|Copyright 1997 by the||Psychology in Spain, 1997, Vol. 1. No 1, 104-118|
|Colegio Oficial de Psicólogos|
Child abuse prevention programmes, centred upon primary and secondary levels, have been instituted in recent years as an option for mitigating this psychosocial phenomenon, attending to the child population in general, and to those with social problems in particular. This review proposes that these programmes should consider as a basic principle adaptation to childrens needs and to the parental capacities of those involved in child care, taking into consideration the familys socio-cultural context. The authors present different strategies for preventing child abuse, notably: a) the development of parental capacities through training in child rearing and care, b) the elimination of possible social isolation of families, through community intervention services.
Los programas de prevención del maltrato infantil, centrado en sus niveles primario y secundario, se han constituido en los últimos años como la opción idónea para mitigar este fenómeno psicosocial al atender adecuadamente a la población infantil en general, y a los niños en dificultad social en particular. Este articulo de revisión plantea que dichos programas deben contemplarcomoprincipio básico la adecuación de las necesidades de los niños y las capacidades parentales de sus cuidadores, teniendo en cuenta el contexto sociocultural en el cual la familia está inmersa. Los autores exponen diferentes estrategias para la prevención del maltrato infantil, destacando entre éstas: a) el desarrollo de la competencia parental para la capacitación de los padres a través del entrenamiento de habilidades en la crianza y educación de sus hijos, b) la eliminación del posible aislamiento social de las familias por medio de una prestación de servicios de intervención comunitaria.
The original Spanish version of this paper has been previously published in Anuario de Psicología Jurídica, 1996, 87-110
*Correspondence concerning this article should be addressed to Miguel Costa Cabanillas. Subdireción General de Programas de Servicios Sociales. Ministerio Trabajo y Asuntos Sociales. José Abascal, 39. 28003 Madrid Spain.
hild abuse prevention is a complex and difficult task requiring the introduction of changes and, most important, the guarantee that those changes are in the right direction and are maintained. This is where the difficulties set in, since it is necessary to overcome great social and cultural obstacles. The classical levels of prevention have been adapted to the abuse phenomenon according to the type of population to which they are directed (Browne, 1988): a) primary prevention when it is applied to all the individuals in a given community; b) secondary prevention when measures are established in populations identified as high risk with respect to abuse; and c) tertiary prevention, referring to intervention made in cases of abuse detected by child care services.
On the other hand, child abuse prevention is seen as a technically possible option (McMillan et al, 1994) and an ethically recommendable alternative, since attention focused exclusively on treatment programmes leaves many children at risk of abuse, and sometimes arrives too late (Browne, 1988). Treatment programmes, after their completion, do not adequately protect many children from a future continuous abuse situation, recidivism rates in protection services are relatively high, and a childs protection may involve its permanent separation from its families (Daro, 1991). In addition, recently-developed instruments for detection of child abuse typologies still have low reliability, leading to many false positive cases; thus, until it is possible to develop a suitable potential risk profile with enough validity and reliability, programmes directed at primary and secondary prevention become a core reference for confronting the phenomenon (Browne and Saqi, 1988). Hence, most of the studies developed on child abuse prevention in the family environment point to the need to establish as a fundamental content in the programmes the whole set of parental abilities for the first years of a childs life, transmitted through assistance in the home (Larson, 1980; Olds et al., 1986, Barth, 1991). Fundamental in this regard is the identification of communities with a high risk of abuse, and the organisation of the supply of health and social services in the population accordingly (McMillan et al., 1993). On the other hand, various research projects on the evaluation of abuse prevention programmes have studied their economic profitability. It is beginning to be confirmed empirically that the exclusive focusing on the treatment of abuse cases involves a very high expense in terms of public resources, prevention being more beneficial in economic terms. (Dato, 1991)
In order to better understand proposed strategies for abuse prevention, we will first consider some epidemiological and socio-historical aspects of the child abuse phenomenon.
CHILD ABUSE: EPIDEMIOLOGICAL AND CONCEPTUAL CONSIDERATIONS
Epidemiological importance. Data from a problem
Epidemiological research is faced with two serious problems when trying to quantify and characterise the abuse phenomenon. On the one hand, the difficult conceptual problem of its definition and, on the other, the no less difficult one of access to information about a phenomenon that, in most cases, generally occurs "indoors", in the private family domain. However, several epidemiological studies have been carried out in the past few years in order to estimate the magnitude of the problem, mainly because the official figures collected by child protection services only show the most severe cases, in which it has been necessary for them to intervene. This kind of detection is called the "tip of the iceberg of child abuse" effect (Starr, 1990), suggesting that the number of cases estimated with such a procedure is well below the real figure. As an example, while US social service agencies have reported an annual incidence of between 1.25% and 1.5% of the child population (Helfer, 1987), the latest survey on family violence (1986) showed similar figures for severe abuse (1.9%), though this percentage rose to an annual 10.7% when light cases were considered (Strauss and Gelles, 1986).
Concentrating on studies made in our country (Spain), we find disparate figures, oscillating between 0.5% and 1.5%. The first study on abuse incidence was made in the autonomous community of Catalonia, and collected the cases detected during 1988 by professionals belonging to different institutions and services throughout the Catalonian territory (Inglés, 1995). To the data collected in the study the authors applied a correction factor in order to estimate at the level of the general population the annual incidence rate, and obtained 0.509% in children between 0 and 16 years old. The second study aimed at ascertaining the prevalence of abuse in the population of the province of Guipúzcoa during 1989 (De Paúl et al., 1995), and the source were professionals attending children but working in the councils of this province; it was estimated that 1.5 % of children under 15 suffered abuse. In The most recent study, made in the autonomous community of Andalusia during the first half of 1993 from similar information sources to those in previous studies, an annual incidence rate of 1.4% for under-18s was estimated for 1992 (Moreno et al., 1995). As mentioned in a recent review of the data by Palacios (1995), it has been found that these differences in the estimation of the problems magnitude cannot be explained by age differences in the reference populations, nor by the information sources used, but rather by methodological differences in the projections made for the estimation of the rates in global populations, even more so when -as shown by this author- the percentages of typological differences in child abuse are very similar in the incidence studies mentioned previously (see Table 1).
