Items related to Child Abuse and Neglect: Definitions, Classifications,...
Synopsis
This landmark book is the first to offer researchers and policymakers perspectives on developing a precise, scientifically valid system of defining, classifying, and measuring child maltreatment. Directly addressing the biggest barriers to research — lack of consistent definitions and measurement approaches — Child Abuse and Neglect is the result of two federally funded workshops that pooled the expertise of two dozen researchers. Together, these experts present a framework for conducting successful research, giving readers the information they need to
- clarify the limitations of current definitions, classification systems, and measurement approaches
- revise the research definitions for four types of abuse: physical abuse, sexual abuse, psychological maltreatment, and neglect
- use multi-method, multi-source approaches to classification and measurement
- understand how social policy trends help or hinder both research and practice
- address the ethical challenges of conducting research with vulnerable children and families
An indispensable resource for researchers and policymakers, this timely volume will help the field reach consensus on how to define and measure child maltreatment — and facilitate research that lays the groundwork for better prevention and treatment efforts.
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About the Author
Dr. Trickett is the David Lawrence Stein/Violet Goldberg Sachs Professor of Mental Health in the School of Social Work and Professor of Psychology in the College of Letters, Arts, and Sciences at the University of Southern California. Dr. Trickett earned her Ph.D. from the New School for Social Research, New York. She is a developmental psychologist whose research, for more than two decades, has focused on the developmental consequences of child abuse and neglect on children and adolescents and on the characteristics of families in which such abuse occurs. She has had an Independent Scientist Award from the National Institute of Mental Health titled The Developmental Consequences of Child Abuse and Violence. In addition, Dr. Trickett is conducting a longitudinal study, now in its 18th year, of the psychobiological impact of familial sexual abuse on girls and female adolescents. She is also the Principal Investigator of a longitudinal study of the impact of neglect on adolescent development funded by the National Institutes of Health. She served as member, and then Chair, of the American Psychological Association's Committee on Children, Youth, and Families from 1992 to 1995 and was member-at-large of the Executive Committee of the Section on Child Maltreatment of APA's Division of Child, Youth, and Family Services. She is a Fellow of APA's Division 7 (Developmental Psychology). Dr. Trickett also directs a university-wide interdisciplinary violence research initiative at the University of Southern California.
Dr. Flanzer earned a bachelor's degree with honors in liberal arts from the University of Illinois–Chicago Circle Campus, a master's degree in educational counseling from Northwestern University, Evanston, Illinois, and a doctorate in Human Development from the Catholic University of America, Washington DC. She is a Certified Institutional Review Board Professional (CIP). Previously, Dr. Flanzer was the Director of the Division of Data, Research and Innovation at the Children's Bureau, Administration on Children, Youth and Family, Administration for Children and Families, DHHS, (1997 to 2003), having worked at the National Center on Child Abuse and Neglect (NCCAN/ACYF/ACF/DHHS) from 1993 to 1997. Prior to working for the federal government, Dr. Flanzer worked for several consulting firms in the Washington DC area conducting program evaluations and research on child maltreatment, runaway and homeless youth, family violence, domestic violence, foster care, and foster care parenting and discipline. Dr. Flanzer has made numerous presentations on these topics to professional and lay audiences. She has been the recipient of several academic honors including membership in Pi Gamma Mu, International Honorary Society in Social Sciences, a Daughters of Isabella Fellowship from The Catholic University of America, and membership in Phi Lambda Theta, the National Honorary Society in Education. In her present position, Dr. Flanzer oversees the human protections program for intramural research at AHRQ and serves as a consultant to the extramural research program. She also serves on many committees and working groups in the Department of Health and Human Services which include serving as an Ex Officio member of the Secretary's Advisory Committee on Human Research Protections (SACHRP) and on the inter-agency National Science and Technology Council (NSTC) Committee on Science (COS) Human Subjects Research Subcommittee (HSRS) under the auspices of the President's Office of Science and Technology Policy (OSTP) and on the Social and Behavioral Research Working Group of the HSRS. While serving at the Children's Bureau, Dr. Flanzer also participated in the Federal Interagency Work Group on Child Abuse and Neglect, the NIH Child Abuse and Neglect Working Group, the Child Neglect Research Consortium, and the Child Welfare League of America's National Council on Research in Child Welfare (1991-2003). She is an occasional reviewer for both Child Abuse & Neglect: The International Journal Child Maltreatment and The Journal of the Professional Society on the Abuse of Children. Presently, she serves as a member of the Institutional Review Board, at Caliber Associates, Fairfax, Virginia and is a member of PRIM&R (Public Responsibility in Medicine and Research)/ARENA (Applied Research Ethics National Association) the professional association for human research protection program practitioners.
