The assessment of child abuse potential and the prevention of child abuse and neglect: A policy analysis

A frequently advocated strategy for increasing the efficiency of child abuse prevention programs is to deliver prevention services to "high-risk" populations. This article critically reviews procedures for the reliable and valid assessment of child abuse potential within an ecological perspective. Factors that limit the usefulness of child abuse risk assessment are discussed. These factors include the uncertain criteria of child abuse and neglect, the low base rate of the phenomenon, and the financial and social costs of such procedures. Finally, the prevention implications of the current and future state of the art in child abuse risk assessment are considered and preventive interventions that do not depend on individual case risk screening are advocated.     

An Integrated Resilience and Ecological Model of Child Abuse (REC-Model)

Much of the theories of child abuse are developed and referenced from the West, while their applications to Chinese society are unclear. It is necessary to examine the cases in Hong Kong to acknowledge the uniqueness in perception and conceptualization of child abuse and the impact of resilience, across different cultural settings. The current study aims to advance an ecological model of child abuse for Hong Kong families by integrating resilience perspective with the ecological systems, namely An Integrated Resilience and Ecological Model of Child Abuse (REC-Model), and to examine the interactions between resilience and risk factors among chronosystemic, microsystemic, marcosystemic, and ontogenic systems on child abuse. Using a cross sectional survey research method and path analysis, 565 families with children studying at ages between 9 and 13 participated and returned self-administered questionnaires in the study. The results showed that Chinese cultural parenting values moderated the influences of risk factors on child abuse, while forgiveness buffered the negative impact of microsystemic factors on child abuse. To prevent child abuse, it is important to decrease the detrimental effects of childhood abuse experiences, reduce marital conflicts, and avoid developing insecure parent-child attachment. Promoting forgiveness, while reducing parents’ rigidity of certain Chinese cultural parenting values, may also help decrease child abuse.     

Risk factors for child sexual abuse

We review the risk and protective factors for child sexual abuse. Overall, characteristics of perpetrators, victims, and families of victims were moderate to strong risk factors for child sexual abuse. However, it is difficult to distinguish between risk factors for extra-familial and intra-familial child sexual victimization because most of the studies combined these two types of child sexual abuse, although the risk factors for these two types of child sexual abuse most likely differ. Research in this area is difficult because etiological and prevention models of victimization would differ substantially from those of perpetration. Given the low yearly prevalence of child sexual victimization, very large samples would be necessary to obtain sufficient power. Thus, most studies have used lifetime prevalence, which may provide much useful information but which add substantial time confounds. Finally, child sexual victimization is probably a misnomer, as the nature, impact, and etiology of sexual victimization most likely differs over the large age span of childhood and gender. Because improved models and prevention programs require improved etiological models (based on knowledge of risk and protective factors), we hope that this review will focus stakeholders on the need for continued research in this area.     

Parental Stress and Children’s Social and Behavioral Outcomes: The Role of Abuse Potential over Time

Parental stress is a well-established risk factor for adverse child outcomes, including the development of aggression, externalizing behavior problems, and anxiety, as well as compromised emotional coping, impaired social cognition, and diminished treatment response. Abuse potential represents a mechanism by which parental stress may impact child social competence and behavior; evidence links parental stress to abuse potential, and abuse potential to a range of negative child social competence and behavioral outcomes. The current study assessed relationships between parental stress, abuse potential, and child social and behavioral outcomes over time. Parents of children ages 2–6 years (N?=?610, 44% girls) reported on perceived parental stress and attitudes towards abuse and neglect, as well as child social competence and behavior problems, before and after a caregiver-directed, community-based intervention. Changes in parental stress, abuse potential, and child social and behavioral outcomes were examined using panel analyses, while controlling for intervention effects and demographic variables. Parental stress predicted child social competence, anxiety/withdrawal, and anger/aggression over time; while the links between stress and anxiety/withdrawal, and stress and social competence, were mediated by child abuse potential, the link between stress and anger/aggression was not mediated by child abuse potential. Findings suggest that abuse potential represents a mechanism by which parental stress and child social and behavioral outcomes are linked. Further, screening for child social competence deficits may identify children at risk for abuse, as well as parents in need of services to reduce stress.     

