1
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Child Abuse
3 hours
Objectives: Upon completion of this course, the student will know the forms of child abuse,
how to recognize abuse, reporting requirements and current statistics on child abuse in the
United States.
INTRODUCTION
Child abuse describes a variety of abnormal behaviors directed against children. It can take
many forms. Child abuse in general is a psychological problem or perversion of the abuser. The
abuser is referred to as the perpetrator of abuse.
Child abuse includes the following conditions:
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Child sexual abuse
Pedophilia
Physical abuse
Child neglect
Emotional neglect
Failure to thrive
Munchausen by proxy syndrome
The following descriptions of child abuse are intended for people who have questions about
abuse and how it may present itself. Although some cases of child abuse are obvious, many are
not. These descriptions may help you identify abuse in its various forms. You will also find
information about what you can do if you observe child abuse or if you are a parent. If you think
you are a child abuser, you will want to seek help.
FORMS OF CHILD ABUSE
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Child sexual abuse includes any activity that uses a child to create sexual gratification
either in you or in others. Although the touching of children as a sign of affection and for
hygiene is considered normal and necessary, there is a way to distinguish normal
touching from child sexual abuse. The key is the intention by the perpetrator to be
sexually aroused by the activity or the intention to create sexual arousal in others. The
intent to use children in any way to create sexual arousal is illegal. This is criminal
behavior that is aggressively prosecuted and severely punished by our legal system.
o Child sexual abuse can include a wide variety of activities, any of which can be
evaluated to determine if they are designed to create sexual gratification.
 Activities can include any conventional adult sexual activity with a child.
Also included are acts such as touching the child's genitals or fondling
with the intention of arousing sexual feelings.
 Prolonged kissing, cuddling, "French" kissing, excessive touching, looking
at children either with or without clothes with the intent to be sexually
aroused can also be included.
 Photographing, videotaping, or filming of children with the intent to create
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2
sexual stimulation is a form of child abuse as well.
Other forms of child sexual abuse include exposure of a child to erotic
material in the form of either live behavior (excessive nudity),
photographs, film, or video. The collection of any photographs or images
of children taken by others in suggestive poses is illegal. The collection of
any excessive number of photographs of naked children in any pose may
draw the attention of law enforcement.
 Any efforts to seduce a minor into a sexual relationship, whether the act is
accomplished or not, will likewise be considered a form of child sexual
abuse and will result in severe legal consequences. Inappropriate
intimacy with children will also be regarded as child sexual abuse. Any of
these situations should be reported to the authorities immediately.
o Take care around children at all times to prevent activities that might be
construed as "sexual" abuse. If reasonable care is taken, displays of affection or
inadvertent incidents that result in exposure of a child to a sexual act or sexual
material (for example, a child walking into a closed bedroom while the parents
are having sex or finding an adult magazine) will not be considered criminal.
o To identify the physical signs of child sexual abuse, parents should know the
normal appearance of the genitalia of their child so that they can identify if any
changes occur. If a child complains about problems with his or her genitals, take
the child to the family doctor for examination. Children in day care, children cared
for by others, or children who spend time alone with other people are at risk of
sexual abuse.
o Changes in behavior, including discipline problems, loss of bowel habits by
soiling or bed wetting, insomnia, nightmares, depression, or other changes in the
way a child normally acts can be signs of sexual abuse. Parents should discuss
the possible reasons for such changes in behaviors with professionals who are in
a position to do proper evaluations of the behavioral changes and explore the
possibility of child sexual abuse.
o Parents, however, should not question the child about possible abuse. Special
techniques and formal interviews are the best forum for discovering and
documenting allegations of sexual abuse. Contacting your family physician or
local child protection services will usually result in adequate initial investigation of
any concerns.
Pedophilia, a form of child sexual abuse, is an abnormal interest in children that is
based on the intention by the perpetrator to be sexually aroused by children
o Someone with an erotic interest in children may collect material that
demonstrates a child in sexual poses. The person may seek interaction with
children with the intention of satisfying an erotic or sexual desire or actively seek
a sexual relationship with a child. Adults who seek sexual relations with children
are the most extreme and deviant of the pedophiles.
o Using children to create erotic materials or for erotic acts with other adults is
another form of child sexual abuse. In this form, the intention is not to arouse the
abuser, but to arouse others. The law does not distinguish one from the other.
