2


Describing the Problem

Child abuse and neglect is well established as an important societal concern with significant ramifications for the affected children, their families, and society at large (see Chapter 4). A critical step in devising effective responses is reasonable agreement on the definition of the problem and its scope. Yet achieving clarity in the area of child abuse and neglect has been an ongoing challenge. Legal definitions vary across states; researchers apply diverse standards in determining incidence and prevalence rates in clinical and population-based studies; and substantial obstacles hamper learning about the experiences of children, especially young children, with caregiver-inflicted abuse or neglect. As a result, definitions of the characteristics of the problem and determinations of its scope will differ depending on the data source used for analysis. This challenge was articulated in the 1993 National Research Council (NRC) report (NRC, 1993) and continues to impede a full understanding of the nature of the child abuse and neglect problem. The purpose of this chapter is to describe briefly what is known about the problem from current data sources and to highlight issues that remain problematic, as well as identify areas in which advances have been made. The chapter addresses, in turn, definitions of child abuse and neglect, incidence rates and the problem of underreporting, trends in the incidence of child abuse and neglect, and how cases are determined by medical and mental health professionals and the legal system. The final section presents conclusions.



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2 Describing the Problem C hild abuse and neglect is well established as an important societal concern with significant ramifications for the affected children, their families, and society at large (see Chapter 4). A critical step in de- vising effective responses is reasonable agreement on the definition of the problem and its scope. Yet achieving clarity in the area of child abuse and neglect has been an ongoing challenge. Legal definitions vary across states; researchers apply diverse standards in determining incidence and prevalence rates in clinical and population-based studies; and substantial obstacles hamper learning about the experiences of children, especially young chil- dren, with caregiver-inflicted abuse or neglect. As a result, definitions of the characteristics of the problem and determinations of its scope will differ de- pending on the data source used for analysis. This challenge was articulated in the 1993 National Research Council (NRC) report (NRC, 1993) and continues to impede a full understanding of the nature of the child abuse and neglect problem. The purpose of this chapter is to describe briefly what is known about the problem from current data sources and to highlight is- sues that remain problematic, as well as identify areas in which advances have been made. The chapter addresses, in turn, definitions of child abuse and neglect, incidence rates and the problem of underreporting, trends in the incidence of child abuse and neglect, and how cases are determined by medical and mental health professionals and the legal system. The final section presents conclusions. 31

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32 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH DEFINITIONS A key definition of child abuse and neglect is contained in Section 3 of the Child Abuse Prevention and Treatment Act (CAPTA)1: At a minimum, any recent act or set of acts or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act, which pres- ents an imminent risk of serious harm. This definition is especially important because it is enshrined in federal legislation. To be eligible to receive funding under Section 1062 of the act, states must, at a minimum, include the conduct described in Section 3 in their state child abuse and neglect authorizing legislation. All 50 states, as well as American Samoa, the Commonwealth of Puerto Rico, the Common- wealth of the Northern Mariana Islands, the District of Columbia, Guam, and the Virgin Islands, have mandatory child abuse and neglect reporting laws that define the terms slightly differently for their jurisdiction and lay out the requirements for mandatory reporting (CWIG, 2011). Federal law defines child abuse and neglect and identifies reporting requirements on tribal lands3 (see CWIG, 2012b, for further information) and on military installations4 (see Military OneSource, n.d., for further information); in some circumstances, state laws on child abuse and neglect reporting also apply to tribal lands and military installations. The Victims of Child Abuse Act5 (also see Chapter 8) lays out requirements for reporting child abuse that occurs on federal lands and in federal facilities. The National Child Abuse and Neglect Data System (NCANDS) is the official government data source to which all states must contribute infor- mation about child abuse and neglect reports. To collect data on reported and confirmed cases of child abuse and neglect uniformly from all states, NCANDS provides the following somewhat more comprehensive definition of child abuse and neglect: An act or failure to act by a parent, caregiver, or other person as defined under State law that results in physical abuse, neglect, medical neglect, sexual abuse, emotional abuse, or an act or failure to act which presents an imminent risk of harm to a child. (ACF, 2012) Many states, reflecting the words “at a minimum” in CAPTA, have more expansive definitions of the conduct that legally constitutes child 1  42 U.S.C. § 5101 note. 2  42 U.S.C. § 52016a. 3  25 U.S.C. § 3202 and 18 U.S.C. § 1169. 4  10 U.S.C. § 1787. 5  42 U.S.C. § 13001, et seq.

