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Background: We investigated the effectiveness of Nurse‐Family Partnership (NFP), a prenatal‐to‐age‐two‐years home‐visiting programme, in British Columbia (BC), Canada. Methods: For this randomised controlled trial, we recruited participants from 26 public health settings who were: <25 years, nulliparous, <28 weeks gestation and experiencing socioeconomic disadvantage. We randomly allocated participants (one‐to‐one; computer‐generated) to intervention (NFP plus existing services) or comparison (existing services) groups. Prespecified outcomes were prenatal substance exposure (reported previously); child injuries (primary), language, cognition and mental health (problem behaviour) by age two years; and subsequent pregnancies by 24 months postpartum. Research interviewers were masked. We used intention‐to‐treat analyses. (ClinicalTrials.gov, NCT01672060.) Results: From 2013 to 2016 we enrolled 739 participants (368 NFP, 371 comparison) who had 737 children. Counts for child injury healthcare encounters [rate per 1,000 person‐years or RPY] were similar for NFP (223 [RPY 316.17]) and comparison (223 [RPY 305.43]; rate difference 10.74, 95% CI ‐46.96, 68.44; rate ratio 1.03, 95% CI 0.78, 1.38). Maternal‐reported language scores (mean, M [SD]) were statistically significantly higher for NFP (313.46 [195.96]) than comparison (282.77 [188.15]; mean difference [MD] 31.33, 95% CI 0.96, 61.71). Maternal‐reported problem‐behaviour scores (M [SD]) were statistically significantly lower for NFP (52.18 [9.19]) than comparison (54.42 [9.02]; MD ‐2.19, 95% CI −3.62, −0.75). Subsequent pregnancy counts were similar (NFP 115 [RPY 230.69] and comparison 117 [RPY 227.29]; rate difference 3.40, 95% CI ‐55.54, 62.34; hazard ratio 1.01, 95% CI 0.79, 1.29). We observed no unanticipated adverse events. Conclusions: NFP did not reduce child injuries or subsequent maternal pregnancies but did improve maternal‐reported child language and mental health (problem behaviour) at age two years. Follow‐up of long‐term outcomes is warranted given that further benefits may emerge across childhood and adolescence. [ABSTRACT FROM AUTHOR]

The article focuses on understanding and addressing adverse childhood experiences (ACEs) amidst the COVID-19 pandemic, highlighting how increased family stress, financial strain, and mental health issues impact children's resilience and long-term outcomes. It emphasizes the role of healthcare and social service providers in identifying risks, promoting resilience, and advocating for supportive environments, especially given the pandemic's effects on family dynamics and community resources.

Although we do not know the specific mental health concerns of adolescents before this study, baseline data suggest that approximately half of the adolescents who responded (51%) had accessed mental health help in the 12 months prior to the assault [[2]]. Keywords: Sexual assault; Adolescents; Mental health; Longitudinal research EN Sexual assault Adolescents Mental health Longitudinal research 1799 1801 3 11/08/23 20231201 NES 231201 This article belongs to the Topical Collection Violence and Women's Mental Health. [Extracted from the article]

Maternal exposure to childhood maltreatment (CM) is associated with offspring behavioral problems; however, little work has examined these associations longitudinally across child development. This study examined the effects of maternal history of CM on trajectories of child internalizing and externalizing behavior measured from toddlerhood to preschool, and the role of maternal depressive symptoms and parenting behavior as potential mediators. Participants included 115 mother–child dyads recruited from a hospital maternity ward. Maternal CM was measured at 3-months postpartum. At 18, 36, and 60 months, maternal depressive symptoms and child behavior were assessed via maternal report and parenting behavior was assessed through direct observation. Findings indicated that children of mothers exposed to CM demonstrated poorer trajectories of problem behavior across early childhood. Maternal depressive symptoms mediated the relation between CM and children's internalizing problems. Findings highlight the importance of screening for maternal depressive symptoms and early intervention for maternal and child mental health. [ABSTRACT FROM AUTHOR]

Exposure to adverse childhood experiences (ACEs) is associated with oxytocin dysregulation in women, such as decreased peripheral oxytocin concentrations, but little is known about vulnerability markers for oxytocin dysregulation in mothers exposed to ACEs. Identifying vulnerability markers may help inform future targets for prevention and intervention programmes. This study provided a preliminary examination of emotion regulation as a potential moderator of the association between maternal ACEs and peripheral oxytocin levels. The current study included a sample of 38 postpartum women. Women completed questionnaires on exposure to ACEs and difficulties with emotion regulation. At a clinic visit at 9 months postpartum, women provided plasma and salivary oxytocin samples anchored around a mother-infant interaction. Associations between maternal ACEs, three dimensions of difficulties with emotion regulation, and peripheral oxytocin concentrations were examined. Linear regression analyses showed that greater difficulties engaging in goal-directed behaviour (β = − 0.50, p = 0.01) and more limited access to effective emotion regulation strategies (β = − 0.68, p < 0.001) were related to reduced plasma oxytocin concentrations in postpartum women. Furthermore, in postpartum women reporting greater exposure to ACEs, higher levels of nonacceptance of emotional responses (β = − 0.55, p = 0.01) and more limited access to effective emotion regulation strategies (β = − 0.54, p = 0.01) were associated with reduced salivary oxytocin response (i.e. decreased change in oxytocin concentrations from baseline) following mother-infant interaction. Difficulties with emotion regulation may serve as a vulnerability marker for oxytocin dysregulation in postpartum women exposed to ACEs, and this suggests that emotion regulation may be an important target for future clinical interventions. Future research is recommended which replicates these preliminary results and which examines how emotion regulation and peripheral oxytocin levels in mothers exposed to ACEs are associated with parenting and child development outcomes. [ABSTRACT FROM AUTHOR]

