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1.
Munchausen syndrome by proxy (MSBP) is a form of child abuse wherein the mother falsifies illness in her child through simulation and/or production of illness, and presents the child for medical care, disclaiming knowledge as to etiology of the problem. From the literature, 117 cases of MSBP were reviewed. The most common presentations of MSBP were bleeding, seizures, central nervous system depression, apnea, diarrhea, vomiting, fever, and rash. Short-term morbidity rate was 100%; long-term morbidity rate was 8%. Mortality rate was 9%. Failure to thrive was associated with MSBP in 14% of cases. All perpetrators of MSBP were the mothers. The origins of this type of aberrant maternal behavior remain abstruse, as do the long-term psychological effects on the child victims. Guidelines for medical, social service, and legal management are provided. 相似文献
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This study examined victim, family, and alleged perpetrator characteristics associated with fatal child maltreatment (FCM) in 685 cases identified by child welfare services in the state of Oklahoma over a 21-year period. Analyses also examined differences in child, family, and alleged perpetrator characteristics of deaths from abuse versus neglect. Case information was drawn from child welfare investigation records for all FCM cases identified by the state Department of Human Services. Fatal neglect accounted for the majority (51%) of deaths. Children were primarily younger than age 5, and parents were most frequently the alleged perpetrators. Moreover, most victims had not been the subject of a child welfare report prior to their death. A greater number of children in the home and previous family involvement with child welfare increased children's likelihood of dying from neglect, rather than physical abuse. In addition, alleged perpetrators of neglect were more likely to be female and biologically related to the victim. These results indicate that there are unique family risk factors for death from neglect (versus physical abuse) that may be important to consider when selecting or developing prevention efforts. 相似文献
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OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect. 相似文献
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E J Saunders 《Child abuse & neglect》1988,12(1):83-90
To meet the needs of mutual clients, perpetrators and victims, social service and judicial system professionals share an obligation to collaborate in cases of child sexual abuse. Unknown is the extent to which individuals in counter professions share common beliefs about perpetrators and victims of child sexual abuse. This paper reports an inquiry into the attitudes of five professional groups within an urban criminal justice system specific to victim credibility, victim culpability, offender culpability, and the crime and punishment of child sexual abuse. As predicted, statistically significant differences in attitudes were found among child welfare social workers, police officers, district attorneys, public defenders, and judges. In particular, groups differed in their beliefs about victim credibility and punishment of offenders, suggesting conflict in addressing two fundamental questions in these cases: (1) Can a child be believed when he or she reports sexual abuse? and (2) How should the system deal with offenders? Both questions beg the continuing attention of all professionals invested in these cases, ultimately benefiting victims and offenders. Both quantitative and qualitative findings are provided in this report. 相似文献
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Lucas DR Wezner KC Milner JS McCanne TR Harris IN Monroe-Posey C Nelson JP 《Child abuse & neglect》2002,26(2):167-186
OBJECTIVE: The present study describes factors related to fatal abuse in three age groups in the United States Air Force (USAF). METHOD: Records from 32 substantiated cases of fatal child abuse in the USAF were independently reviewed for 60 predefined factors. RESULTS: Males were over-represented in young child victims (between 1 year and 4 years of age) and child victims (between 4 years and 15 years of age) but not in infant victims (between 24 hours and 1 year of age). African-American infant victims and perpetrators were over-represented. Younger victims were more likely to have been previously physically abused by the perpetrator. Perpetrators were predominantly male and the biological fathers of the victims. Infant and young child perpetrators reported childhood abuse histories, while child perpetrators reported the highest frequency of mental health contact. Victims' families reported significant life stressors. Families of young child victims were more likely divorced, separated, or single. Incidents with infants and young children tended to occur without witnesses; incidents with child victims tended to have the victim's sibling(s) and/or mother present. Fatal incidents were more frequent on the weekend, in the home, and initiated by some family disturbance. CONCLUSIONS: Differences among groups in factors related to infant and child homicide across age groups may assist in the development of more tailored abuse prevention efforts and may also guide future investigations. 相似文献
