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10
Priorities for Child
Maltreatment Research

Despite the magnitude and significance of the problem of child maltreatment, research in this area is still in an early stage of development. Understanding the complex nature of child maltreatment is a challenging task, one that requires a variety of methods and approaches to clarify the multiple dimensions of this phenomena. Although much insight has been gained over the past three decades, the field has not yet developed an integrated, organized base of knowledge or ongoing data collection efforts that can inform practice, guide the development of programs and policies relevant to child maltreatment, and shape the formation and testing of major hypotheses in this field. As a result, research programs are needed in diverse areas to explore promising directions. At the same time, research on child maltreatment requires guidance, coordination, and leadership to organize the research base and cultivate future generations of researchers who are well trained and informed about the evolution of research questions in this field. Federal agencies in the past have demonstrated leadership in helping to organize and foster research and training in other fields of family systems and child development studies (for example, the National Institute of Child Health and Human Development has played an important role in shaping the development of research on adolescent sexuality, pregnancy, and parenting) that provide examples of the type of institutional support that needs to be provided in developing research on child maltreatment.

The panel concludes that an agenda for child maltreatment research should address four separate objectives. We need knowledge that can:



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Page 343 10 Priorities for Child Maltreatment Research Despite the magnitude and significance of the problem of child maltreatment, research in this area is still in an early stage of development. Understanding the complex nature of child maltreatment is a challenging task, one that requires a variety of methods and approaches to clarify the multiple dimensions of this phenomena. Although much insight has been gained over the past three decades, the field has not yet developed an integrated, organized base of knowledge or ongoing data collection efforts that can inform practice, guide the development of programs and policies relevant to child maltreatment, and shape the formation and testing of major hypotheses in this field. As a result, research programs are needed in diverse areas to explore promising directions. At the same time, research on child maltreatment requires guidance, coordination, and leadership to organize the research base and cultivate future generations of researchers who are well trained and informed about the evolution of research questions in this field. Federal agencies in the past have demonstrated leadership in helping to organize and foster research and training in other fields of family systems and child development studies (for example, the National Institute of Child Health and Human Development has played an important role in shaping the development of research on adolescent sexuality, pregnancy, and parenting) that provide examples of the type of institutional support that needs to be provided in developing research on child maltreatment. The panel concludes that an agenda for child maltreatment research should address four separate objectives. We need knowledge that can:

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Page 344 (1) Clarify the nature and scope of child maltreatment, guided by well-developed research definitions and instrumentation; (2) Provide an understanding of the origins and consequences of child maltreatment to establish a foundation for improving the quality of future policy and program efforts to address this problem; (3) Provide empirical information about the strengths and limitations of existing interventions in preventing and treating child maltreatment to guide the development of new and more effective interventions; and (4) Develop a science policy for child maltreatment research that recognizes the importance of national leadership, human resources, instrumentation, financial resources, and appropriate institutional arrangements for child maltreatment research. A balance needs to be established within and among these four categories, requiring a systematic and coordinated effort among research sponsors both to meet existing needs and to develop a strong foundation for future research. In this chapter, the panel organizes its research priorities within these four headings as a plan for action to implement the research directions outlined in this report. Details regarding each priority area that is high-lighted in this chapter appear in the preceding chapters, and reference guides are provided to facilitate cross-referencing. Under each general heading below, the panel has organized the research priorities in order of their importance, with the most important recommendation listed first within each section. The Nature And Scope Of Child Maltreatment Our nation's ability to diagnose, treat, and prevent child maltreatment depends greatly on the quality of the tools that are available to address the problem. Good science requires good measurements and consistent characterizations of the phenomena under study, so that reported results can be replicated, extended, and subjected to critical comparative analysis. However, research definitions of child maltreatment are currently inconsistent, and the breadth and quality of instrumentation for child maltreatment studies are seriously incomplete. The variation in existing definitions and inadequate instrumentation impede high-quality research, inhibit the comparison of studies of related phenomena, and restrain the development of good evaluations of intervention efforts. Improved definitions and instrumentation will facilitate the development of small- and large-scale epidemiologic investigations that can clarify important dimensions as well as etiologic agents that are keys to understanding the nature and scope of child abuse and neglect.

