A focus on childhood maltreatment and comorbid mental health and learning difficulties.

Author:Mallett, Christopher A.
Position:Delinquency and Incarceration Prevention

Many risk factors that are linked with juvenile delinquency are rooted in childhood, making it critical to investigate this developmental time period. Some of these risk factors, which include maltreatment, mental health problems and learning disabilities, are preventable and/or treatable and may minimize the risk for later youthful offending behaviors. However, if not identified and addressed, these difficulties encountered in childhood may very well continue into adolescence, and may be further complicated by comorbid problems. It is important to highlight that the earlier a difficulty or disability is identified in children, the better the chance that harm can be minimized and outcomes be improved: hence striving to understand onset, prevalence and occurrence of these matters is important. If the etiology and scope of the problems are fully identified and understood, more effective steps can be taken by policymakers and stakeholders across juvenile systems in delinquency and incarceration prevention.

Maltreatment victimization, mental health disorders and learning disabilities are associated with profound difficulties for many children. These difficulties are often inter-related, or comorbid. These experiences and disabilities are also often linked to later or subsequent offending and delinquent behaviors, which for some youthful offenders becomes a recidivism cycle--an outcome with serious repercussions (Garland et al., 2001; Mallett, 2009; Mears and Aron. 2003; Rosenblatt, Rosenblatt and Biggs. 2000). This link from certain childhood difficulties to delinquency is most evident within juvenile detention facilities.

Within these facilities, a majority of youthful offenders have been identified with at least one of these difficulties or maltreatment experiences, though many youthful offenders have combinations of these problems before, during and after release from detention or incarceration (Teplin et al., 2006: Leone and Weinberg, 2010; Washburn et al.. 2008). The prevalence rates of youthful offenders who suffer from these problems within these facilities are substantial (see Table 1)--and all the more so when compared to overall prevalence of these conditions among nonyouthful offenders (New Freedom Commission on Mental Health, 2003; U.S. Department of Education, 2010; U.S. Department of Health and Human Services, 2011).

Table 1. Prevalence Rates Type Incarcerated Child and Youthful Adolescentf pu1ation Offender Population (Percent) (Percent) Maltreatment Victimization 26-60 1 Special 28-45 4-9 Education Disabilities (Learning Disabilities and Emotional Disturbances) Mental Health Disorders 35-80 9-18 Placement into these facilities has deleterious impact. Detention placement and incarceration has increasingly been found to have a causal impact on increased youth reoffend-ing, recidivism and adult incarceration (Holman and Ziedenberg, 2006: Justice Policy Institute, 2009). While incarcerated, many of these adolescents do not receive services that may assist in mitigating the prior offending behavior. In other words, they are not provided with rehabilitative services that may be warranted (Annie E. Casey Foundation, 2009).

While the etiology of some of these difficulties is challenging to determine, most begin in childhood, making it important that preventive measures be pursued to decrease delinquency outcomes. It is much easier, less costly and more effective to minimize the risk that maltreatment, mental health problems and learning disabilities have on children before these difficulties manifest into adolescence. If efforts and change do not occur, then those who end up placed into detention facilities will continue to experience these problems in disproportionate numbers. To frame this problem, this article is separated into three sections: maltreatment victimization. learning disabilities and mental health disorders. For each section, the prevalence and characteristics of the childhood population affected is presented, followed by a review of what is most effective in preventing and treating these difficulties.

Systematic Review Method

This systematic review of the literature focused on the following empirical questions: What is the prevalence of maltreatment victimization, learning disabilities and mental health disorders in the U.S. child and adolescent population?: what are the characteristics of these difficulties and how are they are correlated to offending behaviors, delinquency and incarceration?: and what effective preventive and treatment efforts are available to address these difficulties within the at-risk child and adolescent populations?