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Grandfather-granddaughter incest accounts for about 10% of all reported cases of intrafamilial childhood sexual abuse. In a sample of 10 such cases, all referrals came from mothers fo the child victims; six of these mothers had themselves been abused in childhood by the perpetrator. For eight of the 10 perpetrators, multiple child sexual victims were identified in a pattern that suggests facultative pedohphilia. Ony two of the 18 grandchildren sexually abused by the 10 grandfathers were asymptomatic at the time of report. Grandchild victims from chaotic families showed educational and behavioral symptoms; those from stable families exhibited fears and phobias. Eight of the 18 grandchildren were victimized by multiple perpetrators. The results cast doubt on the assumption that grandparent incest is a benign form of abuse and indicate that there is some justification for the fears expressed by adult incest victims about visitation between their children and the father-perpetrator. 相似文献
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OBJECTIVE: To collect and compare the results of medical, child protective, and law enforcement evaluation of a sample of Maine children who were victims of abusive head trauma (AHT) in order to describe the clinical and evaluative characteristics as they relate to victims, families and perpetrators of such trauma and to improve the professional response to AHT in Maine.METHOD: Retrospective chart review of medical, child protective, and law enforcement records of all AHT victims admitted to two tertiary care hospitals in Maine or seen by the state medical examiner from 1991 to 1994.RESULTS: Nineteen children (age range 2 weeks to 17 months) were identified as victims of AHT (out of a total of 94 head trauma admissions) accounting for 20 hospitalizations during the study period. There was a history of prior injury in 30%, history of prior medical evaluations for possibly abuse related problems in 65%, while, on presentation, 75% had evidence or history of prior injury. The hospitals notified child protective services (CPS) in all 20 cases and correctly identified abuse in 18 (90%). Parental risk factors for abuse identified in CPS records included substance abuse (53%), domestic violence (42%), criminal history (32%), unrealistic expectations (42%), and attachment problems (32%). However, risk factors were inadequately assessed in 53% of homes. Law enforcement identified a likely perpetrator in 79% of cases and in the majority the identified suspect was the father. In the 15 cases where a perpetrator was identified by law enforcement, that person was alone with the child at symptom onset in 14 (93%).CONCLUSIONS: The medical response, at least at the inpatient level, was generally well done with regard to suspicion and reporting. Cases are possibly being missed at the outpatient level. Child protective risk assessment was limited overall yet in a third of the homes where AHT occurred, few if any risk factors were present to aid in identification and prevention. Law enforcement results suggest that a primary suspect for AHT is the caretaker alone with the child at the time of symptom onset. 相似文献
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This study examined professionals' knowledge of a relatively rare form of child abuse, Munchausen syndrome by proxy (MSBP). Eighty-six professionals representing hospital or other medical settings, community services programs, the state children's service agency, and various law enforcement agencies were surveyed. Results indicated that professionals employed in medical or hospital settings were three times more likely to have heard of the syndrome than those employed by community service agencies. Journal articles and colleagues were the most popular sources of information pertaining to MSBP. Respondents identified 77 possible cases of MSBP in their caseloads over the past year. Findings suggest the need for educating community professionals as well as the possibility that the incidence of MSBP has been grossly underestimated. Implications for future research and preventive efforts are discussed. 相似文献
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T C Johnson 《Child abuse & neglect》1988,12(2):219-229
While the seriousness of sexual abuse by adolescents is finally beginning to receive adequate attention from the professional community, the existence of child perpetrators is largely dismissed and denied. Forty-seven boys between the ages of 4 and 13 are described who have molested children younger than themselves. Coercion was involved in all of the cases included in this study. These children had been treated in a program especially designed for child perpetrators at Children's Institute International in Los Angeles. Prior to their own sexually abusive behaviors, 49% of these boys had been sexually abused and 19% physically abused. The children all knew the people who victimized them. These male child perpetrators all knew the children they molested. In 47% of the cases the sexual abuse was of a sibling. The average number of victims of these children was 2.1 with a range of 1 to 7. The mean age at the time of perpetration was 8 years, 9 months. The mean age of the victims of these children was 6 years, 9 months. There was a history of sexual and physical abuse in the majority of the families of these children, as well as a history of substance abuse. This population is compared to adolescent perpetrators. 相似文献