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Page 345 Research Priority 1. A consensus on research definitions needs to be established for each form of child abuse and neglect. The lack of a consensus on research definitions of child maltreatment is one of the major impediments to the development of a strong research base on all aspects of child maltreatment. The development of consensus requires a major federal and professional commitment to a dynamic, evolutionary process, guided by a series of expert multidisciplinary panels and developed in conjunction with agencies that support research in this area, that could review existing work on research definitions. The research definitions should be coordinated with case-report and legal definitions, be developmentally appropriate and culturally competent, provide clear inclusion and exclusion criteria, and provide clear guidance on issues of severity, duration, and frequency of acts of maltreatment (See Recommendations 2-1 and 2-3 in Chapter 2). Research Priority 2: Reliable and valid clinical-diagnostic and research instruments for the measurement of child maltreatment are needed to operationalize the definitions discussed under Research Priority 1. The absence of appropriate instrumentation and methodology is a second serious barrier to the development of good child maltreatment research. The use of appropriate measures in many different areas of child maltreatment is uneven. For example, although certain outcomes in terms of family functioning and individual development can be measured effectively, measures to classify different or multiple forms of child abuse and neglect are poorly developed. The behaviors, characteristics, and experiences of the child and the caretaker and the quality of the caretaking environment need to be assessed by research instruments rather than relying solely on administrative reports. The reliability and validity of these instruments must be established by sound testing for relevance and usefulness with economically and culturally diverse populations. Since effective questioning strategies for children have not been established, programs are also necessary to foster diagnostic research in this field. Instrumentation studies, beginning with pilot studies in a variety of public and private settings, such as medical and educational systems, are necessary to determine the nature, incidence, and prevalence of abuse and neglect experiences among children and adolescents. Research is also needed to train clinicians in the appropriate use of assessment instruments and techniques for obtaining maltreatment histories. Pilot instrumentation studies must incorporate age and culturally sensitive measures to protect families from the possible consequences of misdiagnosis and labeling. Recognizing that improved instruments may lead to detection of previously unreported cases of abuse, ways must be devised to en-

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Page 346 able clinicians and other service providers to refer potentially abusive parents and endangered children for direct assistance without requiring clear evidence of maltreatment prior to the delivery of services (See Recommendations 2-2 and 2-4 in Chapter 2). Research Priority 3: Epidemiologic studies on the incidence and prevalence of child abuse and neglect should be encouraged, as well as the inclusion of research questions about child maltreatment in other national surveys. After considerable work on instrumentation, including investigations into effective questioning strategies, the panel recommends the funding of a series of population-based epidemiologic studies of different size and scope, including children of different ages and different ethnic or cultural backgrounds, to address different child maltreatment research questions. Scientific information about the incidence and prevalence of child maltreatment has significant implications for advancing knowledge in the field. Improved measures of the scope of the problem will strengthen work on etiology, consequences, prevention, and treatment. Knowing more about the nature and scope of child maltreatment in the general population will also provide insights into the extent to which health professionals, social services staff, educators, law enforcement personnel, and others should be trained in this area. Better knowledge about the scope of child maltreatment will also inform the selection of appropriate sites for prevention and intervention, including the use of schools, ospitals, health clinics, juvenile detention facilities, homeless shelters, and community centers. The panel believes that questions on child abuse and neglect should be included on future national surveys (the National Health Interview Survey, the National Survey of Children, and the National Longitudinal Survey of Youth) as part of an expanded data collection effort. Although the inclusion of questions on child maltreatment may raise issues of cost and administrative burdens, past surveys and secondary analyses of existing data sets represent important research opportunities that could provide further insights into the nature and frequency of child abuse and neglect. The data and information collected by child death fatality review teams in various localities may also serve as an important source of information for future research (See Recommendations 3-1 through 3-5 in Chapter 3). Understanding The Origins And Consequences Of Child Maltreatment Research Priority 4: Research that examines the processes by which individual, family, community, and social factors interact will improve understanding of the causes of child maltreatment and should be supported.

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Page 347 Theoretical models that integrate a variety of risk and protective factors are a promising development in research on the origins of child maltreatment, and they deserve further research attention. Rather than endorsing a single approach, the panel recommends that diverse models be developed, incorporating multiple systems that use a variety of research strategies. Such models will allow researchers to learn more about mechanisms that activate or protect against individual child maltreatment and to distinguish between immediate precipitating factors and long-term chronic factors associated with maltreatment. Multidimensional interactive models that capitalize on current knowledge should be strongly encouraged to facilitate examination of combinations of possible etiological factors. For example, rather than studying the role of poverty alone, future research should examine the interactive effects of poverty or unemployment, individual parental characteristics, and neighborhood conditions. Similarly, research on the intergenerational transmission of abusive parenting should focus on factors in the parent's social environment, such as social networks, that may distinguish individuals who do or do not repeat a pattern of abusive parenting. Continued reliance on simplistic univariate models or isolated risk factors in future research may not be productive (See Recommendation 4-1 in Chapter 4). Research Priority 5: Research that clarifies the common and divergent pathways in the etiologies of different forms of child maltreatment for diverse populations is essential to improve the quality of future prevention and intervention efforts. It is particularly important at this time to uncover key pathways for child victimization that may be amenable to prevention or other forms of intervention. Studies that compare the etiologies of different types of maltreatment, including the diverse patterns of risk and protective factors among populations that vary by ethnicity, culture, and economic status, should be supported. For example, being a victim of physical abuse or emotional maltreatment may increase the risk for a child to be victimized by sexual abuse (or vice versa), but the relationships among multiple forms of maltreatment are as yet unexamined. We do not yet know if there are links between different forms of child maltreatment. We also do not know if the etiology for mild, moderate, and severe forms of abuse is the same within the general population and in specific cultural or ethnic groups. In a similar manner, it is not yet known if there is a continuum involving physical punishment, emotional maltreatment, and other forms of child abuse and neglect or whether these are distinctive behaviors with separate etiologies (See Recommendations 4-2 and 4-3 in Chapter 4).

