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1.

Objectives

To identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse.

Methods

Homeless and street-involved persons aged 18-23 filled out a questionnaire and participated in a structured assessment of histories of abuse, tobacco use and substance abuse.

Results

Sixty-four homeless youth in Salt Lake City, Utah completed the study, 43 males and 21 females. Eighty-four percent screened positive for childhood physical and/or sexual abuse occurring before the age of 18; 42% screened positive for both physical and sexual abuse; 72% reported still being affected by their abuse. Among all abuse victims, 44% were interested in treatment for their abuse history and 62% of homeless youth who reported still being affected by their abuse were interested in treatment. Individuals were more likely to be interested in treatment if they were female, had not completed high school or had been previously asked about family dysfunction. Many victims who declined treatment offered spontaneous insight into their decision. Interest in treatment was similar to interest in treatment for other behaviors such as smoking and substance abuse.

Conclusions

Histories of abuse are common among homeless youth. A majority of those reporting a history of abuse are still affected by their abuse. Interest in treatment for a history of abuse was comparable to interest in treatment for other morbidities in the homeless youth population such as tobacco use and substance abuse. Our finding that homeless youth continue to be impacted by their abuse and are interested in treatment should prompt more screening for histories of abuse.  相似文献   

2.

Objective

While the relationship between abusive parenting and violent delinquency has been well established, the cognitive and emotional processes by which this occurs remain relatively unidentified. The objective of this work is to apply a conceptual model linking abusive parenting to the conversion of shame into blaming others and therefore to violent delinquency.

Methods

A retrospective study of 112 adolescents (90 male; 22 female; ages 12-19 years; M = 15.6; SD = 1.4) who were incarcerated in a juvenile detention facility pending criminal charges, completed measures of exposure to abusive and nonabusive discipline, expressed and converted shame, and violent delinquency.

Results

Findings tend to confirm the conceptual model. Subjects who converted shame (i.e., low expressed shame, high blaming others) tended to have more exposure to abusive parenting and showed more violent delinquent behavior than their peers who showed expressed shame. Subjects who showed expressed shame (i.e., high expressed shame, low blaming others) showed less violent delinquency than those who showed converted shame.

Conclusions

Abusive parenting impacts delinquency directly and indirectly through the effects of shame that is converted. Abusive parenting leads to the conversion of shame to blaming others, which in turn leads to violent delinquent behavior.

Practice implications

For juvenile offenders, the conversion of shame into blaming others appears to contribute to pathological outcomes in relation to trauma. Translation of this work into clinical practice is recommended.  相似文献   

3.

Objectives

The objectives of this study are to assess children's competence to state their traumatic experience and to determine psychosocial factors influencing the competency of children's statements, such as emotional factors of children and parents and trauma-related variables, in Korean child sex abuse victims.

Methods

We enrolled 214 children, who visited “Sunflower Children's Center” for sexual abuse. The children were aged 8-13 years. The children's parent were surveyed using questionnaires [Beck Depression Inventory (BDI), State-Trait Anxiety Inventory(STAI)] to obtain demographic information, traumatic event profiles and self-report scale. Children completed psychological measures as follows: Children's Depression Inventory (CDI), Revised Children's Manifest Anxiety Scale (RCMAS), Traumatic Symptom Checklist for Children (TSCC). The modified-Criteria-Based Content Analysis (CBCA) was used to assess children's statements. ANOVA, independent t-test, Pearson correlation were used. All statistics were demonstrated using SPSS 12.0.

Results

Modified-CBCA scores did not differ according to children's level of depression and anxiety. Children with parents who showed supportive reactions, scored significantly higher on the modified-CBCA scores than those with unsupportive parents. Children with severely depressed parents had lower modified-CBCA scores than those with less depressed parents. Modified-CBCA scores were significantly higher in participants who experienced a single traumatic event than those who had multiple events. However, the severity of sexual abuse, relationship with the perpetrator, types of disclosure, and duration of initial disclosure did not show significant differences in capability of statement.

Conclusion

In conclusion, the competence of statements in Korean sexually child sex abuse victims is related to parental emotional states and support rather than children's factors such as psychopathology or age, and appears to be more reliable with a single traumatic experience. Therefore, promoting parental support through psychoeducation is one of the most important things to be done to help children overcome psychologic trauma but also enhance the accuracy of their statement.  相似文献   

4.

Objective

The aim of the study was to examine caregiver management strategies for child sexual abuse (CSA) when presented with hypothetical scenarios that vary in physical invasiveness.

