Child abuse is defined in its severity or otherwise according to the cultural attitudes of the people at any particular point in time in an ever evolving society.
Most societies consider a child to be abused or at risk of abuse when the basic needs of that child are not being met by adults either through omission or commission.
For the purpose of this paper, although when mentioning abuse only family or parents are mentioned, abusers may be members of the extended family, persons known to the family or child, or unknown to the family and child.
Abuse by omission includes physical, emotional and educational neglect. While by commission it includes physical harm, verbal, psychological or emotional, sexual and enticement to illicit acts.
The phenomena of abuse in Malta
The first specialised unit in child protection was set up by the Department of Family Welfare in 1993, where only one social worker was assigned to the unit although other social workers from other Units of the Department were called in to assist in the investigation process. The problem of child abuse in Malta was still not recognised in its severity and in all its entity. Possible reasons for this could have been:
2. lack of a proper data base classifying all the problems within the same family case
A specialised unit was set up in 1994 forming part of the Social Welfare Development Programme. One of the roles of the newly set-up unit was to establish networks with other entities for referral purposes and to co-operate with other governmental and non-governmental organisations in assessment and treatment of the neglected, abused and at risk child.
After the opening of the specialised Unit there was a significant increase in the number of alleged cases referred both to the Department and to the specialised Unit. Reasons for this could have been:
2. The Mass Media was used to try to educate and to make the general public and professionals aware of the phenomena of child abuse and where to refer.
3. The setting up of a help line.
4. School-age children were made more aware of what child abuse is through articles, radio shows and the education system itself.
5. Networks and protocols were established between professionals, and other Departments and Agencies dealing with these type of cases.
In answer to parliamentary question no 12398 dated 17th February 1998, it was stated that during 1995, 1996, 1997 there were 924 cases of alleged abuse on children referred to the Department for Family Welfare and the Child Protection Unit of the SWDP.
The types of abuse reported were:
Sexual ..................................................................17%
Serious Neglect ..................................................36%
Emotional and/or Psychological ......................08%
Abuse before birth * ...........................................01%
37.16% from Area No. 2 (viz: B'Kara, St.Venera, San Gwann, Swieqi, San Giljan, Fgura, Luqa, Pembroke, Xghajra, Zabbar, Tarxien, Qormi and Ta' Giorni);
12.65% from Area No. 3 (viz: B'Bugia, Ghaxaq, Gudja, Kirkop, M'Skala, M'Xlokk, Mqabba, Qrendi, Safi, Zejtun, Zurrieq);
06.71% from Area No. 4 (viz: Attard, Balzan, Lija, Iklin, Mdina, Rabat, Siggiewi, Zebbug, Dingli);
09.53% from Area No. 5 (viz: Gharghur, Mellieha, Mgarr, Mosta, Naxxar, San Pawl il-Bahar); and
0.78% from Area No. 6 (viz: all the towns and villages in Gozo - Malta's sister island)
Mode of referral
Cases of child abuse and children at risk of abuse are mainly referred by Government Departments such as Health, Education, Police, First and Second Hall of the Civil Court and the Juvenile Court, non-governmental organisation such as, Residential facilities for children and parastatal organisations such as Sedqa etc.
Cases are also referred by the child himself/herself, the extended family and others such as neighbours, Parish Priests etc.
Maltese Legislation
Laws in Malta which provide for the protection of abused, neglected or at risk children are:
1.Civil Code.
2. The Criminal Code;
3. The Children and Young Persons (Care Orders) Act, 1980;
4. The Juvenile Court Act, 1980 which was amended in 1985;
5.The Protection of Minors Regulations;
For the purpose of this paper, I am going to elaborate on the Children and Young Persons Act and, at a later stage, on children placed in residential care.
The Children and Young Persons Act provides for the care and protection of children and young persons up to the age of sixteen years (16) and under. A Care order expires at the age of 18 if it is not revoked earlier. This act was passed by Parliament in 1980.
The first Care Order was issued in 1989 and it was the only care order issued for that year. In 1990, four (4) children were put under a 'Care Order', while in 1991, there were sixteen (16) cases, followed by eight (8) cases in 1992, eighteen (18) cases in 1993, five (5) cases in 1994, twelve (12) cases in 1995, eleven (11) cases in 1996, nine (9) cases in 1997 and nineteen (19) cases up to September of the current year.
The total number of children put under a care order between 1989 and 1998 was 103. No Care Orders were issued between 1980 and 1985 because the Juvenile Court was not as yet functional.
The least number of care orders issued was in 1989 when a child was admitted in care following the issuing of a care order. The number rose to sixteen (16) in 1991, and to nineteen (19) up to the beginning of September of this year. As can be observed from the table, there is no pattern of a constant rise in the number of care orders issued per year.
It is also to be noted that, although the number of care orders issued in 1998 was 19, these include 10 children from two families.
Ages of children placed under a Care Order
The largest number of children placed under a Care Order where those under one year of age. In fact, statistics show that there were 14 children under this category. This number was followed by 13 children aged seven, and 8 children aged 5 years, and 7 children in the age category of 1 year, 4 years, 6 years and 9 years.
