Placement Decision-making in Child Welfare: A Provincial Profile of Associated Factors

INTRODUCTIONOut-of-homeplacement is described as being the most costly and intrusive response to achild protection investigation [2]. Out-of-home care is the largest singleexpenditure for many child welfare organizations in Canada [1]. There islimited understanding on the benefits of this costly intervention, and forwhich children placement is best suited for. Children in care are reported toexperience greater behavioural problems [5], hinder youths’ willingness toengage in relationships [6], and decrease cognitive skills [5].  Alberta has seen an increase in child welfareplacements from 2003 when 7% of all child investigations noted a formal childwelfare placement compared with 9% in 2008 [4]. The Alberta Incidence Study of Reported Child Abuse and Neglect 2008(AIS-2008) is the second cycle of a provincial study that examines reportedincidents of child abuse and neglect [4]. Based on a secondary data analysis of the AIS-2008 dataset, this poster will providea provincial profile of factors associated with child welfare placement cases,and no child welfare placement cases in Alberta in 2008.METHODSThisposter is based on 27,417 child maltreatment investigations from the AIS-2008dataset comparing characteristics of cases where placement was noted (n=2,383),and cases where no placement was noted (n=24,764). Bivariate analysis andPearson’s chi-squared tests were conducted to compare select child, household,and case characteristics of these two types of cases.RESULTSA higherpercentage of placement investigations involved children younger than 1 yearold (14%) compared to no placement investigations (8%). At least one childfunctioning concern was noted in 76% of placement child investigations and in42% of no placement child investigations. Ninety-three percent of placementinvestigations noted at least one caregiver risk factor, and 75% of noplacement investigations. Placement cases noted varied percentages ofcategories of maltreatment investigations, with neglect as the most frequent(54%), followed by physical abuse (15%), emotional maltreatment (14%), exposureto intimate partner violence (7%), and sexual abuse (3%). Of no placementcases, neglect was most noted (29%), followed by exposure to intimate partnerviolence (24%), physical abuse (17%), emotional maltreatment (10%), and sexualabuse (3%). Forty percent of placement cases noted emotional harm requiringtherapeutic treatment, compared to a significantly lower percentage for noplacement cases (12%). Placement cases noted a higher percentage where physicalharm was severe enough to require treatment (7%), compared to no placementcases (1%). Seventy-four percent of placement cases noted the duration of asuspected or substantiated maltreatment event occurring over multipleincidents, compared to 41% for no placement investigations.   DISCUSSION AND CONCLUSIONSThisanalysis shows the multi-faceted nature of casework placement decision-making,and the breadth of factors caseworkers consider while attempting to balancecompeting child welfare orientations [3]. Findings are consistent with currentliterature where placement cases were noted as having a higher percentage ofchildren younger than 1 year old, and factors which create a greater level ofrisk to the child such as increased child functioning concerns, increasedcaregiver risk factors, and poorer household conditions. Placement cases notedhigher percentages for physical abuse, neglect, and emotional maltreatment

Differential response and traditional protection investigation: a comparison of two child welfare investigation streams

