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Child abuse essay covers a topic that is brutal but needs to be written about. Criminal behavior poses a threat to society, and it's especially devastating when directed towards children. This painful subject is getting a lot of public attention in the past years, and writing child abuse essays are a way of shining light on this issue. While researching for your essay you will discover heartbreaking statistics – about 1 billion children were abused within the past year. The numbers and facts you will come across are unsettling. child abuse essay samples below will help you gather information for your essays and offer some guidelines when exploring this topic. Writing essays on child abuse is challenging in many ways, so it’s understandable if you need assistance, which we can provide you with.

This project aims to assess whether the primary schools in the UK implemented Eileen Munro’s Recommendations. It critically analyses the effectiveness of child protection in UK’s primary schools. The report advocates for review on child protection targets which enable both children and social workers a freedom to apply judgment as...

The discussion section elaborates the argument on whether any of Eileen Munro’s recommendations were implemented. To begin with, let us briefly review some of the endorsements. The Munro report changes the current child protection approach that is extremely rigid and incomprehensible because of the bureaucratic procedures that leave professionals glued...

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Putting up child protection ensures the safeguard of children from varying harmful activities that they are exposed to from their parents or the environment they live in. It is important to address issues that affect the children as a can severely impact the young ones both psychologically and also physically....

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Child Protection is a fundamental issue that has been addressed at various levels of governance. The United Kingdom is one of the many countries that are still grappling with how best to protect a child from any dangerous exposure. Prof Eileen Munro was tasked to come up with a report...

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Sexual assault is defined as an infringement of a person's sexual space by sexual touch without consent by coercion or physical force to engage in a sexual act against the person's will. It ranges from verbal sexual insults to the physical acts such as groping, rape, and sodomy and child...

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An Assessment of the Brothers` ACE Score and ACE that Might Indicate Future-Offending Behaviour ACE, also known as Adverse Childhood Experiences denotes to the stressful situations that young children encounter as they grow. The child can be either directly hurt through abuse or indirectly regarding the environment, which they are situated...

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In today’s world, cases of child abuse are on the raising trend globally. It’s a matter of great concern when people close to the children; physically, emotionally or sexually abuse them. In most occasions, guardians who are mentally stable and highly conscious of their actions continually and methodically abuse their...

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Child abuse has become a severe social and public health problem and many studies have revealed the alarming number of child abuse cases all over the world. The diverging parenting norms and standards of different cultures has made it difficult to arrive at an agreement on the definition of child...

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The article Preventing Child Sexual Abuse, What Parents Know? analyzes the out parental information with regards to the prevention of child abuse in Saudi Arabia. The study begins with a definition of a sexual offense which is regarded as the engagement of a child in sexual activities without...

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Child Abuse and Neglect Child abuse is any action performed by a parent, guardian, or caregiver that cause serious physical, sexual or emotional harm to a child. On the other hand, child neglect refers to maltreatment of a child due to failure by parent, guardian or caregiver to provide needed care....

Words: 1643

It is universally agreed among scientist, sociologist, physiologist, criminologist and other interested scholars that youths in the adolescence stage are more likely to engage in antisocial behaviors.  However, numerous studies are concerned with activities that teens are more apt to participate in the adolescent stage such as substance abuse and...

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Over the years elderly mistreatment has been recognized as a social problem that has affected the society at large. The magnitude of the problem is uncertain but it is increasing in the United States and other countries in the world. Elderly abuse can be referred to as an intentional act...

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Child Abuse and Neglect Essay

Introduction, events to strengthen the family.

Children are vulnerable individuals whose welfare is dependent on their parents or guardians. This exposes the children to the risk of suffering abuse and neglect from their caretakers. Hunt (2014) declares that the maltreatment of children occurs across all socio-economic, cultural and ethnic groups with negative consequences on the development of the child. Child abuse and neglect have deleterious effects on the future life of the child.

It is therefore necessary to take steps to tackle these issues and ensure the healthy emotional and physical development of the child. This paper will describe four events that can be implemented to strengthen the family and therefore reduce or eliminate incidents of child abuse and neglect.

Playgroup events can play a major role in strengthening the family on issues of child abuse and neglect is playgroups. Parents who come from the same neighborhood or those whose children attend the same school or daycare facility can form playgroups. The events provide a chance for families with similar interests and children of the same ages to connect with each other and share their experiences. Selph and Bougatsos (2013) reveal that the events are hugely beneficial to both the parents and their children.

The children are able to develop through play and interaction with their peers. The social skills and learning of the children is enhanced as they engage in play activities. Research indicates that play groups contribute to shaping family life and equipping parents with the tools necessary to engage in the challenging task of raising children (Hunt, 2014). Playgroup events provide an informal forum for parents to discuss their parenting issues and concern.

Nilsen (2010) confirms that parents are not only able to obtain important advice from their peers, but they also get to realize that other people are going through the same hurdles as they are. This is empowering especially to new parents who might feel overwhelmed by the difficulties of parenting.

These events also promote a feeling of community and each parent begins to take an interest in the wellbeing of the children of his/her friend. This makes it possible to identify incidents of abuse among children in the playgroup and take appropriate action in response.

A church/synagogue/mosque retreat activity for parents and they children can be beneficial in strengthening parents to deal with the issues of child abuse and neglect. Religion plays an important role in the lives of many individuals and they rely on their faith to inform their actions in many situations. The religious institute can therefore play a major role in promoting child safety in the community (Nilsen, 2010).

A retreat event can be planned for the parents in the congregation on a weekend. This retreat will be sponsored by the religious body, which will make it affordable to all the parents. An important advantage of faith-based events is that they possess significant resources since the congregation is made up of a variety of professionals including teachers, nurses, pediatricians, and social works. These professionals will be able to provide free advice on how to safeguard children during the retreat (Hunt, 2014).

Another benefit of the faith-based event is that it relies on the shared religious beliefs of the participants. The religious beliefs of the parents can therefore be used to exhort them to engage in good parenting practices. The religious-based family retreat will provide numerous opportunities for the families to socialize with each other.

There will be coffee breaks during which the parents and children will interact with each other and exchange contacts. Veteran parents will share their experiences and provide advice to the younger parents. The faith-based event will therefore serve as a good opportunity for the parents to establish social support systems.

Technological events can play a part in mitigating child abuse and neglect in the society. Specifically, parents can make use of online forums to learn about appropriate parenting practices and acquire skills for protecting their children against abuse. The online forum should be designed to attract parents who wish to improve the safety and wellbeing of their children. This technological tool can include a facilitator who will initiate discussion topics and moderate the discussions taking place on the website.

Online forums enable parents to express their concerns and issues in a safe environment. Through online forums, parents can be linked to numerous resources for strengthening families. Nilsen (2010) documents that there is a correlation between exposure to educational resources and a decrease in incidents of child abuse and neglect. Parents are also able to gain tangible benefits from the online events. Through the event, parents are made aware of the community resources available to them as they raise their child.

Nilsen (2010) asserts that information on available community resources is of great importance especially to parents who are at-risk of neglecting their children due to limited economic resources. A benefit of online events is that they are accessible to many parents at their convenience.

Parents do not need to adjust their schedules in order to participate in these events. This is an important factor since most parents might be overwhelmed by obligations that make it impossible for them to engage in events that require them to be physically present at venues outside their home or work setting.

Parents can enroll on home visitation programs to assist in the prevention of child abuse and neglect. The home visitation event should be voluntary and semi-formal in nature. An important feature of these events is that Nurses or Educators, who possess expert knowledge on childhood development, carry them out. These experts are able to convey to the parents professional information on subjects such as positive parenting practices.

Selph and Bougatsos (2013) reveal that such events can be of great service to pregnant women as well as families with young children. Through the home visitation, the parents are provided with information about their child’s development. The professionals can also help parents to gain a better understanding about age-appropriate behavior for their children. The home visitation events should be developed with cultural factors in mind.

Different cultures have varying values and customs that influence how the parents deal with their children. Nilsen (2010) asserts that the professionals engaging in the visitation must demonstrate sensitivity to cultures whose values and customs are different from their own. The strengths of the specific culture should be exploited to increase the safety of the child. In cultures were extended family bounds are strong, the visitation events can be scheduled to include some of the members of the extended family.

These members can be equipped to provide assistance to at-risk children and parents within their family. Parents who enroll in home visitation events are well equipped to engage in positive parenting and as a result, they engage in fewer acts of physical aggression towards their children (Promising Practices Network, 2010).

Child abuse and neglect have a lasting negative impact on the lives of children. This paper set out to discuss events that can be used to strengthen families and therefore mitigate or prevent these damaging issues from happening.

The paper has described playgroup events, faith-based activities, technological events, and home visitation programs that can be used to strengthen families. By implementing these events, the family will be equipped to prevent child abuse and neglect therefore ensuring the healthy psychological and physical wellbeing of the child.

Hunt, K. (2014). Safeguarding children – the need for vigilance. Practice Nurse, 44 (6), 18-22.

Nilsen, B. A. (2010). Week by Week: Plans for Documenting Children’s Development. NY: Cengage Learning.

Promising Practices Network. (2010). Promising Practices for Preventing Child Abuse and Neglect . NY: RAND Corporation.

Selph, S. & Bougatsos, C. (2013). Behavioral Interventions and Counseling to Prevent Child Abuse and Neglect: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Annals of Internal Medicine, 158 (3), 179-190.

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Understanding Child Abuse and Neglect (1993)

Chapter: summary.

Child maltreatment is a devastating social problem in American society. In 1990, case reports involving over 2 million children were made to social service agencies. In the period 1979 through 1988, about 2,000 child deaths (ages 0-17) were recorded annually as a result of abuse and neglect (McClain et al., 1993), and an additional 160,000 cases resulted in serious injuries in 1990 alone (Daro and McCurdy, 1991). However tragic and sensational, the counts of deaths and serious injuries provide limited insight into the pervasive dimensions of child abuse and neglect. Reports of child maltreatment reveal little about the interactions among individuals, families, communities, and society that lead to such incidents. The services required for children who have been abused or neglected, including medical care, family counseling, foster care, and specialized education, cost more than $500 million annually, according to estimates by the General Accounting Office (1991).

No specific theories about the causes of child abuse and neglect have been substantially replicated across studies, yet significant progress has been gained in the past few decades in identifying the dimensions of complex phenomena that contribute to the origins of child maltreatment. Furthermore, research in the field of child maltreatment studies is relatively undeveloped when compared with related fields such as child development, social welfare, and criminal violence.

In part, this underdevelopment is influenced by a lack of funds as well as the methodological difficulties of research on topics with a complex

etiology. But in part it is underinvestment due to bias, prejudice, and the lack of a clear political constituency for children in general, and disadvantaged children in particular, in the competition for scarce research funds. Substantial efforts are now required to reach beyond the limitations of current knowledge and to gain new insights that can lead to the prevention of maltreatment and also improve the quality of social services and public policy decisions affecting the health and welfare of abused and neglected children and their families. Long-term research and collaborative ventures are necessary to develop knowledge that can improve understanding of, and response to, child maltreatment.

The panel has identified five key reasons why child maltreatment research should be viewed as a central focus of more comprehensive research activity.

Charge To The Panel

The commissioner of the Administration for Children, Youth, and Families (ACYF) in the U.S. Department of Health and Human Services requested that the National Academy of Sciences convene a study panel to undertake a comprehensive examination of the theoretical and pragmatic research needs in the area of child maltreatment. The Panel on Research on Child Abuse and Neglect was asked specifically to:

The report resulting from this study provides recommendations for allocating existing research funds and also suggests funding mechanisms and topic areas to which new resources could be allocated or enhanced resources could be redirected.

A Developmental And Ecological Perspective

Over the past several decades, a growing number of state and federal funding programs, government reports, specialized journals, and research centers, as well as national and international societies and conferences, have examined various dimensions of the problem of child maltreatment. The results of these efforts have been inconsistent and uneven. In addressing aspects of each new revelation of abuse or each promising new intervention, research efforts often have become diffuse, fragmented, specific, and narrow. What is lacking is a coordinated approach and a general conceptual

framework that can add new depth to our understanding of child maltreatment. A coordinated approach can accommodate diverse perspectives while providing direction and guidance in establishing research priorities and synthesizing research knowledge. Collaborative efforts are also needed to facilitate the integration and application of research on child maltreatment with related areas such as child development, spousal violence, substance abuse, and juvenile delinquency.

In contrast to conceptualizing this report in terms of categories of maltreatment or responses of the social system to child maltreatment, the panel presents a child-oriented research agenda that emphasizes the importance of knowing more about the backgrounds and experiences of developing children and their families, within a broader social context that includes their friends, neighborhoods, and communities. This framework stresses the importance of knowing more about the qualitative differences between children who suffer episodic experiences of abuse or neglect and those for whom maltreatment is a chronic part of their lives. And this approach highlights the need to know more about circumstances that affect the consequences, and therefore the treatment, of child maltreatment, especially circumstances that may be affected by family, cultural, or ethnic factors that often remain hidden in small, isolated studies.

The panel has adopted an ecological developmental perspective to examine factors in the child, family, and society that can exacerbate or mitigate the incidence and destructive consequences of child maltreatment. In the panel's view, this perspective reflects the understanding that development is a process involving transactions between the growing child and the social environment or ecology in which development takes place. Positive and negative factors in the cycle of child development merit attention in shaping a research agenda on child maltreatment. The panel's ecological perspective recognizes that dysfunctional families are often part of a dysfunctional environment. This report extends beyond what is—to what could be, if children and families were supported to attain healthy development. We cannot simply build a research agenda for the existing social system; we need to develop one that independently challenges the system to adapt to new perspectives, new insights, and new discoveries.

Identification And Definitions

Four categories of child maltreatment are now generally distinguished: (1) physical abuse, (2) sexual abuse, (3) neglect, and (4) emotional maltreatment. These four categories have become the focus of separate studies of incidence and prevalence, etiology, prevention, consequences, and treatment, with uneven development of research within each area and poor integration of knowledge across areas. Each category has developed its own

typology and framework of reference terms. As a result, we know very little about the extent to which different types of child abuse and neglect share common risk factors or the ways in which they respond to different types of interventions.

The co-occurrence of different forms of child maltreatment has been examined only to a limited extent and the specific causes, consequences, prevention, and treatment of selected types of child abuse and neglect is relatively unknown. Inconsistencies in definitions often preclude comparative analyses of clinical studies.

The complexity of studies on child maltreatment also reflects the fragmentation of services and responses by which our society addresses specific cases. Furthermore, the duration, source, intensity, timing, and situational context of incidents of child victimization are important. Yet information about these factors is rarely requested or recorded by social agencies or health professionals in the process of identifying or documenting reports of child maltreatment.

Despite vigorous debate over the last two decades, little progress has been made in constructing clear, reliable, valid, and useful definitions of child abuse and neglect. The difficulties in constructing definitions include such factors as lack of social consensus over what forms of parenting are dangerous or unacceptable; uncertainty about whether to define maltreatment based on adult characteristics, adult behavior, child outcome, environmental context, or some combination; conflict over whether standards of endangerment or harm should be used in constructing definitions; and confusion as to whether similar definitions should be used for scientific, legal, and clinical purposes.

Standardization of definitions is difficult and carries with it dangers of oversimplification. However, consistent definitions are necessary for better measurement and instrumentation in the field. Attempts to reach consensus on clear operational measures must be made to overcome existing limitations and to develop more refined measures. The formulation of research definitions of child maltreatment should be guided by four key principles: consideration of the specific objectives the definition must serve; division into homogeneous subtypes; conceptual clarity; and feasibility in practice.

Scope Of The Problem

From 1976, when the first national figures for child maltreatment were generated, to 1990, the most recent year covered by the National Child Abuse and Neglect Data System, reports of maltreatment have grown from 416,033 per year (affecting 669,000 children) to 1,700,000 per year (affecting 2,712,917 children). This alarming rise in the number of reported cases

of child maltreatment has promoted the view that there is an epidemic of child maltreatment in the United States.

The panel's review of national prevalence and incidence child maltreatment studies has revealed important methodological problems that greatly affect the usefulness of these data for drawing conclusions about both the scope and origins of the problem. These methodological problems include definitional issues, confusion of prevalence and incidence, the source of maltreatment data, sampling and design considerations, a paucity of reliable and valid measurement instruments, the problem of retrospective bias, the impact of mandatory reporting requirements on the reliability of survey respondents' reports, and scarce funding for methodological work (specifically instrument development). The paucity of rigorous epidemiological investigations has retarded progress in this field. However, the available evidence suggests that child abuse and neglect is an important, prevalent problem in the United States, with conservative estimates placing the annual number of children affected by this problem at more than 1 million, following an analysis of substantiated rates of reported cases. Child abuse and neglect are particularly important compared with other critical childhood problems because they are often directly associated with adverse physical and mental health consequences in children and families. Furthermore, given the prevalence of childhood maltreatment, the level of federal funds expended in this research area is extremely small when compared with the resources allocated for less prevalent childhood mental disorders, such as autism and childhood schizophrenia.