Correct Treatment / Abuse: A historico-cultural perspective
The definition of abuse, as we have said, is one of the main problems facing researchers and experts in the subject. Its definition implies a social judgement with respect to what is considered adequate for childrens development. The difficulty arises just because there is a lack of social agreement on what might be considered a dangerous and unacceptable way of bringing up children. It becomes difficult to draw a line between what is abuse and what is not, or between an abusing family and a non-abusing one. In any case, the social judgement established to evaluate as good or bad, as optimal or abusing, a certain rearing practice is made within a cultural-historical framework and in terms of two dynamic vectors or forces which constantly interact (see Figure 1). On the one hand there is the scientific knowledge accumulated by researchers and professionals about the growth, development and developmental needs of children; on the other, there are beliefs, values and social criteria expressed through written and non-written norms relating to what the minimum levels of care and attention should be with respect to children.
Indeed, it is between these two vectors that reciprocal transactions and relations contributing to the configuration of the state of infancy in a given epoch are established. There is no doubt that the more advanced research becomes and the more childrens needs become known, the greater is the development of a culture in which values related to the proper treatment of children hold a prominent place. Also, the more this kind of culture is promoted, the more research and the development of knowledge about infancy will be promoted. In this historical and social context, social criteria established with regard to good and bad treatment (abuse) will be progressively more demanding in accordance with the positive development of knowledge about and values regarding childhood. Indeed, this development is historical, in that it changes with the passage of time, and it is social, since it varies according to the socio-cultural reference group. For instance, while a hard slap on the face from the teacher to the pupil may have been considered normal (or even a sign of the teachers professional zeal) in our own environment thirty years ago, today it is considered an abuse. Similarly, taking as a reference other cultural contexts, western societies consider unacceptable certain, quite deeply-rooted, practices in Asian and African countries, such as trepanation of the clitoris in adolescence. Thus, the limits and range of the abuse concept will always be subject to the development of knowledge and of values and culture, which in turn depend on history, education, and social reference groups.
Childrens reference: their needs
Current scientific knowledge about childrens developmental evolution and needs (Schaffer, 1979, 1991; López, 1995a) allows us to establish some conclusions of strategic importance in relation to abuse and its prevention.
a) There exists a clear and solid psychological foundation for considering childhood as an active entity with specific needs that change according to development. These needs, which define children as individual and specific subjects -for example, different from adults- has been the basis for what is called the cross-cultural concept of childhood. Table II shows childrens needs related to feeding and hygiene, as well as to aspects of their psychosocial development during early infancy.
b) The adequate or inadequate satisfaction of such needs appears as an important reference point, and as a sound empirical basis for establishing a social judgement on abuse. We must stress that the needs specified in Table II are framed in the context of developed countries with an established welfare state. Whilst in developing countries the basic childhood needs (food, hygiene, education, socio-sanitary protection, and others) are still not satisfied and, on the whole, this implies an extreme vulnerability with respect to abuse, in the developed countries we consider as necessary for childhood welfare intermediate or higher level needs (UNICEF, 1995). These higher order needs proposed by such countries (cognitive, emotional and social needs) reflect current knowledge on childrens development from an integral perspective (López, 1995a), and involve modifications in the provision or satisfaction modality of the basic needs themselves. In this sense, it can be observed how the way in which the different basic needs categories in Table II are defined also reflects the presence of psychosocial needs, in that it not only describes what the needs are, but also how to satisfy them. Recently, López et al (1995) reviewed in detail the main indicators child attention services may use in order to evaluate the rate of satisfaction of childrens different developmental needs, and so determine the existence of potential risks of child abuse. (Table II).
c) Childrens development and socialisation does not occur in a vacuum but, on the contrary, becomes progressively configured in close relation to and interdependence with its environment (Bronfenbrenner, 1986; Frones, 1994). An environment which is structured according to social groups and scenarios (family, school, adults, peer group, services) of different importance depending on the psychosocial and developmental stage. Current transactional models on child development speak of the existence of a mutual interaction of an emotional as well as cognitive character between the child -with his/her own individual characteristics- and the environment -mediated by family and peer group relations (Bronfenbrenner, 1987; Samerof and Chandler, 1975). It is currently assumed, for example, that socialisation in a parent-child relational context is a process of reciprocal influence, which has some implications for childrens development as well as for parents behaviour with regard to them which, in turn, conditions the childs development (Brody, 1994).
d) The family is taken as the main primary socialisation scenario and, consequently, as a primary source of welfare for the child. It is in the family where all the nutrients for satisfying the childs early basic needs converge. Hence, the family represents an opportunity for socialisation and development. However, it is also within the family where shortcomings and unsatisfied needs show up very early, and make an immediate impact. In this sense, the family also constitutes a risk for childrens development and socialisation. The specific behaviour of attachment figures (mother, father, elder brother/sister, grandparents, etc.) is the most relevant and decisive factor in the provision of a secure basis through which the child explores the environment and interacts with it in a confident way, gaining access to adequate learning; on the other hand, it may be a decisive factor in providing extreme insecurity and uncertainty which impairs adequate development and socialisation. In fact, child abuse can be conceived as the manifestation of a serious impairment in parents relationships with children, which results in retardation and disruptions in the childs development (Beisky, 1984). Thus, it is not surprising that the behaviour of parental and attachment figures is an important aspect in any child abuse prevention strategy. It is for this reason that prevention programmes must analyse those factors conditioning lack of sensitivity on the part of parents and attachment figures with respect to childrens needs and abilities. Such programmes would be designed from a suitable starting point for orienting their goals both towards strengthening the development of abilities in the child that allow for adequate socio-emotional learning and towards the promotion of parental abilities (Wolfe, 1993).
e) Finally, family context is not an isolated entity. On the contrary, it is both a tributary and an active agent, direct or indirect, of its socio-economic and cultural environment, through the influences and transactions maintained with that environment. It is for this reason that the wider context will be analysed and described.
Social and cultural reference: attitudes, opinions, beliefs and values about childhood.
