STOP CHILD ABUSE !!!
Child abuse is the physical, sexual or emotional mistreatment or neglect of a child or children.
[1] In the United States, the
Centers for Disease Control and Prevention
(CDC) and the Department for Children And Families (DCF) define child
maltreatment as any act or series of acts of commission or omission by a
parent or other caregiver that results in harm, potential for harm, or
threat of harm to a child.
[2]
Child abuse can occur in a child's home, or in the organizations,
schools or communities the child interacts with. There are four major
categories of child abuse:
neglect,
physical abuse,
psychological or emotional abuse, and
sexual abuse.
Different jurisdictions have developed their own definitions of what
constitutes child abuse for the purposes of removing a child from
his/her family and/or prosecuting a criminal charge. According to the
Journal of Child Abuse and Neglect,
child abuse is "any recent act or failure to act on the part of a
parent or caretaker which results in death, serious physical or
emotional harm, sexual abuse or exploitation, an act or failure to act
which presents an imminent risk of serious harm".
[3]
Types
Child abuse can take several forms:
[4] The four main types are physical, sexual, psychological, and neglect.
[5]
Physical abuse
Physical abuse
involves physical aggression directed at a child by an adult. Most
nations with child-abuse laws consider the deliberate infliction of
serious injuries, or actions that place the child at obvious risk of
serious injury or death, to be illegal. Physical abuse is the
intentional or non-accidental production of a physical injury. Bruises,
scratches, burns, broken bones, lacerations, as well as repeated
“mishaps,” and rough treatment that could cause physical injury, are the
results of physical abuse.
[6] Beyond this, there is considerable variation. The distinction between
child discipline
and abuse is often poorly defined. Cultural norms about what
constitutes abuse vary widely: among professionals as well as the wider
public, people do not agree on what behaviors constitute abuse.
[7] Some professionals claim that cultural norms that sanction
physical punishment are one of the causes of child abuse, and have undertaken campaigns to redefine such norms.
[8][9][10]
Sexual abuse
Child sexual abuse (CSA) is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation.
[11]Sexual
abuse refers to the participation of a child in a sexual act aimed
toward the physical gratification or the financial profit of the person
committing the act.
[12] [13] Forms of CSA include asking or pressuring a child to engage in sexual activities (regardless of the outcome),
indecent exposure of the
genitals to a child, displaying pornography to a child, actual
sexual contact
with a child, physical contact with the child's genitals, viewing of
the child's genitalia without physical contact, or using a child to
produce
child pornography.
[11][14][15] Selling the sexual services of children may be viewed and treated as child abuse with services offered to the child rather than simple incarceration.
[16]
Effects of child sexual abuse include
guilt and
self-blame,
flashbacks,
nightmares,
insomnia, fear of things associated with the abuse (including objects, smells, places, doctor's visits, etc.),
self-esteem issues,
sexual dysfunction,
chronic pain,
addiction,
self-injury,
suicidal ideation, somatic complaints, depression,
[17] post-traumatic stress disorder,
[18] anxiety,
[19] other
mental illnesses (including
borderline personality disorder[20] and
dissociative identity disorder,
[20] propensity to
re-victimization in adulthood,
[21] bulimia nervosa,
[22] physical injury to the child, among other problems.
[23]
In the United States, approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children.
[24][25][26][27][28]
Most sexual abuse offenders are acquainted with their victims;
approximately 30% are relatives of the child, most often brothers,
fathers, mothers, uncles or cousins; around 60% are other acquaintances
such as friends of the family, babysitters, or neighbours; strangers are
the offenders in approximately 10% of child sexual abuse cases.
[24] In over one-third of cases, the perpetrator is also a minor.
[29]
Psychological/emotional abuse
Emotional abuse is defined as the production of psychological and
social deficits in the growth of a child as a result of behavior such as
loud yelling, coarse and rude attitude, inattention, harsh criticism,
and denigration of the child's personality.
[30] Other examples include name-calling, ridicule, degradation, destruction of personal belongings,
torture or killing of a pet, excessive
criticism, inappropriate or excessive demands, withholding communication, and routine labeling or
humiliation.
