Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: Similarities and differences.

Little is known about similarities and differences in voice hearing in schizophrenia and dissociative identity disorder (DID) and the role of child maltreatment and dissociation. This study examined various aspects of voice hearing, along with childhood maltreatment and pathological dissociation in 3 samples: schizophrenia without child maltreatment (n = 18), schizophrenia with child maltreatment (n = 16), and DID (n = 29). Compared with the schizophrenia groups, the DID sample was more likely to have voices starting before 18, hear more than 2 voices, have both child and adult voices and experience tactile and visual hallucinations. The 3 groups were similar in that voice content was incongruent with mood and the location was more likely internal than external. Pathological dissociation predicted several aspects of voice hearing and appears an important variable in voice hearing, at least where maltreatment is present.

Sexual offences against children: An exploration of attrition in the Northern Ireland criminal justice system

Objective: This paper uses data provided by the Police Service for Northern Ireland (PSNI) to compare the characteristics and outcomes of reported sexual offences involving child and adult victims and explore the factors associated with case outcomes.
Method: PSNI provided data on 8,789 sexual offences recorded between April 2001 and March 2006. Case outcomes were based on whether a case was recorded by police as having sufficient evidence to summons, charge, or caution an offender (detected). Where an offender was summonsed, charged, or cautioned, this is classified as detection with a formal sanction. A case can also be classified as "detected" without a formal sanction. The analysis focused on two key categories of detection without formal sanction: cases in which the police deem there to be sufficient evidence to charge an offender but took no further action because the victim did not wish to prosecute, or because the police or the Public Prosecution Service (PPS) decided that no useful purpose would be served by proceeding.
Results: The analysis confirmed that the characteristics of recorded sexual offences involving adult and child victims vary significantly according to gender, offence type, the timing of report and victim-offender relationship. Almost half of child sex abuse cases are not detected by police and a quarter do not proceed through the criminal justice system because either the victim declines to prosecute or the Police/PPS decide not to proceed. Only one in five child cases involved detection with a formal sanction. Child groups with lower detection with formal sanction rates included children under 5, teenagers, those who do not report when the abuse occurs but disclose at a later date; and those who experience abuse at the hands of peers and adults known to them but not related. The analysis also highlighted variation in formal sanction rates depending on where the offence was reported.
Conclusions: Consideration needs to be given to improving the criminal justice response to specific child groups as well as monitoring detection rates in different police areas in order to address potential practice variation.
Practice implications: Consideration needs to be given to improving the professional response in relation to with particularly lower detection with formal sanction rates. There is also a need to monitor case outcomes to ensure that child victims in different areas receive a similar service.

Fabricated or Induced Illness in Children: A Narrative Review of the Literature

Although child maltreatment due to abuse or neglect is pervasive within our society, less
is known about fabricated or induced illness by carers (FII), which is considered to be a
rare form of child abuse. FII occurs when a caregiver (in 93% of cases, the mother)
misrepresents the child as ill either by fabricating, or much more rarely, producing
symptoms and then presenting the child for medical care, disclaiming knowledge of the
cause of the problem. The growing body of literature on FII reflects the lack of clarity
amongst professionals as to what constitutes FII, the difficulties involved in diagnosis,
and the lack of research into psychotherapeutic intervention with perpetrators. This lack
of clarity further complicates the identification, management and treatment of children
suffering from FII and may result in many cases going undetected, with potentially lifethreatening
consequences for children. It has been suggested that there is a national
under-reporting of fabricated or induced illness. In practice these cases are encountered
more frequently due to the chronic nature of the presentations, the large number of
professionals who may be involved and the broad spectrum including milder cases that
may not all require a formal child protection response. Diagnosis of fabricated disease
can be especially difficult, because the reported signs and symptoms cannot be confirmed
(when they are being exaggerated or imagined) or may be inconsistent (when they are
induced or fabricated). This paper highlights and discusses the controversies and
complexities of this condition, the risks to the child and how it affects children; the
paucity of systematic research regarding what motivates mothers to harm their children
by means of illness falsification; how the condition should be managed and treated for
both mother and child; and implications for policy and practice.

