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Introduction

Lessons Learned from LONGSCAN: Findings from a 20-yr prospective study of maltreatment antecedents and consequences Presented at the 25 th Annual San Diego International Conference on Child and Family Maltreatment, January 22-28, 2011. 1. Introduction. Acknowledge Significant anniversaries

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Introduction

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  1. Lessons Learned from LONGSCAN: Findings from a 20-yr prospective study of maltreatment antecedents and consequences Presented at the 25th Annual San Diego International Conference on Child and Family Maltreatment, January 22-28, 2011 1

  2. Introduction Acknowledge Significant anniversaries Chadwick Center (35 years) San Diego Maltreatment Conference (25 years) LONGSCAN Consortium LONGitudinal Studies in Child Abuse and Neglect Completed 20 year prospective study Website <http://www.iprc.unc.edu/longscan> Age 4-12 data currently available (Data Archive: Cornell University)

  3. LONGSCAN Principal Investigators • East: Howard Dubowitz, MD, MSci • South: Jonathan Kotch, MD, MPH • Midwest: Richard Thompson, PhD • Northwest: Diana English, PhD • Southwest: Alan Litrownik, PhD • CC: Des Runyan, MD, DrPH

  4. Other LONGSCAN Investigators • East • Maureen Black, PhD; Steve Pitts, PhD; Raymond Starr, PhD • South • Christine Cox, PhD; Jon Hussey, PhD • Midwest • Patrick Curtis, PhD; Emalee Flaherty, MD; Mary Schneider, PhD • Northwest • Chris Graham, PhD; David Marshall, PhD • Southwest • John Landsverk, PhD; Rae Newton, PhD; Laura Proctor, PhD • Coordinating Center • Kant Bangdiwala, PhD; Mark Everson, PhD; Wanda Hunter, MPH; Liz Knight, MSW; Terri Lewis, PhD

  5. LONGSCAN: A 20-Year Journey

  6. Plan Session 1 Des Runyan, PI, Coordinating Center, University of North Carolina, Chapel Hill Overview, methods, and some descriptives Diana English, PI Northwest Site, University of Washington Characterizing maltreatment and other adversities Al Litrownik, PI Southwest Site, San Diego State University Outcomes of Child Welfare involvement

  7. Plan Session 2 Howard Dubowitz, PI, Eastern Site, University of Maryland, Baltimore Maltreatment antecedents, father involvement Jonathan Kotch, PI Southern Site, University of North Carolina, Chapel Hill Maltreatment consequences Richard Thompson, PI Midwest Site, Juvenile Protective Association (Chicago, Illinois) Maltreatment consequences

  8. LONGSCAN: Overview, methods, and descriptive findings Desmond Runyan, MD, DrPH The University of North Carolina at Chapel Hill

  9. Overview of LONGSCAN • Planning grant funded in 1989 • Congressionally mandated • Intended to address antecedents and consequences • Planning grants to UNC and JPA of Chicago • Solution to which type of sample: yes • LONGitudinal Studies of Child Abuse & Neglect • 5 distinct studies (East, South, Midwest, Northwest , & Southwest) 11

  10. Each site has integrity as an independent study • Collective efforts magnify impact • Measurement & data coordinated at UNC coordinating center • Common measures, coding, training, data entry • Consortium governance agreement • Committees for governance, measurement, analysis, and publications/dissemination • For more information, see Runyan et al. • 1998 Violence & Aggression

  11. Current Status • Data collection still on-going for 4 of 5 sites - Youth now 14 - 22 years old • Data archived with the National Data Archive on Child Abuse and Neglect (NDACAN) - Age 4, 6, 8, and 12 interviews • Includes CPS record reviews • Over 130 scientific papers • Over 25 dissertations 13

  12. 14

  13. Data Collected (Baseline to age 18) Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18. 15

  14. Data Collected (Baseline to age 18) Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18. 16

  15. Sample Demographics 17

  16. Measurement • Guided by Social-Developmental-Ecological Theory(NRC, 1993; Bronfenbrenner, 1989; Hawkins & Catalano, 1996). • Domains assessed: • Child/Youth: Characteristics, functioning • Caregiver: Characteristic, functioning • Family microsystem: Home environment, functioning • Macrosystem: Neighborhood, school, support 18

