Attitudes towards corporal punishment and reporting of abuse

Health Professionals: Identifying and Reporting Child Physical Abuse-a Scoping Review

Health professionals play a significant role in identifying and reporting child physical abuse (CPA). However, several studies have pointed out non-reporting behavior among these professionals, evidencing difficulties identifying and reporting suspected cases. This review aimed to explore the frequency and possible barriers in identifying and reporting CPA by health professionals worldwide and to identify associated factors. This scoping review was conducted in the Pubmed, Web Of Science, Scopus, and SciELO databases between July 2019 and December 2020. Analytical and qualitative observational epidemiological studies were selected and published in English, Portuguese, and Spanish, with data on the identification and/or reporting of CPA by health professionals. Twenty studies fulfilled the criteria of this review. The studies were conducted with dentists, nurses, pediatricians, and general practitioners. The frequency of identification of CPA ranged from 50% to 89%, while the frequency of reporting ranged from 8% to 47%. This review revealed that health professionals had a low frequency of reporting of CPA, especially for dentists. In addition, several associated factors and barriers in the identification and reporting of CPA were identified in the studies. These were discussed in five main themes: training and continuing education in CPA, impact on professional practice, experiences and perceptions about child protection services, the threshold for suspicion of the professional, and the professional category.

Spare the rod! Implications for community safety partnerships in removing the reasonable chastisement defence in Wales

Parental discipline of children has long included the use of corporal punishment and has drawn conflicting views upon its effectiveness and its long-term effects upon individuals and society as a whole. This article considers the use of such a tactic by individuals, discussing its use and the research surrounding it at the international and national levels. It explores the introduction of the ‘The Children (Abolition of the Defence of Reasonable Punishment) (Wales) Act,’ which will become law in Wales during March 2022. This Act, whilst not creating a specific criminal act in itself, removes the defence of reasonable chastisement for parents when correcting their children in Wales. The article further considers the potential impact that the removal of the reasonable chastisement clause may have for those agencies charged with overseeing the safety of children, including the potential increase in reported cases and the issues of media and public awareness.

Prediction of health, education, and psychosocial professionals' attitudes in favor of parental use of corporal punishment

BACKGROUND

To date, there have been few studies pertaining to the knowledge and attitudes regarding the use of corporal punishment (CP) among professionals working with parents and children. Yet, many parents turn to these professionals for advice on child discipline.

OBJECTIVE

This study aimed to describe professionals' legal knowledge about parental use of CP and their attitudes toward this practice.

METHOD

A study was conducted among professionals working directly with children or their parents through an online questionnaire.

PARTICIPANTS

A total of 1,758 respondents from three sectors of training (psychosocial, health, education) completed the questionnaire.

RESULTS

The results showed that professionals have little knowledge of the legal guidelines surrounding the use of CP in Canada. This poor knowledge as well as the perceived impacts of CP on children acted as predictors of favorable attitudes toward this disciplinary practice. According to the regression analyses, other personal and professional factors also explain a person's approval of CP, including violence in childhood, religious practice, and sources of knowledge. The results also highlighted some findings related to the respondents' professional sectors.

CONCLUSIONS

The study results emphasize the need to better train professionals by targeting cognitive, personal, as well as professional factors.

Factors associated with physicians' assessment and management of child abuse and neglect: A mixed method study

Physicians are a professional group that is highly likely to encounter abused or at-risk children. The aim of this study is to investigate physicians' experiences with abuse cases, their evaluations of abuse risk factors, and their attitudes toward becoming more educated on the subject. One-hundred-sixty-four family physicians at family health centers and public health centers completed a questionnaire, and a group of residents at a university training and research hospital were interviewed in a semi-structured format. One-fifth of the participants had managed a child abuse case at least once. Nearly half of the participants reported acting alone in diagnosing and managing abuse cases. Sixty-eight percent of these physicians stated they would like to receive training on this subject. Gender and having children did not make a difference as to the abuse-management experience of these medical professionals. Female participants placed more importance on risk factors related to "children with mental disabilities" and "alcohol and substance abuse in parents" than their male counterparts. Difficulties in diagnosis, concerns about handling the abuse cases, the impact of culture, various risk factors, the importance of teamwork and a holistic approach, the need for practical training, and the importance of primary prevention were themes that emerged from this survey. This study provides inferences as to which of the physician competencies should be targeted in undergraduate medical education.

