The updating process, which consists of building mental models and adapting them to the changes occurring in the environment, is impaired in neglect patients. A simple rock-paper-scissors experiment was conducted in our lab to examine updating impairments in neglect patients. The results of this experiment demonstrate a significant difference between the performance of healthy and brain damaged participants. While healthy controls did not show any difficulty learning the computer’s strategy, right brain damaged patients failed to learn the computer’s strategy. A computational modeling approach is employed to help us better understand the reason behind this difference and thus learn more about the updating process in healthy people and its impairment in right brain damaged patients. Broadly, we hope to learn more about the nature of the updating process, in general. Also the hope is that knowing what must be changed in the model to “brain-damage” it can shed light on the updating deficit in right brain damaged patients. To do so I adapted a pattern detection method named “ELPH” to a reinforcement-learning human decision making model called “RELPH”. This model is capable of capturing the behavior of both healthy and right brain damaged participants in our task according to our defined measures. Indeed, this thesis is an effort to discuss the possible differences among these groups employing this computational model.

The purpose of this study was to explore the case, organizational, decision maker, and external factors that influence teaching professionals when deciding to report children suspected to be in need of protection. Teachers report 24%, or 175,920 cases to Children’s Aid Societies annually in Canada; researchers who have examined teacher reporting practices, speculate that teachers fail to report between 50 to 84%, or 87,960–147,773 cases of suspected cases to authorities.The conceptual framework for the study came from Baumann, Dalgleish, Fluke, and Kern’s (2011) decision-making ecology framework which claims that individuals consider case, organizational, external, and decision-maker factors when making a decision. Phase one included an analysis of 64 policies on reporting children suspected to be in need of protection from English speaking, public and Catholic school districts and geographically isolated school authorities. Crosson-Tower’s (2013) policy analysis framework was used to analyze education factors, the legal system, document properties, procedures, support systems, training opportunities, and community relationships. Phase two consisted of one hour, semi-structured interviews (n = 7) with individuals who are mandated to report, and who had made at least one report. Interview questions were based on the conceptual framework and from the findings from phase one. Results revealed that many school districts omitted information that could have been beneficial to teachers who were required to report. Throughout the province it also appeared that training opportunities were minimal. This study did not explore whether training actually took place in school districts. Interview data, although not generalizable due to the sample size, appeared to suggest a lack of communication between school districts and parents, and teachers and Children’s Aid Societies (CAS). Conclusion: More research is needed to see how much of the supports listed in school district policies, such as training opportunities and support systems, are actually implemented and the subsequent effect of these actions on teacher’s reporting practices. / Thesis (Master, Education) -- Queen's University, 2014-04-23 15:44:40.667

Child maltreatment (CM) and unintentional childhood injury affects millions of children and cost society billions of dollars annually. The population at risk for CM has congruent demographic characteristics as children that are more likely to have unintentional injuries. Preventing CM through evidence-based home-visiting programs has been shown effective and cost efficient, and the inclusion of home safety in such programs, demonstrates significant reduction of hazards in the home. The overarching goal of the current research is to make a statistical connection between the population at risk for CM and amount of hazards in the home; that these two populations have enough overlap to validate the inclusion of home safety components in CM prevention programs. This study uses data from an ongoing research project that braids two evidence-based parenting programs: SafeCare® and Parents as Teachers. Findings indicate that the correlation between potential for abuse, measured by BCAP scores, and hazards in the home, measured by the HAPI, show a significant correlation r = .23, p < .05. Other variables such as loneliness, distress, and marital status were also found to contribute to this relationship.

