Child abuse and neglect: Incidence and prevention
Child abuse and neglect: Incidence and prevention
- Defining the Problem
- The Causes of Child Abuse and Neglect
- The Abusers
- The Effects of Child Abuse and Neglect
- Cost Effectiveness and Preventative Measures
Developments in the past twenty years have placed child abuse and neglect on the public agenda in a way not previously seen. Australia, like other countries, began to acknowledge the existence and extent of the physical abuse of children during the 1960s and 1970s. This process began with an article published in the Journal of the American Medical Association in 1962 by Kempe and his colleagues where the term 'Battered Child Syndrome' was initially identified (Kempe et al. 1962, pp. 17-24), and medical practitioners were challenged to recognise the incidence. The controversy surrounding the Kempe et al. proposition therefore drew attention to the issue of physical abuse and neglect. As a result it was recognised that widespread damage was being caused to children by society's denial of the problem (Helfer and Kempe 1976). Legislative reform and professional concern followed. At the international level, this led to the United Nations Declaration of the Rights of the Child which codifies the concept that children as individuals have certain rights separate from adults. In 1981 Australia became a signatory to this Declaration.
During the 1980s, the focus of attention moved to child sexual assault when physically abused and neglected children began revealing they were often sexual abuse victims as well (Finkelhor 1986). Alongside this, surveys by rape crisis centres and sexual assault centres showed that many adult women had been sexually abused as children. And, increasingly it is being reported to statutory agencies that young boys are often victims of sexual abuse by people they know and trust (Oates 1990, Goldman and Goldman 1988). The result of all this has been the introduction of more significant legal changes, service development and procedural reform.
Mandatory reporting laws have now been introduced in all Australian States and Territories, except Western Australia and the Australian Capital Territory, where they are under consideration. The laws, however, differ quite significantly in both procedure and requirements (see Angus and Wilkinson 1993, pp.4-5).
Recently there has been an increase in public awareness of the intricacy of all of the issues connected with child abuse and neglect, as well as a realisation of the complexity of the responses required. Much of this is due to increased television, radio and newspaper coverage of the topic as well as specific mass media campaigns.
The professional community, however, continues to recognise that child emotional abuse and child neglect can be just as damaging as child physical abuse and child sexual abuse. There is, therefore, a concern to understand both how best to respond to the issue and what can be done to prevent all types of child abuse and neglect from ever occurring in the first place. The long-term nature of the problem and the difficulties in finding solutions has led to the search for more refined responses which involve a range of activities and support programs (Calvert et al. 1992, p.12). This needs to involve an interdisciplinary perspective and extend across the community in order to protect abused children and bring about change in their families (Untalan and Mills 1992).
Defining the problem
There are many legal and operational variations in the definition of child abuse in Australia, which makes it difficult to provide con sistent national data on incidence. Indeed, variations may occur depending on the context in which they are used. For instance, govern ment departments may use different definitions from those used by community service professionals. However, all of the definitions refer to the physical or psychological damage caused to the child by the abusive behaviour of others, or the failure of others to protect a child from such damage. Most commonly, the categories of abuse cover physical, emotional and sexual abuse, as well as neglect.
The debate surrounding child abuse has now moved away from disbelief that it occurs, to legal and academic discussion as to what parameters it includes (Boss 1987). Many of these arguments centre around disciplinary and other childrearing practices which can sometimes be abusive. For instance, the physical abuse of children can be seen in the context of the prevailing values in our society, where there is a degree of acceptance of violence as a legitimate means of attaining ends. This element of violence is represented in child-rearing practices where physical force is condoned and in some cases encouraged as a disciplinary measure (Miller 1988, Edgar 1991).
Child abuse is, however, more generally characterised by the deliberate infliction of physical, emotional or sexual harm on the child. Child neglect can also incorporate a situation in which there is a failure to provide conditions which are essential for the health, physical and emotional development of the child. The following more detailed descriptions can help identify children in need of intervention.
