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Shifting the prevention of child sexual abuse from children to adults. perpetrators of child sexual abuse, and child sexual offender treatment, should be further.
Table of contents
- Crisis and support contacts for child abuse
- Brazil reports 737 thousand cases of domestic violence in nine years
- Child Sexual Abuse Prevention | Darkness to Light - Darkness to Light
Supporting healthy development for children will not in and of itself prevent abusive behaviors of adults and other children. The clear truth is that child sexual abuse will never be eradicated without getting to the root causes of perpetration. Under each concept are four specific elements. The meaningful prevention of child sexual abuse requires community engagement in the development of strategies, improved institutional response to and prevention of sexual abuse, and supportive services and skills for parents, caregivers, and those who work with children of all ages.
Leadership Team. Our history. Member Directory. National Plan. Six Pillars for Prevention. Prevention Fact Sheets. Apply for Membership. Events in the Field. Programs for neglectful parents typically focus on areas such as nutrition, homemaking, and child care. Parental enhancement programs may help some families who experience child management problems when a sexually abusive father is removed from the home. In these cases, child management skills help develop positive child-parent interaction in sexually abusive families. The efficacy of parent-training approaches for physically abusive parents has been supported by various single-case studies, one study using repeated measures, and group design studies Azar and Twentyman, ; Crimmins et al.
Studies of multiple approaches and diverse populations have provided consistent evidence that parents can acquire behavioral skills and use them in interactions with their children, at least in clinical settings Golub et al. Some evidence suggests that training has reduced parental distress or symptomatology and, in some instances, improved child functioning Wolfe et al. Efforts to expand the scope of parental enhancement programs have fostered attention to parents' cognitive-attributional and affective repertoires see Azar and Siegel, Therapeutic directions highlight the need to incorporate diverse skills and to evaluate the effectiveness of individual approaches see Azar and Wolfe, Following an in-depth assessment, parents participate in customized programs including the use of groups, behavioral methods, and parental aides to offer specialized services including parent-child relations, home safety, nutrition and health maintenance, assertiveness training, job placement and vocational skills training, stress reduction training, alcoholism.
Positive findings from single-subject case reports, reports of clients attaining treatment goals in the majority of cases, and lower recidivism rates for program clients compared with controls for a five-year period of program evaluation support this approach to family treatment Lutzker, ; Luztker and Rice, However, no comparison data were collected, and client assignment to Project Ways was not random.
Crisis and support contacts for child abuse
Evidence also suggests that treatment gains are not maintained when compared with a comparison group Wesch and Lutzker, At present, few definitive studies demonstrate the efficacy of parent training in reducing re-abuse. Evaluations of the clinical impact of intervention on subsequent re-abuse recidivism rates and child and family functioning are needed Kolko, in press. The severity of family dysfunction evident in some cases of abuse or neglect may also limit the applicability of parent-training methods.
Family systems treatment, commonly used in the treatment of intrafamilal sexual abuse, seeks to change the psychosocial interactions among family members. Clinical descriptions of family therapy combined with individual and group therapy suggest its potential usefulness for families who are highly dysfunctional, although controlled evaluations of family therapy in child sexual abuse have not been conducted Alexander, ; Bentovim and Van Elburg, ; Giaretto, , ; Ribordy, ; Sgroi, ; Walker et al. Some programs have indicated a recidivism rate as low as 3 percent Anderson and Shafer, Home-based services and family preservation services address the overall needs of families, include both children and parents, and focus directly on contextual factors, such as poverty, single parenthood, and marital discord, that increase stress, weaken families, and elicit aggressive behavior Kolko, in press.
These programs target functional relationships among diverse individual, family, and systemic problems by combining traditional social work with various therapeutic counselling approaches. The use of home-based services has been advocated in response to the multiple problems found among abusive and neglectful families, difficulties in providing services in a traditional format, and interests in reducing the number of children placed in foster care.
The breadth of potential family dysfunction has encouraged hands-on approaches that address risk factors at. Applications of the home-based approach in child maltreatment have become increasingly popular in recent years. Studies of home-based services have found that a multisystemic approach using multiple treatment modalities resulted in greater improvements in parent-child relationships and child behavior problems than simple parent training in child management skills Brunk et al.
