Randomized Control Trial of a School-Based Curriculum that Teaches About Multiple Forms of Abuse.

Most school-based prevention curricula for young children fail to address multiple types of abuse and limit instruction to a single day, despite evidence that polyvictimization is common and children learn better when allowed to practice material repeatedly. This study utilized a cluster randomized control trial design to evaluate a multi-abuse prevention program, the Monique Burr Foundation for Children (MBF) Child Safety Matters®, based on varying lesson structure. Participants included nine Florida schools consisting of 843 children in grades K-2. Schools were randomized within cluster to implement in two lessons, four lessons, or after study data collection (i.e., control group). Lessons averaged 34 minutes (SD = 8.8 minutes) in length for 2-lesson group and 23.6 minutes (SD = 6.9 minutes) for the 4-lesson condition. Knowledge was assessed before implementation and on average 11 weeks after implementation. There were no statistical differences between clusters. Controlling for pre-test scores, schools in the four-lesson group scored highest on a measure of knowledge of potentially risky and unsafe situations (M = 69.68, SE = .80) on post-test, followed by schools in the two-lesson group (M = 67.31, SE = .77), followed by schools in the control group (M = 62.92, SE = .76). Results support use of more frequent, shorter lessons for prevention programs and the promise of addressing multiple forms of child victimization.

School-based prevention education for children and youth with intellectual developmental disabilities.

Children with intellectual developmental disabilities (IDD) are at a heightened risk of experiencing child maltreatment (CM) when compared to their peers without IDD. Despite expanding evidence supporting the efficacy of school-based CM prevention programs, there are limited programs that tailor their lessons to the unique needs of children with IDD. This discussion first presents information regarding the prevalence and risk factors of CM among children with IDD. We then present existing peer-reviewed CM programs that have been developed for children with IDD. Finally, based on the latest research of CM prevention and special education, we present our considerations for a comprehensive school-based CM prevention program for children with IDD. Prevention programs for children with IDD may increase risk awareness among children with IDD and their parents, equip children with IDD with the protective skills necessary to navigate unsafe situations, and decrease the overall incidence of CM against this population.

Parents' and professionals' perspectives on school-based maltreatment prevention education for children with intellectual and developmental disabilities.

BACKGROUND: Youth with intellectual and developmental disabilities (IDD) are at a significantly increased risk of experiencing maltreatment and abuse. Child maltreatment prevention education programs are effective at improving safety of children and youth, generally. OBJECTIVE: The goal of this study was to understand challenges, benefits, and important considerations of developing an IDD-tailored prevention program. PARTICIPANTS AND SETTING: In total, we recruited 21 professionals and parents who have experience with a child with IDD from New York, Indiana, and Florida. METHODS: Participants were segmented into three focus groups, which were conducted through web-based videoconferencing. Focus groups were moderated by experts in child maltreatment prevention and recorded for data collection. Recordings were transcribed and subsequently coded using a qualitative content analysis approach. RESULTS: The analysis identified several challenges to implementing child maltreatment prevention to students with IDD and pedagogical strategies to overcome those, such as the use of visuals, standardized vocabulary, and relatable examples. Benefits of a prevention program were also mentioned, including feelings of empowerment that can be cultivated by providing opportunities where children with IDD practice being assertive. Considerations for program developers and staff were discussed to ensure that prevention programs are easily adaptable to suit the needs of students with IDD across the continuum. CONCLUSIONS: Previous research has indicated an unmet need for child maltreatment programs among children with IDD. Implementation of an IDD-tailored program must be preceded by gaining invaluable insight from professionals and parents. Findings provide insight into implementation challenges and methods to inform prevention programs.

Child abuse prevention education policies increase reports of child sexual abuse.

