April is National Child Abuse Prevention Month
Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office
April is National Child Abuse Prevention month. Child abuse is a social and public health problem throughout the United States and in our Indian communities. Child abuse, sometimes referred to with the broader term child maltreatment, can come in various forms including neglect, as well as sexual, physical and emotional abuse.
There are about 1 million substantiated reports of child maltreatment in the US per year. Two thirds of these cases are neglect, 16% victims of physical abuse, 9% sexual abuse, and 7% emotional abuse. Since this number includes only those that were reported and substantiated, it is suspected that actual occurrence is much higher. The prevalence in Indian communities varies from tribe to tribe and is less well established, but some studies have shown the prevalence to be about twice as common for neglect, and a little lower than the national average for sexual and physical abuse (CDC Facts at a Glance, Spring 2008).
Child abuse usually occurs at the hands of a child's caregiver, about 75% of the time by the parents. Risk factors in the perpetrator for child abuse include: a personal history of child abuse, substance abuse, and anger/impulse control conditions or other mental illness.
Sometimes the effects of child abuse are obvious and immediate. One devastating example of the effects of physical abuse is the "shaken baby syndrome". The victims of shaken baby syndrome are usually infants or young toddlers, and the condition occurs when an adult squeezes a child while simultaneously shaking them. Squeezing the victim forces blood, at high pressures, into the child's brain, which combined with violent shaking, causes severe tissue damage to the victim, including bleeding and bruising of the brain. It frequently leads to severe, life-long neurological impairments, including blindness, paralysis, seizures and mental retardation.
More commonly, the effects of child abuse are less obvious, but affect the victim over the long term. In fact, the mental and emotional effects of all forms of child abuse can sometimes last a lifetime. Several studies have shown a markedly higher rate of healthcare utilization by victims of child abuse compared to non-victims. One such important study, the Adverse Childhood Experiences study, performed by the Kaiser Permanente and the Centers for Disease Control and Prevention, demonstrated a clear relationship between the number of adverse childhood experiences and a wide range of health conditions, including substance abuse, depression, obesity, heart disease, lung disease and liver disease (Felitti et. al, Relationship of Childhood Abuse and household Dysfunction to Many Causes of Death in Adults, Am J Prev Med, 1998, 14 (4)) .
Primary prevention of child abuse includes raising the awareness of the problem among the general public. This can include distributing parenting literature to all new mothers, or young parents.
Secondary prevention of child abuse includes programs which focus on providing parent training and stress management for parents who are at risk for abusing their children, including young, first-time parents or parents with a history of substance abuse. There are a number of these programs run by the behavioral health departments in our tribal health programs in the California Area.
Tertiary prevention efforts usually involve child protective services. This type of prevention occurs after a caregiver has already abused a child, and is aimed at preventing future abuse. The offender is referred for treatment, sometimes by order of the court, or as a condition for receiving custody of the child back. This treatment is generally structured and focused on anger management. Some of our tribal health behavioral health programs are able to provide this treatment.
One society-wide prevention effort that deserves special mention is Megan's Law. Megan's Law requires all sex offenders to register with their local law enforcement agencies. The information about where sex offenders live is then available to the general public. In the State of California, there is an online, searchable database of the majority of registered sex offenders (www.meganslaw.ca.gov ). This is a tool to help parents, and others who care for children, become aware of potential threats in their neighborhood and to take appropriate safety measures.
For the individual who feels he/she is at risk of abusing a child, help is available. Some of the risk factors for child abuse such as substance abuse, anger control, or other emotional conditions can be addressed through community-based support groups, or by receiving help from a mental health professional. Sometimes people are reluctant to seek help due to stigma, or because they feel guilty about not being able to control their emotions to the point of putting their children at risk. Mental health professional are trained to listen in an empathic way, and provide emotional support and guidance in a non-judgmental manner.
Indian children are our most precious resource, and will be the future leaders of our communities. Child abuse tears at the fabric of society and weakens our communities. Since this is an issue which deserves everyone's attention, please join me in recognition of National Child Abuse Prevention month.
For more information:
National Child Abuse Prevention Month website: http://www.childwelfare.gov/preventing/preventionmonth/
Prevent Child Abuse America: http://www.preventchildabuse.org/index.shtml
National Library of Medicine Child Abuse resources: http://www.nlm.nih.gov/medlineplus/childabuse.html