IDENTIFICATION AND DEFINITIONS
2-1: Recognizing that the absence of consistent research definitions seriously impedes the development of an integrated research base in child abuse and neglect, a series of expert multidisciplinary panels should be convened to review existing work and to develop a consensus on research definitions of each form of abuse and neglect.
2-2: Sound clinical-diagnostic and research instruments for the measurement of child maltreatment are needed to operationalize the definitions discussed under Recommendation 1.
2-3: Research should be conducted on the detection processes that lead to the definition of cases identified in child protective services records and other social agencies that handle child maltreatment.
2-4: Empirical research that builds on existing medical knowledge of the physical indicators of child sexual and physical abuse would assist physicians in the identification of child maltreatment. Such identification would also be facilitated by the development of training programs that integrate research findings from child maltreatment studies into the education of health professionals.
SCOPE OF THE PROBLEM
3-1: State data systems should be improved so that high-quality research on service systems can be conducted.
3-2: Standardized measures and methodological research should be developed for use in epidemiologic studies of child abuse and neglect.
3-3: Data collection efforts should capitalize on future national survey efforts to include questions on child abuse and neglect.
3-4: Research should encourage secondary analyses of existing data available from multiple national surveys for questions about abuse and neglect.
3-5: After considerable work on instrumentation, including investigations into the most effective questioning strategies, the panel recommends the funding of a series of full-scale epidemiologic studies on the incidence and prevalence of child abuse and neglect.
ETIOLOGY OF CHILD MALTREATMENT
4-1: Research using multivariate models and etiological theories that integrate ecological, transactional, and developmental factors will improve our understanding of the causes of child maltreatment. Rather than focusing on specific factors (such as depression, unemployment, or history of abuse), the interactions of variables at multiple ecological levels should be examined.
4-2: Similarities and differences among the etiologies of different forms of child maltreatment should be clarified in order to improve the quality of future prevention and intervention efforts.
4-3: Studies of similarities and differences in the etiologies of various forms of maltreatment across various social class, cultural, and ethnic populations should be supported.
5-1: Research on home visiting programs focused on the prenatal, postnatal, and toddler periods has great potential for enhancing family functioning and parental skills and reducing the prevalence of child maltreatment.
5-2: Research on child sexual abuse prevention needs to incorporate knowledge about appropriate risk factors as well as the relationship between
cognitive and behavioral skills, particularly in situations involving known or trusted adults. Sexual abuse prevention research also needs to integrate knowledge of factors that support or impede disclosure of abuse in the natural setting, including factors that influence adult recognition of sexual abuse or situations at risk for child abuse.
5-3: Research evaluations are needed to identify the extent to which community-based prevention and intervention programs (such as school-based violence or domestic violence prevention programs, Head Start, etc.) focused on families at risk of multiple problems may affect the likelihood of child maltreatment. Research is also needed on these programs to identify methodological elements (such as designs that successfully engage the participation of at-risk communities) that could be incorporated into child maltreatment prevention programs.
5-4: Evaluations of school-based programs designed to prevent violence and to improve parental skills are needed to identify the subpopulations most likely to benefit from such interventions and to examine the impact of school-based programs on the abusive behaviors of young parents.
5-5: Research should be conducted on values and attitudes within the general public that contribute to, or could help discourage, child maltreatment. The role of the media in reinforcing or questioning cultural norms in areas important to child maltreatment, such as corporal punishment, deserves particular attention.
CONSEQUENCES OF CHILD ABUSE AND NEGLECT
6-1: Research that simultaneously assesses consequences across multiple outcomes for multiple types of maltreatment should be supported.
6-2: The consequences of child abuse and neglect should be examined in a longitudinal developmental framework that examines the timing, duration, severity, and nature of effects over the life course in a variety of cultural environments.
6-3: Intergenerational studies require support to identify relevant cycles and key factors that affect intergenerational transmission of child maltreatment.
6-4: Research needs to consider the co-occurrence of multiple forms of child victimization in the social context of child maltreatment behaviors.
6-5: Research on the role of protective factors, including gender differences in vulnerability and manifestations of subsequent problem behaviors, needs further examination.
6-6: Research is needed to improve the methodological soundness of child maltreatment studies, to test hypotheses, and to develop relevant theories of the consequences of childhood victimization.
INTERVENTIONS AND TREATMENT
7-1: Research on the operation of the child protection system, including an evaluation of the sequential stages by which children receive treatment following reports of maltreatment, is a priority need. The factors that influence different aspects of case handling decisions, factors that improve the delivery of case services, and alternatives to existing arrangements for providing services to children and families in distress need to be described and evaluated.
7-2: Controlled group outcome studies are needed to develop criteria to assess the effects of treatment interventions for maltreated children. Adequate measures need to be developed to assess outcomes of treatment for victims of abuse and neglect, and methods by which developmental, social, and cultural variations in abuse symptomatology can be integrated into treatment goals and assessment instruments need to clarified. The criteria that promote recovery and treatment modalities appropriate for children depending on their sex, age, social class, cultural background, and type of abuse need to be identified.
