Community
Child Abuse Prevention Programs
Best Practices
Child abuse and neglect (CAN) is one of the most tragic
social problems in existence. Children
depend on caregivers and parents for not only all physical needs but also for
all emotional needs. Exploitation of
that dependence happens all too often.
Each year, more than three million children are reported as abused or
neglected in the
The safety, well-being, and permanence of all children is
the core value motivating the
In general, neglect is an act of omission while abuse is an act of commission.
Generally, physical abuse is characterized by physical injury, such as bruises and fractures that result from:
· Punching
· Beating
· Kicking
· Biting
· Shaking
· Throwing
· Stabbing
· Choking
· Hitting with a hand, stick, strap, or other object
· Burning
Although an injury resulting from physical abuse is not accidental, the parent or caregiver may not have intended to hurt the child. The injury may have resulted from severe discipline, including injurious spanking, or physical punishment that is inappropriate to the child’s age or condition. The injury may be the result of a single episode or of repeated episodes and can range in severity from minor marks and bruising to death.
Neglect is the failure of a child's primary caretaker to provide adequate food, clothing, shelter, supervision, and medical care. But what is adequate? And is it neglect if the primary caretaker is simply unable to provide for the child's needs, or must the caretaker "willfully" deprive the child? And is it neglect only if the child has suffered harm, or if the child is potentially at harm? And are there other types of deprivation not mentioned above-such as a failure to provide for a child's educational or emotional needs-that also should be classified as neglect? Both legal and research professionals struggle with these questions.
Legal Definitions
The Federal Child Abuse Prevention and Treatment Act (CAPTA) provides minimum
standards for definitions. CAPTA states,
"The term 'child abuse and neglect' means, at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm" (42 U.S.C.A. §5106g(2) (West Supp. 1998).
Using this minimum standard as a foundation, each State provides its own definitions for child abuse and neglect. There are three places in State statutes in which abuse and neglect are defined: (1) reporting laws for child maltreatment, (2) criminal codes, and (3) juvenile court statutes (U.S. Department of Health and Human Services, 2000).
A review of State reporting laws reveals that neglect frequently is defined by the States as deprivation of adequate food, clothing, shelter, or medical care (U.S. Department of Health and Human Services, 2000). However, there is great variation among the States in operationalizing their definitions, which contributes to the lack of clarity on a national level. For example, approximately one-fifth of the States do not define neglect separately from abuse. Of those that do define neglect separately, some also define particular types of neglect, such as abandonment or medical neglect. In addition, many States address related issues in their statutes such as parental incapacity (i.e., parent is hospitalized or incarcerated) or injurious environments (i.e., child is exposed to criminal activity in the home). Most States also specify exemptions or issues to be taken into consideration, including religious exemptions for medical neglect and financial considerations for physical neglect (U.S. Department of Health and Human Services, 2000).
Beyond State reporting laws, various State regulations, policies, and procedures provide guidance for child welfare professionals to determine whether or not neglect has occurred. Various agencies and workers interpret these guidelines as they make decisions about which reports to investigate, and which investigations will result in interventions. Clearly, there is no universal legal or practice definition of child neglect.
Research Definitions
There is little agreement among researchers regarding a conceptual or
operational definition of neglect. Researchers lament this situation because a
lack of consensus makes it difficult to compare findings across studies and
difficult to apply findings to child welfare professionals' interventions
(Black & Dubowitz, 1999; Zuravin, 1991). In addition to using various
definitions, researchers also have used a variety of methods to measure
neglect, including observations of the home, specific behavioral criteria,
medical history, self-report measures, interviews, case record abstractions,
and CPS case findings (Black & Dubowitz, 1999; Zuravin, 1999).
