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A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice
Office on Child Abuse and Neglect, Children's Bureau. Goldman, J., Salus, M. K., Wolcott, D., Kennedy, K. Y.|
|Year Published: 2003|
Chapter Seven: What Can Be Done to Prevent Child Abuse and Neglect?
The seriousness of the effects of maltreatment, presented in the previous chapter, underscore the importance for professionals, along with concerned community members, to help prevent child maltreatment. To break the cycle of maltreatment, communities across the country must continue to develop and implement strategies that prevent abuse or neglect from happening. While experts agree that the causes of child abuse and neglect are complex, it is possible to develop prevention initiatives that address known risk factors. This chapter provides an overview of prevention as a strategy, differentiates the various types of prevention activities, describes major prevention program models, and presents the roles of various sectors in prevention efforts.
Prevention as a Strategy
Prevention efforts most commonly occur before a problem develops so that the problem itself, or some manifestation of the problem, can be stopped or lessened.111 Child abuse and neglect prevention covers a broad spectrum of services—such as public awareness, parent education, and home visitation—for audiences ranging from the general public to individuals who have abused or neglected a child. Community groups, social services agencies, schools, and other concerned citizens may provide these services. Typically, prevention activities attempt to deter predictable problems, protect existing states of health, and promote desired life objectives.112 More specifically, family support services, a major component of child abuse prevention, are designed to strengthen and stabilize families, increase parental abilities, provide a safe and stable family environment, and enhance child development.113
To prevent child abuse and neglect, programs may focus on one or several risk factors discussed in Chapter 5, "What Factors Contribute to Child Abuse and Neglect?" For example, prevention programs may include:
- Substance abuse treatment programs for women with children;
- Respite care programs for families with children who have disabilities;
- Parent education programs and support groups for families affected by domestic violence.
Many prevention programs also focus efforts on strengthening child and family protective factors such as the knowledge and skills children need to help protect themselves from sexual abuse, the promotion of positive interactions between children and parents, and the knowledge and skills parents need to raise healthy, happy children.
Types of Prevention Activities
Child abuse and neglect prevention activities generally occur at three basic levels:
- Primary, or universal, prevention activities are directed at the general population with the goal of stopping the occurrence of maltreatment before it starts.
- Secondary, or selective, prevention activities focus on families at high risk of maltreatment to alleviate conditions associated with the problem.
- Tertiary, or indicated, prevention activities direct services to families where maltreatment has occurred to reduce the negative consequences of the maltreatment and to prevent its recurrence.
Primary or Universal Prevention
Primary prevention includes activities or services available to the general public. Frequently such activities aim to raise awareness among community members, the public, service providers, and decision-makers about the scope and problems associated with child maltreatment. For example:
- Public awareness campaigns informing citizens how and where to report suspected child abuse and neglect;
- Public service announcements on the radio or television encouraging parents to use nonviolent forms of discipline.
These types of programs are particularly popular during April, which is designated by presidential proclamation as Child Abuse Prevention Month. Other primary prevention efforts focus on support services available to the general population, such as pediatric care for all children, childcare, or parent education classes.
Secondary or Selective Prevention
Secondary prevention activities focus efforts and resources on children and families known to be at higher risk for maltreatment. Several risk factors such as substance abuse, young maternal age, developmental disabilities, and poverty are associated with child maltreatment. Programs may direct services to communities or neighborhoods that have a high incidence of one or several risk factors. Examples of secondary prevention programs include the following:
- Parent education programs located in high schools for teen mothers;
- Substance abuse treatment programs for parents with young children;
- Respite care for families who have children with special needs;
- Family resource centers offering information and referral services to families living in low-income neighborhoods.
Family support activities that are available to individuals identified as at risk or community members in a high-risk neighborhood also are considered secondary prevention. For example, local hospitals or community organizations may offer prenatal care and parenting classes to new or expectant parents. Local agencies may provide home visitation services for at risk families with infants and young children. Family support services are intended to assist parents in creating safe home environments and fostering healthy children.
Tertiary or Indicated Prevention
Tertiary prevention activities focus efforts on families in which maltreatment has already occurred. The goal of these programs is to prevent maltreatment from recurring and to reduce the negative consequences associated with maltreatment (e.g., social-emotional problems in children, lower academic achievement, decreased family functioning). These prevention programs may include services such as:
- Intensive family preservation services with trained mental health counselors available to families 24 hours per day for several weeks;
- Parent mentor programs with stable, nonabusive families acting as "role models" and providing support to families in crisis;
- Mental health services for children and families affected by maltreatment to improve family communication and functioning.
