Maltreatment of children is one of the most serious problems that challenges

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Maltreatment of children is one of the most serious problems that challenges social workers. “Child maltreatment constitutes a major public health concern as it crosses all socioeconomic statuses, ethnicities, and genders” (Tufford & Asakura, 2015). Maltreatment include child abuse and neglect. Child maltreatment is “willful acts such as physical, sexual and emotional abuse which harm a child. Neglect is failure to provide for a child’s basic needs” (Fontes, 2005). The National Child Abuse and Neglect Data System definition of child abuse and neglect is more complete: “An act or failure to act by a parent, caregiver, or other person as defined under State law that results in physical abuse, neglect, medical neglect, sexual abuse, emotional abuse, or an act or failure to act which presents an imminent risk of harm to a child” (Administration for Children and Families, 2012). Abuse consist of physical, sexual and emotional. “Physical abuse is the intentional use of physical force that can result in physical harm. Sexual abuse, (rape, molestation, child pornography production and possession) involves pressuring or forcing a child to engage in sexual acts. Emotional abuse, (verbal, mental and psychological) refers to behaviors that harm a child’s self-worth or emotional well-being” (Center for Disease Control and Prevention, 2019). The most common form of maltreatment is neglect. Neglect involves physical, emotional or educational. “Of the children who experienced maltreatment or abuse, three-quarters suffered neglect; 17.2% suffered physical abuse; and 8.4% suffered sexual abuse” (National Children Alliance, 2015). Some children suffer from more than one form of maltreatment. Social workers are key to the prevention of child maltreatment, and the early identification of abuse and neglect. They have distinctive contributions to make in the protection of children. The prevention of abuse starts at identification, through checking the health and development of children who have been abused, to the intervention and the prevention of further abuse. Their role in the care of children and families is key not only to preventing abuse, but also to safeguarding vulnerable children once abuse has started.The welfare of children depends not only on professional observance and the inclination to consider the likelihood of child abuse and neglect, but also responding to those observations. It depends on asking the child, listening to what he says and believing things people think do not, could not or should not happen to children.In 1988, the Child Abuse Prevention and Treatment Act amendments directed the U.S. Department of Health and Human Services to establish a national data collection and analysis program. The National Child Abuse and Neglect Data System, (NCANDS) is a federally sponsored effort that collects and analyzes annual data on child abuse and neglect. The Children’s Bureau in the Administration on Children, Youth and Families, Administration for Children and Families, U.S. Department of Health and Human Services, collects and analyzes the data. The data is collected from all fifty states on a voluntarily bases.Maltreatment is a world-wide problem. “In 2015, an estimated 1,670 children died from abuse and neglect in the United States,” (ACF, 2014). “The Children’s Advocacy Centers around the country served more than 311,000 (NCA, 2015) child victims of abuse, providing victim advocacy and support to these children and their families.”According to the U.S. Administration for Children & Families (2014); nearly 700,000 children are abused in the U.S annually, an estimated 683,000 children were victims of abuse and neglect in 2015, approximately 3.4 million children received an investigation or alternative response from child protective services agencies, and 2.3 million children received prevention services.There are characteristics of child maltreatment which are identified in the child, parent, parental relationships, and communities. The fact that a child is under the age of four years old or is an adolescent is a characteristic that may increase the likelihood of being maltreated. Other characteristics such as; being unwanted, or failing to fulfil the expectations of parents, having special needs, crying persistently or having abnormal physical features may contribute to maltreatment. According to Child Trends (2019) the following statistics were released “ in 2017, children 3 and younger had a maltreatment rate of 15 per 1000, compared with 10 per 1000 for children ages 4 to 7, 8 per 1000 for ages 8 to 11, 7 per 1000 for ages 12 to 15, and 5 per 1000 for children ages 16 to 17”. “Analyses revealed that adolescents represent a substantial proportion of all victims of official child maltreatment reports. The impact of age on substantiation varied as a function of the type of maltreatment, where for adolescents’ sexual abuse reports were more likely to be substantiated, while neglect and physical abuse reports were less likely to be substantiated. Reports involving adolescents were significantly more likely to involve a female victim” (Powers & Eckenrode, 1988).