Despite considerable declines in physical and sexual abuse over recent decades, child maltreatment remains a public health priority. In 2014, 702,000 children were determined to be victims of maltreatment, 75% of whom experienced neglect (DHHS, 2016). An area in need of further scrutiny is the complex relationship of multiple risk factors and the association of those risk factors with subsequent child welfare involvement. The purpose of this three-manuscript dissertation was to examine evidence-based child maltreatment prevention through an empiric examination of risk and novel prevention efforts. The first paper, Getting the Most Juice for the Squeeze: Where SafeCare® and Other Evidence-based Programs Need to Evolve to Better Protect Children, discusses the dissemination and implementation of evidence-based prevention programs using SafeCare as an applied example. The paper concludes with recommendations for evidence-based practices to improve the outcomes of children and families. Among several recommendations, this paper suggests considering innovative implementation settings, collaboration between systems, and response to the underlying risk factors for maltreatment. The second paper, Drug Court as a Potential Point of Intervention to Impact the Well-being of Children and Families of Substance-Using Parents, responds to the recommendation of collaboration and innovation from the first paper. This descriptive study sought to describe the needs of families of adult drug court populations related to parenting and mental health services. Baseline data indicated a low potential for abuse and the need for mental health services among drug court participants and their children under 18-years old. The findings from this paper indicate a potential intervention and collaboration opportunity between the child welfare and criminal justice systems. The third paper, An Examination of Risk Profiles among Mothers Involved with Child Protective Services, responds to the need to better understand underlying risk factors among child welfare involved families as discussed in the first paper. A latent class analysis was conducted to explore the heterogeneity among women reported to child protective services. In what is typically a homogenously treated and characterized sample, this analysis indicated three classes of risk and examined the classes’ association with subsequent referral to child protective services. The findings of this research support the recommendation of the importance of better understanding underlying risk factors to better align services with needs of children and families.

Introduction: Approximately 3 million child maltreatment (CM) referrals are made each year to state and social service agencies (U.S. Department of Health and Human Services- Children’s Bureau, 2012). This number appears to be an underestimate of the size of the problem however. Survey data collected by the Children’s Bureau of the U.S. Department of Health and Human Services estimates that about six million children are maltreated in the U.S. per year. CM negatively impacts the mental and physical health and social outcomes of victims in childhood and adulthood. For example, CM has been linked to obesity and overweight in children and adults. Similar to CM, overweight and obesity are also associated with various long-term and short-term health conditions for children and adults. Beyond the specific provision of food and modeling of eating and exercise behaviors, other family factors have been shown to relate to obesity including disorganized family environments, low parental supervision, maternal antipathy, child maltreatment, and family dysfunction. Objective: To examine the relationship between CM and obesity using a large sample of twin and sibling pairs, I will first examined the simple relationship between various form of abuse and obesity, and then, following the methodology of Vámosi et al. (2011), examine twin and sibling pairs to look at differences in experiences of CM and obesity. Methods: The current study used the Midlife Development in the United States (MIDUS), a public use longitudinal data set with information in the areas of physical, emotional/mental, and lifestyle characteristics of individuals in their 20’s, 40’s, and 60’s. The data set also includes nationally representative data about sibling and twin pairs. The MIDUS I had a sample of 7,108 participants. The MIDUS II was a follow-up of the MIDUS I and included 4,963 participants. The main variables I used were Body Mass Index (BMI) and CM, which was measured through the Conflict Tactics Scale. I controlled for various variables that contribute to overweight or obesity, such as socioeconomic status, educational attainment, physical activity, and depression. The comparison of twin and non-twin sibling data was of particular interest because of the strong genetic component of obesity. Results: Analyses were conducted using SPSS. I first examined simple correlations between abuse variables and obesity. Next, I conducted regression analyses examining the relationship between abuse and obesity, while controlling for gender, educational attainment, age, and several other variables associated with CM and obesity. The third analyses focused on examining differences in the abuse – obesity relationship between twin and sibling pairs. There was a small, negative relationship between BMI continuous and emotional abuse and physical abuse. There was a small, positive relationship between each form of abuse and BMI categories. Discussion: Although statistically significant results were found, they were small. The relationship between obesity and overweight and experience of CM is valid after controlling for various predictors, like health insurance, depression, and self-rated physical and emotional health. Public health practitioners should be sensitive to the physical health of victims of CM, especially concerning obesity and overweight. Many public health practitioners focus on the mental and emotional health of victims of CM, but they should also be made aware of the impact that CM has on physical health. There are several limitations. Regarding the CM variables, participants may have had difficulties recalling events from their childhood, so recall bias is a major limitation. Another limitation is that much of the data is self-reported which could have led to some data, like BMI, being inaccurate. Finally, we do not know the quality of the phone interviews or how well phone interviewers were trained.

