Developing a template for National Child Protection Index Reports

Objectives

What impact does the strengthening of child rights have on the experience and circumstances of children? CRC General Comment 13 emphasizes that defining measurable targets for improvements in child protection is a key element of efforts to strengthen child rights and well-being across the world. This paper describes an attempt to identify key domains relevant to such mapping of child protection indicators, and the feasibility of collecting data—from existing data sources or otherwise—to complete a “National Child Protection Index Report” summarizing achievements and concerns at a national level.

Methods

A process of inter-agency consultation was facilitated by the CPC Learning Network to establish a template for the Index Report. The template was modeled on that used for the “Countdown to 2015” maternal, neonatal and child health initiative, aiming to capture indices not only of key protection risks but also implementation and coverage of key protection measures. The work drew on indicator development and policy initiatives by a number of international child protection agencies. The template developed was used as a basis to pilot national data collection in Indonesia and, at a sub-national level, in northern Uganda.

Findings

The template provides a concise summary of protection issues of relevance to a broad range of constituencies, global and national. However, in the pilot settings, existing routine data collection was inadequate to effectively populate a large proportion of indicators. Mechanisms of collating findings from discrete assessments—another potential source of data for completion of the index report—were also generally underdeveloped.

Practice implications

In settings where state infrastructure allows the collection and analysis of routine data in such domains as health and economic activity, such efforts should be extended to the child protection sector. Discrete assessments by governmental or non-governmental agencies also provide significant potential for more effective sharing and collation of information. National Child Protection sub-clusters or equivalent structures can play an important role in facilitating both of these processes.     

Pediatric response to a large-scale child protection intervention

Objective

In a rural area of the US state of Texas, in April 2008, the Texas Department of Family and Protective Services (DFPS) responded to evidence of widespread child abuse in an isolated religious compound by removing 463 individuals into state custody. This mass child protection intervention is the largest such action that has ever occurred in the United States. The objective of this paper is to characterize the burdens placed on the area's community resources, healthcare providers, and legal system, the limitations encountered by the forensic and public health professionals, and how these might be minimized in future large-scale child protection interventions.

Methods

Drawing on publicly available information, this article describes the child abuse investigation, legal outcomes, experiences of pediatric healthcare providers directly affected by the mass removal, and the roles of regional child abuse pediatric specialists.

Results

Because the compound's residents refused to cooperate with the investigation and the population of the compound was eight times higher than expected, law enforcement and child protection resources were insufficient to conduct standard child abuse investigations. Local medical and public health resources were also quickly overwhelmed. Consulting child abuse pediatricians were asked to recommend laboratory and radiologic studies that could assist in identifying signs of child abuse, but the lack of cooperation from patients and parents, inadequate medical histories, and limited physical examinations precluded full implementation of the recommendations.

Conclusions

Although most children in danger of abuse were removed from the high-risk environment for several months and some suspected abusers were found guilty in criminal trials, the overall success of the child protection intervention was reduced by the limitations imposed by insufficient resources and lack of cooperation from the compound's residents.

Practice implications

Recommendations for community and child abuse pediatricians who may become involved in future large child-protection interventions are presented.     

Psychological maltreatment: maltreatment of the mind: a catalyst for advancing child protection toward proactive primary prevention and promotion of personal well-being

Objective

Child protection, as primarily applied toward narrow corrective intervention, has been judged to be inadequate in dealing with the wide variety of forms and levels of physical, psychological and sexual violence to which children are subjected throughout the world. Concern about this state of affairs has grown as a part of a global increase in commitments and expectations for nations and their societies to be accountable to and for children, particularly in association with the requirements of the UN Convention on the Rights of the Child. A reconstruction of child protection is needed.

Method

Recently, a child rights approach to child protection has been gathering support to drive a transformation of child protection toward primary prevention capable of securing and promoting the rights, safety, well-being, health and development of children. This vision has been given concrete form by the UN Committee on the Rights of the Child through its recently adopted guide (General Comment 13) to fulfilling national obligations to the right of the child to freedom from all forms of violence.