“About four out of five abusers are the victims’ parents. A parent of the child victim was the perpetrator in 78.1% of substantiated cases of child maltreatment” (AFC, 2015). “Difficulty bonding with a newborn, not nurturing the child, having been maltreated themselves as a child, lacking awareness of child development or having unrealistic expectations, misusing alcohol or drugs, including during pregnancy, being involved in criminal activity, and experiencing financial difficulties are characteristics of a parent or caregiver that increase the risk of child maltreatment” (World Health Organization, 2016).Sometimes a family member or an intimate partner may have “physical, developmental or mental health problems, display violence, experience isolation, lack a support network; these are more reasons why child maltreatment happens” (WHO, 2016).Community and society factors may increase the risk of child maltreatment; these include: “gender and social inequality; lack of adequate housing or services to support families and institutions; high levels of unemployment or poverty; the easy availability of alcohol and drugs; inadequate policies and programs to prevent child maltreatment, child pornography, child prostitution and child labor; social and cultural norms that promote or glorify violence towards others, support the use of corporal punishment, demand rigid gender roles, or diminish the status of the child in parent–child relationships; social, economic, health and education policies that lead to poor living standards, or to socioeconomic inequality or instability” (WHO, 2016).” Although children with disabilities make up 10.4% of the population, they represent 25.9% of children with a maltreatment allegation and 29.0% of those with a substantiated allegation; however, increased risk of maltreatment was not consistent across all disability types” (Maclean, 2017). “Children with intellectual disability, mental/behavioral problems, and conduct disorder continued to have increased risk of an allegation and substantiated allegation after adjusting for child, family, and neighborhood risk factors. In contrast, adjusting for these factors resulted in children with autism having a lower risk, and children with Down syndrome and birth defects/cerebral palsy having the same risk as children without disability” (Maclean, 2017). “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 (Widom, Czaja, Bentley, & Johnson, 2012; Monnat & Chandler, 2015; Afifi et al., 2016): diabetes, lung disease, malnutrition, vision problems, functional limitations, heart attack, arthritis, back problems, high blood pressure, brain damage, migraine headaches, chronic bronchitis/emphysema/chronic obstructive pulmonary disease, cancer, stroke, bowel disease, and chronic fatigue syndrome.”“Child abuse and neglect also has been associated with certain regions of the brain failing to form, function, or grow properly” (Bick & Nelson, 2016).A variety of psychological problems can arise from child abuse and neglect. “Diminished functioning and cognitive skills disrupted brain development… can cause impairments to the brain’s executive functions: working memory, self-control, and cognitive flexibility” (Kavanaugh, Dupont-Frechette, Jerskey, & Holler, 2016). Behavioral difficulties are often displayed from victims of child maltreatment. “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” (Thompson et al., 2017). “Several studies have documented the correlation between child maltreatment and future juvenile delinquency and criminal activities” (Herrenkohl, Jung, Lee, & Kim, 2017). Social workers use different interventions in child maltreatment. “The number of interventions aimed at preventing or reducing child maltreatment has increased exponentially over the last decades” (Daro, 2011). These interventions include the investigation of child abuse reports by the child protection agency, clinical treatment of physical and psychological injuries, self-help services, family counseling, legal action against the perpetrator, investigation of the homemaker or respite care and the removal of the child or the offender from the home. “Child maltreatment studies on interventions usually focus on the different types of abuse. However, victim of child physical abuse, neglect, sexual abuse and emotional maltreatment often experience similar psychological effects,” (Erickson and Egeland, 1987).Intervention and treatment are often done after the abuse has occurred. Social work interventions are provided on the macro (community), mezzo (group) and micro (individual/family) levels. Social workers use intervention models in achieving desired goals for service users. These models are used with the understanding that social workers operate at many different levels in society, and with individuals, families, groups and communities. The major models influence the way social workers choose to help people meet their goals. The Problem-solving Model by Perlman emphasis is on social casework. The problem-solving model focuses on understanding the problem, brainstorming possible solutions, having the client pick a solution, having the client try out a solution and then evaluating how the solution worked. The social worker teaches client