Child Abuse and Maltreatment

This webpage identifies the major literature in the field of substance abuse and child welfare practice: child abuse and maltreatment. The time frame is from January 2000 through December 2014.

Bailey, H. N., De Oliveria, C. A., Wolfe, V. V., Evans, E. M., & Hartwick, C. (2012). The impact of childhood maltreatment history on parenting: A comparison of maltreatment types and assessment methods. Child Abuse & Neglect, 36(3), pp. 236-246. DOI: 10.1016/j.chiabu.2011.11.005

The aim of this study was to further understand the differential association between specific types of childhood maltreatment and subsequent parenting difficulties by considering a broad range of childhood experiences and to consider self-reported and observer-rated parenting outcomes. Findings highlight the complexity of associations between child maltreatment and subsequent parenting outcomes. Although much previous research has focused on sexual and physical abuse, other more contextual forms of maltreatment may be similarly or more strongly associated with certain parenting outcomes. Furthermore, different forms of maltreatment may be associated with perceived versus observed parenting outcomes.

Banducci, A. N., Hoffman, E., Lejuez, C. W., & Koenen, K. C. (2014). The relationship between child abuse and negative outcomes among substance users: Psychopathology, health, and comorbidities. Addictive Behaviors, 39(1), pp. 1522-1527.

This article presents the findings of a study in which the authors hypothesized that among adults with substance use disorders, child abuse would be associated with elevated rates of all Diagnostic and Statistical Manual (DSM-IV-TR) psychiatric disorders, substance dependence, and comorbidities. The authors looked at 280 inpatients in treatment and sought to establish whether rates of psychiatric disorders, substance dependencies, and comorbidities differed as a function of child abuse. Findings suggest that individuals who reported experiencing abuse had higher rates of psychiatric orders.

Barth, R. P., Gibbons, C., & Guo, S. (2006). Substance abuse treatment and the recurrence of maltreatment among caregivers with children living at home: A propensity score analysis. Journal of Substance Abuse Treatment, 30(2), pp. 93-104.

Policy and programmatic initiatives of the last decade have focused on increased coordination of services and expansion of prompt substance abuse treatment for mothers initially involved with child welfare services (CWS). Yet, little evidence has been amassed concerning the implications of this approach on the recurrent need for CWS. This study examines data from a large national probability sample of children and their caregivers involved with CWS following an allegation of maltreatment. Data include the recurrence of maltreatment reports for this group of children who remain at home. Selected from 1,101 caregivers with an indicated substance abuse problem, a group of 224 clients who did not receive services were compared with 224 treated clients. Results showed that clients who received substance abuse treatment were nearly twice as likely to have another child abuse report within 18 months. Reasons why participation in substance abuse treatment may result in greater involvement with CWS are posited.

Bartlett, J. D., & Easterbrook, M. A. (2012). Links between physical abuse in childhood and child neglect among adolescent mothers. Children and Youth Services Review, 34(11), pp. 2164-2169.

This study investigated the etiology of neglect among very young mothers focusing on adolescents' experiences in childhood. The authors hypothesized that a history of childhood physical abuse would increase the odds of neglect, whereas a history of childhood positive care would decrease the odds of neglect. Results showed that one in four mothers was neglectful, and neglect was four times as likely with a maternal history of physical abuse in childhood than with no history of maltreatment. As expected, a maternal history of positive care in childhood decreased the likelihood of neglect. Mothers with a history of both childhood physical abuse and positive care were not at increased risk for neglect, suggesting a compensatory effect of care experiences within the context of an abusive relationship. Findings affirm that adolescent mothers are at considerable risk for perpetuating cycles of maltreatment leading to child neglect, and that nuanced descriptions of their childhood histories are essential for understanding cycles of maltreatment.

Berger, L. M., Slack, K. S., Waldfogel, J., & Bruch, S. K. (2010). Caseworker-perceived caregiver substance abuse and child protective services outcomes. Child Maltreatment, 15(3), pp. 199-210.

The authors used data from the National Survey of Child and Adolescent Well-Being to examine associations of child protective services (CPS) caseworkers’ perceptions of caregiver substance abuse with their perceptions of the severity of risk and harm a child experienced as a result of alleged maltreatment, as well as with whether a family experienced a range of CPS outcomes. The outcomes included whether the family received services from CPS, was substantiated for maltreatment, experienced child removal, and was subject to a termination of parental rights (TPR) petition. The authors also compared the magnitude of the association between caseworker-perceived caregiver substance abuse and each outcome to that of the association between other maltreatment-related risk factors and each outcome. Findings suggest that, all else equal, caseworker-perceived caregiver substance abuse is associated with increased caseworker perceptions that children have experienced severe risk and harm and also with an increased probability of each of the CPS outcomes except TPR. These findings imply that CPS decisions are heavily influenced by caseworker perceptions of caregiver substance abuse, regardless of the presence of other risk factors for child maltreatment.

Boles, S.M., Joshi, V., Grella, C., & Wellisch, J. (2005). Childhood sexual abuse patterns, psychosocial correlates, and treatment outcomes among adults in drug abuse treatment. Journal of Child Sexual Abuse, 14(1), pp. 39-55.

This study reports on the effects of having a history of childhood sexual abuse (CSA) on treatment outcomes among substance abusing men and women (N = 2,434) in a national, multi-site study of drug treatment outcomes. A history of CSA was reported by 27.2% of the women and 9.2% of the men. Patients reporting CSA were younger at entry into the current drug treatment, were more likely to be White, were more likely to have a comorbid mental disorder, be alcohol or cocaine dependent, had higher levels of criminal activities, had a higher level of problem recognition, and had a more negative peer influence than patients without CSA. A history of abuse was also related to a lower likelihood of post-treatment abstinence. High concentrations of adults with abuse histories indicate that drug treatment represents an opportunity for targeted intervention strategies to address the often traumatic experiences associated with abuse, and the link between these abusive strategies and drug use.

Brems, C., Johnson, M. E., Neal, D., & Freemon, M. (2004). Childhood abuse history and substance use among men and women receiving detoxification services. American Journal of Drug and Alcohol Abuse, 30(4), pp. 799-821.

The current study was designed to shed additional light on the link of childhood victimization and subsequent substance use and psychological adjustment among men and women receiving detoxification services at a large, comprehensive substance abuse treatment center in the Northwestern United States. Specifically, this study assesses the link between childhood sexual and physical abuse and subsequent life adjustment via the following variables: type and severity of substance use, psychological symptoms, and criminal behavior. Results revealed 20% of men and more than 40% of women reported childhood physical or sexual abuse. Individuals with abuse history reported earlier age of onset of drinking, more problems associated with use of alcohol/drugs, more severe psychopathology, and more lifetime arrests, arrests related to substance use, and arrests related to mental health. Early intervention may be made possible by identifying consumers with such histories early on in their contacts with the substance abuse treatment system and more appropriate treatment planning will ensue. In addition, they will most likely benefit from additional mental health counseling because they have greater psychological distress than individuals without abuse histories do. Criminal activity also increases among individuals with abuse histories, making prevention plans in this regard necessary to serve this population appropriately. This is particularly true with regard to criminal activity that occurs under the influence of drugs or alcohol or in the presence of symptoms of mental illness.

Carnochan, S., Rizik-Baer, D., Austin, M. J. (2013). Preventing the recurrence of maltreatment. Journal of Evidence-Based Social Work, 10(1), pp. 161-178. DOI: 10.1080/15433714.2013.788947

This article presents findings of a literature review on child, family and systemic factors related to maltreatment recurrence and promising practices for improving performance. The authors suggest that there is no clear evidence-based method for preventing the recurrence of maltreatment, and posit four questions in order to generate discussion on the issue.

Center for Substance Abuse Treatment. (2000). Substance abuse treatment for persons with child abuse and neglect issues. Treatment Improvement Protocol (TIP) Series, No. 36. DHHS Publication No. (SMA) 00-3357. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Research and clinical evidence indicates that physical, sexual, and emotional abuse and neglect during childhood can increase a person’s risk of developing substance abuse disorders. This TIP examines treatment issues for both adult survivors of child abuse and neglect and adults in treatment who may be abusing or neglecting their own children. This TIP does not, however, address the treatment needs of children who are currently being abused or who are abusing substances. Definitions and rates of child abuse and neglect are provided for the general population and among those in substance abuse treatment. There is also a review of the literature on links between childhood abuse and subsequent substance abuse. Screening and assessment tools that can be used to determine whether a client has a history of childhood abuse or neglect are included and guidelines on treating clients with histories of child abuse or neglect are provided. The TIP also discusses the personal issues that counselors may encounter when working with clients with histories of abuse or neglect and offers suggestions for addressing them. Treatment guidelines and an overview of the legal issues that counselors should be aware of as mandated reporters are provided. Also included is an overview of continuing and emerging trends such as fast-track adoption and welfare reform.

