Training Psychologists in Integrated Primary Care and Child Maltreatment: Trainee and Supervisor Perspectives on Lessons Learned.

Psychologists are key team members in the delivery of integrated behavioral healthcare. Healthcare reform has supported a shift toward a team-based, interdisciplinary model of service delivery, with increasing emphasis on primary care services, prevention, and health promotion. In conjunction with this shift has been a greater focus on psychosocial problems and social determinants of health, particularly childhood adversity. Psychologists in primary care are uniquely positioned to advance efforts to prevent and ameliorate childhood adversity, which are essential to improving care for underserved populations and reducing health disparities. Targeted training efforts are needed to increase the number of psychologists equipped to work in primary care settings with underserved populations. This paper provides an overview of a training program designed to provide psychology trainees with specialized training in both integrated primary care and child maltreatment. The overarching goal of the program is to provide trainees with the skillset to work within integrated primary care settings and the expertise needed to further efforts to address and prevent child maltreatment, as well as childhood adversity more broadly, to improve outcomes for underserved populations. The paper reviews strengths, challenges, and lessons learned from this program.

Interdisciplinary Training Program (ITP) in child abuse and neglect: Long term effects.

BACKGROUND: University of Oklahoma Health Sciences Center has offered Interdisciplinary Training Program (ITP) for Child Abuse and Neglect since 1987. However, there are limited evaluations on multidisciplinary/interprofessional training for early professionals in the field of child abuse and neglect. OBJECTIVE: This study aimed to examine the effects of the ITP on young professionals in developing their careers and taking leadership roles in the field of child abuse and neglect. METHODS: The anonymous online survey was conducted for students who completed in the ITP from 1989 to 2016 (n = 405, with contact information out of total 508 graduates). One hundred seventy nine alumni (44.2%) responded to the survey. RESULTS: Satisfaction for the ITP was high (m = 9.3, sd = 0.97 on a 10 point scale with higher numbers being positive). Their current contributions to the field of child abuse and neglect were widely seen in child advocacy (43.0%), clinical treatment (39.1%), primary prevention (29.6%), or research (27.9%). Graduates reported they made 133 presentations to civic or professional groups and published 69 articles since they finished the ITP. CONCLUSION: The ITP trainees have made significant contributions to the field in clinical treatment, research, and child advocacy. Alumni were highly satisfied with their experience and continue to see the importance of the ITP to their jobs and career.

Accuracy of a Pediatric Behavioral Health Screener to Detect Untreated Behavioral Health Problems in Primary Care Settings.

An estimated 10% to 20% of youth in primary care exhibit behavioral symptoms and may go underdetected. Most screeners identify risk base of symptoms alone, irrespective of functional impairment. To address this issue, the Pediatric Symptom Checklist-17 (PSC-17), a widely used symptom screener, was combined with functional impairment and current behavioral services enrollment items to form the Pediatric Behavioral Health Screen (PBHS) and assessed compared to the full Child Behavior Checklist (CBCL). A total of 267 youth between 6 and 16 years of age were administered the screener and the CBCL. Areas under the receiver operating curves approached or exceeded 0.90 in all analyses, reflecting excellent classification accuracy. Almost no false negatives were observed among currently untreated cases with functional impairment. No differential item functioning was found. Performance of the PSC-17 as a pediatric primary care behavioral health screener supported previous research, and additional functional impairment items to form the PBHS appeared useful, particularly for interpreting borderline range scores.

Mark Chaffin (1952-2015).

Presents an obituary for Mark Chaffin, who passed away unexpectedly on August 23, 2015, in Atlanta, Georgia, while riding his bike on the Atlanta Beltline, a joy and passion for him. Mark was a leader in the field of child maltreatment research. He dedicated his career to helping at-risk children and families. His distinguished career belied his self-proclaimed, self-effacing lack of accomplishment.

Risk for Child Maltreatment Among Infants Discharged From a Neonatal Intensive Care Unit: A Sibling Comparison.

Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but these findings may be biased by observed and unobserved confounding factors (social, family, and maternal characteristics) including increased surveillance by health care providers. This study expands on previous research by examining and controlling for these potential study biases and confounders using a sibling discordance retrospective cohort study design. Infants born in a Level IV neonatal intensive care unit (NICU) were matched with non-NICU born sibling controls. Cox proportional hazard models with shared frailty terms were used to account for clustering and heterogeneity in CM survival time (time to CM event). Potentially key covariates were selected using the directed acyclic graph approach, and surveillance reports were identified and systematically included or excluded from analyses. Managing these sources of bias reduced but did not eliminate the association between neonatal illness and CM report risk. Risk was especially high during the first year of the NICU infant's life and among families with multiple well-known CM risk factors.

Child Maltreatment Fatalities Related to Inadequate Caregiver Supervision.