However, the generalizability of these findings is limited by methodological problems, including the absence of clear targets for certain conditions Nichol et al. Home-based approaches have demonstrated particular effectiveness with neglectful families Daro, The crisis conditions of some neglectful families, including poverty at the time of the report of neglect, have sometimes been described as the most recent manifestation of a deeply troubled history of the offending parent Polansky et al.
Treatment of neglectful behavior sometimes requires not only resolution of the immediate stressful conditions, but also intensive, long perhaps more than 12 months , and often expensive interventions to alter the parent's fundamental concepts of self, relationships with others, and beliefs about one's ability to affect the circumstances of life. Family preservation programs are designed to prevent the placement of children outside the home while ensuring their safety.
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Family preservation services are often characterized by their intensity hours per week , short duration often 6 weeks , and their flexibility in providing a range of therapeutic and support services tailored to the needs of families in crisis. Family preservation programs are often designed to address multiple goals, including the protection of children, strengthening family bonds, providing stability in crisis situations, increasing family skills and competencies, fostering family use of formal and informal helping resources, and preventing unnecessary out-of-home placement of children Tracy et al.
The Homebuilders program Kinney et al. The Homebuilders model is notable for its individualized interventions, program intensity, flexible schedule, small caseloads, goal orientation, time limited services, and program evaluation efforts Whittaker et al. Individual programs vary by such factors as method of operation drawing on public agency staff or private contracts , level of training, availability of staff, and availability of funds to purchase goods or services for families Kammerman and Kahn, The majority of children remain at home following service termination or at follow-up.
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Most of the evaluative research on family preservation programs reports success on a limited number of measures, such as preventing the placement of children and short-term improvement in family functioning Bath and Haapala, However, the effectiveness of family preservation services remains unclear because most evaluative studies have suffered from methodological problems such as small samples, little reliability with respect to validity of measures, and nonexperimental designs Kinney et al.
Research on family preservation services is also complicated by variations in definitions of outcome, the target population, and the quality of services Wells and Biegel, Recent empirical studies have rigorously examined multiple outcomes of treatment and used experimental and quasi-experimental designs Feldman, ; Mitchell et al, ; Nelson, , ; Pecora et al. These studies have revealed equivocal findings about the effectiveness of family preservation programs, including high placement avoidance rates in control groups Feldman, ; Mitchell et al.
In a recent review of family preservation research, Rossi observes that ''one of the major problems with existing evaluations is that they treat children and their families as if their problems were all the same p. It is likely that mixing clients of different ages, problem types, referral sources, and service domains has weakened the findings of studies.
One recent study evaluated outcomes of family preservation services in different subpopulations of a relatively large sample within one service domain. Significant differences were found between families experiencing different types of maltreatment: fewer physically abused children were placed than those in the neglect and combined groups Bath and Haapala, Despite equivocal evidence of long-term effectiveness, family preservation services are currently believed to be a cost-effective alternative to the institutionalization or foster care placements for many children.
The relationship of poverty to child maltreatment, specifically child neglect, is thought to be significant see Chapter 4. Several government programs designed to alleviate or mitigate the effects of poverty on children are often part of a comprehensive set of services for low-income, maltreating families. Gil has stated that almost 60 percent of families reported for incidents of abuse and neglect received aid from public assistance agencies during or prior to the study year.
However, while national and local child welfare programs designed to improve the well-being of all poor families may provide food, shelter, and other necessary resources, for children in households characterized by neglect or abuse, the relationship between income support, material assistance, and the subsequent reduction of maltreatment has not been systematically addressed. Family-oriented interventions often exist within a context of a broad range of diverse services provided by community agencies.
Medical personnel diagnose and treat physical conditions associated with child maltreatment. Child protection services personnel investigate suspected cases of child maltreatment, select and refer families for treatment services, and decide whether to allow a child to remain in the home. Child welfare services authorities provide financial and social services to families who may be in distress. Courts of law and law enforcement personnel intervene when questions are raised about the safety of the child or the community. Understanding these responses to child maltreatment is important in understanding the experiences of children and families following reports of maltreatment.
