5
states), and in the percentage of children
served. - Part C services are provided to 2.4 of children
between birth and 2 years of age nationally. The
percentage of children and families served among
the individual states varies, ranging from 1.34
to 6.71 (U.S. Department of Education, 2006).
8Basis for the Research
- An under utilization of Part C services among
maltreated infants and toddlers, based on scores
on developmental measure shortly after
investigation by child welfare, has been reported
(Rosenberg et al., 2004 Stahmer et al., 2005
Zimmer Panko, 2006), - Clearly it difficult to determine developmental
delay as an eligibility criteria among infants
who do not have established risk conditions. - This study is looking at the developmental
characteristics of maltreated infants over time
to stress the need for intervention services, and
to determine factors present in infancy
associated with poorer developmental outcomes.
9Research Questions
- What are the characteristics of infants, their
caregivers and type of maltreatment shortly after
the time of investigation by Child Welfare
Services? - Are there discernible developmental profiles for
maltreated infants, 3 and 4½ years after
investigation? - What proportion of maltreated infants were
reported to have an IFSP 12 months after
investigation and what proportion had an IEP 4½
years later? - Are characteristics of maltreated infants, their
caregivers, or maltreatment type related to
developmental outcomes 4½ years later? - What do those findings suggest about the need for
Part C early intervention services?
10Characteristics of Maltreated Infants
- Age
- Gender
- Race
- Health Status
- Neurodevelopmental risk status as assessed by the
Bayley Neurodevelopmental Screener - Cognitive development as indicated by scores in
the cognitive domain of the Battelle
Developmental Inventory
11Caregiver Characteristics
- Age
- Education
- Cognitive impairment
- Mental illness/depression
- Substance abuse
- Domestic violence
- Poverty
- Poor quality home environment as measured by the
HOME
12Maltreatment Characteristics
- Prior reports of maltreatment
- Maltreatment type
- Physical abuse
- Sexual abuse
- Physical neglect
- Supervisory neglect
- Other
- Maltreatment case substantiated
- Reported level of harm to the child
- Child placed out of home
13Developmental Characteristics Examined 3 and 4 ½
Years after Investigation
- Cognitive development
- Language skill
- Adaptive behavior
- Behavioral concerns
- Loneliness social dissatisfaction
14NSCAW Sample
- 6,231 children, birth to 14 years of age, who had
contact with the Child Welfare System - Over Sampled on the basis of
- Children/Families Receiving Child Welfare
Services - Infants
- Sexually Abused Children
- Baseline collection from Nov. 1999 to Apr. 2001
- Follow-Ups at 12, 18, 36, and 54 months after
baseline - 12 month follow-up included only limited data
collection - 54 months follow-up currently available only on
infants at baseline
15Measures
- Neurodevelopment
- Bayley Infant Neurodevelopmental Screener (BINS
0-2 years) - Cognitive Domain
- Battelle Developmental Inventory Cognitive
Domain (BDI 0 3 years) - Kaufman Brief Intelligence Test (K-BIT 4
years) - Adaptive Behavior Domain
- Vineland Adaptive Behavior Scale Screener, Daily
Living Skills sub-domain (VABS) - Communication Domain
- Preschool Language Scale-3 (PLS-3)
16Measures
- Behavior Domain
- Child Behavior Checklist (CBCL 2 years for
parent 5 years for teacher) - Socialization
- Loneliness and Social Dissatisfaction
Questionnaire for Young Children (self report 5
years) - Home environment
- The Home Observation for Measurement of the
Environment (HOME)
17Definition of Delay
- Children scoring 1.5 standard deviations or more
below the mean on a developmental measure were
considered to have a delay. - High Risk for subsequent developmental
difficulties based on the BINS. - Described 3 and 4 ½ years later using