  17. Measurement • Multiple sources & methods • Developed “just-in-time measurement batteries for ages 4, 6 and 8 years • Reports/ratings/questionnaires (Child/Youth, • Caregiver, and Teacher) • Performance (Child/Youth) • Situational tests/samples • Official records (CPS) • Presentation of measures • Interview & Audio-Computer Assisted Self Interview (A-CASI) began at age 12 for child 19

  18. LONGSCAN: Characterizing Maltreatment Longitudinally Diana J. English, PhD University of Washington 20

  19. A First Consideration There are no simple solutions to complex problems……(Some French Guy)

  20. Considerations • How to characterize maltreatment longitudinally: • Type • Severity • Chronicity • Substantiated vs. Unsubstantiated or Indicated

  21. # of Maltreatment Records/Referrals per Child (birth through age 16) 7 Records (3%) 6 Records (4%) 8-22 Records (13%) 5 Records (5%) 4 Records (8%) 1 Record (17%) 3 Records (8%) 2 Records (11%) Total N = 1354 23

  22. LONGSCAN Maltreatment Coding Scheme * Choking Burns Shaking Nondescript Head Torso Buttocks Limbs Violent handling 9 subtypes Physical Abuse Sex Abuse Subtypes Food Hygiene Clothing Shelter Medical Failure to Provide Neglect Lack of Supervision Emotional Abuse Environment Substitute Care Moral / Legal / Educational Neglect Severity Codes 27 Detail Types * Modified Barnett, Manly, Cicchetti Coding Scheme 1993

  23. LONGSCAN Maltreatment Coding* For Severity • Severity is Coded on a Scale of 1 (low) through 6 (high) • Each severity code has specific meaning • Example: Physical Abuse to the Head/Face/Neck • Severity 1 = No marks indicated • Severity 2 = Minor marks • Severity 3 = Numerous or non-minor marks • Severity 4 = Emergency Room or medical treatment • Severity 5 = Hospitalization for more than 24 Hours • Severity 6 = Permanent Disability or Death * Modified Barnett, Manly, Cicchetti Coding Scheme 1993

  24. # of Allegations by Maltreatment Type (birth through age 14) # of Allegations Based on Baseline Sample (N = 1354) Age 26

  25. # of Substantiations by Maltreatment Type (birth through age 14) Descriptive Stats (0-14): Total # of substantiations (0-14) = 2282 Total # of physical abuse substantiations (0-14) = 369 Total # of sexual Abuse substantiations (0-14) = 99 Total # of neglect substantiations (0-14) = 1456 Total # of emotional abuse substantiations (0-14) = 358 Frequencies (0-14): 49% have 1 or more substantiations 14% have 1 or more physical abuse substantiations 6% have 1 or more sexual abuse substantiations 41% have 1 or more neglect substantiations 17% have 1 or more emotional abuse substantiations # of Substantiations Based on Baseline Sample (N = 1354) Age 27

  26. Number of Allegations by Severity, Birth through Age 16, Seattle-Site

  27. Official Records vs. Youth Self Report • Official records – someone in the community – friends, family, professionals call in a report to CPS , CPS determines the report is sufficient to take a complaint, and the complain is assigned to a form of investigation. • Youth Self-Report – a youth reports on their experiences based on recall and perception.

  28. Self Report of Abuse (birth through age 12) * Indicators are NOT mutually exclusive (N = 881) (N = 874) (N = 883) 30

  29. Self Report of Abuse (age 12 through age 16) * Indicators are NOT mutually exclusive (N = 705) (N = 697) (N = 693) 31

  30. Comparing Substantiations to Child Self-Report (birth through age 12) 3.2% 4.3% Psychological Abuse (N = 883) 18.6% 14.2% 7.8% 80.9% 7.7% 33.0% 51.2% 8.1% 32

  31. Maltreatment Chronicity (Seattle LONGSCAN)Extent and Continuity (Birth to Age 8 Interview, N=244) Extended Continuous Situational 28% 27% Extended Episodic Limited Episodic 9% 14% Limited Continuous Data Source: mltx0607 Received from LS CSCC: 07/2006 22%

  32. Chronicity • Extent predicted CBCL externalizing, socialization, depression and PTS • Continuity predicted socialization, anxiety, depression, anger and PTS

  33. Chronicity • Chronicity (however defined) accounted for more of the variance in adaptive functioning (DLS & Socialization) than behavior or emotional functioning

  34. Latent Class Analysis

  35. Caveats for LCA • Classes were not consistent across developmental periods • PA/High maltreatment at earlier developmental stages but not age 12 – age 12 PA/EMT (no neglect) • Most classes include neglect component • Sexual abuse increased over time but not a distinct class

  36. Beyond Yes / No • Effective assessment requires a review of: • All reports including substantiated & not substantiated; • All types of abuse/neglect, not just the type reported in an incident; • Levels of severity by types & patterns over-time; • Age of onset of first experience or report.