One important element of a child neglect definition or classification system is the identification of behaviors or conditions that are considered "neglectful." Some behaviors seem universally classified as neglect by researchers. These include:
However, many behaviors may be categorized differently by different classification systems. The table below illustrates this using examples from two widely known classification systems: the Third National Incidence Study of Child Abuse and Neglect (NIS-3) (Sedlack & Broadhurst, 1996) and the Maltreatment Classification System (MCS) developed by Barnett, Manly and Cicchetti (1993).
|
Two
Classification Systems for Child Maltreatment |
||
|
Behavior |
Sedlack & Broadhurst, 1996 |
Barnett, Manly & Cicchetti, 1993 |
|
Inadequate education |
Educational Neglect |
Moral-Legal/Educational Maltreatment |
|
Exposure to domestic violence |
Emotional Neglect |
Emotional Maltreatment |
|
Exposure to drugs in utero |
Other Maltreatment |
Physical Neglect-Failure to Provide |
|
Exposure to or allowing child to engage in illegal activities |
Emotional Neglect |
Moral-Legal/Educational Maltreatment |
|
Shelter-related neglect such as homelessness or inadequate sanitation or utilities in the child's home |
Not addressed |
Physical Neglect-Failure to Provide |
|
Inadequate nurturance/affection |
Emotional Neglect |
Emotional Maltreatment |
The Department of Health and Human Services’ Third National Incidence Study of Child Abuse and Neglect (NIS-3) is the single most
comprehensive source of information about the current incidence of child
maltreatment in the
Physical Neglect
§
Refusal of health care—the failure to provide or allow needed
care in accordance with recommendations of a competent health care professional
for a physical injury, illness, medical condition, or impairment.
§
Delay in health care—the failure to seek timely and appropriate
medical care for a serious health problem that any reasonable layman would have
recognized as needing professional medical attention.
§
Abandonment—the desertion of a child without arranging
for reasonable care and supervision.
§
Expulsion—other blatant refusals of custody, such as
permanent or indefinite expulsion of a child from the home without adequate
arrangement for care by others or refusal to accept custody of a returned
runaway.
§
Inadequate supervision—leaving a child unsupervised or inadequately
supervised for extended periods of time or allowing the child to remain away
from home overnight without the parent or caretaker knowing or attempting to
determine the child’s whereabouts.
§
Other physical neglect—includes
inadequate nutrition, clothing, or hygiene; conspicuous inattention to
avoidable hazards in the home; and other forms of reckless disregard of the child’s
safety and welfare (e.g., driving with the child while intoxicated, leaving a
young child in a car unattended).
Educational Neglect
§
Permitted chronic truancy—habitual
absenteeism from school averaging at least 5 days a month if the parent or
guardian is informed of the problem and does not attempt to intervene.
·
Failure to Enroll-- failure to register or enroll a
child of mandatory school age, causing the child to miss at least 1 month of
school; or a pattern of keeping a school-aged child home without valid reasons.
§
Inattention to special education need—refusal to allow
or failure to obtain recommended remedial education services or neglect in
obtaining or following through with treatment for a child’s diagnosed learning
disorder or other special education need without reasonable cause.
Emotional Neglect
§
Inadequate nurturing or affection—marked inattention
to the child’s needs for affection, emotional support, or attention.
§
Delay in psychological care—failure to seek
or provide needed treatment for a child’s
emotional or behavioral impairment or problem that any reasonable layman
would have recognized as needing professional, psychological attention (e.g.,
suicide attempt).
Incidence of Child Abuse and Neglect
Definitive numbers of CAN are impossible to gather as many instances go unreported and data collection methodologies vary from study to study. However, an estimated 2.6 million referrals of abuse or neglect concerning nearly 4.5 million children were received by CPS agencies in 2002. More than two-thirds of those referrals were accepted for investigation or assessment (U.S. Department of Health and Human Services, 2004). Maltreatment categories include neglect, medical neglect, physical abuse, sexual abuse, and emotional or psychological maltreatment (Administration for Children and Families, 2003). In 2002, victimization rates for maltreated children were: 60.5% were neglected (including medical neglect), 18.6% were physically abused, 9.9% were sexually abused, and 6.5% were emotionally or psychologically maltreated; 18.9 percent of victims experienced such "other" types of maltreatment as "abandonment," "threats of harm to the child," and "congenital drug addiction" (U.S. Department of Health and Human Services, 2004). Because many children are victims of multiple types of maltreatment, the percentages total greater than 100 percent.