Physical Abuse is characterised by physical injury (for example, bruises and fractures) resulting from practices such as punching, beating, kicking, biting, burning, or otherwise harming a child. Although the injury is not an accident, the parent or caretaker may not have intended to hurt the child. The injury may have resulted from overdiscipline or physical punishment that is inappropriate to the child's age or condition. Or, it may occur when an adult accidentally causes injury by shaking a baby vigorously through anger.
Physical injury may emanate from either a single episode, or from repeated episodes. It can range in severity from minor bruising to death. A single bruise, for example, may be inflicted inadvertently; however, old and new bruises in combination, bruises on several areas of the face, or bruising in an infant suggest abuse (DePanfilis and Salus 1992).
Emotional Abuse is a behavioural pattern whereby a parent or caregiver attacks a child's self-esteem and social competence over a period of time. Some examples of actions which may result in emotional abuse are: children constantly being told they are no good or worthless; children being continually rejected and shown no affection; children subjected to repeated verbal abuse and threats; children punished by being locked up alone or not being allowed to have friends or social activities (NSW Child Protection Council 1993).
Emotional abuse can harm children just as much as other forms of abuse, with which it can occur concurrently. It may, however, be difficult to identify because it does not leave any physical injuries. It often goes unrecognised until a child shows signs of emotional problems. These signs can include: changes in behaviour; lying and stealing; destructive or violent behaviour; rocking the body or sucking things; being very withdrawn or depressed; being aggressive and constantly seeking attention. These signs can also indicate other forms of abuse (NSW Child Protection Council 1993).
Sexual Abuse occurs when an adult or older person uses his or her power over a child to involve the child in sexual activity. The abuser may trick, bribe, threaten, and if necessary force a child to take part in sexual activity. Child sexual assault can include suggestive behaviour or comments, exposure, fondling genitals, masturbation, oral sex, and penetration of the vagina or anus by a finger, penis or any other object. It includes exhibitionism and suggestive behaviour or comments (New South Wales Child Protection Council 1993). Child sexual abuse has, in fact, been defined as 'the involvement of a dependent and develop mentally immature child or adolescent in the sexual activities of an older person/adult, where the younger person is used for the gratification of sexual desires or needs of the older person or where social taboos or family roles are violated' (Child Sexual Abuse Task Force 1987).
Child Neglect is characterised by failure to provide for the child's basic needs. Unlike other forms of abuse, it is an act of omission by a caregiver which jeopardises or impairs the child's physical, intel lectual, or emotional development. A child who is neglected may be at risk of injury or harm owing to inadequate supervision. They may also be constantly tired, hungry, listless, or have medical conditions related to poor hygiene or experience a failure to thrive (South Australian Child Protection Council 1989).
In Australia during 1990-91, there were 49,721 cases of child abuse and neglect reported and investigated by State and Territory Welfare Departments. Forty-five per cent of these cases were substantiated and a further 7 per cent were assessed 'child at risk'. Combined, these represent a rate of 4.9 children per 1,000 children aged between 0-16 years (Angus and Wilkinson 1993, p.8).
Ever since statistics have been kept by State Welfare Departments, the numbers of children reported and confirmed as having been abused have continued to increase. This could be due, in part, to a greater community awareness of the problem rather than an increase in incidence. Educative and legislative changes also mean that professionals are becoming more adept at recognising child abuse with resultant higher notification rates, whilst parents, friends and the community are identifying and responding to the issue more often.
Incidence of Types of Child Abuse and Neglect
The proportion of substantiated cases is similar for each of the four types of abuse and neglect (Angus and Wilkinson, 1993, p.9).
Children of both sexes are represented almost equally overall in substantiated cases of neglect, physical abuse and emotional abuse, while females are the victims in 75 per cent of sexual abuse cases. The age of children represented in the substantiated cases of both physical and emotional abuse is reasonably evenly spread among children aged up to 14 years. Sexual abuse, however, is overwhelmingly higher among females in the 10-14 years category, while the largest proportion of substantiated neglect cases is in children under the age of 5 years.
However, because many occurrences of child abuse and neglect go unreported or undetected, official figures do not necessarily state the true incidence. They tend to reflect only what State government agencies are doing.