INTRODUCTION Determining an appropriate threshold for which children and families should receive child welfare services has been widely debated in literature. Workers are faced with multiple child welfare orientations when determining the appropriate level of intrusiveness during child maltreatment investigations [3]. Parental rights, family preservation, and safety of the child are some of the competing tensions in the child welfare model that investigating workers must balance [2,9]. Differential Response (DR) model is a flexible approach to child maltreatment investigations developed to provide a range of customized investigative streams incorporating family-centered, and strengths-based practices [4]. This model is a less intrusive approach to investigations for low-risk cases that do not present imminent risk to the child, compared to Traditional Protection Investigations (INV) [5,7]. There is a high degree of jurisdictional variation in screening, intake and administration of DR models resulting in a disparity of findings throughout child welfare research [4]. In 2002, the Alberta Response Model was created to allow child welfare agencies to provide flexible investigative streams to families based on the type and severity of child maltreatment [1,8]. The Family Enhancement Program works as part of the Alberta Response Model to provide children and families with a DR investigation stream [1]. High-risk cases are streamed to INV while lower risk families who are willing are streamed to the Family Enhancement Program [1]. This article will inform practitioners’ understandings of DR model by providing a provincial profile of DR streamed investigations while comparing child, household, maltreatment characteristics and case factor associated with each child welfare investigative stream based on the Alberta Incidence Study of Reported Child Abuse and Neglect 2008 (AIS-2008) [6].     METHODS This analysis is based on secondary analysis of the AIS-2008 dataset. The AIS-2008 is the second cycle of a provincial study that examines incidences of reported child abuse and neglect in Alberta for children 17 years and younger. This paper reports on findings based on a total weighted number of 26,957 child investigations that were noted as either DR streamed investigations, or INV streamed investigations. A total of 6,666 child investigations noted use of DR model, while an additional 20,291 child investigations noted use of INV model. Select comparisons of child, household, case and maltreatment factors from two child welfare investigation streams are presented in this analysis. Bivariate analyses and Pearson’s chi-squared test were used to compare each investigative stream and associated factors. For further information on methodology of the AIS-2008 refer to Chapter 2 of the full report [7].   RESULTS Figure 1 shows primary categories of all reported child maltreatment incidents and risk investigations streamed to DR and INV. Significant differences in child investigations were noted for younger children. Eleven percent of DR streamed investigations involved children who were less than 1 year old, and 8% of INV streamed investigations. Caseworkers were asked to report on nine caregiver risk factors, such as alcohol and/or drug abuse, cognitive impairment, and/or victim of intimate partner violence (IPV) [7]. While differences between the two investigative streams for caregiver risk factors would be expected, there were little differences noted. A risk investigation refers to situations where a specific incident of maltreatment has not yet occurred, however circumstances indicate that there is a significant future risk of maltreatment [7]. DR child investigations more frequently noted risk investigations than INV child investigations. For DR investigations, neglect was noted most frequently (38%), followed by exposure to intimate partner violence (23%), physical abuse (10%), and emotional maltreatment (9%). Ten percent of DR investigations noted emotional harm requiring treatment, compared to 16% of INV investigations. One percent of DR investigations noted physical harm severe enough to require medical attention, and 2% of INV investigations. The percentage of DR child investigations resulting in a formal child welfare placement was significantly less (5%) than INV child investigations (10%). Twenty-five percent of DR investigations remained open for ongoing services compared to 32% of INV investigations. DR investigations less often resulted an application to child welfare court (4%), than INV streamed investigations (13%). Figure 1. Primary Categories of All Reported Child Maltreatment Incidents and Risk Investigations in Alberta in 2008 by Child Welfare Investigation Streams. Percentages of type of maltreatment includes total number of child investigations (n=26,957) streamed to differential response (n=6,666), and traditional protection investigation (n=20,291). DISCUSSION AND CONCLUSIONS This secondary data analysis examined 26,957 child maltreatment investigations from the AIS-2008 dataset. The increased flexibility of DR model enables workers to balance some of the competing tensions in child welfare. DR model allows child welfare agencies to provide less intrusive approach to investigations for low-risk investigations, compared to INV model which is intended for investigations presenting greater severity of harm. This exploratory analysis examined differences in characteristics between children and families of child maltreatment investigations streamed to DR approach and INV approach. Future research should examine long term outcomes of investigations streamed to DR and INV. Exploring long term outcomes will provide greater insight into the effectiveness of DR model child maltreatment investigations.   LIMITATIONS While the AIS-2008 dataset provides a unique opportunity to examine the child welfare response to reported maltreatment in Alberta, a number of considerations for this secondary analysis must be made when interpreting these findings. The AIS-2008 dataset; 1) only tracked reports investigated by child intervention services and did not include reports that were screened out, only investigated by police, and never reported; 2) is based on the assessments provided by the investigating child intervention workers and could not be independently verified; 3) is weighted using annual estimates which included counts of children investigated more than once during the year, therefore the unit of analysis for the weighted estimates was a child investigation; 4) as weighted estimates provided some instances where sample sizes were too small to derive publishable estimates [7].

