CHILD MALTREATMENT
RESEARCH, POLICY, AND PRACTICE
FOR THE NEXT DECADE

WORKSHOP SUMMARY

Steve Olson and Clare Stroud, Rapporteurs

Board on Children, Youth, and Families

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CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE FOR THE NEXT DECADE WORKSHOP SUMMARY Steve Olson and Clare Stroud, Rapporteurs Board on Children, Youth, and Families

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract No. HHSP23320110010YC between the National Academy of Sciences and the U.S. Department of Health and Human Services. The views presented in this publication do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-25442-7 International Standard Book Number-10: 0-309-25442-6 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2012. Child maltreatment research, policy, and practice for the next decade: Workshop summary. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE FOR THE NEXT GENERATION1 ANNE C. PETERSEN (Chair), Research Professor at Center for Human Growth and Development, University of Michigan, and Founder and President of Global Philanthropy Alliance RICHARD P. BARTH, Dean, School of Social Work, University of Maryland, Baltimore LUCY BERLINER, Director of Harborview Center for Sexual Assault and Traumatic Stress, Clinical Professor at School of Social Work and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle LINDA M. BURTON, James B. Duke Professor of Sociology, Duke University, Durham, North Carolina MARK J. CHAFFIN, Professor of Pediatrics, Clinical Professor of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City MARY DOZIER, Amy E. du Pont Chair of Child Development, Professor of Psychology, University of Delaware, Newark PHILIP A. FISHER, Professor of Psychology, University of Oregon, Eugene JOHN M. LEVENTHAL, Professor of Pediatrics, Yale University School of Medicine, New Haven, Connecticut JOY D. OSOFSKY, Barbara Lemann Professor of Pediatrics and Psychiatry, Louisiana State University Health Sciences Center, New Orleans Project Staff MELISSA WELCH-ROSS, Project Director (through January 2012) CLARE STROUD, Project Director (from February 2012) ROSEMARY CHALK, Consultant YEONWOO LEBOVITZ, Research Associate CHRISTINA FEDAK, Senior Program Assistant 1 Institute of Medicine and National Research Council planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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Board on Children, Youth, and Families Staff KIMBER BOGARD, Director, Board on Children, Youth, and Families PATRICK BURKE, Financial Associate WENDY KEENAN, Program Associate vi

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report: Lucy Berliner, University of Washington Mark Chaffin, University of Oklahoma Health Science Center Rob Geen, The Annie E. Casey Foundation Sarah (Sally) M. Horwitz, Stanford University Frank Putnam, Cincinnati Children’s Hospital Medical Center David Sanders, Casey Family Programs Charles H. Zeanah, Jr., Tulane University Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Elena O. Nightingale, Institute of Medicine. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the rapporteurs and the institution. vii

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Contents ACRONYMS xiii 1 INTRODUCTION AND OVERVIEW 1 Research, Policy, and Practice for the Next Decade, 2 A Vision for the Future, 3 About This Summary, 4 2 REFLECTIONS ON THE 1993 NRC REPORT UNDERSTANDING CHILD ABUSE AND NEGLECT 7 Expansion of Research, 7 Nature and Scope of Child Maltreatment, 8 Definitions of Child Abuse and Neglect, 9 Consequences of Child Maltreatment, 10 Ethical Issues, 12 Science Policy for Child Maltreatment Research, 12 From Analysis to Action, 13 3 RECOGNIZING AND ASSESSING CHILD MALTREATMENT 15 Medical and Psychosocial Assessment and Diagnosis of Child Abuse and Neglect, 15 Assessment for Mental Health Services Planning, 20 4 SOCIAL TRENDS AND CHILD MALTREATMENT TRENDS 25 Social Trends and Their Implications for Understanding Rates of Child Maltreatment, 26 Data Sources for Understanding Child Maltreatment, 29 ix

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x CONTENTS Child Maltreatment Reporting Practices and Patterns, 38 5 CAUSES AND CONSEQUENCES OF CHILD MALTREATMENT 43 Influence of Neighborhood on Child Maltreatment Behaviors and Reports, 44 Neurobiology of Neglect, 48 Neurobiology of Trauma and Stress Associated with Adverse Early Experience, 50 6 PREVENTING CHILD MALTREATMENT 55 Universal Preventive Interventions, 56 Secondary Preventive Interventions with High-Risk Populations, 60 Prevention of Recurrences and Adverse Outcomes, 63 7 DESIGN AND DELIVERY OF SERVICES 69 Parent-Focused Interventions, 70 Child-Focused Interventions, 72 Families Dealing with Multiple Problems, 75 Implementation of Evidence-Based Practice, 78 8 SYSTEMS-LEVEL ISSUES 81 A Cross-National View of Child Protective Systems, 81 Alternative Child Welfare Services Approaches, 84 Role of Class-Action Suits in Building Evidence-Based Child Welfare Systems, 87 Leadership and Management in Child Welfare Agencies, 91 9 CLOSING REMARKS AND RESEARCH OPPORTUNITIES 95 Closing Remarks, 95 Future Research and Other Opportunities Suggested by Individual Participants, 96 APPENDIXES A REFERENCES 103 B WORKSHOP AGENDA 109 C REGISTERED WORKSHOP ATTENDEES 115

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xi CONTENTS D BACKGROUND PAPER: MAJOR RESEARCH ADVANCES SINCE THE PUBLICATION OF THE 1993 NRC REPORT UNDERSTANDING CHILD ABUSE AND NEGLECT: HIGHLIGHTS FROM THE LITERATURE 119

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Acronyms ACF Administration for Children and Families ACYF Administration on Children, Youth and Families ADHD attention-deficit/hyperactivity disorder AFCARS Adoption and Foster Care Analysis and Reporting System ARC Availability, Responsiveness, and Continuity CAC Child Advocacy Center CAPTA Child Abuse Prevention and Treatment Act CEBC California Evidence-Based Clearinghouse for Child Welfare CFSR Child and Family Service Review CPS Child Protective Services DBT dialectical behavioral therapy DJJ Department of Juvenile Justice DSS Department of Social Services GAL guardian ad litem HHS U.S. Department of Health and Human Services HPA hypothalamus-pituitary-adrenal ICD International Classification of Diseases IEP individualized education program IH-CBT In-Home Cognitive Behavioral Therapy IOM Institute of Medicine IRB institutional review board xiii

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xiv ACRONYMS MDT multidisciplinary team MST multisystemic therapy MTFC-P Multidimensional Treatment Foster Care for Preschoolers NCANDS National Child Abuse and Neglect Data System NCS National Children’s Study NIH National Institutes of Health NIS National Incidence Studies NPM New Public Management NRC National Research Council NSCAW National Survey of Child and Adolescent Well-Being PTS posttraumatic stress PTSD posttraumatic stress disorder QSR quality service review SACWIS Statewide Automated Child Welfare Information System UNICEF United Nations Children’s Fund