1. Lessons learned from LONGSCAN Presented by Diana English, PhD Child Welfare Research Group University of Washington, School of Social Work Desmond K. Runyan, MD, DrPH University of North Carolina at Chapel Hill 1

2. Acknowledgments U.S. Department of Health and Human Services Administration for Children, Youth, and Families Children's Bureau Office on Child Abuse and Neglect National Institutes of Health National Institute of Child Health and Human Development 2

3. LONGSCAN Background 1990 NCCAN funded consortium Focus on child abuse & neglect  Need for theory-based longitudinal studies  Address CAUSES & CONSEQUENCES of abuse and neglect  Implications for… Preventing maltreatment (initial or reoccurrence) Preventing negative effects of maltreatment Promote recovery 3

4. Overview of LONGSCAN LONGitudinal Studies of Child Abuse & Neglect 5 distinct studies (East, South, Midwest, Northwest, & Southwest) 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 4

5. Current Status Data collection on-going - Youth now 14 - 22 years old Data summarized & updated 4 times a year - Data are distributed to sites twice a year Data archived with the National Data Archive on Child Abuse and Neglect (NDACAN) - Age 4, 6, 8, and 12 interviews - Contact interviews through age 11 - Includes CPS record reviews 5

6. 6

7. Data Collected (Baseline to age 18) InterviewsBaseline*4681214+ 16+18+ Child--116611761074895872721452 Caregiver--124712251130956925752283 Child or Caregiver 1354125012361140976947789472 7 Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18.

8. Data Collected (Baseline to age 18) InterviewsBaseline*4681214+ 16+18+ Site East282237255237190197162101 Midwest24522322521618117391-- South243221222190177176130174 Southwest330319299274236216217106 Northwest25425023522319218518991 8 Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14, 16, and 18.

9. Sample Demographics (Baseline to Age 16) Child DemographicsBaseline4681214 + 16 + % Male48.548.848.748.149.848.948.2 % Caucasian26.227.125.725.625.425.526.6 % African American53.351.853.954.554.755.553.1 % Other Race20.521.120.419.9 19.020.3 Mean Age-- 4.6 6.4 8.312.414.416.3 9 Notes. * Baseline refers to data at age 4 or age 6. + Data collection on-going at age 14 and 16.

10. Caregiver Demographics (Baseline to Age 16) Caregiver Demographics 4681214 + 16 + % Married33.133.035.538.337.939.4 % Single44.642.641.234.434.130.9 % Separated 7.9 8.0 8.6 8.1 8.2 7.6 % Divorced12.813.711.815.015.216.2 % Widowed 1.6 2.8 2.9 4.2 4.6 5.9 Mean Income15k- 20k 20k- 25k 25k- 30k 30k- 35k Mean EducationH. S. 10 Notes. + Data collection on-going at age 14 and 16.

11. 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 11

12. Measurement Multiple sources & methods 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) 12

13. LONGSCAN Publications to Date 13 Note. Publications as of February ’09.

14. Exposure of LONGSCAN To Maltreatment

15. Maltreatment History Expand definitions & methods Look at maltreatment  Physical & sexual abuse, neglect, emotional, witnessed violence (home and community)  Beyond just the occurrence: yes/no  Multidimensional (focus on degree or extent - CAN special issue May, 2005 )  Beyond CPS report Age 12 youth self-report 15

16. # of Maltreatment Records/Referrals per Child (birth through age 14) 16 1 Record (16%) 2 Records (12%) 3 Records (9%) 4 Records (7%) 5 Records (5%) 8-22 Records (12%) 7 Records (3%) 6 Records (4%) Total N = 1354

17. Age of First Record/Referral (birth through age 14) 17 # of Children Age of First Record/Referral Descriptive Stats (0-14): Total N of kids with record = 916 Mean Age = 2.2 years (SD = 2.9) Range of Ages = 0 – 14.4 Median Age = 1.2

18. # of Allegations by Maltreatment Type (birth through age 14) 18 # of Allegations Age Based on Baseline Sample (N = 1354)

19. # of Substantiations by Maltreatment Type (birth through age 14) 19 # 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)

20. Findings: Maltreatment Dimensions – Substantiation Status Are there outcome differences for children reported & substantiated compared to those who are reported and NOT substantiated? No differences on 10 developmental, social, emotional and behavioral outcomes for substantiated vs. not substantiated (Hussey et al., 2005). 20

21. Maltreatment Allegations by Severity (birth through age 14) 21 Note. Only includes participants who have an allegation.