Objective: Does exposure to prenatal and postnatal adversity have the same long-term effects on brain development in humans? Methods: We examined whether these two types of exposures differed from their demographically matched controls on a frontal EEG alpha/delta ratio score, a proxy of brain maturation. Young adults born at extremely low birth weight (prenatal adversity; N = 64, Mage = 23.14 years, SDage = 1.26 years) had a lower alpha/delta ratio score compared to normal birth weight controls (N = 76, Mage = 23.60 years, SDage = 1.09 years), while youth exposed to child maltreatment (postnatal adversity; N = 39, Mage = 16.18 years, SDage = 1.15) had a higher alpha/delta ratio compared to controls (N = 23, Mage = 16.00 years, SDage = 1.50 years). Our results suggest that being exposed to pre- and post-natal adversity may have different long-term consequences on brain development. We speculate that these differences might be associated with some of the different functional outcomes known to characterize each type of adverse experience. [ABSTRACT FROM AUTHOR]

Objective: Co-occurring mental health and substance use disorders (concurrent disorders) lead to significant morbidity in children and youth. Programs for integrated treatment of concurrent disorders have been developed; however, there exists little guidance outlining their structure and activities. Our objective was to synthesize available information on outpatient child and youth concurrent disorders programs and produce a comprehensive framework detailing the components of such programs. Methods: We used a four-stage critical interpretive synthesis design: (1) systematic review of published and grey literature, (2) data abstraction to identify program components and purposive sampling to fill identified gaps, (3) organization of components into a structured framework, (4) feedback from programs. We employed an iterative process by which programs reviewed data abstraction and framework development and provided feedback. Results: Through systematic review (yielding 1,408 records total and 7 records eligible for inclusion) and outreach strategies (yielding an additional 7 eligible records), we identified 11 programs (4 American, 7 Canadian) and 2 theoretical models from which data could be abstracted. Program activities were categorized into 12 overarching constructs that make up the components of the framework: accessibility, engagement, family involvement, integrated assessment, psychotherapy for patients, psychotherapy for families, medication management, health promotion, case management, vocational support, recreation and social support, and transition services. Program components are informed by the philosophical orientation of the program and models of care. This framework considers health system factors, clinical service factors, program development, and community partnership that impact program structure and activities. Multidisciplinary teams provide care and include addiction medicine, psychiatry, psychology, nursing, social work, occupational therapy, recreation therapy, peer support, and program evaluation. Conclusion: We developed a comprehensive framework describing components of child and youth outpatient concurrent disorders programs. This framework may assist programs currently operating, and those in development, to reflect on their structure and activities. [ABSTRACT FROM AUTHOR]

The article discusses developments in intimate partner violence (IPV). Topics mentioned include the major types of IPV, the epidemiology, risk indicators, and health effects of IPV, different ways on how to identify, document, and prevent IPV, the differences in IPV between rural and urban areas, and some suggestions for best practice in psychiatry.

Introduction: Dissociative experiences resulting in disruptions in the integration of an organized sense of self are one consequence of childhood maltreatment, and is associated with psychopathology and maladjustment across development. Despite the consequences of dissociative experiences, we know relatively little about the physiological factors associated with the development of dissociative experiences in children exposed to maltreatment. Methods: Using a 3-wave short-term prospective design, we examined the influence of resting frontal alpha asymmetry at rest on the trajectory of dissociative experiences in a sample of adolescents exposed to documented child maltreatment (N = 55; Mage = 15.93, SDage = 1.02). Results: Adolescents with greater relative left frontal alpha asymmetry at rest exhibited increasing trajectories of dissociative experiences over one year. Discussion: Our results are discussed in the context physiological indexes of emotion dysregulation associated with dissociative experiences in youth exposed to child maltreatment. [ABSTRACT FROM AUTHOR]

Although child maltreatment is a major public health concern, which adversely affects psychological and physical development, we know relatively little concerning psychophysiological and personality factors that may modify risk in children exposed to maltreatment. Using a three-wave, short-term prospective design, we examined the influence of individual differences in two disparate psychophysiological measures of risk (i.e., resting frontal brain electrical activity and respiratory sinus arrhythmia) on the trajectories of extraversion and neuroticism in a sample of female adolescents (N = 55; M age = 14.02 years) exposed to child maltreatment. Adolescents exposed to child maltreatment with relatively higher left frontal absolute alpha power (i.e., lower brain activity) at rest exhibited increasing trajectories of extraversion, and adolescents exposed to child maltreatment with relatively lower respiratory sinus arrhythmia at rest displayed increasing trajectories of neuroticism over 1 year. Individual differences in psychophysiological measures indexing resting central and peripheral nervous system activity may therefore differentially influence personality characteristics in adolescent females exposed to child maltreatment. [ABSTRACT FROM AUTHOR]

