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Objectives: This article reviews the available evidence regarding the efficacy, effectiveness, ethics, and sustainability of approaches to strengthen systems to care for and protect children living outside family care in low- and middle-income countries. Method: For trafficked children, children of and on the street, children of conflict/disaster, and institutionalized children, a systems framework approach was used to organize the topic of sustainable approaches in low- and middle-income countries and addresses the following: legislation, policies, and regulations; system structures and functions (formal and informal); and continuum of care and services. The article draws on the findings of a focal group convened by the U.S. Government Evidence Summit: Protecting Children Outside of Family Care (December 12-13, 2011, Washington, DC), tasked with reviewing the literature on systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care in low- and middle-income country contexts. The specific methodology for the review is described in the commentary paper (Higgs, Zlidar, & Balster, 2012) that accompanies these papers. Results: For the most part, the evidence base in support of sustainable long-term care for the populations of interest is relatively weak, with some stronger but unreplicated studies. Some populations have been studied more thoroughly than others, and there are many gaps. Most of the existing studies identify population characteristics, needs, and consequences of a lack of systemic services to promote family-like care. There is some evidence of the effectiveness of laws and policies, as well as some evidence of service effectiveness, in improving outcomes for children outside of family care. Conclusions: Despite the weaknesses and gaps of the existing research, there is a foundation of research for going forward, which should focus on developing and implementing systems for these most vulnerable children. The evidence reviewed indicates that child protection systems should aim for appropriate, permanent family care (including reunification, adoption, kinship care, or kafalah) for children in order to secure the best environment for a child's developmental prospects. Evidence also suggests that the quality and duration of care, including both permanent family care and alternative care, are important regardless of setting. The diversity of political, socioeconomic, historical, regional, community, and cultural contexts in which child protection systems operate need to be taken into account during programming and research design.

In FY 2009, the Children's Bureau funded the Center for the Study of Social Policy, in partnership with ZERO TO THREE: National Center for Infants, Toddlers, and Families, and the National Alliance of Children's Trust and Prevention Funds, to create a National Quality Improvement Center on Early Childhood (QIC-EC) focused on child maltreatment prevention. The purpose of the 5-year QIC-EC is to promote knowledge development, knowledge dissemination, and knowledge integration in this area. Knowledge development focuses on program and systems strategies that contribute to the prevention of child maltreatment and to the promotion of increased family strengths and optimal development among infants and young children (birth-5) who are at high-risk for abuse, neglect, and abandonment. Knowledge dissemination is supported by facilitating collaborative information-sharing and problem-solving via a national QIC-EC Learning Network, the Children's Bureau Training and Technical Assistance network, and ongoing relationships with other stakeholders and partners. Knowledge integration is the culmination and desired impact of knowledge development and knowledge dissemination resulting in positive change for families and children and sustainable, systemic change at multiple levels of the child maltreatment prevention field. Integration happens as effective knowledge development and dissemination activities reinforce, support, and then translate new learning into practice and use. This paper contains the following sections: (1) Affirmation of the Need for the QIC-EC; (2) Designing the Delivery and Evaluation of an Intervention; (3) The Overarching Research Question for the R&D Projects; (4) Outcomes, Indicators, Measurement, and Instrumentation; and (5) Introduction to Evaluation Plans. (Contains 1 figure and 6 tables.)

More than 800,000 American children spend some time in foster care each year, most because they have been victims of child abuse or neglect. The families of 3.5 million children are investigated or assessed for alleged maltreatment each year, and more than 900,000 children are determined to be victims--three-quarters of them neglected, and one-quarter physically or sexually abused. To assist these children, the nation's child welfare systems spend more than $25 billion per year, of which more than $12 billion comes from the federal government. Yet there is broad consensus that these systems, despite the extraordinary efforts of many committed managers, supervisors, and frontline workers, fail to produce the results needed. Too many of the children who encounter them remain unsafe, and too many do not have basic needs such as education and health care met. Most important, far too many of these children and youth are left without the permanent, supportive family every child needs to grow into a healthy and productive adult. The current economic crisis will create ever-higher demands on already over-stretched child welfare systems--and even more reason to ensure that every dollar invested in child welfare is spent wisely. The incoming administration and Congress have an extraordinary opportunity to drive real reform of child welfare nationally, by changing federal policies that are fundamentally misaligned with the goals they are supposed to promote. This paper provides recommendations that most likely will solve these problems such as: (1) Change federal fiscal policy to better promote permanence and well-being; (2) Promote innovation, evaluation, and widespread implementation of policies and practices supported by strong evidence; and (3) Improve both oversight and support of state child welfare systems.

