A survey of state efforts in gathering information on child abuse and neglect in handicapped populations

This paper reports the extent to which states assemble information on the incidence of abuse and neglect among handicapped populations. Data were collected from all states on the types of pre-existing disabilities cited on child abuse reporting forms and the perceived accuracy of this information. The study also sought to identify specific methods used to provide assistance to local agencies regarding the problems associated with abuse of the handicapped. Surveys were distributed to and completed by representatives of the designated child protection agencies within each state and the District of Columbia (n = 51). General findings were that although it is generally acknowledged in research that handicapped children represent a disproportionate number of abuse and neglect victims, nearly half of the states do not collect any information on “special characteristics.” Forms from the remaining states exhibited much variation in style and in the competency of collection techniques. These results suggest a significant lack of services specifically designed to improve the awareness of field representatives on the influence of exceptionalities in abusive cases. This information indicates that training and prevention programs will remain basically inadequate until the relationship between handicapped conditions and abuse/neglect is more clearly defined.     

The recognition of child abuse and the perceived need for intervention by school personnel of primary schools: Results of a vignette study on the influence of case,school personnel,and school characteristics

In 2015, 523 reports of suspected child abuse and neglect (CAN) were brought to the attention of the Confidential Center of Child Abuse and Neglect (CCCAN) of Brussels. Around 38% of these reports came from school personnel. This study investigated which factors affect the recognition of CAN by school personnel of Dutch-speaking primary education in Brussels and their intervention need. Two hundred seventy-nine staff members of 16 schools professionally working with children, filled in a Questionnaire Assessment of Situations of CAN. The instrument consists of 24 vignettes describing CAN. Respondents were asked questions regarding recognition and intervention need about each vignette. Detection, severity assessment, the need for professional help, the need for referral to a CCCAN and the need to involve judicial authorities were mainly associated with case characteristics. Although most situations of CAN were detected, situations of emotional abuse were less often recognized. Situations involving non-Western victims were considered to be more severe and the perceived need for involvement of professional help, CCCAN and judicial authorities was larger. Ethnic stereotypes affect the actions undertaken in case of CAN. Awareness of these reactions may result in equal treatment for all victims. Staff characteristics were little associated with detection and intervention need.     

The expert witness in child abuse and neglect: An interdisciplinary process

The legal system is an important part of a society's response to child abuse and child neglect. Courts need to be guided in their deliberations by experts from many different professions. Consultation and in-court expert testimony is necessary from medicine, psychology, psychiatry, social work and other professions both to prove child abuse and neglect and establish the power of the court to act on behalf of a child but also to guide the court in the intervention strategy most suited to the needs of the child and his family. Non-lawyers often feel uncomfortable in the legal setting. The adversary process is foreign to their training and professional experience. Collaboration with a lawyer greatly improves their effectiveness in court. Lawyers, on the other hand, need to make maximum use of medical and social-psychological experts in the court process in the interests of their clients; but to do so lawyers need a basic understanding of the other professions. With an emphasis on a process of mutual education, the paper presents a framework for collaboration between lawyers and expert witnesses in child abuse and neglect cases. “Expert witness” is defined; informal consultation is encouraged; suggestions for selecting a collaborator are made; initial contracts between lawyer and expert, case conferencing and preparation for trial are discussed; specific advice on direct and cross examination is provided.     

Fatal child abuse in Georgia: the epidemiology of severe physical child abuse

Decisions about the occurrence of child abuse are increasingly difficult to make because concepts of what qualifies as reportable child abuse may be broadening. We examined this question by comparing 51 fatal child abuse cases occurring in Georgia between July 1975 and December 1979 to non-fatal cases and to the Georgia population. Overall rates of fatal child abuse were higher for male perpetrators compared with female and black perpetrators compared with white. However, the latter finding varied with economic and geographic status. The highest child abuse fatality rates were found in poor, rural, white families (3.3/100,000 children) and in poor, urban, black families (2.4/100,000 children). Risk factors for fatal abuse included early childhood (RR 6:1), parental teenage childbearing (RR 4:1), and low socioeconomic status. These characteristics were similar to those of the severe child abuse cases noted in the early child abuse literature. Non-fatal cases did not clearly share these risk factors. Severe abuse, here represented by fatal cases, is a distinct subset of reported child abuse, but characteristics associated with it are frequently attributed to all reportable child abuse. Medical personnel should be aware that they cannot rely on the presence or absence of these characteristics in screening for risk of reportable child abuse. Child abuse research should use restricted, stated case definitions. When intervention and prevention programs are being organized, they should not generalize research findings to all forms of child abuse.     

