Fatality after report to a child abuse registry in Washington State, 1973-1986.

Between 1973 and 1986, 11,085 children born in Washington State were reported to the state child abuse registry. We analyzed the fatality rate subsequent to reported abuse for this cohort of children compared to a population of nonabused children matched on sex, county of birth, and year of birth. Children reported to the child abuse registry had an almost threefold greater risk of death than the comparison population. A report of physical abuse carried the greatest risk of subsequent death. However, the relative risks were also elevated for children who suffered neglect or sexual abuse. Children reported to the registry were almost 20 times more likely than the comparison population to die from homicide. Children less than 1 year of age at time of reported abuse had the highest fatality rate subsequent to abuse, but adolescents had the highest relative risk for fatality after abuse, compared to the population of nonabused children. Rates of fatality subsequent to abuse were equal for males and females. Although this study could not measure the extent to which any given intervention reduced the risk of subsequent fatality in abused children, registries can serve a valuable function in identifying subpopulations at risk and quantifying that risk relative to the general population.     

Child abuse fatalities and cases of extreme concern: lessons from reviews

OBJECTIVE: The study was commissioned by the Welsh Office to pull together lessons from all reports on cases involving either a child abuse fatality or serious child protection concern ("Part 8 Reviews") since the introduction of the Children Act 1989. METHOD: Twenty-one such reports were identified and subjected to a content analysis to extract practice issues. RESULTS: From 19 reports (excluding Reviews concerning adult sexual abusers), the authors identify seven practice themes emerging from that analysis which are related to those identified in previous studies and to six previously undertaken British overviews of child abuse fatalities. The themes are assessment, interagency communications, responsibility, number of professionals involved, role of general practitioners, insufficient training for pediatricians/radiologists, and parental choice. CONCLUSIONS: British child protection agencies are attempting to address apparently conflicting policy objectives. On the one hand they are required to ensure the protection of the most vulnerable children within the child protection system. At the same time they are also being encouraged to adopt a "lighter touch" in child protection work. The authors conclude that the seven themes may provide some indicators as to how these conflicting objectives may be reconciled.     

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.     

Violence among family members of children and adolescents evaluated for sexual abuse

OBJECTIVES: The two aims of this study were to: (1). describe the prevalence and characteristics of domestic adult and child physical violence in the homes of children and adolescents evaluated in a specialized sexual abuse clinic and (2). describe parent or caretaker responses to domestic adult and child violence and child sexual abuse, including tendencies to report or seek medical care. METHOD: A consecutive sample of 164 subjects (ages 7-19) were interviewed in a sexual abuse clinic regarding in-home violent or abusive experiences among family members that had occurred at any time during their childhood. RESULTS: Fifty-two percent of these children and teenagers reported spousal violence in their home. Fifty-eight percent of child sexual offenders who were in-home males also physically abused their adult female partner. Half of in-home males who were physically violent to children also sexually abused them. In 86% of homes with partner violence, the children were also physically assaulted. There was no difference in sexual abuse disclosure rates or patterns for children living with or without adult violence. CONCLUSIONS: Sexually abused children should be questioned about physical abuse and the presence of violence among adults in their home. Safety plans for sexually abused children should incorporate screening for family violence and safety plans for parents and siblings of child victims, when appropriate.     

The "geography" of child maltreatment in Israel: Findings from a national data set of cases reported to the social services

OBJECTIVES: This article examines the "geography" of reported cases of child maltreatment in Israel by determining its frequency and rates according to nationality, area of residence, and size and type of locality. METHOD: The study collected data at the local level in Israel based on reports to social services of cases of child maltreatment during 2000; locality is the unit of analysis. RESULTS: The rate of reported cases of child maltreatment was 17.8 per 1,000 children in Israel in 2000. The rates varied, however, among different localities. They were lower in Arab localities (9 per 1,000 children) than in the Jewish ones (20 per 1,000), higher in large cities and other socioeconomic affluent localities (19 per 1,000), and varied according to the geographic area. CONCLUSIONS: This study demonstrates considerable variation in rates of reported cases of child maltreatment by locality and by population makeup. Thus, to fulfill the Israeli legislation of mandatory reporting of any reasonable suspicion of child maltreatment, the state should better develop policies and services that encourage reporting of child maltreatment among the Arab and ultraorthodox populations and in smaller or socioeconomic disadvantaged localities. Furthermore, the social services must build a bridge to the minority populations in Israel, developing their trust in these services and increasing their propensity to use them.     

