Child Abuse and Neglect
Abstract and Keywords
The true extent of child abuse and neglect is unknown but reports to state agencies indicate over 3 million reports concerning maltreatment of over 6 million children are made each year. Confirmed reports involved over 679,000 children in 2013. Yet, only 32% of the children known to be harmed by maltreatment in the community are investigated by child protective services. The perplexing dilemma in surveillance and service delivery is how to identify those who need help without spuriously including those who do not. This entry focuses on the definition of maltreatment and provides an overview of the history, etiology, and consequences of child abuse and neglect as well as the current trends and dilemmas in the field. To afford some perspective for the reader, some international data and information are provided.
Keywords: child abuse, child neglect, child maltreatment, definitions of maltreatment, etiology of child maltreatment, consequences of child maltreatment, evidence-based practice, disproportionality, cultural competence
The World Health Organization estimates between one quarter and one half of the world’s children are physically abused and as many as one tenth are sexually abused (WHO, 2006, 2014). Worldwide, 41,000 children ages 0–14 are reported to die from homicide each year (WHO, 2014). Unfortunately, the actual number is much larger, since many child fatalities are recorded as accidental deaths (WHO, 2014). Estimated annual rates of child homicide vary from 0.6 per 100,000 in Japan to 7 per 100,000 in the United States and 25 per 100,000 in Estonia (WHO, 2001). While much can be said about differences in definitions and data collection methods among various political and geographic entities, concern regarding children’s health and safety is universal. Yet the term, maltreatment is often subject to wide-ranging definitions (Fokunmoju et al., 2013). In one comparative analysis, Feysteinsdóttir (2004) reported parents in Iceland generally do not use physical force (a commonly cited risk factor for abuse) to discipline children. On the other hand, due to the safety of the communities there, leaving children alone at a relatively young age is commonly practiced and not regarded as maltreatment to the extent that it is in the United States. Internationally, 46 countries have passed laws protecting children from corporal punishment (Global Initiative to End All Corporal Punishment of Children, 2015). This international context sets the stage for understanding the wide ranging differences in standards and laws within the United States as well as internationally.
In the western European tradition, early child protection concerns centered more on children who were orphans and paupers than on child maltreatment. Gradually, attention shifted to how children were treated by those who cared for them. By the mid- to late 1800s, agencies had been established to protect children from excessive harm in their own homes. In Philadelphia, for example, children needing out-of-home placement were described as being from families who were either “too poor or too vicious” to care for them (Clement, 1978; as per Lindsey, 2004). In 1935, the federal Social Security Act created the Children’s Bureau to support the states in protecting “homeless, dependent, and neglected children.” (The Social Security Act of 1935, as cited by Myers, 2011), From the 1880’s through the 1950s, a complex network of private and public agencies were established to protect children from harm at the hands of their caretakers. These agencies were supported by a mix of public and private funds within the framework of state laws and local ordinances prohibiting the maltreatment of children. Until 1974, no federal laws existed to set national standards throughout the United States. Many state laws of the 1960s and, later, the U. S. Child Abuse Prevention and Treatment Act of 1974 (CAPTA) were prompted by a public outcry following publication of “The Battered Child Syndrome” (Kempe, Silverman, Steele, Droegueller, & Silver, 1962). CAPTA signaled federal interest in mandated reporting of maltreatment by professionals and mandatory investigation of reports. Recorded reports of child maltreatment serious enough to trigger an investigation rose from 60,000 in 1974 to 3.5 million in 2013 (USDHHS, 2015).
Federally, the CAPTA Reauthorization Act of 2010, defines child abuse and neglect as: “at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.” To measure the prevalence of maltreatment in the United States, Westat, Inc. developed the definitions in Table 1. These definitions have changed very little since the first National Incidence Study on Child Abuse and Neglect (NIS-1) in 1980.
Table 1 Actions or Inactions of Caretakers Defined as Abusive or Neglectful for the National Incidence Studies on Child Abuse and Neglect (adapted from Westat, Inc., 2015)
The definition of maltreatment is further defined by the type of injury sustained.
Harm is defined as fatal, serious, moderate or probable:
Additional cases many be identified by determining whether the child was endangered:
Legal definitions vary to some degree by state. State statutes are summarized by the Children’s Bureau and available online (Child Welfare Information Gateway, 2014). CAPTA sets a federal standard but each state determines its own specific definitions of child maltreatment. In order to receive federal funding, state laws must be congruent with the federal law and rules, but within CAPTA’s broad definition there is room for variation (Pecora et al., 2000). In addition, localities may vary in how state laws are applied. For example, the definition of caretaker may or may not include a school bus driver. Other sources of variation concern the types of incidents that are disallowed, often combined with the age of the child. In one state for example, educational neglect or truancy is not reportable to child protective services (CPS). School attendance is handled by another governmental agency. In a different state, if a child is under 12 and has seven days of unexcused absences that child will, by law, be reported to CPS as neglected (Child Welfare Information Gateway, 2014; Ramsey County, 2015; Zuel, & Larson, 2005).
