Reported contact with child protection services among those reporting child physical and sexual abuse: results from a community survey

OBJECTIVE: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS). METHODS: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse. RESULTS: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS. CONCLUSIONS: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse.     

Evaluation of the effect of the child protection act on serious child physical abuse in Taiwan

BackgroundFew studies have examined the effects of the Child Protection Act on child maltreatment in Taiwan.ObjectiveThis study estimated the secular trends in the incidence rate of physical abuse of children requiring hospitalization between 1996 and 2013, and the subsequent in-hospital death proportion before and after implementation of the Act in 2003.Participants and settingThe cases were children younger than 12 years old who were hospitalized due to child abuse, shaken-baby syndrome, neglect, or homicide between 1996 and 2013. A comparison group consisted of children requiring hospitalization for other reasons. We used the National Health Insurance database to identify patients.MethodsThe Joinpoint Regression Program was used to estimate temporal trends in the standardized incidence rates.ResultsBetween 1996 and 2013, 2050 children required hospitalization for physical abuse. Before 2005, the annual percent change increased by 9.40 [95% confidence interval (CI), 4.98–14.00] per year, and after 2005 the annual percent change was –4.80 (95% CI, –9.53–0.17) per year. Among the 2050 physically abused children requiring hospitalization, 83 (4%) died in hospital. The in-hospital death proportion was 2.62% before 2003 and 4.90% after 2003, and the ratio of these two proportions was 1.43 (95% CI, 0.80–2.58).ConclusionsThe trend in the incidence of hospitalization of children due to physical-abuse-related injuries started to decline 2 years after implementation of the Child Protection Act. However, the proportion of children who died in hospital as a result of physical abuse requiring hospitalization did not change.     

Child abuse in Hong Kong revisited after 15 years: Characteristics of victims and abusers

The purpose of this paper was to examine the characteristics of the victims and abusers of child abuse cases on the Child Protection Registry in Hong Kong as of March 1995 and to compare findings with a similar community report of child abuse in Hong Kong conducted approximately 15 years earlier. As of March 31, 1995, there were 457 active cases of child abuse or suspected child abuse (44% male and 56% female) on the computerized Child Protection Registry. Fifty percent of the victims were grade school age children between 7–12, and 62.4% suffered physical abuse. The abusers or suspected abusers were 52% male and 48% female with nearly half (49%) in their thirties. The majority of abusers were married/cohabiting (75%) with only a grade school education (60%). As compared to 1979, there was an increase of sexual child abuse cases, female victims of child abuse, and an increase in male abusers or suspected abusers.     

The cycle of victimization: The relationship between childhood maltreatment and adolescent peer victimization

Child maltreatment has been demonstrated to have many short- and long-term harmful consequences for victims, but whether or not child abuse is associated with an increased risk of peer victimization during adolescence is unclear. This study analyzed prospective data from 831 children and parents participating in the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) to investigate the relationships between child physical and sexual abuse and adolescent victimization by peers, as well as the potential for gender to moderate these relationships. Results from ordinal logit regression models indicated that children who were physically abused prior to age 12, based on official reports, parent reports, and child reports, had a greater risk of experiencing more intimidation and physical assault by peers at age 16. Having a history of sexual abuse predicted more physical assault but not intimidation. There was no evidence that gender moderated these relationships; in all cases, the relationship between abuse and revictimization was similar for boys and girls. The findings emphasize the need to provide victims of abuse with assistance to help prevent a cycle of victimization.     

Profile of abused and neglected American Indian children in the Southwest

From both knowledge gained working in Indian communities and a major data collection program, this article examines child abuse and neglect among the Indian tribes in a southwestern state. The period of study covers 1982 through 1985. The study sample consists of 53 children targeted by the local Indian Health Service Hospital Child Protection Team as being abused and/or neglected. In addition, information on the parents, grandparents and, in a number of cases, great-grandparents are examined. The study is a secondary data analysis of clinic and hospital records and interviews with local community health care providers and tribal officials. The results indicate that alcohol abuse was present in 85% of the neglect cases and in 63% of the abuse cases. In addition, child abuse and neglect occurred simultaneously in 65% of the sample. Child abuse and neglect are found to be part of a larger phenomenon of multiproblem families which raises the issue of intergenerational perpetuation of these problems. The results underscore the importance of interagency cooperation in surveillance, treatment, and prevention, as well as more careful and thorough documentation of record maintenance.     