A combination of primary, secondary, and tertiary prevention services are necessary for any community to provide a full continuum of services to deter the devastating effects of child maltreatment.
Major Prevention Program Models
Many popular prevention programs are patterned after one of four models:
- Public awareness activities
- Parent education programs
- Skills-based curricula for children
- Home visitation programs
Public Awareness Activities
Public awareness activities are an important part of an overall approach to addressing child abuse and neglect. The purpose of public awareness activities is to raise community awareness of child abuse and neglect as a public issue and to provide the public with information about available resources and solutions. Such activities have the potential to reach diverse community audiences: parents and prospective parents, children, and community members, including professionals, who are critical to the identification and reporting of abuse.
In designing prevention education and public information activities, national, State, and local organizations use a variety of media to promote these activities, including:
- Public service announcements
- Press releases
- Information kits and brochures
- Television or video documentaries and dramas
Through these media, communities are able to promote support for healthy parenting practices, child safety skills, and protocols for reporting suspected maltreatment.
Organizations Supporting Public Awareness Activities
State Children's Trust FundsState Children's Trust Funds (CTFs) exist in all 50 States and the District of Columbia with the specific goal of preventing child maltreatment. CTFs coordinate prevention activities throughout their State by promoting and funding a variety of community-based programs including public awareness campaigns, home visitation programs, skills-based curricula for children, and parent education and support activities. In addition, many CTFs develop and distribute posters for community groups, schools, and many other professionals working with children. The poster may encourage parents to use positive discipline techniques or encourage children to say "no" to touching that makes them uncomfortable.
Don't Shake the Baby CampaignOne of the largest public awareness initiatives focuses on the prevention of Shaken Baby Syndrome. A national network of Don't Shake the Baby State contacts was established to ensure that all professionals involved in the care of children (e.g., teachers, physicians, nurses, home visitors, parent educators) become aware of the dangers associated with shaking infants. In addition to professionals, this campaign targets parents to alert them to the dangers of shaking their baby as well as playing with the baby in certain ways (e.g., throwing the baby in the air, bouncing the baby on a knee, twisting the baby in the air).
Prevent Child Abuse AmericaPrevent Child Abuse America, formerly the National Committee to Prevent Child Abuse (NCPCA), is a leading national organization actively engaged in public awareness activities. Prevent Child Abuse America, together with Marvel Comics, developed Spider-Man comic books that address child sexual abuse and child safety issues. This organization also distributes an information packet each year to assist community groups planning Child Abuse Prevention Month activities. Both the national office and Prevent Child Abuse America State Chapters throughout the country provide public awareness and other activities to prevent child abuse and neglect.
Blue Ribbon CampaignThe Blue Ribbon Campaign began as a tribute from a Virginia grandmother to a grandchild whose battered body was found at the bottom of a canal. By tying a blue ribbon—signifying the pain and bruises suffered by abused children—around the antennae of her van, Bonnie Finney sought to raise awareness of the devastating effects of child abuse and neglect. Since those early days in the 1980s, the Blue Ribbon Campaign has grown into a national effort to raise awareness of the scope and problem of child maltreatment. The blue ribbon, often worn during April for Child Abuse Prevention Month, serves as the most recognized symbol for child abuse prevention.
Parent Education Programs
Parent education programs focus on enhancing parental competencies and promoting healthy parenting practices and typically target teen and highly stressed parents. Some of these programs are led by professionals or paraprofessionals, while others are facilitated by parents who provide mutual support and discuss personal experiences. These programs address issues such as:
- Developing and practicing positive discipline techniques;
- Learning age-appropriate child development skills and milestones;
- Promoting positive play between parents and children;
- Locating and accessing community services and supports.
Parent education programs are designed and structured differently, usually depending on the curriculum being used and the target audience. Programs may be short-term (i.e., those offering classes once a week for 6 to 12 weeks) or they may be more intensive (i.e., those offering services more than once a week and for up to 1 year). Popular parent education programs include:
- Parents as Teachers—visit www.patnc.org for more information;
- Every Person Influences Children (EPIC)—visit www.epicforchildren.org for more information;
- The Nurturing Program—visit www.nurturingparenting.com for more information.
