Child Abuse Prevention: Protecting Our Kids

April is National Child Abuse Prevention Month, and in the U.S. parents, communities and agencies continue work to reduce and eliminate abuse and neglect.

One of the most recent efforts by the federal government is the Protect Our Kids Act of 2012, written “to establish a commission to develop a national strategy and recommendations for reducing fatalities resulting from child abuse and neglect.” This legislation’s efforts are coming to life through the recent creation of the Commission to Eliminate Child Abuse and Neglect Fatalities. The hope for these efforts is that they can help answer one of the biggest issues facing child abuse prevention efforts  – the lack of a systematic approach and strategy to prevention.

Renewed prevention efforts are vital to children in the U.S.. Although child abuse rates have fallen, child abuse fatalities have not. According to the Every Child Matters education fund “15,510 children are known to have died between 2001 and 2010, which is about 2½ times the number of U.S. troops killed in Iraq and Afghanistan.” Even more troubling is the acknowledgement that these numbers are actually considered a severe underestimation of the actual number of fatalities because there is no standard national reporting system for tracking. The commission will be working to find ways to bridge the reporting gap between state and federal child welfare agencies and improve the quality of data collection.

In spite of needing ongoing improvement in prevention efforts, the U.S. is still a leader in child abuse prevention. In March 2013, Ghana announced participation in International Child Abuse Month to improve prevention efforts in the country citing the U.S. example of reducing abuse statistics through public awareness events, education and ongoing research.

For a look at what some of these prevention efforts look like, check out this video:

Pinwheels for Prevention 2013

International Day Against Drug Abuse and Illicit Trafficking

Today is the International Day against Drug Abuse and Illicit Trafficking. This awareness day, created in 1987 by the United Nations (UN) General Assembly was created to work towards a society free of drugs and violence. Each year the UN Office on Drugs and Crime (UNODC) promotes a theme of health to raise awareness about the global problem of drugs.

The UN Secretary General notes that “drug abuse and illicit trafficking continue to have a profoundly negative impact on development and stability across the world. The billions of dollars generated from illicit drugs fuel terrorist activities and abet other crimes such as human trafficking and the smuggling of arms and people.” These kinds of activities put children at an even greater risk for exposure to violence. The National Survey on Children’s Exposure to Violence reminds us that each year American children are exposed to violence, crime and abuse in their communities and at home. They are more at risk for developing the following:

  • Psychological health outcomes
  • Physical health outcomes
  • Academic difficulties and failure
  • Behavioral problems
  • Delinquency and offending
  • Poly-victimization

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Mental Health, Wellness, and Children

Let’s recap:

This month has been about promoting mental health and children’s mental health awareness. We’ve talked about National Children’s Mental Health Week and National Children’s Mental Health Awareness Day. We’ve also had guest expert blogs about the importance of children’s mental health and the impact of stress on children.

But what is the most important thing to remember and take away from all of this?

Well, prevention and wellness are key!

“Research has shown that children have a wide range of reactions to exposure to violence. Some children are not adversely affected or may show only brief and transient reactions. Others may be more affected, showing significant symptoms and emotional vulnerability. Some develop intense anxiety disorders or posttraumatic stress disorder.” –Safe Start Issue Brief 1, p. 2

The most important thing is the overall well-being of these children.  The protection of their well-being is achieved by building resilience and preventing exposure.

One way of doing this is through the Centers for Disease Control (CDC) Public Health Model. It provides a great way to start and complete the process of enhancing children’s well-being. By framing it this way, there is a body of proof about building resilience and prevention, it provides the means for identifying those at higher risk, and develops and tests strategies for dissemination to communities. The most important thing is the overall well-being of these children.  The protection of their well-being is achieved by building resilience and preventing exposure.

 

Understanding Children’s Exposure to Violence Brief #1 shares some ideas about program types and interventions that can both enhance resilience and reduce risks for children exposed to violence.

  • For all children, participation in high-quality early care and education programs can enhance physical, cognitive, and social development and promote readiness and capacity to succeed in school.
  • For at-risk families, early identification of and intervention with high-risk children by early education programs and schools, pediatric care and mental health programs, child welfare systems, and court and law enforcement agencies can prevent threats to healthy development by detecting and addressing emerging problems.
  • For children and families already exposed to violence, intensive intervention programs delivered in the home and in the community can improve outcomes for children well into the adult years and can generate benefits to society that far exceed program costs.
  • Outcomes improve when highly skilled practitioners provide intensive trauma-focused psychotherapeutic interventions to stop the negative chain reaction following exposure to traumatic stressors (e.g., child abuse and neglect, homelessness, severe maternal depression, domestic violence).

For further information check out the full issue brief here.

So, the best thing we can do to promote children’s wellness is to continue to work to raise awareness to identify those at-risk and advance interventions!

A symptom of a wider problem

Why us?

Why here?

Why did he do it?

These are the questions people always have in the face of tragedy and loss. When things like the Chardon High School shooting happen, often the public and community’s focus is on looking at the lives of the victims and understanding the shooter’s motivation, usually with the feeling of anger.  But it’s really important to make sure we remember to look at the whole picture.

