Recent Submissions

  • Addressing Children's Exposure to Violence and the Role of Health Care

    Dubowitz, Howard (American Medical Association, 2021-05-12)
  • Psychometric Properties of a Self-Report Measure of Neglect during Mid-Adolescence

    Kobulsky, Julia M.; Villodas, Miguel T.; Dubowitz, Howard (Springer Nature, 2020-04-01)
    Developmentally specific measures of neglect remain lacking, especially concerning neglect in adolescence. The current study examines the Mid-Adolescent Neglect Scale (MANS), a 45-item youth, self-reported measure of neglect. Sixteen-year-old participants (N = 802) in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) completed the MANS, and they and their parents completed measures of parent-child relationship quality and parental monitoring. Reports of alleged neglect were coded from child protective services records. The sample was randomly assigned into two groups. Exploratory factor analysis was conducted in the first group (n = 397) and confirmatory factor and convergent validity analyses (n = 405) were conducted in the second group. Five dimensions of adolescent neglect were identified: Inadequate Monitoring, Inattention to Basic Needs, Permitting Misbehavior, Exposure to Risky Situations, and Inadequate Support. Confirmatory factor analysis largely supported the measurement model (CFI = 0.951, TLI =.948, RMSEA = 0.058, 90% RMSEA = 0.055, 0.061), as did convergent validity analyses. Results establish psychometric properties of an adolescent neglect scale that may be valuable to researchers studying neglect during this important developmental period.
  • Cost effectiveness of SEEK: A primary care-based child maltreatment prevention model

    Lane, Wendy G; Dubowitz, Howard; Frick, Kevin D; Semiatin, Josh; Magder, Laurence (Elsevier Ltd., 2020-11-14)
    Background: Funding for prevention interventions is often quite limited. Cost-related assessments are important to best allocate prevention funds. Objectives: To determine the (1) overall cost for implementing the Safe Environment for Every Kid (SEEK) model, (2) cost of implementation per child, and (3) cost per case of maltreatment averted. Design: Cost-effective analysis of a randomized controlled trial. Participants and setting: 102 pediatric providers at 18 pediatric primary care practices. 924 families with children < 6 years receiving care by those providers. Methods: Practices and their providers were randomized to either SEEK training and implementation or usual care. Families in SEEK and control practices were recruited for evaluation. Rates of psychological and physical abuse were calculated by parent self-report 12 months following recruitment. Model costs were calculated including salaries for team members, provider time for training and booster sessions, and development and distribution of materials. Results: Implementing SEEK in all 18 practices would have cost approximately $265,892 over 2.5 years; $3.59 per child per year; or $305.58 ($229.18-$381.97) to prevent one incident. Based on a very conservative cost estimate of $2779 per maltreatment incident, SEEK would save an estimated $2,151,878 in health care costs for 29,610 children. Conclusions: The SEEK model is cost saving. Cost per case of psychological and physical abuse averted were significantly lower than the short-term costs of medical and mental health care for maltreated children. SEEK model expansion has the potential to significantly decrease medical, mental health, and other related costs associated with maltreatment.
  • Child Maltreatment, Early Adult Substance Use, and Mediation by Adolescent Behavior Problems

    Dubowitz, Howard; Roesch, Scott; Lewis, Terri (SAGE Publications Inc., 2020-07-22)
    The purpose of the current study was to examine the potential mediating effects of internalizing and externalizing problems at ages 14, 16 and 18 between types of childhood maltreatment and alcohol and marijuana use problems and disorders in young adulthood. Data were from 473 young adults who participated in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Path analysis was conducted to examine pathways between maltreatment type (birth through age 12), internalizing and externalizing problems at three time points during adolescence, and alcohol and marijuana problem use in young adulthood. Findings indicated significant pathways between physical abuse and internalizing problems at 14, which was associated with alcohol-related substance use disorder in adulthood. Externalizing problems and internalizing problems at age 14 mediated the relationship between physical abuse and marijuana-related symptoms in young adulthood. Emotional and sexual abuse were not associated with substance use problems. Implications for practice are discussed.
  • Preschool Children of Adolescent Parents Benefit from Supportive Mother-partner Relationships but not from Three-generation Households

    Black, M.M.; Kerr, M.; Dubowitz, H.; Hunter, W.; English, D.; Schneider, M.; Hussey, J. (American Academy of Pediatrics, 2000)
  • Childhood abuse and neglect predicts subsequent gastrointestinal symptoms in children: A prospective study

    Van Tilburg, M. A.; Chitkara, D. K.; Zolotor, A.; Graham, J. C.; Dubowitz, H.; Litrownik, A.; Flaherty, E.; Whitehead, W. E.; Runyan, D. (Elsevier, 2007)
  • Maternal Substance Use and Neglectful Parenting: Relationships with Children's Development

