NEW DIRECTIONS IN CHILD ABUSE
AND NEGLECT RESEARCH

Committee on Child Maltreatment Research, Policy, and Practice for the
Next Decade: Phase II

Anne C. Petersen, Joshua Joseph, and Monica Feit, Editors

Board on Children, Youth, and Families

Committee on Law and Justice

     INSTITUTE OF MEDICINE AND
NATIONAL RESEARCH COUNCIL
                    OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
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NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH Committee on Child Maltreatment Research, Policy, and Practice for the Next Decade: Phase II Anne C. Petersen, Joshua Joseph, and Monica Feit, Editors Board on Children, Youth, and Families Committee on Law and Justice

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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 Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by Contract/Grant No. HHSP23320110010YC between the National Academy of Sciences and the Administration for Children and Fami- lies, U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number-13:  978-0-309-28512-4 International Standard Book Number-10:  0-309-28512-7 Additional copies of this report are available for sale 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. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2014. New directions in child abuse and neglect research. 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 Acad- emy 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 en- gineers. 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 engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent 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 Insti- tute 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 Sci- ences 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 Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE FOR THE NEXT DECADE: PHASE II ANNE C. PETERSEN (Chair), Research Professor, Center for Human Growth and Development, University of Michigan, Ann Arbor LUCY BERLINER, Director, Harborview Center for Sexual Assault and Traumatic Stress, Seattle, Washington LINDA MARIE BURTON, James B. Duke Professor of Sociology, Department of Sociology, Duke University, Durham, North Carolina PHAEDRA S. CORSO, Professor, College of Public Health, University of Georgia, Athens DEBORAH DARO, Senior Research Fellow, Chapin Hall at the University of Chicago, Illinois HOWARD DAVIDSON, Director, American Bar Association Center on Children and the Law, Washington, DC ANGELA DÍAZ, Jean C. and James W. Crystal Professor of Adolescent Health, Department of Pediatrics and Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York MARY DOZIER, Unidel Amy E. du Pont Chair of Child Development, Department of Psychology, University of Delaware, Newark FERNANDO A. GUERRA, Clinical Professor of Pediatrics, University of Texas Health Science Center, San Antonio CAROL HAFFORD, Principal Research Scientist, NORC at the University of Chicago, Bethesda, Maryland CHARLES A. NELSON, Professor of Pediatrics and Neuroscience, Richard David Scott Chair of Pediatric, Developmental Medicine, Harvard Medical School, Children’s Hospital Boston, Massachusetts ELLEN E. PINDERHUGHES, Associate Professor, Eliot-Pearson Department of Child Development, Tufts University, Boston, Massachusetts FRANK W. PUTNAM, JR., Professor of Psychiatry, University of North Carolina at Chapel Hill DESMOND K. RUNYAN, Executive Director, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora CATHY SPATZ WIDOM, Distinguished Professor, Psychology Department, John Jay College and the Graduate Center, City University of New York, New York JOAN LEVY ZLOTNIK, Director, Social Work Policy Institute, National Association of Social Workers, Washington, DC v

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Consultants GREGORY A. AARONS, University of California, San Diego RICHARD P. BARTH, University of Maryland REBECCA BERTELL, University of Maryland CINDY CHRISTIAN, The Children’s Hospital of Philadelphia HOWARD DUBOWITZ, University of Maryland DEBORAH HARBURGER, University of Maryland STANLEY J. HUEY, JR., University of Southern California KENT P. HYMEL, The Children’s Hospital of Dartmouth NANCY KELLOGG, University of Texas Health Science Center JOHN LANDSVERK, Rady Children’s Hospital of San Diego LAWRENCE PALINKAS, University of Southern California MATHEW URETSKY, University of Maryland ALLISON WEST, University of Maryland KRISTEN WOODRUFF, University of Maryland FRED WULCZYN, Chapin Hall at the University of Chicago Study Staff MONICA FEIT, Study Director1 JOSHUA JOSEPH, Study Director2 MICHAEL McGEARY, Senior Program Officer3 TARA MAINERO, Research Associate4 ALEJANDRA MARTÍN, Research Associate5 KAREN CAMPION, Research Assistant6 AMANDA PASCAVIS, Research Assistant7 WENDY KEENAN, Program Associate SAMANTHA ROBOTHAM, Senior Program Assistant PAMELLA ATAYI, Administrative Assistant KATHLEEN McGRAW-SHEPHERD, Intern8 KIMBER BOGARD, Director, Board on Children, Youth, and Families ARLENE LEE, Director, Committee on Law and Justice 1  Through January 2013. 2  Starting January 2013. 3  Starting January 2013 through March 2013. 4  Starting September 2013. 5  Through September 2013. 6  Starting December 2012 through August 2013. 7  Starting November 2013. 8  Starting May 2012 through August 2012. vi