22. Findings: Maltreatment Dimensions - Severity Severity construction:  Maximum severity within type  Maximum severity across type  Total or sum of maximum severity  Mean severity Maximum severity by type best predictor of outcomes including adaptive functioning and anger (Litrownik et al., 2005). 22

23. Chronicity of Maltreatment (birth through age 14) 23 34.5% 15.7%13.1% 20.3% 16.4% N = 903

24. Findings: Maltreatment Dimensions - Chronicity Developmental vs. Calendar to examine consequences over time. The developmental approach across a child’s lifespan was the most sensitive – as well as looking at extent (across developmental stages) and continuity (whether there are any gaps) (English et al., 2005). 24

25. Findings: Maltreatment Dimensions -Type Hierarchical Type – prioritized abuse vs. neglect Severity/Frequency Type – based on highest severity or frequency Expanded Hierarchical – differentiated multiple vs. single sub-types All three types predicted child social/emotional and behavioral functioning, however, differentiating multiple vs. single sub-types was the more outcomes (Lau et al., 2005). 25

26. Findings: Maltreatment Dimensions - Combined Type, severity, chronicity and age at first report. Individual maltreatment dimensions have distinct effects on child functioning. Type (based on maximum severity of each type) most consistent predictor across outcomes, however different types predicted different outcomes (English et al., 2005). 26

27. Findings: Maltreatment Dimensions - Combined A comprehensive assessment of a child’s maltreatment experience (not just the presenting incident) including type and severity. Age of onset Pattern (extent and continuity) All are important in understanding the outcome of maltreatment on children’s growth and development. (see Child Abuse & Neglect Volume 29: 2005) 27

28. Self Report of Abuse (birth through age 12) 28 * Indicators are NOT mutually exclusive (N = 881) ( N = 874) (N = 883)

29. Comparing Substantiations to Child Self-Report (birth through age 12) Psychological Abuse (N = 883) 4.3% 18.6% 7.8% 80.9% 14.2% 3.2% 51.2% 7.7% 33.0% 8.1% 29

30. Concordance between Child Self- Report and CPS Substantiations Classifying children/youth with profiles improves ability to identify antecedents and consequences of maltreatment:  No PA/SA  High PA, Low SA  No PA/Moderate SA  High PA, High SA  (35% Youth did not endorse CPS reports) Agreement between CPS report and self- report not high (Everson et al., 2008). 30

31. Concordance between Child Self- Report and CPS Substantiations A-CASI interview rates of abuse 4-6 X higher than in CPS records (Everson et al., 2008). Adolescent psychological adjustment (measured by TSCC & YSR) more strongly associated with self-report than with CPS determination (Everson et al., 2008). 31

32. Discussion Implications of LONGSCAN findings on maltreatment for policy and practice

33. Foster Care in LONGSCAN

34. Foster Care: First 18 months Examined number of placements during first 18 months following removal (N = 415)  1-15 placements : Mean = 4.23 placements  Child behavior problems at time of initial placement predicted subsequent # placements.  # prior placements predicted later behavior problems for those who did not have problems initially (Newton et al., 2000).

35. Long-Term Placement and Violence Exposure Children placed in out of home care before 3.5  At age 6 Reunified children:  Had more exposure to family violence  Experienced more adverse life events  Evidenced increased internalizing problems  Received fewer mental health services  However, felt less isolated  Parents of adoptive kids used more minor violence than foster parents for discipline  Adoptive kids report witnessing less violence in the home (Lau et al., 2003; Litrownik et al., 2003).

36. Long-Term Stability of Early Foster Care Sample Examine caregiver stability for children age 6 to 8 who were removed prior to age 3.5 (N = 285).  1 in 7 unstable  Adoption most stable (compared to reunified, kin care, and non-kin care)  Other predictors of stability: father involvement; child intellectual functioning  Predictors of instability: Child behavior; expressive family (Randazzo et al., under review).

