Opinion
FROM THE INSTITUTE OF MEDICINE VIEWPOINT
Angela Diaz, MD Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, and Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Anne C. Petersen, PhD Center for Human Growth and Development, University of Michigan, Ann Arbor.
Institute of Medicine Report New Directions in Child Abuse and Neglect Research Child abuse and neglect remain a significant US problem affecting millions of children and families. Therefore, the Children’s Bureau of the Administration for Children and Families asked the Institute of Medicine/ National Research Council to update the 1993 National Research Council report, Understanding Child Abuse and Neglect.1 Twenty years later, despite important progress, many challenges remain. Research since 1993 makes clear that child abuse and neglect are serious public health issues affecting victims in all areas of functioning throughout life.
The Study Process Phase 1 involved a 2-day public workshop and summary.2 The Phase 2 charge was to (1) review post-1993 research; (2) identify research informing science, programs, and policy; and (3) recommend research priorities for the next decade. The study committee of 16 experts representing diverse scientific and professional fields released its report3 in September 2013.
Key Findings and Conclusions Scope/Trends
National Child Abuse and Neglect Data System data from fiscal year 2011 reported 3.4 million child abuse and neglect referrals involving 6.2 million children nationally; 75% of the cases were classified as neglect, 18% as physical abuse, and 9% as sexual abuse, with the highest rates among children younger than age 3 years. Strong evidence indicates that sexual abuse has declined substantially over 20 years; most evidence suggests a decline in physical abuse, especially in less serious forms. There is no evidence that neglect is declining overall; however, states vary significantly as to whether neglect is increasing, decreasing, or remaining constant. Difficulties remain in determining the rates of child abuse and neglect because of variations in method; the questions asked; and the source, timing, and circumstances for obtaining information. Research on these trends has received inadequate attention given their important implications for program efforts. Corresponding Author: Anne C. Petersen, PhD, Center for Human Growth and Development, University of Michigan, 300 N Ingalls, Room 1011SW, Ann Arbor, MI 48109 (annepete @umich.edu).
Causes
Causal mechanisms are not adequately understood, primarily because of the paucity of rigorous research needed to test causality. Parental substance abuse, depression, and a parent’s history of child abuse and neglect present the strongest evidence as risk factors. Correlational studies provide valuable information for hypotheses but more rigorous methods are needed to
explain why risk factors result in abuse and neglect in certain situations but not in others. To achieve more effective prevention and treatment policies and interventions, a better understanding of the causal mechanisms, including protective factors, of child abuse and neglect is required. Consequences
The effects of child abuse and neglect are not limited to childhood but cascade throughout life, with significant consequences for victims (on all aspects of human functioning), their families, and society. The estimated annual cost to society of these effects is $80.3 billion. All aspects of development are affected including brain, cognitive, and social development. Characteristics of a child’s exposure to abuse or neglect—including timing, chronicity, severity, and type of abuse—influence the risk for problematic outcomes. Studies of protective factors help explain why some children fare better than others. Recent advances in neural and genomic sciences offer new insights into the neural and biological consequences of child abuse and neglect. Most hopeful is emerging evidence that the effects of early child abuse and neglect can be diminished through intervention. Child Services System
Since 1993, policy, practice, and program initiatives have improved the public child welfare system (CWS). Federal child welfare outcomes now focus on safety, permanency, and well-being; states and localities have also adopted system-level reforms to improve child and family outcomes. Differential response, defined as screening and response to child protective agency reports related to criteria such as level of risk, provides the strongest evidence for improved results. Improved empirical data and cohesive interaction and coordination between the CWS and related systems also show effectiveness. More rigorous evaluations, including evaluation of strategies to implement successful models across varying settings and of highly effective delivery systems and their implementation, are needed. Research is needed on effective aspects of foster care placements, differential CWS experiences based on sociocultural factors, and the impact of state administrative structures on CWS performance. Interventions
Significant advances have occurred in the development, evaluation, and dissemination of model programs for preventing or treating various forms of child abuse and neglect. Prevention strategies, such as early home-visiting
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Copyright 2014 American Medical Association. All rights reserved.
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Opinion Viewpoint
programs, parenting education programs, public awareness campaigns, and professional practice reforms, have demonstrated meaningful improvements in mitigating factors commonly associated with elevated risk for poor parenting including abuse and neglect. Considering treatment, several trauma-focused cognitive behavioral therapy approaches and parent management training programs are effective with children affected by abuse.