The cultural context, attitudes and values constitute an object of study in anthropology, sociology and social psychology, which is difficult to specify and no less difficult to operationalise when we try to measure it or, more ambitiously, to exert some influence on it for prevention purposes. However, regardless of the difficulties and methodological challenges, the social and cultural framework is an inevitable reference, even more so when we try to define a comprehensive panorama on abuse prevention, and most of all, if we take into account the normative and cultural context which sanctions or tolerates certain educational and rearing practices. Some considerations that should be borne in mind are the following:
a) The normative and social framework -given that it admits or sanctions certain practices- constitutes a source of risk or of prevention with respect to child abuse. Garbarino (1977), an expert in the field, identifies two social conditions necessary for child abuse. On the one hand, there must be a cultural justification for the use of force against children and, on the other, the abusing family must be isolated from other families which can provide access to information on infancy, and from community support systems. Moreover, there is some consensus that abuse and abandonment prevention, as well as early detection of risk situations, will only be successful if efforts are directed at producing a greater involvement of society (Dhooper, Royse and Wolfe, 1991). The hypothesis is that a society which has more information about childrens needs will be less tolerant of abusing behaviour and will develop more adequate rearing practices. This hypothesis has been used as a foundation for -among many other things- developing information campaigns for the global population with respect to rearing and child abuse.
b) Changes introduced by prevention programmes in rearing guidelines are more likely to succeed and be maintained in the future if they are sustained by existing social support systems. Most of the significant changes occurring in society do not come from specific efforts directed at changing individual behaviours, but as a result of more global and cultural changes. Clinicians, and those who are in some way dedicated to intervention for purposes of educational or social change at the "micro" level (individuals, small groups and family) may often feel satisfied with the specific changes resulting from their intervention. However, every psychotherapy project or programme for change, regardless of its theoretical background, is faced with the problem of how to maintain in the long term the results and changes effected. This will be difficult without a supportive social and cultural environment. Professor Garbarino uses the car and birds metaphor to illustrate the problem: when we are driving along the road in a car we see how we produce immediate changes, such as the birds flying away from the electric wires as we pass. But if the driver looks in the rearview mirror he/she will see how the birds soon return to their perches. In applying this metaphor to social changes, we mean to suggest that after the intervention of experts and professionals with their sophisticated educational strategies there are changes in rearing techniques which, on occasions, may be quite spectacular in their effects on many risk families. However, as professionals begin to leave those families to their own devices, and they continue to live and behave in the ways dictated by their daily life and conditions, it is likely that the risks which justified the intervention will again impose themselves. A comprehensive prevention strategy should consider influencing in some way or the other those variables that contribute to the stabilising of social life.
c) Normative and social life also contributes to establishing expectations about childhood, some of which may be inappropriate and produce risk situations. There is empirical evidence (Morton, Twentyman and Azar, 1988; Azar, 1989; Milner, 1993) concerning the role of parents unreal expectations about their childrens behaviour in the development of rearing practices with a high risk of abuse. These expectations may have their origin in erroneous beliefs about what a child of a certain age can or cannot do. The prevention hypothesis in this case would be that the problem could be alleviated through the identification of the nature and social location of the most frequent erroneous beliefs and the dissemination of correct or more appropriate information in society with respect to childrens developmental evolution.
d) The identification of these beliefs and attitudes within society is not always easy. Surveys and studies on attitudes and opinions applied in Spain in the last few years reflect a positive change in the population as far as a greater rejection of violence and abuse is concerned (Juste et al., 1991; Torres et al., 1994). In Table III the change occurring in the Spanish general population with regard to their own experience of abuse can be observed. It should be noticed that attitudes and opinions are not consistent predictors of behaviour, so that, when considering survey information, we should bear in mind that subjects responses tend to drift -consciously or unconsciously- toward the ideal models they hold as a socially-desirable referent, which could be a general socio-cultural model, or of the group to which he/she belongs or wants to belong. Data provided by surveys on family violence raise doubts as to whether the results reflect a real change in attitudes in the population or the social and cultural stereotypes existing in the society at a given moment (Strauss and Gelles, 1986). Despite such doubts, both social representations and opinions or attitudes declared by a given society about phenomena such as child abuse can be considered as contributing to the knowledge of what is accepted or rejected, and is felt to be appropriate or inappropriate, with regard to the matter in question. A recent qualitative study on the attitude towards childrens education and child abuse reveals how parents and teachers today reject disciplinary practices based on corporal punishment, but accept other forms of psychological punishment based on removal of affection due to bad behaviour, justifying it as a good for the child (Juste et al, 1995). Thus, behavioural and expressive forms that are positively evaluated or rejected, what is expected or not expected of people belonging to a certain age, gender, occupation, religious, or civil status group, among othervariables constitutes the background of what is established as customary, as possible and as desirable. All of this makes up the social ideology, the social fabric of expectations and values.
e) Especially important for its preventive potential is the role of the mass media -particularly television- in the configuration of beliefs and attitudes. Thus, in the past few years numerous TVprogrammes and series for different age groups have been shown that are oriented towards the promotion of positive social values, such as parent-child dialogue and the rejection of violence within the family. However, we often find at the same time that the media in general contribute to fomenting perceptions and ideas of abuse which far from represent a realistic way of coping with the problem. There is general agreement among specialists (Jiménez et al., 1995) in considering that the mass media deals with abuse in a simplistic way, focusing upon the most dramatic aspects, and failing to take account of the social risks that aid an understanding of the problem. (Table IV).
f) Finally, it is worth noting the role of written norms and laws in the configuration of social values and behaviour patterns in relation to childhood and child abuse prevention. The Childhood Rights Convention and the most recent normative evolution in developed countries, together with a greater knowledge about children, are contributing to the establishment of a current of opinion among professionals that considers children as citizens with rights, and not as mere objects of legal protection, and that advocates the need to establish political measures specifically directed at children as a social group, rather than exclusively as part of the family unit (Wintersberger, 1994). Thus, a certain consensus is forming in relation to values and rights in childhood (Melton, 1991), which even affect the principles orienting the machinery of social attention to childhood. These principles are reflected in the acrostic "CONVENTION" (see Table IV. NB, in Spanish, the first letter of each item forms the word "CONVENCION"), recalling the historic milestone of the "Childhood Rights Convention". This socio-cultural reconceptualisation of childhood also leads to a reconsideration of both traditional indicators for the assessment of programmes, and of socio-demographic statistics, as children become the principal unit of analysis at both the family and the macrosocial level. (Jensen and Saporiti, 1992). Even the separation from official statistics of secondary data about children as units of observation has been proposed. This can be of great utility for both researchers and planners in the assessment of the life conditions of children (Wintersberger and Qvortrup, 1992).