Results/Conclusions

Here, it is argued that the desired transformation of child protection can be greatly facilitated by appreciation and application of knowledge about the psychological domain, in particular, psychological maltreatment, by promotion of an enlightened public health approach, and by giving high priority to determining the origins of violence and to establishing widespread commitment to full development of the uniqueness of each person.     

Child maltreatment and adult health in a national sample: Heterogeneous relational contexts,divergent effects?

Objective

This study considers the long-term health consequences of child maltreatment. Distinct from previous research, we examine the effects of maltreatment in the context of more general parental evaluations.

Method

Analyses used retrospective and current data from the Midlife Development in the United States (MIDUS) study.

Results

A considerable proportion of middle- and older-age adults who experienced frequent maltreatment nevertheless evaluated the relationship with their offending parent as “excellent”, “very good”, or “good” (e.g., 47% for physical and emotional maltreatment by mothers). Maltreated respondents generally evaluated their maltreating parents less favorably than non-maltreating parents, but there was considerable variation in these recollected relationships. Adults who experienced child maltreatment reported a greater number of chronic medical conditions and physical symptoms and lower self-rated health, but effects were smaller when they had positive relationships with their parents than when one or more of the relationships was perceived as negative.

Conclusions

These findings highlight a common and seemingly paradoxical pattern among MIDUS participants: the co-presence of harsh parental behavior and positive recollections of parental relationships during childhood. Moreover, these surprising patterns of retrospective interpretation predict very different experiences of adult health – health problems are most pronounced among maltreatment in cases where the respondent had a generally negative relationship with one or more of his or her parents.     

Child protection assessment in humanitarian emergencies: case studies from Georgia, Gaza, Haiti and Yemen

Objectives

The paper reviews the experiences of conducting child protection assessments across four humanitarian emergencies where violence and insecurity, directly or indirectly, posed a major threat to children. We seek to identify common themes emerging from these experiences and propose ways to guide the planning and implementation of assessments that effectively identify, and suggest means of response to, threats to children's rights and well-being in emergency settings.

Methods

In the context of a field evaluation of an inter-agency resource kit, crisis settings where an inter-agency assessment of child protection had been considered in the period August 2008 to July 2010 were identified. Email correspondence, telephone-based structured interviews and documentary review collated information from child protection coordinating agencies from a total of twenty sites, the minority of which had proceeded to complete an assessment. This paper presents case studies of the experience in Georgia (following the conflict between Russian and Georgian forces in August 2008), Gaza (following the Israeli military incursion beginning in December 2008), Haiti (following the earthquake of January 2010), and Yemen (following the ceasefire agreement between the government and rebel forces in early 2010).

Case study findings

In each setting the context of the humanitarian emergency is outlined. The processes of the planning (and, where appropriate, implementation) of the child protection assessment is described. Where available, the findings of the child protection assessment and their use in shaping interventions are summarized.

Practice implications

Case studies document experience across humanitarian settings widely divergent in terms of the nature of the emergency, social–political context, and institutional capacity. Despite such differences, analysis suggests securing inter-agency coordination, preparation and capacity building, and means of ensuring timeliness of findings to be recurrent themes in the effective mobilization of an effective assessment able to inform programming.     

USING SCHOLARSHIP: Lessons for Practice at One University

In this essay the author views a collection of scholarship as a source of lessons related to institutional practice and considers how institutional planners and other administrative leaders can use such ideas. The collection includes Balancing Acts: Dilemmas of Choice Facing Research Universities, by Jonathan Cole; Crafting Strategy, by Henry Mintzberg; portions of the book In Over Our Heads: The Mental Demands of Modern Life, by Robert Kegan; Collegiality: Toward a Clarification of Meaning and Function, by James Bess; and On the Nature of Institutional Research and the Knowledge and Skills It Requires, by Patrick Terenzini. Although the author draws from experience at one research university, the conclusions may prove useful to those who plan for the future of other higher education institutions.     