Chahine, Z., and Sanders, D. The Road Ahead: Comprehensive and Innovative Approaches for Improving Safety and Preventing Child Maltreatment Fatalities. Child Welfare, 92(2), pp. 237-253.

This article presents a high-level overview of the complex issues, opportunities, and challenges involved in improving child safety and preventing child maltreatment fatalities. It emphasizes that improving measurement and classification is critical to understanding and preventing child maltreatment fatalities. It also stresses the need to reframe child maltreatment interventions from a public health perspective. The article draws on the lessons learned from state-of-the-art safety engineering innovations, research, and other expert recommendations presented in this special issue that can inform future policy and practice direction in this important area.

Chambers, R. M. (2008). In Potter C. C., Potter C. C. (Eds.), Match between family needs and services for high-risk neglecting families. Journal of Public Child Welfare, 2(2), pp. 229 -252.

Child neglect is characterized by a complexity of family problems and needs. Whether families' needs are actually matched to the appropriate services is a critical area for study, although little empirical work exists. In this study, we examine the match between needs and services for a sample of high-risk neglecting families, using cluster analysis to identify clusters of services and previously identified need clusters. The authors examine need-service match from two perspectives: 1) how well services are allocated to family need, and 2) how well family needs are covered by available services. Some service clusters are well allocated to corresponding needs, such as intensive drug court and family preservation services to substance-abusing families; however, other service patterns are much less coherent. With regard to how well needs are covered by available services, although approximately one-third of substance-abusing families receive the intensive drug court intervention, another one-third receive the low-service cluster of services.

Chaney, A., Carballedo, A., Amico, F., Fagan, A., Skokauskas, N., Meaney, J., & Frodl, T. (2014). Effect of childhood maltreatment on brain structure in adult patients with major depressive disorder and healthy participants. Journal of Psychiatry Neuroscience, 39(1), pp. 50-59.

The aim of this study was to investigate whether patients with MDD and a history of childhood maltreatment display more structural changes than patients without childhood maltreatment or healthy controls do. The results of this study suggest that early childhood maltreatment is associated with brain structural changes irrespective of sex, age and a history of depression. Thus, the study highlights the importance of childhood maltreatment when investigating brain structures and indicate that childhood maltreatment is associated with structural brain changes.

Chauhan, P., & Widom, C. S. (2012). Childhood maltreatment and illicit drug use in middle adulthood: The role of neighborhood characteristics. Development and Psychopathology, 24(3), pp. 723–738.

This paper examined whether childhood maltreatment increases the risk of living in neighborhoods with less desirable characteristics (i.e., more disorder and disadvantage, less social cohesion, social control and advantage, and fewer resources) in middle adulthood and whether these neighborhood characteristics influence subsequent illicit drug use. Results showed an indirect effect on illicit drug use via neighborhood disorder among maltreated children, even after accounting for drug abuse symptoms in young adulthood, although this was sex specific and race specific, affecting women and Whites. Overall, child abuse and neglect places children on a negative trajectory that dynamically influences negative outcomes at multiple levels into middle adulthood.

Cheng, T. C., & Lo, C. C. (2010). Drug use among maltreated adolescents receiving child welfare services. Children and Youth Services Review, 32(12), pp. 1735-1739.

This study investigated the impact of child maltreatment, child welfare services, parental substance abuse, and parent–child relationship on adolescents' drug use. In a secondary data analysis of 1,799 adolescents, data were extracted from the National Survey of Child and Adolescent Well-Being. Ordered probit regression showed that level of hard drug use within the past 30 days related to adolescents' lifetime use of hard drugs, emotional closeness to parent, sexual maltreatment, and receipt of in-home services. Implications for services and research are discussed.

Connell, C. M., N. Bergeron, et al. (2007). Re-referral to child protective services: The influence of child, family, and case characteristics on risk status. Child Abuse & Neglect, 31(5), pp. 573-588.

This study examines child, family, and case characteristics that impact rates of re-referral to Child Protective Services (CPS) using data on all closed CPS investigations for the state of Rhode Island between 2001 and 2004. A longitudinal dataset of all referrals to CPS was created using state submissions to the National Child Abuse and Neglect Data System (NCANDS). After excluding children whose initial CPS investigation resulted in removal from the home, a Cox proportional hazards model was tested to examine factors impacting the likelihood of re-referral.

Conners-Burrow, N., McKelvey, L., Kyzer, A., Swindle, T., Cheerla, R., & Kraleti, S. (2013). Violence exposure as a predictor of internalizing and externalizing problems among children of substance abusers. Journal of Pediatric Nursing, 28(4), pp. 340-350.

This study explores the associations between exposure to conflict and crime in the home and community, and child anxiety and self-control problems among 60 children whose mothers were in treatment for substance abuse problems. Experiences with violence and crime were widespread, with many children exposed to multiple incidents. Results reflected that children's exposure to violence and the number of years the mother had been using substances predicted higher anxiety in children, while only exposure to violence predicted problems in self-control. Results highlight the importance of screening for violence exposure.

Covington, T. (2013). The public health approach for understanding and preventing child maltreatment: A brief review of the literature and a call to action. Child Welfare, 92(2), pp. 21-39.

This article argues that it is time to rigorously apply a public health framework to improve our understanding of, and accelerate efforts to, prevent child abuse and neglect. The article describes the fundamentals of a public health approach; discusses how this approach has been applied to improve surveillance of serious maltreatment injuries and fatalities, the understanding of risk and protective factors, and the long-term consequences of maltreatment; and describes how a public health approach is an effective means to prevention.

Danielson, C. K., Amstadter, A. B., Dangelmaier, R. E., Resnick, H. S., Saunders, B. E., Kilpatrick, D. G. (2009). Does typography of substance abuse and dependence differ as a function of exposure to child maltreatment? Journal of Child & Adolescent Substance Abuse, 18(4), pp. 323-342. DOI: 10.1080/10678280902973310

This article investigates the link between child maltreatment, including child sexual assault (CSA) and child physical assault (CPA), and addiction-related symptomatology in a subsample of adolescents from the National Survey of Adolescents, all of whom met DSM-IV criteria for substance abuse or dependence (N = 281). More than 60% of the sample reported a history of CSA and/or CPA. Results indicated significant differences in typography of substance abuse and dependence symptoms and rates of comorbid lifetime PTSD based on assault history, specific assault incident characteristics, and sex. Clinical implications for substance-abusing youths with maltreatment histories are discussed.

Diderich, H. M., Fekkes. M., Verkerk, P. H., Pannebakker, F. D., Velderman, M. K., Sorensen, P. J. G., Baeten, P., Oudesluys-Murphy, A. M. (2013). A new protocol for screening adults presenting with their own medical problems at the Emergency Department to identify children at high risk for maltreatment. Child Abuse & Neglect, 37(12), pp. 1122-1131.

The aim of this study is to assess whether this protocol for screening adults presenting for care in the Emergency Department can identify children at high risk for maltreatment. At assessment, child abuse was confirmed in 91% of referred cases. The protocol has a high positive predictive value of 91% and can substantially increase the detection rate of child abuse in an ED setting. Parental characteristics are strong predictors of child abuse. Implementing guidelines to detect child abuse based on parental characteristics of parents attending the adult section of the ED can increase the detection rate of child abuse and neglect allowing appropriate aid to be initiated for these families.

Dinehart, L. H., Katz, L. F., Manfra, L., & Ullery, M. A., (2013). Providing quality early care and education to young children who experience maltreatment: a review of the literature. Early Childhood Education Journal, 41(4), pp. 283-290. DOI: 10.1007/s10643-012-0553-6

The current paper highlights the few studies that examine the role of early care and education on the developmental and early academic outcomes of children who experience maltreatment. The authors argue that children who experience maltreatment are at significant risk for poor developmental outcomes as a result of the chronic exposure to stress that is typical of this population. Recent evidence emphasizing the effects of stress on brain development is discussed. The review serves as a call for international research efforts to explore the role of ECE on the developmental and early educational outcomes of this vulnerable population of children.

Douglas, E. M., & Brandy, L. M. (2014). Fatal and non-fatal child maltreatment in the US: An analysis of child, caregiver, and service utilization with the National Child Abuse and Neglect Data Set. Child Abuse & Neglect, 38(1), pp. 42-51.

The purpose of this study was to compare children who are fatally and non-fatally maltreated in the United States. In this first national comparison study, we used the Child Abuse and Neglect Data Set of children and families who encounter/receive support from child welfare services. We found that children who were fatally maltreated were younger, were more likely to live with both their parents, and that their families experienced more financial and housing instability compared to non-fatally maltreated children. Overall, families in which children die use/receive fewer social services, as compared to families in which children live. The authors discuss the results with regard to child welfare practice and research.