[31]
Victims of emotional abuse may react by distancing themselves from
the abuser, internalizing the abusive words, or fighting back by
insulting the abuser. Emotional abuse can result in abnormal or disrupted
attachment development, a tendency for victims to blame themselves (
self-blame) for the abuse,
learned helplessness, and overly passive behavior.
[31]
Neglect
Main article:
Child neglect
Child neglect is the failure of a parent or other person with
responsibility for the child to provide needed food, clothing, shelter,
medical care, or supervision to the degree that the child's health,
safety, and well-being are threatened with harm. Neglect is also a lack
of attention from the people surrounding a child, and the non-provision
of the relevant and adequate necessities for the child's survival, which
would be a lacking in attention, love, and nurture.
[32]
Some of the observable signs in a neglected child include: the child is
frequently absent from school, begs or steals food or money, lacks
needed medical and dental care, is consistently dirty, lacks sufficient
clothing for the weather.
[33]
Neglected children may experience delays in physical and psychosocial
development, possibly resulting in psychopathology and impaired
neuropsychological functions including
executive function,
attention,
processing speed, language, memory and social skills.
[34]
Researchers investigating maltreated children have repeatedly found
that neglected children in foster and adoptive populations manifest
different emotional and behavioral reactions to regain lost or secure
relationships and are frequently reported to have disorganized
attachments and a need to control their environment. Such children are
not likely to view caregivers as being a source of safety, and instead
typically show an increase in aggressive and hyperactive behaviors
suggest disrupt healthy or secure attachment with their adopted parents.
These children have apparently learned to adapt to an abusive and
inconsistent caregiver by becoming cautiously self-reliant, and are
often described as glib, manipulative and disingenuous in their
interactions with others as they move through childhood.
[35]
Children who are victims of neglect have a more difficult time forming
and maintaining relationships, such as romantic or friendship, later in
life due to the lack of attachment they had in their earlier stages of
life.
Prevalence
According to the (American) National Committee to Prevent Child
Abuse, in 1997 neglect represented 54% of confirmed cases of child
abuse, physical abuse 22%, sexual abuse 8%, emotional maltreatment 4%,
and other forms of maltreatment 12%.
[36]
A
UNICEF report on child wellbeing
[37]
stated that the United States and the United Kingdom ranked lowest
among industrial nations with respect to the wellbeing of children. It
also found that child neglect and child abuse were far more common in
single-parent families than in families where both parents are present.
[citation needed]
In the USA, neglect is defined as the failure to meet the basic needs
of children including housing, clothing, food and access to medical
care. Researchers found over 91,000 cases of neglect in one year (from
October 2005 to 30 September 2006) using information from a database of
cases verified by protective services agencies.
[2]
Neglect could also take the form of
financial abuse by not buying the child adequate materials for survival.
[38]
The
U.S. Department of Health and Human Services
reports that for each year between 2000 and 2005, "female parents
acting alone" were most likely to be perpetrators of child abuse.
[39]
Fatalities
A child abuse fatality occurs when a child's death is the result of
abuse or neglect, or when abuse and/or neglect are contributing factors
to a child's death. In the United States, 1,730 children died in 2008
due to factors related to abuse; this is a rate of 2 per 100,000 U.S.
children.
[40]
Family situations which place children at risk include moving,
unemployment, having non-family members living in the household. A
number of policies and programs have been put in place in the U.S. to
try to better understand and to prevent child abuse fatalities,
including:
safe-haven laws, child fatality review teams, training for investigators,
shaken baby syndrome prevention programs, and child abuse death laws which mandate harsher sentencing for taking the life of a child.
[41][unreliable source?][verification needed]
Causes
Child abuse is a complex phenomenon with multiple causes.
[42] Understanding the causes of abuse is crucial to addressing the problem of child abuse.
[43] Parents who physically abuse their spouses are more likely than others to physically abuse their children.
[44]
However, it is impossible to know whether marital strife is a cause of
child abuse, or if both the marital strife and the abuse are caused by
tendencies in the abuser.
[44]
Children resulting from
unintended pregnancies are more likely to be abused or neglected.
[45][46] In addition, unintended pregnancies are more likely than intended pregnancies to be associated with abusive relationships,
[47] and there is an increased risk of physical violence during pregnancy.
[48] They also result in poorer maternal mental health,
[48] and lower mother-child relationship quality.