BACKGROUND: It is well supported that engaging in prevention education increases a child's awareness of child sexual abuse. However, due to methodological limitations, prior research has yet to determine whether this knowledge leads to increases in reporting or substantiation of child sexual abuse. OBJECTIVE: We examined whether state mandates for school-based prevention education correlate to changes in reports of child sexual abuse. METHODS: We used a quasi-experimental design to investigate the association between child sexual abuse report rates from 2005 to 2019 and presence of state legislation mandating school-based child sexual abuse prevention curricula. Child sexual abuse report data were obtained from the National Child Abuse and Neglect Data System child files. We focused on reports for school-aged children ages 5-17. Data on state laws on prevention curricula were extracted from enoughabuse.org, Prevent Child Abuse America, ErinsLaw.org, and directly from published legislation. RESULTS: State education mandates were associated with an increase in the incidence of child sexual abuse reports made by education personnel (IRR = 1.22, 95 % CI, 1.01-1.48). Policies were not associated with increases in incidence of child sexual abuse reports made by non-education personnel (IRR = 1.08, 95 % CI, 0.95-1.22) or decreases in likelihood that any given report was confirmed (OR = 1.00; 95 % CI, 0.90-1.12). CONCLUSIONS: There is moderate evidence that adopting state mandates for child sexual abuse prevention education may increase disclosures and reporting of child sexual abuse by school-based sources. There is no evidence that mandates decrease the validity of child sexual abuse reporting by school-based sources.

Moving school-based CSA prevention education online: Advantages and challenges of the "new normal".

One of the many outcomes of the COVID-19 pandemic was a shift in the delivery of elementary (primary) education. Schools transitioned swiftly to e-learning and prioritized education that was already or could be easily adapted to virtual formats. Given the paucity of online content available, it is not likely that child sexual abuse (CSA) prevention education was prioritized. Given that CSA prevention education has demonstrated success in increasing knowledge, protective behaviors, and disclosures, and the potential long-term need for e-learning options, there is a demand for an exploration of how CSA prevention can be implemented using e-learning strategies. In the current discussion, we explore how school-based CSA prevention education could be implemented in a "new normal" context of e-learning. We first present the existing e-learning content for CSA prevention education. We then describe how best practices for prevention education can be applied to e-learning. Finally, we present considerations for the use of e-learning specifically for CSA prevention education. In short, implementing CSA prevention programs through e-learning offers many affordances for program accessibility and reach, flexibility in implementation and opportunities for greater exposure to content, and a wide range of ways to demonstrate effective skills and engage children in cycles of practice and feedback. E-learning, may also, however, limit important conversations between children and trained instructors that lead to disclosures. The extant literature leaves us unsure as to whether implementing CSA prevention programs through e-learning will result in better or worse outcomes for children. However, given the increasing demand for e-learning options, and the promise of some new e-learning programs, further research on the effectiveness of e-learning CSA prevention programs is warranted.

Streamlining Universal Prenatal Screening for Risk for Adverse Birth Outcomes.

OBJECTIVE: Many of the medical risk factors for adverse birth outcomes (e.g., preeclampsia) are regularly monitored in prenatal care. However, many of the psychosocial risk factors associated with adverse birth outcomes (e.g., maternal stress, anxiety, depression, intimate partner violence) are not regularly addressed during routine prenatal care. Comprehensive prenatal screening for psychosocial risk factors for adverse birth outcomes can improve maternal and neonatal outcomes. In this study, we examine an existing tool for opportunities to streamline and improve screening. METHODS: We reviewed medical records for 528 mother-infant dyads, recording maternal responses to a 21-item prenatal risk screening tool, and gestational age/birth weight of infants. Multiple approaches to scoring were used to predict likelihood of adverse birth outcome. RESULTS: Women who answered yes to any of the top four interrelated items were 3.32 times more likely to have an adverse birth outcome. Sensitivity and specificity were 68% and 65%, respectively. CONCLUSION FOR PRACTICE: We identified a short surveillance tool to identify women who are at highest risk and require more in-depth screening, and to rule out women who are at very low risk of an adverse birth outcome.

Child Safety Matters: Randomized Control Trial of a School-Based, Child Victimization Prevention Curriculum.