Higher education as a political issue area: A comparative view of France,Sweden and the United Kingdom

The common view in the literature on higher education in Western Europe is that the issue area has increasingly become enmeshed with national politics in recent decades. This article examines the extent to which this is true of France, Sweden and the United Kingdom. Six indicators of issueness, corresponding to important political actors/arenas, are used to identify temporal and cross-national patterns. It is argued that although it is evidently true that a politicization has occurred it may easily be overstated. Higher education remains a relatively minor concern in the national politics of the three countries. Only in exceptional circumstances, such as in France in 1968, is this pattern of subsystem politics replaced by a pattern of macropolitics. The analysis furthermore suggests the considerable variation in patterns of issueness which may exist between different national contexts.This article was written while the author was visiting with the Higher Education Research Group, Institution for Social and Policy Studies, Yale University. He is indebted to the members of the Group for their helpful comments on an earlier version.     

Identification of ICD codes suggestive of child maltreatment

Objective

In order to be reimbursed for the care they provide, hospitals in the United States are required to use a standard system to code all discharge diagnoses: the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9). Although ICD-9 codes specific for child maltreatment exist, they do not identify all maltreatment-related hospital and emergency department discharges. To increase the usefulness of medical data for public health surveillance of child maltreatment, this project sought to identify ICD-9 codes that are suggestive of child maltreatment.

Methods

After review of the literature and discussions with experts, injuries and conditions that should raise suspicion of child maltreatment (physical or sexual abuse or neglect) were identified and a list of corresponding ICD codes was compiled. Using a statewide electronic database of hospital discharges and emergency department (ED) visits for the year 2000, visits by children assigned these ICD codes were identified, a sample of visits was selected, and medical records were reviewed to assess the circumstances of the injury or illness that led to the visit. Based on information in the medical record, the injury or illness was classified as maltreatment-related, or not.

Results

There were 3,684 visits selected for review. Of these, 2,826 records were reviewed and classified; 1,200 (43%) records met the criteria for being maltreatment-related, 1,419 (50%) contained adequate information indicating the injury/condition was not likely maltreatment-related, and 207 (7%) records did not contain enough information to classify. Sixty-eight ICD codes had >66% of visits classified as maltreatment-related, the a priori criteria for a code to be considered suggestive of maltreatment. Codes suggestive of maltreatment include specific fractures, burns, and injuries of undetermined intent, among others.

Conclusion

Several ICD codes were found that, when used with age restrictions and other specific exclusion criteria, are suggestive of maltreatment. This information may increase the usefulness of hospital discharge data for public health surveillance of child maltreatment.

Practice implications

Use of these suggestive codes facilitates identifying conditions and injuries that are likely maltreatment-related in hospital discharge and ED visit data. When used in conjunction with ICD maltreatment-specific codes, these suggestive codes may enhance the use of medical data for monitoring child maltreatment trends.     

Investigating geographic variation in use of psychotropic medications among youth in child welfare

Objectives

Public Law (P.L.) 110-351, the “Fostering Connections to Success Act,” calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors.

Methods

Cross-sectional analysis of Wave 1 data for the 92 child welfare catchment areas participating in the National Survey of Child and Adolescent Well-being, a random probability sample of 2,504 children ages 2-15 years undergoing investigation for abuse and neglect. We employed multilevel regression modeling to examine the impact of catchment-level variables on medication use, controlling for child-level variables.

Results

Fifteen percent of children reported taking psychotropic medications. Rates of medication use across catchment areas ranged widely from 0 to 40%, a 40-fold difference. On multi-level logistic regression modeling, older age (p < .001), male gender (p < .001), emotional and behavioral problems (p < .001), and insurance (p = .05) were associated with psychotropic medication use at the child-level. At the catchment-level, stressful environment within the child welfare system was negatively associated with medication use. No other catchment-level variables examined were found to explain use.

Conclusions

Striking disparities in medication use exist across catchment areas in this national sample. Of the catchment variables examined, only stressful environment was related to medication use.