Dubowitz, H., Kim, J., Black, M. M., Weisbart, C., Semiatin, J., & Magder, L. S. (2011). Identifying child at high risk for a child maltreatment report. Child Abuse & Neglect, 35(2), pp. 96-104. DOI: 10.1016/j.chiabu.2010.09.003

The aim of this study was to help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect. Method: The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment , maternal education ≤ high school, maternal drug use, maternal depressive, and more children in the family. Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.

Dunlap, E., Golub, A., Johnson, B. D., & Benoit, E. (2009). Normalization of violence: Experiences of childhood abuse by inner-city crack users. Journal of Ethnicity in Substance Abuse, 8(1), pp. 15-34.

This article uses ethnographic data to reveal the processes behind and context of this linkage for one population—poor, inner-city New York residents who became crack users. Life in the inner city is qualitatively different than in more fortunate circumstances. CPA is but one of numerous stressors and factors contributing to ASA. Approximately half of the subjects reported clear recollections of being physically beaten by their mothers or their various male partners. Although several denied being beaten in childhood, they typically reported various forms of physical assaults that they “deserved.” Physical assaults, especially by mothers, were often understood as expressions of love. As such, these respondents viewed their ongoing physical assaults as an ordinary part of their childhood and adolescence. Such physical punishment also socialized and prepared children for the violence that would likely occur during their childhood in their inner-city communities. This analysis highlights how reducing substance abuse in the inner city may require a much more comprehensive effort than a focus on reducing CPA. These findings also have important implications for quantitative research regarding CPA and ASA. Such studies should subdivide their analyses by socioeconomic status to more clearly measure how much of a risk factor CPA represents among wealthier populations and how much not being abused may serve as a protective factor among poor inner-city populations.

Duran, B., Malcoe, L. H., Sanders, M., Waitzkin, H., Skipper, B., & Yager, J. (2004). Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care. Child Abuse Neglect, 28(2), pp. 131-145.

The purpose of this study was to examine the prevalence, types, and severity of child abuse and neglect, and study the relationship between child abuse and neglect and lifetime psychiatric disorders among 234 American Indian women using primary care services. Approximately three-quarters of respondents reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. Severe child maltreatment was strongly associated with lifetime PTSD, and was moderately associated with lifetime substance use disorders, mood disorders, and with two or more disorders. Child abuse and neglect was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for abuse and neglect and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women. These findings also confirm the importance of increasing funds and other resources for observation, primary prevention and treatment programs, and research of child abuse and neglect in American Indian populations.

Eiden, R. D., Foote, A., & Schuetze, P. (2007). Maternal cocaine use and caregiving status: Group differences in caregiver and infant risk variables. Addictive Behaviors, 32(3), pp. 465-476.

This study examined differences between cocaine and non-cocaine-using mothers, and between parental and non-parental caregivers of cocaine-exposed infants on caregiver childhood trauma, psychiatric symptoms, demographic, and perinatal risks. Participants included 115 cocaine and 105 non-cocaine mother-infant dyads recruited at delivery. Approximately 19% of cocaine mothers lost custody of their infants by 1 month of infant age compared to 0.02% of non-cocaine mothers. Mothers who used cocaine during pregnancy had higher demographic and obstetric risks. Their infants had higher perinatal risks. Birth mothers who retained custody of their infants had higher demographic risks and perinatal risks, higher childhood trauma, and higher psychiatric symptoms compared to birth mothers who did not use cocaine and non-parental caregivers of cocaine-exposed infants. Results highlight the importance of addressing childhood trauma issues and current psychiatric symptoms in substance abuse treatment with women who engaged in substance use during pregnancy.

Elwyn, L., & Smith, C. (2013). Child maltreatment and adult substance abuse: the role of memory. Journal of Social Work Practice in Addictions, 13(3), pp. 269-294.

This study examines whether memory of maltreatment is a necessary link in the path leading from prospectively measured childhood maltreatment to adult substance use problems. Official Child Protective Services reports and adult retrospective recall of childhood maltreatment were used to predict illegal drug use and alcohol problems in adulthood. Memory was a necessary link in the path between prospective reports of maltreatment and alcohol problems, and it was an important link in the path between prospective reports and illegal drug use.

Ezzo, F., & Young, K. (2012). Child maltreatment risk inventory: Pilot data for the cleveland child abuse potential scale. Journal of Family Violence, 27(2), pp. 145–155 DOI: 10.1007/s10896-012-9412-x

This article presents data on the development of a child maltreatment actuarial risk inventory, The Cleveland Child Abuse Potential Scale (C-CAPS). Results show that the instrument may have significant potential regarding its ability to detect child maltreatment. The overall factor structure of the instrument is reviewed. The authors argue that actuarial assessment instruments will outperform instruments which rely on clinical decision-making. Lastly, they argue that the tool could be used to assist child protective agencies and courts in determining the appropriateness of reunification plans if a child has been removed from their primary caregiver.

Felitti, V. J. (2002). The relation between adverse childhood experiences and adult health: Turning gold into lead. The Permanente Journal, 6(1), pp. 44-47. Available online at:

This article reports on the Adverse Childhood Experiences Study, a long term, in-depth analysis of over 17,000 adult Americans, matching their current health status against adverse childhood experiences that occurred on average a half-century earlier. The study found that adverse childhood experiences are quite common although typically concealed and unrecognized; that they still have a profound effect a half century later, and that they are the main determinant of the health and social well-being of the nation. The findings are of direct importance to the everyday practice of medicine and psychiatry because they indicate that much of what is recognized as common in adult medicine is the result of what is not recognized in childhood. The ACE Study challenges as superficial the current conceptions of depression and addiction, showing them to have a very strong dose-response relationship to antecedent life experiences.

Fenton, M. C., Geier, T., Keyes, K., Skodol, A. E., Grant, B. F., & Hasin, D. S. (2013). Combined role of childhood maltreatment, family history, and gender in the risk for alcohol dependence. Psychological Medicine, 43(5), pp. 1045-1057. DOI: 10.1017/S0033291712001729

This article looked at data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) and examined 1) the association between sexual abuse, physical abuse, emotional abuse, physical neglect and emotional neglect and adult lifetime DSM_IV alcohol dependence; 2) the specific relationship between each maltreatment and alcohol dependence, additionally controlling for the presence of any other maltreatments; 3) weather the relationship between each maltreatment and alcohol dependence remains significant and 4) whether parental history of alcohol dependence and each childhood maltreatment have synergistic effects on the risk for alcohol dependence. Result of the study show that childhood maltreatments independently increased the risk of alcohol dependence. The authors suggest that early identification and prevention, particularly among those with a family history, and could guide genetic research and intervention development, e.g. programs to reduce the burden of childhood maltreatment may benefit from addressing the negative long-term effects of maltreatments, including potential alcohol problems, across a broad range of childhood environments.

Freisthler, B. (2011). Alcohol use, drinking venue utilization, and child physical abuse: Results from a pilot study. Journal of Family Violence, 26(3), pp. 185-193. DOI: 10.1007/s10896-010-9352-2

A positive relationship between parents’ drinking and child physical abuse has been established by previous research. This paper examines how a parent’s use of drinking locations is related to physical abuse. A convenience sample of 103 parents answered questions on physical abuse with the Conflict Tactics Scale-Parent Child version (CTS-PC), current drinking behavior, and the frequency with which they drank at different venues, including bars and parties. Ordered probit models were used to assess relationships between parent demographics, drinking patterns, places of drinking, and CTS-PC scores. Frequent drinking, frequently going to bars, frequently going to parties in a parent’s own home, and frequently going to parties in friends’ homes had a positive correlation to child physical abuse. The number of drinking locations was positively related to child physical abuse such that parents who report attending and drinking at more of these venues were more likely to be perpetrators of physical abuse. This suggests that time spent in these venues provides opportunities to mix with individuals that may share the same attitudes and norms towards acting violently.

Freisthler, B., Kepple, N. J., & Holmes, M. R. (2012). The geography of drug market activities and child maltreatment. Child Maltreatment, 17(2), pp. 144-152.

This study examines how drug market activities place children at risk of maltreatment over space and time. Based on the data collected the authors posit that census tracts with more drug sales had higher numbers of substantiations, and those with more possessions also had more entries into foster care. The temporal delay between drug sales and child maltreatment referrals may indicate that the surveillance systems designed to protect children may not be responsive to changing neighborhood conditions or be indicative of the time it takes for the detrimental effects of the drug use to appear.