Major findings from the Canadian incidence study of reported child abuse and neglect

OBJECTIVE: To present key findings from the Canadian Incidence Study of Reported Child Maltreatment (CIS) in sufficient detail to provide a basis for international comparisons in terms of forms and severity of maltreatment and the age and sex of victims. METHOD: A survey conducted in a random sample of 51 child welfare service areas across Canada tracked child maltreatment investigations conducted during the months of October to December 1998, produced a national sample of 7672 child maltreatment investigations. Information was collected directly from investigating workers on child and family background, perpetrator characteristics, severity and types of maltreatment and service and court outcomes of investigations. RESULTS: Forty-five percent of investigations were substantiated and in a further 22% of investigations maltreatment remained suspected. Primary reasons for investigation were physical abuse (31%), sexual abuse (11%), neglect (40%), and emotional maltreatment (19%). A larger proportion of physical abuse cases are isolated incidents involving older children and are more likely to lead to injuries. Sexual abuse, neglect and emotional maltreatment involve more chronic situations with children showing signs of emotional harm. Rates of investigated and substantiated maltreatment are lower in Canada compared to the United States, but are higher than rates reported in Australia. CONCLUSIONS: The CIS provides much needed information for developing a better understanding of the profile and needs of children and families investigated by child welfare authorities in Canada. The study also serves as a point from which international comparisons can be made.     

Reporting rates of child sexual abuse in Indigenous communities in two Australian jurisdictions

Child sexual abuse is a significant problem in many Indigenous communities; there is also evidence of chronic under-reporting of this crime. This study aimed to compare reporting rates between Indigenous and non-Indigenous cases of child sexual abuse across two Australian jurisdictions. Datasets comprising child sexual abuse reports from the Police Information Management Systems of the two jurisdictions were used to calculate reporting rates, and to compare case characteristics and case progression. Results indicated that the reporting rate for child sexual abuse of Indigenous children was between two and four times that of non-Indigenous children. In the Indigenous cases, the second jurisdiction had lower reporting rates than the first jurisdiction. Further analysis of the Indigenous cases only found that cases in the second jurisdiction were more severe, more likely to have a forensic interview, and more likely for the suspect to be charged, than in the first jurisdiction. However, there were no significant differences in conviction rates between the two jurisdictions. Differences observed in severity and case progression suggest that the lower reporting rates observed in the second jurisdiction may be due to comparatively high levels of under-reporting, rather than lower actual levels of child sexual abuse. In conclusion, reporting rates of child sexual abuse can be better understood when further information, such as case characteristics and case progression rates, is available.     

Physical or psychological child abuse and neglect: Experiences,reporting behavior and positions toward mandatory reporting of pediatricians in Berlin,Germany

BackgroundChild abuse and neglect (CAN) are common, with a high number of undetected victims. Since 2012, the German Federal Child Protection Act grants doctors an opportunity to circumvent their duty of confidentiality if they suspect CAN may be occurring, despite the reporting of CAN not being mandatory.ObjectiveThis study examines pediatricians’ reporting behavior in cases of CAN and what their attitudes are toward mandatory reporting.Participants and settingAll 378 primary care pediatricians and pediatric psychiatrists in the German capital of Berlin were asked to complete a questionnaire anonymously. The questionnaire was sent by mail to all primary care pediatricians (N = 302) and pediatric psychiatrists (N = 76) in private practice.MethodsPatterns of reporting, response tendencies, and correlations with socio-economic factors were described and statistically examined.ResultsThe response rate was 42% (N = 157). Of the pediatricians, 28% report every suspected case to the authorities. The majority, namely 73%, has difficulties in detecting CAN, and 64% would like additional training. Furthermore, 52% are aware of legally guaranteed counseling options being available if CAN is suspected. Whereas 71% consider mandatory reporting necessary to protect children more effectively, 57% are sure it would simplify their work.ConclusionsMore training on diagnosing CAN should be offered to pediatricians. It is necessary to have a full and frank discussion about making reporting mandatory in cases where there is a reasonable suspicion of CAN. Doctors believe that mandatory reporting standardizes and simplifies working procedures. It may possibly reduce the number of undetected cases of CAN and would allow more children and families access to early protection and supporting measures.     