Associated factors of investigations involving intimate partner violence and other forms of maltreatment; child family, household, and case characteristics

INTRODUCTION The co-occurrence of intimate partner violence (IPV) and child maltreatment intensifies the trauma experienced by children, compared with children who experience IPV alone [3]. IPV is linked to many negative developmental outcomes [2,7]. Children exposed to IPV are at risk for more social challenges [8], emotional issues [1,8], attachment issues [3], behavioural disorders [3], and more academic challenges [3,8]. There is a debate in literature where some researchers state that the involvement of child welfare in matters related to IPV result in overly intrusive interventions. Other research suggests that children exposed to IPV alone do not in general receive more intrusive intervention, but do require comparable supports as those children experiencing other forms of maltreatment. [2,4,6]   The Alberta Incidence Study of Reported Child Abuse and Neglect 2008 (AIS-2008) is a provincial study examining the characteristics of reported child abuse and neglect [5]. The AIS-2008 dataset provides the opportunity to examine characteristics of children and families involved in IPV child investigations, as well as the short term outcomes. This analysis will examine evidence supporting or challenging the use of child welfare services for children and families experiencing IPV in Alberta in 2008.   METHODS The AIS-2008 is the second provincial study on child abuse and neglect to be conducted in Alberta for children 17 years and younger [5]. This article presents select comparisons of child, family, household, and case factors across 3 groups of substantiated child investigations. This includes: 1) IPV only child investigations where IPV was noted as the single child maltreatment concern; 2) co-occurring child investigations where IPV and at least one other form of child maltreatment (physical abuse, sexual abuse, neglect and emotional maltreatment) was noted; and 3) other forms of maltreatment child investigations involving other forms of child maltreatment excluding concerns of IPV. Workers noted IPV as a form of maltreatment if a child had allegedly been a direct witness to physical violence, had indirect exposure to physical violence, and/or exposed to emotional violence. The analyses presented in this article are based on annually and regionally weighted estimates of substantiated child investigations and examines a total of 14,404 substantiated child maltreatment investigations. This includes 3,898 IPV only investigations (27%), 2,302 co-occurring investigations (16%), and 8,204 other forms of maltreatment investigations (57%). Bivariate analyses and Pearson’s chi-squared tests were used to compare IPV investigations with co-occurring investigations and other forms of maltreatment investigations. For further information on the methodology of the AIS-2008 refer to Chapter 2 of the full report [5].   RESULTS Child welfare workers were asked to report on 9 caregiver risk factors at the time of the investigation. Victim and/or perpetrator of domestic violence was excluded as a household caregiver risk factor. Caregiver risk factors varied considerably between IPV only investigations, co-occurring investigations, and other forms of maltreatment investigations. For IPV only investigations, this included alcohol abuse (58%), few social supports (49%), and mental health issues (35%). For co-occurring investigations, alcohol abuse (79%), mental health issues (56%), and few social supports (54%) were the top three concerns that were noted. Other forms of maltreatment investigations identified few social supports (45%), mental health issues (41%), and alcohol abuse (34%). The level of harm was significantly lower for IPV only investigations than both co-occurring investigations and other forms of maltreatment investigations. Fifteen percent of IPV investigations noted severity of emotional harm requiring treatment, compared with 39% of co-occurring investigations, and 26% of other forms of maltreatment investigations. As would be expected, estimates of severity of physical harm were too low to report for IPV only investigations. Sixty-six percent of IPV only investigations involved multiple maltreatment incidents, 88% in co-occurring investigations, and 70% in other forms of maltreatment investigations. Child investigations resulting in out-of-home placement greatly varied by each comparison group. Three percent of IPV only investigations noted formal child welfare placement, 15% in co-occurring investigations, and 20% in other forms of maltreatment investigations. Workers referred 30% of IPV only investigations to ongoing services compared to 56% of co-occurring, and 49% of other forms of maltreatment.   Figure 1. Case Outcome Factors. Percentages of case characteristics include 14,404 child maltreatment substantiated investigations. This includes 3,898 IPV only investigations (27%), 2,302 co-occurring investigations (16%), and 8,204 other forms of maltreatment investigations (57%). DISCUSSION AND CONCLUSIONS The AIS-2008 dataset provides child, caregiver, household, and case factors associated with IPV only investigations, co-occurring investigations, and other forms of maltreatment investigations. While there is concern that the involvement of child welfare in IPV investigations will result in more intrusive interventions [6], findings from this analysis support Black et al. (2008) [1] who recognized that IPV as a single concern does not necessarily result in more intrusive outcomes. Co-occurring investigations noted the highest severity of harm, compared to IPV only investigations and other forms of maltreatment investigations. Subsequent analyses will build on this work in order to examine specific risk and protective factors that are predictive of child welfare placement and the provision of ongoing services. LIMITATIONS While the AIS-2008 dataset provides a unique opportunity to examine the child welfare response to reported maltreatment in Alberta, a number of considerations for this secondary analysis must be made when interpreting these findings. The AIS-2008 dataset; 1) only tracked reports investigated by child intervention services and did not include reports that were screened out, only investigated by police, and never reported; 2) is based on the assessments provided by the investigating child intervention workers and could not be independently verified; 3) is weighted using annual estimates which included counts of children investigated more than once during the year, therefore the unit of analysis for the weighted estimates was a child investigation; 4) as weighted estimates provided some instances where sample sizes were too small to derive publishable estimates [5].