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Page 348 Research Priority 6: Research that assesses the outcomes of specific and combined types of maltreatment should be supported. We currently lack a clear understanding of the outcomes of specific and combined forms of child maltreatment in a variety of cultural contexts. Research is needed that assesses direct and indirect consequences of child maltreatment across different domains of life, such as health, cognitive and intellectual skills, and social behavior. Tightly defined samples that use appropriate comparison groups can reveal significant information about the outcomes of specific forms of child maltreatment. Studies that examine multiple forms of abuse can help compare and contrast child maltreatment outcomes with the consequences of other childhood risk factors. The common practice of treating abused and neglected children together may reveal only a partial portrait of childhood victims' risk for later consequences. Furthermore, longitudinal studies of identified victims (i.e., those who have been reported to authorities) must keep in mind that reporting itself is an intervention in examining the outcomes of abused and neglected children. In the short term, research efforts to describe, document, and evaluate relationships suggested by the clinical literature on the consequences of child maltreatment are necessary. However, in the long term, the field must build and test hypotheses in a longitudinal developmental framework that examines the timing, duration, severity, and nature of effects over the life course within a cultural context. This approach can reveal the real-world complexities of the outcomes of specific and general types of child maltreatment, including gender differences in vulnerability and manifestations of subsequent problem behaviors, the effects of the developmental stage, cultural environment, and belief system of the individual, and the role of protective factors and interventions in the lives of abused and neglected children that appear to lead to more positive outcomes. Well-designed longitudinal research should begin as soon as possible. However, since longitudinal research is by nature a long-term analysis, cross-sectional retrospective designs may be the most effective interim means of identifying the prevalence and effects of maltreatment in adults. Cross-sectional studies conducted with techniques to minimize memory performance error (using anchoring and boundary techniques), can provide retrospective information that can be verified in prospective longitudinal studies (See Recommendations 6-1 through 6-4 in Chapter 6). Research Priority 7: Research is needed to clarify the effects of multiple forms of child victimization that often occur in the social context of child maltreatment. The consequences of child maltreatment may be significantly influenced by a combination of risk factors that have not been well described or understood.

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Page 349 Child maltreatment often occurs against a background of chronic adversity. The assessment of consequences for abused and neglected children is complicated by the co-occurrence of other problems, such as poverty, unemployment, stress, alcohol and drug problems, racism, parental mental illness, and violence. These problems may constitute stressors that affect the psychological well-being of children, families, and communities. The presence or absence of certain characteristics and events in the child's environment may influence a child's response to maltreatment experiences; in some cases the combined effects of two stressors (such as family environment and poor caretaking) may be greater than the sum of the two considered separately. The social context is particularly important, since the effects of abuse or neglect often cannot be separated when families are experiencing a variety of problems. Research in the area of childhood victimization has generally not examined interrelationships among problem behaviors and symptoms of dysfunction. It is not yet known, for example, whether some common underlying factors result in a syndrome of problem behaviors or combined risks or whether discrete behaviors have different etiologies. Researchers who emphasize syndromes believe that identifying and modifying common factors will reduce problem behaviors in a variety of areas. However, if specific problem behaviors represent specific etiologies, then a general intervention strategy might fail to reduce the problems of most individuals (See Recommendation 6-5 in Chapter 6). Research Priority 8; Studies of similarities and differences in the etiologies and consequences of various forms of maltreatment across various cultural and ethnic groups are necessary. The effects of risk potentiating and protective factors in diverse cultural and ethnic groups have not been adequately explored in examining both the origins and consequences of child maltreatment. Researchers have often relied primarily on clinical populations or subjects who have already been identified as offenders as representatives of entire cultural groups. Samples that are more representative of the diversity of American society are necessary to improve research quality. More needs to be known about the effects of what are considered to be normal or acceptable forms of physical discipline, sexual behavior, and parenting styles within various cultural, ethnic, and residential subgroups because cultural norms can have an impact on child maltreatment. Research must address both commonalities and diversity among populations in studying the interactions of variables that promote or prevent various forms of maltreatment and in studying the combinations of factors that foster or inhibit harmful consequences across various dimensions (See Recommendations 6-6 and 6-7 in Chapter 6).

