Child abuse

For patient information on Child physical abuse, click here

For patient information on Child psychological abuse and neglect, click here

Overview
Child abuse is the physical, emotional or sexual abuse or neglect of children by parents, guardians, or others. While most child abuse happens in the child's home, large numbers of cases of child abuse have been identified within some organizations involving children, such as churches, schools, child care businesses, and residential schools. It also can occur almost anywhere (eg kidnappings, random murders etc.) According to a recent UNICEF report on child well-being the United States and the United Kingdom ranked lowest among first world nations with respect to the well being of their children. This study also found that child neglect and child abuse are far more common in single-parent families than in families where both parents are present. There are many forms of abuse and neglect and many governments have developed their own legal definition of what constitutes child maltreatment for the purposes of removing a child and/or prosecuting a criminal charge. In the United States, the Federal Government puts out a full definition of child abuse and neglect and creates a summary of each State definition.

Effects of child abuse
Child abuse in its various forms has numerous effects and consequences, both tangible and intangible, upon society, those mistreated, and those entrusted with the responsibility of its detection, prevention, and treatment. Child abuse can have dire consequences, during both childhood and adulthood. The effects of being abused as a child vary according to the severity of the abuse and the surrounding environment of the child. If the family or school environment is nurturing and supportive, the child will probably have a healthier outcome. The U.S. National Adoption Center found that 52% of adoptable children (meaning those children in U.S. foster care) freed for adoption had symptoms of attachment disorder. Children with histories of maltreatment, such as physical and psychological neglect and physical abuse are at risk of developing psychiatric problems. Such children are at risk of developing a disorganized attachment. Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms, as well as anxiety, depressive, and acting-out symptoms. A study by Dante Cicchetti found that 80% of abused and maltreated infants exhibited symptoms of disorganized attachment.

Negative Consequences of Child Abuse

Emotional effects include low self-esteem, depression and anxiety, eating disorders, relationship difficulties, alienation and withdrawal, and personality disorders.

Physical effects include injury, death, lifelong health problems, cognitive difficulties, and physical disabilities.

Behavioral effects include problems in school and work, delinquency, teen pregnancy, suicide attempts, criminal or antisocial behavior, substance abuse, aggressive behavior, spousal and child abuse, and anger.

Causes of child abuse
There are many causes of child abuse. Many child abusers were themselves victims of abuse. Mental illness is another common factor, with many abusers having personality disorders or other severe forms of mental illness. Psychosocial factors also play a role.

Parental choices and other unforeseen circumstances that place families under extraordinary stress ― for instance, poverty, divorce, sickness, disability, lack of parental skills and drugs are often associated to child maltreatment. Children in families that have a parent deployed in combat are also more likely to be victims of child maltreatment. Many of these factors may contribute to family stress that can result in child abuse or neglect. Understanding the root causes of abuse can help better determine the best methods of prevention and treatment.

Prevention
Given these possible causes, most professionals agree that there are three levels of prevention services; primary prevention, secondary prevention, and tertiary prevention.

Primary prevention
Primary prevention consists of activities that are targeted at the community level. These activities are meant to impact families prior to any allegations of abuse and neglect. Primary prevention services include public education activities, parent education classes that are open to anyone in the community for parents or abusers to interact with the child, and family support programs. Primary prevention can be difficult to measure because you are attempting to impact something before it happens, an unknown variable.

Secondary prevention
Secondary prevention consists of activities targeted to families that have one or more risk factors including families with substance abuse, teen parents, parents of special need children, single parents, and low income families. Secondary prevention services include parent education classes targeted for high risk parents, respite care for parents of a child with a disability, or home visiting programs for new parents.

Tertiary prevention
These families have already demonstrated the need for intervention, with or without court supervision. Prevention supporters consider 'tertiary prevention' synonymous with treatment and entirely different from prevention through family support.

Treatment
Treatment for those experiencing sequelae from abuse, or Complex post-traumatic stress disorder, which may be caused by early chronic maltreatment, should address each dimension. Often treatment must be multi-modal. Children who have experienced complex trauma caused by chronic maltreatment can be treated effectively with Cognitive Behavioral Therapy interventions, other therapeutic interventions, education, EMDR and other approaches. For children with attachment difficulties or disorders there are a number of recognized interventions.

Childhelp
CEO and Co-Founder Sara O’Meara and President and Co-Founder Yvonne Fedderson started Childhelp in 1959, establishing it as a leading national non-profit organization dedicated to helping victims of child abuse and neglect and at-risk children. Childhelp focuses on advocacy, prevention, treatment and community outreach.