The federal data system that aggregates reports of maltreatment made to state CPS agencies is the National Child Abuse and Neglect Data System (NCANDS; USDHHS, 2015). In 2015, the NCANDS annual report indicated there were 3.5 million referrals to CPS in Federal Fiscal Year (FY) 2013 involving 6.4 million children in the United States. Sixty-one percent (60.9%) of these referrals were screened-in for investigation or assessment. Child Maltreatment 2013 reports, “Approximately one fifth of children were found to be victims with dispositions of substantiated (17.5%), indicated (0.9%), and alternative response victim (0.4%). The remaining four-fifths of the children were determined to be nonvictims of maltreatment.” The number of victims exceeded 679,000 children from 52 states or territories, 9.1 per 1000 children (USDHHS, 2015). Table 2 details the types of abuse experienced by these children.
Table 2. Types of Maltreatment Experienced by Children Found to Have Been Maltreated in 2012 by a CPS Agency (USDHHS, 2015)
Type of Maltreatment
Other (for example, abandonment, threats of harm, drug-exposed infants)
(*) Adds to over 100% because a child may have more than one type of maltreatment.
Children known to CPS, however, do not tell the whole story of children who are victimized by child maltreatment. In a 2005–2006 survey of child serving professionals in the United States such as teachers, day care providers and emergency room physicians, the Fourth National Incidence Study on Child Abuse and Neglect (NIS-4) found over 1.25 million children were harmed by maltreatment (fatal, serious, moderate or probable injury from Table 1), and just 32% of these children were investigated by CPS (Sedlak et al., 2010). The children whose maltreatment was not investigated may have never been referred to CPS or they may have been referred and screened out before investigation. It should be noted, in referencing the prevalence of maltreatment the methodological variations in counting have led to some discussion regarding the “true” extent of the problem (see, e.g., Petersen, Joseph, & Feit, 2014).
NCANDS estimates indicate there were 1,520 child fatalities from maltreatment in FY 2013 that were known to CPS. Data from other sources indicate the actual number, including those not known to CPS, may be closer to 2,000 annually (McClain, Sacks, Froehlke, & Ewigman, 1993). In 2011, the Government Accounting Office identified a number of the problems reporting accurately on child maltreatment deaths. For example, local law enforcement, the medical examiner, CPS, vital statistics, and child death review teams may all have different counts due to the varied sources of data and methods of counting. In one of the most thorough investigations of child deaths due to maltreatment to date, McClain et al, applied findings from a study of deaths of children under 5 years old in Missouri from 1983–1986 and other research to national data, arriving at national estimates. They estimated the child maltreatment deaths known to CPS represent from 24% to 65% of the total deaths due to child maltreatment. They found children under 5 years old accounted for 90% of fatal maltreatment; 41% of the maltreatment deaths were those of infants. They also reported about 85% of the child maltreatment deaths they identified were reported to be from other causes. Schnitzer et al. (2013) suggest public health surveillance would aid in increasing our understanding of the nature and magnitude of child maltreatment fatalities.
Characteristics of Children and Families
Younger children, especially those under age two, are more likely to be maltreated than older children and more likely to experience abuse or neglect (USDHHS, 2015). International statistics reveal that child homicide rates for children age 0–4 are double the rates for children age 5–14 (WHO, 2006). The NIS-4 found more females than males are maltreated due to higher rates of sexual abuse of females, more males than females are killed or seriously injured, and children of single parents are at higher risk for maltreatment and injury. Compared to families with higher socioeconomic status, children from families with the lowest socioeconomic status were three times more likely to be abused and seven times more likely to be neglected. Due to higher rates of poverty and accompanying risk factors, African American children and children of Hispanic ethnicity are at higher risk for maltreatment than white children (Drake & Jonson-Reid, 2011; Sedlak et al., 2010; Sedlak, McPherson, & Das, 2010). American Indian, Alaskan Native, Asian, Native Hawaiian, or other Pacific Islander, and mixed race children are not analyzed separately because their small numbers in the NIS-4 sample cannot support the development of accurate national estimates (Sedlak et al., 2010). The issue of poverty and neglect is of particular concern due to the potential confounding of the two. Sometimes families will be referred to CPS due to lack of food, shelter, or clothing that is solely due to lack of money and not a result of maltreatment. In Illinois, the Norman v. McDonald lawsuit, settled in 1991, led to a special fund to aid families who were in danger of child placement due to economic distress (for example, lacking food or housing) but who were not maltreating their children keeping children and families out of CPS when there is no suspicion of maltreatment.
Causes and Consequences of Child Abuse and Neglect
One of the most thorough reviews of etiology of maltreatment is the National Research Council’s 2014 text, New Directions in Child Abuse and Neglect Research (Petersen et al., 2014). In addition to poverty and low socioeconomic status, risk factors for maltreatment include parental substance abuse, parental history of having been maltreated, maternal depression, age of the mother at the birth of her first child, child disability, families without two biological parents, inter-parental violence, lack of familial social supports, and family violence among adults in the household. Different types of maltreatment will have differing dynamics. Social structural and institutional factors also create environments within which maltreatment may be more likely to occur.
