Pilot CWS-R-SAP – v. 1 Current CWS, 4. Introduction

Pilot Child Welfare System Redesign

Strategic Action Plan

 

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4. Introduction

 

“A call to a child abuse hotline is as much a request for help as a call to 911.”[1]

 

This one sentence defines the intent of this Strategic Action Plan. The intent is neither punitive nor accusatory.

  • The intent is from the perspective of the abused and neglected children, whose life becomes more hopeless with every new day in an abusive and toxic family.
  • The intent is from the perspective of concerned people witnessing a child’s traumatic situation and reporting it to the child abuse hotline.
  • The intent is from the perspective of the children languishing in foster care without proper medical and mental health treatment for the trauma from their child abuse and neglect.
  • The intent is from the perspective of the public who read the reports of child abuse and neglect, the horrifying statistics, and ask why something isn’t being done to stop child abuse and neglect.

 

The intent is not to criticize, but to provide alternatives, ideas and recommendations that could make a difference for all. Statistics are provided when they can be used to create a proactive approach to preventing the next similar case. Although some of the statistics may be shocking, the intent is to inform and provide alternatives. Rather than merely reporting the data, use the data as fuel to create better programs and services, to turn reaction into action, and to stop the cycle of child abuse and neglect. The intent is to help to make a difference and to end child abuse and neglect within this generation.

 

Lifelong Effects of Child Abuse and Neglect

“Aside from the immediate physical injuries children can experience through maltreatment, a child’s reactions to abuse or neglect can have lifelong and even intergenerational impacts. Childhood maltreatment can be linked to later physical, psychological, and behavioral consequences as well as costs to society as a whole. … For example, abuse or neglect may stunt physical development of the child’s brain and lead to psychological problems, such as low self-esteem, which could later lead to high-risk behaviors, such as substance use. The outcomes for each child may vary widely and are affected by a combination of factors, including the child’s age and developmental status when the maltreatment occurred; the type, frequency, duration, and severity of the maltreatment; and the relationship between the child and the perpetrator. Additionally, children who experience maltreatment often are affected by other adverse experiences (e.g., parental substance use, domestic violence, poverty), which can make it difficult to separate the unique effects of maltreatment.”[2]

“Some long-term physical effects of abuse or neglect may occur immediately (e.g., brain damage caused by head trauma), but others can take months or years to emerge or be detectable. There is a straightforward link between physical abuse and physical health, but it is also important to recognize that maltreatment of any type can cause long-term physical consequences. Childhood maltreatment has been linked to higher risk for a wide range of long-term and/or future health problems, including—but not limited to—the following:

  • Diabetes
  • Lung disease
  • Malnutrition
  • Vision problems
  • Functional limitations (i.e., being limited in activities)
  • Heart attack
  • Arthritis
  • Back problems
  • High blood pressure
  • Brain damage
  • Migraine headaches
  • Chronic bronchitis/emphysema/chronic obstructive pulmonary disease
  • Cancer
  • Stroke
  • Bowel disease
  • Chronic fatigue syndrome”[3]

“Child abuse and neglect also has been associated with certain regions of the brain failing to form, function, or grow properly. For example, a history of maltreatment may be correlated with reduced volume in overall brain size and may affect the size and/or functioning of the following brain regions:

  • The amygdala, which is key to processing emotions
  • The hippocampus, which is central to learning and memory
  • The orbitofrontal cortex, which is responsible for reinforcement-based decision-making and emotion regulation
  • The cerebellum, which helps coordinate motor behavior and executive functioning
  • The corpus callosum, which is responsible for left brain/right brain communication and other processes (e.g., arousal, emotion, higher cognitive abilities)”[4]

“Additionally, the type of maltreatment a child experiences can increase the risk for specific physical health conditions. For example, one study found that children who experienced neglect were at increased risk for diabetes, poorer lung functioning, and vision and oral health problems. Children who had been physically abused were at higher risk for diabetes and malnutrition. Children who were victims of sexual abuse were more likely to contract hepatitis C and HIV,”[5]

 