Residential treatment programs provide a range of services, including drug and alcohol treatment, confidence building, military-style discipline, and psychological counseling for troubled boys and girls with a variety of addiction, behavioral, and emotional problems. This testimony concerns programs across the country referring to themselves as wilderness therapy programs, boot camps, and academies, among other names. Many cite positive outcomes associated with specific types of residential treatment. There are also allegations regarding the abuse and death of youth enrolled in residential treatment programs. Given concerns about these allegations, particularly in reference to private programs, the Committee asked the US Government Accountability Office (GAO) to: (1) verify whether allegations of abuse and death at residential treatment programs are widespread; and (2) examine the facts and circumstances surrounding selected closed cases where a teenager died while enrolled in a private program.To achieve these objectives, GAO conducted numerous interviews and examined documents from closed cases dating as far back as 1990, including police reports, autopsy reports, and state agency oversight reviews and investigations. GAO did not attempt to evaluate the benefits of residential treatment programs or verify the facts regarding the thousands of allegations it reviewed. Ten closed cases from private programs were selected to examine in greater detail. Specifically, these cases were focused on the death of a teenager in a private residential treatment program that occurred between 1990 and 2004. GAO found significant evidence of ineffective management in most of these ten cases, with many examples of how program leaders neglected the needs of program participants and staff. Three factors played a significant role in most of the deaths examined: untrained staff, inadequate nourishment, and reckless or negligent operating practices. (Contains 4 figures, 1 table, and 8 footnotes.) [This report was produced by the United States Government Accountability Office, formerly known as the General Accounting Office.]

This article describes the Child Development and Parenting Program (CDP), a preventative child abuse program that assists single women who are pregnant or have preschool children to cope constructively with the problems of single parenting. The short-term goals of the program, i.e., providing education in child development and parenting skills and meeting the social and emotional needs of the mothers, are presented as means to achieve the long-term goal of preventing child abuse and neglect. The client population, single women at-risk for child abuse, is described and referral methods are noted. Weekly group meetings, in which staff and volunteers provide a group support system to diminish environmental, psychological, and social stresses associated with child abuse, are reviewed. Innovative techniques are discussed, including provision of meals, creation of a family atmosphere, facilitation of maternal-infant bonding, and utilization of multiple community resources. An evaluation of the 64 women referred to CDP over a 2 year period is included, reflecting the absence of abuse or neglect when the mother entered the program during pregnancy. (NRB)

A study was conducted to examine the effects of child abuse and neglect on children's nonverbal behaviors. It was hypothesized that abused and neglected children would be less active nonverbally than would control group children. Eight abused and neglected children, aged one through three years, were videotaped interacting with their caregivers in a daycare center, and their behavior was compared with that of a matched control group from the same center. Children were desensitized to the presence of the observers and were taped in a familiar room at the center, interacting with a familiar caretaker. After taping was completed, the tapes were coded into 9 categories in three areas of nonverbal behavior: proxemic (distance maintained from caretaker), kinesic (reaching, touching), and gaze (eye contact) behaviors. The scores were analyzed to determine the differences between abused and nonabused children. The results indicated that the abused boys tended be either slightly more exploratory or slightly more active than their nonabused counterparts. The abused girls tended to avoid physical contact with the environment and social engagement with the adult more than their nonabused counterparts or the boys in either group. The results suggest that the abused children conformed more closely to sex stereotypes than did nonabused children. (HTH)

Child maltreatment, defined as acts of commission or omission that harm a child physically or psychologically, adversely affects millions of children nationwide. Since almost two-thirds of these children are of school age, schools could be among the best resources available to combat child maltreatment. This paper examines the responsibilities and policies of Indiana public schools regarding child maltreatment. Section I defines child maltreatment and reviews federal and Indiana laws and reporting requirements. Section II focuses on the ethical and professional responsibilities of educators. Section III presents the results of survey responses from 203 of the state's 304 school corporations to determine their policies and procedures for handling child maltreatment. In section IV, suggestions are offered to improve school policies and procedures that include inservice and preservice education, school policies to ensure accountability in abuse situations, coordination with community child services, state support for maltreatment programs, and standardized record-keeping practices. References and survey data are included. (LMS)

