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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

Challenges in Developing a Prevention Approach

Several barriers have slowed development of a prevention orientation in the field of child maltreatment. The first has been difficulties in defining the problem to be prevented. The second has been a failure to understand the full consequences and costs of child maltreatment. The third has been incomplete understanding of the causes of maltreatment and the ways in which intervention might interrupt those causes.

Definitions
A clear definition of child maltreatment continues to elude experts in the field. CAPTA sets forth a minimum definition of child abuse and neglect as any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse, or exploitation; or an act or failure to act on the part of a parent or caretaker that presents an imminent risk of serious harm.15 Although the medical field is uniquely positioned to identify physical maltreatment of children after the fact, experts broadly agree that child maltreatment can involve harm that leaves no physical evidence.

The definition of child maltreatment now includes physical, emotional, psychological, and sexual abuse, as well as “neglect.”16 Neglect is an imprecise term that can encompass caregivers’ neglect of physical needs such as food, clothing, and shelter, neglect of education, neglect of medical care, and emotional neglect. The term neglect is also susceptible to cultural interpretations of parenting practices in the United States.17 In some cultural enclaves, it is not considered neglectful for children to stay in the home unsupervised because of the proximity of extended family or close ties in the neighborhood. In others, some medical interventions are avoided because of religious beliefs. Depending on the context and legal standards of neglect, these culturally specific practices could be considered child neglect and children could be removed from the home if other strategies are not employed to promote parental behavioral change. Because CAPTA’s definitional framework sets only minimum standards, the details of a definition fall to state policy makers, with the result that definitions of, and legal consequences for, child maltreatment vary by state.18 For this reason, researchers must take into account the range of state definitions when aggregating and interpreting state data.

State definitions remain broad enough to require practitioners in the medical, social services, educational, and legal fields to make case-by-case clinical judgments, some of which can be individually biased or systematically flawed.19 Despite decades of federal and state legislation, these issues continue to challenge the field and heighten the importance of defining child maltreatment and its consequences.

Consequences
Both short- and long-term effects of maltreatment can be severe, for individual children as well as for society. The most serious consequence is the death of the child. In 2006, 1,530 children died as the result of abuse or neglect in the United States.20 In addition, many early childhood deaths attributed to accidents or sudden infant death syndrome (SIDS) may be due to maltreatment.21 Despite imprecise reporting, child maltreatment is the leading cause of injury-related death for children less than one year of age.22

A number of studies indicate that child maltreatment inhibits successful development. Some immediate consequences include physical injuries,23 delayed physical growth,24 neurological damage,25 and cognitive and language deficits.26 Moreover, these consequences are often interrelated. Penelope Trickett and Catherine McBride-Chang found in a review of research that maltreatment had psychobiological consequences, perhaps as a stress reaction.27 Maltreatment affects development and adjustment, as well as relationships with parents, other adults, and peers. Problems include aggression, withdrawal, and isolation.

Maltreatment can directly affect a child’s brain. Danya Glaser found a stress response in the brain in maltreated children, as well as biochemical, functional, and structural changes that are not part of the stress response.28 She concluded, “There is considerable evidence for changes in brain function in association with child abuse and neglect.” These neurobiological findings explain some of the emotional, psychological, and behavioral difficulties facing maltreated children.

Many of the consequences of maltreatment continue into adulthood. Child maltreatment is associated with long-term psychological and emotional problems such as depression, self-injurious behavior, and increased risk of suicidal ideation;29 increased risk of substance abuse, aggression, and criminal activity;30 and post-traumatic stress disorder.31 Cathy Widom found that abused and neglected children had higher rates of adult criminality than a matched control group.32 Amy Silverman and several colleagues found that abused children were functioning more poorly at age twenty-one than were non-abused peers.33 Robin Malinosky-Rummell and David Hansen reviewed seven areas of possible long-term consequences of childhood physical abuse and found that physically abused children demonstrate significantly elevated levels of nonviolent criminal behavior.34 Relational problems associated with the effects of child maltreatment can cause further harm and significant costs to society.35 The effects of maltreatment, in short, compromise lifetime productivity.36

Causes
Policy makers need to understand the wide range of potential causes of child maltreatment before they can develop a clear framework or theory for intervening. One task is to understand risk factors associated with child maltreatment. Another is to consider a range of theories that can tie these risk factors together and provide insights for prevention.

Child maltreatment is associated with many risk factors. Some involve the child, some the parent, and some the context in which the family lives. For example, one clear risk factor is the child’s age. Many studies indicate that the younger a child is, the higher the risk for severe or fatal maltreatment.37 Since 1983, about one-fifth of all children who are admitted to foster care because of maltreatment are less than a year old.38

Parent risk factors are heterogeneous and cannot be characterized by a single psychological orientation or social situation. Risk seems to be related to both internal factors (competencies and vulnerabilities that the parent brings to the situation) and external factors (stressful or socially isolating factors that would affect anyone in that situation).39

Contextual risk factors that contribute to maltreatment risk include small, sparse social networks40 and community disorganization and violence.41 Some data also suggest correlations between child maltreatment in the home and domestic violence, substance abuse, single parenting, and teen pregnancy.42 Among contextual risk factors, the relationship between poverty and maltreatment is particularly complex. Maltreatment is more commonly reported to child welfare agencies in poor and extremely poor families than in families with higher incomes.43 It is unclear whether the discrepancy in rates of reporting accurately reflects maltreatment incidents. The higher rate for families in poverty may be skewed by data collection methods,44 disparity in services to populations in different geographical areas, and professional bias. One study found significant underreporting by hospitals of white and wealthy families of children alleged to be victims of abuse or neglect.45 That finding suggests the need for caution in causally linking low socioeconomic status with higher rates of child maltreatment. Nonetheless, research does suggest a direct link between social stressors, especially perceived economic stress, and higher rates of child abuse.46