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CONSIDERATIONS FROM THE MALTREATMENT AND ADOLESCENT PATHWAYS (MAP) LONGITUDINAL STUDY

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CONSIDERATIONS FROM THE MALTREATMENT AND ADOLESCENT PATHWAYS (MAP) LONGITUDINAL STUDY

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  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
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CONSIDERATIONS FROM THE MALTREATMENT AND ADOLESCENT PATHWAYS (MAP) LONGITUDINAL STUDY

  1. 1. CONSIDERATIONS FROM THE MALTREATMENT AND ADOLESCENT PATHWAYS (MAP) LONGITUDINAL STUDY Christine Wekerle, Ph.D. & MAP Research Team Associate Professor, Pediatrics McMaster University (cwekerle@uwo.ca) Presentation to University of Toronto, Faculty of Social Work, March 31, 2010
  2. 2. MAP RESEARCH TEAM – WWW2.OACAS.ORG Principal Investigator: Chris Wekerle, Ph.D. (McMaster) Supported By: (1) CIHR IGH/OWHC Mid-Career Award (2) Interchange Canada Assignment, Public Health Agency of Canada Co –Investigators: Harriet MacMillan, M.D. (McMaster) Michael Boyle, Ph.D. (McMaster) Nico Trocmé, Ph.D. (McGill) Eman Leung, Ph.D. (UWO) Randall Waechter, Ph.D. (UWO) Deb Goodman, Ph.D. (Toronto CAS) Bruce Leslie, M.S.W. (Catholic CAS) Brenda Moody, M.B.A. (Peel Region CAS) Staff: Maria Chen, Testers, and Volunteers
  3. 3. MAP FUNDING AGENCIES – THANK YOU! • The Canadian Institutes of Health Research (CIHR), Community Action Health Research, and the Institute of Gender and Health • The Ministry of Child & Youth Services Ontario • The Ontario Mental Health Foundation • The Children’s Hospital of Eastern Ontario (CHEO) Centre of Excellence in Child & Youth Mental Health • The Centre for Excellence in Research in Child Welfare • Public Health Agency of Canada • Health Canada
  4. 4. DEFINITION OF CHILDHOOD MALTREATMENT Neglect - failure to provide care in accordance with expected societal standards for food, shelter, protection, affection (e.g., home and personal hygiene, nutrition, supervision) Emotional abuse - verbal abuse, isolation, age- inappropriate discipline, inappropriate confinement, witnessing inter-parental and parental violence Physical abuse - non-accidental bodily injury (e.g. bruises, burns etc.), typically in the context of discipline or shaken baby syndrome Sexual abuse - sexual coercion, including attempts or threats (e.g., fondling, molesting, exposure to pornography) *as defined by the World Health Organization
  5. 5. IMPACT OF CHILDHOOD MALTREATMENT • Developmental traumatology theory (DeBellis) • Biology – Person By Environment interaction • Maltreatment impacts brain structure and functioning towards: (1) over-taxing of stress response system – hypervigilance; quicker reactivity to threat (anger); disengaging from stress slower (2) under-development of safety system – over-focus on other and under-focus on self; lowered (slower) protective and self- soothing and adaptive coping response Gender-based findings: Maltreated females show greater impairment across lifespan, in areas of: Anxiety; Depression; Alcohol Abuse; Substance Abuse; PTSD; Antisocial Personality; Criminality; Suicidality; Obesity (see Gilbert et al., 2009; Wekerle, MacMillan, Leung & Jamieson, 2008)
  6. 6. THEORETICAL BACKGROUND  Attachment theory (e.g., Bowlby) – confidence in sensitivity of caregiver provides secure base, tolerance for distress, less fight-flight; both a “model” and a “template” - guides action to self and others action, selection of future situations  Social learning theory (e.g., Bandura) - role-model of self-reinforcing (self-supporting) or self-punishment (self- harm)  Resiliency theory (e.g., Rutter, Masten, Ungar): dynamic, developmental taking external experiences and internal resources (person x environment interaction) that alters the likelihood of adaptation or maladaptation
  7. 7. ChildChild DevelopmentDevelopment GoalGoal Child Welfare IssuesChild Welfare Issues Child DysfunctionChild Dysfunction AttachmentAttachment Positive SelfPositive Self Affect-regulationAffect-regulation Emotional Abuse:Emotional Abuse: (for example, Witnessing(for example, Witnessing domestic violence,domestic violence, verbal abuse;verbal abuse; lack of adequate soothing)lack of adequate soothing) InternalizingInternalizing SymptomatologySymptomatology Maladaptive CopingMaladaptive Coping Private Self/Private Self/ Healthy SexualityHealthy Sexuality Sexual Abuse:Sexual Abuse: (For example, exposure to(For example, exposure to pornography, sexual contact)pornography, sexual contact) Risky Sexual PracticesRisky Sexual Practices BehavioralBehavioral controlcontrol Physical Abuse:Physical Abuse: (Arbitrary, coercive discipline)(Arbitrary, coercive discipline) Aggression to Authority;Aggression to Authority; Peers; PartnersPeers; Partners Physical IntegrityPhysical Integrity and Acceptanceand Acceptance NeglectNeglect (Food, Shelter, Basics)(Food, Shelter, Basics) Health/HygieneHealth/Hygiene Self-careSelf-care Suicidal IdeationSuicidal Ideation Child Development ModelChild Development Model