INTRODUCTION: As evidenced in the literature, when maltreated children are admitted into state care, they are frequently not afforded sufficient mental health treatment. Concomitantly, foster parents are often not given proper training in providing complex care for these children. As such, the current study aimed to examine the role that foster care has in the development of psychopathology in maltreated children and their caregivers. METHODS: Participants included 234 maltreated youths (ages 7 to 17) presenting for treatment at a community mental health center specializing in childhood trauma. Children and adolescents currently residing in foster care as well as in their biological home environments were included. RESULTS: Results of multiple regression models indicated that a history of foster care plays a significant role in the association between children and adolescents who have witnessed domestic violence and internalizing disorders, externalizing disorders, and parenting stress. DISCUSSION: Results from this study revealed that a lack of foster care history plays a significant role in moderating the development of psychopathology in children and adolescents who have witnessed domestic violence. This association was also found with parenting stress. Future research needs to further explicate the specific roles that a child’s living situation can play in future psychological impairment.

Child maltreatment is a serious public health problem that leads to psychological, physical, behavioral, and economic burdens for children and broader community. Current data suggest that child maltreatment has declined over the past 20 years with the smallest declines in child neglect. In 2013, medical neglect represented approximately 31% of all substantiated cases of child maltreatment. SafeCare® is an evidence-based home visiting program that targets risk factors for child maltreatment by providing three modules: home safety, health, and parent-child interaction, or parent-infant interaction for children who are not walking. The SafeCare health module aims to teach parents how to identify and treat their children when they become ill, reducing the potential for medical neglect. Previous SafeCare research demonstrated that incorporating cell phones into training improves home safety and parent-child interaction outcomes. The current research evaluated the SafeCare health module and the effect cell phone enhancements had on parents’ child health knowledge. Data reaffirm the value of the SafeCare health module to increase parental child health skills and that incorporating cell phone technology may promote generalization and may engage participants and increase effectiveness.

This research was designed to contribute to an understanding of child outcomes and parenting practices associated with father-perpetrated maltreatment, as well as to identify processes that may contribute to emotion regulation difficulties in maltreated children. In particular, the studies described in this dissertation investigated paternal emotion socialization practices as potential pathways to emotion dysregulation in physically maltreated children. In the first study, a normative sample of 200 young adults participated in a retrospective analysis, whereby participants completed questionnaires designed to measure the relationships between history of physical maltreatment, emotion socialization, and current-day emotion regulation. In this study, 26.9% of participants endorsed a childhood history of father-perpetrated physical maltreatment. The second study explored these same relationships in a concurrent analysis of physically maltreating and non-maltreating father-child dyads. Fourteen physically maltreated children and their fathers were recruited from the Children’s Aid Society and treatment programs for abusive fathers, and a control group matched on demographic variables was recruited from the community. Father-child dyads participated in an emotion interaction task where they discussed the child’s experience of negative emotions; interactions were videotaped and coded for fathers’ validating and invalidating responses to children’s emotions. Fathers and children also completed measures that further assessed paternal emotion socialization, as well as children’s emotion regulation. Across both studies, findings indicated that physically maltreated children experienced more difficulties with emotion regulation than their non-maltreated peers. Moreover, abusive fathers were more likely to use non-supportive (neglect, punish, invalidation) and anger magnifying socialization practices, and less likely to use supportive (reward, validation) emotion socialization. Finally, results showed that the relationship between physical maltreatment and emotion dysregulation was mediated through the indirect effects of emotion socialization (reward, neglect, punish, magnify anger, validation, invalidation). In particular, data from child maltreatment victims consistently indicated that paternal neglect of negative emotions and magnification of anger were the strongest unique mediators. Together, results highlight the important role of fathers in the regulatory development of maltreated children. Furthermore, they provide support for intervention efforts designed to decrease non-supportive emotion socialization, while fostering anger management, emotional responsivity, and emotion coaching skills for physically abusive fathers.