Specifically, the panel concludes:

Overview Of Etiological Models

Most forms of maltreatment are part of a pattern of maladaptive behavior that emerges over time, but research evidence regarding the origins and

maintenance of this pattern is not clear. Investigators disagree about whether child maltreatment is a continuum of behaviors (ranging from mild physical discipline to severe forms of physical or sexual abuse) or a set of unique behavioral problems with distinctive etiologies.

Since no single risk factor has been identified that provides a necessary or sufficient cause of child maltreatment, etiological models of child maltreatment have evolved from isolated cause-and-effect models to approaches that consider the combination of individual, familial, environmental, and social or cultural risk factors that may contribute to child maltreatment. The phenomenon of child abuse and neglect has thus been moved away from a theoretical framework of an individual disorder or psychological disturbance, toward a focus on extreme disturbances of childrearing, often part of a context of other serious family problems, such as substance abuse or mental illness.

Interactive models suggest that child maltreatment occurs when multiple risk factors outweigh protective, compensatory, and buffering factors. The role of particular risk or protective factors may increase or decrease during different developmental and historical periods, as individuals, their life circumstances, and the society in which they live change. These models show promise and suggest issues that need to be addressed in research on the etiology of child maltreatment.

Individual Ontogenic Factors

A parent's personality influences child development primarily through the interactive process of parenting. Disrupted parenting can occur in a variety of ways, especially when a parent's personality attributes (such as anger or anxiety) are compounded by additional stresses such as marital conflict, absence of the spouse, poverty, unemployment, and having a difficult child. Individual factors that have sometimes been associated with child maltreatment include adult attitudes, attributions, and cognitive factors; the intergenerational transmission of abusive parenting; the use of alcohol and drugs; characteristics of the child (such as temperament); and demographic factors such as maternal age, marital status, and household density. Research on the role of these individual factors in stimulating or maintaining neglectful or abusive behaviors has been contradictory and inconclusive, suggesting that no single factor, in isolation, can explain with satisfaction the origins of child maltreatment. For example, although alcohol often is cited as a principal risk factor in the etiology of child maltreatment, its relationship to child abuse and neglect remains uncertain. More needs to be known about the unique and immediate effects of alcohol, its co-occurrence with other problem behaviors such as antisocial personality disorder and substance abuse, the circumstances under which different types

of drinking situations lead to or sustain violence against children, and cultural factors that mitigate or exacerbate connections between substance use or abuse and aggression.

Family Factors

Dysfunctions in all aspects of family relations, not just parent-child interactions, are often present in the families of maltreated children, and research is needed to examine whether such dysfunctions contribute to or are consequences of child maltreatment. Anger, conflict, and social isolation are pervasive features of maltreating families. In many cases of maltreatment, there often is not a single maltreated child, but multiple victims. Thus, maltreated children may be exposed to considerable violence involving other family members as well as violence directed toward themselves.

A distinctive feature associated with chronically neglecting families is the chaotic and unpredictable character of the family system. The effect on children of repeated acts of violence or constant fluctuations in the makeup of their household, in addition to child neglect, has not been examined in the research literature, although such factors may contribute to unrelatedness and detachment.

An important gap in the literature on child maltreatment is the lack of comparative analysis of the effects of parenting styles and dysfunctional parenting patterns (including abuse and neglect) on children in different social, ethnic, and cultural groups. The relationships among physical discipline, stress, and parental and family dysfunctions that give rise to the emergence of child maltreatment also need to be clarified.

Although a parent's own history of victimization during childhood is thought to predict child maltreatment, this association is based on retrospective studies that are sometimes methodologically suspect. The relationship between physical discipline and child maltreatment is also largely unknown, particularly in the context of cultural differences and practices. Finally, stressful life events are thought to play an important role on parental abilities, but relations between stress and poor parenting are complex and poorly understood at this time.

Environmental and Community Factors

Family functioning occurs within the context of various social institutions and external forces that influence family and parent-child behaviors. Research on environmental factors has concentrated on neighborhood and community environments, but other factors may affect individual and family functioning as well, including the workplace, the media, the school, church, and peer groups.

Discussion of the relationship of poverty to child maltreatment has persisted since publications of the early professional papers on child abuse in the 1960s. Although child maltreatment is reported across the socioeconomic spectrum, it is disproportionately reported among poor families. Furthermore, child maltreatment—especially child neglect—is not simply concentrated among the poor, but among the poorest of the poor. Whether this association results from greater stress due to poverty-related conditions that precipitate abuse, or from greater scrutiny by public agencies that results in overreporting, or whether maltreatment is but one characteristic of the pattern of disruption among the poorest of the poor continues to be debated. The link between unemployment and maltreatment is significant in understanding the relationship between poverty and maltreatment. Families reported for abuse often have multiple problems, and the abuse may simply be a part—or a consequence—of a broader continuum of social dysfunctions.

Although it occurs in all social levels, violent behavior toward children, particularly severe violence, is more likely in poor families. Despite the fact that the evidence on maternal age as a risk factor for child maltreatment is mixed, mothers with young children living below the poverty line have the greatest risk of behaving violently toward children.

Although neighborhoods are recognized as important in the ecology of child maltreatment, more insight is needed into the processes by which neighborhood conditions and factors affect maltreatment. Poor neighborhoods differ in their social and physical conditions and in their ability to influence specific risks posed to children by poverty, unemployment, and community violence. Socioeconomic conditions have predictive value for explaining child maltreatment rates, yet some neighborhoods have higher or lower child abuse rates than would be expected based on socioeconomic conditions alone.

Social isolation has been identified as an important etiological risk factor in child maltreatment, but its role as a consequence or cause of maltreatment is uncertain. The influence of family ties and organizational affiliations (including employment and education) are poorly understood but increasingly recognized as powerful forces in shaping parenting styles and family functioning. Financial stability, employment, and neighborhoods can create a context that either supports a family during periods of stress or enhances the potential for abuse.

Social and Cultural Factors

Family practices and policies that reflect social and cultural values can foster or mitigate stress in family life. Although the relationship of cultural factors is not well understood, some American societal values may contribute to child maltreatment and they have achieved new importance in emerg-

ing theoretical models of child maltreatment. Racism, for example, can lead to an inequitable distribution of resources, education, and employment that undermine many ethnic minority families' abilities to support their children (financially and emotionally) and to provide parental care. The term societal neglect has been suggested to characterize American tolerance for a situation in which one-fifth of all preschool children live below the poverty line, with a substantially higher rate among ethnic minorities. Societal fascination with violence, including violence toward children, has been suggested as a risk factor for child maltreatment, as has the lack of coherent family leave and family support policies, particularly the absence of preventive health care for infants, children, and adolescents at risk for maltreatment.

Conclusions

Many factors have been identified as contributing to the occurrence of child maltreatment, but single-factor theories of child maltreatment have not been able to identify specific mechanisms that influence the etiology of child maltreatment. Such environmental factors as poverty and unemployment and such individual characteristics as a prior history of abuse, social isolation, and low self-esteem have been significantly associated with child maltreatment offenders, but the relationships among such factors are not well understood in determining the origins of child maltreatment. The panel believes that the etiology of maltreatment involves complex clusters of variables that interact along various dimensions of a child's ecological/transactional system. Factors that increase risk for maltreatment and factors that decrease the likelihood for maltreatment are found at all ecological levels and interact to produce child maltreatment. Although theoretical models that describe the etiological complexity of maltreatment have been developed, they have not been subjected to testing and adequate research. Our recommendations seek to address these limitations.

In the past, the risk factor literature for child maltreatment has been dominated by an orientation that emphasizes correction of perceived weaknesses or problem behaviors and ignores protective factors that may influence outcomes. In recent years, some researchers have begun to examine variables that foster healthy relationships and reduce risk for child maltreatment. The reduction of multiple vulnerabilities as well as the development of compensatory behaviors should be a goal for future prevention research.

Risk Factors and Pathways to Prevention

Until recently, the primary focus in designing preventive interventions was the identification and modification of problematic or damaging parental practices associated with child maltreatment, such as physical discipline, failure to provide children with basic necessities and care, and mismatches between a parent's expectations and a child's ability.

This singular focus on parental roles was altered with the recognition of the prevalence of sexual abuse in the late 1970s. Research on victims of child sexual abuse suggested that risk factors with respect to perpetrator characteristics, victim characteristics, and sociodemographic variables are far more heterogeneous than they are for physical abuse or neglect victims. As a result, prevention advocates focused on ways to strengthen potential victims of sexual abuse through classroom-based instruction for children of all ages.

In recent years, schools have placed a new emphasis on violence prevention programs, designed to equip students to develop nonviolent methods of conflict resolution. Although the generalizability of these programs to the field of child maltreatment has not been systematically assessed, such programs represent a promising direction for future research.

Parental Enhancement Programs

Parental practices in families with young children are a major focus of research on prevention strategies for child maltreatment. Prevention strategies have built on individual, familial, and community-level risk and protective factors that contribute directly to both parental practices and to child well-being. This research foundation has provided the basis for identifying vulnerable families that are at high risk for maladaptive parental practices. Increasingly, at-risk communities are becoming the target of early intervention programs.

Four major types of prevention strategies have been developed for families with young children (defined as the prenatal period through age 8): (1) comprehensive programs, often including home visitor services that vary widely in both scope and content, (2) center-based programs that include a family support component, parent information services, and early childhood education services, (3) community-based interventions that offer a range of family support services, and (4) hospital-based interventions.

Although some well-designed, randomized control, clinical trials exist (such as the Olds study [1986a,b] in upstate New York), many early intervention services lack a theoretical framework and their mission is not always well defined. Some interventions demonstrate that knowledge about child development can be transferred to parents in a relatively brief period of time (i.e., 6-12 weeks), but a time commitment of six months or more is

needed to change attitudes and strengthen parenting and interpersonal skills. Prevention programs need to focus directly on families at most risk for maltreatment, to accommodate families with differing needs and experiences, and to adapt to changing family situations.

Community-Based Prevention Programs

The large majority of existing community-based programs focus on prevention of physical and sexual abuse. Child maltreatment prevention programs that are found in the schools are primarily child sexual abuse prevention programs designed for children in elementary and high schools. In addition to major efforts in child sexual abuse prevention, the panel reviewed two other efforts that may have implications for the prevention of child abuse and neglect. These are community-based antipoverty programs, some of which involve vocational or educational assistance, and the violence prevention programs in the schools designed to educate children, primarily adolescents, about conflict resolution skills. Such programs may be important in helping improve the welfare of many families and peer relations, but they have not been systematically evaluated in terms of their outcomes for child abuse and neglect.

Although sexual abuse prevention education programs have generally achieved the goals of teaching prevention knowledge and skill acquisition, it is not clear that these gains are retained over time or are useful to a child under assault, especially if the offender is a relative or trusted adult. Less is known about the efficacy of child sexual abuse prevention programs compared with prevention efforts directed primarily at the physical abuse and neglect of children. There is disagreement in the child safety field about the theories that should guide child sexual abuse prevention programs. At this juncture, it seems critical for child sexual assault prevention programs to evaluate the contributions of extensive parent and teacher training components. Research efforts should be expanded to include extended after-school programs and in-depth discussion programs for certain high-risk groups (e.g., former victims, teen-age parents).

Since poverty has consistently been associated with child maltreatment, particularly child neglect, programs designed to improve the income of poor families could become a major source of prevention of child neglect. At a time when education has become an important requirement for better-paying jobs, programs designed to increase the career options of young parents through educational and vocational training efforts are commonly viewed as part of the preventive spectrum for child maltreatment.

Day care providers, teachers, principals, and others who have ongoing and long-term contact with children are in a position to identify suspected victims of maltreatment and report them to child protective services. Such

interventions can be a source of reduced incidence for the recurrence or the prevention of child maltreatment. However, the low percentage of suspected cases identified by educators and other personnel in the school system that are eventually reported to child protection agencies may be a cause for concern. Day care providers, educators, and other youth service personnel require training in the identification of child abuse and neglect, guidance in reporting suspected cases, and methods for supporting maltreatment victims and their families, including referrals to relevant treatment services and peer support groups for victims.

Since many families who are reported for child maltreatment are characterized by other forms of violence (including spouse abuse and involvement in criminal assaults), interrupting the cycle of violence in one area of life may have spillover effects on others, but this assumption needs to be tested empirically. School-based interventions have several advantages, including accessibility to a broad youth population, mandated attendance, ease in scheduling, and cost effectiveness. Although school-based violence prevention programs are a promising development, no firm conclusions can be drawn at this time regarding their effectiveness or generalizability for the prevention of child abuse, and it is not known if participants will be less likely to be perpetrators of family violence.

Media representatives can become important participants in public education about prevention in child abuse and neglect. Media efforts to prevent child maltreatment may benefit from lessons derived from the role of the media in addressing public health issues. Similarly, media programs could be developed to promote community support for appropriate parental practices, especially in the use of physical discipline, and to improve the response of bystanders who witness acts of child maltreatment in public places.

Community-based prevention efforts show promise, especially in the design of multisystem approaches that can build on family-school-media-community approaches. Many avenues can be considered in designing prevention programs, but well-designed program evaluations are critical for developing a knowledge base to guide future efforts. The community mental health approach and community-based interventions designed to reduce smoking and heart disease represent much promise, but such efforts have not yet been developed or tested in the area of child maltreatment.

The Role of Cultural and Social Values in Prevention

Prevention programs increasingly focus on ways to foster cultural changes that could lead to regulatory and voluntary approaches to reinforce health messages at other system levels. Several areas that have relevance for prevention research on child maltreatment include attitudes toward the use

of corporal punishment, the effects of criminal sanctions on the maltreatment of children, and the use of violence as a means of resolving conflict. Reliance on corporal punishment by parents has been identified by some researchers as an important risk factor for physical abuse, but corporal punishment is usually not dealt with in programs to prevent physical abuse. Research is needed on whether the inclusion of alternatives to spanking in such programs reduces physical abuse.

In considering the effectiveness of criminal sanctions in the area of child maltreatment, associated problems of abusive and neglectful families need to be recognized. Many of these families are already involved with the legal system because of other behaviors, including substance abuse, juvenile delinquency, and other crimes. Assessment of the impact of criminal sanctions solely in the area of child maltreatment is challenging, since the perpetrators may be removed from the home in a variety of other ways involving the court system.

Evaluations of home visitation programs, school-based programs for the prevention of sexual abuse and violence, and other community-based child maltreatment prevention programs are quite limited. Many evaluations are compromised by serious methodological problems, and many promising preventive interventions do not systematically include child maltreatment as a program outcome. Children and families who are most at risk for child maltreatment may not participate in the interventions, and those that do may not be sufficiently motivated to change or will have difficulty in implementing skills in their social context, especially if they live in violent neighborhoods.

The panel's primary conclusion is that comprehensive and intensive prevention programs that incorporate a theoretical framework, identifying critical pathways to child maltreatment, offer the greatest potential for future programmatic efforts. New theoretical models that incorporate ecological and developmental perspectives have complicated the development of prevention research, but these models hold much promise, for they suggest multiple opportunities for prevention. Prevention research needs to be guided by rigorous evaluation that can provide knowledge about the importance of different combinations of risk and protective factors, the developmental course of various forms of maltreatment, and the importance of replacing or supplementing risk behaviors with compensatory skills. In the face of uncertainty as to whether etiologies of the various forms of child maltreatment are similar or different, a diverse range of approaches to prevention research should be encouraged.

Consequences

For over 30 years, clinicians have described the effects of child abuse and neglect on the physical, psychological, cognitive, and behavioral development of children. Physical consequences range from minor injuries to severe brain damage and even death. Psychological consequences range from chronic low self-esteem to severe dissociative states. The cognitive effects of abuse range from attention problems and learning disorders to severe organic brain syndromes. Behaviorally, the consequences of abuse range from poor peer relations to extraordinarily violent behaviors. Thus, the victims of abusive treatment and the society in which they live pay an enormous price for the results of child maltreatment.

Yet empirical studies of child maltreatment have identified important complexities that challenge our understanding of factors and relationships that exacerbate or modify the consequences of abusive experiences. The majority of children who are abused do not show signs of extreme disturbance. Research has suggested a relationship between child maltreatment and a variety of short- and long-term consequences, but considerable uncertainty and debate remain about the effects of child victimization on children, adolescents, and adults.

