The Role of CSHPs in Preventing Child Abuse and Neglect

Article excerpt

Child abuse remains a horrific public health and social problem in the United States. In 2002, approximately 2.6 million referrals concerning approximately 5 million children were reported to Child Protective Services for suspected child abuse and neglect. Approximately 903,000 children were confirmed victims of child maltreatment. Of these, 61% suffered neglect, including medical neglect; 19% were physically abused; 10% were sexually abused; and 7% suffered emotional abuse. American Indian, Alaska Native, and African American children had the highest victimization rates when compared to the national population. (1)

Boys and girls are almost equally likely to experience neglect and physical abuse. However, girls are four times more likely to experience sexual abuse. (2) In addition, children with disabilities are mistreated at 1.7 times the rate for other children. (3) Nevertheless, on average, victimization rate relates inversely to a child's age. (1) For example, children aged 0 to 3 experience the highest rate of neglect. Though children aged 0 to 5 comprise 25% of children in the United States, they account for 85% of fatalities from child maltreatment. (4)

In 2000, nearly four children died each day from abuse or neglect. Children under age five account for 80% of reported fatalities, contending with congenital anomalies for the second-leading cause of death for children aged 1 to 4 in the United States. (5) However, fatalities due to maltreatment go seriously under-reported due to inadequate investigation, lack of information sharing between investigators and agencies, and antiquated reporting systems that fail to document maltreatment as an official cause of death. (6) Deaths labeled as accidents, child homicides, and Sudden Infant Death Syndrome may be attributed to child maltreatment if more comprehensive investigations were conducted. (7)

Research also documented a link between maltreated children and a range of medical, emotional, psychological, and behavioral problems. (8,9) Costs of this human suffering cannot be measured. Economic costs associated with child abuse and neglect are staggering as well. Conservative estimates suggest the Unites States spends approximately $94 billion per year on direct and indirect costs of child maltreatment. (8)


Child abuse and neglect are defined by the Federal Child Abuse Prevention and Treatment Act (CAPTA), which sets a foundation for each state to describe offenses within civil and criminal codes. (10) CAPTA recognizes four major types of maltreatment.

Physical Abuse. Inflicting of physical injury from punching, beating, kicking, biting, burning, shaking, or otherwise harming a child.

Child Neglect. Failing to provide for the child's basic needs including physical, educational, or emotional.

Sexual Abuse. Performing sexual acts ranging from fondling genitals and exhibitionism to intercourse, rape, sodomy, and exploitation through prostitution or production of pornographic materials.

Emotional Abuse. Acts and omissions of parents or care-givers that caused or could lead to behavioral, cognitive, emotional, or mental disorders. Emotional abuse underlies other forms of abuse. (10)


Most prevention efforts target individual parents, families, or children to change attitudes and behavior that contribute to risk. (11) Bronfenbrenner's (12) ecological model provides a powerful tool in preventing child maltreatment. (13,14) This model views the child's environment as a series of interconnected levels, with the child at the center of a circle of influence. (13) Each level must be addressed to effectively prevent child maltreatment.

Within the model, schools play a critical role identifying and preventing child abuse and neglect. (13,16) Berson (15) says, "Schools have an important responsibility in the protection of children and serve as the system that bridges the family and community into a social network for the child. …