- PLS 3
- VABS
- CBCL- parent and teacher
- KBIT
- Loneliness Social Dissatisfaction
18Characteristics of Infants Investigated by Child
Welfare
Age in months at baseline
0-6 45
7-12 55
Male 49
Race/ethnicity
White 44
African-American 30
Hispanic 21
Other 5
Fair/poor health 8
High risk on the BINS 53
19Caregiver Characteristics
At baseline
Less than high school education 37
Cognitive impairment 13
Mental illness/depression 34
Active or history of domestic violence 56
Poverty 45
Low score on HOME 12
High number of risk factors 34
20Caregiver Characteristics
Female Caregiver age
Education-level
21Household Characteristics
22Family Risks
23Characteristics of Maltreatment
At baseline
Prior report of maltreatment 41
Maltreatment type
Physical abuse 20
Sexual abuse 2
Physical neglect 40
Supervisory neglect 33
Other 5
Severe level of harm 16
Clear evidence of maltreatment 41
Worker reports the child has special needs 14
Maltreatment substantiated 38
Out of home placement 22
24Low Scores at Baseline by Age in Months
25High Risk on BINS by Age at Baseline
26Low Scores 3 Years Later, by Ageat Baseline
Domain 0-6 mos. 7-12 mos. Total
Cognitive 37 32 34
Language 35 38 37
Adaptive Behavior 25 10 17
At least 1 Problem score 59 57 57
27Combinations of Low Score Areas3 Years After
Baseline
Developmental areas
No problem scores 42
Cognitive 12
Language 14
Adaptive behavior 6
Cognitive Language 15
Adaptive Cognitive or Language 5
All problems 6
Total 100
28Low Scores 3 Years after Baseline by
Race/ethnicity
plt.10
29Low Scores 3 Years After Baseline by Gender
plt.05
30Infants with an IFSP, or 4 ½ Years Later an IEP
IFSP in the12 months after baseline 32
IEP 54 months after baseline 20
IFSP 12 months, or IEP 54 months after baseline 37
Those with an IEP who also had an IFSP 54
31Teacher Report of Areas of Concern for Those with
an IEP
Category Category
Learning disability 24 Speech language delay 66
Autism 18 Traumatic brain injury 5
Emotional disturbance 22 ADHD 25
Mental retardation 15 Developmental disability 26
Multiple disabilities 11 Visual impairment 2
Orthopedic 6 Deafness or hearing impaired 2
Other/unknown 13
32Low Score Areas 4 ½ Years Later, by Age at
Baseline
Domain 0-6 mos. 7-12 mos. Total
Cognitive 16 11 13
Language 27 21 25
Adaptive Behavior 42 28 34
At least 1 Problem score 45 44 55
33Focus on Low Language Scores 4 ½ Years after
Baseline (PLS-3)
- Low language scores associated with
- Severe level of harm reported at baseline (plt.05)
- High risk rating on the Bayley scales of infant
neurodevelopment at baseline (plt.001) - No association with
- Child demographic characteristics
- Maltreatment characteristics, including
substantiation - Caregiver risks, age, education-level, poverty
status - Poor quality home environment
- Baseline cognitive delay
34Low Language Scores 4 ½ Years after Baseline
Regression using child characteristics,
R-square .03
Baseline characteristic Odds of age 5 language delay p-value
Age 0-6 months 1.36 .47
Male 1.41 .24
Black .67 .42
Hispanic or other .88 .71
Poor physical health 1.08 .80
High risk BINS 1.46 .28
Cognitive delay 1.52 .19
35Low Language Scores 4 ½ Years after Baseline
Regression using child caregiver
characteristics, R-square .17
Baseline characteristic Odds of age 5 language delay p-value
Age 0-6 months 1.12 .80
Male 1.87 .15
Black .41 .16
Hispanic or other 1.64 .36
High risk BINS 2.34 .11
Poor health 3.00 .03
Cognitive delay .69 .53
Caregiver age lt35 years 1.20 .80
ltHS education .57 .29
Caregiver cognitive impairment 10.59 .01
Mental illness .22 .05
Substance abuse 1.65 .43
Domestic violence 2.46 .14
Below poverty line .86 .80
Poor quality home environment 1.08 .87
36Low Language Scores 4 ½ Years After Baseline
Regression with child, caregiver maltreatment
characteristics, R-square .27
Baseline characteristics related to low language scores Odds of age 5 language delay p-value
Caregiver cognitive impairment 16.12 .02
Caregiver mental illness .20 .03
