Mandatory reporting by nurses of child abuse and neglect

Most Australian jurisdictions have mandatory reporting legislation to compel members of selected professional groups, including nurses, to report suspicions that a child has been or is likely to be subjected to abuse or neglect. This article details the legal obligations of nurses in each jurisdiction, and highlights differences between jurisdictions. Problematic features of the laws are identified, including the use of ambiguous concepts like "reasonable" suspicion and "significant" harm. Literature is reviewed to identify what is known about nurses' legal knowledge, actual reporting practice, and the practical problems that arise for nurses in this context. It is concluded that empirical research needs to be conducted, because it is not known if the laws are practically effective, whether nurses have sufficient training in, and knowledge of, their reporting duties, or what factors influence sound reporting. Such research can inform both the development of sound training systems and recommendations for legal reform.     

The correlates of child physical abuse and neglect by adolescent mothers

Theoretical and empirical knowledge about the link between adolescent motherhood and child maltreatment is in an early stage of development. Research has produced contradictory findings as to a relationship between the two and has not focused on identifying correlates. To fill gaps in the knowledge base and generate hypotheses for future tests, this secondary analysis of data on a subset of 119 mothers who gave birth prior to their 18th birthday focused on identifying characteristics that discriminate among low-income adolescent mothers with maltreated children and comparable mothers whose children were not known to be maltreated. Bivariate analyses of 18 characteristics from several theoretically justified domains revealed that 11 were associated with neglect and four with abuse. Step-sise discriminant analysis identified six correlates of neglect that correctly classified 85% of the mothers and four for abuse that correctly classified 79% of the mothers. Discussion focuses on implications for future research and hypothesis generation.     

Knowledge of child abuse and neglect in nursing students: Assessment and perspectives

Misdiagnosis of child abuse and neglect can delay early treatment. Some authors have pointed out that nurses can miss child abuse and neglect diagnoses due to a lack of knowledge. It is unclear whether the lack of knowledge is due to students' insufficient preparation in nursing school and/or a deficiency in continuing education. An 18-item questionnaire was administered to final-year nursing students to assess their degree of knowledge on child abuse and neglect and to evaluate if the lack of knowledge was due to insufficient teaching/training during nursing school. The students were also asked to evaluate themselves by assigning a score to their knowledge. A statistical comparison was performed to define whether sufficient/insufficient results were associated with the following variables: sex, pediatric or general nursing student, attending pediatric lectures, training in pediatric wards/ambulatories, and attending specific lectures on child abuse and neglect. The study population comprised 175 students (154 females, 20 males, 1 unknown). Exactly 66.3% of the participants had ≤9/18 correct answers. Of all students, 77.7% self-evaluated their level of knowledge as ≤5/10. The comparisons yielded statistically significant differences between the groups with sufficient objective knowledge and those unrelated to training in pediatric wards/ambulatories or pediatric nursing students. Overall, there was little objective knowledge on the subject, which may be related to insufficient teaching/training in nursing schools. Useful corrective strategies include further teaching on child abuse and neglect, preferably using a practical approach. Further, common teaching/training programs should be conducted by both pediatric and general nursing schools.     

Family and social factors associated with substantiation of child abuse and neglect reports

One hundred fifty-nine families who were reported for child abuse or neglect to a country social services agency in a single fiscal year were studied empirically to test the ecological model of child abuse and neglect. Several family and social factors were studied. Only two, size of family and stage in family developmental cycle, were significantly associated with an increased risk of substantiation of the report. Two potential sources of social support, the use of regular child care and the presence of an extended family member, were tested for their effect on substantiation in those cases where risk factors such as the two mentioned above and combinations of risk factors such as single parenthood and unemployed head of household were associated with higher rates of substantiation. In every case, these two examples of social support reduced the substantiation rate. The influence of the use of regular child care was especially strong in mitigating the effect of the family and social risk factors.     

The role of stress in the commission of subsequent acts of child abuse and neglect

Data from 1874 clients, who were reported to authorities and treated for abuse and neglect, were examined to determine the role of stress in the commission of subsequent acts. Several case, client, and family characteristics were examined. It was hypothesized that the contribution of stressful events in clients' lives would have a greater effect than all other factors assessed. Results indicated that stress, while contributing to the explanation of subsequent acts of child maltreatment, explains only 9% of the variance over that already explained by other factors. In fact, stressful events, along with seriousness of initial assault, contributed significantly to the explanation of the commission of subsequent acts of child maltreatment.     

