Child Abuse Prevention

As distraught Florence Wallace held the broken body of her 3 year old granddaughter, the girl summoned the strength to utter a waning, “I love you. I really love you.” Despite the grandmother’s repeated pleas to investigate abuse by the girl’s foster mother, Doris Bennett, the foster mother beat the child into a 5 day coma, and eventually, her June 11 death. Wallace had spent 2 years fighting for custody of her grandchildren, taken by L.A. county social workers after a pipe broke in their rental home.[Riccardi, 1999][National Coalition for Child Protection Reform, 2008]

Every day, approximately 2,450 children are abused. Throughout the United States, abuse plagues children of all ages, burdening our social infrastructure while draining social, medical, and judicial resources and costing taxpayers an estimated 94 billion annually. Equally unfortunate is our marginal success at combating the problem. Between 2001 and 2005 incidences of maltreatment decreased by a mere .4% per child per capita despite a 14.2% increase in spending[Devoot, Allen & Geen]. The problem is not in the will; Americans distaste for abuse is abundant. The problem is the way. In the U.S., resources pour in to help children after abuses occur, even at times to the detriment of the victim. Child abuse and severity of incidents can be reduced by focusing on child and parent based prevention programs. In reducing maltreatment, truly, an ounce of prevention is worth ten pounds of cure.

Intervention programs, including police intervention, mental and behavioral health treatment, and medical attention, changes in custody and out of home care can be costly, ineffective, reduce the familial quality of life and actually create more problems than they solve. Intervention’s failures suggest the need for expansion of preventative measures, which can be more cost effective, more successful in averting maltreatment; enhance quality of life in both family and community, and show the greatest impact in preventing future abuses.

There are 3 main approaches to child abuse. Primary prevention seeks to prevent child abuse before it starts, targeting society at large. Secondary prevention targets at risk populations to prevent abuse before it occurs, and tertiary programs attempt to reduce the re-occurrence of abuse.

Child abuse is severe mistreatment of a child by an adult through physical violence, neglect, sexual abuse, or emotional cruelty. Every day approximately an average of 2,450 children are abused. Of those cases, 60% are victims of neglect, 20% experienced physical abuse and 10% are sexually abused. While children can be victimized at any age, 75% are younger than 3. Every day 5 children die of abuse and neglect. [Childhelp.org] Child abuse and neglect affect victims throughout their lifetime. Abuse is linked to poor academic performance, low levels of education attained, and future income potential. Homeless populations have high correlations with homelessness, in part due to failures on the part of the child welfare system, but this number increases in abused populations that have not been removed from abusive homes, and those placed with relatives. As mental health goes, depression, anxiety, mood disorders, dissociative identity disorder, substance abuse and addictions are all associated with childhood abuse. Nearly 66% of people in treatment for drug abuse report being abused as children and 80% of abused children have received diagnosis for a psychiatric disorder by the age of 21. Abused children have higher likelihoods of entering abusive relationships, both as victim and perpetrator, and have a greater likelihood of abusing their own children. Child abuse is associated with criminality; abused children are 28% more likely to get arrested as adults and 30% more likely to commit violent crimes. Childhood abuse can be linked to high risk behavior such as promiscuity, teen parenthood, and STD's, teen drug and alcohol abuse, and gang involvement. It may even shorten life expectancy by heightening the risk of chronic and infectious disease, overdose, obesity and increased suicides, compounded by poverty effects that reduce the population's access to quality medical care. [childhelp.org]

