Preventing Child Abuse and NeglectWord文件下载.docx

Preventing Child Abuse and NeglectWord文件下载.docx

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Foramiddle-agedadministratorthiswasadreamcometrue.Threemonthstoreadwhatevercaughtmyinterest,totaketimetothink,tointerviewpractitionersfromotherstates,tothink,totalkwithresearchers,tothink,todiscussissueswithlegislators,totaketimetothinkandthentoreadagain.IcannotrecallatimewhenIhadtheluxuryofbeingabletoconcentrateonjustonething,withoutotherresponsibilities.

Anotherpleasureofthequarterwastheopportunitytoattendanationalprofessionalconferenceinadisciplineotherthanmyown.IspentfourdaysinSaltLakeCitygettingacquaintedwithcuttingedgeresearchandpracticeinpreventingchildabuse.Havingthusimmersedmyselfinthiscourseofstudy,whatwordsofwisdomdoIhaveforEarlyReportreaders?

Ithinkwemust,eachofusinourownroles,inchildcare,schools,universities,insocialservicesandinthepoliticalarena,takeactiontopreventabuse.

ItisnotenoughtoreadthepapersandwatchTVandsayweareemotionallydistressed,disgustedweareangry,sad,unabletotrulyunderstandhowthiscouldbehappeninginourcommunitywhichisknowntohaveahighqualityoflife.SenatorHatch,ofUtah,saidit,"

Shockandrevulsionwillnothelpthevictims."

HenryKempewarnedus,25yearsago.Hesaidthatifwefailtousewhatweknow--andwaitforallthestatisticsandknowledge,wewillraiseanotherwholegenerationofchildabusers.Todaytheresearchevidenceproveshimright.Weknownow,withcertainty,thatthephrase"

timehealsallwounds"

doesnotholdforchildrenwhohavebeenvictimsofabuseandneglect-thesechildrenmusthavetheirwoundstreated.Wealsoknowthattreatmentishelpful,butitoftendoesnotcompletelyeliminatetheeffectsofabuseandneglectandtheendresultcanbethepotentialforthosechildrenbecomingtheabusersinthenextgeneration.

Wehavenotbeenidleduringthelast25years.Wehavecreatedreportinglaws,wehavemadeabuseacrime,wehaveestablishedprogramsfortreatmentofparentsandchildren.Wehavestruggledwithsocialandmoralissues,suchas'

doweprotectparentsrightsorchildren'

srights'

.

Dr.RichardKrugman,DirectoroftheKempeCenterforthePreventionandTreatmentofChildAbuseandNeglect,whowillparticipateintheMinnesotaRoundTable（seepage8）,hassaidargumentsbetweenDemocratsandRepublicans-debatesofpunishmentvs.treatmentofoffendersanddiscussionsofmedicalmodelsvs.socialworkmodelsare"

...adultdichotomieswhicharemeaninglesstochildren-whileweargue,theyhurt.Wemusthavethewilltoworktogether.Abusedkidsdonotcareaboutourdifferences."

Wemustbegintospendmoreofoureffortsandmoreofourdollarsonprimaryprevention（actiontostopaspecificproblembeforeitstarts）doingpubliceducationusingavarietyofmodes.

Atthesametimewemustinvestinsecondaryprevention,（earlydiagnosisandtreatmentofindividualsandfamiliesatriskforabuse）.Childpsychologists,psychiatrists,socialworkers,pediatricians,andotherswhohavestudiedthecausesandeffectsofabuseagreethatchildabuseismostoftenadisorderofattachment.Inpreventingthedevelopmentofabuserstheimportanceofgoodattachmentanditslonglastingeffectscannotbeoverstated.Thispointsclearlytotheneedforparenttraining,startingwithprenatalcareandcounseling.

JaneGilgun（page4）advisesusto"

tell,tell,tell"

andAlanSroufe,oftheMother-ChildProject（seebelow）,remindsusthatthisisnotasimpletask."

Wemustbeinthereforthelonghaul,inourtimewewillnotsolvethisproblem;

butmaybewecankeeptheshipafloat."

InthisissueofEarlyReportthearticlesprovideinsightsaboutresearchprojects,trainingprograms,andeffortsatcoordinationofservicesthataretakingplaceattheUniversityofMinnesotaandinourcommunity.OtherinformationaboutpreventionofabusethathavebeenpublishedasaFACTFINDserviceareavailableuponrequest.

UsingResearchinPreventiveIntervention

byMarthaFarrellErickson,Ph.D.Coordinator,ProjectSTEEPUniversityofMinnesota

Mostofusagreeweshouldtrytopreventchildabuse,yetthereislessagreementastohowortowardwhomtodirectourefforts.Twobodiesofresearchhelpusanswerthosequestions:

1）studiesthatidentifypeoplemostatriskofabusingandthatpinpointriskfactorstotargetforchangethroughpreventiveintervention;

2）studiesthatevaluatetheeffectivenessofpreventiveinterventionstrategies:

Whatreallyworksandforwhom?

