Prävalenz, Diagnostik und Prävention von Kindeswohlgefährdung

Die drei in dieser Arbeit behandelten Manuskripte beschäftigen sich mit dem Thema „Prävalenz, Diagnostik und Prävention von Kindeswohlgefährdung“ und sind im Kontext der Initiative für frühe und niedrigschwellige Hilfsangebote für Familien mit besonderen Belastungen, sog. „Frühe Hilfen“, seit 2005 entstanden. Im ersten Manuskript „Prävalenz“ werden die vorhandenen Prävalenzzahlen zur Verbreitung und längsschnittlichen Entwicklung von Missbrauch, Misshandlung und Vernachlässigung (MMV) dargelegt und kritisch diskutiert. Während die Zahl öffentlich bekannt gewordener Fälle von MMV unter der 1 ‰-Grenze liegt, gehen retrospektive Befragungen von einer Prävalenz über 10 % aus. Die Autoren diskutieren die schlechte empirische Datenlage vor dem Hintergrund der „Frühen Hilfen“ und fordern die einheitliche und standardisierte Erfassung von Risiken und tatsächlicher Kindeswohlgefährdung, um Bedarf und Effektivität von frühen Unterstützungsprogrammen genauer abschätzen zu können. Darauf aufbauend wird das zweite Manuskript „Diagnostik“ vorgestellt, in dessen Rahmen die Testgütekriterien des „Anhaltsbogens für ein vertiefendes Gespräch“ untersucht wurden. Der Anhaltsbogen ist ein zweistufiges Screeningverfahren für Risikofaktoren rund um die Geburt, dessen Einsatz als Praxisinstrument sich im Rahmen des Modellprojektes „Guter Start ins Kinderleben“ an verschiedenen Geburtskliniken bewährt hat. Die Gütekriterien sind hinsichtlich der Interraterreliabilität und der Kriteriumsvalidität als zufriedenstellend zu bezeichnen. Wie auch bei anderen Screeningverfahren im Kontext von „Frühen Hilfen“ ist die prädiktive Validität allerdings noch nicht ausreichend abgesichert. Die Bedeutung eines Screeningverfahrens für die Prävention von Kindeswohlgefährdung wird diskutiert. Schließlich werden im Rahmen des dritten Manuskriptes „Prävention“ Ergebnisse der Wirkungsevaluation der Entwicklungspsychologischen Beratung dargestellt, die im Rahmen von „Guter Start ins Kinderleben“ an einer Risikostichprobe von N = 96 Mutter-Kind-Paaren durchgeführt wurde. Die Evaluation weist auf die teilweise Wirksamkeit der EPB hinsichtlich der mütterlichen Feinfühligkeit und der kindlichen emotionalen Entwicklung im ersten Lebensjahr hin. Die Risikobelastung der Mütter, hoch vs. moderat, stellte sich als entscheidende Moderatorvariable für die Wirksamkeit des Interventionsansatzes dahingehend heraus, als dass die Effekte nur für die hoch belastete Gruppe gefunden werden konnten. Die Ergebnisse werden vor dem Hintergrund internationaler und nationaler Befunde der Programmevaluation zur frühen Förderung erörtert.The three submitted manuscripts of the dissertation deal with “prevalence, diagnosis and prevention of child abuse and neglect”. They grew out of the initiatives of early preventive intervention, so called “Frühe Hilfen”, which aim to offer low threshold services to families at risk. The development started in Germany in the year 2005. The first manuscript “Prevalence“ reviews and critically discusses data concerning the scope and longitudinal development of child abuse and neglect (CAN) in Germany. Whereas the officially detected cases of CAN are under 1 ‰, retrospective survey studies indicate prevalence rates over 10 % of the different age groups. The authors discuss the deficient statistical data in context of early preventive interventions. They advocate a national strategy for standardized assessment of risks and acts of child maltreatment in order to improve allocation and evaluation of the early services for families at risk. Furthermore, the second manuscript “Diagnosis” explores the test criteria of the “Short questionnaire for risk indexes around birth“ (RIAB). The RIAB is a two-stage screening tool, which assesses risk factors around birth and in the early postnatal period. The use of this instrument in different maternal clinics in context of the model project “A good start to life” showed its practicability. The criteria of interrater-reliability and criterion validity can also be described as satisfying. As a constraint, the predictive validity is not enough ensured as it is the case with other screening tools used in context of early preventive interventions. The screening tool is discussed concerning its practical relevance for prevention of child maltreatment. Finally, the third manuscript „Prevention“ reports about the evaluation of the “Ulm Model”, an attachment based early preventive intervention. The pilot study was undertaken in context of the program “A good start to life” with a high risk sample of N = 96 mother-infant-pairs. The evaluation points to the partial effectivity of the “Ulm Model” with regard to maternal sensitivity and infant emotional development during the first year. The amount of risk factors (moderate vs. high) turned out to be an important moderator of the intervention effect. The effect was only found for the high-risk group. The results are discussed against the background of (inter-) national program evaluation of early prevention