This study evaluates the impact of the Parent Linking Project III (PLP III) on its participants. The PLP III is a comprehensive program for teenage mothers which offers workshops in parenting, mother-child interaction, and vocational awareness, and provides day care services that allow teen mothers to take the opportunity to complete their high school education. The subjects of the study were 23 black teenage mothers aged 15-18 years, and their children aged 5-48 months. The Adult Adolescent Parenting Inventory, the Nursing Child Assessment Teaching Scale, and the Coopersmith Self-Esteem Inventory were administered before and after participation in the project to determine the project's impact on participants' parenting attitudes, mother-child interaction skills, and self-esteem. It was found that the mean response scores increased favorably for inappropriate expectations of the child, lack of empathy for the child, corporal punishment, and role reversal. The results indicate a need for early and comprehensive intervention programs for teenage mothers and their children. The study concludes with list of 21 references. (RJC)

Although research has established a linkage between maltreatment and running away, there have been few in-depth investigations of this phenomenon. This study was conducted to: (1) describe the nature of maltreatment among runaway and homeless youth; (2) provide a profile of their family and demographic characteristics; (3) examine how maltreated runaway and homeless youth differ from the runaway and homeless youth population at large; and (4) present behavioral indicators of adolescent maltreatment to assist with the uncovering of maltreatment among troubled youth. Data were derived from the Statewide Teamwork for Abused Runaways (STAR) project, a federal research and demonstration project designed to strengthen services to runaway and homeless youth and their families. Subjects included 223 abused and neglected youth who sought services from nine runaway and homeless youth programs in New York. A questionnaire on the nature of maltreatment, youth and family characteristics, and the runaway program's experience with child protective services, and the Youth Information Form were completed by project staff when services were terminated. Youth were not directly interviewed with the instruments. The results revealed that, compared to runaways and homeless youth in general, the maltreated sample had a higher percentage of females, and a higher percentage of Black and Hispanic program users. Maltreatment was the primary reason most of the maltreated subjects sought help from the project. The results of the study affirm the importance of identifying maltreatment among runaway and homeless youth. (Thirty-five references are provided.) (NB)

One of seven reports in the Innovations in Protective Services series, this document reports on the development of a model of case management that clarified what is expected from Child Protective Service (CPS) specialists. By conducting a literature review, studying the role of the CPS case manager, and developing a case management model, the Case Management Project attempted to eliminate misunderstanding of CPS caseworkers' role. The review of the social work literature substantiated the fact that confusion exists about CPS caseworker roles. The survey asked physicians, attorneys, foster parents, teachers, and caseworkers to identify which of eight roles CPS workers performed and skills needed by protective service workers. Responses varied markedly among groups of respondents. The model presumes that there are three main roles in CPS work: case manager, caseworker, and case specialist. Each role should be assumed by a different member of a "case team." The three team members are ultimately responsible to a supervisor of case services. These four people make up the case team and handle cases as they are assigned to a CPS unit. Each of the three specialists takes the same role with each case assigned to the team. A paper summarizing the findings of the literature review, a paper summarizing the survey's results, and the proposed case management model are appended. (RH)

This paper briefly reviews current knowledge about child abuse in foster care, and presents preliminary findings from a study identifying characteristics of abused children by type of abuse, and type of abuse by behavior of the child. Research indicates that foster children at risk for abuse exhibit specific characteristics, such as having experienced multiple placements, or having special needs or handicapping conditions. Foster parents who maltreat children are typically older, more affluent, and more likely to be married than maltreating biological parents. Agency practices related to foster care abuse include making emergency placements, overloading foster homes, mismatching child and family, infrequent home visits, and lack of foster parent training. Analysis of 176 abuse incidents shows that certain children may be more vulnerable to abuse in family foster homes than others. Data strongly suggest that foster parents need help in understanding toileting behavior and the regression in this area that is likely to occur when a child undergoes trauma. Behaviors interpretable as direct challenges to adult authority were among those most likely to lead to physical abuse, especially those involving physical aggression or use of bad language toward the adult. If these children are to be safely placed, potential foster families must receive better training. (RH)

Most child abuse has a violent quality. A review of the research on child abusers reveals some interesting psychosocial and historical characteristics. Research has shown violence to be more likely in less stable populations, in persons with poor driving records and histories of severe accidents, and in those who are undereducated and unsuccessful in life. Violent individuals, compared to nonviolent persons, have been found to be more likely to reside in the southern United States and to adhere to a cultural group that advocates physical punishment. These violent individuals often have a history of parental deprivation, post childhood enuresis, cruelty to others as children, hurt self-esteem, and alcohol or sedation abuse. Psychologically abusive parents tend to be depressed, to project their self-hatred to the child, and to have a role reversal with the child. Some forms of child abuse involve infanticide, rejection, sexual abuse, restriction, oppression, and slavery. Parents who sexually abuse their daughters often feel depreciatory to women and are sexually rigid and punitive. Psychologically the abusive parent has phobic ideation, marked ambivalence, unresolved oral aggression, and sado-masochistic conflicts with a breakthrough of sadistic pre-genital material. The quality of the entire parental relationship is more significant than the actual physical abuse, with abandonment being the most serious abuse to the child. Clearly all forms of child abuse are a family affair. (Author/NB)

