Changing patterns in community attitudes to child abuse

Tasmania is the island state of Australia with a population of 416,000 people. A statewide programme on child abuse was commenced with the passing of a Child Protection Act in 1974. The results of the introduction of education programmes for professional groups and of providing information for the community have been analysed. Since 1972 notifications of suspected cases of child abuse have risen sixfold, but even now there are fewer cases reported in areas away from the main professional centre in the state. In the types of abuse being reported, there has been a sharp rise in self referrals and children deemed to be at risk. Sexual abuse may have been dealt with by other agencies before, but is now being notified. There has been a change in the age groups of children coming under notice with an increase in those between 2 and 12 years and a fall in those 0–2 years. The proportions of notifications from the various agencies have changed with considerably more coming from self referrals, from community referrals and from the education services. These trends would seem to indicate that both the professionals and the community are more aware of child abuse than formerly.     

Stopping abuse before it occurs: Different solutions for different population groups

This paper reports on a conference at which participants reviewed indepth the literature on child abuse prevention and child development, as it pertains to different cultural and ethnic population groups, and identifies alternative prevention strategies for these different groups. The efficacy of the following interventions are analyzed: perinatal support programs, education for parents, treatment for abused children, early and periodic childhood screening and treatment programs: social skills training for children and young adults; mutual aid programs and neighborhood support groups; family support services such as crisis care; public information about child abuse and community development activities such as employment assistance. The paper concludes that although treatment services for different groups may be quite similar, prevention strategies must take account of the individual and unique values, norms and socialization patterns of different groups.     

Interagency collaboration: Strengthening substance abuse resources in child welfare

Supporting child welfare (CW) workers’ ability to accurately assess substance abuse needs and link families to appropriate services is critical given the high prevalence of parental substance use disorders (SUD) among CW-involved cases. Several barriers hinder this process, including CW workers’ lack of expertise for identifying SUD needs and scarcity of treatment resources. Drawing from theories and emergent literature on interagency collaboration, this study examined the role of collaboration in increasing the availability of resources for identifying and treating SUDs in CW agencies. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, study findings highlight a lack of SUD resources available to CW workers. On the other hand, the availability of SUD resources was increased when CW agencies had a memorandum of understanding, co-location of staff, and more intense collaboration with drug and alcohol service (DAS) providers. These results provide evidence to support efforts to improve collaboration between CW and DAS providers and showcase specific collaboration strategies to implement in order to improve service delivery.     

An experimental evaluation of in-home child abuse prevention services

Perinatal child abuse prevention projects are rarely rigorously evaluated. Women were referred to the Child Parent Enrichment Project (CPEP) project during or just after pregnancy if identified as at-risk of engaging in child abuse by community professionals. Clients were randomly assigned to CPEP services (n = 97) or traditional community services (n = 94). CPEP services are based on ecological theory and involve six months of home visiting by paraprofessional women and linkage to other formal and informal community resources. No advantages on self-report measures for the CPEP group were measured at posttest, and follow-up reports of child abuse were similar for both groups. Consumer satisfaction indicates that clients highly valued the program. Some indication of greater success with families with less serious problems was observed. The results argue for caution regarding the capacities of perinatal child abuse prevention services to serve the high-risk clientele they often receive.     

The effect of Alaska's home visitation program for high-risk families on trends in abuse and neglect

