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Good morning and happy Monday.  I hope this finds everyone well.  This morning, I’d like to direct your attention to a particularly insidious form of abuse – insidious not because it is worse than any other form of abuse, but because it is less frequently recognized and thus less frequently treated.  The abuse to which I’m referring is psychological maltreatment, and it is the subject of a recent study and report entitled “Unseen Wounds:  The Contribution of Psychological Maltreatment to Child and Adolescent Mental Health and Risk Outcomes.”  The report is published in Psychological Trauma:  Theory, Research, Practice and Policy, a publication of the American Psychological Association.
Psychological maltreatment, or PM, is particularly challenging to identify because of its intangible nature.  And while it can be perpetrated by anyone, its most pernicious form is that perpetrated by parents and/or caregivers.  The researchers note that “available evidence and guiding theory suggest that PM inflicted by a primary caregiver in early childhood, or chronically throughout childhood and adolescence, is more deleterious to a child’s overall development.”  Id., p. S19.
The researchers are careful to distinguish PM from the “characteristics of dysfunctional parenting (e.g., inconsistent, chaotic, emotionally dysregulated parenting…).”  Id.  PM is distinct from dysfunctional parenting in that PM is characterized by a “chronic, severe and escalating pattern of emotionally abusive and neglectful parental behavior” combined with increased risk of psychological harm to the child.”  Id.
In examining PM, the researchers looked to test whether “[y]outh reporting PM will exhibit equivalent or higher baseline levels of symptom severity, risk behavior, and functional impairment compared with physically or sexually abused youth; and [whether] [t]he co-occurring presence of PM with physical or sexual abuse will be associated with worse clinical outcomes compared with outcomes among other categories of maltreated youth (i.e., those who report only physical, only sexual, or combined physical and sexual abuse).”  Id., p. S20.
To test these hypotheses, the researchers “examined baseline assessment data from maltreated youth, as archived in the National Child Traumatic Stress Network (NCTSN) Core Data Set (CDS).”  Id.  Their study sample “consisted of 5,616 children, comprised of 2,379 (42%) boys and 3,237 girls.”  Id.
The researchers’ findings “strongly support the hypotheses that PM in childhood not only augments, but also independently contributes to, statistical risk for negative youth outcomes to an extent comparable to statistical risks imparted by exposure to physical abuse (PA), sexual abuse (SA), or their combination (PA + SA).”  Id., p. S24.  Moreover, they found that “PM was the strongest and most consistent predictor of internalizing problems (e.g., depression, GAD, SAD, attachment problems).  With respect to the prediction of externalizing problems, (e.g., behavioral problems, self-injury, criminal activity), PM exhibited a strong association comparable to that of PA and greater than that of SA.”  Id., p. S25. 
But perhaps most concerning is that the researchers found that PM “is the most prevalent form of maltreatment in the NCTSN CDS.  A history of PM exposure was identified in the majority (62%) of more than 5,000 maltreatment cases examined in this study, with nearly one quarter (24%) of maltreatment cases comprised exclusively of PM.”  Id., p. S24.  But this is in contrast to “official reports of PM to child welfare agencies [which] portray PM as a relatively rare phenomenon:  Only 7.6% of official reports to child welfare agencies identified the occurrence of PM in 2009.”  Id., p. S19.  Perhaps “[t]he comparatively covert nature of PM can … lead investigators to focus on other more “tangible” forms of maltreatment, as well as to adopt an apathetic or helpless outlook regarding how best to intervene.”  Id.
This study creates a powerful argument against apathy, and encourages practitioners to engage in “efforts to increase recognition of PM as a potentially formidable type of maltreatment in its own right [which] should be at the forefront of mental health and social services training efforts, including incorporation of education on PM into graduate training curricula and continuing education of child service professionals.”  Id., p. S26.  Furthermore, the researchers implore practitioners to develop “theoretically grounded interventions for the sizable subpopulation of traumatized youth exposed to PM….  Appropriately constructed guiding theory, assessment tools, interventions, and clinical training methods are needed to support accurate risk screening and case identification, effective intervention, workforce development and public policy.”  Id
I strongly encourage you to download this article and share it widely with your colleagues, team members and agency partners.  And I further encourage you to engage in discussions regarding this form of child maltreatment.  By recognizing it, we can take the first step toward eradicating it.   
As always, I thank you for reading, and for all that you do on behalf of the children you serve.  
Warm regards,  
Teresa  
516 C Street, NE | Washington, DC 20002 US
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