The current study examined the utility of Self-Trauma Theory for explaining the long-term impact of the experience of childhood physical discipline and/or psychological maltreatment. Specifically, the self-capacities of interpersonal relatedness, identity, and affect regulation were tested as mediators of the impact of child maltreatment on different tension-reducing behaviors in adulthood: substance use, aggression, and suicidality. Hierarchical regression analyses were used to examine data collected from 268 university students who completed the Personality Assessment Inventory, Comprehensive Child Maltreatment Scale, and Inventory of Altered Self-Capacities. Results showed that the self-capacities were each predicted by different combinations of maltreatment variables and that the ability of self-capacities to mediate the long-term impact of child maltreatment is dependent on the tension-reducing behavior under examination. Specifically, identity impairment significantly predicted alcohol use problems and interpersonal conflicts significantly predicted drug use problems. Interpersonal conflicts partially mediated the relationship between child maltreatment and aggression as emotional abuse continued to exert a significant effect on aggression after controlling for self-capacities. Lastly, identity impairment and affect dysregulation fully mediated the relationship between child maltreatment and current suicidality. Theoretical implications are discussed as well as directions for future research. / Dissertation Chair: Donald U. Robertson, Ph.D. Dissertation Committee Members: Lynda M. Federoff, Ph.D., John A. Mills, Ph.D., ABPP

The Aim of this study was to gain an understanding of how educational welfare officers reason and act when there is a suspicion of child maltreatment. An employee who regularly meets children where there is a suspicion of child maltreatment is required by law to report it to social services. Five educational welfare officers from the Kronoberg county, as well as one from an adjacent county, received vignettes with three fictive accounts of children who were being maltreated.  The educational welfare officers were then interviewed and asked questions concerning the vignettes. The results and following analysis showed that if there was a suspicion of child maltreatment, then the educational welfare officers in general reported it to the social services. However, an exception to this was when they believed it not to be in the best interest of the child to report their suspicions. The results further showed that stigma, as described by Goffman (2014), was a factor that could drive the educational welfare officers towards acting in a way that wasn´t in accordance to what was required by the law. The actions they took could further be understood by using Lipsky´s (2010) “Theory of discretion”, which in this study translated to whether they acted in a way that was either fully in accordance to the law or in a more dubious way.

Child maltreatment has been linked to a wide range of poor child outcomes. Although children's reports of parenting are essential within clinical contexts, such as child welfare investigations or forensic interviews, children's reports of parental behaviors are not widely used within research contexts. Delineating child reports of maltreatment and parenting in the context of research could enhance methods of assessment and inform clinical practice. Thus, the present research sought to examine the utility of children's reports of deficient parenting and maternal alcohol abuse in the prediction of childhood internalizing and disruptive behaviors. Participants were 350 children aged 4 to 9 and their mothers, who were enrolled in a 3-year longitudinal study examining parenting and children's social development. A multi-method, multisource approach to data collection was used. Children's internalizing and disruptive behaviors were assessed at two time points occurring approximately 12 months apart, and were based on mothers' reports and research assistant observations. Information regarding parenting and maternal alcohol abuse was obtained from children, mothers, and direct observational measures. Structural equation modeling was used to explore the effects of deficient parenting and maternal alcohol abuse on concurrent and prospective child behavior problems. Age was included as a potential moderator of the link between deficient parenting and child behavior. A single construct conceptualization of deficient parenting was not supported by the data and the influences of each aspect of deficient parenting were examined independently. Results were varied across informants and depending on the specific aspect of parenting being assessed, providing partial support for the hypotheses. Among younger children, child-reported care neglect significantly predicted later anxiety and was marginally associated with concurrent disruptive behaviors. Current maternal alcohol abuse was marginally associated with both concurrent disruptive and internalizing behavior. Among older children, the multi-source index of care neglect significantly predicted later disruptive behaviors, while the multi-source index of harsh discipline and child-reported supervisory neglect predicted concurrent disruptive behaviors. For both age groups, mothers' lifetime history of alcohol abuse significantly predicted concurrent and later disruptive behavior, and later internalizing behavior. Children's reported exposure to maternal alcohol abuse was significantly associated with concurrent disruptive behaviors. The link between harsh discipline and concurrent internalizing problems was marginally significant. Finally, supervisory neglect was associated with internalizing behaviors, but results varied depending on the measure of supervision used. Current findings provided additional support for the utility of distinguishing between aspects of deficient parenting and examining the unique influences of aspects of parenting on child behavior. Overall, findings offer support for the predictive validity of children's reports of parenting and maternal alcohol abuse, and emphasize the importance of assessing children's experiences of parenting separately from other informants. Findings highlight the complexity of the relation between parenting and child adjustment, and suggest that the nature of these relations maybe fluid across children's development.