A comparison of two cohorts among child welfare investigations in Alberta: child, caregivers, household, & case risk factors

INTRODUCTION In 2008, the province of Alberta reported children eleven years and younger made up 71% of all investigations [5]. More than 8,400 children five years of age or younger came to the attention of child welfare in Alberta in 2008 for allegations of child abuse and neglect, compared to approximately 7,700 children ages six to eleven years of age. Younger children are especially vulnerable to their surrounding environment and are heavily dependent on their caregivers to meet their basic needs; which inevitably provides the foundation for future developmental growth [6]. It is imperative for younger children to achieve critical developmental milestones such as language, brain development, emotional regulation, and attachment bonds [6]. Research indicates that younger children who experience maltreatment have an increased risk for health, behavior, and psychological functioning concerns in later life [2,5,6]. The accumulation of risk factors has been attributed to poorer internal and external behavioral trajectories in later childhood and adolescent years [1,3,6,8,9]. Examining child, caregiver, household, and case risk factors associated with these two cohorts will contribute to a greater understanding of the complex experiences between these child age groups. This paper seeks to provide researchers and practitioners with awareness concerning the impact of risk factors on this vulnerable population.   METHODS This secondary analysis was conducted on data collected for the Alberta Incidence Study of Reported Child Abuse and Neglect (AIS-2008). The AIS-2008 collected 2,239 child maltreatment investigations from fourteen randomly selected child intervention services offices over a three month case selection period (October 1, 2008 to December 31, 2008). Offices were stratified by jurisdiction and size to ensure that all subpopulations were fairly represented in the study, with additional consideration for Aboriginal organizations. This article presents select comparisons of child, family, household, and case factors of child maltreatment investigations and risk of future maltreatment investigations. The analyses compares two child age cohorts: 0-5 years old and 6-11 years old. Bivariate analyses and Pearson’s chi-squared tests were used to examine differences in risk factors associated with the younger and older cohorts.   This analysis was conducted using weighted estimates of 16,120 child investigations for incidents of maltreatment involving children 11 years of age and younger in Alberta. Of the total weighted estimate, 8,415 alleged child maltreatment  investigations involved children five years and younger and 7,705 maltreatment investigations involved children between six and 11 years of age. Analysis included substantiated, suspected and unfounded investigations for the two cohorts from the AIS-2008 data. For further information, refer to the methodology chapter of the AIS-2008: Major Findings Report [5].   RESULTS Figure 1 shows case risk factors for child investigations where a child 11 years old and younger was involved. Thirty-one percent of the 0-5 year old cohort remained open for on-going services and 9% of cases were streamed to differential or alternative response. Twenty-nine percent of the 6-11 cohort remained open for on-going services and of those, 10% of cases were streamed to differential or alternative response. Fifty-one percent of investigations of the 0-5 cohort were previously reported to child welfare for suspected maltreatment. For the older cohort, 61% of investigations were previously reported to child welfare for suspected maltreatment. Workers were asked to report on 6 housing safety concerns: accessible weapons, accessible drugs or drug paraphernalia, drug production or trafficking in the home, chemicals or solvents used in production, other home injury and health hazards. One or two of these household hazard risk factors were identified in 16% of investigations in the 0-5 cohort and 14% in the 6-11 cohort. For the 0-5 cohort, emotional harm was documented in 16% of investigations, whereas physical harm was noted in 7% of investigations. For the older cohort, emotional harm was documented in 30% of investigations and physical harm was documented in 5% of investigations. While 10% of the 0-5 cohort investigations were placed in a child welfare placement, 7% of 6-11 cohort investigations were placed in a child welfare placement.   Figure 1. Case Risk Factors. Percentages of case characteristics include all child investigations for incidents of child maltreatment where a child 11 years or younger was involved (n=16,120), 0-5 years old cohort (n=8,415), and 6-11 years old cohort (n=7,705). DISCUSSION AND CONCLUSIONS This secondary analysis of the AIS-2008 dataset examined child, caregiver, household, and case risk factors associated with the two youngest cohorts investigated by the child protection system. Firstly, these findings support the need to focus on both the additive effects and breadth of risk factors pertaining to child investigations, rather than focusing on solely one risk factor during an investigation. Second, the present findings indicate that families with young children in the child welfare system are faced with many significant stressors or multiple risk factors, such as parental mental health, social isolation, drug or alcohol abuse, intimate partner violence, financial hardship, and may also have young children experiencing poor functioning in multiple areas of their development. Children eleven and under have longer sustained involvement and multiple involvement with child protection services. Lastly, the array of risk factors and protective factors identified by child welfare workers could potentially shape both prevention and intervention strategies in preventing rates of re-referral and increase overall positive outcomes for children and families.   LIMITATIONS While the AIS-2008 dataset provides a unique opportunity to examine the child welfare response to reported maltreatment in Alberta, a number of considerations for this secondary analysis must be made when interpreting these findings. The AIS-2008 dataset; 1) only tracked reports investigated by child intervention services and did not include reports that were screened out, only investigated by police, and never reported; 2) is based on the assessments provided by the investigating child intervention workers and could not be independently verified; 3) is weighted using annual estimates which included counts of children investigated more than once during the year, therefore the unit of analysis for the weighted estimates was a child investigation; 4) as weighted estimates provided some instances where sample sizes were too small to derive publishable estimates [5].

