Preventing Child Abuse and Neglect
The term evokes emotion in every one of us. Some are
angry--actually outraged. Some are frustrated by the difficulties
and obstacles in dealing with abuse. Some are bewildered by the
complexity of the issues. And there are those who relive the
feelings of being victimized in their own childhood. Whatever
role we play professionally, in the political arena, or in our
families, child abuse is a problem which demands our attention.
During the first quarter of this academic year I was fortunate
to have a leave from my usual work to study the issues related to
child maltreatment and to develop a plan for "giving
away" useful information about the prevention of child
abuse.
For a middle-aged administrator this was a dream come true.
Three months to read whatever caught my interest, to take time to
think, to interview practitioners from other states, to think, to
talk with researchers, to think, to discuss issues with
legislators, to take time to think and then to read again. I
cannot recall a time when I had the luxury of being able to
concentrate on just one thing, without other responsibilities.
Another pleasure of the quarter was the opportunity to attend
a national professional conference in a discipline other than my
own. I spent four days in Salt Lake City getting acquainted with
cutting edge research and practice in preventing child abuse.
Having thus immersed myself in this course of study, what words
of wisdom do I have for Early Report readers? I think we must,
each of us in our own roles, in child care, schools,
universities, in social services and in the political arena, take
action to prevent abuse.
It is not enough to read the papers and watch TV and say we
are emotionally distressed, disgusted we are angry, sad, unable
to truly understand how this could be happening in our community
which is known to have a high quality of life. Senator Hatch, of
Utah, said it, "Shock and revulsion will not help the
victims."
Henry Kempe warned us, 25 years ago. He said that if we fail
to use what we know--and wait for all the statistics and
knowledge, we will raise another whole generation of child
abusers. Today the research evidence proves him right. We know
now, with certainty, that the phrase "time heals all
wounds" does not hold for children who have been victims of
abuse and neglect -these children must have their wounds treated.
We also know that treatment is helpful, but it often does not
completely eliminate the effects of abuse and neglect and the end
result can be the potential for those children becoming the
abusers in the next generation.
We have not been idle during the last 25 years. We have
created reporting laws, we have made abuse a crime, we have
established programs for treatment of parents and children. We
have struggled with social and moral issues, such as 'do we
protect parents rights or children's rights'.
Dr. Richard Krugman, Director of the Kempe Center for the
Prevention and Treatment of Child Abuse and Neglect, who will
participate in the Minnesota Round Table (see page 8), has said
arguments between Democrats and Republicans -debates of
punishment vs. treatment of offenders and discussions of medical
models vs. social work models are "...adult dichotomies
which are meaningless to children -while we argue, they hurt. We
must have the will to work together. Abused kids do not care
about our differences."
We must begin to spend more of our efforts and more of our
dollars on primary prevention (action to stop a specific problem
before it starts) doing public education using a variety of
modes.
At the same time we must invest in secondary prevention,
(early diagnosis and treatment of individuals and families at
risk for abuse). Child psychologists, psychiatrists, social
workers, pediatricians, and others who have studied the causes
and effects of abuse agree that child abuse is most often a
disorder of attachment. In preventing the development of abusers
the importance of good attachment and its long lasting effects
cannot be overstated. This points clearly to the need for parent
training, starting with prenatal care and counseling.
Jane Gilgun (page 4) advises us to "tell, tell,
tell" and Alan Sroufe, of the Mother-Child Project (see
below), reminds us that this is not a simple task. "We must
be in there for the long haul, in our time we will not solve this
problem; but maybe we can keep the ship afloat."
In this issue of Early Report the articles provide insights
about research projects, training programs, and efforts at
coordination of services that are taking place at the University
of Minnesota and in our community. Other information about
prevention of abuse that have been published as a FACT FIND
service are available upon request.
by Erna Fishhaut, M.A. Coordinator, CEED
Using Research in Preventive
Intervention
Most of us agree we should try to prevent child abuse, yet
there is less agreement as to how or toward whom to direct our
efforts. Two bodies of research help us answer those questions:
1) studies that identify people most at risk of abusing and that
pinpoint risk factors to target for change through preventive
intervention; 2) studies that evaluate the effectiveness of
preventive intervention strategies: What really works and for
whom? Two studies at the University of Minnesota represent these
areas of research and are yielding findings with important
implications for practice and policy in the area of child abuse
prevention.
