Child abuse and neglect: Perspectives on a national emergency

Hundreds of thousands of children are being abused and neglected in the United States annually. The structures devised to respond to this abuse and neglect have been unsuccessful. The United States government continues to spend billions of dollars on programs to deal with the effects of these unsuccessful responses. Child abuse and neglect in the United States now represent a national emergency. In this article, we will provide a historical, cultural, and contemporary perspective on child abuse and neglect. This perspective throws light on the complexity of the national emergency and provides a context for further exploration of the issue.     

Etiological Patterns of Child Abuse and Neglect

A review of the various etiological possibilities for child abuse and neglect, designed to offer an additional and different possibility. Consideration is first given to problems, namely the lack of universal definition, heterogeneous effects, and retrospective research. The probability of multifactor models is noted, and sexual abuse is given separate consideration, followed by an exploration of the existing models termed ecological, transactional, transitional, and attachment. An interactive aggression model is then offered as the new possibility. Empirical evidence for cultural and/or ethnic predispositions suggests that society can be a supporting or inhibiting factor in terms of promoting or opposing violence.     

Understanding Child Outcomes: An Application to Child Abuse and Neglect

Recently, there have been several empirical studies exploring the effects of abortion on child outcome by correlating the availability of abortion to a mother at the time of a child's birth. This paper presents a model that helps explain the process, as well as establish that the incidence of child neglect is also reduced by access to abortion. It argues that the birth of a child reduces the desired quality of not only that particular birth but of all previous and subsequent offspring. More specifically, a family does not reduce the quality invested in a particular child, whether unwanted or not, but in all family members. Several propositions derived from the model are empirically tested. Some of the findings include that access to abortion reduces the neglect of children, yet is positively associated with sexual abuse. Furthermore, unlike the stylized facts, blacks and female-headed households are no more likely to neglect and abuse their children than other households once availability of abortion, employment status, income and other variables are taken into account. Finally, income and the poverty rate are found to be unrelated with maltreatment, while other variables such as the unemployment rate have better explanatory power.     

Risk Factors in Child Abuse and Neglect

Our knowledge of those factors which place children at risk for physical or sexual abuse is both limited and imprecise. The reasons for these limitations derive from both practical methodological constraints and a lack ofdefinitional consensus among researchers in this field. This paper discusses the difficulties, both methodological and practical, involved in the development of a scientifically-based knowledge of risk factors in child abuse. Those factors known or commonly believed to be related to risk for child abuse and neglect are then ,described, with emphasis on those which appear to be popularly and clinically over-valued as predictors of abuse: demographic variables, psychopathology, and history of abuse. Likely foci for future research in this area are then described, with special attention to the problems inherent in each.     

Depression and Elder Abuse and Neglect Among a Community-Dwelling Chinese Elderly Population

ABSTRACT

Our recent survey of an elderly cohort in mainland China suggests that elder abuse and neglect are common. Unfortunately, there is minimal knowledge about the risk factors for elder abuse and neglect among this population. We aimed to examine depression as a risk factor for elder abuse and neglect among Chinese elderly. A cross-sectional study was performed in a major urban medical center in NanJing, China. Depression was assessed using the Geriatric Depression Scale and direct questions were asked regarding abuse and neglect experienced by the elderly since the age of 60; 412 patients completed the survey. The mean age of the participants was 70 and 34% were female. Depression was found in 12% of the participants and elder abuse and neglect was found in 35% of the participants. After multiple logistical regression, feeling of dissatisfaction with life (OR, 2.92; 95% CI, 1.51–5.68, p < 0.001), often being bored (OR, 2.91; CI, 1.53–5.55, p < 0.001), often feeling helpless (OR, 2.79; CI, 1.35–5.76, p < 0.001), and feeling worthless (OR, 2.16; CI, 1.10–4.22, p < 0.001) were associated with increased risk of elder abuse and neglect. Multiple logistic regression modeling showed that depression is independently associated with elder abuse and neglect (OR, 3.26; CI, 1.49–7.10, p < 0.003). These findings suggest that depression is a significant risk factor associated with elder abuse and neglect among Chinese elderly.     