  8. 8. MAPS GOALS & STRATEGIES Collects data from youth (ages 14.0 to 17.0 years) who are active on the child welfare caseload from an urban catchment area and are randomly selected 1. Evaluates the health and well-being of adolescents involved in the CPS system in one urban catchment area, (a)comparing MAPS females to MAPS males; (b) comparing to ON population matched on age and SES (OSDUHS) 2. Examines PTSD symptomatology as a contributing / mediating factor in health risk behaviours among CPS adolescents – example, teen dating violence
  9. 9. MAP PROJECT TIMELINE Initial 6 months 1 year 1.5 year 2 year 2.5 year 3 year Maltreatment Mental Health Substance use Dating Violence Risky Sexual Practices OSDUHS X X X In Progress In Progress In Progress In Progress In Progress In Progress
  10. 10. OSDUS PAPER; MOHAPATRA ET AL. (2009) RESULTS – FEMALE STUDENTS Bullying Others - Female 32.6 22.7 0 10 20 30 40 Non-maltreated Maltreated Percentbullying Bully Victimization - Female 27.7 41.4 0 10 20 30 40 50 Non-maltreated Maltreated Percentvictimization ► Maltreated female were 1.5 times more likely to bully and 1.7 times more likely to be victims of bullying, as compared to non-maltreated females. For bullying, no significant relationship with maltreatment history for males ► Females with higher psychological distress were over 2 times as likely to bully others (perpetrator) and to be bullied by others (victim), as compared to non-distressed female peers. ► Maltreatment did not predict how often bullying occurred; but whether it did or did not happen.
  11. 11. MAPS FEMALES & DELINQUENCY  MAPS Year 1 testing, using OSDUHS questions MAPS females higher delinquency than ON females; Crown Ward status buffers delinquency among MAPS females  Damaged Property OR=1.35  Beating up on purpose OR=1.53  Carried weapon (gun/knife) OR=1.78  Participated in gang fights OR=1.83  Ran away from home OR=1.74  Physical fight at school OR=1.96
  12. 12. FEMALES & SELF-HARM – ONTARIO STUDY (RHODES ET AL. 2008)  Based on Ontario hospital data on youth 12-17 years (Emergency Dept presentations, NACRS dataset)  Females more likely than males to be coded as deliberate self-poisonings (DSP), except with acetaminophen agent groups  Girls under age 15, 5 times more likely DSP  Females more likely to present with self-poisonings on most single and multiple agents, including antidepressants  Females not significantly different from males in medically serious overdose  Most presented to emergency (a) after-hrs and (b) were not admitted to hospital  did not receive suicide intent assessment  missed opportunity for mental health intervention  Suicide prevention - acetominophen type agents can be very toxic in overdose and females may have less physical tolerance  Implications: Need for greater study of self-harm among child welfare youth using administrative database (Dr. Anne Rhodes, SMH study) and child welfare database (Dr. Deb Goodman, serious occurrence report study)
  13. 13. MAPS PRELIMINARY RESULTS @ 2-YEAR TESTING MARK ON DELIBERATE SELF- HARM  At 2-year testing, females > CTQ subscale scores on all maltreatment subscales  Overall, 30% reported DSH acts, with most reporting more than 1 category  Females more likely to report cutting, severe scratching, head-banging, preventing wounds from healing, putting themselves purposefully in danger, using substances to excess  Males more likely to self-burn  53% of DSH impulsive; 18% thought 1 month or more about DSH  DSH youth higher Anger-inward score (STAXI), most prevalent reason “punish self”
  14. 14. MAPS FEMALES & DATING  For Females - Romantic relationships  Autonomy; Identity  MAPS: Physical childhood abuse co-loaded with emotional abuse for females (PA/EA)  MAPS: For females, majority PA/EA perpetrator was mother; majority SA perpetrator non-parent male (61%)  MAPS: Early Dating; Female Avg. age=13 years (SD=2.33)  12% MAPS Females report sex before age 13; over 2x US comparable findings for community youth  MAPS Females > Males gave birth/fathered child (10% vs. 1%)  MAPS: Females are likely to date older partners (Avg. age=18 years; compared to MAPS males (Avg. age=15)  Implications: For females, relationships insults more impactfuly emotionally on self-concept; and poor role-modeling may create greater risk