Epigenetics refers to changes in how an individual’s genes are expressed and used, which may be temporary or permanent (National Scientific Council on the Developing Child, 2010). These changes can even be passed on to the person’s children. An epigenetic change can be caused by life experiences, such as child maltreatment or substance exposure. For example, one study found that children who had been maltreated exhibited changes in genes associated with various physical and psychological disorders, such as cancer, cardiovascular disease, immune disorders, schizophrenia, bipolar disorder, and depression.”[6] [bolding added for emphasis]

 

Psychological Problems

Child abuse and neglect can cause a variety of psychological problems. Maltreatment can cause victims to feel isolation, fear, and distrust, which can translate into lifelong psychological consequences that can manifest as educational difficulties, low self-esteem, depression, and trouble forming and maintaining relationships. Researchers have identified links between child abuse and neglect and the following psychological outcomes.[7]

 

Diminished executive functioning and cognitive skills.

  • “Disrupted brain development as a result of maltreatment can cause impairments to the brain’s executive functions: working memory, self-control, and cognitive flexibility (i.e., the ability to look at things and situations from different perspectives).”[8]
  • “Children who were maltreated also are at risk for other cognitive problems, including difficulties learning and paying attention.”[9]

 

Poor mental and emotional health.

Experiencing childhood maltreatment is a risk factor for depression, anxiety, and other psychiatric disorders throughout adulthood.[10]

  • Studies have found that adults with a history of ACEs [Adverse Childhood Experiences] had a higher prevalence of suicide attempts then those who did not.[11]
  • Adults with major depression who experienced abuse as children had poorer response outcomes to antidepressant treatment, especially if the maltreatment occurred when they were aged 7 or younger.[12]

 

Attachment and social difficulties.

  • Infants in foster care who have experienced maltreatment followed by disruptions in early caregiving can develop attachment disorders. Attachment disorders can negatively affect a child’s ability to form positive peer, social, and romantic relationships later in life.[13]
  • Children who experience abuse or neglect are more likely to develop antisocial traits as they grow up, which can lead to criminal behavior in adulthood.[14]

 

Posttraumatic stress.

  • Children who experienced abuse or neglect can develop posttraumatic stress disorder (PTSD), which is characterized by symptoms such as persistent re-experiencing of the traumatic events related to the abuse; avoiding people, places, and events that are associated with their maltreatment; feeling fear, horror, anger, guilt, or shame; startling easily; and exhibiting hypervigilance, irritability, or other changes in mood.[15]
  • PTSD in children can lead to depression, suicidal behavior, substance use, and oppositional or defiant behaviors well into adulthood, which can affect their ability to succeed in school, and create and nurture important relationships.[16]

 

Toxic Stress.

  • Strong, frequent, or prolonged activation of a person’s stress response system, often referred to as toxic stress, can have long-lasting damaging effects on an individual’s health, behavior, and ability to learn.[17]
  • Toxic stress can be caused by experiencing ACEs, including child maltreatment. It can change an individual’s brain architecture, which can cause the person’s stress response system to be triggered more frequently and for longer periods of time and place him or her at an increased risk for a variety of physical and mental health problems, including cardiovascular disease, depression, and anxiety.”[18]

 

Behavioral Consequences

Victims of child abuse and neglect often exhibit behavioral difficulties even after the maltreatment ends. The following are examples of how maltreatment can affect individuals’ behaviors as adolescents and adults.[19]

 

Unhealthy sexual practices.

  • Studies suggest that abused or neglected children are more likely to engage in sexual risk-taking as they reach adolescence, including a higher number of sexual partners, earlier initiation of sexual behavior, and transactional sex (i.e., sex exchanged for money, gifts, or other material support), which increases their chances of contracting a sexually transmitted disease.[20]

 

Juvenile delinquency leading to adult criminality.