STUDY NUMBER ONE: INDICATORS OF RISK
The Mother-Child Interaction Project, initiated in 1975 by
Drs. Byron Egeland and Alan Sroufe of the Institute of Child
Development has followed 267 women and their first-born children
beginning during pregnancy. The researchers assessed the mother's
attitudes and feelings, the child's development the parent-child
relationship, and the broader social environment. Because the
families all were low-income at the start of the study and
experienced many of the stressors associated with poverty, there
was a higher probability of maltreatment in this sample than in
the general population. Indeed, in the first six years of the
study about 60 children were identified by the researchers as
experiencing some type of maltreatment: physical abuse, neglect,
verbal abuse, sexual abuse, or emotional neglect. Virtually all
of these children, now young teenagers, have exhibited problems
as compared to non-maltreated children from the same low-income
sample, particularly in social relationships with both peers and
adults.
Perhaps the most useful information from this study is the
identification of factors that predict which parents are most
likely to maltreat their children. These risk factors include:
failure to prepare for baby's arrival; lack of awareness and
understanding of the complexity of the child and the parent/child
relationship; lack of interest in the baby; insensitivity to the
infant's signals; a high degree of stress in the parent's life,
particularly relationship difficulties; lack of social support
for the parent; and the parent's own history of having been
abused.
An important question relates to the last risk factor: how to
break the intergenerational cycle of maltreatment. In the
Mother-Child Project, 30% of mothers who had been abused in their
own childhood went on to provide good care for their children.
How were they able to break the abuse pattern? Three factors seem
to influence this:
1) nurturance and Support during childhood from some adult
other than the abuser; 2) a supportive relationship with their
current partner; and 3) involvement in therapy for at least six
months.
The third finding converges with what other researchers and
clinicians have observed about the need for abuse victims to face
the pain of their experience and come to some healthy resolution
of those past issues if they are to avoid repeating the
experience with their own children.
STUDY NUMBER TWO: PUTTING RESEARCH TO WORK
In an effort to apply the findings from the Mother-Child
Project, I worked with Drs. Egeland and Sroufe to develop STEEP
(Steps Toward Effective Enjoyable Parenting), a preventive
intervention program for new parents and their infants. Using a
combination of home visits and group sessions with a trained
facilitator, we have intervened with 75 first-time mothers from
the second trimester of pregnancy through their child's first
birthday.
Participants, recruited through obstetric clinics, must be
low-income, at least 17 years old, and have no more than a high
school education. Although not an entrance requirement, about 95%
are single at the baby's birth, and a majority report having been
abused in some way in childhood. To determine program
effectiveness, the 75 intervention families are being compared to
75 families who meet the same entrance requirements but do not
participate in the intervention. Success is determined by
assessments done when the babies are one year, 19 months, and 24
months of age.
The link between Project STEEP and the Mother-Child Project is
that the risk indicators identified in the earlier study have
helped us determine barriers to a good parent-child relationship
so we can work with the families to remove those barriers. Our
intervention efforts are aimed at such things as helping parents
prepare for the baby's arrival, promoting understanding of the
complexity of parent-child relationships, increasing social
support, promoting life management and communication skills that
might reduce some of the stressful events in the mother's life,
and helping the parent learn to interpret and respond
appropriately to the baby's signals. Importantly, we also use a
variety of therapeutic techniques to help parents look
realistically at their own history, understand how it influences
their interactions with their child, and see ways to move beyond
their past.
Although we don't have all the data from Project STEEP, we see
encouraging signs of growth in the participating families. As the
needs and strengths of each family are unique, so are the signs
of their progress: a mother with a lifelong history of being
victimized finally finds the strength to leave a violent
boyfriend; another mother remains attuned to her child's needs
while mourning the death of two close family members; and an
18-year-old mother not only returns to high school, but goes on
to college and successfully balances the demands of school and
parenthood. We have been affirmed repeatedly in designing a
flexible program that allows us to meet each family where they
are, building on the strengths of each individual and the social
network of which they are a part.
WHAT WE HAVE LEARNED
Our experience has heightened our awareness of the need for
continuity, predictability, genuine caring and commitment on the
part of service providers. We have seen that the relationship
between the STEEP facilitator and her client is what really
matters, and building those relationships is not always easy. To
do intervention based on one-to-one relationships requires a
great deal of support and supervision for staff, and a constant
awareness that we each 3 bring our own emotional issues, past and
present, into our relationships with clients and with each other.
We do a disservice to our clients and ourselves if we sweep those
issues under the rug.