  15. 15. MAP FEMALES & TEEN DATING VIOLENCE  YRBSS – US high school (grades 9-12) 1999-2005 (6%-18%) “ever hit, slapped, physically hurt on purpose” – 10% avg. endorsement – no gender difference  7 items tapping teen dating violence (1) victimization and (2) perpetration, over the past 12 months  Physical Abuse (3 items): “kicked, hit, or punched partner” 26%; 34% “slapped or pulled partner’s hair” 22%; 27% “pushed,shoved,shook,pinned down partner” 29%; 30%  Emotional Abuse (4 items): “said things to make partner angry” 66%; 62% “threatened to hurt partner” 21%; 24% “threatened partner in attempt to have sex” 17%; 14% “threatened to hit or throw something at” 22%; 27%
  16. 16. Pag e 18 POSTTRAUMATIC STRESS DISORDER (PTSD) SYMPTOMATOLOGY MEDIATION MODEL Mediator: PTSD Symptomatology (TSCC clinical cut-offs) Outcome: Dating Violence Predictor: Childhood Maltreatment Direct effect of Emotional Abuse on dating violence perpetration: .40 (.20) .45(.14) .32(.12) Direct effect dropped to non-significant [.26(.16)] after controlling for TSCC .79(.22).42(.15) Direct effect of Emotional-Physical Abuse on victimization in dating violence: .98 (.49) Direct effect dropped to non-significant [.53(.49)] after controlling for TSCC Male Mediation Model: Goodman, p<.05 Female Mediation Model: Goodman=2.26, p<.05
  17. 17. SELF-COMPASSION: Useful Construct for Supporting Maltreatment “Recovery” and Preventing Maltreatment- Related Impairment? • What? • Healthy form of self-acceptance • Tendency to treat self kindly in face of perceived inadequacy • How? • By engaging in self-soothing and positive self-talk • Recognizing discomfort as part of being human • Promoting a sense of connection to others • Able to face painful thoughts by quelling self- pity and “melodrama” (tolerating victim viewpoint)
  18. 18. SELF-COMPASSION SCALE (NEFF, 2003) 6 subscales & Total Score: a. Self-Kindness: “I try to be loving towards myself when I’m feeling emotional pain.” b. Self-Judgment: “I can be a bit cold-hearted towards myself when I'm experiencing suffering.” c. Common Humanity: “I try to see my failings as part of the human condition.” d. Isolation: “When I fail at something that's important to me, I tend to feel alone in my failure.” e. Mindfulness: “When something painful happens I try to take a balanced view of the situation.” f. Over-identified “When something upsets me I get carried away with my feelings.”
  19. 19. SELF-COMPASSION – MAP RESULTS  Protect against excessive or unrealistic negative self-feelings or self-thoughts  (Neely et al., 2009)  MAPS Preliminary Data:  Higher Self-Compassion Scores, Lower PA, EA, EN scores  Higher Self-Compassion Scores, Lower TSCC scores
  20. 20. MAP: SELF-COMPASSION RESULTS  N = 90 at the 2.0 year testing mark where Self-Compassion Scale (SCS) given (40% Males, 60% Females)  Adolescent Mean Age = 18.1  years (SD Age = 0.99;Range Age,16 to 20)   Child Protective Services (CPS) Status:  Temporary Care: 2.2%  Society Ward: 10.1%  Crown Ward (termination of parenting rights): 75.3%  Community Family: 12.4%  Years with CPS Average = 10.1 years (SD = 4.53; Range = 1 to 19 years)  Ethnicity: White: 22.9%; Black: 16.7%; Hispanic 6.3%; Other: 14.6%; Combination of Two or More: 39.5% With youth self-reported maltreatment, higher physical and emotional abuse is linked with lower self-compassion; Lower self-compassion is linked with higher trauma symptoms
  21. 21. Percentage of children and youth with functioning problems with depression and/or anxiety, ADD/ADHD and any psychiatric disorder, by type of substantiated maltreatment, investigated cases, Ontario (2003) Source: Ontario Incidence Study (OIS-2003) (2005) Note: Data included reflect the 6 months prior to the investigation, as confirmed by psychiatric diagnosis or as suspected by observation or report. Functioning problems with Depression and/or Anxiety are reflected in the first set; ADD or ADHD is reflected in the second set. The third set reflects only confirmed psychiatric diagnoses. Data are based on a sample of 3193 OIS substantiated maltreatment forms with completed child functioning information.
  22. 22. Percentage of CAS-involved youth, aged 16-18 years, who participated in the MAPS reporting using substances in the past year, as compared to non-CAS- involved Ontario youth (OSDUHS), Ontario Source: Maltreatment and Adolescent Pathways (MAP) Study (2009); OSDHUS (2007)
  23. 23. Percentage of CAS-involved youth, aged 15-17 years, who participated in the MAP reporting engaging in risky sexual behaviour, as compared to Canadian youth (Statistics Canada), Ontario and Canada Source: Maltreatment and Adolescent Pathways (MAP) Study (2009); Statistics Canada (2007).
  24. 24. MAP AS A LONGITUDINAL STUDY - opportunity to consider change over time - opportunity to consider entry and exit from clinical levels of impairment "stayers" and "movers” - limited by ability to retain representative sample - handling missing data and unique issues with child welfare samples

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