The scientific study of child maltreatment and its consequences is in its infancy. Until recently, research on the consequences of physical and sexual child abuse and neglect has been limited by delays between the child's experience and official identification of maltreatment. Maltreatment often occurs in the presence of multiple problems within a family or social environment, including poverty, violence, substance abuse, and unemployment. Distinguishing consequences that are associated directly with the experience of child maltreatment itself rather than other social problems is a daunting task for the research investigator.

As a result, we do not yet understand the consequences on children of particular types or multiple forms of abuse. Nor do we yet know the importance of the particular timing, intensity, and context of abuse on the outcome. Factors such as age, gender, developmental status, family relationships, and placement experiences of the child may influence the outcomes of maltreatment experiences. Disordered patterns of adaptation may lie dormant, only to appear during times of stress or in conjunction with particular circumstances. Furthermore, certain intrinsic strengths and vulnerabilities within a child and the child's environment may affect the extent to which abuse will have adverse consequences.

Victims of child abuse and neglect are at increased risk for delinquency and running away, but the majority of childhood victims do not manifest these problem behaviors. Significantly less is known about connections between childhood victimization and other problem behaviors, such as teen-

age pregnancy, use of alcohol and illicit drugs, and self-destructive behavior. Alcohol and illicit drug use are both illegal for teenagers, creating a natural confounding of alcohol and substance use with delinquency. Diagnoses of alcoholism are complicated by the presence of antisocial personality disorder, which in turn may include components of criminal behavior and sexual promiscuity. Engaging in any one of these behaviors, then, might increase the likelihood of involvement in other high-risk behaviors.

Issues of Stigma, Bias, and Discrimination

Problem behaviors may result from the chain of events occurring subsequent to the victimization rather then the victimization experience per se. For example, being separated from one's biological parents, subsequent to the abuse and neglect incident(s), and placed in foster care can be associated with deleterious effects. Furthermore, children can encounter discrimination against their race, color, language, life and family styles, and religious and cultural beliefs that affect their self-esteem and magnify the initial and lasting effects of both types of victimization. The observed relationship between early childhood victimization and later problem behaviors may also be affected by practices of the juvenile justice system that disproportionately label and treat maltreatment victims as juvenile offenders.

Protective Factors

Not all abused and neglected children grow up to become dysfunctional adults. A broad range of protective factors, such as temperamental attributes, environmental conditions, and positive events, can mitigate the effects of early negative experiences. The consequences of childhood maltreatment vary by demographic, background, and clinical variables—such as the child's gender, the family's socioeconomic status, and the level of marital and family violence.

Individual characteristics, such as high intelligence, certain kinds of temperament, the cognitive appraisal of victimization experiences, a relationship with a significant person, and out-of-home placement experiences protect some childhood victims. But conflicting or indirect evidence about most of these characteristics and experiences results in a major gap in knowledge about what factors make a difference in the lives of abused and neglected children. Research is needed to determine the role of protective factors and mediating individual characteristics, particularly how they operate to increase or decrease vulnerability for problem behaviors.

Placement outside the home may act to protect abused and neglected children from serious long-term consequences, but such an action is controversial. Foster care placements may pose additional risks for the abused or

neglected child, and the trauma of separation from one's biological family can also be damaging. Although some out-of-home placements may exacerbate stress in children from abusive and neglectful households, such placements may not always be deterimental. However, abused and neglected children in foster care and other out-of-home placement experiences, who typically come from multi-problem families, are a particularly vulnerable group because they have experienced both a disturbed family situation and separation from their natural parents.

Knowledge of the long-term consequences of childhood maltreatment into adulthood is extremely limited, with sparse information on intellectual and academic outcomes and medical and physiological consequences. Some research has addressed parenting behaviors (particularly the intergenerational effects of abuse), but the vast majority of existing research has focused on psychosocial outcomes and, in particular, psychopathology.

Childhood victimization often occurs in the context of multiproblem homes. Other family variables, such as poverty, unemployment, parental alcoholism or drug problems, and other factors that affect social and family functioning, need to be disentangled from the specific effects of childhood abuse and neglect. Few studies have assessed the long-term consequences on the development of abused and neglected children, beyond adolescence and into adulthood. Control groups matched on socioeconomic status and other relevant variables become necessary and vital components of this research, in order to determine the effect of childhood victimization on later behavior, in the context of family and demographic characteristics.

Interventions And Treatment

Research on interventions in child maltreatment is complicated by ethical, legal, and logistical problems, as well as difficulties in isolating factors specifically associated with child abuse and neglect in programs that often include families with multiple problems. Interventions include the assessment and investigation of child abuse reports by state child protection agencies, clinical treatment of physical injuries, legal action against the perpetrator, family and individual counseling, self-help services, and informal provision of goods and services (e.g., homemaker and respite care). Multiple agencies determine policies that guide interventions in child abuse and neglect and coordinate human and financial resources to fulfill these objectives. Researchers in this area have limited resources to collect compatible data, the results of project evaluations are rarely published in the profes-

sional literature, and issues of service delivery and accessibility are difficult to document.

The fragmentary nature of research in this area inhibited the panel's ability to evaluate the strengths and limitations of the intervention process. Furthermore, we did not have sufficient time to evaluate the full spectrum of administrative and legal procedures associated with reports of child maltreatment. The panel has thus focused its attention on those areas in which significant theory and empirical evidence exist.

Treatment of Child Victims

Despite the large literature on the detrimental effects of child maltreatment, the majority of treatment programs do not provide services directed at the psychosocial problems of the abused child. Children's involvement in treatment programs has generally occurred in the context of family-based services in which some children have received direct programmatic attention but others have not. Treatment interventions for child victims of abuse and neglect draw extensively from approaches for treating other childhood and adolescent problems with similar symptom profiles, but the psychological effects of abuse have not been well formulated in terms of theoretical constructs that can provide a basis for intervention.

Treatment of Adult Survivors

The treatment of adult survivors of childhood sexual victimization is a newly emerging field; the first programs appeared in the late 1970s. Many adult survivors of child abuse do not identify themselves as such, and most treatment programs or studies for adult survivors focus on child sexual abuse rather than other forms of child maltreatment. Research on the treatment of adult survivors is submerged in the literature on adult psychological disorders such as addiction, eating disorders, borderline personality disorders, and sexual dysfunction.

Treatment for Adult and Adolescent Sex Offenders

The treatment of child molesters is a controversial issue. Treatment programs are frequently offered to adult and adolescent offenders as part of plea bargaining negotiations in criminal prosecutions. The traditional assumption has been that children and society are better protected by offender treatment than by traditional prosecution and incarceration if the treatment service is effective. However, there is currently considerable debate about whether child molesters can be effectively treated. Until recently, adolescent sexual offenders have been neglected in clinical and research literature.

Empirically tested models to explain why adolescents commit sexual crimes or develop deviant sexual interest patterns are lacking.

The most common approaches to treating child molesters are comprehensive treatment programs aimed at simultaneously treating multiple aspects of deviant sexual behavior. Although many different approaches to the treatment of sexual offenders have been tried (including group therapy, family systems treatment, chemical interventions, and relapse prevention), scientific data indicating sustained reductions in recidivism are not available. Most studies follow offenders for only one year after treatment, and the effectiveness of the treatments in eliminating molestation behavior beyond that period is not known. Preliminary outcome data on the treatment of juvenile sex offenders show positive outcomes, although there is a lack of substantive research in the field and a lack of consensus regarding basic principles of treatment.

Family-Oriented Interventions

Most treatment interventions for physical abuse, child neglect, and emotional abuse seek to change parenting practices or the home environment. Only recently have treatment services incorporated empirical findings that examine the interactions of family members, abusive parents' perceptions of their children, behavioral characteristics that may restrict parenting abilities, and emotional reactions to stressful childrearing situations.

A lack of consensus exists regarding the effectiveness of a wide range of treatment services for maltreating families, including parental enhancement programs, family systems treatment, home-based services, and family support programs. Outcome studies have indicated positive behavioral and attitudinal changes as a result of family or parent treatment, but few studies have examined the effects of such interventions on subsequent reports of child abuse and neglect beyond one year. Definitive conclusions about the generalizability of the findings from studies of family-oriented programs in reducing subsequent child maltreatment are difficult to develop because the participants in these programs often present varied types of parental dysfunction.

Family Income and Supplemental Benefits

Government programs designed to alleviate or mitigate the effects of poverty on children are often part of a comprehensive set of services for low-income, maltreating families. Such programs include Social Security supplemental income programs, Aid to Families with Dependent Children, Women with Infants and Children food supplement program, Head Start, rent-subsidy programs, and school lunch programs, among others. While

national and local child welfare programs designed to improve the well-being of all poor families may provide food, shelter, and other necessary resources for children in households characterized by neglect or abuse, the relationship between income support, material assistance, and the subsequent reduction of maltreatment has not been systematically addressed.

Community-Based Interventions

Family-oriented interventions often exist within a context of a broad range of diverse services provided by community agencies. Understanding these responses to child maltreatment is important in understanding the experiences of children and families following reports of maltreatment. Yet little is known about the efficacy of these community-based interventions.

A few treatment programs have been developed at the community level to provide services to families, such as counseling and educational services for the parents, supervised day care, and specialized referrals for community services, including mental health care, housing, and substance addiction treatment. Although such neighborhood-focused programs may assist children who are victims of abuse or neglect, program evaluations usually do not consider outcomes in terms of maltreatment subpopulations.

Medical Treatment of Child Abuse

Health professionals in private practice, community health clinics, and hospitals are often the first point of contact for abused children and their families when physical injuries are sustained. Little is known about treatments recommended for abused children in medical settings, and even less is known about specific treatment outcomes. Studies suggest, however, that many health professionals may not be sufficiently trained to detect or validate signs of abuse or to deal with the emotional, technical, and legal aspects of evaluating maltreated children, particularly sexually abused children.

Child Protective Services

Child protection agencies receive and screen initial reports of child abuse and neglect from educators, health personnel, police, members of the public (e.g., neighbors, family friends), relatives (including siblings and parents), and others to determine whether investigation is required. The processes that determine their responses to children and families have not attracted much research attention, although a few studies have attempted to document and characterize various stages of the process and their effects on children and families. Evaluations of operations of child protective services

are complicated by the emergency situation in which most investigations occur, the confidential nature of the process, limited budgets, staff turnover, variations in definitions of child maltreatment and the absence of clear objectives, procedures, and standards of evaluation. The lack of systematic record-keeping and compatible data, and political sensitivity also inhibit the observation and analysis of decisions made by child protective services workers.

Research on the nature and effectiveness of risk assessment and referral decisions involving maltreating families is difficult, and we know little about factors that influence the assessment, investigation, and substantiation of specific cases; the operation of the referral system and follow-up services; the character of cases that are likely to receive services; the nature, intensity, and length of the services provided; and outcomes resulting from intervention services for different types of child maltreatment. Many factors can affect referral decisions, including availability of services, costs to clients and sponsors, ease of access, client attitudes, perceived need, and organizational relations. Recent clinical reports of child abuse cases suggest that many cases are closed immediately after services have been initiated and, in some instances, even prior to actual service delivery.

Child Welfare Services

The decision to allow a maltreated child to remain with family members or relatives during treatment is a critical and controversial aspect of the case management process. In some cases, temporary or permanent foster care is provided to children on the premise that protection of the child from physical harm is paramount.

Research on services provided to children in foster or kinship care is difficult. Information about children in foster care is often dispersed among biological parents, foster parents, relatives, and caseworkers, and cooperation among agencies providing services is frequently hampered by issues of confidentiality, funding and eligibility requirements, budgetary restrictions, and the specialized nature of professional services, that tend to focus on isolated problems.

Legal Intervention in Child Maltreatment

A small proportion of child maltreatment cases that are reported to child protection agencies become involved with juvenile courts, family courts, and criminal courts. Areas of convergence and conflict between the goals of service providers and the legal system in the treatment of child abuse and neglect have been documented, but much uncertainty remains in this area. Legal interventions in child maltreatment are complicated by many factors,

such as the absence of physical evidence, difficulties in obtaining consistent and reliable testimony from children, emotional trauma that might be incurred in forcing a child victim to testify against a parent or other adult who may have harmed him or her, and inconclusive scientific evidence regarding the effectiveness of treatment in halting abusive and neglectful behavior. Even though relatively low numbers of sexually abused children are involved in court proceedings, the legal treatment of child sexual abuse cases has attracted significant research attention. Almost nothing is known about the quality of court experiences for children or adults who are affected by physical abuse, neglect, and emotional maltreatment.

Social and Cultural Interventions

National policies, professional services, and institutional programs sometimes reveal inconsistent policies and fundamental value conflicts. Values that strongly influence the current American social context for responding to reported or suspected child maltreatment include respect for child safety and family preservation. The rights of individual privacy, confidentiality, and other liberties that are often constitutionally guaranteed also influence both the provision of social and professional interventions as well as evaluations of their effectiveness.

The conditions under which child, parental, or community rights should supersede all other rights and obligations, and the criteria that should be considered in balancing long-term dangers against immediate threats, are unclear. Research defining the ''best interests of the child" is becoming a significant issue in determining the outcomes of assignment of visitation and custodial rights in court decisions.

Medical, psychological, social, and legal interventions in child maltreatment cases seek to reduce the negative physical, behavioral, and emotional consequences of child abuse and neglect, foster attitudes and behaviors that improve the quality of parent-child interactions, and limit or eradicate recurrences of maltreatment. Interventions have been developed in response to public, professional, legal, and budgetary pressures that often have competing and sometimes contradictory policies and objectives. Some interventions focus on protecting the child or protecting the community; others focus on providing individual treatment for the child or the offender; others emphasize developing family coping strategies and improving skills in parent-child interactions. Assumptions about the severity of selected risk factors, the adequacy of caretaking behaviors, the impact of abuse, and the steps necessary to prevent abuse or neglect from recurring may vary.

Little is known about the quality of existing interventions in treating different forms of child maltreatment. No comprehensive inventory of treatment interventions currently exists, and we lack basic descriptive and evaluative information regarding key factors that influence the delivery and results of treatment for victims and offenders at different developmental stages and in different environmental contexts. A coherent base of research information on the nature and the effectiveness of treatment is not available at this time to guide the decisions of case workers, probation officers, health professionals, family counselors, and judges.

Investigations of child maltreatment reports often influence the development and availability of other professional services, including medical examinations, counseling, evaluation of risk factors, and substantiation of complaints. Research on various federal, state, and private agency involvement and interactions in treatment interventions has not been systematically organized. Although the panel acknowledges the challenges of performing research in this area, future study designs require adequate sample sizes, well-characterized and well-designed samples, and validated and comparable measures.

Human Resources, Instrumentation, And Research Infrastructure

Child maltreatment research in the 1990s will require a diverse mix of professional skills and collaborative efforts. The development of human resources, measurement tools, and research infrastructure in this field is complicated by the absence of support for problem-oriented research efforts in academic centers; the legal and ethical complexities associated with this kind of research; the lack of a shared research paradigm that can integrate interdisciplinary efforts across types of maltreatment; problems in gaining access to relevant data and study populations; the absence of data and report archives; and funding inconsistencies associated with shifting research priorities.

The Research Community

A variety of disciplines and subject areas contributes to studies of child maltreatment, including medicine (especially pediatrics and psychiatry), psychology, social work, criminal justice, law, sociology, public health, nursing, anthropology, demography, statistics, and education. Few systematic efforts have been made to integrate research on child maltreatment with the knowledge that has evolved from recent studies of normal child development, family systems, adult and child sexual behavior, family violence, community violence, substance abuse, poverty, and injuries.

Academic training for professionals who must work in the area of child maltreatment has not kept pace with the demands for expertise. About a dozen child maltreatment research programs exist at various universities, medical centers, and child advocacy organizations, but the depth and quality of these centers as well as the skills and affiliations of their research staff are generally unknown. Consequently, considerable effort is needed to deepen and broaden the human resources, instrumentation, and research infrastructure available for addressing the key research questions.

The number of doctorates and other advanced degrees that involve dissertations on child maltreatment studies has been increasing over the past decade, reflecting a growing interest in research in this field. Although many universities offer graduate courses in child abuse and neglect, less than half a dozen universities now sponsor graduate or postgraduate training programs in this field. Graduate training programs have achieved consensus regarding the general body of information necessary in the field of child maltreatment, but considerable variability exists in the length of the programs, student eligibility requirements, time requirements for classroom instruction and practical experience, and the availability of financial support.

Methodological Issues

The absence of support for methodological research has impeded scientific progress in child maltreatment studies. The development of adequate research tools is essential to move a research field beyond theoretical or design problems toward the collection and analysis of empirical data.

