Prevention of child sexual abuse in the United States: Scoping review of United States legislative policies.

BACKGROUND: States in the United States (US) have passed and enacted legislation for the purpose of preventing child sexual abuse (CSA) since 2000, but it is unknown whether these legislative policies reduce adult-perpetrated CSA. OBJECTIVE: Review the literature from 2000 to 2023 to understand which US CSA prevention policies have been evaluated, the effectiveness of these policies, study populations, and barriers and facilitators associated with the implementation of CSA prevention policies. METHODS: The study protocol was published prior to undertaking the review: PMC10603531. The review follows Joanna Briggs Institute methodology and is reported according to the PRISMA-ScR Checklist. We searched 27 databases, hand searched reference lists of included studies, and sent notice via listserv to other researchers in the field. Articles were included if the content focused on CSA prevention policies and the effects. No limits to methodology were applied. Methodological rigor was assessed. RESULTS: 2209 potentially relevant articles were identified; 20 articles advanced to full-text review, three satisfied the inclusion criteria. Three eligible studies focused on CSA prevention education policies, while the other focused on mandated reporting policies. Effects of these policies were mixed in relation to CSA reporting and substantiation rates. No study considered child demographics. CONCLUSIONS: Despite decades of legislative action for CSA prevention across the US, only a few studies have assessed the effects of these policies. These findings highlight the need for additional research to ensure that CSA prevention policies such as CSA prevention education in schools and mandated reporting practices are working as intended.

Child Sexual Abuse in the United States: A Commentary on Current Policy Approaches to Prevention and Aspirations for the Future.

Child sexual abuse (CSA) is a significant threat to the health and well-being of children in the United States (US). Public policies are a key public health strategy for the primary prevention of violence, including CSA. In 2021, the Enough Abuse Campaign and Prevent Child Abuse America published a comprehensive report entitled A Call to Action for Policymakers and Advocates: Child Sexual Abuse Prevention Legislation in the States to encourage state leaders to create a comprehensive strategy to prevent CSA in the US. Findings from the report show that the nation has made some effort to address CSA, but more focus needs to be given to primary prevention strategies that stop it from occurring in the first place. The report also illustrates the variability of CSA prevention policies across the US and highlights critical gaps in current approaches that must be addressed. In the spirit of the special issue, the authors reflect on key policy issues in the field, including the lack of a federal policy framework for CSA prevention, dedicated funding for the prevention of CSA, and research on the effectiveness of policies intended to prevent CSA. Suggestions for future directions in relation to policy development provided in this commentary will be useful to a variety of stakeholders interested in the topic of CSA prevention policy.

Initial Health Outcomes of a Community-Based Collaboration for Children in Foster Care.

Children entering foster care have complex health needs that can persist across the lifespan. Efforts to improve access to primary care services exist; however, few have been tested. This study evaluated the Missoula Foster Child Health Program, a tri-agency, community-based collaboration in Montana, to determine its impact on health outcomes for youth in care. Demographic, health outcome, and child welfare data were collected from 485 children (50 percent male, 50 percent female, aged 0-18). At program admission, children had unmet service needs, lacking a primary care provider (30 percent), a dental provider (58 percent), and required vaccinations (33 percent). Three-quarters of children had at least one health condition, and one-third had a behavioral health concern. Overall, children in the program had significant decreases in physical and behavioral health problems from admission to discharge. Older children and those with fewer placements were more likely to have positive health changes. Data are promising, representing positive health outcomes of a community-based model for children in care.

Childcare Subsidy Employment and Copayment Requirements and Child Maltreatment.

Economic support programs for low-income families may play an important role in preventing child abuse and neglect. In the United States, childcare subsidies are provided to low-income families who meet certain requirements to offset the high cost of childcare. States have flexibility in setting many policies related to the provision of childcare subsidies, which results in a great deal of variation in how the programs operate between states. One policy dimension on which states vary is the number of employment hours required to receive childcare subsidies. A small body of work has begun to investigate the ways in which these state policy variations might relate to child maltreatment. Using 11 years of administrative data from the United States, the current study sought to estimate the relationship between two sources of variation in childcare subsidy policies: employment requirements and copayment size; and child neglect, physical abuse, and emotional abuse substantiations. The study found a nuanced relationship between required employment and neglect substantiations. Specifically, requiring some level of work was not associated with neglect substantiations, but requiring 30 hours of employment was associated with higher rates. The study did not find a relationship between copayment size and maltreatment substantiations.

Prevention of child sexual abuse in the USA: a scoping review protocol of US legislative policies.

