Growing up in a family environment that includes child maltreatment can result in an array of negative consequences for children, including health, behavioral, developmental, and social difficulties, and these consequences can persist over the lifetime. Families who have come to the attention of child welfare services for child maltreatment are at particularly high risk for experiencing multiple concurrent problems, including intimate partner violence, substance abuse, and mental health issues, as well as other family challenges. It is essential to intervene effectively with this population. However, there are few qualitative studies of parent experiences in the child welfare system through which to better understand parents' perspectives and identify additional or more effective points of intervention. This exploratory study utilized a mixed-methods design, primarily focusing on in-depth qualitative interviews with parents in the child welfare system, to explore participants' lived experiences within the continuum of child welfare services. Participants in this study experienced a range of interconnected stressors that impacted both their ability to effectively parent their children as well as successfully complete the services required of them by the child welfare system. Qualitative interviews revealed that parents experienced an overall lack of empowerment, effective communication, and support through their experience with the child welfare system, until they accessed the therapeutic services they were required to attend near the end of their time in the system. Parents were more responsive when services were more supportive, rather than punitive, and individualized to their needs and strengths. This study suggests that systematically implementing more individualized, family-centered services throughout the continuum of services provided by the child welfare system would be effective in intervening with families. Findings also indicate the need for continued qualitative research with parents to address both areas of intervention for families who have already maltreated their children and the prevention of maltreatment and other related stressors in families who are at risk.

Emotional invalidation is a construct closely related to childhood maltreatment, which has been linked theoretically and empirically to the development of psychopathology. This study sought to advance the empirical investigation into emotional invalidation through three primary objectives: 1) to critically review the way emotional invalidation is currently defined and measured in the existing literature, 2) to offer a novel approach at conceptualizing and measuring emotional invalidation as a two part construct comprised of emotionally invalidating behaviors and perceived emotional invalidation, and 3) to experimentally test the effects of invalidating behaviors on a person's perception of emotional invalidation and their level of emotional distress. Results suggest that the invalidation paradigm created for this study did lead participants in this condition to report higher levels of perceived emotional invalidation compared to participants in the neutral condition; however, they did not report higher levels of emotional distress. Potential moderation was examined for participants' levels of borderline personality features and childhood maltreatment based on the theoretical relationships among emotional invalidation and these constructs. Unexpectedly, participants' borderline personality features and childhood maltreatment histories did not individually contribute unique variance in the prediction of emotional distress, but together did predict higher levels of emotional distress. In regards to the perception of emotional invalidation, neither borderline personality features or childhood maltreatment were found to be significant predictors. The need exists for continued research in this area as many questions remain unanswered, and the implications for determining what makes some types of emotional invalidation harmful are significant.

Child maltreatment in the pediatric population is becoming more prevalent in today’s society and is being seen more frequently in the primary care setting. Universal prevention of child maltreatment plays a significant role in nursing practice. The American Academy of Pediatrics set forth guidance for pediatricians to practice when assessing a pediatric patient for maltreatment; however, such guidance is not available for advanced practice nurses and little to no training is provided in the clinical setting. In order to accurately identify the child who is a suspected victim of maltreatment, advanced practice nurses must possess the ability to assess, evaluate, refer, investigate, and provide appropriate outcomes for the child and his/her families. The purpose of this Doctor of Nursing (DNP) project was to create an on-line learning tutorial for advanced practice nurses regarding the prevention of child maltreatment in the clinical setting. The goal of the on-line learning tutorial was to address the crucial role advanced practice nurses have in the prevention of child maltreatment and promote the well-being and safety of children. This project used a quasi-experimental, one-group, pre-test/post-test design to determine the effectiveness of an on-line learning tutorial related to child maltreatment. The pre-test and post-test would determine the inferences on the effect of the intervention by examining the differences in the pre- and post-test results. This study provided significant evidence demonstrating that an on-line learning tutorial on the implementation of child maltreatment prevention in the clinical setting was an effective means for increasing knowledge of nurse practitioner graduate students on child maltreatment. The results demonstrated a significant increase in the test scores of the participants after viewing the on-line learning tutorial, indicating the tutorial was effective.

