1. Lessons Learned from LONGSCAN: Lessons Learned from LONGSCAN: Findings from a 20-yr prospective study of maltreatment antecedents and consequences Presented at the 25 th Annual San Diego International Conference on Child and Family Maltreatment, January 22-28, 2011 1

2. Introduction Acknowledge Significant anniversaries Chadwick Center (35 years) San Diego Maltreatment Conference (25 years) LONGSCAN Consortium LONGitudinal Studies in Child Abuse and Neglect Completed 20 year prospective study Website http://www.iprc.unc.edu/longscan Age 4-12 data currently available (Data Archive: Cornell University)

3. LONGSCAN Principal Investigators East: Howard Dubowitz, MD, MSci South: Jonathan Kotch, MD, MPH Midwest: Richard Thompson, PhD Northwest: Diana English, PhD Southwest: Alan Litrownik, PhD CC: Des Runyan, MD, DrPH

4. Other LONGSCAN Investigators East Maureen Black, PhD; Steve Pitts, PhD; Raymond Starr, PhD South Christine Cox, PhD; Jon Hussey, PhD Midwest Patrick Curtis, PhD; Emalee Flaherty, MD; Mary Schneider, PhD Northwest Chris Graham, PhD; David Marshall, PhD Southwest John Landsverk, PhD; Rae Newton, PhD; Laura Proctor, PhD Coordinating Center Kant Bangdiwala, PhD; Mark Everson, PhD; Wanda Hunter, MPH; Liz Knight, MSW; Terri Lewis, PhD

5. LONGSCAN: A 20-Year Journey

8. Plan Session 1 Des Runyan, PI, Coordinating Center, University of North Carolina, Chapel Hill Overview, methods, and some descriptives Diana English, PI Northwest Site, University of Washington Characterizing maltreatment and other adversities Al Litrownik, PI Southwest Site, San Diego State University Outcomes of Child Welfare involvement

9. Plan Session 2 Howard Dubowitz, PI, Eastern Site, University of Maryland, Baltimore Maltreatment antecedents, father involvement Jonathan Kotch, PI Southern Site, University of North Carolina, Chapel Hill Maltreatment consequences Richard Thompson, PI Midwest Site, Juvenile Protective Association (Chicago, Illinois) Maltreatment consequences

10. LONGSCAN: LONGSCAN: Overview, methods, and descriptive findings Desmond Runyan, MD, DrPH The University of North Carolina at Chapel Hill 10

11. Overview of LONGSCAN Planning grant funded in 1989 Congressionally mandated Intended to address antecedents and consequences Planning grants to UNC and JPA of Chicago Solution to which type of sample: yes LONGitudinal Studies of Child Abuse & Neglect 5 distinct studies (East, South, Midwest, Northwest, & Southwest) 11

12. Each site has integrity as an independent study Collective efforts magnify impact Measurement & data coordinated at UNC coordinating center Common measures, coding, training, data entry Consortium governance agreement Committees for governance, measurement, analysis, and publications/dissemination For more information, see Runyan et al. 1998 Violence & Aggression

13. Current Status Data collection still on-going for 4 of 5 sites - Youth now 14 - 22 years old Data archived with the National Data Archive on Child Abuse and Neglect (NDACAN) - Age 4, 6, 8, and 12 interviews - Includes CPS record reviews - Over 130 scientific papers - Over 25 dissertations 13

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15. Data Collected (Baseline to age 18) InterviewsBaseline*4681214+ 16+18+ Child--116611761074895872721452 Caregiver--124712251130956925752283 Child or Caregiver 1354125012361140976947789472 15 Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18.

16. Data Collected (Baseline to age 18) InterviewsBaseline*4681214+ 16+18+ Site East282237255237190197162101 Midwest24522322521618117391-- South243221222190177176130174 Southwest330319299274236216217106 Northwest25425023522319218518991 16 Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18.

