Early Detection of Child Neglect

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					Early Detection of Child Neglect

               Findings from a 4-site
               prospective study of
               teen and adult mothers
               and infants
Centers for the
Prevention of Child Neglect

   Presentation by Robin Gaines Lanzi, Sharon
    Landesman Ramey, and Shannon Carothers
   Georgetown University Center on Health and
    Education

   January 20, 2006
   Federal Child Neglect Research Consortium
National Centers for
the Prevention of Neglect

   Established in 1999
   Purpose: To design and conduct research to
    advance understanding of the etiology and effective
    strategies to prevent child neglect across diverse
    populations and settings
   Founding Senior Scientists: John Borkowski, Sharon
    and Craig Ramey, Bette Keltner, Judy Carta, and
    Steve Warren
   Website: http://cpcn.nd.edu/
Major funded projects include:

   The First-Time Parenting Study of Adolescent and
    Adult Mothers and Infants (NICHD, DOE, CDC,
    Centennial Wireless, Cingular)
   Prevention of Child Neglect: 4-site RCT of “My Baby
    and Me” Program (NICHD)
   Adolescent Development and Responsibilities
    (NICHD K Award)
   Advancing methods to study parenting and neglect
    (Robert Wood Johnson)
   The Baby Library (Reading is Fundamental)
The First Time Parenting Project

   Study Sites: Birmingham, Kansas City,
    Washington, D.C., and South Bend, IN
   Study Participants:
    –   396 teen moms (15 – 18 yrs)
    –   162 adult moms (> 22 yrs) matched for education,
        ethnicity/race, and income level to the teen
        sample
    –   124 adult moms (> 22 yrs) with at least 2 years of
        college, matched for ethnicity/race enrolled during
        3rd trimester
       The Centers for Prevention of Child Neglect
                   Conceptual Model
                                                       (+)

 Maternal
Adjustment         (+)

                                   Maternal                            Care
(+)                               Styles and                           Giving
                   (-)           Readiness to
                                    Parent                                             (+) or
 Maternal                                                                                (-)
  Health          (+)                                          (-)
                                                                                                   Child
 (+)     (-)                                                                                    Development
                         (-)
                                                                                 (-)
                 (+)
   Social                                                            Parenting
  Supports       (-)
  & Stress                                                   (-)     (Neglect)
                                     Infant Health &
                                        Behavior

                 (+)
   Maternal                                                          (+)
 Intelligence,
 Literacy and
                               (+)
  Education
Data obtained during:

   Second trimester of pregnancy (including measures
    of plans related to parenting)
   Home visits when baby was 4 months old and 6
    months old
   Cell phone interviews when child was 4 to 5 months
    old
   Subsequent data collection (lab and home visits, cell
    phone interviews) at 8, 12,15, 18, 24, 30, & 36 mos.
Tools to measure early risk for neglect
include:

   Self-report via standardized interviews (multi-
    occasion)
    –   Child Abuse Potential Inventory - CAPI (Milner,1986)
    –   Parenting Style (Bavolek, 1985)
    –   Beck Depression Inventory (Beck, 1987)
    –   Parent-Child Activities (CPCN, 2000) cell phone interviews
    –   Study-specific items about responsibility and neglect
   Direct observations
    –   Parent-Child Interactions (Landry, 2000)
    –   HOME (Caldwell & Bradley)
    –   Risk of Physical Neglect Indicators (CPCN, 2002)
   Key Constructs hypothesized to be
   precursors of early child neglect

                       Maternal
                      Adjustment
                  ?s ability to do good job,
                  be emotionally supportive
                                                 Parenting
                          Depressed             Beliefs & Info
Maternal Health       Unhappy (CAPI)           Lack of or wrong info
   Behavior                                     about child needs &
 & Health Care
                                                 effective practices
                      Readiness
                       to Parent
                   Unwilling to accept
                   new responsibilities
                    No plans for care
Maternal Adjustment

         Uncertain about ability to provide
         emotional support to children
          Uncertain about ability to do
         good job raising children
          Beck clinical moderate to severe
         depression scores
          CAPI Unhappiness score
Uncertain (when pregnant) about ability to
provide emotional support to children

   10%




    5%




    0%
         Teen moms      Adult low-   Adult high-
                     resource moms resource moms

                       p<.0001
Uncertain (when pregnant) about
ability to do good job raising children

   20%

   15%

   10%

    5%

    0%
         Teen moms      Adult low-   Adult high-
                     resource moms resource moms

                       p <.01
Beck moderate to severe clinical
depression ratings (when pregnant)

   25%

   20%

   15%

   10%

    5%

    0%
         Teen moms     Adult high-   Adult high-
                     resource moms resource moms
CAPI Unhappiness Score
(when pregnant)

  40%
  35%
  30%
  25%
  20%
  15%
  10%
        Teen moms      Adult low-   Adult high-
                    resource moms resource moms

                       p < .01
Readiness to Parent

         Unwilling to recognize and
        accept new parenting
        responsibilities
         Cannot name who or where
        to seek medical care/advice
Unwillingness to recognize and accept new
parenting responsibilities (when pregnant)