Risk Factors
While child abuse can occur within every economic, ethnic, cultural or religious group, and at all levels of education, some groups experience challenges that may increase the likelihood of abuse. Some indicators are:
•Families who are isolated. Groups that have fewer community supports, fewer friends, close relatives, lack of religious affiliations, and other social connections can be more prone to abusive relationships.
•Parents who were abused as children can lack problem solving, communication, and nonviolent approaches to child rearing. Without counseling or learning other parenting methods, often abused parents emulate their parents abusive parenting and communication styles and abuse continues generationally.
•Families who are often in crisis experience higher incidences of abuse. This may indicate personality or skill deficiencies that lead to frequent crises also lead to maltreatment, or that the frequent crises cause higher levels of stress, leading to increases in child abuse incidence and severity.
•Caretakers who abuse drugs or alcohol indicate greater likelihood of abuse. Again, it is undetermined weather the underlying cause of the substance abuse are linked to the child abuse, or weather the substance abuse causes violence. Certainly data indicates the latter. Intoxication can lead to lapses in judgment, heightened violence, lowered ability to communicate and poor problem solving skills. [Child Welfare Information Gateway]Child Abuse Prevention Gateway. “Substance Abuse and Child Maltreatment” web published 2009. http://www.childwelfare.gov/pubs/factsheets/parentalsubabuse.cfm web viewed 12/12/09
• Heavy criticism of children can be symptomatic of maltreatment, of poor communication, or of a misunderstanding of child development.
• Rigid discipline techniques and inflexibility can be indicative of maltreatment.
• Adults who show too much or little concern for the child, lack of empathy, and lack of connection with their children have higher ratios of abuse and neglect.
• Parents who feel they have a difficult child or children with disabilities have higher prevalence of abuse. Stress of parenting can be compounded by lack of understanding on the part of caretakers, by the child's limitations and by community and family influences.
• Similar to families in crises, families under heavy stress have higher indicators for abuse. As with crisis, stresses can decrease a families ability to function and communicate well, and tension can build up, leading to abuses. [Ianelli, 2005]
Prevention and Protection
When possible, prevention methods can do the most good in terms of child welfare, community well being and long term cost. Protection and intervention methods often occur after the abuse, which may have already endangered a child’s physical and emotional well being. Additionally, protection and intervention programs are costlier, considering medical expenses, foster care, legal and court expenses and future criminality.
Child based preventative education teaches children to identify abuse and understand situations that can lead to their own endangerment, understand that abuse is never acceptable, avoid potential dangers and abusive situations, communicate in ways that deter maltreatment, and how to get help. Some examples of common child based preventative programs are Red Flag, Green Flag, Good Touch, Bad Touch,and Boss of my Body. These programs approach prevention of sexual abuse through education. They explain what kinds of behavior are safe and what to do in instances of unsafe behaviors. Another program is the SAFE kids program which teaches courses to children learning to manage healthy relationships, bullying, communication, anger management and online safety.[[The Rape and Abuse Crisis Center 1980][Child Abuse Prevention Association]

Costs vary depending by program, but implementing a comprehensive sexual abuse awareness program in school can cost as little as $200 per class [amazon.com] Issues like bullying, respect, body limits, safety planning, and identifying dangerous situations can be addressed in classrooms for the cost of printing, time and a dedicated teacher or social worker.

Parent based prevention methods include education programs, home visitation programs, substance abuse and mental health treatment, basic resource assistance, child care assistance, new parent classes, and social support groups. Nursing home visitation programs send health practitioners into the child's home to monitor growth and development of the child. This can offer parents advice on parenting, nurturing, and caretaking as well as demonstrate procedures that can help alleviate medical symptoms. New parent classes can teach parents how to care for their newborn, deal with crying, how to nurture, and what to expect. These types of programs work to eliminate early childhood abuse by teaching parents to become effective caregivers. Further, these type of classes reduce feelings of isolation and lack of support that can lead to abusive conditions.
Substance abuse represents an estimated one-two thirds of maltreatment cases, and occupies more than 20% of $24 billion states spend on child welfare. Mental health and substance abuse treatment programs assist in reducing and preventing abuse by addressing both the direct issue of substance abuse and mental illness, but also by approaching underlying conditions that may contribute to both the illness (or substance use) and abusive caretaking. Often, rehabilitative services will offer support to family members affected by the use or illness, giving them tools to compensate for deficiencies in their caretaker. Further, indicators of abuse can be earlier recognized and interventions more quickly take place in families in treatment than in those without. In South Dakota, studies report $8.43 savings in child welfare for every $1 spent. [Leonardson, 1995]