Physical Abuse in U.S. Children: Risk Factors and Deficiencies in Referrals to Support Services

More than 600,000 U.S. children are reported for physical abuse annually. Risk factors are proposed in the literature, but a comprehensive, national assessment of risk factors and support services has not been conducted. An analysis of national data from the National Child Abuse and Neglect Dataset revealed that domestic violence, parental alcohol and drug use, prior child abuse and neglect, public assistance receipt, and child behavior problems are associated with higher odds of substantiated physical abuse reports, compared to unsubstantiated reports. Most families, however, failed to receive relevant support services for any of these risk factors. Screening by physicians, child protection workers, and others for these risk factors could help identify children at increased risk for physical abuse and inform prevention efforts and support-service provision.     

Sexual offenses against children: Patterns and motives

Children are the quintessential innocent victims; therefore, special opprobrium is reserved for offenders who sexually abuse them. This article describes the more prominent typologies of pedophilic sex offenders and discusses the role of child pornography in child sexual abuse of actual children. It next examines the often overlooked population of women offenders who sexually abuse children. Attention then turns to the sexual abuse of children in child care settings and by members of the clergy; practical recommendations are provided for reducing the risk of this kind of institutional child sexual abuse. Theoretical conceptualizations of child sexual abuse are considered, in the three main categories of cognitive–psychodynamic theories, neuropsychological conceptualizations, and contributions from the emerging field of evolutionary psychology. Finally, recommendations are made for developing a way of handling sex offenders, including sexual offenders against children, that balances the fair administration of justice with society's obligation to protect vulnerable potential victims.     

Where do we go from here? Moving toward an integrated approach to family violence

This article discusses patterns across reviews of the risk and protective factors for each of seven forms of family violence: partner physical, psychological, and sexual abuse; child physical, psychological, and sexual abuse and child neglect. We note that both child and partner literatures have large research bases on risk factors for physical abuse, but relatively few articles on psychological or sexual abuse (or child neglect). In addition, co-occurrence of forms of maltreatment within families is high, but little integrative work has been conducted. We argue that the overlap of both occurrence and risk factors across forms of maltreatment suggests that both etiological and intervention models would be improved by considering all forms of maltreatment more explicitly in a family (rather than dyadic) context.     

Association between Child Abuse and Health Risk Behaviors among Chinese College Students

Little is known about the link between child abuse and health risk behaviors among Chinese college students. This cross-sectional study examined the prevalence of child abuse and its relations with individual and clusters of health risk behaviors among Chinese college students. A total of 507 students participated in this survey. The prevalence of child abuse from the highest to the lowest was emotional neglect (53.9%), physical neglect (49.0%), emotional abuse (21.8%), physical abuse (18.3%), and sexual abuse (18.1%), respectively. Males were more likely to report child abuse than females (p?<?0.01). For males, emotional abuse was associated with internet addiction [OR?=?2.28; 95%CI (1.00, 5.20)] and suicidal behavior [OR?=?12.47, 95%CI (2.61, 59.54)]; while sexual abuse was associated with internet addiction [OR?=?2.30, 95%CI (1.14, 4.66)]. For females, emotional abuse was significantly associated with increased risks for self-harm behavior [OR?=?15.03, 95%CI (3.59, 63.07)] and suicidal behavior [OR?=?5.16, 95%CI (1.63, 16.40)]. Physical abuse was related to risks for internet addiction [OR?=?2.50, 95%CI (1.03, 6.04)] significantly. Two-step cluster analysis showed that participants in clusters with more health risk behaviors reported higher scores of child abuse. These findings suggest that child abuse was associated with both individual and clustering of health risk behaviors among Chinese college students.     

Examining Partner and Child Abuse: Are We Ready for a More Integrated Approach to Family Violence?

Research and treatment for partner abuse and child abuse are relatively distinct enterprises, yet when the theoretical and research literatures related to these two forms of family violence are examined together, the likelihood of meaningful associations is strikingly apparent. Partner abuse and child abuse co-occur more often than one might expect by chance, and in the context of overlapping theories and risk factors, this suggests that a more integrated conceptualization might be fruitful. We summarize and provide a framework for describing the large number of similar predictors of partner and child abuse, identify some potentially interesting dyadic differences, comment on how our research methodologies could address an integrated area of family violence, and suggest some directions for future research and treatment.     

Risk factors in child maltreatment: A meta-analytic review of the literature

This review presents the results of a series of meta-analyses identifying the relative strength of various risk factors for child physical abuse and neglect. Data from 155 studies examining 39 different risk factors were included in the review. Large effect sizes were found between child physical abuse and three risk factors (parent anger/hyper-reactivity, family conflict and family cohesion). Large effect sizes were also found between child neglect and five risk factors (parent–child relationship, parent perceives child as problem, parent's level of stress, parent anger/hyper-reactivity, and parent self-esteem).     