17. Sample Demographics Child DemographicsBaseline % Male48.5 % Caucasian26.2 % African American 53.3 % Other Race20.5 17

18. Measurement Guided by Social-Developmental-Ecological Theory (NRC, 1993; Bronfenbrenner, 1989; Hawkins & Catalano, 1996). Domains assessed: Child/Youth: Characteristics, functioning Caregiver: Characteristic, functioning Family microsystem: Home environment, functioning Macrosystem: Neighborhood, school, support 18

19. Measurement Multiple sources & methods Developed “just-in-time measurement batteries for ages 4, 6 and 8 years Reports/ratings/questionnaires (Child/Youth, Caregiver, and Teacher) Performance (Child/Youth) Situational tests/samples Official records (CPS) Presentation of measures Interview & Audio-Computer Assisted Self Interview (A-CASI) began at age 12 for child 19

20. LONGSCAN: LONGSCAN: Characterizing Maltreatment Longitudinally Diana J. English, PhD University of Washington 20

21. A First Consideration There are no simple solutions to complex problems……(Some French Guy)

22. Considerations How to characterize maltreatment longitudinally: Type Severity Chronicity Substantiated vs. Unsubstantiated or Indicated

23. # of Maltreatment Records/Referrals per Child (birth through age 16) 23 1 Record (17%) 2 Records (11%) 3 Records (8%) 4 Records (8%) 5 Records (5%) 8-22 Records (13%) 7 Records (3%) 6 Records (4%) Total N = 1354

24. LONGSCAN Maltreatment Coding Scheme * Subtypes Physical Abuse Sex Abuse Neglect Emotional Abuse Moral / Legal / Educational Neglect Lack of Supervision Failure to Provide Food Hygiene Clothing Shelter Medical Environment Substitute Care Severity Codes 27 Detail Types Head Torso Buttocks Limbs Violent handling Choking Burns Shaking Nondescript 9 subtypes * Modified Barnett, Manly, Cicchetti Coding Scheme 1993

25. LONGSCAN Maltreatment Coding* For Severity Severity is Coded on a Scale of 1 (low) through 6 (high) Each severity code has specific meaning Example: Physical Abuse to the Head/Face/Neck Severity 1 = No marks indicated Severity 2 = Minor marks Severity 3 = Numerous or non-minor marks Severity 4 = Emergency Room or medical treatment Severity 5 = Hospitalization for more than 24 Hours Severity 6 = Permanent Disability or Death * Modified Barnett, Manly, Cicchetti Coding Scheme 1993

26. # of Allegations by Maltreatment Type (birth through age 14) 26 # of Allegations Age Based on Baseline Sample (N = 1354)

27. # of Substantiations by Maltreatment Type (birth through age 14) 27 # of Substantiations Age Descriptive Stats (0-14): Total # of substantiations (0-14) = 2282 Total # of physical abuse substantiations (0-14) = 369 Total # of sexual Abuse substantiations (0-14) = 99 Total # of neglect substantiations (0-14) = 1456 Total # of emotional abuse substantiations (0-14) = 358 Frequencies (0-14): 49% have 1 or more substantiations 14% have 1 or more physical abuse substantiations 6% have 1 or more sexual abuse substantiations 41% have 1 or more neglect substantiations 17% have 1 or more emotional abuse substantiations Based on Baseline Sample (N = 1354)

28. Level of SeverityLow (percents of rows) HighTotal (% of col.) Types of Allegations1 (%)2 (%)3 (%)4 (%)5 (%) Physical Abuse292 (51.4)124 (21.8)128 (22.5)20 (3.5)4 (0.7)568 (22.8) Sexual Abuse13 (9.3)10 (7.1)64 (45.7)47 (33.6)6 (4.3)140 (5.6) Neglect: Failure to Provide279 (37.2)192 (25.6)171 (22.8)92 (12.3)17 (2.3)751 (30.1) Neglect: Lack of Supervision113 (22.3)86 (17.0)88 (17.4)170 (33.5)50 (9.9)507 (20.3) Emotional Abuse77 (16.7)39 (8.5)221 (47.9)51 (11.1)73 (15.8)461 (18.5) Neglect: Moral/Legal15 (22.1)24 (35.3)5 (7.4)13 (19.1)11 (16.2)68 (2.7) Total (percents of rows)789 (31.6)475 (19.0)677 (27.1)393 (15.8)161 (6.5)2495 (100) Number of Allegations by Severity, Birth through Age 16, Seattle-Site

29. Official Records vs. Youth Self Report Official records – someone in the community – friends, family, professionals call in a report to CPS, CPS determines the report is sufficient to take a complaint, and the complain is assigned to a form of investigation. Youth Self-Report – a youth reports on their experiences based on recall and perception.