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Page 350 Improving Treatment And Preventive Interventions The quality of existing treatment and preventive interventions is affected by many factors, including the social and legal context in which programs and policies are developed, the allocation of human and financial resources, and the strength of the research base that informs and guides intervention programs and services. At present, we have limited knowledge about the range or nature of treatment and preventive services for child maltreatment or the context in which these services are available to children and their families. Research evaluations in this area therefore must seek to broaden understanding of what currently exists as well as documenting what services appear to work for which individuals or groups, and under what circumstances. Research on service interventions must also seek to identify factors and mechanisms that facilitate, or impede, the exchange of knowledge between researchers who study the origins, nature, scope, and outcomes of child maltreatment and those who develop and implement policies and programs for child and family services in the public sector. Research Priority 9: High-quality evaluation studies of existing program and service interventions are needed to develop criteria and instrumentation that can help identify promising developments in the delivery of treatment and prevention services. Independent scientific evaluations are needed to clarify the outcomes to be assessed for service delivery programs in the area of child maltreatment. Such evaluations should identify the outcomes to be assessed, clarify the instrumentation and measures that can provide effective indicators of child and family well-being or dysfunction, develop the criteria that should be considered in evaluating the effectiveness of a specific program or service, and use appropriate control groups. Evaluation studies currently rely heavily on reported incidents of child maltreatment as a measure of program effectiveness. Given the uncertainties associated with official detection of child maltreatment, such outcomes may have limited value in measuring the achievements or limitations of a selected program intervention. Rigorous evaluation studies should be an essential part of all major demonstration projects in the area of child maltreatment, and funds should also be available for investigator-initiated evaluation studies of smaller program efforts. Smaller programs should be encouraged to use similar assessment instruments, so that results can be compared across studies. Scientific program evaluations, published in the professional literature, are an important means of transferring the knowledge and experience gained in the service sector into the research community. Such information exchange can improve the quality of studies on the origins, consequences, and other as-

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Page 351 pects of child maltreatment, ultimately leading to improved services and programs. Evaluation research is particularly important in the following areas: • Evaluation studies are needed of specific program interventions, such as foster care, family preservation services, and self-help programs that examine the conditions and circumstances under which selected programs are beneficial or detrimental to the child. Special consideration should be given to factors that might be related to outcomes, such as characteristics of the process by which the service was provided, the circumstances under which the child was removed from the original home, characteristics of the child's original home environment and foster family, and characteristics of the child (including age at time of services provided) (See Recommendations 7-3 and 7-6 in Chapter 7). • Empirical research is also needed to determine the degrees to which criminal sanctions deter child abuse and the degree to which removal of offenders or children from the home protects the child from abuse. For example, abuse rates and recidivism rates in jurisdictions making heavy use of criminal sanctions and child removal might be compared with matched jurisdictions that rarely use these approaches. Since the relative effectiveness of punitive compared with helping approaches could be different for physical abuse, sexual abuse, and neglect, each of these types of abuse needs to be distinguished. • Rigorous scientific evaluations of home visiting programs, focused on the prenatal, postnatal, and toddler periods, are necessary prior to the development of nationwide home visiting programs. Such evaluations should include rigorous scientific measurements, appropriate measures of child abuse and neglect, and clarification of the theoretical assumptions that shaped the home visitation efforts.   Home visiting programs have great potential for enhancing family functioning and parenting skills and reducing the prevalence of child maltreatment. However, given the state of knowledge about what programs work, for whom they work, and whether they influence child abuse and neglect directly (via a reduction in child abuse and neglect) or indirectly (via changes in parenting skills and parental characteristics such as depression, problem solving, fertility, and employment), the panel recommends that no major home visiting programs be funded that do not include an evaluation component that incorporates appropriate social and behavioral science design, measures of child abuse and neglect, or both. Subgroup analyses are strongly recommended, requiring samples that are large enough to identify groups for whom the intervention was effective (See Recommendation 5-1 in Chapter 5). • Evaluations of treatments for specific forms of child maltreatment are needed to identify criteria that promote recovery and to identify treat-

