Child Maltreatment & Child Welfare Critical Issues

1. CIHR New Emerging Team (NET): The impact of childhood maltreatment on adolescent and adult outcomes

2. Child Maltreatment & Child Welfare Critical Issues • High Prevalence – High Cost

3. Family Violence in Canada INCIDENCE: 22 out of 1000children reported to child welfare 9.7/1000 “substantiated” child abuse/neglect (CIS, 1998) INDIVIDUAL COST: 22% adults who were abused/neglect deemed resilient (No homelessness, juvenile/adult arrests etc.) (McGloin & Widom, 2001) SOCIETAL COST: Ontario - $863 million spent on child welfare (2002-2003) US – child abuse cost $258 million/day or $94 billion/year

4. Child Maltreatment & Child Welfare Critical Issues • Complex Problem - Complex Solutions

7. Child Maltreatment & Child Welfare Critical Issues • Relevant Research Needed

8. Differential Trends by Form of Maltreatment: Ontario Incidence Study 1993-1998 • 90% increase in substantiated physical abuse: 4,200 to 8,000 • 44% decrease in substantiated sexual abuse: 3,400 to 1,900 • 102% increase in substantiated neglect: 4,400 to 8,900 • 770% increase substantiated emotional maltreatment/ exposure to DV: 1,000 to 8,700 1 2 3

9. Publication Volume By Maltreatment Type (Behl et al., 2003)

10. Child Maltreatment & Child Welfare Critical Issues • Research Capacity is Critical

11. 10-year Trend in Child Maltreatment Publications under the First Author

12. Child Maltreatment & Child Welfare Critical Issues • High Prevalence – High Cost • Complex Problem - Complex Solutions • Relevant Research Needed • Research Capacity is Critical • Critical Issues for Prevention & Evidence-Based Practice and Policy Goal Attainment Need a Network Approach

13. Childhood maltreatment is a significant risk factor for Canadian healthy development • Child maltreatment is often an on-going, family systems problem within complex systems (i.e. education, neighbourhood, community, youth justice, social services including public, mental health) • 22 of every 1000 Canadian children are reported to child welfare each year - with 9.7 / 1000 of these are deemed substantiated neglect (40%), physical (31%), emotional (19%), and sexual abuse (10%) • Reports to child welfare were estimated at 135,573 cases for 1998; and across substantiated cases, “high risk” groups were found by gender • Intergenerational cycle of abuse and neglect has been estimated at 30%, and with such persistence of maltreatment and arrival of new cases, service delivery in child welfare is further complicated • Literature reviews conclude that there is lack of a well-designed intervention research, a dominance of single-focus rather than integrated research agendas, inattention to service utilization models and effectiveness, and gaps in knowledge of effective dissemination and training on co-morbidities that are associated with violence in relationships

14. Impacts of Childhood Maltreatment • Economics and quality of life perspectives • Quality of life is defined in terms of both health and standard of living • Poor overall health is predicted by single-parent and low socioeconomic status, low child academic status, and female gender • Effects on schooling • Child welfare-involved youth display greater residential instability and its attendant interrupted schooling, higher absenteeism and drop-out rates, and limited vocational training • Effects on labor market outcomes • Low school outcomes create substantial obstacles to a better-trained workforce, larbor market participation, and future productivity • Such factors, in turn, contribute to poverty, adult unemployment and further marginalization • Effects on health • Injuries sustained during abuse can lead to life-long physical and cognitive disabilities, ranging from the less severe to the near-fatal such as chronic pain and brain injury

15. New Emerging Team (NET) Objectives The NET has 5 key objectives: • Increase the quality, amount, and scope of maltreatment-focused, integrative research needed for a science-based public health approach to violence • Bring together established researchers with maltreatment-related expertise • Extend current projects and launch new research to benefit from NET expertise • Identify priority research areas • Mentor new researchers

18. Canadian Child Welfare Research Network (CCWRNet) Objectives The CCWRNet has 5 key objectives: • Increasing the amount, quality, and breadth of child welfare and related research • Increasing the relevance of and uptake by the child welfare and related systems • Increasing research capacity in leadership, student, practitioner roles • Improving the quality of life for child welfare-involved families through establishing empirically-validated cost-effective interventions with known positive impacts • Reducing child maltreatment through efficacious prevention interventions and social innovation initiatives

21. Focus on The Maltreatment Adolescent Pathways (MAP) Study

22. Maltreatment and Adolescent Pathways (MAP) Project • Research Questions: • Childhood maltreatment has been linked to health risk behaviours • How at-risk is a child-welfare population of youth? Over time? • What is the underlying process that mediates the impact of childhood maltreatment on adverse outcome in adolescence? • Is an epidemiological study feasible in a child welfare sample? • MAP Feasibility Study & MAP Longitudinal Study

