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9 Closing Remarks and Research Opportunities CLOSING REMARKS In her final wrap-up presentation at the workshop, Anne Petersen, chair of the planning committee, listed the themes that struck her as im- portant during the presentations and discussions. 1. The causes of child maltreatment. If the causes of child mal- treatment are not understood, then interventions will just treat symptoms. This approach is not sustainable in the long run. Re- search has made progress in identifying these causes, and more can be learned. 2. Definitions and measures. The problem of defining and measur- ing child maltreatment was a theme in the NRC 1993 report. Since then, many new possibilities for measurement and defini- tion have been identified. 3. Systems-level considerations. Research on the characteristics of systems and possible changes in those systems has enabled new levels of understanding about how systems work to generate both outcomes and data about those outcomes. 4. Translational research. Research needs to be designed so that it is relevant to policy and practice. 5. Child maltreatment science policy. Science policy for child mal- treatment research was identified in the 1993 NRC report as an important issue and it remains important today. Research needs to be funded if understanding is to progress, and emerging data need to be integrated with current systems, said Petersen. 6. A child-centered perspective. This also was a theme of the 1993 NRC report and remains a theme of research, policy, and prac- tice today. “We could have a really slick system that is not doing 95
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96 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE anything for the problem of child maltreatment,” said Petersen. The current emphasis on child well-being and parenting inter- ventions bears promise that children will be at the center of fu- ture reforms. FUTURE RESEARCH AND OTHER OPPORTUNITIES SUGGESTED BY INDIVIDUAL PARTICIPANTS The speakers at the workshop identified many priorities and ques- tions for future research and other opportunities for future action. These are compiled here to provide a sense of the range of suggestions made; additional detail and nuanced discussions are available in the preceding chapters. The suggestions are identified with the speaker who made them and should not be construed as reflecting consensus from the workshop or endorsement by the National Academies. Recognizing and Assessing Child Maltreatment A consensus on research definitions needs to be established for each type of child maltreatment based on sound testing for rele- vance and usefulness in economically and culturally diverse populations. (Widom) Systems of evaluation and care for child maltreatment need addi- tional study, including the linkages between child abuse pediatri- cians and CPS agencies. Particular attention should also be given to the roles of CACs and multidisciplinary teams because these are tightly linked to evaluation. (Leventhal) Researchers should examine how to improve the decision mak- ing of primary care clinicians, emergency room physicians, and child abuse pediatricians. (Leventhal) Research is needed on which children need which diagnostic tests. (Leventhal) Many research questions could be asked on assessment for men- tal health services planning: Within the context of frontline child welfare practice, how o well do current (and proposed) assessment tools and proce- dures identify children with particular problems who likely need mental health services?
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97 CLOSING REMARKS AND RESEARCH OPPORTUNITIES What are the major sources of error in child welfare assess- o ment approaches? How should assessment approaches be adjusted due to fac- o tors such as culture, ethnicity, race, and gender to reduce disparities? What is the influence of worker background and experience o on the implementation of assessment systems? What are the most parsimonious and efficient approaches (in o terms of financial cost, worker and family time, training, su- pervision, and compliance effort) to effective assessment? What levels of assessment can be reasonably performed by o typical child welfare workers, and what levels require addi- tional community professional resources? What are the minimal knowledge and skills needed in the o child welfare workforce to do the levels of assessment nec- essary for good practice? What sorts of initial and ongoing training, supervision, and o monitoring of practice are needed to achieve and maintain effective assessment activity? To what degree can technology be used to make the assess- o ment process (and application of assessment results) more efficient and more effective without negating appropriate child welfare worker judgment? Does greater coordination of assessment tasks with commu- o nity resources and the family result in better assessment? (Saunders) Social Trends and Child Maltreatment Trends A series of large population-based epidemiological surveys is needed to produce a more accurate picture of the nature and scope of child maltreatment, including the types of maltreatment that are currently excluded from existing official statistics. (Widom) Child maltreatment should be included as a focal topic in the Na- tional Children’s Study. (Widom) The constrained fiscal outlook calls for the development of cost- effective primary prevention models, sophisticated tools to as- sess the risk for secondary maltreatment, and better methods for tracking and monitoring high-risk families. (Paxson)
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98 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE Longitudinal data are needed to understand how family structure is related to maltreatment. (Paxson) The national analysis and distribution of NCANDS data should include trends by maltreatment type or by subgroups and state- level trends by maltreatment type. The analysis and distribution of NIS data should include trends in specific subforms of mal- treatment, at least in some categories. (Sedlak) Additional efforts should be made to publicize and disseminate existing data; facilitate full use of existing data; systematically collect data to guide prevention, including representative sam- ples of both maltreated and nonmaltreated children; improve maltreatment data in other systems such as the National Crime Victimization Survey and the National Incident-Based Reporting System; and look beyond CPS when defining maltreatment to al- so consider children’s other victimization experiences. (Sedlak) The Children’s Bureau should publicize NCANDS and NIS data more effectively to help professionals, media, and the public learn about and understand trends. (Jones) More research focused on epidemiological approaches to child maltreatment can reveal what is working so that interventions have a greater effect than they have had in the past. (Jones) Integrated data systems are needed that could facilitate planning, contribute to cost estimates, and help measure system-relevant outcomes. (Jonson-Reid) System decision-making labels like substantiation need to be ful- ly decoupled from research and data systems seeking to discrim- inate between maltreated and nonmaltreated children. (Jonson- Reid) Additional research is needed on the reliability of data suggest- ing declines in certain types of child maltreatment. Efforts are al- so needed to improve public health surveillance, including the ability to track data at the community level in addition to the state level. (Putnam) Causes and Consequences of Child Maltreatment The contextual factors that contribute to child maltreatment need more study, including genes, poverty, parenting styles, beliefs regarding discipline, cultural differences, and community re- sources. These contextual factors should be studied in combina-