N. Dickon Reppucci, Ph.D., received his doctoral degree in clinical psychology from Harvard University in 1968, was a psychology faculty member at Yale University from 1968 to 1976, and became Professor of Psychology at the University of Virginia in 1976. Since then, he has served the Psychology Department as Director of the Program in Research and Clinical Community Psychology (1976-1980), coordinator of the Community Psychology program (1980-present), and Director of Graduate Studies (1984-1995). As President of APA's Division 27 (The Society for Community Research and Action) in 1986, Dr. Reppucci initiated the Biennial Conferences on Community Research and Action. He is a Fellow of the American Psychological Association, the American Psychological Society, and the American Association of Applied and Preventive Psychology. He has served on several editorial boards, including the American Journal of Community Psychology, Journal of Consulting and Clinical Psychology, and Professional Psychology, and was Associate Editor of Law and Human Behavior (1986-1996). Dr. Reppucci has served on National Institute of Mental Health Internal Review Committees concerned with violence and antisocial behavior and with life-span development and preventive intervention, the Virginia Advisory Council on Prevention and Promotion (1985-1992), and the Executive Committee of the National Consortium on Law and Children and The Child Maltreatment section of APA's Division 37. His books include The Sexual Abuse of Children (Jossey-Bass, 1988) and Prevention in Community Mental Health Practice (Brookline Books, 1991), both coauthored with Jeffrey Haugaard. Author of more than 100 professional works, Dr. Reppucci's most recent articles have been concerned with juvenile delinquency, preventing child abuse, and adolescent decision making in legal contexts. In 1991, he was honored as the Outstanding Scholar in Psychology by the Virginia Association of Social Scientists.
Kyle L. Snow, Ph.D., is Program Director for research in early childhood education at Research Triangle Institute (RTI) International. He is also Principal Investigator for the Early Childhood Longitudinal Study–Birth (ECLS–B) cohort, a prospective longitudinal study of a nationally representative cohort of children studied from 9 months to kindergarten.
Dr. Snow has also held a faculty appointment at Wilkes University in Wilkes-Barre, Pennsylvania, and taught courses at Cornell University, American University, and Seton Hall University. Dr. Snow holds a bachelor’s degree in psychology from Castleton State College in Vermont and master’s and doctoral degrees in human development from Cornell University. Dr. Snow’s areas of specialization include infant and child development, the interface between early social and cognitive development, and children’s transition to school.
