A new age for child protection--General Comment 13: why it is important, how it was constructed, and what it intends?

Children continue to be subjected to high levels of violence (i.e., physical, psychological and sexual maltreatment) throughout the world. International concern about violence against children has increased significantly during the last decade. A Study on Violence Against Children, encouraged by the UN Committee on the Rights of the Child, conducted under the auspices of the United Nations Secretary General and reported in 2006, has become a rallying call to improve child protection. Child protection practices and systems have been judged to be generally inadequate and, in some cases, destructive. It is widely recognized that business as usual—more of the same—will not do. A General Comment (guide to fulfilling obligations) for Article 19, the central conceptualization of child protection of the UN Convention on the Rights of the Child, has the potential to promote a worldwide reformulation of child protection priorities, policies, and practices by virtue of the infusion of a child rights approach. It can be a mechanism for framing and promoting the transformational change needed – for a genuine paradigm shift. Here, explication is given for the historical context, rationale, centrality of child rights, process of development, holistic nature, and primary elements of General Comment 13 (GC13): The child's right to freedom from all forms of violence. GC13 embodies and champions a child rights approach to child protection entailing strong support for proactive primary prevention, promotion of good child care, and a commitment to secure the rights and well-being of all children. A child rights-based, comprehensive coordinating framework is recommended for the implementation of GC13.     

Head injury secondary to suspected child maltreatment: results of a prospective Canadian national surveillance program

Objective

We sought to determine the incidence, clinical features, and demographic profile of head injury secondary to suspected child maltreatment (abuse or neglect) in Canada to help inform the development and evaluation of prevention programs for abusive head injuries.

Methods

From March 1, 2005 to February 28, 2008, an average of 2,545 paediatricians and paediatric subspecialists were surveyed monthly through the established network of the Canadian Paediatric Surveillance Program. We calculated incidence rates using the number of confirmed cases over the product of the duration of the study (3 years) and population estimates by age group.

Results

There were 220 confirmed cases of head injury from suspected child maltreatment. The annual incidence rate was 14.1 per 100,000 for children less than 1 year of age and 1.4 per 100,000 for those less than 15 years. Seventy three percent (141) of cases involved infants less than 12 months of age and 52% (100) of cases involved infants less than 6 months of age. Seventy-five percent (165) of cases presented to the emergency room. With regard to outcome, 12% (27) of cases resulted in death and 45% (75) of survivors had neurological sequelae at discharge. Thirty percent (67) of all cases, as well as 30% (8) of deaths were previously known to child welfare authorities.

Conclusion

This study provides an estimate of the rate of head injury secondary to suspected child maltreatment in Canada. The young age and poor medical outcomes of those involved highlights the need for prevention efforts that are implemented early in life. Given that a significant percentage of injured infants and children were already known to child welfare authorities, the study also highlights the need to establish and evaluate additional preventive efforts for parents and caregivers already in the child welfare system.     

Forensic child sexual abuse evaluations: assessing subjectivity and bias in professional judgements

Objectives

Evaluators examining the same evidence often arrive at substantially different conclusions in forensic assessments of child sexual abuse (CSA). This study attempts to identify and quantify subjective factors that contribute to such disagreements so that interventions can be devised to improve the reliability of case decisions.

Methods

Participants included 1106 professionals in the field of child maltreatment representing a range of professional positions or job titles and years of experience. Each completed the Child Forensic Attitude Scale (CFAS), a 28-item survey assessing 3 forensic attitudes believed to influence professional judgments about CSA allegations: emphasis-on-sensitivity (i.e., a focus on minimizing false negatives or errors of undercalling abuse); emphasis-on-specificity (i.e., a focus on minimizing false positives or errors of overcalling abuse); and skepticism toward child and adolescent reports of CSA. A subset of 605 professionals also participated in 1 of 3 diverse decision exercises to assess the influence of the 3 forensic attitudes on ratings of case credibility.