37. Foster Care – Discipline Practices and Child Aggression, Kin & Non-Kin Kin use more harsh disciplinary practice (N = 80). Parents who use aggressive problem solving strategies have more aggressive youth (DeRobertis & Litrownik, 2004).

38. Discussion Implications of foster care findings on policy/practice.

39. Family Context Caregiver violence exposure as a child/adult Current and/or recent domestic violence/family conflict Caregiver depressive symptomatology Parenting 39

40. Neglect – A Different Conceptualization Definition of neglect as psychological and physical safety and security. Unsafe or dirty home & untreated behavioral problems predicted language impairments & developmental problems (Dubowitz et al., 2005). A stimulating home environment predicted less impairment in cognitive development (Dubowitz et al., 2005). 40

41. Neglect – A Different Conceptualization Multiple changes in residence predicted externalizing behavior problems (Dubowitz et al., 2005). Exposure to verbally aggressive discipline predicted more behavior problems (Dubowitz et al., 2005). Conclusion: Important to conceptualize neglect in terms of child’s developmental needs (safety and security). 41

42. Neglect Examined individual and cumulative relationship among physical, psychological and environmental neglect and development (Age 3-5, N =136 - FTT & HIV Risk). Psychological neglect associated with increased internalizing/externalizing problems. Cumulative neglect index associated with internalizing problems 42

43. Influence of Early and Later Maltreatment on Childhood Aggression at ages 4, 6 & 8 43

44. Influence of Early and Later Maltreatment on Childhood Aggression at ages 4, 6 & 8 This study suggests that early neglect may be a more important precursor of youth violence than is physical abuse (Kotch et al., 2008). Limitations:  not a representative probability sample  the possibility of false negatives cannot be ruled out  site is a potential confounder 44

45. Caregiver’s History of Violence Exposures as a Child and/or Adult (age 4) 45 Of those assaulted (n = 608): 52% experienced some form of physical assault/abuse as a child or teenager. 44% experienced some form of sexual assault /abuse before age 13. 36% experienced some form of sexual assault/abuse as a teen. 75% experienced some form of physical assault as an adult. 22% experienced some form of sexual assault as an adult. Caregiver Report at Age 4 Interview (N = 923)

46. Caregiver’s History of Violence Exposures as a Child and/or Adult Maternal child victimization more powerful indicator of child behavior problems at age 4 than caregiver adult victimization (Thompson, 2007). Caregivers victimized during childhood and adulthood had worse outcomes than if victimized either as an adult or child, or no victimization (Dubowitz et al., 2001). 46

47. Caregiver’s History of Violence Exposure as a Child and/or as an Adult Chronic victimization in childhood and adulthood more common than victimization in childhood alone or as an adult alone (Dubowitz et al., 2001). Women who were physically and/or sexually abused had worse outcomes than those with only one type of abuse (Dubowitz et al., 2001). 47

48. Caregiver’s History of Violence as a Child and/or as an Adult Caregivers victimized in childhood and adulthood had:  More depressive symptomatology;  Used harsher parenting behaviors;  Children had higher internalizing and externalizing scores on the CBCL (Dubowitz et al., 2001). 48

49. Caregiver’s History of Violence Exposure as a Child and/or as an Adult Caregivers with a history of CSA at increased likelihood of a violent adult relationship (English et al., 2003). Caregivers with a history of child physical abuse at increased risk of a violent adult relationship (English et al., 2003). 49

50. Caregiver’s History of Violence Exposures as a Child and/or as an Adult Caregivers with a history of CSA more depressed (Thompson, 2006). Adult victimization and depression predicted maltreatment (Thompson, 2006). Adult sexual victimization predicted problem drinking but not maltreatment (Thompson, 2006). Maternal adult physical victimization predicted a 2- 3 fold increase in risk of maltreatment (Thompson, 2006). 50

51. Discussion Implications of Caregiver History of Abuse/Neglect on policy/practice.

52. Background – “Domestic Violence” 2007 - 3.3 million reports of CA/N Co-occurrence of CA/N and adult domestic violence reported at 30-60% in clinical populations Estimates of 47% (2,000/35,000 random sample) of investigated CPS referrals - based on 1 item in assessment matrix and includes history & current 1999/2000 US national probability sample of 3,931 CPS cases - 14% current DV, 19% history of DV Between 990,000 – 1,410,000 estimated DV issues (current and/or past) present in CPS referrals