Both are severely prosecuted.
o Pedophilia, although a mental disorder, if not resisted, repressed, and treated will
result in the most severe legal consequences. The law will not tolerate
pedophilia. It is imperative that any person who feels sexually attracted to
children immediately seek help from a qualified therapist. People who use
children to create sexual arousal for others are already involved in serious
criminal activity. Report any suspicions to police immediately.
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3
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Physical abuse of children is defined as excessive intentional physical injury to a child
or corporal punishment of a child. Torture, beatings, and assault of children are obvious
forms of physical abuse.
o Corporal punishment by parents, on the other hand, is subject to evaluation and
interpretation. In general, spanking with a hand and other forms of mild physical
punishment that do not leave any marks are considered within the realm of
parental discretion.
o Punishment that leads to marks that last for more than a few minutes can be
interpreted as abuse, regardless of intention. The use of any objects to strike a
child (other than with your open hand) is wrong. That includes belts, paddles,
sticks, or any other object. A family tradition of beatings will not be an acceptable
excuse for severe injury to a child.
o Excessive physical discipline is harmful and dangerous to children. Small
children can be killed by relatively minor acts of physical violence (for example,
shaking, dropping, or throwing the child against hard surfaces). Any severe
beatings with an object, forceful shaking, submersion in hot water, intentional
burning, and other forms of intentional infliction of pain are inappropriate and
criminal behaviors.
o Any person who has been reared in an environment of violence may be more
likely to inflict violence on others. People who recognize their tendencies to get
angry, out of control, or violent should seek help. They can learn anger
management, child rearing techniques, and try to suppress their violent
tendencies at all times.
o Seeing others inflict physical abuse on children should prompt immediate action
by the observer. People who are physically violent generally demonstrate
violence again—at higher levels. Early intervention is the best strategy to avoid
lifelong consequences.
Child neglect in any form when it concerns a child’s welfare is generally considered to
be criminal behavior. Child neglect will be considered as a possible diagnosis for
children that are poorly cared for, not fed properly, improperly clothed, denied basic
necessities, denied proper medical care, or treated with indifference to a degree that
appears to cause damage or suffering.
o Parents, caregivers, and guardians of children must seek help from medical and
social services in situations in which children have less-than-adequate care.
Children can develop long-term medical and developmental problems from such
neglect.
o Failure to continue to get help for a child who is not doing well or who is
improperly cared for may be interpreted as another form of neglect. This can
result in criminal action or action by child protective services that may result in
children being removed from the home and placed in foster care.
Emotional neglect is a condition in which children do not get adequate attention from
their parents or guardians.
o With mild forms of emotional neglect, children can develop rebellious behaviors
or become alienated from their parents.
o In more severe cases of emotional neglect, especially with babies or very young
children, neglect can result in very abnormal behaviors, such as these:
 Listlessness
 Profound detachment from the parents
 Poor bonding with other people
 Poor interactive skills with other children or at times inappropriate
attachment to anyone who will pay attention to them
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o
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These behaviors in young children continue as they get older and can transform
into other personality or mental disorders that can be difficult, if not impossible to
treat.
o Parents who feel their relationship to their children is causing problems, is
stressful, or not working well should consider the following questions:
 Are you spending time with your children in recreational or learning
activities in which they are the focus of your attention?
 Do you show your children love and affection?
 Do you feel out of control of your children or detached from them and
their activities?
 Do you have excessive behavioral problems with your children?
 Are you supervising their time during which you are caring for them or
letting them be on their own and unsupervised?
 Is there excessive yelling, anger, or punishment?
 Do you yourself exhibit bad behaviors in front of your children that
disregard the children such as drug use, profanity, physical violence,
bigotry, or ignoring the child's feelings and concerns?
o Parents who recognize any of these problems can avoid the consequences of
emotional neglect through parental training courses, reading, and effort. Seeking
a little help can achieve big results. Children are very responsive to any positive
effort put forth by a parent to improve the parent-child relationship, especially
when children are young.
Failure to thrive is a condition in which children fail physically to develop normally to
their full genetic potential. It is caused, most commonly, by medical conditions that can
result in children not growing as expected. At times, though, it can be caused by
intentional or unintentional behavior on the part of the parent.
o The diagnosis is made when a doctor compares the growth of a child on
standard growth charts and looks for changes in the rate of growth of a child.