  • Several studies have documented the correlation between child maltreatment and future juvenile delinquency and criminal activities.[21]
  • According to research funded by the National Institute of Justice within the U.S. Department of Justice, Office of Justice Programs, children who experience maltreatment in the form of physical and emotional abuse are more likely to develop antisocial behaviors and form relationships with other antisocial people.[22]
  • There is a difference between girls and boys in the way child maltreatment influences delinquent behavior. In a study, girls tended to express internalizing behaviors (e.g., depression, social withdrawal, anxiety), while boys tended to express externalizing behaviors (e.g., bullying, aggression, hostility) leading up to adult criminal behavior.[23]

 

Alcohol and other drug use.

  • Adults who had been maltreated as children are at a significantly higher risk of substance use disorders than adults who have not been maltreated.[24].[25]

 

Future perpetration of maltreatment.

  • Although most children who have experienced abuse and neglect do not go on to abuse or neglect their own children, research suggests they are more likely to do so compared to children who were not maltreated.[26]
  • This cycle of maltreatment can be a result of children learning early on that physical abuse or neglect is an appropriate way to parent.[27

 

The Costs of Child Abuse and Neglect

Although the physical, psychological, and behavioral consequences of child abuse and neglect weigh heavily on the shoulders of the children who experience it, the impact of maltreatment does not end there. Society pays a price for child abuse and neglect in both direct costs (e.g., hospitalizations, foster care payments) and indirect costs (e.g., long-term care, lost productivity at school, juvenile and criminal justice systems costs).[28]

 

A study by researchers from the Centers for Disease Control and Prevention (CDC) developed estimates using 2015 data for the cost of child maltreatment in the United States.[29]

  • For nonfatal incidents of child maltreatment, the researchers estimated a lifetime cost of $831,000 per child, and
  • for fatal incidents of child maltreatment, it estimated a lifetime cost of $16.6 million per child.
  • It appraised the annual cost of nonfatal child maltreatment in the United States to be $428 billion (based on the number of substantiated cases of nonfatal maltreatment) or $2 trillion (based on the number of investigated instances of nonfatal maltreatment).
  • The costs in this study include both tangible costs (e.g., child welfare, health care, juvenile justice) and intangible costs (e.g., pain, suffering, grief).[30]

 

Cost of Injury Analysis[31]

Cost-of-injury analysis (also referred to as cost-of-illness or cost-of-failure analysis) attempts to estimate the economic impact of child abuse and neglect on society (or on a local community). In other words, how much does it cost when a community fails to prevent child abuse and neglect?

These analyses frequently estimate both direct and indirect costs associated with child maltreatment. Direct costs include those associated with addressing the immediate needs of maltreated children. They might include:

  • Hospitalization for severe injuries resulting from abuse and neglect
  • Medical treatment (such as physician visits, emergency department visits, outpatient clinics, dental visits, physical therapy, etc.) for health problems resulting from abuse and neglect
  • Mental health treatment for issues resulting from abuse and neglect
  • Child welfare services to intervene in existing cases of child abuse and neglect
  • Law enforcement and judicial system costs associated with intervention

Indirect costs include those associated with the long-term and secondary effects of maltreatment, as well as productivity losses for the abused child (missing school) or parent/caretaker (needing to attend criminal hearings or stay home with an injured child). Examples of indirect costs include:

  • Special education costs
  • Treatment for chronic physical and mental health problems as a result of child abuse and neglect
  • Costs of increased juvenile delinquency and adult criminality
  • Lost productivity to society (due to decreased earning potential, unemployment, or premature death)
  • Costs associated with treatment of increased substance abuse
  • Costs associated with interventions for domestic violence resulting from child maltreatment

 

Adverse Childhood Experiences (ACE) Response
University of Albany & Prevent Child Abuse America seeks to connect research data and its potential for real-world application to prevent adverse childhood experiences and their consequences through policy and program leadership, community development, and direct practice.[32]

 

The Costs and Economic Impact of Violence Against Children
Pereznieto, Montes, Langston, & Routier (2014) ChildFund Alliance looks at the global cost of physical, psychological, and sexual violence against children. It also discusses levels of government spending for prevention and response and offers cost-effective solutions.[33]

 

The Economics of Child Abuse
Safe & Sound reports on the extent of the economic cost of child abuse in San Francisco and risk factors that contribute to it. This report aims to shed light on the economic burden child abuse has on communities and its implications.[34]

 

References

[1] Dan Scott, retired sergeant in the Los Angeles County Sheriff’s office and a leader in the effort to improve cross reporting between child protective services (CPS) and law enforcement.