Fuller, T. L., & Wells, S. J. (2003). Predicting maltreatment recurrence among CPS cases with alcohol and other drug involvement. Children and Youth Services Review, 25(7), pp. 553-569.

The current study examined factors predictive of short-term (e.g. within 60 days) maltreatment recurrence among CPS cases with AOD involvement. The authors found that four factors were related to an increased risk of short-term maltreatment recurrence: 1) the safety assessment factor involving caretaker AOD use checked "yes;" 2) a high risk assessment rating for caretaker criminal behavior; 3) no police involvement during the investigation; and 4) families headed by single, African-American women. The findings of the current study have several implications for CPS practice. They underscore the importance of including information on caretaker substance use in ongoing safety and risk assessment activities. Once substance use has been identified as a risk factor, investigators should have tools that help them determine the history and extent of addiction, as well as associated problems such as criminal behaviors, health problems, and mental illness. It is vital for investigators to then translate this information into an effective safety plan that addresses the risks present.

Gill, D. F. (2012). Identifying child abuse. Clinician Reviews, 22(3), pp. 29-36.

This article, written form the point of view of a clinical nurse, makes the argument that nurses and doctors are well positioned to identify and report child abuse when they encounter it in their daily practice. It provides definitions of all the types of child abuse, risk factors, and provides a case study as an example.

Hager, A. D & Runtz, M. G. (2012). Physical and psychological maltreatment in childhood and later health problems in women: An exploratory investigation of the roles of perceived stress and coping strategies. Child Abuse and Neglect, 36(5), pp. 393-403.

This study investigated the association between childhood physical and psychological maltreatment and self-reported physical health concerns in adult women. Findings suggest that child maltreatment is an important risk factor for adverse health outcomes in later life and that current stress and coping strategies may influence this relationship. Implications for the physical health of maltreatment survivors are discussed. Practice implications: The management of perceived stress and the use of adaptive emotion-focused coping responses in the everyday lives of maltreated women may be particularly useful points of intervention in order to mitigate physical health concerns in adulthood.

Hart, H. & Rubia, K. (2012). Neuroimaging of child abuse: A critical review. Frontiers in Human Neuroscience, 6(52), pp. 1 – 24.

This article reviews the literature for associations between child maltreatment and cognitive and neuroimaging abnormalities. The authors outline current findings of neuropsychological studies, discusses findings of structural and functional deficits associated with childhood maltreatment as well as review the limitations of previous work done and discuss future work. Overall, the better controlled studies that show a direct correlation between childhood abuse and brain measures suggest that the most prominent deficits associated with early childhood abuse are in the function and structure of lateral and ventromedial fronto-limbic brain areas and networks that mediate behavioral and affect control. Future, large scale multimodal neuroimaging studies in medication-naïve subjects, however, are needed that control for psychiatric co-morbidities in order to elucidate the structural and functional brain sequelae that are associated with early environmental adversity, independently of secondary co-morbid conditions.

Herrenkohl, T. I, Hong, S., Klika, J. B., Herrenkohl, R. C., & Russo, M. J. (2012). Developmental impacts of child abuse and neglect related to adult mental health, substance use, and physical health. Journal of Family Violence, 28(2), pp. 191-199. DOI: 10.1007/s10896-012-9474-9

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. According to the authors, 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.

Herrenkohl, T. I., Hong, S., Klika, J. B., Herrenkohl, R. C., & Russo, M. J. (2013). Developmental impacts of child abuse and neglect related to adult mental health, substance use, and physical health. Journal of Family Violence, 28(1), pp. 191-199

This article presents the findings of a study which examined the association between officially recorded child abuse and neglect and adult mental health, substance use, and physical health outcomes. The results of the study show that adults maltreated as children reported more symptoms of adult depression, anxiety, and more impairment due to mental and physical health problems, they also reported lifetime alcohol problems and appear at greater risk for substance abuse.

Hien, D., Cohen, L. R., Caldeira, N. A., Flom, P., & Wasserman, G. (2010). Depression and anger as risk factors underlying the relationship between maternal substance involvement and child abuse potential. Child Abuse & Neglect, 34(1), pp. 105-113.

In this article, the authors examine the role emotion regulation deficits in the area of anger arousal and reactivity are associated with child abuse potential in mothers with substance use and depressive disorders. 152 urban mothers were interviewed on measures of substance use, diagnosis of depression, anger arousal and reactivity and child abuse potential. Results show that anger arousal and reactivity were found to be partial mediators of the relationship between diagnostic category and child abuse potential. The authors identify areas for prevention and treatment.

Howell, M. L. (2008). Decisions with good intentions: Substance use allegations and Child Protective Services screening decisions. Journal of Public Child Welfare, 2(3), pp. 293-316.

This quantitative study of decision-making factors related to screening maltreatment reports was conducted to investigate whether personal biases, values, and stereotypes surrounding parental drug use and race influenced screening decisions. In one southeastern state, 86 child welfare intake supervisors reviewed 10 scenarios alleging maltreatment. Participants decided which reports to accept for investigation, identified influential decision-making factors, and rated personal and organizational values surrounding parental drug use on a scale developed by the researcher. Participants' decision-making patterns suggest that when their values and child welfare policies conflicted in their desire to protect children, supervisors were willing to compromise policy standards for initiating investigations. The social justice implications of these findings are important for child welfare workers and administrators to consider.

Hurme, T. (2008). Risk factors for physical child abuse in infants and toddlers. European Journal of Pediatric Surgery, 18(6), pp. 387-391.

This study examined the risk factors and injuries in physical child abuse between November 2003 and February 2007. The uptake area of the University Hospital of Turku, Finland, consists of about 700,000 inhabitants. Forty-eight cases of physical child abuse were examined. The median age of the abused children was 2.2 years, for children with skull fractures it was 0.5 years. The incidence of child physical abuse increased during the study period; it was 0.6/month in 2004 and 1.7/month in 2006. Mortality in the study group was 2.1%.

Hyman, S. M., Garcia, M., & Sinha, R. (2006). Gender specific associations between types of childhood maltreatment and the onset, escalation and severity of substance use in cocaine dependent adults. American Journal of Drug and Alcohol Abuse, 32(4), pp. 655-664.

The authors examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. Results indicated that, in men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.

Jaffee, S. R., Bowes, L., Ouellet-Marin, I., Fisher, H. L., Moffitt, T. E., Merrick, M. T., & Arsenault, L. (2013). Safe, stable, nurturing relationships break the intergenerational cycle of abuse: A prospective nationally representative cohort of children in the United Kingdom. Journal of Adolescent Health, 53(4 Supplement), pp. S4-S10.

The purpose of this study was to identify contextual and interpersonal factors that distinguish families in which the intergenerational transmission of maltreatment is maintained from families in which the cycle is broken. Results show that supportive and trusting relationships with intimate partners, high levels of maternal warmth toward children, and low levels of partner violence between adults distinguished families in which mothers but not children experienced maltreatment from families in which mothers and children experienced maltreatment. Families in which only mothers experienced maltreatment were largely similar to families in which neither generation experienced maltreatment, except that mothers belonging to the former group were more likely to have a lifetime history of depression and low levels of social support. Safe, stable, nurturing relationships between intimate partners and between mothers and children are associated with breaking the cycle of abuse in families.

Juhnke, G. A., Henderson, K., & Juhnke, B. A. (2013). The Juhnke, Henderson, Juhnke child abuse and neglect risk assessment scale: a mnemonic instrument used to assess potential maltreatment of children. The Family Journal: Counseling and Therapy for Couples and Families, 21(1), pp. 57-64. DOI: 10.1177/1066480712456820

The primary intent of the authors is to describe the Juhnke, Henderson, Juhnke Child Abuse and Neglect Risk Assessment scale and its use as an aid to facilitate a thorough assessment of child sexual, physical abuse or neglect. The scale is an evidenced informed instrument that considers 20 child maltreatment risk factors identified by the U.S. Department of Health and Human Services (USDHHS) Office of Child Abuse and Neglect. The primary purpose of the scale is to facilitate a thorough maltreatment assessment and to generate guidelines that can be used, in conjunction with clinical judgment, to aid in the creation of an effective child protective agency report and potentially facilitate effective intervention.

LaFlair, L. N., Reboussin, B. A., Storr, C. L., Letourneau, E., Green, K. M., Motjabai, R., & Pacek, L. R. (2013). Childhood abuse and neglect and transitions in stages of alcohol involvement among women: A latent transition analysis approach. Drug and Alcohol Dependence. 132(3), pp. 491-498.

