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 of definitional 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.     

Prevention of child abuse and neglect and improvements in child development

The aim of the study was to evaluate the implementation of a section in the Danish Social Assistance Act which encourages local authorities to offer families services in order to support children at risk of child maltreatment. The specific purpose of the present paper is to answer the question: Will the socio‐psychological development of children known to social services be improved when abuse and neglect are reduced? A sample of 1,138 children was drawn at random from new social services cases starting in 1998. Subsequently, about 80 per cent were evaluated by local caseworkers on the basis of a standardised questionnaire covering a period of four years. The most damaging family conditions seemed to be psychological maltreatment, physical/sexual abuse and neglect. Maltreated children were more often in a depressed state, unhappy, socially isolated, or they had an eating disorder, inadequate or under‐nutrition, suicidal tendencies, lack of concentration, or disturbed behaviour, compared to those children who were not exposed to abuse and neglect. If parental behaviour improved, effects on children's well‐being were also observed and positive changes in children's socio‐psychological development were identified. The questionnaire explored the impact of various interventions, including services geared to strengthen the child's network, but results indicated that the child displayed reduced risk of reactive symptoms only when parental behaviour improved and abuse and neglect were reduced. Copyright © 2009 John Wiley & Sons, Ltd.     

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.     

Specialist assesstnent services for child abuse and neglect

This paper describes the Child Protection Service, Flinders Medical Centre, South Australia, a specialist assessment service for infants, children and adolescents following allegations of abuse and neglect. The psychosocial and medical services provided for infants, children, adolescents and their families are outlined briefly and the Child Protection Service's view that the assessment process can and needs to be therapeutic is discussed. Data was provided about the age and gender of infants, children and adolescents seen and the number of families referred on for longer-term therapeutic intervention. The unit's philosophical stance, affecting its clinical practice and interagency and consultation service, is described, as is its research focus. The paper also raises a number of issues that warrant further and detailed attention. These include the need for workers to monitor and attend to their emotional responses while working in the area of abuse and the destructive potential of denial that may consequently and subtly impact on professional practice. The tendency for professionals and the wider society to ignore the impact of physical abuse is also raised.     

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.     

Getting with the (evidence-based) program: An evaluation of the Incredible Years Parenting Training Program in child welfare

This study evaluates four group sessions of the Incredible Years (IY) Parenting Training Program used for the first-time in two child welfare agencies in New York State. Few studies have examined process and evaluation outcomes of evidence-based parenting programs in child welfare. Qualitative staff interviews and surveys on parenting behaviors were used to examine program processes, improvements in parenting behaviors, and participant satisfaction. Program participation was associated with less parental distress, defensive responding, dysfunctional parent-child interactions, child difficulty, total stress, and greater empathy and social support. The effectiveness of this evidence-based, parent education program in the context of a child welfare population, as well as implementation challenges and recommendations, are discussed.     

A multi-site evaluation of Parents Raising Safe Kids Violence Prevention Program

The Parents Raising Safe Kids Program (PRSK) is a research-based manualized violence prevention curriculum designed to decrease coercive parenting behavior, encourage positive discipline, increase media violence literacy, and increase child development knowledge. This study is a multi-site pre-post comparison evaluation of PRSK's effectiveness with diverse parents, including those who are incarcerated, in drug treatment and both English and Spanish speaking. Results indicate that PRSK was successful at improving media violence literacy, positive parenting behavior, child development knowledge, anger management, and prosocial problem solving. Additionally, PRSK was especially efficacious for Spanish speaking participants, who improved more than English speakers. Due to the need for appropriate and cost-effective programs for underrepresented groups, these results add to the growing evidence base supporting the use of PRSK with diverse parents. PRSK is effective in educating caregivers about nonviolent parenting behavior and child development. It is flexible, focuses on parents of very young children, and is cost effective. The program costs a fraction of other evidence-based practices yet statistical effect sizes for change over time are comparable.     

