New Directions in Child Abuse and Neglect Research Committee on Child Maltreatment Research, Policy, and Practice for the Next Decade: Phase II Board on Children, Youth, and Families Copyright © National Academy of Sciences. All rights reserved. THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract/Grant No. HHSP23320110010YC between the National Academy of Sciences and the Administration for Children and Families, U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data ISBN 978-0-309-28512-4 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: IOM (Institute of Medicine) and NRC (National Research Council). 2013. New Directions in child abuse and neglect research. Washington, DC: The National Academies Press. Copyright © National Academy of Sciences. All rights reserved. Copyright © National Academy of Sciences. All rights reserved. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org Copyright © National Academy of Sciences. All rights reserved. COMMITTEE ON CHILD MALTREATMENT RESEARCH, POLICY, AND PRACTICE FOR THE NEXT DECADE: PHASE II ANNE C. PETERSEN (Chair), Research Professor, Center for Human Growth and Development, University of Michigan, Kalamazoo LUCY BERLINER, Director, Harborview Center for Sexual Assault and Traumatic Stress, Seattle, WA LINDA MARIE BURTON, James B. Duke Professor of Sociology, Department of Sociology, Duke University, Durham, NC PHAEDRA S. CORSO, Professor, College of Public Health, University of Georgia, Athens DEBORAH DARO, Senior Research Fellow, Chapin Hall at the University of Chicago, IL HOWARD DAVIDSON, Director, American Bar Association Center on Children and the Law, Washington, DC ANGELA DÍAZ, Jean C. and James W. Crystal Professor of Adolescent Health, Department of Pediatrics and Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY MARY DOZIER, Amy E. du Pont Chair of Child Development, Department of Psychology, University of Delaware, Newark, DE FERNANDO A GUERRA, Clinical Professor of Pediatrics, University of Texas Health Science Center, San Antonio, TX CAROL HAFFORD, Principal Research Scientist, NORC at the University of Chicago, Bethesda, MD CHARLES NELSON, Professor of Pediatrics and Neuroscience, Richard David Scott Chair of Pediatric, Developmental Medicine, Harvard Medical School, Children’s Hospital Boston, MA ELLEN PINDERHUGHES, Associate Professor, Eliot-Pearson Department of Child Development, Tufts University, Boston, MA FRANK PUTNAM Jr., Professor of Psychiatry, University of North Carolina at Chapel Hill DESMOND K. RUNYAN, Executive Director, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora CATHY SPATZ WIDOM, Distinguished Professor, Psychology Department, John Jay College and the Graduate Center, City University of New York, NY JOAN LEVY ZLOTNIK, Director, National Association of Social Workers Foundation, Social Work Policy Institute, Washington, DC Consultants GREG AARONS, University of California, San Diego RICK BARTH, University of Maryland REBECCA BERTELL, University of Maryland CINDY CHRISTIAN, The Children’s Hospital of Philadelphia HOWARD DUBOWITZ, University of Maryland DEBORAH HARBURGER, University of Maryland STAN HUEY, University of Southern California KENT HYMEL, The Children’s Hospital of Dartmouth NANCY KELLOGG, University of Texas Health Science Center JOHN LANDSVERK, Rady Children’s Hospital of San Diego LAWRENCE PALINKAS, University of Southern California MATTHEW URETSKY, University of Maryland ALLISON WEST, University of Maryland KRISTEN WOODRUFF, University of Maryland FRED WULZYN, Chapin Hall at the University of Chicago v Copyright © National Academy of Sciences. All rights reserved. New Directions in Child Abuse and Neglect Research IOM Staff MONICA FEIT, Study Director (until January 2013) JOSHUA JOSEPH, Study Director (from January 2013) MICHAEL MCGEARY, Senior Program Officer (from January 2013 to March 2013) WENDY KEENAN, Program Associate ALEJANDRA MARTÍN, Research Associate KAREN CAMPION, Research Assistant SAMANTHA ROBOTHAM, Senior Program Assistant FAYE HILLMAN, Financial Officer PAMELLA ATAYI, Administrative Assistant KATHLEEN MCGRAW-SHEPHERD, Intern (from May 2012 to August 2012) KIMBER BOGARD, Director, Board on Children, Youth, and Families vi Copyright © National Academy of Sciences. All rights reserved. New Directions in Child Abuse and Neglect