[48]
Substance abuse
can be a major contributing factor to child abuse. One U.S. study found
that parents with documented substance abuse, most commonly alcohol,
cocaine,
and heroin, were much more likely to mistreat their children, and were
also much more likely to reject court-ordered services and treatments.
[49]
Another study found that over two-thirds of cases of child maltreatment
involved parents with substance abuse problems. This study specifically
found relationships between alcohol and physical abuse, and between
cocaine and sexual abuse.
[50]
Unemployment and financial difficulties are associated with increased rates of child abuse.
[51] In 2009 CBS News reported that child abuse in the United States had increased during the
economic recession.
It gave the example of a father who had never been the primary
care-taker of the children. Now that the father was in that role, the
children began to come in with injuries.
[52]
A 1988 study of child murders in the US found that children are 100
times more often killed by a "non-biological parent (e.g. step-parent,
co-habitee or boyfriend/girlfriend of a biological parent)" than by a
biological parent.
[53] An
evolutionary psychology
explanation for this is that using resources in order to take care of
another person's biological child is likely not a good strategy for
increasing
reproductive success.
[53] More generally, stepchildren have a much higher risk of being abused which is sometimes referred to as the
Cinderella effect.
Psychologists conducted a study in the United States in 2010 which
examined over 200 regular church attendees from eleven different
denominations of
Christianity, most of whom were educated, upper-middle class White Americans, found that
extrinsic religious orientation
was associated with a greater risk of physical child abuse. Those with a
more extrinsic religious orientation who also adhered to greater
social conformity were particularly more likely to share characteristics with physically abusive subjects. Subjects who adhered to
Biblical literalism exhibited a higher potential of physical child abuse. Those who had a more
intrinsic religious orientation
were not found to be at a greater risk of child abuse, although they
sometimes exhibited greater social conformity or a greater propensity
for holding literal interpretations of the Bible. Approximately 85% of
the study's subjects were parents.
[54]
Child abuse worldwide
Child abuse is an international phenomenon.
Poverty and
substance abuse are common widespread international issues, and no matter the location, show a similar trend in the correlation to child abuse.
Although these issues can likely contribute to child maltreatment,
differences in cultural perspectives play a significant role in the
treatment of children. In certain nations, the battle for
equality within the sexes plays a large part in a child’s upbringing. During the
Soviet period,
there were conflicts regarding the traditional housewife versus the
emphasis on equality within the sexes. Some women felt a considerable
amount of pressure to carry out their motherly duties, obtaining an “
authoritarian” parenting style, acting dominating and emotionally distant towards her children while overly involved in her own career.
[55]
Many were encouraged to use more firm and direct disciplinary methods,
as well as be overbearing and overprotective of their children.
[56]
Now that this Communist Era has ended, there are many positive
changes being put into play. While there is a new openness and
acceptance regarding parenting styles and close relationships with
children, child abuse still remains a serious concern. Although it is
now more publically recognized, it has certainly not cease to exist.
While controlling parenting may be less of a concern, financial
difficulty,
unemployment, and substance abuse still remain to be dominating factors in child abuse throughout
Eastern Europe.
[57]
A study conducted by members from several
Baltic and
Eastern European countries, together with specialists from the
United States, examined the causes of child abuse in the countries of
Latvia,
Lithuania,
Macedonia and
Moldova. In these countries, respectively, 33%, 42%, 18% and 43% of children reported at least one type of child abuse.
[58]
According to their findings, there was a serious of correlations
between the potential risk factors of parental employment status,
alcohol abuse, and family size within the abuse ratings.
[59]
In three of the four countries, parental substance abuse was
considerably correlated with the presence of child abuse, and although
it was a lower percentage, still showed a relationship in the fourth
country (Moldova).
[60]
Each country also showed a connection between the father not working
outside of the home and either emotional or physical child abuse.
[61]
These cultural differences can be studied from many perspectives.
Most importantly, overall parental behavior is genuinely different in
various countries. Many may view
child abuse, both emotional and physical, as socially acceptable. Each
culture
has their own “range of acceptability,” and what one may view as
offensive, others may seem as tolerable. Behaviors that are normal to
some may be viewed as abusive to others, all depending on the
societal norms of that particular country.