Methodology and instrumentation issues present one of the most significant barriers to the development of child maltreatment research. A number of issues deserve particular attention:

In many cases research instruments may simply be unavailable. Measures have been developed to assess "normal" child behavior or other problems in samples of unabused children, but they may not be adequate to assess child maltreatment issues and they may not be standardized on diverse cultural or ethnic populations. Furthermore, available research instruments adapted from other fields may not provide significant information for the practitioner. Difficulties in the use of instruments may result from training—researchers have often come from disciplines that give inadequate

attention to the importance of valid and reliable measures and empirical results. Overall, the use of standard measures of family characteristics and social environmental characteristics seems to be less frequent in child maltreatment research than in child development and family research in general.

The development and use of standardized measures in child maltreatment research is complicated by an additional set of pragmatic and professional factors, including the lack of budgetary support for instrumentation research projects, publication policies that discourage discussions of psychometric work in reporting research results, and research sponsors' preference for substantive rather than methodological topics.

Although some useful resources can be identified, the field of child maltreatment studies has not successfully developed a comprehensive information service designed to integrate research publications from diverse professional and private sources in an easily accessible format. In contrast to effective dissemination programs focused on criminal justice research, limited efforts exist to summarize and disseminate maltreatment research findings from the fields of psychology, social work, medicine, and other relevant disciplines.

Federal Funding for Research

Federal support for child maltreatment research is currently divided among 28 separate offices in 5 federal departments—the departments of Health and Human Services, Justice, Education, Defense, and Transportation. The forms of federal research support are diverse, including large research center program awards, individual research awards, data collection efforts, individual training grants, and evaluations of demonstration projects. With the exception of the National Center for Child Abuse and Neglect, which has a research program focused explicitly on studies of child maltreatment, most federal agencies support child maltreatment research in the context of other scientific objectives and program responsibilities, such as research on violence, maternal and child health care, family support, mental health, and criminal justice. As a result, federally supported research activities that may advance scientific knowledge of the identification, causes, consequences, treatment, and prevention of child abuse and neglect are often embedded within other research studies that have multiple objectives. No central repository exists to maintain an ongoing index of federally supported research on child maltreatment.

A 1992 forum sponsored by the Federal Interagency Task Force on Child Abuse and Neglect indicated that the total federal research budget for studies directly related to child maltreatment research is in the $15-20 million range. It is important to note that these figures reflect only research that is "primarily relevant" to child abuse and neglect studies. Additional

research efforts related to child maltreatment are also sponsored by federal agencies, although the level of investment in these secondary research efforts depends on the perceived significance of studies about parent-child interactions, substance abuse, family violence, and juvenile delinquency to child maltreatment.

The relevance of child maltreatment research to the central mission of each federal department appears to be idiosyncratic and uneven. Adopting a comprehensive view of research on child maltreatment presents certain difficulties of identification, organization, and taxonomy. Efforts to prevent child abuse and neglect and improve child welfare are dispersed among a wide range of federal programs within the U.S. Department of Health and Human Services alone. However, most of these efforts are not "child abuse" in name, and no systematic effort has been made to evaluate the lessons for child maltreatment learned from them. Various direct services for abused children and their families, demonstration projects, and educational and information dissemination activities are scattered throughout other federal program efforts as well.

Clearly, not all research on children, families, poverty, and violence is relevant to studies of child maltreatment. However, the fragmented and specialized character of the current federal research portfolio in these issues can hamper systematic efforts to organize and build on advances in research. The specialized roles of federal programs that have relevance for studies of child maltreatment continue to inhibit the development of this field. Research investigators and program officers in separate agencies are often unaware of previous studies or active projects related to their research interests. Researchers funded by separate agencies to conduct studies on aspects of child maltreatment often work with separate theoretical paradigms, use different sample populations, develop project-specific methodologies, draw on separate research databases, and present their results in a wide variety of journals and professional meetings. The absence of a central tracking and documentation resource center and the diffuse organization of the federal research portfolio, as well as the fragmented bureaucratic and legislative requirements that are associated with child maltreatment, inhibit the development of a dynamic and interdisciplinary research field.

State Roles in Research on Child Maltreatment

No comprehensive inventory of state research programs exists for studies on child maltreatment issues, but it is unlikely that the total amount of research funds available from individual state agencies is significant (i.e., greater than $1 million per year). However, individual scientists reported to the panel that they have received occasional research support from various state agencies, including the maternal and child health departments and

family services offices in the states of Hawaii, Illinois, and Minnesota, the children's trust funds administered by the states, and other offices. The decentralized and sporadic nature of state-funded research efforts discourages efforts to build collaborative interdisciplinary research teams or long-term studies focused on complex research topics.

States are a potential source of future support for specific training and data collection programs in areas such as the criminal justice, education, and public health systems that need to be integrated into comprehensive studies of outcomes and consequences of child abuse and neglect. It is useful to think of the state agencies as important partners in building an expanded research base for studies of child maltreatment.

State science programs are expected to assume a larger role in sponsoring and using research related to domestic health, social, and environmental issues in the decades ahead. The 1992 report of the Carnegie Commission on Science, Technology and Government, for example, concluded that new scientific and technological advisory organizations will be needed to foster better communication between and within the states. These organizations will need to improve the gathering of scientific knowledge, of identifying best practices, and of suggesting research priorities in national science and technology forums. Studies on child maltreatment should be viewed as an important opportunity for building collaborative state and federal research organizations directed toward long-term improvements in social service programs in areas such as child protection, child welfare, family counseling, and foster care.

Private Foundations

In addition to research funding from governmental agencies, at least eight private foundations have selected child abuse and neglect as a priority funding area. Despite this interest, the amount of funds provided by private foundations for studies on child maltreatment is quite limited.

The nongovernmental sector may be an important source of potential funding for dissertation and graduate student support in funding studies on the relationships among child maltreatment, child development, family welfare, poverty, and others. It is most important, therefore, to see the private sector as a collaborator in strengthening the research foundation for studies on child maltreatment.

Support for child maltreatment research has developed in a haphazard, piecemeal fashion, reflecting the absence of a national plan for providing research, educational, and professional support for studies of child abuse and neglect. Governmental roles in this area have been complicated by

poor leadership, the absence of sufficient funds to support a robust research program, uncertainties about the most promising research directions to pursue, tensions between the role of the federal and state governments in sponsoring projects in such areas as child maltreatment and child and family welfare, and conflicting social values about the proper interventions to develop in response to child maltreatment incidents. Tensions also exist in the allocation of funds between professional and social services for maltreated children and their families and research projects that seem to provide no immediate benefits for these groups.

Given the current status and evolution of child maltreatment studies, a broad diversity of parallel efforts should be maintained. Top-down or centralized approaches should be avoided that may discourage or fail to recognize the significance of emerging theoretical paradigms, instrumentation research, and other approaches that seek to extend the boundaries of current knowledge about the origins, scope, and consequences of child abuse and neglect. In particular, attention to cultural and ethnic issues that affect our understanding of childhood needs, child development, and family life require a breadth of effort that currently does not exist in the research community.

While diversity of effort is important to maintain, the panel concludes that better national leadership is needed to organize the research base. Such leadership requires more informed documentation of research efforts so that scientific findings, instrumentation, theory, and data can be better recorded, integrated, and disseminated to researchers and practitioners. There is also a pressing need to connect education, research, and practice so that individuals who become caseworkers, family counselors, administrators, legal officials, and future scientists have a richer understanding of the complexities of child maltreatment. Finally, the development of both young and mature scientists needs attention to build a foundation for future explorations of the intricate scientific questions that lie ahead.

Ethical And Legal Issues

Ethical and legal issues for studies of child maltreatment will gain increasing prominence with the growth of research activities on child maltreatment, especially as researchers acquire the ability and resources to conduct long-term prospective studies of nonclinical samples involving large numbers of children and families.

Human Subjects Research Issues

Many ethical issues arise in the course of human subjects research, some of which have special relevance for studies of child maltreatment.

Five issues that deserve special attention are: (1) the recruitment of research subjects; (2) informed consent and deception; (3) assignment of subjects to experimental or control programs; (4) issues of privacy, confidentiality, and autonomy; and (5) debriefing or desensitizing of research subjects following research on matters that may involve deception or significant stress.

Issues Derived from Research on Children and Families

The validity of scientific research takes on special relevance in studies of children and other vulnerable populations, when research results are likely to influence social policy and public perceptions of the problem under study. Information that scientists disseminate about child victimization is often socially and politically sensitive and can affect both parental and professional behavior as well as public policy. Scientific information, communicated through the popular media, can influence the manner in which abusive parents view abuse, and the ways in which victims view themselves. High-quality research is needed to provide information that has a factual, scientific basis, rather than information based on conjecture or opinion.

Because validity is so important but hard to achieve in research on children and families, factors that affect validity are receiving increased attention. These factors include the definitions of child maltreatment, instrumentation and research methods, selection of subject samples, collection of data, interpretation of findings, and safeguards for ensuring privacy, confidentiality, and reliability in the research study.

Research on Socially Sensitive Topics

Scientific studies of child maltreatment require extraordinary care and confidentiality in eliciting, safeguarding, and disclosing information from respondents because of the socially sensitive nature of the research subject. Family disciplinary practices, the use of violence between family members, and expressions of anger or rage are difficult to detect, observe, and record. Research on children's sexual development is one of the most unexamined areas in all of social science, impeded by a variety of social taboos, political sensitivities, and ethical ambiguities in general and discussions of sexual behavior with children in particular.

Researchers who seek to foster valid and creative research projects must address fundamental ethical issues in the recruitment of research subjects; the process of obtaining informed consent; the assignment of subjects; debriefing, dehoaxing, and desensitizing subjects when deception or stress-

ful research is involved; and in providing referrals for children and family members in distress.

Research Priorities

Despite the clear significance of child maltreatment, the panel concludes that research in this area is in an early stage of development. Although much insight has been gained over the past three decades, the field has not yet developed an integrated and organized base of knowledge or ongoing data collection efforts that can inform practice, guide the development of programs and policies relevant to child maltreatment, and shape the formation and testing of major hypotheses in this field. As a result, research is needed in diverse areas to explore promising directions. At the same time, research on child maltreatment requires guidance, coordination, and leadership to organize the research base and cultivate future generations of researchers who are well trained and informed about the complex research questions in this field.

The panel concludes that a research agenda for child maltreatment studies should address four separate objectives. We need knowledge that can:

Each chapter in this report includes key research recommendations within the topic under review. In the final chapter of the report (Chapter 10) the panel uses the four headings listed above as a framework for organizing the research priorities that it selected as the most important to address in the decade ahead. Details regarding each priority area appear in the individual chapters of the report.

Under each general heading below, the panel has organized the research priorities in order of their importance, with the most important recommendation listed first within each section.

The Nature and Scope of Child Maltreatment

Research definitions of child maltreatment are inconsistent, and the breadth and quality of instrumentation for child maltreatment studies are seriously incomplete. The variation in existing definitions and inadequate instrumentation impedes high-quality research, inhibits the comparison of studies of related phenomena, and restrains the development of good evaluations of intervention efforts. Improved definitions and instrumentation will facilitate the development of small- and large-scale epidemiologic investigations. These investigations would provide solid information on the occurrence of these important problems as well as on key etiologic agents.

Research Priority 1. A consensus on research definitions needs to be established for each form of child abuse and neglect. The development of consensus requires a major federal and professional commitment to a dynamic, evolutionary process, guided by a series of expert multidisciplinary panels and developed in conjunction with existing agencies, that could review existing work on research definitions.

Research Priority 2: Reliable and valid clinical-diagnostic and research instruments for the measurement of child maltreatment are needed to operationalize the definitions discussed under Research Priority 1. The absence of appropriate instrumentation and methodology is a second serious barrier to the development of good child maltreatment research. The reliability and validity of these instruments must be established by sound methodology, including testing their relevance and usefulness for economically and culturally diverse populations.

Research Priority 3: Epidemiologic studies on the incidence and prevalence of child abuse and neglect should be encouraged, as well as the inclusion of research questions about child maltreatment in other national surveys. After considerable work on instrumentation, including investigations into effective questioning strategies, the panel recommends funding several epidemiologic studies of different size and scope (including different age groups and ethnic groups) to address several different questions relating to child maltreatment (for example, the extent of the hidden nature of abuse).

Understanding the Origins and Consequences of Child Maltreatment

Research Priority 4: Research that examines the processes by which individual, family, community, and social factors interact will improve understanding of the causes of child maltreatment and should be supported. Theoretical models that integrate a variety of risk and protective factors are a promising development in research on the origins of child maltreatment and deserve further research attention. Rather than endorsing

a single approach, the panel recommends that diverse models be tested using a variety of research strategies so that researchers can test theory and generate hypotheses about mechanisms that activate or protect against individual child maltreatment.

Research Priority 5: Research that clarifies the common and divergent pathways in the etiologies of different forms of child maltreatment for diverse populations is essential to improve the quality of future prevention and intervention efforts. Studies that compare the etiologies of different types of maltreatment, and the patterns of risk and protective factors among populations that vary by ethnicity, cultural, and economic status, should be supported. It is particularly important at this time to uncover key pathways for child victimization that may be amenable to prevention or other forms of intervention.

Research Priority 6: Research that assesses the outcomes of specific and combined types of maltreatment should be supported. Research is needed that assesses direct and indirect consequences of child maltreatment across different domains of life, such as health, cognitive and intellectual skills, and social behavior in a variety of cultural contexts.

Research Priority 7: Research is needed to clarify the effects of multiple forms of child victimization that often occur in the social context of child maltreatment. The consequences of child maltreatment may be significantly influenced by a combination of risk factors that have not been well described or understood. The presence or absence of certain characteristics and other adverse events may influence a child's response to childhood victimization, and in some cases the combined effects of two stresses (such as family environment and poor caretaking) may be greater than the sum of the two considered separately. The social context is particularly important, since the effects of abuse or neglect often cannot be separated from other problems confronting families experiencing a variety of problems. It is not yet known whether a syndrome of problem behaviors or combined risks have common origins or whether discrete behaviors have different etiologies. These contrasting pathways have different implications for intervention strategies.

Research Priority 8: Studies of similarities and differences in the etiologies and consequences of various forms of maltreatment across various cultural and ethnic groups are necessary. The effects of risk potentiating and protective factors on child maltreatment in diverse cultural and ethnic groups have not been adequately explored.

Improving Treatment and Preventive Interventions

At present, we have limited knowledge about the range or nature of treatment and preventive services for child maltreatment or the context in

which these services are available to children and their families. Research evaluations in this area therefore must seek to broaden understanding of what currently exists as well as documenting what services appear to work for which individuals or groups, under what circumstances. Research on service interventions must also seek to identify factors and mechanisms that facilitate, or impede, the transfer of knowledge between researchers who study the origins, nature, scope, and outcomes of child maltreatment and those who develop and implement policies and programs for child and family services in the public sector.

Research Priority 9: High-quality evaluation studies of existing program and service interventions are needed to develop criteria and instrumentation that can help identify promising developments in the delivery of treatment and prevention services. Independent scientific evaluations are needed to clarify the outcomes to be assessed for service delivery programs in the area of child maltreatment. Such evaluations should identify the outcomes to be assessed, clarify the instrumentation and measures that can provide effective indicators of child and family well-being or dysfunction, and develop the criteria that should be considered in evaluating the effectiveness of a specific program or service. Evaluation studies currently rely heavily on reported incidents of child maltreatment as a measure of program effectiveness. Given the uncertainties associated with official detection of child maltreatment, such outcomes may have limited value in measuring the achievements or limitations of a selected program intervention.

Rigorous evaluation studies should be an essential part of all major demonstration projects in the area of child maltreatment, and funds should also be available for investigator-initiated evaluation studies of smaller program efforts. Smaller programs should be encouraged to use similar assessment instruments, so that results can be compared across studies. Scientific program evaluations, published in the professional literature, are an important means of transferring the knowledge and experience gained in the service sector into the research community. Such information exchange can improve the quality of studies on the origins, consequences, and other aspects of child maltreatment, ultimately leading to improved services and programs.

Evaluation research is particularly important in the following areas:

Research Priority 10: Research on the operation of the existing child protection and child welfare systems is urgently needed. Factors that influence different aspects of case handling decisions and the delivery and use of individual and family services require attention. The strengths and limitations of alternatives to existing institutional arrangements need to be described and evaluated. We have very poor information about the methods and mechanisms used to identify and confirm cases of child maltreatment, to evaluate the severity of child and family dysfunction, to assess personal and social resources, family strengths, and extrafamilial influences, and to match clients to appropriate treatments based on these formulations. An analysis is needed of interactions among different agencies involved in intervention and treatment and the degree to which decisions made by one agency affect outcomes in others. A research framework that provides standardized classifications and descriptions of child maltreatment investigations, adjudications, and treatment services should be developed. Comparative studies are needed to describe the agencies involved in the system, the types of interventions available for selected forms of maltreatment, the costs of investigating and responding to reports of child maltreatment, and the outcomes of case reports. Such studies should also consider the development of alternatives to existing institutional arrangements to improve the quality of service delivery systems.