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Page 352   ment modalities that are appropriate for children and offenders depending on their sex, age, social class, spoken language or culture, and type of abuse. Treatment evaluations need to incorporate a developmental perspective, including recognition of the impact of child maltreatment on children of different ages and in different contexts. Treatment strategies need to incorporate what we have learned about consequences of child abuse and neglect. The criteria selected for treatment outcome studies are also particularly important because they shape the emphasis of the intervention. The treatment of children with developmental disabilities, past histories of abuse, and factors associated with maintenance of treatment effects (e.g., concomitant therapy for parents), all require special attention because they can all influence treatment outcomes (See Recommendations 7-2 and 7-5 in Chapter 7). • Research evaluations of sexual abuse prevention programs are necessary, particularly to determine the outcomes of personal reports of sexual abuse that are often disclosed as a result of such programs. Research needs to address the development of measures for sexual abuse prevention research, natural histories of post-prevention training experiences, factors that support or impede disclosure of abuse in the natural setting, and the roles of parents and other adults in the prevention of sexual abuse.   Evaluations of child sexual abuse prevention should incorporate knowledge about appropriate risk factors as well as the relationship between cognitive and behavioral skills, particularly in situations involving known or trusted adults. Sexual abuse prevention research also needs to integrate knowledge of factors that support or impede disclosure of abuse in the natural setting, including factors that influence adult recognition of sexual abuse and situations at risk for child abuse (See Recommendation 5-2 in Chapter 5). • Research is needed on the extent to which community-based prevention and intervention programs (such as school-based violence and domestic violence prevention programs, and Head Start) focused on families at risk of multiple problems may affect the likelihood of child maltreatment. Research is also needed on these programs to identify methodological elements (such as designs that successfully engage the participation of at-risk communities) that could be incorporated into child maltreatment prevention programs. If exposure to a greater number of risk factors increases the risk for violence and child abuse, then community-based prevention and intervention programs need to target multiple childhood risk factors in both the family and the school domains, as well as within the broader social context of the child (e.g., peers, neighborhood). In addition to recommending comprehensive and intensive programs that address multiple risk factors associated with violence and abuse, we

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Page 353 recommend research evaluations on the long-term effectiveness of home-school collaborations, supplemented by booster sessions at developmentally appropriate points in time. School and community-based programs need to be sensitive to the specific social, cultural, gender, and other characteristics and experiences of their participants. Furthermore, major prevention programs need to include a long-term follow-up as part of their evaluation, including information on long-term outcomes, such as arrests for violent behavior and child abuse (See Recommendation 5-3 in Chapter 5). Research Priority 10: Research on the operation of the existing child protection and child welfare systems is urgently needed. Factors that influence different aspects of case handling decisions and the delivery and use of individual and family services require attention. The strengths and limitations of alternatives to existing institutional arrangements need to be described and evaluated. We have very poor information about the methods and mechanisms used to identify and confirm cases of child maltreatment, to evaluate the severity of child and family dysfunction, to assess personal and social resources, family strengths, and extrafamilial influences, and to match clients to appropriate treatments based on these formulations. An analysis is needed of interactions among different agencies involved in intervention and treatment and the degree to which decisions made by one agency affect outcomes in others. A research framework that provides standardized classifications and descriptions of child maltreatment investigations, adjudications, and treatment services should be developed. Comparative studies are needed to describe the agencies involved in the system, the types of interventions available for selected forms of maltreatment, the costs of investigating and responding to reports of child maltreatment, and the outcomes of case reports. Such studies should also consider the development of alternatives to existing institutional arrangements to improve the quality of service delivery systems. Research should be conducted on the detection processes that lead to the definition of cases identified in child protective services records and other social agencies that handle child maltreatment. Research is needed to evaluate the stages by which children receive services following reports of maltreatment as well as to identify methods by which developmental, social, and cultural variations in abuse symptomatology are integrated into treatment goals and assessment instruments. We lack data about accessibility and affordability of treatment services for abused and neglected children and their families. Information is needed on critical individual, social, cultural, and contextual factors that can determine the success or failure of child maltreatment interventions (See Recommendation 7-1 in Chapter 7).

