A comprehensive child sexual abuse treatment program

The number of families troubled by parent-child incest in the typical community is much larger than suspected by professional helpers. If left unattended, the victim(s) and the family as a whole will be critically traumatized. Parental incest in the nuclear family can be likened to terminal cancer in the individual. The community must encourage the incestuous families to seek treatment and must provide comprehensive in-depth therapy to all members of the family. The etiology and dynamics of parental incest and the treatment method developed by the Directors of the Child Sexual Abuse Treatment Program of Santa Clara County (CSATP), California, are discussed. Over the past ten years the CSATP has provided therapy to over 4,000 children and their families (about 14,000 individuals), by far the largest number so treated by any single organization. About 90% of the children have been returned to their families; and the recidivism rate in the families who have completed the treatment program remains at less than 1%.     

A systems approach to child abuse: management and treatment issues

In the systems approach certain patterns of family interaction are seen as fitting with physical abuse towards children in the family. If these interactions are blocked or changed using specific family therapy interventions, the risk of further abuse will be significantly reduced. Identifying typical patterns of interaction that fit with abuse is a useful first step in planning the management of physically abusing families. A full systemic formulation of the presenting problem will address numerous systems and sub-systems simultaneously, notably the family-professional system, the family within the extended family/friendship system, and the nuclear family. Interventions may have to be directed on a variety of these levels. The Marlborough Family Service has assessed and treated over 100 child-abusing families. A family day unit is used as the setting, and a multifamily group as the principle medium of treatment. Within the day unit real life stress situations are recreated around everyday issues, enabling families to find new and nonviolent solutions to the problems of daily life. In the cases seen, approximately one-third have resulted in a recommendation of permanent alternative family care for the children. In those families reunited, the re-injury rate has been found to be extremely low.     

Shared parenting: A new paradigm for the treatment of child abuse

The thesis of this article is that child abuse can be most effectively prevented by recasting it as a part of a larger problem of inadequately parented families. Services for these families may be offered for voluntary participation. They need not be thought of as treatments since they would be designed to prevent rather than treat injuries. The goal of the services would be to improve the childrearing experiences of children in two ways: by helping their parents to function more effectively and providing whatever elements of parental functioning (nurture, education, discipline, or protection) which the natural parents could not give. The proposed facilities would provide supplemental parenting and other services for children as necessary. Facilities would include outreach into the homes, family drop-in centers, family half-way houses for parents who can take care of their children only with onsite supervision, and residential facilities and foster homes at which natural parents would be encouraged to visit and participate. The majority of child abuses occur when there is stress on parents who are inadequate because they themselves have received deficient parenting. The proposed services would relieve stress on parents. This sharing of parental responsibilities between the natural parents and the sharing parents encountered in the proposed facilities would provide children with more adequate parenting than they could receive from their natural parents alone. This would give them a chance to grow into adequate, nonabusive parents and thus interrupt the generational cycle of abuse.(ABSTRACT TRUNCATED AT 250 WORDS)     

Maternal and paternal physical abuse: Unique and joint associations with child behavioral problems

Although there is a substantial amount of literature documenting the relationship between child abuse and behavioral problems in China, there is, on the other hand, a limited number of studies on the joint and unique associations of maternal and paternal physical abuse with child behaviors within the Chinese context. The present study, using the family systems theory as the theoretical framework, aims to examine these joint and the unique associations of maternal and paternal physical abuse with externalizing and internalizing behaviors among a community sample of Chinese children. A total of 296 children (54.7% boys, mean age 12.31 ± 0.56 years) from two-parent families participated in the study, and they reported their physical abuse experience by their mother and father in the previous year using the Chinese version of the Parent-Child Conflict Tactics Scale. Participants, using the Youth Self Report, reported personal externalizing and internalizing behaviors, and, similarly, their mothers, using the Child Behavior Checklist, assessed children’s externalizing and internalizing behaviors. Linear mixed effect models with random intercept and slope were used to examine the joint and unique associations of maternal and paternal physical abuse with child externalizing and internalizing behaviors. Results revealed that physically abused children were more likely to be simultaneously abused by both mothers and fathers. Furthermore, when compared with their non-abused counterparts, children with physical abuse that was carried out solely by mothers (externalizing behaviors: β = 6.71, 95% CI = 2.45–10.98, p < 0.01; internalizing behaviors: β = 4.52, 95% CI = 0.37–8.66, p < 0.05) or by both mothers and fathers (externalizing behaviors: β = 4.52, 95% CI = 1.80–7.24, p < 0.001; internalizing behaviors: β = 2.98, 95% CI = 0.34–5.61, p < 0.05) reported more externalizing and internalizing behaviors. Externalizing and internalizing behaviors of children who were physically abused solely by fathers did not significantly differ from those of their non-abused counterparts, which may result from the small sample size. The present findings suggest that maternal physical abuse may have a dominant and unique association with child behaviors, regardless of whether paternal physical abuse occurs within the family. Implications for future research and practice within the Chinese context regarding the subject of child behaviors and parental abuse are discussed.     