At Present there are 3 children
aged 12 years and another 3 aged 15 and 1 adolescent aged 14
Origin of children placed under a Care Order
The 103 children and young persons, of whom 45 are females and 58 are males, who were put under a Care Order, came from 56 different households. Seventeen (17) of the household were residing with a single parent while the remaining thirty nine (39) were living in a household with a couple where either one of the carers was a parent or the couple were not married. It is to be noted that for the purpose of this paper, unmarried couples living together at the time of the abuse are also considered as a couple.
Placement of Children after the issuing of a Care Order
83.5% of the children placed under a Care Order were admitted in Care. An insignificant percentage were at a later stage, placed in foster care. 10.7% remained with the family and the case was closely monitored by the social worker following the case, while the remaining 5.8% were entrusted in the care of a member of the extended family.
Occupation of Parents
27 parents worked as unskilled labourers, 1 parent held an office job , 11 parents were self-employed, and 56 of the 95 parents were either unemployed or housewives.
It is evident that a very
high number of parents, whose children were put under a care order, were
unemployed resulting in the lack of an adequate and regular income for
the family.
Paternity
76 children out of the 103 children were recognised by their father.
Type of Abuse
Care Orders were classified under neglect, physical abuse, emotional abuse and sexual abuse.
However, in most of the cases, after investigations were made, more than one type of abuse was identified.
Although emotional abuse is listed as an independent category no care order was issued explicitly for this type of abuse.
Emotional abuse is difficult to verify and proof unless the abuse is characterised by other symptoms such as neglect, physical harm or others. In all cases of abuse, emotional harm has always been significant to all the cases.
Neglect
101 cases out of 103 cases of children who were put under a Care Order were found to be in a state of neglect because they lacked basic needs such as nutrition, basic hygiene, clothing and so forth. Children are also considered to be neglected when they are found to be left unattended for long periods of time.
A neglected child is one whose physical, mental or emotional condition becomes impaired due to lack of appropriate and adequate basic care or supervision, which causes harm to the child 's development or endangers the child in any way.
Physical Abuse
A physically abused child is one whose parents or carers inflict or permit injury or protracted impairment of physical health or allow the risk of such injury.
Physical abuse is also considered when Children are demonstrably harmed as a result of physical injury when the nature of the injury is not consistent with the account of how it occurred, or where there is definite knowledge or reasonable suspicion that the injury was inflicted by any person having custody or care of the child.
From the study undertaken, it results that 57 of the parents whose children were placed under a care order, have physically abused their children.
Sexual Abuse
Sexual abuse is defined as the involvement of dependant, chronologically or mentally immature children and adolescents in any sexual activity, especially when they do not fully comprehend what is happening and are unable to give informed consent or when it violates the social taboos of family roles, bearing in mind that all sexual activity with an underaged minor is a crime since a minor is not deemed to be able to give sexual consent at law.
Out of 103 care orders issued, only 6 cases (5.8%) were classified under sexual abuse.
According to statistics, collected in 1995, 1996 and 1997 out of the 924 cases of alleged abuse, 17% were reported as sexual abuse. This figure does not by any means, give us the real picture of child sexual abuse cases in Malta. There is a discrepancy between the number of Care Orders issued because of sexual abuse and the number of cases as reported in the Parliamentary Question.
One of the reasons for this discrepancy is that frequently, the abuser was not one of the parents and therefore the abuse did not necessitate the issuing of a care order to protect the child.
On the other hand, although the number of care orders classified under sexual abuse is very low, there might have been other cases where the abuse was certified but an alternative solution was found, in the best interest of the child, such as the abuser moving out of the household or the child being placed with a relative or significant other.
There were many more cases of alleged sexual abuse which were hard to prove due to lack of evident physical signs. Without sufficient grounds and evidence, the issuing of a Care Order for sexual abuse is difficult.
In other cases, an unfounded allegation of sexual abuse was used as a tool by a parent against the other parent when the couple were proceeding to obtain legal separation. The child, in these cases, was used by one of the parents to gain care and custody of the child.
Parental characteristics of children placed under a care order
The traits characterising the 95 parents of the children placed under a care order were classified as follows:
heightened anxiety 14.7%,
aggressiveness 61.1%, impulsivity 51.6%, lack of child rearing skills 72.6%,
lack of parental skills 91.6% psychological problems 78.9%, psychiatric
problems 32.6%, drug related problems 16.8%, alcohol related problems 6.3%,
ill-health 15.5%, severe marital problems 42.1%, diffuse social problems
71.6%, social isolation 23.2%. criminal involvement 20%.
From the table above, it can easily be observed that a very high percentage of parents lack child rearing skills and basic parental skills. 78.9% of the parents presented psychological problems which hindered the parents in carrying out their roles.
Socially diffused problems such as illiteracy, unemployment, sub-standard housing, depressed areas and financial difficulties are common characteristic traits of these parents.