Anne H. Cohn Donnelly (1991), director of the US National Committee for Child Abuse Prevention, reviewed international abuse prevention efforts over the previous decade. In her review she also set the challenge for the new decade, which was summarised as to do more of the same that has been done (public education, social commitment, legislation, development of prevention services) and to take on new challenges (impact of drug addition on parenthood, special attention to parents living in poverty or social difficulty, violence in the mass media, and orienting child protection agencies towards their original function of helping families).
In our view, and continuing the line of argument we are presenting, child abuse prevention must be oriented by the satisfaction of the childs needs in their socio-cultural context, and always based on a thorough knowledge of the variables explaining child abuse. There would be three means or strategies which, in general terms, match those proposed by Anne H. Cohn Donnelly: to create a socio-cultural context sensitive to childrens needs, to improve parents competence in providing and satisfying those needs, especially where children are in special situations of high social risk, and, finally, to improve the competence of services providing assistance for parents, children and families in their general development and their coping with everyday life problems.
A starting point for preventive action: research.
Preventive action continues to need guidance from research and theoretical developments which aid understanding of the phenomenon of violence. We will hardly be able to orient prevention if we do not know the answers to some of the basic questions: Why do people behave in the way they do? Why are there people who, in certain circumstances, behave violently, while others do not? What are the most probable risk factors or variables that can cause violent acts in such circumstances ? What is the best way to protect children from the effects or consequences of abuse? Why are there children who are not affected by adversity and violence, even when it is present? - and so on. Research and theoretical development on violence are seen as basic nutrients on which to establish the orientation and direction of preventive actions. It is true that, today, there is a great deal of research and many theoretical models, and some of the answers to these questions are beginning to be sketched, but it is no less true that there is still a long way to go. Many of the existing theoretical models, especially the so-called ecological models (Beisky, 1980; Bronfenbrenner, 1987) are rather organisational models for orienting preventive actions, but they need to be fed by other more basic paradigms in order to respond to many of these questions. Other models (Cichetti and Lynch, 1993; Morton, Twentyman and Azar, 1988; Azar, 1989; Milner, 1993), though providing partial explanation levels, have shown the need for continuing basic research on child abuse, in order to specify existing relations between different levels in conceptual models (Cicchetti and Lynch, 1993). It is also necessary to adapt these models to the socio-demographic particularities of each community and evaluate the specific weight for each main risk factor involved in child abuse according to cultural characteristics, and so to orient preventive action at community levels (Morales et al., 1994).
Creating a social and cultural context sensitive to childrens needs
a) Development and dissemination of knowledge about childhood and childrens rights. The childs unavoidable biological and social dependency upon adults establishes an original inequality which makes abuse and exploitation possible. A basic strategy that may contribute to its neutralisation is the development of processes (research and dissemination of information) that allow us to become more familiar with childrens needs, and to establish, within the social fabric, new, emerging values about childhood. In this sense, public administrations and university departments should continue, and even increase, their efforts to develop research on childhood in general and on children at risk in particular. The set of relevant information about childhood that is being developed, as well as the Childs Rights Convention, should be a topic for seminars, debates, conferences, educational activities and social awareness campaigns, and should also be matters of concern for the different professionals directly or indirectly involved in child services.
b) Elimination of norms and conditions promoting and legitimating violence in society. This involves questioning the current social order, since it implies reducing or alleviating existing socio-economic inequalities. In this sense, struggling against violence may mean pursuing the utopia of abolishing inequalities. Without trying to dodge this more global perspective on social change, which may mean having to touch on matters such as economic and employment policies and the arms market, it is clearly necessary that, in an active manner, through legislation programmes and initiatives and more information on childrens needs, some steps are made towards the elimination of physical punishment as a child-rearing practice and in schools, and towards the outlawing of violence in those media that glamorise and legitimate it.
c) Active and collective participation in family life. Participation of all members in everyday family life is one of the most solid bases on which to establish space for the development of harmonious co-existence, in that the family constitutes the prime scenario of socialisation. With regard to active and collective participation in family life we understand that there is a necessity, on the one hand, for the promotion of actions to eliminate potential inequalities that may exist in its core for reasons of sex, between father and mother and between brothers and sisters; and on the other hand, for the implantation in family scenarios values of respect for diversity of options and opinions each of the members may hold, and for the fomenting of collective participation in decision-making, always according to the limitations imposed by the childs level of development. All of this, in turn, implies the use of other practices and new learning in relation to improving communication and the negotiation and resolution of problems of everyday co-existence.
The development of parental competence
Parents capacity for the rearing and education of children is not an exclusively private, family matter. In this sense, the development of parental competence is considered from a dual perspective. On the one hand, it involves the definition of specific educational principles and strategies orienting training programmes. On the other, it implies eliminating the isolation of families at risk, so that they can gain access to the most advanced attentional values and criteria relating to childhood that exist in their social and cultural context.
a) Principles and criteria orienting parental training programmes. Change in parental behaviour, through training programmes, has been one of the most frequently-used strategies for the prevention of physical abuse and abandonment. Most of the programmes that aim to improve parental capacity or competence are based on a series of principles and conditions which, after a review of the relevant literature (Heider, 1958; Rosenthal and Jacobson, 1968; Bandura, 1986; Cerezo, 1992; Wallace, H. and Miller, B, 1993; Cerezo et al, 1995; DOcon et al., 1995) we have summarised in Table V. In an excellent review, McMillan et al (1994) conclude that integrated programmes, in which home support services and other community services are combined, are the most effective kind for high risk families. The interested reader may consult other interesting references (Olds et al., 1986; Cerezo, 1992; Butler et al., 1993; Arruabarrena and De Paul, 1994).
b) Reduction of social isolation in high risk families. Social isolation is one of the risk variables described in child abuse literature. What society demands, culturally and socially, with regard to what is considered to be proper treatment of children, ceases to have an effect if the isolation of a family makes these cultural patterns inaccessible. Moreover, social isolation favours the fact that primary socialisation scenarios become even more private, leading to arbitrary decisions about what is good and bad for those who still do not have the competence to decide for themselves. Furthermore, the more isolated the family, the more difficult to detect are abuse and/or negligence (TABLE V).