Mandatory reporting between legal requirements and personal interpretations: Community healthcare professionals' reporting of child maltreatment

BACKGROUND

Healthcare professionals working at community-based services have a crucial position in raising concerns about possible child maltreatment. Yet, barriers exist to healthcare professionals adhering to mandatory reporting rules and regulations.

OBJECTIVE

The current study investigated the various forms by which healthcare professionals working in community services manage mandatory reporting, their reasoning and experience with formal requirements. The study has utilized the decision-making-ecology model as a conceptual framework.

PARTICIPANTS AND SETTING

The study was carried out in the largest district of the largest health-management organization in Israel, across fourteen sites located at seven cities. Eighteen healthcare professionals of various occupational groups participated in in-depth semi-structured interviews.

RESULTS

The results reveal that out of the of 52 recent cases that have been suspected for possible child maltreatment, only 58 % were reported as legally required. Yet, about half were reported in delay. Practitioners were more likely to report after additional evidence accumulated and increased the level of suspicion or after failing to manage the issue by other means of support. The analysis identified multiple factors that combined to impact the decision-making regarding reporting. Those were clustered around the individual case, healthcare professional, organizational setting, and external context.

CONCLUSIONS

Our results emphasize the importance of workplace-environmental conditions in promoting optimal reporting behaviors, including working in multi-disciplinary teams, availability of rapid expert consultation, provision of emotional-support, and reciprocal exchange of information with child-protection-services.

Corporal punishment of children: discipline or abuse?

Introduction: Corporal punishment is a public health problem due to its impact on the physical, psychological, and social interactions of children.

Objectives: To determine the knowledge of pediatricians in Lebanon regarding corporal punishment, their preventive, educational, and legal role.

Methods: A cross-sectional descriptive study conducted on 153 pediatricians in Lebanon, by a questionnaire distributed at the 12th Annual Congress of the Lebanese Pediatric Society and the North Lebanon Pediatric Society.

Results: Less than 50% and less then 60% of pediatricians know the effects of physical punishment on the physical and psychic health of the child, respectively. About 74.2% and 23.2% of pediatricians disagree with Article186 of the Lebanese Criminal Code and Lebanese Law422/02 (Article25), respectively. Only 76.2% of Lebanese pediatricians always advise the abandonment of corporal punishment and 4.7% advise its use for discipline.

Conclusion: Pediatricians play a fundamental role in the abolition of corporal punishment, but this cannot be accomplished without improving their skills in this area. They are invited to seek legal reforms in Lebanon to abolish the use of corporal punishment as a means of disciplining children.

Attitudes, beliefs, and perceived norms about corporal punishment and related training needs among members of the "American Professional Society on the Abuse of Children"

Hitting children for disciplinary purposes (i.e., spanking or corporal punishment [CP]) is a strong risk factor for child physical abuse and is highly prevalent in the U.S. Yet, little is currently known about the relevant attitudes, beliefs, or training needs of key professionals who often advise parents regarding child discipline strategies. A survey of the American Professional Society on the Abuse of Children (APSAC) membership, comprised of mental health professionals, physicians, child welfare professionals, and other professionals in the child maltreatment field, was conducted to assess attitudes, beliefs, perceived norms, training needs, and motivations to change norms regarding CP (N=571, response rate=51%). Most respondents agreed that spanking is a bad disciplinary technique (82%), is harmful for children (74%), and leads to negative outcomes (M=3.0, SD=0.6) more frequently than positive outcomes (M=2.1, SD=0.6; t=20.8; p<0.0001) for children. Professionals reported perceiving that their colleagues' level of endorsement of CP (M=2.4, SD=1.0) was higher than their own (M=1.9, SD=1.0; t(568)=-10.7, p<0.0001) though still below the midpoint. Professionals reported high levels of preparedness to effectively advise parents on non-physical child discipline strategies, but reported perceiving lower levels of preparedness amongst their colleagues. They reported highly valuing giving such advice to parents and being very motivated to participate in activities designed to change social norms regarding CP. Most APSAC members are poised to change these norms and, in doing so, to help reduce rates of child physical abuse in the U.S.

