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Preventing child maltreatment1 |
A public health approach to preventing child maltreatmentA public health approach to
preventing child maltreatment
Dr Dinesh Sethi
Violence and Injury Prevention
WHO European Centre for Environment and Health , Rome
Preventing child maltreatment2 |
Key facts and figures from the WHO European Region - 1
Key facts and figures from the WHO European Region - 1
• Almost 1,500 children aged 0-14 years died in the WHO European Region in 2002 as a result of homicide (*)
• The rates for children 0 – 4 years are double that for those aged 5 – 14 years.
• Occurrence of sexual abuse in childhood is as high as 20 % in women and 5 – 10 % in men (*)
• About 34 % of young people report being bullied at least once in the past 60 days (**)
• About 75,000 children are estimated to be involved in the sex trade in Eastern Europe (*)
• Available data suggest that severe physical punishment has an incidence of 5 – 8 % (*)
(*) Injuries and Violence in Europe, Why they matter and what can be done (2006) WHO Regional Office for Europe(**) Young people’s health in context - Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey (2004) WHO Regional Office for Europe
Preventing child maltreatment3 |
Standardized mortality rates for homicides in children aged 0 - 14 years for countries with more than 1 million inhabitants in the most recent year
(deaths/100,000 population)Source: WHO EURO Mortality Database June 2006
0 0.5 1 1.5 2
2004Russian Federation2004Ukraine2004Lithuania2005Estonia2004Kazakhstan2004Belarus2005Austria2004Latvia2002Slovakia1997Belgium2003Albania2003Israel2003Hungary2003Norway2004Republic of Moldova2004Romania2002Serbia and Montenegro2001Denmark2002Switzerland2003TFYR Macedonia2002France2003Armenia2003Portugal2004Finland2004Germany2002Sweden2004Netherlands2004Slovenia2004Czech Republic2004Kyrgyzstan2004Poland2004Uzbekistan2004Spain2004Bulgaria1998Turkmenistan2001Tajikistan2004Greece2004United Kingdom2002Azerbaijan2001Italy2001Georgia2002Ireland2004Croatia
SDR(0-14), Homicide and assault, per 100000, Last available
Preventing child maltreatment4 |
UN SG's Study onViolence Against Children
UN SG's Study onViolence Against Children
Gap between human rights commitment and investment in evidence-based prevention programmes and services
Preventing child maltreatment5 |
Objectives of the guideObjectives of the guide
Convey knowledge of what's needed to design and implement child maltreatment prevention programmes as outcome evaluation studies
Expand the evidence base to include more outcome evaluation studies from low- and middle-income countries
Help prioritize child maltreatment prevention in international and national health and development agendas
Preventing child maltreatment6 |
Guide Content overviewGuide Content overview• Introduction
• Nature and consequences of child maltreatment
• Epidemiological and case-based information
• Prevention of child maltreatment
• Services for affected children and families
• Conclusions and recommendations
• Appendices
Preventing child maltreatment7 |
IntroductionIntroduction
• Focus on child maltreatment in age 0-14 years• Perpetrators mostly parents and family members• Place of occurrence mostly private
• Professional audiences• Health• Social• Legal • Research
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Systematic, population-level approachSystematic, population-level approach
SurveillanceWhat is the Problem?
Identify risk and protective factors
What are the causes?
ImplementationScaling up effective
policy and programmes
Develop andevaluate
interventionsWhat works and for
whom?
