Child Maltreatment

Chapter 2

Overview

• Currently, the literature recognizes four major types of maltreatment: physical abuse, physical neglect, emotional maltreatment, and sexual abuse.

• Physical abuse and neglect are often comorbid manifestations.

• Child maltreatment is a significant problem in the United States.

• Its significance derives from its prevalence and the serious consequences of maltreatment for individuals, families, and neighborhoods and for society as a whole.

Overview

• It has been suggested that child abuse is fundamental in three ways: first, it is correlated with a broad range of other social problems; second, it is a sensitive marker of the strength of the social fabric; third, it denies the worth of children.

• It is clear that for individuals there are very profound negative sequelae.

• These include psychological, social, academic, and emotional problems and deficits.

Incidence

• When the battered child syndrome was first promulgated, it was estimated to be affecting about 300 hospitalized children.

• This proved to be a gross underestimation of the true extent of the problem.

• 2.9 million cases were reported in 1993.• Of these, just over 1,000 were fatalities related

to child maltreatment.• Based on several national reports, 18,000

serious disabilities and 141,000 serious injuries arise annually from maltreatment.

Definition of child abuse and neglect

• Abuse has been defined as the degree to which parents may use inappropriate or aversive strategies to control their child or children.

• Neglect has been defined as the degree to which parents provide little stimulation or structure or fail to provide minimal standards of nurturing and care giving in the crucial areas of education, nutrition, supervision, health care, emotional availability, and general safety.

• This definition encapsulates the twin concepts of commission (abuse) and omission (neglect) that often characterizes these two phenomena.

Definitions

• Hutchison (1990) has suggested that definitions of maltreatment have been developed to meet four interrelated purposes: social policy and planning, legal regulations, research, and case management.

• Wells (1994) has suggested that a prerequisite for the future child protection research agenda is the development of “commonly accepted, sufficiently specific definitions of maltreatment and injury that can be used uniformly in the field.”

Assessment Methods

• The non-unitary nature of child abuse and neglect suggests that they require multi-method, multi-source assessment and intervention.

• It is recommended that the clinician select from a variety of assessment procedures dictated by the unique features of each individual case.

• The primary concern in any assessment of child abuse and neglect must be the assessment of immediate risk to the child.

Assessments

• Having addressed the initial determination of child safety, the objective of parenting assessment should be the determination of “functional parenting competencies” based upon what the parent or caregiver understands, believes, knows, does, and has the capacity to do.

• This implies that the current and potential future behavior of the parent becomes central to clinical assessment.

Structured Clinical Interviews

• The modal form of clinical assessment is the interview.• However, as a vehicle for obtaining information in

situations of family violence, the interview often suffer from respondent distortion, self serving, or social desirability bias and poor recall.

• In an effort to guide clinicians in the assessment of abusive families, the Child Abuse and Neglect Interview Schedule was devised.

• It is designed to assess maltreating behaviors such as corporal punishment, physical abuse, and history of maltreatment, and is utilizable with the general population.

Structured Clinical Interviews

• Structured interviews may also consist of various combinations of existing instruments.

• In choosing empirical measures, the clinician should have a clear understanding of the purpose of the assessment, the type of information required, the interventions available, and the family’s strengths and cultural background, as well as the applicability of measures with diverse populations.

Computerized Assessment Methods

• The advent and availability of personal computers has made the collection and analysis of client information a much more accessible and flexible task.

• One measure of general individual and family functioning is the Multi-Problem Screening Inventory which provides the clinician with a 334-item scale measuring 27 dimensions of family and individual functioning.

• Subscales addressing physical and non-physical abuse, depression, self-esteem, partner problems, child problems, and family problems are contained in this instrument.

Computerized Assessment Methods

• A measure more directly focused on children is the Child Well-Being Scales; a multidimensional measure of potential threats to the well-being of children.

• The scales include both child an family measures and were originally designed as an outcome measure for child welfare services, rather than for clinical assessment.

• However, the scales has been in use as a clinical decision-making tool since the early 1990’s.

Self-Report Methods

• The Child Abuse Potential Inventory as well as being the most extensively researched instrument of its kind, has a validity index designed to detect biased or random response patterns.

• The scale includes items related to distress, rigidity, child problems, family problems, unhappiness, loneliness, negative self-concept, and negative concept of the child.

Observation Methods

• Several available observational procedures are designed to assess selected behaviors or qualities of the parent-child interaction.

• The 100 item Home Observation Measurement of the Environment (HOME) which assesses the quality of stimulation in the child’s early environment.

• This scale consists of some self-report items; however, the majority are based on observation of the parent and child.

Observational Methods

• An observational system designed to evaluate parent control strategies was developed by Schaffer and Crooke (1980).

• Examination of the parent-child interaction system using this model yields the classic, tripartite, antecedent child behavior-parent control-consequence child behavior model.

• Some caution is merited in the use of observation measures, as they require extensive training for reliable use.

Family Strengths

• The family or individual need concentration of many assessment measures mean they are often deficit focused. This can tend to color the perspective of the clinician, as well as further stigmatizing already demoralized parents.

• It is crucial that clinicians take into account the strengths and potential resources possessed by families.

• These may include interpersonal skills; affective involvement; supportive friends, family, and neighbors; motivation; or other compensatory characteristics.

Effective Social Work Interventions

• Unlike neglect, which is often readily observable condition, child abuse is most often a private phenomenon.

• This makes it almost impossible to observe, at least until after the event.

• Most child abuse treatment programs are aimed at the amelioration of the correlates of maltreatment, such as parent-child conflict, anger, vulnerability to stress, and social isolation, rather than maltreatment per se.

Child-Focused Interventions

• There are now a handful of studies, primarily therapeutic day treatment and peer-mediated social skills, that provide some preliminary guidance in interventive choice to redress the deficits sustained through maltreatment.

• Services to children may also make some contribution to breaking the intergenerational transmission of abuse.

Parent-Focused Interventions

• Parent training. The form of intervention for parents appearing most frequently in the empirical literature is parent training.

• This has been presented in videotaped demonstrations, discussion, modeling, and role playing and is allied with contingency contracts.

• Sessions often include information on human development, child management, and problem solving as well as instruction, modeling and rehearsal, and self-control strategies (relaxation training and use of self-statements).

Parent Training

• The training is based on a social learning model targeted at problems in child management and child development, and in the literature has often been accompanied by home visits in order to facilitate generalization.

• Multisystemic therapy was associated with more effective restructuring of parent-child relations.

• Parent training was more effective at reducing the number of identified social problems.

Behavioral and Cognitive-Behavioral Interventions

• Composite treatment (cognitive restructuring, relaxation procedures, problem-solving) was the most effective in alleviating anger.

• This treatment package is very encouraging, because the gains were made in only six sessions.

Summary

• The empirical literature on the treatment of physical abuse and neglect consists of several broad types: child-focused interventions aimed at social and cognitive development; parent-focused interventions, primarily behavioral and cognitive-behavioral; social network interventions; and multi-service or multi-component treatments.

Summary

• Research seems to indicate that those likely to remain in treatment are the most motivated and the least chronic child abusers.