Transcript Guidelines - ChildONEurope

A public health approach to
preventing child maltreatment
Dr Dinesh Sethi
Violence and Injury Prevention
WHO European Centre for
Environment and Health , Rome
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Preventing child maltreatment
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
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SDR(0-14), Homicide and assault, per 100000, Last available
Russian Federation 2004
Ukraine 2004
Lithuania 2004
Estonia 2005
Kazakhstan 2004
Belarus 2004
Austria 2005
Latvia 2004
Slovakia 2002
Belgium 1997
Albania 2003
Israel 2003
Hungary 2003
Norway 2003
Republic of Moldova 2004
Romania 2004
Serbia and Montenegro 2002
Denmark 2001
Switzerland 2002
TFYR Macedonia 2003
France 2002
Armenia 2003
Portugal 2003
Finland 2004
Germany 2004
Sweden 2002
Netherlands 2004
Slovenia 2004
Czech Republic 2004
Kyrgyzstan 2004
Poland 2004
Uzbekistan 2004
Spain 2004
Bulgaria 2004
Turkmenistan 1998
Tajikistan 2001
Greece 2004
United Kingdom 2004
Azerbaijan 2002
Italy 2001
Georgia 2001
Ireland 2002
Croatia 2004
0
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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
0.5
Preventing child maltreatment
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1.5
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UN SG's Study on
Violence Against Children
Gap between human rights commitment
and investment in evidence-based
prevention programmes and services
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Preventing child maltreatment
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
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Preventing child maltreatment
Guide Content overview
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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
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Preventing child maltreatment
Introduction
• Focus on child maltreatment in age 0-14 years
• Perpetrators mostly parents and family members
• Place of occurrence mostly private
• Professional audiences
•
•
•
•
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Health
Social
Legal
Research
Preventing child maltreatment
Systematic, population-level approach
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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?
Preventing child maltreatment
1. Nature and consequences: definition
Violence
Self-Inflicted
Suicide
Interpersonal
self-abuse
child
Nature of
Violence:
Physical
Sexual
Psychological
Deprivation
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family/partner
partner
Collective
community
elder
acquaintance
stranger
social
political
economic
1. Nature and consequences: ecological model
Society
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Community
Preventing child maltreatment
Relationship/
Family
Individual
1. Nature and consequences: life course
approach
Death
Death
Early
Death
Disease, Disability
Adoption of
Health-risk Behaviors
Social, Emotional, &
Cognitive Impairment
Adverse Childhood Experiences
Birth
Birth
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2. Epidemiological and case-based information
• Population-based epidemiological surveys
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•
•
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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
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Preventing child maltreatment
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
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2. Epidemiological and case-based information
Categories and prevalence of
Adverse Childhood Experiences
Category
Prevalence (%)
Abuse, by Category
Psychological (by parents)
Physical (by parents)
Sexual (anyone)
11%
11%
22%
Household Dysfunction, by Category
Substance Abuse
Mental Illness
Mother Treated Violently
Imprisoned Household Member
26%
19%
13%
3%
Felitti et al, 1998
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3. Prevention of child maltreatment
Address underlying causes
and risk factors
Child maltreatment occurs
PREVENTION
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IDENTIFICATION
REPORTING
REFERRAL
TREATMENT
INVESTIGATION
FOLLOW-UP
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
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3. Prevention of child maltreatment
Examples of outcome evaluation indicators
Ecological level
Time from
intervention to
measurement
Short
Infant/child
Infant development
Parent/family
Community/
society
Parental knowledge Belief in
and expectations
acceptability of
punishment
Educational
achievement
Long
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Adult reporting
health risk
behaviours
Preventing child maltreatment
Encounters with
criminal justice
system
Homicide rates in
children 0-4 years
old
4. Services for affected children and families
Child maltreatment occurs
PREVENTION
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IDENTIFICATION
REPORTING
REFERRAL
TREATMENT
INVESTIGATION
FOLLOW-UP
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
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4. Protecting the child
 Reporting laws: issues to consider
 Integrated assessment of families at risk
 Intervention for the best interest of the child
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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
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Information on violence prevention in Europe
www.euro.who.int/violenceinjury
To obtain Preventing child maltreatment
Send an Email giving your name, organization, postal
address and the number of copies required to:
[email protected]
or download a PDF version from
http://whqlibdoc.who.int/publications/2006/9241594365_eng.pdf
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Preventing child maltreatment
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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