Dr. Feerick holds a bachelor's degree in English and a master's degree in Developmental Psychology from Columbia University, and a doctorate in Developmental Psychology from Cornell University. Early in her career, Dr. Feerick worked as a language arts teacher and director of development/contributions at an independent junior high school in New York City, while also working as a freelance editor/reader for Penguin Books, U.S.A. She has also served in research and statistical consultant positions on several federally-funded research projects at St. Luke's–Roosevelt Hospital in New York City, the New York State Research Institute on Alcoholism and Addictions, and the National Data Archive on Child Abuse and Neglect, and has published articles and book chapters addressing various aspects of child maltreatment and family violence. Dr. Feerick has been the recipient of numerous fellowships and awards, including an individual National Research Service Award from the National Institutes of Health (NIH) and a Society for Research in Child Development (SRCD) Executive Branch Policy Fellowship. From 1998–2004, Dr. Feerick served as a Health Scientist Administrator/Program Director at the National Institute of Child Health and Human Development, where she directed a large research and training program in child development, family processes, and child maltreatment and violence, in addition to serving on numerous inter-agency work groups and committees including the Federal Interagency Work Group on Child Abuse and Neglect, the NIH Child Abuse and Neglect Working Group (which she co-chaired), the Inter-Agency Work Group on Children Exposed to Violence (which she developed and chaired), and the Technical Advisory Group for the Fourth National Incidence Study (NIS-4) of the Office of Child Abuse and Neglect. She is currently working as an independent consultant, a freelance science writer, a Liaison for the Section on Child Maltreatment of the Division on Children, Youth, and Families of the American Psychological Association, and a reviewer for several peer-reviewed journals, while completing several writing projects and raising her two children.
Dr. Knutson holds a bachelor's degree in Psychology from Augustana College, Rock Island, IL, a master's degree in Psychology and a doctorate in Clinical Psychology from Washington State University. After completing a post-doctoral fellowship in Medical Psychology at The University of Oregon Medical School, he joined the faculty at The University of Iowa, where he was a recipient of the Regents' Award for Faculty Excellence in 1999. He has served two tours of duty as Director of Clinical Training at Iowa, and he directed the Department's training clinic for ten years. He has held editorial positions on Journal of Abnormal Psychology, Journal of Clinical Child Psychology, and Aggressive Behavior, and he is a fellow of the American Psychological Association and the American Psychological Society. He served three terms as Treasurer of the International Society for Research on Aggression. Dr. Knutson's early research career focused on basic processes underlying the development of aggression, with his research on child maltreatment commencing in the late 1970s. He has also devoted considerable effort to research on psychological factors, including family relations, in the outcome of cochlear implants with deafened populations. Dr. Knutson has published more than 100 journal articles and book chapters on aggression, physical child abuse, neglect, the association between abuse and disabilities, cochlear implants, and methodology pertaining to the assessment of child maltreatment. Dr. Knutson served on two Federal committees focused on research definitions of child maltreatment and he was a member of the Technical Advisory Group for the Fourth National Incidence Study (NIS-4) of the Office of Child Abuse and Neglect. His current active research support is examining the role of supervisory and care neglect in the development of young children's aggression and the influence of exposure to domestic violence on young children's social adjustment.
Excerpt. © Reprinted by permission. All rights reserved.
Excerpted from Chapter 2 of Child Abuse and Neglect: Definitions, Classifications, and a Framework for Research, edited by Margaret M. Feerick, Ph.D., John F. Knutson, Ph.D., Penelope K. Trickett, Ph.D., and, Sally M. Flanzer, Ph.D.
Copyright © 2006 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
The author recognizes the research contributions of Purva Rawal in developing this chapter.
In 1991, Dr. Wade Horn, then Commissioner for the Administration on Children, Youth and Families (ACYF) in the U.S. Department of Health and Human Services (DHHS), asked the National Academy of Sciences to develop a research agenda that could guide future studies of child maltreatment. Several factors prompted his request. The research community had long expressed interest in developing a synthesis of findings from the extensive research literature that had emerged since the passage of the Child Abuse Prevention and Treatment Act of 1974 (PL 93–247). In addition, program staff within DHHS were concerned with the quality of the future child maltreatment research program. Their objective was to develop a set of programmatic research priorities that could offer protection against persistent congressional efforts to set aside, or “earmark,†funds in the federal child abuse research program for special interest service delivery projects. Up to that time, child abuse and neglect research projects within the ACYF were largely responsive to immediate and programmatic information needs within the child protection and child welfare services practice community and were generally uninformed by conceptual or disciplinary frameworks. The result was a fragmentary and patchwork research field that had second-class status within the scientific community when compared with theory-driven research sponsored by the National Institute of Child Health and Human Development (NICHD), the National Institute of Mental Health (NIMH), and other components of the National Institutes of Health (NIH). Furthermore, stakeholders within the federal government and the research community were hopeful that the development of a coherent rationale and research agenda on child maltreatment would lead to the expansion of funds available to support studies in the area.