   50%

   40%

   30%

   20%

   10%

   0%
         Teen moms      Adult low-   Adult high-
                     resource moms resource moms
Prenatal Parenting Beliefs

             Endorses more
            abusive/neglectful parenting,
            harsh punishment, authoritarian
            parenting, and less responsivity
            to child
             Higher CAPI Rigidity scores
Parenting Style: Abuse/Neglect Scores
during pregnancy

   30%


   20%


   10%


    0%
         Teen moms      Adult low-   Adult high
                     resource moms resource moms

                        p < .001
Parenting Style: Punishment Scores
during pregnancy

   40%


   30%


   20%


   10%
         Teen moms      Adult low-   Adult high
                     resource moms resource moms

                       p < .01
Parenting Style: Authoritarian Scores
during pregnancy

   50%

   40%

   30%

   20%

   10%

    0%
         Teen moms      Adult low-   Adult high
                     resource moms resource moms

                       p < .001
Parenting Style: Lack of Responsivity
to Child Scores during pregnancy

   50%

   40%

   30%

   20%

   10%

    0%
         Teen moms      Adult low-   Adult high
                     resource moms resource moms

                       p < .001
CAPI Rigidity Scores
during pregnancy

  40%
  35%
  30%
  25%
  20%
  15%
  10%
        Teen moms      Adult low-   Adult high-
                    resource moms resource moms

                      p < .001
Summary of findings about neglect
precursors during pregnancy

Low resource mothers have higher rates of:
   –   Maternal adjustment problems including mental health
       issues and uncertainty about ability to do a good job raising
       child and to provide emotional support
   –   Unwillingness to accept parental responsibilities
   –   Endorsing use of more abusive/neglectful, punitive, rigid,
       and authoritarian parenting practices, and less responsivity
       to child
   Teen mothers have highest rates of any group on
     almost all precursors
Similar Patterns of Early Precursors of
  Likely Neglectful Behaviors during
      1st 6 months of Baby’s Life

                   With the exception that even
                   more teen moms become even
                   more unwilling to accept parental
                   responsibilities when baby is 6
                   mos. old
Unwillingness to recognize and accept new
parenting responsibilities



             During Pregnancy                               When Baby is 6 months old
45%                                                   45%

35%                                                   35%

25%                                                   25%

15%                                                   15%

 5%   Teen m om s      Adult low -    Adult high-
                                                      5%    Teen m om s      Adult low -    Adult high-
                    resource m om s resource m om s                       resource m om s resource m om s



                                                                            p<.0001
Lack of willingness to recognize and accept new
parenting responsibilities related to parenting styles
and maternal adjustment during 1st 6 months



   Lower scores on the HOME and SHIF (supplemental
    home items for impoverished families)
   Independent observations of mother-child interactions
    including verbal content, general verbalness, and
    physical intrusiveness
Early Precursors of Likely Neglectful
Behaviors Risk Index

   Lack of willingness to accept new parental responsibilities
   Uncertain about ability to provide emotional support to children
   Uncertain about ability to do good job raising children
   Beck clinical – moderate to severe depression scores
   CAPI Unhappiness and Rigidity scores
   Parenting Style - endorses more abusive/neglectful parenting,
    harsh punishment, authoritarian parenting, and less
    responsivity to child
Early Precursors of Likely Neglectful
Behaviors Risk Index


 30                        Mean (SD) Risk Score by Group
                     Teen moms                  2.16 (1.88)
 25                  Adult low resource moms 1.98 (1.82)
                     Adult high resource moms 0.95 (1.22)
 20                  p < .001



 15
 10
 5
 0
             Number of Risk Factors

         0   1   2   3          4   5   6    7     8
 Early Precursors of Likely Neglectful Behaviors
 Risk Index Significantly Related to Home
 Environment and Mother-Child Interactions

                            Teens    Adult low   Adult high Total
                                     resource    resource Sample
                                     moms        moms
HOME                        -.17**   -.41**      -.25*    -.29**
SHIF                        -.17**   -.24**      -.28*    -.24**
Child - Warmth Seeking      -.14*                         -.16*
Sensitivity                 -.16*                         -.19**
Contingent Responsiveness   -.22**                        -.23**
Physical Intrusiveness      -.14*                         -.15**
Punitive Tone                        -.32**               -.11*
Verbal Content                       -.21*                -.12*
General Verbalness          -.13*                -.23*    -.16*
11 cases of child neglect reported to
local authorities (partial listing of total)

 7 were teen mothers
 3 were adult mother with low resources
1 was adult mother with high resources
We are now constructing developmental
  trajectories for reported cases to ascertain
  type(s), timing, and severity of reported
  neglect and relationship to precursors
Research, Intervention, Service,
   and Policy Implications

				
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