3. The assistant secretary of the Administration for Children and Families should convene senior-level leadership of all federal agencies with a stake in child abuse and neglect research to discuss and assign accountability for the implementation of a strategic plan to advance a national research agenda on child abuse and neglect. Recommendations 4 through 7 are aimed at providing critical steps toward the development of infrastructure that will sustain a national, multidisciplinary research enterprise.
Research Infrastructure
4. The Centers for Disease Control and Prevention, in partnership with the Federal Interagency Work Group on Child Abuse and Neglect, should develop and sustain a national surveillance system for child abuse and neglect that links data across multiple systems and sources.
As in 1993, improved infrastructure, support, and coordination are needed for efficient, productive research on child abuse and neglect. The primary challenge is the lack of high-level federal research coordination. Additional needs include effective training of multidisciplinary researchers; a high-quality public health surveillance system; sustained funding for rigorous research endeavors; interdisciplinary research centers; and research attentive to diverse and underserved populations. Also needed are continued federal investment in longitudinal, nationally representative studies and quality improvements in administrative data, as well as increased attention to establishing causality in developmental research and intervention studies. Policy
Numerous changes have been made to federal and state laws and policies designed to impact the incidence, reporting, and negative health and economic consequences of child abuse and neglect; however, to our knowledge, little research has evaluated the impact of these changes.
Recommendations The first 3 recommendations support the development of national processes for coordinating and prioritizing investment in child abuse and neglect research infrastructure. 1. Federal agencies, in partnership with private foundations and academic institutions, should implement a research agenda designed to advance knowledge and understanding of the causes and consequences of child abuse and neglect, as well as the identification and implementation of effective services for its treatment and prevention. These research priorities, fall into 3 major categories: research on the causes and consequences of child abuse and neglect, services research in complex systems, and child abuse and neglect policy research. 2. The Federal Interagency Work Group on Child Abuse and Neglect, under the auspices of the assistant secretary of the Administration for Children and Families, should develop a strategic plan that details a business plan, an implementation strategy, and departmental accountability for the advancement of a national research agenda on child abuse and neglect. ARTICLE INFORMATION Published Online: November 11, 2013. doi:10.1001/jamapediatrics.2013.4560. Conflict of Interest Disclosures: None reported.
5. Federal agencies, in partnership with private foundations and academic institutions, should invest in developing and sustaining a cadre of researchers who can examine issues of child abuse and neglect across multiple disciplines 6. Federal agencies, in partnership with private foundations and academic institutions, should provide funding for new multidisciplinary education and research centers on child abuse and neglect in geographically diverse locations across the United States. 7. The National Institutes of Health should develop a new child maltreatment, trauma, and violence study section under the Risk, Prevention, and Health Behavior Integrated Review Group. Recommendations 8 and 9 call for policy evaluations within all new federal and state legislation related to child abuse and neglect to catalyze this important area of research. 8. To ensure accountability and effectiveness and to encourage evidence-basedpolicymaking,Congressshouldincludesupportinallnew legislation related to child abuse and neglect, such as reauthorizations of the Child Abuse Prevention and Treatment Act, for evaluation of the impact of new child abuse and neglect laws and policies and require a review of the findings in reauthorization discussions. 9. To ensure accountability and effectiveness, to support evidencebased policy making, and to allow for exploration of the differential impact of various state laws and policies, state legislatures should include supportinallnewlegislationrelatedtochildabuseandneglectforevaluation of the impact of new child abuse and neglect laws and policies and require a review of the findings in reauthorization discussions.
Conclusion There has been great progress in child abuse and neglect research since the publication of the 1993 report. We now know that the effects of child maltreatment are lifelong, with enormous costs to society. Significant advances in prevention and treatment give us hope that we can reduce and perhaps prevent compromised lives. Realizing the promise of recent research advances requires a comprehensive, integrated, and coordinated national approach.
2. Board on Children, Youth, and Families; Institute of Medicine; National Research Council. Child Maltreatment Research, Policy, and Practice for the Next Decade: Workshop Summary. Washington, DC: The National Academies Press.
3. Institute of Medicine; National Research Council. New Directions in Child Abuse and Neglect Research. 2013. Washington, DC: The National Academies Press.
REFERENCES 1. National Research Council. Understanding Child Abuse and Neglect. Washington, DC: The National Academies Press; 1993.