Rates of fatalities due to CAN are equally alarming. In 2002, an estimated 1,400 child fatalities were caused by abuse or neglect (U.S. Department of Health and Human Services, 2004). There is evidence that as many as 50 to 60 percent of these deaths go unrecorded (Crume et al., 2002). Those at the highest risk, comprising 44% of total child CAN fatalities, are children under one year of age—that is, the most defenseless population imaginable is the most likely to be killed by his or her own parent (Fromm, 2001).
Understanding CAN: Risk and Protective Factors
There has been a shift in the perceived causes to CAN
amongst researchers. The previous model
was a cause-and-effect approach focusing on the abuser. As research has progressed it has become
obvious that the perpetrators of CAN do not operate in vacuums—that the problem
has many causes that can come from sources extending beyond the
individual. This paradigm shift has
opened the doors for prevention programs as it gives a comprehensive strategy
for engaging the diverse origins of
Important characteristics of the family are linked with child maltreatment. Families in which there is substance abuse are more likely to experience abuse or are at a higher risk of abuse (Ammerman et al., 1999; Besinger et al., 1999; U.S. Department of Health and Human Services, 1993). But, identifying families in which substance abuse is present can be difficult. The Child Welfare League of America (2001) recently found that substance abuse is present in 40 to 80 percent of families in which children are abuse victims. Recent studies also have established a link between having a history of childhood abuse and becoming a victimizer later in life, including Clarke et al. (1999), confirming some of the earliest work in the field. DiLillo, Tremblay, and Peterson (2000) found that childhood sexual abuse increased the risk of perpetrating physical abuse on children as adults. Domestic violence and lack of parenting or communication skills also increase the risks of maltreatment to children.
Parent-related Risk Factors |
|
Factors related to the community and the larger society also are linked with child maltreatment. Poverty, for example, has been linked with maltreatment, particularly neglect, in each of the national incidence studies (Sedlak & Broadhurst, 1996), and has been associated with child neglect by Black (2000) and found to be a strong predictor of substantiated child maltreatment by Lee and Goerge (1999). Bishop and Leadbeater (1999) found that abusive mothers reported fewer friends in their social support networks, less contact with friends, and lower ratings of quality support received from friends. Violence and unemployment are other community-level variables that have been found to be associated with child maltreatment. Perhaps the least understood and studied level of child maltreatment is that of societal factors. Ecological theories postulate that factors such as the narrow legal definitions of child maltreatment, the social acceptance of violence (as evidenced by video games, television and films, and music lyrics), and political or religious views that value noninterference in families above all may be associated with child maltreatment (Tzeng, Jackson, & Karlson, 1991).
|
Community/Societal
Risk Factors |
|
Though children are not responsible for the abuse inflicted upon them, certain child characteristics have been found to increase the risk or potential for maltreatment. Children with disabilities or mental retardation, for example, are significantly more likely to be abused (Crosse, Kaye, & Ratnofsky, 1993; Schilling & Schinke, 1984). Evidence also suggests that age and gender are predictive of maltreatment risk. Younger children are more likely to be neglected, while the risk for sexual abuse increases with age (Mraovick & Wilson, 1999). Female children and adolescents are significantly more likely than males to suffer sexual abuse.
|
Child-Related
Risk Factors |
|
It is obvious from this new paradigm that many social
problems are antecedents to CAN—a battered wife is more likely to abuse her
children, as is an alcoholic father. Thus combating almost any societal ill
will have a positive impact on
Poverty and occurrences of CAN are inextricably
linked. Given the scope of poverty in
There were 542,000 children in foster care as of
Preschool children range in age from
|
Age |
Rate Per 1,000 Children |
|
0-3
|
16.0 |
|
4-7 |
13.7 |
|
8-11 |
11.9 |
|
12-15 |
10.6 |
|
16-17 |
6.0 |
(
Research has shown that children with disabilities
are 1.7 times as likely to be victimized by
CAN is the leading cause of runaway and homeless youth. One study showed that 46% of runaway and homeless youth had been physically abused and 17% had been forced into unwanted sexual activity by a family or household member (U.S. Department of Health and Human Services, 1997).