A review of the relationship between poverty and child abuse and neglect: Insights from scoping reviews,systematic reviews and meta-analyses

An up-to-date and accurate picture of the evidence on the impact of poverty is a necessary element of the debate about the future direction of children's social care services internationally. The purpose of this paper is to update evidence about the relationship between poverty and child abuse and neglect (CAN) published since a previous report in 2016 (Bywaters et al., 2016). A systematic search was conducted, identifying seven reviews. Poverty was found to be consistently and strongly associated with maltreatment, be that in terms of familial or community-level poverty, or in terms of economic security. Findings demonstrated that both the type and the quantity of economic insecurities impacted child maltreatment. Certain economic insecurities – income losses, cumulative material hardship and housing hardship – reliably predicted future child maltreatment. Likewise, as families experienced more material hardship, the risk for maltreatment intensified. In some studies, the relationship between poverty and maltreatment differed by abuse type. Future reviews need to investigate individual papers and their findings across different CAN measures, definitions, samples, abuse types and conceptualisations of poverty to provide a comprehensive understanding of the current research base and the directions which need to be taken to further understand and prevent CAN.     

Similarities and differences in program registers: A case study

Researchers, clinicians, and other professionals are increasingly in need of cost-effective, evidence-based programs and practices. However, these individuals may lack the time and, for some, the required expertise to search for and identify such interventions. To address this concern, several online registers that list or categorize programs according to their empirical evidence of effectiveness have been established. Although these registers are designed to simplify the task of selecting evidence-based interventions, the use of distinct review processes and standards by each register creates discrepancies in final program classifications, which can pose a challenge for users. The present case study highlights three programs that have been evaluated by more than one register and have received similar or different classifications. Reasons for inconsistencies are discussed, and several recommendations for evaluating organizations and register users are provided to enhance the functionality and ease of use of online program registers.     

The prevalence and nature of abuse and neglect in children under four: a national survey

This paper reports the results from a Danish national survey of child abuse and neglect. Data were obtained by a written questionnaire sent to all home health visitors. All newborn Danish children receive visits by a home health visitor several times during their first year of life. For children in need of special care for social reasons the visits may continue until school age (at 6 or 7 years). The questionnaire included four checklists of signs of abuse and neglect. The home health visitors were asked to record what they had actually observed visiting the children in their homes. Eighty‐three per cent (covering about 80% of all newborns) answered the questionnaire. The objective was to establish a scientific based framework that could be used to guide preventive efforts. Ten per cent of all children under 1 year of age may be characterized as children in need of special care for social reasons, the most frequent single reason being reliance on social assistance, alcohol abuse or violence against the mother. A minimum of 4% of infants are subjected to broadly defined abuse or neglect from one or more of the four categories: physical abuse, physical neglect, emotional abuse and emotional neglect, physical and emotional neglect being the most frequent and physical maltreatment the most rare. Copyright © 1999 John Wiley & Sons, Ltd.     

A systematic review on community-based interventions for elder abuse and neglect

Elder abuse and neglect is a societal issue that requires prevention and intervention strategies at the practice and policy level. A systematic review on the efficacy of community-based elder abuse interventions was undertaken to advance the state of knowledge in the field. The peer-reviewed literature between 2009 and December 2015 were searched across four databases. Two raters independently reviewed all articles, assessed their methodological quality, and used a modified Sackett Scale to assign levels of evidence. Four thousand nine hundred and five articles were identified; nine were selected for inclusion. Although there was Level-1 evidence for psychological interventions (n = 2), only one study on strategies for relatives (START) led to a reported decrease in elder abuse. There was Level-4 evidence for conservatorship, an elder abuse intervention/prevention program (ECARE), and a multidisciplinary intervention (n = 4), in which one study yielded significant decreases in elder abuse and/or neglect. The remaining three were classified as Level-5 evidence (n = 3) for elder mediation and multidisciplinary interventions. There are limited studies with high levels of evidence for interventions that decrease elder abuse and neglect. The scarcity of community-based interventions for older adults and caregivers highlights the need for further work to elevate the quality of studies.     