Yet little is known about the efficacy of these community-based interventions. A few treatment programs have been developed at the community level to provide services to families, such as counseling and educational services for the parents, supervised day care, and specialized referrals for community services, including mental health care, housing, and substance addiction treatment Zuravin and Taylor, Although such neighborhood-focused programs may assist children who are victims of abuse or neglect, program evaluations usually do not consider outcomes in terms of maltreatment subpopulations.
Health professionals in private practice, community health clinics, and hospitals are often the first point of contact for abused children and their families when serious physical injuries are sustained. Medical examinations of abused children enable physicians to identify physical conditions requiring medical treatment including sexually transmitted disease and pregnancy , collect forensic evidence, document abuse histories, and refer abusive families to other services.
Psychosocial examinations can document the nature, severity, and chronicity of behaviors exhibited by the abused child. Nurses and hospital social workers also play an influential role in managing or detecting child abuse cases in medical settings. Health professionals are required by law to report cases of suspected abuse to child protection agencies, but the use of discretion in such reports is common. Little is known about treatments recommended for abused children in medical settings, and even less is known about specific treatment outcomes.
Studies suggest, however, that many health professionals may not be sufficiently trained to detect or validate signs of abuse or to deal with the physical, psychological, and legal aspects of evaluating maltreated children, particularly sexually abused children. Examinations of suspected abuse, specifically sexual abuse, sometimes have been described as "revictimizing" children.
Sexual examinations sometimes frighten many children and can involve sensations similar to those experienced during victimization. The psychological effects of medical examinations following sexual assault e. The reliability of diagnostic conclusions in physical examinations for sexual abuse has been questioned and is currently the subject of study.
Medical examinations of sexually abused children often include testing for sexually transmitted diseases. Sexual abuse is a potential mode of transmission of infection by the human immunodeficiency virus HIV in children, although the incidence of HIV transmission through child sexual abuse is unknown. One recent study attempted to estimate the number of children infected with HIV as a result of pediatric sexual abuse in the United States and Canada Gellert et al. This study concluded that sexual abuse resulted in HIV infection in 52 percent of home settings when both biological parents were present and a coinfection rate of HIV and other sexually transmitted diseases of 33 percent Gellert et al.
Selective testing guidelines have. Child protective service officials are obligated to respond to cases of suspected child maltreatment. They evaluate the validity of complaints, perform risk assessments of families, monitor cases, and develop and implement family service plans. Child protection agencies receive and screen initial reports of child abuse and neglect from educators, health personnel, police, members of the public e. Limited resources often prevent child protection agencies from responding to increasing numbers of reports see Chapter 3 within the 24 or 48 hours mandated by state child welfare legislation Child Welfare League of America, In most locales the system is understaffed, many caseworkers are poorly trained, and high turnover rates are common.
However, one national survey has indicated that more than one-third of confirmed cases of child maltreatment received no therapeutic or supportive services McCurdy and Daro, The processes that determine child protective services responses to maltreated children and their families have not attracted much research attention, although such influences have a profound influence on the treatment process.
Evaluations of CPS operations are complicated by the emergency situation in which many investigations occur, as well as variations in definitions of child maltreatment, and the absence of clear objectives, procedures, or standards of evaluation. However, a few studies have made an initial effort to document and characterize the various stages of the CPS process and their effects on children and families Crittenden, There has been little systematic study of factors that influence classification or misclassification of reports. For example, middle-class families are less likely to be defined as dangerous and in need of intervention than lower-class families Knudsen, Complaints against ex-spouses known to be involved in custody disputes are likely to be viewed as less dangerous for a child than battering reports made by medical personnel Knudsen, Factors that influence the methods used to investigate allegations of maltreatment are poorly understood.
State agencies often lack consistent criteria to help workers to make informed judgments in their investigations of reported or suspected child maltreatment. Factors that appear to be correlated with the substantiation of a report include the beliefs or assumptions of child protective services workers, the age of an alleged victim, and reports of multiple or recent incidents Thoennes and Tjaden, However, empirical data do not confirm a causal relationship for any single factor, and data describing the life course of cases over time are not available.