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DESCRIBING THE PROBLEM 33 abuse and neglect for purposes of mandatory reporting. In some states, for example, only conduct by current caregivers is defined as reportable child abuse and neglect; in other states, the conduct must be reported regardless of the perpetrator’s relationship to the child. Pennsylvania, for example, considers only acts of abuse as reportable acts of maltreatment and uses a different mechanism for capturing neglect. CAPTA permits states to limit reporting to “recent” acts, but most states have no time limit on when the conduct occurred for the mandatory reporting requirement to be invoked. A summary of the differences in states’ child abuse and neglect reporting laws is available (CWIG, 2011). How child abuse and child neglect are defined and who is obligated to report them are subject to changes in awareness or level of concern about possible abuse- and neglect-related hazards faced by children. It is common for a specific case, especially one involving an egregious situation not addressed by extant law, to prompt advocacy for legislative change (Gainsborough, 2010). Newly identified problem areas, changes in societal consensus about child protection, and revelations that certain groups of professionals are not included in mandatory reporting laws are typical scenarios for bringing about statutory reforms. In 2012, 107 bills address- ing child abuse and neglect reporting were introduced in 30 states and the District of Columbia (NCSL, 2012). For example, a number of states ex- panded mandatory reporting to apply to university employees in response to the Penn State Sandusky scandal. In some cases, such changes have unintended consequences. An ex- ample is the occasional inclusion of exposure to domestic violence as a statutorily specified form of reportable child abuse and neglect, a result of increasing awareness of the association between domestic violence and child abuse and neglect and concern for the welfare of children exposed to this violence, so that affected children would receive protection and services. The Minnesota state legislature instituted such a change in 1999. The result was a dramatic increase in the number of referrals, emanating mainly from law enforcement officials who responded to reports of domestic violence and, as mandated, reported the family to child protective services. Parents, primarily mothers, who themselves were victims of domestic violence thus became the subjects of neglect reports based on their alleged failure to pro- tect their children from exposure to the violence. This was not the intent of the legislation, and the provision was quickly rescinded (Edleson et al., 2006). Child abuse and neglect laws are for the most part concerned with pa- rental behaviors of omission or commission that place children in jeopardy. Acts of omission usually are characterized as neglect. They include failing to provide adequate supervision; not protecting children from known dangers; and not providing for basic needs, such as proper medical care, adequate

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34 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH food and clothing, safe/hygienic shelter, and school attendance. Child ne- glect reports may also be made in some states if a child is born affected by illegal drug or alcohol abuse by the mother or if a child is living where drugs are being manufactured and/or distributed. Child abuse, on the other hand, refers to acts of commission by a care- giver. Physical abuse encompasses physical assaults that exceed permitted corporal punishment. States may define explicitly the types of behavior that fall in this category. In some cases for example, the age of the child may determine whether a behavior is acceptable discipline (e.g., slapping an in- fant versus an older child across the face). Sexual abuse generally includes the range of sexual behaviors that are defined by criminal statutes, includ- ing sexual exposure, sexual touching, rape, and sexual exploitation. Emo- tionally abusive behaviors include threatening, terrorizing, or deliberately frightening a child; rejecting, ridiculing, shaming, or humiliating behaviors; extreme isolating or restricting behaviors; and corruption or encouraging involvement in illegal behaviors. However, of the 48 states that mention emotional abuse in law, only Delaware identifies specific emotionally abu- sive caregiver behaviors; most states define emotional abuse by its impact on the child’s mental health (CWIG, 2011). Because the involvement of the child protection system focuses on caregivers, cases of abuse committed by non-family members or siblings may be classified as neglect. In those cases, it is the presumed or alleged failure of the caregiver to protect the child that drives the designation. For example, the majority of sexual abuse and a notable proportion of serious physical abuse cases involve non-family mem- bers as perpetrators (Finkelhor and Dziuba-Leatherman, 1994). Instances of abuse committed by a non-family member, a sibling, or another person regularly present in the household are classified as neglect if it is determined that the caregiver failed to protect the child victim from that individual. As noted, child abuse and neglect laws also vary in how mandated re- porters are defined. Some states define all adult citizens as mandated report- ers, but most specify certain groups of professionals and others who work with children (CWIG, 2012a). State laws usually exempt from a reporting obligation priests acting in the role of receiving confession; states vary, however, as to whether reporting is required of priests or pastors acting in other capacities. Regardless of the groups specified, anyone not listed as a mandated reporter can still make a report. Both mandated reporters and others are legally protected for good faith reports, while mandated report- ers who fail to report may be prosecuted for that failure. No evidence-based research has assessed whether the breadth of inclusion in mandatory report- ing laws makes a difference in rates of reporting, although it may affect substantiation rates (McElroy, 2012; also see the discussion of mandatory reporting laws in Chapter 8). Some acts of child abuse and neglect are also crimes. The specific statu-

