Abuse and Neglect: Scope of the Problem
This information was taken directly from Child Welfare Information Gateway
Child abuse prevention efforts have grown exponentially over the past 30 years. Some of this expansion reflects new public policies and expanded formal services such as parent education classes, support groups, home visitation programs, and safety education for children. In other cases, individuals working on their own and in partnerships with others have found ways to strengthen local institutions and create a climate in which parents support each other.
This issue brief underscores the importance of prevention as a critical component of the nation’s child protection system. It outlines programs and strategies that are proving beneficial in reducing the likelihood of child maltreatment. Looking ahead, the brief identifies key issues facing high-quality prevention programs as they seek to extend their reach and impacts.
Scope of the Problem
Recent research documenting the number of child maltreatment cases observed by professionals working with children and families across the country suggests prevention efforts are having an impact. For example, the Fourth Federal National Incidence Study on Child Maltreatment (Sedlak et al., 2010) reported a 19-percent reduction in the rate of child maltreatment as reported in a similar survey conducted in 1993. Substantial and significant drops in the rates of sexual abuse, physical abuse, and emotional abuse observed by survey respondents occurred between 1993 and 2006. Although no significant declines were observed in cases of child neglect, the NIS data mirror a similar drop in the number of physical and sexual abuse cases reported in recent years to local child welfare agencies (U.S. Department of Health and Human Services, 2010). Between 1990 and 2009, the number of substantiated cases of physical abuse dropped 55 percent, and the number of substantiated sexual abuse cases declined 61 percent (Finkelhor, Jones, & Shattuck, 2011).
Despite these promising trends, child maltreatment remains a substantial threat to a child’s well-being and healthy development. In 2009, over 3 million children were reported as potential victims of maltreatment. The risk for harm is particularly high for children living in the most disadvantaged communities, including those living in extreme poverty or those living with caretakers who are unable or unwilling to care for them due to chronic problems of substance abuse, mental health disorders, or domestic violence. In 2009, an estimated 1,770 children—or over 4.8 children a day—were identified as fatal victims of maltreatment. As in the past, the majority of these children—over 80 percent—were under the age of four (U.S. Department of Health and Human Services, 2010). While child maltreatment is neither inevitable nor intractable, protecting children remains challenging.
History of Child Abuse Prevention
Modern public and political attention to the issue of child maltreatment is often pegged to Henry Kempe’s 1962 article in the Journal of the American Medical Association on the “battered child syndrome” (Kempe, Silverman, Steele, Droegemueller, & Silver, 1962). In contrast to those early pioneers who had used clinical case studies to explain maltreatment patterns, Kempe and his colleagues examined hospital emergency room X-rays for 1 year from 70 hospitals around the country and surveyed 77 district attorneys. These efforts painted a vivid and disturbing picture of children suffering physical and emotional trauma as a result of overburdened parents or caretakers using extreme forms of corporal punishment or depressed single mothers failing to provide for their children’s basic emotional and physical needs.
Armed with these descriptions, Kempe persuaded Federal and State policymakers to support the adoption of a formal child abuse reporting system. Between 1963 and 1967, all States and the District of Columbia passed child abuse reporting laws. Federal reporting guidelines were established in 1974 with the authorization of the first Federal Child Abuse and Neglect Prevention and Treatment Act. The 1980s represented a period of significant expansion in public awareness of child maltreatment, research on its underlying causes and consequences, and the development and dissemination of both clinical interventions and prevention strategies. As more became known of the diversity within the maltreatment population, unique subpopulations were singled out for specific programmatic options and legislative attention (Daro, 1988). On the prevention front, two distinct programmatic paths emerged (Daro, 1988):
- Services to new parents
- General parenting education classes
- Parent support groups
- Family resource centers
- Crisis intervention services such as hotlines and crisis nurseries (Cohn, 1983)
Interventions targeting reductions in child sexual abuse, including:
- Universal efforts designed to teach children the distinction between good, bad, and questionable touching; the concept of body ownership; or the rights of children to control who touches their bodies and where they are touched (Wurtele & Miller-Perrin, 1992)
- Educational programs that encouraged children and youth who had been victimized to report these incidences and seek services
The effectiveness of general parent education and support programs during this time was generally limited to parents able to access these options. Prevention efforts were far less successful in attracting and retaining families who did not know they needed assistance or, if they recognized their shortcomings, did not know how to access help (Daro, 1993).
By the 1990s, emphasis was placed on establishing a strong foundation of support for every parent and child, available when a child is born or a woman is pregnant. And the way to reach new parents centered on home- based interventions (U.S. Advisory Board, 1991). The seminal work of David Olds and his colleagues showing initial and long-term benefits from regular nurse visiting during pregnancy and a child’s first 2 years of life provided the most robust evidence for this intervention (Olds, Sadler, & Kitzman, 2007). Equally important, however, were the growing number of home visitation models being developed and successfully implemented within the public and community-based service sectors. Although less rigorous in their evaluation methodologies, these models demonstrated respectable gains in parent- child attachment, access to preventive medical care, parental capacity and functioning, and early identification of developmental delays (Daro, 2000).
After implementing home visitation programs for over a decade, the prevention field is facing an important challenge. Recent Federal legislation included in the Patient Protection and Affordable Care Act of 2009 will provide States $1.5 billion over the next 5 years to expand the provision of evidence-based home visitation programs to at-risk pregnant women and newborns. While research justifies an expansion of several high-quality national home visitation models, it also indicates that not all families are equally well-served by this approach; retention in long-term interventions can be difficult; and identifying, training, and retaining competent service providers is challenging. Even intensive interventions cannot fully address the needs of the most challenged populations—those struggling with serious mental illness, domestic violence, and substance abuse, as well as those rearing children in violence and chaotic neighborhoods.
Faced with the inevitable limitations of any individual program model, increased emphasis is being placed on approaches that seek change at a community or systems level (Daro & Dodge, 2009). The current prevention challenge is not simply expanding formal services but rather creating an institutional infrastructure that supports high-quality, evidence-based direct services. In addition, prevention efforts have embraced a more explicit effort to both reduce risks and enhance key protective factors, fostering strong partnerships with other local programs serving young children. Among the most salient investments in promoting protective factors are efforts to strengthen parental capacity and resilience, support a child’s social and emotional development, and create more supportive relationships among community residents (Center for the Study of Social Policy, 2004). Communities where residents believe in collective responsibility for keeping children safe may achieve progress in reducing child abuse and strengthening child well-being.
Identifying and Implementing Quality Programs
All prevention services need to embrace a commitment to a set of practice principles that have been found effective across diverse disciplines and service delivery systems. A suggested list of best practice standards appears on the following page. As a group, these items represent best practice elements that lie at the core of effective interventions. To the extent that direct service providers and prevention policy advocates hope to maximize the return on their investments, supporting service strategies that embrace the following principles will be essential:
- A strong theory of change that identifies specific outcomes and clear pathways for addressing these core outcomes, including specific strategies and curriculum content
- A recommended duration and dosage or clear guidelines for determining when to discontinue or extend services that is systematically applied to all those enrolled in services
- A clear, well-defined target population with identified eligibility criteria and strategy for reaching and engaging this target population
- A strategy for guiding staff in balancing the task of delivering program content while being responsive to a family’s cultural beliefs and immediate circumstances
- A method to train staff on delivering the model with a supervisory system to support direct service staff and guide their ongoing practice
- Reasonable caseloads that are maintained and allow direct service staff to accomplish core program objectives
- The systematic collection of information on participant characteristics, staff characteristics, and participant service experiences to ensure services are being implemented with fidelity to the model, program intent, and structure
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