Research on the nature and effectiveness of referral decisions involving maltreating families is difficult, and we know little about the operation of the referral system and follow-up services; the character of cases that are likely to receive services; the nature, intensity, and length of the services provided; and outcomes resulting from intervention services for different types of child maltreatment.
Many factors can affect referral decisions, including availability of services, costs to clients and sponsors, ease of access, client attitudes, perceived need, and organizational relations Knudsen, Recent clinical reports of child abuse cases suggest that many cases are closed immediately after services have been initiated and, in some instances, even prior to actual service delivery. The confidential nature of reports and investigations, the lack of systematic record-keeping and compatible data, and political sensitivity inhibit the observation and analysis of decisions made by child protective services.
Improvements in knowledge about factors that foster or inhibit service referrals may increase the potential for flexible responses and tailoring of interventions for individual families. Some methods that bear empirical evaluation have been proposed to enhance this outcome, including the use of multiple informants, semistructured interview measures, interdisciplinary evaluation teams, and statistically derived assessment profiles that could translate into service plans Baglow, The number of children placed in foster care during the past decade has increased dramatically.
In , the U. House of Representatives Select Committee on Children, Youth, and Families estimated that nearly , children were in out-of-home placements and that by the population of children in out-of-home care may be more than , children. The decision to allow a maltreated child to remain with family members or relatives during treatment is a critical and controversial aspect of the case management process.
Children can be removed from the home for a variety of reasons, including physical illness or incapacity of the child's caregiver, mental illness of the parent often the mother , child personality or emotional problems, severe neglect or abuse, criminal involvement of the parent, or family problems, such as substance abuse, and homelessness Aber, ; Jenkins and Sauber, ; Runyan and Gould, ; Runyan et al. In some cases temporary foster care sometimes called "respite care" is provided to protect the child and to provide a period for family members to improve the conditions that resulted in the child's removal from the home.
Some children placed in foster care, particularly in urban areas, reside with relatives who subsequently receive foster care support payments, a procedure known as "kinship care. Foster care is often viewed as a temporary solution to an emergency situation and the average length of time in foster care has been decreasing in recent years: the median amount of time in foster care remains 1. However, five years has been shown as the average length of time spent by children in foster care in some cities Fanshel, ; Wiltse and Gambrill, One study of foster children in San Francisco suggested that two-thirds of the children were expected to remain in foster care until their maturity Wiltse and Gambrill, In addition to the length of placement, research has.
Proponents of foster care point to the potential for serious physical harm that can occur when abused and neglected children remain in a dangerous environment, and the psychological and developmental risks to the child that can occur from uncertain living arrangements. Critics argue that family preservation is an important cultural value, children should not be removed unnecessarily from their homes, the costs of placing a child in foster care are significant, and foster care placement may have detrimental consequences, 13 including the potential for abuse while in foster care as well as developmental effects particularly if young children experience multiple placements.
Furthermore, the supply of foster care homes has become increasingly limited, especially in large cities Kammerman and Kahn, As a result, community resistance to the forced removal of a child from the home remains high.
Current governmental policies seek to reduce the numbers of children requiring foster care or adoptive placement, to reduce the time lag between temporary and permanent placement of young children, and to reduce multiple placements for children. Although public policy decisions regarding the use of foster care must ultimately reflect value judgments within the community, the lack of solid empirical evidence about the nature of placement experiences and selection criteria hinders decision making in this area Wald, ; Wald et al.
Research on the placement of physically abused and neglected children has yielded diverse and contradictory findings, influenced by differences in methodology and in the variables selected for study Hunter et al. Many foster care studies do not distinguish between maltreated and nonmaltreated children, although one recent study indicated that approximately 50 percent of the , children who entered foster care in were abused or neglected Tatara, , Placement decisions are often influenced by measures of parental functioning or cooperation Boehm , , availability of maternal support Hunter et al.
Two studies have suggested that poor families, in particular, are more likely to have a child removed, even after controlling for the nature of the abuse Katz et al. Although children in foster care are known to be at high risk for severe emotional, behavioral, and physical difficulties, comprehensive physical and mental health services are not available for children in foster care Goerge and Kranz, ; Schuerman et al.