Children less than one year of age are a vulnerable population. Injury, and child abuse and neglect (child maltreatment) are causes of morbidity and mortality in this population. The literature suggests that the family characteristics of both sub-populations are similar and they may be the same sub-population (Peterson and Brown 1994). Large scale studies have revealed that there are multiple risk markers that are predictive of child abuse and neglect (Browne 1995, Sidebotham et al. 2001, 2002). There is mixed evidence as to whether home visiting can have an impact on preventing injury and child abuse and neglect. This study aims to show that children who are injured and maltreated are the same sub-population. The study also examines the impact of child, family and societal risk markers on the likelihood of a child presenting for an injury or child maltreatment, and the effect of home visiting on the outcomes of injury and/or child maltreatment. This study is a retrospective cohort study using administrative data from three administrative data systems. The data from these systems were merged as part of a work project and de-identified. The de-identified data set contained data at an individual child level and formed the study sample. There were 11,821 children in the sample who lived within the Royal Children's Hospital Health Service District. Variables included demographic data, family characteristics, service contacts which included injury and Child Advocacy Service contacts (a proxy for child maltreatment). The main results of the study indicate there is a small cross-over of the sub-populations and these children are an extremely at-risk sub-population with a very high prevalence of risk markers. The research found that for children less than one year of age the 4.1% of the study sample presented for an injury contact and 1.1% of the study sample has a Child Advocacy Service (CAS) contact. There was 5.17% of the injury sub-population, compared to 0.93% of the non-injured population who had a CAS contact. Nineteen percent (19 %) of children who had a CAS contact also had an injury contact. The study also found that sole parents, mothers with an intellectual disability, and mothers who live in temporary/rental housing are predictors of injury and child maltreatment. Another finding is that an injury contact is a significant predictor of child maltreatment. A child who had an injury was 9 times more likely to attend for a CAS contact than a non-injured child (AOR 9.087 significant at 95% confidence interval (CI), (4.863-17.073). The introduction of home visiting into the model was examined and it was found that more than one home visit has the potential to reduce the likelihood of a child having child maltreatment contact if the mother is a sole parent, less than 20 years of age, abused as a child, lives in a family violence situation, has a mental health problem, is intellectual disabled or uses illicit substances. Whilst the results show a reduction, the impact clinically would be that home visiting as a single strategy will not prevent a CAS contact. The service implications of the study revealed that, there is a high usage of Department of Emergency Medicine (DEM) of Triage Category 4 and 5 clients. This presents an opportunity to look at alterative service model for these clients. Not all CAS clients were seen by the Primary Care Program, this also presents an opportunity to develop a pathway back to preventative health care services for this vulnerable group. The practice implications are that further research is required to identify the decision making process within DEM for injury presentation to identiy the indicators that DEM staff use to make a referral to the CAS. The identification of risk by Child Health Nurses requires further research to identify if the low occurrence of family risk variables in the study sample is a result of interview skills or data recording. The study has identified that there is a cross-over sub-population of injured and maltreated children. The research findings will provide information not previously available in the Australian context. At a service level the findings provide data to improve practice and service delivery.

While studies have examined risk factors and consequences of child maltreatment in general, relatively few have focused specifically on neglect, especially maternally perpetrated child neglect. This is despite evidence that neglect is the most common and most rapidly increasing form of maltreatment, with some of the most serious long-term effects on child development. Maternal neglect constitutes a substantial disturbance in the mother-child relationship. For this reason, after establishing the epidemiology of neglect at a population level, this thesis examines the neurobiology of patterns of mother-infant attachment using functional MRI. Disturbance in mother-infant attachment, in conjunction with family, social and societal risk and protective factors, constitutes the likely pathway to maternal neglect. Specific objectives were: 1) to describe the magnitude of the problem of maternal neglect in Australia, using longitudinal population-based studies; 2) to identify risk and protective factors associated with neglect, both in a high risk population of extremely low birth weight (ELBW) infants and a representative birth cohort; 3) to specifically explore whether breastfeeding was protective against maternally perpetrated neglect; 4) to examine the consequences of child neglect on infant cognitive development and head growth; and 5) to determine how maternal brain and endocrine responses differ according to patterns of adult attachment security. In Part A, two cohort studies examined the epidemiology of child abuse and neglect among mothers and their infants born at the Mater Mothers’ Hospital in Brisbane, Australia. Cohort databases were confidentially linked with official notifications of child abuse and neglect. The first cohort included 353 ELBW infants who were assessed at birth and at 1, 2 and 4 years of age. The second cohort included 7223 children whose mothers were enrolled prenatally into the Mater-University of Queensland Study of Pregnancy (MUSP), where data were collected at birth, 6 months, and 5 and 14 years. The initial ELBW study examined all reported notifications of neglect, while the MUSP study focused particularly on substantiated maternally perpetrated neglect and the protective effect of breastfeeding. These studies examined a broad range of social and biological predictors. Outcome variables for child neglect were examined in the ELBW cohort using cognitive z-scores and growth parameters. Analytic techniques included multivariate modelling. In Part B, the neurobiology of mother-infant attachment was examined by monitoring a cohort of 61 first-time mothers from Houston, Texas, over 4 study visits. The mothers’ attachment classifications were determined during pregnancy using the Adult Attachment Interview. At 6 months, mother-infant pairs were videotaped, and serum oxytocin measures collected before, during and after interaction. At 10 months, the mothers viewed pictures of their own and unknown infants during functional MRI scanning. The first report examined the brain responses of 28 mothers to happy, neutral and sad infant face cues. The next compared brain responses of 15 mothers with “secure” attachment patterns to 15 “insecure/dismissing” mothers, and also examined differences in peripheral oxytocin response to mother-infant interaction. Data were analysed using a general linear model and repeated measures ANOVA. Overall, more than 1 in 10 children were reported for suspected child maltreatment, 3-5% as a result of substantiated neglect and 3% with maternally perpetrated neglect, with higher rates seen in the ELBW cohort. Duration of breastfeeding was inversely associated with the odds of maternal neglect, with non-breastfeeding mothers almost 4 times more likely to neglect their child compared to mothers who breastfed for 4 or more months, after adjusting for covariates. Other significant risk factors for substantiated maternal neglect included low education, young maternal age, and race, which were also significant univariate predictors in the ELBW population. ELBW children exposed to neglect showed a progressive decline in cognitive functioning over the first 4 years of life, as well as a significantly reduced head circumference at 2 and 4 years. When mothers viewed their own infant’s faces, compared with an unknown infant, key dopamine-associated reward processing regions of the brain were activated, including the midbrain’s ventral tegmental area/substantia nigra, striatum and prefrontal cortex. Mothers with an insecure/dismissing type of attachment showed significantly less activation of these reward regions in response to both happy and sad own-infant faces. On viewing their own infant’s crying faces, these mothers showed activation of the anterior insula, a region involved in feelings of unfairness, pain and disgust. “Secure” mothers showed greater peripheral oxytocin responses during mother-infant interaction, which were correlated with activation of the pituitary/hypothalamic region of the brain, where oxytocin is produced and secreted. These findings confirm the magnitude of neglect as a public health concern, with identifiable consequences and specific risk and protective factors. The neurobiological studies identify neuroendocrine systems associated with mother-infant responses and patterns of adult attachment. Together, these studies theoretically link secure mother-infant attachment with brain reward activation and oxytocin response, breastfeeding success, and a reduced risk for maternal neglect. Implications for prevention and intervention, and future research plans, are discussed.