Child Abuse Homicide
It is generally accepted that a strong link exists between fatal and non-fatal child abuse, and that the extensive body of literature and research which focuses on non-fatal events provides useful insights into the causes of fatal events (Gelles 1985, Strauss and Kantor 1987). From the reverse perspective, it has been concluded in a study of cross national determinants of child homicide that because fatal incidents are so often preceded by less serious forms of abuse, the charac teristics of these homicides help us to understand the causes of non fatal events (Fiala and Le Free 1988).
An analysis of Australian homicide data during the three-year period from mid-1989 to mid-1992, has shown that there were 86 victims aged under 15 years. Sixty of these children were killed by their parents or de facto parents. Three of the remainder were killed by other family members, and twelve by acquaintances; only three were known to be victims of strangers, whilst for a further eight the offender's identity was unknown (Strang 1993).
Twenty-two of these child homicides were classified as resulting from deliberate abuse. All were aged under 4 years and fifteen were less than 12 months of age (Strang 1993). The assessment of abuse was based upon the character of the event: the assault upon the child was sudden and impulsive, the offender was the caregiver and the immediate stimulus arose from the victim (d'Orban 1979). (A further thirty-two children died as a consequence of a family dispute, while twelve were victims of the psychotic illness of the offender. Six of the children were known to be victims of a fatal sexual assault, and two were abandoned neonates. The remaining victims died in a variety of circumstances, and in most of these cases not enough is known to classify their deaths in any satisfactory way) (Strang 1993).
The causes of child abuse and neglect
Child abuse and neglect occur across all socioeconomic, religious and ethnic groups. No one single source can be identified (Finkelhor and Korbin 1988). Moreover, different types of child abuse have different features; for instance, the circumstances surrounding the sexual abuse of children may be quite different from those surrounding cases of neglect or physical abuse. However, the pattern of interaction between the adults, the children, and the corresponding environment provides some identifiable correlates. These are described below.
Problems resulting from a lack of skills and knowledge have been suggested as characteristic of some abusive adults. These include lack of parenting skills (including overuse of physical punishment), problems with coping and self-control, marital difficulties, and a general deficiency in interpersonal skills. Inadequate knowledge of child development may result in inappropriate parental expectations and this, in turn, can contribute to abusive behaviour. This may manifest itself in behavioural patterns which accept violence as a way to solve family problems, or a belief that children are the property of their parents (National Center on Child Abuse and Neglect 1992).
Specific situations, such as early or premature pregnancy, physical illness, and poor ability of parents to empathise with their children, can substantially increase the likelihood of physical and emotional child abuse, as well as neglect. This is particularly so when social stress and social isolation characterise the family; a lack of support networks may contribute to difficulties. Drugs and alcohol as well as poverty can also be contributing factors (Garbarino 1982). With child sexual abuse, an additional risk factor is a particular adult view of masculinity where there is a need to sexually dominate a child as a means of demonstrating power.
Certain children are more physically and emotionally vulnerable than others to abusive and neglectful behaviour. The child's age as well as physical, mental, emotional, and social development can greatly increase or decrease the likelihood of abuse and neglect, depending on the interactions of these characteristics with parental factors outlined above. Younger children, due to their size and development status, are particularly vulnerable to physical abuse, emotional abuse and neglect (DePanilis and Salus 1992). It must be emphasised, however, that although there are characteristics which make children vulnerable, children are not responsible in any way for their abuse.
The reaction of adults to behaviour such as aversive crying and unresponsiveness in children, can increase the likelihood of abuse. This is particularly the case if the adult has poor ability to empathise with the child and experiences difficulty in controlling his or her emotions. Infants who are constantly ill, or who have experienced low birthweights due to such factors as prematurity, could be less capable of eliciting positive responses from mothers who lack not only nurturing skills but practical support. In general, children who are perceived as 'different', such as disabled children, are at greater risk (Jaudes and Diamond 1985). And, indeed, social isolation is as much a contributory factor for children as it is for parents. The incidence of child sexual abuse may increase with emotional deprivation in a child who may then be more readily coerced into accepting an abnormal form of 'affection' from an adult (Oates 1990, p.11).
