TRISTAN'S MOON

INSTITUTE OF MEDICINE and NATIONAL RESEARCH COUNCIL of the National Academies

New Directions in Child Abuse and Neglect Research

Each year, child protective services receive reports of child abuse and neglect involving six million children, and many more go unreported. The long-term human and fiscal consequences of child abuse and neglect are not relegated to the victims themselves — they also impact their families, future relationships, and society.

In 1993, the National Research Council (NRC) issued the report, Understanding Child Abuse and Neglect, which provided an overview of the research on child abuse and neglect. Twenty years later, the Children's Bureau, Administration on Children, Youth, and Families asked the Institute of Medicine (IOM) and the NRC to convene a committee of experts to update the 1993 report and provide new recommendations to respond to this public health challenge.

In this latest report, New Directions in Child Abuse and Neglect Research, the committee concludes that while there has been great progress in child abuse and neglect research, a coordinated, national research infrastructure with high-level federal support needs to be established and implemented immediately. The committee recommends an actionable framework to guide and support future child abuse and neglect research.

Examining the Current State of Research

Among other findings, major research advances in the field of child abuse and neglect over the past two decades have illuminated the developmental and biological processes associated with the consequences of abuse and neglect. Adverse outcomes for victims of child abuse and neglect can include depression, post-traumatic stress disorder, poor physical health, and attention difficulties and delinquency. However, every experience is unique, and a child’s personal characteristics, family and social context, as well as the severity, frequency, and timing of the abuse can affect these outcomes. Services research has identified a wealth of effective prevention and treatment models, but the causes, factors explaining variation in individual experiences of abuse and neglect, strategies for implementing prevention and treatment programs in community settings, and effects of changes to laws and policies for child abuse and neglect are in need of further research.

Support for child abuse and neglect research, reflective of the multifaceted nature of the topic, is fragmented across federal agencies, private foundations, and academic centers and is further limited by a small aggregate research budget. The scattered nature of funding opportunities also discourages scientists from pursuing child abuse and neglect research as a sustainable career path. All of these factors have made it difficult to develop and maintain coordinated support for child abuse and neglect research.

The committee calls for a comprehensive, multidisciplinary approach to child abuse and neglect research. This approach should examine factors related to both children and adults across physical, mental, and behavioral health domains — including those in child welfare, economic support, criminal justice, education, and health care systems — and assess the needs of a variety of subpopulations. It should also clarify the causal pathways related to child abuse and neglect and, more importantly, assess efforts to interrupt these pathways.

It is equally important that advancements in knowledge about child abuse and neglect inform strategies for policy and practice in order to improve the well-being of children and families. The existing research infrastructure is not sufficient to respond to this public health challenge, and the report identifies four areas to look to in developing a coordinated research enterprise: a national strategic plan, a national surveillance system, a new generation of researchers, and changes in the federal and state programmatic and policy response.

Developing a National Strategic Plan

One of the key research priorities identified in the 1993 report was the need for federal leadership to guide, plan, and coordinate research on this topic. Twenty years later, the IOM/NRC committee found that high-level, federal coordination of research is still lacking. The committee recommends that a variety of federal agencies partner with private foundations and academic institutions to implement a national research agenda to support research on child abuse and neglect. The committee identifies key research priorities to be included in this agenda, focusing on the causes and consequences of child abuse and neglect, services provided in complex systems, and child abuse and neglect policy. To advance this new agenda, the committee recommends that the Federal Interagency Work Group on Child Abuse and Neglect, under the auspices of the Assistant Secretary for the Administration for Children and Families, develop a strategic plan with an implementation strategy, a detailed business plan, and designation of departmental accountability. This plan will need to be completed and vetted by appropriate leadership in time to be incorporated into the President’s budget for fiscal year 2015.

Creating a National Surveillance System

Reports on the incidence and prevalence of child abuse and neglect are vital to better understanding the magnitude of the problem, helping to identify populations at the greatest risk, and in the examination of the significance of both national and state trends. However, identifying children exposed to child abuse and neglect for research purposes often draw from sources that characterize abuse and neglect in different ways, leading to high variability and inconsistencies.

The committee recommends that the Centers for Disease Control and Prevention, in partnership with the Federal Interagency Work Group on Child Abuse and Neglect, create and sustain a national surveillance system for child abuse and neglect that links data across multiple systems and sources. One of the first steps to creating this national system should be to develop an approach to promote a more standardized use of definitions of child abuse and neglect across sources from which national data are to be drawn.

Because abused and neglected children come in contact with multiple systems — such as mental and physical health care, child welfare, education, and law enforcement — the data should be obtained from and shared among a variety of sources.