To answer these questions, the review search was completed through the following databases: Social Work Abstracts, SocIndex, ERIC, Criminal Justice Abstracts, PsychInfo, and Psychology and Behavioral Sciences Collection. These searches utilized the following terms, both individually and in combination with each other: mental health, disorders, special education. learning disability, substance abuse, substance use, school problems, delinquency, offenders, juvenile, detention, incarceration, maltreatment and trauma.

Maltreatment Victimization

Federal and subsequent state laws direct the investigation and reporting of certain specific acts defined as maltreatment victimizations: physical, sexual and emotional! psychological abuse, and neglect (Wiig, Spatz-Widom and Tuell, 2003). More than 2.9 million reports of abused or neglected children (and adolescents) were fielded by children's services protection agencies in 2009, with 709,000 of those substantiated. Seventy-eight percent of those cases were deemed to be neglect; 18 percent were for physical abuse; 9 percent were for sexual abuse; and 8 percent were for emotional or psychological abuse (the total is greater than 100 percent due to multiple types of maltreatment in some cases). For three of every four of these children, there was no prior history of maltreatment victimization (U.S. Department of Health and Human Services. 20111. However. it has been strongly hypothesized that investigated and substantiated cases of maltreatment are just the identified portion of a most underreported phenomenon--with some estimates of maltreatment affecting perhaps more than 8 million of this country's children (Finkelhor, 2008).

Victims vary in terms of age, gender and race. Children younger than eight years old are at higher risk than older children for substantiated cases of any of these maltreatment types, with the highest risk for those younger than one year of age. The infant to age 12 population accounts for approximately three of every four substantiated maltreatment victimization cases: though youths older than 12 are still at risk, accounting for the remaining 25 percent of cases (National Child Abuse and Neglect Data System, 2010). Overall, rates of maltreatment victimization are higher for females than for males, but not significantly, making their maltreatment risk fairly equal. However, some minority children. including African-American, American Indian, Alaska Native and multiracial children, are at higher risk for maltreatment than their Caucasian counterparts (Centers for Disease Control and Prevention. 2010: Magruder and Shaw. 2008: U.S. Department of Health and Human Services, 2011).

Early identification and assessment. A number of decision-making and assessment instruments and models have been developed to assist the child welfare system (and other systems) in identifying those families most at risk of maltreating their children. Three of these have been found effective through systematic testing. First, the family assessment approach was designed for at-risk families in which the parents were not found to have maltreated their children, but who pose high risks for doing so in the future. This assessment approach utilizes family and community resources in devising a strengths-focused plan on eliminating conditions that place a child at risk within the home (Siegel and Loman. 2006). Second, the structured decision-making (SDM) model is a set of assessment tools that identifies key decision points within child protection agency cases and provides intervening directives. These areas of assessment include response priority. safety, risk factors (individual, family, school and community), and family strengths and needs (Children's Research Center, 1999; Wagner and Bell. 1998; Wiebush, Freitag and Baird, 2001). Similarly, the third model, the CIVITAS child trauma assessment, focuses on the same domains as the SDM model, including medical needs, family and social areas, life history and traumatic events, behavioral and emotional difficulties, and academic/cognitive challenges. It also provides risk and intervention directives (Conrad, Dobson, Schick, Runyan and Perry, 1998).

Prevention. Prevention of childhood maltreatment, and its subsequent harmful effects, is the best practice and policy. There exists a number of effective programs and interventions for preventing or decreasing maltreatment victimization risks.

Home-visiting programs. Home-visiting programs, delivered through a multitude of different methods and with various professional providers, share common intervention goals. These goals include providing parents with the following: education, information, access to other services, support and direct instruction on parenting practices (Brooks-Gunn, Berlin and Fuligni, 2000: Howard and Brooks-Gunn, 2009). They also share a common perspective that altering parental practices can have long-term benefits for child development, though this may not directly prevent child maltreatment (Kendrick et al., 2000: Sweet and Applebaum, 2004). Such in-home programs, often delivered by nurses or related paraprofessional staff. may focus on one primary role or service, or may offer more complete family support services. In some cases, the home visitor focuses on being a source of support, while in...

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