Parental Depression and Child Outcomes: The Mediating Effects of Abuse and Neglect

Using longitudinal data on 1,813 children and parents from a nationally representative child‐welfare sample, National Survey of Child and Adolescent Well‐Being (NSCAW), this study investigated physically abusive and neglectful parenting as mediating the effects of parent depression on child mental health by developmental stage. Findings from latent growth models indicated that parental depression had a significant impact on child outcomes for all youths, but of the 2 types of parenting behaviors, only neglectful parenting mediated the relationship for preschool and school‐aged children. Neither parenting behavior mediated the effects of parental depression for adolescents.     

Elder Abuse and Neglect in African American Families: Informing Practice Based on Ecological and Cultural Frameworks

Despite the rapid growth of the elderly African American population in the U.S., elder abuse and neglect in African American families continue to be underdeveloped areas of study. This article presents an ecological and culturally informed framework for the study of elder abuse in African American populations. The model was developed based on Bronfenbrenner's Human Ecological Theory. The model identifies risk factors associated with different systems that have an influence on the lives of African American families. Cultural protective factors also are identified in the model. The model is intended to provide an understanding of elder abuse and neglect in African American families by considering the influence of contextual factors such as the legacy of slavery, social exclusion, and structural segregation and racism. Specific suggestions for practice are proposed according to cultural strengths of African American communities as well as the ecological premises of the model.     

NIS interpretations: Race and the National Incidence Studies of Child Abuse and Neglect

The National Incidence Studies (NIS) of Child Abuse and Neglect are the primary estimates of actual child maltreatment rates in the United States. Findings from the NIS-2 of 1986, and the NIS-3, of 1993, have been presented as demonstrating that Blacks and Whites are maltreated at equal rates. The NIS-4, using 2006 data, was presented as showing markedly different findings from the prior NIS studies with regard to race. A supplementary NIS-4 report on race argued that differences between the NIS-3 and NIS-4 were due to better precision and an expanding income gap between Blacks and Whites between 1993 and 2006. This paper will demonstrate that the NIS-2 and NIS-3 did not, as is commonly believed, show equivalence between Black and White maltreatment rates and that the NIS-2, NIS-3 and NIS-4 do not differ markedly in their racial findings. Further, the large historical increase in the Black/White income gap cited in the NIS-4 race supplement derives from a simple failure to account for inflation. If left unaddressed, misinterpretations of NIS data will continue to misinform policy, cloud the issue of racial bias in the child welfare system and obscure the ongoing role of concentrated poverty in driving racial disproportionality.     

Child Abuse Investigations: Reasons for using Child Advocacy Centers and Suggestions for Improvement

Child protective service (CPS) and child abuse law enforcement (LE) investigators have been required by the majority of states to work together when investigating criminal cases of child abuse. Child Advocacy Centers (CACs) and other^. multidisciplinary models of collaboration have developed across the United States to meet these requirements. This study surveyed 290 CPS and LE investigators who use a CAC in their investigations of criminal cases of child abuse. Reasons given for using, centers, include legal or administrative mandate and protocol, child appropriate environment, support, referrals, capacity for medical exams, expertise of center interviewers and access to video and audio technology. Respondents also identified ways that centers could be more helpful.     

Powerlessness and Abuse and Neglect of Older Adults

ABSTRACT

This article is a qualitative study which addresses the interacting relationship between the environmental context of care giving and abuse and neglect of older adults. These are examined through a thematic content analysis of risk factors identified in sixteen ‘in depth’ interviews of abused and neglected victims including two of their abusers. The interviews provide a portrait of their past and present situations, their roles and relationships and the process through which the interviewees move into their described process of powerlessness.

The interviewees are analysed through a critical, systemic, ecological analysis of the historical, gender and cultural perspectives of the interviewees. Through the relationships of the victims and their abusers in the macro, meso, exo and micro systems, questions are raised about the growing debate regarding changes in family patterns and demographics that affect how societies define the provision of care to their dependent adults. They demonstrate that violence is produced by complex interacting systems and significant events, that impact on the life courses of some older adults and some care givers leading them into powerless positions and resulting in abuse and neglect.     

