日本儿童保护体系强化干预后家庭功能障碍对儿童虐待的累积风险效应：纵向分析。
Cumulative risk effect of household dysfunction for child maltreatment after intensive intervention of the child protection system in Japan: a longitudinal analysis.
机构信息
Department of Social Psychiatry and Mental Health, Faculty of Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan.
Department of Social Welfare, Hanazono University, 8-1 Nishinokyo Tsubonouchi-cho, Nakagyo-ku, Kyoto, 604-8456, Japan.
出版信息
Environ Health Prev Med. 2018 Apr 20;23(1):14. doi: 10.1186/s12199-018-0703-6.
BACKGROUND
Building an effective casework system for child maltreatment is a global issue. We estimated the effect of household dysfunction (i.e., interparental violence, caregiver mental health problems, and caregiver substance abuse) on child maltreatment to understand how to advance the current framework of child welfare.
METHODS
The sample comprised 759 children (1- to 17-year-old; mean age was 10.6; 404 boys and 355 girls) placed in temporary custody units (one of the strongest intervention of the Japanese child protection system). Caseworkers from 180 units across 43 prefectures completed questionnaires on children and their family and were asked whether a child maltreatment report had been made after cancelation of custody in a 15-month follow-up period. The relations of household dysfunction and maltreatment reports were assessed using the Cox proportional hazard model.
RESULTS
About half (48.4%) of the children had been placed in the unit because of maltreatment, and 88.3% had a history of victimization. Seventy-six cases had maltreatment reports after cancelation. We entered household dysfunction variables individually into the model, and each had a significant relationship with maltreatment reports (hazard ratios for interparental violence, caregiver mental health problem, and substance abuse were 1.69, 1.69, and 2.19, respectively) after covariate adjustment. When treating these three variables as cumulative risk score model of household dysfunction, the hazard ratio increased with increasing number of score (1.96 for score two; 2.35 for score three; score 0 as reference).
CONCLUSIONS
Greater household dysfunction score is a risk of maltreatment after intensive intervention. It is imperative to construct systems facilitating cooperation between child and adult service sectors and to deliver seamless services to children and families. Our findings provide child protect services with risk-stratified interventions for children at victimization risk and promote adult-focused services to be proactive in prevention or intervention for adults with perpetration risk.
背景
建立有效的儿童虐待案件工作系统是一个全球性问题。我们评估了家庭功能障碍（即父母间暴力、照顾者心理健康问题和照顾者物质滥用）对儿童虐待的影响，以了解如何推进当前的儿童福利框架。
方法
该样本包括 759 名儿童（1 至 17 岁；平均年龄为 10.6；404 名男孩和 355 名女孩），他们被安置在临时监护单位（日本儿童保护系统最强有力的干预措施之一）。来自 43 个县的 180 个单位的工作人员完成了关于儿童及其家庭的问卷，并在 15 个月的随访期内询问了在监护权取消后是否有儿童虐待报告。使用 Cox 比例风险模型评估家庭功能障碍与虐待报告的关系。
结果
约一半（48.4%）的儿童因虐待而被安置在该单位，88.3%的儿童有受害史。76 例在取消监护权后有虐待报告。我们将家庭功能障碍变量逐个输入模型，在协变量调整后，每个变量与虐待报告都有显著关系（父母间暴力、照顾者心理健康问题和物质滥用的危害比分别为 1.69、1.69 和 2.19）。当将这三个变量视为家庭功能障碍的累积风险评分模型时，随着评分的增加，危害比增加（评分二为 1.96；评分三为 2.35；评分零为参考）。
结论
更高的家庭功能障碍评分是密集干预后虐待的风险。迫切需要构建促进儿童和成人服务部门之间合作的系统，并为儿童和家庭提供无缝服务。我们的研究结果为儿童保护服务机构提供了针对处于受害风险的儿童的风险分层干预措施，并促进了以成人为重点的服务，以便主动预防或干预有侵害风险的成人。
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