Responding to abuse: Children's experiences of child protection in a central district,Uganda

Part of a comprehensive response to violence against children involves child protection systems, but there are few data available on such systems in low-income countries. This study describes the characteristics and help seeking behavior of children referred to local child protection services and the quality of the first-line response in one district in Uganda. Participants included 3,706 children from 42 primary schools who participated in a baseline survey on violence as part of the Good Schools Study (NCT01678846, clinicaltrial.gov). Children who disclosed violence were referred according to predefined criteria based on the type, severity, and timeframe of their experiences. Children were followed up to 4 months after the study ended. First-line responses by receiving agencies were classified into 3 categories: plan for action only, some action taken, and no plan and no action taken. Appropriateness of responses was based on which agency responded, timeliness of the response, quality of the documentation, and final status of the case. From the baseline survey, 529 children (14%) were referred. Girls were more likely to be referred and to meet the criteria for a serious case (9% girls, 4% boys). In total, 104 referrals (20%) had some kind of concrete action taken, but only 20 (3.8%) cases met all criteria for having received an adequate response. Nearly half (43%) of referred children had ever sought help by disclosing their experiences of violence prior to the baseline survey. In our study areas, the first-line response to children's reports of abuse was poor even though some referral structures are in place.     

Relationship between child abuse exposure and reported contact with child protection organizations: Results from the Canadian Community Health Survey

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design (n = 23,395; household response rate = 79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR = 15.8; 95% CI = 10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse.     

Prevalence of child abuse in Kerala,India: An ICAST-CH based survey

BackgroundChild abuse is a major concern in India with frequent reports of extreme maltreatment and fatalities. A dearth of robust and methodologically sound studies has resulted in ambiguity regarding the extent of child abuse in the general population.ObjectivesTo estimate the one-year and lifelong prevalence of exposure to violence, physical abuse, emotional abuse, sexual abuse, and neglect using a validated instrument—the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool – Child, Home Version (ICAST-CH).Participants and Setting: Adolescents (n = 6957) attending randomly selected schools in one city in Kerala, India.MethodsCross-sectional survey using self-report instrument.ResultsThe one-year prevalence of any abuse was 89.9% (95% CI: 89.1–90.7) suggesting that child maltreatment was widespread. Physical and emotional abuses were also very common. Although sexual abuse was least common, a considerable proportion of adolescents reported it; one-year prevalence of sexual abuse was 16.7% and lifetime prevalence was 19.9%. Boys reported more abuse than girls across all the categories of abuse (including sexual abuse). Abuse was more frequent in the higher age groups and classes at school. Abuse was also more frequent in nuclear families and families that reported alcohol use. Children who reported an abusive experience usually faced more than one category of abuse; abuse in one category was significantly associated with abuse in other categories.ConclusionsAbuse of children is alarmingly common. There is an urgent need for improving the awareness surrounding this issue as it is a major public health challenge faced by the country. The priority should be on setting up easily accessible support services for children.     

Impact of childhood abuse history on psychological symptoms among male and female soldiers in The U.S. Army

The long-term psychological effects of four different types of childhood maltreatment were examined among 1,072 male and 305 female soldiers on active duty in the United States Army. The predictor variables included four subscales from the Childhood Trauma Questionnaire (CTQ)—(1) physical-emotional abuse, (2) sexual abuse, (3) emotional neglect, and (4) physical neglect. An additional sexual abuse variable based on the four screening questions developed by Finkelhor, Hotaling, Lewis, and Smith (1990) was also included. Outcome was measured by the Brief Symptom Inventory and a dissociation scale developed by Briere and Runtz (1988). MANOVAs were conducted for each outcome measure. Physical-emotional abuse contributed to most of the effects. However, sexual abuse contributed additional significant effects to all of the subscales. In general, males and females showed similar outcomes, but certain gender differences were noted.     

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.     

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.     

The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers,children and young people and young adults

Objectives

To measure the prevalence of maltreatment and other types of victimization among children, young people, and young adults in the UK; to explore the risks of other types of victimization among maltreated children and young people at different ages; using standardized scores from self-report measures, to assess the emotional wellbeing of maltreated children, young people, and young adults taking into account other types of childhood victimization, different perpetrators, non-victimization adversities and variables known to influence mental health.

Methods

A random UK representative sample of 2,160 parents and caregivers, 2,275 children and young people, and 1,761 young adults completed computer-assisted self-interviews. Interviews included assessment of a wide range of childhood victimization experiences and measures of impact on mental health.

Results

2.5% of children aged under 11 years and 6% of young people aged 11–17 years had 1 or more experiences of physical, sexual, or emotional abuse, or neglect by a parent or caregiver in the past year, and 8.9% of children under 11 years, 21.9% of young people aged 11–17 years, and 24.5% of young adults had experienced this at least once during childhood. High rates of sexual victimization were also found; 7.2% of females aged 11–17 and 18.6% of females aged 18–24 reported childhood experiences of sexual victimization by any adult or peer that involved physical contact (from sexual touching to rape). Victimization experiences accumulated with age and overlapped. Children who experienced maltreatment from a parent or caregiver were more likely than those not maltreated to be exposed to other forms of victimization, to experience non-victimization adversity, a high level of polyvictimization, and to have higher levels of trauma symptoms.