At times, families that otherwise would provide necessities for their children become unable to do so, due to hardships, lack of income or physical limitations. Their children's needs may be neglected as a result. In fact, the most prevalent factor in cases of child maltreatment is poverty, often occurring in single parent headed households. Basic needs assistance programs such as the Federal Housing Program, food stamps, TANF, medicaid, career training, disability , and child support assistance have a direct effect on poverty based neglect. Acceptance of assistance often involve some rules and overview such as: children's enrollment in school, home visitation, or counseling, leading to early detection of potential warning signs. Further, addressing familial needs can reduce stress and crisis, reducing the incidence of stress related child abuse. Community child care centers and after school care, offering low or no cost child care provides care giving alternatives to parents that may otherwise leave children unsupervised or at the mercy of older siblings.
Poverty and neglect represent a large fiscal cost to state and federal government. State and Federal costs for foster care total an average of $21,092 per child annually vs. $2,499 for children receiving welfare benefits. By addressing poverty related neglect, spending could be decreased almost tenfold.

Intervention has it's place too. Unfortunately, programs like foster and residential facility care are overused to the detriment of child and familial well being. The National Coalition for Child Protection Reform reports that foster children are twice as likely to die of abuse in foster care as in the general population, that sexual abuse was four times and physical abuse was three times more prevalent in foster children. Even this grim figure is overshadowed by group home statistics. NCCPR states 28 times more sexual abuse and ten times more physical abuse in group homes than general populations. A Michigan study showed that maltreated children left in their own homes with little or no help or outside intervention fared better on average that similarly maltreated children who were placed in foster care. A child's risk of abuse in foster and institutionalized care increases as well. Foster children become homeless at a higher rate than other adults under 25 years old. Teens who have “aged out” of the foster care system have difficulty making new living arrangements, finding themselves homeless at 18. Due to overwhelming case loads, foster families often lack support, training, and supervision that could produce better outcomes. [NCCPR, 2009] By assisting families who could be preserved through some of the above discussed measures, the weight of children who shouldn't be in foster care can be lifted from the system, allowing foster parents and child welfare agencies to provide better oversight, counseling, advocacy and support for children truly in jeopardy.

“The case for prevention is persuasive. Not only is it the humane approach, it is the financially responsible approach. Programs designed to prevent child maltreatment serve society in several ways; they build stronger, healthier children; they reduce the burdens on state services such as education, law enforcement, corrections, and mental health; and they free money to be spent on more life-enhancing projects. An ounce of prevention truly is worth a pound of cure.” [Caldwell, 1992]

In a March 3, 2004 USA Today editorial, sociologist David Finklehor reported a 42% decline between 1992 to 2001 in child sexual abuse cases. In another report, author Ann Burgess attributes this decline to preventative factors. “Finkelhor identified a number of possible causes for the apparent decline, such as the fact that many children have received preventive safety classes in school, making them potentially less-amenable targets, and that parents and youth organizations have been educated and become more aware, thus making it difficult for child molesters to operate with impunity (Finklehor, 2004).” [Burgess, 2005] “The fact that prevention programs seem to be making a difference offers encouragement, especially in the area of child sexual abuse prevention. Research on child maltreatment programs has focused on three main areas: home visitation programs, parent education programs, and school-based programs. Nurses participate in all three types of programs.” Other possibilities include the national sex offender registry, created in 1994. This program requires people over the age of 18 who have been convicted of sexual offenses to register their addresses and place of employment. Laws limit the distance from schools and childcare facilities such offenders can work or reside. Additionally laws prevent them from working directly with youth in such roles as teachers or care providers. Citizens can access this registry to learn who in their neighborhood has been convicted of sexual crimes, and take greater precautions.

Conclusion

There is nothing more tragic than abuse that could've been prevented, but wasn't; families that could have remained together, but were instead torn apart. Child Abuse occurs every day and affects millions of lives. While it is unrealistic to expect to completely eradicate child maltreatment, preventative measures can and should be increased. By emphasizing prevention, child abuse can be drastically reduced and costs associated with child welfare can be decreased greatly. By preventing maltreatment through efforts to build child and family strengths, we cannot repair broken lives, but we can reassure grandmothers like Wallace, “This will never happen again.”



