Innovative handheld technologies are changing the possibilities for delivering public health interventions. The present research describes a preliminary examination of the effects of iPhone™ both as an assessment tool for data collection and as an enhancement to an in-home child safety intervention. Three families with children under age seven were trained to use an iPhone to video targeted rooms in their homes following SafeCare® safety module intervention implementation during which rooms were secured for accessible safety and health hazards. The iPhone was used to communicate feedback, logistical information, and clarification of safety content. The effectiveness of iPhone and iPhone video was examined using a multiple baseline design across settings replicated across families. All rooms across subjects demonstrated significant decreases in home hazards. Face-to-face (F2F), in-home time of the home visitor was progressively reduced and replaced by video data collection over the course of the intervention. These data suggest that handheld technology tools are a promising means of data collection for in situ safety interventions and for augmenting interaction during intervention. Implications of these findings for reducing costs of F2F intervention as high-quality handheld video capabilities become increasingly ubiquitous and for engaging and retaining participants are discussed.

Parents who abuse drugs and alcohol are at increased risk of child maltreatment, including the neglect of their children’s health. The present research investigates the effectiveness of the SafeCare® Health module in training mothers with a history of substance abuse living in a residential treatment facility to correctly identify and treat their children’s illnesses. Three mothers of children ages 5-years-old and younger participated in the study. Using a multiple-baseline, single-case experimental design, the research team examined the participants’ ability to select the most appropriate course of action for addressing their children’s illnesses. Results indicate that parents’ skills increased steadily during the intervention, with two of the three participating parents demonstrating mastery of the skills presented. The results suggest that this intervention has great potential to be feasible and effective with this population in this setting. Future research should further investigate the relevance of this intervention with vulnerable populations living in a residential setting to examine whether the changes in targeted parenting skills result in changes in behavior that impact child maltreatment incidence reductions.

This study evaluated the impact of delivery of the Period of PURPLE Crying (PURPLE), in a group of first-time mothers. Frustration with crying is reported as a trigger for abusive head trauma (AHT).The primary objective was to determine whether there was a change in knowledge about crying and shaking after exposure to PURPLE. Factors associated with behavioral responses to crying were studied as was the utility of PURPLE. There was a significant increase in knowledge about infant crying (P = 0.001) after program delivery that was predicted by low baseline knowledge (P < 0.01). There was a non-significant negative change in shaking knowledge (P = 0.5), which may have been the consequence of high baseline knowledge of shaking. The PURPLE program was characterized as informative and useful by participants. Additional to evaluate the impact of program delivery on other caregivers and on the rates of AHT is recommended.

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.

Although a history of childhood maltreatment is widely considered to be a risk factor for the perpetration of abuse or neglect in successive generations, the intergenerational transmission theory of child maltreatment has demonstrated mixed support over more than three decades of research. Using a prospective, longitudinal design, this study sought to investigate adolescent, young adult, and reproductive risk factors for the intergenerational continuity of child maltreatment, analyzing data from a sample of 147 women with a history of childhood maltreatment and child welfare services involvement (CWS), juvenile justice system (JJS) involvement, and out-of-home placements. The participants were originally recruited in adolescence for a randomized control trial (RCT) assessing the impact of the Treatment Foster Care Oregon (TFCO) intervention. Maltreatment continuity was measured using both official CWS records and participant self-report of contact with CWS. More than half the sample (n = 79, 53.7%) demonstrated maltreatment discontinuity (MD), indicating no evidence of maltreatment of offspring, and under half demonstrated maltreatment continuity (MC; n = 68, 46.3%). Using separate logistic regression analyses to test three models, results indicated that higher levels of hard drug use in adolescence increased the likelihood of maltreatment continuity at young adult follow-up by 47%. Partner risk in young adulthood was a strong predictor of maltreatment continuity, increasing the likelihood of maltreatment of offspring by over 2 times, or 103%. Marijuana use in young adulthood also emerged as strong predictor of MC, but not in the expected direction: higher levels of marijuana use were associated with a 56% decreased likelihood of MC. An older age at first birth significantly predicted a 52% decreased likelihood of maltreating offspring. Study limitations, future directions, and implications for interventions are discussed.