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DESCRIBING THE PROBLEM 35 tory definitions and names of those crimes vary by state, but in general, criminal statutes cover the same acts in all states. Sexual abuse is always a crime; most cases are classified as felonies. Physical abuse is a crime unless the behavior falls within the discipline exception for corporal punishment. Most cases of physical abuse are likely to be classified as misdemeanors un- less a child is seriously injured or dies. A minority of neglect cases involve criminal conduct. When the failure to supervise, protect, or provide care for a child rises to a certain level of negligent treatment, it may meet the criteria for violation of criminal codes (e.g., child endangerment or criminal neglect) and can be prosecuted. Just because child abuse and neglect falls within the statutory definition of a crime, however, does not mean it will be fully investigated by law enforcement and prosecuted. Law enforcement in- vestigations and prosecutions tend to focus on sexual abuse and on serious physical abuse and very serious neglect that have resulted in a child’s expe- riencing physical harm or death (e.g., starvation, inflicted medical trauma). As with state laws, child abuse and neglect is defined in various ways for research purposes. The National Incidence Study (NIS)-4 (Sedlak et al., 2010a) applies two definitional standards: a harm standard and an en- dangerment standard. The harm standard is restricted to cases in which children have been harmed by child abuse and neglect, whereas the endan- germent standard encompasses children who have not yet been harmed under certain circumstances. The numbers vary depending on which defini- tion is used (NIS-4 harm standard = 1.25 million children; endangerment standard = 3 million children). Under both standards, alleged instances of abuse or neglect are classified according to eight major categories. Table 2-1 lists actions or failures to act that are representative of each type of abuse or neglect and, for the purposes of this chapter, provides examples of how these forms of maltreatment can be defined in a research setting. A widely used method of defining child abuse and neglect in research is the classification scheme developed by Barnett and colleagues (1993). Many studies focused specifically on child abuse and neglect use these definitions rather than the officially reported labels (e.g., English et al., 2005). The Centers for Disease Control and Prevention (CDC) also has recommended a set of uniform definitions for public health purposes to allow for moni- toring of incidence over time and detection of trends (Leeb et al., 2008). Notably, both the classification scheme developed by Barnett and colleagues and the CDC recommendations are designed for analysis of existing infor- mation from public sources, primarily child protective services case records. Slack and colleagues (2003) note that research definitions developed for analysis of child protective services case records may not be applicable to survey research. They argue that these definitions may capture risk factors associated with the detection of child abuse and neglect rather than risk factors associated with the commission of child abuse and neglect. They

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36 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH TABLE 2-1  National Incidence Study (NIS)-4 Abuse and Neglect Classifications Sexual Abuse • Intrusion sex without force • Intrusion sex involving use of force •  hild’s prostitution or involvement in pornography with C intrusion • Molestation with genital contact • Exposure/voyeurism • Providing sexually explicit materials •  hild’s involvement in pornography without intrusion C •  ailure to supervise the child’s voluntary sexual activity F •  ttempted/threatened sexual abuse with physical contact A • Other/unknown sexual abuse Physical Abuse • Shake, throw, purposefully drop • Hit with hand • Hit with object • Push, grab, drag, pull • Punch, kick • Other physical abuse Emotional Abuse • Close confinement: tying/binding • Close confinement: other • Verbal assaults and emotional abuse • Threats of sexual abuse (without contact) • Threats of other maltreatment • Terrorizing the child • Administering unprescribed substances • Other/unknown abuse Physical Neglect •  efusal to allow or provide needed care for a diagnosed R condition or impairment •  nwarranted delay in seeking or failure to seek needed care U • Refusal of custody/abandonment • Other refusal of custody • Illegal transfer of custody •  ther or unspecified custody-related maltreatment—unstable O custody arrangements • Inadequate supervision • Inadequate nutrition • Inadequate personal hygiene • Inadequate clothing • Inadequate shelter •  ther/unspecified disregard of child’s physical needs and O physical safety