    Harrington, D.; Dubowitz, H.; Black, M.M.; Binder, A. (Routledge, 1995)
  • Child Welfare in the United States: In Theory and Practice

    Dubowitz, H.; DePanfilis, D. (Nova Science Publishers, Inc., 2009)
  • A Profile of Kinship Care

    Dubowitz, H.; Feigelman, S. (CHILD WELFARE LEAGUE OF AMERICA, 1993)
  • Impact of early home intervention on the growth of low-income infants with failure-to-thrive: Infancy through age

    Black, M.M.; Hutcheson, J.; Winslow, M.; Dubowitz, H.; Starr, R.H., Jr. (Federation of American Societies for Experimental Biology, 1996)
    Evaluated the longterm impact of home intervention on growth of children with failure-to-thrive (FTT). 130 children under age 2 (mean age = 12.7 months, SD = 6.4) recruited from urban pédiatrie primary care clinics. Born at gestational age > 36 weeks, birthweight AGA, no organic problems. Weight-for-age < 5th percentile at recruitment. Randomized into clinic plus home intervention (n=64) or clinic only (n=66). All children followed in a multidisciplinary Growth and Nutrition Clinic. Home intervention conducted by trained lay personnel who provided maternal support and guidance in parent-child developmental activities during weekly visits for one year. Hierarchial linear modeling used to examine intraindividual growth curves from recruitment through age 4. Rate of linear growth higher among children who received home intervention. No difference in rate of weight gain as a function of home intervention. Findings support a cautious optimism regarding the impact of home intervention on growth among children with FTT. Funded by the Maternal and Child Health Research Program.
  • A randomized clinical trial of home intervention for children with failure to thrive

    Black, M.M.; Dubowitz, H.; Hutcheson, J.; Berenson-Howard, J.; Starr, R.H., Jr. (American Academy of Pediatrics, 1995)
    Objective. To evaluate the efficacy of a home-based intervention on the growth and development of children with nonorganic failure to thrive (NOFTT). Design. Randomized clinical trial. Participants. The NOFTT sample included 130 children (mean age, 12.7 months; SD, 6.4) recruited from urban pediatric primary care clinics serving low income families. All children were younger than 25 months with weight for age below the fifth percentile. Eligibility criteria included gestational age of at least 36 weeks, birth weight appropriate for gestational age, and no significant history of perinatal complications, congenital disorders, chronic illnesses, or developmental disabilities. Children were randomized into two groups: clinic plus home intervention (HI) (n = 64) or clinic only (n = 66). There were no group differences in children's age, gender, race, or growth parameters, or on any of the family background variables. Most children were raised by single, African-American mothers who received public assistance. Eighty-nine percent of the families (116 of 130) completed the 1-year evaluation. Interventions. All children received services in a multidisciplinary growth and nutrition clinic. A community-based agency provided the home intervention. Families in the HI group were scheduled to receive weekly home visits for 1 year by lay home visitors, supervised by a community health nurse. The intervention provided maternal support and promoted parenting, child development, use of informal and formal resources, and parent advocacy. Measurements. Growth was measured by standard procedures and converted to z scores for weight for height and height for age to assess wasting and stunting. Cognitive and motor development were measured with the Bayley Scales of Infant Development, and language development was measured by the Receptive/Expressive Emergent Language Scale. Both scales were administered at recruitment and at the 12- month follow-up. Parent-child interaction was measured by observing mothers and children during feeding at recruitment and at the 12-month follow-up, and the quality of the home was measured by the Home Observation Measure of the Environment 18 months after recruitment. Analyses. Repeated-measures multivariate analyses of covariance were used to examine changes in children's growth and development and parent-child interaction. Analyses of covariance were used to examine the quality of the home. Independent variables were intervention status and age at recruitment (1.0 to 12.0 vs 12.1 to 24.9 months). Maternal education was a covariate in all analyses. When changes in developmental status and parent-child interaction were examined, weight for height and height for age at recruitment were included as covariates. Results. Children's weight for age, weight for height, and height for age improved significantly during the 12-month study period, regardless of intervention status. Children in the HI group had better receptive language over time and more child-oriented home environments than children in the clinic-only group. The impact of intervention status on cognitive development varied as a function of children's ages at recruitment, with younger children showing beneficial effects of home intervention. There were no changes in motor development associated with intervention status. During the study period, children gained skills in interactive competence during feeding, and their parents became more controlling during feeding, but differences were not associated with intervention status. Conclusions. Findings support a cautious optimism regarding home intervention during the first year of life provided by trained lay home visitors. Early home intervention can promote a nurturant home environment effectively and can reduce the developmental delays often experienced by low income, urban infants with NOFTT. Subsequent investigations of home intervention should consider alternative options for toddlers with NOFTT.
  • Behavior problems of children in kinship care

    Dubowitz, H.; Zuravin, S.; Starr, R.H., Jr.; Feigelman, S.; Harrington, D. (Lippincott Williams & Wilkins, 1993)
    An increasing number of children needing out-of-home care are being placed with relatives. Despite this pervasive policy, there has been scant research on children in this arrangement called kinship care. The objectives of this study were (1) to assess the behavior of children in kinship care and (2) to identify predictors of their behavior. The caregivers of 346 children in kinship care completed the Child Behavior Checklist (CBCL). Background information was obtained from caregivers and caseworkers. Forty-two percent of boys and 28% of girls had overall CBCL scores in the clinical range, compared with an expected 10% in the general population. Logistic regressions revealed several variables significantly associated with behavior problems including: Reason for placement, gender, race, caregiver's perception of the child, caregiver's educational level, number of contacts between caregiver and caseworker, long-term plan, and child's age. The frequent behavior problems among these high-risk children in kinship care suggest they all deserve mental health evaluations; at a minimum, periodic screening is indicated. Copyright 1993 by Williams & Wilkins.
  • Medical neglect: what can physicians do?

    Dubowitz, H. (MedChi, 1994)
    Neglect is the most prevalent form of child maltreatment. Although the morbidity and mortality associated with it are significant, child neglect has attracted relatively little attention from professionals, the media, and the public. This article focuses on unmet, basic needs of children, particularly with regard to health care. In addition to defining neglect, the article discusses incidence, etiology, various forms of medical neglect, and principles for evaluation and management.
  • Sequelae of reporting child abuse.

    Dubowitz, H.; Newberger, E. (American Academy of Pediatric Dentistry, 1986)
  • Failure to thrive

    Krugman, S.D.; Dubowitz, H. (American Academy of Family Physicians, 2003)
    Failure to thrive is a condition commonly seen by primary care physicians. Prompt diagnosis and intervention are important for preventing malnutrition and developmental sequelae. Medical and social factors often contribute to failure to thrive. Either extreme of parental attention (neglect or hypervigilance) can lead to failure to thrive. About 25 percent of normal infants will shift to a lower growth percentile in the first two years of life and then follow that percentile; this should not be diagnosed as failure to thrive. Infants with Down syndrome, intrauterine growth retardation, or premature birth follow different growth patterns than normal infants. Many infants with failure to thrive are not identified unless careful attention is paid to plotting growth parameters at routine check-ups. A thorough history is the best guide to establishing the etiology of the failure to thrive and directing further evaluation and management. All children with failure to thrive need additional calories for catch-up growth (typically 150 percent of the caloric requirement for their expected, not actual, weight). Few need laboratory evaluation. Hospitalization is rarely required and is indicated only for severe failure to thrive and for those whose safety is a concern. A multidisciplinary approach is recommended when failure to thrive persists despite intervention or when it is severe. Copyright Copyright 2003 American Academy of Family Physicians.
  • Teaching pediatric residents about child maltreatment

    Dubowitz, H.; Black, M.M. (Lippincott Williams & Wilkins, 1991)
    Child maltreatment is a growing problem faced by pediatricians; however, there are many deficiencies in pediatricians' relevant knowledge and skills. Residency programs typically have included limited teaching in the area of child maltreatment. Fifty pediatric residents participated in an evaluation of a model educational course in child maltreatment developed by an interdisciplinary faculty. The course resulted in significant short-term improvements in knowledge and skills as well as a greater sense of competence in managing cases of child maltreatment. The importance of teaching pediatric residents about the “new morbidity” is discussed. © 1991 Journal of Developmental & Behavioral Pediatrics. All rights reserved.
  • Maria: stubborn, willful, and always full of energy.

    Stein, M.T.; Graziano, A.; Howard, B.; Dubowitz, H. (Lippincott Williams & Wilkins, 1996)
  • Child abuse programs and pediatric residency training

    Dubowitz, H. (American Academy of Pediatrics, 1988)
    Child maltreatment has become an increasingly important concern for pediatricians. The purpose of this study was to assess, via mailed questionnaires, the training and resources of pediatric residents in the area of child maltreatment. Responses were received from 72% of all US programs. The median amount of training was eight hours during the first and third years of training and seven hours during the second year, approximately half of this was clinical supervision in the care of maltreated children. Eighty-one percent of programs had an interdisciplinary team for suspected cases of child maltreatment. Only 17 of 167 programs reported a separate budget for their team. Although two thirds of programs were rated as adequate or better, 79% of respondents wanted to strengthen their teaching efforts. There appears to be a limited commitment by residency programs to enhance the competency of pediatricians in the area of child maltreatment. There is a need for improved training and resources.

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