53. Background Lack of clarity in definition of DV/IPAV/IPC – “woman battering vs. common couple violence” Research on special populations or community populations may not be applicable to at-risk or CPS referred populations Limited examination of female IPAV/IPC and child maltreatment and child outcomes

54. Aggressive and Violent Behavior Conflict Tactics Scale (Partner to Partner) Violence Items (English et al., in press) Mean (SD) Male-Only AV Perps. (N = 24) Mean (SD) Males in Bi- Lateral AV Couples (N = 351) Mann- Whitney Mean (SD) Female- Only AV Perps. (N = 77) Mean (SD) Females in Bi-Lateral AV Couples (N = 351) Mann- Whitney Minor Violence Scale (# times)0.21 (0.83)0.68 (1.83)ns0.16 (0.54)1.1 (2.24)p <.001 …person threw something at other person0.04 (0.20)0.19 (0.61)ns0.06 (0.37)0.42 (0.97)p <.001 …person push-shove-grab other person0.17 (0.63)0.34 (0.89)ns0.09 (0.40)0.49 (1.05)p <.001 …person slapped other person0.00 (0.00)0.14 (0.60)ns0.00 (0.00)0.21 (0.68)p <.005 54

55. Aggressive and Violent Behavior Conflict Tactics Scale (Partner to Partner) Violence Items (English et al., in press) Mean (SD) Male-Only AV Perps. (N = 24) Mean (SD) Males in Bi- Lateral AV Couples (N = 351) Mann- Whitney Mean (SD) Female- Only AV Perps. (N = 77) Mean (SD) Females in Bi-Lateral AV Couples (N = 351) Mann- Whitney Severe Violence Scale (# times)0.25 (1.20)0.38 (1.59)ns0.15 (0.80)0.78 (2.29)p <.005 …person kick-bit-hit other person with fist0.08 (0.41)0.11 (0.52)ns0.05 (0.46)0.24 (0.78)p <.05 …person hit other person with something0.04 (0.20)0.12 (0.51)ns0.03 (0.23)0.29 (0.81)p <.005 …person beat other person up0.12 (0.61)0.09 (0.51)ns0.03 (0.23)0.14 (0.59)ns …person choked other person0.00 (0.00)0.04 (0.28)ns0.05 (0.36)0.04 (0.34)ns …person threatened other with knife-gun0.00 (0.00)0.03 (0.24)ns0.00 (0.00)0.08 (0.44)ns …person used knife-gun on other person0.00 (0.00)0.01 (0.09)ns0.00 (0.00)0.01 (0.13)ns 55

56. Results – CTS P-to-P (Overall prevalence) MaleFemaleSignificance Verbal Aggression82.7%93.6%p<.001 Minor Aggression15.5%24.6%p<.005 Severe Aggression7.7%15.3%p<.001

57. Children Exposed to IPAV Significant child behavior problems for all types of IPAV (verbal, minor and severe) and for male and/or female perpetrators (English et al., in press). Conclusion: Need for comprehensive assessment of IPAV when assessing risk, safety and harm issues for children.

58. Discussion Majority of IPAV in this sample is bilateral, and women report more IPAV than their partners. No difference in rates or type of IPAV in unilateral IPAV homes (males/ females), however, females may sustain greater injury The majority of reported IPAV is verbal – but not necessarily benign for children

59. Discussion Child outcomes are best in homes where no maltreatment/no IPAV is reported From the maltreated child’s perspective the impact of witnessing IPAV appears not to vary based on gender of perpetrator From the non-maltreated child’s perspective, witnessing female-only IPAV does have an impact, as does witnessing bilateral IPAV (both compared to homes without IPAV)

60. Intimate Partner Violence/Aggression and Child Outcomes Conclusion: Need for comprehensive assessment of IPAV when assessing risk, safety and harm issues for children in homes where IPAV reported as an issue.