Research Priority 11: Service system research on existing state data systems should be conducted to improve the quality of child maltreatment research information as well as to foster improved service interventions. Variations in state definitions of child abuse and neglect as well as differences in verification procedures result in significant unevenness in the quality of research data on child maltreatment reports.

Research Priority 12: The role of the media in reinforcing or questioning social norms relevant to child maltreatment needs further study. Important lessons can be learned from the role of the media in fostering healthy or unhealthy behaviors in areas such as the use of alcohol, smoking, drug use, and condom use. Research is needed that can identify the significant pathways by which key factors and behaviors affect child maltreatment, such as parenting styles, the use of corporal punishment, the use of violence and time-out periods in stress management and conflict resolution, and young children's relationships with strangers and abusive caretakers.

A Science Policy for Research on Child Maltreatment

The complexity of the problem of child maltreatment requires a sustained commitment to high-quality research, national leadership, human resources, and adequate funds. Scientific knowledge can contribute to our understanding of the nature, scope, origins, and consequences of child maltreatment, but such knowledge cannot be developed in a haphazard manner. Thus the panel has formulated priorities for science policy and the research infrastructure that supports child maltreatment studies in order to highlight key strengths and existing deficiencies in the research system.

Research Priority 13: Federal agencies concerned with child maltreatment research need to formulate a national research plan and provide leadership for child maltreatment research. Existing fragmentation in the federal research effort focused on child maltreatment requires immediate attention. National leadership is necessary to develop a long-term plan that would implement the child maltreatment research priorities identified by the panel, help coordinate the field, and focus it on key research questions. The panel believes that Congress, federal agency directors, and the research community should weigh the strengths and limitations of alternative federal research management approaches presented in this report in considering how to implement a national research plan for child maltreatment. Once a course of action has been formulated, current and proposed agency research activities need to be examined so that areas of strength, duplication of effort, and gaps in current efforts can be identified.

Research Priority 14: Governmental leadership is needed to sustain and improve the capabilities of the available pool of researchers who can contribute to studies of child maltreatment. National leadership is also required to foster the integration of research from related fields that offer significant insights into the causes, consequences, treatment, and prevention of child maltreatment.

Research Priority 15: Recognizing that fiscal pressures and budgetary deficits diminish prospects for significant increases in research budgets generally, special efforts are required to find new funds for

research on child abuse and neglect and to encourage research collaboration and data collection in related fields. The federal government spent about $15 million in fiscal year 1992 on research directly related to child maltreatment. As a first step in strengthening the research portfolio, the panel recommends that the research budgets of the National Center on Child Abuse and Neglect, the National Institute of Mental Health, the National Institute of Child Health and Human Development, the Centers for Disease Control and Prevention, and the Department of Justice that are relevant to child maltreatment studies be doubled over the next three years. Second, the panel recommends that the National Center on Child Abuse and Neglect convene a consortium of government agencies, private foundations, and research scientists to develop a task force to identify ways in which research on programs relevant to child maltreatment (such as substance abuse, spousal violence and child abuse, child homicides, juvenile delinquency, and so forth) can be more systematically integrated into the research infrastructure for child abuse and neglect.

Research Priority 16: Research is needed to identify organizational innovations that can improve the process by which child maltreatment findings are disseminated to practitioners and policy makers. The role of state agencies in supporting, disseminating, and utilizing empirical research deserves particular attention. Research on the information dissemination process can strengthen the ways in which science is used to inform and advise legislative and judicial decision makers. Such research can also contribute to the effective partnerships among scientists, practitioners, clinicians, and governmental officials to encourage the use of sound research results in formulating policies, programs, and services that affect the lives of thousands of children and their families.

State agencies have an important role in developing and disseminating knowledge about factors that affect the identification, treatment, and prevention of child maltreatment. The National Center on Child Abuse and Neglect should encourage the development of a state consortium that can serve as a documentation and research support center, allowing the states to collaborate in sponsoring child maltreatment studies and facilitating the dissemination of significant research findings to state officials.

Research Priority 17: Researchers should design methods, procedures, and resources that can resolve ethical problems associated with recruitment of research subjects; informed consent; privacy, confidentiality, and autonomy; assignment of experimental and control research participants; and debriefings. Research is needed to clarify the nature of individual and group interests in the course of research, to develop clinical advice and experience that can resolve such conflicts among such interests, and to identify methods by which such guidance could be communicated to researchers, institutional review boards, research administrators, research subjects, and others.

Daro, D. 1988 Confronting Child Abuse: Research for Effective Program Design . New York: The Free Press, Macmillan.

Daro, D., and K. McCurdy 1991 Current Trends in Child Abuse Reporting and Fatalities: The Results of the 1990 Annual Fifty State Survey . Chicago: National Committee for Prevention of Child Abuse.

General Accounting Office 1991 Child Abuse Prevention: Status of the Challenge Grant Program . May. GAO:HRD91-95. Washington, DC.

McClain, P.W., J.J. Sacks, R.G. Froehlke, and B.G. Ewigman 1993 Estimates of fatal child abuse and neglect, United States, 1979 through 1988. Pediatrics 91(2):338-343.

Olds, D.L., C.R. Henderson, R. Chamberlin, and R. Tatelbaum 1986a Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics 78:65-78.

Olds, D.L., C.R. Henderson, R. Tatelbaum, and R. Chamberlin 1986b Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics 77:16-28.

The tragedy of child abuse and neglect is in the forefront of public attention. Yet, without a conceptual framework, research in this area has been highly fragmented. Understanding the broad dimensions of this crisis has suffered as a result.

This new volume provides a comprehensive, integrated, child-oriented research agenda for the nation. The committee presents an overview of three major areas:

• Definitions and scope —exploring standardized classifications, analysis of incidence and prevalence trends, and more.
• Etiology, consequences, treatment, and prevention —analyzing relationships between cause and effect, reviewing prevention research with a unique systems approach, looking at short- and long-term consequences of abuse, and evaluating interventions.
• Infrastructure and ethics —including a review of current research efforts, ways to strengthen human resources and research tools, and guidance on sensitive ethical and legal issues.

This volume will be useful to organizations involved in research, social service agencies, child advocacy groups, and researchers.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Child abuse and neglect.

Dulce Gonzalez ; Arian Bethencourt Mirabal ; Janelle D. McCall .

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Last Update: July 4, 2023 .

• Continuing Education Activity

The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” There are four main types of abuse: neglect, physical abuse, psychological abuse, and sexual abuse. Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm. This activity reviews the epidemiology, presentation, and diagnosis of child abuse and highlights the role of the interprofessional team in its management and prevention.

• Identify the etiology of child abuse and neglect.
• Review the presentation of a child with abuse and neglect.
• Outline the treatment and management options child abuse and neglect.
• Describe interprofessional team strategies for improving care coordination and outcomes in children with abuse and neglect.
• Introduction

The World Health Organization (WHO) defines child maltreatment as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity.” There are four main types of abuse: neglect, physical abuse, psychological abuse, and sexual abuse. Abuse is defined as an act of commission and neglect is defined as an act of omission in the care leading to potential or actual harm.

• Neglect may include inadequate health care, education, supervision, protection from hazards in the environment, and unmet basic needs such as clothing and food. Neglect is the most common form of child abuse.
• Physical abuse may include beating, shaking, burning, and biting. The threshold for defining corporal punishment as abuse is unclear. Rib fractures are found to be the most common finding associated with physical abuse.
• Psychological abuse includes verbal abuse, humiliation, and acts that scare or terrorize a child, which may result in future psychological illness of the child.
• Sexual abuse is defined as “the involvement of dependent, developmentally immature children and adolescents in sexual activities which they do not fully comprehend, to which they are unable to give consent, or that violate the social taboos of family roles.” Some cases of sexual abuse do not need to involve oral, anal, or vaginal penetration and may include exposure to sexually explicit materials, oral-genital contact, genital-to-genital contact, genital-to-anal contact, and genital fondling.

A significant amount of child abuse cases frequently are missed by healthcare providers. For the diagnosis of child abuse to be made, there needs to be a high index of suspicion. [1] [2] [3]

All races, ethnicities, and socioeconomic groups are affected by child abuse with boys and adolescents more commonly affected. Infants tend to have increased morbidity and mortality with physical abuse. Multiple factors increase a child’s risk of abuse. These include risks at an individual level (child’s disability, unmarried mother, maternal smoking or parent’s depression); risks at a familial level (domestic violence at home, more than two siblings at home); risks at a community level (lack of recreational facilities); and societal factors (poverty). Other risk factors include living in an unrelated adult’s home and being a child previously reported to child protective services (CPS). All of these increase the risk of child maltreatment. There are also protective factors that decrease the risk of child maltreatment, which includes family support and parental concern. Preventive factors include parental education regarding child development and parenting, social support, as well as parental resilience. [4] [5] [6]

• Epidemiology

Each year, millions of children are investigated by the Child Protective Services for child abuse and neglect. In 2014, over 3.2 million children were subjects of child maltreatment reports, of those, 20% were found to have evidence of maltreatment. [7]

• History and Physical

To diagnose a patient with child maltreatment is difficult since the victim may be nonverbal or too frightened or severely injured to talk. Also, the perpetrator will rarely admit to the injury, and witnesses are uncommon. Physicians will see children of maltreatment in a range of ways that include:

• An adult or mandated reporter may bring the child in when they are concerned for abuse
• A child or adolescent may come in disclosing the abuse
• The perpetrators may be concerned that the abuse is severe and bring in the patient for medical care
• The child may present for care unrelated to the abuse, and the abuse may be found incidentally.

Physical abuse should be considered in the evaluation of all injuries of children. A thorough history of present illness is important to make a correct diagnosis. Important aspects of the history-taking involve gathering information about the child’s behavior before, during, and after the injury occurred. History-taking should include the interview of each caretaker separately and the verbal child, as well. The parent or caretaker should be able to provide their history without interruptions in order not to be influenced by the physician’s questions or interpretations.

Physical Abuse

Child physical abuse should be considered in each of the following:

• A non-ambulatory infant with any injury
• Injury in a nonverbal child
• Injury inconsistent with child’s physical abilities and a statement of harm from the verbal child
• Mechanism of injury not plausible; multiple injuries, particularly at varying ages
• Bruises on the torso, ear or neck in a child younger than 4 years of age
• Burns to genitalia
• Stocking or glove distributions or patterns
• Caregiver is unconcerned about injury
• An unexplained delay in seeking care or inconsistencies or discrepancies in the histories provided. 

"TEN 4" is a useful mnemonic device used to recall which bruising locations are of concern in cases involving physical abuse: Torso, Ear, Neck and 4 (less than four years of age or any bruising in a child less than four months of age). A few injuries that are highly suggestive of abuse include retinal hemorrhages, posterior rib fractures, and classic metaphyseal lesions.

Bruising is the most common sign of physical abuse but is missed as a sentinel injury in ambulatory children. Bruising in non-ambulatory children is rare and should raise suspicion for abuse. The most common areas of bruising in non-abused children are the knees and shins as well as bony prominences including the forehead. The most common area of bruising for the abused children includes the head and face. Burns are a common form of a childhood injury that is usually not associated with abuse. Immersion burns have characteristic sharp lines of demarcation that often involves the genitals and lower extremities in a symmetric pattern, and this is highly suspicious for abuse.

Abusive Head Trauma

Abusive head trauma (AHT), also known as the shaken baby syndrome, is a form of child physical abuse with the highest mortality rate (greater than 20%). Symptoms may be as subtle as vomiting, or as severe as lethargy, seizures, apnea, or coma. Findings suggestive of AHT are retinal hemorrhages, subdural hematomas, and diffuse axonal injury. An infant with abusive head trauma may have no neurologic symptoms and may be diagnosed instead with acute gastroenteritis, otitis media, GERD, colic and other non-related entities. Often, a head ultrasound is used as the initial evaluation in young infants. However, it not the test of choice in the emergency setting. In the assessment of AHT, the ophthalmologic examination should be performed, preferably by a pediatric ophthalmologist.

Skeletal Trauma

The second most common type of child abuse after neglect is physical abuse. Eighty percent of abusive fractures occur in non-ambulatory children, particularly in children younger than 18 months of age. The most important risk factor for abusive skeletal injury is age. There is no fracture pathognomonic for abuse, but there are some fractures that are more suggestive of abuse.  These include posterior or lateral rib fractures and “corner” or “bucket handle” fractures, which occur at the ends of long bones and which result from a twisting mechanism. Other highly suspicious fractures are sternal, spinal and scapular fractures.

Abdominal Trauma

Abdominal trauma is a significant cause of morbidity and mortality in abused children. It is the second most common cause of death from physical abuse, mostly seen in infants and toddlers. Many of these children will not display overt findings, and there may be no abdominal bruising on physical exam. Therefore, screening should include liver function tests, amylase, lipase, and testing for hematuria. Any positive result can indicate the need for imaging studies, particularly an abdominal CT scan.

Sexual Abuse

If a child demonstrates behavior such as undressing in front of others, touching others' genitals, as well as trying to look at others underdressing, there may be a concern for sexual abuse. It is important to understand that a normal physical examination does not rule out sexual abuse. Indeed, the majority of sexual abuse victims have a normal anogenital examination. In most cases, the strongest evidence that sexual abuse has occurred is the child’s statement.

Physical examination may not only demonstrate signs of physical abuse but may show signs of neglect. The general examination may show poor oral hygiene with extensive dental caries, malnutrition with significant growth failure, untreated diaper dermatitis, or untreated wounds.

All healthcare providers are mandated reporters, and, as such, they are required to make a report to child welfare when there is a reasonable suspicion of abuse or neglect. One does not need to be certain, but one does need to have a reasonable suspicion of the abuse. This mandated report may be lifesaving for many children. an interprofessional approach with the inclusion of a child-abuse specialist is optimal.

Any child younger than two years old for whom there is a concern of physical abuse should have a skeletal survey. Additionally, any sibling younger than two years of age of an abused child should also have a skeletal survey. A skeletal survey consists of 21 dedicated views, as recommended by the American College of Radiology. The views include anteroposterior (AP) and lateral aspects of the skull; lateral spine; AP, right posterior oblique, left posterior oblique of chest/rib technique; AP pelvis; AP of each femur; AP of each leg; AP of each humerus; AP of each forearm; posterior and anterior views of each hand; AP (dorsoventral) of each foot. If the findings are abnormal or equivocal, a follow-up survey is indicated in 2 weeks to visualize healing patterns.

Laboratory evaluation may be performed to rule out other diseases as causes of the injuries. These can including bone (calcium, magnesium, phosphate, alkaline phosphatase), hematology (CBC), coagulation (PT, PTT, INR), metabolic (glucose, BUN, creatinine, albumin, protein), liver (AST, ALT), pancreatic (amylase and lipase), and bleeding diathesis (von Willebrand antigen, von Willebrand activity, Factor VIII, Factor IX and platelet function assays).

One should take into consideration that the most common differential diagnosis of non-accidental injury is an accidental injury. [8] [9] [10]

• Treatment / Management

Initial management of an abused child involves stabilization, including assessing the patient’s airway, breathing, and circulation. Once ensured that the patient is stable, a complete history and physical examination is required. With the suspicion for any form of child abuse, CPS needs to be informed. If there is a child abuse specialist at the pediatric center, their involvement would be optimal. If the patient is seen in an outpatient setting, there may be a need to transfer the patient to a hospital for laboratory and radiologic evaluation as well as the appropriate continuation of care. Even if a child was transferred to another physician or facility, the physician first involved with the patient care still has the responsibility of being a mandated reporter. It is not the responsibility of the physician to identify the perpetrator, but it is to recognize potential abuse. The physician can continue to advocate for the child, ensuring that the patient receives the appropriate follow-up services.

Victims of sexual abuse should have their physical, mental, and psychosocial needs addressed. Baseline sexually transmitted infection (STI) and pregnancy testing should be performed as well as empiric treatment for HIV, gonorrhea, chlamydia, trichomonas, and bacterial vaginosis infection for the adolescent victims. This management is possible if the patients present within 72 hours of the incident to receive appropriate care as well as emergency contraception if desired. Prepubertal patients are not provided with the prophylactic treatment due to the low incidence of STIs in this age group. Urgent evaluation is beneficial in the patients who need prophylactic treatment, those with anogenital injury, for forensic evidence, optimally in less than 72 hours, for urgent child protection, and in those having suicidal ideation or any other form of symptom and/or injury requiring urgent medical care. [11] [12] [13]

• Differential Diagnosis
• Idiopathic thrombocytopenic purpura
• Vascular malformations
• Collagen vascular disorder 
• Osteogenesis imperfecta
• Complications
• Disfigurement
• Emotional trauma
• Mental retardation
• Consultations
• Psychiatrist
• Orthopedic surgeon  
• Neurologist
• Child protective services
• Pearls and Other Issues

Child abuse is a public health problem that leads to lifelong health consequences, both physically and psychologically. Physically, those who undergo abusive head trauma may have neurologic deficits, developmental delays, cerebral palsy, and other forms of disability. Psychologically, child abuse patients tend to have higher rates of depression, conduct disorder, and substance abuse. Academically, these children may have poor performance at school with decreased cognitive function.