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A personal microcomputer data base program was used to study 184 substantiated 1981 child abuse and neglect cases in the city of Lansing, Michigan. Data on 18 variables were entered directly into the microcomputer from the agency case closing forms in 7 hours. The microcomputer can sort by one or more variables. In analyzing the data, the following questions were addressed: Who reports the child abuse cases? In what types of families does abuse occur? Who are the perpetrators in relation to the child? Who are the victims by age and race? What types of abuse are substantiated? How many of the cases are repeats? Where are substantiated cases located? This study was both simple and inexpensive, requiring minimal staff time, a microcomputer with a data base program, and data already available in agency files. This study could be duplicated in any area by noncomputer persons to help professionals, community organizers, and others to better understand their community and help the abusive family. 相似文献
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OBJECTIVE: Study objectives were to describe a hospital Child Protection Team's (CPT) efforts to develop and implement a protocol for systematic evaluation and management of accusations that hospital staff have abused pediatric patients, and to learn how to avoid problematic patient encounters and cope with existing accusations. METHOD: This study reports on a retrospective series of cases from one pediatric hospital between 1982 and 1996. It includes a survey of national children's hospitals' experience from 1990 through 1995. RESULTS: After initial complaints to our hospital's CPT, it became apparent that procedures were inadequate to protect the safety of patients and rights of the accused. A protocol for reporting, evaluation, and management of accusations was developed and implemented by the CPT. Thirty-four accusations of abuse of children by staff were reviewed. Seventeen of the physical abuse cases included bruising, fractures, rough handling, and verbal abuse. Eighteen sexual abuse complaints included touching and sexual statements. Complaints were substantiated in 23% of the accusations, and a third of the identified staff members were fired or resigned. Child victims had a high frequency of chronic illness. They and their families frequently had histories of prior abuse, mental illness, and social disarray. These factors made children more likely to become victims of real abuse and to misinterpret standard hospital procedures as abusive. All service areas of the hospital and types of hospital staff were accused of patient abuse. CONCLUSIONS: Few children's hospitals have formal protocols for internal management of or training programs to avoid complaints. Institutions and their staff who care for children should anticipate abuse complaints, train them in risk reduction methods, and develop accusation management plans. 相似文献
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Denov MS 《Child abuse & neglect》2003,27(1):47-61
OBJECTIVE: To explore the experiences of victims of female sex offenders with regard to disclosing sexual abuse to a professional, and importantly, the impact of professional responses on victims. METHOD: The data were derived from one-to-one semi-structured interviews with 14 (7 males, 7 females) victims of child sexual abuse by female perpetrators. Victims ranged in age from 23 to 59 years and were recruited through professional referrals or through poster advertisements in counseling services. Participants responded to questions on their family background, experience(s) of sexual abuse, experience(s) disclosing the sexual abuse to a professional, and the impact of professional responses. RESULTS: The majority of victims reported sexual abuse by their mothers. The average age of onset of the sexual abuse was age 5, lasting, on average, 6 years. Five participants reported experiencing severe, moderate and mild sexual abuse, four reported experiencing both severe and mild sexual abuse and five reported experiencing moderate and mild sexual abuse. The findings underscore the significance of professional intervention in relation to victim disclosures of sexual abuse by females. Professional responses to disclosures, whether positive or negative, appeared to have a crucial impact on the well-being of victims. Supportive professional responses including the acknowledgment and validation of victims' experiences of sexual abuse appeared to mitigate the negative effects of the abuse. In contrast, unsupportive responses where professionals minimized, or disbelieved victims' allegations of sexual abuse appeared to exacerbate the negative effects of the sexual abuse, ultimately inciting secondary victimization. CONCLUSION: The study highlights the need for the development and implementation of professional training initiatives to sensitize professionals to the issue of female sex offending and the intervention needs of victims. Failure to do so could have negative consequences for victims sexually abused by females. 相似文献