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DESCRIBING THE PROBLEM 37 TABLE 2-1 Continued Educational Neglect • Permitted chronic truancy • Other truancy • Failure to register or enroll • O  ther refusal to allow or provide needed attention to a diagnosed educational need Emotional Neglect • Inadequate nurturance/affection • Domestic violence • Knowingly permitting drug/alcohol abuse • K  nowingly permitting other maladaptive behavior • R  efusal to allow or provide needed care for a diagnosed emotional or behavioral impairment/problem • F  ailure to seek needed care for an emotional or behavioral impairment/problem • Overprotectiveness • Inadequate structure • Inappropriately advanced expectations • E  xposure to maladaptive behaviors and environments • O  ther inattention to developmental/emotional needs Other Maltreatment • Lack of preventive health care • G  eneral neglect—other/unspecified neglect allegations • Custody/child support problems • Behavior control/family conflict issues • Parent problem • General maltreatment—unspecified/other Not Codable by • Involuntary neglect Any NIS Standard • Chemically dependent newborns • Nonmaltreatment cases SOURCE: Sedlak et al., 2010a. have built on the framework created by Barnett and colleagues (1993) to develop a set of research definitions for neglect that they intend for use in survey research. Likewise, other investigators develop their own study-specific designa- tions. These definitions vary in comprehensiveness and behavioral specific- ity. For example, a study not focused specifically on child abuse and neglect but interested in it as one of many independent variables may use a single general question to get at the construct. Finding: Child abuse and neglect are defined differently for different purposes. Legal definitions at the state level are properly subject to the legislative process. In research, however, the variability in definitions

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38 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH compromises learning the true scope and characteristics of the prob- lem, understanding trends over time, and determining the relationship between child abuse and neglect and various outcomes. Finding: State laws vary in what groups are specified as mandated reporters of child abuse and neglect. No evidence-based research has assessed whether the breadth of inclusion in mandatory reporting laws makes a difference in rates of reporting, although it may affect sub- stantiation rates. INCIDENCE RATES AND THE PROBLEM OF UNDERREPORTING Determining the true incidence of child abuse and neglect is prob- lematic for the same reason encountered in attempting to quantify any social problem: discrepancies between actual rates and the number of cases reported to authorities. It is well established that most crimes (the excep- tion being homicide) are not reported (Langton et al., 2012). Data on the incidence of child abuse and neglect are derived from three primary sources: NCANDS, the official reporting system for cases of child abuse and neglect referred to state child protective services; two U.S. government surveys— the Uniform Crime Reporting (UCR) system, administered by the Federal Bureau of Investigation (FBI), and the National Crime Victimization Survey (NCVS), administered by the Bureau of Justice Statistics (BJS) to a large representative sample of U.S. citizens aged 12 and older; and the NIS, a study conducted every decade by the Department of Health and Human Services on a nationally representative sample that captures both cases of abuse and neglect reported to child protective services and unreported cases identified by professionals working with children. National Child Abuse and Neglect Data System Each state receiving a federal Basic State Grant for child abuse and neglect prevention and treatment programs is required to submit data an- nually to NCANDS.6 In fiscal year (FY) 2011, all states, the District of Co- lumbia, and all territories contributed to NCANDS counts of the number of cases referred to child protective services, the number accepted for in- vestigation, the number substantiated, the case characteristics, and the case outcomes. As previously noted, the definitions of child abuse and neglect used by child protective services vary by state, as do reporting requirements. Because NCANDS collects information from child protective services case files in each state, the data reflect inconsistencies in state-level definitions of 6  42 U.S.C. § 5106a(d).