These measurements are usually taken during well-child visits to the family
doctor.
o Any decrease in the rate of growth of a child with respect to weight, height, or
head size will raise concern and force the doctor to consider the diagnosis of
failure to thrive. The doctor will begin to seek a reason for the decrease in the
rate of growth and try to make sure that there is no intentional behavior by the
parents responsible for the child's slow growth.
o Medical conditions that affect growth will generally be tested. But if there is no
other explanation for the abnormal growth, parents will be suspected of
intentional abuse. This could include these behaviors:
 Denying the child food
 Feeding the child the wrong foods
 Emotional neglect
 Allowing a child to remain ill (not seeking medical care)
o Once failure to thrive is considered, parents must comply with their doctor’s
recommendations regarding testing and any other investigation into the child’s
failure to thrive. If not, the doctor's suspicion may increase that the parent is
contributing to or causing the condition.
o Although some children are destined to be small, they generally grow at a
predictable rate. If a child is eating adequately and consuming an adequate
number of calories and generally appears happy and healthy, regardless of size,
there is little reason to worry.
Munchausen by proxy syndrome is a serious psychiatric disorder of parents or
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Child Abuse
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guardians of children. Perpetrators manufacture, intentionally or unintentionally, signs
and symptoms of disease in their child. They do this, not for the good of the child, but
generally to satisfy their own abnormal need. By literally making the child sick, the
caregiver has excessive contact with doctors and hospitals. Children undergo
unnecessary testing and treatment for diseases that they do not have.
o This condition is difficult for doctors to identify. Other family members or friends
can usually sense an excessive amount of medical activity surrounding an
apparently healthy child. If you suspect this is happening, you should inform the
parent and the family physician of any such concerns.
o Parents can ask themselves these questions with respect to seeking medical
attention for their children:
 Are you overly concerned about the health of your children?
 Do you remain concerned about minor problems that you have been told
not to worry about?
 Do you find yourself obsessing over possible medical problems that might
affect your children?
 Have you ever done an intentional act to make a child appear ill?
 Do you have any motivation or will you derive any benefit if you make
your child appear ill?
o Parents who see this behavior in themselves should stop the medical attentionseeking behavior and seek psychiatric help as soon as possible.
BASIC PARENTI SKILLS
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General parenting guidelines
Raising children can be a successful and satisfying experience. Without basic parenting
skills, the task is difficult and frustrating.
Children seek love and discipline. Discipline takes the form of structured environment,
rules, and boundaries, not just physical punishment and obedience. Love is the
complementary behavior to discipline. Both are necessary if you are to be a successful
parent. Both are needed to create the correct balance of concern and caring required in
raising well-adjusted and happy children. When love and discipline are blended
correctly, your child will be mentally healthy, self-assured, responsible, self-controlled,
and prepared for their own parenting experience.
Problem teenagers can be more difficult to manage, but social organizations, friends,
parents, and other family members along with counseling and patience can help.
Parents should be wary that bad behavior caused by poor parenting skills can
sometimes be diagnosed as a mental disorder, hyperactivity, or attention deficit disorder.
Efforts to alter behavior through the thoughtful use of love and discipline should be tried
before resorting to medication and other medical treatment, which can have a lasting
effect on children and on their self-image. When problems with children are severe,
children need to be evaluated by professionals to determine if they have true psychiatric
problems.
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The limited role of corporal punishment
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It is important for parents to understand the limited role of spanking and corporal
punishment. Many parents have successfully raised children with no corporal
punishment at all.
If punishment is to be used, it must be done carefully.
o
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Light spanking or hand slapping with an open hand can be used to discourage
dangerous behaviors such as reminding a 1-year-old trying to play with an
electric socket.
o Other situations where light spanking can be employed are with children between
the ages of 1-3 years who choose to ignore verbal direction in dangerous
situations. Reserve this for situations such as being told "no" for very
unacceptable behaviors such as leaning out windows or pulling at glasses of hot
liquid.
o Any physical punishment should be given with words that demonstrate love and
concern for the child. Make it clear to the child that any and all punishment is
done because you love the child.
o Use words of discouragement in place of spanking as the child's language skills
and level of maturity improve.
o After the age of 3 years, there should be very little need or use of any physical
punishment of a child. If behavioral and control problems continue through this
age, seek counseling and work out detailed plans on how to deal with bad
behavior.
