YALE MEDICAL LIBRARY Digitized by the Internet Archive in 2017 with funding from Arcadia Fund https://archive.org/details/developmentofinsOOihna DEVELOPMENT OF AN INSTRUMENT TO IDENTIFY NEWBORNS AT RISK OF CHILD ABUSE OR NEGLECT A Thesis Submitted to the Yale University School of Medicine in Partial Fulfillment of the Requirements for the Degree of Doctor of Medicine by Denise Huan-hsuan Kung Ihnat 1991 YMLftuc- 02 ’91 11 Table of Contents List of Figures iv List of Tables v Acknowledgments viii Abstract x Chapter One: Introduction 1 Chapter Two: Background 5 An Historical Perspective on Child Maltreatment 6 The Role of Prediction/Prevention 11 Prior Attempts to Predict Maltreatment 18 Clinimetrics and the Development of Rating Scales 34 Chapter Three: Methods 42 Phase I: Development of the Screening Instrument 44 Phase II: Pilot Testing of the Instrument 50 Phase III: Tests of Inter-Expert Agreement and Concurrent Validity 55 Phase IV: Evaluation of the Instrument 64 Chapter Four: Results 68 Phases I and II 69 Phase III 69 Phase IV 75 Chapter Five: Discussion 80 Ethical Considerations 86 Conclusions 88