7-3: Well-designed outcome evaluations are needed to assess whether intensive family preservation services reduce child maltreatment and foster the well-being of children in the long-term.
7-4: Studies of foster care that examine the conditions and circumstances under which foster care appears to be beneficial or detrimental to the child are urgently needed.
7-5: Large-scale evaluation studies of treatments for perpetrators of sexual and physical abuse and neglect (familial as well as extrafamilial), with lengthy follow-up periods and control groups of untreated or less intensively treated offenders, need to be designed to compare different treatment modalities. Because of their relatively low costs, evaluations of self-help and support programs may be particularly beneficial. Early intervention through
the treatment of adolescent offenders also deserves special consideration at this time.
7-6: Effective interventions for neglectful families need to be identified. Large-scale evaluation studies of child neglect should be developed to determine types of interventions that can mitigate chronic neglectful behaviors among offending parents and improve outcomes for children victimized by neglect.
HUMAN RESOURCES, INSTRUMENTATION,
AND RESEARCH INFRASTRUCTURE
8-1: Better measures are needed to assess the strengths and weaknesses of the available pool of researchers who can contribute to studies of child maltreatment. A directory of active research investigators, identifying key fields of research interests, should be developed in collaboration with professional societies and child advocacy organizations, whose members have research experience on child abuse and neglect.
8-2: Governmental agencies and foundations that sponsor research in child maltreatment need to recognize the importance of strengthening research resources in the disciplines that contribute to understanding of child abuse and neglect. In particular, efforts to cross-fertilize research across and within disciplines are necessary at this time.
8-3: The creation of a corps of research-practitioners familiar with studies of child maltreatment, especially in the fields of law, medicine, psychology, social work, sociology, criminal justice, and public health, should be an explicit goal of federal, state, and private agencies that operate programs in areas of child welfare, child protection, maternal and child health, and family violence.
8-4: The cultural and ethnic diversity of the corps of research investigators concerned with child maltreatment studies is not broad enough to explore the importance of culture and ethnicity in theories, instrumentation, and other aspects of research on child abuse and neglect. Special efforts are needed at this time to provide educational and research support for researchers from ethnic and cultural minorities to strengthen the diversity of human resources dedicated to this topic.
8-5: The interdisciplinary nature of child maltreatment research requires the development of specialized disciplinary expertise as well as opportunities for collaborative research studies. Postdoctoral training programs designed
to deepen a young scientist’s interests in research on child abuse and neglect should be given preference at this time over graduate student dissertation support, although both training efforts are desirable in the long term.
8-6: Federal agencies should develop mechanisms to provide continuing support, in collaboration with state agencies, for interdisciplinary training programs that can provide graduate and post-graduate education in the examination of child maltreatment issues.
8-7: Research agencies should give priority attention to the development and dissemination of research instruments that have been shown to be effective in improving the quality of data collected in child maltreatment studies. Particular attention should be given in the near term to instruments that improve the identification of child maltreatment in order to lessen research dependence on reported cases of child abuse and neglect. Attention should be given to the development of instruments that are sensitive to ethnic and cultural differences and that can improve the quality of etiology and consequences studies in selected subgroups.
8-8: Several multidisciplinary centers should be established to encourage the study of child maltreatment and to integrate research in the training of service providers. The purpose of these centers should be to assemble a corps of faculty and practitioners focused on selected aspects of child abuse and neglect, and to provide a critical mass in developing long-term research studies, evaluating major demonstration projects to build on and expand the existing base of empirical knowledge, and building a research-based curriculum for the law, medical, and social service schools.
8-9: The level of financial support currently available for research on child maltreatment is poorly documented. The Congress should request that the General Accounting Office conduct a thorough review of all ongoing federally supported research on child abuse and neglect to identify and categorize research programs that are directly or indirectly relevant to this area, particularly if their primary goal is in support of a related objective, such as the reduction of family violence, injuries, infant mortality, and so forth.
8-10: Very small amounts of research funds are available for in-depth, prospective, long-term studies of child maltreatment. The research budgets for the National Center on Child Abuse and Neglect (NCCAN), the National Institute of Mental Health, the National Institute of Child Health and Human Development, the Centers for Disease Control and Prevention, and the Department of Justice as the primary funders of child maltreatment studies,
should be reviewed to identify sources of support that might be pooled for longitudinal studies of interest to several agencies.
8-11: State agencies have an important role in developing and disseminating knowledge about factors that affect the identification, treatment, and prevention of child maltreatment. NCCAN should encourage the development of a state consortium that can serve as a documentation and research support center, allowing the states to collaborate in child maltreatment studies and facilitating the dissemination of significant research findings to state officials and service providers.
8-12: As best as can be determined, the federal government currently spends about $15 million per year on research directly related to child maltreatment. Recognizing that fiscal pressures and budgetary deficits diminish prospects for significant increases in research budgets generally, special efforts are required to develop new funds for research on child abuse and neglect. In addition, governmental leadership is required to identify and synthesize research from related fields that offers insights into the causes, consequences, treatment, and prevention of child maltreatment.
