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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