Recognizing the potential of classrooms as a context for identifying and addressing child victimization, several U.S. states now mandate the inclusion of child abuse prevention in school curricula. There are, however, a limited number of evidence-based and developmentally appropriate curricula designed for elementary. This study utilized a randomized control trial (RCT) design to evaluate the knowledge acquisition of children who received the Monique Burr Foundation's Child Safety Matters curriculum, a program designed to educate kindergarten to Grade 5 children about bullying, cyberbullying, four types of abuse (physical, sexual, emotional, and neglect), and digital dangers. Participants included 1,176 students from 72 classrooms in 12 Florida schools across eight counties. Schools were matched in pairs and randomly assigned to receive the program or be in a wait-list control. Knowledge was assessed with a questionnaire administered prior to the curriculum (T1) as well as approximately 3 weeks (T2) and approximately 7 months (T3) after implementation. Analyses were conducted with class means examining grade, treatment condition, and time. The interaction of treatment and time was significant, F(2, 90) = 17.024, p < .000. Children who received the curriculum increased their knowledge about potentially risky situations, and this knowledge was sustained over 7 months to the follow-up assessment. Children in the control schools did not have similar gains. The current classroom-based child maltreatment prevention education is a promising strategy to address children's vulnerability to abuse and its consequences.

Preventing Traumatic Causes of Maternal Death.

Despite medical advances, maternal deaths in the U.S. are more common than in nearly all other developed nations. In addition, racial disparities have continued to widen. Driving our rates are maternal deaths from trauma such as homicide, suicide, and drug overdose. Here we discuss limitations of existing practices in prenatal and postpartum care in preventing maternal deaths. We then outline three simple yet novel strategies for changing care to prevent traumatic cases of maternal mortality.

Adverse Childhood Experiences Are Associated with Cardiometabolic Risk among Hispanic American Adolescents.

OBJECTIVE: To assess the relationship between adverse childhood experiences (ACEs) and cardiometabolic risk among Hispanic adolescents. STUDY DESIGN: This cross-sectional study was conducted at an academic research center in Gainesville, Florida. Participants were locally recruited, and data were collected from June 2016 to July 2018. Participants (n = 133, 60.2% female) were healthy adolescents aged 15-21 years who self-identified as Hispanic, were born in the US, and had a body mass index (BMI) between ≥18.5 and ≤40 kg/m2. Primary outcomes were BMI, body fat percentage, waist circumference, and resting blood pressure. Associations between ACEs and cardiometabolic measures were assessed by multivariable logistic regression models, which controlled for sex, age, parental education, and food insecurity. Results were sex-stratified to assess potential variations. RESULTS: Reporting ≥4 ACEs (28.6%) was significantly associated with a greater BMI (P = .004), body fat percentage (P = .02), and diastolic blood pressure (P = .05) compared with reporting <4 ACEs. Female participants reporting ≥4 ACEs were significantly more likely to have a greater BMI (P = .04) and body fat percentage (P = .03) whereas male participants reporting ≥4 ACEs were significantly more likely to have a greater BMI (P = .04), systolic blood pressure (P = .03), and diastolic blood pressure (P = .03). CONCLUSIONS: Hispanic adolescent participants who experienced ≥4 ACEs were more likely to have elevated risk markers of obesity and cardiometabolic disease. Further research is needed to elucidate the physiological mechanisms driving these relationships.

Increased Tdap and Influenza Vaccination Acquisition Among Patients Participating in Group Prenatal Care.

CenteringPregnancy, an alternative to traditional prenatal care, offers additional time between clinicians and patients with the goal of increasing knowledge, understanding, and autonomy in pregnant participants. We investigated whether these women would be more likely to receive recommended Tdap and influenza vaccinations relative to others who received one-on-one traditional prenatal care. Our study employed a retrospective chart review of all women who participated in CenteringPregnancy group care compared to a group of matched women who received only traditional prenatal care at a large, quaternary care referral academic center. We extracted demographic and clinical characteristics from charts that included maternal age during pregnancy care and parity. Outcome variables of interest were influenza and Tdap vaccination status. Compared with traditional obstetrical care patients, women who participated in CenteringPregnancy were 1.7-2.7 times more likely to obtain the Tdap and influenza vaccines. These findings may be attributable to the increased opportunity for patient education and social support offered by the CenteringPregnancy model.

Variation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type - Florida, 2016-2018.

Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.

Improving Developmental Screening, Discussion, and Referral in Pediatric Practice.

