Papers by Janet Schneiderman
Child Abuse & Neglect, Apr 1, 2012
Purpose-(1) To identify and compare rates of body mass index (BMI) ≥ 85% (overweight/ obesity) an... more Purpose-(1) To identify and compare rates of body mass index (BMI) ≥ 85% (overweight/ obesity) and BMI ≥ 95% (obesity) in maltreated versus comparison young adolescents; (2) To determine whether demographic/psychological characteristics are related to high BMI; (3) To determine whether type of maltreatment is related to high BMI in maltreated young adolescents. Methods-We compared a sample of maltreated young adolescents to a comparison sample of adolescents from the same neighborhood. The maltreated sample (N=303) of young adolescents (ages 9-12) came from referrals from the county child welfare department in Los Angeles, CA from new cases of maltreatment opened in specified zip codes. A comparison sample (N=151) was recruited from the same zip codes. The total sample (both maltreated and comparison) was 77% Black or Hispanic and 23% White or biracial with 53% males and 47% females. A stepwise logistic regression was used to examine predictors of high BMI with demographic/psychological covariates and maltreatment group. The maltreated young adolescents were selected and the logistic model included all covariates as well as an interaction between gender and each maltreatment type (neglect, sexual, and physical abuse). Results-Maltreated young adolescents were similar to comparison adolescents in obesity prevalence (27.1% and 34.4%, respectively), although comparison young adolescents were 1.7 times more likely to have overweight/obesity than the maltreated young adolescents (95% CI = 1.13-2.76). No demographic variables predicted high BMI. For the comparison young adolescents, depression slightly increased the odds of overweight/obesity (OR = 1.08, 95% CI = 1.01-1.15). Being neglected reduced the odds of being in the overweight/obesity and obesity group when combining genders. For females, but not males, sexual and physical abuse slightly reduced the odds of obesity. Conclusions-Both the maltreated and comparison young adolescents had a high prevalence of overweight and obesity, which puts them at risk for health problems. Maltreatment reduced the odds of having a high BMI for adolescents in this study, which is opposite to research in adults. Further exploration of the mechanism of how maltreatment is related to weight as adolescents age, with specific emphasis on differences between genders, is needed.
Child Maltreatment, 2013
This retrospective medical chart review examined the prevalence of overweight/obesity (≥85th perc... more This retrospective medical chart review examined the prevalence of overweight/obesity (≥85th percentile) and obesity (≥95th percentile) in Hispanic foster children aged 2–18 years in Los Angeles, California. Logistic regression was used for boys and girls separately to analyze polyvictimization (i.e., one vs. two or more types of maltreatment), type of maltreatment (abuse vs. neglect), and age-group as risk factors for overweight and obesity. Almost 40% of participants were overweight/obese, with the highest prevalence (47.7%) observed among children aged 12–18. Children aged 6–18 were at an increased risk of overweight/obesity and obesity compared with children aged 2–5. Although polyvictimization has been shown to have adverse health effects, in this study, it was related to slightly lower odds of obesity for boys but was unrelated to high weight for girls. Addressing the obesity epidemic among Hispanic foster children is vital to preventing continued obesity and the development o...
Child Abuse & Neglect, 2012
Objectives-To examine emergency department (ED) use among children involved with child protective... more Objectives-To examine emergency department (ED) use among children involved with child protective services (CPS) in the U.S. but who remain at home, and to determine if ED use is related to child, caregiver and family characteristics as well as receipt of CPS services. Method-We analyzed data on 4,001 children in the National Survey of Child and Adolescent Well-being. Multivariate models compared rates of ED use for whether the family received CPS services or did not receive CPS services as well as child characteristics, caregiver characteristics and caregiver/family psychological variables. Results-ED use among children who remained at home receiving CPS services was similar to that of children who did not receive CPS services (35.6% and 37.4%, respectively). In multivariate modeling, children with families who received CPS services, children six years or older, and children without a chronic health problem were less likely to use the ED. Children who remained at home in families identified with numerous stressors and, therefore, likely at high risk for future
Maternal and Child Health Journal, 2010
Journal of Public Child Welfare, 2011
Journal of Ethnic And Cultural Diversity in Social Work, 2010
The purpose of this study was to explore child welfare caregivers' perceptions of health care acc... more The purpose of this study was to explore child welfare caregivers' perceptions of health care access barriers and pediatric health care use for children under their care. The caregivers have different levels of English-language use. A cross-sectional sample of 237 parents was interviewed at a child welfare pediatric clinic in Los Angeles, California. Non-English-speaking parents utilized pediatric health services for their children as often as English-speaking parents. Few differences existed in relation to parents' perceptions of access barriers with English-speaking parents rating barriers related to inconvenience of services and rudeness of staff as more troublesome than parents who were non-English speaking. All parents rated difficulty understanding doctors' explanations as the greatest access barrier, which may negatively affect adherence to health recommendations for children in the child welfare system.