Mediating effects of parental psychological distress and individual-level social capital on the association between child poverty and maltreatment in Japan

Child poverty is well known as a major risk factor for child maltreatment. However, it is not known whether parental psychological distress and individual-level social capital mediate the association. We examined the mediation effect of these two factors on the association between child poverty and maltreatment. In the Adachi Child Health Impact of Living Difficulty (A-CHILD) Study, a questionnaire was administered to all caregivers of first-grade children in every public elementary school in Adachi City between July and November 2015, and valid responses were used for analysis (N = 3944). Logistic and Poisson regression analyses were employed to examine the association between child poverty and maltreatment. Child poverty was defined in this study as meeting one of these criteria: 1) household income less than 3 million yen; 2) deprivation of specific material items that children or the household requires, or 3) experience of being unable to pay for lifeline utilities. Child maltreatment (physical abuse, neglect, and psychological abuse) was answered by parents. We confirmed a robust association between child poverty and maltreatment. Mediation analysis indicated that parental psychological distress mediated more than 60% of the association between child poverty on physical abuse and psychological abuse, while individual-level social capital mediated only 10% of the association with any type of maltreatment. In addition, structural equation modeling analysis revealed that the association was mediated by both parental psychological distress and social capital simultaneously. The findings suggest that supporting parental psychological distress may be an effective intervention to remedy the negative impact of child poverty on maltreatment.     

Predictors of justice system involvement: Maltreatment and education

Decades of research have established that experience of abuse and/or neglect in childhood is related to negative outcomes, such as juvenile delinquency. Existing research has shown that involvement in child welfare services is also related to juvenile delinquency, particularly for children who are victims of neglect. Research has also identified educational factors such as chronic absenteeism as significant predictors of involvement in the juvenile justice system. However, little research has investigated the combined influence of educational factors, child abuse, and involvement in child protective services on justice system involvement. The current study examined the influence of educational factors and involvement in child protective services on justice system involvement. The study utilized records from an educational database of children who attended a school within a county of Mississippi in any year from 2003 through 2013. Cases were then matched with records from the county Youth Court, Law Enforcement agencies, and Child Protection Services. A multivariate logistic regression controlling for gender, race, current age, and time at risk was conducted to involvement in the justice system. In general, educational factors were stronger predictors of justice system involvement than allegations of maltreatment.     

Oral health-related quality of life in Brazilian child abuse victims: A comparative study

This study aims to assess and compare Oral Health-Related Quality of Life (OHRQoL) in child abuse victims and non-abused children in a Southern Brazilian city. The study compared two independent samples of children aged 8–10 years: 48 child abuse victims recruited from a centre for Child and Adolescent Psychological Support (NACA) for abused children, and 144 public and private school students. Data collection consisted of administration of the Child Perceptions Questionnaire 8–10 (CPQ_8-10) to measure OHRQoL (dependent variable), clinical examination (dental caries), and collection of socioeconomic and demographic information (age, sex, skin colour, family income, and type of school). Multiple linear regression models were used to assess the association between presence of abuse and OHRQoL and subscales. After adjustment for clinical and sociodemographic variables, child abuse victims were found to exhibit higher CPQ scores on the overall scale and on the oral symptoms and functional limitations subscales. In conclusion, child abuse victims have a higher impact on OHRQoL. Based on the results, it is possible to suggest that greater care should be taken of these children, not only in providing treatment for oral disorders, but also in providing interdisciplinary care.     

Active surveillance of child abuse fatalities.