Fatal and non-fatal child maltreatment in the US: An analysis of child,caregiver, and service utilization with the National Child Abuse and Neglect Data Set

The purpose of this study was to compare children who are fatally and non-fatally maltreated in the United States. In this first national-comparison study, we used the Child Abuse and Neglect Data Set of children and families who encounter/receive support from child welfare services. We found that children who were fatally maltreated were younger, were more likely to live with both their parents, and that their families experienced more financial and housing instability compared to non-fatally maltreated children. Overall, families in which children die use/receive fewer social services, as compared to families in which children live. We discuss the results with regard to child welfare practice and research.     

Fatal child neglect: Characteristics,causation, and strategies for prevention

Research in child fatalities because of abuse and neglect has continued to increase, yet the mechanisms of the death incident and risk factors for these deaths remain unclear. The purpose of this study was to systematically examine the types of neglect that resulted in children's deaths as determined by child welfare and a child death review board. This case review study reviewed 22 years of data (n = 372) of child fatalities attributed solely to neglect taken from a larger sample (N = 754) of abuse and neglect death cases spanning the years 1987–2008. The file information reviewed was provided by the Oklahoma Child Death Review Board (CDRB) and the Oklahoma Department of Human Services (DHS) Division of Children and Family Services. Variables of interest were child age, ethnicity, and birth order; parental age and ethnicity; cause of death as determined by child protective services (CPS); and involvement with DHS at the time of the fatal event. Three categories of fatal neglect – supervisory neglect, deprivation of needs, and medical neglect – were identified and analyzed. Results found an overwhelming presence of supervisory neglect in child neglect fatalities and indicated no significant differences between children living in rural and urban settings. Young children and male children comprised the majority of fatalities, and African American and Native American children were over-represented in the sample when compared to the state population. This study underscores the critical need for prevention and educational programming related to appropriate adult supervision and adequate safety measures to prevent a child's death because of neglect.     

Harsh parenting and child aggression: Child moral disengagement as the mediator and negative parental attribution as the moderator

As the negative outcomes of harsh parenting for child development have been gradually revealed, researchers become increasingly interested in the mechanisms through which harsh parenting affects child development. This study aimed to explore the mediating role of child moral disengagement and the moderating role of negative parental attribution in the relation of harsh parenting to child aggression. A sample of 397 Chinese adolescents aged from 12 to 16 years (227 boys and 170 girls, Mage = 13.98) with their parents were recruited as participants from two public schools situated in rural areas of Shandong province in China. Data were gathered from parents reporting on their harsh parenting and negative parental attribution, adolescents reporting on their moral disengagement, and peers nominating out aggressive children. Results indicated that harsh parenting was both directly and indirectly associated with adolescent aggression via adolescent moral disengagement. Negative parental attribution was found to moderate the indirect relation of harsh parenting to adolescent aggression via moral disengagement. Specifically, harsh parenting was only significantly associated with moral disengagement for adolescents with high levels of moral disengagement was more likely to induce aggression among adolescents with high levels of negative parental attribution (bsimple = of harsh parenting to adolescent aggression, adolescent moral disengagement could mediate the association between harsh parenting and aggressive behaviors for adolescents with high levels of negative parental attribution.     

Child maltreatment among school children in the Kurdistan Province, Iran

OBJECTIVE: This study examines the determinants of three types of child maltreatment: physical maltreatment, mental maltreatment, and child neglect among school children in the Kurdistan Province of Iran. The analysis examines the impact of socioeconomic, familial, demographic, and household dynamic factors on the three child maltreatment outcomes, and compares the differential impact of these factors across the three types of child maltreatment. A greater understanding of the factors associated with child maltreatment has the potential to inform public health interventions aimed at reducing specific forms of maltreatment and at identifying at risk populations. METHODS: Data were collected from 1,370 school students, age 11-18. Separate logistic models are fitted for six binary outcomes examining self-reported experiences of physical maltreatment in the home or school, mental maltreatment in the home or school, and child neglect in the home or school. RESULTS: Male children were more likely to report experiencing any kind of child maltreatment than girls. Residency in a rural area, poor parental relationships and the use of addictive substances by household members were associated with increased odds of reporting child maltreatment. Poor school performance was associated with the reporting of experiencing maltreatment at school. CONCLUSION: Each of the forms of child maltreatment is highly correlated with socioeconomic, demographic, and living condition factors. The results point to the strong influence that familial factors have in shaping a child's likelihood of reporting maltreatment. Characteristics of the mother were associated with maltreatment, but not characteristics of the father. The results highlight a number of mechanisms through which public health interventions may seek to reduce the prevalence of child maltreatment in Kurdistan; different approaches are needed to reduce child maltreatment in the home and school environments.     