This paper addresses the potential impact of Temporary Assistance for Needy Families (TANF) on the incidence of child maltreatment. Potential risks include maltreatment related to poverty, loss of benefits because of sanctions or time limits, and problems finding child care. While the total number of substantiated cases of maltreatment decreased in 1999, the estimated number of children in foster care grew significantly. This may demonstrate that TANF is having no negative impact on the rates of child abuse and neglect, or it may reflect alternative case handling. Research raises red flags suggesting that policies adopted under TANF may be increasing children's risk of maltreatment. For example, grant reductions are associated with increased entry into child welfare; subsequent employment in light of welfare losses may influence the likelihood of Child Protective Services involvement; increased proportions of working single mothers are associated with increased rates of neglect; and a comprehensive package of welfare reforms may increase maltreatment rates. Recommendations include focusing TANF on the reduction of child and family poverty and considering additional measures of welfare reform's success. Three appendices present an overview of TANF, major child welfare programs, and child welfare provisions in the 1986 welfare law. (SM)

Child abuse and neglect (CA&N), as a social and psychological phenomenon, represents a major area of concern internationally. This study examined the prevalence and self-reported effects of CA&N in Iran through a descriptive investigation of high school students' experiences. A sample consisting of 2,240 high school students representing 5 geographical areas of Tehran completed the Child Abuse and Neglect Questionnaire and the short form of the Beck Depression Inventory. Preliminary analyses indicated that 24% of the sample was subjected to some form of physical abuse, while 34% reported past physical abuse experiences. Overall, 43% of the participants reported they had been battered at least once in their lives. The high rate of physical abuse was followed by emotional abuse (23%), neglect (15.5%), and sexual abuse (4.7%) in the sample. The results suggest that child abuse may be a significant social problem in Iran, but one that is not openly acknowledged as a function of the sociopolitical climate. (Author/JDM)

This study examines how Australian and British preservice training programs incorporate child abuse intervention. Australian student teachers complete compulsory training in mandated notification as part of their program. Evaluation of student teachers who completed the training indicated that they highly valued it, though they were confused about who mandated reporters were, categories of child abuse and neglect, and whether or not they had civil immunity if they reported in good faith. Confusion about policies and procedures directly influenced their confidence in identifying and reporting. In the United Kingdom, pressure over performance standards has left the issue of child welfare on hold, though one standard states that qualified teachers should demonstrate a working knowledge and understanding of teachers' legal liabilities and responsibilities. Surveys of student teachers who participated in training with the newly developed Child Protection in Initial Teacher Training Tutor Pack indicated that this course needed to be integrated into, not grafted onto, the main program. Though most students believed teachers had a role in child protection, many expressed anxiety and confusion over the issue, including those who felt confident in their role related to child protection. Students wanted more thorough training on child protection. (Contains 63 references.) (SM)

Children in foster care are the most educationally at risk population in New York City, and the longstanding failure of the responsible agencies to address the educational needs of foster children in New York City is a problem that has, for the most part, been ignored. This paper reports on a study aimed at creating a database to inform the delivery of educational services to children in foster care. Data collection involved the dissemination and collection of more than 280 surveys competed by foster and biological parents, educators, social workers, case workers, education professionals, lawyers, and foster children themselves. Most of the biological parents responding (89%) said that they were unaware of, and never informed about, the Early Intervention program while their children were in foster care, and half of foster parents did not know about this program. Only 18% of foster parents reported that children in their care were enrolled in preschool programs. Forty-two percent of the foster children stated that they did not start school immediately on entering foster care, and over 75% stated that they did not remain in their school once placed in foster care, with nearly 65% reporting that they transferred in the middle of the school year. Thirty percent of foster care youth reported receiving special education services, nearly three times the average for New York City. More than half of the young people who responded (52%) reported that they did not feel prepared to support themselves after they left foster care, and over 50% were not satisfied with the quality of the education received while in foster care. These findings and others demonstrate the lack of attention paid to the education of children in foster care. Recommendations are made to improve educational services for these children, while meeting federal, state, and local requirements. (SLD)