OBJECTIVES: At 6 sites serving 21 communities, Alaska implemented Healthy Families Alaska, a home visitation program using paraprofessionals designed to decrease child abuse and neglect. The primary study objective was to compare changes over time in Child Protective Services outcomes by Healthy Families Alaska enrollment status. METHODS: Enrollment status was linked to birth certificates for birth years 1996-2002 which in turn was linked to the Alaska Child Protective Services database for outcome years 1996-2004. All children were followed through the study databases until age 2 years. RESULTS: There were 40,099 children born during 1996-2002 to residents of Healthy Families Alaska communities and 985 were enrolled in the program. Physical abuse referrals among enrolled children decreased from 73 to 42 per 1000 child-years of follow-up from 1996-1998 to 2000-2002 (p=.005); all of this decrease occurred among children who received 20 or more home visitations. This decrease may have been unrelated to program impact as a similar decrease in referral was seen among unenrolled high-risk children. Compared to unenrolled high-risk children, enrolled children had a modest decrease in the proportion with substantiated neglect but no difference in the proportion with neglect referral or physical abuse referral or substantiation. CONCLUSIONS: Little evidence exists that Alaska's home visitation program had a measurable impact on child maltreatment outcomes. PRACTICE IMPLICATIONS: Within Alaskan communities that had a home visitation program targeting families at high risk for child abuse, changes in Child Protective Services outcomes among children less than 2 years of age were followed over time by program enrollment status. Enrollment was associated with a substantial decrease in physical abuse referrals, but a similar decrease was seen among unenrolled high-risk children. No improvement was seen in physical abuse substantiation. A greater number of home visitations was not associated with fewer abuse outcomes. This work supports most of the recent literature, which questions the field effectiveness of home visitation programs. In combination with other studies, the current work may lead decision-makers and funding agencies to re-examine the usefulness of home visitation programs, particularly those using a methodology similar to that implemented in Alaska.     

Formative evaluation of a collaborative community-based child abuse prevention project

OBJECTIVE: Together for Kids is a child abuse prevention project that serves children and families in two neighboring communities in a mid-sized Canadian city. The project, a collaborative endeavor of various agencies in the health, social services, and law enforcement sectors, focuses on preventing child abuse and neglect through family support and programming. This article presents the results of a formative evaluation of the project focusing on client and team member views on project implementation. METHOD: The evaluation strategy was primarily qualitative. In-person interviews following a semi-structured format were conducted with 17 clients and 10 team members by an external evaluator. In addition a review of all client records was conducted. RESULTS: The community-based approach, the multidisciplinary composition of the team, the ability to seek services when needed, the immediacy of the response time and the availability of support during stressful times were all aspects of the project that clients found beneficial. The most beneficial aspect of the project, however, was the informal support received from team members who were accepting, non-threatening, and non-judgmental. Team members found the collaborative approach made access to services easier for clients, particularly for those who were more socially isolated. CONCLUSIONS: Multidisciplinary, community-based models of service delivery contribute to a more effective and compassionate response to vulnerable families. Attention to the variables identified as important aspects of the project from the clients' perspective in this evaluation may assist others in developing similar programs.     

Child sexual abuse and exploitation—A global glimpse

The view of what constitutes child abuse and neglect is dependent on the laws, cultural context, local thresholds and the availability. Since 1982, the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) has conducted surveillance of child maltreatment and child protection every two years, published in World Perspectives on Child Abuse. It is hoped that up to date information will inform the development of laws, policies and programs to better address child abuse and neglect. This article is based on data on child sexual abuse and exploitation from 73 countries gathered online in 2015-16 for the 12 edition of World Perspectives. Respondents were key informants who were knowledgeable professionals in the child protection field. They were encouraged to consult with colleagues so as to provide accurate information. Countries were grouped into different regions of the world and into income level categories. The findings focus on definitions of abuse and neglect, laws, policies and programs to address and prevent maltreatment and barriers to prevention. It is evident that there is considerable variability across regions and country income categories, and that programs and services need to be considerably strengthened, even in high income countries.     

Optimising implementation of reforms to better prevent and respond to child sexual abuse in institutions: Insights from public health,regulatory theory,and Australia’s Royal Commission

The Australian Royal Commission Into Institutional Responses to Child Sexual Abuse has identified multiple systemic failures to protect children in government and non-government organizations providing educational, religious, welfare, sporting, cultural, arts and recreational activities. Its recommendations for reform will aim to ensure organizations adopt more effective and ethical measures to prevent, identify and respond to child sexual abuse. However, apart from the question of what measures institutions should adopt, an under-explored question is how to implement and regulate those measures. Major challenges confronting reform include the diversity of organizations providing services to children; organizational resistance; and the need for effective oversight. Failure to adopt theoretically sound strategies to overcome implementation barriers will jeopardize reform and compromise reduction of institutional child sexual abuse. This article first explains the nature of the Royal Commission, and focuses on key findings from case studies and data analysis. It then analyzes public health theory and regulatory theory to present a novel analysis of theoretically justified approaches to the implementation of measures to prevent, identify and respond to CSA, while isolating challenges to implementation. The article reviews literature on challenges to reform and compliance, and on prevention of institutional CSA and situational crime prevention, to identify measures which have attracted emerging consensus as recommended practice. Finally, it applies its novel integration of regulatory theory and public health theory to the context of CSA in institutional contexts, to develop a theoretical basis for a model of implementation and regulation, and to indicate the nature and functions of a regulatory body for this context.     