Prior reports .27 .05
Severe level of harm 7.77 .02
Statistical trends (plt.10) High risk BINS,
domestic violence, Other as the primary type of
maltreatment
37Predictors of IEP 4 ½ After Baseline
Regression with child, caregiver maltreatment
characteristics, R-square .26
Baseline characteristics related to Special Education 4 ½ years later Odds of having an IEP p-value
Male 5.00 .01
Child cognitive problem .21 .02
Caregiver cognitive impairment 13.21 .002
Caregiver mental illness .30 .03
Statistical trends (plt.10) Age 0-6 months at
baseline, Hispanic, low level of child harm
38Emotional-behavioral Problems Reported 4 ½ Years
Later
Problem type with clinical-level score with clinical-level score
Problem type Teacher report Parent report
Total problems 9 21
Internalizing 9 7
Externalizing 13 20
39Self-report of Loneliness and Social
Dissatisfaction 4 ½ Years Later
Age at baseline 1 SD or greater above the mean
0 6 months 16
7 12 months 11
Total 13
40Summary
- More than half of maltreated infants are at high
risk for poor developmental outcomes, based on
the presence of multiple risk factors such as
high family stress (61), single parent (48),
and domestic violence (56), coupled with a low
score on a measure of cognition, language or
neurodevelopmental risk status (BINS). - 32 of maltreated infants were reported to have
an IFSP in the period of time 12 months after
baseline. - Three years after baseline more than half are
reported to have a delay in at least one of the
domains measured, with cognitive (12) and
language delays (14) being the most common. - Three years after baseline 74 of boys were
reported to have a low score in at least one
domain.
41Summary
- Using language as a global marker of development
revealed infant caregiver characteristics
associated with low scores 4 ½ years later - Poor infant health
- Caregivers with a cognitive impairment
- Caregiver mental illness was associated with
reduced likelihood of language delay - Likely due to the self-report, laptop computer
method used to have caregivers describe their
mental health/depression - Adding maltreatment characteristics, infant
health was no longer predictive, but reported
severity of harm was. - Prior report of maltreatment was negatively
related to language delay.
42Summary continued
- When infants were 5 years of age, 1/5 of them
were reported to have an IEP, but only about half
of those children were reported to have had an
IFSP. - Factors associated with having an IEP 4 ½ years
later - Male infants
- Caregiver cognitive impairment
- Infant cognitive problem (-)
- Caregiver mental illness (-)
43Summary continued
- Maltreated infants at five years of age
- 25 low score on a language measure
- 20 IEP
- 13-20 reported to have clinical level
externalizing problems - 7-9 reported to have clinical level
internalizing problems - 13 of the children report loneliness or social
dissatisfaction - Factors in infancy found to be associated
- Infant poor health
- Caregiver cognitive impairment
- Severe level of harm
- Maltreatment characteristics not found to be
associated - Substantiation
- Poverty - though these children are
disproportionately poor - Out of home placement
44Discussion Points
- Have Part C services been adapted to meet the
needs of these children and families? - Many maltreated infants have multiple risk
factors, recognized as a Part C eligibility in
only a few states, yet these findings support the
increased likelihood of poor outcomes for these
children. - What can be done to help meet the needs of these
children and families and to help children get
services earlier? - Has the CAPTA requirement to refer substantiated
infants and toddlers resulted in more children
being served? - Substantiation is the criteria for referral, yet
these findings show that this is not
significantly related to outcomes.
45Anita_Scarborough_at_unc.edu
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