[2] Rosen, A. L., Handley, E. D., Cicchetti, D., & Rogosch, F. C. (2018). The impact of patterns of trauma exposure among low income children with and without histories of child maltreatment. Child Abuse & Neglect, 80, 301–311. doi: 10.1016/j.chiabu.2018.04.005

[3] Widom, C. S., Czaja, S. J., Bentley, T., & Johnson, M. S. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow up. American Journal of Public Health, 102, 1135–1144. doi: 10.2105/ AJPH.2011.300636

[4] Bick, J., & Nelson, C. A. (2016). Early adverse experiences and the developing brain. Neuropsychopharmacology, 41, 177–196. Retrieved from https://www.nature.com/articles/ npp2015252. doi: 10.1038/npp.2015.252

[5] Widom, C. S., Czaja, S. J., Bentley, T., & Johnson, M. S. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow up. American Journal of Public Health, 102, 1135–1144. doi: 10.2105/ AJPH.2011.300636

[6] Cicchetti, D., Hetzel, S., Rogosch, F. A., Handley, E. D., & Toth, S. L. (2016). An investigation of child maltreatment and epigenetic mechanisms of mental and physical health risk. Development and Psychopathology, 28, 1305–1317. doi: 10.1017/S0954579416000869

[7] Child Welfare Information Gateway. (2019). Long-term consequences of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau

[8] Kavanaugh, B.C., Dupont-Frechette, J. A., Jerskey, B.A., & Holler, K. A. (2016). Neurocognitive deficits in children and adolescents following maltreatment: Neurodevelopmental consequences and neuropsychological implications of traumatic stress. Applied Neuropsychology: Child, 6, 64–78. Doi: 10.1080/21622965.2015.1079712

[9] Bick, J., & Nelson, C. A. (2016). Early adverse experiences and the developing brain. Neuropsychopharmacology, 41, 177–196. Retrieved from https://www.nature.com/articles/ npp2015252. doi: 10.1038/npp.2015.252

[10] Child Welfare Information Gateway. (2019). Long-term consequences of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau

[11] Choi, N. G., DiNitto, D. M., Marti, C. N., & Choi, B. Y. (2017). Association of adverse childhood experiences with lifetime mental and substance use disorders among men and women aged 50+ years. International Psychogeriatrics, 29, 359–372. doi:10.1017/ S1041610216001800

[12] Williams, L. M., Debattista, C., Duchemin, A. M., Schatzberg, A. F., & Nemeroff, C. B. (2016). Childhood trauma predicts antidepressant response in adults with major depression: data from the randomized international study to predict optimized treatment for depression. Translational Psychiatry, 6, e799. doi: 10.1038/tp.2016.61

[13] Doyle, C., & Cicchetti, D. (2017). From the cradle to the grave: The effect of adverse caregiving environments on attachment and relationships throughout the lifespan. Clinical Psychology: Science and Practice, 24(2), 203–217. Doi: 10.1111/cpsp.12192

[14] U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. (2017). Pathways between child maltreatment and adult criminal involvement. October 12, 2017. Retrieved from https://nij.gov/topics/ crime/children-exposed-to-violence/Pages/pathways-between-child-maltreatment-and-adult-criminal-involvement.aspx

[15] Sege, R. D.; Amaya-Jackson, L.; American Academy of Pediatrics Committee on Child Abuse and Neglect, Council on Foster Care, Adoption, and Kinship Care; American Academy of Child and Adolescent Psychiatry Committee on Child Maltreatment and Violence; & National Center for Child Traumatic Stress. (2017). Clinical considerations related to the behavioral manifestations of child maltreatment. Pediatrics, 139(4). Retrieved from http://pediatrics.aappublications.org/content/pediatrics/ early/2017/03/16/peds.2017-0100.full.pdf

[16] Ibid.