This study aimed to: (1) identify stages of women’s alcohol involvement, (2) examine the probability of transitions between stages, and (3) investigate the influence of four domains of childhood abuse and neglect (sexual abuse, physical abuse, neglect, and witness to domestic violence), assessed individually and as poly-victimization, on transitions. Based on the findings, the authors claim that women reporting any childhood abuse and neglect were more likely to advance from the non-problem drinking class at Wave 1 to severe and hazardous drinking classes at Wave 2 relative to women without this history. Associations were also observed between individual domains and transition from no problems to severe alcohol stage. Results suggest a long-term impact of childhood abuse and neglect as drivers of progression in women’s alcohol involvement.

Lanier, P., Kohl, P.L., Benz, J., Swinger, D., & Drake, B. (2014). Preventing Maltreatment with a Community-Based Implementation of Parent–Child Interaction Therapy. Journal of Child and Family Studies. 23(1), pp. 449-460. DOI: 10.1007/s10826-012-9708-8

The purpose of this study was to examine rates of child abuse and neglect reports following a community implementation of Parent–Child Interaction Therapy (PCIT), an evidence-supported intervention for the prevention of maltreatment. During the follow-up period, 12.5 % of families had a report for physical abuse or neglect. Reports of prior victimization as a child and prior perpetration as an adult were strong predictors of a report of perpetration after PCIT. Dosage of PCIT and change in clinical measures did not increase risk for a later report. PCIT can be an effective intervention for preventing maltreatment. Family history of child welfare involvement is a prominent factor in assessing risk for future involvement.

Laslett, A., Room, R., Dietze, P., & Ferris, J. (2012). Alcohol’s involvement in recurrent child abuse and neglect cases. Addiction, 107(10), pp. 1786-1793.

This paper examined whether or not: (a) care-giver ‘alcohol abuse’ is associated with recurrent child maltreatment; (b) other ‘risk factors’ affect this relationship; and (c) which of alcohol abuse or other drug abuse plays a stronger role. It also examined (d) how children and families where alcohol-related child abuse was identified were managed by child protection services (CPS) in Victoria, Australia. According to the results of this study, where career alcohol abuse was identified children were significantly more likely to experience multiple incidents compared with children where this was not identified, as were children where other family risk factors (including markers of socio-economic disadvantage) were identified. The majority of children whose carers were identified with alcohol abuse experienced either repeat incidents or interventions. Alcohol and drug abuse in carers are important risk-factors for recurrent child maltreatment after accounting for other known risk factors; the increased risk appears to be similar between alcohol and drug abuse.

Lee, S., Jonson-Reid, M., & Drake, B. (2012). Foster care re-entry: Exploring the role of foster care characteristics, in-home child welfare services and cross-sector services. Children and Youth Services Review, 34(9), pp. 1825–1833. DOI: 10.1016/j.childyouth.2012.05.007

This study seeks to advance the understanding of how modifiable and non-modifiable factors may impact the likelihood of re-entry into foster care. Results show that children removed from homes with parents who had multiple risk factors (e.g., no high school diploma, mental health diagnosis, criminal record, or teen parents) or were receiving AFDC prior to entry were more likely to re-enter. The receipt of in home child welfare services during or after foster care was associated with reduced risk of re-entry. Having the longest placement with a relative was associated with decreased risk of re-entry. The data also suggest that in-home child welfare services provided during and after foster care may be associated with improved long-term permanency after return home. Given the continued import of caregiver risk factors even among reunified families, services provided to support reunification should include attention to caregiver needs outside parenting.

Libby, A. M., Orton, H. D., Novins, D. K., Spicer, P., Buchwald, D., Beals, J., & Manson, S. M. (2004). Childhood physical and sexual abuse and subsequent alcohol and drug use disorders in two American-Indian tribes. Journal of Studies on Alcohol, 65(1), pp. 74-83.

The purpose of this study was to examine the relationship of childhood physical and sexual abuse to subsequent lifetime alcohol or drug use disorders between two American Indian tribes. A sample of 3,084 American Indians participated in a large-scale, community-based study. Participants were asked about traumatic events and family history and were administered standard diagnostic measures of substance use disorders. Prevalence of childhood physical abuse was approximately 7% for both tribes, and childhood sexual abuse was 4%-5%, much higher for females. Childhood physical abuse had a stronger effect than childhood sexual abuse on lifetime substance dependence. Childhood sexual abuse, on the other hand, was more associated with lifetime substance abuse. Females more commonly experienced childhood abuse but were less likely than males to develop substance use disorders. The results provide clinical guidance to constellations of risk factors and expand the population at risk to include males. This study is unique in that it is one of the few that examines tribal and cultural variations among American Indians. The authors provide several observations that would be helpful when developing interventions for this population.

Liebschutz, J., Savetsky, J.B., Saitz, R., Horton, N.J., Lloyd-Travaglini, C., & Samet, J.H. (2002). The relationship between sexual and physical abuse and substance abuse consequences. Journal of Substance Abuse Treatment, 22(3), pp. 121-128.

This study examines the relationship between past physical and sexual abuse and drug and alcohol related consequences. Three hundred fifty-nine male and 111 female subjects were recruited from an urban inpatient detoxification unit. Eighty-one percent of women and 69% of men report past physical and sexual abuse, starting at a median age of 13 and 11, respectively. Physical and sexual abuse was significantly associated with more substance abuse consequences for both men and women. This study reinforces the high rate of physical and sexual abuse among both men and women admitted for detoxification. Thus, future research should develop interventions to lessen the substance abuse consequences of physical and sexual abuse. There is a need for trauma and PTSD assessments among substance abuse clients, and battered women’s shelters should be aware of substance abuse issues among its clients.

Luke, N. & Banerjee, R. (2012). Differentiated associations between childhood maltreatment experiences and social understanding: A meta-analysis and systematic review. Developmental Review, 33(1), pp. 1-28.

This article examines the links between childhood physical abuse and neglect and skills of social understanding (including emotion recognition and understanding, perspective taking, false belief understanding, and attributional biases) in 51 empirical studies. The results of the review showed an overall negative effect of maltreatment, but moderation analyses revealed that significantly stronger effects were found for measures of emotion understanding rather than recognition, and for younger rather than older age groups. The broader review also reveals a complex and differentiated profile of social understanding among maltreated children.

Magura, S., & Laudet, A. B. (1996). Parental substance abuse and child maltreatment: Review and implications for intervention. Children and Youth Services Review, 18(3), pp. 193-220.

In this article the authors review the link between child abuse and neglect and parental substance abuse. The authors state that substance abuse interferes with parenting, and jeopardizes the child’s emotional, psychological and physical development. Authors advocate that treatment programs should including parenting and focus on the whole family.

Marshall, B. D., Galea, S., Wood, E., and Kerr, T. (2013). Longitudinal associations between types of childhood trauma and suicidal behavior among substance users: A cohort study. American Journal of Public Health, 103(9), pp. e69-e75.

In this study, the authors examined the longitudinal associations between different types and severities of childhood trauma and suicide attempts among illicit drug users. According to the results, individuals with severe to extreme levels of sexual abuse, physical abuse, and emotional abuse predicted suicide attempts, but not associated with increased risk of suicidal behavior. The authors conclude that severe abuse confer substantial risk of repeated suicidal behavior in adulthood. Illicit drug users require intensive secondary suicide prevention efforts, particularly among those with a history of childhood trauma.

McGlade A., Ware R., Crawford, M. (2009). Child protection outcomes for infants of substance-using mothers: a matched-cohort study. Pediatrics, 124(1), pp. 285-93.

Parental drug use is a critical public health issue; it is estimated to be present in up to 80% of referrals to Australian child protection agencies. However, no data regarding the child protection outcomes of infants of substance-using parents exist in Australia, and no comparisons have been made with infants of non-substance-using parents. We assessed differences in substantiated abuse between 2 groups of mothers in Brisbane to quantify this risk. Mothers who disclosed opiate, amphetamine, or methadone use between 2000 and 2003 were identified and compared with non-substance-using mothers who were matched for gender and gestational age. All infants were linked to the Department of Child Safety Child Protection Information System database. Child protection outcomes, such as substantiated notifications and entry into foster care, were compared between groups.

Miller, A. B., Esposito-Smythers, C., Weismoore, J. T., and Renshaw, K. D. (2013). The relation between child maltreatment and adolescent suicidal behavior: a systematic review and critical examination of the literature. Clinical Child and Family Psychology Review, 16(2), pp. 146-172. DOI: 10.1007/s10567-013-0131-5

In this review, the authors evaluated all of the research literature to date examining the relationship between child maltreatment (CM) and adolescent suicidal ideation and attempts. Results generally suggest that childhood sexual abuse, physical abuse, emotional abuse, and neglect are associated with adolescent suicidal ideation and attempts across community, clinical, and high-risk samples. The authors conclude with an overview of the clinical implications of this research, including careful, detailed screening of CM history, past suicidal behavior, and current suicidal ideation, as well as the need for integrated treatment approaches that effectively address both CM and adolescent suicidal ideation and suicide attempts.