A classification of child abuse and its relation to treatment and prognosis

This paper is based on five years' clinical experience of assessing parents who injure their children. During this time it has become obvious that there is a complex variety, not only of parental and paediatric pathology, but also of response to treatment. “Abuse of children is not a disease entity but a pattern of behaviour and like all such patterns it has a multiplicity of paths by which it is reached” (Scott 1977).There is therefore a great need to evolve a way of breaking down the large psychiatrically heterogenous group into smaller groups, who not only share certain characteristics, but who have some predictive value in terms of treatment and prognosis. This has become particularly important as the number of referrals are rising and the spectrum is widening. We are not only seeing larger numbers of less severely injured children, but also many more less conspicuously abnormal parents. (N.S.P.C.C. Battered Child Research Department reports 1969–1977).     

Three models of child abuse consultations: A qualitative study of inpatient child abuse consultation notes

Child abuse pediatricians have multiple roles in caring for abused children, including prevention, diagnosis, treatment, and, when needed, expert legal opinion. The child physical abuse consultation differs from the traditional medical consultation in that it has medical, investigative and legal audiences, all of whom have different information needs. How child abuse pediatricians approach their cases and how they document their initial inpatient consultations that will be used by such a diverse audience is currently unexplored. We used content analysis to examine 37 child physical abuse consultation notes from a national sample of child abuse pediatricians in order to understand physicians’ approaches to these consultations. Three commonly used models of child physical abuse consultation were identified in the data that we named the base model, the investigative model, and the family-dynamic model. While model types overlap, each is distinguished by key features including the approach used to gather information, the information recorded, and the language used in documentation. The base model most closely mirrors the traditional medical approach; the investigative model concentrates on triangulation of sources of information; and, the family-dynamic model concentrates on physician perceptions of family relationships. The three models of consultations for child physical abuse mirror the areas of child abuse pediatrics: diagnostic, forensic and therapeutic. These models are considered in relationship to best practice from other medical specialties with forensic components.     

Characteristics of child sexual abuse treatment programs

Within the professional community, a vast number of sexual abuse treatment programs have emerged to meet the needs of victims and their families. Significant variations among these programs can be observed due to differences in philosophy, system context, client focus, problem definition, and the treatment strategy adopted. Unfortunately, little comparative information is available regarding the operation of different programs and, more importantly, their relative treatment effectiveness. This article presents the findings from a nationwide survey of 553 sexual abuse treatment programs. The survey focused on program context, client, and service characteristics. Overall it was found that most programs are affiliated with a larger public or private agency, focus on treating victims, and rely on a combination of individual, family, dyad, and group therapy approaches.     

Developmental effects of child abuse: A review

Most research investigating the effects of physical child abuse on children's development has been based on uncontrolled or poorly controlled studies having small samples, no long-term follow-up, and weak instrumentation. These studies, as well as some which have been more carefully designed, have generally suggested seriously detrimental developmental consequences in physical, intellectual, behavioral, and emotional areas. Some recent controlled follow-up studies challenge such a negative picture of abuse. In particular, a study by Elmer, which is probably the most carefully conducted study yet done, found that the harmful effects of abuse dissipated years after the abusive incident and that socioeconomic status (SES) and related factors may be more important than abuse in determining the course of child development. To improve the quality and clarity of future research on developmental effects of child abuse, this paper discusses, in four major areas, problems which plague the research. Definition: The extent, type, and frequency of abuse should be more carefully defined to allow studies to be compared. The types and amounts of social service interventions should also be specified. Generalization: Research should include more middle and upper SES children, more of the mildly and moderately abused, and more neglected children to allow generalization to the total population of maltreated children. Causality: Since developmental deficits may be the cause as well as the effects of abuse and because outside factors such as SES may lead to both the abuse and the deficits, there is a need for large-scale longitudinal studies which can untangle the cause and effect web of abuse by following children from birth and measuring many factors which might affect development (e.g., SES, birth abnormalities, abuse). Statistical Analysis: Future studies should always use statistical analysis and should obtain larger samples and utilize outcome and classification measures with demonstrated reliability and validity to increase statistical power.     