Alternatives to physical violence
There is ample evidence that the following forms of punishment are workable solutions
that eliminate the need for any physical forms of punishment:
o
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Timeouts
Sending children to their rooms
Taking away privileges of various types
Denying children enjoyable activities
REPORTING ABUSE
You may have questions about possible abuse in your own behavior or, more often,
about the behavior of others. State law mandates that certain people, called mandated
reporters, report any suspected child abuse to authorities. These are teachers, police,
and doctors.
Nonmandated reporters, however, which includes almost everyone else, frequently are
the first people to notice possible abuse. Ironically, nonmandated reporters are actually
the people most likely to be able to identify potential abusers. They are the people who
see abuse early enough to play an active role in preventing it and saving the abuser
from the terrible consequences that are associated with child abuse.
The first observer of abuse or abusive tendencies is in a position to intervene with the
potential abuser before any substantial abuse has taken place.
Although we would like to think that abusers are receptive to having these tendencies
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pointed out, generally they are not. Unfortunately, abusive tendencies frequently turn
into abusive behaviors, which are usually difficult, if not impossible, to stop. This forces
the typical observer of abuse into the unenviable, but necessary, position of having to
report the abuser to the proper authorities.
Reporting is the only effective step to control the abuser and stop the abuse. If reporting
a pattern of abuse is delayed, the abuse situation usually gets worse until the abuser
and his or her behaviors are discovered by others. At this point, law enforcement usually
becomes aware of the situation.
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Statutes-at-a-Glance
2001
Mandatory Reporters of Child Abuse and Neglect
Each State designates individuals, typically by professional group, who are mandated by law to
report child maltreatment. Any person, however, may report incidents of abuse or neglect.
Individuals Typically Mandated to Report
Individuals typically designated as mandatory reporters have frequent contact with children.
Such individuals include:
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Health care workers
School personnel
Day-care providers
Social workers
Law enforcement officers
Mental health professionals
Some States also mandate animal control officers, veterinarians, commercial film or
photograph processors, substance abuse counselors, and firefighters to report abuse or
neglect. Four States--Alaska, Arkansas, Connecticut, and South Dakota--include domestic
violence workers on the list of mandated reporters. Approximately1 eighteen States require all
citizens to report suspected abuse or neglect regardless of profession.
Standard for Making a Report
Typically a report must be made when the reporter suspects or has reasons to suspect that a
child has been abused or neglected.
Categories
Approximately twenty-six States specify when a communication is privileged. Privileged
communications are exempt from mandatory reporting laws. The privilege most widely
recognized by the States is that of attorney-client. The privilege pertaining to clergy-penitent
also is frequently recognized. For example, when a priest becomes aware of child abuse
through confessions or in the capacity of spiritual advisor, he is not required to report. Very few
States recognize the physician-patient and mental health professional-patient privileges as
exempt from mandatory reporting laws.
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Statutes-at-a-Glance
2001
Reporting Penalties
Many cases of child abuse or neglect are neither reported nor investigated even when suspected
by professionals. Therefore, almost every State imposes penalties, in the form of a fine or
imprisonment, on those who knowingly and/or willfully fail to report. Also, in order to prevent
malicious or intentional reporting of cases that are not founded, several States impose additional
penalties for false reports of child abuse or neglect.
Penalties for Failure to Report
Approximately forty-four States and the District of Columbia have enacted statutes specifying the
penalties for failure to report child abuse or neglect. Of these jurisdictions, approximately thirtythree States and the District of Columbia use a "knowingly," "knows or should have known," and/or
"willfully" standard. Other standards include "intentionally" and "purposely." A few States impose
penalties without providing a standard. Failure to report is classified as a misdemeanor in
approximately thirty-four States.
Penalties for False Reports
Approximately twenty-nine States have statutes specifying penalties for false reports of child
abuse or neglect. The most common standards are "knowingly" and/ or "willfully." The penalties
imposed are similar to those for failure to report. The majority of States classify false reporting as a
misdemeanor. In nine States, however, a false report may be classified as a felony.
ABUSE AND THE LAW
Take care in interpreting certain behaviors in adults and children that suggest the possibility of
abuse. Parents and all reporters of abuse must realize that accusations of abuse are taken very
seriously by law enforcement, child abuse professionals, and prosecutors. While the reporter of
abuse (mandated or nonmandated) is granted immunity from any liability when they make
reports about possible abuse, such reports should be done in good faith only. This is not always
the case.