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1. Nature and consequences: definition1. Nature and consequences: definition
Suicide self-abuse
Self-Inflicted
child partner elder
family/partner
acquaintance stranger
community
Interpersonal
social political economic
Collective
Violence
Nature of Violence:
Physical Sexual Psychological Deprivation
Preventing child maltreatment10 |
IndividualRelationship/ Family
CommunitySociety
1. Nature and consequences: ecological model1. Nature and consequences: ecological model
Preventing child maltreatment11 |
1. Nature and consequences: life course approach
1. Nature and consequences: life course approach
Adverse Childhood Experiences
Social, Emotional, & Cognitive Impairment
Adoption ofHealth-risk Behaviors
Disease, Disability
EarlyEarlyDeathDeath
Death
Birth
Death
Birth
Preventing child maltreatment12 |
2. Epidemiological and case-based information2. Epidemiological and case-based information
• Population-based epidemiological surveys• Use of physical punishment• Exposure to child maltreatment• Current health risk behaviours• Current health status
• Facility-based case information• Non-fatal cases (known and suspected)• Fatalities (known and suspected)
• Using information for advocacy
Preventing child maltreatment13 |
2. Population-based epidemiological surveys
2. Population-based epidemiological surveys
• Survey instruments• Parent-child Conflict Tactics Scale• Adverse Childhood Experiences Study questionnaires• Lifetime Victimization Survey Screening questionnaire• ISPCAN Child Abuse Screening Tools
• Adapting survey methods to local conditions
• Sampling strategies
• Ethical considerations
Preventing child maltreatment14 |
Categories and prevalence of Adverse Childhood Experiences
Prevalence (%)
Abuse, by Category Psychological (by parents) 11% Physical (by parents) 11% Sexual (anyone) 22%
Household Dysfunction, by Category Substance Abuse 26% Mental Illness 19% Mother Treated Violently 13% Imprisoned Household Member 3%
Category
Felitti et al, 1998
2. Epidemiological and case-based information2. Epidemiological and case-based information
Preventing child maltreatment15 |
3. Prevention of child maltreatment3. Prevention of child maltreatment
PREVENTION IDENTIFICATIONREPORTINGREFERRAL
TREATMENT
INVESTIGATIONFOLLOW-UP
Address underlying causes and risk factors
Child maltreatment occurs
Preventing child maltreatment16 |
3. Prevention of child maltreatment3. Prevention of child maltreatment• Societal and community
• Providing early childhood education and care• Reducing alcohol availability• Changing norms that support child maltreatment
• Relationship• Home visitation programmes• Training in parenting
• Individual• Reducing unintended pregnancies• Increasing access to pre- and post-natal services
Preventing child maltreatment17 |
3. Prevention of child maltreatment3. Prevention of child maltreatment
Ecological level
Time from intervention to measurement
Infant/childParent/familyCommunity/ society
Infant developmentParental knowledge and expectations
Belief in acceptability of punishment
Educational achievement
Adult reporting health risk behaviours
Encounters with criminal justice system
Homicide rates in children 0-4 years old
Examples of outcome evaluation indicators
Short
Long
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4. Services for affected children and families4. Services for affected children and families
Child maltreatment occurs
PREVENTION IDENTIFICATIONREPORTINGREFERRAL
TREATMENT
INVESTIGATIONFOLLOW-UP
Preventing child maltreatment19 |
Integrated mental/physical health and forensic assessment– Consent
– History
– Top-to-toe physical exam, including genito-anal exam
– Documentation and treatment of injuries
– Mental health assessment
– Screening or treatment for STIs, HIV
– Prevention of pregnancy
– Forensic examination
Psychosocial support
Support services for families
4. Treatment and support4. Treatment and support
Preventing child maltreatment20 |
Reporting laws: issues to consider
Integrated assessment of families at risk
Intervention for the best interest of the child
4. Protecting the child4. Protecting the child
Preventing child maltreatment21 |
Conclusions and recommendationsConclusions and recommendations
• Base policies, plans, programmes and services on scientific evidence
• Define child maltreatment cases and outcome indicators using international norms and behavioural definitions from well-tested instruments
• Design and implement prevention programmes and services as outcome evaluation studies
• Integrate wherever possible prevention and services into existing systems
Preventing child maltreatment22 |
Information on violence prevention in Europe
www.euro.who.int/violenceinjury
To obtain Preventing child maltreatment
Information on violence prevention in Europe
www.euro.who.int/violenceinjury
To obtain Preventing child maltreatment
Send an Email giving your name, organization, postal address and the number of copies required to:
or download a PDF version from
http://whqlibdoc.who.int/publications/2006/9241594365_eng.pdf
Preventing child maltreatment23 |
Zurich project on the social development of
children
Zurich project on the social development of
children
Eisner, M. 2004. http://www.z-proso.unizh.ch/Dokumente/NEWSLETTER1en.pdf
Longitudinal study– 1000 children– 1000 parents
Prevention programme– Triple P– Paths
Randomized Control Trial