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Acknowledgments T his report reflects contributions from numerous individuals and groups. The committee takes this opportunity to recognize those who so generously gave their time and expertise to inform its deliberations. To begin, the committee would like to thank the sponsor of this study. Support for the committee’s work was provided by the U.S. Department of Health and Human Services, Administration for Children and Fami- lies, Administration on Children, Youth and Families, Children’s Bureau, Office on Child Abuse and Neglect. We wish to thank Joe Bock, Melissa Brodowski, Catherine Nolan, Bryan Samuels, and Dori Sneddon for their guidance and support. The committee greatly benefited from the opportunity for discussion with individuals who made presentations at and attended the committee’s workshops and meetings (see Appendix B). The committee is thankful for the useful contributions of these many individuals. The committee could not have done its work without the support and guidance provided by the Institute of Medicine (IOM)/National Research Council (NRC) project staff: Karen Campion, Monica Feit, Joshua Joseph, Wendy Keenan, Tara Mainero, Alejandra Martín, Kathleen McGraw- Shepherd, Amanda Pascavis, and Samantha Robotham. The committee gratefully acknowledges Kimber Bogard of the Board on Children, Youth, and Families and Arlene Lee and Jane Ross of the Committee on Law and Justice for their guidance on this study. vii

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viii ACKNOWLEDGMENTS Many other staff within the IOM/NRC provided support to this project ­ in various ways. The committee would like to thank Pamella Atayi, Patrick ­ Burke, Laura DeStefano, Chelsea Frakes, Faye Hillman, Nicole Joy, ­ ichael M McGeary, Abbey Meltzer, and Patti Simon. Finally, Rona Briere and Alisa Decatur are to be credited for the superb editorial assistance they provided in preparing the final report.

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Reviewers T his 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 confiden- tial to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Dolores Subia BigFoot, University of Oklahoma Health Sciences Center Jeanne Brooks-Gunn, Columbia University Mark J. Chaffin, University of Oklahoma Health Sciences Center Diana English, University of Washington Sally Flanzer, U.S. Department of Health and Human Services (Retired) Joan Kaufman, Yale University Jill E. Korbin, Case Western Reserve University Richard D. Krugman, University of Colorado at Denver Kristen Shook Slack, University of Wisconsin–Madison Charles H. Zeanah, Tulane University Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the ix

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x REVIEWERS report before its release. The review of this report was overseen by Robert S. Lawrence, Johns Hopkins University, and Nancy E. Adler, University of California, San Francisco. Appointed by the National Research Council and the Institute of Medicine, they were 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 authoring committee and the institution.

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Contents SUMMARY 1 1 INTRODUCTION 15 The 1993 Report, 16 Trends Since 1993, 16 The Current Study, 18 Study Approach, 19 Research Advances in Child Abuse and Neglect, 23 A Systems Framework for Child Abuse and Neglect, 25 The Unique Role of Social and Economic Stratification, 27 Conclusion, 28 Organization of the Report, 29 References, 29 2 DESCRIBING THE PROBLEM 31 Definitions, 32 Incidence Rates and the Problem of Underreporting, 38 Incidence Trends, 48 Determination of Child Abuse and Neglect, 53 Conclusions, 61 References, 62 3 CAUSALITY 69 Establishing a Causal Connection, 70 Candidate Explanatory Factors for Child Abuse and Neglect, 72 xi

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xii CONTENTS Protective Factors, 95 Methodological Challenges, 96 Conclusions, 97 References, 101 4 CONSEQUENCES OF CHILD ABUSE AND NEGLECT 111 Cascading Consequences, 112 Background, 113 Neurobiological Outcomes, 117 Cognitive, Psychosocial, and Behavioral Outcomes, 128 Health Outcomes, 141 Adolescent and Adult Outcomes, 144 Individual Differences in Outcomes, 148 Economic Burden, 152 Conclusions, 154 References, 155 5 THE CHILD WELFARE SYSTEM 175 Overview of the Child Welfare System, 176 Major Policy Shifts in Child Welfare Since 1993, 191 System-Level Reforms Intended to Improve Practice and Outcomes, 196 Research on Key Policy and Practice Reforms, 201 Focus on Well-Being Outcomes, 210 Issues That Remain to Be Addressed, 213 Conclusions, 234 References, 235 6 INTERVENTIONS AND SERVICE DELIVERY SYSTEMS 245 Treatment Programs, 247 Prevention Strategies, 253 Common Issues in Improving Program Impacts, 265 Building an Integrated System of Care, 276 Conclusions, 281 References, 283 7 RESEARCH CHALLENGES AND INFRASTRUCTURE 297 Components of the Child Abuse and Neglect Research Infrastructure, 297 Challenges in Child Abuse and Neglect Research, 326 Existing Opportunities to Create an Integrated Child Abuse and Neglect Research Infrastructure, 332

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CONTENTS xiii Conclusions, 340 References, 341 8 CHILD ABUSE AND NEGLECT POLICY 349 The Policy Landscape, 352 Federal Laws and Policies, 354 State Laws and Policies, 364 Conclusions, 380 References, 380 9 RECOMMENDATIONS 385 Guiding Principles, 386 Recommendations, 389 Final Thoughts, 405 References, 406 APPENDIXES A WORKSHOP OPEN SESSION AGENDAS 407 B RESEARCH RECOMMENDATIONS AND PRIORITIES FROM THE 1993 NATIONAL RESEARCH COUNCIL REPORT UNDERSTANDING CHILD ABUSE AND NEGLECT 411 C BIOSKETCHES OF COMMITTEE MEMBERS 421

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