Linkages between child abuse and attention-deficit/hyperactivity disorder in girls: behavioral and social correlates

OBJECTIVE: The objectives of this study were to examine whether girls with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of having histories of abuse and to assess whether the presence of an abuse history may constitute a distinct subgroup of youth with ADHD. METHOD: We examined rates and correlates of child abuse in an ethnically and socioeconomically diverse sample of girls with attention-deficit/hyperactivity disorder (ADHD; n=140) and a matched comparison sample of girls without ADHD (n=88), all aged 6-12 years. A thorough chart review reliably established documented rates of physical and sexual abuse in both samples. RESULTS: There were significantly higher rates of abuse for girls with ADHD (14.3%) than for the comparison sample (4.5%), with most of the abuse found in girls with the Combined as opposed to the Inattentive type. Higher rates of externalizing behaviors (including objective observations in a research summer camp) and peer rejection (indexed through peer sociometric nominations) characterized the subgroup of girls with ADHD with abuse histories compared to the subgroup without such histories, with moderate to large effect sizes. Subgroup differences regarding internalizing problems and cognitive deficits did not emerge. Findings regarding peer rejection were explained, in part, by higher rates of observed aggressive behavior in the abused subgroup. CONCLUSIONS: The findings raise important questions about the possible etiologic and/or exacerbating role of abusive trauma in a subgroup of children with ADHD.     

Essential elements of successful child abuse and neglect treatment

Not all child abuse is preventable. Society faces an ongoing need to support programs that treat the members of families in which abuse occurs. There is little systeamatically generated knowledge on the most efficient and effective ways to assist parents and children faced with abuse. The purpose of our 40-month study of eleven child abuse and neglect demonstration service programs in the United States was to expand the knowledge base in this area by determining, through evaluative research, the essential elements of successful treatment programs. This paper highlights our findings that pertain to more effective delivery of services to abusive and neglectful parents.     

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.     

Child pornography: A hidden dimension of child abuse

In the decade of the 70s, much was learned about abused and neglected children and their families, Public outcry demanded action at the state, regional and national level hoping that the effort would generate more effective methods of identification, intervention and treatment. Consequently, researchers and theoreticians initiated efforts that were aimed at providing a better understanding of why some parents abuse or neglect their children while others do not. In spite of all the energy and time, one form of child abuse continues to flourish relatively unnoticed—child pornography, or as it is more commonly known in the trade, “kiddie” or “chicken” porn. Because of the dearth of information about the subject, this paper addresses five key issues: (1) Who are the children who become the young stars of pornographic films? (2) How many children are estimated to be involved in this activity? (3) What are the presumed effects of such involvement on children? (4) Legal issues related to the control of the pornographic industry: and (5) What is the challenge to social work and other helping professionals?     

The handicapped child and child abuse

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.     

The analysis and treatment of child abuse by behavioural psychotherapy

The results from use of behaviour therapy with child abuse cases is very encouraging. Data has been presented to show the approach both economical and rewarding. Our experience suggests that selected social workers may be able to learn to use the approach with a relatively short period of training.     

Prenatal prediction of child abuse and neglect: A prospective study

Five hundred eighty-seven women in a combined Maternity-Infant, Children and Youth project were interviewed at between 3 and 6 months of gestation by a skilled masters degree social worker (M.S.W.) using a Family Stress Checklist developed at the University of Colorado Health Sciences Center. Only 7% of the women were scored as “high risk” for serious parenting problems. Neither single status nor teenage status increased the risk significantly. A review of charts of 100 of the children whose mothers had been considered “at risk” was conducted 2 to 2.5 years later, and compared with 100 charts on children whose mothers had been considered at “no risk,” giving the following results: Twenty-five children had experienced failure to thrive, neglect or abuse. Twenty of these were from the original high risk mothers, giving an incidence of neglect/abuse in that group of 52%. The no risk control group of 100 mothers showed a 2% incidence of abuse/neglect; a low risk group showed a 4% incidence of abuse/neglect; and a mid-score group had an abuse/neglect rate of 5%. The scale proved a remarkably accurate predictor, with a sensitivity (percent correct negatives) of 89%. The authors suggest use of such scales prenatally or even before conception as a step toward the development of true preventive measures.