Administration for Children And Families. “Strengthening Families and Communities” http://www.preventchildabuse.org/publications/downloads/2009_resource_guide.pdf. Published 2009 web viewed 11/17/09

The 87 page document covered a lot of information. It added specific plans of action, questions to ask parents, information pamphlets, with talking points aimed at parents, kids and community members. It outlined ideas for broaching prevention ideas to children, conflict resolution data, information on appreciating children, age development expectations for children, community engagement, and public service announcements.

It encompassed a broad range of prevention techniques, covering children, parents, caregivers and the community. Further, the fact sheets were helpful in analyzing how one might go about identifying a family at risk without using stereotypical information (poverty, family stress, substance abuse) that can both expend resources where unnecessary and leave gaps where stereotypes do not exist, but abuse may become present. Another thing I thought was admirable was the ability of the approach technique to involve families in their own prevention (as in "parent partnerships" on page 12). Also I appreciated the position encouraging child welfare agencies to change their posture to support and mediate families in crisis, among case workers, foster parents, children and parents.


Blakester, Adam. “Practical Abuse and Neglect Prevention” Pub: Australian Institute of Family Studies National Child Protection Clearinghouse NCPC NEWSLETTER VOL . 14 NO. 2 , WINTER 2006 http://www.aifs.gov.au/nch/pubs/newsletters/nl2006/winterab.pdf web viewed 11/08/09

The author begins with Australian Statistics involving the prevalence and challenges of child abuse cases as well as potential cultural miscommunications between indigenous groups and child advocacy groups. While the introduction includes the broad statistics of Australia as a whole, the focus of the paper centers on indigenous aborigine groups.
The author covers 3 types of preventative strategies; primary, secondary, and tertiary, which involve 1. Community practices and attitudes that lend themselves to familial wellness, 2. Strategies that target high risk groups, and 3. Strategies that react and protect after abuse occurs.
The paper uses several case studies; one using an ecological approach to community focused emphasis on improved child and maternal nutrition; one very successful case restructured a South Wales community with additional tools that assisted parents and community members; one in Sydney used children's art to portray a vision of a desirable society. The children returned to 4 basic premises, respect, multiculturism, access to services, and "friendly places" (parks, healthy environments, etc.); and a Queensland group that assembled an action plan for Child Protection Week.

Much of the focus of the article involved using holistic, eco-psychological approaches to improve children's and family wellness. In most of the cases, change was not forced, but collaborated with members of the community, possibly contributing to the outcome. I will probably not refer to the statistics, but the case studies were highly interesting weather I do or don't use them. Further, the article cited other articles I may be able to use. Notably, the approaches seemed to be both highly fiscally and socially effective, a point with which I intend to conclude on my own paper. The diagrams within the article were particularly interesting, because while the case studies or the aborigines cannot easily cross cultural boundaries, the diagrams can be multiculturally effective.
Burgess, Ann. Essay:“Child Abuse Prevention: The Role of Nurse Examiners”. From book: “Preventing Child Sexual Abuse: A National Resource Directory and Handbook National Sexual Violence Resource Center, A Project of the Pennsylvania Coalition Against Rape” p. 17-18. published National Sexual Violence Resource Center, 2005
This 270 page book is compilation of essays from working professionals in the field of child sexual abuse. Burgess is a nurse practitioner, who discusses medical roles in prevention. She also describes factors which may have lead to an overall decline in child sexual abuse.
Caldwell, R.A." The Costs of Child Abuse vs. Child Abuse Prevention: Michigan’s Experience." Michigan State University June 12, 1992. www.msu.edu/user/bocost.html. Web viewed 11/08/09
The document was created to analyze the cost of Michigan's child abuse programs against it effectiveness. He describes the costs of preventative programs, and of interventive programs. He analyzes both direct and indirect cost of child abuse programs. The author was extremely thorough in his research, and while I could not use Michigan's numbers, many of the programs he described were useful in generating momentum for my own thoughts.
C. J. Newton MA, Learning Specialist "Child Abuse: An Overview", and published TherapistFinder.net) Mental Health Journal  April, 2001 web view 12/8/09  http://www.findcounseling.com/journal/child-abuse/abuse-neglect.html

Child Abuse Prevention Association "Programs and Services" http://www.childabuseprevention.org/Programs web viewed 11/08/09
This fact sheet contains a small description about some programs offered at their center.