The specific circumstances of some families can increase the likelihood of child abuse and neglect. These can include such factors as marital conflict and domestic violence, difficult relationships with extended family members, employment problems and, once again, social isolation. Physical and health problems may also increase the risk. As a result, families involved in child abuse and neglect tend to exhibit a pattern of day-to-day interaction characterised by a low level of social exchange, low responsiveness to positive behaviour, and high responsiveness to negative behaviour. Ineffective and inconsistent punishment and discipline are often used. Research on attachment and bonding has also demonstrated the importance of early parent-child interactions within the first days of life, particularly with premature and ill new-born babies. Studies have found that the less parent-infant contact during the peri-natal period, the more likelihood there is of abuse and neglect occurring (Wolfe 1991).
It has been suggested in the United States that blended and step families are at an increased risk of child sexual abuse, where girls living with stepfathers rather than biological fathers, are five times more likely to be reported as having been sexually abused. Girls are at increased risk from the boyfriends and suitors of their mother who may be seeking a new partner (Finkelhor 1979, Russell 1984).
Environmental factors are often found in combination with child, adult and family factors. For example, changes in financial conditions, employment status or family structure may shake family stability. Some parents may not be able to cope with the strain resulting from these changes, and as a result may experience difficulty in caring for their children (Wolfe 1991).
Stress caused by conditions such as poverty is also associated with higher rates of reported child abuse and neglect (Vinson et al. 1989). And, indeed, structural factors such as health and housing are as important as income in contributing towards the incidence of child abuse and neglect. As the social structure in which a family lives becomes more stressful, more and more reliance by adults on coercion and violence to control the irritating daily events is likely to occur (Wolfe 1991).
On a structural level, it must also be recognised that inadequate welfare resources which may result in unsuitable policies, practices and procedures both within government departments and institutions, can be a major problem. This leads to an extension of child abuse and neglect from a perception of a problem which largely occurs in families to its inclusion within broader societal systems.
Systems and Organisations
Three types of abuse which can be included in societal systems have been identified: institutional abuse; program abuse; and system abuse. Institutional abuse has been defined to include abuse as a result of: 'any system, program, policy, procedure or individual interaction with a child in placement that abuses, neglects, or is detrimental to the child's health, safety, or emotional and physical well-being, or in any way exploits or violates the child's basic rights' (Gil 1982, p.9). Program abuse has been defined as occurring when 'programs operate below accepted service standards or rely upon harsh and unfair techniques to modify behaviour' (Gil 1982, p.9). System abuse has been defined as abuse that is 'perpetuated not by a single person or agency, but by the entire child care system stretched beyond its limits' (Powers, Mooney and Nunno 1990).
Most abusers are known to the child or have some relationship to the child. Parents were identified as responsible for abuse or neglect in over half of the substantiated cases referred to by the Australian Institute of Health and Welfare in 1990-91 (Angus and Wilkinson 1993). In fact, parents were responsible for 54 per cent of cases; step parents, de facto parents, foster parents and guardians were cited in 10 per cent of cases; siblings and other relatives were the offenders in 6 per cent of cases; friends and neighbours in 8 per cent of cases; and persons other than relatives or friends and neighbours represented 22 per cent of the cases (Angus and Wilkinson 1993, p.13). A detailed breakdown of the relationship of the maltreater to child by type of abuse and neglect is shown at Figure 3.
Australian citizens who travel to other countries and use children for either pornography or prostitution are also abusers. In particular, governments and the community have begun to show concern about Australian men's abuse of children in Asian countries. It is most likely that these men are also sexually abusing children in Australia (Calvert 1993, p.9).
The effects of child abuse and neglect
In a study to determine the effects of child abuse and neglect, it was concluded that 'we do not believe that many children can develop coping skills and be emotionally healthy in a chronically abusive or neglectful environment' (Farber and Egeland 1987). And, indeed, there is evidence that the immediate effects of physical abuse can be catastrophic for children, sometimes resulting in mental retardation, brain damage or death. The longterm consequences can also be devastating, leaving physical and emotional scars which may result in psychiatric illness (Burdekin 1993), or an inability to form meaningful relationships. One of the most extreme responses to this can, in fact, be youth suicide (Kosky 1987). On the other hand, there may be an outward manifestation of the abuse, such as unusual aggressiveness or assaultive behaviour replicating that which was inflicted. Eckersley (1988) and the Burdekin Report (1989) both refer to marginalised adolescents who are victims of child abuse and family fragmentation.