Two different studies found that children in foster care were generally underreferred for clinical services Hochstadt and Harwicke, ; Meddin and Hansen, Research on services provided to children in foster or kinship care is difficult. Information about children in foster care is often dispersed among biological parents, foster parents, relatives, and caseworkers, and cooperation among agencies providing services is frequently hampered by issues of confidentiality, rigid funding and eligibility requirements, budgetary restrictions, and the specialized nature of professional services that tend to focus on isolated problems National Commission on Children, Therapists who provide treatment to children in foster care are often influenced by financial and contractual considerations, interagency relations and history, and the effects of decisions on future referrals Molin, A small proportion of child maltreatment cases that are substantiated by child protection agencies can become involved with juvenile courts, family courts, and criminal courts, but no cohesive policy exists to guide the justice system's response to child abuse and neglect cases Smith et al.
Juvenile courts handle dependency proceedings, including adoption and foster care placements, when evidence exists that a parent is unable to protect and properly care for a child. Child maltreatment cases may be relevant to family courts when one parent seeks action against the other and evidence of abuse usually sexual abuse is considered in visitation or family custody decisions. Criminal courts handle charges against adults who have severely harmed or molested a child and can mandate that child abusers receive treatment.
Areas of convergence and conflict between the goals of service providers and the legal system in the treatment of child abuse and neglect have been documented, yet much uncertainty remains. Research on crimi-. In some cases, the prosecution of an offender can be an impediment to treatment. For example, a parent's willingness to comply with treatment may be diminished if he or she believes that statements made during therapy will be used to incriminate them or terminate their parental rights Davidson et al. Psychological problems that underlie maltreatment are usually not resolved by criminal sanctions because courts and prisons often lack resources to provide adequate treatment to offenders.
An unsuccessful prosecution can also reduce the effectiveness of voluntary or court-ordered treatment, encourage noncompliance, and subject the child to further maltreatment DeFrancis and Lucht, Legal interventions in child maltreatment are complicated by many factors, such as the absence of physical evidence, difficulties in obtaining consistent and reliable testimony from children, emotional trauma that might be incurred in forcing a child victim to testify against a parent or other adult who may have harmed him or her, and inconclusive scientific evidence regarding the effectiveness of treatment in halting abusive and neglectful behavior.
However, even though relatively low numbers of sexually abused children involve court proceedings Goodman et al. For example, the Department of Justice has sponsored numerous studies on the experience of the criminal and juvenile justice systems in handling child maltreatment cases, the effects of participation in the justice system on children, and the validity of children's statements and behaviors as indicators of abuse Whitcomb, However, systematic evaluations of the largest victim support programs Court Appointed Special Advocates and the Guardian ad litem programs 18 have not been conducted.
The impact of guardian ad litems and volunteer Court Appointed Special Advocates on the outcome of court cases and on the children they represent is not known. The role of the courts in ordering particular forms of treatment to prevent child abuse and neglect, such as the use of Norplant an implantable contraceptive for women who have histories of being reported for child maltreatment Feringa, Iden, and Rosenfield, ; Scott, ; the use of castration for male sexual offenders; or the placement of newborns in foster.
Social and cultural values have influenced the development of interventions in child maltreatment in both professional and public institutions. In many situations, these values are complementary and reinforcing, but conflicts can arise. National policies, professional services, and institutional programs may sometimes be governed by different priorities that reveal inconsistent policies and fundamental value conflicts. The principal values that strongly influence the current American social context for responding to reported or suspected child maltreatment include child safety and family preservation.
The rights of individual privacy, confidentiality, and other liberties that are often constitutionally guaranteed also influence both the provision of social and professional interventions as well as evaluations of their effectiveness. The conditions under which child, parental, or community rights should supersede all other rights and obligations, and the criteria that should be considered in balancing long-term dangers against immediate threats, are unclear.
The safety of the child is usually a paramount interest, but minimal risks to the child may be tolerated to help families remain intact. Various anecdotal reports have illustrated cases in which children were not adequately protected because an offender remained in a caretaking role for the child during treatment or delays in court proceedings.
For some children, foster care or removal of the offender from the home is the only way to protect the child from imminent harm, even though the out-of-home placement may result in further psychological or social damage and long-term costs to society. Research defining the best interests of the child is becoming a significant issue in determining the outcomes of assignment of visitation and custodial rights in court decisions.
