Editorial perspective: Treatment of complex maltreatment - beyond the NICE guideline? Manuals, muddles or modules (original) (raw)
Related papers
‘Recognising and responding to child maltreatment’
Professionals in child health, primary care, mental health, schools, social services, and law-enforcement services all contribute to the recognition of and response to child maltreatment. In all sectors, children suspected of being maltreated are under-reported to child-protection agencies. Lack of awareness of the signs of child maltreatment and processes for reporting to child-protection agencies, and a perception that reporting might do more harm than good, are among the reasons for not reporting. Strategies to improve recognition, mainly used in paediatric practice, include training, use of questionnaires for asking children and parents about maltreatment, and evidence-based guidelines for who should be assessed by child-protection specialists. Internationally, studies suggest that policies emphasising substantiation of maltreatment without concomitant attention to welfare needs lead to less service provision for maltreated children than do those in systems for which child maltreatment is part of a broad child and family welfare response.
Child Maltreatment 2 Recognising and responding to child maltreatment
2009
Professionals in child health, primary care, mental health, schools, social services, and law-enforcement services all contribute to the recognition of and response to child maltreatment. In all sectors, children suspected of being maltreated are under-reported to child-protection agencies. Lack of awareness of the signs of child maltreatment and processes for reporting to child-protection agencies, and a perception that reporting might do more harm than good, are among the reasons for not reporting. Strategies to improve recognition, mainly used in paediatric practice, include training, use of questionnaires for asking children and parents about maltreatment, and evidence-based guidelines for who should be assessed by child-protection specialists. Internationally, studies suggest that policies emphasising substantiation of maltreatment without concomitant attention to welfare needs lead to less service provision for maltreated children than do those in systems for which child maltr...
Child Abuse & Neglect, 2011
Objective: To develop further the understanding of emotional abuse and neglect. Methods: Building on previous work, this paper describes the further development of a conceptual framework for the recognition and management of emotional abuse and neglect. Training in this framework is currently being evaluated. The paper also briefly reviews more recent work on aspects of the definition, harm caused by emotional abuse and neglect and threshold. Results: The paper arrives at a working definition as 'persistent, non-physical, harmful interactions with the child by the caregiver, which include both commission and omission.' There are many forms of harmful caregiver-child interactions, which can be placed in five categories, each category reflecting the fulfillment of one of the child's basic psycho-social needs and requiring a different therapeutic approach for its alleviation. The caregiver-child relationship is embedded within a psycho-social context. It is suggested that greater clarity can be gained about the child and family when information is sorted into the appropriate tiers of concerns: Tier 0-Social & environmental factors, Tier I-Caregiver risk factors, Tier II-Caregiver-child interactions and Tier III-Child's functioning. It is further suggested that while intervention is required, this is directed towards protection, rather than providing immediate protection of the child. The work takes the form of a time-limited trial of therapeutic work to gauge the capacity of the caregivers to change. This initial work focuses Tiers 0-II. Statutory steps might be required in order to encourage the caregivers to engage. If insufficient progress is achieved, active child protection may be required which might include placing the child in an alternative family. However, some, usually older, children will remain in the emotionally abusive environment and they will require ongoing help and support. Conclusion: While a greater understanding of emotional abuse and neglect is now possible, further evaluation of the utility of this framework is suggested.
Interventions to prevent child maltreatment and associated impairment
The Lancet, 2009
Although a broad range of programmes for prevention of child maltreatment exist, the eff ectiveness of most of the programmes is unknown. Two specifi c home-visiting programmes-the Nurse-Family Partnership (best evidence) and Early Start-have been shown to prevent child maltreatment and associated outcomes such as injuries. One populationlevel parenting programme has shown benefi ts, but requires further assessment and replication. Additional in-hospital and clinic strategies show promise in preventing physical abuse and neglect. However, whether school-based educational programmes prevent child sexual abuse is unknown, and there are currently no known approaches to prevent emotional abuse or exposure to intimate-partner violence. A specifi c parent-training programme has shown benefi ts in preventing recurrence of physical abuse; no intervention has yet been shown to be eff ective in preventing recurrence of neglect. A few interventions for neglected children and mother-child therapy for families with intimate-partner violence show promise in improving behavioural outcomes. Cognitive-behavioural therapy for sexually abused children with symptoms of post-traumatic stress shows the best evidence for reduction in mental-health conditions. For maltreated children, foster care placement can lead to benefi ts compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefi ts for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures. (3 suppl): 21-35. 5 Theodore AD, Chang JJ, Runyan DK, et al. Epidemiologic features of the physical and sexual maltreatment of children in the Carolinas. Pediatrics 2005; 115: e331-37. 6
Can Common Elements Support a Public Health Approach to Child Maltreatment?
International Journal On Child Maltreatment: Research, Policy And Practice, 2022
Despite ongoing reforms to child protection systems and calls for a greater focus on prevention and early intervention, demand on statutory services continues to grow across developed countries. The reasons for this are multiple and complex and include: (1) barriers that exist within service systems themselves; (2) the entrenched and interwoven nature of the drivers of child maltreatment and (3) limited access to programs that can be implemented at scale. This means that empirically supported interventions that can address child maltreatment are not widely available to support a public health response. Several innovations to address the aforementioned challenges draw on 'common elements' approaches. Common elements are the discrete techniques commonly found in programs supported by evidence. Over the last 30 years, the evidence base regarding therapeutic techniques for child maltreatment has remained relatively stable, yet there has been a significant increase in the number of evidence-based programs or protocols available. Many of these protocols consist of different combinations of the same therapeutic elements. The Institute of Medicine in the USA has recently called for further research into common elements for psychosocial interventions as an approach to widening access to empirically supported techniques. This article will explore whether common elements may assist in overcoming some of the challenges we are facing in 'realising' a public health response to child maltreatment. The potential benefits and limitations of the approach will be outlined, as well as the existing evidence base, and future directions for research and evaluation.
Strategies to Prevent Child Maltreatment and Integration Into Practice
2010
Introduction Preventing child abuse and neglect spares children physical and psychological pain and improves their long-term health outcomes. Dubowitz (2002) noted that prevention “is intuitively and morally preferable to intervening after the fact.” Therefore, the potential for harm to adults from child maltreatment calls us to action. Early intervention may be more effective in preventing abuse and neglect, may save money for society, and may improve peoples’ overall health and well-being, perhaps the most important goals a society can accomplish.