Due to high levels of poverty, unemployment, lack of social services and alcoholism within the Native American and migrant populations, these children are at a quadruple threat.
The consequences of CAN are extensive. CAN affects not only each child it victimizes, but that child’s family, local communities and society as a whole. Conservative estimates put the national direct costs of CAN including hospitalization, chronic health problems, mental health care system, welfare system, law enforcement, and judicial system at $24,384,347,302; the indirect costs including special education, mental health and health care, juvenile delinquency, lost productivity to society, and adult criminality at $69,692,535,227. This puts the estimated total cost at over $94 billion. (Fromme, 2001). A brief overview of the non-financial consequences experienced by the victims of CAN follows.
|
Physical Health
Consequences |
Behavioral
Consequences |
Psychological
Consequences |
|
|
|
(Source:
Given the broad range of impact CAN has, it is imperative that prevention is addressed on a broad scale. The individual risk factor areas (parent related, child related, community/societal) are interrelated; addressing one will impact the others in a successful prevention program. The recent reauthorization of CAPTA and origination of CBCAP addresses this need for community-based prevention.
Protective Factors that Help Prevent Child Abuse and
Neglect
Exposure
to significant risk factors does not necessarily mean that child abuse or other
problem behaviors will inevitably follow. Many children growing up in
what appear to be high-risk families and environments emerge relatively problem
free. Research indicates that the presence of protective factors balances and buffers risk factors.
Protective
factors are the attitudes, beliefs, behaviors, and circumstances that build resilience Resilience allows individuals to flourish even under
adverse circumstances. Resilient people, even though they may be
exposed to multiple risk factors, are less inclined than others exposed to the
same risk factors to use drugs or engage in other problem behaviors. Some
people appear to be naturally more resilient that others, but there is also
evidence that resilience can be enhanced by increasing protective factors.
Researchers, practitioners, and policy makers are now increasingly thinking about protective factors within children and families that can reduce risks, build family capacity, and foster resilience. In 1987, case studies of three victims of child maltreatment began to shed light on the dynamics of survival in high-risk settings. Resilience in maltreated children was found to be related to personal characteristics that included a child's ability to: recognize danger and adapt, distance oneself from intense feelings, create relationships that are crucial for support, and project oneself into a time and place in the future in which the perpetrator is no longer present (Mrazek & Mrazek, 1987).
Since then, researchers have continued to explore why certain children with risk factors become victims and other children with the same factors do not. What are the factors that appear to protect children from the risks of maltreatment? In a recent overview by the Family Support Network, factors that may protect children from maltreatment include child factors, parent and family factors, social and environmental factors. Child factors that may protect children include good health, an above-average intelligence, hobbies or interests, good peer relationships, an easy temperament, a positive disposition, an active coping style, positive self-esteem, good social skills, an internal locus of control, and a balance between seeking help and autonomy.
Parent and family protective factors that may protect children include secure attachment with children, parental reconciliation with their own childhood history of abuse, supportive family environment, household rules and monitoring of the child, extended family support, stable relationship with parents, family expectations of pro-social behavior, and high parental education. Social and environmental risk factors that may protect children include middle to high socioeconomic status, access to health care and social services, consistent parental employment, adequate housing, family participation in a religious faith, good schools, and supportive adults outside the family who serve as role models or mentors (Family Support Network, 2002). Some recent studies have found that families with two married parents encounter more stable home environments, fewer years in poverty, and diminished material hardship (Lerman, 2002).
A review
of the literature suggests numerous factors that contribute to resilience
against CAN:
|
Parental
Protective Factors |
|