Child Maltreatment: Theory, Policies, Strategies – A Critical Review
By: Meghan Arnold, Advisor – Gary Apperson
Abstract
In this paper, a brief history of child maltreatment is addressed, as well as statistics
showing the need for action against child maltreatment. Several theories account for child
maltreatment, including but not limited to, social learning theory and attachment theory.
This paper will address review on the effects of child maltreatment, both physical and
emotional. Cases of child maltreatment require the collaboration between agencies,
especially the public health system and the criminal justice system. The public health
system practices a systematic way on handling cases of child-maltreatment. An
investigator must follow crucial protocols when interviewing abused children in order to
earn the child’s trust and cooperation.
Keywords: child assault, physical abuse, emotional abuse, sexual abuse, child
neglect.
I. Introduction
Despite a wide range of prevention efforts, child maltreatment cases continue to
produce high victimization rates, and as such, warrant further review. This paper will
begin by defining specific terms that are germane to the topic of child maltreatment. The
next section will provide a brief history of child maltreatment and how the criminal
justice system has evolved to protect children. This will be followed by a scope of the
problem section that details the enormity of the problem. The following section will offer
a theory framework to account for child maltreatment causation. Next, a literature review
will explain effects of child maltreatment. A discussion section that will examine
research studies on the difficulties investigating child maltreatment follows, and then,
offers recommendations based on current published research. Finally, a conclusion will
recap this paper’s most important points.
The significance of this paper is that it contributes to the criminal justice system
by critically reviewing child maltreatment policies as they relate to their mission of
reducing child abuse. This paper is written for colleagues and clerisy who have a
professional or academic interest in reducing child maltreatment through more precise
strategies and policies.
II. Terms Defined
In this paper, maltreatment will utilize the Center for Disease Control (2014)
definition as any act or series of acts of commission or omission by a parent or other
caregiver that result in harm, potential for harm, or threat of harm to a child. Neglect as
defined by Hess and Orthmann (2010) is the failure to meet a child’s basic needs,
including housing, food, clothing, education, and access to medical care. Physical abuse
refers to beating, whipping, burning, or otherwise inflicting physical harm upon a child
(Hess and Orthmann, 2010). Furthermore, emotional abuse as defined by Hess and
Orthmann (2010) is causing fear or feelings of unworthiness in children by such means as
locking them in closets, ignoring them, or constantly belittling them. Finally, sexual
abuse includes sexual molestation, performing sexual acts, statutory rape, and seduction
of a child (Hess and Orthmann, 2010).
III. Brief History
The abuse of children is not a new problem, and there have been reports of child
maltreatment dating prior to 1875. The New York Society for the Prevention of Cruelty
to Children was established in 1875 as the world’s first organization devoted entirely to
child protection services (Myers, 2009). Prior to 1875, many children who were
mistreated went without protection of the law and the government. Interventions to
protect children were sporadic, but did occur (Myers, 2009). During these times, adults
were aware of child maltreatment, but children were still generally unprotected. It was
not until 1935 when Congress passed the Social Security Act that created aid to
dependent children that brought focus to the protection of child maltreatment. In this
provision, the Children’s Bureaus were authorized to cooperate with state public welfare
agencies in establishing, extending, and strengthening the protection and care of
homeless, dependent, and neglected children, and children in danger of becoming
delinquent (Myers, 2009). The 1960s witnessed a huge interest in child abuse, mainly due
to physicians playing a key role. Congress placed new emphasis on child protection with
the amendments to the Social Security Act, requiring states to pledge that child welfare
programs would be available statewide. Significant progress has been made since the
amendment of the Social Security Act, although practitioners have better identified
continuing child maltreatment issues that need to be addressed. Child protection services
were available across the country, the growth of these services helped thousands of
children, and there were rapid deployment of laws that require professionals to report
suspected abuse and neglect (Myers, 2009).
IV. Scope of the Problem
According to the Children’s Bureau of the U.S. Department of Health and Human
Services, in 2011 there were approximately 742,000 instances of confirmed child
maltreatment. The overall national child victim rate was 9.9 child victims per 1,000
children in the population. State child victims’ rates varied dramatically, ranging from 1.2
child victims per 1,000 children to 24.0 child victims per 1,000 children. The national
child victim rate decreased from 10.3 child victims per 1,000 children in the population in
2008 to 9.9 in 2011. It is estimated that worldwide 150 million girls and 73 million boys,
less than 18 years of age, are abused every year (Molyneux, Kennedy, Dano, and
Mulambia, 2013). Hess and Orthmann (2010) report that currently, professionals initiate
more than half of all reports of alleged child abuse or neglect. The three most common
report sources were teachers, lawyers or police officers, and social services staff (Hess
and Orthmann, 2010).