Some people are willing to use allegations of abuse to achieve their own goals at the expense
of an accused person. Once allegations of abuse are made, the general belief by the authorities
is that accusations are true until proven otherwise. False accusations can rarely be taken back
without very significant damage to families and the lives of the accused person.
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False allegations can arise from family members, enemies, or from unhappy or disturbed
children. Children can be manipulated by adults to make false accusations. The younger
the child, the more susceptible the child is to manipulation.
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False allegations of abuse occur in a small number (3-5%) of all abuse reports. But
under certain circumstances, the percentage can increase. In divorce and custody
disputes, in which allegations of abuse are raised, the percentage of false allegations
has been reported to be as high as 22%.
Misinterpretation of medical findings or behaviors (especially sexual abuse behaviors) by
overly protective authorities (at school, day care, and in medical facilities) have been
responsible for many false allegations of abuse, even when all parties (including the
children) deny that abuse has occurred.
Although the vast majority of allegations of abuse are true (more than 95%), the number of false
accusations that occur make it necessary to at least consider the truth of each accusation as
part of a complete evaluation. It is a crime to make false statements about abuse.
DIFFERING CULTURAL NORMS FOR CHILD REARING
Various cultures have different cultural norms with respect to appropriate behavior toward
children.
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Some cultures are more "touchy" than others.
Some believe in physical discipline to an extreme.
There are cultures in which certain things that are done to children out of caring create
the appearance of child abuse.
In some cultures, rituals are performed. These same rituals may be unacceptable in the
country in which you live.
In general, the laws of the country in which you live are the laws that must be obeyed.
PREVENTION OF CHILD ABUSE
Child abuse is prevented, first, through awareness, then early detection and intervention.
Protecting children from abuse is the first and foremost concern of police and child protection
authorities.
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In an ideal world, psychiatric help would be available to treat those who abuse children.
But that is rarely the case. Most abusers, once they have acted out and committed acts
of abuse, are arrested, charged, tried, convicted, sent to prison, and marked for life as
sexual offenders.
To prevent abuse by changing the behavior of the abuser (whether they are a loved one
or a friend), tendencies to be abusive must be identified before any actual abuse takes
place. Once a tendency is identified, the best hope for treating this serious mental
disorder is behavioral counseling.
THE COSTS OF CHILD MALTREATMENT
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Child abuse and neglect cost our society dearly, not only in terms of the trauma caused
to the maltreated individuals but also in economic terms. Economic costs include the
funds spent each year on child welfare services for abused and neglected children as
well as the large sums dedicated to addressing the short- and long-term consequences
of abuse and neglect. Effective prevention programs that promote the safety and wellbeing of children and families hold potential for lessening the suffering and trauma
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experienced by children and greatly reducing these economic costs.
To date, few in-depth and rigorous financial analyses have been conducted to give us a
solid understanding of the total costs of maltreatment (i.e., the costs of not preventing
child abuse and neglect) as compared with the economic savings associated with
prevention. Nevertheless, several prevention advocates, researchers, and evaluators
have begun to grapple with these issues. The purpose of this paper is to promote
greater understanding of what is known about the financial costs of maltreatment and to
encourage continued examination and comparison of these costs with the benefits of
prevention. The paper begins with a discussion of the cost elements that make up the
total cost of child maltreatment. The second section highlights findings from selected
studies that have conducted cost-benefit and cost-of-failure analyses.
THE COSTS OF CHILD MALTREATMENT
Child abuse and neglect have known detrimental effects on the physical, psychological,
cognitive, and behavioral development of children (National Research Council, 1993).
These consequences range from minor to severe and include physical injuries, brain
damage, chronic low self-esteem, problems with bonding and forming relationships,
developmental delays, learning disorders, and aggressive behavior. Clinical conditions
associated with abuse and neglect include depression, post-traumatic stress disorder,
and conduct disorders. Beyond the trauma inflicted on individual children, child
maltreatment also has been linked with long-term, negative societal consequences. For
example, studies associate child maltreatment with increased risk of low academic
achievement, drug use, teen pregnancy, juvenile delinquency, and adult criminality
(Widom, 1992; Kelly, Thornberry, and Smith, 1997). Further, these consequences cost
society by expanding the need for mental health and substance abuse treatment
programs, police and court interventions, correctional facilities, and public assistance
programs, and by causing losses in productivity. Calculation of the total financial cost of
child maltreatment must account for both the direct costs as well as the indirect costs of
its long-term consequences.
