Child neglect and abuse are serious issues that may induce lasting adverse effects on the victims. In the US, nearly five kids die daily at the hands of abusers (Child Help, 2012). According to the Centers for Disease Control and Prevention (CDC) (2010), over 3 million cases of child neglect and abuse were filed in 2008. As the numbers continue to rise, however, the incidences reported in nursing appear to decline. In a review of cases of child mistreatment reported by healthcare providers, researchers mentioned that twenty-one percent of all suspected cases were never reported (Eads, 2013). Thus, child abuse is an epidemic that requires urgent intervention, especially by healthcare providers. The primary goal in the prevention of child neglect and abuse is to stop the violence from occurring. In particular, the provision of safe and stable nurturing environments and relationships for every child and family can prevent child abuse and allow kids to achieve their goals in life (CDC, 2016). Typically, child abuse is a complex problem rooted in an unhealthy relationship or social environment. Consequently, preventing the vice requires comprehensive approaches that influence individual behaviors, relationships among neighbors and families, community involvement, and societal culture. Effective strategies for preventing child abuse concentrate on the modification of societal norms, practices, and policies in order to establish safe and stable nurturing environments and relationships (CDC, 2016). As such, the present study focuses on healthcare-related policies, ethical issues and decisions, and global systems aimed at preventing child abuse.
Policies
Since the publishing of the National Research Council report in 1993, numerous modifications of the state and federal policies have been made in order to alter the “incidence, reporting, and negative health and economic consequences of child abuse and neglect” (Petersen et al., 2014). State and federal laws define the constituents of child abuse. In addition, they designate the persons who should report a suspected case of child abuse. State laws that address child abuse were passed in each of the fifty states after the Social Security Act was amended in 1962. The amendment required each state to add child protection programs to its system of child welfare. One of the best-known federal policies and laws is the “Child Abuse Prevention and Treatment Act (CAPTA)” which authorized funds for state grant programs focusing on child protection interventions in the case of suspected child abuse (Petersen et al., 2014). Although all states receive limited funding, they have made considerable improvements to child neglect and abuse legislation as required by CAPTA. Typically, CAPTA has established minimum thresholds for defining child abuse, but states can institute variations beyond the thresholds. The state definitions are established by child protection departments and state legislative authority. In particular, they comprise definitions of emotional abuse, neglect, sexual abuse, and physical abuse. Nevertheless, the definitions have variations, and certain states have specified additional forms of neglect and abuse. For instance, many states define physical child abuse in terms of physical injuries, but others also include circumstances where kids feel threatened or face a significant risk of being harmed. Supervisory neglect and failure to offer proper parental care are often included in the definition of neglect, although 24 states have specified educational neglect and others have included medical neglect (Petersen et al., 2014). Thus, confusion exists over child abuse’s legal definition. The confusion is further exacerbated by the differences in standards and guidelines used to define child abuse within and among various professional groups, agencies, and disciplines. For example, the standards of child abuse cases appear to vary among nurses, child protection services, and courts (Petersen et al., 2014). Therefore, there is a need for new research to investigate the effect of such differing interpretations and standards on the protection of kids from neglect and abuse.
Although domestic violence is also defined in different ways across the states, laws in 23 states consider cases where children witness violence between family members as child mistreatment. The laws protect kids from such exposure, although variations exist among such laws. Legal consequences associated with the violations of state laws may include visitation privileges’ removal, mandated counseling, fines, and jail time. For example, in Georgia, a violent act committed in front of kids is “termed third-degree child cruelty and is considered a misdemeanor” (Petersen et al., 2014). However, the absence of adequate research into the implications of such legal approaches may lead to policy-making processes that lack evidence-based support.
Ethical Decisions and Issues
Ethical standards for nurses working with mental health patients clarify the importance of confidentiality in therapeutic relationships. Generally, the nurses’ reputation is based on the critical need to preserve the clients’ intimate revelations. Ultimately, such healthcare professionals would lose the society’s confidence if they chose to breach confidentiality. In the interest of societal wellbeing and safety, however, two exceptions have been added to the confidentiality associated with therapeutic associations. The first exception is imminent and clear danger to clients or other persons whereas the second involves the revelation of an incident of child neglect or abuse. Accordingly, each of the 50 states has established mandatory child abuse reporting (Child Welfare Information Gateway, 2016). Moreover, the law has specified that nurses should report suspected cases of child neglect or abuse provided that the clients are younger than the legal age of consent at the time of the incident. Still, nurses are sometimes concerned about the impact of mandated reporting on the patient-nurse relationship. Experienced nurses have also pointed out their concern regarding the benefits of overburdened child protection systems (Schols et al., 2013). Such nurses argue that their efforts, in the absence of reporting, have relatively more benefits and help to preserve counseling relationships. In this regard, the nurses’ main concern is ensuring the preservation of beneficence towards child victims. As such, the professionals maintain that exposing child victims to court systems may not be in the best interest of the kids. Sometimes, issues related to “confidentiality and consent for physical and mental health treatment” involving minor clients pose considerable challenges to nurses (Jackson et al., 2014). Consequently, the nurses are required to make effective decisions regarding such matters in spite of the lack of clear or comprehensive legislation and policies.