The more hidden effect on children of continually witnessing domestic violence may have similar results as direct abuse and neglect. Children in such situations can, like abused children, exhibit low self-esteem, lack of trust in adults, attention-seeking behaviour, chronic illness, allergies and frequent injuries, self-destructive behaviour including substance abuse and offending, as well as depression and homelessness (Blanchard et al. 1992).
Finkelhor (1984, 1986) proposes that early experiences have a powerful outcome on adult behaviour. And, in fact, an abusive childhood has been documented as the most consistent factor in the histories of those who abuse children. These parents have rarely experienced nurturing, trusting relationships with their own caregivers (Steele and Pollock 1968).
In a recent study (Widom 1992) conducted in the United States, the consequences of abusive experiences have been the subject of extensive research on the link between child abuse, neglect and criminal behaviour. A group of people who had suffered childhood abuse and neglect were compared with a matched group not officially recorded as maltreated. They were tracked through official records over a 15 to 20 year period. It was found that in the group of people who had been abused and neglected as children, the odds of future delinquency, adult criminality overall and, specifically, arrest for a violent crime, increased by around 40 per cent.
The gravity of child abuse and neglect in Australia is demonstrated by a range of reports (Donovan and Francas 1992, National Committee on Violence 1990, South Australian Government Taskforce 1986, NSW Child Sexual Assault Task Force 1985). One of these, the Report of the National Committee on Violence, recommended that the prevention of child abuse and neglect be the responsibility of a national body (Recommendations 21 and 22). In 1991, the Prime Minister announced the establishment of the National Child Protection Council, the mandate of which is to prevent child abuse and neglect.
The National Child Protection Council is made up of representatives from each State and Territory Government, the Commonwealth Government, and the community and reports to the Commonwealth Minister for Family Services. As a result, there is now a commitment from both Federal and State Governments to cooperate in a coordinated national approach. Under its Terms of Reference (National Child Protection Council Secretariat 1992), the Council is entrusted with working cooperatively to give a national focus to the prevention of child abuse and neglect, and aims to achieve this by:
- promoting and commissioning research on child abuse and neglect;
- encouraging attitudes which will lead to a reduction in child abuse and neglect;
- promoting non-violent and non-abusive child rearing practices and ideas in the home and community;
- identifying and pursuing other strategies appropriate to the prevention of child abuse and neglect.
The National Child Protection Council is particularly concerned with developing primary and secondary prevention strategies to reduce the incidence of child abuse and neglect. It recognises that the protection of children is closely linked to the concept of strengthening families. This in turn, is associated with the need for a general change in community attitudes to reflect the value and importance of children, as well as the need for improvements in income, health and housing so that parents' ability to care for children can be enhanced. A detailed national strategy with these objectives for preventing child abuse has been developed for the National Child Protection Council (Calvert 1993).
Primary prevention refers to programs targeted at the whole community with the aim of stopping abuse before it starts. It encompasses both children and adults by including such strategies as mass media advertising, education through the publication of pamphlets and personal safety programs for children. Examples include: National Child Protection Week promoted by NAPCAN; the 'Pete and Penny' program sponsored by the Medical Benefits Fund (MBF); and the media campaigns run by State governments, such as: Victoria's 'Stand Up Against Child Sexual Abuse, Western Australia's 'Grow Together', the anti-verbal abuse campaign run by the Queensland Centre for the Prevention of Abuse; the NSW Child Protection Council's campaign from 1986 to 1988; and also the Personal Safety programs which are conducted through schools and groups in many parts of Australia (National Child Protection Council Secretariat 1992).
Secondary prevention refers to programs which target specific sections of the population considered to be more at risk of abuse and in greater need of support. Examples of such programs are young parent support services, isolated single parent services and respite services, including crisis care (National Child Protection Council Secretariat).