It is important as physicians to have a high index of suspicion for child maltreatment since early identification may be lifesaving.

• Enhancing Healthcare Team Outcomes

Child abuse is a public health problem that leads to lifelong health consequences, both physically and psychologically. Physically, those who undergo abusive head trauma may have neurologic deficits, developmental delays, cerebral palsy, and other forms of disability. Psychologically, child abuse patients tend to have higher rates of depression, conduct disorder, and substance abuse. Academically, these children may have poor performance at school with decreased cognitive function. It is important as clinicians to have a high index of suspicion for child maltreatment since early identification may be lifesaving. Nurses, doctors, pharmacists, and all other healthcare workers should not hesitate to report child abuse.

When it comes to child abuse, all healthcare workers have a legal, medical and moral obligation to identify the problem and report it to CPS. The majority of child abuse problems present to the Emergency Department; hence nurses and physicians are often the first ones to notice the problem. The key is to be aware of the problem; allowing abused children to return back to their parents usually leads to more violence and sometimes even death. Even if child abuse is only suspected, the social worker must be informed so that the child can be followed as an outpatient. The law favors the clinician for reporting child abuse, even if it is only a suspicion. On the other hand, failing to report child abuse can have repercussions on the clinician. Unfortunately, despite the best practices, many children continue to suffer from child abuse. [14] [15] [16] (Level V)

Evidence-based outcomes

Child abuse is a serious problem in many countries. While there is an acute awareness of the problem, many children fail to be referred to CPS and consequently continue to suffer abuse, sometimes even death. In a busy emergency room, signs of child abuse are missed, and thus healthcare workers must be vigilant of abuse in any child who presents with injuries that are out of place. [2] [17] (Level V)

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Disclosure: Dulce Gonzalez declares no relevant financial relationships with ineligible companies.

Disclosure: Arian Bethencourt Mirabal declares no relevant financial relationships with ineligible companies.

Disclosure: Janelle McCall declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Gonzalez D, Bethencourt Mirabal A, McCall JD. Child Abuse and Neglect. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Review Emotional abuse and neglect (psychological maltreatment): a conceptual framework. [Child Abuse Negl. 2002] Review Emotional abuse and neglect (psychological maltreatment): a conceptual framework. Glaser D. Child Abuse Negl. 2002 Jun; 26(6-7):697-714.

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Child Abuse Essay Example

Many parents are not aware of the signs of child abuse. This is largely due to the fact that they do not want to believe it could happen or they are in denial. Abuse can manifest itself as an extreme lack of empathy, which is also known as coldness. There are other signs to look for including a decline in school performance, mood swings, and aggressive behavior. If you suspect your child has been abused there are several resources available to help find out if it truly happened and get them to help if necessary.

• Thesis Statement
• Introduction

Essay Example On Child Abuse

Thesis Statement Every kind of child abuse is harmful to better cognitive development which can create multiple social issues. Introduction Child abuse is an umbrella term that covers so many aspects. It is not just limited up to torturing or dismantling a child on a physical basis but mental and sexual harassment is also a part of it. Sometimes in many cases, parents are found to be guilty of such major problems in society. The goal of different types of child abuse also differs in every situation. For instance, parents abusing their child by forcing him to work at minor age are backed by the financial crisis of the family. Similarly, mental torture could be given to a child for performing below the par in his studies. All these pressures restrict the proper growth of children which leads to many crises in society. Get Non-Plagiarized Custom Essay on Child Abuse in USA Order Now Main Body Child abuse is rising with increasing poverty and competition among people. To become the survivor of this cut-throat competition, it becomes a necessity for people to push their minor children into the workforce. Here are some important points that will highlight the issue of child abuse in a deeper sense. Who is Responsible for Child Abuse? We cannot blame a single person for the problem of child abuse. As discussed above child abuse could be described in multiple dimensions. A person who abuses a child sexually cannot be justified on any grounds but pushing children to work at a minor age can be justified with poverty. Here are some forces that are responsible for child abuse. Society –  Multiple social customs based on the cast restrict children to take admission to the school. These customs are mainly gendered biased for girls and transgender. As a result of which these children have to work at a very low age. Social Institutions –  Social institutions like a police departments, education centers are also biased towards the punishment of culprits who are responsible for child abuse and giving admission to students of lower strata respectively. Class System –  Class system is another big reason for child abuse in society due to different rights for the people of different classes. Poverty –  Poverty is the most challenging reason that is difficult to cope up with for child abuse. Parents are sending their children and wards to labor at a very small age due to poverty. These were the main reasons behind child abuse that must be uprooted from society. We cannot imagine a society that is ideal and does not involve child abuse at any point without mitigating the issue of poverty in it. How to Deter the Issue of Child Abuse Child abuse is a problem that needs to be addressed very carefully. This is the high time when professionals and intelligentsia of society should take some major steps to reduce and eradicate this problem. Here are some suggestions that could be used for handling the problem of child abuse by people. Equal Distribution of Economic Resources – The economic resources of a region or country must be distributed evenly among the citizens. This is very important to maintain equality among people of different communities. When there will be no crisis for money the issue of child abuse could be managed at some level. No Injustice on the Grounds of Cast and Gender –  By reducing the injustice on the grounds of cast and gender we can send all the children to school easily. Thus child labor would no longer exist in society. Awareness about Child Abuse in the Society –  Child abuse awareness campaign in the different parts of the world is also important. Parents are not mindful of the fact many times that their children are exploited on sexual as well as physical grounds by the rich when. Often poor children are taken away by the rich businessmen and merchants in the name of the job. But the wages paid to these children are negligible as compared to the work they have to do. When parents would be aware of this fact they will not send the children for manual labor. Conclusion We should work together in a union to fight against the problem of child abuse. Children are the main pillar of any nation for economic and social growth. If they will be harassed and given major traumas in their very childhood, it can disturb society with their growth. Intelligentsia of society should discuss some relevant points to deter with this serious problem effectively. Only then a bright and stable future of a country or nation could be presumed by the citizens. Buy Customized Essay on Child Abuse At Cheapest Price Order Now

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Penn State University Libraries

Child abuse and neglect.

• Definitions | Penn State
• Find Databases
• Find Government Resources
• Find Pennsylvania Law
• Find Statistics and Online Resources

Books and E-Books

Pubmed articles, children's & young adult literature with child abuse and neglect themes, reference books.

Find more articles in PubMed by using search terms such as  child abuse ,  child sexual abuse , or  child maltreatment  - or - use the links in the  Related citations area in the records to the articles listed below.

Note : on the Abstract page, choose  LinkOut - More Resources  for full text sources.

Screening/Diagnosis

• Evaluation and treatment of childhood physical abuse and neglect: a review Cummings M, Berkowitz SJ. 2014.
• Why are suspected cases of child maltreatment referred by educators so often unsubstantiated? King CB, Scott KL. 2014.
• Listen to the children: kids’ impressions of Who Do You Tell Tutty, LM. 2014.
• The evaluation of children in the primary care setting when sexual abuse is suspected Crawford-Jakubiak JC, JE Committee on Child Abuse and Neglect. American Academy of Pediatrics 2013.
• Child maltreatment: promising approaches and new directions Preer G, Sorrentino D, Ryznar E, Newton AW. 2013
• Effects of systematic screening and detection of child abuse in emergency departments Louwers EC, Korfage IJ, Affourtit MJ, Scheewe DJ, van de Merwe MH, Vooijs-Moulaert AF, et al. 2012
• Unexplained fractures: child abuse or bone disease? A systematic review Pandya NK, Baldwin K, Kamath AF, Wenger DR, Hosalkar HS. 2011
• Medical and legal implications of testing for sexually transmitted infections in children more... less... Hammerschlag MR, Guillén CD. 2010
• Improving child protection in the emergency department: a systematic review of professional interventions for health care providers Newton AS, Zou B, Hamm MP, Curran J, Gupta S, Dumonceaux C, Lewis M. 2010
• Screening for child abuse at emergency departments: a systematic review Louwers EC, Affourtit MJ, Moll HA, de Koning HJ, Korfage IJ. 2010
• Child abuse and neglect: diagnosis and management Jacobi G, Dettmeyer R, Banaschak S, Brosig B, Hermann B. 2010

Epidemiology | Statistics | Impact

• Does childhood sexual abuse victimization translate into juvenile sexual offending? New evidence. DeLisi M, Kosloski AE, Vaughn MG, Caudill JW, Trulson CR. 2014.
• The impact of abuse and learning difficulties on emotion understanding in late childhood and early adolescence Pons F, de Rosnay M, Bender PK, Doudin PA, Harris PL, Gimenez-Dasi M. 2014.
• Fatal and non-fatal child maltreatment in the US: an analysis of child, caregiver, and service utilization with the National Child Abuse and Neglect Data Set Douglas EM, Mohn BL. 2014.
• Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System Palusci VJ, Covington TM. 2014.
• Adverse childhood experiences and child health in early adolescence Flaherty EG, Thompson R, Dubowitz H, Harvey EM, English DJ, Proctor LJ, Runyan DK. 2013.
• An examination of measures related to children’s exposure to violence for use by both practitioners and researchers Acosta J, Barnes-Proby D, Harris R, Francois T, Hickman LJ, Jaycox LH, Schultz D. 2012
• Child physical abuse and adult mental health: a national study Sugaya L, Hasin DS, Olfson M, Lin KH, Grant BF, Blanco C. 2012.
• Child abuse and other traumatic experiences, alcohol use disorders, and health problems in adolescence and young adulthood Clark DB, Tatcher DL, Martin CS. 2010
• Sexually transmitted diseases among adults who had been abused and neglected as children: a 30-year prospective study Wilson HW, Widom CS. 2009
• Childhood sexual abuse and adolescent pregnancy: a meta-analytic update Noll JG, Shenk CE, Putnam KT. 2009
• Gender, victimization, and psychiatric outcomes Gershon A, Minor K, Hayward 2008
• Men’s self-definitions of abusive childhood sexual experiences, and potentially related risky behavioral and psychiatric outcomes Holmes, WC. 2008

Legislation | Trends | Possible Solutions

• Trends in children’s exposure to violence, 2003 to 2011 Finkelhor D, Shattuck A, Turner HA, Hamby SL. 2014.
• The need for a comprehensive public health approach to preventing child sexual abuse Letoumeau EJ, Eaton WW, Bass J, Berlin FS, Moore SG. 2014.
• Institute of medicine report: new directions in child abuse and neglect research Diaz A, Peterson AC. 2014.
• Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions Langstrom N, Enebrink P, Lauren EM, Lindblom J, Werko S, Hanson RK. 2013
• Prevention of child sexual abuse: analysis and discussion of the field Zeuthen K, Hagelskaer M. 2013
• Mandatory reporting of child abuse and neglect: crafting a positive process for health professionals and caregivers Pietrantonio AM, Wright E, Gibson KN, Alldred T, Jacobson D, Niec A. 2013.
• Utilizing online training for child sexual abuse prevention: benefits and limitations Paranal R, Washington TK, Derrick C. 2012
• Child abuse and its legislation: the global picture Cutland M. 2012.
• Trends in childhood violence and abuse exposure: evidence from 2 national surveys Finkelhor D, Turner H, Ormrod R, Hamby SL. 2010
• Child abuse, confidentiality, and the Health Insurance Portability and Accountability Act [American Academy of Pediatrics policy statement] Committee on Child Abuse and Neglect. 2010
• Doing the right thing: a primary care pediatrician's perspective on child abuse reporting McCarthy C. 2008
• Translating child abuse research into action Flaherty EG, Sege RD, Hurley TP. 2008.

• Child Abuse Sourcebook online via Gale Virtual Reference Library

• Victims of Sexual Assault and Abuse online via ProQuest ebrary

• Encyclopedia of Stress online via ScienceDirect

• << Previous: Find Statistics and Online Resources
• Last Updated: Nov 13, 2023 1:54 PM
• URL: https://guides.libraries.psu.edu/child-abuse-neglect

Momfluencer Ruby Franke wrote in her journal that it was 'a big day for evil' as she detailed how she tortured her children

• The Washington County Attorney's Office has released several files related to Ruby Franke's case.
• Among them is the disgraced momfluencer's journal where she recounted how she abused her kids.
• Franke and her associate Jodi Hildebrandt will each serve up to 30 years in prison for their crimes.

Ruby Franke, the former family vlogger who pleaded guilty to abusing two of her children , detailed in handwritten journal entries how she carried out some of the abuse.

In copies of the entries, which were released by the Washington County Attorney's Office on Friday, the Utah mother of six described several incidents of abuse inflicted on two of her children, whose names were redacted and replaced with "R" and "E" by authorities.

In one entry from July 11, 2023, the disgraced momfluencer wrote that it was a "big day for evil."

Related stories

Franke, who once ran the popular YouTube channel "8 Passengers," then went on to describe an incident where she held her hands over her son's nose and mouth while holding him underwater.

In an entry for the following day, Franke described how she cut off her daughter's hair and "doused" her with water in the "dog wash" as punishment for wanting to break a two-day fast she had forced her to do.

"These selfish, selfish children who desire only to take, lie, and attack have zero understanding of god's love for them," Franke wrote the next day in her journal.

Franke and her business partner, Jodi Hildebrandt — who ran the controversial parenting YouTube channel "ConneXions" together — were arrested in August 2023, and both charged with six felonies after Franke's 12-year-old son escaped from Hildebrandt's home in Ivins, Utah and sought help from a neighbor.

The arrest followed years of controversy and allegations of child abuse surrounding Franke and her family vlogging channel , which documented her life with her now-estranged husband, Kevin Franke, and their children.

Franke and Hildebrandt were each sentenced to up to 30 years in prison for their crimes.

In a case summary , the Washington County Attorney's Office said that Franke and Hildebrandt were motivated by religious extremism.

"The women appeared to fully believe that the abuse they inflicted was necessary to teach the children how to properly repent for imagined 'sins' and to cast the evil spirits out of their bodies," it said.

Watch: Disturbing details behind "Momfluencer" Ruby Franke's arrest

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The Brutality of Sugar: Debt, Child Marriage and Hysterectomies

By Megha Rajagopalan and Qadri Inzamam. Photographs and video by Saumya Khandelwal.

This story was produced in collaboration with The Fuller Project. March 24, 2024

Archana Ashok Chaure has given her life to sugar.

She was married off to a sugar cane laborer in western India at about 14 — “too young,” she says, “to have any idea what marriage was.” Debt to her employer keeps her in the fields.

Last winter, she did what thousands of women here are pressured to do when faced with painful periods or routine ailments: She got a hysterectomy, and got back to work.

This keeps sugar flowing to companies like Coke and Pepsi.

Supported by

By Megha Rajagopalan and Qadri Inzamam

Photographs and Video by Saumya Khandelwal

This story was produced in collaboration with The Fuller Project.

The two soft-drink makers have helped turn the state of Maharashtra into a sugar-producing powerhouse. But a New York Times and Fuller Project investigation has found that these brands have also profited from a brutal system of labor that exploits children and leads to the unnecessary sterilization of working-age women.

Young girls are pushed into illegal child marriages so they can work alongside their husbands cutting and gathering sugar cane. Instead of receiving wages, they work to pay off advances from their employers — an arrangement that requires them to pay a fee for the privilege of missing work, even to see a doctor.

An extreme yet common consequence of this financial entrapment is hysterectomies. Labor brokers lend money for the surgeries, even to resolve ailments as routine as heavy, painful periods. And the women — most of them uneducated — say they have little choice.

Hysterectomies keep them working, undistracted by doctor visits or the hardship of menstruating in a field with no access to running water, toilets or shelter.

Removing a woman’s uterus has lasting consequences, particularly if she is under 40. In addition to the short-term risks of abdominal pain and blood clots, a hysterectomy is often accompanied by the removal of the ovaries, which brings about early menopause, raising the chance of heart disease, osteoporosis and other ailments.

But for many sugar laborers, the operation has a particularly grim outcome: Borrowing against future wages plunges them further into debt, ensuring that they return to the fields next season and beyond. Workers’ rights groups and the United Nations labor agency have defined such arrangements as forced labor.

“I had to rush to work immediately after the operation, as we had taken an advance,” Ms. Chaure said. “We neglect our health in front of money.”

