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7 INTERVENTIONS AND TREATMENT
Pages 253-291

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From page 253...
... These treatment interventions are viewed by some as a form of tertiary prevention, for they are often designed not only to remedy whatever harm may have occurred, but also to prevent future occurrences of child maltreatment and to minimize the negative consequences of child maltreatment experiences for children and their families. Some observers believe that the concept of treatment, in the field of child maltreatment studies, should be restricted to interventions that are therapeutic in nature, thus distinguishing such programs from social and legal efforts to investigate or prosecute reports of child abuse and neglect.
From page 254...
... Many studies of interventions for victims of child maltreatment distinguish between different types of abuse, particularly sexual abuse. However, victims of child physical abuse, sexual abuse, neglect, and emotional maltreatment often experience similar psychological effects (e.g., fearfulness, aggression, low selfesteem, and depression)
From page 255...
... In keeping with a process-oriented approach, the panel has included discussions of child protective services, law enforcement, and medical responses to reports of child maltreatment because of their potential to exacerbate or diminish the negative consequences of child maltreatment and influence the provision and effectiveness of treatment. It should be noted, however, that this review is selective.
From page 256...
... Despite the large literature on the detrimental effects of child maltreatment that Chapter 6 outlines, the majority of treatment programs do not provide services directed at the psychosocial problems of the abused child. (~.hil~lr~n's involvement in treatment programs has generally occurred in the context of family-based services in which they have received direct programmatic attentions (Kolko, in press)
From page 257...
... Clinical literature on the treatment of child sexual abuse tends to emphasize the importance of expression and exploration of feelings, alteration of attributions of responsibility, and reduction of fear and anxiety (Berliner and Wheeler, 1987~. To the panel's knowledge there are minimal outcome data on the comparative effectiveness of group and individual treatments for sexually abused children.
From page 258...
... , education, experience of "lesser" sexual abuse (Follette et al., 1991)
From page 259...
... However, there is currently considerable debate about whether child molesters can be effectively treated. The most common approaches to treating child molesters are comprehensive treatment programs aimed at simultaneously treating multiple aspects of deviant sexual behavior.
From page 260...
... Adolescent Sex Offenders Until recently, adolescent sexual offenders have been neglected in clinical and research literature, and empirically tested models to explain why adolescents commit sexual crimes or develop deviant sexual interest patterns are minimal (Becker, 1991~. The components and goals of treatment for adolescent sex offenders are similar to those involved in the treatment of adult sex offenders.
From page 261...
... Only recently have treatment services begun to incorporate empirical findings that build on ecological, developmental models of child maltreatment and examine the interactions of family members, abusive parents' perceptions of their children, behavioral characteristics that may restrict parenting abilities, and emotional reactions to stressful childrearing situations (Wolfe, 1992:9~. Contemporary parent training programs focus on improving cognitive-behavioral skills and usually adapt behavioral methods designed originally to assist non-abusive families with behaviorally disturbed children (Wolfe, 1992:10~.
From page 262...
... Parental enhancement programs may help some families who experience child management problems when a sexually abusive father is removed from the home. In these cases, child management skills help develop positive child-parent interaction in sexually abusive families.
From page 263...
... Family Systems Treatment Family systems treatment, commonly used in the treatment of intrafamilal sexual abuse, seeks to change the psychosocial interactions among family members. Clinical descriptions of family therapy combined with individual and group therapy suggest its potential usefulness for families who are highly dysfunctional, although controlled evaluations of family therapy in child sexual abuse have not been conducted (Alexander, 1990; Bentovim and Van Elburg, 1987; Giaretto, 1976, 1978; Ribordy, 1990; Sgroi, 1982; Walker et al., 1988~.
From page 264...
... Family preservation programs are designed to prevent the placement of children outside the home while ensuring their safety. Family preservation services are often characterized by their intensity (20-30 hours per week)
From page 265...
... Significant differences were found between families experiencing different types of maltreatment: fewer physically abused children were placed than those in the neglect and combined groups (Bath and Haapala, 1993~. Despite equivocal evidence of long-term effectiveness, family preservation services are currently believed to be a cost-effective alternative to the institutionalization or foster care placements for many children.
From page 266...
... Medical personnel diagnose and treat physical conditions associated with child maltreatment. Child protection services personnel investigate suspected cases of child maltreatment, select and refer families for treatment services, and decide whether to allow a child to remain in the home.
From page 267...
... Medical examinations of sexually abused children often include testing for sexually transmitted diseases. Sexual abuse is a potential mode of transmission of infection by the human immunodeficiency virus (HIV)
From page 268...
... The processes that determine child protective services responses to maltreated children and their families have not attracted much research attention, although such influences have a profound influence on the treatment process. Evaluations of CPS operations are complicated by the emergency situation in which many investigations occur, as well as variations in definitions of child maltreatment, and the absence of clear objectives, procedures, or standards of evaluation.
From page 269...
... State agencies often lack consistent criteria to help workers to make informed judgments in their investigations of reported or suspected child maltreatment. Factors that appear to be correlated with the substantiation of a report include the beliefs or assumptions of child protective services workers, the age of an alleged victim, and reports of multiple or recent incidents (Thoennes and Tjaden, 1990~.