The context of program implementation and evaluation: A pilot study of interorganizational differences to improve child welfare reform efforts

This article contributes to the growing literature on evaluation and implementation science by examining the interaction between staff perceptions of organizational strength with perceptions and indicators of program fidelity. As part of a pilot project related to the evaluation of the Family to Family initiative, a survey was distributed to employees within two urban child welfare agencies with a total of 410 respondents across both sites, for a combined response rate of 72.2%. Survey results were analyzed both in terms or respondents' perception of their agency as well as in relation to measures of program performance and workload. Multivariate models show that organizational indicators are the most significant and positive predictors of perceived program implementation. Specifically, staff who positively perceived the availability of information within their agency also believed that the programs were well implemented in their agency. These findings suggest that as the value of program changes are articulated within an organization, the implementation of the initiative is perceived to improve.     

Looking at engagement and outcome from the perspectives of child protection workers and parents

This paper reports a study that sought to understand what facilitates engagement between parents and child protection workers and to ascertain the relationship between such engagement and intervention outcome. Quantitative and qualitative data were gathered through personal interviews with 131 worker-parent dyads (workers and corresponding parents receiving service) from 11 child protection agencies in Ontario, Canada. Measures included scales for engagement, parental well-being (depression and stress), and worker well-being (burnout, job satisfaction, stress). Outcome measures included perception of child safety, changed parenting practices and satisfaction. A relationship was found between workers' perception of parent engagement and parents' perception of their own engagement, as well as between the perceptions that workers and parents had around their own respective engagement. Workers who were satisfied with service outcomes were significantly more engaged than those who were unsatisfied. Parents thinking that their children were safer as a result of intervention were significantly more engaged than parents who thought that their children were less safe. The strongest reason given by parents for positive change was being able to trust their worker (p < .001) and believing that their worker was knowledgeable about parenting (p < .01). Qualitative data suggested that parents valued experienced workers because they thought such workers could better understand their problems and how to deal with them. Correspondingly, workers felt that experience enabled them to better understand clients' problems and provide more effective support. No relationship was found between parent engagement and parental depression or stress, but the mean depression score for parents placed them at risk of clinical depression. There was a negative correlation between worker stress and engagement. The study demonstrates that engagement between clients and workers is related to positive outcomes (as reported by workers and parents) and supports the contention that promoting engagement is integral to a successful child protection intervention.     

Recognizing,reporting, and responding to abuse,neglect, and self-neglect of vulnerable adults: an evaluation of the re:act adult protection worker basic curriculum

Abuse and neglect of vulnerable adults are significant problems, the identification and management of which is increasingly being made the legal responsibility of healthcare professionals. In response, some jurisdictions have developed training to assist professionals in these duties. This study evaluates the re:act Adult Protection Worker Basic Curriculum training from British Columbia, Canada. One hundred and fifty-seven participants, 109 training completers and 48 non-completers, answered a survey evaluating their confidence, knowledge, and applied knowledge in identifying, reporting, and investigating cases of suspected abuse, neglect, and self-neglect of vulnerable adults. Comparisons of training completers to non-completers showed significant gains in completers’ perceived confidence and knowledge, but no improvement in applied knowledge. The type of healthcare professional being trained and the length of training did not impact learner improvement. The results suggest ways in which both training and evaluation can be improved (e.g., supervised practice) to increase and detect gains in knowledge and practice.     