61. Domestic Violence (DV) DV associated with higher alcohol use by female caregiver (English et al., 2003). DV associated with poor family health and competence, poor family cohesion & high family conflict (SFI) (English et al., 2003). DV was not related to child outcome when other factors taken into account, The effect on children through mother’s depression and reduced capacity to parent (English et al., 2003).

62. Domestic Violence (DV) Poor quality mother/father relationships predicted higher child internalizing problems (Black, Papas et al., 2002). Black/Papas findings consistent with Katz & Gottman – children exhibit externalizing problems with mutually hostile caregiver(s) and internalizing when father figure is angry (Katz & Gottman).

63. Witnessing Violence Caregivers report higher youth internalizing scores than youth, and internalizing scores increase with exposure to violence (Lewis et al., in preparation). Child maltreatment associated with higher externalizing scores and higher caregiver depression (Lewis et al., in preparation). Higher witnessed violence scores associated with higher externalizing scores (Lewis et al., in preparation).

64. Domestic Violence (DV) Poor quality mother/father relationships predicted higher child internalizing problems (Black, Papas et al., 2002). Black/Papas findings consistent with Katz & Gottman – children exhibit externalizing problems when caregiver(s) mutually hostile and internalizing when father figure is angry (Katz & Gottman). 64

65. Domestic Violence (DV) In homes with DV, young age of caregiver, low education level, low income, & low religious involvement > risk of maltreatment (Cox et al., 2003). Social support moderates relationship between DV & maltreatment (Cox et al., 2003). 65

66. Witnessing Violence Caregivers report higher youth internalizing scores than youth, internalizing scores increase when there is any exposure to violence (Lewis et al., in prep.). Child maltreatment associated with higher externalizing scores and higher caregiver depression (Lewis et al., in preparation). Greater witnessed violence associated with higher externalizing scores (Lewis et al., in preparation). 66

67. Caregiver Depression (4, 6, 8, 12, and 14) 67 Note. + At ages 4, 6, 12, and 14 the CES-D was utilized. A score of16 or higher has been used extensively as the cut-off point for high depressive symptoms however, false positives on the order of 15% to 20% have resulted from use of this cut-off point, leading some researchers to suggest that a higher cut-off point be used (Boyd, Weissman, Thompson, & Myers, 1982; Zich, Attkisson, & Greenfield, 1990). * At age 8, the Brief Symptom inventory (BSI) was utilized. A cut-off of 63 or higher was used to determine clinical depression for the BSI. 31% 69%70%91%73% 30% 9% 27%

68. Discussion Implication for findings on intimate partner aggression/violence, child exposure on policy/practice?

69. Depression and Child Maltreatment If Caregiver is victim of child abuse or neglect as child:  More depressed (Dubowitz et al., 2001) 69

70. Depression & Child Maltreatment If Caregiver depressed:  Perceive partner relationship more negatively (Black, Papas et al., 2002).  Children are 1.6 times more likely to be maltreated (Radhakrishna et al., 2006; Thompson, 2006).  Not related to neglect in adolescence (Black, Papas et al., 2002). 70

71.  Perceive child needs services but child not necessarily involved in services (Thompson et al., 2007; Dubowitz et al., 2001).  Perceive more behavioral problems but effect of maltreatment on child outcome not mediated by caregiver depression (Thompson et al., 2007; Black, Papas et al., 2002). Depression & Child Maltreatment

72. Maternal Depressive Symptoms Depression symptoms did not predict re-referral when controlling for type of maltreatment and whether or not maltreatment was substantiated (Thompson & Wiley, 2009). 72

73. Quality of Parenting Parental warmth (empathy) moderates caregiver’s use of physical discipline and externalizing behavior (Lau et al., 2006). Physical discipline not effective with children predisposed to impulsive, aggressive or non-compliant behavior (Lau et al., 2006). 73

74. Quality of Parenting If behavior already problem at age 4, parental use of physical discipline predicts behavior problems at older ages (Lau et al., 2006). Harsh discipline predicts child’s internalizing and externalizing problems (Dubowitz et al., 2001). Caregivers with violent & aggressive behaviors toward each other more likely to use verbal aggression and minor violence with child (English et al., 2003). 74