Integrating families within the social networks of the community in which they live is the best method for correcting the perverse effects to which isolation leads. However, the great problem we are facing is that, on the one hand, these social networks often do not exist, or are extremely difficult to generate. In our country (Spain), with the exception of the strong neighbourhood movement in the seventies, during the transition to democracy, there is no well-structured social fabric. On the other hand, families in high social risk situations are precisely those which usually find themselves involved in social exclusion processes. Thus, the answer to this problem is not easy and -as nearly always- transcends the capacities of child protection services. Some lines of action are seen as highly relevant for confronting the problem of isolation:
- Redefining urban design and neighbourhood spaces. Cities, districts and residential areas in general are behaviour scenarios which, as such, can promote either social and neighbourhood cohesion or segregation. The verticality of cities with large, isolated apartment blocks, with no common spaces or facilities which bring together neighbours, parents and children from different families, results in the typical urban image that impedes the development of social and neighbourhood networks. Individual decisions to share interests and experiences with other people must, at least, have the same opportunities as the decision to become isolated.
- Normalising the childhood and family services network. Specific programmes and services for the poor or for minority cultural groups at social risk may, paradoxically, stigmatise the very population it is trying to help. Assistance services or programmes for abused children, or those at risk, must be linked to a normalised network of services and resources accessible for the general population. In some cases, families may become socialised through their children, who have access to services used by children from different social strata.
- Reducing social exclusion processes through policies of employment, housing, and integration of minority cultural groups.
- Promoting the feeling of community (Sarason, 1974) by processes of decentralisation of power and of decision-making in local affairs. An essential feature of the community concept is the control and power dimension (Sue and Zane, 1980). By control and power we understand the individuals capacity to influence decisions affecting his/her own life. In Seligmans original learned helplessness concept (1975), power, control or influence refers to the relationship that is established between actions and results. Helplessness or powerlessness may occur when results are independent of an individuals actions. In this sense, to foment the feeling of community is equal to promoting the individuals feeling of power and control in the community where they live, which, in turn, implies involving them in decision-making on matters affecting them.
Improving the competence of services
The need for a global and anticipatory approach to preventive action leads us to ask serious questions about the prevailing style of services, whereby the responsibility for protection against abuse is deposited, reactively and almost exclusively, in the hands of the social services. Below are some of the most relevant observations in this regard:
a) Actions and measures oriented to children at risk must be situated within the development of integral plans and programmes for the child. Many of the desirable actions mentioned earlier require the joint action of different sectors. As Albee (1992) -one of the international authorities on prevention- would say, the best child abuse and suffering prevention programme would be that which could ensure that every child born anywhere was healthy, welcomed by parents with a secure economic status who jointly planned his/her conception, birth and development. Obviously, such a desideratum, which we share, cannot be imagined other than through the implementation of intersectorial policies in which sanitary, educational and social services are adequately co-ordinated, and of sectorial policies in areas such as employment and housing that make their presence felt. The reduction of poverty, inequality and unemployment, and the provision of adequate housing, food, health and general assistance services and of educational opportunities are steps that might reduce stress in families and contribute in a special way to alleviating or reducing certain risk conditions for child abuse. However, the intersectorial conception should not be taken into account only at the time of introducing particular programmes or services. It should be a basic conception running through the entire planning process, and informing all the different sectors, at their different levels, about the needs and demands to be borne in mind with regard to children. In this sense, the development of territorial indicators of childrens risk and welfare (Cornejo, 1992), would be of great assistance to the intersectorial establishment of priorities, as well as for the assessment, also intersectorial, of prevention plans and programmes.
b) Normalised educational services must promote the strengthening of coping abilities in children and families. Strengthening, or increasing competence (Albee, 1980; Costa y López, 1986) is seen as one of the principal preventive strategies centred on individuals, be they children or adults (Swift, 1992; Elias, 1995). By strengthening we refer to the developmental process people experience which enables them to make decisions about their lives (how to live, where to live, who to live with), to gain access to resources, and to face the problems and challenges posed by everyday life. In the child abuse domain there are two basic orientations, which fit well with the US National Committee for Child Abuse Prevention recommendations (Cohn, 1991). These recommendations are:
- Training of children and adolescents. Child and adolescent training programmes are primarily aimed at protecting children from abuse and from the attacks of other children (Olweus, 1992), promoting alternative behaviour to aggression (Goldstein and Keller, 1991), preventing unwanted pregnancies (Gilchrist et al, 1979; Gilchrist and Schinke, 1983; Cáceres and Escudero, 1994), and preventing sexual abuse (López, 1995). These are basically personal security programmes providing children with instruction and training on how to discriminate normal from improper body contact (caresses, etc.), a good secret from a bad one, how to identify risky situations, and how to protect themselves from sexual aggression. Evaluations being made on sexual abuse prevention programmes (López, 1995b) conclude by pointing out that older children benefit from them more than pre-school children, and that global and comprehensive programmes supported by families are more effective than those providing only specific instruction and training services. Félix López (1995b), who is opposed to the development and implementation of specific and independent sexual abuse prevention programmes, has recently published an excellent monograph, in Spanish, suggesting an especially interesting proposal for our socio-cultural context, within the framework of global programmes for health education.
