Transcript Document

Child Abuse and Neglect
Causes, Policies, Opportunities
Professor Mark A Bellis
UK WHO Focal Point for Violence and Injury Prevention
Director, Policy, Research & Development, Public Health Wales
Chair, World Health Organization Collaborating Centre for Violence Prevention, Liverpool
[email protected]
Child Abuse - Distribution and Focus
Under15’s Deaths assault or undetermined 44
63
Child Homicides UK 2012/13
7,964 Cruelty & neglect offences
Sexual offences against children 23,633 Police UK 2012/13.
police UK 2012/13
36,202 NSPCC helpline abuse or neglect
contacts in 2012/13
 42,500 Children looked after due to abuse
10 -15yrs Violent crime 250,000 Focus and neglect 31 March 2013.
2012/13 (Est UK).
Distribution

5% Children
980,000 (11-17yrs) experienced
sexually abused 650,000
(Est. UK)
high levels of abuse/neglect
(est. UK)
Three in five people describe child abuse and neglect as “common” in the UK
Based on NSPCC
Adverse Childhood Experiences
Percentage
25
Verbal
Physical
Sexual
20
15
10
5
0
1
Aged 18 to 69 (n = 3,885)
2
3
Deprivation Quintile
4
5
Bellis et al, BMC Medicine, 2014
Adverse Childhood Experiences
Troubled Families - Average 9 problems. 40% had 3 or more children
Aged 18 to 69 (n = 3,885)
Bellis et al, BMC Medicine, 2014
Cumulative Proportion of Individuals
not diagnosed with a Major Disease with Age
Aged 18 to 69 (n = 3,885) Bellis et al, Journal of Public Health, 2014
1.000
0.900
Cumulative proportion not diagnosed
at period end
0.800
0.700
0.600
0.500
0.400
35% have history of major disease






Cancer
Type II Diabetes
Cardio Vascular Disease
Digestive/Liver Disease
Stroke
Respiratory Disease
0.300
70% have history of major disease
0.200
0.100
0 ACEs
4+ ACEs
0.000
0-9
10-19
20-29
30-39
Survival period
40-49
50-59
Differences are independent of Deprivation
60-69
Risk Factors for Child Maltreatment
Poor parenting skills
Victim of
child
abuse
Academic problems
Impaired bonding
Perpetrator
of child
abuse
Alcohol
Drugs
Stress, Depression, Anxiety
Unplanned, Teenage, Parental
conflict
Youth
violence
Unemployment
Poor mental health
Pregnancy
Conduct disorder
Domestic
and sexual
violence
Poor housing
High crime area
Based on Hughes & Bellis , WHO, 2013
www.preventviolence.info
Globally 390 journal articles (2007- June 2014) - Primary Prevention
Youth violence
Child maltreatment
Self-directed violence
Intimate partner violence
Sexual violence
Other
219
41
39
30
21
40
0
50
100
150
Child Maltreatment Studies
 Parenting programmes 16 (39%)
 Home visiting
10 (24%)
 Other*
8 (37%)
 USA
 Europe
 UK
200
(ex UK)
250
27 (66%)
3
1
* Child skills programmes, support groups, media campaigns, screening and referral,
therapeutic approaches, parent/child/school programmes
Missing - systematic evidence on cornerstone of local early years
programmes (universal health professional support by health
visitors in the first two years of a child’s life)
Child Maltreatment Prevention – 1001 Days
£
Legal framework, Safe guarding, Criminal Justice, Social Care
Universal Identification
(e.g. maternal
substance), support &
referral - Enhanced Paediatrics
• Increasing
evidence
of programme
cost-effectiveness
especially
Cultural Change e.g. Social Norms and Capital
Environmental Change e.g. Alcohol Access
taking a multi-agency approach
Educational – Acute Harms - Shaken Baby
• Debate over programme type and extent of targeting
ACE Free Early Years
Media and Professional Work on Long Term Importance of Early Years
30:1
Based on Marmot Proportionate Universalism and WHO report on preventing child maltreatment
Deprivation - Affluence
Violence against children
Risk Factor
Poor early development
Assault
Location
Number
1-2
3-5
6-10
Area of
residence
Number
1-4
5-9
>10
Royal
Liverpool
AED
(TIIG 2008)
Integrated Intelligence for Prevention of
Violence, Abuse and Neglect
Local measures of other illegal
behaviours are available (e.g. drug
use) but not child maltreatment of
domestic violence.
• ≈ 1/3 of child abuse is under influence of
alcohol – alcohol related 
• USA model
• 1 less outlet per 1,000 people  severe
violence towards children by 4%
• 10% increase in excise tax on beer  severe
violence towards children by 2.3%
Local Action 1906
Abuse of Alcohol and its Consequences
The habit of drinking to excess leads to the ruin of the families, disgust for work,
poverty, misery, theft and crime.
Thousands of instances of cruelty to children occur annually in this City from the
neglect and brutality of parents, often reduced to poverty through wasting their
money on drink.
RESPONSIBLE BODIES
Community Safety Partnerships – Joint working, Data exchange, Joint services
Public Health England – Evidence
Director of Public Health – Local Authority Services, Joint Strategic Needs Assessment
Clinical Commissioning Groups – Commissioning
ADVERSE CHILDHOOD
EXPERIENCES
Contraceptive & Family Planning Services
Unwanted/Teenage Pregnancy
Maternity & Midwifery Services
Positive Parenting
Abuse identification, Safe-guarding
SERVICE QUALITY
Elder abuse
Patient care
MENTAL HEALTH AND SUBSTANCE USE
Multisystemic Therapy
Cognitive Behavioural Therapy
Substance Use services
Other Mental Health Services
OTHER SECTORS
Education
Immigration
Social inequalities
ALCOHOL
Prevention messages
Treatment & Care
Identification and Brief Motivation
Licensing and Inspection
Data exchange
MONITORING AND MILESTONES
Public Health Outcomes Framework
Domestic Violence
Violent Crime and Sexual Violence
Older People’s perception of Community Safety
International Leadership and Collaboration
Sixty-seventh World Health Assembly 24 May 2014 Strengthening role
of health system in addressing violence, particularly against women
and girls, and against children. Urges Member States to:
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strengthen the role of health systems in addressing violence
ensure those at risk have timely, effective & affordable health services access
strengthen their contribution to prevention programmes
ensure health system engagement with education, justice, social services
strengthen the national response, improving data collection & dissemination
enhance capacities, including through training
WHO Child Maltreatment Prevention Plan 2014–2020
• a life-course, evidence-informed, health and inter-sectoral approach
• 64th WHO Regional Committee for Europe
Global Status Report on Violence Prevention
Lancet/WHO series on Early Child Development
Summary
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Child Protection  Evidence Informed Prevention
Multi-departmental consideration of benefits & savings
National Campaign awareness of the long-term impacts
Professional awareness and training
Environmental issues e.g. role of alcohol
Intelligence targeted home visiting & parental support
R&D – delivery in Universal Health/Social systems
Integrated agenda child development and child abuse
Integrated response across all types of violence