Medical, psychological, social, and legal interventions in child maltreatment cases are based on assumptions that such interventions can reduce the negative physical, behavioral, and psychological consequences of child abuse and neglect, foster attitudes and behaviors that improve the quality of parent-child interactions and limit or eradicate recurrences of maltreatment.
Interventions have been developed in response to public, professional, legal, and budgetary pressures that often have competing and sometimes con-. Some intervention services focus on protecting the child or protecting the community; others focus on providing individual treatment for the child, the offender, or both; others emphasize developing family coping strategies and improving skills in parent-child interactions.
Assumptions about the severity of selected risk factors, the adequacy of caretaking behaviors, the impact of abuse, and the steps necessary to prevent abuse or neglect from recurring may vary given the goals and context of the intervention. Little is known about the character and effects of existing interventions in treating different forms of child maltreatment.
No comprehensive inventory of treatment interventions currently exists, and we lack basic descriptive and evaluative information regarding key factors that influence the delivery and outcomes of treatment for victims and offenders at different developmental stages and in different environmental contexts. A coherent base of research information on the effectiveness of treatment is not available at this time to guide the decisions of case workers, probation officers, health professionals, family counselors, and judges.
Investigations of child maltreatment reports often influence the development and availability of other professional services, including medical examinations, counseling, evaluation of risk factors, and substantiation of complaints. Research on various federal, state, and private agency involvement in treatment interventions has not been systematically organized, and information that describes how these groups interact is not readily available.
Although the panel acknowledges the challenges of performing research in this area, future study designs require particular sensitivity to the need for adequate sample sizes, well-characterized and designed samples, and validated and comparable measures. Specific causal relationships between services and outcomes have not been determined through experimental research designs with random assignment of subjects to treatment and control or comparison groups.
In contrast, there have been successful applications of randomized clinical trials for other social problems, such as school-age pregnancy Klerman and Horwitz, as well as randomized programs involving the response of law enforcement agencies to domestic violence reports Sherman, Some researchers have suggested reforms in the data collection processes in clinical and legal decision making in child maltreatment cases so that service plans can be used for research purposes as well Aber, Recommendation Research on the operation of the child protection system, including an evaluation of the sequential stages by which.
The factors that influence different aspects of case handling decisions, factors that improve the delivery of case services, and alternatives to existing arrangements for providing services to children and families in distress need to be described and evaluated. A research framework that provides standardized classifications and descriptions of child maltreatment investigations, adjudications, and referral decisions should be developed to analyze the operation of the child protection system.
This classification system should be employed in a national study designed to facilitate data collection and to clarify the types of agencies involved in the system, the forms of maltreatment that stimulate treatment referrals, the range of interventions available for selected forms of maltreatment, the costs of investigating and responding to reports of child maltreatment, and the outcomes of case reports. Analysis is needed of the interaction among different agencies involved in intervention and treatment and the degree to which decisions made by one agency affect outcomes in others.
Recommendation Controlled group outcome studies are needed to develop criteria to assess the effects of treatment interventions for maltreated children. Adequate measures need to be developed to assess outcomes of treatment for victims of abuse and neglect, and methods by which developmental, social, and cultural variations in abuse symptomatology can be integrated into treatment goals and assessment instruments need to clarified.
The criteria that promote recovery and treatment modalities appropriate for children depending on their sex, age, social class, cultural background, and type of abuse need to be identified. Research on the impact of abuse on children of different ages and in different contexts needs to be integrated into effective treatment strategies. In assessing treatment outcomes, consideration needs to be given to the child's developmental stage, cognitive abilities, and gender.
The types of therapies e. The criteria selected for treatment outcome studies are particularly important because they shape the emphasis of the intervention. The treatment of children with developmental disabilities, past histories of abuse, and factors associated with maintenance of treatment effects e. The gap between research information on critical factors and conditions under which treatment is provided also needs to be bridged by identifying individual, social, cultural, and contextual variables that affect the use and outcome of treatment interventions.