Helping children to the other side of silence: a study of the impact of the stay safe programme on Irish children's disclosures of sexual victimization

OBJECTIVE: This study aimed to evaluate the effectiveness of a school based safety skills program--The Stay Safe Programme--in facilitating the disclosure of sexual abuse among sexually victimized children and adolescents in Dublin. METHOD: A Cohort of 145 children who had participated in the Stay Safe Programme prior to their referral to a sexual abuse assessment unit were compared with a cohort of 443 children who had not participated in the prevention program on a range of disclosure related variables abstracted from case notes. RESULTS: More Stay Safe participants, particularly female adolescents, made disclosures of suspected sexual abuse than non-participants. A higher rate of initial disclosure to teachers was made by Stay Safe participants and more teachers in schools participating in the Stay Safe Programme initiated referrals for evaluation of suspected child sexual abuse. Following assessment a higher rate of confirmed abuse occurred among Stay Safe participants and for these confirmed cases more Stay Safe participants made purposeful disclosures and in significantly more cases referral was due to the child telling someone about the abuse. These differences in disclosure between program participants and non-participants were unrelated to demographic factors or characteristics of the abuse. CONCLUSIONS: The Stay Safe Programme was an effective secondary prevention intervention deserving widespread implementation.     

Incarcerated mothers' perceptions and interpretations of their fatally maltreated children

Fatally maltreated children are an elusive component in the complex interaction that has led to their premature deaths. Retrospective research with women imprisoned for fatal child maltreatment indicated recurring themes of maternal interpretations of their children as rejecting and developmentally abnormal, either advanced or delayed. Separations and difficulties during reunions were critical. The fatality was not a one-time event, but the exit point of a recurrent cycle of abusive interaction.     

Child abuse and neglect in Denmark: Medicolegal aspects

On the basis of material selected at the Institute of Forensic Medicine. Aarhus, from 1959 to 1980. we estimated the frequency of mortality from child abuse in Denmark to be 0.5 child deaths per million inhabitants per year. This figure is equal to that in Sweden and Norway but lower than most other countries. The study population included 53 abused children: 33 living children (18 boys and 15 girls) and 20 fatalities (11 boys and 9 girls). The social background of the children and abusers (32 men and 15 women) is described in connection with the juridical and social outcome of the cases. Cases with repetitive lesions were the most important evidence of child abuse. In cases with non-repetitive injuries, it was more difficult to prove that child abuse had taken place, but subdural hematoma and abdominal lesions with rupture of the duodenum or tearing of the mesenterium were very strong evidence. We think that a better handling of cases of child abuse or neglect could be obtained with extended collaboration between the social authorities, the police, the public prosecutor, the pediatrician and the forensic pathologist.     

Maltreatment of children in The Netherlands: an update after ten years

Governmental consultation and advice on child abuse and neglect in the Netherlands started in 1972 as a two-year experiment with four offices for "confidential doctors" in four major cities of the country. After these two experimental years, a governmental institute for prevention of child abuse and neglect was organized. Over the ensuing decade the number of offices increased to ten, covering the whole country. The State Department of Welfare, Public Health, and Environment collected data from the confidential doctors and their coworkers every year. This study compares the data of the first year 1974 with those of 1983 in order to detect changing patterns over a 10-year period. The major changes are as follows: a threefold increase in cases, an extraordinary increase in cases of emotional maltreatment, an increase in detection of child fatalities but decrease in severity of physical abuse. Sexual abuse was hardly recognized in 1974 but gradually was recognized more frequently during the study decade and accounted for an alarming 7.2% of detected cases of maltreatment in 1983. No change was found in the social conditions of the family and the identity of the perpetrators--primarily fathers and/or mothers. A decrease was noted in the percentage of married parents. The increased percentage of single parents was primarily represented by mothers alone. An increase in the numbers of victims residing at home and a decrease in the need for children's homes as a temporary or permanent residence is attributed to aftercare. The discrepancy between the results of this voluntary notification system in the Netherlands and the results of a mandatory reporting system as used in the U.S.A. is still very high. The hope is that the government will decide to make reporting of maltreatment mandatory for everyone.     

From maltreatment report to juvenile incarceration: the role of child welfare services

OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.     