News headlines are showing a variety of reasons and speculation for why T.J. Lane – for all appearances, a normal, great kid with a bright future – did something this.

Was it just random?

One report said

“Lane told police that he did not know the students, that he picked them randomly,
according to the report. But some of the students who were shot had known
Lane since at least middle school. Some rode the bus with him each day.”

Was he just an overlooked danger?

Because another one points out that

“Lane wasn’t a student at Chardon, but he went there to catch a bus that would
drop him off at an alternative school for at-risk teens.”

Or is he repeating a cycle of violence from things he witnessed as a child?

Because, yet another report mentions that

“Both parents were charged with domestic violence against
each other and his father was very violent.”

Or finally, did he just do it because of a broken heart?

Because yet, another report says that

“A group of friends close to Lane’s former girlfriend told ABC News that the girl had dated Lane, and that after they broke up, she began seeing one of the victims, Russell King Jr. Lane felt forgotten after the couple broke up, one of the students said.”

The reality is that we may never know why he brought the gun that day and shot those other teens. There is no excuse that will ever justify T.J. Lane’s actions that day, but there is an explanation. It’s vital we try to understand the root cause, and this is outlined in The National Survey on Children’s Exposure to Violence.

“ [It] confirms that most of our society’s children are exposed to violence in their daily lives. More than 60 percent of the children surveyed were exposed to violence within the past year, either directly or indirectly (i.e., as a witness to a violent act; by learning of a violent act against a family member, neighbor, or close friend; or from a threat against their home or school).”

There are two sides to every story, and many reasons that tragedies happen, but a variety of violence exposures are often at the root of these occurrences, and they are the symptoms of a wider problem. Knowing how often our children are exposed to violence is imperative, and we have to understand the whole picture of violence.

This can be done through:

  1. Continued training of practitioners and public health officials
  2. Public awareness about the problem of violence exposure
  3. Recognition of the signs of trauma
  4. Continued field research on the issue

Exposure to violence is an epidemic and a problem that affects everyone that it touches; things like the Chardon School shooting are often a symptom of this wider problem. So, what’s really important beyond just helping schools and communities to heal is to understand this whole picture of violence and continue finding ways to prevent and protect our children.

Human Trafficking: Global Phenomena. Domestic Concern.

Human Trafficking: Global Phenomena. Domestic Concern.

Over the last several years, the topic of human trafficking – or modern day slavery as many advocates call it – has captured the attention and pulled on the heart strings of the American public. U.S. citizens became indignant as they realized that slavery, something they thought fixed a century ago, was still growing in the world. Since then, countless organizations, advocacy campaigns, and fundraisers have been created to help the victims of global trafficking, especially the women and girls trafficked in our country.

Unfortunately, many people still don’t know that these same horror stories happen in their state, their county, their city. Recent reports cite that American born girls and boys are just as likely to be trafficked domestically as immigrant children. Amy Fine Collin recently wrote a story for Vanity Fair on domestic sex trafficking about two trafficked American girls, Gwen and Alicia, and the police officers, lawyers, social workers, and doctors who helped free them. “A pound of heroin or an AK-47 can be retailed once, but a young girl can be sold 10 to 15 times a day—and a “righteous” pimp confiscates 100 percent of her earnings,” Collin writes. This is an American reality, one that unfortunately is targeting younger and younger children.

Continue reading

Background and Basics of Mandated Reporting

As noted on Friday, mandated reporting laws have been in existence since around the 1960s in the United States, a requirement for states that want to receive money from the Child Abuse Prevention and Treatment Act (CAPTA). These laws were supposed to  encourage reporting to help Child Protective Services (CPS) protect vulnerable children from abuse and/or unhealthy living situations in their state. Because of this, many states decided to mandate specific groups of professionals to report, people they felt would be the best equipped to identify abused and neglected children.  And with that mandate some states outline legal consequences for failing to report.

However, as illustrated by the Penn State scandal, mandatory reporting laws are now more seen as a way to enforce and police reporting activities or failing to report. These conflicting ideas result in a variety of barriers for mandated reporters encountering suspicious situations.

A Reporting “How to”

Researchers Warner and Hansen characterize reporting activities in four phases:  assessment and evaluation of the situation, identification of suspected abuse, reporting to authorities, and validations of suspicions. (Influence of Case and Professional…, Hasen et al) The very basics are highlighted in the chart below.

 

Generally,  verbal reports are made to one of three entities – the state’s reporting hotline, the state’s child protective services agency, or law enforcement. A verbal report must be followed up by a written report and then the case is entered into the state database.

Whether or not the case is substantiated – meaning evidence of maltreatment was found – the report will stay in the database for a designated period of time (specific to each state).

Next, the state’s child protection agency will investigate the situation. The case will be ruled one of three ways: unfounded, meaning there was no evidence of maltreatment; indicated, meaning it is likely that maltreatment has occurred; or substantiated, meaning sufficient evidence of maltreatment was found. If the report of abuse is substantiated and/or indicated, a case will be opened and a caseworker assigned to the family. If the case is unfounded or indicated, referrals to voluntary community-based services are provided and the report remains in the system for the specified period of time.