Results

Exploratory factor analysis identified 4 factors or attitude subscales that corresponded closely with the original CFAS scales: 2 subscales for emphasis-on-sensitivity and 1 each for emphasis-on-specificity and skepticism. Attitude subscale scores differed significantly by sample source (in-state trainings vs. national conferences), gender, years of experience, and professional position, with Child Protective Service workers unexpectedly more concerned about overcalling abuse and more skeptical of child disclosures than other professionals—a pattern of scores associated with an increased probability of disbelieving CSA allegations. The 3 decision exercises offered validation of the attitude subscales as predictors of professional ratings of case credibility, with adjusted R²s for the three exercises ranging from .06 to .24, suggesting highly variable effect sizes.

Conclusions

Evaluator disagreements about CSA allegations can be explained, in part, by individual differences in 3 attitudes related to forensic decision-making: emphasis-on-sensitivity, emphasis-on-specificity, and skepticism toward child reports of abuse. These attitudes operate as predispositions or biases toward viewing CSA allegations as likely true or likely false. Several strategies for curbing the influence of subjective factors are highlighted including self-awareness of personal biases and team approaches to assessment.     

Emotion recognition in fathers and mothers at high-risk for child physical abuse

Objective

The present study was designed to determine whether parents at high risk for physical child abuse, in comparison with parents at low risk, show deficits in emotion recognition, as well as to examine the moderator effect of gender and stress on the relationship between risk for physical child abuse and emotion recognition.

Methods

Based on their scores on the Abuse Scale of the CAP Inventory (Milner, 1986), 64 parents at high risk (24 fathers and 40 mothers) and 80 parents at low risk (40 fathers and 40 mothers) for physical child abuse were selected. The Subtle Expression Training Tool/Micro Expression Training Tool ( [Ekman, 2004a] and [Ekman, 2004b]) and the Diagnostic Analysis of Nonverbal Accuracy II (Nowicki & Carton, 1993) were used to assess emotion recognition.

Results

As expected, parents at high risk, in contrast to parents at low risk, showed deficits in emotion recognition. However, differences between high- and low-risk participants were observed only for fathers, but not for mothers. Whereas fathers at high risk for physical child abuse made more errors than mothers at high risk, no differences between mothers at low risk and fathers at low risk were found. No interaction between stress, gender, and risk status was observed for errors in emotion recognition.

Conclusions and practice implications

The present findings, if confirmed with physical abusers, could be helpful to further our understanding of deficits in processing information of physically abusive parents and to develop treatment strategies specifically focused on emotion recognition. Moreover, if gender differences can be confirmed, the findings could be helpful to develop specific treatment programs for abusive fathers.     

Bridge over troubled water: using implementation science to facilitate effective services in child welfare

To maximize benefits to children and their families, effective practices need to be used competently in child welfare settings. Since the 1990s, researchers and policy makers have focused attention on empirically supported interventions (ESIs). Much less attention has been paid to what is needed to implement these in a range of real-world settings. Without proper implementation, which includes an evaluation strategy from feasibility to fidelity to on-going work on moderators and mediators of program effects, established effective programs can be rendered ineffective in practical application. The paper will touch on progress, to date, of implementation science, its application to child welfare programs and practices, and will highlight a set of practical strategies for implementing empirically supported interventions in child welfare.     

Changes in parental depression symptoms during family preservation services

Objectives

Parental depression symptoms often change over the course of child welfare family preservation and parenting services. This raises the question of whether certain processes in family preservation services might be associated with depression symptom change. This study tests three correlational models of change among family preservation service participants: (a) changes in depression symptoms are one facet of broad general changes in wellbeing; (b) the quality of the home visitor-client relationship is associated depression symptom changes; and (c) linking parents to adjunctive services is associated with symptom changes.

Methods

Participants were 2,175 parents in family preservation services, largely for child neglect, who were surveyed using standard measures at pre-treatment, post-treatment and 6 month follow-up. Change patterns were evaluated using growth models, including bivariate parallel and multivariate second-order models.

Results

Parallel growth was noted among depression symptoms and changes in social, economic, familial, and parenting domains. A second order change model positing a global change pattern fit the data well. Working alliance had a modest association with improvement, but successful linkage to outside mental health services was not associated with improvement.

Conclusions

Changes in diverse indicators of wellbeing follow a global pattern which might support use of less complex rather than more fully comprehensive service plans. Findings about lack of adjunctive usual care mental health service benefit may be related to uncontrolled factors and this is a topic in need of additional study.