Kinderpornografie

The quantity and distribution of child abuse material (“child pornography”) has substantially risen since the advent of the internet facilitated access. Due to the international character of the associated delinquency prosecution is confronted with several difficulties. In 2003 the European Union established a framework agreement to legally combat child pornography. The market for child abuse material is profitable, as production is comparably cheap. The number of convictions for relevant crimes varies but is generally still on a high level, even though reporting of relevant contents is decreasing. Providers and users might have switched to less controllable internet platforms. The physical and/or psychological sequelae for victims of child pornography are serious and ongoing. Studies show that compared to hands-on-offenders users of child exploitation material are generally younger, better educated and less often have a criminal record. Some of them (10–25?%) fulfill the diagnostic criteria of pedophilia. A child pornography offender’s risk of committing a hands-on-offence seems to be increasing with the diagnosis of pedophilia and antisocial personality traits. According to existing data, individuals whose only criminal record refers to illegal pornography seem to be at low risk for future offending with child abuse (0.2–6.6?%). Offenders who were already convicted for child abuse have a higher risk for re-offending when consuming (deviant) pornography. Several cognitive behavioral treatment manuals exist, however accurate diagnostic assessment and indication are required.     

Associations between child physical abuse potential,observed maternal parenting,and young children's emotion regulation: Is participation in Early Head Start protective?

Clinicians working with Early Head Start (EHS) families consider family well-being and positive parent–child relationships as foundational to school readiness. Understanding the links between risk factors and these dimensions of family engagement can inform clinical decision-making, as risk assessments are used to tailoring program services. The current study examined the associations between high risk, or potential, for child physical abuse and both parenting quality and children's emotion regulation (ER) during toddlerhood; EHS participation was examined as a buffer. The sample included EHS-eligible mothers of infants (N = 80) drawn from one site of the EHS Research and Evaluation Project. Associations were tested between mothers’ potential for child physical abuse, measured during infancy, and observed maternal sensitivity, positive regard, harshness, and children's ER skills at child ages 1 and 2 years. Results indicated that high potential for child physical abuse was associated with lower positive regard at age 1 and lower ER skills at age 2. EHS participation operated as a buffer on each of these associations. Implications for screening for child physical abuse potential and the constructs it represents in clinical settings as well as how EHS can promote family engagement are discussed.     

Deviant Scripturalism and Ritual Satanic Abuse Part Two: Possible Masonic, Mormon, Magick, and Pagan Influences

Having shown in a previous paper the possible Judeo-Christian influences that may exist in ritual satanic abuse, this study compares portions of people's accounts (using interviews and diaries from several alleged survivors), with doctrinal precedents for satanic ritual abuse in deviant interpretations of Masonic, Mormon, Magick, and Pagan traditions.     

Evaluation of an Air Force Child Physical Abuse Prevention Project Using the Reliable Change Index

Three hundred and seventy-nine parents at 25 Air Force bases participated in a collaborative child physical abuse prevention project designed by the United States Air Force Family Advocacy Program and Father Flanagan's Boys' Home (Boys Town). These participants were active duty or civilian employee parents and their spouses who completed the Boys Town Common Sense Parenting ® program as part of a comprehensive prevention effort. We hypothesized that participants would report decreased child behavior problems, improved relationships with family members, and reduced risk for child physical abuse after attending parenting sessions. Results supported this hypothesis. The data were also analyzed to determine the frequencies of individual parents who made statistically reliable changes on the dependent measures using Jacobson's Reliable Change Index. Nineteen to 30% of the participants reported significant improvement in the areas assessed. Parents who improved in abuse risk were at a higher level of risk and were less satisfied with family relationships prior to their participation than those who did not change. Implications for prevention of child physical abuse and future directions for research are discussed.     

Children with Disabilities

Abstract

Children in out-of-home care due to abuse and neglect are at disproportionately high risk for disabling conditions. The reasons for the over-representation of children with disabilities in the child welfare system are reviewed and discussed in this chapter. Factors discussed include impact of abuse and neglect, the impact risk factors such as exposure to community and domestic violence and poverty, risk of abuse or neglect associated with disability, and child welfare system factors. In addition, the need for greater efficacy in identification of disability, identification of service needs, and linkage with and delivery of services to serve the needs of children with disabilities in out-of-home care is addressed. Recommendations for policy review at State and Federal levels are offered along with direction for future research.     