Despite the high prevalence of father-perpetrated maltreatment, relatively little empirical attention has been given to men who abuse and neglect their children (Dubowitz, 2006, 2009; Haskett, Marziano, & Dover, 1996). To further our understanding, the current dissertation explored father-child relational dynamics that underlie risk for child maltreatment. In the first study, data from a sample of 121 maltreating fathers were used to discern differential patterns of parenting dynamics using both theoretical and statistical approaches to classification. It was hypothesized that fathers would show problems predominantly in one of five areas: emotional unavailability; negative attribution, harshness, and rejection; developmentally inappropriate interaction; poor psychological boundaries; and exposure of a child to hostile inter-parental relations. Contrary to expectation, little support was obtained for the predominant problem hypothesis. Although methodological limitations may play a role, results indicated that men were more clearly differentiated by the degree of severity evidenced across their problematic parent-child interactions, than by differences in the specific pattern of problems they experienced. An interesting finding from Study 1 was that increasingly severe relational problems were associated with a misprioritization of parent and child needs. Study 2 further explored this dynamic by revising and re-evaluating a self-report measure of men’s ability to balance needs in the father-child relationship. Data from two samples (93 community fathers and 85 maltreating fathers) provided mixed results: Support was obtained for the internal consistency and construct validity of the image-emotional needs subscale of the measure; however, minimal support was obtained for the personal needs subscale. Furthermore, in contrast to expectation, discriminant validity was not obtained for either subscale, as maltreating fathers reported a better ability to balance needs on both scales than fathers drawn from a community sample. Social desirability was one of several factors deemed to play a key role in this finding. Each study’s contribution to the field is reviewed, along with discussion of limitations and future directions.

Despite the high prevalence of father-perpetrated maltreatment, relatively little empirical attention has been given to men who abuse and neglect their children (Dubowitz, 2006, 2009; Haskett, Marziano, & Dover, 1996). To further our understanding, the current dissertation explored father-child relational dynamics that underlie risk for child maltreatment. In the first study, data from a sample of 121 maltreating fathers were used to discern differential patterns of parenting dynamics using both theoretical and statistical approaches to classification. It was hypothesized that fathers would show problems predominantly in one of five areas: emotional unavailability; negative attribution, harshness, and rejection; developmentally inappropriate interaction; poor psychological boundaries; and exposure of a child to hostile inter-parental relations. Contrary to expectation, little support was obtained for the predominant problem hypothesis. Although methodological limitations may play a role, results indicated that men were more clearly differentiated by the degree of severity evidenced across their problematic parent-child interactions, than by differences in the specific pattern of problems they experienced. An interesting finding from Study 1 was that increasingly severe relational problems were associated with a misprioritization of parent and child needs. Study 2 further explored this dynamic by revising and re-evaluating a self-report measure of men’s ability to balance needs in the father-child relationship. Data from two samples (93 community fathers and 85 maltreating fathers) provided mixed results: Support was obtained for the internal consistency and construct validity of the image-emotional needs subscale of the measure; however, minimal support was obtained for the personal needs subscale. Furthermore, in contrast to expectation, discriminant validity was not obtained for either subscale, as maltreating fathers reported a better ability to balance needs on both scales than fathers drawn from a community sample. Social desirability was one of several factors deemed to play a key role in this finding. Each study’s contribution to the field is reviewed, along with discussion of limitations and future directions.