The sequelae of child maltreatment are well documented and include but are not limited to higher risk of drug abuse, behavior problems, delinquency, arrest and incarceration, failed relationships, and maltreatment of offspring (Petersen et al., 2014). Protective factors are now known to be critically important in determining vulnerability to, and outcomes of, child maltreatment. Fraser and Terzian (2005) report that communication and problem solving and parental competence in child discipline and supervision are important factors mediating the effects of poverty. Sources of resilience come not only from one’s own biological, cognitive and personal experiences but also from the school, the neighborhood and the community at large. The authors summarize, the child who is most likely to fend off or minimize deleterious consequences is able to use resources available, engage in opportunities for support from others and has a source of support in the larger environment (Fraser & Terzian, 2005).
Responding to Child Maltreatment
Child welfare systems in Western Europe and North America have organized systemic responses to child maltreatment that vary to some degree with respect to their philosophical orientations, maltreatment definitions, and threshold indicating the need for placement. Gilbert, Parton, and Skivenes (2011) reviewed 10 countries in Europe and North America and concluded these child protection systems tended to be child focused (child needs support and care), family service focused (family needs support and care) or oriented toward child protection (children need to be protected from their parents). Internationally, systems vary greatly (UNICEF, UNHCR, and Save the Children and World Vision, 2013). In the United States, systems vary from state to state but generally include response to reports that may include investigation and/or family assessment (an alternative to investigation), assessment of risk to the child, determination of services needed (including possible out-of-home placement), and efforts to provide or connect people with those services. The decision to provide services is often based on risk to the child vs. concerns about whether or not the allegation is substantiated.
Effective interventions may focus on prevention or remediation and may involve broad-based social change, community organization or development, social policy change, or direct intervention with children and families. They may, for example, address the reduction of poverty, building social and support networks, changing child welfare laws and policies to enable family maintenance, or interventions in parenting styles, respectively (Munro, 2008; Petersen et al., 2014; Wulczyn, Barth, Yuan, Harden, & Landsverk, 2005). Most importantly, they should combine attention to the evidence base of the practice to be used with the degree to which the intervention is culturally competent (Wells, Merritt, & Briggs, 2009). The evidence may be developed based on large-scale policy interventions such as subsidized guardianship for kinship caretakers or may be more specific to direct interventions with children and families. (See the reference list for selected recommended readings.)
Challenges, Debates/Trends, and Directions
Definition affects every part of society’s response with respect to funding, court intervention, and even out-of-home placement. It dictates who receives services, degree of intrusion into family life, and whether a child might be placed in out-of-home care. The effort to make definitions responsive to children’s needs is ongoing (Wald, 2015). Requirements to report are often reviewed and revised, particularly after highly publicized cases that may have escaped attention (see, e.g., KeepKidsSafe.PA.gov). USDHHS (2015) found that states with more stringent reporting requirements (e.g., “must” report vs. “may” report) also had somewhat higher rates of confirmed victims. Many more non-offending families may be investigated, but more victims are also found.
The disproportionate representation of children of color in the system, particularly African American and Indigenous peoples has received a good deal of attention. While risk is higher for those who are the poorest, the rate of over-representation has brought more attention to the need for social reforms and prevention (Bartholet, 2009). The situation highlights the need for more effective means of prevention, including amelioration of extreme poverty and social disorganization. The relative cost-effectiveness of focusing on prevention vs. remediation and treatment is the focus of ongoing attention (Fang, Brown, Florence, & Mercy, 2012).
Trends mirror ongoing social concerns such as the proliferation of violent media that reinforce all forms of violence and the concurrent dwindling support for families in their communities (Petersen et al., 2014). At the level of individual and family intervention, the question is whether basic services such as housing and substance abuse treatment are available (Gilbert et al., 2011). In addition, practitioners and policy makers are questioning whether evidence-based practices are known and readily available to all families in need. The need for evidence-based practices is great and the research capacity to meet the need is severely limited by the available funding (Shlonsky & Benbenishty, 2014).
Role of, and Implications for, the Social Work Profession and Inter-disciplinary Connections
The social work profession has historically been involved in the design and delivery of child protective services as well as in addressing the social conditions that perpetuate the problem. A current challenge is to improve practice by understanding and applying research and by opening the door for ongoing practice evaluation. In addition to ongoing quality improvement, addressing public perceptions regarding funding of social services and preventive efforts could be tackled through the conduct and use of cost-effectiveness studies to show how much financial and societal cost can be saved by early intervention. At the same time, efforts to address the social issues that perpetuate risk cannot be neglected. Social workers may be involved in providing and supervising child welfare services, providing treatment services in other agencies, planning and implementing prevention strategies, organizing community supports for families and children, helping to change policy legislation, and/or developing administrative rules and procedures at the agency level. All of this work will continue to be done in the context of interdisciplinary relationships. Child maltreatment touches all professions—medicine, law, education, child care, and many others. It is only through an interdisciplinary focus that progress can be made.
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