From page 270...
... is provided to protect the child and to provide a period for family members to improve the conditions that resulted in the child's removal from the home. Some children placed in foster care, particularly in urban areas, reside with relatives who subsequently receive foster care support payments, a procedure known as "kinship care." A child's permanent removal from the home and legal termination of parental rights may be sought by child welfare officials when family or parental characteristics associated with abusive or neglectful behavior show no signs of improvement.
From page 271...
... Proponents of foster care point to the potential for serious physical harm that can occur when abused and neglected children remain in a dangerous environment, and the psychological and developmental risks to the child that can occur from uncertain living arrangements. Critics argue that family preservation is an important cultural value, children should not be removed unnecessarily from their homes, the costs of placing a child in foster care are significant, and foster care placement may have detrimental consequences,~3 including the potential for abuse while in foster care as well as developmental effects (particularly if young children experience multiple placements)
From page 272...
... Juvenile courts handle dependency proceedings, including adoption and foster care placements, when evidence exists that a parent is unable to protect and properly care for a child. Child maltreatment cases may be relevant to family courts when one parent seeks action against the other and evidence of abuse (usually sexual abuse)
From page 273...
... However, even though relatively low numbers of sexually abused children involve court proceedings (Goodman et al., 1989; Martin and Hamilton, 1989) ,~6 the legal treatment of child sexual abuse cases has attracted significant research attention (Goodman et al., 1989; Runyan et al., 1988~.
From page 274...
... The principal values that strongly influence the current American social context for responding to reported or suspected child maltreatment include child safety and family preservation. The rights of individual privacy, confidentiality, and other liberties that are often constitutionally guaranteed also influence both the provision of social and professional interventions as well as evaluations of their effectiveness.
From page 275...
... Investigations of child maltreatment reports often influence the development and availability of other professional services, including medical examinations, counseling, evaluation of risk factors, and substantiation of complaints. Research on various federal, state, and private agency involvement in treatment interventions has not been systematically organized, and information that describes how these groups interact is not readily available.
From page 276...
... A research framework that provides standardized classifications and descriptions of child maltreatment investigations, adjudications, and referral decisions should be developed to analyze the operation of the child protection system. This classification system should be employed in a national study designed to facilitate data collection and to clarify the types of agencies involved in the system, the forms of maltreatment that stimulate treatment referrals, the range of interventions available for selected forms of maltreatment, the costs of investigating and responding to reports of child maltreatment, and the outcomes of case reports.
From page 277...
... Recommendation 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. In addition to examining the role of family preservation programs in preventing foster care and other out-of-home child placement decisions, evaluations of family preservation services need to consider the effects of such programs in encouraging positive parent and child interactions and other factors that affect child and family well-being.
From page 278...
... Strategies for recruiting and retaining neglectful families in treatment programs need to be developed and could benefit from comparative studies of strategies used in modifying other behaviors that are resistant to change, such as drug addiction. Future efforts should explore the relative merits of long-term impacts of infant stimulation programs and other intensive services for neglected children and examine the relative contributions of intervention methods for different factors associated with neglect, such as lack of parental involvement or investment, lack of resources, a misunderstanding of the child's needs, social isolation, and maternal depression.
From page 279...
... . Since the 1970s the nation has witnessed a steady decline in the percentage of child maltreatment reports that are substantiated as well as an increase in the total number of reports.
From page 280...
... Young children's interactions with anatomical dolls is one type of behavior commonly evaluated in assessing suspected victims of child sexual abuse. Although anatomical dolls often help children describe what has happened to them and are often used in the assessment of young children, conflicting evidence exists about behavioral differences between the behavior of sexually abused and nonabused children with anatomical dolls (Kendall-Tackett, 1992; Realmuto and Wescoe, 1992)
From page 281...
... Bath, H.I., and D.A. Haapala 1993 Intensive family preservation services with abused and neglected children: An examination of group differences.
From page 282...
... Van Elburg 1987 Child sexual abuse: Children and families referred to a treatment project and the effects of intervention. British MedicalJournal 295(6611)
From page 283...
... 1981 Decision-making under uncertainty: Foster care for abused and neglected children? American Journal of Public Health 71:685-686.
From page 284...
... :59-76. 1982 A comprehensive child sexual abuse treatment program.
From page 285...
... Morris 1990 Child sexual abuse: Who goes home? Child Abuse and Neglect 14:61-68.
From page 286...
... Moser, and S.R. Weldy 1988 Behavioral/emotional indicators of child sexual abuse among child psychiatric in patients: A comparison with physical abuse.
From page 287...
... Biegel, eds., Family Preservation Services: Research and Evalua tion. Newbury Park, CA: Sage Publications.
From page 288...
... Biegel, eds., Family Preservation Services: Research and Evaluation. Newbury Park, CA: Sage Publications.
From page 289...
... Gould 1985 Foster care for child maltreatment: Impact on delinquent behavior. Pediatrics 75 :562-568.
From page 290...
... Pecora, eds. 1991 Intensive Family Preservation Services: An Instructional Sourcebook.
From page 291...
... Powell, eds., Lasting Effects of Child Sexual Abuse. Newbury Park, CA: Sage Publications.


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