More than 1,500 children died in the United States in 2011 due to child maltreatment. A substantial portion of these deaths were due to neglect. Previous research has found that a large percentage of child neglect cases involve supervisory neglect; however, the role of inadequate caregiver supervision (ICS) in child maltreatment deaths is unknown. The present study reviewed files from the Child Death Review Board in the state of Oklahoma for the years 2000 to 2003 to examine (a) how many deaths were due to inadequate caregiver supervision and (b) which child, caregiver, family, alleged perpetrator, and incident characteristics predicted risk for death related to ICS. Results indicated that almost half of the child maltreatment deaths were related to ICS. Older children and those living in homes with greater numbers of children were more likely to die from causes related to ICS. In addition, the alleged perpetrators of deaths related to ICS were more likely to be biological parents than alleged perpetrators of non-ICS-related deaths. These findings suggest that interventions to assist caregivers in providing appropriate levels of supervision for their children may be important for reducing children's risk for death.

Fatal child neglect: characteristics, causation, and strategies for prevention.

Research in child fatalities because of abuse and neglect has continued to increase, yet the mechanisms of the death incident and risk factors for these deaths remain unclear. The purpose of this study was to systematically examine the types of neglect that resulted in children's deaths as determined by child welfare and a child death review board. This case review study reviewed 22 years of data (n=372) of child fatalities attributed solely to neglect taken from a larger sample (N=754) of abuse and neglect death cases spanning the years 1987-2008. The file information reviewed was provided by the Oklahoma Child Death Review Board (CDRB) and the Oklahoma Department of Human Services (DHS) Division of Children and Family Services. Variables of interest were child age, ethnicity, and birth order; parental age and ethnicity; cause of death as determined by child protective services (CPS); and involvement with DHS at the time of the fatal event. Three categories of fatal neglect--supervisory neglect, deprivation of needs, and medical neglect--were identified and analyzed. Results found an overwhelming presence of supervisory neglect in child neglect fatalities and indicated no significant differences between children living in rural and urban settings. Young children and male children comprised the majority of fatalities, and African American and Native American children were over-represented in the sample when compared to the state population. This study underscores the critical need for prevention and educational programming related to appropriate adult supervision and adequate safety measures to prevent a child's death because of neglect.

Fatal child maltreatment: characteristics of deaths from physical abuse versus neglect.

This study examined victim, family, and alleged perpetrator characteristics associated with fatal child maltreatment (FCM) in 685 cases identified by child welfare services in the state of Oklahoma over a 21-year period. Analyses also examined differences in child, family, and alleged perpetrator characteristics of deaths from abuse versus neglect. Case information was drawn from child welfare investigation records for all FCM cases identified by the state Department of Human Services. Fatal neglect accounted for the majority (51%) of deaths. Children were primarily younger than age 5, and parents were most frequently the alleged perpetrators. Moreover, most victims had not been the subject of a child welfare report prior to their death. A greater number of children in the home and previous family involvement with child welfare increased children's likelihood of dying from neglect, rather than physical abuse. In addition, alleged perpetrators of neglect were more likely to be female and biologically related to the victim. These results indicate that there are unique family risk factors for death from neglect (versus physical abuse) that may be important to consider when selecting or developing prevention efforts.

Brief FASD prevention intervention: physicians' skills demonstrated in a clinical trial in Russia.

BACKGROUND: Alcohol consumption during pregnancy can result in a range of adverse pregnancy outcomes including Fetal Alcohol Spectrum Disorders (FASD). Risky drinking among Russian women constitutes a significant risk for alcohol-exposed pregnancies (AEP). Russian women report that obstetrics and gynecology (OB/GYN) physicians are the most important source of information about alcohol consumption during pregnancy and developing effective prevention interventions by OB/GYNs is indicated. This is the first study focused on implementation of an AEP prevention intervention at women's clinics in Russia. METHOD: The paper describes the intervention protocol and addresses questions about the feasibility of a brief FASD prevention intervention delivered by OB/GYNs at women's clinics in Russia. Brief physician intervention guidelines and two evidence-based FASD prevention interventions were utilized to design a brief dual-focused physician intervention (DFBPI) appropriate to Russian OB/GYN care. The questions answered were whether trained OB/GYN physicians could deliver DFBPI during women's routine clinic visits, whether they maintained skills over time in clinical settings, and which specific intervention components were better maintained. Data were collected as part of a larger study aimed at evaluating effectiveness of DFBPI in reducing AEP risk in non-pregnant women. Methods of monitoring the intervention delivery included fidelity check lists (FCL) with the key components of the intervention completed by physicians and patients and live and audio taped observations of intervention sessions. Physicians (N = 23) and women (N = 372) independently completed FCL, and 78 audiotapes were coded. RESULTS: The differences between women's and physicians' reports on individual items were not significant. Although the majority of physician and patient reports were consistent (N = 305), a discrepancy existed between the reports in 57 cases. Women reported more intervention components missing compared to physicians (p < 0.001). Discussing barriers was the most difficult component for physicians to implement, and OB/GYN demonstrated difficulties in discussing contraception methods. CONCLUSIONS: The results supported the feasibility of the DFBPI in Russia. OB/GYN physicians trained in the DFBPI, monitored, and supported were able to implement and maintain skills during the study. In addition to the alcohol focus, DFBPI training needs to have a sufficient component to improve physicians' skills in discussing contraception use.