[62]
Asian parenting perspectives, specifically, hold different ideals from
American culture. Many have described their traditions as including
physical and
emotional
closeness that ensures a lifelong bond between parent and child, as
well as establishing parental authority and child obedience through
harsh
discipline.
[63] Balancing disciplinary responsibilities within parenting is common in many
Asian cultures, including
China,
Japan,
Singapore,
Vietnam and
Korea.
[64]
To some cultures, forceful parenting may be seen as abuse, but in other
societies such as these, the use of force is looked at as a reflection
of parental devotion.
[65]
The differences in these cultural beliefs demonstrate the importance of examining all
cross-cultural perspectives when studying the concept of child abuse.
Effects
There are strong associations between exposure to child abuse in all
its forms and higher rates of many chronic conditions. The strongest
evidence comes from the Adverse Childhood Experiences (ACE's) series of
studies which show correlations between exposure to abuse or neglect and
higher rates in adulthood of chronic conditions, high-risk health
behaviors and shortened lifespan.
[66] A recent publication,
Hidden Costs in Health Care: The Economic Impact of Violence and Abuse,
[67]
makes the case that such exposure represents a serious and costly
public-health issue that should be addressed by the healthcare system.
Child abuse is a major life stressor that has consequences involving the
mental health of an adult but, the majority of studies examining the
negative consequences of abuse have been focused on adolescences and
young adults.
[citation needed]
It has been identified that childhood sexual abuse is a risk factor for
the development of substance-related problems during adolescence and
adulthood.
[citation needed]
The early experiences of child abuse can trigger the development of an
internalizing disorder, such as anxiety and depression. For example,
adults with a history of some form of child abuse, whether sexual abuse,
physical abuse, or neglect, have more chances of developing depression
than an adult who has never been abused.
[citation needed] Child abuse can also cause problems with the neurodevelopment of a child.
[citation needed] Research
[by whom?]
shows that abused children often develop deficits with language,
deregulation of mood, behaviour and also social/emotional disturbances.
These risks are elevated when child abuse is combined with traumatic
events and/or fetal alcohol exposure.
[citation needed]
A big concern with researchers is the degree to which maltreated
children grow up to be maltreating adults or if they exhibit social
signs of abuse or neglect. Studies show that 90 percent of maltreating
adults were maltreated as children in their life. When children were 2
studies show that 16 percent of 267 high risk mothers mistreated thir
own children, to different effects.
[68]
The first two years of a child's life is when parents invest the least
in their children. Almost 7 million American infants go to child care
services, like day care, and a majority of that care is poor. Serious
consequences occur when young children are maltreated, including
developmental issues.
[69]
16 percent of those 267 high risk mothers mistreat their two year old
children in different ways. 55 percent of the children experienced
physical abuse, 55 percent experienced neglect, 43 percent experienced
hostile and rejecting parenting, and 43 percent experienced unavailable
parenting.
[68]
Psychological effects
Children who have a history of neglect or physical abuse are at risk of developing
psychiatric problems,
[70][71] or a
disorganized attachment style.
[72][73][74] Disorganized attachment is associated with a number of developmental problems, including
dissociative symptoms,
[75] as well as anxiety, depressive, and
acting out symptoms.
[76][77] A study by Dante Cicchetti found that 80% of abused and maltreated infants exhibited symptoms of
disorganized attachment.
[78][79] When some of these children become parents, especially if they suffer from
posttraumatic stress disorder (
PTSD),
dissociative symptoms, and other sequelae of child abuse, they may
encounter difficulty when faced with their infant and young children's
needs and normative distress, which may in turn lead to adverse
consequences for their child's social-emotional development.
[80][81]
Despite these potential difficulties, psychosocial intervention can be
effective, at least in some cases, in changing the ways maltreated
parents think about their young children.
[82]
Victims of childhood abuse, it is claimed, also suffer from different
types of physical health problems later in life. Some reportedly suffer
from some type of chronic head, abdominal, pelvic, or muscular pain
with no identifiable reason.
[83]
Even though the majority of childhood abuse victims know or believe
that their abuse is, or can be, the cause of different health problems
in their adult life, for the great majority their abuse was not directly
associated with those problems, indicating that sufferers were most
likely diagnosed with other possible causes for their health problems,
instead of their childhood abuse.