Objective. Although pediatricians' use of standardized screening tools for identifying developmental delays has increased, only 63% of pediatricians report performing standardized screening as recommended. The purpose of the current quality improvement project was to improve developmental monitoring, screening, and referral for developmental concerns by pediatricians. Method. Twenty-eight pediatricians completed an in-person meeting, monthly webinars, and individualized feedback from an Expert Work Group on progress across a 3-month action period. Results. Statistically significant increases were observed in rates of autism screening, discussions of screening results with families, and referral following abnormal results. There was no statistically significant change in rates of general developmental screening. Comparing self-report with record review, pediatricians overestimated the extent to which they conducted discussion and referral. Conclusions. Universal screening for all children has yet to be achieved. The current project supports that practice-based improvements can be made and delineates some of the routes to success.

The relationship between foster care entries and high-dose opioid prescribing in California.

An important effect of the current opioid epidemic is on children whose parents are unable to provide appropriate care. We employ quarterly, county-level data for California for 2009-2016 to study the relationship between foster care entries and opioid misuse by their parents. Our linear regression analysis includes both county and time fixed effects and controls related to child removal risk. We improve on the limited existing research in the area by analyzing higher frequency data, examining a proximal measure of opioid abuse, and allowing for differential associations by urbanicity. We found a positive association between the rate of child removals and the rate of residents who were cumulatively prescribed a high dose of opioids (>90 morphine milligram equivalents (MMEs) per day) during the quarter. A one standard deviation in this rate is associated with a roughly 9% increase in the overall removal rate. We further found that the association between removals and high MMEs is especially pronounced in rural areas and largely not existent in urban areas. Our results provide a more precise estimate of the relationship between the potential for opioid misuse and child welfare.

Association of Friday School Report Card Release With Saturday Incidence Rates of Agency-Verified Physical Child Abuse.

Importance: Corporal punishment is a leading risk factor for physical abuse. Strong anecdotal evidence from physicians and other professionals working in child protection suggest that punishment-initiated physical abuse for school-aged children increases after release of report cards. However, no empirical examination of this association has occurred. Objective: To examine the temporal association between school report card release and incidence rates (IRs) of physical abuse. Design, Setting, and Participants: This retrospective study reviewed calls to a state child abuse hotline and school report card release dates across a single academic year in Florida. Data were collected in a 265-day window from September 8, 2015, to May 30, 2016, in the 64 of 67 Florida counties with report card release dates available (16 960 days). Participants included all children aged 5 to 11 years for whom calls were made. A total of 1943 verified cases of physical abuse were reported in the study period in the 64 counties. Data were analyzed from October 2017 through May 2018. Exposures: School report cards release across a single academic year, measured daily by county. Main Outcomes and Measures: Daily counts of calls to a child abuse hotline that later resulted in agency-verified incidents of child physical abuse across a single academic year by county. Results: During the academic year, 167 906 calls came in to the child abuse hotline for children aged 5 to 11 years; 17.8% (n = 29 887) of these calls were suspected incidents of physical abuse, and 2017 (6.7%) of these suspected incidents were later verified as cases of physical abuse before excluding the 3 counties with no release dates available. Among the 1943 cases included in the analysis (58.9% males [n = 1145]; mean [SD] age, 7.69 [1.92] years), calls resulting in verified reports of child physical abuse occurred at a higher rate on Saturdays after a Friday report card release compared with Saturdays that do not follow a Friday report card release (IR ratio, 3.75; 95% CI, 1.21-11.63; P = .02). No significant association of report card release with IRs was found for any other days of the week. Conclusion and Relevance: This association of school report card release and physical abuse appears to illustrate a unique systems-based opportunity for prevention.

Animal cruelty as an indicator of family trauma: Using adverse childhood experiences to look beyond child abuse and domestic violence.

Youth who engage in animal cruelty are known to be at increased risk of perpetrating violence on other people in their lives including peers, loved ones, and elder family members. These youths have often been exposed to family violence, including animal cruelty perpetrated on their beloved pets by violent adults. The current study utilizes a data set of 81,000 juvenile offenders whose adverse childhood experiences are known and includes 466 youth who self-report engaging in animal cruelty. Compared to the larger group of juvenile offenders, the children admitting to engaging in animal cruelty are younger at time of first arrest, more likely to be male, and more likely to be White. When looking at their reports of adverse childhood experiences (ACEs), they are more likely than other juvenile offenders to have an array of adverse experiences beyond family violence and to have four or more ACEs. Although the youth who are cruel to animals are already troubled, the fact that they present to law enforcement at early ages provides early opportunities for intervention. Service providers outside the law enforcement field, such as teachers, physicians, veterinarians and animal control officers may be able to identify these vulnerable youth, and refer them to needed services before violence is visited on other humans.