Pediatrics, 2021
OBJECTIVES To examine whether postneonatal infants reported for maltreatment face a heightened ri... more OBJECTIVES To examine whether postneonatal infants reported for maltreatment face a heightened risk of deaths attributable to medical causes. METHODS Birth and death records for all children born in California between 2010 and 2016 (N = 3 455 985) were linked to administrative child protection system records. Infants were prospectively followed from birth through death or age 1 year. Reports of maltreatment and foster care placement episodes were modeled as time-varying covariates; sociodemographic characteristics at birth were modeled as baseline covariates. Stratified, multivariable competing risk models were used to estimate the adjusted relative hazard of postneonatal infant death attributed to a medical cause (n = 1051). RESULTS After adjusting for baseline risk factors, and compared with infants never reported for maltreatment, the medical-related mortality risk was almost twice as great among infants reported once for maltreatment (hazard ratio: 1.77; 95% confidence interval:...
Children and Youth Services Review, 2010
This study's purpose was to identify differences in pediatric health care barriers and utilizatio... more This study's purpose was to identify differences in pediatric health care barriers and utilization among children in child welfare by caregiver type (birth parents, kin, and unrelated foster). Surveys were administered to 237 caregivers in the waiting room of an outpatient pediatric clinic in Los Angeles, California. Least-square means of access-to-care barriers derived from general linear models were compared across three types of caregivers. Multiple logistic regression models were employed to compare odds of good health status, availability of regular physician, and up-to-date vaccination across caregiver types. In the multivariate analysis, birth parents with children in child welfare were more likely to rate transportation as an access barrier (p = 0.05) and unrelated caregivers were less likely to rate clinic hours inconvenient (p = 0.03) than other caregivers. Children with unrelated foster caregivers were less up-to-date on their vaccinations. All caregivers rated "difficulty understanding doctor's explanation", "wait too long to see a doctor", and "clinic hours inconvenient" as the most difficult access barriers. Children who remain at home with their birth parents and receive child welfare services have similar pediatric health access barriers as children in foster care and should be included in policy initiatives about improving health care for children in child welfare.
Child Abuse & Neglect, 2013
Objective: The aims of this study of predominately racial/ethnic minority children in foster care... more Objective: The aims of this study of predominately racial/ethnic minority children in foster care (N = 360, birth to 19 years old) in Los Angeles, CA were to examine the (1) prevalence of obesity (≥95 percentile) and overweight/obese (≥85 percentile) upon entrance to foster care (T1) and after 1 year in foster care (T2); (2) comparison of high weight categories to national statistics; (3) relationship of changes in weight status to age, reason for entry into foster care, and placement. Methods: Chi-square test and McNemar test comparing paired proportions were used to determine whether there were significant changes in the proportion of high weight categories between T1 and T2. Chi-square test or Fisher's exact test were used to evaluate the association between age, placement, and reason for foster care with the change in weight category. Changes in weight were categorized as (1) decreased in weight, (2) remained at overweight or obese, (3) increased in weight, or (4) remained normal. Results: The proportion of obese and obese/overweight children between ages 2 and 5 were significantly lower at T2 than T1. There were no significant changes in the prevalence of obesity for the total population at T2. Children age 6 or older had a higher prevalence of obesity and overweight/obesity compared to national statistics. Of children at all ages, 64.7% of children of all ages entered foster care with a normal weight and stayed in the normal range during their first year in foster care, 12.2% decreased their weight, 15.4% remained overweight or obese, and 7.7% increased their weight. Age and parental substance use was related to change in weight category from T1 to T2. Conclusion: Children did not become more overweight or obese in foster care; however 28% of the children were obese or overweight upon entry into foster care. Children who are 6 years or older and obese upon entering foster care should be targeted for weight reduction. The pediatric community and child welfare system need to work together by including weight percentiles in the foster care file and training/monitoring child welfare caregivers in weight reduction interventions.