In response to the Commissioner’s request, the National Academy of Sciences (NAS) convened a study panel, referred to as the Panel on Research on Child Abuse and Neglect, within the National Research Council (NRC), the operating arm of the NAS that was responsible for ad hoc studies. The panel was chaired by Anne C. Petersen, Ph.D., a well-known researcher in the field of adolescent development who was then Vice President for Research and Dean of the graduate school at the University of Minnesota. The 16 panel members included distinguished researchers in the field of child abuse and neglect, as well as others who were not directly associated with this field but who presented solid credentials and expertise in the areas of epidemiology, statistics, pediatric medicine, child development, and sociology.The composition of the NRC panel was designed to mix researchers who had expertise in the field with others who could critique the quality and coherence of child abuse and neglect studies by comparing this research literature with other areas of child and family studies. The NRC panel conducted its work through a series of public and private deliberations, an extensive review of the research literature, the development of commissioned papers, and a survey of leading organizations in child maltreatment research.
The purpose of the panel was to perform a comprehensive examination of the theoretical and pragmatic research needs in the field of child abuse and neglect. More specifically, the study was designed to 1) review and assess research on child abuse and neglect, including work previously conducted by the ACYF and other public and private agencies; 2) identify research relevant to the child abuse and neglect field; and 3) outline research priorities for the upcoming decade. Research priorities that were identified included shaping building blocks for knowledge development in child maltreatment, finding new research avenues that could be funded by public and private agencies, and suggesting research areas within the field that might no longer be funding priorities.
The report of the panel, Understanding Child Abuse and Neglect (NRC, 1993), is now considered a landmark synthesis of child abuse and neglect research. It provided a foundation that has since guided many discussions about the importance of developing a common conceptual framework, research definitions, rigorous classification, and empirical measurement in the field of child maltreatment. The panel’s study also represented a pivotal moment in shifting the field from a patchwork effort of applied research studies to a more cohesive set of activities striving to improve theory, instrumentation, measurement, and data collection efforts.
One result of the NRC panel’s report was that the NIH and the Children’s Bureau in the Administration on Children, Youth and Families convened two workshops focused on defining and classifying child abuse and neglect (the first in December 1999 and the second in September 2000) that were the inspiration for this book. Therefore, it is useful to reexamine the basic framework and approach adopted by the NRC panel and to consider their relevance for contemporary discussions of classification, theory, measurement, and definitions of child abuse and neglect.
SHIFTING FRAMEWORKS FOR RESEARCH ON VIOLENCE AND CHILD DEVELOPMENT
The work of the NRC panel was inf luenced indirectly by other studies that were underway within the NRC in the late 1980s and early 1990s. In 1988, a consortium of federal agencies—the National Institute of Justice, the National Science Foundation, and the Centers for Disease Control—had asked the NAS to assess the state of scientific knowledge about violence, to consider the implications of that understanding for preventive interventions, and to design research and evaluation studies that could improve the understanding and the control of violence. In response, the NAS created the NRC Panel on the Understanding and Control of Violent Behavior, chaired by sociologist Albert Reiss from Yale University. The Reiss panel eventually published a four-volume series of reports that included a summary report as well as a series of background papers commissioned by the committee (NRC, 1993/1994).