Sugar producers and buyers have known about this abusive system for years. Coca-Cola’s consultants, for example, visited the fields and sugar mills of western India and, in 2019, reported that children were cutting sugar cane and laborers were working to repay their employers. They documented this in a report for the company, complete with an interview with a 10-year-old girl.

In an unrelated corporate report that year, the company said that it was supporting a program to “gradually reduce child labor” in India.

Labor abuse is endemic in Maharashtra, not limited to any particular mill or farm, according to a local government report and interviews with dozens of workers. Maharashtra sugar has been sweetening cans of Coke and Pepsi for more than a decade, according to an executive at NSL Sugars, which operates mills in the state.

PepsiCo, in response to a list of findings from The Times, confirmed that one of its largest international franchisees buys sugar from Maharashtra. The franchisee just opened its third manufacturing and bottling plant there. A new Coke factory is under construction in Maharashtra, and Coca-Cola confirmed that it, too, buys sugar in the state.

These companies use the sugar primarily for products sold in India, industry officials say. PepsiCo said the company and its partners purchase a small amount of sugar from Maharashtra, relative to total production in the state.

Both companies have published codes of conduct prohibiting suppliers and business partners from using child and forced labor.

“The description of the working conditions of sugar-cane cutters in Maharashtra is deeply concerning,” PepsiCo said in a statement. “We will engage with our franchisee partners to conduct an assessment to understand the sugar-cane cutter working conditions and any actions that may need to be taken.”

Coca-Cola declined to comment on a detailed list of questions.

The heartland of this exploitation is the district of Beed, an impoverished, rural region of Maharashtra that is home to much of the migrant sugar-cutting population. One local government report surveyed approximately 82,000 female sugar-cane workers from Beed, and found that about one in five had had hysterectomies. A separate, smaller government survey estimated the figure at one in three.

“The thinking of women is, if we get the surgery, then we’ll be able to work more,” said Deepa Mudhol-Munde, the district’s magistrate, or top civil servant.

The abuses continue — despite local government investigations, news reports and warnings from company consultants — because everyone says somebody else is responsible.

Big Western companies have policies pledging to root out human rights abuses in their supply chains. In practice, they seldom if ever visit the fields and largely rely on their suppliers, the sugar-mill owners, to oversee labor issues.

The mill owners, though, say that they do not actually employ the workers. They hire contractors to recruit migrants from far-off villages, transport them to the fields and pay their wages. How those workers are treated, the owners say, is between them and the contractors.

Those contractors are often young men whose only qualification is that they own a vehicle. They are merely doling out the mill owners’ money, they say. They could not possibly dictate working conditions or terms of employment.

Nobody pushes women to get hysterectomies as a form of population control. In fact, having children is commonplace. Because girls typically marry young, many have children in their teens.

Instead, they seek hysterectomies in hopes of stopping their periods, as a drastic form of uterine cancer prevention or to end the need for routine gynecological care.

“I couldn’t afford to miss work to see the doctor,” said Savita Dayanand Landge, a sugar-cane worker in her 30s who got a hysterectomy last year because she hoped it would end her need to visit doctors.

India is the world’s second largest sugar producer, and Maharashtra accounts for about a third of that production. In addition to supplying Indian and Western companies, the state has exported sugar to more than a dozen countries, where it disappeared into the global supply chain.

The abuses are born from the Maharashtra sugar industry’s peculiar setup. In other sugar regions, farm owners recruit local workers and pay them wages.

Maharashtra operates differently. About a million workers, typically from Beed, migrate for days to fields in the south and west. Throughout the harvest, from about October to March, they move from field to field, carting their belongings with them.

Instead of wages from farm owners, they receive an advance — often around $1,800 per couple, or roughly $5 a day per person for a six-month season — from a mill contractor. This century-old system reduces labor costs for sugar mills.

Our reporters interviewed people at every stage of the supply chain, including dozens of laborers, contractors, mill owners and former executives at multinational companies. The Times also examined medical records and interviewed doctors, lawmakers, government officials, researchers and aid workers who have spent careers examining the livelihoods of Maharashtra’s sugar workers.

Ms. Chaure is petite, barely five feet tall, with a tiny gold nose-ring in the shape of a flower and a grin that takes over her whole face. She speaks a million miles an hour and, when she feels particularly passionate, she grabs your wrist to make sure you are listening.

“It’s easy for people to take advantage of us,” she said, “because we have no education.” She has spent her life cutting sugar for a mill owned by NSL Sugars.

She began working in the sugar fields as a preteen and, now in her early 30s, she expects to continue for the rest of her life. The work has kept her family in the most grueling poverty, the kind that makes her skip meals so her three children have enough to eat.

Ms. Chaure knows there is nothing for her beyond sugar. But she hopes things will be different for her children.

‘There Wasn’t Any Option Left’

Ms. Chaure lay back on an operating-room cot last winter preparing for her hysterectomy. The hospital was bigger than any near her village, with clean floors and a busy, professional-looking staff.

As she looked at the white ceiling, the thought crossed her mind that, once she slipped out of consciousness, she might not come back.

Her hands trembled.

Who, she wondered, would look after her children?

“But since there wasn’t any option left for me,” she said, “I did it.”

Ms. Chaure had traveled to a city hospital hours from her village.

On a given day, the waiting room is crowded with patients from the countryside sitting nervously on metal chairs or cross-legged on the floor as a loudspeaker blares out names.

The women often have familiar ailments: pain that radiates down from their lower backs and prolonged or irregular periods that make work more difficult.

For Ms. Chaure, it was a heavy kind of ache, like a pull. She had pain in her hip, too. It pulsed down her leg and never seemed to go away. Her periods were irregular, which she suspected was from working all through her pregnancies, often forgoing food.

In the fields, Ms. Chaure, like the others, sleeps on the ground, spends hours a day hunched over and carries heavy loads on her head.

Tampons and pads are expensive and hard to find, and there is nowhere to dispose of them. Without access to running water, women address their periods in the fields, with reused cloth that they try to wash discreetly by hand.

“All the problems are intermingled with their personal hygiene and their economic condition. They have to work so hard,” said Dr. Ashok Belkhode, whose Maharashtra practice includes gynecology.

Hysterectomy is a routine surgery performed around the world, though infrequently for women in their 20s and 30s. In India, it is more common, including as a form of birth control, and other parts of the country also have high hysterectomy rates. But in Maharashtra’s sugar industry, everyone — contractors, other workers, even doctors — pushes women toward the surgery.

That is what happened to Ms. Landge, a mother of four with a red bindi and arms full of green bangles. She lives in a tiny concrete home atop a hill, overlooking her village and acres of farmland that turns the color of mustard seeds during the dry months.

Doctors prescribed painkillers and vitamins for her back and abdominal pain, but every appointment cost her a day’s wages and a fee for missing work.

“Everywhere I went,” Ms. Landge said, “hysterectomy was suggested.”

Ms. Chaure ended up on the operating table because a sonogram showed that she had ovarian cysts, her medical records show.

Instead of simply removing the cysts, her surgeon told her she should have a hysterectomy. She did not question the advice. She knew so many women who had done the same. She was terrified of getting cancer. And maybe this would end her pain, and the doctor visits.

“I might not be able to work well if the problems persist,” she said.

Years earlier, to pay one of her children’s medical bills, Ms. Chaure had sold a pair of gold earrings, a gift from her father worth about $30. Now there was nothing left to sell.

So she and her husband borrowed more money from their sugar contractor, promising to return next season to repay it. They already owed so much, Ms. Chaure figured, that they would have to go anyway.

The surgeon removed Ms. Chaure’s uterus, a cyst, an ovary and a fallopian tube. In an interview, her surgeon said it was necessary because the cyst was unusually large.

The Times shared details from Ms. Chaure’s file with Dr. Farinaz Seifi, the director of gynecology at Bridgeport Hospital and a professor at the Yale School of Medicine. “There was absolutely no indication for hysterectomy,” she said.

‘I Was Very Young’

In her wedding photographs, Ms. Chaure stares straight-faced into the camera. She had never met the groom. But that was normal. The same had happened to many of her friends.

Like many rural women in Maharashtra, Ms. Chaure does not know her exact age. She figures she was about 14 on her wedding day. It was two years after she dropped out of her village school so her parents could take her to the sugar fields.

“I was scared to get married,” she recalled, “really scared.”

She knew that marriage meant the end of something. She had dreamed of becoming a nurse. She could picture it — she would wear a crisp, clean uniform and work beneath a whirring ceiling fan, protected from the sun.

But marriage is the moment when many girls give up their futures, and their bodies, to sugar.

Every fall before the harvest, usually in October, the mill owners dispatch contractors to villages in Beed like Ms. Chaure’s to recruit laborers.

Child marriage is illegal in India and is regarded internationally as a human rights violation. Its roots in India run deep, and it has complex cultural and economic causes.

But in this part of Maharashtra, two economic incentives push girls into marriage.

First, sugar cutting is a two-person job. Husband-and-wife teams make twice as much as a man working alone. The two-person system is known as koyta, after the sickle that cuts the sugar cane.

Second, the longer that children accompany their parents in the field, the longer parents must support them. So families often seek to marry off daughters young, even in early adolescence.

“If we are married, their stress reduces and the responsibility is shifted to our husband’s shoulders,” Ms. Chaure said. “So they marry us off.”

Several women recalled being married only months after their first periods.

The links between marriage and sugar go so deep that girls were once married at the mill gates. Even now, weddings are often held before the harvest and the term “gate cane wedding” still comes up.

“Without koyta, there would be no reason to get married,” said Zhamabai Subhashratod, a 30-something sugar laborer who was married in her early teens and later had a hysterectomy.

Contractors, too, have an incentive to find brides, even if it means pressuring parents to marry off young daughters, said Tatwashil Baburao Kamble, the former head of Beed’s child-welfare committee.

“I’ve seen cases where the contractors tried to get it done before taking laborers to the farm — all their belongings were packed,” Mr. Kamble said. “All that was left was to get married.”

Some contractors even lend money for weddings.

“I’ve paid for weddings, for hospital bills,” said Bapurao Balbhim Shelke, a contractor who formerly worked for Dalmia Bharat Sugar.

“I just add the amount to the next year’s bill, and they can work it off,” said Dattu Ashruba Yadav, a contractor who lives in Beed. He said he had lent one couple 50,000 rupees, or about $600, for their wedding. That represents several months of a typical couple’s earnings.

Mira Govardhan Bhole has been working in the sugar fields since her marriage, about a year after her first period. Ms. Bhole is in her 30s but has a round baby face that always looks cheerful.

As a newlywed, she would disappear into cooking to avoid her husband.

When he told her she would have to cut sugar, she sobbed uncontrollably. “They brought me by throwing me in the vehicle,” she said. “I hadn’t even taken a bath or anything.”

In the field, she felt overwhelmed. There, sugar cane surrounds you, the stalks growing so high and close together that you can make out the sky only in patches.

The men bend forward, whipping machetes. The women usually do the rest.

First, they tear the sharp leaves off the cane. It takes practice. Pull downward and you will be fine, but stroke upward, even by accident, and the leaves make gashes as thin as paper cuts.

What Ms. Bhole remembers most about her first weeks is that her palms hurt so badly that she cried and cried.

After stripping the leaves, the women stack the cane in bundles.

They carry the bundles on their heads, then load them onto trucks.

Season after season, the weight can break down the disks in your neck, leaving a constant stiffness. If you ask doctors in the region what happens to the bodies of women in the sugar fields, this is the first injury they mention. Ms. Chaure has this problem, too, and she winces when she thinks about it.

More relentless, though, is the punishment of field life. The workday often ends after midnight, when trucks have hauled away the last of the day’s crop. Women sleep under tarpaulin tents with their families on thin mats cast onto the ground.

They wake as early as 4 a.m. to fetch water, build a fire, boil tea and cook lentils and vegetables. They wash clothes in a basin and then it is back to work, stripping and hauling sugar cane.

Workers said there were almost never official contracts or records tallying how much they cut. At the end of the season, contractors almost always declare that a balance remains.

“There is no possible way they could pay it back within one season,” said Ranjit Bhausaheb Waghmare, a contractor for Dalmia Bharat Sugar.

Dalmia supplies Coca-Cola in Maharashtra, according to S. Rangaprasad, who runs one of the mills there. Dalmia records also list Mondelez, the owner of Cadbury, as a customer. The company said it was “deeply concerned to hear allegations of labor issues at one of our suppliers. We will investigate.”

Pepsi’s franchisee also buys from Dalmia, but from mills outside the state, PepsiCo said.

Ms. Bhole sometimes fantasizes about a different life. A relative in a city a few hours away works as a housekeeper. The idea of getting paid to do chores sounds incredible.

But she says that no matter how hard she and her husband work, at the end of each season, her contractor says they still owe money. They have to return.

Worker-rights advocates say this is tantamount to bonded labor, a practice banned by law.

When Ms. Chaure’s husband took her to the fields after their wedding, she hoped they would be done in a season. That was more than 15 years ago. They are still in debt.

“We take an advance, repay some, and again take another advance,” she said.

The sugar mills keep all of this — child marriage, underage labor, wage debt and working conditions — at an arm’s length. Child marriage, they say, is a social problem that has nothing to do with the industry.

They say the contractors are responsible for the workers.

“The mill does not take on the burden of employing them,” said Mr. Rangaprasad, the head of a Dalmia mill.

Things Could Have Changed

Shubha Sekhar, a Coca-Cola executive who has focused on human rights in India, talked during the Covid pandemic to a group of university students. Speaking by videoconference, she described the challenges of operating in a country that Coke’s own documents identify as risky because of child and forced labor.

Typically, corporations buy from suppliers, she explained. With sugar, she said, at times “one doesn’t have visibility of what is happening beyond, in deep agriculture.”

But those deep fields are typically just outside the doors of Coke’s own suppliers. Sugar cane loses weight — and value — each minute after it is cut, so mills are usually built close to the farms.

All of the problems, including child marriage and hysterectomies, have been known in the region for years.

There was even a moment, not too long ago, when things might have changed.

In 2019, the newspaper The Hindu BusinessLine reported on an unusually high number of hysterectomies among female sugar-cane cutters in Maharashtra. In response, a state lawmaker, along with a team of researchers, launched an investigation. They surveyed thousands of women.

Their report that year described horrible working conditions and directly linked the high hysterectomy rate to the sugar industry. Unable to take time off during pregnancy or for doctor visits, women have no choice but to seek the surgery, the report concluded.

By happenstance, Coca-Cola issued its own report that year. After unrelated accusations out of Brazil and Cambodia about land-grabbing, Coca-Cola had hired a firm to audit its supply chain in several countries.

The auditors, from a group called Arche Advisors, visited 123 farms in Maharashtra and a neighboring state with a small sugar industry.

They found children at about half of them. Many had simply migrated with their families, but Arche’s report found children cutting, carrying and bundling sugar cane at 12 farms.

Nearly every laborer interviewed by reporters said children commonly worked in the sugar fields. The youngest ones do chores. Older ones perform all the work of cane cutters. A Times photographer saw children working in the fields.

The 2019 report includes an interview with a 10-year-old girl who “loves to go to school,” but instead works alongside her parents.

“She picks the cut cane and stacks it into a bundle, which her parents then load onto the truck,” the report says.

Arche noted that Coca-Cola suppliers did not provide toilets or shelter. And it cited “flags in the area of forced labor.” Only a few of the mills it surveyed had policies on bonded or child labor, and those applied only to the mills, not the farms.

The government report called on factories to provide water, toilets, basic sanitation and the minimum wage.

Few if any changes have been carried out.

Major buyers like PepsiCo and Coca-Cola say they hold their suppliers to exacting standards for labor rights. But that promise is only as good as their willingness to monitor thousands of farms at the base of their supply chains.

That rarely happens. An executive at NSL Sugars, a Coca-Cola and PepsiCo franchisee supplier that has mills around the country, said that soda-company representatives could be scrupulous in asking about sugar quality, production efficiency and environmental issues. Labor issues in the fields, he said, would almost never come up.

Soda-company inspectors seldom if ever visit the farms from which NSL sources its sugar cane, the executive said. The PepsiCo franchisee, Varun Beverages, did not respond to calls for comment.

Mill owners, too, rarely visit the fields. Executives at Dalmia and NSL Sugars say they keep virtually no records on their laborers.

“No one from the Dalmia factory has ever visited us in the tents or the fields,” said Anita Bhaisahab Waghmare, a laborer in her 40s who has worked at farms supplying Dalmia all her life and said she had a hysterectomy that she now regretted.

Ed Potter, the former head of global workplace rights at Coca-Cola, said the company had conducted many human rights audits during his tenure. But with so many suppliers, oversight can seem random.

“Imagine your hands going through some sand,” he said. “What you deal with is what sticks to your fingers. Most sand doesn’t stick to your fingers. But sometimes you get lucky.”