Les enfants autochtones en protection de la jeunesse au Québec : leur réalité comparée à celle des autres enfants

Les populations autochtones canadiennes ont un passé difficile qui influence leur vécu actuel. Les recherches canadiennes et ailleurs dans le monde s’entendent sur la surreprésentation des enfants autochtones en protection de l’enfance. Au Canada, la surreprésentation s’explique présentement par la présence de conditions de vie dégradées plutôt qu’en raison d’un traitement différentiel des services de protection à l’égard des enfants autochtones. La présente étude ajoute aux connaissances sur les mauvais traitements et la réponse des services de protection de la jeunesse aux enfants autochtones québécois en s’intéressant à trois questions : leur surreprésentation, leurs différences par rapport aux autres enfants et les prédicteurs du placement. D’abord, à partir des données administratives de la protection de la jeunesse, la surreprésentation des enfants autochtones est évaluée à trois étapes des services : les signalements retenus, les situations fondées et les placements. Les enfants autochtones et les autres enfants sont comparés sur un ensemble de caractéristiques personnelles, familiales, parentales des signalements et des services rendus. Les prédicteurs du placement des enfants desservis par la protection de la jeunesse sont enfin vérifiés, en portant une attention particulière à l’importance du statut autochtone dans cette prédiction. Les résultats révèlent une augmentation de la surreprésentation des enfants autochtones d’une étape à l’autre des services de protection considérés. Ces enfants ont plus souvent des conditions de vie difficiles et sont confrontés à davantage de facteurs de risque que les autres enfants. Le statut autochtone est important dans la prédiction du placement, même après l’ajout d’un ensemble de caractéristiques pouvant contribuer à la prédiction. La complexité d’accès aux services de première ligne dans les communautés autochtones ou l’influence d’une variable non considérée, telle la pauvreté matérielle et économique, constituent de possibles explications. Les implications pour la recherche et la pratique sont discutées.

Portrait sociodémographique, anamnestique et psychopathologique des enfants placés en Centre jeunesse et à qui l'on prescrit des médicaments psychotropes.

Cette thèse a pour but de mieux comprendre le recours aux médicaments psychotropes chez les enfants hébergés en Centre jeunesse, une population qui compte parmi les plus médicalisées. Afin d’y parvenir, les caractéristiques sociodémographiques, anamnestiques et psychopathologiques des enfants placés qui reçoivent des psychopharmacoprescriptions ont été analysées. L’échantillon se compose de 101 enfants de 6 à 12 ans placés en foyer de groupe ou centre de réadaptation, dont 71 recevant des médicaments psychotropes. Les données ont été obtenues par le biais de questionnaires remplis par les éducateurs, par une entrevue semi-structurée réalisée auprès des enfants et une analyse du dossier. Sur le plan de la structure, cet ouvrage comprend une introduction, quatre articles et une conclusion. Le premier article comporte une recension des écrits sur l’usage de la psychopharmacothérapie chez les jeunes placés dans les services de la protection de la jeunesse. Il a été constaté que les taux de prescriptions peuvent varier entre 13% et 77%, selon le type de placement et les régions à l’étude. La symptomatologie des enfants placés qui reçoivent des médicaments psychotropes est caractérisée par des problèmes extériorisés et des troubles psychotiques. Les corrélats du recours à la prescription concernent à la fois la sévérité du tableau clinique, mais aussi le type et l’instabilité du placement, l’âge et le sexe de l’enfant ainsi que la formation des intervenants. Enfin, les écrits recensés font état de l’influence des neurosciences dans les milieux médicaux sur les décisions de prescrire. Le deuxième article présente la prévalence des psychopharmacoprescriptions chez les enfants de 6 à 12 ans placés hors d’un milieu familial. Les résultats indiquent que 70,3% des jeunes reçoivent au moins une prescription, le plus souvent signées par des médecins spécialistes. La plupart se composent de psychostimulants et d’antipsychotiques atypiques, prescrits pour des troubles de l’attention avec hyperactivité. Le troisième article cherche à préciser les caractéristiques sociodémographiques et anamnestiques des enfants placés qui prennent des médicaments psychotropes. Les résultats indiquent que les sujets médicamentés et non médicamentés ont vécu des stresseurs psychosociaux similaires. Par contre, les enfants placés qui reçoivent une psychopharmacothérapie ont été retirés de leur milieu familial à un plus jeune âge. Le quatrième article consiste à cibler leur portrait psychopathologique et à connaître leur niveau de fonctionnement global. Il s’intéresse également aux connaissances et aux perceptions des éducateurs sur la psychopharmacothérapie. Les résultats révèlent que les enfants médicamentés ont plus souvent un diagnostic de trouble mental inscrit à leur dossier. Selon les éducateurs, ils présentent davantage de problèmes extériorisés et intériorisés. À partir de données autorévélées, aucune distinction ne peut être établie entre les sujets, puisque les uns et les autres rapportent un niveau comparable de symptômes et de signes diagnostiques. Enfin, les symptômes de stress post-traumatique et l’opinion favorable des éducateurs sur la psychopharmacothérapie constituent des prédicteurs significatifs de la probabilité de recourir à un traitement médicamenteux. En conclusion, l’apport des résultats de cette recherche est analysé à la lumière des études antérieures. Les retombées cliniques sont discutées et des pistes de recherche futures sont suggérées. .