Background: There is an emerging literature suggesting that clinicians can go through a process of personal change when engaging in psychotherapeutic work with trauma survivors, which parallels that experienced by clients themselves. The current evidence regarding the relationship between engaging in psychological therapy and compassion satisfaction, vicarious post-traumatic growth and vicarious resilience is inconclusive. A number of methodological weaknesses in the existing literature were identified. The review highlights the need for future research to examine the contextual, demographic and psychological factors which allow therapists to experience positive psychological outcomes from their trauma work. Objective: This study aims to explore vicarious post-traumatic changes in clinicians who work with adult survivors of complex trauma and the role of organisational factors in these changes. Method: Grounded theory methodology was used to analyse interview data with twelve participants (nine female and three male), all of whom had high complex trauma caseloads. Results: The study generated a theory proposing that undertaking trauma work involves the interplay between numerous challenges pertaining to clinicians’ expectations of themselves, therapeutic challenges and organisational neglect. Engaging in trauma work with clients leads to psychological and emotional changes in therapists. A lack of organisational support further contributes to such changes, leaving clinicians feeling isolated and overwhelmed. In order to cope with these challenges, clinicians develop coping mechanisms in the form of emotional detachment and accessing external supports. Alongside this, clinicians identify positive effects of trauma work arising from the therapeutic relationship. These positive outcomes appear to mediate the more negative effects of trauma work, relating to psychoemotional changes and lack of organisational support. Conclusion: These findings suggest a need for a greater understanding of the degree of reciprocity between clients, clinicians and services and the provision of trauma-informed services both for clients and clinicians.

Background: Maltreated children, including those who are looked after away from home, are amongst the most vulnerable members of society. Due to the relational trauma that most looked after children have experienced they are at increased risk of attachment and mental health difficulties, which can impede their ability to form close relationships with new carers. Indeed, many such children behave in ways that fail to elicit caregiving or even as if they do not need caregivers, and providing sensitive, therapeutic care to these vulnerable children can be a considerable challenge. Aims: The aims of this thesis were threefold: to review the impact of maltreatment experiences on children’s executive functioning, to investigate the prevalence of attachment and trauma-related difficulties in children in foster care, and their impact on the parenting task of foster carers. Methods: Aims are addressed in two journal articles. To address the first aim, a systematic review of research regarding the association between maltreatment and executive function in children and adolescents is presented in journal article one. Subsequent aims are addressed in journal article two, a cross-sectional study with foster carers of children in care aged 3-12 years who completed self-report measures investigating the emotional, behavioural, attachment and trauma related difficulties of their foster child, the perceived quality of the relationship, and levels of parenting stress and sense of competence. Results: The systematic review revealed that the majority of studies demonstrated a significant impairment in one or more areas of executive ability in maltreated children, with particular support for impairments in inhibitory control, executive working memory and decision making. However, there was only limited support for impairments in cognitive flexibility, planning/problem solving, and fluency. Furthermore, there was considerable variability between studies in the specific deficits reported. Results from the empirical study highlight the prevalence of attachment and trauma-related difficulties in children in foster care. Hierarchical regression analyses revealed that levels of foster carer-rated inhibited attachment behaviour was a significant predictor of quality of the foster carer-child relationship and parenting stress. The level of emotional and behavioural difficulties also emerged as a significant predictor of quality of the foster carer-child relationship, and parenting sense of competence. Conclusions: This thesis highlights the pervasive impact of relational trauma on children. Results of the systematic review indicate its impact on children’s executive ability. The empirical study reveals the high prevalence of attachment and trauma-related difficulties in children in foster care, and provides insight into factors related to quality of the foster carer-child relationship, and the stress and sense of competence of foster carers. Implications for interventions and service provision regarding maltreated children who become looked after away from home, and their carers, are discussed.