Child Welfare Information Gateway. “Preventing Child Abuse and Neglect”. Web Published 2008. childwelfare.gov/pubs/factsheets/preventingcan.cfm Accessed November 2009 
This fact sheet provided information about preventative programs offered to assist in combating child abuse and a guideline for which factors most greatly impact success in preventative programs. It offered descriptions of some of the programs and discussed 3 types of prevention. The information was helpful for generating my own ideas and opinions about the subject.
Childhelp. "National Child Abuse Statistics". www.childhelp.org/resources/learning-center/statistics. Web viewed 12/08/09
This fact sheet offered a bulleted list of statistics on the effects of child abuse.

Green, Rob; DeVooght, Kerry; Allen, Tiffany. “Federal, State, and Local Spending to Address Child Abuse and Neglect in SFY 2006”. pub:December 2008 page 7 figure 1 www.childtrends.org web view 12/08/09

Ianelli, Vincent M.D. “Child Abuse Statistics.” About.com. Web Published July 15, 2007 pediatrics.about.com/od/childabuse/a/05_abuse_stats.htm. accessed December 12, 2009
This web publication offered basic information about child abuse. The author addressed the prevalence of abuse, who is abused, what constitutes abuse, and who reports abuse. Although the information was very broad, some of the details were helpful. I also was able to use his references to find more detailed information on the topic.

Leonardson, Gary R. Ph.D. “Substance Abuse Treatment Produces Savings in South Dakota”. Published 1995 by South Dakota Division of Alcohol and Drug Abuse
The five page report discusses both South Dakota and national substance abuse statistics, issues, cost to society and cost benefit ratio of prevention and treatment. I found the section on maltreatment particularly helpful and used several of his statistics.

National Coalition for Child Protection Reform. “Child Abuse and Poverty”. updated Jan. 1, 2008 viewed 12/8/09
This web paper focuses on the confusion of poverty with abuse as evidence of the need for the website's goal: child welfare reform. The paper outlined mislabeling poverty as abuse as a serious problem that causes great long term problems for children. It offers as evidence a list of families and the circumstances that led to out of home care. While the information evoked a strong emotional impact, and offered excellent resources for specific cases, it lacks credibility adding statistics. The authors did, however, create a strong introduction into the topic if they were willing in the future to elaborate on the following: How prevalent is the problem; and comparatively, which children have greater success indicators later in life?
National Coalition for Child Protection Reform “FOSTER CARE VS. FAMILY PRESERVATION: THE TRACK RECORD ON SAFETY AND WELL-BEING“. www.nccpr.org updated Jan. 1 2008 viewed 12/8/09
The main goal of the website is to support the case for child welfare reform and to encourage family preservation in place of removal of children from natural families. That in mind, this paper is one of a series of fact sheets, this one discussing and offering statistics on which children are safer from abuse, neglect and harm; children that remain in questionable homes or children who are removed. The information is substantiated, however the piece lacks credibility due to inability to present a comparative bigger picture.

Newton, C. J. MA, Learning Specialist "Child Abuse: An Overview", and published TherapistFinder.net) Mental Health Journal April, 2001 web view 12/8/09 http://www.findcounseling.com/journal/child-abuse/abuse-neglect.html

Prevent Child Abuse America “Fact Sheet: An Approach to Preventing Child Abuse”. www.preventchildabuse.org viewed 11/17/09

The fact sheet was a compilation of data about how their program advocated the "prevention of child abuse before it occurs". The document lists many different techniques including: home visits to new parents, prenatal and post natal preparation for emotional stresses during medical visits, high risk group education programs, early treatment and counseling for post-abuse children (to prevent perpetration by the former victim), good quality child care,life skills training for children and young adults, and crisis support.

I was certain programs like these existed, but have had difficulty finding information (except home visiting). I'm hoping the website has more similar resources, especially in areas of young adult life skills programs, which I would argue should be more required in school than Algebra. I have not and likely never will use any form of Algebra. Young adults need social education, anger management, and communication skills more. Back on point, am also looking for more information about high risk targeting and education.