Trauma craneoencefálico severo en la UCIP del Hospital de la Misericordia, 2010-2013

El Trauma Craneoencefálico (TCE) infantil constituye un motivo frecuente de consulta en Urgencias y supone la primera causa de muerte en niños, llegando a ser hasta del 50% en trauma severo. En Colombia se conocen cifras de TCE por algunos estudios descriptivos, pero no existen reportes en Bogotá ni específicamente en TCE severo. Objetivo: Caracterizar el trauma craneoencefálico severo pediátrico en la Unidad de Cuidado intensivo del Hospital de la Misericordia entre los años 2010 y 2013. Materiales y métodos: Un estudio descriptivo retrospectivo fue realizado en el Hospital de la Misericordia mediante revisión de las historias clínicas de los pacientes que ingresaron a la Unidad de Cuidado Intensivo pediátrico con diagnóstico de trauma craneoencefálico severo entre el año 2010 al 2013. Resultados: Se incluyeron 63 pacientes (71,4% hombres) con una edad mediana de 4 años (RIQ 2-8). La mayoría de los traumas fueron originados por caída o accidente de tránsito (79,4%). La principal lesión fue fractura de cráneo (79%). Casi la mitad de los pacientes sufrieron algún tipo de secuela neurológica al egreso (47,1%). La mayoría de los pacientes que murieron (19%) sufrieron choque hipovolémico (83,3%) y presentaron trauma asociado (66,7%). Conclusión: Las características y epidemiología del trauma craneoencefálico en nuestra población muestran claras similitudes con lo reportados en otras series de la literatura mundial y de Colombia, excepto por la mortalidad, que se esperaba más alta al estudiar solo pacientes con TCE severo.

What determines the out-of-home placement of children in the USA?

Using NCANDS data of US child maltreatment reports for 2009, logistic regression, probit analysis, discriminant analysis and an artificial neural network are used to determine the factors which explain the decision to place a child in out-of-home care. As well as developing a new model for 2009, a previous study using 2005 data is replicated. While there are many small differences, the four estimation techniques give broadly the same results, demonstrating the robustness of the results. Similarly, apart from age and sexual abuse, the 2005 and 2009 results are roughly similar. For 2009, child characteristics (particularly child emotional problems) are more important than the nature of the abuse and the situation of the household; while caregiver characteristics are the least important. All these models have low explanatory power.

Abordagem dos maus tratos na infância por unidades de saúde da família

The goal of this study was to apprehend conceptualizations and professional experiences concerning child maltreatment as reported by physicians and nurses working for the Family Health Strategy implemented in a medium-sized city in São Paulo state. It is a descriptive qualitative study in which 20 professionals were included and semi-structured taped interviews were used. The data obtained were analyzed according to the Collective Subject Discourse and systematized into five themes: Conceptualizations of child maltreatment; Professional training to work in this field; Professional experiences related to such aggravations; Difficult and easy aspects faced during care provision to child maltreatment in the Family Health Strategy; Proposals to promote child safety. It was concluded that care provision to such aggravation types by family health units is configured as an important strategy to promote child safety and support families in relation to this issue. However, it was observed that, in order to qualify professionals for such care provision, it is necessary to invest in continuing education for the multiprofessional team. Also, municipal policies concerning care provision to child abuse, particularly in the organization of integrated work of the health care, education, social welfare and justice sectors must be urgently established by actively including the general society in such process