[17] National Scientific Council on the Developing Child. (2014). Excessive stress disrupts the architecture of the developing brain (Working paper 3). Retrieved from https://developingchild.harvard.edu/resources/wp3/

Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment in the United States, 2015. Child Abuse & Neglect, 86, 178–183. doi: 10.1016/j.chiabu.2018.09.018

[18] National Scientific Council on the Developing Child. (2014). Excessive stress disrupts the architecture of the developing brain (Working paper 3). Retrieved from https://developingchild.harvard.edu/resources/wp3/

Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment in the United States, 2015. Child Abuse & Neglect, 86, 178–183. doi: 10.1016/j.chiabu.2018.09.018

[19] Child Welfare Information Gateway. (2019). Long-term consequences of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau

[20] Thompson, R., Lewis, T., Neilson, E. C., English, D. J., Litrownik, A. J., Margolis, B. . . . Dubowitz, H. (2017). Child maltreatment and risky sexual behavior. Child Maltreatment, 22, 69–78. doi: 10.1177/1077559516674595

[21] Herrenkohl, T. I., Jung, H., Lee, J. O., & Kim, M.-H. (2017). Effects of child maltreatment, cumulative victimization experiences, and proximal life stress on adult crime and antisocial behavior. Retrieved from https://www.ncjrs.gov/ pdffiles1/nij/grants/250506.pdf

[22] U.S. Department of Justice, Office of Justice Programs, National Institute of Justice. (2017). Pathways between child maltreatment and adult criminal involvement. October 12, 2017. Retrieved from https://nij.gov/topics/ crime/children-exposed-to-violence/Pages/pathways-between-child-maltreatment-and-adult-criminal-involvement.aspx

[23] Herrenkohl, T. I., Jung, H., Lee, J. O., & Kim, M.-H. (2017). Effects of child maltreatment, cumulative victimization experiences, and proximal life stress on adult crime and antisocial behavior. Retrieved from https://www.ncjrs.gov/ pdffiles1/nij/grants/250506.pdf

[24] LeTendre, M. L., & Reed, M. B. (2017). The effect of adverse childhood experience on clinical diagnosis of a substance use disorder: Results of a nationally representative study. Substance Use & Misuse, 52, 689– 697. doi: 10.1080/10826084.2016.1253746

[25] Choi, N. G., DiNitto, D. M., Marti, C. N., & Choi, B. Y. (2017). Association of adverse childhood experiences with lifetime mental and substance use disorders among men and women aged 50+ years. International Psychogeriatrics, 29, 359–372. doi:10.1017/ S1041610216001800

[26] Yang, M., Font, S. A., Ketchum, M., & Kim, Y. K. (2018). Intergenerational transmission of child abuse and neglect: Effects of maltreatment type and depressive symptoms. Children and Youth Services Review, 91, 364–371. doi: 10.1016/j.childyouth.2018.06.036

[27] Child Welfare Information Gateway. (2018). Cycle of abuse. Retrieved from https://www.childwelfare.gov/topics/can/ impact/long-term-consequences-of-child-abuse-and-neglect/abuse/

[28] Child Welfare Information Gateway. (2019). Long-term consequences of child abuse and neglect. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau

[29] Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment in the United States, 2015. Child Abuse & Neglect, 86, 178–183. doi: 10.1016/j.chiabu.2018.09.018

[30] Peterson, C., Florence, C., & Klevens, J. (2018). The economic burden of child maltreatment in the United States, 2015. Child Abuse & Neglect, 86, 178–183. doi: 10.1016/j.chiabu.2018.09.018

[31] Child Welfare Information Gateway, Cost-of-Injury Analysis, https://www.childwelfare.gov/topics/preventing/developing/economic/cost-injury/

[32] Child Welfare Information Gateway, Cost-of-Injury Analysis, https://www.childwelfare.gov/topics/preventing/developing/economic/cost-injury/

[33] Ibid.

[34] Ibid.

 

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To submit questions or comments, please email Jo@Jo-Calk.com. I welcome all input, ideas, and suggestions. Thank you for caring for children.

Blessings,

Jo Calk