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A public health approach to preventing child maltreatment

A public health approach to preventing child maltreatment. Dr Dinesh Sethi Violence and Injury Prevention WHO European Centre for Environment and Health , Rome. Key facts and figures from the WHO European Region - 1.

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A public health approach to preventing child maltreatment

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  1. A public health approach to preventing child maltreatment Dr Dinesh Sethi Violence and Injury Prevention WHO European Centre for Environment and Health , Rome

  2. Key facts and figures from the WHO European Region - 1 • Almost 1,500 children aged 0-14 years died in the WHO European Region in 2002 as a result of homicide (*) • The rates for children 0 – 4 years are double that for those aged 5 – 14 years. • Occurrence of sexual abuse in childhood is as high as 20 % in women and 5 – 10 % in men (*) • About 34 % of young people report being bullied at least once in the past 60 days (**) • About 75,000 children are estimated to be involved in the sex trade in Eastern Europe (*) • Available data suggest that severe physical punishment has an incidence of 5 – 8 % (*) (*) Injuries and Violence in Europe, Why they matter and what can be done (2006) WHO Regional Office for Europe (**) Young people’s health in context - Health Behaviour in School-aged Children (HBSC) study: international report from the 2001/2002 survey (2004) WHO Regional Office for Europe

  3. Standardized mortality rates for homicides in children aged 0 - 14 years for countries with more than 1 million inhabitants in the most recent year (deaths/100,000 population) Source: WHO EURO Mortality Database June 2006

  4. UN SG's Study onViolence Against Children • Gap between human rights commitment and investment in evidence-based prevention programmes and services

  5. Objectives of the guide • Convey knowledge of what's needed to design and implement child maltreatment prevention programmes as outcome evaluation studies • Expand the evidence base to include more outcome evaluation studies from low- and middle-income countries • Help prioritize child maltreatment prevention in international and national health and development agendas

  6. Guide Content overview • Introduction • Nature and consequences of child maltreatment • Epidemiological and case-based information • Prevention of child maltreatment • Services for affected children and families • Conclusions and recommendations • Appendices

  7. Introduction • Focus on child maltreatment in age 0-14 years • Perpetrators mostly parents and family members • Place of occurrence mostly private • Professional audiences • Health • Social • Legal • Research

  8. Systematic, population-level approach Surveillance What is the Problem? Identify risk and protective factors What are the causes? Implementation Scaling up effective policy and programmes Develop and evaluate interventions What works and for whom?

  9. 1. Nature and consequences: definition

  10. 1. Nature and consequences: ecological model Society Community Relationship/ Family Individual

  11. 1. Nature and consequences: life course approach Death Birth Death Birth Early Early Death Death Disease, Disability Adoption of Health-risk Behaviors Social, Emotional, & Cognitive Impairment Adverse Childhood Experiences

  12. 2. Epidemiological and case-based information • Population-based epidemiological surveys • Use of physical punishment • Exposure to child maltreatment • Current health risk behaviours • Current health status • Facility-based case information • Non-fatal cases (known and suspected) • Fatalities (known and suspected) • Using information for advocacy

  13. 2. Population-based epidemiological surveys • Survey instruments • Parent-child Conflict Tactics Scale • Adverse Childhood Experiences Study questionnaires • Lifetime Victimization Survey Screening questionnaire • ISPCAN Child Abuse Screening Tools • Adapting survey methods to local conditions • Sampling strategies • Ethical considerations

  14. Categories and prevalence of Adverse Childhood Experiences 2. Epidemiological and case-based information Prevalence(%) Category Abuse, by Category Psychological (by parents) 11% Physical (by parents) 11% Sexual (anyone) 22% Household Dysfunction, by Category Substance Abuse 26% Mental Illness 19% Mother Treated Violently 13% Imprisoned Household Member 3% Felitti et al, 1998

  15. 3. Prevention of child maltreatment Address underlying causes and risk factors Child maltreatment occurs IDENTIFICATIONREPORTINGREFERRALTREATMENT INVESTIGATIONFOLLOW-UP PREVENTION

  16. 3. Prevention of child maltreatment • Societal and community • Providing early childhood education and care • Reducing alcohol availability • Changing norms that support child maltreatment • Relationship • Home visitation programmes • Training in parenting • Individual • Reducing unintended pregnancies • Increasing access to pre- and post-natal services

  17. 3. Prevention of child maltreatment Examples of outcome evaluation indicators Short Long

  18. 4. Services for affected children and families Child maltreatment occurs IDENTIFICATIONREPORTINGREFERRALTREATMENT INVESTIGATIONFOLLOW-UP PREVENTION

  19. 4. Treatment and support • Integrated mental/physical health and forensic assessment • Consent • History • Top-to-toe physical exam, including genito-anal exam • Documentation and treatment of injuries • Mental health assessment • Screening or treatment for STIs, HIV • Prevention of pregnancy • Forensic examination • Psychosocial support • Support services for families

  20. 4. Protecting the child • Reporting laws: issues to consider • Integrated assessment of families at risk • Intervention for the best interest of the child

  21. Conclusions and recommendations • Base policies, plans, programmes and services on scientific evidence • Define child maltreatment cases and outcome indicators using international norms and behavioural definitions from well-tested instruments • Design and implement prevention programmes and services as outcome evaluation studies • Integrate wherever possible prevention and services into existing systems

  22. Information on violence prevention in Europe www.euro.who.int/violenceinjuryTo obtain Preventing child maltreatment • Send an Email giving your name, organization, postal address and the number of copies required to: • violenceprevention@who.int • or download a PDF version from • http://whqlibdoc.who.int/publications/2006/9241594365_eng.pdf

  23. Zurich project on the social development of children • Longitudinal study • 1000 children • 1000 parents • Prevention programme • Triple P • Paths • Randomized Control Trial Eisner, M. 2004. http://www.z-proso.unizh.ch/Dokumente/NEWSLETTER1en.pdf

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