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, [email protected]
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
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