Monitoring abuse related deaths of infants and young children yields information necessary to the formulation of sound public policy. Birth and death certificates were correlated with information in the state Child Abuse and Neglect Registry on 104 abuse related fatalities. Significant findings include: very young age of parents at the first pregnancy; high rate of single parenthood; significantly lower educational achievement of victims' mothers; late, inadequate prenatal care; complications during pregnancy; and low birth weight among victims. The authors suggest Active Surveillance as a model for collecting information pertaining to child fatalities. Using Active Surveillance, a review team examines information from state agencies pertaining to children and families to review or determine cause of death and to collect demographic data on victims and perpetrators. Active Surveillance decreases the possibility of misidentifying abuse related deaths as accidental, and allows state agencies to follow abuse fatalities, collecting pertinent information and adjusting policy accordingly. The authors argue that, using Active Surveillance, states and nations may monitor success in preventing child abuse fatalities just as they now use infant mortality to monitor progress in public health, thus creating a stable and reliable standard for measuring progress in eliminating one type of child abuse.     

Problems in interagency collaboration: Lessons from a project that failed

Several institutions (e.g., child welfare, police, court, health, education, social service) are necessarily involved in the management of child abuse in all communities. The need for better cooperation among them has been acknowledged; inquests into child deaths resulting from abuse have often attributed some blame to faulty communication and/or poor cooperation between the institutions. The Community Child Abuse Team (CCAT) Project was designed by these same institutions in Hamilton, Ontario, to maximize interagency collaboration. The hypothesis, that this "interagency collaboration" model would provide more efficient and effective services to abused children and their families, was never tested. During its 30 months of operation the CCAT program never materialized as planned and funding was terminated. This paper describes selected problems and issues that arose during the struggle to implement the project. The central problematic issue was control. Those responsible for the project lacked the power to insist that the design be adhered to during the initial stage.     

Changing patterns in community attitudes to child abuse

Tasmania is the island state of Australia with a population of 416,000 people. A statewide programme on child abuse was commenced with the passing of a Child Protection Act in 1974. The results of the introduction of education programmes for professional groups and of providing information for the community have been analysed. Since 1972 notifications of suspected cases of child abuse have risen sixfold, but even now there are fewer cases reported in areas away from the main professional centre in the state. In the types of abuse being reported, there has been a sharp rise in self referrals and children deemed to be at risk. Sexual abuse may have been dealt with by other agencies before, but is now being notified. There has been a change in the age groups of children coming under notice with an increase in those between 2 and 12 years and a fall in those 0–2 years. The proportions of notifications from the various agencies have changed with considerably more coming from self referrals, from community referrals and from the education services. These trends would seem to indicate that both the professionals and the community are more aware of child abuse than formerly.     

Family child care in four Midwestern states: Multiple measures of quality and relations to outcomes by licensed status and subsidy program participation

Quality of family child care in four Midwestern states was examined using four measures designed to assess structural and/or process quality to determine if dimensions converge or vary across types of family child care (licensed and license-exempt/registered) and subsidy receipt (programs serving children whose care is paid by subsidies and programs not serving subsidized children). Two instruments designed specifically for use with family child care that measure both structural and process quality were used (Family Day Care Rating Scale and Quality Instrument for Informal Child Care), as well as one instrument measuring process quality (Caregiver Interaction Scale) and one instrument measuring structural quality (Midwest Child Care Assets Index). The two instruments designed to measure both structural and process quality in family child care were highly correlated with each other, while both of these were moderately correlated with the measure of process quality. The measure of structural quality was not significantly correlated with the measure of process quality. Licensed family child care homes scored higher than license-exempt/registered family child care homes on three of the four measures (all but the Caregiver Interaction Scale), and family child care homes receiving child care subsidies scored lower than those not receiving subsidies on three of the four measures (all but the Assets Index).     

Characteristics of child abuse homicides in the state of Kansas from 1994 to 2007

Objective

This study described the epidemiology of child abuse homicides in the state of Kansas from 1994 to 2007. It focused on obtaining significant details on all recorded child abuse homicides in Kansas during this time frame to provide critical information that can be used for future preventive measures.