Although the activities of these two studies occurred at the same time, the two groups did not meet, nor did they share research materials. However, the conceptual framework that evolved from the Reiss panel was “in the air†at the time the Petersen panel was convening, and it helped to guide discussions that focused on how to move the field of child abuse away from an applied research orientation toward one that was grounded more firmly in theory, measurement, classification, and data. One important contribution from the Petersen panel was the recognition of the need for multiple classification schemes in addressing violent events as well as of the inherent limits of using administrative data records to guide empirical and scientific studies. Because research on child abuse and neglect had often depended (and continues to depend) on records from child protective and child welfare agencies rather than from population-based, longitudinal, or experimental studies, the need to disaggregate different types of child abuse and neglect into new categories based on a theory-driven classification scheme acquired central importance in the Petersen panel.
The studies on violence research and child abuse were the first in what would become a series of reports on other aspects of family violence published by the NRC. Subsequent publications included “Understanding Violence against Women†(1996); “Violence in Families: Assessing Prevention and Treatment Programs†(1998); and, in 2002, “Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence.†Each report had its own study committee, study sponsor, and study director, and each report considered separate research literatures. Nevertheless, the research literatures examined in these multiple reports showed a movement toward a gradual acceptance of the importance of conceptual frameworks and the need for stronger theory to guide the discovery of fundamental processes in the study of complex human behavior, parenting practices, and family systems.
Two influential lines of research were emerging within the child development literature that drew child maltreatment studies toward a broader ecological framework of parent–child interactions. The first, ecological systems theory, developed by Urie Bronfenbrenner (1979) and others, has had a profound inf luence on research in child development. Ecological systems theory, as described by Bronfenbrenner, asserts that child development occurs through a complex process of interactions between the immediate environment of the child and broader environmental layers, such as the family, school, church, community, and larger society and cultural norms. Development is shaped at the microsystem level by family and local community factors, at the mesosystem level by intermediate societal factors and institutions, and at the macrosystem level by national and global factors. Disruption at any one of these layers affects the others as well. Thus, child development is a complex interaction between the child’s biology and proximal and distal environmental influences (Bronfenbrenner, 1979).
Second, studies of violence in the latter part of the 20th century moved toward an analysis of biobehavioral actions within social settings and studies of child development and parental caregiving. These shifts were inf luenced by transitions in new theories that sought to account for the role of social and cultural factors in human behavior and interpersonal relationships (Garbarino, 1977; Wolfe, 1991). Researchers began conceptualizing child maltreatment from a transactional perspective, in which factors associated with families, communities, and the larger society and culture acquired greater importance in examining processes that contributed to child maltreatment as well as child development. The result was a de-emphasis on personal factors, such as parental psychopathology, and greater attention to the examination of interactions among individual, family, and community stressors (Belsky, 1980; Cicchetti & Lynch, 1993). The increasing level of sophistication in consideration of multiple causal pathways and processes was characteristic of other social policy studies at the time.
New paradigms were created to reconcile the nature and sources of aggression and violence in human relationships with emerging theory describing stages of child development, parental caregiving and disciplinary practices, and family interactions in coping with stress and conf lict. The result was a significant shift in both the field of violence research and the field of child development, away from a narrow focus on mechanistic models that isolated individual psychiatric and psychological factors toward a more expansive, yet still poorly conceptualized, approach that put greater emphasis on settings, cultural forces, and dynamics in child development and their role in multiple pathways to abuse and neglect (Cicchetti & Lynch, 1993; Wolfe, 1991). Greater research attention was devoted to understanding the role of risk and protective factors in the social environment; the processes of resiliency; and the ways in which the presence or absence of psychological, social, and cultural supports within the family and community help to mediate or inf luence certain types of stressful interactions involving care for children, particularly those who are young (Belsky, 1980; Egeland, Breitenbucher, & Rosenberg, 1980; Polansky, Gaudin, & Kilpatrick, 1992).