[83]
One long-term study found that up to 80% of abused people had at least
one psychiatric disorder at age 21, with problems including depression,
anxiety, eating disorders, and suicide attempts.
[84].
One Canadian hospital found that between 36% and 76% of women mental
health outpatients had been abused, as had 58% of women and 23% of men
schizophrenic inpatients.
[85]
The effects of child abuse vary, depending on the type of abuse. A 2006 study
[which?] found that childhood emotional and sexual abuse were strongly related to adult
depressive symptoms, while exposure to
verbal abuse and witnessing of
domestic violence
had a moderately strong association, and physical abuse a moderate one.
For depression, experiencing more than two kinds of abuse exerted
synergetically stronger symptoms. Sexual abuse was particularly
deleterious in its intrafamilial form, for symptoms of depression,
anxiety, dissociation, and
limbic irritability.
[clarification needed]
Childhood verbal abuse had a stronger association with anger-hostility
than any other type of abuse studied, and was second only to emotional
abuse in its relationship with dissociative symptoms.
[citation needed] More generally, in the case of 23 of the 27 illnesses listed in the questionnaire of a French
INSEE
survey, some statistically significant correlations were found between
repeated illness and family traumas encountered by the child before the
age of 18 years.
[86] According to
Georges Menahem,
the French sociologist who found out these correlations by studying
health inequalities, these relationships show that inequalities in
illness and suffering are not only social. Health inequality also has
its origins in the family, where it is associated with the degrees of
lasting affective problems (lack of affection, parental discord, the
prolonged absence of a parent, or a serious illness affecting either the
mother or father) that individuals report having experienced in
childhood.
[citation needed]
Physical effects
Children who are physically abused are likely to receive bone fractures, particularly rib fractures,
[87] and may have a higher risk of developing cancer.
[88]
Children who experience child abuse & neglect are 59% more likely
to be arrested as juveniles, 28% more likely to be arrested as adults,
and 30% more likely to commit violent crime.
[89]
The immediate physical effects of abuse or neglect can be relatively
minor (bruises or cuts) or severe (broken bones, hemorrhage, or even
death). In some cases the physical effects are temporary; however, the
pain and suffering they cause a child should not be discounted.
Meanwhile, the long-term impact of child abuse and neglect on physical
health is just beginning to be explored. The long-term effects can be:
- Shaken baby syndrome.
Shaking a baby is a common form of child abuse that often results in
permanent neurological damage (80% of cases) or death (30% of cases).[90]
Damage results from intracranial hypertension (increased pressure in
the skull) after bleeding in the brain, damage to the spinal cord and
neck, and rib or bone fractures (Institute of Neurological Disorders and
Stroke, 2007).
- Impaired brain development. Child abuse and neglect have been shown,
in some cases, to cause important regions of the brain to fail to form
or grow properly, resulting in impaired development (De Bellis &
Thomas, 2003). These alterations in brain maturation have long-term
consequences for cognitive, language, and academic abilities
(Watts-English, Fortson, Gibler, Hooper, & De Bellis, 2006). NSCAW
found more than three-quarters of foster children between 1 and 2 years
of age to be at medium to high risk for problems with brain development,
as opposed to less than half of children in a control sample (ACF/OPRE,
2004a).
- Poor physical health. Several studies have shown a relationship
between various forms of household dysfunction (including childhood
abuse) and poor health (Flaherty et al., 2006; Felitti, 2002). Adults
who experienced abuse or neglect during childhood are more likely to
suffer from physical ailments such as allergies, arthritis, asthma,
bronchitis, high blood pressure, and ulcers (Springer, Sheridan, Kuo,
& Carnes, 2007).[91]
On the other hand, there are some children who are raised in child
abuse, but who manage to do unexpectedly well later in life regarding
the preconditions. Such children have been termed
dandelion children, as inspired from the way that
dandelions seem to prosper irrespective of soil, sun, drought, or rain.
[92] Such children (or currently grown-ups) are of high interest in finding factors that mitigate the effects of child abuse.
Prevention
A support-group structure is needed to reinforce parenting skills and
closely monitor the child's well-being. Visiting home nurse or
social-worker visits are also required to observe and evaluate the
progress of the child and his/her caretaking situation. The
support-group structure and visiting home nurse or social-worker visits
are not mutually exclusive. Many studies have demonstrated that the two
measures must be coupled together for the best possible outcome.