Lethal child neglect

The jurisdiction of the Hannover Institute of Legal Medicine recently experienced an unusually high incidence of lethal child neglect, with three cases in a 5-month period in 1999. Case 1: A girl received an inappropriate and inadequate diet of tea and oatmeal. The child was never breastfed, nor did it ever receive any other formula. The parents report the infant to have been healthy until she suddenly began projectile vomiting at the age of 13 weeks. For the next 3 days the infant was not able to maintain an adequate intake. The mother reports finding the child dead in its bed on the morning of the fourth day. Attempts by medical personnel to revive the child were unsuccessful. Case 2: A mother began spoon-feeding the infant puree on the fourth day of life, which according to the manufacturer's specifications is suitable for children between 4 and 8 months of age. At the age of 5 weeks, the infant was reported to have vomited half the just previously ingested meal, after which she took a nap. Some time later the parents observed the infant to be quite pale, however, assumed this was a result of sleep. When the mother finally did pick her up, the child was lifeless, and the parents brought her to the hospital. Medical personnel could however, only declare the infant dead, documenting a rectal temperature of 30 degrees C. Case 3: A 3.5-year-old girl died after her mother left the locked apartment and did not return for several weeks. The body of the child was found lying dressed on the floor in a state of advanced decay and mummification. Common findings in all three cases include lack of prenatal care, home birth without the help of a midwife, low socioeconomic status or maternal alcohol abuse, body weights below the 3rd percentile, extreme dehydration, fatty hepatic degeneration, thymic atrophy and signs of aspiration.     

An integrated understanding of elder abuse and neglect

In the past three decades, society has developed interest in what has come to be called elder abuse. Since interest initially appeared, concern about elder abuse has gone through different cycles regarding the conceptualization of the problem, appropriate responses, and explanations. A recent trend has witnessed a call for an interdisciplinary and integrated understanding of, and response to, elder abuse. This article describes what is meant by an integrated response to elder abuse. Ways to promote a broader response to the problem are suggested.     

Elder abuse and neglect cases reviewed by appellate courts

With increasing attention focused on abuse and neglect of the elderly in domestic and institutional settings, nearly every state has passed legislation to protect these vulnerable adults. While the legal system has become involved at the trial court level, the appellate courts have not yet been very active. Only ten reported cases in the United States during 1981–1993 were appealed to a higher court. This article documents these few cases and explores the reasons for their ultimate dispositions.     

Intergenerational child abuse and coping

Many studies have investigated the consequences of child sexual abuse (CSA) but few have examined the intergenerational effects of poly- victimization and maladaptive coping. The purpose of this investigation was to examine patterns of maltreatment and maladaptive coping among second-generation CSA survivors. It is hypothesized that: (a) maternal CSA history would be associated with a higher incidence of poly-victimization and maladaptive coping and (b) experiencing more forms of abuse would mediate the relation between maternal CSA history and maladaptive coping behaviors. The method used was a chart review of 139 sexually abused females aged 12 to 17, examining maternal abuse history, maladaptive coping behaviors, and child maltreatment. The results showed that poly-victimization differed as a function of maternal CSA history but maladaptive coping did not. Experiencing more types of abuse was associated with both self-injurious behaviors and substance use. In conclusion, results support the hypothesis that second generation CSA survivors are more likely to experience poly-victimization. Future research should address how intergenerational patterns of abuse might affect presenting symptomatology and treatment outcome.     

Subgaleal hematoma in child abuse

The mother brought her 31/2-year-old son to a paediatric clinic as his forehead was swollen and bluish in appearance. She was unable to give any explanation for this lesion. Clinically it was noted that a very visible and also palpable, doughy swelling was present both in the forehead as well as the hard skull areas. Some hours later, a massive bilateral periocular haematoma appeared. Whilst X-rays were unable to provide any diagnostic help, the sonographic examination of the skull carried out on the same day revealed an extensive subgaleal haematoma. This phenomenon is described in radiological literature as "scalping" and is caused by the use of considerable, blunt violence against the head (shear stresses, e.g. by pulling at the hair). The mother's boyfriend later confessed forceful pulling of the hair.     

Childhood history of abuse and adult child abuse potential

The experience of aversive interactions within the family of origin is believed to increase the probability of parental physical child abuse. To test this hypothesis, 375 subjects were given a Childhood History Questionnaire (CHQ) and the Child Abuse Potential (CAP) Inventory. The CHQ contained a series of questions about the presence and frequency of various abusive behaviors and associated sequelae that were received and/or observed before and/or after puberty. The CAP Inventory was used to measure adult physical child abuse potential. As expected, a childhood history of physical abuse was significantly related to adult physical child abuse potential; and, as chronicity increased, so did abuse potential. The experience of physical abuse prior to puberty produced higher abuse scores than the experience of physical abuse after puberty. The study provides preliminary data indicating the childhood experience of a caring adult and / or caring friend moderates adult child abuse potential.     