Maternal and Child Health Journal, 2012
Objectives-Overweight and obesity is a growing problem for children in foster care. This study de... more Objectives-Overweight and obesity is a growing problem for children in foster care. This study describes the prevalence of overweight and obesity in an urban, ethnic minority population of children ages 2-19 in long-term foster care (N = 312) in Los Angeles, California. It also investigates whether demographics or placement settings are related to high body mass index. Methods-The estimates of prevalence of overweight/obesity (≥ 85th percentile) and obesity (≥ 95th percentile) were presented for gender, age, ethnicity, and placement type. Multiple logistic regression was used to examine potential associations between demographic and placement variables and weight status. Results-The prevalence of overweight/obesity was 40% and obesity was 23% for the study population. Children placed in a group home had the highest prevalence of overweight/obesity (60%) and obesity (43%) compared to other types of placement. Within this study, older children (ages 12-19) were more likely to be overweight/obese than normal weight compared to children between 2 and 5 years old when controlling for gender, ethnicity and placement (OR = 2.10, CI =1.14-3.87). Conclusions-These findings suggest that older age and long-term foster care in general may be risk factors for obesity. Child welfare agencies and health care providers need to work together to train caregivers with children in long-term foster care in obesity treatment interventions and obesity prevention strategies.
Maternal and Child Health Journal, 2012
Objectives-Overweight and obesity is a growing problem for children in foster care. This study de... more Objectives-Overweight and obesity is a growing problem for children in foster care. This study describes the prevalence of overweight and obesity in an urban, ethnic minority population of children ages 2-19 in long-term foster care (N = 312) in Los Angeles, California. It also investigates whether demographics or placement settings are related to high body mass index. Methods-The estimates of prevalence of overweight/obesity (≥ 85th percentile) and obesity (≥ 95th percentile) were presented for gender, age, ethnicity, and placement type. Multiple logistic regression was used to examine potential associations between demographic and placement variables and weight status. Results-The prevalence of overweight/obesity was 40% and obesity was 23% for the study population. Children placed in a group home had the highest prevalence of overweight/obesity (60%) and obesity (43%) compared to other types of placement. Within this study, older children (ages 12-19) were more likely to be overweight/obese than normal weight compared to children between 2 and 5 years old when controlling for gender, ethnicity and placement (OR = 2.10, CI =1.14-3.87). Conclusions-These findings suggest that older age and long-term foster care in general may be risk factors for obesity. Child welfare agencies and health care providers need to work together to train caregivers with children in long-term foster care in obesity treatment interventions and obesity prevention strategies.
Maternal and child health journal, Jan 31, 2015
Objectives This study of primarily Latino caregivers and Latino child welfare-involved children h... more Objectives This study of primarily Latino caregivers and Latino child welfare-involved children had the following aims: (1) explore the return appointment adherence patterns at a pediatric medical clinic; and (2) determine the relationship of adherence to return appointments and caregiver, child, and clinic variables. Methods The sample consisted of caregivers of child welfare-involved children who were asked to make a pediatric outpatient clinic return appointment (N = 87). Predictors included caregiver demographics, child medical diagnoses and age, and clinic/convenience factors including distance from the clinic to caregiver's home, days until the return appointment, reminder telephone call, Latino provider, and additional specialty appointment. Predictors were examined using χ(2) and t tests of significance. Results Thirty-nine percent of all caregivers were nonadherent in returning for pediatric appointments. When return appointments were scheduled longer after the initial ...
Maternal and Child Health Journal
To explore how caregivers’ (birth parents, adoptive parents, relative caregivers, and unrelated c... more To explore how caregivers’ (birth parents, adoptive parents, relative caregivers, and unrelated caregivers) depressive symptoms moderate the concordance between their and their youth’s assessment of the youth’s physical health symptoms, diseases, and physical health status. Participants included 224 youth with mean age of 18.0 years (SD = 1.3) and their caregivers. Multiple-group models were run to test whether caregiver depression status moderated the concordance between youth and caregiver report of physical health outcomes. Models compared caregivers above the mean for depression in the sample (n = 62) with caregivers below the mean for depression in this sample (n = 128). There was a strong correlation between youth and caregiver report of pain in the last 30 days and physical health status in the caregiver group with no/fewer depressive symptoms [r (128) = 0.29, p = 0.04; r (128) = 0.59, p < 0.01], but no significant correlation between the two in the caregiver group with higher depressive symptoms [r (62) = − 0.27, p = 0.27; r (62) = − 0.14, p = 0.57]. Higher caregiver depressive symptoms was associated with worse concordance between caregiver and youth assessment of the youth’s pain and physical health status. These two health issues are less visible and more subjective and communication between caregiver and youth may be affected by the caregiver’s depressive symptoms. Since both caregiver and youth assessments of a youth’s physical health provide the best clinical data, it may be helpful for health providers to assess caregiver’s mental health status to provide a more complete picture.
