The maltreatment-violence link: Exploring the role of maltreatment experiences and other individual and social risk factors among young people who offend

Objective: This study investigated the extent to which violent offending in a population of young people detained in secure care facilities is related to variations in child maltreatment after controlling for other known individual and social correlates of crime. Method: Official child protection and youth justice records and survey information for 1819 young people were analyzed. Measures included: maltreatment factors (including type, timing and recurrence); out-of-home care placement factors (including type, age at first placement, stability and duration of placements); social factors (including family and peer risk indicators); and individual factors (including factors relating to intelligence and education, substance use, mental health problems, and behavior). Gender and cultural background were also investigated as potential moderating factors. Logistic regression was used to determine the independent effect of maltreatment factors on violent convictions in the presence of other risk factors. Results: Persistent maltreatment was a consistent predictor of violent convictions. Other independent predictors included: aggression, anger, Indigenous status, and male gender, with household conflict also approaching significance. Conclusion: Collaborative and integrated responses from both child protection and juvenile justice may be needed if comprehensive violence prevention strategies are to be developed for young offenders

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

sj-docx-1-tva-10.1177_15248380221126186 – Supplemental material for Intergenerational Transmission of Parental Adverse Childhood Experiences and Children’s Outcomes: A Scoping Review

Supplemental material, sj-docx-1-tva-10.1177_15248380221126186 for Intergenerational Transmission of Parental Adverse Childhood Experiences and Children’s Outcomes: A Scoping Review by Lixia Zhang, Joshua P. Mersky, Anne Marie H. Gruber and June-Yung Kim in Trauma, Violence, & Abuse</p