These and other research developments influenced the Petersen panel to adopt an ecological, developmental perspective in examining the etiology, incidence, and consequences of child maltreatment. For instance, Egeland et al. (1980) conducted a prospective study of the antecedents of child maltreatment in which they compared families that had been reported for child maltreatment with high-risk families that appeared to provide adequate levels of care. Results demonstrated that the association between risk level in families and whether children were maltreated was far from linear; in fact, many mothers who were considered high-risk for maltreating their children did not do so, and many incidents of maltreatment occurred among mothers judged to be at low risk (Egeland et al., 1980). This study demonstrated the complexity of the relationships among parental characteristics, environmental stressors, and the occurrence of child maltreatment.
The shift in research paradigms had profound implications for the definition and classification of child abuse and neglect experiences. In addition, recognition of the variations and gaps associated with legal and administrative definitions of child maltreatment emerged within policy and programmatic fields, fostering more receptivity to research-based definitions and measurement. However, the research field itself was changing and rearranging conceptual frameworks (Belsky, 1980; Cicchetti & Lynch, 1993). For instance, Garbarino (1977) and Belsky (1980) created ecological models of child maltreatment based largely on Bronfenbrenner’s work. Cicchetti and Lynch (1993) later created transactional and interactive models of child maltreatment, in which combinations of risk factors and protective factors were assumed to interact across all ecological levels to contribute to the occurrence of child maltreatment behaviors. The result of these new frameworks was greater ambiguity and confusion as to how to define the principal elements of abuse and neglect and how to align science-based definitions with legal standards and administrative records. However, this ambiguity should not be viewed as a step backwards. Indeed, it acted as a precursor to a deeper understanding of the critical elements of abuse and neglect, and it offered an opportunity to reframe definitions that could subsequently guide policy and practice by focusing on the most critical aspects of child maltreatment as well as those behaviors that might be most amenable to change.
One other body of research literature deserves mention here, although it did not receive major consideration in the NRC study on child abuse and neglect. In the mid-1980s, public health agencies on injury began to form more rigorous classification and definitional standards to improve the quality of surveillance and epidemiological studies of injury. In 1985, a NRC study, “Injury in America: A Continuing Public Health Program,†summarized these efforts, recommending improving the systematic collection of injury data to strengthen prevention strategies. The report concluded, among other things, that significant uncertainties and gaps in the epidemiology of injury occurrence impeded scientific understanding of the causes and consequences of assaultive injuries. Most importantly for the child maltreatment field, the report recommended that funding for research on the prevention of injury and maltreatment of children should be proportionate to its status as the largest cause of death and disability in youth.
The public health injury surveillance system began to pay attention to child abuse and neglect within the category of “intentional injuries,†and it eventually developed a detailed classification scheme that is now part of the International Classification of Disease (ICD) codes. Newer versions of the ICD codes include “E-codes,†which classify external causes of injury, such as the use of guns or knives in assault injuries. It is noteworthy that the child development and violence research literatures are still explaining how to adapt the detailed ICD classification scheme to provide additional injury-specific information, such as identifying the time of day or locations where injuries occur or their association with particular actions such as feeding or disciplinary behaviors.MOVING BEYOND LEGAL CATEGORIES OF ABUSE AND NEGLECT
The 1974 Child Abuse and Prevention Treatment Act (CAPTA; PL 93–247) stipulated that the new National Center on Child Abuse and Neglect (NCCAN) investigate the incidence of child abuse and neglect across the country. CAPTA and the research that emerged from it led to more specific classification of child abuse and neglect. At the time that the Petersen panel began its work, four general categories of child maltreatment—a result of CAPTA—were commonly recognized in the research literature: physical abuse, sexual abuse, neglect, and emotional or psychological maltreatment. Most research studies had focused on physical and sexual abuse. The amount of attention focused on neglect in the research community was limited, despite the fact that cases of child neglect constituted more than half of the reports received annually by child protection agencies, were widely recognized as the most common individual type of maltreatment. The second National Incidence Study (NIS–2; DHHS, 1988) also demonstrated that neglect was involved in 63% of the reported cases. Wolock and Horowitz, commenting on this phenomenon, wrote about “the neglect of neglect†in a 1984 paper.Recognizing that these four categories encompassed a broad range of behaviors, the NRC report “Understanding Child Abuse and Neglect†(1993) stated that although broad consensus might exist around extreme forms of child abuse and neglect (e.g., beatings, disfigurement, and sexual abuse), less severe manifestations presented more complicated issues with respect to definition and classification. Furthermore, a classification scheme by types of abuse might be useful for pragmatic or legal reasons, but it lacked the conceptual constructs that could help research studies differentiate the pathways to and outcomes associated with abuse and neglect. Co-occurrence of different types of maltreatment was common, blurring even the appearance of mutually exclusive sequelae by type. The “types of abuse†typology also provided little support in comparing research findings across studies or in explaining the sequence, timing, or relationship of maltreatment to other family processes and social behaviors. Therefore, the panel was searching for alternative frameworks and definitions that could address these limitations and help to improve data collection efforts that would strengthen the overall field of child abuse and neglect research.