Global Prevalence of Past-year Violence Against Children: A Systematic Review and Minimum Estimates

CONTEXT

Evidence confirms associations between childhood violence and major causes of mortality in adulthood. A synthesis of data on past-year prevalence of violence against children will help advance the United Nations' call to end all violence against children.

OBJECTIVES

Investigators systematically reviewed population-based surveys on the prevalence of past-year violence against children and synthesized the best available evidence to generate minimum regional and global estimates.

DATA SOURCES

We searched Medline, PubMed, Global Health, NBASE, CINAHL, and the World Wide Web for reports of representative surveys estimating prevalences of violence against children.

STUDY SELECTION

Two investigators independently assessed surveys against inclusion criteria and rated those included on indicators of quality.

DATA EXTRACTION

Investigators extracted data on past-year prevalences of violent victimization by country, age group, and type (physical, sexual, emotional, or multiple types). We used a triangulation approach which synthesized data to generate minimum regional prevalences, derived from population-weighted averages of the country-specific prevalences.

RESULTS

Thirty-eight reports provided quality data for 96 countries on past-year prevalences of violence against children. Base case estimates showed a minimum of 50% or more of children in Asia, Africa, and Northern America experienced past-year violence, and that globally over half of all children-1 billion children, ages 2-17 years-experienced such violence.

LIMITATIONS

Due to variations in timing and types of violence reported, triangulation could only be used to generate minimum prevalence estimates.

CONCLUSIONS

Expanded population-based surveillance of violence against children is essential to target prevention and drive the urgent investment in action endorsed in the United Nations 2030 Sustainable Development Agenda.

Corporal Punishment: Evaluation of an Intervention by PNPs

INTRODUCTION

Corporal punishment (CP) is defined as the use of physical force with the intention of causing a child to experience pain but not injury for the purpose of correction or control of the child's behavior. CP has been linked to a variety of negative consequences for children, including physical abuse, eternalizing behavioral problems, and slowed cognitive development. Many American children continue to experience CP at the hands of their parents and other caregivers. The purpose of this study was to evaluate learner attitude toward CP before and after implementation of a pediatric nurse practitioner-designed educational intervention and influences upon learner attitude and beliefs about CP.

METHOD

This study used a pre- and postsurvey design to assess learner attitude about CP before and after participation in an educational intervention. Influences upon learner attitudes and beliefs regarding CP were also described. Learners (N = 882) were health care providers.

RESULTS

Nearly all learners (n = 747; 84.7%) stated that the way their parents disciplined them influenced their attitudes toward CP. Fewer than one fifth of learners who were also parents (n = 126; 14.4%) reported that their child's health care provider had ever discussed child discipline with them. Prior to the educational intervention, more than one third of learners (n = 351; 39.88%) endorsed spanking as sometimes necessary, yet significantly fewer learners (n = 251; 28.9%; p < .001) made this statement after the educational intervention. Child discipline management was included in the health care provider education for fewer than half of learners (n = 365; 41.4%).

DISCUSSION

The potential for experiencing CP as a child to result in negative consequences for children has been well documented, yet many American parents continue to use CP as a form of child discipline, and some pediatric health care professionals continue to endorse its use. Pediatric health care providers, including nurses and pediatric nurse practitioners, need to be educated about child discipline and CP. All pediatric health care providers need to advocate for the use of positive parenting principles and discourage the use of CP.