Practice implications

These findings highlight significant geographic variation in medication use that most likely reflect both under-use and over-reliance on psychotropic medication. The link between child welfare environment and medication use suggests the influence of systemic, as opposed to clinical, causes of variation in medication use. This requires greater implementation of organizational processes governing quality of care for this highly vulnerable population.     

Mothers in methadone treatment and their involvement with the child protection system: A replication and extension study

Objectives

Although a high level of involvement with the child protection system has been identified in families where parental substance use is a feature, not all such parents abuse or neglect their children or have contact with the child protection system. Identifying parents with substance-use histories who are able to care for their children without intervention by the child protection system, and being able to target interventions to the families who need them the most is important. This study interviewed a relatively large sample of mothers about their histories, their children and their involvement with the child protection system. We hypothesized that mothers in opioid pharmacological treatment who are involved with child protection services are different in characteristics to those mothers who are not involved.

Methods

One hundred and seventy-one women, with at least one child aged under 16 years, were interviewed at nine treatment clinics providing pharmacological treatment for opioid dependence across Sydney, Australia.

Results

Just over one-third of the women were involved with child protection services at the time of interview, mostly with children in out-of-home care. Logistic regression analyses revealed that factors which significantly increased the likelihood of the mother being involved with the child protection system were: (1) having a greater number of children, (2) being on psychiatric medication, and (3) having less than daily contact with her own parents.

Conclusions

This study replicates and extends the work of Grella, Hser, and Huang (2006) and the limited literature published to date examining the factors which contribute to some substance-using mothers becoming involved with the child protection system while others do not. The finding that mental health problems and parental supports (along with the number of children) were significantly associated with child protection system involvement in this study, indicates a need for improved interventions and the provision of treatment and support services if we are to reduce the involvement of the child protection system with these families.     

Critical incidents and critical requirements in mentoring

Many traditional faculty now find themselves working with nontraditional students. New faculty models such as mentoring have emerged in response to the new student. The purpose of this study was to examine the mentoring role at Empire State College, State University of New York, on the basis of mentors' behavior responses to mentor-defined problems. The Critical Incident Technique was the method used to elicit reported and recalled incidents which either facilitated or impeded mentoring. Significant problems cited in the findings included communications gap in mentor/student relationship and the student's incompletion of academic work. Typical corresponding responses to such problems included providing support, demythologizing the learning process, setting behavior limits, and assessing and reassessing student performance. On the other hand, the critical requirements which were inductively derived from the critical incidents, as well as the practical implications which were gleaned from the study, revealed a definite extension of the traditional faculty role.The original document from which this article was adapted, including an extensive bibliography is on file with University of Microfilms International, Ann Arbor Michigan, 48108.     

Explanations for child sexual abuse given by convicted offenders in Malawi: no evidence for "HIV cleansing"

Objective

A commonly cited, but unproven reason given for the rise in reported cases of child sexual abuse in Sub-Saharan Africa is the “HIV cleansing myth”—the belief that an HIV infected individual can be cured by having sex with a child virgin. The purpose of this study was to explore in Malawi the reasons given by convicted sex offenders for child sexual abuse and to determine if a desire to cure HIV infection motivated their offence.

Methods

Offenders convicted of sexual crimes against victims under the age of 18 were interviewed in confidence in Malawi's two largest prisons. During the interview the circumstances of the crime were explored and the offenders were asked what had influenced them to commit it. Each participant was asked the closed question “Did you think that having sex with your victim would cure or cleanse you from HIV?”

Results

58 offenders agreed to participate. The median (range) age of offenders and victims was 30 (16-66) years and 14 (2-17) years, respectively. Twenty one respondents (36.2%) denied that an offence had occurred. Twenty seven (46.6%) admitted that they were motivated by a desire to satisfy their sexual desires. Six (10.3%) stated they committed the crime only because they were under the influence of drugs or alcohol. None of the participants said that a desire to cure or avoid HIV infection motivated the abuse.

Conclusion

This study suggests that offenders convicted of a sexual crime against children in Malawi were not motivated by a desire to be cured or “cleansed” from HIV infection. A need to fulfil their sexual urges or the disinhibiting effect of drugs or alcohol was offered by the majority of participants as excuses for their behaviour.     