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FROM THE INSTITUTE OF MEDICINE VIEWPOINT
Angela Diaz, MD Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, and Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Anne C. Petersen, PhD Center for Human Growth and Development, University of Michigan, Ann Arbor.
Institute of Medicine Report New Directions in Child Abuse and Neglect Research Child abuse and neglect remain a significant US problem affecting millions of children and families. Therefore, the Children’s Bureau of the Administration for Children and Families asked the Institute of Medicine/ National Research Council to update the 1993 National Research Council report, Understanding Child Abuse and Neglect.1 Twenty years later, despite important progress, many challenges remain. Research since 1993 makes clear that child abuse and neglect are serious public health issues affecting victims in all areas of functioning throughout life.
The Study Process Phase 1 involved a 2-day public workshop and summary.2 The Phase 2 charge was to (1) review post-1993 research; (2) identify research informing science, programs, and policy; and (3) recommend research priorities for the next decade. The study committee of 16 experts representing diverse scientific and professional fields released its report3 in September 2013.
Key Findings and Conclusions Scope/Trends
National Child Abuse and Neglect Data System data from fiscal year 2011 reported 3.4 million child abuse and neglect referrals involving 6.2 million children nationally; 75% of the cases were classified as neglect, 18% as physical abuse, and 9% as sexual abuse, with the highest rates among children younger than age 3 years. Strong evidence indicates that sexual abuse has declined substantially over 20 years; most evidence suggests a decline in physical abuse, especially in less serious forms. There is no evidence that neglect is declining overall; however, states vary significantly as to whether neglect is increasing, decreasing, or remaining constant. Difficulties remain in determining the rates of child abuse and neglect because of variations in method; the questions asked; and the source, timing, and circumstances for obtaining information. Research on these trends has received inadequate attention given their important implications for program efforts. Corresponding Author: Anne C. Petersen, PhD, Center for Human Growth and Development, University of Michigan, 300 N Ingalls, Room 1011SW, Ann Arbor, MI 48109 (annepete @umich.edu).
Causes
Causal mechanisms are not adequately understood, primarily because of the paucity of rigorous research needed to test causality. Parental substance abuse, depression, and a parent’s history of child abuse and neglect present the strongest evidence as risk factors. Correlational studies provide valuable information for hypotheses but more rigorous methods are needed to
explain why risk factors result in abuse and neglect in certain situations but not in others. To achieve more effective prevention and treatment policies and interventions, a better understanding of the causal mechanisms, including protective factors, of child abuse and neglect is required. Consequences
The effects of child abuse and neglect are not limited to childhood but cascade throughout life, with significant consequences for victims (on all aspects of human functioning), their families, and society. The estimated annual cost to society of these effects is $80.3 billion. All aspects of development are affected including brain, cognitive, and social development. Characteristics of a child’s exposure to abuse or neglect—including timing, chronicity, severity, and type of abuse—influence the risk for problematic outcomes. Studies of protective factors help explain why some children fare better than others. Recent advances in neural and genomic sciences offer new insights into the neural and biological consequences of child abuse and neglect. Most hopeful is emerging evidence that the effects of early child abuse and neglect can be diminished through intervention. Child Services System
Since 1993, policy, practice, and program initiatives have improved the public child welfare system (CWS). Federal child welfare outcomes now focus on safety, permanency, and well-being; states and localities have also adopted system-level reforms to improve child and family outcomes. Differential response, defined as screening and response to child protective agency reports related to criteria such as level of risk, provides the strongest evidence for improved results. Improved empirical data and cohesive interaction and coordination between the CWS and related systems also show effectiveness. More rigorous evaluations, including evaluation of strategies to implement successful models across varying settings and of highly effective delivery systems and their implementation, are needed. Research is needed on effective aspects of foster care placements, differential CWS experiences based on sociocultural factors, and the impact of state administrative structures on CWS performance. Interventions
Significant advances have occurred in the development, evaluation, and dissemination of model programs for preventing or treating various forms of child abuse and neglect. Prevention strategies, such as early home-visiting
jamapediatrics.com
JAMA Pediatrics February 2014 Volume 168, Number 2
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archpedi.jamanetwork.com/ by a University of Georgia User on 06/02/2015
101
Opinion Viewpoint
programs, parenting education programs, public awareness campaigns, and professional practice reforms, have demonstrated meaningful improvements in mitigating factors commonly associated with elevated risk for poor parenting including abuse and neglect. Considering treatment, several trauma-focused cognitive behavioral therapy approaches and parent management training programs are effective with children affected by abuse.