Direct Costs
Direct costs reflect expenditures incurred by the child welfare system as well as the
judicial, law enforcement, health, and mental health systems in responding to abused
and neglected children and their families. Direct costs include expenses associated with
hospitalization and medical services provided to treat injuries resulting from abuse, child
protective services (CPS) and/or police investigations; foster care and other out-of-home
placement services for maltreated children; and family preservation, rehabilitation, and
treatment programs.
Government expenditures for child welfare programs provide a benchmark for estimating
a portion of the annual direct costs of child abuse and neglect. For fiscal year 1998,
Federal expenditures to States for major child welfare programs will exceed $4.5 billion.
This figure includes child welfare services, foster care, adoption assistance, and family
preservation and support, but excludes Medicaid dollars, an important source of
treatment funding for children and families. Based on a survey of State child welfare
agencies (CWLA, 1997), Federal funding accounts for less than half (42%) of State child
welfare expenditures with the remainder supported by State (49%) and local (9%)
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funding.
A recent study by the Missouri Children's Trust Fund (1997) provides a different lens
through which to view direct costs of maltreatment. The study analyzed the direct
economic costs of one type of child maltreatment-Shaken Baby Syndrome (SBS)-in
Missouri over a 10-year period. The study found that the State spent at least $6.9
million, or approximately $32,500 on each of the 214 identified SBS victims. These costs
included $4 million in Medicaid expenses, $1.9 million for Division of Family Services
expenditures, and nearly $1 million for Department of Mental Health services.
Indirect Costs
Indirect costs reflect the long-term economic consequences of child maltreatment in
such areas as special education, mental health, substance abuse, teen pregnancy,
welfare dependency, domestic violence, homelessness, juvenile delinquency, and adult
criminality. Indirect costs are more difficult to assess than direct costs, and frequently
calculations are based on assumptions or they are extrapolated from research. For
example, Deborah Daro (1988) estimated a national indirect juvenile delinquency cost of
$14.9 million based on the following: an estimated 177,300 adolescent maltreatment
victims nationwide in 1983; research indicating a 20 percent delinquency rate among
adolescent victims; and average costs ($21,000 per year) for 2 years of correctional
institutionalization for these abused and delinquent youth. The same analysis estimated
that if 1 percent of severely abused children were to suffer permanent disabilities, the
annual cost of community services for treating children with developmental disabilities
would increase by $1.1 million.
Indirect costs also may include inferred costs of lost productivity associated with injury,
incarceration, long-term unemployment, or death. For example, Daro's cost analysis
(1988) projected that the national cost in future lost productivity of severely abused or
neglected children is between $658 million and $1.3 billion each year, assuming that
their impairments reduce their future earnings by as little as 5 percent to 10 percent. A
Michigan study (Caldwell, 1992) used rates of per capita income and average lifetime
participation in the labor force to generate average lifetime earnings of, and calculate
lost tax revenue from, those children who died as a result of child abuse or preventable
infant mortality. The study concluded that, in addition to the devastating personal losses
experienced by the families of the infants and children who died, the State lost an
estimated $46 million in tax revenue. (Although this figure represents the loss of tax
revenue over a lifetime, it can also be interpreted as the per year loss to the State if the
rates of tax, abuse, and mortality remain relatively stable.)
As the above examples show, the total financial costs of child abuse and neglect can be
quite high. Conversely, the potential benefits or savings from prevention also are high.
These costs and potential savings form the basis of cost-benefit analyses.
Highlights from Child Maltreatment 1999
April 2001
This fact sheet presents highlights from the Federal publication Child Maltreatment 1999
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. The highlights are based on responses from the States to the 1999 National Child
Abuse and Neglect Reporting System (NCANDS). Data were collected in aggregate
through the Summary Data Component Survey or at the case level through the Detailed
Case Data Component of NCANDS.