INTRODUCTION: Child sexual abuse (CSA) poses a significant threat to the health and well-being of children in the USA and globally. Many states have introduced or implemented policies to address and prevent CSA, but little research has linked the effects of this legislation on the reduction of adult-perpetrated CSA. The objective of this scoping review is to identify US policies which aim to prevent CSA, explain the components of these types of legislation, review evidence of effectiveness, describe the populations included in the literature, and identify barriers and facilitators to the implementation of said policies. METHODS AND ANALYSIS: This scoping review will follow Joanna Briggs Institute methodology for scoping reviews and will use the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Sources of peer-reviewed evidence from January 2000 to July 2023 will be included. Relevant publications will first be searched in PubMed/MEDLINE database, then 25 other databases. The reference lists of included studies and high-yield journals will be hand searched. Articles which focus on the types of CSA prevention policies and their effects will be included. Studies must clearly demonstrate a connection between policies and CSA outcomes. Title, abstract, full-text screening and extraction will be completed by a team of three researchers. Critical appraisal of the included studies will be performed. Extracted data will be displayed in tabular form and a narrative summary will describe the results of the review. ETHICS AND DISSEMINATION: This scoping review will provide an extensive overview of legislative policies which aim to prevent CSA in the USA. Results of this review will inform future CSA prevention policies in the USA, particularly regarding policy development, evaluation and implementation. Results will be disseminated through a peer-reviewed publication.

Addressing Systemic Racism in the American Professional Society on the Abuse of Children Publications.

The United States continues to grapple with longstanding policies and systems that have adversely impacted historically marginalized communities who identify (and are racialized) as non-White. These stem from a legacy of structural and systemic racism, and the long-term consequences of sanctioned colonization. This legacy rests upon a field of scholarly research that is similarly fraught with white supremacy. As a field, we must examine the process of producing and publishing the body of evidence that has codified harmful policies and practices. Although racial and ethnic disparities have been discussed for decades in the child welfare and health systems, systemic racism has received comparatively little attention in academic research and journals. In this commentary, the authors detail concrete steps over the coming years that will advance diversity, equity, inclusion and justice through American Professional Society on the Abuse of Children's (APSACs) flagship journal, Child Maltreatment. The journal is committed to anti-racist publication processes, such that the journal pledges to develop procedures, processes, structures, and culture for scholarly research that promotes diversity, equity, inclusion, and justice in all forms.

Child Maltreatment During the Pandemic.

What happened with child abuse and neglect during the pandemic? Emergency department and child welfare data suggest a decline in reports; however other sources of data suggest that risk for abuse and neglect remained high during COVID-19. In this commentary, the authors highlight the complicated, and at times contradictory, evidence as to what occurred with child abuse and neglect during the pandemic. The commentary concludes with suggestions for future research.

Using research-practice-policy partnerships to mitigate the effects of childhood trauma on educator burnout.

BACKGROUND: The effects of COVID-19 pandemic on children have been immense. OBJECTIVE: In this commentary, we argue for the need to utilize research-practice-policy partnerships to address the issue of educator burnout and Secondary Traumatic Stress. PARTICIPANTS AND SETTING: Education systems have the potential to be the site of public health interventions in helping to identify and address the needs of children and families. METHODS: In this commentary, we review the literature on child trauma and adversity, educator burnout, and research-practice-policy partnerships. RESULTS: With the return to in-person learning, educators, and the systems in which they work are overwhelmed by the magnitude of mental health challenges presenting in the classroom due to child trauma. As a result, many educators are reporting high levels of compassion fatigue, secondary trauma, and burnout, which are known predictors of leaving the workforce. Many of the strategies employed to address educator compassion fatigue, secondary trauma, and burnout focus directly on the individual level (e.g., deep breathing, yoga). Yet the compassion fatigue, secondary trauma, and burnout are rooted in larger system failures to address the growing needs of children and families. CONCLUSIONS: By bringing together key community members, including educators, and utilizing local data to inform policy decisions, actionable, trauma-informed solutions can create the conditions for thriving educators and therefore, thriving children.

Using the Core Components of a Public Health Framework to Create a Child and Family Well-being System: Example from a National Effort, Thriving Families, Safer Children.

Thriving children require safe, stable, nurturing relationships and environments. When caregivers have the resources and support they need, at the appropriate time, and in culturally meaningful ways, they can structure environments and experiences for their children that optimize development. However, all too many caregivers and children experience trauma and adversity that consistently threaten such environments. The USA currently lacks a universal system of care and support for children and families leaving the child welfare system as the only option for many families to get help. This forces child welfare agencies to address problems and issues they are ill-equipped to address. In this paper, we review how a new national effort in the USA, Thriving Families, Safer Children is integrating the core components of a public health framework to create a child and family well-being system across the country. Case study examples are provided from 4 Thriving Families, Safer Children sites. Thriving Families, Safer Children sites are utilizing the core components of a public health framework to address social and structural determinants of health including systemic racism, with a strong focus on changing systems and contexts, through participatory methods of engaging those with lived expertise, to ensure the service context where families can get what they need, when they need it, with an emphasis on promoting race equity. Efforts to transform child welfare through the Thriving Families, Safer Children movement are aligned with the core components of a public health framework.