Sanjay Khatal, the managing director of a major lobbying group for sugar mills, said that mill owners could not provide any worker benefits without being seen as direct employers. That would raise costs and jeopardize the whole system.

“It is the very existence of the industry which can come into question,” he said.

One thing that changed after the government report was a rule intended to prevent unscrupulous doctors from profiting off unneeded surgeries.

“Some doctors have made it a way to earn more money,” said Dr. Chaitanya Kagde, a gynecologist at a government-run facility in Beed. (Though public hospitals offer hysterectomies free or at reduced cost, they are often far from rural women.)

The new rule required the civil surgeon, the district’s top health official, to approve hysterectomies.

But hysterectomies on younger women continue. Though many doctors agree that some surgeons perform them too often, they also note that patients request the surgery.

In an interview last May, Beed’s civil surgeon at the time, Suresh Sable, said the government should not second-guess doctors. “It’s not necessary to question their authority,” he said.

He said his office still approved 90 percent of hysterectomy requests.

One day last May, a few months after the harvest, Ms. Chaure and her husband made their way to the plot of land they farm near their home. It was 104 degrees. There was almost no shade or breeze and the air was so hot it took the shape of waves in the distance.

Her son, Aditya, was at the age where he was putting everything in his mouth — the back of a sticker, a Good Day biscuit, a pink toy watch. He was so preoccupied that he seemed to have forgotten to fuss.

Ms. Chaure, wearing a light floral sari, scooped him in one arm and hiked down the field.

It had been about six months since her hysterectomy and Ms. Chaure’s body hurt worse than usual.

Everything ached, especially her midsection. She was fed up with doctors and the work that had done this to her.

For the first time since being a teenager, she did not know whether she could migrate to cut sugar cane that season.

But the idea of borrowing more money without working to repay it terrified her.

She already stretched the family budget paper thin — growing tomatoes and peppers in a patch behind their home of concrete and corrugated metal.

“We have wasted our whole lives in this work,” she said.

By September, with the harvest looming, she still did not know if she could work. The contractor, she said, had been hassling her and her husband to take a bigger advance.

“It makes me so mad when those people say, ‘Nobody forced you to be a laborer,’” she said. She was washing her family’s clothes in a plastic bowl, slapping each garment against a rock. “Nobody chooses this life.”

It had been an exhausting few days. All three of her children had been coughing. The day before, she and her husband had fought, and he had hurled a basket of fresh cotton that she had just picked to the ground, covering it with mud. It could not be sold.

Finally, her husband left for the fields, to work alone. She stayed behind, resigned to the fact that it would push her family even deeper into poverty.

She worries about her children. She still harbors hopes for Aditya and his two big sisters, who are about 8 and 5 years old.

But Priyanka, the oldest, drove her crazy, skipping school to horse around with her younger siblings. Ms. Chaure remembers missing school herself, then dropping out. She remembers her dreams of being a nurse.

She wants things to be different for her daughter.

“I want her to be someone,” she said. “Do something in life.”

But for all her optimism, Ms. Chaure knows how tough it will be for her children, and how things are likely to go.

“They don’t like it,” she said. “But they need to get used to this life.”

This article was reported in collaboration with The Fuller Project, a journalism nonprofit that reports on global issues affecting women. Ankur Tangade contributed reporting. Produced by Nico Chilla .

Megha Rajagopalan is an international investigative reporter based in London. More about Megha Rajagopalan

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‘Big day for evil’: Former YouTuber Ruby Franke detailed how she abused her children in handwritten journal entries

Ruby Franke, a former YouTube family vlogger from Utah who was sentenced last month on child abuse charges , detailed months of abuse in handwritten journal entries released by prosecutors Friday.

In the heavily redacted entries, Franke repeatedly insisted that her son was possessed by a demon. In one entry from July 11, 2023, she wrote that it was a “big day for evil” and described an incident where her son was pushed into water and she held her hand over his nose and mouth.

She wrote that she did that to help the boy.

In another entry, Franke called her daughter “manipulative” and described how she forced the girl to stand in the rain for two hours.

In February, Franke received four separate prison sentences of one to 15 years each. Her business partner, Jodi Hildebrandt , received the same sentence.

Both women were arrested in August 2023  and pleaded guilty to four counts of second-degree aggravated child abuse after police found one of Franke’s sons emaciated with open wounds and bound with duct tape.

The boy had escaped Hildebrandt’s home to a neighbor’s house. One of Franke’s daughters was found in Hildebrandt’s home in a similar malnourished condition.

The journal entries, released by the Washington County Attorney’s Office, mainly focused on two of Franke’s six children. Officials redacted their names and identified the daughter, 9, as “E” and the son, 12, as “R.”

“R was told to stand in the sun w/his sun hat,” Franke wrote in the July 11, 2023, entry. “He is defiant. ... R, or I should say his demon, stays in the shade. I push R into the sun. R comes back. I come back with a cactus poker. When I poke his back to get in the sun R doesn’t even flinch. I poke him on the neck. He is in a trance & doesn’t appear to feel anything. Jodi taps him on the cheeks to wake him up.”

Franke also wrote that same day that her son was pushed into a pool and she held her hand “tightly over his nose & mouth.”

In a July 12, 2023, entry, Franke wrote that she cut her daughter’s hair off and “doused” her with water in the “dog wash.”

“E said she wanted to run away. Jodi told E she has no idea what is waiting for her,” Franke wrote.

Prosecutors also released police body camera video, photos and interrogation tapes.

In a home security video from Aug. 30, 2023, Franke’s son asked a neighbor if he could “do two favors.”

“Well, what are they?” the neighbor asked.

“Take me to the nearest police station,” the boy responded. “Well, actually just one is fine.”

The neighbor told the boy to have a seat on his front porch.

A second video showed the man on the phone as a woman assessed the boy’s injuries.

“He has duct tape ... there’s sores around them,” the man said. The woman said the boy needed immediate attention.

Prosecutors said that Franke and Hildebrandt were motivated by “religious extremism.”

“The women appeared to fully believe that the abuse they inflicted was necessary to teach the children how to properly repent for imagined ‘sins’ and to cast the evil spirits out of their bodies,” the Washington County Attorney’s Office said in a case summary .

The family became known for its popular and often controversial YouTube channel “8 Passengers,” where Franke documented her life with her husband, Kevin Franke, and their six children.

The channel had more than 2 million subscribers before it ended. Kevin Franke later filed for divorce after her arrest .

During her sentencing, Franke apologized to her children.

“I ... believed dark was light and right was wrong,” she said. “I would do anything in this world for you. I took from you all that was soft and safe and good.”

Hildebrandt said she hoped the children would be able to “heal physically and emotionally.”

“One of the reasons I did not go to trial is because I did not want them to emotionally relive the experience, which would have been detrimental to them,” she said. “My hope and prayer is that they will heal and move forward to have beautiful lives.”

Minyvonne Burke is a senior breaking news reporter for NBC News.

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Dismay as Louisiana lookback law for child sexual abuse victims struck down

Court rules 4-3 to overturn law that had allowed victims to file civil suits over sexual abuse that took place decades ago

In a split ruling that has major implications for hundreds of child sexual abuse victims, the Louisiana state supreme court has struck down a law that had allowed victims to file civil lawsuits over molestation that happened decades ago.

Child molestation victims and their advocates were devastated by the 4-3 ruling from a court whose members are elected.

Lawyers Richard Trahant, Soren Giselson and John Denenea, who represented the plaintiffs in the case at the center of Friday’s ruling, said: “Today, four of the seven … justices overruled a law passed by a unanimous Louisiana legislature, signed by then governor [John Bel] Edwards, supported by then attorney general and current governor Jeff Landry and current attorney general Liz Murrill. That’s nearly 200 elected officials who viewed this law as being constitutional.

“Four elected officials just obliterated that. They cannot fathom the excruciating pain this decision has heaped upon adults who were raped as children and already suffer a life sentence.”

Richard Windmann , president of Survivors of Childhood Sex Abuse, said: “Once more the victims and survivors of childhood sex abuse have been denied justice. The institutionalized, systematic and wholesale rape of our children by these organizations is self-evident.”

Windmann pledged to take the case to the US supreme court if necessary, calling it “the final stop to see if we, as human beings, are going to let these atrocities stand and continue to happen”.

Kathryn Robb of ChildUSA, an advocacy group that helped pass lookback or revival windows across the country, said Friday’s ruling meant “predators and institutions that protect predators are going to continue with their bad practices”.

“They’re going to continue with their coverup,” Robb said. “They’re going to continue with putting children in harm’s way. And so I’m saddened. I’m saddened by this decision.”

Such laws were upheld as constitutional in 24 states and the District of Columbia. Louisiana now joins Utah as the only states to find them unconstitutional, Robb said.

Louisiana’s supreme court heard arguments in January involving cases filed against the Roman Catholic diocese of Lafayette over allegations that a priest in that region – about 135 miles (217km) west of New Orleans – molested several children between 1971 and 1979.

The lawsuits were filed under a “lookback window” law the Louisiana legislature passed unanimously in 2021, which eliminated deadlines for old claims in recognition of scientific research that found the average victim doesn’t come forward until that person is 52 years old.

Four Louisiana supreme court justices – James Genovese, Scott Crichton, Jeff Hughes and Piper Griffin – concurred that the “lookback window” law is unconstitutional. The majority opinion written by Genovese said reviving old sexual abuse claims violated the due-process rights of alleged abusers and their enablers to no longer be sued for damages once the original deadline to do so had passed.

The deadlines for filing such lawsuits have changed over the years. In the 1960s and 70s, victims – even children – had a single year to come forward. Those deadlines were extended in the 1980s and 90s to allow child victims to file suit well beyond their 18th birthdays. In 2021, such deadlines were eliminated entirely.

Several justices said from the bench that, regardless of how horrendous the harm caused by child molestation, applying the law retroactively raised constitutional concerns. But in his dissent Friday, Justice William Crain said Louisiana lawmakers should retain the power to give that right to victims.

“Absent a constitutional violation, which defendants have not established, the forum for this debate is the legislature, not this court,” Crain wrote. “The legislature had that debate and – without a single dissenting vote – abolished the procedural bar and restored plaintiffs’ right to sue.”

Crain was joined in dissent by colleagues Jay McCallum and John Weimer, the court’s chief justice.

Friday’s ruling does not affect measures eliminating deadlines to demand civil damages in cases of child sexual abuse that occurred after the law was enacted in 2021.

The lookback window struck from the books Friday was not exclusively for clergy abuse claimants. But it prompted many new cases of that nature against Louisiana’s Catholic institutions and clerics who worked for them.

Among the organizations standing to gain most from Friday’s ruling is the archdiocese of New Orleans, which declared bankruptcy in 2020 in an attempt to dispense with a mound of litigation related to a decades-old clerical molestation scandal there. The lookback window was the strongest legal weapon that clergy abuse accusers seeking damages from the archdiocese had in their efforts to drive the value of their claims up.

With the lookback window no longer a factor, the archdiocese’s efforts to settle those claims for as cheaply as possible received a significant boost.

“The organizations that enable and protect child molesters are rejoicing over this ruling,” said attorney Kristi Schubert, who represents a number of clerical abuse claimants caught up in the New Orleans archdiocese’s bankruptcy. “The ruling shields wrongdoers from the consequences of their evil actions.”

Some supporters of Catholic clergy abuse victims expressed concern that the Louisiana supreme court would ultimately rule against them after its justices prayed with New Orleans archbishop Gregory Aymond at a service in October at St Louis Cathedral. Organizers said the service’s purpose was for members of Louisiana’s legal profession to join Aymond – the leader of the state’s conference of Catholic bishops – in praying for the healing of clerical molestation victims.

Neither the archdiocese of New Orleans nor the diocese of Lafayette immediately commented on Friday’s court decision when asked.

Ramon Antonio Vargas contributed reporting

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Easter 2024

‘I will not feed a demon': YouTuber Ruby Franke’s child abuse case rooted in religious extremism

This image taken from body camera footage provided by Washington County Attorney’s Office shows Jodi Hildebrandt, left, and Ruby Franke, center, being arrested on child abuse charges on Aug. 30, 2023, in Ivins, Utah. The twelve-year-old son of Franke, a Utah mother of six who gave parenting advice to millions via a once-popular a YouTube channel, had escaped through a window and approached several nearby homes until someone answered the door, according to documents released Friday. (Washington County Attorney’s Office via AP)

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SALT LAKE CITY (AP) — The malnourished and badly bruised son of a parenting advice YouTuber politely asks a neighbor to take him to the nearest police station in newly released video from the day his mother and her business partner were arrested on child abuse charges in southern Utah.

The 12-year-old son of Ruby Franke, a mother of six who dispensed advice to millions via a popular YouTube channel, had escaped through a window and approached several nearby homes until someone answered the door, according to documents released Friday by the Washington County Attorney’s office.

Crime scene photos, body camera video and interrogation tapes were released a month after Franke and business partner Jodi Hildebrandt , a mental health counselor, were each sentenced to up to 30 years in prison. A police investigation determined religious extremism motivated the women to inflict horrific abuse on Franke’s children, Washington County Attorney Eric Clarke announced Friday.

“The women appeared to fully believe that the abuse they inflicted was necessary to teach the children how to properly repent for imagined ‘sins’ and to cast the evil spirits out of their bodies,” Clarke said.

Franke, 42, and Hildebrandt, 54, pleaded guilty to four counts of aggravated child abuse that included convincing Franke’s two youngest children they were evil and subjecting them to manual labor, dayslong fasting and conditions Clarke has described as “concentration camp-like.”

The women, who have said they belong to the Church of Jesus Christ of Latter-day Saints, were arrested last August at Hildebrandt’s house in Ivins, a picturesque suburb of St. George, after her neighbor Danny Clarkson opened his door to find the emaciated boy. Their actions have been condemned by other Mormon parenting bloggers who say they misrepresented their community and the religion.

In the video, the boy is seen shoeless, walking away — wearing torn socks with his ankles wrapped in bloody duct tape and plastic wrap — but turns back when Clarkson answers the door. He and his wife, Debi, could be seen on their Ring camera feeding the child, calling 911 and asking him about the lacerations on his ankles and wrists, which the boy insisted were his fault.

“I got these wounds because of me,” the boy tells the couple as they share worried looks. He tells first responders his younger sister is still in Hildebrandt’s house, and police rush to the home.

The boy later told investigators that Hildebrandt had used rope to bind his arms and his feet to weights on the ground. She used a mixture of cayenne pepper and honey to dress his wounds, according to the police report. He had been told by Franke and Hildebrandt that everything being done to him was an act of love.

In handwritten journal entries also released Friday, Franke chronicles months of daily abuse that included starving her son and 9-year-old daughter, forcing them to work for hours in the summer heat and isolating them from the outside world. The women often made the kids sleep on hard floors and sometimes locked them in a concrete bunker in Hildebrandt’s basement.

Franke insists repeatedly in her journal that her son is possessed by the devil. In a July 2023 entry titled “Big day for evil,” she describes holding the boy’s head under water and closing off his mouth and nose with her hands. Franke tells him the devil will lie and say she is hurting him but that she is actually trying to save him.

She later justifies withholding food and water from her son, writing, “I will not feed a demon.”

Franke’s attorney, LaMar Winward, and Hildebrandt’s attorney, Douglas Terry, did not immediately respond Friday to requests for comment on the new evidence.

Body camera video shows officers entering Hildebrandt’s house and detaining her on the couch while others scour the winding hallways in search of the young girl. They quickly discover a child with a buzzcut sitting cross-legged in a dark, empty closet. After hours of sitting with the girl and feeding her pizza, police coax her out.

Franke describes shaving the girl’s head several times for whining, and writes in her journal, “If she is going to act sick, she can look sick.”

Franke and her husband, Kevin Franke, launched “8 Passengers” on YouTube in 2015 and amassed a large following as they documented their experiences raising six children in a Mormon community in Springville. The couple also have a 15-year-old and a 16-year-old, as well as two adult children.

She later began working with Hildebrandt’s counseling company, ConneXions Classroom, offering parenting seminars, launching another YouTube channel and publishing content on their shared Instagram account, “Moms of Truth.”

Ruby Franke was already a divisive figure in the parent vlogging world. The Franke parents had been criticized online for banning their oldest son from his bedroom for seven months for pranking his brother. In other videos, Ruby Franke talked about refusing to take lunch to a kindergartener who forgot it at home.

The “8 Passengers” YouTube channel has since ended, and Kevin Franke filed for divorce shortly after his wife’s arrest. He appears stunned in interrogation footage when officers inform him of his son’s condition. He had not seen his wife or children since Franke asked him to move out in July 2022, investigators said.

Kevin Franke has filed several petitions in the months since his wife’s arrest in hopes of regaining custody of his four minor children, who were taken into state custody.