Child Abuse

Treatment and System Responses

When it is determined that a child has been abused or neglected, the system will intervene. The primary state agency responsible for children is social services, but children are first identified in any number of ways: by neighbors, relatives, day-care staff, teachers, or medical professionals. Medical professionals and day-care staff often identify young children, because the doctor's office and the day-care center are common places for children to be seen on a regular basis. School personnel frequently identify older children when changes in behavior, attendance, or school performance are noticed. Suspicions of abuse or neglect are then referred to the appropriate social services agency for a more thorough investigation.

One of the first concerns for social services is the safety of the child. The agency's primary purpose is to ensure that no further harm comes to the child. If the perpetrator of maltreatment (the person suspected of abusing or neglecting the child) is to continue to have access to the child, this can be handled in In August 1954 eleven-year-old Joe Roach was found chained to his bed in his home in Houston, Texas. Rather than going into the house to sleep and be mistreated by his parents the night before, the boy spent the night in a doghouse in the backyard of his home. (Bettmann/Corbis) several ways. What happens next will depend on the type and severity of abuse or neglect and the mandates of the state. The perpetrator will often contract with social services and agree not to maltreat the child. The person can agree to leave the home temporarily. The child can also be removed from the unsafe environment and placed in the care of a relative or foster family.

Many times children will require a medical evaluation to determine what harm has been done, document the extent of harm, and treat any new or existing medical conditions. The needs of the whole child should be addressed during a medical evaluation, although emergent needs are prioritized. In the case of shaken baby syndrome, for example, the majority of these children are brought in on an emergency basis when they stop breathing at home. Obviously these children require intensive care even before the determination of abuse is made. For other children, the medical evaluation may entail treating a broken bone, tending to lacerations, evaluating bruises, or examining for sexually transmitted diseases. It can also involve recommending a developmental evaluation for a child who is developmentally delayed or recommending medical and behavioral treatment for depression.

Further treatment usually involves obtaining mental health services or additional services for the family. The goals of these services are to assist the child and family in coping with the maltreatment and to restore family functioning. Mental health services can be directed to the child or to the child's caretakers, if the child is too young or unable to participate actively in treatment sessions on her own. Play therapy is very commonly employed in this setting. For the family, evaluating the home environment and the circumstances surrounding the abuse or neglect is critical to assisting the family and preventing maltreatment from reoccurring. There may be social services such as food stamps or parenting education that can assist the family and reduce family stressors. Parents and caregivers may also be prior victims of child maltreatment and/or violence in other forms and benefit from mental health, substance abuse, or domestic violence resources themselves.

Consequences of Maltreatment

The consequences of maltreatment for children who are abused or neglected vary a great deal. There are many factors that affect what happens after maltreatment, including: the developmental stage of the child at the time of the abuse or neglect, the type and chronicity of abuse or neglect, the relationship of the perpetrator to the child, and the child's temperament and natural ability (intelligence). There are also several different categories of consequences, including: medical or physical consequences; emotional, behavioral, or cognitive consequences; short-term versus long-term consequences; and consequences with or without intervention by social services or others.

One significant principle that appears in the child maltreatment literature repeatedly is that children suffering multiple types of abuse or neglect tend to have a poorer outcome than children who suffer only one type or incident of abuse or neglect. Studies that document the long-term effects of child abuse and neglect mirror these findings. These studies show that lifestyle choices and responses to stress may be altered, leading to greater risk for adult criminal behavior and significant health problems (such as heart disease) in adulthood.

Prevention of Maltreatment

Unfortunately, there is little data on how to prevent child maltreatment. Home visiting programs have shown the most promise in the primary prevention of maltreatment, which is preventing abuse or neglect before it occurs. Home visiting programs involve pairing new parents with someone trained or experienced in child development so that the new parents can learn how to care for and respond to the needs of their infants. The most widely modeled programs, when studied, have been successful in reducing the incidence of but have not entirely eliminated child maltreatment in the study populations. Issues of funding in many geographic regions have limited the availability of such services to those families considered at higher risk for maltreatment.

Efforts in the prevention of maltreatment primarily function on the level of secondary prevention. Intervention by social services or other professionals occurs when maltreatment has already taken place or when children are considered already at risk for abuse or neglect. In these situations the focus is on preventing further abuse or neglect, as well as treating and minimizing complications of the maltreatment that has occurred.

There is no doubt that prevention of child maltreatment is a complex issue. There are multiple factors involved when a child is abused or neglected, factors related to the individual child, the family structure, and other environmental stressors (such as poverty). The cycle of violence is a well-known phenomenon, where today's victims become tomorrow's perpetrators. In order to prevent child maltreatment, prevention itself must become a priority. This will require commitment and collaboration from many sources, including individuals, professionals, community groups, and government agencies. All of these sources must be willing to work together to make a difference for children.