Teachers' knowledge, attitudes, and beliefs about child abuse and its prevention.

In considering the great responsibility placed upon teachers to involve themselves in child abuse prevention, education, and detection, the National Committee for Prevention of Child Abuse (NCPCA) conducted a nationwide survey of teachers from 40 school districts in 29 randomly selected counties. The survey explores teachers knowledge, attitudes, and beliefs about child abuse and its prevention. Five hundred and sixty-eight teachers responded, revealing that while the majority of teachers confront child abuse among their students, they are provided insufficient education on how to address it. Other findings are reported with respect to teachers' reporting behavior, potential barriers to reporting, child assault prevention programs, and corporal punishment in schools.     

A police-led community response to Child abuse and Youth Sexual Violence and Abuse in Indigenous communities in Far North Queensland: “Speak Up. Be strong. Be Heard.”

BackgroundChild abuse and Youth Sexual Violence and Abuse (YSVA) are persistent social issues across the globe. The development and implementation of effective prevention strategies are a common focus for those working at the coalface. The Cairns Child Protection Investigation Unit of the Queensland Police Service (QPS) developed and implemented the “Speak Up. Be Strong. Be Heard.” (SUBSBH) initiative. This police-led multi-component child abuse prevention initiative has been implemented in 26 Aboriginal and Torres Strait Islander communities across the Far North Queensland Police District since June 2016.ObjectiveThe aim of this research was to evaluate the success of the SUBSBH initiative.Participants and settingExisting data held by QPS were examined. These data include statistics on reporting of YSVA offences, internal program documents and reports, and evaluation feedback forms completed prior to this evaluation study. Information collected via these sources pertained to 26 Indigenous communities within the Far North Queensland Police District. The above-mentioned feedback forms were completed by 307 participants, of whom approximately 90% are Indigenous.MethodsThis study adopted desktop analysis and triangulation through a range of qualitative and quantitative data to ensure robust and rigorous evaluation of the SUBSBH initiative.ResultsThe study found that the initiative was successful in meeting basic accepted practice for child abuse and YSVA prevention programs, receiving positive participant feedback on the educational program, achieving the initiative’s objective to increase reporting of YSVA, and achieving cost-efficiency in meeting outcomes. Importantly, the increase in reporting of YSVA was statistically significant.ConclusionThis study contributes to current understanding regarding the implementation of multi-component child abuse prevention initiatives and provides an example of a cost-efficient police-led community response to child abuse and YSVA in Indigenous communities. The findings may guide responses in other communities which grapple with this critical social issue.     

Child abuse and neglect in American Indian communities

Child abuse and neglect have recently been found to occur among American Indians at rates comparable to other American population groups. Little is known about the clinical spectrum of Indian maltreatment, the psychodynamics and effective treatment modalities. Cultural misunderstanding, modernization, poverty, situational stress, poor parenting skills because of early break-up of Indian families, alcoholism, unusual perceptions of children, handicapped children, and divorce constitute factors associated with maltreatment in cases cited. Old solutions of removing children from families were largely inappropriate and ineffective and are being replaced by local efforts to develop foster homes, supportive family services, and legal procedures to protect children. Communication between agencies involved and mistrust of outsiders plus a lack of trained personnel and available community resources continue to pose major barriers to effective treatment and prevention efforts. Recent federal policies and laws clearly place the responsibility for child welfare in the hands of Indian tribes and tribal courts. The non-Indian health professional has an important but limited role in providing technical expertise and in aiding development of community resources, taking care to support but not usurp the emerging leadership of Indian people.     