3. The assistant secretary of the Administration for Children and Families should convene senior-level leadership of all federal agencies with a stake in child abuse and neglect research to discuss and assign accountability for the implementation of a strategic plan to advance a national research agenda on child abuse and neglect. Recommendations 4 through 7 are aimed at providing critical steps toward the development of infrastructure that will sustain a national, multidisciplinary research enterprise.
Research Infrastructure
4. The Centers for Disease Control and Prevention, in partnership with the Federal Interagency Work Group on Child Abuse and Neglect, should develop and sustain a national surveillance system for child abuse and neglect that links data across multiple systems and sources.
As in 1993, improved infrastructure, support, and coordination are needed for efficient, productive research on child abuse and neglect. The primary challenge is the lack of high-level federal research coordination. Additional needs include effective training of multidisciplinary researchers; a high-quality public health surveillance system; sustained funding for rigorous research endeavors; interdisciplinary research centers; and research attentive to diverse and underserved populations. Also needed are continued federal investment in longitudinal, nationally representative studies and quality improvements in administrative data, as well as increased attention to establishing causality in developmental research and intervention studies. Policy
Numerous changes have been made to federal and state laws and policies designed to impact the incidence, reporting, and negative health and economic consequences of child abuse and neglect; however, to our knowledge, little research has evaluated the impact of these changes.
Recommendations The first 3 recommendations support the development of national processes for coordinating and prioritizing investment in child abuse and neglect research infrastructure. 1. Federal agencies, in partnership with private foundations and academic institutions, should implement a research agenda designed to advance knowledge and understanding of the causes and consequences of child abuse and neglect, as well as the identification and implementation of effective services for its treatment and prevention. These research priorities, fall into 3 major categories: research on the causes and consequences of child abuse and neglect, services research in complex systems, and child abuse and neglect policy research. 2. The Federal Interagency Work Group on Child Abuse and Neglect, under the auspices of the assistant secretary of the Administration for Children and Families, should develop a strategic plan that details a business plan, an implementation strategy, and departmental accountability for the advancement of a national research agenda on child abuse and neglect. ARTICLE INFORMATION Published Online: November 11, 2013. doi:10.1001/jamapediatrics.2013.4560. Conflict of Interest Disclosures: None reported.
5. Federal agencies, in partnership with private foundations and academic institutions, should invest in developing and sustaining a cadre of researchers who can examine issues of child abuse and neglect across multiple disciplines 6. Federal agencies, in partnership with private foundations and academic institutions, should provide funding for new multidisciplinary education and research centers on child abuse and neglect in geographically diverse locations across the United States. 7. The National Institutes of Health should develop a new child maltreatment, trauma, and violence study section under the Risk, Prevention, and Health Behavior Integrated Review Group. Recommendations 8 and 9 call for policy evaluations within all new federal and state legislation related to child abuse and neglect to catalyze this important area of research. 8. To ensure accountability and effectiveness and to encourage evidence-basedpolicymaking,Congressshouldincludesupportinallnew legislation related to child abuse and neglect, such as reauthorizations of the Child Abuse Prevention and Treatment Act, for evaluation of the impact of new child abuse and neglect laws and policies and require a review of the findings in reauthorization discussions. 9. To ensure accountability and effectiveness, to support evidencebased policy making, and to allow for exploration of the differential impact of various state laws and policies, state legislatures should include supportinallnewlegislationrelatedtochildabuseandneglectforevaluation of the impact of new child abuse and neglect laws and policies and require a review of the findings in reauthorization discussions.
Conclusion There has been great progress in child abuse and neglect research since the publication of the 1993 report. We now know that the effects of child maltreatment are lifelong, with enormous costs to society. Significant advances in prevention and treatment give us hope that we can reduce and perhaps prevent compromised lives. Realizing the promise of recent research advances requires a comprehensive, integrated, and coordinated national approach.
2. Board on Children, Youth, and Families; Institute of Medicine; National Research Council. Child Maltreatment Research, Policy, and Practice for the Next Decade: Workshop Summary. Washington, DC: The National Academies Press.
3. Institute of Medicine; National Research Council. New Directions in Child Abuse and Neglect Research. 2013. Washington, DC: The National Academies Press.
REFERENCES 1. National Research Council. Understanding Child Abuse and Neglect. Washington, DC: The National Academies Press; 1993.
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Copyright 2014 American Medical Association. All rights reserved.
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