Objective: Posttraumatic Stress Disorder (PTSD) is highly prevalent in clinical and forensic mental health populations. Understanding the link between childhood maltreatment and the underlying mechanisms that can increase the vulnerability to developing and maintaining PTSD is imperative in clinical conceptualisations and intervention targets. A significant proportion of research is conducted with non mental health populations and there is a paucity of research with forensic populations. The first objective was to review the literature, in clinically related and forensic samples, investigating the association of emotion regulation with childhood maltreatment and Posttraumatic Stress (PTS) symptoms/PTSD. Emotion dysregulation and social problem solving deficits are commonly reported in the forensic population and have been associated with a number of psychopathologies. The empirical study examined the role of emotion regulation and social problem solving skills in the relationship between childhood maltreatment and adulthood trauma symptomatology in a male forensic population. Method: A systematic search of literature investigating the role of emotion regulation in relation to childhood maltreatment and/or PTS symptoms/PTSD was conducted using electronic databases; Medline, PsycINFO, Cinahl, Behavioural and Sciences Collection, EMBASE and PILOTS. Studies that met predetermined inclusion criteria were systematically reviewed. The empirical study employed a cross sectional design to examine the role of emotion regulation and social problem skills in the relationship between childhood maltreatment and adulthood trauma symptomatology. Fifty two male forensic mental health patients completed four self-report questionnaires; Childhood Trauma Questionnaire, Difficulties in Emotion Regulation Scale, Social Problem Solving Inventory-Revised: Short Form and the Post Traumatic Stress Disorder Checklist – Civilian Version. Results: The systematic review indicated strong evidence to suggest links between childhood maltreatment and emotion dysregulation, and emotion dysregulation and PTS symptoms/PTSD within clinically related and forensic samples. Preliminary evidence suggests a mediating role of emotion regulation in the relationship between childhood maltreatment and PTSD. The empirical study found that overall childhood maltreatment, childhood emotional abuse, sexual abuse and emotional neglect were associated with greater emotion dysregulation. Childhood sexual abuse, emotional neglect and physical neglect were associated with poorer social problem solving skills. With the exception of childhood physical abuse, all forms of childhood maltreatment, emotion dysregulation and poor social problem solving were correlated with greater trauma symptomatology. Mediation analysis indicated that both emotion dysregulation and poor social problem solving mediated the relationship between childhood emotional neglect and PTS symptoms in adulthood. Conclusions: The systematic review identified that further research is required within clinical populations to better understand the underlying causal pathways between childhood maltreatment and the development and maintenance of PTS symptoms/PTSD. The empirical study gives further insight into the forensic psychopathology and highlights the relevance of emotion regulation and social problem solving in the treatment of PTS symptoms.

abstract: There are a number of factors known to influence the occurrence of child maltreatment, including parental history of child maltreatment. Youth aging out of the foster care system have been shown to experience a number of challenges associated with the transition to adulthood, including early unintended pregnancy and parenting. However, despite the presumed risks associated with being in foster care and having a history of child maltreatment, very little research has been conducted to examine the parenting attitudes among youth aging out. This study explored the parenting attitudes and parental risk of child maltreatment among youth aging out of foster care in Arizona and examined the relationship between relational support and parenting. Foster youths' parenting attitudes and parental risk of child maltreatment across five constructs: parental expectations, parental empathic awareness of children's needs, beliefs regarding the use of corporal punishment, parent-child roles, and children's power and independence were assessed. Linear regression analyses were conducted to assess the relationship between youths' perceived social support from friends, family, and significant others and their parenting attitudes and youths' current living arrangements and their parenting attitudes. Findings indicate that youth had lower than the median normed sample scores on two out of the five parenting constructs, parental empathic awareness of children's needs and parent-child roles. Overall, 17% of youth in the sample were considered high risk of child maltreatment as parents, while 79% were considered medium risk. Perceived social support from friends was significantly associated with higher scores regarding youths' attitudes about the use of corporal punishment and children's power and independence. Youth living with foster parents had significantly higher scores than youth living on their own across three out of the five parenting attitude constructs. Youth living with relatives had higher scores than youth living on their own on the empathic awareness of children's needs parenting construct. Findings suggest that youth may rely on friends for social support and may develop more nurturing parenting attitudes if residing with foster parents or relatives. Implications for policy, intervention, and practice are discussed. &#8195; / Dissertation/Thesis / Ph.D. Social Work 2014