Riccardi, Nicholas. “Grandmother Blames County in Latest Death of Foster Child” Los Angeles Times B1 June 15, 1999
The article described the heart wrenching story of a grandmother, who's grandchild was beaten to death in foster care. Two years prior, the children had been removed from the grandmother's home after the family experienced plumbing problems. The article discussed another grandchild who resided in a mental hospital after experiencing sexual abuse in a separate foster home. I referred to this article as a way to establish problems with the current solution, and suggest that at times the cure is worse than the disease.
Rape and Abuse Crisis Center. “Red, Flag, Green Flag”. Published 1980, revised 1987

This booklet is geared toward an elementary school aged child audience and discusses safe and unsafe touching, grownups to trust and how to handle a “red flag touch”. I think this type of booklet (activity book) combined with discussions addressed throughout elementary and middle school can be and has proven to be an excellent resource in reducing child sexual abuse.

Research

National Coalition for Child Protection Reform FOSTER CARE VS. FAMILY PRESERVATION: THE TRACK RECORD ON SAFETY AND WELL-BEING read on the web 11-25-09 www.nccpr.org

There is alot of information throughout this site that contrasts child protection agency intervention- removal from families- with family preservation. I was familiar with most of this data before finding it on the website. The site offers case studies of children abused within the foster care system, case studies of children who shouldn't have been removed from their birth parents, racism, cultural supremacy and poverty removals, suggestions for improvement.

This paper in particular, is a short opinion piece evaluating the records of various states, and comparing it to data on how many children are abused in the system. One problem with this type of information is that it is difficult to get accurate numbers, with child welfare agencies who often investigate claims of foster care/ group home abuse directly interested in the groups and homes. It is there fore difficult to get unbiased results.
From my own experiences, I can say that I have witnessed firsthand abuse and neglect in 5 of 8 of the foster homes I grew up in, even to the severity of hospitalization. When it was repoorted, no follow up occured. Years later, one of the more violent homes, who had been reported a number of times for physical abuse recieved Utah's Foster Family of the Year award.

Outline

Outline
Thesis: Prevention should be emphasized and preferred over intervention to end child abuse. (it’s weak, I know)
1. Prevention costs less than intervention
a. Total cost of intervention.
• foster/residential care
• incarceration of victims
• cost of institutionalizing/ rehabilitating perps
• legal costs
b. Proposed and current cost of preventative
c. Long Term cyclic increasing cost of intervention
d. Long term potential savings – prevention
2. Interventive Programs are relatively ineffective in preventing effects of child abuse
a. Future criminality & high risk behavior after abuse
• % abused adolescents and teens incarcerated or legally disciplined
• % of incarcerated adults abuse survivors
• high risk sex, drugs, careers, pregnancy, perps
b. Quality of life
• emancipated into homelessness/ extreme poverty
• homeowners/ income ownership
• % below poverty line
• depression & related illness
• health
c. Abuse continues within the social welfare system
• state fiscal motivation not to improve family condition
• deaths in state care
• educational/ social stigma and neglect
• association with high risk groups/ drugs/ behaviors
3. Preventative programs are effective.
a. Austrailia studies
b. Sexual abuse successful decline in the US
c. High risk groups can be targeted for additional assistance
d. Education linked to better parenting/ caretaking

4. Not quite sure yet
5. Conclusion- proposal
a. Increase focus from intervention in all but severe child abuse cases to familial preservation through increased support, education, and rehabilitation, and anger/ stress management
b. Increase preventative education through social skills/ anger & relationship management programs in all school levels
c. Increase funding for effective programs that educate parents and caretakers, offered at free or low cost for adults at local neighborhood locations.
d. Offer educative child development and parenting classes as part of prenatal care, including home visitation assistance for risk groups.
e. Increase community funded safe after school & child care programs, and emergency respite care
f. Apply pressure on leaders to promote family wellness requirements such as required paid maternity/ paternity leave, better crisis housing, substance abuse treatment, and low cost counseling for parents/ children/ families and community members