Methods

One hundred fifty three caregivers were given 3 scenarios of CSA with 7 management strategies presented in the 21-item Taking Action Strategies (TAS) scale. Caregivers were asked to rate strategies according to their willingness to carry out each action with rating of 5 = greater likelihood of carrying out the action specified while a rating of 1 = a lower likelihood of carrying out that action. CSA scenarios included exposure to pornography/masturbation, fondling, and penetration while management strategies including fighting the accused, blaming the child, and outreaching to the authorities. Repeated measures ANOVA was used to compare mean TAS scores for the management strategies across CSA scenarios.

Results

The difference between TAS scores across the abuse scenarios was statistically significant (p < .001). Mean TAS scores reflected greater preference for taking action if the abusive act was perceived as more physically intrusive (exposure to pornography/masturbation-TAS 3.5, fondling-TAS 3.7, penetration-TAS 3.8). Caregivers reported being less willing to handle a disclosure of CSA without outreach (TAS 2.5 and 2.0 for fighting and blaming the child, respectively) and more willing to manage a disclosure with outreach to authorities (TAS 3.8, 4.5, and 4.7 for outreaching to Child Protective Services [CPS], to the child's healthcare provider and police, respectively). A predictor of caregiver outreach to authorities identified was the caregiver having past interactions with CPS.

Conclusion

Perception of the physical invasiveness of CSA and demographic factors can impact caregiver management strategies after a disclosure.

Practice implications

Results suggest that several factors influence caregiver management of sexual abuse. These factors warrant further study, as they are potential contributors to declining trends in CSA cases observed. Other implications include the need for educational efforts targeting caregivers. These interventions should focus on dispelling myths about the perceived physical invasiveness of CSA. These perceptions should not mitigate a caregiver's decision to involve the authorities in their management after a disclosure. Lastly, despite criticisms of the child protective systems, caregivers with past encounters with CPS view these related agencies as valuable resources.  相似文献   

5.

Objectives

Current research has been inconsistent in corroborating that parents’ compromised empathy is associated with elevated physical child abuse risk, perhaps in part because of an emphasis on dispositional empathy rather than empathy directed at their own children. Research has also relied on self-reports of empathy that are susceptible to participant misrepresentation. The present study utilized an analog task of parental empathy to investigate the association of parental empathy toward one's own child with physical child abuse potential and with their tendency to punish perceived child misbehavior.

Methods

A sample of 135 mothers and their 4–9 year old children were recruited, with mothers estimating their children's emotional reactions using a behavioral simulation of parental empathy. Mothers also provided self-reports on two measures of child abuse potential, a measure of negative attributions and expected punishment of children using vignettes, as well as a traditional measure of dispositional empathic concern and perspective-taking.

Results

Findings suggest that parental demonstration of poorer empathic ability on the analog task was significantly related to increased physical abuse potential, likelihood to punish, and negative child attributions. However, self-reported dispositional empathy exhibited the pattern of inconsistent associations previously observed in the literature.

Conclusions

Parental empathy appears to be a relevant target for prevention and intervention programs. Future research should also consider similar analog approaches to investigate such constructs to better uncover the factors that elevate abuse risk.  相似文献   

6.

Objective

This study described the epidemiology of child abuse homicides in the state of Kansas from 1994 to 2007. It focused on obtaining significant details on all recorded child abuse homicides in Kansas during this time frame to provide critical information that can be used for future preventive measures.

Methods

A retrospective case review was conducted on data gathered by the Kansas State Child Death Review Board for all cases of “child abuse homicides” that occurred from 1994 to 2007.

Results

A total of 170 child abuse homicide cases in Kansas between 1994 and 2007 were identified. The majority of these cases (63.5%) were considered fatal child physical abuse. There was a predominance of female victims (55.9%). The vast majority of victims were White (78.8%), followed by Black (17.1%). One to 2-year-olds accounted for the largest age group of children who were victimized (33.5%). For cases with known prenatal care status, 74% of mothers received adequate prenatal care. The largest percentage of victims was children of single mothers (40.6%), with no prior history of child abuse (60%). The majority of deaths occurred in the victim's residence (81.8%). The greatest number of deaths occurred secondary to abusive head trauma (42.9%), followed by asphyxia (21.8%). When a trigger was known, 44.2% involved inconsolable crying. The most common perpetrator was the victim's biological father (26.6%), followed by the victim's biological mother (24.9%), then the victim's mother's male paramour (19.8%).