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Page 354 Research Priority 11: Service system research on existing state data systems should be conducted to improve the quality of child maltreatment research information as well as to foster improved service interventions. Variations in state definitions of child abuse and neglect as well as differences in verification procedures result in significant unevenness in the quality of research data on child maltreatment reports. Effort is needed on a national level to: • mandate state compliance with data acquisition and reporting efforts, as in other federal efforts like Medicaid and Medicare; • develop uniform case definitions with measurable criteria; • identify the criteria used by social service agencies in making assessment, investigation, substantiation, and referral decisions; • identify potential sources of bias in current procedures for reporting and investigation of reported cases; • redesign state data-processing systems so that uniform individual-level data are available and unduplicated counts of children affected by abuse and neglect are easily obtainable; • establish an expert panel to periodically review the data system, establish quality indicators, and identify key areas for services systems investigation; • make available state-level data as public use data tapes; • conduct ethnographic studies to identify the systems-level features that affect reporting and case verification; and • provide sufficient incentive for state child welfare agencies to become equal partners in the research process while acknowledging the problems (e.g., understaffing, management emphasis) of state-level research (See Recommendation 3-1 in Chapter 3). Research Priority 12: The role of the media in reinforcing or questioning social norms relevant to child maltreatment needs further study. Important lessons can be learned from the role of the media in fostering healthy or unhealthy behaviors in areas such as the use of alcohol, smoking, drug use, and condom use. Research is needed that can identify the significant pathways by which key factors and behaviors affect child maltreatment, such as parenting styles, the use of corporal punishment, the use of violence and time-out periods in stress management and conflict resolution, and young children's relationships with strangers and abusive caretakers. Rather than simply highlighting sensational aspects of abusive cases, the media can play an important role in disseminating research results and en-

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Page 355 couraging behaviors that have relevance for fostering positive family relationships and the protection of children (See Recommendation 5-4 in Chapter 5). A Science Policy For Research On Child Maltreatment The complexity of the problem of child maltreatment requires a sustained commitment to high-quality research, national leadership, human resources, and adequate funds. Scientific knowledge can contribute to our understanding of the nature, scope, origins, and consequences of child maltreatment, but such knowledge cannot be developed in a haphazard manner. Thus the panel has formulated priorities for science policy and the research infrastructure that supports child maltreatment research in order to highlight key strengths and existing deficiencies that need attention. Research Priority 13: Federal agencies concerned with child maltreatment research need to formulate a national research plan and provide leadership for child maltreatment research. Existing fragmentation in the federal research effort focused on child maltreatment requires immediate attention. National leadership is necessary to develop a long-term plan that would implement the child maltreatment research priorities identified by the panel. Such a plan would help coordinate the field and focus it on key research questions. Effective governmental research leadership requires: • A commitment to high-quality research on child maltreatment, including the support of relevant theoretical work, instrumentation, and data collection efforts; • Staff members who have experience in and understanding of the research process; • Procedures that provide opportunities for researchers to receive feedback from their peers on the quality of their proposals and to incorporate that feedback in revised and improved research proposals; • An administrative process that ensures that research proposals will be evaluated on the basis of the quality of the work proposed rather than the political or programmatic relationships of the research investigators; • A broad-based relationship with service providers that effectively disseminates research findings and encourages their use in clinical services, treatment efforts, preventive interventions, and child maltreatment programs and policies.

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Page 356 At present, the lead federal research agency for child maltreatment studies (the National Center on Child Abuse and Neglect) does not meet all these criteria. As a result, the panel examined alternative methods of organizing federal research leadership in this field. Three possible approaches deserve further consideration: (1) The research mission of the National Center on Child Abuse and Neglect could be strengthened with the necessary staff, budgetary, and program resources so that it can provide leadership in this area; (2) The lead agency responsibility for research on child maltreatment could be transferred to an agency with a distinguished research record (such as the National Institute of Mental Health, the National Institute of Child Health and Human Development, or the Maternal and Child Health Bureau) that has established procedures and experience in supporting high-quality research; (3) The research mission of the National Center on Child Abuse and Neglect could be consolidated with the research functions of other bureaus and centers within the Administration of Children, Youth, and Families (such as Head Start, the Children's Bureau, and others) so that a research institute within ACYF could develop scientific studies directly relevant to existing and proposed ACYF programs. Each of these approaches has advantages and disadvantages. Strengthening the existing research effort of the National Center on Child Abuse and Neglect has the advantage of continuing the core research activity developed within that agency and ensuring an explicit focus on child maltreatment research. However, the center has not demonstrated that it has the resources or research expertise necessary to support long-term research studies, postgraduate training programs, and interdisciplinary centers. Its responsibilities in providing federal funds for state child maltreatment programs also create a political climate in which the expansion of the research program may be seen as a weakening of a commitment to child maltreatment services, if additional funds are not available for the full range of program activity. Deficiencies in the existing research program could be addressed by designating a research agency, such as the the National Institute of Mental Health, the National Institute of Child Health and Human Development, or Maternal and Child Health, as the lead agency for child maltreatment research. This proposal has the advantage of placing child maltreatment research within an agency that has a record of scientific achievement and experienced research staff. However, it is not certain that another research agency would have the authority and the necessary commitment to child maltreatment research that are necessary to sustain an effective program focused explicitly on this topic. Other agencies may lack extensive ties