According to Crum, Joyner, Ellis, and Saul (2013), the total lifetime financial
costs associated with just one year of confirmed cases of child maltreatment totals $124
billion. The average lifetime cost per victim of nonfatal child maltreatment was
$210,012, which included costs for childhood and adult medical care, productivity losses,
child welfare, criminal justice, and special education services (Crum et al., 2013).
Moreover, Crum et al. (2013) further reports the estimated average lifetime cost per death
was $1,272,900, which includes medical costs and productivity losses. The costs of child
maltreatment are comparable to the societal costs of other major public health problems,
such as Type 2 Diabetes.
V. Theory Framework to Account for Child Maltreatment
The theoretical assumptions informing child maltreatment interventions are
shifting. Originally, child maltreatment was believed to be a consequence of individual
psychopathology (Garrett, 1997). Researchers are beginning to recognize that it is also a
family and social problem. There are a number of theories that guide research strategies
for child maltreatment, two of which are the social learning theory and attachment theory.
According to social learning theory as originally posited by theorist Bandura,
behavior is learned through two methods in which learning occurs by being rewarded for
one’s actions or by observation and imitation of the behavior of others (Bandura, 1971;
Garrett, 1997). According to this theory, abused children learn to be abusive through
modeling the observed behavior and continuing this behavior into their adulthood. This
pattern of aggression is commonly referred to as the cycle of violence. The cycle of
violence suggests that a childhood history of physical abuse predisposes the survivor to
violence in later years (Samuels, 2001). There have been several key findings associated
with the cycle of violence. A child that had been abused or neglected as a child increased
the likelihood of arrest as a juvenile by 59 percent, maltreated children were arrested
more frequently, and physically abused and neglected children were most likely to be
arrested later for a violent crime (Samuels, 2001).
Attachment theorists believe humans develop a repertoire of behaviors that
promote interaction between themselves and their caregivers (Garrett, 1997). Children
learn these behaviors as a result of how they were nurtured by their caregivers. The type
of bond that develops between child and caregiver affects the child’s later relationships
(Garrett, 1997). According to the Garrett, children who are neglected or abused may be
more distrustful, have limited self-esteem, and seek out more maladaptive relationships
later in life. Attachment theorists believe not only does the abuse and neglect impact the
children during their juvenile years, but these patterns may even continue into adulthood.
The type of care giving the child received is the type of care giving the child will provide
later in life as a parent.
VI. Literature Review
Child abuse and neglect can result in serious and permanent physical, mental and
emotional damage, as well as in future criminal behavior (Hess and Orthmann, 2010).
Research has shown a link between adverse childhood experiences and adult chronic
disease and negative health behaviors (Crum et al., 2013). Physical damage can involve
bruising, damage to any organs including the brain, and damage to ears, eyes, or limbs.
Severe physical damage may result in mental retardation, loss of limbs, restricted
language ability, or even death (Hess and Orthmann, 2010).
In addition to immediate consequences such as physical injuries, maltreatment
can impact a child’s brain development and lead to life-long health problems (Crum et
al., 2013). These life-long health problems may include heart, lung and liver disease,
cancer, depression, obesity, substance abuse, and eating disorders. Emotional damage
may result in a child’s impaired self-concept and self-worthiness. Emotional damage can
also lead to aggressive behavior and anxiety. Children who suffer emotional abuse may
act out in social settings, such as school. Destructive behavior could have negative
implications on the child’s health and safety (Hess and Orthmann, 2010). Research on
brain development has shown that abuse and neglect can lead to sustained stress
responses in children (Crum et al., 2013). According to Crum et al. (2013), this stress
response results in sustained high levels of hormones, and this can negatively impact
brain architecture.
Child dysfunctional behaviors are frequently classified as either externalizing
(e.g. hostility, aggression, delinquency, conduct disorder, attention problems) or
internalizing (e.g. anxiety, depression, withdrawal, somatic complaints) (Binder,
McFarlane, Nava, Gilroy, and Maddoux, 2013). According to Binder et al. (2013),
children exposed to abuse of their mothers demonstrate high rates of externalizing and
internalizing behaviors. Boys and girls tend to respond differently. Boys tend to respond
to abuse in a more externalizing behavior, whereas, girls tend to respond to abuse in a
more internalizing behavior. As girls grow older, some studies have reported girls
demonstrating more violent aggressive behaviors than boys (Binder et al., 2013).
Another effect of child abuse is that as an adult, the former victim frequently
becomes a perpetrator of child abuse (Hess and Orthmann, 2010). According to Child
Welfare (2012), research suggests about one-third of all individuals who were abused or
neglected as children will subject their own children to maltreatment. This cycle of abuse
can occur when children who either experienced maltreatment or witnessed violence
between their parents or caregivers, learn to use physical punishment as means of
parenting their own children (Child Welfare, 2012).