Conclusions

Familiarity with characteristics involved in child abuse homicide allows for opportunities to enlist important preventive measures. Most child abuse homicides occurred at the hands of the victim's biological parents and in the victim's own residence. Prevention should be focused on parent education and coping mechanisms for the frustrating features of crying in normal infants that lead to shaking or abuse.  相似文献   

7.

Objectives

The current study examined the independent effects of mothers’ childhood abuse (CA) and intimate partner violence (IPV) on psychopathology and functional impairment in children; and the potential moderating and mediating role of individual and family factors in these relationships. Additionally, this study explored the potential cumulative effects of both maternal CA and IPV on children's outcomes.

Method

The sample included 547 Spanish children and adolescents aged between 8 and 17 years, and their parents, who had accessed mental health services. The assessment was based on structured interviews with the children and their parents. Statistical analyses were carried out through hierarchical multiple, negative-binomial and logistic regressions, and Structural Equation Models.

Results

Children whose mothers experienced CA and those whose mothers suffered physical IPV showed increased DSM-IV disruptive disorders and externalizing behavior problems, respectively. Children who directly observed physical IPV and also suffered physical punishment by parents showed increased internalizing problems. IPV had effects, either direct or indirect by physical punishment, on children's externalizing problems. Cumulative effect analyses indicated that the prevalence of disruptive disorders was highest in children whose mothers had suffered both CA and IPV.

Conclusion

Spanish children whose mothers have suffered CA, IPV or both, are at high risk of serious conduct problems, whereas children exposed to IPV and who were also physically abused are at greater risk of internalizing problems. Physical punishment of children contributes in part to explain externalizing problems of IPV-exposed children. These findings indicate potential targets of assessment and intervention for families seeking help in mental health services.  相似文献   

8.

Objective

This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England.

Methods

Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment).

Results

A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death.

Conclusions

Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.  相似文献   

9.

Objective

Analysis of the validity and implementation of a child maltreatment actuarial risk assessment model, the California Family Risk Assessment (CFRA).

Questions addressed

(1) Is there evidence of the validity of the CFRA under field operating conditions? (2) Do actuarial risk assessment results influence child welfare workers’ service delivery decisions? (3) How frequently are CFRA risk scores overridden by child welfare workers? (4) Is there any difference in the predictive validity of CFRA risk assessments and clinical risk assessments by child welfare workers?

Method

The study analyzes 7,685 child abuse/neglect reports originating in 5 California counties followed prospectively for 2 years to identify further substantiated child abuse/neglect. Measures of model calibration and discrimination were used to assess CFRA validity and compare its accuracy with the accuracy of clinical predictions made by child welfare workers. The extent of use of an override feature of the CFRA and child welfare worker reliance on CFRA risk scores for making service decisions were analyzed.

Results

Imperfect but better-than-chance predictive validity was found for the CFRA on a range of measures in a large temporal validation sample (n = 6,543). For 114 cases where both CFRA risk assessments and child welfare worker clinical risk assessments were available, the CFRA exhibited evidence of imperfect but better-than-chance predictive validity, while child welfare worker risk assessments were found to be invalid. Child welfare workers overrode CFRA risk assessments in only 114 (1.5%) of 7,685 cases and provided in-home services in statistically significantly larger proportions of higher- versus lower-risk cases, consistent with heavy reliance on the CFRA.

Conclusions/practice implications

Until research identifies actuarial models exhibiting superior predictive validity when applied in every-day practice, the CFRA is, and will be a valuable tool for assessing risk in order to make in-home service-provision decisions.  相似文献   

10.

Objectives

To present a detailed confession from a perpetrator of Shaken Baby syndrome.

Methods

Case study.

Results

We present a confession of Shaken Baby syndrome describing how the perpetrator severely injured a 3 year old with repeated bursts of acceleration-deceleration (shaking). The child sustained retinal and intracranial hemorrhage. Details of the confession and circumstances by which it was obtained lead us to believe its accuracy.

Conclusions

Accurate perpetrator confessions offer useful windows into realities and pathophysiology of abusive head trauma.  相似文献   

11.

Objectives

Published protocols for forensic interviewing for child sexual abuse do not include specific questions about what prompted children to tell about sexual abuse or what made them wait to tell. We, therefore, aimed to: (1) add direct inquiry about the process of a child's disclosure to a forensic interview protocol; (2) determine if children will, in fact, discuss the process that led them to tell about sexual abuse; and (3) describe the factors that children identify as either having led them to tell about sexual abuse or caused them to delay a disclosure.