The Childhelp National Child Abuse Hotline, 1-800-4-A-CHILD®, operates 24 hours a day, seven days a week and receives calls from throughout the United States, Canada and the U.S. Virgin Islands, Puerto Rico and Guam. Childhelp’s programs and services also include residential treatment services (villages); children’s advocacy centers; therapeutic foster care; group homes and child abuse prevention, education and training. Childhelp also created the National Day of Hope® that mobilizes people across America to join the fight against child abuse.

Najidah
The Najidah Association was originally established as a Domestic and Family Violence service. In 2003 Najidah began to advocate on behalf of the child victims of DV. Citing the Australian national practice standards for working with children exposed to DV, Najidah revised their practice to respond on the basis that (as per the Australian Standards) exposing children, and or failing to protect children from DV is a form of child abuse. Najidah also began a campaign to highlight the fact that 70% of people in DV refuges are in fact children.

Further to this Najidah has developed a suite of programs that respond to the needs of abused children and the prevention of child abuse. These programs have since won national acclaim and recognition as best practice.

C.A.S. Children's Aid Societies in Canada
The children's aid society (CAS), also known as Family and Children's Services (F&CS), is a non-profit agency working in local communities to provide help and support to children and their families in Canada.

ISPCAN (International Society for Prevention of Child Abuse and Neglect)
The International Society for Prevention of Child Abuse and Neglect, founded in 1977, is the only multidisciplinary international organization that brings together a worldwide cross-section of committed professionals to work towards the prevention and treatment of child abuse, neglect and exploitation globally.

Objectives •	To increase awareness of the extent, the causes and possible solutions for all forms of child abuse. •	To disseminate academic and clinical research to those in positions to enhance practice and improve policy. •	To support international efforts to promote and protect the Rights of the Child. •	To improve the quality of current efforts to detect, treat and prevent child abuse. •	To facilitate the exchange of best practice standards being developed by ISPCAN members throughout the world. •	To design and deliver comprehensive training programs to professionals and concerned volunteers engaged in efforts to treat and prevent child abuse.

SPARC (Society for the Protection of the Rights of the Child)
SPARC is a Pakistan-based child abuse prevention organization. In its annual report titled 'The State of Pakistan's Children-2006', SPARC stated that Pakistan had the highest maternal, which at the present-time was 70 deaths per 1,000 live births, and infant mortality rates in South Asia. The report stated around four children were abused daily, and in 2006 there were a total of 2,447 cases of abuse.

Authorities
Depending on the country, the agencies responsible for investigating child abuse are either managed nationally, regionally, or locally. These agencies may be called Child Protective Services (CPS), Department of Children and Family Services (DCFS), or by other similar names. In the U.S., these agencies are usually listed in the state government section of the telephone book under "Children" or "Health" or "Human Services". In a few instances in the U.S., some of the functions of these agencies are outsourced to private individuals or companies.

People who investigate claims of child abuse may be called a "children's social worker" (CSW) or a case worker.

Reporting abuse and neglect in Australia
Child abuse and neglect is the subject of mandatory reporting in most Australian jurisdictions. Usually professional people such as doctors, nurses and teachers are bound to report strong evidence of abuse or neglect. State authorities, such as the Child Protection Unit of the Department of Human Services (Victoria), have statutory authority to investigate and deal with child abuse.

A document from Child Protection and Family Services, in Melbourne states: "The service system is facing escalating and changing demand pressures and we are increasingly aware of growing client complexity. Too many children, young people and families are coming back into the child protection system on a repeat basis with services making little impact on their issues. The analysis confirms this and identifies the need for a strategic rethink if we are to achieve better outcomes for vulnerable children, young people and their families. "

Reporting Abuse in the UK
All professionals who work with children, such as teachers, health professionals and the like are required to report to social services (or the police as appropriate) any 'concern' amounting to possible 'significant harm' (neglect, physical, sexual or emotional abuse) regarding a child's welfare. The police and social services operate a multi-agency approach in cases of serious abuse. A system of referrals to Social Services so that one authority held all information started in the 1960s following the death of Maria Colwell, but was insufficiently effective and a number of notorious cases over the years have resulted in several major overhauls of the system, the most recent following the death of Victoria Climbie in 2000. Social Service departments, organised regionally, are required to investigate reports of abuse, keep records and take appropriate action to protect children. This can range from the provision of advice and support to families through to immediate removal under an Emergency Protection Order, and Care Proceedings which may result in permanent placement of the child outside the family. The threshold to enable a court to make an order is actual or likely significant harm. In care proceedings the welfare of the child is paramount and all information affecting the welfare of a child must be disclosed by professionals, including lawyers, regardless of their clients' interests.