Exploring policies for the reduction of child physical abuse and neglect

Policies can be powerful tools for prevention given their potential to affect conditions that can improve population-level health. Given the dearth of empirical research on policies’ impacts on child maltreatment, this article (a) identifies 37 state policies that might have impacts on the social determinants of child maltreatment; (b) identifies available data sources documenting the implementation of 31 policies; and (c) utilizes the available data to explore effects of 11 policies (selected because they had little missing data) on child maltreatment rates. These include two policies aimed at reducing poverty, two temporary assistance to needy families policies, two policies aimed at increasing access to child care, three policies aimed at increasing access to high quality pre-K, and three policies aimed at increasing access to health care. Multi-level regression analyses between within-state trends of child maltreatment investigation rates and these 11 policies, controlling for states’ childhood poverty, adults without a high school diploma, unemployment, child burden, and race/ethnicity, identified two that were significantly associated with decreased child maltreatment rates: lack of waitlists to access subsidized child care and policies that facilitate continuity of child health care. These findings are correlational and are limited by the quality and availability of the data. Future research might focus on a reduced number of states that have good quality administrative data or population-based survey data on child maltreatment or reasonable proxies for child maltreatment and where data on the actual implementation of specific policies of interest can be documented.     

Type and severity of child abuse and college students'' lifetime suicidality

Objective: The present study compared reported histories and severity of child sexual abuse, child physical abuse, and both, in college men and women.Method: Four hundred and eighty-six consenting undergraduates completed measures of suicidality, sexual abuse (SA), and physical abuse (PA). Based on their responses, they were categorized into 12 mutually exclusive groups: no PA/no SA (n = 234), moderate PA/no SA (n = 78), severe PA/no SA (n = 34), no PA/mild SA (n = 21), moderate PA/mild SA (n = 12), severe PA/mild SA (n = 5), no PA/moderate SA (n = 20), moderate PA/moderate SA (n = 15), and severe PA/moderate SA (n = 10).Results: Participants who reported both severe sexual and severe physical abuse reported more lifetime suicidality than participants who reported either mild sexual and/or physical abuse. Those who reported sexual abuse involving invasive sexual acts such as rape, and physical abuse involving behaviors that resulted in physical injury to the child, were more suicidal than those who reported less severe abuse. In addition, although combined sexual and physical abuse correlated with increased suicidality, unexpectedly, there was no interaction. Finally, women students endorsed more reasons for living than men and about the same level of suicidal ideas and global suicidality, despite a greater likelihood of having been abused.Conclusions: The absence of an interaction between sexual and physical abuse suggests that this increased suicidality is additive rather than multiplicative. An implication is that college counseling personnel need to be aware of the suicidal risk of women and men students reporting either sexual or physical abuse.     

Narrative fragmentation in child sexual abuse: The role of age and post-traumatic stress disorder

The present study aimed to assess the effects of age and PTSD on the narrative fragmentation in memories for child sexual abuse. Lexical complexity, cohesion and coherence were analyzed within a group of 86 allegations of children (M = 10 years; SD = 3.7; range: 4–17) who were victims of sexual abuse. Results illustrated that age played an important role in establishing narrative coherence and predicted the level of orientation, the sequence of events and the level of evaluation of the event. Instead, PTSD was related to narrative coherence and cohesion. Therefore, in children, the narrative fragmentation could be an effective diagnostic tool for understanding the effects of PTSD. Moreover in a legal setting the traumatic effects of PTSD on the narrative coherence and cohesion could be significant indices in the evaluation of child testimony.     