REFERRALS AND REPORTS
As referrals of possible child maltreatment come to the attention of child protective
services (CPS), they either are winnowed from consideration or transmitted further for
investigation or assessment ("screened in" or "screened out") For those reports
screened in, a further determination is made about whether to investigate. The role of
the CPS agency includes deciding whether to take further protective actions on behalf of
a child.
o
Of the estimated 2,974,000 referrals received, approximately three-fifths (60.4%)
were transferred for investigation or assessment and two-fifths (39.6%) were
screened out.
o
More than half of child abuse and neglect reports (54.7) were received from
professionals. The remaining 45.3 percent of reports were submitted by
nonprofessionals, including family and community members.
o
Most States have established time standards for initiating the investigation of
reports. The average response time to initiate investigating reports was 63.8
hours.*
o
Slightly fewer than one-third of investigations (29.2%) resulted in a disposition of
either substantiated or indicated child maltreatment. More than half (54.7%)
resulted in a finding that child maltreatment was not substantiated.*
o
The average annual workload of CPS investigation and assessment workers was
72 investigations.*
CHILD MALTREATMENT VICTIMS
Victims of maltreatment are defined as children who are found to have experienced
substantiated or indicated maltreatment or are found to be at risk of experiencing
maltreatment.
o
There were an estimated 826,000 victims of maltreatment nationwide. The 1999
rate of victimization, 11.8 per 1,000 children, decreased from the 1998 rate of
12.6.*
o
Almost three-fifths of all victims (58.4%) suffered neglect, while one-fifth (21.3%)
suffered physical abuse; 11.3 percent were sexually abused. More than one-third
(35.9%) of all victims were reported to be victims of other or additional types of
maltreatment.
o
The highest victimization rates were for the 0-3 age group (13.9 maltreatments
per 1,000 children of this age in the population), and rates declined as age
increased.
o
Rates of many types of maltreatment were similar for male and female children,
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but the sexual abuse rate for female children (1.6 female children for every 1,000
female children in the population) was higher than the sexual abuse rate for male
children (0.4 male children per 1,000).
o
Victimization rates by race/ethnicity ranged from a low of 4.4 Asian/Pacific
Islander victims per 1,000 children of the same race in the population to 25.2
African-American victims per 1,000 children of the same race in the population.
o
Children who had been victimized prior to 1999 were almost three times more
likely to experience recurrence during the 6 months following their first
victimization in 1999 than children without a prior history of victimization.
PERPETRATORS
A perpetrator of child abuse and/or neglect is a person who has maltreated a child while
in a caretaking relationship to that child.
o
Three-fifths (61.8%) of perpetrators were female. Female perpetrators were
typically younger than their male counterparts-41.5 percent of female
perpetrators were younger than 30 compared with 31.2 percent of male
perpetrators who were younger than 30.
o
Almost nine-tenths (87.3%) of all victims were maltreated by at least one parent.
The most common pattern of maltreatment was a child victimized by a female
parent acting alone (44.7%).
o
Female parents were identified as the perpetrators of neglect and physical abuse
for the highest percentage of child victims. In contrast, male parents were
identified as the perpetrators of sexual abuse for the highest percentage of
victims.
FATALITIES
Child fatality estimates are based on data recorded by CPS agencies and/or other
agencies.
o
An estimated 1,100 children died of abuse and neglect, a rate of approximately
1.62 deaths per 100,000 children in the general population.*
o
Slightly more than 2 percent (2.1%) of all fatalities occurred while the victim was
in foster care.*
o
Children younger than a year old accounted for 42.6 percent of the fatalities, and
86.1 percent were younger than 6 years of age.
o
Maltreatment deaths were more often associated with neglect (38.2%) than with
any other type of abuse.
o
Slightly more than one-tenth (12.5%) of the families of child fatalities had
received family preservation services in the 5 years prior to the deaths, while only
2.7 percent of the child fatality victims had been returned to the care of their
families prior to their deaths.*
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SERVICES PROVIDED
CPS agencies provide services to prevent future instances of child abuse and neglect
and to remedy harm that has occurred as a result of child maltreatment. Preventive
services are provided to parents whose children are at risk of abuse or neglect.
Remedial or post-investigative services are offered to families that have experienced a
child maltreatment episode.
o
Nationwide, an estimated 1,563,000 children (22.3 out of every 1,000 children in
the population) received preventive services.*
o
The average time from the start of investigation to provision of service was 47.4
days.*
o
Nationally, 55.8 percent of child victims (an estimated 461,000) received postinvestigative services, and an additional 14.2 percent of children with
unsubstantiated reports (an estimated 217,000) also received services.*
o
Nationally, an estimated 171,000 child victims were placed in foster care. An
estimated additional 49,000 children who were not victims (i.e., children with
unsubstantiated reports) were placed in foster care.*
o
About one-fifth (21.2%) of victims had received family preservation services
within the previous 5 years, while more than 5 percent (5.1% of victims) had
been reunited with their families in the previous five years.*
o
Court actions were initiated for an estimated 26.1 percent of maltreatment
victims. Four-fifths of these victims (79.3%) were provided with court-appointed
representatives.*
*Findings required by the Child Abuse Prevention and Treatment Act, as amended in
1996, to be included in all annual State data reports to the Secretary of Health and
Human Services. Because this is only the third year that many of these data have been
required, not all States were able to provide data on every item.