Conclusions

The past year maltreatment rates for children under age 18 were 7–17 times greater than official rates of substantiated child maltreatment in the UK. Professionals working with children and young people in all settings should be alert to the overlapping and age-related differences in experiences of childhood victimization to better identify child maltreatment and prevent the accumulative impact of different victimizations upon children's mental health.     

Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing

The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.     

Self-reported adverse childhood experiences and quality of life among children in the two last grades of Dutch elementary education

BackgroundAdverse Childhood Experiences (ACEs) may have a life-long impact on mental health and are related to physical disease, such as diabetes and cardiovascular diseases in adulthood. Research on ACEs suffers from recall bias when performed with adults.ObjectiveTo estimate the prevalence of ACEs and the interrelationships between ACEs as reported by children, and to determine the impact on their self-reported quality of life (QoL). Children’s opinions on the ACE-Questionnaire were also obtained.MethodA cross-sectional study was conducted with a child version of the ACE-Questionnaire. This questionnaire assesses parental separation or divorce, physical and emotional child abuse and neglect, sexual violence, domestic violence, household substance abuse, psychological issues or suicide, and incarceration of a household member. QoL was measured with the Kidscreen-10.Participants and settingThe questionnaire was completed by 644 children at a mean age of 11 years (range 9–13 years), in the two last grades of regular elementary schools, recruited throughout the Netherlands.ResultsData were weighted by ethnicity to obtain a representative sample of children in Dutch elementary education. Of all children, 45.3% had one or more out of ten ACEs. Child maltreatment was experienced by 26.4%. ACEs often co-occurred. A higher number of ACEs correlated with a lower mean level of QoL (p < 0.001). Mean QoL was 8.5 points lower (Cohen’s d = 0.8) in children who experienced child maltreatment. Children’s opinions on the questionnaire were positive in 82.4%.ConclusionPrevention of ACEs, professional training and trauma-focus in schools are urgently needed.     

Remaking collective knowledge: An analysis of the complex and multiple effects of inquiries into historical institutional child abuse

This article provides an overview and critical analysis of inquiries into historical institutional child abuse and examines their multiple functions and complex effects. The article takes a broadly international view but focuses primarily on Australia, the UK and Ireland, jurisdictions in which there have been major national inquiries. Drawing on sociological and other social science literature, it begins by considering the forms, functions, and purposes of inquiries. An overview of emergent concerns with institutional abuse in the 1980s and 1990s is then provided, followed by an examination of the response of many governments since that time in establishing inquiries. Key findings and recommendations are considered. The final sections of the article explore the evaluation of inquiries, both during their operation and in their aftermath. Policy change and legislative reform are discussed but the focus is on aspects often underplayed or overlooked, including an inquiry’s credibility, its role in processes of knowledge production, and the part it plays in producing social and cultural shifts. In the context of growing numbers of inquiries across Western democracies, including the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, it is argued that grasping the complexity of the inquiry mechanism, with its inherent tensions and its multiple effects, is crucial to evaluating inquiry outcomes.     

Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey

A preliminary survey was conducted on primary school aged children (N = 302) between seven to twelve years of age, who attend the local Community Child Centers (CCC) in the economically deprived areas of Jeollabukdo in South Korea for the purpose of identifying the children who have been exposed to on-going child maltreatment and poverty, and their needs. Both standardized and non-standardized self-report types of surveys were carried out and completed by both the children and the teachers of the CCC. As would be expected, emotional and behavioral problems are more pronounced by the children who are exposed to child maltreatment and poverty compared to the children who were not exposed to these adversities, or who were not poor. The more severely abused children in terms of frequency and co-occurrence of different abuses appear to display more behavioral problems than less severely abused children. Teachers reported that the children who were able to play a musical instrument and had arts therapy experiences appear to have less behavioral problems, particularly delinquent and aggressive behavior in comparison to the children who did not have such ability and experiences. Through the survey, it was possible to identify the children in need of therapeutic intervention and discover clinically relevant information. Clinical implications will be discussed further.     

Severe punishment of children by staff in Romanian placement centers for school-aged children: Effects of child and institutional characteristics

The objective of this study was to determine whether children's characteristics and/or institutional characteristics were predictors of severe punishments (including beatings) and/or frequency of punishments that children received from staff in Romanian institutions. The data was hierarchical with institutionalized children (N = 1391) nested within 44 institutions, and the measurement of punishments by the staff and frequency of punishments had a binary distribution. Thus, multilevel logistic regression models were used to examine the effects of individual and institutional level variables on reported punishments and to account for the clustering of the children within institutions. Two general patterns of results emerged. First, regarding individual level variables, it was found that: (1) amount of time spent by children in their current institutions had a significant effect on the probability of being punished by staff and the frequency of this punishment; (2) the probability of being punished was higher for boys than for girls; and (3) having no siblings in the institution increased the odds of being punished several times. Second, regarding institutional level variables: (4) being in placement centers for school-aged children with a traditional type of institutional organization increased the odds of severe punishment compared to a familial/mixed type. The results of the present study highlight the importance of understanding the consequences of institutionalization in a broader way, where children not only experienced early severe psychosocial deprivation as documented in other studies, but also high levels of severe punishments administered by institutional staff.     