- Training in early education scenarios (family and infant schools) is particularly interesting with regard to developing social interest in others and empathetic capacity (putting oneself in the place of others).This empathetic capacity may be acquired (or altered and interrupted by experience of abuse in early infancy) through a specific curriculum of emotional education and of training in interpersonal problem-solving. The presence of stable and coherent attachment figures is a fundamental component in the development and learning of this capacity (Cerezo, 1995). Meanwhile, training programmes for pre-school children similar to those of Spivac and Shure (1974), and all the studies made in connection with what are called resiliency or protection factors (Rutter, 1977; Werner, 1989; Dugan et al., 1989), especially promoted by the University of Vermont, constitute a particularly useful focus for the development of primary prevention. There is now sufficient information about what is represented by strong and competent families -or strong and competent attachment figures- capable of giving love, support and affection and establishing clear and coherent rearing norms. A great deal is known about what is desirable in rearing and education for the development of competent and non-violent children. In Albees words (1992), the next task is to find ways of ensuring the best environmental conditions for such learning.
d) Development of processes for improving the detection of and early attention to helplessness and child abuse cases. From a secondary prevention perspective, the development of processes improving detection and early attention are especially relevant. There are two strategies of particular interest. One of these, the reduction of family isolation, was discussed above; the other directly affects the prevailing protection system: the change in the style of service provision with regard to protection and social attention mechanisms.
A passive, "waiting" or "administrative", style of providing services may come to constitute a serious obstacle to prevention, in general, and to the prevention of family abuse and violence, in particular. In Figure 2, the limited reach of preventive strategies with such a service provision style can be observed. Secondary and tertiary prevention can only be expected in individuals or small groups -and even then, secondary prevention is difficult to develop. If we consider the graphic image of the "abuse icebergs" (Figure 3), we see that the detection and research capacity of the mechanisms of social attention, especially relevant for secondary prevention, is seriously called into question:
- Social services usually "see" only the tip of the iceberg of child abuse in populations at social risk, the most frequent clients for these services. That is, they typically see severe or especially high-profile abuse, difficult to hide within the private family context.
- Social services, however, "do not see" lighter forms of abuse, nor the risk conditions in which families and children live. The rest of the "iceberg" remains hidden. The failure to perceive these aspects becomes especially serious when the victims of family violence are small children, who do not develop active behaviour in denouncement of the abuse or abandonment situation. Meanwhile, neither do the social services "see" the conditions in populations at social risk, who, socially excluded, fail to be reached by either the information circuits or the professional culture of services. It may even occur that the main recipients of social services and assistance programmes are not the most needy social sectors, but rather the best-informed ones. Moreover, the best-informed, when an "administrative" style, out of touch with the target population, prevails, are usually those that are closest to the professional culture of services. Thus, social support provided by professionals for populations with obvious social inequalities may inadvertently contribute to emphasising these differences even more.
- Social services "do not see" even the tip of the iceberg of the no social risk population, since those constituting this population are not usually clients of these services.
The service provision style becomes relevant, then, in relation to the reach and effects of prevention. It is necessary for child protection services, and the professionals working in them, to develop a proactive, rather than reactive, style. Also, working within an intersectorial perspective involves "looking to each side", keeping an eye on other sectors such as education and health, which affect children in a special way. In fact, schools and health services may constitute especially sensitive indicators of the risk conditions in which children live. Above all, however, approaching these problems from an intersectorial perspective means "looking outside the office", in order to observe childrens life scenarios where violence and abuse is "fabricated", to detect it as soon as possible, to break down socio-economic barriers that may exist in access to services, to guarantee the flow of information for those who, having more needs but also more communication and information difficulties, do not use the services, and, once and for all, to work with neighbourhood and social networks. The problem of child abuse needs to be dealt with in an active style -which some authors have called a "searching style" (Rapaport, 1977; Costa and López, 1986; Costa 1994)- as opposed to a passive, "waiting" style, in which those providing the service passively wait for potential users to demand it.
e) Emphasis on the pedagogical and community nature of services. Table VI summarises some of the potentially useful criteria for increasing the effectiveness of services aimed at helping families in situations of social risk. Accepting these criteria implies introducing changes in the service provision style, as previously pointed out, and in the attitudes and abilities of service providers themselves. A greater capacity for communication and resolving unexpected problems, respect for the knowledge of non-experts, and an attitude that promotes the active involvement of clients and users will undoubtedly be important ingredients of the curricula of future professionals.
Aber, J. LAlien, J. P., Carlson, V. and Cicchetti, D. (1989): The effects of maltreatment en development during early childhood: recent studies and their theoretical, clinical, and policy implications. In D. Cicchetti, V. Carlson (eds). Child maltreatment. Theory and research on the causes and consequences of child abuse and neglect. Cambridge: Cambridge University Press (579-619).
Albee, G.W. (1980) : A competency model to replace the deffect model. In M.S. Gibbs, J.R. Lachenmeyer, & J. Sigal (Eds), Community psychology: Theoretical and empirical approaches. New York: Gardner, (213-238).
Albee, G. W. (1992): Saving Children Means Social Revolution. In G. W. Albee, L. A, Bond and T. V. Cook Monsey (Eds). Improving Children´s Lives. Global perspectives on Prevention. Newbury Park: SAGE, 311-329.
Arruabarrena, M. I. and De Paúl, J, (1994): Maltrato a los niños en la familia Evaluación y tratamiento. Madrid Pirámide.
Azar, S. T. (1989): Training parents of abused children, In C, E. Schaefer & J, M, Briesmeister (Eds). Handbook of parent training. New York John Wiley. (414-441).
Bandura, A. (1986): Pensamiento y acción. Barcelona: Martinez Roca.
Barth. R. P. (1991): An experimental evaluation of in-home child abuse prevention services. Child Abuse & Neglect, 15, 363-375
Beisky, J. (1980): Child maltreatment: An ecological integration. American Psychologist, 35, 320-335.
Beisky J. (1984): Tire determinants of parenting: A process model. Child Develop, 55. 83-96
Brody. G. H. (1994): Family processes and child and adolescent development. An introduction to the special issues, Family Relations, 43 : 359.