Methods

Forensic interviewers were asked to incorporate questions about telling into an existing forensic interview protocol. Over a 1-year period, 191 consecutive forensic interviews of child sexual abuse victims aged 3-18 years old in which children spoke about the reasons they told about abuse or waited to tell about abuse were reviewed. Interview content related to the children's reasons for telling or for waiting to tell about abuse was extracted and analyzed using a qualitative methodology in order to capture themes directly from the children's words.

Results

Forensic interviewers asked children about how they came to tell about sexual abuse and if children waited to tell about abuse, and the children gave specific answers to these questions. The reasons children identified for why they chose to tell were classified into three domains: (1) disclosure as a result of internal stimuli (e.g., the child had nightmares), (2) disclosure facilitated by outside influences (e.g., the child was questioned), and (3) disclosure due to direct evidence of abuse (e.g., the child's abuse was witnessed). The barriers to disclosure identified by the children were categorized into five groups: (1) threats made by the perpetrator (e.g., the child was told (s)he would get in trouble if (s)he told), (2) fears (e.g., the child was afraid something bad would happen if (s)he told), (3) lack of opportunity (e.g., the child felt the opportunity to disclose never presented), (4) lack of understanding (e.g., the child failed to recognize abusive behavior as unacceptable), and (5) relationship with the perpetrator (e.g., the child thought the perpetrator was a friend).

Conclusions

Specific reasons that individual children identify for why they told and why they waited to tell about sexual abuse can be obtained by direct inquiry during forensic interviews for suspected child sexual abuse.

Practice implications

When asked, children identified the first person they told and offered varied and specific reasons for why they told and why they waited to tell about sexual abuse. Understanding why children disclose their abuse and why they wait to disclose will assist both professionals and families. Investigators and those who care for sexually abused children will gain insight into the specific barrier that the sexually abused child overcame to disclose. Prosecutors will be able to use this information to explain to juries why the child may have delayed his or her disclosure. Parents who struggle to understand why their child disclosed to someone else or waited to disclose will have a better understanding of their child's decisions.  相似文献   

12.

Objectives

Pediatric fractures suspicious for abuse are often evaluated in emergency departments (ED), although corresponding diagnostic coding for possible abuse may be lacking. Thus, the primary objective of this study was to determine the proportion of fracture cases investigated in the ED for abuse that had corresponding International Classification of Diseases (ICD) codes documenting abuse suspicion. Additional objectives were to determine the proportion of these fractures with admission ICD abuse coding, and physician text diagnoses recording abuse suspicion in the ED and/or admission notes. Factors possibly associated with abuse-related ED ICD codes were also examined.

Methods

Children less than three years of age that presented primarily with a fracture to two large academic children's hospitals from 1997 to 2007 and were evaluated for suspicion of abuse by child protective services were included in this retrospective review. The main outcome measure was the proportion of the fracture cases that had abuse suspicion reflected in ED discharge ICD codes.

Results

Of the 216 eligible patients, only 23 (11.5%) patients had ED ICD codes that included the possibility of abuse. Forty-nine (22.7%) had the possibility for abuse documented by physicians as an ED discharge diagnosis. In addition, 53/149 (35.6%) of all admitted patients and 34/55 (61.8%) of confirmed abuse cases included abuse-related admission ICD coding. Female gender was found to be a factor associated with ED ICD abuse codes.

Conclusion

Current standards of ICD coding result in a significant underestimate of the prevalence of children assessed in the ED and hospital wards for possible and confirmed abusive fracture(s).  相似文献   

13.

Objective

To determine the prevalence of five forms of abuse/neglect during childhood and adolescence in a group of schizophrenic patients with a history of violence.

Methods

Twenty-eight patients hospitalized in a highly secured psychiatric unit were included. Abuse and neglect during patients’ growth were evaluated with the childhood trauma questionnaire (CTQ). History of substance abuse (consumption of cannabis, and/or alcohol, and/or heroin, and/or cocaine during the year that preceded the hospitalization), incarceration, and death of a close parent were also collected.

Results

We found that 46.4% of patients experienced at least 1 form of abuse and/or neglect during childhood and 21.4% of them had experienced more than 2 forms of abuse and/or neglect. The 2 most frequent forms of neglect and abuse were physical abuse (39.3%) and emotional neglect (17.9%). History of substance abuse was found for cannabis (57.1%), alcohol (57.1%), and cocaine and/or heroin (35.7%). We found that 42.8% of patients had 1 close relative who had died during their growth and that 41.6% of these deaths were violent.