The aim of this review is to provide a unified perspective of unilateral spatial neglect (USN). USN is a neurological disorder frequently observed following damage or diseases to the brain. It is particularly associated with strokes to specific anatomical structures within the right hemisphere. Patients with USN fail to respond to or orient towards stimuli located in the hemispace contralateral to the lesion. They also show peculiar behavioral manifestations. There are several distinct subtypes of USN which can affect sensory or motor modalities, spatial representations, the range of space, or pure imagery. This disorder can appear in any sensory modality but the majority of studies have investigated the visual aspect of USN in these subtypes. Theoretical proposals are supported by empirical evidence deriving from neuroimaging which distinguish between these subtypes of USN. Thus, the heterogeneity of the disorder is evident and clinical assessment methods face great difficulties while prevalence rates vary. The neural pathways of spatial attention distinguish between the ventral and dorsal visual streams, both with distinct functional roles and anatomical bases. Prism adaptation (PA) is a common rehabilitation technique among many others and has shown positive effects on USN while having some limitations. A general discussion and concluding remarks are presented in the final section followed by future research suggestions.

Philosophiae Doctor - PhD / The primary intent of this study was to seek solutions to the practical problems experienced by practitioners in their management of child abuse cases. A fundamental problem regarding the current management of child abuse is that there is no guarantee that a child entering the child protective system will be dealt with in terms of a set procedure and/or protected against further abuse. To address this problem in the Western Cape, the Intervention Research (IR) methodology (Rothman & Thomas, 1994) was used to develop a Protocol for the Multi- Disciplinary Management of Child Abuse and Neglect. IV The protocol was designed for agencies that intervene in instances of child abuse. It establishes criteria and procedures for interdisciplinary co-ordination and effective case management, delineates the professional roles and responsibilities and provides step-by-step intervention procedures. The Intervention Research Design and Development methodology provided a useful framework to apply social science research methods to child protective practice and policy reform. IR focuses on the design of practice guidelines for intervention and policy reform. It can be conducted in a diversity of practice settings and therefore enhances collaborative efforts and inter-agency exchange among practitioners and among practitioners and universities. The study evolved through six phases involving inter-as well as intra-disciplinary activities. These activities were guided by systematic and deliberate research procedures, techniques and instruments. The research phases included: problem analysis; information gathering and synthesis; the development and design of the protocol; testing the protocol through a process of workshops and finally, the launch and dissemination of the protocol. http://etd.uwc.ac.za A core element of the study was the active participation and collaboration of a broad range of key stakeholders, including: victims of child abuse, their families, service providers, and policy makers. The methods and instruments used were therefore designed to enhance participation and included interviews, workshops and observation of court processes. The bottom-up approach and collaborative design enhanced the level of contextual relevance, ownership and the commitment of stakeholders. As a demonstration of this commitment, the protocol has been endorsed by the Ministry of Justice and the Ministry of Health and Social Services of the Western Cape. The Department of Social Services has committed financial support to the project and is pilot testing it in three districts. The study cautions that protocols alone cannot eradicate and solve all the problems in the child protective field and asserts that there is an urgent and critical need to develop and to implement a National Strategy on Child Abuse. Such a National strategy should include legislation that supports and enforces all aspects of a national policy on child abuse. At minimum, national policy should ensure consistent political will and leadership. This means that broad statements about the obligations of politicians and state officials is not enough. These should be followed by specific accountability and measuring mechanisms for enforcement. State policy should also provide guidelines for standardized and appropriate working conditions, recruitment and training of staff. Furthermore, it should provide for a broad array of effective and accessible services to all children and families and the co-ordination of such services. Finally, legislation should include specific obligations regarding the appropriation of adequate and flexible funding to see that commitments made to children are realized

The purpose of this study was to examine the cognitive and emotional functioning of neglected, physically abused, and clinical control children between six and thirteen years of age who were referred for testing at the Dallas Child Guidance Clinic.