Children exposed to intimate partner violence (CE-IPV) are at increased risk for later health and social difficulties. To date, studies have primarily focused on CE-IPV as a unitary construct; this may lead to the mistaken assumption that all subtypes of CE-IPV (i.e., exposure to direct or indirect physical abuse, or exposure to emotional abuse) are equally harmful requiring similar responses from child welfare services. The purpose of this study was to examine child welfare responses by CE-IPV subtype in a large Canadian child welfare sample. Using data from the Canadian Incidence Study of Reported Child Abuse and Neglect–2008 (N = 2,184), we examined child welfare responses to CE-IPV subtypes or their co-occurrence. Information was obtained from child welfare workers' reports. Cases with co-occurring subtypes of CE-IPV were more likely to be substantiated and involved multiple incidents compared with that with single CE-IPV subtypes. Cases with direct physical CE-IPV and co-occurring CE-IPV were also more likely to remain open and have an application considered or made to child welfare court. Exposure to emotional IPV was the least likely to warrant interventions by welfare services, including referrals to specialized services. These results suggest that within CE-IPV subtypes, there is evidence of different responses (recommendations and services) once a case has been opened by a worker. Future research is needed to examine the effectiveness of the responses and outcomes for children following child welfare interventions. [ABSTRACT FROM AUTHOR]

There is widespread recognition across the full range of applied research disciplines, including health and social services, about the challenges of integrating scientifically derived research evidence into policy and/or practice decisions. These "disconnects" or "knowledge-practice gaps" between research production and use have spawned a new research field, most commonly known as either "implementation science" or "knowledge translation." The present paper will review key concepts in this area, with a particular focus on "integrated knowledge translation" (IKT)-which focuses on researcher-knowledge user partnership-in the area of mental health and prevention of violence against women and children using case examples from completed and ongoing work. A key distinction is made between the practice of KT (disseminating, communicating, etc.), and the science of KT, i.e., research regarding effective KT approaches. We conclude with a discussion of the relevance of IKT for mental health intervention research with children and adolescents. [ABSTRACT FROM AUTHOR]

Despite numerous studies identifying a broad range of harms associated with the use of spanking and other types of physical punishment, debate continues about its use as a form of discipline. In this commentary, we recommend four strategies to move the field forward and beyond the spanking debate including: 1) use of methodological approaches that allow for stronger causal inference; 2) consideration of human rights issues; 3) a focus on understanding the causes of spanking and reasons for its decline in certain countries; and 4) more emphasis on evidence-based approaches to changing social norms to reject spanking as a form of discipline. Physical punishment needs to be recognized as an important public health problem. [ABSTRACT FROM AUTHOR]

Objective: Child abuse can have devastating mental health consequences. Fortunately, not all individuals exposed to child abuse will suffer from poor mental health. Understanding what factors are related to good mental health following child abuse can provide evidence to inform prevention of impairment. Our objectives were to 1) describe the prevalence of good, moderate, and poor mental health among respondents with and without a child abuse history; 2) examine the relationships between child abuse and good, moderate, and poor mental health outcomes; 3) examine the relationships between individual- and relationship-level factors and better mental health outcomes; and 4) determine if individual- and relationship-level factors moderate the relationship between child abuse and mental health.Method: Data were from the nationally representative 2012 Canadian Community Health Survey: Mental Health ( n = 23,395; household response rate = 79.8%; 18 years and older). Good, moderate, and poor mental health was assessed using current functioning and well-being, past-year mental disorders, and past-year suicidal ideation.Results: Only 56.3% of respondents with a child abuse history report good mental health compared to 72.4% of those without a child abuse history. Individual- and relationship-level factors associated with better mental health included higher education and income, physical activity, good coping skills to handle problems and daily demands, and supportive relationships that foster attachment, guidance, reliable alliance, social integration, and reassurance of worth.Conclusions: This study identifies several individual- and relationship-level factors that could be targeted for intervention strategies aimed at improving mental health outcomes following child abuse. [ABSTRACT FROM AUTHOR]

Background: Family physicians and other primary care practitioners are encouraged or expected to screen for an expanding array of concerns and problems including intimate partner violence (IPV). While there is no debate about the deleterious impact of violence and other adverse psychosocial exposures on health status, the key question raised here is about the value of routine screening in primary care for such exposures. Discussion: Several characteristics of IPV have led to consideration for routine IPV screening in primary care and during other healthcare encounters (e.g., emergency room visits) including: its high prevalence, concern that it may not be raised spontaneously if not prompted, and the burden of suffering associated with this exposure. Despite these factors, there are now three randomized controlled trials showing that screening does not reduce IPV or improve health outcomes. Yet, recommendations to routinely screen for IPV persist. Similarly, adverse childhood experiences (ACEs) have several characteristics (e.g., high frequency, predictive power of such experiences for subsequent health problems, and concerns that they might not be identified without screening) suggesting they too should be considered for routine primary care screening. However, demonstration of strong associations with health outcomes, and even causality, do not necessarily translate into the benefits of routine screening for such experiences. To date, there have been no controlled trials examining the impact and outcomes - either beneficial or harmful - of routine ACEs screening. Even so, there is an expansion of calls for routine screening for ACEs. Summary: While we must prioritize how best to support and intervene with patients who have experienced IPV and other adverse psychosocial exposures, we should not be lulled into a false sense of security that our routine use of "screeners" results in better health outcomes or less violence without evidence for such. Decisions about implementation of routine screening for psychosocial concerns need similar rigorous debate and scrutiny of empirical evidence as that recommended for proposed physical health screening (e.g., for prostate and breast cancer). [ABSTRACT FROM AUTHOR]