75. Discussion Caregiver depression and quality of parenting – implications for policy/practice?

76. Maltreatment outcomes

77. % of Kids in the Normal/Borderline/ Clinical Range for Externalizing Behaviors (ages 4-16) 77 Child Behavior Checklist Teacher Report Form Youth Self Report Form

78. Highlights of LS Findings Examining Externalizing Behaviors About 20% of LONGSCAN children in clinical range across ages Teachers report more clinical problems than parents Children self-report fewer behavior problems By any source, 60% of LONGSCAN children are in the NORMAL range on externalizing behavior 78

79. % of Kids in the Normal/Borderline/ Clinical Range for Internalizing Behaviors (ages 4-16) 79 Child Behavior Checklist Teacher Report Form Youth Self Report Form

80. Highlights of LS Findings Examining Internalizing Behaviors Caregivers report more problems as children age At 8, teachers noted more internalizing problems than did caregivers Youth self report had lowest sense of problems By any reporter, over 70% of the children were normal on internalizing behaviors! 80

81. % of Kids in the Normal/Borderline/ Clinical Range for Total Problems (ages 4-16) 81 Child Behavior Checklist Teacher Report Form Youth Self Report Form

82. Highlights of LS Findings Examining Total Problems Children looked worse at age 8 No overall pattern of doing better or worse Teachers more likely to note problem behaviors By any source of report 60% of children were in the normal range on total problems! 82

83. Trauma Symptom Checklist (ages 8, 12, 16) 83 Mean T Scores Age 8 Frequencies: - 9% Clinical on Anger T Score - 24% Clinical on Anxiety T Score - 18% Clinical on Depression T Score - 16% Clinical on PTSD T Score Age 12 Frequencies: - 2% Clinical on Anger T Score - 2% Clinical on Anxiety T Score - 2% Clinical on Depression T Score - 2% Clinical on PTSD T Score Age 16 Frequencies: - 2% Clinical on Anger T Score - 2% Clinical on Anxiety T Score - 2% Clinical on Depression T Score - 4% Clinical on PTSD T Score Higher scores, indicate greater distress.

84. Highlights of LS Findings using Trauma Symptom Checklist as an Outcome Stability of trauma symptoms in a high risk sample under examination (Lewis et al., in preparation). Adolescent psychological adjustment (Trauma Symptom Checklist & Youth Self Report) more strongly associated with self- reports than with CPS determinations (Everson et al., 2008). Children appear to do better on psychological symptoms as they age! 84

85. Vineland Screener (ages 6, 8, 12) 85 Mean Standard Scores Higher scores, indicate greater competence.

86. Highlights of LS Findings using Vineland Screener as an Outcome While psych distress score are better for older children Daily living and socialization scores decline Impact of other forces on these high risk children? Education, neighborhoods? 86

87. WPPSI (age 6) and WRAT (age 12) 87 % of Standard Scores 15% 16% 69% N = 1144 N = 840 9% 12% 79%

88. Highlights of LS Findings using WPPSI/WRAT as Outcomes Pattern again is that 60% of the children are in the normal range! Increase in 10% of sample with cognitive problems. 88

89. Suicidality (age 8) More maltreatment was associated with an increased likelihood of suicidal ideation (OR 2.0) (Thompson et al., 2005). Witnessed violence also increased the risk of > suicidal ideation (OR 1.6) (Thompson et al., 2005). 89

90. Relative Contributions of Violence at ages 8 and 12

91. Sample Children from five sites who had completed the Youth Self Report (n=872) at age 12 VariableN% Male Gender41649 Minority Race64876 Self-report of abuse Physical Sexual Psychological 199 138 346 23 16 40

92. Analysis Hierarchical Linear Regression will be presented We predict the outcomes: Youth Self-Report scores for total problems, internalizing & externalizing scales 1: we examine how race, gender, and site predict scores 2: we add witnessing community violence 3: we add witnessing family violence 4: we add self-reported exposure to child abuse At each stage, we see how much better the model predicts child distress on Youth Self Report