This process is the general flow, no matter where the reporting happens. Anything more specific is dictated by the individual state’s legislation.

State Mandates

In order to get Title IV money (CAPTA), states are required to produce their own specific mandated reporting laws to further define who must report, what must be reported, and how to report. The major differences between states are who is a mandated reporter, what degree of abuse are they to report on, and timing of abuse (whether only past abuse or threat of future harm).

In general, state’s definitions of mandated reporting falls into three categories based on the degree of knowledge the mandated reporter needs to have to report: believe, suspect, know. Let’s look at each a little more in-depth:

1. Eighteen states have belief-based mandates, the broadest of legal definitions for what a mandated reporter is supposed to report. If the mandated reporter has any reason to believe there is abuse going on, they are required to report. The benefits of this is encouraging reporting of any situation in the best interest of the child. However, more often than not this leads to both under- and over-reporting since there are no guidelines for what defines abuse.

2. Thirteen states employ the suspected-based mandates, which is based on the idea that mandated reporters judge a suspicious situation against some sort of professional standards to decide whether or not the situation needs to be reported. This type of law seeks to mitigate biases or inappropriate personal lenses by applying professional lenses to dictate reporting activities. However, like the belief-based laws, professionals often find this definition too vague and it leads to individual interpretations of laws, abuse, and professional conduct.

3. Sixteen states have knowledge-based mandates, which use the very legal terms of evidence and knowledge to dictate reporters’ responsibility. This allows the most legal protection for mandated reporters; however, they still remain suspiciously vague about what kind of evidence and how much is needed to know that abuse is taking place. This can also lead to underreporting.

(The other 3 states have laws that do not fit into these three “degree” categories.)

Another difference between states is who must report. Currently, 18 states have universal laws, which means that everyone is a mandated reporter. Several others, including Congress, have bills before their legislative bodies to make everyone a mandated reporter. The other states mandate those who are child-serving jobs. The most common professions according to the National Child Welfare Gateway  are medical staff and doctors, teachers and school personnel, and social workers. Other states include day care providers, community center workers, coaches, and others.

And lastly, “timing” of abuse mandated to report differs among states. Some states require an actual instance of abuse or neglect to be suspected to trigger reporting where as some states push for more inclusive laws to include “future threat of harm” as a prevention measure. This gets into the idea of the purpose of mandated reporting laws – whether they are to prevent and protect or just protect. The positives and negatives of the current laws will be discussed further on this blog later this week.

As can be seen above, each of the mandates presents its own set of barriers and unintended consequences. The general response since the Penn State scandal broke is to push lawmakers to amend policies to include the most people as reporters and broadest interpretations of abuse as possible. However, many experts are now cautioning this approach as broad laws have been found to increase confusion of professionals about what is required of them as well as under-reporting since there is no clear guidance or training provided to professionals and especially to the general public. Also, there are concerns about what false reports can do to vulnerable families and children.

The best laws are those that answer the following questions in clear specific language:

- Who is required to report?

- What type of abuse and neglect are reportable?

- What level of suspicion is acceptable and how is this expressed?

- Are reporters required to report all sources of abuse or just parents/caregivers?

- Are any new types of abuse required? – poverty neglect, exposure to porn,

- Define by extent of harm  or report any occurrence

- Report only incidences of abuse or threats to future safety?

- How much time is given to make the report?

(Mandatory Reporting Legislation…Mathews and Kenny, Feb 2008, p 589)

Mandates that answer these questions equip mandated reporters to be knowledgeable about abuse and their responsibilities, feel supported in their actions, and know how to balance legal requirements and practice questions in order to help the CPS protect children. As a whole, vague legislative mandates lead professionals to feel uncertainty about specific legal requirements, fear of losing treatment alliance and other results reporting could have on their client-practitioner relationships. There is also a fear of making the situation worse such as retaliations against the child victim, and lack of faith in the child protection services ability and actions in reported cases. Later this week we will look into the barriers for mandate reporters and some of the policy recommendations and practice solutions that are out there.

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For more resources about your individual state laws, signs and symptoms of abuse, and other issues surrounding mandated reporting, please see the following resources.

Child Abuse Reporting Statues (complied by National Clearinghouse on Child Abuse and Neglect) http://www.childabuse.com/newsletter/statues.htm#lawscivil

Child Welfare Information Gateway – Mandated Reporting publications http://www.childwelfare.gov/search/search_results.cfm?term=Mandatory%20reporters

“Recognizing and Responding to Child Maltreatment” by Bilger et all http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2808%2961707-9/fulltext#article_upsell

Checkout it out now! mPreventViolence: Communication and Technology for Violence Prevention

Checkout the live webcast now! For updates about the workshop, follow @theIOM on Twitter using the hashtag#mPreventViolence.

http://events.tvworldwide.com/Events/IOM/IOM111208.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&utm_campaign=12.08.11+Violence+Prevention+webcast&utm_content=12.08.11%20Meeting%20-%20Violence%20Prevention%20webcast%20&utm_term=Unknown

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