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99 CLOSING REMARKS AND RESEARCH OPPORTUNITIES tion to understand both the causes and consequences of mal- treatment. (Widom) Research is needed on neighborhood and wider contextual condi- tions that influence child maltreatment, with implications specif- ically for prevention and interventions to improve neighborhood and community contexts. (Korbin) Research is needed to better understand the factors involved in definition, recognition, and reporting of child maltreatment, with implications specifically for improving recognition and reporting practices and policies. (Korbin) Research should seek a better understanding of residential selec- tion and efforts to improve housing and neighborhood condi- tions. (Korbin) Further research on the neurobiology of abuse and neglect is needed, given the many implications of this research for psycho- pathology. (Teicher) Preventing Child Maltreatment Policy makers should explore how Medicaid could be used as a vehicle for the prevention and treatment of child maltreatment. (Paxson) Additional research is needed on the sustainability of reform and population-level change. (Daro) Research needs to generate a greater understanding of the critical elements necessary for high-quality interventions and a sense of how much programs can adapt while still retaining those ingre- dients. (Daro) The effective use of technology to implement prevention pro- grams should be explored further; this could have many benefi- cial impacts, such as improving supervision, empowering participants to seek information, and strengthening provider– participant relationships. (Daro) Public and private programs and personal acts of mutual reci- procity need to be integrated more closely to maximize support for community programs. (Daro) Research should examine evidence-based treatments that can be borrowed from other intervention science sources, identify key cross-cutting elements and adapt them, modularize them, assem-
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100 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE ble them, prioritize them, and triage them to better fit for specific child maltreatment settings. (Chaffin) Researchers should develop evidence-based case management and assessment-driven service pathways. (Chaffin) Researchers should look beyond immediate outcomes to the de- velopmental, occupational, social, and health consequences of interventions for children in the system. (Chaffin) Research needs to look at the trajectory of interaction with service systems across a family’s child-rearing years, changing devel- opmental issues and the match with evidence-based treatments, and the role of monitoring, check-up, and follow-up. (Chaffin) The Design and Delivery of Services More research is needed on disseminating and implementing evidence-based treatments. (Landsverk, Dorsey) Research is needed on treating grief and loss in children who are cut off from their parents due to termination of parental rights. (Dorsey) Research needs to look more intensively at how to get evidence- based treatments into community settings. (Dorsey) Research on stepped, sequential care, high-reach, brief interven- tions (perhaps using technology), and proactive identification of families at risk should be a high priority. (Ondersma) Researchers need to develop and test models of sustainment for child maltreatment programs. (Aarons) There is a need for methodological innovation in research de- sign, implementation methods, and measures, for example, innovative efforts in roll-out designs, system dynamics, network analysis, decision science, and implementation climate. (Aarons) Technological innovations should be developed as implementa- tion methods. (Aarons) System-Level Issues Research should examine what cross-national analyses can re- veal about the access, availability, and impacts of services. (Fluke)
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101 CLOSING REMARKS AND RESEARCH OPPORTUNITIES Research is needed on types of leadership and leadership align- ment across system and organization levels that support evidence- based practice implementation and sustainment. (Aarons) Additional research on differential response could address these questions: What is the response, and what do differential response o workers do? Which aspects of differential response implementation are o plausibly linked to improving outcomes for children and families? Are the positive effects on families due to assignment to a o noninvestigative pathway, so that families are not further harmed by involvement in the child welfare system, or to ac- tual provision of services? How do criteria for assignment influence the effectiveness of o the noninvestigative pathway (e.g., should some cases only be served under the formal system)? How does participation in the noninvestigative pathway dif- o ferentially affect families with different demographic, social, or cultural characteristics? Does assignment to a noninvestigative pathway affect child o and family well-being beyond safety? What is the total cost-effectiveness of differential response o when costs to other service and support systems are considered? Will the key findings for child and family outcomes hold up o under more rigorous evaluation designs? What is the impact on the child welfare system as a whole o when multiple pathways are incorporated into an agency’s response to allegations of maltreatment? What changes in administrative data collection and analysis o will best capture the impact of differential response? Given the limited evidence that cases are being referred from o differential response back to CPS agencies, why is this not occurring? (Barth; note: many questions are taken directly from or based on questions from QIC-DR .) Systematic evaluations need to be conducted of experimentalist approaches to child welfare services such as quality service re- views. (Sabel)
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102 CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE Greater emphasis on dissemination and implementation of re- search is needed. (Landsverk) Policy and Support for Child Maltreatment Research Administrative and grant review processes need to ensure that reviewers have adequate expertise with child maltreatment to en- sure that maltreatment research proposals are evaluated on the basis of the quality of the work proposed. (Widom) The capabilities of the researchers who can contribute to child maltreatment research need to be sustained and improved, for example, through postdoctoral grants. (Widom) A funding mechanism is needed that can reflect the interdiscipli- nary nature of child maltreatment research and extend to gradu- ate and postgraduate training. (Widom) Early-career investigators and institutional review boards need education in how to deal with ethical issues that may arise during research on child maltreatment, such as reporting requirements. (Widom) Guidelines are needed for the use of videotaped interviews done for maltreatment assessments, for example, guidelines regarding confidentiality and access. (Putnam) Fellowships in child abuse pediatrics should be funded. (Leventhal) More research could be done in cooperation with CACs. (Osofsky, Leventhal)