Opportunities for prevention and intervention with young children: lessons from the Canadian incidence study of reported child abuse and neglect

Abstract Background The most effective way to provide support to caregivers with infants in order to promote good health, social, emotional and developmental outcomes is the subject of numerous debates in the literature. In Canada, each province adopts a different approach which range from universal to targeted programs. Nonetheless, each year a group of vulnerable infants is identified to the child welfare system with concerns about their well-being and safety. This study examines maltreatment-related investigations in Canada involving children under the age of one year to identify which factors determine service provision at the conclusion of the investigation. Methods A secondary analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect CIS-2008 (PHAC, 2010) dataset was conducted. Multivariate analyses were conducted to understand the profile of investigations involving infants (n=1,203) and which predictors were significant in the decision to transfer a case to ongoing services at the conclusion of the investigation. Logistic Regression and Classification and Regression Trees (CART) were conducted to examine the relationship between the outcome and predictors. Results The results suggest that there are three main sources that refer infants to the Canadian child welfare system: hospital, police, and non-professionals. Infant maltreatment-related investigations involve young caregivers who struggle with poverty, single-parenthood, drug/solvent and alcohol abuse, mental health issues, lack of social supports, and intimate partner violence. Across the three referral sources, primary caregiver risk factors are the strongest predictor of the decision to transfer a case to ongoing services. Conclusions Multivariate analyses indicate that the presence of infant concerns does not predict ongoing service provision, except when the infant is identified with positive toxicology at birth. The opportunity for early intervention and the need to tailor interventions for specific caregiver risk factors is discussed

Opportunities for prevention and intervention with young children: lessons from the Canadian incidence study of reported child abuse and neglect

Background: The most effective way to provide support to caregivers with infants in order to promote good health, social, emotional and developmental outcomes is the subject of numerous debates in the literature. In Canada, each province adopts a different approach which range from universal to targeted programs. Nonetheless, each year a group of vulnerable infants is identified to the child welfare system with concerns about their wellbeing and safety. This study examines maltreatment-related investigations in Canada involving children under the age of one year to identify which factors determine service provision at the conclusion of the investigation. Methods: A secondary analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect CIS-2008 (PHAC, 2010) dataset was conducted. Multivariate analyses were conducted to understand the profile of investigations involving infants (n=1,203) and which predictors were significant in the decision to transfer a case to ongoing services at the conclusion of the investigation. Logistic Regression and Classification and Regression Trees (CART) were conducted to examine the relationship between the outcome and predictors. Results: The results suggest that there are three main sources that refer infants to the Canadian child welfare system: hospital, police, and non-professionals. Infant maltreatment-related investigations involve young caregivers who struggle with poverty, single-parenthood, drug/solvent and alcohol abuse, mental health issues, lack of social supports, and intimate partner violence. Across the three referral sources, primary caregiver risk factors are the strongest predictor of the decision to transfer a case to ongoing services. Conclusions: Multivariate analyses indicate that the presence of infant concerns does not predict ongoing service provision, except when the infant is identified with positive toxicology at birth. The opportunity for early intervention and the need to tailor interventions for specific caregiver risk factors is discussed