8-13: Effective incentives and dissemination systems should be developed to convey empirical findings to individuals who are authorized to make social welfare decisions on behalf of children. We need to strengthen the processes by which science is used to inform and advise legislative and judicial decision makers. And we need effective partnerships among scientists, practitioners, clinicians, and governmental officials to encourage the use of sound research results in formulating policies, programs, and services that affect the lives of thousands of children and their families.
ETHICAL AND LEGAL ISSUES IN
CHILD MALTREATMENT RESEARCH
9-1: The disclosure of unreported incidents of abuse by research subjects requires greater analysis to clarify the circumstances that foster such disclosures, the methods by which researchers respond to subject disclosures, and the outcomes for research subjects who disclose incidents of maltreatment.
9-2: Methodological research is needed to develop design procedures and resources that can resolve ethical problems associated with recruitment, informed consent, privacy and confidentiality, and assignment of experimental and control groups.
9-3: Research is needed to determine the impact of debriefings both on subjects’ post-project perceptions as well as on research results. This research will have ethical implications for the inclusion or omission of such interviews in research designs.
9-4: Research on the institutional research board process should be done to improve the quality of the process by which studies of child abuse and neglect are initiated and approved.
PRIORITIES FOR CHILD MALTREATMENT RESEARCH
Research Priority 1: A consensus on research definitions needs to be established for each form of child abuse and neglect. (See Recommendations 2-1 and 2-3)
Research Priority 2: Reliable and valid clinical-diagnostic and research instruments for the measurement of child maltreatment are needed to operationalize the definitions discussed under Research Priority 1. (See Recommendations 2-2 and 2-4)
Research Priority 3: Epidemiologic studies on the incidence and prevalence of child abuse and neglect should be encouraged, as well as the inclusion of research questions about child maltreatment in other national surveys. (See Recommendations 3-1 through 3-5)
Research Priority 4: Research that examines the processes by which individual, family, community, and social factors interact will improve understanding of the causes of child maltreatment and should be supported. (See Recommendation 4-1)
Research Priority 5: Research that clarifies the common and divergent pathways in the etiologies of different forms of child maltreatment for diverse populations is essential to improve the quality of future prevention and intervention efforts. (See Recommendations 4-2 and 4-3)
Research Priority 6: Research that assesses the outcomes of specific and combined types of maltreatment should be supported. (See Recommendations 6-1 through 6-4)
Research Priority 7: Research is needed to clarify the effects of multiple forms of child victimization that often occur in the social context of child maltreatment. The consequences of child maltreatment may be significantly
influenced by a combination of risk factors that have not been well described or understood. (See Recommendation 6-5)
Research Priority 8: Studies of similarities and differences in the etiologies and consequences of various forms of maltreatment across various cultural and ethnic groups are necessary. (Recommendations 6-6 and 6-7)
Research Priority 9: High-quality evaluation studies of existing program and service interventions are needed to develop criteria and instrumentation that can help identify promising developments in the delivery of treatment and prevention services. (See Recommendations 5-1, 5-2, 5-3, 7-2, 7-3, 7-5, and 7-6)
Research Priority 10: Research on the operation of the existing child protection and child welfare systems is urgently needed. Factors that influence different aspects of case handling decisions and the delivery and use of individual and family services require attention. The strengths and limitations of alternatives to existing institutional arrangements need to be described and evaluated. (See Recommendation 7-1)
Research Priority 11: Service system research on existing state data systems should be conducted to improve the quality of child maltreatment research information as well as to foster improved service interventions. (See Recommendation 3-1)
Research Priority 12: The role of the media in reinforcing or questioning social norms relevant to child maltreatment needs further study. (See Recommendation 5-4)
Research Priority 13: Federal agencies concerned with child maltreatment research need to formulate a national research plan and provide leadership for child maltreatment research. (See Recommendations 8-2 and 8-6)
Research Priority 14: Governmental leadership is needed to sustain and improve the capabilities of the available pool of researchers who can contribute to studies of child maltreatment. National leadership is also required to foster the integration of research from related fields that offer significant insights into the causes, consequences, treatment, and prevention of child maltreatment. (See Recommendations 8-1, 8-3, 8-4, 8-5, and 8-7)
Research Priority 15: Recognizing that fiscal pressures and budgetary deficits diminish prospects for significant increases in research budgets generally, special efforts are required to find new funds for research on child
abuse and neglect and to encourage research collaboration and data collection in related fields. (See Recommendations 8-9, 8-10, and 8-12)
Research Priority 16: Research is needed to identify organizational innovations that can improve the process by which child maltreatment research findings are disseminated to practitioners and policy makers. The role of state agencies in supporting, disseminating, and utilizing empirical research deserves particular attention. (See Recommendation 8-11)
Research Priority 17: Researchers should design methods, procedures, and resources that can resolve ethical problems associated with recruitment of research subjects; informed consent; privacy, confidentiality, and autonomy; assignment of experimental and control research participants; and debriefings. (See Recommendations 9-1 through 9-4)