We also have learned how much harder it is to
"empower" people than to "help" them. We
constantly ask ourselves how we can provide just enough
information and support to allow a client to experience the
success of solving a problem "on her own." The theme of
empowerment is important at all levels of our program: Just as we
try to empower the parents we want parents to learn to empower
their children; just as I want staff to empower the clients, I
want to empower the staff. As professional "helpers" we
sometimes tend to do so much for others that we send them a
message that they can't get along without us.
Finally, the STEEP facilitators and I have become increasingly
aware that both risk and maltreatment are on a continuum; they
are not categorical, all-or-nothing variables. We all are
"at risk" in some way, and more so at some times and in
some situations than others. Under certain conditions any of us
would abuse or neglect a child and probably most of us who are
parents have maltreated our children in some way at some time. So
preventing child abuse is not an "us" helping
"them" situation. Our staff and clients alike share
common hopes and dreams and face similar challenges and
struggles. We are all in this together, trying to balance our own
needs with those of our children, and trying to remember that
even the youngest infant is a human being with feelings and
rights.
by Martha Farrell Erickson, Ph.D. Coordinator, Project STEEP
University of Minnesota
Healing the Hidden Wounds
Why do some people maltreated in childhood become abusers and
others do not? What can be done to break the cycle of abuse?
These are questions I try to answer through intensive interviews
with adults maltreated in childhood.
My sample is fairly evenly divided among men perpetrators of
child molestation and rape as well as women and men who did not
become abusers. I have interviewed 51 persons an average of 5
times each, for up to 20 hours. Through such detailed
investigations into individual lives, I hope to find
developmental patterns which differentiate abusers from those not
known to have abused.
PSYCHOLOGICAL DAMAGE: "I MUST BE BAD"
I have found that individuals maltreated in childhood all
suffer psychological damage, even when they don't become abusers.
The damage has at least 2 components: cognitive and emotional.
Typically, a maltreated child sees maltreatment as proof of being
bad, unloved, and unlovable. "Dad's hurting me meant I was
bad." "If she loved me, she wouldn't hurt me."
"I must be ugly, stinking, and rotten or I wouldn't be
treated this way." These are ways abused persons think about
their abuse.
PRESSURE COOKERS ABOUT TO BLOW
Such thought patterns are painful. How individuals cope with
the psychological pain of childhood maltreatment appears to
differentiate abusers from non-abusers. In my sample, the men who
became molesters and rapists never confided in anyone about their
hurts of feelings; they kept their thoughts to themselves. Their
feelings built up over the years until they were like pressure
cookers about to blow.
For rapists and child molesters, it can take only a small
slight to send them off to abuse. As one molester said, "I'd
have a fight with my wife, and I'd go look for my daughter to
have sex with." Having sex with his daughter soothed him. It
was a palliative for his emotional pain. Rapists describe their
rape behavior as a way of dealing with superintense feelings of
desperation, rage, and frustration. Stalking a woman and raping
her gave them a tremendous rush. It relieved them of their
emotional pain.
RELATIONSHIPS HELP HEAL THE WOUNDS
Those who were not abusers found pro-social ways of relieving
emotional pain. The men and women I interviewed who were not
abusers were capable of self-disclosure about intimate and
painful details of their lives, although some women and no men
who were sexually abused told anyone for several or more years
after the abuse. They often suffered in silence for years, but as
soon as they thought they had found someone to trust, they shared
their intimate experiences. Their intimate relationships with
others helped them challenge maltreatment-induced ideas that
being maltreated means "I'm bad." Most of all, they
seemed to know that they were suffering.
The men who were abusers frequently said they were out of
touch with all feelings but anger. Being out of touch with the
self and isolated from others appears to be a major factor in
becoming an abuser. Developing relationships with others seems to
help heal some of the wounds of child maltreatment.
WHAT CAN WE DO?
Persons who have been maltreated in childhood experience
intense pain. Some cope with their pain in anti-social ways,
while others use more pro-social methods of coping. Early
intervention into the lives of maltreated children not only will
relieve human suffering, but it prevents the development of major
anti-social behaviors.
Step One: Educate. Children and parents need to know
about abuse. Persons who have been maltreated often do not
realize they have been maltreated. Persons who maltreat,
especially when it takes the form of unresponsiveness or teasing,
often do not realize they are being abusive.
Describe to people the type of thinking associated with the
psychological damage of child maltreatment. Describe the
emotional pain associated with maltreatment.