Methods

A retrospective case review was conducted on data gathered by the Kansas State Child Death Review Board for all cases of “child abuse homicides” that occurred from 1994 to 2007.

Results

A total of 170 child abuse homicide cases in Kansas between 1994 and 2007 were identified. The majority of these cases (63.5%) were considered fatal child physical abuse. There was a predominance of female victims (55.9%). The vast majority of victims were White (78.8%), followed by Black (17.1%). One to 2-year-olds accounted for the largest age group of children who were victimized (33.5%). For cases with known prenatal care status, 74% of mothers received adequate prenatal care. The largest percentage of victims was children of single mothers (40.6%), with no prior history of child abuse (60%). The majority of deaths occurred in the victim's residence (81.8%). The greatest number of deaths occurred secondary to abusive head trauma (42.9%), followed by asphyxia (21.8%). When a trigger was known, 44.2% involved inconsolable crying. The most common perpetrator was the victim's biological father (26.6%), followed by the victim's biological mother (24.9%), then the victim's mother's male paramour (19.8%).

Conclusions

Familiarity with characteristics involved in child abuse homicide allows for opportunities to enlist important preventive measures. Most child abuse homicides occurred at the hands of the victim's biological parents and in the victim's own residence. Prevention should be focused on parent education and coping mechanisms for the frustrating features of crying in normal infants that lead to shaking or abuse.     

Implementation of routine electronic health record-based child abuse screening in General Emergency Departments

BackgroundRoutine child abuse screening is an approach to early identification of abuse. Previous studies evaluated paper-based screens; the widespread use of electronic health records suggests that screening is more likely to succeed if integrated into the electronic record.ObjectiveTo implement an electronic health record-based child abuse screen in a diverse hospital system and to evaluate the screening rate, rate of positive screens, and number of reports to Child Protective Services and assess whether hospital and patient characteristics are associated with these rates.Participants and settingChildren <13 years of age evaluated at one of 13 Emergency Departments within University of Pittsburgh Medical Center Health System.MethodsA previously validated child abuse screen was slightly modified and integrated into Cerner. Multivariable logistic regression models were used to estimate the odds of the outcomes of interest, controlling for key covariates.ResultsOf 17,163 eligible children: 68% received the screen of which 1.9% were positive. The rate of reports to Child Protective Services was higher among children who were screened (p < 0.0001). Younger children were more likely to be screened, have a positive screen, and have a report filed. There was no difference in the odds of being screened according to hospital teaching status, size or urban vs rural location.ConclusionsA child abuse screening tool can be integrated into the electronic health record in a large health-care network. The increased number of reports among children who were screened suggests that screening facilitates detection of suspected maltreatment.     

Parents’ perception of child behavior,parenting stress,and child abuse potential: Individual and partner influences

Based on the Social Information Processing model of parenting risk for child abuse, the present study examined the associations between mothers’ and fathers’ perception of child behavior and child abuse potential, as well as whether parenting stress mediates the association between these constructs. Two hundred and fifty-nine mother-father couples raising preschool children answered the Child Behavior Checklist (CBCL), the Parenting Stress Index (PSI), and the Child Abuse Potential Inventory (CAPI). The results of dyadic path analysis showed that perception of child behavior was related to heightened parenting stress and abuse potential in both mothers and fathers. Concerning partner effects, we found that mothers’ perception of child behavior problems was positively associated with fathers’ parenting stress and that the higher the mothers’ distress, the higher the fathers’ risk of physical abuse. Finally, parenting distress partially mediated the association between parents’ perception of child behavior and child abuse potential, with mothers’ perception of their children as problematic showing a significant indirect effect through distress on their own abuse risk and on fathers’ CAP as well. These findings suggest that parental distress may represent a critical mechanism by which parents’ negative views of their children contribute to abuse potential. Moreover, mothers seem to influence fathers’ tendency towards abusive behaviors.     