Conclusion

It appears important to systematically search for and assess a history of abuse and neglect during growth in schizophrenic patients with a history of violence, in order to offer specific treatments for this group of patients.  相似文献   

14.

Objectives

The present study investigated the influence of juror gender and infant victim disability on jurors’ reactions to infanticide cases.

Methods

Participants (men and women undergraduates) read a summary of a mock trial involving alleged father-perpetrated infanticide. The infant was described as severely mentally disabled or as not disabled. Participants completed a series of case-related judgments (e.g., guilt; sentence; and empathy, sympathy, and similarity toward the defendant and victim).

Results

There were pervasive gender differences such that compared to men, women mock jurors rendered more guilty verdicts, perceived the father/defendant as having greater intent to kill his infant, and felt less similar to the defendant. Compared to men, women also believed the father was more responsible and the pneumonia was less responsible for the infant's death, had less sympathy and empathy for the defendant, endorsed more negative beliefs about the father, and were more likely to believe the infant was a unique person. Mediational analyses revealed that these statistically significant effects were explained, in part, by gender differences in attitudes toward the defendant. Further, whether the infant victim was portrayed as severely disabled (versus developmentally normal) had little effect on central case judgments such as verdict, but jurors who believed the infant was severely disabled gave significantly shorter sentences to the defendant, were less likely to perceive the defendant as mentally ill, and felt significantly less empathy for and similarity to the infant victim.

Conclusions

Although juror gender consistently predicted juror's judgments, there were fewer effects of disability status. Even so, bias against disabled infants manifested for several dependant variables.

Practical implications

This research can inform legal professionals about the potential for bias in juror decision-making, and in turn, help facilitate fairness and justice for the youngest and most vulnerable victims of child abuse.  相似文献   

15.

Objective

The present study was designed to determine whether parents at high risk for physical child abuse, in comparison with parents at low risk, show deficits in emotion recognition, as well as to examine the moderator effect of gender and stress on the relationship between risk for physical child abuse and emotion recognition.

Methods

Based on their scores on the Abuse Scale of the CAP Inventory (Milner, 1986), 64 parents at high risk (24 fathers and 40 mothers) and 80 parents at low risk (40 fathers and 40 mothers) for physical child abuse were selected. The Subtle Expression Training Tool/Micro Expression Training Tool ( [Ekman, 2004a] and [Ekman, 2004b]) and the Diagnostic Analysis of Nonverbal Accuracy II (Nowicki & Carton, 1993) were used to assess emotion recognition.

Results

As expected, parents at high risk, in contrast to parents at low risk, showed deficits in emotion recognition. However, differences between high- and low-risk participants were observed only for fathers, but not for mothers. Whereas fathers at high risk for physical child abuse made more errors than mothers at high risk, no differences between mothers at low risk and fathers at low risk were found. No interaction between stress, gender, and risk status was observed for errors in emotion recognition.

Conclusions and practice implications

The present findings, if confirmed with physical abusers, could be helpful to further our understanding of deficits in processing information of physically abusive parents and to develop treatment strategies specifically focused on emotion recognition. Moreover, if gender differences can be confirmed, the findings could be helpful to develop specific treatment programs for abusive fathers.  相似文献   

16.
17.
Although frustration has long been implicated in promoting aggression, the potential for poor frustration tolerance to function as a risk factor for physical child abuse risk has received minimal attention. Instead, much of the extant literature has examined the role of anger in physical abuse risk, relying on self-reports of the experience or expression of anger, despite the fact that this methodology is often acknowledged as vulnerable to bias. Therefore, the present investigation examined whether a more implicit, analog assessment of frustration tolerance specifically relevant to parenting would reveal an association with various markers of elevated physical child abuse risk in a series of samples that varied with regard to age, parenting status, and abuse risk. An analog task was designed to evoke parenting-relevant frustration: the task involved completing an unsolvable task while listening to a crying baby or a toddler's temper tantrum; time scores were generated to gauge participants’ persistence in the task when encountering such frustration. Across these studies, low frustration tolerance was associated with increased physical child abuse potential, greater use of parent–child aggression in discipline encounters, dysfunctional disciplinary style, support for physical discipline use and physical discipline escalation, and increased heart rate. Future research directions that could better inform intervention and prevention programs are discussed, including working to clarify the processes underlying frustration intolerance and potential interactive influences that may exacerbate physical child abuse.  相似文献   

18.

Objective

To examine whether depressed mood and anger mediate the effects of sexual abuse and family conflict/violence on self-injurious behavior and substance use.

