Child Abuse Recognition, Reporting and Prevention: A Culturally Congruent Approach

Journal of Multicultural Nursing & Health, Summer 2005 by Campbell, Eleanor T

This article explores the dichotomy between cultural practices of child rearing and the legal definition of child abuse. Background on the topic is presented from both viewpoints. Culturally congruent strategies that can be adopted by professionals working with suspected child maltreatment cases are discussed using Leininger's transcultural nursing theory. A case exemplar illustrates the significance of providing culturally congruent care when dealing with suspected child abuse. Implications for nursing and other mandated reporters are discussed.

KEY WORDS: Child abuse; Child Maltreatment; Culture; Nursing.

In many parts of the world, child abuse has only recently emerged as a major social problem. Media exposure of child sexual trafficking and employment of minors has heightened public awareness of child maltreatment as a global issue. The World Health Organization, WHO and the United Nations have defined four areas of child abuse & neglect including physical abuse, child sexual abuse, neglect and negligent treatment, and emotional abuse. The majority of countries of the world have accepted these definitions (WHO, 2002) see table 1. However, implementation of these definitions to prevent child abuse varies among cultures. While governments and agencies define child abuse based on public policy, social and cultural acceptance is based on cultural context. For example, "the Vietnamese practice of "coining" rubbing the chest and "cupping" placing heated cups over the chest of a child with respiratory illness instead of using antibiotics and humidification has been seen as a form of child neglect and abuse by Western health care professionals" (Davis, 2000; Cowen, 1999 p.3).

The affinity one has for one's own cultural values and child- rearing practices sometimes conflict with the legal definition of child abuse and neglect. Research indicates that adults parent as they have been reared; this includes nurses and other mandated reporters of child abuse who view certain child care practices through their own set of experiential lenses based upon their personal up bringing and own set of cultural values (Roer-Strier, 2001). Variations in interpretation may have serious implications for mandated reporters of child abuse and laypersons caring for children. Inaccurate or under reporting of potential maltreatment may occur as a result of such misunderstandings (Fluke, Yuan, Hedderson, & Curtis, 2003). As nurses and client populations become even more culturally diverse, preventing, recognizing and reporting cases of suspected abuse present a growing concern.

Statistics

Recent reports of child abuse indicate that there are three million cases nationally, with approximately one million confirmed. Tragically, averages of two thousand children die each year as a consequence of child abuse or neglect. In 2001 childhood fatalities were estimated at 1,200 or 1.71 children per 100,000 population of children (National Clearinghouse on Child Abuse and Neglect Information, 2004a). Findings of maltreatment are proportionately higher for children of ethnic minority groups.

Statistics on race and ethnicity of victims of child abuse indicate a higher percentage among certain minority children. Data based on percentages per thousand children are 21.7% for American Indian or Alaska Native, 20.2% for African Americans, 10.7% for Whites, 9.5% for Hispanics, and 3.7% for Asian Pacific Islanders. Although reports of maltreatment are proportionately higher among minorities, determination of maltreatment is not consistent (National Clearinghouse on Child Abuse and Neglect Information, 2004a). Reasons for the increase in reports of abuse for minority children vary however, economic disparities account for a significant number among this population who are exposed to greater public scrutiny by social service organizations in comparison to middle class families. These findings indicate the need for cultural considerations both ethnic and socioeconomic in order to decrease the incidence of false accusations of child maltreatment by professionals and the devastating consequences to families of such reporting.

DEFINITIONS OF ABUSE/NELECT

The Federal Child Abuse Prevention and Treatment Act (CAPTA) identify a minimum foundation for state legislation on child abuse and neglect. "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents imminent risk of serious harm" (Administration for Children & Families, 2003; National Clearinghouse on Child Abuse and Neglect Information, 2004b). Under this act, each state is responsible for providing its own definitions of child maltreatment. Most states in the US have written legal definitions on child maltreatment. These include physical and emotional neglect and abuse, and sexual abuse, table 1.

The interpretation of these laws may be variable based upon geographic region and cultural context. In Florida for example, public school teachers are allowed to physically discipline children with written permission from parents. In New York however, this behavior would be interpreted as physical abuse and punishable under the law. Such regional deviations are clearly confusing to the public.