CT Evidence for Subchondral Trabecular Injury of the Femoral Head in Transient Osteoporosis of the Hip: A Case Report

A 28-yr-old woman presented with both hip pain that started sequentially during the peripartum period. Diagnosis of transient osteoporosis of the hip (TOH) was made based on typical findings of plain radiographs and magnetic resonance images. The subchondral trabeculae of the femoral head were evaluated on serially taken coronal multiplanar reformation computerized tomogram images. At 4 weeks after pain onset, marked decrease in the sclerotic density with irregular discontinuation was observed in the primary compression trabeculae. At 12 weeks, a focal area of irregular thickening of trabeculae was observed. At 20 weeks, sclerotic density of trabeculae recovered markedly and the focal area of irregular trabecular thickening disappeared. At 1 yr, subchondral trabeculae recovered almost completely. The evidence of subchondral trabecular injury was observed in the femoral heads of TOH

Recombinant mussel proximal thread matrix protein promotes osteoblast cell adhesion and proliferation

BACKGROUND: von Willebrand factor (VWF) is a key load bearing domain for mamalian cell adhesion by binding various macromolecular ligands in extracellular matrix such as, collagens, elastin, and glycosaminoglycans. Interestingly, vWF like domains are also commonly found in load bearing systems of marine organisms such as in underwater adhesive of mussel and sea star, and nacre of marine abalone, and play a critical load bearing function. Recently, Proximal Thread Matrix Protein1 (PTMP1) in mussel composed of two vWF type A like domains has characterized and it is known to bind both mussel collagens and mammalian collagens. RESULTS: Here, we cloned and mass produced a recombinant PTMP1 from E. coli system after switching all the minor codons to the major codons of E. coli. Recombinant PTMP1 has an ability to enhance mouse osteoblast cell adhesion, spreading, and cell proliferation. In addition, PTMP1 showed vWF-like properties as promoting collagen expression as well as binding to collagen type I, subsequently enhanced cell viability. Consequently, we found that recombinant PTMP1 acts as a vWF domain by mediating cell adhesion, spreading, proliferation, and formation of actin cytoskeleton. CONCLUSIONS: This study suggests that both mammalian cell adhesion and marine underwater adhesion exploits a strong vWF-collagen interaction for successful wet adhesion. In addition, vWF like domains containing proteins including PTMP1 have a great potential for tissue engineering and the development of biomedical adhesives as a component for extra-cellular matrix

Impacts of Detailed Land-Use Types and Urban Heat in an Urban Canopy Model on Local Meteorology and Ozone Levels for Air Quality Modeling in a Coastal City, Korea