In addition to parent education programs, mutual support groups also may strengthen families and help prevent child maltreatment. For example, Parents Anonymous affiliates work within their communities and States to provide support and resources to overwhelmed families struggling to cope with everyday stresses and strains.
Skills-based Curricula for Children
Many schools and local community social service organizations offer skills-based curricula to teach children safety and protection skills. Most of these programs focus efforts on preventing child sexual abuse and teaching children to distinguish appropriate touching from inappropriate touching. Many curricula have a parent education component to give parents and other caregivers the knowledge and skills necessary to recognize and discuss sexual abuse with their children. Curricula may use various methods to teach children skills including:
- Workshops and school lessons
- Puppet shows and role-playing activities
- Films and videos
- Workbooks, storybooks, and comics
Examples of skills-based curricula include programs such as Talk About Touching, Safe Child, Reach, Recovery, Challenge, Good Touch/Bad Touch, Kids on the Block, and Illusion Theater.
Home Visitation Programs
Home visitation programs that emphasize the health and well-being of children and families have existed in the United States since the late 19th century. Organizations and agencies in fields as varied as education, maternal and child health, and health and human services, use home visitation programs to help strengthen families. Home visitation programs offer a variety of family-focused services to pregnant mothers and families with newborns. Activities encompass structured visits in the family's home, informal visits, and telephone calls. Topics addressed through these programs often include:
- Positive parenting practices and nonviolent discipline techniques;
- Child development;
- Maternal and child health issues;
- Accessing available social services;
- Establishing social supports and networks;
- Learning to advocate for oneself, one's child, and one's family;
- Preventing accidental childhood injuries through the development of a safe home environment.
Recent evaluations suggest that both short- and long-term positive outcomes may occur for mothers and children receiving home visitation services. During a two-year period, nurses provided home visitation services to a group of poor, unmarried, teen mothers in Elmira, New York. Only 4 percent of the nurse-visited families had verified reports of child abuse and neglect compared to 19 percent of the families who did not receive home visits by nurses.114 A follow-up study further supported these positive results: the number of verified reports of child maltreatment for the nurse-visited group of mothers was nearly half that of mothers who did not receive home visitation services during the next 15 years.115 Additional positive outcomes among nurse-visited mothers included lower levels of smoking, fewer and better-spaced subsequent pregnancies, and more months working, as well as fewer emergency room visits by children for injuries. Several studies of home visitation programs using nonmedical professionals also showed a significantly lower number of verified maltreatment reports for home-visited mothers.116
Home Visitation Programs
- Home Visitation 2000 provides services to first-time mothers in Denver, Colorado. This program focuses efforts on improving maternal health, environmental health (home safety), quality of caregiving for infants and toddlers, maternal life course development (education and employment), and social support. For more information, visit www.unitedwaydenver.org/IRIS/aa0g6f81.htm. (Please note: this link is no longer available.)
- Hawaii's Healthy Start is a statewide, multisite program that screens, identifies, and provides services to families at high risk for child abuse and neglect. Most families are enrolled after the birth of a child, but some enroll during the prenatal period. For more information, visit www.state.hi.us/doh/legrpts2002/mchs_healthystart.pdf. (Please note: this link is no longer available.)
- Healthy Families America (HFA) is a national initiative launched by Prevent Child Abuse America and Ronald McDonald House Charities in 1992. Modeled after Hawaii's Healthy Start, HFA currently has home visitation programs in more than 3,000 sites across the country. For more information, visit www.healthyfamiliesamerica.org.
Role of Various Entities in Prevention Efforts
Prevention programs typically are administered through specific entities, based on an area of interest or professional expertise. Increasingly, health care providers, community organizations, social services agencies, schools, the faith community, and employers are becoming involved in the well-being of children and families. All members of the community are working together to prevent child maltreatment and ensure the health and safety of children and families. The following sections describe how these organizations are providing prevention services to strengthen and support families.
Health Care Providers
Health care providers are in a unique position to assist in the prevention of child maltreatment. These professionals have routine access to children and families by providing regular appointments, immunizations, and interventions to common illnesses. Activities that promote the health of children and their parents and contribute to the prevention of child maltreatment include:
- Prenatal health care that improves pregnancy outcomes and health among new mothers and infants;
- Early childhood health care that supports normal development and the health of young children;
- Family-centered birthing and perinatal coaching that strengthens early attachment between parents and their children;
- Home health visitation that provides support, education, and community linkages for new parents;
- Support programs that assist parents of children with special health and developmental problems.