In implementing this recommendation, closer integration of diverse research and practice traditions needs to be developed to improve the quality of treatment interventions in response to child maltreatment. Recommendation Well-designed outcome evaluations are needed to assess whether intensive family preservation services reduce child maltreatment and foster the well-being of children in the long term. In addition to examining the role of family preservation programs in preventing foster care and other out-of-home child placement decisions, evaluations of family preservation services need to consider the effects of such programs in encouraging positive parent and child interactions and other factors that affect child and family well-being.
Evaluations should examine the methods by which families acquire skills that foster positive family interactions and the factors that reduce crises that lead to the need for services. Such evaluations should also measure the impact of family preservation programs on parent and child functioning, psychological health, and long-term consequences for the child and family that are associated with participation in the program. Comparing families in family preservation services with those in alternative services or those who receive no services could test the efficacy of various models of intensive family preservation services as well as the effect of key service components, such as the intensity and duration of services on outcomes.
The costs of family preservation services, including all services received by families during counseling and after termination, need to be determined. Such research will provide data on the costs of treating families and would furnish a baseline from which to compare the effectiveness of different approaches. Recommendation Studies of foster care that examine the conditions and circumstances under which foster care appears to be beneficial or detrimental to the child are urgently needed. Special consideration should be given to factors that might be related to outcomes, such as characteristics of the process by which the child was removed from the original home, characteristics of the foster family, and characteristics of the child including age at placement or adoption.
Evaluations of regional studies of children placed in foster care as a result of. The proposed evaluations should draw on the study of abuse effects to develop a physical and mental health profile that can be used in planning treatment interventions for these children. Recommendation Large-scale evaluation studies of treatments for perpetrators of sexual and physical abuse and neglect familial as well as extrafamilial , with lengthy follow-up periods and control groups of untreated or less intensively treated offenders, need to be designed to compare different treatment modalities.
Because of their relatively low costs, evaluations of self-help and support programs may be particularly beneficial. Early intervention through the treatment of adolescent offenders also deserves special consideration at this time. A large-scale evaluation to test comparative studies of self-help, support, and other therapeutic techniques should be conducted to describe ways in which such peer- and professional-led groups maintain a healthy or unhealthy change-oriented approach.
The length of service and scope of participation in programs warrants research attention. Evaluations should examine factors that promote change in abusive behavior and psychological processes associated with abusive behavior e. Recommendation Effective interventions for neglectful families need to be identified. Large-scale evaluation studies of child neglect should be developed to determine types of interventions that can mitigate chronic neglectful behaviors among offending parents and improve outcomes for children victimized by neglect.
Information should be sought about the historical, social, and psychological characteristics of neglectful parents in order to identify key variables that may become the focus of treatment interventions. Strategies for recruiting and retaining neglectful families in treatment programs need to be developed and could benefit from comparative studies of strategies used in modifying other behaviors that are resistant to change, such as drug addiction. Future efforts should explore the relative merits of long-term impacts of infant stimulation programs and other intensive services for neglected children and examine the relative contributions of intervention methods for different factors associated with neglect, such as lack of parental involvement or investment, lack of resources, a misunderstanding of the child's needs, social isolation, and maternal depression.
An excellent review of research on emotional maltreatment is included in a special issue of Development and Psychopathology , Vol. White's evaluation of 29 service improvement grants funded by the National Center on Child Abuse and Neglect between and with a client impact of families; Study IV: Berkeley Planning Associates' evaluation of 19 clinical demonstration projects funded by the National Center on Child Abuse and Neglect between and with a client impact of 1, families. Studies that include school-age children primarily as participants in parent training or multisystemic programs are described later in this chapter under family treatments.
A critical component of these programs was supplemental parent training Kazdin et al. In the Homebuilders model, 90 percent of children remained in the home during the month follow-up Kinney et al. Although researchers generally agree that prevention of external placement is an appropriate indicator of programmatic success, the use of this measure alone poses several problems: 1 it is difficult to compare placement rates over time and across communities because not all children who enter family preservation programs would have been placed; 2 placements are affected by factors that are external to success or failure in treatment, such as the availability of after-care services or institutional placements in a community; 3 improvements in the quality of parent-child relationships are not a documented outcome Daro, ; Wells and Biegel, This figure assumes that the child would be in foster care a total of 8 years, the average length of stay for the Maryland caseload, and that the family-based services would be provided for a total of 15 months, with intensive intervention during the initial 3 months Daro, Current training in child abuse focuses predominantly on physical abuse and typically covers only identification and reporting Alexander, In New York City, for example, although workers have an average of In most states, caseworkers are required to have only a college degree; only in New Mexico and North Dakota are degrees in social work required Dugger, Since the s the nation has witnessed a steady decline in the percentage of child maltreatment reports that are substantiated as well as an increase in the total number of reports.
