Child Maltreatment The Lancet Series
Launched in London, UK, Dec 2, 2008
Website: http://www.thelancet.com/series/child-maltreatment [subscrition required]
Few topics are more emotive than child maltreatment. "Children, the most precious and vulnerable members of our societies, deserve closer attention to their care and education and better protection against abuse", states a Comment introducing the Series.
Executive summary
The Lancet has collaborated closely with the Royal College of Paediatrics and Child Health, London, UK, in formulating the Child Maltreatment Series. It is to clinicians and other professionals responsible for caring for children that The Lancet's Child Maltreatment Series is aimed, with the intention of providing them with a rigorous and up-to-date summary of scientific evidence and conceptual work on this complex and demanding topic.
Series Comments
When childhood dies
Richard Turner, Richard Horton
The landscape of child maltreatment
Dorothy A Scott
Supporting paediatricians who work in child maltreatment
Carole Jenny
Safeguarding children: a call to action
Albert Aynsley-Green, David Hall
Series Papers
Burden and consequences of child maltreatment in high-income countries
Ruth Gilbert, Cathy Spatz Widom, Kevin Browne, David Fergusson, Elspeth Webb, Staffan Janson
Summary
“….Child maltreatment remains a major public-health and social-welfare problem in high-income countries. Every year, about 4—16% of children are physically abused and one in ten is neglected or psychologically abused. During childhood, between 5% and 10% of girls and up to 5% of boys are exposed to penetrative sexual abuse, and up to three times this number are exposed to any type of sexual abuse. However, official rates for substantiated child maltreatment indicate less than a tenth of this burden. Exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences. Child maltreatment substantially contributes to child mortality and morbidity and has longlasting effects on mental health, drug and alcohol misuse (especially in girls), risky sexual behaviour, obesity, and criminal behaviour, which persist into adulthood. Neglect is at least as damaging as physical or sexual abuse in the long term but has received the least scientific and public attention. The high burden and serious and long-term consequences of child maltreatment warrant increased investment in preventive and therapeutic strategies from early childhood…’
Recognising and responding to child maltreatment
Ruth Gilbert, Alison Kemp, June Thoburn, Peter Sidebotham, Lorraine Radford, Danya Glaser, Harriet L MacMillan
Summary
‘…..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…”
Interventions to prevent child maltreatment and associated impairment
Harriet L MacMillan, C Nadine Wathen, Jane Barlow, David M Fergusson, John M Leventhal, Heather N Taussig
Summary
“….Although a broad range of programmes for prevention of child maltreatment exist, the effectiveness of most of the programmes is unknown. Two specific 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 population-level parenting programme has shown benefits, 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 specific parent-training programme has shown benefits in preventing recurrence of physical abuse; no intervention has yet been shown to be effective 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 benefits compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefits for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures….”
Promotion of children’s rights and prevention of child maltreatment
Richard Reading, Susan Bissell, Jeffrey Goldhagen, Judith Harwin, Judith Masson, Sian Moynihan, Nigel Parton, Marta Santos Pais, June Thoburn, Elspeth Webb
Summary
“…..In medical literature, child maltreatment is considered as a public-health problem or an issue of harm to individuals, but less frequently as a violation of children's human rights. Public-health approaches emphasise monitoring, prevention, cost-effectiveness, and population strategies; protective approaches concentrate on the legal and professional response to cases of maltreatment.
Both approaches have been associated with improvement in outcomes for children, yet maltreatment remains a major global problem. We describe how children's rights provide a different perspective on child maltreatment, and contribute to both public-health and protective responses. Children's rights as laid out in the UN convention on the rights of the child (UNCRC) provide a framework for understanding child maltreatment as part of a range of violence, harm, and exploitation of children at the individual, institutional, and societal levels.
Rights of participation and provision are as important as rights of protection. The principles embodied in the UNCRC are concordant with those of medical ethics. The greatest strength of an approach based on the UNCRC is that it provides a legal instrument for implementing policy, accountability, and social justice, all of which enhance public-health responses. Incorporation of the principles of the UNCRC into laws, research, public-health policy, and professional training and practice will result in further progress in the area of child maltreatment….”
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