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Maltreated Infants: Identifying Factors Associated with Poorer Outcomes

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Follow-Ups at 12, 18, 36, and 54 months after baseline. 12 month follow-up included ... 54 months follow-up currently available only on infants at baseline ... – PowerPoint PPT presentation

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Title: Maltreated Infants: Identifying Factors Associated with Poorer Outcomes


1
Maltreated 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
2
Organization of Presentation
  • Data Source
  • Research Questions
  • Findings
  • Discussion
  • Implications for Service Provision

3
Source 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.

4
Long-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.

5
Growing 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.

6
Definition 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.

7
Part 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).

8
Basis 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.

9
Research 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?

10
Characteristics 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

11
Caregiver Characteristics
  • Age
  • Education
  • Cognitive impairment
  • Mental illness/depression
  • Substance abuse
  • Domestic violence
  • Poverty
  • Poor quality home environment as measured by the
    HOME

12
Maltreatment 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

13
Developmental Characteristics Examined 3 and 4 ½
Years after Investigation
  • Cognitive development
  • Language skill
  • Adaptive behavior
  • Behavioral concerns
  • Loneliness social dissatisfaction

14
NSCAW 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

15
Measures
  • 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)

16
Measures
  • 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)

17
Definition 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

18
Characteristics 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
19
Caregiver 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
20
Caregiver Characteristics
Female Caregiver age
Education-level
21
Household Characteristics
22
Family Risks
23
Characteristics 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
24
Low Scores at Baseline by Age in Months
25
High Risk on BINS by Age at Baseline
26
Low 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
27
Combinations 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
28
Low Scores 3 Years after Baseline by
Race/ethnicity
plt.10
29
Low Scores 3 Years After Baseline by Gender
plt.05
30
Infants 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
31
Teacher 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
32
Low 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
33
Focus 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

34
Low 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
35
Low 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
36
Low 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
37
Predictors 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
38
Emotional-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
39
Self-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
40
Summary
  • 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.

41
Summary
  • 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.

42
Summary 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 (-)

43
Summary 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

44
Discussion 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.

45
Anita_Scarborough_at_unc.edu
Visit Project Website for updates
http//www.fpg.unc.edu/promise/
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