Cost-effectiveness of differential techniques for mail questionnaires

As part of a follow-up study of a national sample of 59,000 freshmen who enrolled in colleges or universities in the fall of 1966, 14 random samples of approximately 1000 students each were assigned to various mail survey techniques. Cost and response rate data were examined to determine the relative cost-effectiveness of the techniques. The results indicated that use of nonprofit outgoing postage, window envelopes, and business reply returns lowered the costs per contact and did not significantly impair rate of return. Use of a second-wave questionnaire was a very effective technique for increasing the response rate.Data collection for this project was supported by NSF #R000101 and NIH #OD 72-2029. Partial support for the analysis was provided by NSF-C741.     

Double-coding: a key to knowledge utilization and generation in the instruction and learning of skills

Double-coding refers to the simultaneous holding in declarative and procedural memory stores of information concerning the performance of a skill. Skill acquisition typically terminates in a stage of automatization during which declarative coding of skill-relevant information is lost or becomes irretrievable. It is argued that maintenance of both declarative and procedural knowledge relevant to skills and their performance permits unique metacognitive capabilities. It is argued further that these metacognitive capabilities are basic to constructive generation and utilization of such skill-relevant knowledge. Speculation is entertained concerning instructional means of helping learners to maintain double-coding of skill-relevant information, thus maximizing the constructive, metacognitive capabilities presumed to issue from such double-coding.     

Societal obligations to the urban poor child

This pluralistic, highly advantaged society, with a diverse and divided population, has both moral and economic obligations to assist the urban poor child to overcome the adverse conditions of his life circumstances. A national urban policy designed to ameliorate the substandard condition of the urban poor is recommended, along with the institution of realistic policies and programs of effective schooling for poor children and youth. The urban poor, in turn, have a responsibility to accept and use wisely the help offered to them. Thus obligation is mutual and reciprocal between society and its urban poor, though the greater burden is on the society to make it possible for urban poor children to surmount adverse conditions under which they find themselves due to accidents of birth.     

How to deal with emotional abuse and neglect: further development of a conceptual framework (FRAMEA)

Objective

To develop further the understanding of emotional abuse and neglect.

Methods

Building on previous work, this paper describes the further development of a conceptual framework for the recognition and management of emotional abuse and neglect. Training in this framework is currently being evaluated. The paper also briefly reviews more recent work on aspects of the definition, harm caused by emotional abuse and neglect and threshold.

Results

The paper arrives at a working definition as ‘persistent, non-physical, harmful interactions with the child by the caregiver, which include both commission and omission.’ There are many forms of harmful caregiver-child interactions, which can be placed in five categories, each category reflecting the fulfillment of one of the child's basic psycho-social needs and requiring a different therapeutic approach for its alleviation. The caregiver-child relationship is embedded within a psycho-social context. It is suggested that greater clarity can be gained about the child and family when information is sorted into the appropriate tiers of concerns: Tier 0 – Social & environmental factors, Tier I – Caregiver risk factors, Tier II – Caregiver-child interactions and Tier III – Child's functioning. It is further suggested that while intervention is required, this is directed towards protection, rather than providing immediate protection of the child. The work takes the form of a time-limited trial of therapeutic work to gauge the capacity of the caregivers to change. This initial work focuses Tiers 0–II. Statutory steps might be required in order to encourage the caregivers to engage. If insufficient progress is achieved, active child protection may be required which might include placing the child in an alternative family. However, some, usually older, children will remain in the emotionally abusive environment and they will require ongoing help and support.

Conclusion

While a greater understanding of emotional abuse and neglect is now possible, further evaluation of the utility of this framework is suggested.     

