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Journal Issue: Preventing Child Maltreatment Volume 19 Number 2 Fall 2009

Progress toward a Prevention Perspective
Authors: Matthew W. Stagner Jiffy Lansing

The Evolution of Child Maltreatment Prevention in the United States

Child maltreatment prevention has evolved in a complex policy environment over the past forty years. Despite decades of public efforts to combat abuse and neglect, child maltreatment remains a significant social problem in the United States. Finding the most effective ways to prevent maltreatment could reap significant benefits both for individuals and for society, but the best ways to identify and respond to those at risk of maltreatment remain elusive.

Modern perspectives on child maltreatment can be traced to the early 1960s, when advances in radiological technology enabled physicians to visualize and document abuse.5 In 1962, Dr. Henry Kempe published the first empirical work on the scope of “battered child syndrome,” describing for the first time the medical aspects of child abuse.6 Kempe’s study documented more than 300 cases of suspected maltreatment discovered in emergency rooms. It provided insight into the scope of the problem, served as a model for similar scientific surveys, and offered “diagnostic clues” for physicians and other frontline responders. It also made an explicit public policy recommendation to develop an official reporting system to protect children who are suspected of being victims of abuse.

In response to Kempe’s call for action, states began to develop response systems and reporting laws. The laws required professionals working with children, such as doctors, teachers, and therapists, to report suspected cases of child maltreatment to a state agency.7 For states that adopted official reporting systems, Congress authorized grants to be used to protect children against abuse. By 1967, in what Barbara Nelson calls “one of the most rapidly adopted legislative trends in the twentieth century,” all states and the District of Columbia had passed some form of reporting laws.8 The medical field continues to have a strong influence over child maltreatment intervention, though state reporting and response systems now focus on social, rather than medical, services.

During the 1960s and 1970s, these newly developing social service channels motivated the public to begin reporting suspected abuse. David Gil’s 1965 public opinion poll revealed that although only 23 percent of respondents said that they would report families they suspected of being involved in child maltreatment to the police, 45 percent said they would report such suspicions to social service agencies.9 The increase in formalized channels for reporting helped to build the field of child maltreatment prevention as a scientific and applied endeavor. It also advanced the professionalization of practitioners working with children and families affected by maltreatment. The focus of these systems, however, was on responding to reports of maltreatment, rather than on prevention.

The federal Child Abuse and Neglect Prevention and Treatment Act (CAPTA) was signed into law in 1974. Though “prevention” was part of the title, the initial legislation was largely based on preventing the recurrence of child maltreatment through establishing reporting laws and child protective service systems. CAPTA’s initial guidelines encouraged states to establish specific agencies to track and investigate reports of maltreatment with the aim of protecting the children from future harm after a report was made.

Most interventions in the child maltreatment field are now geared toward families first known to authorities after maltreatment occurs. In 2006, charges of abuse or neglect were substantiated for an estimated 905,000 children.10 In nonfatal cases of substantiated abuse, nearly three-quarters of victims (74.7 percent) had no history of prior confirmed victimization, and about 10 percent were infants under the age of one year, meaning, for first children, there was little time to intervene.11 One study found that approximately 19 percent of fatalities caused by child maltreatment occurred in infants under the age of one year. Almost a third of these infants—32.7 percent—were less than one week old.12

The CAPTA legislation, which has gone through many amendments, was most recently reauthorized as the Keeping Children and Families Safe Act of 2003. This latest incarnation highlights the growing interest in preventing maltreatment before it occurs by directly funding child maltreatment prevention. The law also funds assessment, investigation, prosecution, and treatment activities and supports research, evaluation, technical assistance, and data collection activities. It established the Office on Child Abuse and Neglect within the federal bureaucracy.

Child maltreatment policy efforts are complicated by social mores, such as continuing corporal punishment in some schools, violence in the media, or neighborhoods with entrenched poverty, and by public policies, such as those that lead to poor educational systems or limited access to health insurance.13 Over the past few decades, public consciousness about child maltreatment has been raised by professional recognition of the problem, scientific research on the causes and effects, increased media attention to incidents of abuse, and advocacy for policy developments. New policy developments include flexibility in eligibility requirements and federal funding to support community-based early interventions, family-strengthening efforts, early education programs, and child welfare system infrastructure enhancements.14