Methods

A cross-sectional national survey was conducted including 9,085 16-19 year old students attending all high schools in Iceland in 2004. Participants reported frequency of sexual abuse, family conflict/violence, self-injurious behavior, substance use, depressed mood, and anger.

Results

Sexual abuse and family conflict/violence had direct effects on self-injurious behavior and substance use among both genders, when controlling for age, family structure, parental education, anger, and depressed mood. More importantly, the indirect effects of sexual abuse and family conflict/violence on self-injurious behavior among both males and females were twice as strong through depressed mood as through anger, while the indirect effects of sexual abuse and family conflict/violence on substance use were only significant through anger.

Conclusions

These results indicate that in cases of sexual abuse and family conflict/violence, substance use is similar to externalizing behavior, where anger seems to be a key mediating variable, opposed to internalizing behavior such as self-injurious behavior, where depressed mood is a more critical mediator.

Practice implications

Practical implications highlight the importance of focusing on a range of emotions, including depressed mood and anger, when working with stressed adolescents in prevention and treatment programs for self-injurious behavior and substance use.  相似文献   

19.

Objective

The persecution of children as witches has received widespread reportage in the international mass media. In recent years, hundreds of children have been killed, maimed and abandoned across Africa based on individual and village-level accusations of witchcraft. Despite the media focus, to date, very little systematic study has investigated the phenomenon. In this case study, the persecution of child witches in Ghana is studied to explore the nature and patterns of witch hunts against children in the West African nation.

Methods

There are no reliable national data on child abuse related to witchcraft accusations in Ghana. For this study, 13 cases of child witch hunts appearing in the local media during 1994-2009 were analyzed. Case summaries were constructed for each incident to help identify the socio-demographic characteristics of assailants and victims, victim-offender relationships, the methods of attacks, the spatial characteristics, as well as the motivations for the attacks.

Results

Children branded as witches ranged in age from 1-month-old to 17-years-old, were primarily from poor backgrounds, and lived in rural areas of the country. Accusations of witchcraft and witch assaults were lodged by close family members often through the encouragement of, or in concert with Christian clergymen and fetish priests. Accused witches were physically brutalized, tortured, neglected, and in two cases, murdered. For school-aged children, imputations of witchcraft contributed to stigmatization in both the community and at school, resulting in dropping out. The most frequently expressed reason for persecution of the child was suspicion that the child had used witchcraft to cause the death or illness of family relations or someone in the community. Another reason was suspicion that the child was responsible for the business failure or financial difficulties of a perceived victim.

Conclusions

The results of this research are consistent with findings in the witchcraft literature suggesting that seemingly inexplicable illnesses, untimely deaths, and financial hardships tend to be the major causal forces generating witch hunts. Additional research is necessary to further shed light on child witch hunts in Ghana and other countries.

Practice implications

To reduce the incidence of such abuse, there is a need for increased advocacy and protections for children in the society. The government must also increase the penalties for child abuse. This will serve as a deterrent to potential offenders. Additionally, through public service campaigns, educating citizens about the causes and trajectories of diseases, will lead to a significant diminution of witchcraft accusations and the associated violence.  相似文献   

20.

Objectives

Public Law (P.L.) 110-351, the “Fostering Connections to Success Act,” calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors.

Methods

Cross-sectional analysis of Wave 1 data for the 92 child welfare catchment areas participating in the National Survey of Child and Adolescent Well-being, a random probability sample of 2,504 children ages 2-15 years undergoing investigation for abuse and neglect. We employed multilevel regression modeling to examine the impact of catchment-level variables on medication use, controlling for child-level variables.

Results

Fifteen percent of children reported taking psychotropic medications. Rates of medication use across catchment areas ranged widely from 0 to 40%, a 40-fold difference. On multi-level logistic regression modeling, older age (p < .001), male gender (p < .001), emotional and behavioral problems (p < .001), and insurance (p = .05) were associated with psychotropic medication use at the child-level. At the catchment-level, stressful environment within the child welfare system was negatively associated with medication use. No other catchment-level variables examined were found to explain use.

Conclusions

Striking disparities in medication use exist across catchment areas in this national sample. Of the catchment variables examined, only stressful environment was related to medication use.

Practice implications

These findings highlight significant geographic variation in medication use that most likely reflect both under-use and over-reliance on psychotropic medication. The link between child welfare environment and medication use suggests the influence of systemic, as opposed to clinical, causes of variation in medication use. This requires greater implementation of organizational processes governing quality of care for this highly vulnerable population.  相似文献   

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