Step Two: Support. When abused persons realize they
have been, there needs to be some place for them to go to work
out the effects of their maltreatment. The effects are insidious
with and can take intensive individual and group psychotherapy.
Agencies with well-trained professionals and humane peer support
groups are bottom line necessities.
Step Three: Lobby. Tell and tell and tell your
neighbors, your friends, other precinct caucus attendees, school
board candidates and committee members, other public officials
and candidates for public office. Testify at the state
legislature. Write letters to the editor. Write letters to
foundations and other funding agencies to support both research
and programs on maltreatment. Don't ever stop telling.
by Jane F. Gilgun, Ph.D. School of Social Work University of
Minnesota
A Call to Action
1. FINDING THE LEADERS: FRONT-LINE
WORKERS AS SOURCES OF KNOWLEDGE
Child care workers, public health nurses, social workers,
counselors, therapists, and early childhood educators all know
the faces and eyes of maltreated persons. They have
experience-based understandings of the causes and consequences of
child maltreatment, but to a large extent they are an untapped
resource for leadership.
Potential leaders may be held down because of the very work
they do. Unfortunately, front-line workers often are exhausted by
their work. Undervalued and under paid, they may even take second
jobs, leading to further exhaustion. They may avoid talking about
their work because they want to avoid snide comments. "How
can you stand doing that work?" "What are you, a baby
snatcher?" A hazard of any kind of job is to "go
native," that is, to t identify with the persons whom we
work. Persons who have been maltreated in childhood often feel
powerless. Those who work directly with maltreated persons are at
risk to identify with powerlessness and to feel and act
powerless. These are common reasons for not doing more, such as
lobbying, public speaking, or program development. But if
researchers, program developers, policy makers and lobbyists ask
these workers to share their expertise, it will help them put
their work in perspective and recognize and fulfill their own
potential for leadership.
2. TELL AND TELL AND TELL
Prevention programs routinely tell children who have been
abused to tell and tell and tell until someone listens. That's
pretty good advice. We who work in the area of abuse could turn
that same principle on ourselves. We could tell and tell and tell
until we get what we want for children.
3. AN EXPERIMENTAL APPROACH
Do we know how to prevent child abuse? Are we asking funders
to throw money at a poorly-understood problem? We know enough to
begin. We can succeed with an experimental approach, developing
prevention programs that:
- Are based on reliable and valid theory and research;
- Incorporate insights of front-line workers;
- Have an evaluation component: does it work, and how?;
- Are flexible, incorporating new components in systematic
ways;
- Begin at 1 or 2 sites and, as their effectiveness is
shown, are replicated planfully and gradually.
We need to support programs and service providers. We need to
fund experimental projects and programs that work. Yes, we know
enough to begin.
by Jane F. Gilgun, Ph.D.
Book Review
Confronting Child Abuse:
Research for Effective Program Design
by Deborah Daro
This book gets my vote for the "best book" for those
interested in public policy about preventing child abuse. It
addresses issues squarely, gives insight, and provides thoughtful
solutions to many of the dilemmas we face.
Daro, the Director of the National Center on Child Abuse
Prevention Research, states that despite the increase in public
awareness, the capability of state and local agencies to
effectively identify, treat and prevent child abuse and neglect
remains inadequate. She offers a comprehensive review of child
abuse research and a clearly organized discussion of the issues
which are of paramount importance in improving the handling of
child maltreatment cases.
Daro's book is a must for anyone -agencies, administrators,
policy makers who is interested in the search for effective
prevention. It has important implications for both policy and
practice. No where else in the literature will you find such
comprehensive cost-benefit analyses of specific types of
intervention and prevention efforts, and the long-term costs (to
the greater society) of nonintervention as well.
CONFRONTING CHILD ABUSE shows that 20 years of field research,
on parents who have been or are "at risk" of abusing
their children and on the victims of maltreatment, offer a solid
knowledge base upon which practitioners can draw to improve
practice. It contains information about the subpopulations of
maltreatment and the specific treatment with descriptions of
economic, demographic and family pattern, and prevention
strategies that show the most promise. This offers administrators
and on-the-line practitioners specific guidelines for shaping
reforms in delivery of service and in policy.
The author cuts right to the core of issues that policy
makers, child advocates and those who participate in the child
protection system face daily. While mistreatment of children or
the failure to care for children is the central legal and policy
issue, precisely how parents or caretakers choose to mistreat
their children is of secondary concern. For clinical practice,
however, the reverse is true.