Childcare Subsidy Enrollment Income Generosity and Child Maltreatment.

In the United States, childcare subsidies are available to low-income working parents to assist with the cost of childcare. The subsidies are provided as block grants to states, which allows for a great deal of flexibility in the specific policies guiding their distribution. Prior research has found a protective link between childcare subsidies and child maltreatment, but the variations in policies have been much less explored. The current study used longitudinal administrative child welfare data from 10 years (2009-2019) linked with state policies regarding the income eligibility requirements of states to examine the impact of these policies on child abuse and neglect among young children (0-5); early school-age children (6-12), and older children (13-17). Using multiple regression and controlling for state demographic characteristics, the study found that more generous policies surrounding income eligibility were related to lower rates of child abuse and neglect investigations at the state level.

Supporting Fathers to Prevent Child Maltreatment: How Paid Family Leave and Child Care Subsidies are Part of a Public Health Approach.

There are multiple components of a public health approach for preventing child maltreatment. One of these components is the question of who to intervene with. Fathers are an under-targeted and under-studied group for child maltreatment prevention. In this conceptual article, we describe a public health approach for intervening with fathers. Acknowledging financial stress as a key risk factor for child maltreatment among fathers, we explore two policy interventions that aim to increase economic support for families during the early years of a child's life: paid family leave and child care subsidies. During the weeks following the child's birth, paid family leave can promote child-father bonding and enable fathers to engage in more caregiving during a critical family transition. After paid family leave ends, child care subsidies can make child care affordable for families with low income, thereby promoting parents' employment and earnings. We conclude by highlighting ways in which fathers can take an active role in preventing child maltreatment.

The neurophysiological embedding of child maltreatment.

Maltreatment adversely impacts the development of children across a host of domains. One way in which maltreatment may exert its deleterious effects is by becoming embedded in the activity of neurophysiological systems that regulate metabolic function. This paper reviews the literature regarding the association between childhood maltreatment and the activity of three systems: the parasympathetic nervous system, the sympathetic nervous system, and the hypothalamic-pituitary-adrenal axis. A particular emphasis is placed on the extent to which the literature supports a common account of activity across these systems under conditions of homeostasis and stress. The paper concludes with an outline of directions for future research and the implications of the literature for policy and practice.

How COVID-19 Is Placing Vulnerable Children at Risk and Why We Need a Different Approach to Child Welfare.

The onset of the COVID-19 pandemic brings new worries about the welfare of children, particularly those of families living in poverty and impacted other risk factors. These children will struggle more during the pandemic because of financial pressures and stress placed on parents, as well as their limited access to services and systems of support. In this commentary, we explain how current circumstances reinforce the need for systemic change within statutory child welfare systems and the benefits that would accrue by implementing a continuum of services that combine universal supports with early intervention strategies. We also focus on promising approaches consistent with goals for public health prevention and draw out ideas related workforce development and cross-sector collaboration.

Intention to Engage in Maternal and Child Health Home Visiting.

Home visiting (HV) programs have the potential to improve maternal and child health. As federal and state initiatives expand the reach of these programs, understanding what factors enhance uptake and retention of the services becomes increasingly important. This qualitative study used a Reasoned Action Model (RAM) and a cultural lens to explore factors influencing the engagement of women with low-income in HV programs. We conducted 21 semi-structured interviews in both English and Spanish in a prenatal clinic in an urban public health department. The constructs most salient for participants were emotions and affect, behavioral beliefs, and self-efficacy. In the context of an urban public health prenatal clinic, HV marketing and outreach should highlight convenience and social support, as well as clearly communicate program content and intent. In practice, HV programs must be flexible to work around work and home schedules; marketing and outreach should emphasize that flexibility.

Gender Differences in Intimate Partner Violence: A Predictive Analysis of IPV by Child Abuse and Domestic Violence Exposure During Early Childhood.

This study focused on gender differences in the prediction of adult intimate partner violence (IPV) by subtypes of child abuse and children's exposure to IPV. Latent classes of adult IPV consisted of a no violence (20.3%), a psychological violence only (46.2%), a psychological and sexual violence (9.2%), a multitype violence and intimidation (6.8%), and a psychological and physical violence with low intimidation class (17.5%). Physical-emotional child abuse and domestic violence exposure predicted a higher likelihood of multitype violence for males. Sexual abuse predicted a higher likelihood of this same class for females. Implications for future research and prevention are discussed.

