Documenting Opportunity for Systematic Identification and Mitigation of Risk for Child Maltreatment - 24/10/22
, Melissa Jonson-Reid, PhD b, John N. Constantino, MD aRésumé |
This is a communication of preliminary data as a matter of priority in relation to Clinical Trials protocol ID 2018110118; NCT 04438161. This protocol represents, to our knowledge, a first-ever attempt to convert an epidemiologic discovery on risk for child maltreatment (CM) into a readily deployable modification of obstetrical practice designed to offset risk for CM and its psychiatric sequelae. Before1 and during the coronavirus disease 2019 (COVID-19 pandemic),2,3 CM has incurred a burden of epidemic proportions to U.S. children, with confirmed incidents occurring on the order of 12% of the population. Wu et al.4 and Putnam-Hornstein and Needell5 previously established that profiles of risk ascertained exclusively from birth records identified specific groups of newborns at highly elevated risk for official-report CM. For example, infants with the joint characteristics of low birth weight, more than 2 siblings, and maternal characteristics of being unmarried, on Medicaid, and smoking during pregnancy (ascertained separately) were found to have a 7-fold risk for maltreatment compared with the population average.4 Putnam-Hornstein and Needell showed that newborns with 3 or more risk factors ascertained from birth records (including any of the above, delayed prenatal care, less than high school maternal education, and maternal age less than 24 years) comprised 15% of an epidemiologic birth cohort but accounted for more than half of all the children in the cohort who experienced substantiated official-report maltreatment by the age of 5 years. This study explored whether prospective implementation of birth records screening in an urban obstetrical service recapitulated the association with CM observed in an epidemiologic context and whether families in higher echelons of risk (ascertained in this manner through birth records) could be prospectively engaged in supportive interventions of demonstrated effect in reducing the occurrence of CM. This work follows on promising efforts elsewhere to use birth records information to prioritize support services for young families,6 though such innovations have yet to be systematically incorporated into obstetrical or newborn medical services of U.S. health systems.
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| This work was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, as part of the Center for Innovation in Child Maltreatment Policy, Research and Training (P50 HD096719; J.N. Constantino project P.I., M. Jonson-Reid center P.I.) Work was completed through the Department of Psychiatry, Child Division at Washington University School of Medicine in St. Louis, in conjunction with the Brown School of Social Work and the obstetrical units and clinics of Barnes Jewish Hospital, St. Louis. |
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| Written consent was obtained as approved by the Washington University School of Medicine Institutional Review Board, HRPO# 201811018. |
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| Clinical trial registration information: Study to Understand Risk and Resilience Opportunity for Newborns After Delivery (SURROuND); clinicaltrials.gov/; NCT04438161. |
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| A subset of this data was presented at the American Academy of Child and Adolescent Psychiatry 68th Annual Meeting; October 25-30, 2021; Virtual. The only prior publication was in the form of a program abstract for this conference (j.jaac.2021.07.706). |
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| Author Contributions |
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| Conceptualization: Tandon, Jonson-Reid, Constantino |
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| Data curation: Tandon, Jonson-Reid |
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| Formal analysis: Tandon, Jonson-Reid |
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| Funding acquisition: Jonson-Reid, Constantino |
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| Investigation: Tandon, Constantino |
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| Methodology: Tandon, Constantino |
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| Project administration: Tandon, Constantino |
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| Resources: Tandon, Constantino |
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| Supervision: Tandon, Constantino |
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| Validation: Tandon, Jonson-Reid, Constantino |
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| Visualization: Constantino Visualization: Constantino |
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| Writing – original draft: Tandon |
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| Writing – review and editing: Jonson-Reid, Constantino |
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| The authors would like to acknowledge the efforts of Yi Zhang, MS, of Washington University, for data management; Kyria Brown, MSW, MPH, of Washington University, for her input on a previous draft of this manuscript; Shannon Lenze, PhD, of Washington University, for input on study design; and Claire Karlen, PhD, of Ranken Jordan, and Hannah Jeffries, MAC, of Covenant Theological Seminary, for recruitment and enrollment of the participants. |
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| Disclosure: Dr. Tandon has reported royalties from AuthorHouse for a children’s book series on mental health. Dr. Jonson-Reid has reported receipt of royalties from Oxford University Press for a book on child maltreatment and Pearson Publishing for a textbook, neither of which was used in this work. Dr. Constantino has reported receipt of royalties from Western Psychological Services for the commercial distribution of the Social Responsiveness Scale, which was not used in this work. |
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| All statements expressed in this column are those of the authors and do not reflect the opinions of the Journal of the American Academy of Child and Adolescent Psychiatry. See the Guide for Authors for information about the preparation and submission of Letters to the Editor. |
Vol 61 - N° 11
P. 1313-1316 - novembre 2022 Retour au numéro
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