Bronfenbrenner, U. (1986): Ecology of the family as a context for human development research perspectives, Developmental Psychology, 22 723-742.
Bronfenbrenner, U. (1987): La ecología del desarrollo humano. Barcelona Paidós.
Browne, K. (1988): The nature of child abuse and neglect: an overview. In K. Browne, C. Davies and P, Stratton (eds), Early prediction and prevention of child abuse. Chichester John Wiley & Sons (15-30).
Browne, K. & Saqi, S. (1988): Approaches to screening for child abuse and neglect, In K Browne, C. Davies and P. Stratton (eds), Early prediction and prevention of child abuse. Chichester John Wiley & Sons (57-85).
Butler, C. ; Rickel, A. U. ; Thomas, E. and Hendren, M. (1993): An intervention program to build competencies in adolescent parents. The Journal of Primary Prevention. 13, 3, 183-198.
Cáceres, J. and Escudero, V. (1994): Relación de pareja en jóvenes y embarazos no deseados. Madrid: Pirámide.
Cerezo, A. (1992): Programa de asistencia psicológica a familias con problemas de relación y abuso infantil. Valencia: Generalitat Valenciana
Cerezo, A., DOcon, A. and Doiz, L. (1995): Mother-child interactive patherns in abusing/non-abusing families. An observational study. Communication presented at IV State Congress on child abuse, Seville, 8-11 Novenber, 1995.
Cicchetti, D & Lynch, M. (1993) Toward en ecological/transactional model of community violence and child maltreatment: consequences for childrens development. Psychiatry, 56:96-118.
Cohn, A. H. (1991): What we have learned about prevention: What we should do about it. Child Abuse & Neglect, 15, 99-106.
Costa, M. and López. E, (1986) Salud comunitaria. Barcelona. Martinez Roca
Costa, M. (1994): La formació permanent i la investigació aplicada. In Congrés Europeo DAtencio a la Infancia de 1992. Barcelona: Generalitat de Catalunya. Departament de Benestar Social, (249-255).
Dato, D. (1991) Strategies and models in child abuse prevention In A R, Roberts (ed), Contemporary prespectives on crisis intervention and prevention. New Jersey Prentice-Hall inc. (161-184).
De-Paúl, J., Arruabarrena I., Torres B. and Muñoz R, (1995): La prevalencia del maltrato infantil en la provincia de Guipúzcoa. Infancia y aprendizaje, 71 49-58.
Dhooper, S, S. ; Royse, D. D. and Wolfe, L. C. (1991) A statewide study of the public acttitudes toward child abuse. Child Abuse & Neglect, 1 5, 37-44.
DOcon; Dolz, L. and Pons-Salvador, G. (1995): Patterns of family interaction and child abuse, A comparative study of abuse and abandonment case. Poster presented at IV State Congress on child abuse, Seville, 8-11 Novenber, 1995.
Dugan T, F, and Coles, R. (1989): The child in our times. Studies in the development of resiliency. New York: Brunner/Mazel.
Elias, M. J. (1995) Primary prevention as health and social competence promotion. The Journal of Primary Prevention, 16, 1, 5-24.
Fink, A. and McCloskey, L. (1990): Moving child abuse and neglect prevention programs forward improving no program evaluations, Child Abuse & Neglect, 14: 1 87-206.
Frones, I. (1994): Dimensions of childhood In: Qvortrup J, Bardy M, Sgritta G, Wintersberger H, (eds.) Childhood matters Social theory, practice, and politics. Avebury: European Centre Vienna, Astigate Publishing limited, 145-1 75.
Garbarino, J. (1977): The human ecology of child maltreatment. Journal of Marriage and the Family, 39, 721-735.
Gelles, R. J. (1993): Family violence. In R. L Hampton, T, P. Gullota (eds), Family violence. Prevention and Treatment. Newbury Park: Sage Publications, (1-24).
Gilchrist, L. D, and Schinke, 5 P. (1983), Coping with contraception cognitive and behavioral methods with adolescents. Cognitive Therapy and Research, 7, 379-388.
Gilchrist, L. D; Schinke, S. P and Blythe, B.I. (1979): Primary Prevention Services for Children and Youth. Child Youth Services Review, 1, 279 391.
Helfer R. E (1987): The developmental basis of child abuse and neglect an epidemiological approach In: Heifer R E., Kempe R. S., (eds) The battered child Chicago: The University of Chicago Press 60-80.
Inglés, A. (1995) Origen, proceso y algunos resultados del estudio sobre los malos tratos infantiles en Cataluña, Infancia y aprendizaje, 71 23-32.
Jensen, A. M and Saporiti, A. (1992): Do children count ?. Childhood as a social phenomenon A statistical compendium In Bardy M., Qvortrup J, Sgritta G., Wintersberger H, (eds) Childhood as a social phenomenon. Eurosocial Report 36/17. Vienna: European Centre for Social Welfare Policy and Research.
Jiménez J.; Moreno M.; Oliva A., Palacios J. and Saldaña D. (1995): El maltrato infantil en Andalucía. Sevilla: Consejería de Trabajo y Asuntos Sociales.
Juste M. G., Ramirez A. and Barbadillo P. (1991): Actitudes y Opiniones de los españoles ante la infancia. Colección en Estudios y Encuestas N. 26. Madrid: Centro de Investigaciones Sociológicas,
Juste, M. G., Morales, J. M. and Costa M. (1995). Actitudes y opiniones de los españoles ante el maltrato infantil dentro del ámbito familiar. Diseño de la investigación y avance de resultados del estudio piloto. Sevilla: Asociación Andaluza para la Defensa de la Infancia y la Prevención del Maltrato (ADIMA), 605-606.
Larson, C, P. (1980): Efficacy of prenatal and postpartum home visits on child health and development, Pediatrics, 66, 1 91-1 97
López, F. (1995a) Necesidades de la infancia y protección infantil. Fundamentación teórica, clasificación y criterios educativos. Madrid: Ministerio de Asuntos Sociales.
López, F. (l995b): Prevención de los abusos sexuales de menores y educación sexual. Salamanca: Amarú Ediciones.