An experimental study of gender and situation in the perception and reportage of child abuse

This study examined the effects of gender, situation, and characteristics of witnesses in the perception and reportage of child abuse. Three scenarios representing themes of neglect, psychological, and physical abuse were evaluated by 144 nonprofessionals not mandated by law to report child abuse. The variables of gender and age of the child, gender of parent, and whether or not the abuse was precipitated by an act of the child were systematically manipulated to produce a 2 X 2 X 2 X 2 X 3 randomized design. Some demographic data on subjects were treated as covariates. Multivariate analysis of variance (MANOVA) was performed on the data. No gender bias in subject's evaluations of victim or perpetrator was discovered. Female subjects viewed the scenarios more critically than did males. Younger subjects were less critical of mistreatment than were older subjects. Perception of the mistreatment as serious was not a good predictor of subsequent official reporting. The scenario involving physical abuse was rated as serious by 86.1% of the subjects, but only 39.5% of these subjects indicated that they would have reported it. Subjects indicated the highest rate of reporting for the neglect scenario which they rated as less serious than physical abuse. These results suggest that official reports are unreliable as an indicator of the incidence of 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.     

Differences in child sexual abuse cases involving child versus adolescent complainants

While adolescents report the highest rates of sexual abuse victimization, few studies have investigated how child sexual abuse (CSA) cases involving adolescent complainants may differ from cases involving child complainants. The current study draws on 3,430 allegations of CSA in Canada to compare abuse characteristics and judicial outcomes in cases involving adolescent complainants to cases involving child complainants. Adolescent complainants were more likely than child complainants to be abused by a stranger or a person with a community connection to the complainant, while children were more likely than adolescents to be abused by a parent or other relative. Furthermore, compared to child complainants, adolescent complainants were more frequently involved in the most intrusive offenses and their cases were more likely to involve violence. Both groups were most likely to disclose the abuse to a parent, though a greater proportion of children disclosed the abuse to a parent. There were no differences in the delay to disclosure. Accused were equally likely to plead “guilty” and to be convicted in cases involving child and adolescent complainants. However, offenders convicted of the most intrusive offenses received longer probation sentences when the complainant was a child than when the complainant was an adolescent. These findings have implications for ensuring appropriate support and services to adolescent victims of CSA.     

Intergenerational transmission of child abuse: Predictors of child abuse potential among racially diverse women residing in domestic violence shelters

Parental risk for perpetrating child abuse is frequently associated with intergenerational patterns of abuse: being abused increases the risk for future abuse. Yet, the mechanisms of intergenerational abuse are unclear, and the risk factors for perpetrating child abuse are interrelated. Research suggests that history of childhood abuse, psychiatric distress, and exposure to intimate partner violence (IPV) are all related risk factors for perpetrating child abuse. We investigated these three risk factors using the developmental psychopathology framework in a racially diverse sample of high-risk women: women residing in domestic violence shelters. 211 mothers residing in domestic violence shelters completed measures of their own childhood abuse (defined narrowly in a 10-item self-report survey), exposure to and severity of IPV victimization, and structured interviews to diagnose psychiatric disorders. We utilized a hierarchical regression model to predict child abuse potential, accounting for risk factors in blocks roughly representing theorized temporal relationships: childhood abuse followed by psychiatric diagnoses, and then recency of exposure to IPV. Consistent with hypotheses, the strongest predictor of current child abuse potential was the psychiatric diagnosis of PTSD. Mediation tests further explicated that the relationship between maternal history of childhood sexual abuse and current potential for perpetrating child abuse is mediated by IPV-related PTSD symptoms. Results suggest that IPV-related PTSD symptoms, rather than exposure to abuse (i.e., childhood abuse or IPV), is most strongly associated with child abuse potential in recent IPV survivors. Interventions which can ameliorate maternal psychopathology and provide resources are recommended for these vulnerable families.     

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.     