By understanding complex family environments, it is possible to formulate prevention programs for families who may have special needs; for example, people living in rural and remote areas, Aboriginal and Torres Strait Islander peoples, those who are physically and intellectually disabled and those from non-English speaking backgrounds. It is essential to take into account traditions, patterns and systems which maintain particular beliefs about men and women in a way that recognises the influence these beliefs have on the incidence of child abuse and neglect and its prevention (Pecora et al. 1992; Calvert et al. 1992).
However, an audit of all primary and secondary child abuse prevention programs currently being conducted by the National Child Protection Clearing House has confirmed that, in general, child abuse prevention activities are not widely available and do not cover all forms of abuse. In addition, child abuse prevention media campaigns conducted to date have tended to be of limited duration and frequency.
Several overseas programs demonstrate the possible scope of primary and secondary prevention initiatives. For example, the Healthy Start program in Hawaii identifies participants by screening hospital births and interviewing new mothers. For families considered in need, lay home visitors provide supportive, non-stigmatising services which continue until the children are 5-years-old (US Government General Accounting Office 1992, p.50). In the United Kingdom, voluntary services are also used in an adaptation of this model called Homestart.
Another example from the United States is the Elmira Prenatal/Early Infancy Project; a family support program which involves nurse home visiting. This has been remarkably successful in bringing about a reduction in child abuse among women bearing first children, who were either teenagers or unmarried and of low socioeconomic status. The project reported a 50 per cent reduction in the child abuse rate as well as improved conditions through maternal education and the reduction of subsequent unintended pregnancies (US Government General Accounting Office 1992, p.64). The program is presently being replicated and evaluated elsewhere in the United States, an essential process in gauging program effectiveness.
Tertiary prevention, which refers to intervention to help those who have already been abused, with the aim of preventing its recurrence, is the responsibility of State and Territory governments. Examples of tertiary prevention include the provision of services to cater for the needs of abused children and their families and the enactment of legislation to protect children or punish alleged offenders.
Faced with the need to take urgent action to protect children, governments have, up to now, concentrated most of their efforts on tertiary prevention through meeting the immediate needs of children who have been abused. Estimates based on South Australian costs put the total expenditure of this response by the various State Departments of Community Services in 1991-92 at approximately $90 million not including the cost of the services provided by health workers, police and community organisations (Calvert 1993).
Cost effectiveness and preventative measures
The Government Accounting Office in the United States has identified studies which suggest that, while primary and secondary prevention can be costly, it pays for itself in the long run (US Government General Accounting Office 1992, p.23). One of the studies (Daro cited in US Government General Account Office 1992) estimated that the cost in future lost productivity of severely abused children in the USA was between $658 million and $1.3 billion annually, based on the assumption that the children's impairments caused by the abuse would limit their potential earnings by just 5 to 10 per cent (US Government Accounting Office, p.25 cited in Calvert 1993 p.10).
Another study by the Michigan Children's Trust Fund, compared the costs of an early intervention program which started prenatally and worked intensively with parents for the first year of a child's life, with the costs incurred when a child is abused (US Government General Accounting Office, p.25 cited in Calvert 1993, p.10). The study showed that, offering the early intervention to every family in the state was approximately one-twentieth of the costs associated with abuse and low birthweight babies.
Australia's signature on the United Nations Convention on the Rights of the Child, as well as State and Territory legislation, represents government acknowledgment of responsibility for protecting all children from harm. The Australian community, in turn, has a responsibility to ensure that this becomes a reality. The price of child abuse and neglect in human costs, human resources, and monetary terms, is too high to ignore. Child care, practical support and parenting programs as well as treatment programs are needed. Effective child abuse prevention must develop from a strong child, family and services base. Unless children and families have adequate housing, health, education and income security, efforts to prevent child abuse will be hindered. Government, community and individual attitudes also need to reflect the value and importance of children in Australian society.
Equally important to the success of child abuse prevention is the coordination of programs and activities inherent in a national approach. This has the potential to strengthen the role of both the local community and the family making the cumulative impact greater. The creation of a more caring and safer society for Australia's children must therefore assume universal priority as we approach the third millenium.
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