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Page 357 with service providers and policy makers that would foster greater utilization and dissemination of research in this field. The proposed creation of a research institute within ACYF appears to have substantial merit and attracted the interest of the panel. However, such a proposal requires clarification of the research programs of other ACYF components and the consideration of the sustainability of its research mission separated from programmatic activities. The panel was not able to develop this material in the limited time available for this study. The panel believes that Congress, federal agency directors, and the research community should weigh the strengths and limitations of each approach discussed above in considering how federal leadership might best be provided in implementing a national research plan for child maltreatment. Once a course of action has been formulated, current and proposed agency research activities need to be examined so that areas of strength, duplication of effort, and gaps in current efforts can be identified (See Recommendation 8-2 and 8-6 in Chapter 8). Research Priority 14: Governmental leadership is needed to sustain and improve the capabilities of the available pool of researchers who can contribute to studies of child maltreatment. National leadership is also required to foster the integration of research from related fields that offer significant insights into the causes, consequences, treatment, and prevention of child maltreatment. The following steps need to be taken to foster career development and to expand the human resources that provide the foundation for studies of child maltreatment: • The interdisciplinary nature of child maltreatment research requires the development of specialized disciplinary expertise as well as opportunities for collaborative research studies. Researchers in child maltreatment projects increasingly need to cross disciplinary boundaries, in terms of theories, instrumentation, and constructs, and to integrate relevant literature from multiple disciplines. For example, signs of behavioral distress patterns may be similar in physical and sexual abuse, although they may be labeled differently. Similarly, research on child abuse, stress, and trauma needs to integrate findings from the psychological literature with more recent physiological findings, such as those that examine the relationship between sexual abuse, stress, and early puberty. Governmental agencies and foundations that sponsor research in child maltreatment need to recognize the importance of strengthening research resources in the disciplines as well as fostering interdisciplinary collaboration that will contribute to understanding of child abuse and neglect.

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Page 358 • Federal and state agencies should develop mechanisms for interdisciplinary graduate and postgraduate training programs focused on the examination of child maltreatment issues. Postdoctoral training programs designed to deepen a young scientist's interests in research on child abuse and neglect should be given preference at this time over graduate student dissertation support, although both training efforts are desirable in the long term. External fellowship training for health professionals interested in child maltreatment research is particularly important, given the broad range of roles that health professionals are expected to play in detecting, identifying, confirming, treating, and preventing child abuse and neglect. Postdoctoral training programs should include an emphasis on working with diverse ethnic and cultural groups. • The creation of a corps of research-practitioners familiar with studies of child maltreatment should be an explicit goal of federal, state, and private agencies that operate programs in areas of child welfare, child protection, maternal and child health, spousal violence, and child maltreatment. The proposed corps of research-practitioners will encourage the development of studies on selected child maltreatment issues as well as facilitate the integration of relevant research findings into agency services and programs. • A directory of active research investigators, identifying key fields of research interests, should be developed in collaboration between professional societies and child advocacy organizations whose members have research experience on child abuse and neglect. A consortium of university research programs should also be developed to provide expanded opportunities for information exchange and dissemination among multiple institutions and research disciplines. • The cultural and ethnic diversity of the corps of research investigators concerned with child maltreatment studies is not broad enough to explore the importance of culture and ethnicity in theories, instrumentation, and other aspects of research on child abuse and neglect. Special efforts are needed at this time to train child maltreatment researchers in the importance of ethnic and cultural factors in this field. Efforts are also needed to provide educational and research support for researchers from ethnic and cultural minority groups to strengthen the diversity of human resources dedicated to this topic. • When a sufficient research budget is available to support an expanded corps of research investigators from multiple disciplines, multidisciplinary research centers should be established to foster collaboration in research on child maltreatment. The purpose of these centers should be to assemble a corps of faculty and practitioners focused on selected aspects of child abuse and neglect, including medical, psychological, social, legal, and cultural aspects of child abuse and neglect. The proposed centers could

