RE: New Lancet Report on Incidence of Child Maltreatment

["Taylor, Peggy" <pbillings@xxxxxx>]

This study raises interesting questions about the prevailing assumption that the demonstrated relationship between child maltreatment and poverty is evidence that low income parents are more likely to be 'poor' parents and mistreat their children.
 
I would love to see or conduct a study that looks at the differences in outcomes of child protective service investigations and child welfare initial hearings for parents with sufficient resources to have a private attorney and health insurance to cover family services with outcomes in investigations and hearings where parents have none of these resources.  How often are identified mistreated children not served by child welfare agencies because their parents' private attorney proposes a safetly plan that includes family therapy with a therapist of the parents' choice?  
 
Is it possible that the 'demonstrated' associated between poverty and child maltreatment is more of a measure of families' wherewithall to pay for legal and mental health services themselves than it is a measure of the safety of children in families with higher incomes and better insurance?  
 
Peggy Taylor, LMSW
Lawrence, Kansas

________________________________

From: bounce-3366075-6834006@xxxxxxxxxxxxxxxx on behalf of F.Schultz@xxxxxxxxxxxxxxxxx
Sent: Fri 12/5/2008 8:01 PM
To: child-maltreatment-research-l@xxxxxxxxxxxxxxxx
Subject: New Lancet Report on Incidence of Child Maltreatment




 I thought that many might be interested in this new report.


Child Abuse Much More Common Than Official Statistics Indicate

Caroline Cassels
Medscape Medical News 2008. (c) 2008 Medscape
http://www.medscape.com/viewarticle/584817_print

December 5, 2008 - Child abuse in high-income countries is far more
common than official statistics show, with just 10% of suspected cases
investigated and substantiated annually, new research suggests.

Published online December 4 in the Lancet, the study, led by Ruth
Gilbert, MD, from University College London Institute of Child Health,
United Kingdom, is 1 of a series of 4 papers in this issue of the Lancet
that highlight the issue of childhood maltreatment.

According to the study, 4% to 16% of children are physically abused and
1 in 10 is neglected or psychologically abused every year. In addition,
between 5% and 10% of girls and up to 5% of boys are exposed to
penetrative sexual abuse, and up to 3 times this number are exposed to
any type of sexual abuse. However, the investigators note that official
rates for substantiated child maltreatment indicate less than a tenth of
this burden.

The impact of child maltreatment can have devastating and long-lasting
consequences that persist into adulthood. For instance, the authors note
that maltreated children are at increased risk for criminal behavior,
are more likely to engage in risky sexual behavior, and are at
significantly higher risk for drug and alcohol abuse.

"The most tragic manifestation of the burden of child maltreatment is
the thousands of child deaths every year due to murder or neglect," the
authors write.

According to the World Health Organization, worldwide, 155,000 children
younger than 15 years die annually as a result of abuse or neglect.
Biological parents are responsible for 80% of cases and stepparents for
15%.

In the United Kingdom, 35% of child murder victims are younger than 1
year. It is estimated that in the European Union, 4 in every 1 million
children die from homicide or manslaughter every year. In central and
eastern Europe and the Newly Independent States, the rate is 3 times
greater, the authors report.

Abuse Significantly Underreported

A second study, also conducted by Dr. Gilbert and colleagues, shows that
in most settings child abuse is significantly underreported - even by
schools and community-health services that have continuous contact with
children.

However, this phenomenon also extends to professionals in primary care,
mental health, and law enforcement.

Reasons for underreporting, say the authors, include lack of awareness
about the signs of maltreatment and the processes for reporting to
child-protection agencies, and the perception that reporting might do
more harm than good.

However, even when maltreatment is suspected, the authors note,
professionals often do not report the case unless they have a high level
of certainty that maltreatment has occurred.

To illustrate the extent of uncertainty about maltreatment, the
researchers highlight a prospective study from the United States that
showed that doctors suspected about 10% of 15,000 child-injury visits
were due to maltreatment. However, only 6% of cases were reported
(Pediatrics 2008;122:611-619).

"Professionals who have continuous contact with children, such as people
working in schools and community health services, can have a leading
role in recognizing, responding to, and supporting maltreated children.
Their scarce reporting to child-protection agencies is a cause for
concern, and we need to find out whether maltreatment is being
recognized and dealt with in other ways. Doubts are widespread that the
benefits of reporting suspected case of maltreatment to child-protection
services outweigh the harms," the authors conclude.

In an accompanying editorial, Richard Horton, MB, editor of the Lancet,
and senior editor Richard Turner, MD, express hope that this series of
articles will raise awareness about child abuse and will help guide
clinicians and other professionals who come in contact with children who
might be abuse victims.

"It is to clinicians and other professionals responsible for caring for
children that the Lancet's Child Maltreatment Series is aimed, with the
intention of providing them with a rigorous and up-to-date summary of
scientific evidence and conceptual work on this complex and demanding
topic," they write.

The researchers have disclosed no relevant financial relationships.

Lancet. Published online December 4, 2008.

Freya Schultz, Staff Analyst
Santa Barbara County Social Services, Child Welfare Services
234 Camino del Remedio
Santa Barbara, CA 93110
(805) 696-8972

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