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Supporting child welfare (CW) workers’ ability to accurately assess substance abuse needs and link families to appropriate services is critical given the high prevalence of parental substance use disorders (SUD) among CW-involved cases. Several barriers hinder this process, including CW workers’ lack of expertise for identifying SUD needs and scarcity of treatment resources. Drawing from theories and emergent literature on interagency collaboration, this study examined the role of collaboration in increasing the availability of resources for identifying and treating SUDs in CW agencies. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, study findings highlight a lack of SUD resources available to CW workers. On the other hand, the availability of SUD resources was increased when CW agencies had a memorandum of understanding, co-location of staff, and more intense collaboration with drug and alcohol service (DAS) providers. These results provide evidence to support efforts to improve collaboration between CW and DAS providers and showcase specific collaboration strategies to implement in order to improve service delivery. 相似文献
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Epidemiology and etiology of reported cases of child physical abuse in Zimbabwean primary schools 总被引：6，自引：0，他引：6
Shumba A 《Child abuse & neglect》2001,25(2):265-277
OBJECTIVE: There were two objectives: First, to determine the nature and extent of physical abuse perpetrated on primary school pupils by their teachers; second, to determine why some teachers physically abuse their primary school pupils in Zimbabwe. METHOD: Epidemiological data of reported physical abuse by teachers in Zimbabwe between January 1990 and December 1997 were analyzed using information in their files. RESULTS: The study found that 78.9% of the perpetrators were male while 21.1% were female; 92.1% of the perpetrators were trained teachers while 7.9% were untrained; 58.7% of the victims were male while 41.3% were female; 91.4% of the cases were reported by the pupils themselves and 8.7% by the school head; 73.9% of these cases were reported to the Ministry of Education and 26.1% to the police. In this study, 80.4% of the victims were beaten, whipped or hit by their perpetrators; 10.9% were clapped or slapped; 4.3% were punched with fists; 2.2% each were kicked and pinched, respectively. CONCLUSIONS: The findings indicate that teachers perpetuate various forms of physical abuse and that this form of abuse is now on the increase. The findings indicate that some perpetrators use corporal punishment on female pupils against the stipulated Public Service (Disciplinary) Regulations. What is clear is that the Public Service (Disciplinary) Regulations seem not to be deterrent enough because the majority of the perpetrators are merely fined or reprimanded while only a very small percentage is discharged from the teaching service. 相似文献
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Monitoring abuse related deaths of infants and young children yields information necessary to the formulation of sound public policy. Birth and death certificates were correlated with information in the state Child Abuse and Neglect Registry on 104 abuse related fatalities. Significant findings include: very young age of parents at the first pregnancy; high rate of single parenthood; significantly lower educational achievement of victims' mothers; late, inadequate prenatal care; complications during pregnancy; and low birth weight among victims. The authors suggest Active Surveillance as a model for collecting information pertaining to child fatalities. Using Active Surveillance, a review team examines information from state agencies pertaining to children and families to review or determine cause of death and to collect demographic data on victims and perpetrators. Active Surveillance decreases the possibility of misidentifying abuse related deaths as accidental, and allows state agencies to follow abuse fatalities, collecting pertinent information and adjusting policy accordingly. The authors argue that, using Active Surveillance, states and nations may monitor success in preventing child abuse fatalities just as they now use infant mortality to monitor progress in public health, thus creating a stable and reliable standard for measuring progress in eliminating one type of child abuse. 相似文献
