Other MCH Issues and Special Populations Marsha R. Smith, M.D., M.P.H. Medical Director, Perinatal and Reproductive Health Center for Maternal and Child Health

Child Abuse and Neglect Physical Abuse Sexual Abuse Neglect Mental Injury Source: MD Department of Human Resources (DHR), Child Protective Services (CPS)

Child Abuse and Neglect: CPS Findings Definitions Indicated: credible evidence, which has not been satisfactorily refuted, that physical abuse, neglect, or sexual abuse did occur. Unsubstantiated: insufficient amount of evidence to support a finding of indicated or ruled out. Ruled Out: a finding that abuse, neglect, or sexual abuse did not occur.

Child Abuse and Neglect In 2009, –53,796 reports to CPS –27,956 new investigations 2009 vs –4,647 more reports than 2008 –1,406 more investigations than in 2008 Source: DHR StateStat, Child Protective Services/Investigations Data, FY 09

Child Abuse and Neglect Of the 31,206 total investigations conducted in 2009: 20.2% (6,312) of the findings were indicated 20.2% (6,294) of the findings were unsubstantiated 60% (18,600) of the findings were ruled out Source: DHR StateStat, Child Protective Services/Investigations Data, FY 09

Health Consequences of Child Abuse and Neglect Researchers have identified links between child abuse and neglect and the following: –Difficulties during infancy –Poor mental and emotional health –Cognitive difficulties –Social difficulties –Impaired brain development –Poor physical health –Difficulties during adolescence –Juvenile delinquency and adult criminality Sources (in order): Dubowitz, Papas, Black, & Starr, 2002; Silverman, Reinherz, & Giaconia, 1996; U.S. Department of Health and Human Services, 2003; Schore, 2003; De Bellis & Thomas, 2003; Springer, Sheridan, Kuo, Carnes, 2007; Kelley, Thornberry, & Smith, 1997; English, Widom, & Brandford, 2004 *Complete source list available upon request

Health Needs of Out-of-Home Youth: Juvenile Justice Many have a diagnosable mental health disorder Higher rates/earlier onset of risky health behaviors –cigarette smoking –drug use –binge drinking –gang involvement –sexual activity (Morris, et al. 1995). Less likely to have an identifiable, regular source of medical care prior to incarceration Sources: Shufelt, J. and J. Cocozza. “Youth with Mental Health Disorders in the Juvenile Justice System: Results from a Multi-State Prevalence Study,” National Center for Mental Health and Juvenile Justice, Research and Program Brief, 2006; Morris, et al. “Health Risk Behavioral Survey from 39 Juvenile Correctional Facilities in the United States,” Journal of Adolescent Health, 1995;17: ; Feinstein, et al. “Medical Status of Adolescents at Time of Admission to a Juvenile Detention Center,” Journal of Adolescent Health, 1998;22:

Health Needs of Out-of-Home Youth: Children in Foster Care In a national study of children in foster care for at least one year, the following was found: –Lasting or recurring health problem (27%) Asthma (8%) –Delays in neurodevelopment –Behavioral problems (25-50%) –Social skills categorized as “low” (40% Source: Research Brief: “Who Are the Children in Foster Care? Findings from the National Survey of Child and Adolescent Well-Being.” Administration for Children and Families, Office of Planning, Research and Evaluation (2004).

Reproductive Health Risks of Youth in Foster Care Almost half of youth who ever lived in foster care are under age 16 when they have sex for the first time compared to one-third of all other youth. Young adults who lived in foster care are 1.9 times more likely to have ever experienced forced sex when compared to all other youth. Source: Child Trends Inc. (2009). Analysis of the National Longitudinal Study of Adolescent Health. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy.

Reproductive Health Risks of Youth in Foster Care

Teen Births in Maryland In 2008, there were 6,630 babies born to young Maryland mothers under the age of 20. Teen births accounted for nearly 9% of all 2008 births in the state. 1/3 of these births were to teens under the age of 18, including 100 births to teens ages 14 and younger. Source: MD Vital Statistics Administration

Teen Births in Maryland

Sexually Transmitted Infections: Chlamydia

Chlamydia in Teens

HIV in Maryland Women 2,866 reported HIV diagnoses during 2007 of these 37.1% (1,063) were female. –The proportion of HIV diagnoses in MD that were female has more than doubled from 15.3% in 1985 to 37.1% in ,270 total living with HIV (12/31/07) –10,137 (35.9%) were female. –Rate of cases per 100,000 women –1 in every 286 women in Maryland Source: MD DHMH, Infectious Disease and Environmental Health Administration, Center for HIV Surveillance and Epidemiology. Fact Sheet-HIV/AIDS and Women in Maryland. November 2009.

HIV in Maryland Women Most Common Exposure Categories Adult/adolescent women (age 13+) with reported HIV diagnoses in 2007 Heterosexual exposure (71.3%) Injection drug use (27.0%). Source: MD DHMH, Infectious Disease and Environmental Health Administration, Center for HIV Surveillance and Epidemiology. Fact Sheet-HIV/AIDS and Women in Maryland. November 2009.

HIV in Maryland Women Total living HIV case rates –8 to 20 times higher among non- Hispanic blacks, as compared to Hispanics, non-Hispanic whites, and other races. –Highest among women in their 40’s, followed by women in their 30’s and their 50’s. Source: MD DHMH, Infectious Disease and Environmental Health Administration, Center for HIV Surveillance and Epidemiology. Fact Sheet-HIV/AIDS and Women in Maryland. November 2009.

HIV in Maryland Women

Perinatal Transmission of HIV In 2008, there were 217 exposed infants (born to women with HIV) HIV exposed births per 100,000 Source: MD DHMH, Center for HIV Surveillance and Epidemiology. Fact Sheet-HIV/AIDS and Women in Maryland. November Preliminary Data from for Exposed Infants and Transmissions by Birth Year Birth YearNumber of Exposed Infants Number of HIV+ Babies

HIV in Children Of the 2,866 reported HIV diagnoses during 2007 in Maryland, 10 (0.3%) were among pediatric cases (<13 years of age). 108 pediatric cases living with HIV in MD –Of total living pediatric HIV cases in MD: 55.6% female and 44.4% male –89.6% non-Hispanic black, 6.6% non-Hispanic white, 1.9% Hispanic and 1.9% other races. Source: MD DHMH, Center for HIV Surveillance and Epidemiology, Fact Sheet-HIV/AIDS and Women in Maryland. November 2009.

Male Involvement and Fatherhood Family planning Parenting Prevention of sexually transmitted infections Prevention of child abuse and neglect Role model/mentoring for children Prevention of infant mortality

Priorities Identified by Stakeholder Survey: Child and Adolescent Health Asthma--a leading cause of childhood hospitalizations Childhood lead poisoning Medical Home and access to primary care Mental health—access to services for increasing needs Overweight and obesity—need for healthy nutrition and physical fitness Child abuse and neglect School readiness and academic success Violence and Injuries—leading causes of child and adolescent deaths; bullying, gang violence Health insurance access and coverage Lack of family support and connectedness