VII. Discussion
Challenges in investigating crimes against children may include protecting the
child from further harm, the need to collaborate with other agencies, and the difficulties
that come with interviewing the child. The primary responsibility for an investigator
assigned to a child abuse case, is the safety of the child (Hess and Orthmann, 2010). If the
officer feels the child is in immediate danger, the officer may opt to take the child into
temporary custody. Under child protection legislation Wisconsin State Statute 48.19 (d),
the officer does not need a warrant to remove a child from an environment if the officer
believes the child is subject to further abuse or is in immediate danger. Another challenge
for investigators is the need to collaborate with other agencies, such as social services,
child welfare, and health agencies (Hess and Orthmann, 2010). Child maltreatment is a
complex problem that requires multiple systems working together to bring about
necessary change; not only in individual behavior and family functioning, but also to
community and social contexts that affect individual families (Crum et al., 2013). The
lack of coordination between agencies can lead to cases falling through the cracks and
even have dangerous and devastating results (Hess and Orthmann, 2010). No one agency
or organization can accomplish the problem of child maltreatment alone, as current
research indicates a team approach produces the best outcomes.
Lastly, it may be extremely difficult for an investigator to interview a child.
Studies by Hess and Orthmann (2010) report that when children are young, they have
limited vocabulary, and could possibly be afraid to talk to anyone due to threats from the
abuser. Abused children may not complain directly of what has happened to them. This
may be due to being threatened by the perpetrator, the child is ashamed, embarrassed or
do not think that they will be believed (Molyneux et al., 2013). Furthermore, Molyneux et
al. (2013), reports most disclosures are accidental and prompted after a change in
behavior is recognized, rather than being spontaneous or initiated by the victim of abuse.
VIII. Recommendations
Adequate responses to the needs of survivors of abuse require the services of
several different agencies, which must work together (Molyneux et al., 2013).
Coordinated responses between agencies can minimize the likelihood of conflicts
between these agencies with different philosophies and mandates on how to handle a
child abuse case (Hess and Orthmann, 2010). Communication, cooperation, and
teamwork are vital, but are often hampered due to lack of funding (Molyneux et al.,
2013). The criminal justice system and the public health system both play vital roles in
response to child-maltreatment.
The extreme burden and consequences of child maltreatment, both to individuals
and society, makes the issue a public health problem (Crum et al., 2013). The public
health system attempts to solve the problems of child maltreatment in a systematic way.
According to Crum et al. (2013), the first step is defining and monitoring the problem
(i.e., surveillance). Well-carried out surveillance provides an understanding of prevalence
and risk, and supports effective planning, implementation, and evaluation of public health
programs. Next is to identify risk and protective factors. This step focuses on
characteristics that increase or decrease the likelihood someone will be a victim or a
perpetrator of child maltreatment (Crum et al., 2013). Next, Crum et al. (2013) continues
with the third step of developing and testing prevention strategies. This step builds on the
first two steps to create programs and strategies that promote protective factors and
reduce risk factors in individuals and communities. The final recommended step is
assuring widespread adoption. This involves scaling up evidence-based programs and
practices through dissemination and implementation in a range of settings (Crum et al.,
2013).
Public health agencies are not the only agency that focuses on child maltreatment.
The criminal justice system must follow certain protocols when addressing child
maltreatment cases. When an officer is given the task to interview a young child, the
officer must consider the child’s age and their ability to be able to explain what
happened. It is best to conduct the interview in the child’s home or at a friend’s home
(Hess and Orthmann, 2010). The officer may also consider it is better to wear civilian
clothes, rather than his/her uniform. The uniform may intimidate the child, and possibly
lead to the child not wanting to give the officer any information. Investigators must
maintain rapport when interviewing a child. The interviewer should sit next to the child,
should not look down at the child, and even sit on the floor to be at the same level as the
child. Hess and Orthmann (2010) recommend the interviewer should speak to the child in
calm and friendly voice, try to learn about the child’s interests, and possibly even sharing
their own interests with the child.
IX. Conclusion
The staggering rates of which children are abused are alarming. Research shows
not only does maltreatment have immediate effects, such as physical bruising, but also
has long term effects on a child. When a child suffers from maltreatment, the child may
grow up to repeat this same type of abuse on his/her children, which leads to a
detrimental cycle of abuse. Multiple agencies must come together to fight the battle
against child maltreatment. Public health agencies and the criminal justice system should
collaborate in order to not only focus on the individual’s needs, but the community needs
as well. There are several key factors for an investigator to handle a case of child abuse.
An investigator must be willing to work with other agencies, make a split decision on
whether the child needs to be taken from the abuser’s custody, and also needs to be able
to speak to the child in a courteous and trusting manner.
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