Oral health in children investigated by Social services on suspicion of child abuse and neglect

Child abuse and neglect (CAN) are likely to have negative consequences on health; however, for oral health, studies on associated outcomes are sparse. The purpose of this study was to assess oral health and oral health behaviors in relation to suspected CAN among children being investigated by the Swedish Social Services. The material comprised data from the Social Services and dental records; the sample, 86 children and 172 matched controls. The children in the study group had a higher prevalence of dental caries than the control group; in addition, levels of non-attendance and dental avoidance were high, as was parental failure to promote good oral health. We found four factors that, taken together, indicated a high probability of being investigated because of suspected CAN: prevalence of dental caries in primary teeth, fillings in permanent teeth, dental health service avoidance, and referral to specialist pediatric dentistry clinics. If all four factors were present, the cumulative probability of being investigated was 0.918. In conclusion, there is a high prevalence of dental caries, irregular attendance, and a need for referral a pediatric dental clinic among Swedish children under investigation due to suspected CAN. Social context is an important factor in assessing the risk of developing dental caries, the inclination to follow treatment plans, and the prerequisites for cooperation during treatment. Routinely requesting dental records during an investigation would provide important information for social workers on parental skills and abilities to fulfill the basic needs of children.     

Strengthening Universal Primary Education in Uganda: The potential role of an asset-based development policy

This paper is divided into three complementary parts. First, we examine the challenges to the Universal Primary Education (UPE) policy in Uganda, including insufficient instructional materials and family-level poverty. Second, guided by asset theory, and based on a systematic review of studies on asset-based development programs and interventions, we assess the potential of these programs in addressing the challenges of UPE, and improving access to UPE. Third, we conclude with a discussion of the implication of using asset-based development as one structural-level approach that may strengthen the UPE policy.     

Children's views on child abuse and neglect: findings from an exploratory study with Chinese children in Hong Kong

Objectives

This research study explored children's views on issues about child abuse in Hong Kong and examined their implications on child protection work and research in Chinese societies.

Method

Six primary schools were recruited from different districts of Hong Kong. Five vignettes of child maltreatment in the form of flash movies were presented to 87 children in 12 focus groups for discussion. The process was video-taped and the data were transcribed verbatim for data analysis by NUDIST.

Results

(1) Children do not have a homogeneous view on issues about child abuse and neglect, and their awareness and sensitivity to different kinds of child abuse are also different; (2) some of their views on child abuse and neglect are uniquely their own and are markedly different from those of adults; (3) some of the views expressed by children, however, are very much akin to those of adults, such as the factors they would consider in deciding whether a case is child abuse or not; (4) children's disclosure of abuse in Hong Kong is often affected by the Chinese culture in which they live, like filial piety and loyalty to parents.

Conclusion

Children's views on issues of child abuse and neglect, no matter they are the same or different from those of adults, serve to inform and improve child protection work. Children are not only victims in need of protection. They are also valuable partners with whom adult practitioners should closely work.

Practice implications

Children have, and are able to give, views on child abuse. They should be listened to in any child protection work no matter their views are same with or different from those of adults. As this study suggests, the relatively low sensitivity of the children to child neglect and sexual abuse, and their reluctance to disclose abuse and neglect due to their loyalty to parents are areas to focus on in preventive child protection work in a Chinese society like Hong Kong.     

Effects of a violence prevention intervention in schools and surrounding communities: Secondary analysis of a cluster randomised-controlled trial in Uganda

The Good School Toolkit is effective in reducing staff violence against children in Ugandan primary schools. A secondary analysis of cluster-randomised trial data was conducted to investigate intervention effects on school operational culture, and on normative beliefs and violence against children from caregivers outside of school. Students and staff completed cross-sectional surveys at baseline in 2012 and follow-up in 2014. Students’ caregivers completed follow-up surveys only. Data from 3820 students, 597 staff, and 799 caregivers were included in cross-sectional analyses at follow-up. Statistically significant intervention effects were observed for aspects of school operational culture, including students’ greater perceived emotional support from teachers and peers, students’ greater identification with their school, students’ and staffs’ lower acceptance of physical discipline practices in school, and students’ and staffs’ greater perceived involvement in school operations. Outside the school, the intervention was associated with significantly lower normative beliefs accepting the use of physical discipline practices in schools (adjusted mean difference, AMD: −0.77; 95%CI: −0.89 to −0.66; p < 0.001) and at home (AMD: −0.67; 95%CI: −0.80 to −0.54; p < 0.001), based on aggregated caregiver reports. No differences between groups were observed in past-week violence against children at home. This intervention shows promise as a platform for addressing violence against children within the school environment and surrounding community.     

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.