Child Abuse and NeglectCauses, Policies, Opportunities

Professor Mark A BellisUK WHO Focal Point for Violence and Injury Prevention

Director, Policy, Research & Development, Public Health Wales

Chair, World Health Organization Collaborating Centre for Violence Prevention, Liverpoolm.a.bellis@bangor.ac.uk

Based on NSPCC

5% Children

sexually abused 650,000(Est. UK)

980,000 (11-17yrs) experiencedhigh levels of abuse/neglect (est. UK)

Three in five people describe child abuse and neglect as “common” in the UK

Child Abuse - Distribution and Focus

63 Child Homicides UK 2012/13Under15’s Deaths assault or undetermined 44

Sexual offences against children 23,633 police UK 2012/13 36,202 NSPCC helpline abuse or neglect

contacts in 2012/13

7,964 Cruelty & neglect offencesPolice UK 2012/13.

42,500 Children looked after due to abuseand neglect 31 March 2013.10 -15yrs Violent crime 250,000

2012/13 (Est UK).

Focus

Distribution

Adverse Childhood Experiences

Bellis et al, BMC Medicine, 2014Aged 18 to 69 (n = 3,885)

1 2 3 4 50

5

10

15

20

25Verbal Physical Sexual

Deprivation Quintile

Perc

enta

ge

Adverse Childhood Experiences

Bellis et al, BMC Medicine, 2014Aged 18 to 69 (n = 3,885)

Troubled Families - Average 9 problems. 40% had 3 or more children

0-9 10-19 20-29 30-39 40-49 50-59 60-690.000

0.100

0.200

0.300

0.400

0.500

0.600

0.700

0.800

0.900

1.000

0 ACEs 4+ ACEs

Survival period

Cu

mu

lati

ve p

rop

orti

on n

ot d

iagn

osed

at

per

iod

en

d

Cumulative Proportion of Individuals not diagnosed with a Major Disease with Age

Cancer Type II Diabetes Cardio Vascular Disease Digestive/Liver Disease Stroke Respiratory Disease

Aged 18 to 69 (n = 3,885) Bellis et al, Journal of Public Health, 2014

35% have history of major disease

70% have history of major disease

Differences are independent of Deprivation

Victim of child

abuse

Youth violence

Domestic and sexual

violence

Perpetrator of child abuse

Impaired bonding

Poor parenting skills

Academic problems

Conduct disorder

Unemployment

Poor housing

High crime area PregnancyUnplanned, Teenage, Parental

conflict

Poor mental health Stress, Depression, Anxiety

Based on Hughes & Bellis , WHO, 2013

AlcoholDrugs

Risk Factors for Child Maltreatment

Globally 390 journal articles (2007- June 2014) - Primary Prevention

Other

Sexual violence

Intimate partner violence

Self-directed violence

Child maltreatment

Youth violence

0 50 100 150 200 250

40

21

30

39

41

219

Parenting programmes 16 (39%) Home visiting 10

(24%) Other* 8

(37%)

Child Maltreatment Studies USA 27

(66%) Europe (ex UK) 3 UK 1* Child skills programmes, support groups, media campaigns, screening and referral,

therapeutic approaches, parent/child/school programmes

www.preventviolence.info

Missing - systematic evidence on cornerstone of local early years programmes (universal health professional support by health visitors in the first two years of a child’s life)

Universal Identification (e.g. maternal substance), support & referral - Enhanced Paediatrics

Media and Professional Work on Long Term Importance of Early Years

Legal framework, Safe guarding, Criminal Justice, Social Care

Violence against children Risk Factor Poor early development

Cultural Change e.g. Social Norms and Capital Environmental Change e.g. Alcohol Access

Deprivation - Affluence

AC

E F

ree

Ear

ly Y

ears

Based on Marmot Proportionate Universalism and WHO report on preventing child maltreatment

Targeted

Home Visiting, Parenting Programmes

Educational – Acute Harms - Shaken Baby

Child Maltreatment Prevention – 1001 Days£

• Increasing evidence of programme cost-effectiveness especially taking a multi-agency approach

• Debate over programme type and extent of targeting

30:1

Royal Liverpool AED

(TIIG 2008)

1-2 3-5 6-10

Assault LocationNumber

1-4 5-9 >10

Area of residenceNumber

Integrated Intelligence for Prevention of Violence, Abuse and Neglect

Local measures of other illegal behaviours are available (e.g. drug use) but not child maltreatment of domestic violence.

• ≈ 1/3 of child abuse is under influence of alcohol – alcohol related

• USA model• 1 less outlet per 1,000 people severe

violence towards children by 4% • 10% increase in excise tax on beer severe

violence towards children by 2.3%

The habit of drinking to excess leads to the ruin of the families, disgust for work, poverty, misery, theft and crime.

Thousands of instances of cruelty to children occur annually in this City from the neglect and brutality of parents, often reduced to poverty through wasting their money on drink.

Local Action 1906Abuse of Alcohol and its Consequences

ADVERSE CHILDHOODEXPERIENCES

Contraceptive & Family Planning ServicesUnwanted/Teenage Pregnancy

Maternity & Midwifery ServicesPositive Parenting

Abuse identification, Safe-guarding

SERVICE QUALITYElder abusePatient care

ALCOHOLPrevention messages

Treatment & CareIdentification and Brief Motivation

Licensing and InspectionData exchange

MENTAL HEALTH AND SUBSTANCE USEMultisystemic Therapy

Cognitive Behavioural TherapySubstance Use services

Other Mental Health Services

OTHER SECTORSEducation

ImmigrationSocial inequalities

RESPONSIBLE BODIESCommunity Safety Partnerships – Joint working, Data exchange, Joint services

Public Health England – EvidenceDirector of Public Health – Local Authority Services, Joint Strategic Needs Assessment

Clinical Commissioning Groups – Commissioning

MONITORING AND MILESTONESPublic Health Outcomes Framework

Domestic ViolenceViolent Crime and Sexual Violence

Older People’s perception of Community Safety

Sixty-seventh World Health Assembly 24 May 2014 Strengthening role of health system in addressing violence, particularly against women and girls, and against children. Urges Member States to: • strengthen the role of health systems in addressing violence• ensure those at risk have timely, effective & affordable health services access• strengthen their contribution to prevention programmes• ensure health system engagement with education, justice, social services• strengthen the national response, improving data collection & dissemination• enhance capacities, including through training

WHO Child Maltreatment Prevention Plan 2014–2020• a life-course, evidence-informed, health and inter-sectoral approach• 64th WHO Regional Committee for Europe

Global Status Report on Violence Prevention

Lancet/WHO series on Early Child Development

International Leadership and Collaboration

Summary • Child Protection Evidence Informed Prevention• Multi-departmental consideration of benefits & savings • National Campaign awareness of the long-term impacts• Professional awareness and training• Environmental issues e.g. role of alcohol• Intelligence targeted home visiting & parental support• R&D – delivery in Universal Health/Social systems • Integrated agenda child development and child abuse• Integrated response across all types of violence