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Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects can be profound and life altering for victims. There is substantial literature from high income countries about signs of abuse, but a dearth of data from low and middle income countries like Pakistan. Healthcare professionals (HCP) are ideally placed to detect abuse, but, to inform interventions, an understanding of their experiences, training needs and cultural beliefs is needed. This study aimed to: (1) Explore the challenges that HCP face when managing cases of abuse; (2) Explore cultural beliefs and understand how these shape practice and (3) Identify training needs. A qualitative study using a phenomenological design was conducted. In-depth interviews were conducted with doctors, nurses and security staff in the emergency department of a large private hospital in Pakistan (n = 15). Interviews were undertaken in Urdu, translated into English and analysed using an inductive thematic approach. Multiple challenges were identified. The process of referral to legal services was poorly understood and further training and guidelines was suggested by participants. As the legal system in Pakistan does not allow HCP to keep potentially abused patients in their custody, they felt restricted in their ability to advocate and concerned about the safety of both the identified children and themselves. HCP have potential to detect abuse early; however, in Pakistan there are numerous challenges. HCP require support through training, as well as clear institutional frameworks and legal support to undertake this role. 相似文献
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OBJECTIVE: This study uses administrative data to track the first re-reports of maltreatment in a low-income, urban child welfare population (n=4957) while controlling for other public service involvement. Service system involvement is explored across the following sectors: Child Welfare, Income Maintenance, Special Education, Juvenile Court, and various forms of Medicaid-reimbursed medical or mental health care. This study builds knowledge by adding the services dimension to an ecological framework for analyses and by following recurrence for a longer period of time than prior investigations (7.5 years). METHOD: We model the re-reporting of a child for maltreatment as a function of child, caregiver, service, and neighborhood characteristics using data from birth records, child welfare, income maintenance, Medicaid, adult corrections, juvenile court, special education, law enforcement, and census sources. Bivariate and multivariate analyses are presented, the latter using Cox regression with a robust sandwich covariance matrix estimate to account for the intracluster dependence within tracts. RESULTS: Key results across bivariate and multivariate analyses included a lower rate of re-reporting among children with parents who were high school graduates and/or permanently exited from the first spell on AFDC (p<.0001); and for children in families that received less intensive in-home services compared to those not receiving services, receiving intensive in-home, or foster care services (p<.0001). Higher rates of re-reporting were found for children with Medicaid mental health/substance abuse treatment records (p<.0001) and special education eligibility for emotional disturbance (p<.005). CONCLUSIONS: Caretaker characteristics and non-child welfare service use patterns had a strong association with the likelihood of a child being re-reported to the child welfare agency and should be more heavily attended to by child welfare workers. High rates of service sector overlap suggest that interagency ties and cooperation should be strengthened. The lower risk associated with less intensive in-home services compared to un-served cases may indicate under-identification of in-home service eligibility following a first report of maltreatment. 相似文献
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OBJECTIVE: This study compared recidivism rates for alleged maltreatment perpetrators whose initial report was substantiated and those whose initial report was not substantiated, to determine whether they returned to the child welfare system at differing rates. METHOD: Statewide administrative child welfare services data over a period of 4 1/2 years was analyzed. The sample included 31,531 perpetrators of intrafamilial maltreatment. Separate analyses were conducted for each type of maltreatment (sexual abuse, physical abuse, and neglect). RESULTS: Bivariate relationships (substantiation status and recidivism) were analyzed using survival curves, and the study found that recidivism patterns differed by type of maltreatment and by substantiation status at the index event. Multivariate analyses using Cox Proportional Hazards models found that bivariate relationships held true even when controlling for neighborhood mean income, ethnicity, and gender. CONCLUSIONS: The study's finding that perpetrators whose index event was not substantiated return to the child welfare system at a high rate suggests the need to learn how to discriminate those unsubstantiated alleged perpetrators who are most at risk for recidivism. The finding of frequent cross-type recidivism indicates that intervention should focus on common themes across maltreatment types. 相似文献