[93]
Children's school programs regarding "good touch...bad touch" can
provide children with a forum in which to role-play and learn to avoid
potentially harmful scenarios. Unintended conception increases the risk
of subsequent child abuse, and large family size increases the risk of
child neglect.
[46] Thus a comprehensive study for the National Academy of Sciences concluded that affordable
contraceptive services should form the basis for child abuse prevention.
[46][94] "The starting point for effective child abuse programming is
pregnancy planning," according to an analysis for US Surgeon General
C. Everett Koop.
[46][95]
April has been designated Child Abuse Prevention Month in the United States since 1983.
[96] U.S. President
Barack Obama continued that tradition by declaring April 2009 Child Abuse Prevention Month.
[97] One way the
Federal government of the United States
provides funding for child-abuse prevention is through Community-Based
Grants for the Prevention of Child Abuse and Neglect (CBCAP).
[98]
Resources for child-protection services are sometimes limited.
According to Hosin (2007), "a considerable number of traumatized abused
children do not gain access to protective child-protection strategies."
[99]
Briere (1992) argues that only when "lower-level violence" of children
ceases to be culturally tolerated will there be changes in the
victimization and police protection of children.
[100]
Treatment
A number of treatments are available to victims of child abuse.
[101]
Trauma-focused cognitive behavioral therapy, first developed to treat
sexually abused children, is now used for victims of any kind of trauma.
It targets trauma-related symptoms in children including
post-traumatic stress disorder (PTSD),
clinical depression and
anxiety.
It also includes a component for non-offending parents. Several studies
have found that sexually abused children undergoing TF-CBT improved
more than children undergoing certain other therapies. Data on the
effects of TF-CBT for children who experienced only non-sexual abuse was
not available as of 2006.
[101]
The purpose of dealing with the thoughts and feelings associated with
the trauma is to deal with nightmares, flashbacks and other intrusive
experiences that might be spontaneously brought on by any number of
discriminative stimuli in the environment or in the individual’s brain.
This would aid the individual in becoming less fearful of specific
stimuli that would arouse debilitating fear, anger, sadness or other
negative emotion.In other words, the individual would have some control
or mastery over those emotions.
[102]
Abuse-focused
cognitive behavioral therapy
was designed for children who have experienced physical abuse. It
targets externalizing behaviors and strengthens prosocial behaviors.
Offending parents are included in the treatment, to improve parenting
skills/practices. It is supported by one randomized study.
[101]
Rational Cognitive Emotive Behavior Therapy consists of ten distinct
but interdependent steps. These steps fall into one of three theoretical
orientations (i.e., rational or solution focused, cognitive emotive,
and behavioral) and are intended to provide abused children and their
adoptive parents with positive behavior change, corrective interpersonal
skills, and greater control over themselves and their relationships.
They are: 1) determining and normalizing thinking and behaving, 2)
evaluating language, 3) shifting attention away from problem talk 4)
describing times when the attachment problem isn’t happening, 5)
focusing on how family members “successfully” solve problematic
attachment behavior; 6) acknowledging “unpleasant emotions” (i.e.,
angry, sad, scared) underlying negative interactional patterns, 7)
identifying antecedents (controlling conditions) and associated negative
cognitive emotive connections in behavior (reciprocal role of thought
and emotion in behavioral causation), 8) encouraging previously abused
children to experience or “own” negative thoughts and associated
aversive emotional feelings, 9) modeling and rewarding positive behavior
change (with themselves and in relationships), and 10) encouraging and
rewarding thinking and behaving differently. This type of therapy shifts
victims thoughts away from the bad and changes their behavior.
[103]
Child-parent psychotherapy was designed to improve the child-parent
relationship following the experience of domestic violence. It targets
trauma-related symptoms in infants, toddlers, and preschoolers,
including PTSD, aggression, defiance, and anxiety. It is supported by
two studies of one sample.
[101]
Other forms of treatment include group therapy, play therapy, and art
therapy. Each of these types of treatment can be used to better assist
the client, depending on the form of abuse they have experienced. Play
therapy and art therapy are ways to get children more comfortable with
therapy by working on something that they enjoy (coloring, drawing,
painting, etc.). The design of a child's artwork can be a symbolic
representation of what they are feeling, relationships with friends or
family, and more. Being able to discuss and analyze a child's artwork
can allow a professional to get a better insight of the child.