Research REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Dolores Subia BigFooot, University of Oklahoma Health Sciences Center Jeanne Brooks-Gunn, Columbia University Mark J. Chaffin, University of Oklahoma Health Sciences Center Diana English, University of Washington Sally Flanzer Joan Kaufman, Yale University Jill E. Korbin, Case Western Reserve University Richard D. Krugman, University of Colorado at Denver Kristen Shook-Slack, University of Wisconsin-Madison Charles H. Zeahah, Tulane University Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Robert S. Lawrence, Johns Hopkins University, and Nancy E. Adler, University of California, San Francisco. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. vii Copyright © National Academy of Sciences. All rights reserved. New Directions in Child Abuse and Neglect Research CONTENTS SUMMARY S-1 1 INTRODUCTION 1-1 2 DESCRIBING THE PROBLEM 2-1 3 CAUSALITY 3-1 4 CONSEQUENCES OF CHILD ABUSE AND NEGLECT 4-1 5 THE CHILD WELFARE SYSTEM 5-1 6 INTERVENTIONS AND SERVICE DELIVERY SYSTEMS 6-1 7 RESEARCH CHALLENGES AND INFRASTRUCTURE 7-1 8 CHILD ABUSE AND NEGLECT POLICY 8-1 9 RECOMMENDATIONS 9-1 APPENDIX A WORKSHOP OPEN SESSION AGENDAS Appendix A-1 APPENDIX B COMMITTEE BIOSKETCHES Appendix B-1 APPENDIX C RESEARCH RECOMMENDATIONS AND PRIORITIES FROM THE 1993 NRC REPORT, UNDERSTANDING CHILD ABUSE AND NEGLECT Appendix C-1 viii Copyright © National Academy of Sciences. All rights reserved. New Directions in Child Abuse and Neglect Research Summary In the two decades since the National Research Council (NRC) issued its 1993 report Understanding Child Abuse and Neglect, a new science of child abuse and neglect has been launched, yielding findings that delineate a serious public health problem. Fully 6 million children are involved in reports to child protective services, and many more cases go undetected. Nationally, about three quarters of cases are classified as neglect, and the majority of reports involve children under the age of 5. Important findings on the consequences of child abuse and neglect reveal the problem is not confined to children and childhood; rather, the effects of child abuse and neglect cascade throughout the life course, with costly consequences for individuals, families, and society. These effects are seen in all aspects of human functioning, including physical and mental health, and in important arenas such as education, work, and social relationships. Addressing this public health problem will require an immediate, coordinated research response that is grounded in the complex environments and systems within which child abuse and neglect occurs, and has high-level federal support. This study was conducted in response to a request from the Administration for Children, Youth, and Families (ACYF) within the Department of Health and Human Services to update the research highlighted in the 1993 NRC report (see Appendix D for research recommendations from the 1993 report). [B02] ACYF asked that the updated report “provide recommendations for allocating existing research funds and also suggest funding mechanisms and topic areas to which new resources could be allocated or enhanced resources could be redirected.” Specifically, ACYF asked the expert committee appointed to undertake this study to  build on a review of the literature and findings from the evaluation of research on child abuse and neglect;  identify research that provides knowledge relevant to the programmatic, research, and policy fields;  recommend research priorities for the next decade, including new areas of research that should be funded by public and private agencies; and  identify areas that are no longer a priority for funding. The Institute of Medicine (IOM) and the NRC within the National Academies appointed a committee with expertise across a broad array of disciplines associated with child abuse and neglect to carry out this study. The committee commissioned a number of background papers that summarized research findings and detailed research infrastructure needs in key areas of child abuse and neglect research. It held four face-to-face meetings, including two public sessions, and numerous conference calls to review the literature; discuss the current understanding of the Copyright © National Academy of Sciences. All rights reserved.