Syftet med denna kvalitativa studie har varit att undersöka förskollärares definition av omsorgssvikt, samt om emotioner påverkar att förskollärare gör en anmälan till socialtjänsten gällande omsorgssvikt. Empirin samlades in med kvalitativa intervjuer av fyra förskollärare, som hade erfarenhet av anmälan till socialtjänsten. Intervjuerna analyserades med hjälp av teori om omsorgssvikt, emotioner samt interaktionsritualer. Studien ger inblick och förståelse för förskolepersonalens kunskap och erfarenheter av omsorgssvikt samt om hur emotioner formar relationer mellan de inblandade och kan påverka en anmälan. Resultatet visade att förskollärarnas definition av omsorgssvikt inte består av ett visst antal tecken, utan att de bildar sig en helhetsuppfattning av barnets situation. Studien visar att emotioner kan påverka att en anmälan görs, både genom att förskollärarna tvekar och därmed förlänger processen, men också genom att en anmälan överhuvudtaget inte alls upprättas. / The aim of this qualitative study was to study pre-school teachers´ definition of child maltreatment, and the impact of emotions in reporting child maltreatment to the Social Services. The empirical data was collected through qualitative in-depth interviews of four pre-school teachers, who were all experienced in reporting child maltreatment to the Social Services. The interviews were analyzed using emotion theory, theory on child maltreatment and interaction ritual theory. The study provides insight and understanding of their knowledge and experience of child maltreatment, how emotions shape the relationship between the people involved as well as how emotions affect reporting. The result shows that preschool teachers´ definition of child maltreatment is not composed of one or two signs of neglect, but by forming an overall picture of the child's situation. The study also shows that emotions can affect the reporting of child maltreatment both in the sense of actually reporting, as well as hesitating and therefore prolonging the process, but also possibly that the neglect is not reported at all.

This capstone project was conducted to evaluate trainer trainee satisfaction and acceptability from social validation questionnaires for SafeCare provider training s conducted by the National SafeCare Training and Research Center. Data were collected from 82 training participants from 2007 to 2009. SafeCare is an evidence-based parenting skills program created for at-risk and maltreating parents. The National SafeCare Training and Research Center utilizes a trainer-training model to teach professionals at the community-level. Trainees are instructed in four SafeCare modules: health, home safety, parent-child and parent-infant interactions. Social validation questionnaires are administered to evaluate process and procedures, outcome measures, staff performance, and training methods. Overall, SafeCare provider training was reported as valuable across all three social validation questionnaires. Trainees also reported a strong agreement for utilizing the skills learned during training in their future field work. Training staff performance received high satisfaction ratings as well.

Inappropriate parental expectations of age-appropriate behaviors and unawareness of developmental milestones can increase instances of child maltreatment. Additionally, experiences of child maltreatment can have a negative impact on the developmental trajectory of a child. The present research describes a parental aide, the tDevelop, delivered to parents at risk for child maltreatment through SafeCare Parent-Child Interaction (PCI) training with the aim of increasing identification of developmental milestones and age-appropriate activities. Two high-risk families with children close to 24-months of age were recruited from a residential program for young mothers working to develop self-sufficiency skills. The families were presented with the tDevelop along with traditional PCI information, including Planned Activities Training and age-appropriate activities. Data from a multiple-probe, single-case experimental design, suggest that mothers are able to recognize developmental milestones with increased accuracy upon intervention with the tDevelop. These findings suggest that the enhanced PCI protocol may enhance parental identification of developmental milestones.

Objectives: Concerns have been raised that child welfare systems may inappropriately target poor families for intrusive interventions. The term “neglect” has been critiqued as a class-based label applied disproportionately to poor families. The objectives of the study are: to identify the nature and frequency of clinical and poverty-related concerns in child neglect investigations and to assess the service referral response to these needs; to examine the contribution of poverty-related need to case decision-making; and to explore whether substantiated cases of neglect can be divided into subtypes based on different constellations of clinical and poverty-related needs. Methods: This study is a secondary analysis of data collected through the 2008 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS‑2008), a nationally representative dataset. A selected subsample of neglect investigations from the CIS‑2008 (N = 4,489) is examined through descriptive analyses, logistic regression, and two-step cluster analysis in order to explore each research objective. Results: Children and caregivers investigated for neglect presented with a range of clinical and poverty-related difficulties. Contrary to some previous research, the existence of poverty-related needs did not influence case dispositions after controlling for other relevant risk factors. However, some variables that should be, in theory, extraneous to case decision-making emerged as significant in the multivariate models, most notably Aboriginal status, with Aboriginal children having increased odds of substantiation, ongoing service provision and placement. Cluster analyses revealed that cases of neglect could be partitioned into three clusters, with no cluster emerging characterized by poverty alone. Conclusions: The majority of children investigated for neglect live in families experiencing poverty-related needs, and with caregivers struggling with clinical difficulties. While poverty-related need on its own does not explain the high proportion of poor families reported to the child welfare system, nor does it account for significant variance in case decision making, cluster analysis suggests that there exists a subgroup of “neglected” children living in families perhaps best characterized by the broader notion of social disadvantage. These families may be better served through an orientation of family support/family welfare rather than through the current residual child protection paradigm.

