Child Maltreatment

1
Child Maltreatment

• Chapter 2

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.

3
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.

4
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.

5
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.

6
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.

7
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.

8
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.

9
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.

10
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
  familys strengths and cultural background, as
  well as the applicability of measures with
  diverse populations.

11
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.

12
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 1990s.

13
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.

14
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 childs early environment.
• This scale consists of some self-report items
  however, the majority are based on observation of
  the parent and child.

15
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.

16
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.

17
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.

18
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.

19
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).

20
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.

21
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.

22
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.

23
Summary

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