Journals > Journal: Preventing Child Maltreatment > Article: Epidemiological Perspectives on Maltreatment Prevention
Journal Issue: Preventing Child Maltreatment Volume 19 Number 2 Fall 2009
Introduction
According to federal data, roughly 905,000 U.S. children were abused or neglected in 2006.1 A 2005 study by David Finkelhor and several colleagues cited by the Centers for Disease Control and Prevention estimates that approximately 8.7 million of the nation’s children—about one in every seven—have been maltreated.2 A recent California study estimates that 38 percent of black children and 20 percent of white children will have had contact with the child welfare system (including maltreatment reports) by age seven.3 Not surprisingly, the effects of child abuse and neglect are far-reaching. In early childhood, maltreatment can impair brain development and regulatory functioning; later in childhood, maltreatment-related problems such as poor school performance, increased disruptive behaviors, and depression emerge; once maltreatment victims reach adulthood, they are more likely to abuse substances. These are just a few of the ways maltreatment affects the children involved (to say nothing of how it affects others in the family).
The need for effective preventive programs is clear. The question is where to invest, on whose behalf, and when in the life cycle. Maltreatment involves children of all ages. In 2006, for example, 11 percent of the victims reported to state child welfare agencies were under the age of one. That same year, twelve- to fifteen-year-olds accounted for almost one in five victims. Because of the many different populations of children and youth at risk, interventions must be aligned with the unique developmental phase that each group represents: a one-size-fits-all solution will not accurately address the variety of issues these children present.
Perpetrators of maltreatment also span a wide age range. According to National Child Abuse and Neglect Data System data, nearly 75 percent of all perpetrators were between the ages of twenty and thirty-nine, an exceptionally wide age band when viewed through the joint perspectives of life span development and intervention design.4 Although perpetrators tend to be parents (more than half are mothers), relatives abuse children, too. In the case of sexual abuse, relatives make up the single largest group—30 percent —of all perpetrators.
Maltreatment is also linked with poverty and its associated burdens: single parenthood, social isolation, unemployment, poor education, and residential segregation among non-whites.5 That said, maltreatment is not restricted to poor communities; nor do all similarly poor communities have comparable rates of maltreatment.6 Among states reporting to the National Child Abuse and Neglect Data System, the average maltreatment rate in the ten states with the lowest poverty rates was 9.2 per thousand, compared with 13.3 per thousand in the states with highest poverty rates.7 In 2000, the maltreatment rate reported for white infants living in low-poverty counties (5.4 per thousand) exceeded the rates reported for all older white children living in high-poverty counties (2.8 per thousand to 4.9 per thousand).8
My goal in this article is to show how data on the incidence and distribution of maltreatment might be used to strengthen prevention programs in the face of the myriad challenges —individual, family, and community—facing the child welfare system. Investing in prevention, broadly defined, involves at least three distinct problems. First, the nation’s child welfare system is highly diverse. State laws define the behaviors that constitute maltreatment, govern who must report maltreatment, and shape current investments in the service infrastructure.9 Moreover, local child welfare programs, whether public county programs or those within the private sector, operate in their own unique context and represent varying degrees of financial support. The notion that a single set of investments in prevention programs will have direct and unambiguous benefits, even within a single state, reaches well past what the available data tell us.
Second, it is not entirely clear where along the continuum of an individual child welfare case prevention programs ought to start. This problem has at least two dimensions. Inside the relatively narrow world of child protection, it is a given that prevention services should aim to prevent maltreatment in the first instance. Policy discussions inside the child welfare system, however, have engaged problems as diverse as preventing the use of foster care and preventing the problems faced by youth aging out of foster care. Prevention, it seems, depends on one’s position along the need-service trajectory. It is important to be clear about where along the continuum preventive services are targeted.
The third problem is that maltreatment affects children’s developmental trajectories in profound ways. Victims of child abuse—that is, cases when allegations of maltreatment are substantiated—may or may not receive child welfare services following the investigation. Either way, the available data suggest that children touched by the child welfare system face substantial cognitive, social, and behavioral deficits.10 Prevention programs offer a chance to minimize the effects of maltreatment on the developing child, but many, if not most, jurisdictions lack the infrastructure to do so within the traditional child welfare system. Creating preventive service capacity that minimizes developmental effects will stretch the system well beyond its current policy, practice, and financial boundaries.
What then do the data say about maltreatment and how can the data be used to promote strategic allocation of preventive service programs? In the first instance, the data must be aligned with experts’ views of the causes of maltreatment. As a general matter, scholars recognize that “no single risk factor or set of risk factors [has] emerged as providing a necessary or sufficient cause of maltreatment.” 11 In response, they have developed transactional theories that weigh the interplay between the individual (parent and child), the family, and the environmental context in which people grow and develop.12 Second, it is helpful to understand recent trends in maltreatment and patterns of state variation. As noted, states differ significantly both in the number of maltreatment reports in general and in how the number of reports changes over time. The pattern of these variations yields useful insights about what an increase in preventive service investments might accomplish, given where the investments are made.
With regard to where to invest and on whose behalf, I present two views of the available data. The first view, based on the fact that maltreatment rates are highest during certain periods of children’s lives, considers developmental influences on the risk profile. In part, the link between age and maltreatment reflects the institutional context of children’s lives (for example, reports of physical abuse increase when children enter school). More important, however, the data reveal bi-directional influences rooted in what a child needs and what a parent can give as children pass through childhood. Inasmuch as these influences are present in a variety of contexts and in a variety of populations, the findings represent the kind of durable patterns one can use to plan and implement preventive service programs.
The second view considers social context and speaks directly to the contribution of poverty in explaining why some places—states, counties, or neighborhoods—have higher rates of maltreatment. Embedded in this discussion is the issue of race and ethnicity and the fact that children of color are much more likely than white children to be reported to child welfare agencies. The issue of social context also highlights an important policy and practice choice. On the one hand, prevention interventions must target specific risks given a theory of why parents maltreat. On the other hand, investments should go to communities where maltreatment is most common, relatively speaking. The choices are not mutually exclusive: interventions in high-risk neighborhoods have to draw on a theory that explicitly addresses the causes of maltreatment within both the family and the community context.
In the final section of the article, I turn the focus to maltreatment recurrence—that is, to allegations of maltreatment that follow a prior allegation. In this context I highlight substance abuse, because children whose substantiated maltreatment is related to substance abuse are much more likely to experience recurrence than are children investigated for other reasons. Detailing the influence of substance abuse here offers an opportunity to see how it fits within the broader discussion.