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DESCRIBING THE PROBLEM 39 types of maltreatment, reporting requirements, and procedures for respond- ing to reports of child abuse and neglect. NCANDS reports are issued annually. According to the FY 2011 NCANDS report (ACF, 2012), there were 3.4 million referrals involving 6.2 million children; some of the children were the subject of more than one referral. Nationally, more than three-quarters of these cases are classified as neglect, 18 percent as physical abuse, and 9 percent as sexual abuse. The specific rates vary among states but overall reflect the general pattern that a substantial majority of cases are neglect, with physical and sexual abuse representing much smaller groups. Based on NCANDS, victims of child abuse and neglect are approxi- mately evenly divided between males and females. The highest rates of child abuse and neglect occur among the very youngest children (see Table 2-2). Perpetrators are mainly parents (81 percent) and among parents are pri- marily biological parents (88 percent), which reflects the legal definition for reportable cases. Somewhat more than half of perpetrators are female (ACF, 2012). These demographic characteristics are also reflected in other data sources, such as the NIS-4 (Sedlak et al., 2010a). In FY 2011, NCANDS reported 1,545 child fatalities resulting from abuse and neglect. Again, young children were at greatest risk: 80 percent of victims were less than 4 years old. Deaths were higher among boys than girls. About 70 percent of the fatalities are associated with neglect and nearly half are attributed to physical abuse, either exclusively or in com- bination. A Government Accountability Office (GAO, 2011) report notes that the NCANDS method relies only on cases reported to child protective services for these figures. The report states that not all child fatalities due to abuse and neglect are known to the child welfare system, suggesting that the actual figure is likely higher, although it acknowledges the difficulty of obtaining an accurate count. An important limitation of NCANDS is that it does not capture accu­ rate rates of child abuse and neglect among American Indian children. Only states submit information to NCANDS; there are no mechanisms for tribal child welfare systems to submit data to the system. American Indian and Alaska Native families and children whose cases are reported to and inves- tigated by state child protection authorities and who self-identify as Ameri- can Indian or Alaska Native are included in NCANDS. Children served by tribal child welfare systems, the Bureau of Indian Affairs, or the Indian Health Service are not. Thus, “it is estimated that 40 percent of all cases of child abuse and neglect among American Indian and Alaska Native children are not reported to NCANDS” (Cross and Simmons, 2008, p. 3; also see Earle and Cross, 2001). NCANDS is further limited in its ability to reveal the levels of abuse and neglect suffered by American Indian and Alaska N ­ ative children by the fact that state or county employees, rather than

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40 TABLE 2-2  Child Maltreatment Cases/Victims, Rates per Thousand Population Ages 0-17,a by Various Characteristics, 2002-2011 Characteristic 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Total 12.3 12.4 12.0 12.1 12.1 10.6 10.3 9.3 9.3 9.1 Gender Male 11.6 11.6 11.2 11.3 11.4 9.9 9.7 8.8 8.7 8.7 Female 13.1 13.1 12.6 12.7 12.7 11.1 10.8 9.7 9.7 9.6 Age 0-3 16.0 16.4 16.1 16.5 16.8 14.9 14.7 13.6 13.7 14.3 4-7 13.7 13.8 13.4 13.5 13.5 11.5 11.0 9.7 9.7 9.9 8-11 11.9 11.7 10.9 10.9 10.8 9.5 9.2 8.1 8.0 7.7 12-15 10.6 10.7 9.3 10.2 10.2 8.7 8.4 7.6 7.3 7.0 16-17 6.0 5.9 6.1 6.2 6.3 5.4 5.5 5.1 5.0 4.8 Race and Hispanic Origin of Victimb Non-Hispanic white 10.7 11.0 10.7 10.8 10.7 8.3 7.9 7.8 8.1 7.9 Non-Hispanic black 20.2 20.4 19.9 19.5 19.8 15.4 15.4 15.1 14.7 14.3 Hispanic 9.5 9.9 10.4 10.7 10.8 9.2 9.0 8.7 8.6 8.6 Non-Hispanic American Indian or 21.7 21.3 15.5 16.5 15.9 12.4 12.6 11.5 11.3 11.4   Alaska Native Non-Hispanic Asian — 2.7 2.9 2.5 2.5 2.2 2.2 2.0 1.9 1.7 Non-Hispanic Pacific Islander — 21.4 17.6 16.1 14.3 11.5 10.7 11.3 9.8 8.5 Multiple races 12.4 12.8 14.6 15.0 15.4 11.8 12.4 12.4 10.0 10.1