Comparing policies for children of parents attending hospital emergency departments after intimate partner violence,substance abuse or suicide attempt

To improve identification of child maltreatment, a new policy (‘Hague protocol’) was implemented in hospitals in The Netherlands, stating that adults attending the hospital emergency department after intimate partner violence, substance abuse or a suicide attempt should be asked whether they care for children. If so, these children are referred to the Reporting Center for Child Abuse and Neglect (RCCAN), for assessment and referrals to support services. An adapted, hospital-based version of this protocol (‘Amsterdam protocol’) was implemented in another region. Children are identified in the same manner, but, instead of a RCCAN referral, they are referred to the pediatric outpatient department for an assessment, including a physical examination, and referrals to services. We compared results of both protocols to assess how differences between the protocols affect the outcomes on implementation, detection of child maltreatment and referrals to services. Furthermore, we assessed social validity and results of a screening physical examination. We included 212 families from the Amsterdam protocol (cohort study with reports by pediatric staff and parents) and 565 families from the Hague protocol (study of RCCAN records and telephone interviews with parents). We found that the RCCAN identified more maltreatment than pediatric staff (98% versus at least 51%), but referrals to services were similar (82% versus 80% of the total sample) and parents were positive about both interventions. Physical examination revealed signs of maltreatment in 5%. We conclude that, despite the differences, both procedures can serve as suitable methods to identify and refer children at risk for maltreatment.     

Do elementary school‐based child abuse prevention programs work? A high school follow‐up

Despite the widespread use of school‐based abuse prevention programs, few studies support their effectiveness in helping children avoid victimization. Most studies that evaluate prevention programs measure changes in children's knowledge and not subsequent behavior. Further, the link between knowledge, behavior, and the ability to avoid or reduce victimization has not been established. In this study the impact of a school‐based prevention program was assessed by surveying students at a high school in southern California where students from feeder elementary and junior high schools were known to have had abuse prevention programs available to them. Data were collected anonymously on 137 high school students during their Health class. A quasi‐experimental design was utilized, comparing the 72 students who had attended one or more school‐based abuse prevention program with the 65 who stated they had not participated in a prevention program. Demographic similarities between the two groups were established. Students who attended prevention programs were more knowledgeable about abuse concepts and reported fewer incidents of abuse. However, the effectiveness of students' responses to abuse, even when they were using strategies taught by the prevention programs, was variable. Questions about the effectiveness of these strategies with familial and nonfamilial abuse are discussed. © 2001 John Wiley & Sons, Inc.     

Randomized trial of a statewide home visiting program: impact in preventing child abuse and neglect

OBJECTIVES: To assess the impact of home visiting in preventing child abuse and neglect in the first 3 years of life in families identified as at-risk of child abuse through population-based screening at the child's birth. METHODS: This experimental study focused on Hawaii Healthy Start Program (HSP) sites operated by three community-based agencies. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Child abuse and neglect were measured by observed and self-reported parenting behaviors, all hospitalizations for trauma and for conditions where hospitalization might have been avoided with adequate preventive care, maternal relinquishment of her role as primary caregiver, and substantiated CPS reports. Data were collected through annual maternal interviews (88% follow-up each year of all families with baseline interviews); observation of the home environment; and review of CPS, HSP, and pediatric medical records. RESULTS: HSP records rarely noted home visitor concern about possible abuse. The HSP and control groups were similar on most measures of maltreatment. HSP group mothers were less likely to use common corporal/verbal punishment (AOR=.59, p=.01) but this was attributable to one agency's reduction in threatening to spank the child. HSP group mothers reported less neglectful behavior (AOR=.72, .02), related to a trend toward decreased maternal preoccupation with problems and to improved access to medical care for intervention families at one agency. CONCLUSIONS: The program did not prevent child abuse or promote use of nonviolent discipline; it had a modest impact in preventing neglect. Possible targets for improved effectiveness include the program's implementation system and model.     

Violence: An annotated bibliography of selected publications and resources

Reducing violence-related injuries and deaths among youth requires an integrated community-based approach, involving policy, education, legal and regulatory, and environmental modification strategies. Developing violence-prevention programs demands an understanding of the problem, knowledge of existing programs and their effectiveness, technical expert assistance, and human and material resources. This annotated bibliography of selected publications and resources relates to violence and violence prevention. The purpose of the bibliography is to provide a first point-of-entry for using the literature and for identifying and locating additional resources. The publications include a collection of research reports, conference proceedings and their background papers, and articles exploring issues and reviewing prevention strategies and resources. Resource entries identify federal agencies, academic centers, and projects that provide a range of services and assistance.     