93. Standardized Betas for Internalizing YSR Scores Betap p p Female0.05 NS 0.05 NS 0.03 NS Black Race-0.04 NS -0.04 NS -0.04 NS East site-0.09 NS -0.08 NS -0.04 NS Central site-0.05NS-0.04 NS -0.02 NS South site-0.01NS0.00 NS 0.00 NS SW site-0.05NS-0.04 NS -0.05 NS Witness violence0.16 <.001 0.11 <.001 0.12 <.001 Witness IPV0.13 <.001 0.11 <.01 Physical abuse0.12 <.001 Sexual abuse0.11 <.01 Psych abuse0.17 <.001 R square0.020.040.13 R square change-0.020.09

94. Looking Back at Age 8 Exposure Data used Child Protective Services Records Outcomes: Trauma Symptom Checklist & CBCL For TSC Depression Score- 13% of variance explained Standardized Beta for neglect = 0 Standardized Beta for Sexual abuse =.02 Standardized Beta for physical abuse=.04 Standardized Beta for emotional abuse =.04 Standardized Beta for violence in home =.15 Standardized Beta for neighborhood violence =.23

95. At age 8, exposure to domestic violence and neighborhood violence were predictive of depression At age 8, abuse, neglect, & sexual abuse did not strongly predictor depression Age 12 self-reported psychological maltreatment predicted most of the child outcome CPS allegations containing reports of psychological maltreatment explain almost none of the child outcome

96. Abuse, Neglect and HIV Risky Behaviors Trajectory Modeling of LONGSCAN Children

97. HIV Risk and Sexual Abuse 5000 teens diagnosed with HIV each year 234 teens died of HIV in 2005 Acquired through risky sexual behavior & substance abuse 7% of teens sexually active before age 13 Extensive literature links CSA to risky behavior Cross-sectional and retrospective Need to understand the relative contribution of CSA to risky behaviors

98. Methods & approach Examine trajectories of sexual abuse, other forms of maltreatment, & risky behavior 725 subjects (all 5 sites) with Age 14 interview Maltreatment exposure classified by MMCS Witnessed violence by Coddington Life Events Risky behaviors by DISC questions about drugs & alcohol and separate sexual activity questionnaire Most youth denied either behavior “Proc Traj” groups children by longitudinal patterns of exposure

99. Sexual Abuse & Physical Abuse Trajectories 2 groups for SA: 14% who had a pattern of sexual abuse & most with no CSA 2 groups for PA: 32% with a pattern of physical abuse & most with no PA

100. Group Trajectories for Emotional Abuse, Neglect, & Witnessed Violence 3 groups for emotional abuse 3 group model of neglect 3 groups on witnessed violence

101. CSA, PA, EA, neglect & witnessed violence explaining alcohol use, sexual activity or both.

102. Summing it up! 102 Largest Longitudinal study of child maltreatment to date Sample demographics have held pretty well (>50%AA) Attrition has been acceptable Standard coding of maltreatment is important Most of sample reported 0-2 times Most maltreatment low to moderate severity 50% of reported maltreatment in single developmental period or limited - not chronic

103. Summing it up II Substantiation versus allegation- little difference Astounding differences between self-report and what DSS knows Behavior at placement predicted # foster care placements For children with few problems: # placements predict problems later Early Neglect, not physical abuse, associated with aggression at ages 4,6, & 8

104. Summing it up III Maternal exposure to maltreatment has impact on next generation IPV has strong influences on children and risk of maltreatment recurrence About 30% of mothers has clinical depression Harsh discipline predicted more behavior problems Majority of children not in clinical range on TSCC, CBCL, YSR, etc. At age 8, witnessing IPV more hazardous that SA or PA At age 12, psychological abuse greatest risk

105. Summing it up IV Among teens, HIV risk behaviors associated with sexual abuse and physical abuse, not so much CPS reported emotional abuse or neglect Maltreatment explains just a small portion of risky behavior Lots of work left to do with LONGSCAN data

106. LONGSCAN Website (http://www.iprc.unc.edu/longscan/) Public website: Provides background information, helpful links, and contact information. Access to publications, measures manuals, presentations, policies, and research briefs (Vol. 1 - Hunter & Knight, 1998; Vol. 2 -The LONGSCAN Investigators, 2006). Internal website: Access to electronic publications, data dictionaries, retrieval information, grant submissions, final reports, & manuscript proposals. 106