Predictors and correlates of anger toward and punitive control of toddlers by adolescent mothers

In this study, the impact of rejection/acceptance experienced during the adolescent mother's childhood, social support received after the baby's birth, and infant irritability on angry, punitive maternal behavior are tested, and possible links between such maternal behavior and indices of child anger and noncompliance, low confidence, and social withdrawal are investigated. 40 mothers who gave birth as adolescents and their 2-year-old children participated in the study. When mothers experienced both rejection during childhood and little support from a partner after birth, they were likely to exhibit angry and punitive parenting. Infant irritability did not predict maternal behavior. Angry and punitive mothers had children who were angry and noncompliant and who distanced themselves from their mothers. Taken as a main effect, infant irritability was unrelated to later child behavior. However, the association between maternal behavior and 2 aspects of child behavior was stronger for children as irritable at 3 months postpartum: when irritable infants had angry and punitive mothers they were more likely to be angry and noncompliant and to exhibit less confidence than less irritable infants who experienced the same pattern of parenting.     

Which juvenile crime victims get mental health treatment?

OBJECTIVE: To explore factors that facilitate the receipt of mental health treatment among juvenile crime victims. METHOD: Telephone interviews were conducted with a national sample of 157 caretakers whose children had suffered a serious sexual or physical assault in the previous year. RESULTS: Twenty-two percent of caretakers had thought about getting professional counseling for their child victims, and 20% of the child victims actually received it. But half of the families who thought about it did not follow through on their consideration. Moreover, nearly half of those victimized children who actually received counseling did so without their families reporting that they had considered it in advance. The level of symptoms and parent-child relationship factors were related to considering counseling which was in turn strongly related to actually getting counseling. Other factors were independently related to receiving counseling, such as the victimization occurring at school and the victim being perceived as at fault to some degree. Advice to get counseling and medical insurance also played roles. CONCLUSIONS: These findings suggested two pathways to counseling. One occurred via direct parental concern, and was associated with such variables as parental perceptions that the child was depressed or withdrawn or that the parent-child relationship had been negatively affected. The other pathway occurred independent of parental concern, most likely via school interventions, because this counseling was in conjunction with school victimizations.     

Factors associated with nurses' intention to report child abuse: a national survey of Taiwanese nurses

OBJECTIVE: The objectives were to determine the experiences of Taiwanese nurses with a new child abuse reporting law and to assess attitudinal correlates of nurses' intention to report. METHOD: A stratified quota sampling technique was used to select registered nurses working in pediatric, psychiatric and emergency care units in Taiwan. A total of 1400 (return rate 88%) questionnaires from 1617 nurses were used. The questionnaire includes demographic information, attitudes toward and knowledge of child abuse and reporting laws, and eight vignettes of child abuse. RESULTS:Most nurses (86%) said they had never reported a child abuse case; 21% said they had failed to report a suspected case of child abuse. Most (80%) had never had any child abuse education. About 75% felt their nursing education and in-service training was inadequate or absent. Most had an inadequate knowledge of the reporting law (mean score: 60% correct). Nurses only answered 17-43% of the law-related questions correctly. The majority accepted the professional responsibility to report. There were some differences among pediatric, psychiatric and emergency care nurses. In general, these Taiwanese nurses had negative attitudes toward corporal punishment and toward parents who abuse their children. The study also identified a variety of attitudes related to intention to report relevant to the Theory of Planned Behavior. CONCLUSIONS:Nurses accept responsibility for reporting but they believe their professional preparation for reporting is inadequate. There is a strong need for in-service and pre-service education about child abuse among nurses in Taiwan.     

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 sexual abuse and bulimic symptomatology: relevance of specific abuse variables

OBJECTIVE: This study examined specific aspects of child sexual abuse in relation to symptom severity among hospitalized patients diagnosed with bulimia nervosa. METHOD: Participants were 45 hospitalized bulimic women who reported a history of child sexual abuse. Structured interviews were conducted in order to obtain detailed information regarding specific features of the abusive event(s). Participants also completed instruments that measured depression and eating pathology. RESULTS: There were no significant differences in severity of depression or eating disturbance among women reporting differing abusive experiences including intrafamilial versus extrafamilial abuse, abuse with or without the use of physical force, one versus multiple incidents, early abuse versus abuse occurring after age 14, contact versus noncontact abuse, disclosed versus undisclosed, and combined physical/sexual abuse versus sexual abuse alone. CONCLUSION: The specific characteristics of child sexual abuse are not related to the level of symptomatology for hospitalized bulimic patients. This study suggests that differences in the nature of the abuse may not be as important as the fact that the abuse occurred in the first place.