30. Self Report of Abuse (birth through age 12) 30 * Indicators are NOT mutually exclusive (N = 881) ( N = 874) (N = 883)

31. Self Report of Abuse (age 12 through age 16) 31 * Indicators are NOT mutually exclusive (N = 705) ( N = 697) (N = 693)

32. Comparing Substantiations to Child Self-Report (birth through age 12) 32 Psychological Abuse (N = 883) 4.3% 18.6% 7.8% 80.9% 14.2% 3.2% 51.2% 7.7% 33.0% 8.1%

33. Maltreatment Chronicity (Seattle LONGSCAN) Extent and Continuity (Birth to Age 8 Interview, N=244) Situational 28% Limited Episodic 14% Limited Continuous 22% Extended Episodic 9% Extended Continuous 27% Data Source: mltx0607 Received from LS CSCC: 07/2006

34. Chronicity Extent predicted CBCL externalizing, socialization, depression and PTS Continuity predicted socialization, anxiety, depression, anger and PTS

35. Chronicity Chronicity (however defined) accounted for more of the variance in adaptive functioning (DLS & Socialization) than behavior or emotional functioning

36. Latent Class Analysis LCA’s by Age Group 0-3.11mo.4-7.11mo.8-12 Low Maltreatment69%73%81% Neglect/EMT15%10%8% PA/High Maltreatment 16%17%3% High Maltreatment (All Types) N/A 8%

37. Caveats for LCA Classes were not consistent across developmental periods PA/High maltreatment at earlier developmental stages but not age 12 – age 12 PA/EMT (no neglect) Most classes include neglect component Sexual abuse increased over time but not a distinct class

38. Beyond Yes / No Effective assessment requires a review of: All reports including substantiated & not substantiated; All types of abuse/neglect, not just the type reported in an incident; Levels of severity by types & patterns over-time; Age of onset of first experience or report.

39. Beyond Yes/No Maltreatment is a complex phenomena Importance of longitudinal approach Importance of psychological and/or emotional maltreatment Importance of continuity – imminent risk vs. cumulative harm

40. LONGSCAN: LONGSCAN: Child Welfare involvement and outcomes Al Litrownik, PhD San Diego State University 40

41. Southwest Site-San Diego Parent Study 5/90 through 10/91 removed for CAN 1,221 (birth-17), out-of-home > 5 months Procedures Interview child/caretaker 5, 11, & 17 mos Review records (e.g., DSS, Medicaid) LONGSCAN 330 (of 532) <3.5 yrs when removed Interview every year

42. Child Welfare Context Goals Protect/Maintain family/Stable/Promote development Responsibilities Assess risk/Recommend placement & services/Monitor adherence Attempts to promote Goals (e.g., Laws) Child & Family Service Reviews (1994) Adoption & Safe Families Act (1997) Many recommendations/perspectives (e.g., The Future of Children, 2004) What LONGSCAN tells us Parent Study (first 18 months after entry; birth to 17 year olds) Long Term (4 to 18 years) Describe results of 9 studies then summarize

43. Caregiver Drug & Alcohol Use (CDAU) 18-month post-removal record review 639 families CDAU based on court documents (e.g., caseworker reports, psychological evaluations) CDAU in 79% of families CDAU associated with younger, single parent, and neglect (Besinger, Garland, Litrownik, & Landsverk, 1999)

44. Multiple Placements 415 children (2 to 16 at removal) CBCL: Time 1 (6-mos) - Time 2 (18 mos) DSS record review (# placements 18 mos) Findings: 1 to 15 placements (mean=4.23) Child BPs predicted # subsequent placements # placements predicted subsequent BPs for those who did not have them initially (Newton, Litrownik, & Landsverk, 2000)

45. Permanent Placements at Age 6: Descriptives 254 Caregivers at Age 6 Reports from caregivers and children Caregiver Characteristics & Resources (e.g., SES, health) Adopt = Non-Kin Foster > Kin Foster > Reunified Family violence (CTS, Life Events, Things I’ve Seen & Heard) Reunified > family violence exposure Adoptive > Non-Kin Foster use of minor violence for discipline Adoptive witness < violence at home (Litrownik, Newton, Mitchell & Richardson, 2003)

