Protocol to investigate child abuse in foster care

Hennepin County Community Services, a large urban agency in the midwestern United States, developed specific procedures for investigating complaints of abuse and neglect of children in foster care in 1980. During the period from May 1980 through November 1981, approximately 125 complaints of abuse and neglect in foster homes were investigated. This article discusses the Protocol, including the institutional abuse meeting, investigation by an independent third party, and statements of finding. Factors that appear to be significant in abusing foster parents are marital status, if the foster parents had children of their own, length of time licensed, and presence of previous complaints. Victims were slightly more likely to be male, aged 4-12. Many victims appeared to have adjusted well to the foster homes. Information is presented on how the abuse was reported. Recommendations include: investigations conducted by an objective third person, commitment of the administration, and enlistment of legal personnel and foster parents during implementation. Also included are prevention of abuse through comprehensive screening and then training of foster parents, social workers' close contact with foster parents and foster children, avoiding high risk placement, forbidding corporal punishment, and sensitizing social workers to abuse-neglect of children in foster care.     

Prevention of elder abuse in long-term care facilities

The objective of this study is to investigate the types of interventions used to prevent elder abuse in long-term care facilities. Eighteen English and Spanish articles published between 2015 and 2019 were reviewed systematically. The analysis indicated that the focus of proposed strategies has been to prevent staff-to-resident abuse and resident-to-resident aggression. The interventions targeting both staff-to-resident abuse and resident-to-resident aggression include training, changes in organizational and environmental factors, and changes in supervision and control. The results demonstrate the need for a comprehensive approach and creation of relevant social policies in developing these interventions.     

Survivors of institutional abuse in long-term child care in Scotland

BackgroundThe Scottish Child Abuse Inquiry (SCAI) commissioned the research project to document the outcomes of institutional abuse in long-term child care in Scotland.ObjectiveTo profile the experiences of survivors abused in long-term child care in Scotland, and to develop a model which linked maltreatment, risk and protective factors, and outcomes.Participants and Setting225 survivors of historical institutional abuse in Scotland, who made witness statements to SCAI.MethodsData were extracted from witness statements using a coding frame developed through a thematic analysis of a subsample of 52 statements.ResultsSurvivors had been in care in predominantly Catholic and non-religious residential institutions in Scotland for an average of 8 years, having entered at an average age of 6.8 years. They had suffered multiple forms of maltreatment. Maltreatment rates were: physical abuse, 95.6%; emotional abuse, 85.3%; sexual abuse, 60.4%; emotional neglect, 51.1%; and physical neglect, 37.3%. Across the lifespan survivors had negative outcomes in psychosocial adjustment (96%), mental health (84%), and physical health (43%). The effect of maltreatment in care on psychosocial problems was mediated by both risk and protective factors; and on mental health was mediated by risk factors, but not protective factors. Maltreatment in care had a direct effect on physical health which was not mediated by risk or protective factors. The effects of the cumulative number of risk factors on adverse mental health and psychosocial outcomes was greater than that of maltreatment, and protective factors had a limited impact on adverse outcomes.ConclusionsEvidence-based child protection policies and practices should be implemented to prevent institutional abuse and treat child abuse survivors in Scotland.     

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.     

A coordinated attempt for prevention of child abuse at the antenatal care level

The authors report the preliminary result of an integrated approach to the primary prevention of the child abuse syndrome. The problem has been approached through a new concept of prenatal and postnatal care, the obstetrical team working in close cooperation with the child psychiatrist of the department of pediatrics. The obstetrical team followed 91 patients during their pregnancy; they were all discussed at supervisory sessions. This permitted a gynaecologist and a social nurse to develop a therapeutic plan for 72 patients. For the 19 more problematic cases, the child psychiatrist intervened immediately in the surroundings of the antenatal clinic. Short, specific psychotherapeutic interventions based on the alleviation of a family crisis have remedied important stress situations. The favourable influence of this new methodology has led to: (1) reduction of a potentially high expected prematurity rate; (2) improved integration of out-patient and in-patient care; (3) improved adaptation of the health staff to this type of situation. A case example to illustrate the functioning of both teams is given.     

Child care workers' knowledge about reporting suspected child sexual abuse.

As reports of the sexual abuse of preschool-aged children increase and the number of children in day care expands, it is important to recognize child care workers as potentially important resource persons for sexually abused preschoolers. Although they are potential resources for abused children, they may fail to report suspected abuse if they do not know their legal responsibilities and their rights and protections under the law. The purpose of this study was to determine child care workers' knowledge about their reporting rights and responsibilities. Relative to child sexual abuse experts, day care personnel knew significantly less about the procedures for reporting suspected abuse and their protection under the law. Suggestions for improving child care workers' knowledge about reporting suspected sexual abuse cases are provided.     