TwostudiesattheUniversityofMinnesotarepresenttheseareasofresearchandareyieldingfindingswithimportantimplicationsforpracticeandpolicyintheareaofchildabuseprevention.

StudyNumberOne:

IndicatorsofRisk

TheMother-ChildInteractionProject,initiatedin1975byDrs.ByronEgelandandAlanSroufeoftheInstituteofChildDevelopmenthasfollowed267womenandtheirfirst-bornchildrenbeginningduringpregnancy.Theresearchersassessedthemother'

sattitudesandfeelings,thechild'

sdevelopmenttheparent-childrelationship,andthebroadersocialenvironment.Becausethefamiliesallwerelow-incomeatthestartofthestudyandexperiencedmanyofthestressorsassociatedwithpoverty,therewasahigherprobabilityofmaltreatmentinthissamplethaninthegeneralpopulation.Indeed,inthefirstsixyearsofthestudyabout60childrenwereidentifiedbytheresearchersasexperiencingsometypeofmaltreatment:

physicalabuse,neglect,verbalabuse,sexualabuse,oremotionalneglect.Virtuallyallofthesechildren,nowyoungteenagers,haveexhibitedproblemsascomparedtonon-maltreatedchildrenfromthesamelow-incomesample,particularlyinsocialrelationshipswithbothpeersandadults.

Perhapsthemostusefulinformationfromthisstudyistheidentificationoffactorsthatpredictwhichparentsaremostlikelytomaltreattheirchildren.Theseriskfactorsinclude:

∙Failuretoprepareforbaby'

sarrival

∙Lackofawarenessandunderstandingofthecomplexityofthechildandtheparent/childrelationship

∙Lackofinterestinthebaby

∙Insensitivitytotheinfant'

ssignals

∙Ahighdegreeofstressintheparent'

slife,particularlyrelationshipdifficulties

∙Lackofsocialsupportfortheparent

∙Theparent'

sownhistoryofhavingbeenabused

Animportantquestionrelatestothelastriskfactor:

howtobreaktheintergenerationalcycleofmaltreatment.IntheMother-ChildProject,30%ofmotherswhohadbeenabusedintheirownchildhoodwentontoprovidegoodcarefortheirchildren.Howweretheyabletobreaktheabusepattern?

Threefactorsseemtoinfluencethis:

1.Nurturanceandsupportduringchildhoodfromsomeadultotherthantheabuse

2.Asupportiverelationshipwiththeircurrentpartner

3.Iinvolvementintherapyforatleastsixmonths

Thethirdfindingconvergeswithwhatotherresearchersandclinicianshaveobservedabouttheneedforabusevictimstofacethepainoftheirexperienceandcometosomehealthyresolutionofthosepastissuesiftheyaretoavoidrepeatingtheexperiencewiththeirownchildren.

StudyNumberTwo:

PuttingResearchtoWork

InanefforttoapplythefindingsfromtheMother-ChildProject,IworkedwithDrs.EgelandandSroufetodevelopSTEEP（StepsTowardEffectiveEnjoyableParenting）,apreventiveinterventionprogramfornewparentsandtheirinfants.Usingacombinationofhomevisitsandgroupsessionswithatrainedfacilitator,wehaveintervenedwith75first-timemothersfromthesecondtrimesterofpregnancythroughtheirchild'

sfirstbirthday.

Participants,recruitedthroughobstetricclinics,mustbelow-income,atleast17yearsold,andhavenomorethanahighschooleducation.Althoughnotanentrancerequirement,about95%aresingleatthebaby'

sbirth,andamajorityreporthavingbeenabusedinsomewayinchildhood.Todetermineprogrameffectiveness,the75interventionfamiliesarebeingcomparedto75familieswhomeetthesameentrancerequirementsbutdonotparticipateintheintervention.Successisdeterminedbyassessmentsdonewhenthebabiesareoneyear,19months,and24monthsofage.

ThelinkbetweenProjectSTEEPandtheMother-ChildProjectisthattheriskindicatorsidentifiedintheearlierstudyhavehelpedusdeterminebarrierstoagoodparent-childrelationshipsowecanworkwiththefamiliestoremovethosebarriers.Ourinterventioneffortsareaimedatsuchthingsashelpingparentsprepareforthebaby'

sarrival,promotingunderstandingofthecomplexityofparent-childrelationships,increasingsocialsupport,promotinglifemanagementandcommunicationskillsthatmightreducesomeofthestressfuleventsinthemother'

slife,andhelpingtheparentlearntointerpretandrespondappropriatelytothebaby'

ssignals.Importantly,wealsouseavarietyoftherapeutictechniquestohelpparentslookrealisticallyattheirownhistory,understandhowitinfluences