Assessing Capacity Within a Context of Abuse or Neglect

In 2000, with the implementation of Part III of the Adult Guardianship Act: Support and Assistance for Abused and Neglected Adults, British Columbia formally recognized the need to examine issues of decisional capacity of older adults within a context of abuse or neglect. Interestingly, however, although the test of capacity was clearly laid out under this piece of legislation, the potential influence that living in a situation of abuse or neglect may have on how the person makes decisions is not explicitly addressed. Similarly, this is a missing link throughout the literature discussing decisional capacity in older adults. This gap exists despite the fact that determining the “protection” needs of someone who is being abused and/or neglected often hinges directly on that person's decisional capacity. The purpose of this article is to examine the unique aspects associated with assessing and determining capacity for older adults who are living in a situation of abuse or neglect. The specific objectives are to: (a) examine how living in a situation of abuse or neglect may influence the determination of capacity and (b) explore the implications of conducting an assessment within a potentially abusive context. The legal notion of undue influence and the psychological concept of relational connection are introduced as potentially important for considering decision making within this context.     

Child Abuse and Neglect inChina: What the Papers Say

In order to gain an insight into attitudes towards child abuse in China, a review of a number of newspapers for a period of 3 months was carried out. There was a dearth of relevant stories in national papers, but more in the local type of newspaper read by the majority of Chinese. Overall there were few reports relating to child abuse, especially in the intrafamilial setting. Of particular note is the number of reports of neglect of children following divorce. Violence towards students by teachers also features prominently. But by far the most reported issue is the damaging effect on children resulting from pressures for good academic performance in a highly competitive society.     

Child Abuse and Sudden Infant Death

In times past, parents were usually blamed when an infant died suddenly and unexpectedly. A more caring attitude evolved with the adoption of the term ‘cot death’ or ‘sudden infant death syndrome’ (SIDS). Recent research looking at the factors responsible for SIDS has focused on aspects of child care and parental behaviour. Epidemiological studies confirm that several risk factors associated with child maltreatment are also to be found in many families who experience a sudden infant death. Social deprivation and other well-known associated features linked to maltreatment are correlated with sudden death in infancy. It is suggested that both physical abuse (suffocation is the most usual mechanism proposed) and neglect (failure to thrive, failure to recognize and treat illness) are important mechanisms. Infanticide (filicide) has existed widely over past centuries and its continuation in modern times is reflected in the highest murder rates of all age groups in infancy. However, much fatal abuse and neglect remains hidden, as demonstrated from the results of detailed fatality reviews. The evidence linking child abuse and neglect with sudden unexpected death in infancy is reviewed.     

Elder Abuse and Neglect: A Survey of Clergy Awareness,Knowledge, and Intervention Preferences

This article explores the research question: What is the perceived level of elder abuse and neglect awareness and knowledge among Protestant clergy members in Kentucky? Of the 300 clergy contacted, 160 participated, for a response rate of 53.3%. Pearson Chi-Square analyses were used to determine statistical significance, and phi coefficient correlations examined the strength of the associations between variables. Findings indicate that approximately 44% of clergy members in this study report some “awareness” of elder abuse and neglect. However, 56% of clergy respondents do not know that Kentucky is an “any person” mandatory reporting state. Specifically, participating clergy appear poorly informed about legal requirements for reporting elder abuse and neglect and perceive types of abuse differently. Untrained clergy with little formal training indicate a willingness to provide therapy to victims despite reporting that they do not feel qualified to do so.     

Times of Transition: Elder Abuse and Neglect in Israel

ABSTRACT

The present paper addresses the advancement of research, policies, legislation, and practice experiences designed to deal with the phenomenon of elder abuse and neglect in Israel in times of transition. The paper presents a short overview of the demographic scene, reflecting population characteristics and needs that impact care giving as well as elder abuse and neglect. The developments of scientific knowledge and its accumulation, especially the empirical data from the first national survey on elder abuse and neglect are discussed. Further, legislative developments relating to four generational laws and the advancement of policies and innovative practice experiences are described and analyzed. Finally, future challenges in the field are identified.     