Subsidizing child care: How child care subsidies affect the child care used by low-income African American families

To evaluate the type and quality of child care used by low-income families who were either receiving or not receiving subsidized child care, we interviewed 111 African American parents from a randomly selected sample of low-income families. We inquired about their child-care use, satisfaction with care, work stress, and employment history. Using standardized assessment instruments, independent observers in the children's child-care setting evaluated the quality of the care and characteristics of the providers. We found that families using subsidized child care were more likely to use center care and other more formal types of care, while families not using subsidized child care were more likely to use a relative in the relative's home. Families using subsidized care tended to use licensed and registered child-care arrangements more than non-subsidized families. Also, subsidized families spent approximately half as much out-of-pocket money for child care. However, we found no evidence that the care used by families using subsidized care was of any higher quality than that used by non-subsidized families. We examine the possibility that child-care subsidy programs may not be adequately designed or funded to increase the availability of quality child care to low-income families. Educators and policy makers may want to consider additional means of increasing access to quality care in low-income families.     

Evaluation of the effectiveness of the stay safe primary prevention programme for child sexual abuse

OBJECTIVE: This child abuse prevention study aimed to evaluate the effectiveness of the Stay Safe Programme in training unscreened 7 and 10 year old children in personal safety skills. Subsidiary aims were to evaluate the program's impact on children's self-esteem and parents' and teachers' knowledge and attitudes of relevance to child abuse and protection. METHOD: Changes in safety knowledge and skills and self-esteem of 339 children who participated in the Stay Safe Programme were compared with those of 388 waiting list controls. Children in the training group were also followed up at 3 months. In addition, the knowledge and attitudes of parents and teachers of children who completed the program were evaluated before and after the program and 5 month follow-up data were collected from teachers only. RESULTS: Compared with waiting-list controls, trained children showed significant improvements in safety knowledge and skills and these gains were maintained at follow-up. The greatest gains were made by 7 year olds. Children who participated in the program also showed significant improvements in self-esteem which were maintained at 3 months follow-up but only the 7 year olds in the training group made significantly larger gains in self-esteem than their control group counterparts. Children with a higher socioeconomic status benefited more from the program than less privileged children. Both parents and teachers showed significant improvements in knowledge and attitudes concerning protection over the course of the program and for teachers, these gains were maintained at follow-up. CONCLUSION: The findings suggest that the Stay Safe Programme was effective in training children in safety skills and so may usefully be used as a primary prevention intervention for child abuse.     

Funding realities: child abuse diagnostic evaluations in the health care setting.

OBJECTIVE: This study examines staffing, funding sources, reimbursement, and financing of medically-oriented child protection teams. METHOD: A 16-item questionnaire on the composition, size, and services of the team, program costs, revenue sources, reimbursement rates, and perceptions of funding stability was mailed to a sample of 118 medically-oriented child protection teams. RESULTS: After excluding 10 programs, an overall response rate of 68% was obtained. Teams varied in configuration, services, charges, and funding. Over 50% identified funding as being important, yet, demonstrated varying levels of awareness of budget and reimbursement issues. Many generally relied on patient care reimbursement from health care and government payers. Some programs seemed to be doing well financially while others were struggling. Approximately one-third of the respondents indicated that funding was unstable. CONCLUSIONS: Many programs are innovatively knitting together patch-works of funding and support to serve children and families in need. Team leaders should increase their knowledge of fiscal issues in order to be effective advocates at the institutional level for continued team support. A potential way of accomplishing this would be to utilize the existing structure of a national professional association and its national meeting to provide a forum for relatively successful programs to showcase their "ideal models" of team financing.     

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.     

Hospital-based primary prevention strategy in child abuse: a multi-level needs addressment

The purpose of this study was to evaluate a primary prevention effort in child maltreatment, the focus of which was a community-wide endeavor (i.e., subjects were not prescreened for risk potential). Specific components of the planned intervention addressed four causal levels of maltreatment: individual, family, community, and cultural factors. That assessment was intended to build strengths in those parenting areas which are predictive of abusive or neglectful outcomes. Target areas included knowledge of child development, child-rearing attitudes, mother-infant interaction patterns, and parenting skills. A posttest-only control group design was employed. The control postpartum mothers received traditional or routine hospital services; experimental mothers received special in-hospital and after-care services by trained student nurse volunteers. These volunteers functioned in a dual educative/supportive role. Experimental mothers reported more realistic expectations of behavior, embraced more democratic child-rearing principles, providing more verbal stimulation to their infants (reflecting an increased sensitivity), and displayed increased problem-solving abilities.