Working with child protective services and law enforcement: what to expect

The process whereby a clinician decides that child abuse is a diagnostic possibility is often marked with doubt and fear. Abusive parents can present convincing lies, and children with suspicious injuries can have unusual accidents. Personal thresholds for reporting suspected abuse vary considerably. Clinicians may mistrust or misunderstand the roles and responsibilities of the investigators and legal professionals involved. This article aims to improve understanding of the community responses to a report of child abuse, and enable the clinician to work effectively with child protective services, law enforcement agencies, and legal professionals to ensure child safety and family integrity when appropriate.

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OBJECTIVE

To determine the opinion of medical students attending Laval University (Québec, Québec) regarding the controversial subject of corporal punishment in children.

METHOD

For five consecutive years, from the 2006/2007 through to the 2010/2011 school year, an opinion poll was completed by the fourth year medical students at Laval University during a seminar concerning the maltreatment of children.

RESULTS

Of the 712 students questioned, 91% were younger than 30 years of age and 74% were female. With respect to the use of corporal punishment on children, 22% of the respondents declared they were in favour of it. More men than women were in favour of this disciplinary practice, with 31% of the men in favour compared with 18% of the woman (adjusted RC 2.2 [95% CI 1.4 to 3.4]; P=0.0003). Approximately 36% of the students who had experienced corporal punishment were in favour of it, compared with only 4% of those who had not experienced this form of discipline (adjusted RC 16.5 [95%CI 8.6 to 31.4]; P<0.0001). Among those who stated that they had been victims of physical abuse, 25% declared themselves in favour of this practice, which was a similar proportion to those who had not been victims of physical abuse (21%) (P=0.52).

CONCLUSION

While several medical organizations have declared opposition to the use of corporal punishment, greater than one in five future Quebec doctors are in favour of this disciplinary method and could influence the behaviour of parents in this regard.

Differentiating between child protection and family support in the Canadian child welfare system's response to intimate partner violence, corporal punishment, and child neglect

Rates of reported child maltreatment nearly doubled in Canada over the period 1998-2003, an increase that reflects growing awareness of the harmful effects of an expanding array of parental behaviors, including corporal punishment, lack of supervision, and exposure to intimate partner violence (IPV). Some of these situations may benefit from voluntary family support programs outside of the child welfare system. Analyzing a sample of 11,807 investigations, this paper compares cases where the sole concern is exposure to IPV, or hitting a child, or neglect, or other forms of investigated maltreatment. Situations where exposure to IPV or potentially abusive hitting were the sole reason for investigation presented with fewer risk factors and were less likely to lead to ongoing child welfare interventions compared to other maltreatment investigations. While situations involving alleged neglect presented a higher risk profile and elicited a more intensive child welfare response than did exposure to IPV or hitting, opportunities for alternative services were nevertheless identified. The study also found that visible minority families were overrepresented in cases involving hitting and that Aboriginal families were overrepresented in cases involving neglect. Overall the findings support the development of alternative response programs in Canada.

Child maltreatment: the Lebanese children's experiences

BACKGROUND

This study examined the prevalence, risk factors and consequences associated with child maltreatment in the home.

METHODS

The sample was 1028 (556 boys; 472 girls) Lebanese children aged 8-17 years (M = 11.89; SD = 1.67). Children were administered an interview questionnaire that included the International Child Abuse Screening Tool, the Trauma Symptom Checklist and the Family Functioning in Adolescence Questionnaire.

RESULTS

Approximately 30% of the children reported at least one incident of witnessing violence, 65% reported at least one incident of psychological abuse and 54% reported at least one incident of physical abuse over a 1-year period. The results showed an overlap between children's reports of witnessing violence in their homes and physical and psychological abuse that were associated with adolescents' trauma symptoms. Family-related variables significantly predicted three forms of child maltreatment.