The use of telemedicine in child sexual abuse evaluations

OBJECTIVE: To describe the advantages, disadvantages and current status of child abuse consultations conducted through telemedicine networks. METHOD: The results of a telephone survey of seven statewide telemedicine networks are reported and discussed with respect to goals, funding, technical support and expertise, infrastructure, and extent of use. Quality assurance and liability issues concerning telemedicine child abuse consultations are also reviewed. RESULTS: The goals of telemedicine networks in child abuse are to provide (1) expertise to less experienced clinicians primarily in rural areas; (2) a method for peer review and quality assurance to build consensus of opinions particularly in sexual abuse cases; and (3) support for professionals involved in an emotionally burdensome area of pediatrics. Problems encountered by existing networks include: (1) funding for equipment and reimbursement for consultation; (2) consistent technical support: (3) clinician lack of technical expertise, knowledge, or motivation; and (4) lack of network infrastructure. Legal considerations include licensure exemptions for consulting across state lines, potential for malpractice, patient confidentiality and security of images forwarded over modem lines, and liability of the equipment, consulting site, and the consultant in criminal proceedings. CONCLUSIONS: Telemedicine consultations offer a unique opportunity to raise the standard of care in child abuse evaluations, but success depends on clinician motivation, appropriate infrastructure, and ongoing funding and technical support.     

Child on child sexual abuse: psychological perspectives

OBJECTIVE: This study describes the emotional and behavioral responses of children who have been sexually victimized by juveniles (CC) 17 years of age and younger compared to child victims of adults (CA) 18 years of age and older. METHOD: A total sample of N = 194 children and adolescents participated in the study, with 26% (n = 51) comprising CC and 74% (n = 143) encompassing CA. The mother/caretaker was administered a demographic form, Achenbach's Child Behavior Checklist (CBCL), and the Family Assessment Measure (FAM-P). The child was given the Family Assessment Measure (FAM-C) and the Trauma Symptom Checklist for Children (TSCC). The clinician completed the Parental Reaction to Incest Disclosure Scale (PRIDS). RESULTS: No differences were found between the two groups for the type of sexual abuse, penetration, or the use of force. CC were younger and more likely to be males who were abused in a school setting, home, or a relative's home by a sibling or a non-related male. CC endorsed clinically significant sexual preoccupations and manifested borderline clinically significant symptomatology. CONCLUSIONS: Children victimized by other children manifested elevated levels of emotional and behavioral problems and were not significantly different from those who had been sexually abused by adults.     

Fatal child maltreatment: Characteristics of deaths from physical abuse versus neglect

This study examined victim, family, and alleged perpetrator characteristics associated with fatal child maltreatment (FCM) in 685 cases identified by child welfare services in the state of Oklahoma over a 21-year period. Analyses also examined differences in child, family, and alleged perpetrator characteristics of deaths from abuse versus neglect. Case information was drawn from child welfare investigation records for all FCM cases identified by the state Department of Human Services. Fatal neglect accounted for the majority (51%) of deaths. Children were primarily younger than age 5, and parents were most frequently the alleged perpetrators. Moreover, most victims had not been the subject of a child welfare report prior to their death. A greater number of children in the home and previous family involvement with child welfare increased children's likelihood of dying from neglect, rather than physical abuse. In addition, alleged perpetrators of neglect were more likely to be female and biologically related to the victim. These results indicate that there are unique family risk factors for death from neglect (versus physical abuse) that may be important to consider when selecting or developing prevention efforts.     

Childhood history of abuse and child abuse potential: The role of parent's gender and timing of childhood abuse

It has been suggested that being physically abused leads to someone becoming a perpetrator of abuse which could be associated to parents’ gender, timing of the physical abuse and specific socio-demographic variables. This study aims to investigate the role the parents’ gender, timing of childhood abuse and socio-demographic variables on the relationship between parents’ history of childhood physical abuse and current risk for children. The sample consisted of 920 parents (414 fathers, 506 mothers) from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect who completed the Childhood History Questionnaire and the Child Abuse Potential Inventory. The results showed that fathers had lower current potential risk of becoming physical abuse perpetrators with their children than mothers although they did not differed in their physical victimization history. Moreover, the risk was higher in parents (both genders) with continuous history of victimization than in parents without victimization. Prediction models showed that for fathers and mothers separately similar socio-demographic variables (family income, number of children at home, employment status and marital status) predicted the potential risk of becoming physical abuses perpetrators. Nevertheless, the timing of victimization was different for fathers (before 13 years old) and mothers (after 13 years old). Then our study targets specific variables (timing of physical abuse, parents’ gender and specific socio-demographic variables), which may enable professionals to select groups of parents at greater need of participating in abuse prevention programs.