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design ( n = 23,395; household response rate = 79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR = 15.8; 95% CI = 10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse. [ABSTRACT FROM AUTHOR]

Resources addressing intimate partner violence (IPV) play a role in shaping how physicians conceptualize and perform their roles in caring for affected patients. This study combines environmental scanning with critical discourse analysis (CDA) to parse how roles of physicians were represented in 28 education materials and policy documents about IPV, taking the Canadian training milieu as an example. We developed a cyclical model of three core physician roles in addressing IPV—learning about IPV, identifying patients experiencing IPV, and responding to patients' disclosures of IPV. The construction of these physician roles is suggestive of an ongoing process of medicalization of IPV. [ABSTRACT FROM AUTHOR]

Children exposed to intimate partner violence (IPV) are at increased risk of experiencing behavioral difficulties including externalizing and internalizing problems. While there is mounting evidence about mental health problems in children exposed to IPV, most of the research to date focuses on IPV exposure as a unitary, homogeneous construct. The purpose of this study was to examine the association between subtypes of IPV exposure on child functioning and presence of harm within a child welfare sample. Given the evidence of the “double whammy” effect, co-occurring IPV exposure was also examined. Using data from the Canadian Incidence Study of Reported Child Abuse and Neglect – 2008 ( n = 2,184) we examined whether specific IPV exposure subtypes or their co-occurrence resulted in a greater risk of child maladjustment. Information was obtained from child welfare workers’ reports. Caregiver and household risk factors were also examined. Co-occurring IPV exposure resulted in the greatest risk for reported child maladjustment. Exposure to emotional IPV and direct physical IPV were significantly associated with increased risk of internalizing problems and presence of harm. Caregiver mental health and lack of social support emerged as significant risk factors for behavior problems. This study adds to the evidence that exposure to subtypes of IPV may be differentially related to child functioning. Given that risk factors and child functioning is part of the decision-making framework for case worker referrals, this study provides important preliminary evidence about how the child welfare system operates in practice with respect to sub-types of exposure to IPV. These findings suggest that intervening with children exposed to different types of IPV may require a tailored approach. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is endemic in societies around the world and detrimental to women's wellbeing. Abused women are frequent users of health services. Despite the recent World Health Organization guidelines on IPV and sexual violence, we need more evidence on effective responses to women in health care settings. Developing robust evidence with potential to inform policy and clinical practice requires greater clarity and consistency across studies in the selection and use of outcomes to evaluate interventions. Drawing on systematic reviews and individual trials aimed at reducing abuse and improving women's health, we discuss critical issues in respect of outcomes. We discuss primary, secondary, intermediate and proxy outcomes and measures used to evaluate interventions for women who experience IPV. We offer recommendations about which outcomes to assess and approaches to doing so within the context of trials in health care settings. [ABSTRACT FROM AUTHOR]

Abstract: Children's exposure to intimate partner violence (IPV) is increasingly recognized as a type of child maltreatment that has a level of impairment similar to other types of abuse and neglect. Despite advances in the area of IPV, the safety planning strategies recommended as part of the overall response to IPV need to be examined in terms of their implications for children. This article discusses these strategies within the context of child safety, comparing IPV safety planning with approaches aimed at reducing exposure to other types of violence such as child sexual abuse, as well as general child safety strategies. Despite the emphasis on safety planning in information available on responding to IPV, the actual effectiveness of such planning in improving safety and reducing violence is unknown. Safety planning provided to children by a parent experiencing IPV, especially when IPV is ongoing and not recognized by anyone outside the home, may lead to confusing messages for children, particularly if there is an emphasis on secrecy. While awaiting evidence about the effectiveness of specific safety planning strategies for children, we suggest basic principles and general strategies that emphasize universality in terms of education about any type of violence or abuse in the home being unacceptable, as well as the need to focus on safety in general. [Copyright &y& Elsevier]

Exposure to intimate partner violence is increasingly being recognized as a form of child maltreatment; it is prevalent, and is associated with significant mental health impairment and other important consequences. The present article provides an evidence-based overview regarding children's exposure to intimate partner violence, including epidemiology, risks, consequences, assessment and interventions to identify and prevent both initial exposure and impairment after exposure. It concludes with specific guidance for the clinician. [ABSTRACT FROM AUTHOR]