Primary care providers emphasize the prevention of disease and the promotion of health and well-being. With this foundation, they have a natural role in the prevention of child abuse and neglect.
Many community organizations offer a wide range of services for children and families. Boys and Girls Clubs, scouting troops, and local YMCA/YWCAs provide social and recreational opportunities for children and families. Community centers, food banks, emergency assistance programs, and shelters offer various family support services to increase family resources and decrease stress. Exchange Clubs, fraternal organizations, advocacy groups, and ethnic, cultural, and religious organizations also support child maltreatment prevention activities.
Specific examples of prevention activities found within community-based organizations include:
- Self-help and mutual aid groups that provide nonjudgmental support and assistance to troubled families;
- Natural support networks that provide families with informal helpers and community resources;
- Child and respite care programs that reduce the stress parents experience and provide positive modeling for parents and children.
Many grassroots efforts develop dynamic partnerships of professionals, businesses, faith-based organizations, concerned citizens, and other groups interested in creating prevention efforts that address the needs of their community.
Social Services Agencies
Increasingly, social service agencies and professionals are expanding their focus to include programs that prevent family problems from escalating to abuse or neglect. Effective social service initiatives for strengthening families and preventing child maltreatment include:
- Parent education services, which help parents to develop adequate child-rearing knowledge and skills;
- Parent aide programs, which provide supportive, one-on-one relationships for parents;
- Crisis and emergency services, which support parents and children at times of exceptional stress or crisis;
- Treatment for abused children, which prevents an intergenerational repetition of family violence.
As State and local social service agencies examine new ways of "doing business," many are pooling resources to provide more prevention services.
With increased public and professional attention on the serious social problems affecting children and adolescents, schools have become the focus for many new prevention efforts including:
- Comprehensive, integrated prevention curricula to provide children with the skills, knowledge, and information necessary to cope successfully with the challenges of childhood and adolescence;
- Personal safety programs;
- Support programs for children with special needs to help reduce the stress on families with a child with disabilities.
Since most children attend public or private schools, school-based prevention activities have the potential to reach the majority of U.S. children.
Religious institutions are among the most influential organizations in many communities. Churches, temples, synagogues, mosques, and other faith-based groups play an important role in reaching out to and helping families at risk. Spiritual leaders can use their religious messages as a positive force in preventing child abuse and neglect and advocating nonabusive parenting practices. Faith communities frequently foster and offer important social supports to families.117 Empirical studies suggest a significant relationship between an individual's participation in faith practices and physical and mental well-being.118 Improved social supports and enhanced well-being can help strengthen families and act as protective factors. Faith communities can participate in prevention efforts through activities such as:
- Training religious and lay leaders to recognize the signs and symptoms of child maltreatment;
- Sponsoring or allowing self-help, parent education, and support groups to meet at their facilities;
- Offering respite care for congregation members in need of short-term relief from caregiving responsibilities;
- Collecting clothes and baby care products (e.g., diapers, car seats) for new parents;
- Sponsoring afterschool programs and safety training for latchkey children;
- Organizing mentoring programs that pair responsible adults with children;
- Disseminating information on child development, parental stress, and community resources for parents;
- Offering special outreach and education programs for parents and students associated with parochial schools.
As the number of parents working outside the home continues to grow, the need increases for workplace policies that support family functioning and promote the prevention of child maltreatment. Family-focused initiatives for the workplace include:
- Flexible work schedules and other "family friendly" policies that help employees to balance the demands of their work and parental commitments;
- Parental leave policies that reduce stress on new parents and help facilitate positive attachments between parents and their infants;
- Employer-supported child care;
- Family-oriented policies that support healthy and humane working conditions and ensure adequate family income;
- Employee assistance programs that can provide information on reducing stress.
For all working parents, a supportive work environment can help ease the stress of the dual responsibilities of work and family. For some already vulnerable parents, a supportive work climate may prevent family dysfunction, breakdown, abuse, and neglect.119
Working together, the various sectors of the community—health care providers, community-based organizations, social services agencies, schools, the faith community, employers, other community practitioners and concerned citizens—can help strengthen families, foster healthy child development, and reduce child maltreatment.
For more information on child abuse and neglect prevention, contact one of the organizations listed in Appendix B.
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