Millet, L. S., Kohl, P. L., Jonson-Reid, M., Drake, B., & Petra, M. (2013). Child maltreatment victimization and subsequent perpetration of young adult intimate partner violence: An exploration of mediating factors. Child Maltreatment, 18(2), pp. 71-84. DOI: 10.1177/ 1077559513484821

This study examined whether young adults with documented histories of child maltreatment had higher records of documented severe intimate partner violence (IPV) perpetration than an income-matched control group. Results of the study found that that IPV perpetration rates were higher among maltreated than control participants and higher in maltreated men than in women. For men, maltreatment had both direct and mediated effects on IPV perpetration through violent delinquency. For women, maltreatment did not directly or indirectly predict IPV perpetration, though low power makes these findings tentative. The study highlights the importance of child maltreatment prevention as a way to reduce violence later in life and suggests that the juvenile justice system may also provide a point of intervention for the maltreated youth.

Najavits, L. M. (2009). Psychotherapies for trauma and substance abuse in women: Review and policy implications. Trauma, Violence & Abuse, 10(3), pp. 290-298.

Women are subject to high rates of interpersonal violence. One frequent co-occurring issue is substance abuse, which may arise post-trauma as a way to cope. In this article, psychosocial therapies for co-occurring trauma and substance abuse are reviewed. Description of empirically studied models is provided, as well as results of the empirical studies. Overall, this area of work suggests positive growth in the availability of new models but very limited empirical work thus far for all but one model. Directions for the future include the need for greater study of treatments in this area, as well as the need to address issues beyond specific models (e.g., workforce issues, access to care, and changing the culture of treatment systems). Policy implications are also offered.

Noll, J. G. (2009). In Trickett P. K., Harris W. W., Putnam F. W., Trickett P. K., Harris W. W. and Putnam F. W.(Eds.). Cumulative burden borne by offspring whose mothers were sexually abused as children. Journal of Interpersonal Violence, 21(3), pp. 424-449.

This multigenerational study empirically demonstrates the extent to which offspring whose parents experienced childhood abuse are at increased risk of being abused or neglected. Females with substantiated childhood sexual abuse and non-abused comparison females were assessed at six points spanning 18 years in a prospective, longitudinal study. Non-abusing parents or caregivers and offspring were also assessed. Descriptive results indicate that offspring born to mothers with histories of sexual abuse were more likely to be born preterm, have a teenage mother, and be involved in protective services. Abused mothers were more likely to be high-school dropouts, be obese, and have experienced psychiatric problems, substance dependence, and domestic violence. Results provide evidence for the advantages of intervention and prevention programs for victims of childhood maltreatment and their families. Primary prevention/intervention efforts extending throughout development and focusing on the cumulative risk to offspring will likely improve victim outcomes and curtail intergenerational transmission of adversity.

Onigu-Otite, E. C., & Belcher, H. (2012). Maternal drug abuse history, maltreatment, and functioning in a clinical sample of urban children. Child Abuse & Neglect, 36(6), pp. 491-497.

This article examined the association between maternal drug abuse history, maltreatment exposure, and functioning, in a clinical sample of young children seeking therapy for maltreatment. Approximately half (47.3%) of the children in the study had a history of maternal drug abuse (MDA). In this study, MDA history was associated with increased odds of and abandonment, and decreased odds of sexual abuse. In addition to maternal drug abuse, clinicians working with children need to identify other factors which could place the child at added risk for maltreatment. This study highlights the need for a multi-disciplinary approach to prevention and intervention programs needed to diminish adverse socio-environmental conditions prevalent in urban environments.

Palusci, V. J., & Ondersma, S. J. (2012). Services and recurrence after psychological maltreatment confirmed by child protective services. Child Maltreatment, 17(2), pp. 153-163. DOI: 10.1177/ 1077559511433817

Recurrence rates of psychological maltreatment (PM) and the services that may reduce those rates have not been systematically evaluated. The National Child Abuse and Neglect Data System was used for 2003–2007 to study a cohort of children in 18 states with PM reports first confirmed by child protective services (CPS) during 2003. PM recurrence rates after counseling and other referrals were assessed while controlling for factors associated with service referral and other maltreatment. A total of 11,646 children had a first CPS-confirmed report with PM, and 9.2% of them had a second-confirmed PM report within 5 years. Less than one fourth of families were referred for services after PM, with service referrals being more likely for families with poverty, drug or alcohol problems, or other violence. Controlling for these factors, counseling referral was associated with a 54% reduction in PM recurrence, but other services were not associated with statistically significant reductions. Few families in which PM was confirmed receive any services, and most services provided were not associated with reductions in PM recurrence. Clarification of key services associated with efficacious prevention of PM is needed.

Palusci, V. J., & Covington, T. M. (2014). Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System. Child Abuse & Neglect, 38(1), pp. 25-36.

This article looked at child deaths from cases from 2005 to 2009 in the U.S. National Child Death Review Case Reporting System to compare child and offender characteristics and to link that information with actions taken or recommended by review teams. Child, caretaker, and offender characteristics, and outcomes were compared to team responses, and findings were compared to published case series. Among 49,947 child deaths from 23 states entered into the Case Reporting System during the study period, there were 2,285 cases in which child maltreatment caused or contributed to fatality. Over one-half had neglect identified as the maltreatment, and 30% had abusive head trauma. Several child and offender characteristics were associated with specific maltreatment subtypes, and child death review teams recommended and/or planned several activities in their communities.

Pecora, P. J., Chahine, Z., & Graham, J. C. (2013). Safety and Risk Assessment Frameworks: Overview and Implications for Child Maltreatment Fatalities. Child Welfare, 92(2), pp. 143-160.

This article highlights current models used in child protection to assess safety and risk, and discusses implications for child maltreatment fatalities. The authors advance that current risk and safety practice approaches were not designed to accurately estimate the likelihood of low base-rate phenomena and have not been empirically tested in their ability to predict or prevent severe or fatal child maltreatment. They advance that, regardless of the ultimate effectiveness of safety and risk tools, competent assessment and decision making in child protection depend on sound professional judgment and a comprehensive systemic approach that transcends the use of specific tools.

Pederson, C. L., Vanhorn, D. R., Wilson, J. F., Martorano, L. M., Venema, J. M., & Kennedy, S. M. (2008). Childhood abuse related to nicotine, illicit and prescription drug use by women: Pilot study. Psychological Reports, 103(2), pp. 459-466.

A sample of 811 women ages 18 to 59 (M=26.0, SD=6.5) responded to an advertisement by telephone. Inquiries were made about childhood abuse status and adult use of alcohol, nicotine, and prescription and illicit drugs. Significant associations were noted for reported sexual, physical, and emotional childhood abuse with use of nicotine, marijuana, and antidepressants in adulthood. Reported childhood physical and emotional abuses were also significantly associated with use of cocaine and anxiolytics, and sexual abuse with antipsychotic use in adulthood. Only childhood emotional abuse was associated with the use of sleeping pills. Number of types of abuse was significantly related with use of nicotine, marijuana, cocaine, antidepressants, antipsychotics, and anxiolytics, whereas alcohol use was not related to any type of abuse. The long-term effects of childhood emotional abuse may be just as severe as physical or sexual abuse.

Pirard, S., Sharon, E., Kang, S.K., Angarita, G.A., & Gastfriend, D.R. (2005). Prevalence of physical and sexual abuse among substance abuse patients and impact on treatment outcomes. Drug and Alcohol Dependence, 78(1), pp. 57-64.

More than half of substance abusers entering addiction treatment report a history of physical or sexual abuse. It is unclear if such a history impacts treatment outcomes. This one-year follow-up study of 700 substance abusers sought to clarify the relationship between lifetime physical and/or sexual abuse and addiction treatment outcome to help address the specific needs of this population. This study found that abused subjects, predominantly women, were significantly more impaired at baseline on clinical dimensions including family/social severity and psychiatric severity as measured by the Addiction Severity Index, and general level of functioning than non-abused subjects. In addition, the abused group less frequently endorsed heroin and cocaine in favor of alcohol and polydrug use. Abused subjects reported more prior medical and psychiatric treatments. Abuse history was not a predictor of no-show for treatment. Over the 1-year follow-up, lifetime physical and/or sexual abuse was significantly associated with worse psychiatric status and more psychiatric hospitalizations and outpatient treatment despite receiving similar intensive addiction treatment. These findings indicate that substance abuse patients with lifetime physical or sexual abuse have worse treatment outcomes than their counterparts. The development of programs that would specifically address the needs of substance abusers with histories of abuse might improve the efficacy and lower the costs of treatment for this population.