THE INFLUENCE OF CHILDHOOD ABUSE ON LONGITUDINAL COURSE OF RECOVERY IN PSYCHIATRIC REHABILITATION

Background: Empirical outcome studies have identified specific symptomatic, cognitive, emotional and functional sequelae of childhood abuse in people with severe mental illness (SMI). These findings illuminate the need for an integrated understanding of biological, psychological, environmental, and developmental aspects of SMI. Purpose: The purpose of the present study includes the following: 1) to examine reliability and validity of the comprehensive child abuse rating system in a sample of individuals with SMI, 2) to examine the influence of childhood abuse severity on recovery of psychotic symptoms, neurocognition and social-cognition, and social functioning in people with SMI during 12 months of inpatient psychiatric rehabilitation, and 3) to examine moderating effects of social cognition on the relationship between severity of different types of child abuse history and social functioning. Results: In Study I (N=171), the child abuse rating system produced reliable ratings and some subtypes of child abuse history were related to poorer premorbid functioning and cognition, higher overall psychiatric symptoms, and lower social functioning. In Study II (N=161), the longitudinal factor pattern invariance of the measures of social functioning, externality, and psychiatric symptoms were confirmed across 3 time points (e.g., at admission, at 6 months, and at 12 months). In addition, significant but varied linear relationships between subtypes of child abuse and each level of assessment of functioning were identified. In Study III (N=143), the results showed that higher baseline social inference, independent of history of child physical abuse (CPA), played a protective role in improvements in social functioning. High externality appeared to be counter-therapeutic for individuals with no history of CPA but protective for individuals with a more severe history of CPA. Conclusion: The child abuse rating system appears to provide reliable and valid assessment of subtypes of child abuse history of individuals with SMI. Considering the extreme heterogeneity in both SMI and child maltreatment, the current finding sheds light on providing individualized treatment and assessment planning for individuals with SMI and a history of childhood abuse.

Empowering Medical Professionals to Help Victims of Trafficking

Purpose: to provide commentary of two review articles that discuss the role of medical professionals in combating human trafficking: “Health Care Providers' Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene” by Isaac, Solak, and Giardino, and “Human Trafficking: What is the Role of the Health Care Provider?” by Crane and Moreno. Findings: Both articles provide a good introduction and explanation of the psychosocial and medical issues faced by many trafficking victims; however, they succeed only to varying degrees in describing all the gaps in the medical system and the vital next steps forward. Conclusion: The key next steps in the fight against human trafficking include: multidisciplinary teams need to improve coordination on all forms of human maltreatment; schools for all medical professions and social work need to significantly strengthen their curriculum on diagnosing and treating human maltreatment; and groups that provide training on human trafficking should partner with other agencies and organizations that provide training on child maltreatment and domestic violence.

That Wall is Around My Heart: Family Centered Practice

The author uses a clinical case study, in which he works with a teenager and his adoptive parents to illustrate how placement and adoption decisions can provide physical safety while at the same time exacerbating and extending overlooked and destructive effects of child abuse. The case study highlights the continuing impact of childhood trauma on the interpersonal patterns of behavior within the family, whether biological, kinship, foster or adoptive. The tendency for patterns of aggression and reactivity to be repeated by the victim and his or her caregivers in a foster or adoptive home, and then to extend into the next generation, is an integral aspect of the cycle of child abuse and underscores a critical challenge for skilled and patient staff in family-based service programs.