Nursing Forum
Nursing organizations and leaders adopted the social determinants of health (SDOH) as essential t... more Nursing organizations and leaders adopted the social determinants of health (SDOH) as essential to the delivery of health care, but little is known about working registered nurses' (hereafter nurses) views on the SDOH. The purpose of this study was to (1) explore nurses' perceptions of how SDOH affect patient care and (2) describe nurses' ideas about how SDOH can be addressed to improve outcomes and services. Thirteen registered nurses with a baccalaureate in nursing beginning their online graduate advanced practice educational program were interviewed. This qualitative descriptive study used constant comparative analysis for data analysis. The analysis found two major themes: (1) SDOH are integrated into the nurses' care. The SDOH experienced by patients challenges the nurses to provide care at the patient's level and to provide usable patient education, and (2) health-care delivery change is needed to achieve equity and to provide health care to those in need. The nurses recommended more organized, seamless health-care delivery and interdisciplinary advocacy to achieve these needed changes. Nurse educators and nurse leaders can harness the frustration and ingenuity of nurses to help the nurses advocate for health-care change that integrates the SDOH.
Development and Psychopathology
The Young Adolescent Project (YAP) is an ongoing longitudinal study investigating the effects of ... more The Young Adolescent Project (YAP) is an ongoing longitudinal study investigating the effects of abuse and neglect on adolescent development. It is a multidisciplinary study guided by a developmental, ecological perspective, and designed to consider the physical, social, and psychological effects of childhood maltreatment through the transition from childhood to adolescence. Four waves of data collection have been completed, ranging from early (Mean age = 10.95) to late adolescence (Mean age = 18.24). Members of the maltreated group (n = 303) were selected from new cases that had been opened by the Department of Child and Family Services, whereas the comparison group (n = 151) were not involved with child welfare but lived in the same neighborhoods as the maltreated group. The study assessed a wide variety of domains including physical development (e.g., height, weight, body mass, pubertal development); physiological reactivity (e.g., cortisol); cognitive abilities; mental health (e...
Journal of Adolescent Health
PURPOSE Child maltreatment increases risk for obesity, yet differential effects of maltreatment t... more PURPOSE Child maltreatment increases risk for obesity, yet differential effects of maltreatment type remain unclear. Cortisol reactivity may help clarify these effects, given links among cortisol reactivity, maltreatment, and obesity. We examined these associations in boys and girls across adolescence. METHODS We collected data from 454 adolescents (212 girls) across four waves (aged 8-13 years at Time 1), including 303 maltreated youth. We modeled body mass index (BMI) percentile trajectories arrayed by age separately for boys and girls and tested whether cortisol reactivity at Time 1 moderated the association between maltreatment type and BMI growth. RESULTS In girls, cortisol reactivity moderated the association between maltreatment type and quadratic change in BMI. At low levels of cortisol, sexually abused girls had a steeper quadratic increase in BMI compared with comparison (-.65, 95% confidence interval [CI] -1.09 to -.22) and physically abused (-.76, 95% CI -1.29, -.24) girls. At high levels of cortisol, sexually abused girls did not differ from comparison (.15, 95% CI -.40 to .70) or physically abused (.21, 95% CI -.38 to .80) girls in quadratic change in BMI. In boys, cortisol reactivity did not moderate the association between maltreatment type and BMI growth. CONCLUSIONS The combination of lower cortisol reactivity and sexual abuse may put girls at risk for BMI increase during later adolescence. Given the negative consequences of high BMI, identifying and intervening with these girls could lead to better health and well-being among this group. Cortisol reactivity may not play the same role among boys.