[104]
Seeing a therapist is the first step on the process to
recovery.Therapy is the art and science of helping children make sense
of their feelings, thoughts, and behavior and learn how to control their
behavior and improve interactions with others.The therapist has an
important role in helping a child recover from the effects of abuse and
neglect. The therapist serves a number of functions, including, helping
the child address issues related to abuse and neglect, serving as a
model for appropriate adultchild relationships, working to improve
family relationships, and supporting positive and productive peer
relationships and support systems.
[105] After a therapist has assessed a victim they can begin to plan the patients specific treatment that is best for them.
Ethics
One of the most challenging ethical dilemmas arising from child abuse
relates to the parental rights of abusive parents or caretakers with
regard to their children, particularly in medical settings.
[106] In the United States, the 2008 New Hampshire case of
Andrew Bedner
drew attention to this legal and moral conundrum. Bedner, accused of
severely injuring his infant daughter, sued for the right to determine
whether or not she remain on life support; keeping her alive, which
would have prevented a murder charge, created a motive for Bedner to act
that conflicted with the apparent interests of his child.
[106][107][108] Bioethicists
Jacob M. Appel and
Thaddeus Mason Pope
recently argued, in separate articles, that such cases justify the
replacement of the accused parent with an alternative decision-maker.
[106][109]
Child abuse also poses ethical concerns related to
confidentiality,
as victims may be physically or psychologically unable to report abuse
to authorities. Accordingly, many jurisdictions and professional bodies
have made exceptions to standard requirements for confidentiality and
legal privileges
in instances of child abuse. Medical professionals, including doctors,
therapists, and other mental health workers typically owe a duty of
confidentiality to their patients and clients, either by law and/or the
standards of
professional ethics, and cannot disclose personal information without the
consent
of the individual concerned. This duty conflicts with an ethical
obligation to protect children from preventable harm. Accordingly,
confidentiality is often waived when these professionals have a good
faith suspicion that child abuse or neglect has occurred or is likely to
occur and make a report to local
child protection
authorities. This exception allows professionals to breach
confidentiality and make a report even when the child or his/her parent
or guardian has specifically instructed to the contrary. Child abuse is
also a common exception to
Physician–patient privilege:
a medical professional may be called upon to testify in court as to
otherwise privileged evidence about suspected child abuse despite the
wishes of the child and his/her family.
[110]
Organizations
There are organizations at national, state, and county levels in the
United States that provide community leadership in preventing child
abuse and neglect. The National Alliance of Children's Trust Funds and
Prevent Child Abuse America are two national organizations with member
organizations at the state level.
Many investigations into child abuse are handled on the local level
by Child Advocacy Centers. Started over 25 years ago at what is now
known as the National Children's Advocacy Center
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in Huntsville, Alabama by District Attorney Robert "Bud" Cramer these
multi-disciplinary teams have met to coordinate their efforts so that
cases of child abuse can be investigated quickly and efficiently,
ultimately reducing trauma to the child and garnering better
convictions.
[112][113] These Child Advocacy Centers (known as CACs) have standards set by the National Children's Alliance.
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Other organizations focus on specific prevention strategies. The
National Center on Shaken Baby Syndrome focuses its efforts on the
specific issue of preventing child abuse that is manifested as
shaken baby syndrome.
Mandated reporter training is a program used to prevent ongoing child abuse.
NICHD, also known as the National Institute of Child Health &
Human Development is a broad organization, but helps victims of child
abuse through one of its branches. Through the Child Development and
Behavior (CDB) Branch, NICHD raises awareness efforts by supporting
research projects to better understand the short- and long-term impacts
of child abuse and neglect. They provide programs and observe National
Child Abuse Prevention Month every April since 1984. The Children’s
Bureau leads activities for the Month, including the release of updated
statistics about child abuse and neglect, candlelight vigils, and
fundraisers to support prevention activities and treatment for victims.
The Bureau also sponsors a “Blue Ribbon Campaign,” in which people wear
blue ribbons in memory of children who have died from abuse, or in honor
of individuals and organizations that have taken important steps to
prevent child abuse and neglect.
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