An urban canopy model (UCM), with detailed urban land-use and anthropogenic heat information, is required to reproduce and understand the urbanization process and its impact on regional climate and urban air quality. This study investigates the UCM impact on simulated meteorology and surface ozone in the coastal city of Busan using the WRF-SMOKE-CMAQ model coupled with (UCM case), and without the UCM (NOUCM case). The UCM and NOUCM case results suggest that UCM case generally produces warmer temperatures and deeper planetary boundary layer (PBL) heights, especially in the early morning and night time, than the NOUCM case. Owing to urban heating and enhanced turbulent mixing incorporation in the center of the city, the sea breeze in the UCM case tends to penetrate faster and more strongly than in the NOUCM case. After sea breeze arrival at the urban center, the urban heat island effect prevents its penetration further inland. In the UCM case in the late afternoon, local meteorological changes induce remarkable increases in simulated O3 concentrations over the downwind (up to 17.1 ppb) and downtown (up to 10.6 ppb) areas. This is probably due to an increase in temperature in the urban areas and the wind convergence zone movement due to the sea breeze interaction and offshore flows. The increase in O3 concentration in the late afternoon results in the model bias reduction under previously underestimated O3 conditions due to high NOx emissions. The simulated O3 concentrations in the UCM case are more similar to the observed O3 concentrations compared to those of the NOUCM case

Lomerizine inhibits LPS-mediated neuroinflammation and tau hyperphosphorylation by modulating NLRP3, DYRK1A, and GSK3α/β

IntroductionLomerizine is a calcium channel blocker that crosses the blood–brain barrier and is used clinically in the treatment of migraines. However, whether lomerizine is beneficial in modulating neuroinflammatory responses has not been tested yet.MethodsTo assess the potential of lomerizine for repurposing as a treatment for neuroinflammation, we investigated the effects of lomerizine on LPS-induced proinflammatory responses in BV2 microglial cells, Alzheimer’s disease (AD) excitatory neurons differentiated from induced pluripotent stem cells (iPSCs), and in LPS-treated wild type mice.ResultsIn BV2 microglial cells, lomerizine pretreatment significantly reduced LPS-evoked proinflammatory cytokine and NLRP3 mRNA levels. Similarly, lomerizine pretreatment significantly suppressed the increases in Iba-1, GFAP, proinflammatory cytokine and NLRP3 expression induced by LPS in wild-type mice. In addition, lomerizine posttreatment significantly decreased LPS-stimulated proinflammatory cytokine and SOD2 mRNA levels in BV2 microglial cells and/or wild-type mice. In LPS-treated wild-type mice and AD excitatory neurons differentiated from iPSCs, lomerizine pretreatment ameliorated tau hyperphosphorylation. Finally, lomerizine abolished the LPS-mediated activation of GSK3α/β and upregulation of DYRK1A, which is responsible for tau hyperphosphorylation, in wild-type mice.DiscussionThese data suggest that lomerizine attenuates LPS-mediated neuroinflammatory responses and tau hyperphosphorylation and is a potential drug for neuroinflammation- or tauopathy-associated diseases