Journal of Public Child Welfare
ABSTRACT The study examined whether youth demographics, family factors, and maltreatment type wer... more ABSTRACT The study examined whether youth demographics, family factors, and maltreatment type were related to unstable housing and whether unstable housing predicted delinquency and marijuana use. Participants included 216 child welfare-affiliated adolescents (mean age = 18.2 years). Youth with more lifetime residences were more likely to experience unstable housing although Latino youth (compared to White, Black, or multiethnic/biracial) were less likely to experience unstable housing. Unstable housing was associated with subsequent delinquency. Caregiver type (parent vs. relative/unrelated caregiver) was not related to unstable housing, thus homelessness prevention programs should include youth who remain with their parents and those with non-parent caregivers.
Academic Pediatrics
A parent-child relational framework was used as a method to train pediatric residents in basic kn... more A parent-child relational framework was used as a method to train pediatric residents in basic knowledge and observation skills for the assessment of child development. Components of the training framework and its preliminary validation as an alternative to milestone-based approaches are described. Pediatric residents were trained during a 4-week clinical rotation to use a semistructured interview and observe parent-child behavior during health visits using clinical criteria for historical information and observed behavior that reflect developmental change in the parent-child relationship. Clinical impressions of concern versus no concern for developmental delay were derived from parent-child relational criteria and the physical examination. A chart review yielded 330 preterm infants evaluated using this methodology at 4 and 15 months corrected age who also had standardized developmental testing at 6 and 18 months corrected age. Sensitivities and specificities were computed to examine the validity of the clinical assessment compared with standardized testing. A subset of residents who completed 50 or more assessments during the rotation was timed at the end of 4 weeks. Parent-child behavioral markers elicited from the history and/or observed during the health visit correlated highly with standardized developmental assessment. Sensitivities and specificities were 0.72/0.98 and 0.87/0.96 at 4 to 6 and 15 to 18 months, respectively. Residents completed their assessments &lt;1 minute on average if they had completed at least 50 supervised assessments. A parent-child relational framework is a potentially efficient and effective approach to training residents in the clinical knowledge and skills of child development assessment.
Child Maltreatment
The present study used data from an ongoing longitudinal study of the effects of maltreatment on ... more The present study used data from an ongoing longitudinal study of the effects of maltreatment on adolescent development to (1) describe rates of maltreatment experiences obtained from retrospective self-report versus case record review for adolescents with child welfare–documented maltreatment histories, (2) examine self-reported versus child welfare–identified maltreatment in relation to mental health and risk behavior outcomes by maltreatment type, and (3) examine the association between the number of different types of maltreatment and mental health and risk behavior outcomes. Maltreatment was coded from case records using the Maltreatment Case Record ion Instrument (MCRAI) and participants were asked at mean age = 18.49 about childhood maltreatment experiences using the Comprehensive Trauma Interview (CTI). Results showed that an average of 48% of maltreatment found by the MCRAI for each type of maltreatment were unique cases not captured by the CTI, whereas an average of 40% se...
Journal of Child and Family Studies, 2016
Both childhood maltreatment and frequent childhood residence changes are associated with poor beh... more Both childhood maltreatment and frequent childhood residence changes are associated with poor behavioral outcomes including drug use and delinquency. It is not clear whether a higher number of residences results in poorer outcomes for maltreated adolescents compared to adolescents living in the same community but without child welfare-documented maltreatment. Our study of child welfare-affiliated maltreated youth (n=216) and comparison youth (n=128) from the same community (age M = 18.21, SD = 1.42) examined: 1. whether child/caregiver characteristics and maltreatment status were associated with lifetime number of residences and 2. whether child/ caregiver characteristics, residences, and maltreatment status were associated with delinquency and marijuana use. The outcomes of this study, number of residences, delinquency, and marijuana use, were all skewed, and consequently negative binomial regressions were used. Maltreatment status, ever living with a non-parent caregiver, and being older are associated with more residence changes during childhood. More residences and male sex are associated with person offense delinquency and marijuana use. In lower income neighborhoods, such as where the adolescents in this study lived, residence changes are not unusual, but in this study maltreated youth moved more often than youth from the same community. It is important to help caregivers who live in disadvantaged neighborhoods, especially families with child welfare involvement, understand the behavioral consequences of residence changes and provide support for stable long-term housing.
Uploads
Papers by Janet Schneiderman