The Impact of Title IV-E Training on Case Outcomes for Children Serviced by CPS

This study was designed to determine if the professional social work education provided by Title IV-E stipends leads to better case outcomes for children serviced by a southern state in the U.S. Desired case outcomes included lower levels of recurrence of child maltreatment, lower levels of foster care re-entries, greater stability of foster care placements, more reunifications with families within 12 months of placement in foster care, and more adoptions within 24 months of being placed in foster care. Data were obtained from the state’s case outcome records. The findings from the study indicate that Title IV-E stipend workers had significantly better outcomes than Non-Title IV-E workers in two areas: reunifications within twelve months and finalized adoptions within twenty-four months. In addition, non-Title IV-E workers with social work degrees were significantly more likely to achieve positive outcomes regarding recurrence of maltreatment, stability of foster care placement, and length of time to achieve adoption. The study recommends that state child protective service (CPS) agencies continue to offer Title IV-E child welfare training programs and hire degreed social workers. CPS should also continue to support the Title IV-E program and encourage employees to participate in the program. In addition, it is recommended that jobs be restructured to maximize activities that positively impact case outcomes and that the salaries of CPSworkers be increased. Additional research should also be conducted to contribute to a better understanding of other factors that positively impact case outcomes.

Socioemotional Outcomes of Children Sexually Abused during Early Childhood

This study investigated the nature and impact of the sexual abuse of children ages birth through 6 years. The purpose was to enhance knowledge about this understudied population through examination of: (1) characteristics of the abuse; (2) socioemotional developmental outcomes of young victims; and (3) potential moderating effects of family dynamics. An ecological-developmental theoretical framework was applied. Secondary data analysis was conducted using data collected from the consortium Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). A sample of 250 children was drawn from LONGSCAN data, including children who were sexually abused (n=125) and their nonabused counterparts (n=125), matched on demographic variables. Results revealed that young victims of sexual abuse were disproportionately female (91 girls; 73%). The sexual abuse committed against these youngsters was severe in nature, with 111 children (89%) experiencing contact offenses ranging from fondling to forcible rape. Sixty-two percent of child victims demonstrated borderline, clinical, or less than adequate functioning on normative, expected socioemotional outcomes. Child victims reported low degrees of perceived competence and satisfaction in the social environment. When compared with their nonabused counterparts, child victims demonstrated significantly poorer socioemotional functioning, as evidenced by aggressive behaviors, attention and thought problems. Sexually abused youngsters also reported lower self-perceptions of cognitive and physical competence and maternal acceptance. Family dynamic factors did not significantly moderate the relationships between abuse and socioemotional outcomes, with one exception. The caregivers’ degree of empathy for their children had a significant moderating effect on the children’s social problems. This study contributes to an otherwise scant body of literature on the sexual abuse of preschoolers. Findings provide implications for social work practice, especially in the development of assessment and prevention strategies.

Los conocimientos acerca del maltrato infantil de los futuros profesionales de la educación: un estudio exploratorio

Los profesionales de la educación se encuentran, en su ejercicio profesional, en una posición privilegiada para realizar una detección precoz del maltrato infantil y para identificar posibles casos de riesgo. Sin embargo, en ocasiones, maestros y educadores en general aducen falta de conocimiento y formación para realizar dichas tareas. Es por ello que, en este trabajo deseamos insistir en la necesidad de analizar la formación de los futuros profesionales de la educación en torno al maltrato infantil, tanto en el seno de la familia como fuera de ella, y ya sea ejercido por un adulto o por otros menores. No olvidemos que la identificación temprana de comportamientos violentos y, por supuesto, la puesta en marcha de estrategias sólidas para su prevención requieren disponer de una buena capacitación. Por esta razón, hemos realizado un estudio piloto que nos permitiera conocer la formación que los estudiantes del Grado de Pedagogía tienen sobre el maltrato infantil, utilizando un cuestionario que hemos diseñado específicamente para alcanzar tal propósito. En la realización de un estudio piloto contamos con una muestra de 24 alumnos y alumnas del 4º curso del Grado de Pedagogía. Entre las conclusiones alcanzadas destacamos que, tras analizar los datos derivados del pase piloto, podemos concluir que los futuros pedagogos consideran necesario tener formación específica al respecto, una preparación que, mayoritariamente, consideran insuficiente y muy limitada para poder afrontar sus responsabilidades profesionales en el futuro.

Exploring associations between violent discipline and aggressive behavior in children ages 4-5 in The Republic of Nicaragua: A secondary data analysis of the 2011 Demographic and Health Survey

Thesis (Master's)--University of Washington, 2016-06