LIMITATIONS OF SERVICE-BASED DEFINITIONS
In the absence of universal definitions of child abuse and neglect, different service sectors and the research community had developed separate and multiple criteria and classification frameworks for each of the four traditional categories of child maltreatment: physical abuse, sexual abuse, neglect, and emotional or psychological maltreatment. Definitions of child abuse and neglect were largely driven by state laws and regulations, creating inconsistencies and variations that impeded the use of standardized assessment instruments. Additional complications were associated with high caseloads and gaps in social services, inaccurate or incomplete information, and limited services for affected families (Hoaglin, Light, McPeek, Mosteller, & Stoto, 1982; Leventhal, 1990). The NRC report reviewed these approaches, indicating that although service-oriented definitions were necessary for delivery, practice, and policy purposes, they were characterized by fragmentation and inconsistencies that represented serious impediments to improving the quality of data and knowledge in this field. Medical and clinical definitions, social services definitions, and legal and judicial definitions are reviewed in the following sections.
Medical and Clinical Definitions
For decades, physicians had recognized child abuse and neglect as a disturbing and sometimes unique set of physical conditions, frequently characterized by fractures, burns, scars, other injuries, and parental deprivation of medical care. In the early 1990s, however, no universal medical definition of child abuse and neglect, much less of physical abuse per se, existed. If physicians thought in terms beyond injury and treatment, their classifications were likely to be hindered by state definitions that included ambiguous terms such as substantial, unjustified, and allowable (Johnson, 1990). Over time, health professionals acquired greater expertise through clinical experience and improved instrumentation in detecting signs of abuse or neglect. For example, in the case of “shaken baby syndrome,†physicians began to search for physical signs of shaking (e.g., bruises, retinal hemorrhaging) and for more moderate symptoms, including poor feeding history or flu-like symptoms in the absence of diarrhea or fever (Palmer, 2000). Other tell-tale signs of abuse and/or neglect included discrepant or vague explanations of child injuries, delay in seeking care, a family crisis or history of abuse, trigger behaviors by the child, unrealistic expectations of the child by the parents (often involving personal hygiene, feeding, or emotional regulation), isolation of the family, and the parent’s own history of abuse (Krugman, 1983).
In the area of sexual abuse, the medical literature focused predominantly on physical findings, such as chafing, abrasions, bruising of the inner thighs and genitalia, scarring in specific genital areas, and specific abnormalities of the hymen (American Academy of Pediatrics, 1991). According to a report published by the Office of Juvenile Justice and Delinquency Prevention, the presence of certain sexually transmitted diseases also often served as the first indicator of sexual abuse, especially among young children (Hammerschlag, 2001).