The role of cranial MRI in identifying patients suffering from child abuse and presenting with unexplained neurological findings

OBJECTIVE: The aim of this study was to demonstrate the usefulness of cerebral MRI to detect possible child abuse in children with unexplained neurologic findings. METHOD: Between 1990 and 1997, 208 children were referred for suspected physical child abuse to the Child Protection Clinic of Ste-Justine Hospital, a tertiary care pediatric hospital. Among them, 39 children presented initially with neurological findings. For 27 of them, the CT Scan results prompted the diagnosis of child abuse. However, in 12 children, even if a CT-Scan was performed, the diagnosis and/or the mechanisms of the neurologic distress remained obscure. Investigation was completed with MRI study in those 12 cases. RESULTS: MRI findings were diagnostic for physical abuse in eight cases. A diagnosis of child abuse was made in two more cases by a combination of MRI and skeletal survey findings. In one case, MRI was suggestive but the diagnosis of child abuse could not be confirmed. One case was misinterpreted as normal. CONCLUSIONS: MRI is the test of choice to rule out child abuse when faced with a child presenting unexplained neurologic signs lasting for few days. The fact that MRI can better differentiate collections of different ages makes this imaging test particularly useful in identifying cases of child abuse. These results, however, always have to be integrated in a well conducted multidisciplinary clinical approach.     

Institutional child abuse in Greece: some preliminary findings

A long-term study on child abuse and neglect in Greece is being carried out at the Institute of Child Health, Athens. A multidisciplinary team is investigating the nature of the problem in Greece, is trying a system of therapeutic intervention to families, is evaluating the adequacy of child protection as it is used in child abuse and neglect, and is examining the efficacy of the law. During a one year period, 5 children cared for in institutions were referred to the program. All were boys. All were children with minor or major handicaps. Two of died from the abusive incident. A study of the circumstances of the injury, and of the conditions in Greek institutions, supports the idea that institutional and family child abuse share many common characteristics. Special mention is made of the Greek circumstances pertaining to child protection and the law.     

Becoming and being DLP: Designated Liaison Persons’ experience of the role in the Irish primary school†

This paper reviews the role of the Designated Liaison Person (DLP) for Child Protection in the Irish primary school context. This is a role assigned by the Board of Management to a person in the school who oversees all matters pertaining to child protection including reporting abuse, liaising with staff and outside agencies in relation to child protection and meeting parents as required. Given the responsibilities associated with the role, it is normally the Principal teacher in the school who undertakes the role. A study undertaken with a number of DLPs in a variety of schools of different size and type highlights the multifaceted nature of the role, the supports available to DLPs and the challenges in undertaking this responsibility. The responsibility of ensuring the DLP is taking the correct course of action in making a referral of abuse in relation to a child is highlighted in the findings. Recent updates in child protection legislation which will impact on child protection procedures and policy in the school environment are also considered in this paper.     

Child sexual abuse in sub-Saharan Africa: a literature review

OBJECTIVE: This article reviews the English-language literature on child sexual abuse in sub-Saharan Africa (SSA). The focus is on the sexual abuse of children in the home/community, as opposed to the commercial sexual exploitation of children. METHODS: English language, peer-reviewed papers cited in the Social Sciences Citation Index (SSCI) are examined. Reports from international and local NGOs and UN agencies are also examined. RESULTS: Few published studies on the sexual abuse of children have been conducted in the region, with the exception of South Africa. Samples are predominantly clinical or University based. A number of studies report that approximately 5% of the sample reported penetrative sexual abuse during their childhood. No national survey of the general population has been conducted. The most frequent explanations for the sexual abuse of children in SSA include rapid social change, AIDS/HIV avoidance strategies and the patriarchal nature of society. Child sexual abuse is most frequently perpetrated by family members, relatives, neighbors or others known to the child. CONCLUSIONS: There is nothing to support the widely held view that child sexual abuse is very rare in SSA-prevalence levels are comparable with studies reported from other regions. The high prevalence levels of AIDS/HIV in the region expose sexually abused children to high risks of infection. It is estimated that, approximately.6-1.8% of all children in high HIV-incidence countries in Southern Africa will experience penetrative sexual abuse by an AIDS/HIV infected perpetrator before 18 years of age.