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Page 359   provide a critical mass in developing long-term research studies and evaluating major demonstration projects to build on and expand the existing base of empirical knowledge. The proposed centers should have a regional distribution, be associated with major academic centers, have the capacity to educate professionals of various disciplines, and launch major research efforts. Examples of the cancer and diabetes research centers funded by the National Institutes of Health could serve as models, as could the Prevention Intervention Research Centers sponsored by the National Institute of Mental Health (See Recommendations 8-1, 8-3, 8-4, 8-5, and 8-7 in Chapter 8). Research Priority 15: Recognizing that fiscal pressures and budgetary deficits diminish prospects for significant increases in research budgets generally, special efforts are required to find new funds for research on child abuse and neglect and to encourage research collaboration and data collection in related fields. The federal government spent about $15 million in fiscal year 1992 on research directly related to child maltreatment. As a first step, the panel recommends that the relevant budgets for child maltreatment research of the National Center on Child Abuse and Neglect, the National Institute of Mental Health, the National Institute of Child Health and Human Development, the Centers for Disease Control and Prevention, and the Department of Justice be doubled over the next three years. Second, the panel recommends that the National Center on Child Abuse and Neglect convene a consortium of government agencies, private foundations, and research scientists to identify ways in which research on programs relevant to child maltreatment (such as substance abuse, spousal violence, child homicides, juvenile delinquency, and so forth) can be more systematically integrated into the research infrastructure for child abuse and neglect. Congress needs to recognize the centrality of the issue of child maltreatment in contributing to a wide range of social problems and family pathologies. Our country spends little on building the knowledge and resource base we need to treat and prevent incidents of child abuse and neglect, particularly in light of the enormous human, economic, and social costs associated with violence toward children. Furthermore, Congress should recognize that the level of financial support currently available for research on child maltreatment is not well understood or easily obtainable. Congress should request that the General Accounting Office conduct a thorough review of all ongoing federally supported research on child abuse and neglect, identifying and categorizing research programs that are relevant to this area, even if their primary goal is in support of a different objective, such as the reduction of spousal violence, childhood injuries, and infant mortality. Since child maltreatment is known to be a significant factor in the

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Page 360 development of many social pathologies, research on child abuse and neglect should be an integral part of the programmatic activity for each of these areas. The proposed task force should develop a formula whereby each agency sponsoring research on social problems should be encouraged to allocate 10 percent of its funds to studies on basic and applied research studies on child maltreatment, administered through a consortium effort that would encourage the transfer of knowledge among these separate programs (See Recommendations 8-9, 8-10, and 8-12 in Chapter 8). Research Priority 16: Research is needed to identify organizational innovations that can improve the process by which child maltreatment research findings are disseminated to practitioners and policy makers. The role of state agencies in supporting, disseminating, and utilizing empirical research deserves particular attention. We currently know very little about the ways in which empirical research findings are disseminated to such individuals as social agency officials, educators, judges, law enforcement officers, and many others who are responsible for the social welfare and protection of children. Research on the information dissemination process can strengthen the ways in which science is used to inform and advise legislative and judicial decision makers. Such research can also contribute to effective partnerships among scientists, practitioners, clinicians, and governmental officials to encourage the use of sound research results in formulating policies, programs, and services that affect the lives of thousands of children and their families. State agencies have an important role in fostering and disseminating knowledge about factors that affect the identification, treatment, and prevention of child maltreatment. The National Center on Child Abuse and Neglect should encourage the development of a collaborative state consortium to serve as a documentation and research support center. One potential model of a state collaborative research consortium is the Strategic Highway Research Program administered by the Transportation Research Board in the National Research Council. The empirical base of knowledge that guides state programs and practices in the area of child maltreatment needs national attention and sustained organization. The states need a consortium device through which regional and national research seminars can be organized, collaborative research studies can be developed, and relevant research findings can be disseminated to a wide pool of personnel. A national child abuse and neglect research information service, similar to the ''Research in Brief" program operated through the Department of Justice, would be a significant asset to the state agency personnel and service providers (See Recommendation 8-11 in Chapter 9).

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Page 361 Research Priority 17: Researchers should design methods, procedures, and resources that can resolve ethical problems associated with recruitment of research subjects; informed consent; privacy, confidentiality, and autonomy; assignment of experimental and control research participants; and debriefings. Research is needed to clarify the nature of individual and group interests in the course of research, to develop clinical advice and experience that can resolve such conflicts among such interests, and to identify methods by which such guidance could be communicated to researchers, institutional research boards, research administrators, research subjects, and others. Such advice should include consideration of spoken language, language comprehension, literacy, and reading orientation (left to right or vice versa). Issues of data sharing, privacy, confidentiality, and autonomy in the field of child maltreatment research need further development, especially in prospective studies of maltreating and nonmaltreating families. Ethical issues likely to arise in longitudinal prospective studies need to be identified, to clarify principles of responsible conduct regarding the treatment of risk factors, researcher responses to suspected abuse scenarios, and the rights of research subjects to privacy, confidentiality, and autonomy. The ethical and legal role of researchers in responding to suspected or unreported disclosures of maltreatment requires methodological considerations in formulating appropriate guidance for the research community. Finally, empirical analyses of research protocols and institutional research board reviews of proposed research projects on child maltreatment should be conducted to determine factors that influence approval and disapproval decisions, the use of waivers and certificates of confidentiality, and other factors that affect the manner in which research investigators address ethical and legal issues in the course of their research (See Recommendations 9-1 through 9-4 in Chapter 9).

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