Caregiver-fabrïcated illness in a child is a form of child maltreatment caused by a caregiver who falsifies and/or induces a child's illness, leading to unnecessary and potentially harmful medical investigations and/or treatment. This condition can result in significant morbidity and mortality. Although caregiver-fabricated illness in a child has been widely known as Munchausen syndrome by proxy, there is ongoing discussion about alternative names, including pediatric condition falsification, factitious disorder (illness) by proxy, child abuse in the medical setting, and medical child abuse. Because it is a relatively uncommon form of maltreatment, pediatricians need to have a high index of suspicion when faced with a persistent or recurrent illness that cannot be explained and that results in multiple medical procedures or when there are discrepancies between the history, physical examination, and health of a child. This report updates the previous clinical report "Beyond Munchausen Syndrome by Proxy: Identification and Treatment of Child Abuse in the Medical Setting." The authors discuss the need to agree on appropriate terminology, provide an update on published reports of new manifestations of fabricated medical conditions, and discuss approaches to assessment, diagnosis, and management, including how best to protect the child from further harm. [ABSTRACT FROM AUTHOR]

Epidemiological surveys measuring the prevalence of child maltreatment generate essential knowledge that is required to enhance human rights, promote gender equality, and reduce child abuse and neglect and its effects. Yet, evidence suggests Institutional Review Boards (IRBs) may assess the risk of these studies using higher than normal thresholds, based on a perception they may cause high distress to participants. It is essential for IRBs and researchers to have an accurate understanding of the nature and extent of participant distress associated with these studies, and of the duties of researchers towards survey participants, so that meritorious research is endorsed and duties to participants discharged. Assessment by IRBs of the ethics of such research must be appropriately informed by scientific evidence, ethical principles, and legal requirements. This article adds to knowledge by considering participant distress in child maltreatment surveys and its appropriate ethical and operational treatment. We provide an updated overview of scientific evidence of the frequency and severity of distress in studies of child maltreatment, a review of ethical requirements including a focus on beneficence and participant welfare, and a new analysis of researchers' legal duties towards participants. Our analyses demonstrate that participant distress is infrequent and transitory, that researchers can satisfy ethical requirements towards participants, and that legal liability does not extend to emotional distress. Informed by these bodies of knowledge, we distil key principles of good epidemiological practice to provide solutions to operational requirements in these surveys, which both fulfil ethical requirements to participants, and demonstrate trauma-informed practice. [ABSTRACT FROM AUTHOR]

This JAMA Insights Clinical Update reviews clinical indicators of intimate partner violence (IPV) and ways that clinicians can ask about and begin to assist individuals who experienced IPV in phased, sensitive approaches that do not encourage patients to act before they are ready or compromise their autonomy or safety. [ABSTRACT FROM AUTHOR]

In this article, the authors focus on risk factors, prevalence and special population associated with intimate partner violence (IPV). They state that IPV includes physical aggression such as hitting, beating and psychological abuse, which can result in depressive disorders. They also state that IPV occurs in all type of social groups in the world and IPV increases risk of violence exposure to children.

Abstract: Objectives: Exposure to child maltreatment is associated with physical, emotional, and social impairment, yet in Canada there is a paucity of community-based information about the extent of this problem and its determinants. We examined the prevalence of child physical and sexual abuse and the associations of child abuse with early contextual, family, and individual factors using a community-based sample in Ontario. Methods: The Ontario Child Health Study is a province-wide health survey of children aged 4 through 16 years. Conducted in 1983, a second wave was undertaken in 1987 and a third in 2000–2001. The third wave (N =1,928) included questions about exposure to physical and sexual abuse in childhood. Results: Males reported significantly more child physical abuse (33.7%), but not severe physical abuse (21.5%), than females (28.2% and 18.3%, respectively). Females reported significantly more child sexual abuse (22.1%) than males (8.3%). Growing up in an urban area, young maternal age at the time of the first child''s birth, and living in poverty, predicted child physical abuse (and the severe category), and sexual abuse. Childhood psychiatric disorder was associated with child physical abuse (and the severe category), while parental adversity was associated with child sexual abuse and severe physical abuse. Siblings of those who experienced either physical abuse or sexual abuse in childhood were at increased risk for the same abuse exposure; the risk was highest for physical abuse. Conclusions: These findings highlight important similarities and differences in risk factors for physical and sexual abuse in childhood. Such information is useful in considering approaches to prevention and early detection of child maltreatment. Clinicians who identify physical abuse or sexual abuse in children should be alert to the need to assess whether siblings have experienced similar exposures. This has important implications for assessment of other children in the home at the time of identification with the overall goal of reducing further occurrence of abuse. [Copyright &y& Elsevier]

Objective: Child maltreatment is linked with numerous adverse outcomes that can continue throughout the lifespan. However, variability of impairment has been noted following child maltreatment, making it seem that some people are more resilient. Our review includes a brief discussion of how resilience is measured in child maltreatment research; a summary of the evidence for protective factors associated with resilience based on those studies of highest quality; a discussion of how knowledge of protective factors can be applied to promote resilience among people exposed to child maltreatment; and finally, directions for future research. Method: The databases MEDLINE and PsycINFO were searched for relevant citations up to July 2010 to identify key studies and evidence syntheses. Results: Although comparability across studies is limited, family-level factors of stable family environment and supportive relationships appear to be consistently linked with resilience across studies. There was also evidence for some individual-level factors, such as personality traits, although proxies of intellect were not as strongly related to resilience following child maltreatment. Conclusions: Findings from resilience research needs to be applied to determine effective strategies and specific interventions to promote resilience and foster well-being among maltreated children. [ABSTRACT FROM AUTHOR]