46. Going Home 218 children in same placement age 4-6; reunified/not Measures: CBCL-Internalizing, MH services, social isolation, stressful life events (e.g., instability, family dysfunction, violence) (Lau, Litrownik, Newton, & Landsverk, 2003)

47. Structural Model* Family Dysfunction Mental Health Provider Contacts Internalizing Sx CBCL Reunification Age 4Age 6 *Model Fit Indices:  2 (19)=20.2, p=0.38; CFI=0.99; RMSEA=0.03; RMSR=0.04 Stressful Life Event Social Isolation Internalizing Sx CBCL Harm Instability Low Support Loneliness

48. Discipline Practices & Child Aggression 70 Kin and Non-Kin Foster parents at Age 8 Measures Caregiver: Discipline Methods and CBCL Children: Social Problem Solving Findings Harsh disciplinary practices: Kin > Non-Kin Parent Harsh disciplinary practices  use of aggressive problem solving strategies of children (DeRobertis & Litrownik, 2004)

49. Caregiver Stability 285 children from 6 to 8 Dependent variable: With same caregiver Classification & Regression Tree (CART) analysis to identify potential predictors Neighborhood/Community Home Environment Caregiver Characteristics Child Characteristics (Proctor, Randazzo, Litrownik, et al., under review)

50. Regression Tree: Same Caregiver 6 to 8 Total Sample = 285 Stable = 86% Unstable = 14% Adopted = 87 Stable = 98% Unstable = 2% Not Adopted = 198 Stable = 81% Unstable = 19% Lo/Med Dad Involvement=173 Stable = 78% Unstable = 22% Hi Dad Involvement = 25 Stable = 100%

51. Other Predictors of Stability Lower Levels of Family Expressiveness Higher Child Intellectual Functioning Positive Interviewer Ratings of Caregiver Lower Child Externalizing Behavior Problems

52. Resilience in Child Welfare Sample 40-50% of children in CW exhibit an internalizing or externalizing disorder Resilience: Positive adaptation despite significant adversity or trauma Dynamic; can change over time Objective: Pattern of resilience over time (age 6 to 14) Identify risk and protective factors (Proctor, Skriner, Roesch, & Litrownik, 2010)

53. Internalizing Behavior Problems

54. Externalizing Behavior Problems

55. Predictors of Resilient Outcomes Protective factors Early social competence Early cognitive ability Placement stability Risk factors: Late physical abuse Early sexual abuse

56. Antecedents: Re-reports Two LONGSCAN Child Welfare Cohorts (Northeast and Southeast) CPS report prior to age 4 Pattern of subsequent reports (4-14) Found 4 patterns Potential predictors Type of Placement or Living Caregiver Characteristics Alcohol Abuse Depression Ethnicity Type of Early Maltreatment (Physical, Sexual, Neglect) (Proctor, Litrownik, et al., In Preparation)

57. 4 Classes: Proportion with a Report

58. Re-Reports Significant predictors of reports Biological Caregiver Caregiver evidencing Alcohol Abuse Depression

59. Long Term Outcomes 190 youth Adopted (74) Reunified (71) Foster (45) CBCL (Broad-Band Internalizing and Externalizing Behavior Problems at ages 4 and 14) DISC Diagnoses at Age 14 (Litrownik, Proctor, et al., In Preparation)

60. Internalizing Problems (Raw Score)

61. Externalizing Problems (Raw Score)

64. Summary Protection & Family Maintenance Risk Reunification  fewer resources (e.g., services, economic, caregiver functioning), unstable stressful environments, violence exposure, re- reports Kin Foster > harsh discipline practices Protective Reunified more socially connected Stability & Development Stable placement/caregiver important Adopted youth more stability than other situations By early adolescence adopted youth develop more problems

65. Practice & Policy Implications There is no simple answer We could do a better job Each case is unique Requires full assessment (i.e., risk, functioning) Recognize potential problems and intervene (e.g.) Alcohol and drug treatment If reunify, need to provide resources If adopt, prepare adoptive parents for difficult teen years (e.g., anticipatory guidance)

66. The End : Session 1 Presentations

67. Questions & Comments Website: http://www.iprc.unc.edu/longscan National Data Archive on Child Abuse & Neglect http://www.ndacan.cornell.edu