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Type of Maltreatmentc Neglect 7.2 7.5 7.4 6.3 6.4 6.2 7.4 8.1 7.1 7.2 Physical abuse 2.3 2.3 2.1 1.7 1.6 1.1 1.7 1.8 1.6 1.6 Sexual abuse 1.2 1.2 1.2 0.9 0.9 0.8 1.0 1.0 0.8 0.8 Psychological or emotional abuse 0.8 0.6 0.9 0.7 0.7 0.4 0.8 0.8 0.7 0.8 Medical neglect 0.3 0.3 0.3 0.2 0.2 0.1 0.2 0.3 0.2 0.2 Other 3.3 3.7 3.2 1.5 1.5 0.4 0.9 — — 0.9 aIncludes “substantiated” cases, in which investigation results in a disposition concluding that the allegation of maltreatment or risk of maltreat- ment was supported or founded according to state law or policy—the highest level of finding by a state agency. Also includes cases designated “indicated” or “reason to suspect,” which are those not substantiated by investigation but for which there is reason to suspect that the child may have been maltreated or was at risk of maltreatment. Not all states distinguish between substantiated and indicated dispositions. All data for 2009 and later represent “unique” cases—children who have experienced at least one instance of substantiated or indicated maltreatment (see definition above), with duplicate cases removed. bEstimates for specific racial groups have been revised to reflect the new Office of Management and Budget race definitions and include only those who are identified with a single race. Hispanics may be of any race. cA child may be a victim of multiple types of maltreatment and is counted once for each type (2007, when children were counted once only, was an exception). SOURCES: CDC, 2003; Children’s Bureau, 1995-2011, reprinted with permission from Child Trends (2013). 41

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58 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH greatest number of reported cases involve neglect, and most do not involve criminal conduct, the child protective services investigation is the only process applied to making a determination about child abuse and neglect in the majority of cases. Caseworkers make home visits and observe the safety and hygiene status of the household; inspect bruises and injuries; and conduct interviews with children (when appropriate), caregivers, reporters, and others who may have relevant information (such as relatives, teachers, and health care providers). They then draw conclusions about whether the information and evidence thus obtained meet the legal standards for child abuse and neglect. Law enforcement officials investigate crimes. They generally engage in the same activities as child welfare system caseworkers (e.g., interviewing victims and witnesses, examining home conditions); they may also collect evidence from crime scenes, undertake forensic analyses, and interrogate suspects. In many jurisdictions, child protective services and law enforce- ment officials conduct joint investigations (Cross et al., 2005). A key activity in many child abuse and neglect dependency and criminal investigations, especially in cases involving sexual abuse and some involving physical abuse, is interviewing the child. Interviewing methods most likely to lead to accurate and complete reports have been extensively investigated (e.g., Cronch et al., 2006; Lamb et al., 2009; Larsson and Lamb, 2009; Saywitz et al., 2002). The protocol of the National Institute for Child Health and Development (NICHD) is the approach that has been the most researched in real-life settings and in laboratory analogue experiments, and serves as the model for the current standard of practice (Lamb et al., 2007). Other extant models, none of which has undergone the same level of empirical evaluation, share almost all the same procedures and practices as the NICHD protocol (Anderson et al., 2010). Legal Determinations A legal determination of child abuse and neglect is based on the weigh- ing of admissible evidence that is collected following the accepted proce- dures for the specific legal arena. The common law legal system in the United States is adversarial and is based on principles that protect the due process rights of those who are accused and risk loss of liberty, access to their children, or assets. The legal contexts vary by whether they are crimi- nal or civil, the intended outcomes of the case, and the standard of proof that applies. The two primary legal systems that make determinations about child abuse and neglect are the child protection system and the criminal justice system (Myers, 2012). The child protection system carries out an adminis- trative and civil justice process that involves the state’s seeking to intervene