Understanding barriers to parent involvement in Head Start: a research-community partnership

The present study was conducted by a research institute, The NCJW Center for the Child, in partnership with two Head Start agencies in New York City. The research grew out of practitioners’ concerns about parent involvement in their programs and what barriers may be inhibiting participation. Sixty-eight mothers whose children had completed one year of Head Start were interviewed using the Barriers to Parent Involvement Survey. Results revealed that mothers reported the presence of many difficult life experiences, but few were reported as actual barriers by many mothers. Five out of 20 of these experiences were associated with staff ratings of mothers’ level of participation. Developing ways to address barriers to participation at the Head Start agencies is discussed in light of the research findings. Information about wider application of the survey as well as research and programmatic implications of the results are included.     

Child psychological maltreatment in Palestinian families

OBJECTIVES: This study was designed to identify predictors of child psychological maltreatment (CPM) in Palestinian families. It examined the relative contributions of child characteristics, parents' sociodemographics, and economic hardship, in addition to family's characteristics such as family values, family ambiance, gender inequities, parental support, harsh discipline, and other forms of maltreatment, to psychological maltreatment. METHOD: The sample consisted of 1000 school age children who ranged in age from 12 to 16 years. Two school counselors carried the interviews with children at school, and with the available parent at home. RESULTS: Child school performance was specifically associated with CPM. The two-parent families and parents from refugee camps appeared to employ more psychological maltreatment of their children than single-parent families and parents from urban and rural areas. Parents who perceived that the family did not have enough money to meet the child's needs were more likely to abuse their children psychologically. Gender inequities, harsh discipline, family ambiance, and lack of parental support were the most salient predictors of CPM. Child psychological maltreatment occurred concurrently with other forms of maltreatment such as physical abuse and child's labor. Parental psychological maltreatment proved to be weakened with high traditional family values. CONCLUSION: A significant proportion of the sample could be considered psychologically maltreated. Intervention and prevention efforts should be focused on child welfare, educational programs aimed at high-risk parents, and mobilization of the community and social services agencies.     

The services provided during a child abuse and/or neglect case investigation and the barriers that exist to service provision

More than one million cases of child abuse and neglect come to attention of child protection agencies each year. During the course of investigating these cases, social workers are charged with protecting the child while assessing whether or not abuse or neglect has actually occurred. Child welfare philosophy also dictates that at the same time the investigation is being conducted, the social worker strives to maintain the family intact, if at all possible. One way to address this dual responsibility of protecting the child while working towards family stability is through the provision of services during the investigation. The purpose of this paper is to identify the services that are provided during the course of a child abuse and/or neglect case investigation. The paper also identifies the barriers that exist both within an agency and within the external community that discourage the provision of services to children and families. The findings of this research show that in the majority of cases services are not provided during the investigation. In those case investigations where services are provided, a much broader range of services are considered for provision than are actually delivered. The research also found that placement is the most frequently provided service; however, only one-third of those children in placement receive any clinical services while in placement. Finally, this study found that the greatest barrier to service provision is a lack of evidence necessary to intervene in the home situation.     

Approaches to child protection case management for cases involving people with disabilities

OBJECTIVES: This exploratory study examines the delivery of child protection services by county child protection agencies involving cases with a family member with a disability. METHOD: Telephone surveys were conducted with the directors or their designees of 89% of the child protection agencies in a Midwestern state. Respondents were asked about the policies and/or procedures for approaching cases involving a person with a disability and the barriers and strengths agencies have in serving people with disabilities. RESULTS: Only 6.7% of respondents reported their agency had a written policy related to serving persons with a disability. There were 18 different approaches to serving clients with a disability within child protection, with the most common being informally teaming for information, dual case assignment, and teaming with an outside consultant. Five counties had specialty workers who were experts in both child protection and disability. Barriers reported varied between rural and non-rural counties, with the most important barriers being lack of resources, lack of knowledge regarding disabilities, systems conflicts, and rural issues, such as lack of providers and lack of transportation. Strengths included accessing and coordinating services, individualizing services, good collaboration and creativity. CONCLUSION: While few county agencies had any written policies, both formal and informal collaboration is happening at the individual level. The lack of standardization in providing services indicates a need for more attention to issues regarding disability within child protection, including more training for workers, the development of models of collaborative case management and the removal of systemic barriers.