Objectives. Reports on child health in Canada often refer to the disproportionate burden of poor health experienced by Aboriginal children and youth, yet little national data are available. This paper describes the health of First Nations and Inuit children and youth based on the First Nations and Inuit Regional Health Survey (FNIRHS). Study design. The FNIRHS combines data from 9 regional surveys conducted in 1996-1997 in Aboriginal reserve communities in all provinces. The target population consisted of all onreserve communities. All households or a random sample of households or adults (depending on province) were selected based on their population representation. Methods. One child was randomly selected from each participating household, except in Ontario and Nova Scotia, where children were randomly selected based upon their population representation. Alberta did not include the section on children's health in their regional survey. Results. Approximately 84% of adults, who were proxy respondents for their child, rated their children's health as very good or excellent. The most frequently reported conditions were ear problems (15%), followed by allergies (13%) and asthma (12%). Broken bones or fractures were the most frequently reported injuries (13%). Respondents reported that 17% of children had behavioural or emotional problems. Overall, 76% of children were reported to get along with the family "very well" or "quite well."Conclusions. While most respondents rated their child's health as very good or excellent, injuries, emotional and behavioural problems, respiratory conditions and ear problems were reported among many Aboriginal children. Issues such as substance abuse, exposure to violence and academic performance were not addressed in the 10 core survey questions. Clearly there is a need for more in-depth information about both the physical and emotional health of Aboriginal children and youth. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the effectiveness of intimate partner violence (IPV) screening and positive results communication to clinicians. The study included 6,743 English-speaking female patients, aged 18 to 54 years from different medical facilities in Ontario. Study participants who reported previous IPV were interviewed every six months until 18 months regarding reexposure to IPV and quality of life. Researchers concluded that their findings do not offer sufficient evidence to support the use of IPV screening in health care settings.

It is important to understand the epidemiology of intimate partner violence (IPV) experienced by both males and females. Data were drawn from the U.S. National Comorbidity Survey Replication. The relationships between physical IPV and child abuse, mental disorders, and suicidal ideation and attempts among males and females were examined. The results indicate that child sexual abuse was associated with IPV among males, whereas child physical and sexual abuse was associated with IPV among females. IPV was associated with poor mental health outcomes for males and females, although sex differences are noted. The sex differences indicate that females experience a wider range of poor mental health outcomes compared to males. Knowledge about correlates of IPV can be useful in identifying individuals exposed to violence. Further research is required to identify effective methods to reduce exposure to IPV and to adequately address the specific needs of male and female victims of IPV. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined stress reactivity and its relationship to major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) among maltreated youth. We examined differences between maltreated and control participants in heart rate and cortisol resting and reactivity levels in response to a psychosocial stressor. Methods: We recruited 67 female youths aged 12 to 16 with no prior history of depression from child protection agencies and a control group of 25 youths matched on age and postal code. Child maltreatment was measured with two self-report instruments. Psychiatric status was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Results: Piecewise multilevel growth curve analysis was used to model group differences in resting and reactivity cortisol levels and heart rate in response to the Trier Social Stress Test (TSST). During the resting period, both the maltreated and control groups showed a similar decline in levels of cortisol. During the reactivity phase, youth in the control group showed an increase in cortisol levels following the TSST and a gradual flattening over time; maltreated youth exhibited an attenuated response. This blunted reactivity was not associated with current symptoms of MDD or PTSD. There were no group differences in resting and reactivity levels of heart rate. Conclusions: These findings provide further support for hypothalamic-pituitary-adrenal axis dysregulation among maltreated youth. Since the ability to respond to acute stressors by raising cortisol is important for health, these findings may assist in understanding the vulnerability of maltreated youth to experience physical and mental health problems. [Copyright &y& Elsevier]

The article presents an overview of programs in Great Britain that have been developed to help prevent the physical, sexual and psychological abuse of children and to treat victims of child abuse. A discussion of the benefits of home visit programs, positive parenting programs, hospital based education programs, school based education programs, cognitive behavioral therapy and foster care programs, is presented. The importance of having future research on child abuse use interventions which have been assessed in clinical trials is discussed. INSET: Key messages.

Objective: This study presents evaluative data on the Childhood Experiences of Violence Questionnaire (CEVQ), a brief, self-report measure of youth victimization. Methods: Literature reviews, expert consultations and qualitative interviews informed the development of the CEVQ. Test–retest reliability of the preliminary and final versions of the CEVQ was examined. Child welfare workers (n =11) assessed content validity. Construct validity was assessed by comparing levels of emotional and behavioral problems of youth with self-reports (n =177) of victimization. Criterion validity was tested by comparing clinicians’ judgment of child physical abuse (PA) and child sexual abuse (SA) with youths’ self-reports (n =93). Results: In general, test–retest intra-class correlations (ICCs) for the preliminary version of the questionnaire were good to excellent. Reliability estimates for the stem questions in the final version of the CEVQ were excellent, except for peer violence items which showed fair to good agreement. ICCs for PA, severe PA, SA, and severe SA of the CEVQ were .85, .77, .92, and .87, respectively. Youth with self-reported victimization had significantly higher scores for most categories of emotional and behavioral disorders. Experts classified victimization items as relevant. Kappa coefficients comparing clinician's judgments and youth's self-reports for PA, severe PA, SA, and severe SA were .67, .64, .70, and .50, respectively. Conclusions: The present findings provide preliminary evidence that the CEVQ is a brief, reliable, valid and informative instrument for assessing exposure to victimization and maltreatment among youth. Practice implications: Although this instrument is not appropriate for clinical use at this time, its psychometric properties will make it useful in conducting further epidemiological research and studies evaluating interventions aimed at reducing victimization. [Copyright &y& Elsevier]