Global Systems
Although an international agreement on behaviors constituting child abuse may emerge in the near future, differences between the definitions adopted in various countries will continue occurring. Significant variations in definitions will most probably arise between the developed and developing countries because social conditions and local cultures influence the identification of behaviors that constitute child abuse (Crews & Crews, 2010). Typically, kids that have encountered sexual abuse, physical mistreatment, and societal or parental neglect are found in nearly every country, regardless of the economic conditions of the country. Obviously, child protection on a global scale is crucial to protecting children’s right to world development, growth, and survival. In turn, the protection allows them to develop and become productive citizens that make valuable contributions to local neighborhoods and the global community. Unfortunately, studies have shown that about 300 million kids worldwide experience daily abuse, exploitation, and violence (Crews & Crews, 2010). The abuse includes child slavery, enrollment in armed conflicts, child marriages, child labor, and female genital mutilation. Sadly, the global response to such mistreatment is always inherently linked to funding levels. Although the percentage of developing nations enacting formal response systems and child abuse policies continues to grow, wide discrepancies in service availability are still being reported (Crews & Crews, 2010). Regardless of efforts to establish response and surveillance systems, therefore, a significant proportion of kids is expected to remain at a high risk of experiencing physical and emotional abuse. There is hope that international and national partnerships will continue engaging in efforts to ameliorate service availability to children all over the world. Crews and Crews (2010) suggested that the efforts should focus on improving training and education programs, as well as disseminating best practices. Luckily, it seems that such efforts are undergoing realization on a global scale, though at a slow pace.
Conclusion
Child abuse is considered an epidemic that requires urgent intervention from nurses and other healthcare providers. Accordingly, the present study has identified healthcare-related policies, ethical issues, and global systems associated with the prevention of child abuse. Over the years, various state and federal laws have been enacted to reduce the adverse economic and health consequences of child mistreatment, as well as increase the reporting of child abuse. Nonetheless, issues related to confidentiality appear to affect the reporting of child abuse among healthcare providers. Hence, there is a need to improve and clarify current legislation and policies. On a global scale, child protection efforts have increased in recent years but more effort is still required to eliminate the sexual abuse, physical mistreatment, and societal or parental neglect that confront many kids worldwide.
References
Centers for Disease Control and Prevention (CDC). (2010). Child maltreatment: Facts at a glance. Retrieved from: http://www.cdc.gov/ViolencePrevention/pdf/CM-DataSheet-a.pdf
Centers for Disease Control and Prevention (CDC). (2016). Child abuse and neglect: prevention strategies. Retrieved from https://www.cdc.gov/violenceprevention/childmaltreatment/prevention.html
Child Help. (2012). National child abuse statistics. Retrieved from: http://www.childhelp.org/pages/statistics/
Child Welfare Information Gateway. (2016). Mandatory reporters of child abuse and neglect. Retrieved from https://www.childwelfare.gov/pubPDFs/manda.pdf
Crews, G. A., & Crews, A. D. (2010). Do you know how your children are? International perspectives on child abuse, mistreatment, and neglect. International Journal of Justice Studies, 1(1), 26-37. Retrieved from http://mds.marshall.edu/cgi/viewcontent.cgi?article=1030&context=criminal_justice_faculty
Eads, K. (2013). Breaking silence: Underreported child abuse in the healthcare setting. Online Journal of Health Ethics, 9(1), 1-9. doi:10.18785/ojhe.0901.01.
Jackson, M. K., Burns, K. K., & Richter, M. S. (2014). Confidentiality and treatment decisions of minor clients: a health professional’s dilemma & policy makers challenge. SpringerPlus, 3, 320. doi:10.1186/2193-1801-3-320.
Petersen, A. C., Joseph, J., & Feit, M. (eds) (2014). Child abuse and neglect policy. In New Directions in Child Abuse and Neglect Research. Washington (DC): National Academies Press (US). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK195993/
Schols, M. W., de Ruiter, C., & Öry, F. G. (2013). How do public child healthcare professionals and primary school teachers identify and handle child abuse cases? A qualitative study. BMC Public Health, 13, 807. doi:10.1186/1471-2458-13-807.