  37. Beyond Yes/No • Maltreatment is a complex phenomena • Importance of longitudinal approach • Importance of psychological and/or emotional maltreatment • Importance of continuity – imminent risk vs. cumulative harm

  38. LONGSCAN: Child Welfare involvement and outcomes Al Litrownik, PhD San Diego State University 40

  39. Southwest Site-San Diego Parent Study 5/90 through 10/91 removed for CAN 1,221 (birth-17), out-of-home > 5 months Procedures Interview child/caretaker 5, 11, & 17 mos Review records (e.g., DSS, Medicaid) LONGSCAN 330 (of 532) <3.5 yrs when removed Interview every year

  40. Child Welfare Context Goals Protect/Maintain family/Stable/Promote development Responsibilities Assess risk/Recommend placement & services/Monitor adherence Attempts to promote Goals (e.g., Laws) Child & Family Service Reviews (1994) Adoption & Safe Families Act (1997) Many recommendations/perspectives (e.g., The Future of Children, 2004) What LONGSCAN tells us Parent Study (first 18 months after entry; birth to 17 year olds) Long Term (4 to 18 years) Describe results of 9 studies then summarize

  41. Caregiver Drug & Alcohol Use (CDAU) 18-month post-removal record review 639 families CDAU based on court documents (e.g., caseworker reports, psychological evaluations) CDAU in 79% of families CDAU associated with younger, single parent, and neglect (Besinger, Garland, Litrownik, & Landsverk, 1999)

  42. Multiple Placements 415 children (2 to 16 at removal) CBCL: Time 1 (6-mos) - Time 2 (18 mos) DSS record review (# placements 18 mos) Findings: 1 to 15 placements (mean=4.23) Child BPs predicted # subsequent placements # placements predicted subsequent BPs for those who did not have them initially (Newton, Litrownik, & Landsverk, 2000)

  43. Permanent Placements at Age 6: Descriptives 254 Caregivers at Age 6 Reports from caregivers and children Caregiver Characteristics & Resources (e.g., SES, health) Adopt = Non-Kin Foster > Kin Foster > Reunified Family violence (CTS, Life Events, Things I’ve Seen & Heard) Reunified > family violence exposure Adoptive > Non-Kin Foster use of minor violence for discipline Adoptive witness < violence at home (Litrownik, Newton, Mitchell & Richardson, 2003)

  44. Going Home 218 children in same placement age 4-6; reunified/not Measures: CBCL-Internalizing, MH services, social isolation, stressful life events (e.g., instability, family dysfunction, violence) (Lau, Litrownik, Newton, & Landsverk, 2003)

  45. Structural Model* Age 4 Age 6 Internalizing Sx CBCL Internalizing Sx CBCL Low Support Mental Health Provider Contacts Social Isolation Loneliness Instability Reunification Stressful Life Event Harm Family Dysfunction *Model Fit Indices: c2(19)=20.2, p=0.38; CFI=0.99; RMSEA=0.03; RMSR=0.04

  46. Discipline Practices & Child Aggression 70 Kin and Non-Kin Foster parents at Age 8 Measures Caregiver: Discipline Methods and CBCL Children: Social Problem Solving Findings Harsh disciplinary practices: Kin > Non-Kin Parent Harsh disciplinary practices  use of aggressive problem solving strategies of children (DeRobertis & Litrownik, 2004)

  47. Caregiver Stability 285 children from 6 to 8 Dependent variable: With same caregiver Classification & Regression Tree (CART) analysis to identify potential predictors Neighborhood/Community Home Environment Caregiver Characteristics Child Characteristics (Proctor, Randazzo, Litrownik, et al., under review)

  48. Regression Tree: Same Caregiver 6 to 8

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