This mixed-methods dissertation considers the experiences of women who used substances during pregnancy. Retrospective interviews with 15 women, currently accessing inpatient substance abuse treatment, identify trends in women’s experiences prior to accessing these services. Women report being concerned about the impact of their substance use on the developing baby, seeking information, reducing substance use outside of accessing treatment services, and engaging in healthy behaviors to protect the baby from harm. Trends related to trying to reduce harm to the baby during pregnancy are then further explored through quantitative analyses. Data on harm reduction behaviors prior to accessing treatment were collected from an additional 54 women. A clinical and research tool for visually tracking patterns of maternal substance use over the course of pregnancy was developed. This tool identifies the high prevalence of women who decrease their substance use during pregnancy outside of accessing treatment services. Clinical use of this tool is considered. In addition, a questionnaire, designed to identify engagement in harm reduction and health promoting behaviors, was administered. Data suggests that harm reduction and health promotion behaviors are common and tend to begin early on in pregnancy. Women report beginning to decrease their substance use, on average, beginning at the end of the first trimester. The timing of beginning to reduce substance use is not associated with the timing of entering substance abuse treatment in relation to a given pregnancy. However, maternal mental health and perceived barriers to accessing services do predict when, in relation to pregnancy, women enter treatment. As a whole, this research suggests that continued use of substances during pregnancy is not due to indifference towards the developing baby. Instead, women report being concerned about their babies and being engaged in the process of positive self-change. There are public health and clinical implications to these findings. This research suggests the opportunity to build upon the motivation that women have to decrease their substance use. In addition, this research suggests the importance of focusing policy and intervention efforts on addressing perceived barriers to accessing treatment services.

The present study aims to integrate resilience concepts within the context of a theoretical model for child maltreatment, the ecological model, as well as to describe risks and protective factors leading to a better interaction as a dynamic process. Thinking deeply about maltreatment from the point of view of resilience implies focusing on the serious consequences it produces, as well as on the assessment of children’s resources to continue growing and developing despite the risks. We may promote children’s potential by understanding resilience within a child maltreatment framework based on this model (interactional, bidirectional and reciprocal). / El presente trabajo integra conceptos vinculados a la resiliencia en el ámbito del maltrato infantil desde el modelo ecológico, haciendo énfasis en la descripción de factores de riesgo y protectores, a fin de acercarnos a la comprensión de sus modalidades de interacción como proceso dinámico. Esto implica enfocarse, no solo en las graves consecuencias que el maltrato produce, sino también en el estudio de los recursos infantiles que permiten a los niños continuar con su desarrollo a pesar del riesgo. Se considera que la comprensión de la resiliencia en el ámbito del maltrato infantil desde este modelo interaccional, bidireccional y reciproco puede acercarnos a pensar mejores modos de promover potencialidades en la infancia.

Background Child maltreatment has increased over the past years. There is no direct relation-ship between child maltreatment and the actual living condition of the children. All children should be protected against all types of physical, mental and sexual abuse. It is of great im-portance that nurses have knowledge of how to report when they suspected child maltreatment. Aim The aim was to describe nurses´ experiences of reporting when child maltreatment is sus-pected. Methods A method to contribute to evidence-based nursing with ground in analysis of qualita-tive research was performed. In this study nine qualitative articles were analyzed. Results From the analysis three main themes were identified; a difficult task, need of support and create a holistic view of children. Seven subthemes were identified; manage their own lack of knowledge, uncertainty and fear, trust their judgment and courage to act,protection of children's safety and well-being, support from colleagues and management, interact with child protection services, strengthen trust with related parents of the child and environment affecting children.Conclusion Conclusions that can be deduced from this study are to highlight the need for support and knowledge of how a report is conducted. Consequences to not report child maltreat-ment is described in this study as well as which benefits a report of child maltreatment may give for both children and close relatives.