The mental health of Canada’s Aboriginal women has received little scholarly attention. This paper describes the mental health of First Nations women living on reserve in Ontario and compares these findings with results from the National Population Health Survey (NPHS). Reserve communities were randomly selected within urban, rural, remote and special access regions. Depression was measured by the Composite International Diagnostic Interview. Alcohol use and health services utilization questions were identical to those used in the NPHS. Compared with NPHS women, First Nations women reported significantly higher rates of depression (18% vs 9%) but significantly lower rates of alcohol use (55% vs 74% reported drinking in the last year), although significantly greater proportions reported having 5+ drinks on one occasion (43% vs 24%). Given the burden of suffering associated with depression and the twofold risk found here, it is important to examine risk and protective factors specific to First Nations women. The findings of a higher proportion of abstainers, but also a higher proportion of consumers of 5+ drinks among First Nations women relative to NPHS women indicate the need for a more careful investigation, based on community rather than clinical data, of patterns of alcohol use. [ABSTRACT FROM AUTHOR]

Child maltreatment is associated with a huge burden of suffering, yet there are serious gaps in knowledge about its epidemiology and approaches to intervention. This article describes the development of a proposed national research framework in child maltreatment, as requested by the Department of Justice, Canada, based on (1) a review of the literature, (2) consultation with experts, and (3) application of evaluation criteria for considering research priorities. The article identifies gaps in knowledge about child maltreatment in Canada and proposes a research agenda to make evidence-based policy decisions more likely. Although this work was driven by gaps in Canada's knowledge about child maltreatment, the international scope of the review and consultation process could make the findings useful to broader research and policy audiences. [ABSTRACT FROM AUTHOR]

The article presents a randomized clinical study examining the best method for intimate partner violence screening in health care settings. The trial was conducted at emergency departments, women's health clinics, and family practices in Ontario, Canada. Three screening methods were examined, including a written self-completed questionnaire, a face-to-face interview with medical personnel, or a self-completed questionnaire on the computer. The Partner Violence Screen, the Women Abuse Screening Tool and the Composite Abuse Scale were used. The study found that women prefer the self-completed methods over the face-to-face approach. INSET: Screening Instruments Used in the Study.

Community-based population survey data were used to explore whether remaining in school, independent of achievement status, was associated with lower rates of psychopathology in adulthood among participants self-reporting exposure to child physical and/or sexual abuse. Remaining in school, independent of one's achievement status, was significantly associated with a lower probability of experiencing externalizing but not internalizing disorders. Theoretical and educational implications of these results are discussed. [ABSTRACT FROM AUTHOR]

Summary Background Recurrence of child maltreatment is a major problem, yet little is known about approaches to reduce this risk in families referred to child protection agencies. Since home visitation by nurses for disadvantaged first-time mothers has proven effective in prevention of child abuse and neglect, we aimed to investigate whether this approach might reduce recidivism. Methods We enrolled in a randomized controlled trial 163 families with a history of one index child being exposed to physical abuse or neglect to compare standard treatment with a program of home visitation by nurses in addition to standard treatment. The main outcome was recurrence of child physical abuse and neglect based on a standardized review of child protection records. Analysis was by intention to treat. Findings At 3-years' follow-up, records were available for 160 of 163 (98%) families randomized. 139 (85%) completed follow-up. Recurrence of child physical abuse (31 [43%] in the control group vs 29 [33%] in the intervention group) and neglect (37 [51%] vs 41 [47%]) did not differ between groups. However, hospital records showed significantly higher recurrence of either physical abuse or neglect in the intervention group than in the control group (21 [24%] vs 8 [11%]). There were no differences between groups for the other secondary outcome measures. Interpretation Despite the positive results of home visitation by nurses as an early prevention strategy, this visit-based strategy does not seem to be effective in prevention of recidivism of physical abuse and neglect in families associated with the child protection system. Much more effort needs to be directed towards prevention before a pattern of abuse or neglect is established in a family. [ABSTRACT FROM AUTHOR]

Objective: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada.Method: The sample consisted of 8,472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined.Results: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem.Conclusions: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families. [Copyright &y& Elsevier]

Objective: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS).Methods: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9,953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse.Results: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS.Conclusions: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse. [Copyright &y& Elsevier]