López, F.; López, B.; Fuertes, J.; Sánchez, J. M.; and Merino, J. (1995): Necesidades de la infancia y protección infantil. Actuaciones frente a los malos tratos y desamparo de menores. Madrid, Ministerio de Asuntos Sociales.
MacMillan, H. L, MacMiiian, J. H, & Offord, D. R (1993): Periodic health examination, 1993 update: 1 Primary prevent en of child maltreatment. Canadian Medical Association Journal, 1 48, 1 51-1 63
MacMillan, H, L., MacMillan, J, H., Offord, D. R,; Griffith, L, and MacMillan, A, (1994): Primary Prevention of Child Abuse and Neglect: a critical review Part I.. Journal of Child Psychology and Psychiatry, Vol 35, N. 5, 836-856.
Melton, G. B. (1991) Preserving the dignity of children around the world the UN convention on the rights of the child. Child Abuse Negl, 15: 343-350.
Merino, C. Fernández, E. Alvárez, A. et al. (1995): El niño de 0 a 3 años Guía para padres y educadores. Madrid: Editorial Escuela Española.
Milner, J. (1993): Social information processing and physical child abuse. Clinical Psychology Review, 1 3, 275-294.
Morales, J. M., Martínez-Salceda, V. and Zunzunegui, V. (1994): Modelos conceptuales del maltrato infantil un estudio de casos y controles, Gaceta Sanitaria, 8: 208-209.
Moreno M C.; Jiménez J.; Oliva A.; Palacios J. and Saldaña D. (1995): Detección y caracterización del maltrato infantil en la Comunidad Autónoma Andaluza. Infancia y aprendizaje, 71: 33-47.
Morton, T. L. Twentyman, C.T.& Azar, S. T. (1988) Cognitive-behavioral assessment and treatment of child abuse. En N. Epstein, S. E. Schlesinger, & W, Dryden (Eds). Cognitive-behavioral therapy and the families. New York : Brunner/Mazei, (87 11 7).
Olds, D.L.; Henderson Jr. C. R., Chamberlin, R Tatelbaum, R. (1986): Preventing child abuse and neglect: a randomized trial of nurse home visitation, Pediatrics, 78, 65-78.
Olweus, D. (1992): Victimization among schoolchildren: intervention and prevention, In G, W. Albee, L. A. Bond and T V. Cook Monsey (Eds), Improving Chlldrens Lives. Global perspectivas en Prevention. Newbury Park: SAGE, (279-295).
Palacios, J. (1995): Los datos del maltrato infantil en España: una visión de conjunto. Infancia y Aprendizaje, 71, 69-75.
Rappaport, J. (1977): Community Pychology: Values, research and action, New York: Holt, Rinehart & Winston.
Rosenthal, R. and Jacobson, L. (1968): Pygmalion in the classroom Teacher expectation and pupils intellectual development. New York: Holt, Rinehart and Wiston.
Rutter, M. (1979): Protective factors in childrens responses to stress and disadvantage, In M W. Kent & J, E. Roif (Eds). Primary Prevention of Psychopathology. Volume III: Social Competence in Children. Hanover, NH: University Press og New England. (49-74).
Sameroff A, and Chandler M. (1975): Reproductive risk and the continuum of caretaking causality. In: Horowitz E, (Ed). Review of child development research. Chicago: University of Chicago Press.
Schaffer, H, R. (1979): El desarrollo de la sociedad. Madrid: Pablo del Rio.
Schaffer, H. R. (1991): Early social development. In M. Woodhead, R. Carr and P. Light (Eds). Becoming a person. Londres: The Open University.
Sarason, S. B. (1974): The psychological sense of comunity. Prospects for a community psychology. San Francisco: Jossey-Bass.
Seligman, M. E. P. (1975): Helplessness, On depression, development and death. San Francisco: W. H. Freeman.
Spivack, G. and Shure, M. B. (1974) Social adjustment of young children, San Francisco: Jossey-Bass.
Starr R. H . Dubowitz H. and Bush E. A. (1990): The epidemiology of child maltreatment. In: Ammerman RT, Hersen M, (Eds), Children at risk An evaluation of factors contributing to child abuse and neglect. New York: Plenum Press, 23-54.
Straus, M. A. & Gelles, R. J. (1986): Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys. Journal of Marriage and Family, 48, 465-479.
Sue, St. and Zane, N. (1980): Learned Helplessness Theory and Community Psychology. In M.S. Gibbs, J R. Lachenmeyer & J. Sigal (Eds), Community Psychology Theoretical and empirical approaches. New York Gardner Press. (12-143).
Swift, C. (1992): Empowerment: The greening of prevention. In M. Kessier, St. E. Goldston and J. M. Joffe (Eds). The Present and Future of Prevention. Newbury Park SAGE, (99-11 l).
Torres, M.; Alvira, F., Blanco, F. and Sandi, M. (1994): Relaciones padres-hijos. Madrid: Ministerio de Asuntos Sociales.
UNICEF (1995): Estado Mundial de la infancia, 1995. Barcelona: J & J Asociados.
Wallace, H. and Millar, B. (1993): Adding Atribution to Parenting Programs, Families in Society. The Journal of Contemporary Human Services, Febrero, 93, 84-92.
Werner, E. E. (1989) Vulnerability and Resiliency: A Longitudinal Perspective. In M. Brambring, F. Lösel & H. Skwronek (Eds), Children at Risk: assessment, longitudinal research, and intervention. New YorK: Walter de Gruyter & Co. (157-172).
Wintersberger, H. and Qvortrup, J. (1992): Request to statistical offices. In A. M. Jensen, A. Saporiti, (Eds). Do children count?. Childhood as a social phenomenon. A statistical compendium, Eurosocial Report 3611 7. Viena: European Centre for Social Welfare Policy and Research, 75-77.
Wintersberger, H. (1994): Children and society, In Steering Committe In Social Policy (ed). Project 111.8. Childhood policies. Strasbourg: Steering Committe en Social Policy 1994: 41-70.
Wolfe, D. A. (1993): Child abuse prevention blending research and practice. Child Abuse Review, 2: 153-165.