Putnam-Hornstein, E. & Needell, B. (2011). Predictors of child protective service contact between birth and age five: an examination of California’s 2002 birth cohort. Children and Youth Services Review, 33(1), pp. 2400-2407.

This article presents findings from a study which used population-level birth data from children born in 2002 and used that data to describe children at greatest risk for maltreatment during the first five years of life. Results show that 11 of the 12 birth variables examined presented as significant predictors of contact with child protective services.

Richmond-Crum, M., Joyner, C., Fogerty, S., Ellis, M. L., & Saul, J. (2013). Applying a public health approach: The role of state health departments in preventing maltreatment and fatalities of children. Child Welfare. 92(2), pp. 99-117.

Child maltreatment prevention is traditionally conceptualized as a social services and criminal justice issue. Although these responses are critical and important, alone they are insufficient to prevent the problem. A public health approach is essential to realizing the prevention of child abuse and neglect. This paper discusses the public health model and social-ecology framework as ways to understand and address child maltreatment prevention and discusses the critical role health departments can have in preventing abuse and neglect. Information from an environmental scan of state public health departments is provided to increase understanding of the context in which state public health departments operate. Finally, an example from North Carolina provides a practical look at one state’s effort to create a cross-sector system of prevention that promotes safe, stable, and nurturing relationships and environments for children and families.

Robboy, J., & Anderson, K. G. (2011). Intergenerational child abuse and coping. Journal of Interpersonal Violence, 26(17), pp. 3526-3541. DOI: 10.1177/0886260511403758

The purpose of this investigation was to examine patterns of maltreatment and maladaptive coping among second-generation CSA survivors. It is hypothesized that: (a) maternal CSA history would be associated with a higher incidence of poly-victimization and maladaptive coping and (b) experiencing more forms of abuse would mediate the relation between maternal CSA history and maladaptive coping behaviors. The method used was a chart review of 139 sexually abused females aged 12 to 17, examining maternal abuse history, maladaptive coping behaviors, and child maltreatment. The results showed that poly-victimization differed as a function of maternal CSA history but maladaptive coping did not. Experiencing more types of abuse was associated with both self-injurious behaviors and substance use. In conclusion, results support the hypothesis that second generation CSA survivors are more likely to experience poly-victimization. Future research should address how intergenerational patterns of abuse might affect presenting symptomatology and treatment outcome.

Robertson, A. A., Baird-Thomas, C., & Stein, J. A. (2008). Child victimization and parental monitoring as mediators of youth problem behaviors. Criminal Justice and Behavior, 35(6), pp. 755-771.

This study examines the effects of family characteristics, parental monitoring, and victimization by adults on alcohol and other drug (AOD) abuse, delinquency, and risky sexual behaviors among 761 incarcerated juveniles. The majority of youth reported that other family members had substance abuse problems and criminal histories. These youth were frequently the victims of violence. Relationships between victimization, parental monitoring, and problem behaviors were examined using structural equation modeling. Monitoring was negatively related to all problem behaviors. However, type of maltreatment was related to specific problem behaviors. The effects of family substance abuse and family criminal involvement on outcomes were mediated by monitoring and maltreatment. The study underscores the need to provide family-focused and trauma-related interventions for juvenile offenders.

Rosenkranz, S. E., Muller, R. T., & Henderson, J. L. (2012). Psychological maltreatment in relation to substance use problem severity among youth. Child Abuse & Neglect, 36(5), pp. 438– 448.

The purpose of the current study was to look at psychological maltreatment experiences, examining the extent to which emotional abuse and emotional neglect predict substance use problem severity among youth. The results of the current study are consistent with those of a body of research describing the detrimental effects of psychological maltreatment. The findings have potential implications for the development and provision of trauma-informed youth substance use treatment services. The findings suggest that attending to the sequelae of psychological maltreatment may be important in assisting these youth in achieving successful treatment outcomes.

Schneiderman, J. U., Hurlburt, M. S., Leslie, L. K., Zhang, J. & McCue Horwitz, S. (2012). Child, caregiver, and family characteristics associated with emergency department use by children who remain at home after a child protective services investigation. Child Abuse and Neglect, 36(1), pp. 4-11.

The objective of this article is to examine emergency department (ED) use among children involved with child protective services (CPS) in the US but who remain at home, and to determine if ED use is related to child, caregiver and family characteristics as well as receipt of CPS services. ED use among children who remained at home receiving CPS services was similar to that of children who did not receive CPS services (35.6% and 37.4%, respectively). According to the findings, children with families who received CPS services, children 6 years or older, and children without a chronic health problem were less likely to use the ED. Children who remained at home in families identified with numerous stressors and, therefore, likely at high risk for future abuse and neglect were 1.73 times more likely to have repeat ED use than children in low risk families. Children who remain at home after a CPS evaluation are at high risk for ED use.

Slack, K. S., Berger, L. M., DuMont, K., Yang, M., Kim, B., Ehrhard-Dietzel, S., & Holl, J. L. (2011). Risk and protective factors for child neglect during early childhood: a cross-study comparison. Children and Youth Services Review, 33(1), pp. 1354-1363.

The results presented in this article are from three separate longitudinal studies to identify risk and protective factors associated with subsequent neglect during early childhood. Results show that economic and parenting factors were common risk factors among all three studies, along with parental depression and self-efficacy.

Smith, B.D., & Testa, M.F. (2002). The risk of subsequent maltreatment allegations in families with substance-exposed infants. Child Abuse & Neglect, 26(1), pp. 97-114.

This study seeks to assess the relationship between identified prenatal substance use and the risk of subsequent maltreatment allegations among families involved with child protective services, and to compare the types of safety threats encountered by children whose parents had SEI allegations to the types of safety threats faced by children whose parents had other types of allegations. A clearer understanding of these relationships can help child welfare agencies develop family-centered protective interventions that better balance the severity of risks posed by prenatal substance use against the harms of parent-infant separation and out-of-home placement. The authors found that the risk of subsequent allegations associated with parents whose child welfare case opened following an SEI allegation was compared to parents whose case opened following other types of allegations. The authors found that the likelihood of subsequent allegations was greater among parents in the SEI group. However, the increased risk resulted almost entirely from subsequent SEI-related allegations. Parents in the SEI group were not more likely to incur other types of allegations such as physical abuse or lack of supervision. The authors concluded that an increased risk of subsequent maltreatment has been used to justify opening child protective cases on the basis of an SEI allegation alone. The results suggest that concerns about SEI allegations might be balanced with concerns about other risks facing substance-exposed and non-exposed children and that child welfare authorities might pursue the same family-centered interventions with families having an SEI allegation that are pursued with families having other types of allegations.

Street, K., Whitlingum, G., Gibson, P., Cairns, P., & Ellis, M. (2008). Is adequate parenting compatible with maternal drug use? A 5-year follow-up. Child: Care, Health & Development, 34(2), pp. 204-206.

This prospective, cohort study compares child protection outcomes over the first 5 years of life in a group of children born to self-declared drug-using mothers recruited during pregnancy (cases) and a group of children matched for gestational age, chronological age, maternal neighborhood and place of delivery whose mothers made no such declaration of problematic drug use (controls). We monitored local child protection registers to identify cohort members who came to the attention of the local authority. RESULTS Of the 71 original cases and 142 original controls, 55 (77%) and 96 (68%) remained in the area enrolled in local schools at 5 years of age. In total, 26 (47.3%) of the case children were subject to child protection procedures compared with 18 (18.8%) of the control children. This risk difference of 28.5% (95% CI 13.2% to 43.9%) has increased marginally since our previous report in this journal of child protection outcomes at 18 months of age (32% vs. 7%). However, the level of intervention deemed necessary to protect the child has increased significantly with six cases (compared with one control child) taken into the care of the local authority. Despite early maternal intentions and multiple supportive interventions, 27% of children born to women with significant substance abuse problems in our area required child protection during the pre-school years. Child protection risk assessment procedures need to weigh problematic maternal drug use heavily. Intervention studies with child welfare outcomes are needed to identify the most effective harm reduction strategies and inform public debate on how we can minimize child abuse related to substance misuse.

Sun, A.-P., Freese, M. P., Fitzgerald, M. (2007). An Exploratory Study of Drug-Exposed Infants: Case Substantiation and Subsequent Child Maltreatment. Child Welfare, 86(3), pp. 33.

This study explores factors related to drug-exposed infants' case substantiation and subsequent child maltreatment. Child protective services computerized administrative data (from January 1998 to October 2001) were obtained from an urban Nevada county. The data included 457 drug-exposed infant cases. Chi-square, t-test, one-way ANOVA, and logistic regression were used to analyze the data. Results indicate that: (1) drug-exposed infant case substantiation was related to the type of drug exposure and the unit to which the case was assigned, but not to the mother's ethnicity; and (2) subsequent maltreatment among drug-exposed infants was related to the mother's age and prior parental alcohol abuse, but not to the type of drug exposure, nor to the initial drug-exposed infant status of case substantiation. Implications for child welfare practice and research are discussed.