Examination of the Extent to which Employment Factors are Associated with Reduced Child Maltreatment Potential and Drug Use

Job assistance programs are commonly recommended for parents of children who have been victimized by child maltreatment, particularly when illicit drugs are indicated. However, the relationship between employment factors, substance abuse, and risk of child maltreatment has received limited empirical attention. Therefore, the current study examines employment factors in a sample of 72 mothers, who were referred by child protective services for treatment of substance abuse and child neglect. Child maltreatment potential was found to be negatively associated with number of hours employed and self-reported happiness with employment. The association between child abuse potential and personal income of participants approached significance (p?=?.057), and the results were not influenced by social desirability. Employment satisfaction significantly contributed to the prediction of child maltreatment potential over and above other employment factors and control variables. These findings suggest that when mothers are involved in child protective services their risk of perpetrating child maltreatment may be reduced when they are assisted in gainful employment that is personally satisfying. Happiness with employment was the only employment factor correlated (inversely) with substance use (biological testing, self-report of participants). Future directions are discussed in light of the results, including the importance of considering employment satisfaction when conducting vocational assistance programs in this population.     

Physical Abuse and Childhood Disability

SUMMARY

Several authors have hypothesized that children with disabilities are at increased risk for physical abuse. Such a finding would be consistent with current ecological models, which posit that certain child characteristics (e.g., behavior problems) in combination with other risk factors can lead to abuse. The paucity of research in this area makes it difficult to draw firm conclusions at this time. However, the few studies conducted suggest that child characteristics play a minor role in the etiology of abuse. Despite the lack of evidence indicating that children with disabilities are at significantly greater risk for abuse than their nondisabled peers, the presence of a disability raises some unique issues in the identification, assessment, and treatment of special needs children. This article reviews the literature linking abuse and disability as a risk factor. In addition, impediments encountered in the assessment and treatment of abused children with disabilities and their families are discussed and guidelines for practice are presented.     

Case vignette: child abuse or acceptable cultural norms -- child psychiatrist's response; ethical issues in culturally relevant interventions; cultural contexts

Three families from the nation of the Gambia have become socially acquainted in the greater Metropolis area where they have relocated from their native country. All three families have preadolescent daughters. None of the girls has as yet undergone the ritual "female circumcision" commonly practiced in their native country. Five of the six parents think it would be a good idea to hold such a ritual ceremony in Metropolis next month. The sixth parent is uneasy about the procedure and wonders if it is appropriate anyway. The parent comes to talk with you, a physician or mental health professional, about this. The parent describes concerns about the procedure and the practice in general, but notes that some groups in the United States do "similar things," referring to the ritual circumcision of Jewish boys at 8 days of age. The parent adds that if the procedure is not possible in the United States, it could be done in the Gambia when the family returns there on holiday. Discussants were asked for their opinions regarding advice to the parent's ethical obligations (especially in the case of mandated reporting of suspected child abuse).     

Prevalence of Sexual Abuse Among Children with Conduct Disorder: A Systematic Review

Many clinicians and researchers have speculated that child sexual abuse and conduct disorder co-occur frequently, yet no systematic reviews of literature have specifically addressed both these conditions. To estimate the prevalence of sexual abuse among children with conduct disorder, the pertinent literature was systematically reviewed. Ten databases were searched, supplemented with hand search of reference lists from retrieved papers. Blind assessments of study eligibility and quality were conducted by two independent researchers. Disagreements were resolved by consensus. Twenty-three studies meeting minimum quality criteria that were enough to insure objectivity and not to invalidate results and including 7,256 participants with either conduct disorder or child sexual abuse were examined. The prevalence of child sexual abuse among participants with conduct disorder was 27 %; however, such figure might be underestimated due to selection, sampling, and recall biases; poor assessment methods; and narrow definitions of abuse in included studies. Participants with conduct disorder, compared with healthy individuals, reported higher rates of child sexual abuse. However, compared with other psychiatric populations, they reported similar or lower rates. There was also some evidence suggesting that children with conduct disorder might be more likely to report child physical abuse. Female participants with conduct disorder, compared with males, were significantly more likely to report child sexual abuse. Youths with conduct disorder are at risk of being (or having been) sexually abused, although such risk seems to be neither more specific to nor stronger for these individuals, compared with people with other psychiatric disorders.