CONCLUSION

These results highlight the importance of examining children's multiple experiences of violence in their homes in research designs, prevention efforts and policy mandates. However, it should be noted that estimates of prevalence (as opposed to estimates of the relation between variables which is relatively more robust to selection bias) are open to error because of the nature of our sample.

Educational paper: Detection of child abuse and neglect at the emergency room

The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be recognised. Early diagnosis of CAN is important, as without early identification and intervention, about one in three children will suffer subsequent abuse. This educational paper provides the reader with an up-to-date and in-depth overview of the current screening methods for CAN at the ER.

CONCLUSION

We believe that a combined approach, using a checklist with risk factors for CAN, a structured clinical assessment and inspection of the undressed patient (called 'top-toe' inspection) and a system of standard referral of all children from parents who attend the ER because of alcohol or drugs intoxication, severe psychiatric disorders or with injuries due to intimate partner violence, is the most promising procedure for the early diagnosis of CAN in the ER setting.

Attitudes and child abuse reporting behaviours among Hong Kong GPs

BACKGROUND

GPs are often the first contact for injured children and hence play a crucial role in early identification and intervention of child abuse cases in the community.

OBJECTIVES

To investigate Hong Kong GPs' attitudes and behaviours towards child abuse reporting and their opinions on the introduction of a mandatory reporting system.

METHODS

A cross-sectional survey was conducted in 2006 among GPs who were attending or had attended a local postgraduate family medicine course.

RESULTS

One hundred and seventy-one GPs participated in this study, among which only 8.9% received formal child abuse training. Only 35.8% of those GPs who had encountered suspected cases reported every case. GPs who considered reporting could produce more harm than good to the family or child, who concerned about maintaining anonymity and who were reluctant to get involved with legal system were less likely to make a report [odds ratio (OR) 0.21-0.27; 95% confidence interval (CI) 0.06-0.11, 0.67-0.86]. 'Concern on own anonymity' was the only significant independent predictor for reporting (OR 3.47; 95% CI 1.11-10.87). Despite the low satisfaction with the present reporting system, 67.3% would not support the introduction of a mandatory reporting system. Logistic regression showed previous training could predict supportive attitude towards mandatory reporting (OR 4.84, 95% CI 1.01-23.27).

CONCLUSIONS

This study shows low reporting behaviour among Hong Kong GPs. The major barriers to report are identified and can only be addressed by education and a carefully designed support system for GPs. Further research engaging a multidisciplinary approach is required to work towards an optimally beneficial system for the children.

Establishment of interdisciplinary child protection teams in Turkey 2002-2006: identifying the strongest link can make a difference!

OBJECTIVES

The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome.

METHODS

A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software.

RESULTS

Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period.

CONCLUSIONS

A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear.

PRACTICE IMPLICATIONS

Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

What predicts injury from physical punishment? A test of the typologies of violence hypothesis

OBJECTIVE

This study examined the power of child, perpetrator, and socio-economic characteristics to predict injury in cases of reported child physical abuse. The study was designed to assess the validity of the assumption that physically injurious incidents of child physical abuse are qualitatively different from those that do not result in injury, that their generative factors are distinctive, and that the quality of caregiving in these two types of incidents is different.

METHOD

A weighted, nationally representative sample of 8,164 substantiated punishment abuse cases in Canada was used. Various models were constructed and evaluated through logistic regression.

RESULTS

Of six potential predictors - child age, perpetrator sex, child functioning, parent functioning, economic stress, and social stress - none predicted injury to the child.

CONCLUSIONS

The findings suggest that injurious and non-injurious physical abuse cannot be distinguished on the basis of the personal characteristics or circumstances of the child or perpetrator.