Source: U.S. Department of Health and Human Services. Child Maltreatment 1999:
Reports from the States to the National Child Abuse and Neglect Data System.
(Washington, DC: U.S. Government Printing Office, 2001).
REFERENCES
o
o
o
o
o
Berkowitz CD: Pediatric abuse. New patterns of injury. Emerg Med Clin North Am
1995 May; 13(2): 321-41[Medline].
Chadwick DL: Color Atlas of Sexual Abuse. Chicago, IL: Mosby; 1989.
Heger AH, Emans SJ: Evaluation of the Sexually Abused Child: A Medical
Textbook and Photographic Atlas. NY: Oxford University Press; 1992.
McCann J, Wells R, Simon M, et al: Genital findings in prepubertal girls selected
for nonabuse: a descriptive study. Pediatrics 1990 Sep; 86(3): 428-39[Medline]
McCann J, Voris J, Simon M, et al: Perianal findings in prepubertal children
selected for nonabuse: a descriptive study. Child Abuse Negl 1989; 13(2): 17993[Medline].
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o
o
o
Quinn K: The credibility of children's allegations of sexual abuse. In: Behavioral
Sciences and the Law. Vol 6 1988: 181-199.
Reece RM: Child abuse: Medical Diagnosis and Management. Philadelphia: Lea
& Febiger; 1994.
Tintinalli JE, Kelen GD, Stapczynski JS: Emergency Medicine: a Comprehensive
Study Guide. NY: McGraw-Hill; 2000.
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Child Abuse Assessment
1. Child abuse
a. Is only physical
b. May be physical or verbal
c. Is only verbal
d. Can take many forms
2. Child abuse may include:
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a.
b.
c.
d.
Child sexual abuse
Pedophilia
Child neglect
All of the above
3. The intent to use children in any way to create sexual arousal is
a. Frowned upon but not illegal
b. Sometimes illegal
c. Always illegal
d. None of the above
4. An abnormal interest in children that is based on the intention by the perpetrator
to be sexually aroused by children is known as
a. Pedophilia
b. Physical abuse
c. Weird
d. Munchausen by proxy syndrome
5. Excessive intentional physical injury to a child or corporal punishment of a child is
known as
a. Pedophilia
b. Physical abuse
c. Sexual abuse
d. Munchausen by proxy syndrome
6. _______ can be considered as a possible diagnosis for children that are poorly
cared for, not fed properly, improperly clothed, denied basic necessities, denied
proper medical care, or treated with indifference to a degree that appears to
cause damage or suffering.
a. Sexual abuse
b. Physical abuse
c. Emotional abuse
d. Child neglect
7. This is a condition in which children do not get adequate attention from their
parents or guardians.
a. Child neglect
b. Emotional neglect
c. Munchausen by proxy syndrome
d. None of the above
8. This is a condition in which children fail physically to develop normally to their full
genetic potential. It is caused, most commonly, by medical conditions that can
result in children not growing as expected. At times, though, it can be caused by
intentional or unintentional behavior on the part of the parent. This is known as
a. Child neglect
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b.
c.
d.
Munchausen by proxy syndrome
Physical abuse
Failure to thrive
9. This is a serious psychiatric disorder of parents or guardians of children.
Perpetrators manufacture, intentionally or unintentionally, signs and symptoms of
disease in their child. They do this, not for the good of the child, but generally to
satisfy their own abnormal need. By literally making the child sick, the caregiver
has excessive contact with doctors and hospitals. Children undergo unnecessary
testing and treatment for diseases that they do not have.
a. Munchausen by proxy syndrome
b. Sexual abuse
c. Physical abuse
d. Failure to thrive
10. Individuals typically designated as mandatory reporters have frequent contact
with children. Such individuals include:
a. Teachers
b. Health care professionals
c. Day-care providers
d. All of the above
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