how to solve his own problems using problem solving skills. The Task-Centered Practice formulated by Reid and Epstein is a short-term model for social work. Social Workers and clients collaborate, create goals, strategies and steps to achieve outcomes. This model focuses on breaking down the problem into small tasks that the client can accomplish. The social worker may use rehearsal, deadlines, and contracts, in order to help the client feels successful and motivated towards solving the problem.Narrative uses letters and other methods to help the client re-author their lives” (Alice Morgan, 2000).Cognitive Behavioral Therapy focuses on the relationship between thoughts, feelings, and behaviors. Social workers assist clients in identifying patterns of irrational and self-destructive thoughts and behaviors that influence emotions.Crisis Intervention model used when someone is dealing with an acute crisis. The model includes seven stages: assess safety and lethality, rapport building, problem identification, address feelings, generate alternatives, develop an action plan, and follow up. This social work practice model is commonly used with clients who are expressing suicidal ideation.Systems theory emphasizes reciprocal relationships between the elements that constitute a whole. These concepts also emphasize the relationships among individuals, groups, organizations, or communities and mutually influencing factors in the environment.Psychodynamic Theory is concerned with how internal processes such as needs, drives, and emotions motivate human behavior. Emotions have a central place in human behavior. Unconscious, as well as conscious mental activity serves as the motivating force in human behavior. Early childhood experiences are central in the patterning of an individual’s emotions, and therefore, central to problems of living throughout life. Individuals may become overwhelmed by internal and/or external demands. Individuals frequently use ego defense mechanisms to avoid becoming overwhelmed by internal and/or external demands. Psychodynamic theory is what the social worker uses when s/he looks at early attachment relationships, and the developmental history of the client which includes past trauma or abuse. Social learning theory suggests that human behavior is learned as individuals interact with their environment. Problem behavior is maintained by positive or negative reinforcement. Cognitive- behavioral therapy looks at what role thoughts play in maintaining the problem. Emphasis is on changing dysfunctional thoughts which influence behavior. Methods which stem from this theory are the gradual shaping of new behavior through positive and negative reinforcement, modeling, stress management: biofeedback, relaxation techniques, cognitive restructuring, imagery and systematic desensitization. Conflict Theory draws attention to conflict, dominance, and oppression in social life. Groups and individuals try to advance their own interests over the interests of others. Power is unequally divided, and some social groups dominate others. Social order is based on the manipulation and control of nondominant groups by dominant groups. Lack of open conflict is a sign of exploitation. Social change is driven by conflict, with periods of change interrupting long periods of stability. Social workers use this theory to understand clients who are experiencing oppression in some form or another in our capitalist society.In a study by Van der Put, Assink, Gubbels, (2018), “Cognitive behavioral therapy, home visitation, parent training, family-based/multisystemic, substance abuse, and combined interventions were effective in preventing and/or reducing child maltreatment.” Interventions for child maltreatment may come from social service, law enforcement or the health care industry. Social service programs include education programs, service provider training programs, and community support groups. “Social service interventions may consist of casework as well as therapeutic services designed to provide parenting education, child and family counseling, family support…concrete services such as income support or material aid, institutional placement, mental health services, in-home health services, supervision, education, transportation, housing, medical services, legal services, in- home assistance, socialization, nutrition, and child and respite care” (Institute of Medicine and National Research Council, 1998). Interventions often attempt to mitigate risk factors and enhance protective factors. Interventions may be implemented in different settings, including the home, newborn nursery, and primary care; school; and community-based settings. They may include parenting programs, comprehensive parent education and support programs, and psychotherapy. Some common interventions include home interventions, pediatric primary care programs, psychotherapy programs, parent education, and community-based programs“Of these methods, only long-term home visitation (up to two years) has been found to be effective in reducing the incidence of child abuse as measured by hospital admissions, emergency department visits and reports to child protective services” ( MacMillan, MacMillan, Offord, Griffith, MacMillan, 1994).