Uliando, A. & Mellor, D. (2012). Maltreatment of children in out-of-home care: A review of associated factors and outcomes. Children and Youth Services Review, 34(12), pp. 2280-2286.

This paper provides an overview of the nature and consequences of the maltreatment of children in out-of-home care. It discusses maltreatment by individual perpetrators such as carers or other children, and maltreatment inflicted through policies, processes and decisions made within the child protection system. The impacts of maltreatment in out-of-home care on children are reviewed, and the child, worker and system factors that contribute to maltreatment of children in care are discussed. The need for changes in child protection services is highlighted.

Valtonen, K., Cameron Padmore, J., Sogren, M., & Rock, L. (2009). Lived experiences of vulnerability in the childhood of persons recovering from substance abuse. Journal of Social Work, 9(1), pp. 39-60.

The aim of the study was to deepen understanding of the context of vulnerability which is associated with drug-taking behavior and addiction. The researchers sought to identify recurring psychosocial and environmental factors in the childhood and early adulthood backgrounds of the participants. It is significant that nearly half of the Trinidad group and two-thirds of the Barbados group reported experience of rejection or abandonment in childhood. A profile of stressful or traumatic experiences was compiled for each participant, from which it was possible to identify co-occurring pairs of stressors, which suggest inter-relationships between the phenomena. Marked co-occurrence was found between domestic violence and alcoholism and domestic violence in the participants' family background.

Vaugt, E., Lanctot, N., Paquette, G., Collin-Vezina, D., & Lemieux, A. (2014). Girls in residential care: From child maltreatment to trauma-related symptoms in emerging adulthood. Child Abuse & Neglect, 38(1), pp. 114-122.

The current study examined the association between child maltreatment and trauma-related symptoms in emerging adulthood – over and above the incidence of such symptoms and conduct problems during adolescence – among a sample of female adolescents in residential care using data from a longitudinal study. Results of the study indicated that child maltreatment, especially emotional abuse and neglect, was related to anxious arousal, depression, and anger in emerging adulthood. This study showed that females from our sample often reported different types of maltreatment during childhood and that these traumatic experiences were significantly associated with poor adult psychological functioning.

Weiss, N. H., Tull, M. T., Lavender, J., & Gratz, K. L. (2013). Neglect Role of emotion dysregulation in the relationship between childhood abuse and probable PTSD in a sample of substance abusers. Child Abuse & Neglect, 37, pp. 944-954.

This study examined associations among childhood abuse, emotion dysregulation, and probable posttraumatic stress disorder (PTSD) within a sample of 93 substance use disorder (SUD) patients in residential treatment. SUD patients with probable PTSD reported (a) greater severity of childhood sexual, physical, and emotional abuse and (b) significantly higher levels of overall emotion dysregulation and the specific dimensions of difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Findings of the present study highlight a potential mechanism underlying the relationships between both childhood emotional and physical abuse and PTSD in SUD patients.

Welsh, J., Precey, G., & Lambert, P. (2008). Parents of children at risk—a multi-agency initiative to address substance misuse amongst parents whose children are at risk of neglect. Child Abuse Review, 17(6), pp. 454-462.

The article presents information about parents as substance abusers and the impact that this behavior has on young children. The authors comment on the report called "Hidden Harm" that was released in 2003 by the Advisory Council on the Misuse of Drugs. The report shows that the cities of Brighton and Hove in England have some of the highest percentages of parental drug abusers. The report also considers the needs of children affected by these circumstances and the health and developmental consequences that they face in such environments.

Widom, C. S., & Hiller-Sturmhofel, S. (2001). Alcohol abuse as risk factor for and consequence of child abuse. Alcohol Research and Health, 25(1), pp. 52-57.

The relationship between child abuse and the use or abuse of alcohol has two aspects. First, some findings have indicated that parental alcohol abuse may be associated with the physical or sexual abuse of children. Research findings in this area remain inconsistent, however. Second, the experience of being abused as a child may increase a person's risk for alcohol-related problems as an adult. This relationship has best been demonstrated in women who had been victims of childhood abuse. Several factors most likely contribute to or influence this relationship, including coping skills; antisocial behavior; and psychological problems, such as posttraumatic stress disorder. This article review studies assessing alcohol-related and non-alcohol-related factors that might contribute to parental child abuse and presents research findings concerning the relationship between childhood victimization and subsequent adult alcohol abuse. Within this discussion, the article explores how future research may identify further characteristics that could increase a person’s risk for developing alcohol abuse as a consequence of childhood victimization.

Widom, C. S., Schuck, A. M., & White, H. R. (2006). An examination of pathways from childhood victimization to violence: The role of early aggression and problematic alcohol use. Violence and Victims, 21(6), pp. 675-691.

Using prospective data from a cohort design study involving documented cases of child abuse and neglect and a matched control group, the authors examine two potential pathways between childhood victimization and violent criminal behavior: early aggressive behavior and problematic drinking. Results revealed different pathways for men and women. For men, child maltreatment has direct and indirect (through aggressive behavior and problematic alcohol use) paths to violence. For women, problematic alcohol use mediates the relationship between childhood victimization and violence, and, independent of child maltreatment, early aggression leads to alcohol problems, which lead to violence. The authors suggest that interventions for victims of childhood maltreatment need to recognize the role of early aggressive behavior and alcohol problems as risk factors for subsequent violence.

Wilson, H. W., & Widom, C. S. (2010). Predictors of drug-use patterns in maltreated children and matched controls followed up into middle adulthood. Journal of Studies on Alcohol and Drugs, 71(6), pp. 802-809.

This study examines whether child abuse; child neglect; demographic, family and social, behavioral, economic, and neighborhood risk; and protective factors predict different drug-use patterns into middle adulthood. Using a prospective cohort design, individuals with documented cases of childhood physical and sexual abuse and neglect (processed during 1967-1971) and a matched control group were followed into middle adulthood. Participants completed in-person interviews in 1989-1995 (average age 29), 2000-2002 (average age 39.5), and 2003-2004 (average age 41). The sample for this study included 374 women and 332 men. Four patterns of drug use were revealed: (a) abstinence and low use (34%), (b) adolescent and young adult limited use (31%), (c) chronic-persistent use (29%), and (d) late use (7%). The chronic-persistent pattern was associated with being male, parental substance-use problems, involvement in crime, and neighborhood problems. The late-use pattern was significantly associated with childhood neglect and being Black, when other risk factors were controlled; bivariate analyses also indicated associations with female gender, lower income, and greater neighborhood disadvantage. This study revealed two patterns of drug use involving substance use and substance-related problems in middle adulthood that are associated with different sets of risk factors. Further research is needed to understand the late-drug-use pattern, which appears to disproportionately involve low-income Black women with histories of childhood neglect. These individuals may be missed in efforts to prevent or reduce drug use among youths.

Young-Wolff, K. C., Kendler, K. S., Kericson, M. L., & Prescott, C. A. (2011). Accounting for the association between childhood maltreatment and alcohol-use disorders in males: A twin study. Psychological Medicine, 41, pp. 59-70. DOI: 10.1017/S0033291710000425

An association between childhood maltreatment and subsequent alcohol abuse and/or dependence (AAD) has been found in multiple studies of females. Less is known about the association between childhood maltreatment and AAD among males, and the mechanisms that underlie this association in either gender. One explanation is that childhood maltreatment increases risk for AAD. An alternative explanation is that the same genetic or environmental factors that increase a child's risk for being maltreated also contribute to risk for AAD in adulthood. Lifetime diagnosis of AAD was assessed using structured clinical interviews in a sample of 3527 male participants aged 19–56 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. The sources of childhood maltreatment–AAD association were estimated using both a matched case–control analysis of twin pairs discordant for childhood maltreatment and bivariate twin modelling. Approximately 9% of participants reported childhood maltreatment, defined as serious neglect, molestation, or physical abuse occurring before the age of 15 years. Those who experienced childhood maltreatment were 1.74 times as likely to meet AAD criteria compared with males who did not experience childhood maltreatment. The childhood maltreatment–AAD association largely reflected environmental factors in common to members of twin pairs. Additional exploratory analyses provided evidence that AAD risk associated with childhood maltreatment was significantly attenuated after adjusting for measured family-level risk factors. Males who experienced childhood maltreatment had an increased risk for AAD. Our results suggest that the childhood maltreatment–AAD association is attributable to broader environmental adversity shared between twins.

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