Childhood sexual abuse among males has been associated with many negative psychological outcomes. Studies have attempted to identify which sexual abuse characteristics (e.g., duration, age of onset) are associated with mental health difficulties. While informative, this research has been mostly limited to variable-centered analyses, which do not capture the heterogeneity in males’ abuse experiences and psychological presentations. This two-part dissertation advances our understanding of how best to measure childhood sexual abuse and how to account for the diversity of sexual abuse experiences and outcomes among men using a person-centered approach. Given that there are few validated measures of childhood sexual abuse, the first study examined the psychometric properties of a commonly-used measure in the sexual abuse literature, the Sexual Victimization Survey (SVS; Finkelhor, 1979). Once the validity and reliability of the SVS were established, the SVS was used to generate profiles on the basis of abuse characteristics (Study 2). Data for both studies were drawn from a sample of 302 males (85% Caucasian) aged 18 to 65 years seeking support for childhood sexual abuse. Participants completed a modified version of the SVS as well as the sexual abuse subscale of the Childhood Experiences of Violence Questionnaire-Short Form (CEVQ-SF; Tanaka et al., 2012). Twenty-one males completed the SVS again one week later for test-retest purposes. The SVS showed high inter-rater reliability on sexual abuse status and sexual abuse characteristics. Most males (85%) who endorsed sexual abuse on the SVS did so on the CEVQ-SF, resulting in fair concurrent validity. The SVS showed perfect one-week test-retest reliability on abuse status, as well as good to excellent agreement on sexual abuse characteristics between the initial and one week time points. Given the strong psychometric properties of the modified SVS, it was then used to generate childhood sexual abuse profiles in Study 2. Once participants with significant missing data were deleted, 215 men remained and were included in the generation of profiles. Latent profile analyses revealed three distinct profiles which varied in the severity of abuse experiences. The Severe profile (n = 56, 26%) depicted sexual abuse which began in mid-childhood and consisted of a one or two time fondling by an unfamiliar extrafamilial perpetrator. Men in the More Severe profile (n = 71, 33%) also experienced abuse in mid-childhood by an extrafamilial perpetrator, but experienced more severe sexual acts that spanned several months to several years. Men in this profile were emotionally closer to their perpetrators prior to abuse onset than males in the Severe profile. The Most Severe profile (n = 88, 41%) depicted abuse which began in early childhood and consisted of very severe sexual acts by trusted individuals both within and outside of the family. Men in the Most Severe were significantly more likely to concurrently have experienced child emotional and physical abuse as well as a greater number of non-victimization adversities, compared with men in the other two profiles. Profiles varied with respect to psychological outcomes. Males in the More Severe and Most Severe profiles reported significantly more internalizing problems than men in the Severe profile, and men in the Most Severe profile reported significantly more trauma symptoms than men in the Severe profile. Certain contextual variables were also associated with greater psychological difficulties, namely greater present-day use of avoidant coping predicted more internalizing and externalizing problems, as well as greater trauma symptoms. Worse childhood family functioning was associated with more internalizing and externalizing problems, and disclosure of the abuse (compared to non-disclosure) was associated with more externalizing problems and trauma symptoms. These results have several research and clinical implications, including tailoring assessment and treatment to meet the individual needs of male survivors.

In 2014, the Child Protective Services received 3.6 million referrals alleging child abuse and neglect, of which, 702,000 children were victims of abuse and neglect and an estimated 1,580 children died due to maltreatment. In addition to this appalling toll, the welfare effects of child victimization are substantial. Evidence suggests that compared to demographically similar adults who were non-victims, adults with documented histories of maltreatment are more likely to engage in criminal behavior; have adverse mental and physical health problems such as depression, addiction and post-traumatic stress disorder; and have lower levels of education and earnings. These essays contribute toward the understanding of the consequences of two very distinctive policies – mandatory arrest and medical marijuana laws – and their impact on child maltreatment. An important and controversial question in criminal justice policy concerns whether aggressive sanctions, such as mandatory arrest policies, serve as effective deterrents to familial violence. Chapter 1 provides a theoretical framework that models child abuse in which I allow for a strategic interaction between the child and his or her abuser. The comparative statics yield clear predictions of the impact of sanctions on child maltreatment – as the cost and probability of external interventions rise, the probability of violence falls. I follow this theoretical analysis with an empirical investigation of the impact of mandatory arrest policies on child victimization. I find a statistically significant and positive relationship between states that have implemented mandatory arrest laws and reported child maltreatment rates. This may seem surprising; however there are two explanations for the results. The likely explanation is that reporting of maltreatment increased in states mandating arrest; alternatively, recidivism may have increased in these states. Evidence from the OLS estimates for the reporting of abuse and child fatality rates (a proxy for the true incidence of child abuse), demonstrates that the increase in maltreatment is not due to recidivism but, in fact, more people reporting abuse to the police and Child Protective Services. The most important result that emerges from the data, however, is that while reported abuse increases in states with mandatory arrest laws, the true incidence of maltreatment actually falls. The ultimate goal of this paper is to stimulate further theoretical and empirical research that focuses on child abuse and prevention, thus enhancing an understanding of how sanctions influence child victimization. The next chapter looks at one potential risk factor for child maltreatment –marijuana use and liberalization –using evidence from medical marijuana laws (MMLs). Chapter 2 begins by extending the current MML-crime literature by providing a comprehensive evaluation of the impact of MMLs implemented at the state level on reported child victimization rates. I show that specific modes of medical marijuana regulation differentially influence the magnitude of reported incidences of child abuse, a finding which sheds new light on the current literature. More specifically, using fixed effects analysis applied to data from the National Child Abuse and Neglect Database System (NCANDS) and the Uniform Crime Reports (UCR), I show that states that allow for home cultivation in addition to decriminalizing its use see a further increase in the magnitude of reported incidences of child maltreatment rates. Since completing my dissertation, I have continued to investigate into issues that have implications for both theory and practice in my field. To that extent, I plan to analyze the slowly developing public sphere –a platform where culture and social change rely on both media and conversation.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20053号 / 医博第4161号 / 新制||医||1018(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 佐藤 俊哉, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM