• Kinship care: Research and practice issues

      Dubowitz, H.; Zuravin, S.; Starr, R.H., Jr.; Feigelman, S.; Harrington, D. (Lippincott Williams & Wilkins, 1993)
    • In Reply

      Dubowitz, H.; Black, M.M.; Harrington, D. (American Medical Association, 1993)
    • 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.
    • A Profile of Kinship Care

      Dubowitz, H.; Feigelman, S. (CHILD WELFARE LEAGUE OF AMERICA, 1993)
    • A follow-up study of behavior problems associated with child sexual abuse

      Dubowitz, H.; Black, M.M.; Harrington, D.; Verschoore, A. (Elsevier, 1993)
      The objectives of this study were to examine: (a) behavior in children evaluated for sexual abuse, (b) the stability of their behavior over 4 months, and (c) the relationship between aspects of the abuse and the children's behavior. The Child Behavior Checklist (CBCL) was completed by parents of 93 prepubertal children evaluated for sexual abuse and 80 nonabused children matched on age, gender, and race. A follow-up CBCL was completed after 4 months by 45% of parents of abused children. Sexually abused children had significantly more behavior problems than comparison children, including depression, aggression, sleep and somatic complaints, hyperactivity, and sexual problems. At follow-up, only those children who initially had externalizing behavior in the clinical range improved significantly. During the initial evaluation, behavior problems were associated with the child�s disclosure of abuse and during follow-up, behavior problems were associated with abnormal physical findings. However, behavior problems were not related to characteristics of the abuse or perpetrator, likelihood of abuse, or therapeutic services. The persistence of behavior problems suggests that children suspected of having been sexually abused should receive an assessment of their psychological status and careful follow-up. Copyright 1993, Pergamon Press Ltd.. All rights reserved.
    • Parenting style and developmental status among children with nonorganic failure to thrive

      Black, M.M.; Hutcheson, J.J.; Dubowitz, H.; Berenson-howard, J. (Oxford University Press, 1994)
      Examined differences in several developmental indices of competence among 102 low-income, inner-city, predominantly African American children with non-organic failure to thrive (NOFTT) and a comparison group of 67 children with adequate growth matched on age, gender, race, and socioeconomic status. Parents were categorized into one of three groups (nurturant, authoritarian, and neglecting) based on observations during feeding. Parents of children with NOFTT were less nurturant and more neglecting than parents of comparison children. Associations between parenting style and children's social-cognitive development were similar across groups. Children of nurturant parents consistently demonstrated better social-cognitive development. Results support the importance of considering heterogeneity among high-risk families and the need to examine the relationships linking parenting style and child development. Copyright 1994 Plenum Publishing Corporation.
    • Neglecting the Neglect of Neglect

      Dubowitz, H. (SAGE Publications Inc., 1994)
    • 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.
    • Children in kinship care: How do they fare?

      Dubowitz, H.; Feigelman, S.; Harrington, D.; Starr, R.H., Jr.; Zuravin, S.; Sawyer, R. (Elsevier, 1994)
      The placement of children in need of out-of-home care with relatives (i.e., kinship care) has been an increasing trend. The study summarized in this paper represents the first comprehensive assessment of the physical and mental health and educational status of children in kinship care. The anticipated high risk status of these children was supported by study findings in all areas of assessment. These findings are discussed and recommendations are offered for policy, practice and future research.
    • School performance of children in kinship care

      Sawyer, R.J.; Dubowitz, H. (Elsevier, 1994)
      This study represents the first comprehensive assessment of the school performance of children placed in the care of a relative, an arrangement termed kinship care. The educational programs, academic achievement, and cognitive and language skills of the children were assessed with a teacher questionnaire and standardized tests. Compared to their peers, high rates of grade retention and participation in special and remedial education, as well as significant academic achievement, cognitive, and language deficits were found. Most teachers, however, reported that educational services were appropriate and several interventions had proven successful. Analyses of predictor variables showed that placement at a later age and fewer children in the home were associated with higher academic achievement. Results are reviewed in the context of other foster care studies, and recommendations are made regarding future research and educational needs of children in kinship care.
    • School behavior of children in kinship care

      Dubowitz, H.; Sawyer, R.J. (Elsevier, 1994)
      This paper is based on the first comprehensive study of the health and educational status of children in kinship care, an increasingly frequent arrangement where children are placed in the care of relatives, mostly following neglect or abuse. Questionnaires were completed by teachers of 75% of the 374 school-age children. in kinship care in one city, and additional information was obtained from caseworkers, caregivers, and school records. Compared to classroom peers, children in kinship care had poor study habits and attention and concentration skills. Other common problems included overactive, aggressive, and attention-seeking behavior. Most children had average or better relationships with teachers and peers. Multivariate analyses yielded several predictors that explained a modest amount of the variation in the children's school behavior. There was poor to moderate concordance in the assessments of teachers, caregivers, and caseworkers concerning various school related behaviors. Schools, caseworkers, and pediatricians should pay special attention to children in kinship care and ensure that this high-risk group of children receives necessary services. Copyright 1994 Elsevier Science Ltd.
    • Sexual abuse: Developmental differences in children's behavior and self-perception

      Black, M.M.; Dubowitz, H.; Harrington, D. (Elsevier, 1994)
      Developmental differences in behavior and self-perception were examined in a group of 44 preschool and school-age children referred for evaluation of sexual abuse and 41 comparison children with no history of sexual abuse, matched on age and gender, and from a similar socioeconomic background. Children suspected of having been sexually abused were rated by their parents as having more internalizing and externalizing problems than comparison children. When children rated their self-competence and social acceptance, there were no group differences between children based on their abuse status; however, there was significant within-group variation among the children suspected of having been sexually abused. Preschool children had elevated scores of perceived competence and social acceptance, and school-age children had depressed scores. There were no age differences among the children in the comparison group. The results suggest that among children suspected of abuse, not only does their self-perception vary by their developmental level, but preschool children may respond with elevated perceptions of themselves. Focusing on individual differences in children's response to suspicions of sexual abuse enables us to identify risk and protective factors that contribute to the psychological outcomes of child sexual abuse.
    • 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.
    • Sources of Health Care and Health Needs Among Children in Kinship Care

      Feigelman, S.; Zuravin, S.; Dubowitz, H.; Harrington, D.; Starr, R.H., Jr.; Tepper, V. (American Medical Association, 1995)
    • Maternal Substance Use and Neglectful Parenting: Relationships with Children's Development

      Harrington, D.; Dubowitz, H.; Black, M.M.; Binder, A. (Lawrence Erlbaum Associates Inc., 1995)
    • Maternal Substance Use and Neglectful Parenting: Relationships with Children's Development

      Harrington, D.; Dubowitz, H.; Black, M.M.; Binder, A. (Routledge, 1995)
    • Family violence: A child-centered, family-focused approach

      Dubowitz, H.; King, H. (W.B. Saunders, 1995)
      Child maltreatment and spousal abuse are complex problems without simple solutions. Pediatricians can play a critical role in the early detection of abuse, carry out an initial assessment, and make appropriate referrals. By taking a family-focused perspective, and considering the social-emotional and economic context in which all family members live, the pediatrician will be more sensitive and alert to both the stressors and strengths within each family. Child maltreatment and spousal abuse affect children directly and indirectly in a variety of domains, including social-interactional, emotional status, self-image, behavior, and learning. A better understanding of these issues will enhance the comprehensiveness of the pediatrician's efforts and provide a better outcome for children and their families.
    • Maria: stubborn, willful, and always full of energy.

      Stein, M.T.; Graziano, A.; Howard, B.; Dubowitz, H. (Lippincott Williams & Wilkins, 1996)
    • 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.
    • The roots of competence: Mother-child interaction among low income, urban, African American families

      Black, M.M.; Hutcheson, J.J.; Dubowitz, H.; Starr, R.H., Jr.; Berenson-Howard, J. (Elsevier, 1996)
      This study examined developmental competence and mother-child interaction during feeding and play among 110 low income, urban African American infants and toddlers, and their mothers. Convergent validity was examined by comparing two parental factors (nurturance and control) and two child factors (interactive communication and affective regulation) from feeding and play observations with data from observations in the home, performance on standardized developmental assessments, and parental questionnaires. The extension of factors derived from observations of mothers and children during feeding and play into analyses based on ecological theory relating parental nurturance and control to children's competence provided construct validity for the observational procedure, and contributed to our understanding of mother-child relationships and the development of competence among low income, African American children. Copyright 1996 Ablex Publishing Corporation.