23. MAP Feasibility Study Funded by CIHR/CAHR Christine Wekerle, Ph.D., Principal Investigator Anne-Marie Wall, Ph.D.,Co-Principal Investigator Harriet MacMillan, MD., Co-Investigator Nico Trocme, Ph.D., Co-Investigator Michael Boyle, Ph.D., Co-Investigator Randall Waechter, M.A., Project Manager In Collaboration With Children’s Aid Society of Toronto (Deb Goodman) Advisory Board: Dan Cadman, Rob Ferguson, Heidi Kiang, Joanne Filippelli, Franz Noritz, Ron Smith, Rhona Delisle Catholic Children’s Aid Society (Bruce Leslie) Advisory Board: Jim Langstaff, Sean Wyers, Coreen Van Es, Mario Giancola, Tara Nassar, Kate Schumaker Jewish Family and Child Service (Yosi Derman) • Examines 4 indexes of poor developmental health among the child welfare youth population (across community, in care status): • Mental Health • Substance Abuse • Dating Violence • Risky Sexual Practices

24. What is the MAP Feasibility Study? Special Features of the MAP: • Random sampling of 14 to 17 year-old youth from child-welfare population • Maltreatment is tracked via youth self-report (CTQ, CEVQ) as well as caseworker report • Youth anonymity is maintained via self-generated ID numbers across multiple testing points • Measures are synchronized with large-scale population studies (e.g. OSDUS, NLSCY), making comparison between community and child-welfare samples possible • Longitudinal arm tracks the trajectories of different measures over time, and thus provides an opportunity for examining the chain of causal mechanism of maltreatment-teen health risk relationship

25. Childhood Maltreatment Mediator: Post-traumatic stress symptomatology Poor Mental Health Dating violence Risky sexual behavior Substance abuse Mediators:Causal Factors Preceding Target Change • The identification of mediator provides target for cost-effective intervention and ground for evidence-based policy decision.

26. Mediators:Causal Factors Preceding Target Change • PTSD symptomatology as mediator (DeBellis, 2001) • Teens most frequently endorse intrusive memories, numbness, reminders are distressing, dissociative response, efforts to forget about event, hypervigilance, reliving the event • a significant proportion of adults diagnosed with alcohol dependence experience clinically significant levels of PTSD symptomatology • individuals who suffer resultant PTSD as a result of childhood maltreatment may use alcohol as a means of coping

27. MAP Feasibility Study: Research Process • Mean Age of tested youth: 15 years (data on n=87; 50 females, 37 males) • Ineligibility Rate: Overall 31% (Case closed, AWOL, Discharged, mental health issues, developmental delay, In custody, Not identified client) • Refusal Rate: Overall 30% (Community: 55%, In-care: 17%; Males: 39%; Females: 19%) • Reasons given for Refusal: “Just not interested”/ no reason: 65% (Parental Refusal: 14%; “Too busy”: 8%;“Not comfortable sharing”: 5%;Other: 8%) • Recruitment Rate: Overall 70% (Community: 45%; In-care: 83%;Males: 61%; Females: 81%) • Reasons given for participation: Money: 59%;“No reason given”: 32%; Other: 9% • Average testing time: 2.8 hrs (Range = 2.0 to 4.5 hrs) • Avg. Cost/Ss/Testing: $133.11 – Youth paid ON minimum wage/4hrs Home ($70.21) + $28.00 = $98.21 (>80% youth selected testing at residence) CAMH ($1.90) + $28.00 = $29.90 (+$5.00 food/refreshment cost)

28. MAP Feasibility Study: Preliminary Result Childhood Maltreatment PTSD Symptomatology Poor Mental Health Dating violence Risky sexual behavior Substance abuse • 90% of female adolescents had experienced either one or more forms of sexual abuse, and almost 80% of male had experience either one or more forms of physical abuse. • The severity and duration of maltreatment experience is associated with the number and acuteness of PTSD symptomatology • While in general PTSD symptomatology is associated with the four indicators of poor developmental health in maltreated adolescents, there are stark gender differences: • PTSD symptomatology in maltreated female adolescents is associated with: 1) internalizing symptoms, 2) victimization in dating violence, 3) risky sexual behavior – illicit drug-use as part of their sexual activity, 4) experienced difficulty in stopping drug and alcohol even if they wanted to • PTSD symptomatology in maltreated male adolescents is associated with: 1) externalizing behaviors, 2) perpetration and victimization in dating violence, 3) risky sexual behavior – un-protected sexual activities, 4) more illicit drug use

29. Childhood Maltreatment PTSD Symptomatology Poor Mental Health Dating violence Risky sexual behavior Substance abuse MAP Feasibility Study: Preliminary Result • Testing the full mediation model: • Feasibility has small sample size, not enough statistical power – awaits MAP Longitudinal Study • Only partial mediation of PTSD symptomatology in the relationship between childhood maltreatment and internalizing symptom in female, and between maltreatment and victimization in dating violence in the combined sample. • Encourages continued research on PTSD symptomatology as a key mediator of diverse teen outcomes • No current maltreatment-specific PTSD intervention for teens exists; may need gender-specific intervention