Although the rising percentage of unsubstantiated reports does not necessarily reflect an ineffective or inefficient reporting system, it increases pressure on resources and emphasizes the need to reexamine present reporting laws and investigatory systems Eckenrode et al. The decision to close cases may be in response to the administrative problem of increased caseloads, but one effect of this practice is to remove potentially useful social service agency pressure and monitoring that can motivate parents to participate in treatment.hostmaster.vclean.life/end-world-horizons.php
Brazil reports 737 thousand cases of domestic violence in nine years
It is possible that the proportion may be even higher, since several of the other categories, such as child abandonment , could reasonably be considered as stemming from child maltreatment. Since the s, state legislatures have passed laws to facilitate prosecution of child maltreatment cases. The rules governing the admissibility of evidence have been broadened by the Supreme Court.
The types of out-of-court or hearsay statements that can be admitted into court proceedings have been expanded, and several states allow videotaped versions of children's testimony or shielding a child witness from the defendant during their testimony Reppucci and Aber, The latter two innovations continue to be controversial because they restrict the defendants' Sixth Amendment right to confront witnesses in criminal trials. Empirical studies have not yet documented the impact of these techniques Reppucci and Aber, According to 52 law enforcement agencies responding to a Police Foundation survey, only 39 percent of child sexual abuse cases result in arrest; 42 percent of these cases are not prosecuted because they lack sufficient evidence to meet criminal standards of proof beyond a reasonable doubt or involve children viewed as too young to be credible witnesses Martin and Hamilton, In the majority of sexual abuse cases that are prosecuted, children do not actually testify in criminal court.
In one study of sexual abuse cases referred for prosecution, approximately 8 percent of child victims testified Goodman et al. Negative consequences of testifying in sexual abuse cases appear to be specifically associated with multiple testimonies, the harshness of direct and cross-examination experiences, age, lack of corroborative evidence, and lengthy delays in the criminal prosecution process Goodman et al. Intimidating atmospheres and fear of the separation from a loved one also have particularly negative effects on children Goodman et al.
Researchers have not attempted to identify the percentage of children traumatized by testifying, the risk factors for experiencing trauma, or the types of abuse that cause the most trauma to testify about Reppucci and Aber, Assessing the validity of behaviors and statements of suspected victims of child abuse in the absence of definitive physical evidence poses many challenges. The accuracy and reliability of a child's allegations are affected by factors such as the consistency of the account, vocabulary appropriate to the child's developmental level, lack of motivation to fabricate the account, appropriate affect, spontaneity, and consistency with corroborative evidence Perry and Wrightsman, Most of research in this area has focused on sexual abuse victims.
Young children's interactions with anatomical dolls is one type of behavior commonly evaluated in assessing suspected victims of child sexual abuse.
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Although anatomical dolls often help children describe what has happened to them and are often used in the assessment of young children, conflicting evidence exists about behavioral differences between the behavior of sexually abused and nonabused children with anatomical dolls Kendall-Tackett, ; Realmuto and Wescoe, Victim witness programs are available in more than 7, communities across the United States Whitcomb, Approximately 13, trained volunteers serve as Court Appointed Special Advocates in dependency hearings and advise judges and prosecutors about victims' needs and request specific intervention.
Guardian ad litems are attorneys appointed by juvenile courts to represent a child's best interests, accompany the child to court proceedings, and obtain necessary social, medical, and mental health services. Existing measures developed to address psychological and other aspects of human functioning are not necessarily associated with abuse impacts particularly sexual abuse impacts. Researchers may require new assessment instruments that are sensitive to abuse-related symptomatology with reasonable psychometric characteristics in order to evaluate outcomes of intervention studies Briere, ; Elliott and Briere, Aber, J.
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