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DESCRIBING THE PROBLEM 59 in families, often but not always to assume temporary custody of children (e.g., establishing child abuse or neglect and then obtaining authority of the court for the child’s placement) or in a small fraction of cases to terminate parental rights. In these court cases (often called dependency cases), the standard of proof typically is more probable than not; in a case involving termination of parental rights, a higher standard of clear and convincing evidence has been set by the U.S. Supreme Court. The goals of the crimi- nal justice system are to hold lawbreakers accountable and punish them, to bring justice for victims, and to protect the community. The standard of proof here is the highest (beyond a reasonable doubt) because the case involves the government’s restricting an adult’s liberty, including the pos- sibility of incarceration. Child abuse and neglect also may be addressed in family court custody matters when it is alleged by one parent seeking to restrict the other parent’s access to the child. In addition, civil tort actions may be brought in which a child, or someone on his/her behalf, sues a care- giver, the government, or another entity for negligence, seeking monetary damages. The large majority of both civil and criminal proceedings regarding child abuse and neglect do not progress to a formal fact-finding hearing or a trial. In many child protection cases, usually those not requiring a court order to remove a child from home against parental wishes, no formal legal process is even initiated; the family agrees to a voluntary service plan that is overseen by the state. Even when a dependency petition is filed in court, in the large majority of cases the parent reaches an agreement or case settlement regarding dependency, often without admitting to having committed an act of child abuse and neglect. On the criminal side, charges are not filed in many cases, even when prosecutors may believe a crime oc- curred, because of difficulties entailed in proving the case and in meeting the legal standard of proof of beyond a reasonable doubt. In the majority of cases when charges are filed, the accused pleads guilty to the crime or to a lesser crime. Substantiation The child protection system’s classification of a child abuse and neglect case as substantiated is an administrative procedure for making a formal recorded determination about the validity of a child abuse and neglect report. In most states, the result of an investigation of a report is classified as substantiated or unsubstantiated, although some states use other termi- nology (e.g., founded/unfounded) to describe the investigative outcome. In 2011, approximately 19 percent of screened-in cases were substantiated, or “indicated” (ACF, 2012). Substantiation can be legally disputed because the consequences of a substantiated report can be significant for caregivers

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60 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH (e.g., job loss or being barred from certain professions or by certain employ- ers) (CWIG, 2013; McCarthy et al., 2005). No formal conclusion about whether child abuse and neglect occurred is recorded in cases that are referred for an alternative response (sometimes called a family assessment or differential response) and not formally inves- tigated (CWIG, 2013). In 2011, about 10 percent of all cases reported to NCANDS received an alternative response (ACF, 2012), but that percentage is increasing. As of 2011, 17 states were implementing differential response at some level, and 6 states planned to implement it in the near future. Rates of substantiation vary dramatically across states (ACF, 2012), and there is little consensus on what accounts for this variation. Overall, every method used to determine the accuracy of child abuse and neglect allegations has weaknesses and cannot be considered definitive. To some ex- tent, this does not matter as long as the victims are safe and receive needed services. For example, most crimes will not be reported or prosecuted or result in conviction of the perpetrator; however, crime victims will still have access to many services designed to help them recover from the effects of the crime, and most can take at least some steps toward protecting themselves from the perpetrator. Although child abuse victims are dependent on care- givers for future protection, many parents can and do take steps to protect their children from known perpetrators or correct their own neglectful or abusive behavior. In terms of access to needed services, what happens officially in a case is unrelated to receipt of services in the child welfare system. The National Survey of Child and Adolescent Well-Being, a large longitudinal study of a nationally representative sample of cases reported to child protective services, produced illustrative results. Comparisons of cases that were closed or kept open, or were substantiated or not, revealed no difference in key variables related to services or outcomes (Hussey et al., 2005; Kohl et al., 2009). The difficulty of ascertaining the validity of cases using official report- ing or procedural outcomes may have more of an effect on research and interpretation of findings than on the lives of children who enter the child welfare system. For example, Kohl and colleagues (2009) argue that if substantiation does not discriminate true from untrue cases of child abuse and neglect, it is not a meaningful or accurate way of learning about the characteristics of actual abuse and neglect and its relationships to outcomes since the comparison group of unsubstantiated cases will contain many true cases. Therefore, child abuse research may benefit if consensus is achieved not only on definitions, but also on the meaning of different classification mechanisms for child abuse and neglect reports. Finding: Significant advances have been made in dealing with children who may have been abused and neglected when they come in contact