A comprehensive 5-year evaluation of project 12-ways: An ecobehavioral program for treating and preventing child abuse and neglect

Evaluations of services designed to ameliorate the problems associated with child abuse and/or neglect (CAN) are relatively rare. The present investigation examines the impact of ecobehavioral services provided to families with extensive histories of CAN and examines the demographics of two groups of families. Project 12-Ways provides in-home ecobehavioral treatment to families referred by the state protective service agency. Impact data were collected and compared from families served by Project 12-Ways and families served by the stale protective service agency and other community programs. These data focused on the rates of CAN, placement of children outside of the parental home, and permanent termination of parental rights. Comparisons were made on pretreatment, treatment, and post-treatment rates. It was determined that both samples experienced significant decrements in CAN. While the two samples were equivalent in rates of CAN, data were presented showing differences in severity and priority of CAN which suggest that ecobehavioral services can be successful in reducing CAN. Thus, a heuristic model is available for evaluating CAN, including the manner in which the data were collected, the range of independent variables included, and the considerable span of the families' lives covered in the evaluation. These results suggest some modification of the way in which follow-up data are collected and used to change policy and practice.     

Undetected and detected child sexual abuse and child pornography offenders

Current knowledge about risk factors for child sexual abuse and child pornography offenses is based on samples of convicted offenders, i.e., detected offenders. Only few studies focus on offenders not detected by the criminal justice system. In this study, a sample of 345 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia or hebephilia (paraphilia not otherwise specified), were assured of confidentiality, and self-reported lifetime sexual offending against prepubescent and/or pubescent children. Two sets of group comparisons were conducted on self-report data of risk factors for sexual reoffending. Measures of risk factors address the following dimensions identified in samples of convicted offenders: sexual preferences (i.e. co-occurring paraphilias), sexual self-regulation problems, offense-supportive cognitions, diverse socio-affective deficits, and indicators of social functioning (e.g., education, employment). Men who admitted current or previous investigation or conviction by legal authorities (detected offenders) were compared with those who denied any detection for their sexual offenses against children (undetected offenders). Group comparisons (detected vs. undetected) were further conducted for each offense type separately (child pornography only offenders, child sexual abuse only offenders, mixed offenders). Although there were more similarities between undetected and detected offenders, selected measures of sexual-self regulation problems, socio-affective deficits, and social functioning data demonstrated group differences.     

Child abuse and neglect prevention and treatment program--HHS. Final rule

This rule contains a new basic State grant requirement to implement the Child Abuse Amendments of 1984 (Pub. L. 98-457). As a condition of receiving State grants under the Child Abuse Prevention and Treatment Act, States must establish programs and/or procedures within the State's child protective service system to respond to reports of medical neglect, including reports of the withholding of medically indicated treatment for disabled infants with life-threatening conditions. Other changes in regulations required by these Amendments will be published as a separate NPRM at a later date.     

Elder abuse and neglect: challenges and directions for legal reform

The last two decades have heralded an increased community and professional awareness of the phenomenon of elder abuse and the challenges it poses to the enjoyment of the human rights of some older people. The contemporary Australian legal system provides many of the components of a framework required to assist in the promotion of the rights of the elderly and in the prevention and remedy of elder abuse. This framework acts in concert with health and community services dedicated to the advancement of health and wellbeing into old age. In the future, the acknowledgment and adoption of international legal principles which are directed to the needs of the elderly, the reform of existing domestic legislation and the development of new elder-specific statutes may all impact upon the incidence and consequences of elder abuse. To date, no Australian jurisdiction has adopted a legislative regime targeted specifically at the issues confronting older Australians who may be vulnerable to abuse and neglect. This column looks at some of the options for legal reform in this area.     

Using recidivism data to evaluate project 12-ways: An ecobehavioral approach to the treatment and prevention of child abuse and neglect

Many programs and projects have been remiss at looking at outcome variables such as recidivistic child abuse and neglect. Presented here are program evaluation data which examine recidivism data over 5 years across more than 700 families. Families receiving services from Project 12-Ways, a multifaceted in-home ecobehavioral approach, were compared with families indicated in the same region who received child protective services other than those offered by Project 12-Ways. Families who receive services from Project 12-Ways are less likely to reinjure or neglect their children again.