Background: Despite growing public concern about child maltreatment, the scope and severity of this significant public health issue remains poorly understood. This article examines the nature and severity of the physical harm associated with reports of child maltreatment documented in the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS). Methods: The CIS collected information directly from child welfare investigators about cases of reported child abuse or neglect. A multistage sampling design was used to track child maltreatment investigations conducted at selected sites from October to December 1998. The analyses were based on the sample of 3780 cases in which child maltreatment was substantiated. Results: Some type of physical harm was documented in 18% of substantiated cases; most of these involved bruises, cuts and scrapes. In 4% of substantiated cases, harm was severe enough to require medical attention, and in less than 1% of substantiated cases, medical attention was sought for broken bones or head trauma. Harm was noted most often in cases of physical abuse compared to other forms of maltreatment. Interpretation: Rates of physical harm were lower than expected. Current emphasis on mandatory reporting, abuse investigations and risk assessment may need to be tempered for cases in which physical harm is not the central concern. [ABSTRACT FROM AUTHOR]

Objective: The authors examined the risk that family disruption and Iow socioeconomic status in early childhood confer on the onset of major depression in adulthood. Method: Participants were 1,104 offspring of mothers enrolled during pregnancy in the Providence, R.I., site of the National Collaborative Perinatal Project. Measures of childhood family disruption and socioeconomic status were obtained before birth and at age 7. Structured diagnostic interviews were used to assess respondents' lifetime history of major depressive episode between the ages of 18 and 39. Survival analysis was used to identify childhood risks for depression onset. Results: Parental divorce in early childhood was associated with a higher lifetime risk of depression among subjects whose mothers did not remarry as well as among subjects whose mothers remarried. These effects were more pronounced when accompanied by high levels of parental conflict. Independent of the respondents' adult socioeconomic status, Iow socioeconomic status in childhood predicted an elevated risk of depression. Conclusions: Family disruption and Iow socioeconomic status in early childhood increase the long-term risk for major depression. Reducing childhood disadvantages may be one avenue for prevention of depression. Identification of modifiable pathways linking aspects of the early childhood environment to adult mental health is needed to mitigate the long-term consequences of childhood disadvantage. [ABSTRACT FROM AUTHOR]

Context: Intimate partner violence is prevalent and is associated with significant impairment, yet it remains unclear which interventions, if any, reduce rates of abuse and reabuse. Objective: To systematically review, from the perspective of primary health care, the available evidence on interventions aimed at preventing abuse or reabuse of women. Data Sources: MEDLINE, PsycINFO, CINAHL, HealthStar, and Sociological Abstracts were searched from the database start dates to March 2001 using database-specific key words such as domestic violence, spouse abuse, partner abuse, shelters, and battered women. References of key articles were hand searched. The search was updated in December 2002. Study Selection: Both authors reviewed all titles and abstracts using established inclusion/exclusion criteria. Twenty-two articles met the inclusion criteria for critical appraisal. Data Extraction: Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, both authors independently reviewed the 22 included studies using an established hierarchy of study designs and criteria for rating internal validity. Quality ratings of individual studies—good, fair, or poor—were determined based on a set of operational parameters specific to each design category developed with the US Preventive Services Task Force. Data Synthesis: Screening instruments exist that can identify women who are experiencing intimate partner violence. No study has examined, in a comparative design, the effectiveness of screening when the end point is improved outcomes for women (as opposed to identification of abuse). No high-quality evidence exists to evaluate the effectiveness of shelter stays to reduce violence. Among women who have spent at least 1 night in a shelter, there is fair evidence that those who received a specific program of advocacy and counseling services reported a decreased rate of reabuse and an improved quality of life. The benefits of several... INSET: Box. Canadian Task Force of Preventive Health Care Levels. [ABSTRACT FROM AUTHOR]

Objective: The study's goal was to examine the relationship between a history of parental psychiatric disorder and a history of child abuse in a general population sample of Ontario residents. Method: A representative community sample of 8548 respondents who participated in the Ontario Mental Health Supplement (OHSUP) were interviewed about parental psychiatric history and completed a self-report measure of childhood physical and sexual abuse. Results: The lifetime prevalence of either parent with a psychiatric disorder was as follows: 14.1% for depression, 3.7% for manic depression, 2.4% for schizophrenia, 2.4% for antisocial behavior, and 17.3% for any parental psychiatric disorder. Respondents reporting a parental history of depression, mania, or schizophrenia had a two to threefold increase in the rates of physical, sexual, or any abuse. Parental history of antisocial disorder increased the risk of exposure to physical abuse (adjusted odds ratios [OR 6.1] and any abuse [OR 7.5]). There was no statistically significant difference between parental psychiatric disorder and childhood physical or sexual abuse by gender of the respondent There was a trend for increasing risk associated with father only, mother only, and both parents having any psychiatric disorder. Conclusions: The elevated risk for physical and sexual abuse among respondents reporting a parental history of psychiatric illness highlights the need to examine the mechanism for this association. Such information is important in developing approaches to assist families where the risk of child maltreatment is increased. [ABSTRACT FROM AUTHOR]

Examines the relationship between childhood maltreatment history and adult psychopathology in clinical populations in Ontario. Correlation between physical abuse and psychiatric morbidity; Issues on the social and environmental causes; Concerns on the nature and duration of the abuse.

Investigates the association of childhood abuse and psychiatric disorders in single and married mothers in Ontario. Relationship of childhood abuse with adult mental health of mothers; Comparison of income and health difficulties between single and married mothers; Role of childhood abuse as a predictor of maternal psychiatric morbidity.