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DESCRIBING THE PROBLEM 61 with medical, mental health, or social services professionals. It has be- come more common for these professionals to screen children routinely for abuse and other traumatic experiences. The children’s accounts are generally accepted, at least for purposes of meeting the “reasonable sus- picion” standard for making a child abuse report, except when there is significant evidence for coercion or contamination of their statements. Children who are suspected of being abused are commonly referred for specialized assessment, as well as clinical and support services. Finding: Overall, substantial improvements have been achieved in the assessment and investigative procedures for determining whether child abuse and neglect has occurred since the 1993 NRC report was issued. Widely accepted standards for proper interviewing have been adopted by child protective services, law enforcement officials, and forensic evaluators and are well known even among general health, mental health, and other professionals (Lamb et al., 2007). Finding: Rates of substantiation of child abuse and neglect allegations by child protective services vary dramatically across states, and there is little consensus on what accounts for this variation. Overall, every method of determining the accuracy of child abuse and neglect allega- tions has weaknesses, and no method can be considered definitive. This limits the substantiation classification as a meaningful way to learn about the characteristics of actual abuse and neglect and their relation- ships to outcomes. CONCLUSIONS Child abuse and neglect is a pervasive societal problem, with recent NCANDS data indicating that 3.4 million child abuse and neglect refer- rals involving 6.2 million children were made in a single year across the United States and its territories. As will be discussed in Chapter 4, these incidents of child abuse and neglect entail a substantial risk for deleterious consequences that can hinder child development and lead to problems that persist across the life course. Cases of child abuse and neglect are referred to child protective services based on mandatory reports by professionals such as teachers, law enforce- ment officials, social service providers, and physicians, as well as good-faith reports by citizens. Not all cases of child abuse and neglect are reported, and standards for reasonable suspicion of abuse and neglect are not always clear- cut. Therefore, official reports do not capture all cases in which child abuse and neglect is suspected or even is detected and acted upon. For research purposes, then, sole reliance on referral data from child protective services

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62 NEW DIRECTIONS IN CHILD ABUSE AND NEGLECT RESEARCH cannot capture the full scope of child abuse and neglect. Incorporating data from additional sources is necessary to determine the true incidence of the problem. In addition, child abuse and neglect are defined differently for the varying purposes for which related information is collected, confounding attempts to portray the scope of the problem accurately or examine the sur- rounding circumstances. Results across studies based on surveys also may vary according to the survey methodology employed. Movement toward a reasonable degree of standardization in these areas is therefore needed. Difficulties in ascertaining the scope of child abuse and neglect have contributed to uncertainties regarding whether the incidence of the problem is increasing or decreasing or cases are being detected and reported more frequently. Available trend data provide strong evidence that sexual abuse has declined substantially in the past two decades; the balance of evidence favors a decline in physical abuse, especially its more common and less seri- ous forms. There is no evidence that neglect is declining overall. However, states vary significantly as to whether neglect is increasing, decreasing, or remaining constant. Discrepancies and ambiguity across analyses of differ- ent data sources highlight a need for more systematic empirical analyses of these trends over time. Research is needed to learn more about trends in child abuse and neglect and the variables that may account for decreases in the incidence of the problem or the lack thereof. REFERENCES ACF (Administration for Children and Families). 2012. Child maltreatment, 2011 report. Washington, DC: U.S. Department of Health and Human Services, ACF. Alvarez, K. M., M. C. Kenny, B. Donohue, and K. M. Carpin. 2004. Why are profes- sionals failing to initiate mandated reports of child maltreatment, and are there any empirically based training programs to assist professionals in the reporting process? Aggression and Violent Behavior 9(5):563-578. Anderson, J., J. Ellefson, J. Lashley, A. Lukas Miller, S. Olinger, A. Russell, J. Stauffer, and J. Weigman. 2010. Cornerhouse forensic interviewing protocol: RATAC. Thomas M. Cooley Journal of Practical and Clinical Law 12:193-331. APA (American Psychiatric Association). 2013. DSM-5 diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: APA. Barnett, D., J. T. Manly, and D. Cicchetti. 1993. Defining child maltreatment: The in- terface between policy and research. Child Abuse, Child Development, and Social Policy 8:7-73. Berger, L. M., and J. Waldfogel. 2011. Economic determinants and consequences of child maltreatment. OECD social, employment and migration working papers, no. 111. Paris, France: OECD Publishing. Berger, R. P., J. B. Fromkin, H. Stutz, K. Makoroff, P. V. Scribano, K. Feldman, L. C. Tu, and A. Fabio. 2011. Abusive head trauma during a time of increased unemployment: A multicenter analysis. Pediatrics 128(4):637-643.

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