Understanding the investigation-stage overrepresentation of First Nations children in the child welfare system: An analysis of the First Nations component of the Canadian Incidence Study of Reported Child Abuse and Neglect 2008

Objectives

The overrepresentation of Aboriginal children in child welfare systems in the U.S., Canada, and Australia is well documented, but limited attention has been paid to investigation-stage disproportionality. This paper examines the overrepresentation of First Nations (the largest of three federally recognized Aboriginal groups in Canada) children, focusing on three questions: (1) What is the level/nature of First Nations overrepresentation at the investigation stage? (2) What is known about the source of referrals in child welfare investigations involving First Nations children? (3) What risk factors and child functioning concerns are identified for investigated First Nations children and families?

Methods

The First Nations Component of the Canadian Incidence Study of Reported Child Abuse and Neglect (FNCIS-2008) was designed to address limitations in existing Aboriginal child welfare data: it sampled one quarter of the Aboriginally governed child welfare agencies that conduct investigations in Canada, gathered data on over 3,000 investigations involving First Nations children, and incorporated weights designed for analysis of First Nations data. Bivariate analyses are used to compare investigations involving First Nations and non-Aboriginal children.

Results

The rate of investigations for First Nations children living in the areas served by sampled agencies was 4.2 times that for non-Aboriginal children; investigation-stage overrepresentation was compounded by each short term case disposition examined. A higher proportion of First Nations than non-Aboriginal investigations involved non-professional referrals, a pattern consistent with disparities in access to alternative services. Workers expressed concerns about multiple caregiver risk factor concerns for more than ½ of investigated First Nations families and, with the exception of “health issues”, identified every caregiver/household risk factor examined in a greater percentage of First Nations than non-Aboriginal households.

Conclusions

It would be extremely difficult to reduce First Nations overrepresentation at later decision points without addressing overrepresentation at the investigation-stage. Despite the serious needs of investigated First Nations families, alternatives to traditional child protection responses may be appropriate in many cases. If First Nations overrepresentation is to be reduced, child welfare agencies must be equipped to provide supports needed to help families address factors such as poverty, substance abuse, domestic violence, and lack of social supports.     

Self reported awareness of child maltreatment among school professionals in Saudi Arabia: impact of CRC ratification

Objectives

The Convention on the Rights of the Child (CRC) was ratified by Saudi Arabia 15 years ago; yet addressing the issue of child maltreatment only began in more recent years. School professionals play a significant role in children's lives, as they spend a great deal of time with them and are hence essential to protecting and identifying those in danger or at risk. The objective of this study is to identify school professional's awareness of child maltreatment and the existing national policies and procedures to examine the extent of efforts made in Saudi Arabia and to activate the roles of schools and school professionals in protecting children from violence and implementation of Article 19 of the CRC.

Methods

This was a cross-sectional study, where school professionals from randomly selected schools throughout the country were invited to participate in a self-administered questionnaire.

Results

A total of 3,777 school professionals participated in the study. Fifty-five percent of professionals had at least 10 years of work experience. A low-level of awareness of child maltreatment was found in about 1/3 of school professionals. Only 1.9% of school professionals had ever attended any sort of specific training on child maltreatment, though 69.3% of those who had not, were willing to attend future training. With regards to awareness of CRC Article 19 or policies and procedures addressing child maltreatment, only 22% reported being aware of it.

Conclusion

The majority of school professionals in Saudi Arabia have a low-intermediate level of awareness of child maltreatment, ratification of CRC, and related national policies and procedures, yet most are willing to attend training programs on this subject matter. Efforts need to be made in the country to fill this gap.     

Talking back to big bird: Preschool users and a simple speech recognition system

The present study examined the effectiveness of one configuration of automatic speech recognition (ASR) software and hardware with a child sample of 36 three-year-olds and a comparison sample of 20 adults. Subjects used a speaker-dependent, template-based system to play a simple Sesame Street naming game. Results indicated that while the system performed well with adults, it was much less effective with children. An analysis of the children's performances indicates that children's speech is more variable, in both volume and content, than that of adults. The ASR system responded ineffectively to this variability, resulting in inferior performance. Specific behaviors and their effects on the ASR system are identified, and possible system modifications that address these behaviors are noted.     

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

Objective

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

Methods

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

Results

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

Conclusions

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