Establishing a New Generation of Dedicated Researchers

The complexity of child abuse and neglect research requires a cadre of researchers from diverse disciplines to collaborate on ways to unravel the underlying causes and consequences of child abuse and neglect. Private foundations and academic institutions, in partnership with federal agencies, should invest in developing and sustaining researchers from different disciplines to examine child abuse and neglect through training opportunities and at all levels of their careers. To promote a multidisciplinary perspective and train this new generation of researchers, the committee also recommends support by federal agencies in partnership with private foundations and academic institutions for the funding of new multidisciplinary education and research centers in geographically diverse locations in the United States.

In addition, the committee recommends that the National Institutes of Health develop a new child abuse and neglect, trauma, and violence study section under the Risk, Prevention, and Health Behavior Integrated Review Group.

Making Changes in Federal and State Policy

In the past two decades, there have been changes to federal and state laws and policies designed to increase the reporting and reduce the incidence and negative health and economic consequences of child abuse and neglect. However, little work has been done to evaluate the impact of these changes and determine these policies’ effectiveness. Research in this area would help influence future policy at both the federal and state levels. The report recommends that both Congress and state legislatures include support within all new legislation related to child abuse and neglect to evaluate the impact of new child abuse and neglect laws and policies, as well as require a review of the findings in reauthorization discussions to ensure accountability and effectiveness and to encourage evidence-based policy making.

Conclusion

Child abuse and neglect is a complex societal problem that requires a comprehensive response. The science of prevention and treatment along with the testing of associated programs and services have shown that the incidence of child abuse and neglect can be reduced and negative effects can be mitigated. Capitalizing on what we have learned requires exploring new directions when investing research dollars.

The IOM/NRC committee’s recommendations are designed to help transition the existing research and service system infrastructure of child abuse and neglect research into a well-coordinated, supported, multidisciplinary scientific enterprise at a national level. These changes will take time, making it all the more important that stakeholders at federal, state, and community levels take collective action as soon as possible.

Committee on Child Maltreatment Research, Policy, and Practice for the Next Decade: Phase II

Anne C. Petersen (Chair)
Research Professor, Center for Human Growth and Development, University of Michigan, Kalamazoo, MI

Lucy Berliner
Director, Harborview Center for Sexual Assault and Traumatic Stress, Seattle, WA

Linda Marie Burton
James B. Duke Professor of Sociology, Department of Sociology,
Duke University, Durham, NC

Phaedra S. Corso
Professor, College of Public Health,
University of Georgia, Athens, GA

Deborah Daro
Senior Research Fellow,
Chapin Hall at the University of Chicago, Chicago, IL

Howard Davidson
Director, American Bar Association Center on Children and the Law, Washington, DC

Angela Diaz
Jean C. and James W. Crystal Professor of Adolescent Health,
Department of Pediatrics and Department of Preventative Medicine, Mount Sinai School of Medicine, New York, NY

Mary Dozier
Amy E. du Pont Chair of Child Development, Department of Psychology, University of Delaware, Newark, DE

Frenando A Guerra
Clinical Professor of Pediatrics,
University of Texas Health Science Center, San Antonio, TX

Carol Hafford
Principal Research Scientist,
NORC at the University of Chicago, Bethesda, MD

Charles Nelson
Professor of Pediatrics and Neuroscience, Richard David
Scott Chair of Pediatric, Developmental Medicine, Harvard Medical School, Children’s Hospital Boston, Boston, MA

Ellen Pinderhughes
Associate Professor, Eliot-Pearson Department of Child Development, Tufts University, Boston, MA

Frank Putnam Jr.
Professor of Psychiatry, University of North Carolina at Chapel Hill,
Chapel Hill, NC

Desmond K. Runyan
Executive Director, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, Aurora, CO

Cathy Spatz Widom
Distinguished Professor, Psychology Department, John Jay College and the Graduate Center, City University of New York, New York, NY

Joan Levy Zlotnik
Director, Social Work Policy Institute,
National Association of Social Workers, Washington, DC

STUDY STAFF

Monica Feit
, Study Director (until January 2013)

Joshua Joseph, Study Director (as of January 2013)

Michael McGeary, Senior Program Officer (from January 2013 to March 2013)

Wendy Keenan, Program Associate

Alejandra Martín, Research Associate

Karen Campion, Research Assistant

Samantha Robotham, Senior Program Assistant

Faye Hillman, Financial Officer

Pamella Atayi, Administrative Assistant

Kathleen McGraw-Shepherd, Intern (from May 2012 to August 2012)

Kimber Bogard, Director, Board on Children, Youth, and Families

STUDY SPONSOR


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INSTITUTE OF MEDICINE and NATIONAL RESEARCH COUNCIL of the National Academies

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