The NRC report indicated that although the medical diagnosis of child abuse had improved, especially in the area of physical abuse, research in this area was retrospective, clinical, and frequently derived from observation of individuals from one institution. A major shortcoming in the development of medical definitions of abuse was the absence of prospective and population-based studies that could describe the routine as well as extreme range of physical conditions that occur during the development of young children within different racial and ethnic groups. These physical conditions include sexual development and the array of injuries that may be particularly damaging at certain critical developmental periods for infants, toddlers, and preschoolers, regardless of their origins.
Social Services Definitions
Most of the data associated with child maltreatment studies is derived from case records and administrative data collected by child protective services (CPS) and child welfare agencies. In the early 1990s, with support from Congress, NCCAN began a series of initiatives to standardize the application of definitions and classification guidelines within the child protection and child welfare administrative datasets and the state data collection systems that were used to track and report individual cases. These initiatives included the development of the National Child Abuse and Neglect Data Systems (NCANDS), the State Automated Child Welfare Information System, and, more recently, the Adoption Foster Care Analysis and Reporting System (DHHS, 2006).
The development of standardized case definitions and classification criteria was challenged by the long-standing tradition of child protection and child welfare as a state-based responsibility within the United States. This fragmentation and the absence of a separate data system to guide scientific studies hampered progress in developing generalizable knowledge and theory. In seeking to upgrade the quality of state information and tracking systems, federal agencies needed to respect and accommodate significant variations in state law, reporting requirements, and administrative capacity at the local and county levels. Through a series of conferences and technical assistance and consensus-building efforts, the quality of the NCANDS data and the automated child protection and child welfare information systems began to improve; however, major shortcomings that continue to deter classification efforts still remain in the areas of incomplete or missing data, duplicated cases, and inconsistent reporting practices.
One important limitation in using administrative datasets to define and classify child abuse and neglect cases is the variation that is introduced by uncontrolled methods of case detection and selection into those datasets. The resource limitations within the child protection and child welfare fields contribute to case selection strategies that are comparable to the clinical bias that exists in medical settings. CPS samples rarely include mild forms of child maltreatment, because such cases are routinely screened out when physical evidence to support allegations is lacking. The frequency of contacts between social services agencies and poor children may contribute to overrepresentation of these populations in the CPS case records. As noted in the NRC report, regional or chronological differences in maltreatment rates may ref lect different patterns and standards of reporting and selection criteria as well as differences in agency resources, rather than true differences in underlying rates of occurrences of abuse and neglect.
Legal and Judicial Definitions
The NRC report also reviewed the role of legal and judicial standards in developing early definitions of child abuse and neglect. The panel noted that legislative acts, such as CAPTA (1974), began to broaden the study of prohibited behaviors by moving attention beyond the precise characteristics of abusive acts themselves to include greater consideration of their consequences for the child. Broader legal definitions of child abuse included emotional injury, neglect, lack of provision of medical services by parents, and factors damaging children’s moral development, in addition to physical abuse (Cicchetti & Barnett, 1991). The Juvenile Justice Standards Project used three major categories to define child abuse: physical harm, emotional damage, and sexual abuse, with strict standards within each of the three categories (Wald, 1977). In the absence of empirical definitions, the law and the courts drew on evidentiary standards derived from legislative guidelines, professional opinion, and customary practice. These definitions were intended to guide legal interventions, not long-term treatment or prevention efforts or research studies, and their focus was often more stringent than the approaches used in medical, social services, or research settings, searching out the aspects of the report or event that made the best evidence for a successful prosecution.
For example, in the Juvenile Justice Standards Project (Wald, 1977), the following definitions were used:
- Physical harm is defined as disfigurement, impairment of bodily functions, or other serious physical injury.
- Emotional damage is evidenced by severe anxiety, depression or withdrawal, or untoward aggressive behavior toward self or others; and the child’s parents are unwilling to provide treatment for him or her.
- Sexual abuse is limited to those cases in which the child is seriously harmed physically or emotionally thereby. Such a definition excludes many cases in which consequences are not immediately apparent but may emerge at later points in the developmental cycle.
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