Mediating and moderating effects of social support in the study of child abuse and adult physical and mental health.

A number of cross-sectional and a few longitudinal studies have shown a developmental relationship between child abuse and adult physical and mental health. Published findings also suggest that social support can lessen the risk of adverse outcomes for some abused children. However, few studies have investigated whether social support mediates or moderates the relationship between child abuse and adult physical and mental health. Structural equation modeling was used to examine data on these topics from a longitudinal study of more than 30 years. While a latent construct of physical and emotional child abuse did not predict adult health outcomes directly, child abuse did predict outcomes indirectly through social support. A test of variable moderation for child abuse and social support was nonsignificant. Results suggest that social support may help explain the association between child abuse and health outcomes at midlife. Implications of the findings for prevention and treatment are discussed. (PsycINFO Database Record

Effects of Physical and Emotional Child Abuse and Its Chronicity on Crime Into Adulthood.

Analyses tested hypotheses that pertain to direct and indirect effects of parent-reported physical and emotional abuse on later self-reported criminal behavior in a sample of 356 adults of a longitudinal study of more than 30 years. Childhood antisocial behavior was included in analyses as a potential mediator. Physical abuse only predicted adult crime indirectly through childhood antisocial behavior, whereas emotional abuse predicted adult outcome both directly and indirectly. Chronicity of physical abuse was indirectly related to later crime in a subsample test for those who had been physically abused (n=318), whereas chronicity of emotional abuse was neither directly nor indirectly related to adult crime in a test of those who had been emotionally abused (n=225). Implications for future research and practice are discussed.

Longitudinal examination of peer and partner influences on gender-specific pathways from child abuse to adult crime.

Research provides increasing evidence of the association of child abuse with adult antisocial behavior. However, less is known about the developmental pathways that underlie this association. Building on the life course model of antisocial behavior, the present study examined possible developmental pathways linking various forms of child abuse (physical, emotional, sexual) to adult antisocial behavior. These pathways include child and adolescent antisocial behavior, as well as adulthood measures of partner risk taking, warmth, and antisocial peer influences. Data are from the Lehigh Longitudinal Study, a prospective longitudinal study examining long-term developmental outcomes subsequent to child maltreatment. Participant families in the Lehigh Longitudinal Study were followed from preschool age into adulthood. Analyses of gender differences addressed the consistency of path coefficients across genders. Results for 297 adult participants followed from early childhood showed that, for both genders, physical and emotional child abuse predicted adult crime indirectly through child and adolescent antisocial behavior, as well as adult partner and antisocial peer influences. However, for females, having an antisocial partner predicted an affiliation with antisocial peers, and that in turn predicted adult crime. For males, having an antisocial partner was associated with less partner warmth, which in turn predicted an affiliation with antisocial peers, itself a proximal predictor of adult crime. Sexual abuse also predicted adolescent antisocial behavior, but only for males, supporting what some have called "a delayed-onset pathway" for females, whereby the exposure to early risks produce much later developmental outcomes.

Does Child Maltreatment Predict Adult Crime? Reexamining the Question in a Prospective Study of Gender Differences, Education, and Marital Status.

Bivariate analyses of adult crime and child maltreatment showed that individuals who had been maltreated as children, according to child welfare reports, subsequently committed more crime than others who had not been maltreated. Analyses of crimes by category-property, person, and society-provided further evidence of a link between child maltreatment and crime at the bivariate level. Tests of gender differences showed that crime generally is more prevalent among males, although females with a history of maltreatment were more likely than those in a no-maltreatment (comparison) group to report having had some prior involvement in crime. Surprisingly, multivariate analyses controlling for childhood socioeconomic status, gender, minority racial status, marital status, and education level showed that, with one exception (crimes against society), the significant association between child maltreatment and crime observed in bivariate tests was not maintained. Implications for future research are discussed.

Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health.

This study examined the association between officially recorded child abuse and neglect and adult mental health, substance use, and physical health outcomes. Data are from a longitudinal study of more than 30 years in which individuals were interviewed most recently in their mid -30s. Analyses consisted of group comparisons using chi-square tests for categorical variables and independent samples t-tests for continuous measures. Logistic and linear regressions controlled for gender and childhood SES, adult age, marital status, and education. Adults maltreated in childhood reported more symptoms of adult depression, anxiety, and more impairment due to mental and physical health problems. A higher percentage of those with maltreatment histories reported lifetime alcohol problems and appear at greater risk for substance abuse. Most findings of these bivariate analyses remained significant after accounting for gender and childhood socioeconomic status. Somewhat fewer significant results were observed after controlling for adult age, marital status, and education.