Understanding of elder abuse and neglect among health care professionals in Malaysia: An exploratory survey

ABSTRACT

Elder abuse and neglect (EAN) is a hidden public health challenge for Malaysia. This cross-sectional survey studied the awareness of EAN among 148 doctors and nurses from two neighboring states in Malaysia using a self-administered questionnaire exploring their knowledge, perceptions, practices, and experience concerning EAN. Both doctors and nurses demonstrated poor understanding of signs of EAN and exhibited misperceptions on reporting requirements. Both groups perceived EAN as a national burden and reporting it as their responsibility; but most felt they had not been trained to diagnose it. Many were unsure of procedures and whether their own intervention could be effective. Only four (nurses) of 41 participants who suspected abuse during the past year reported the cases. Targeted education and uniform protocols are mandatory to ensure best practice with regards to EAN. Further research is crucial to extend this inquiry into the broader health care workforce.     

Family characteristics of children in cases of alleged abuse and neglect

Information is presented about the family composition, structure and significant relationships of 2069 children referred to an English social services department for suspected abuse and neglect. Of these children, 373 (18%) were subsequently placed on the child abuse register. Very few members of extended families were recorded as being significant in the lives of these children. Contrary to earlier research, less than one‐third of children lived with a lone or unmarried mother. However, children whose parents were married and living together were less likely to be registered. Nearly half of the mothers and one‐fifth of the fathers of registered children were aged 21 or less at their child's birth. Compared to all those referred, a significantly larger number of children registered were conceived by younger or older men. Two in five of the siblings of registered children were under 6, and the younger the siblings, the more likely the child was to be registered. Children with two or more siblings were also more likely to be registered. Copyright © 1999 John Wiley & Sons, Ltd.     

The preoccupation with thresholds in cases of child death or serious injury through abuse and neglect

Thresholds into and between services emerged as a significant theme in the biennial analysis of cases of child death and serious injury through abuse and neglect ‘serious case reviews’ carried out in England for the (then) Department for Education and Skills between 2003–05. The preoccupation with thresholds was one of a number of interacting risk factors and many children's cases were on the boundary of services and levels of intervention. In most cases child protection did not come ‘labelled as such’ which reinforces the need for all practitioners, including those working with adults to be alert to the risks of significant harm. Policy makers should acknowledge that staff working in early intervention are working within the safeguarding continuum and not in a separate sphere of activity. The emotional impact of working with hostility from violent parents and working with resistance from older adolescents impeded engagement, judgement and safeguarding action. In the long term neglect cases that were reviewed, the threshold for formal child protection services was rarely met and some agencies and practitioners coped with feelings of helplessness by adopting the ‘start again syndrome’. Adequate resources are essential but not sufficient to redress the problems. Effective and accessible supervision is crucial to help staff to put into practice the critical thinking required to understand cases holistically, complete analytical assessments, and weigh up interacting risk and protective factors. Copyright © 2008 John Wiley & Sons, Ltd.     

The prevalence of elder abuse and neglect in Iran: a systematic review and meta-analysis

ABSTRACT

Objective: The aim of this study was to estimate the prevalence of elder abuse and neglect in Iran.

Methods: We searched PubMed, Embase, Scopus, and PsycINFO by the end of 2017. The prevalence was calculated based on the percentage or the amount reported in the studies. Heterogeneity was assessed by the I² statistic, and the data were combined using random effects model. The results were reported as the pooled estimates and the 95% confidence intervals (CIs). The review protocol was registered in PROSPERO (CRD42017070744).

Results: A total of 16 studies involving 6,461 participants aged 60 years and over were included. The pooled prevalence for overall elder abuse was 45.7% (95% CI: 27.3–64.1, p < .001).

Discussion: The prevalence of elder abuse and neglect is substantial in the Iranian population aged 60 years and over. More research is needed to investigate the actual prevalence of elder abuse at the national level.     

Federal dissemination of child abuse and neglect information

This review examines the recent history of efforts at the federal level to disseminate child abuse and neglect information and describes current challenges to these endeavors. Two dissemination models are defined as are the problems associated with the adaptation of those models. Finally, general principles for transmitting information and the processes involved in such transmission are reviewed.