U.S. child death review programs: assessing progress toward a standard review process.

BACKGROUND: Child death review (CDR) programs examine the circumstances of children's deaths to gain information on how and why children die for the purpose of promoting the health, safety, and protection of children. PURPOSE: The purpose of this study was to conduct a systematic review of the 50 states and District of Columbia CDR programs, with specific focus on the use of standardized procedures and best-practice recommendations. This included assessment of which deaths are reviewed, the model of review, team membership, and standardization of data collection and reporting. METHODS: Data were collected through semistructured phone interviews with representatives of the 50 states and District of Columbia CDR programs and online sources. Data collection and analyses were conducted in 2009. RESULTS: Forty-eight states and the District of Columbia have active CDR programs at the state and/or local level, and the majority use a national data collection system. However, results revealed numerous inconsistencies across programs in policies, procedures, and data collection. CONCLUSIONS: This study reflects the minimal progress that has been made in the CDR process in the U.S. since the last systematic review of the programs in 2001. The study documents substantial discrepancies among the U.S. CDR programs, affecting the consistency of data obtained by individual states and, ultimately, prevention efforts at the national level. Information from this review can inform CDR programs as they develop and refine procedures and guide future research on the effectiveness and limitations of variations in procedures.

Factors related to sibling removal after a child maltreatment fatality.

OBJECTIVES: Many children who die from abuse or neglect are survived by siblings. However, little data are available about what happens to these siblings after the victim's death, such as whether they are removed from their home. Even less is known about how decisions are made regarding sibling removal following a child fatality. This study examined social-ecological factors related to the likelihood that siblings would be removed from their homes after a child maltreatment fatality. METHODS: This study utilized Oklahoma child death review and child welfare data from 1993 to 2003 for 250 families to examine which sibling, caregiver, alleged perpetrator, family, community, and maltreatment characteristics were related to sibling removal following a child maltreatment fatality. RESULTS: Logistic regression analyses indicated that younger sibling age, more previous family reports to child welfare, and type of maltreatment (i.e., abuse rather than neglect) predicted greater likelihood of sibling removal. CONCLUSIONS: The sibling and family factors found to be related to sibling removal are consistent with literature indicating that these variables are associated with death from child maltreatment. Few caregiver and family variables were predictive of sibling removal, despite evidence that such variables are related to child maltreatment fatalities. Further research that investigates siblings' return to their homes and subsequent CPS referrals would help to clarify whether decisions about sibling removal were useful in protecting siblings from future maltreatment. PRACTICE IMPLICATIONS: It may be important for child welfare workers to consider more caregiver and family factors when making removal decisions after a child maltreatment fatality.

Use of focus groups in developing FAS/FASD prevention in Russia.

Fetal alcohol syndrome is a severe outcome of alcohol use during pregnancy, and the rates may be higher in countries with greater use of alcohol. To obtain information from Russian physicians (N = 23), women (N = 23), and male partners (N = 5), focus groups were conducted with 51 participants in St. Petersburg, Russia. The main objective was to determine the participants' knowledge, attitudes, and behavior related to drinking during pregnancy. Data were analyzed using ATLAS-ti 5.0. The results will be used to develop a survey of Russian professionals and women leading to FAS prevention programming. The study's limitations are described.

Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports.

A randomized trial was conducted to test the efficacy and sufficiency of parent-child interaction therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Physically abusive parents (N=110) were randomly assigned to one of three intervention conditions: (a) PCIT, (b) PCIT plus individualized enhanced services, or (c) a standard community-based parenting group. Participants had multiple past child welfare reports, severe parent-to-child violence, low household income, and significant levels of depression, substance abuse, and antisocial behavior. At a median follow-up of 850 days, 19% of parents assigned to PCIT had a re-report for physical abuse compared with 49% of parents assigned to the standard community group. Additional enhanced services did not improve the efficacy of PCIT. The relative superiority of PCIT was mediated by greater reduction in negative parent-child interactions, consistent with the PCIT change model.

Child maltreatment training in doctoral programs in clinical, counseling, and school psychology: where do we go from here?

The American Psychological Association (APA) has called for improving knowledge regarding child abuse and neglect among psychologists by increasing training. The present study examined the extent of child abuse training provided by APA-accredited doctoral programs in clinical, counseling, and school psychology by surveying the training directors in 1992 and 2001. The survey assessed available coursework, practica, and research experience in the area of child maltreatment. Findings indicated that more than half of all programs cover child maltreatment in three or more courses, and most programs discuss child maltreatment in ethics/professional seminars. Most students have some exposure to clients with abuse-related problems, and some have opportunities to participate in maltreatment research. Nonetheless, training falls short of APA recommendations for minimal levels of competence in child maltreatment, with no change in training in the past decade. Recommendations for improving training include more discussion among program faculty, attention to essential competencies, and specific suggestions for developing interdisciplinary training.