PRACTICE IMPLICATIONS

A common criterion for child welfare intervention into cases of suspected physical abuse is injury or risk of injury. This criterion assumes that injurious and non-injurious assaults are qualitatively different phenomena, predicted by different risk factors. In the present study an attempt was made to differentiate between injurious and non-injurious cases of punitive physical abuse on the basis of characteristics of the child, perpetrator, family, and social context. None of these factors explained the likelihood of injury, suggesting that the prediction of injury as an intervention criterion may be questionable.

Assessment of need for a school-based mental health programme in Nigeria: perspectives of school administrators

The majority of children in Nigeria are unable to access mental health services. In this resource-poor setting, a school-based mental health service can be used to reach children who would otherwise not have access. An essential first step in the development of a school-based mental health programme is a needs assessment. Key informants (KIs) from southwest Nigeria were interviewed to identify their perspectives on child mental illness and needs for a school mental health programme. Data were analysed using interpretative phenomenological analysis. Although KIs sometimes used derogatory terms to describe mental illness, they were able to give full descriptions of different kinds of mental illnesses in children and a range of causes based on the bio-psychosocial model of disease. KIs acknowledged deficiencies in their training even though they currently use parent, child and environment-centred interventions to deal with mental health problems in school. KIs reported teachers as comfortable with handling mental health issues in children and suggested interventions that included development of basic and ongoing training. Barriers, such as poverty, ignorance and stigma need to be addressed, while government involvement and enlightenment campaigns are critical components of a successful programme.

Predictors of adult attitudes toward corporal punishment of children

This study identifies predictors of favorable attitudes toward spanking. Analyses were performed with survey data collected from a representative sample of 1,000 adults from Quebec, Canada. According to this survey, a majority of respondents endorsed spanking, despite their recognition of potential harm associated with corporal punishment (CP) of children. The prediction model of attitudes toward spanking included demographics, experiencing or witnessing various forms of family violence and abuse in childhood, and perceived frequency of physical injuries resulting from CP. Spanking was the most reported childhood experience (66.4%), and most violence and abuse predictors were significantly and positively correlated. Older respondents who were spanked in childhood and who believed that spanking never or seldom results in physical injuries were the most in favor of spanking. On the other hand, respondents who reported more severe physical violence or psychological abuse in childhood were less in favor of spanking. Findings are discussed in terms of prevention of CP and family coercion cycle.

Child abuse study among Swedish physicians and medical students

BACKGROUND

The purpose of the present paper was to examine the attitudes and experiences of reporting child abuse and neglect among primary care and hospital-based physicians and to study the responses of physicians and medical students to case vignettes suggestive of possible physical abuse or neglect.

METHODS

Physicians at the child health centers in Göteborg primary care (n= 44) and the general pediatricians at the pediatric hospital (n= 21) in Göteborg answered a questionnaire regarding their attitude and experiences reporting child abuse and neglect. The physicians and medical students (n= 34) responded to three case vignettes in which child abuse and neglect could be suspected.

RESULTS

A majority of the physicians had reported child abuse and neglect to the social services (80%). No differences were found between primary care and hospital-based physicians in terms of reporting or attitudes. Two-thirds of the physicians had suspected child abuse and neglect and decided not to report, and the major reason for not reporting was a lack of confidence in social services organization. Twenty-one percent had never reported a child for abuse or neglect during their working career. Medical students were more likely to report hypothetical cases than physicians.

CONCLUSION

Many physicians have reported child abuse to social services but also have neglected to do so even when suspecting abuse. It is important that medical students' willingness to report is continued when starting to work clinically and that all physicians should be continuously educated.

Familial violence socialization in childhood and later life approval of corporal punishment: a cross-cultural perspective

The use of corporal punishment has been associated with several negative outcomes for children. As a result, scholars have begun to study factors that are associated with the approval of corporal punishment. Using data from the International Dating Violence Study, the author implemented analysis of covariance and multilevel modeling analyses to determine that there were significant associations among culture, personal and group experiences of familial violence socialization, and attitudes about corporal punishment.