Elder Abuse and Neglect in an Urban Chinese Population

ABSTRACT

This study aims to investigate the prevalence of elder abuse and neglect in an urban Chinese population. A cross-sectional study was performed in a major urban medical center in NanJing, China. A total of 412 participants completed the survey and 145 (35%) participants screened positive for elder abuse and neglect. The mean age of the victims was 69 years and 59% were male. Caregiver neglect was the most common form of abuse, followed by financial exploitation, psychological abuse, physical abuse, sexual abuse, and abandonment. Thirty-six percent of the victims suffered multiple forms of abuse and neglect. In the logistical regression analyses of the data, female gender, lower education and lower income were demographic risk factors associated with elder abuse and neglect. A better understanding of these and additional risk factors associated with elder abuse and neglect in older Chinese people is needed.     

An Overview of Elder Abuse and Neglect in Australia

ABSTRACT

Only relatively recently has the issue of elder abuse come to prominence in Australia. Until the late 1980s it was a hidden problem with little knowledge of its presence. Attention was drawn to elder abuse after the publication of a number of reports and research projects, allowing the development of responses at national and state levels. This paper gives an overview of the development of elder abuse as a social, legal and medical issue in Australia, and describes the diverse range of responses from the national, state and territory governments.     

An analysis of children and young people's calls to ChildLine about abuse and neglect: a study for the Scottish Child Protection Review

In 2001 a young child, who was known to child protection agencies, was murdered by her stepfather. Following a recommendation of an inquiry into her death, a ministerial multidisciplinary review of child protection across Scotland was carried out. The review aimed to promote the reduction of abuse or neglect of children and to improve the services for children who experience abuse or neglect. It was carried out by a multidisciplinary team and the report made 16 recommendations. The review was informed by a series of sub‐projects. This paper describes one sub‐project that aimed to collect the views of children and young people who might have been abused but might not have had contact with child protection agencies. The study was carried out in conjunction with ChildLine Scotland. Call data for one year were made available for quantitative analysis. Qualitative analysis was carried out on the counsellors' notes on all calls relating to abuse and neglect taken during a 2‐week period. Children described signi?cant levels of abuse and neglect. Many had told no‐one of the abuse and in particular had not contacted child protection agencies. The paper considers the implications of the ?ndings for the child protection system. Copyright © 2004 John Wiley & Sons, Ltd.     

Mapping the Elder Mistreatment Iceberg: U.S. Hospitalizations With Elder Abuse and Neglect Diagnoses

Purpose: This study describes U.S. hospitalizations with diagnostic codes indicating elder mistreatment (EM). Method: Using the 2003 Nationwide Inpatient Sample (NIS) of the Healthcare Costs and Utilization Project (HCUP), inpatient stays coded with diagnoses of adult abuse and/or neglect are compared with stays of other hospitalized adults age 60 and older. Results: Few hospitalizations (< 0.02%) were coded with EM diagnoses in 2003. Compared to other hospitalizations of older adults, patients with EM codes were twice as likely to be women (OR = 2.12, 95% CI = 1.63–2.75), significantly more likely to be emergency department admissions (78.0% vs. 56.8%, p < .0001), and, on average, more likely to have longer stays (7.0 vs. 5.6 days, p = 0.01). Patients with EM codes were also three to four times more likely to be discharged to a facility such as a nursing home rather than “routinely” discharged (i.e., to home or self-care) (OR = 3.66, 95% CI = 2.92–4.59). Elder mistreatment–coded hospitalizations compared to all other hospitalizations had on average lower total charges ($21,479 vs. $25,127, p < .001), with neglect cases having the highest charges in 2003 ($29,389). Implications: Knowledge about EM is often likened to the “tip of the iceberg.” Our study contributes to “mapping the EM iceberg”; however, findings based on diagnostic codes are limited and should not be used to minimize the problem of EM. With the so-called graying of America, training is needed in recognizing EM along with research to improve our nation's response to the mistreatment of our elderly population.