The point is made that unique subpopulations should be singled
out for specific programs or legislative attention. If we can
prevent abuse or treat specific populations, we may not feel it
is so necessary to find a single solution to the problems of
maltreatment. After all, no single virus causes maltreatment.
Families cannot be inoculated against abuse or neglect. Some
children appear to cope effectively with a wide range of
maltreatment while others suffer long-term physical and emotional
trauma. In the same way, certain services are effective in
curbing maltreatment and remediating its negative consequences in
some families while having no notable impact on others.
General treatment programs have had limited success which has
led to the subpopulation approach -with programs targeted to
specific groups. There are four types of maltreatment
consistently cited in the literature: physical abuse; physical
neglect; emotional maltreatment; and sexual abuse. This is the
first level of categorization, and Daro suggests that there is a
need to further refine the subdivisions to determine the most
effective prevention and treatment strategies.
CONFRONTING CHILD ABUSE also addresses child abuse and neglect
and child maltreatment being viewed as classless. It has not
traditionally been viewed as function of poverty, nor as a
disorder limited to a particular class or culture. This view is
rooted in existing evidence generated by many studies. The author
reminds us, however, that this theory perpetuates the notion that
the flaws are in the individual parent, child, or household,
therefore absolving society from accepting responsibility for the
well-being of all its children.
Research provides important policy insight and guidance for
practice, but also gives cause for concern: notably that
treatment efforts in general are still not very successful. Child
abuse and neglect continue despite early, thoughtful and often
costly intervention.
This book suggests that there is a need to focus not only on
direct services to families at risk, but on the broader social
systems with which the families interact. Examples of current
best practice and policy in the field are provided and give much
food for thought. Although some treatment strategies are
excellent and some prevention programs have been effective, we
are a long way from having the problems solved.
By Erna Fishhaut h. Confronting Child Abuse: Research for
Effective Program Design, 1988. New York: the Free Press.
The University Responds
Continuing Education for
Professionals
A training program in child abuse prevention will begin at the
University of Minnesota in January, 1991. The Child Abuse
Prevention Specialization Program (CAPS) is designed to provide
continuing education study for practitioners interested in
acquiring a solid knowledge base and improving their practice.
The first of its kind in the country, CAPS also will give
graduate students an opportunity to place an emphasis on child
abuse prevention. CAPS, a 20-credit program (courses, seminars,
and field work) will help students understand the causes and
effects of child abuse, the range of prevention work done in the
community, leadership roles, and how to focus community concern
and responsibility.
A cohort of 20 students will begin the program and take
courses together over 18-months. This should foster a network of
interdisciplinary, culturally diverse professionals who can work
cooperatively in prevention services. Administered by the Early
Childhood Studies Program in Continuing Education and Extension,
with its proposed academic home in the School of Social Work, the
CAPS program is the result of collaboration among child abuse
experts from those departments as well as Child Development,
Educational Psychology, Nursing, and Public Health. Community
leaders in child abuse prevention provided advice in designing
the program.
A Coordination Concept
Dr. Robert ten Bensel, School of Public Health, is working
toward development of a Center for the Prevention of Child
Maltreatment. He proposes a joint venture of the University of
Minnesota and community prevention programs. Such a Center, with
academic advisory board and community forums, would focus on
programs that support community involvement. It could foster
innovative prevention approaches involving academic and community
professionals in the areas of community service, education, and
research. It might provide consultation and technical assistance,
state-of-the-art information on child maltreatment, and formal
and informal instruction at the University and in the community.
The Center could empower community programs to evaluate their
prevention activities and make their case for continuing efforts.
Research efforts could include preventive intervention projects
identified, designed, implemented and evaluated through
collaboration of University staff and community professionals.
A NOTE ON PREVENTION PROGRAMS There is little evidence
that school prevention programs that try to teach children to
protect themselves actually change children's attitudes or
behaviors, or minimize the risk of maltreatment. Based on the
belief that knowledge about abuse is necessary for children to
protect themselves, many adults believe the only way to really
protect children is to frighten them. As a result, children who
take part in such programs may become more fearful, mistrustful
of adults in general, and more insecure. Or, unrealistic
self-confidence may lead to inappropriate risk taking.
There is also concern that the focus on child abuse
prevention, along with caregivers' fear of accusations may change
the ways caregivers interact with children. The result could be
caregivers who are less likely to exhibit natural, safe,
appropriate and nurturing affection and touch.
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Spring 1990, Volume 17, Number 3