Association of Adverse Childhood Experiences with Co-occurring Health Conditions in Early Childhood.

OBJECTIVE: To understand how adverse childhood experiences (ACEs) are associated with co-occurring physical, mental and developmental problems during early childhood. METHOD: A subsample of 19,957 children aged 2-5 years were selected from the 2011-2012 National Survey for Child Health. Outcomes included 18 health conditions organized in singular condition domains (physical, mental, and developmental), and combinations of condition domains (e.g., physical plus mental, mental plus developmental, etc.). Predictors included 8 ACEs (divorce of a parent, death of a parent, exposure to domestic violence, living with someone with a drug or alcohol abuse problem, household member with a mental illness, parent incarceration, neighborhood violence, discrimination). Multivariable logistic regression was performed controlling for demographic characteristics, having a personal doctor, health insurance coverage, and seeing a health care professional in the previous year. RESULTS: Experiencing 3 or more ACEs before the age of 5 years was associated with increased likelihood of nearly every co-occurring condition combination across 3 domains of health. Most notably, experiencing 3 or more ACEs was also associated with a 2-fold increase in likelihood of having ≥1 physical condition and ≥1 developmental condition, a 9-fold increase in likelihood of having ≥1 mental and ≥1 developmental condition, and a 7-fold increase in likelihood of having ≥1 physical, ≥1 mental, and ≥1 developmental condition. CONCLUSION: This study demonstrates that we can identify the health effects of adversity quite early in development and that management should include communication between both health care and early childhood education providers.

Visits to Primary Care and Emergency Department Reliance for Foster Youth: Impact of Medicaid Managed Care.

OBJECTIVE: To examine the rate of access to primary and preventive care and emergency department (ED) reliance for foster youth as well as the impact of a transition from fee-for-service (FFS) Medicaid to managed care (MC) on this access. METHODS: Secondary administrative data were obtained from Medicaid programs in one state that transitioned foster youth from an FFS to an MC (Texas) and another state, comparable in population size and racial/ethnic diversity, which continuously enrolled foster youth in an FFS system (Florida). Eligible participants were foster youth (aged 0-18 years) enrolled in these states between 2006 and 2010 (n = 126,714). A Puhani approach to difference-in-difference was used to identify the effect of transition after adjusting for race/ethnicity, gender, and health status. Data were used to calculate access to primary and preventive care as well as ED reliance. ED reliance was operationalized as the number of ED visits relative to the number of total ambulatory visits; high ED reliance was defined as ≥33%. RESULTS: The transition to MC was associated with a 6% to 13% increase in access to primary care. Preventive care visits were 10% to 13% higher among foster youth in MC compared to those in FFS. ED reliance declined for the intervention group but to a lesser extent than did the control group, yielding a positive mean percentage change. CONCLUSIONS: Foster youth access to care may benefit from a Medicaid MC delivery system, particularly as the plans used are designed with the unique needs of this vulnerable population.

Youth Arrested for Trading Sex Have the Highest Rates of Childhood Adversity: A Statewide Study of Juvenile Offenders.

A history of childhood adversity is associated with high-risk behaviors and criminal activity in both adolescents and adults. Furthermore, individuals with histories of child maltreatment are at higher risk for engaging in risky sexual behavior, experiencing re-victimization, and in some cases, becoming sexual offenders. The purpose of the current study was to examine the prevalence of individual and cumulative adverse childhood experiences (ACEs) reported by 102 offending youth who were arrested for trading sex and 64,227 offending youth who were arrested for various other crimes, using Florida's Positive Achievement Change Tool. Youth with violations related to sex trafficking had higher rates for each ACE as well as number of ACEs, particularly sexual abuse and physical neglect. These findings have implications for identifying adverse experiences in both maltreated and offending youth as well as tailoring services to prevent re-victimization.