The main causes of child neglect and physical abuse are attributed to:
2. Child characteristics
3. Early parent-child relationships
4. Societal attitude and environmental stresses and resources
Parents identify both with their parents and with their experiences as children. Some parents have certain strengths or environmental supports that enable them to remake their own pasts in more positive ways as they raise their own children, making parenting a developmental growth process. Other parents become witnesses of their own negative childhood experience and repeat the past.
According to Ainsworth (1980) a second feature in "the backgrounds of many abusive parents is a history of an early disturbance of attachment to their parents that influences the bonding process of their children."
A third factor is "the parents' lack of self-esteem and unresolved developmental needs that predispose them to inordinate stress and frustration in their parenting role." (Eldridge and Finnican 1985)
A fourth factor is alcohol and drug abuse.
The Child's own balances and characteristics may play a role in abusive acts. In a study carried out by Steele (1980) it resulted that "high risk" children seemed prone to be abused and neglected. He also described children who are "difficult" by virtue of being hyperactive, fussy, hard to feed or cuddle, irregular in their sleeping patterns, or who cry incessantly. Among older children, provocative behaviour such as aggression, stealing, sexual activity or truancy seemed to predispose some children to abusive parental responses.
The Placement of Children into Care
In an answer to parliamentary question No. 13478 dated 27th March 1998, it was stated that there were 279 children living in 17 residential facilities during 1997.
The ages of these children ranged from under one year up to 16 years .
The Central Office of Statistics reports that during 1997, the total population of children between 0 and 16 years was 91635. This means that 0.3% of the whole child population was living away from the family in residential settings.
For the purpose of this paper, a study was carried out in three residential facilities, one of which is the only facility that caters for children between the ages of 0 to 3 years, whilst the other two receive children between the ages of 4 and 16. The total number of children studied was 136.
The study showed that, at the time of admission in care, 86 of these children were either abused, or at risk of abuse, whilst the remaining 50 had no apparent sign of abuse or risk of abuse.
Types of Admission
94 of the children were
admitted with the parent/parents' consent; 33 were admitted following the
issuing of a Care Order; while the remaining 9 were admitted by a Court
decree.
Reason for Admission
The reasons given on admission
show that 26 children were admitted for physical abuse, 8 for sexual abuse
and the remaining 102 were found to be in a state of neglect due to the
parent/parents' inability to assume proper care or to supply adequate supervision.
These figures show that in the procedure for assessing 'neglect' on admission,
although 50 of the children were admitted when no sign of abuse was evident,
still they were included with the 102 cases classified under child neglect
at the time of admission due to other, sometimes circumstantial, evidence.
One of the reasons for this,
is the lack of a formal national risk assessment procedure which sets the
policies and guidelines for the admission of children into care.
Admission Case Conference
Case conferences were held
prior to 35 admissions; the other 101 children were admitted without a
case conference. Care plans were formulated in 38 cases prior to admission
whilst 98 cases were admitted without a definite care plan. Care plans
are being adhered to in 74 of the cases, whilst in 62 of the cases that
either no care plan was ever formulated or that the care plan is not being
followed. Case reviews are held regularly in 80 of the cases. In the remaining
56 cases, case reviews are irregular and the last review was held over
a year ago, or no case review was ever held.
Professional services offered
to children in care is sporadic and intermittent due to the lack of human
and community resources available for this client group. 67 of the children
receive psychological counselling, while a few of these children also receive
speech therapy. In most of the cases the services offered are being provided
for by the residential facility. 52 of the families attend parental skills
courses, receive psychological or psychiatric services, or form part of
a support group.
Child intervention cannot be treated in isolation, independent of the reality of the parents, without considering the home situation and the needs of the other siblings.
The decision to place a child outside the home is a serious one that has many implications for both the child and family. Some of these implications include:
- the feeling generated by the separation, ranging from parental guilt to further scapegoating of the child;
- disruption of the community relationship for the child;
- the stigma of placement;
- loss and grief for the child and family;
- problems of attachment in fitting back with the original family system.
(Pipitone and Maidman 1984)
At the specific level of treatment, the contribution is to develop interventions that improve the situation within the family, so that the child can remain in the home but at a level of risk that is known and is reduced to acceptable levels.
Families who abuse and neglect their children often lack essential provisions and community supports that can ensure a decent standard of living and provide them with some relief from stress. Crisis nurseries, day-care centres, housing assistance and home-help are only a few of the services from which families may benefit.
We certainly need to improve the protection of children and to make the work of the professionals dealing with such cases and of the caring agencies more effective. However the long-term solution to the problem cannot depend solely on the ability of professionals to protect children against abuse, but also on the resources available in the community. For effective social work intervention to take place, the work load of social workers dealing with cases of children at risk should be manageable and adequately supervised.
Our prime objective as professionals, and as a society, must be that parents will protect their children and refrain from abusing them.
Three types of preventive measures need to be undertaken:
1) basic research into family systems and violence.
2) applied research on treatment needs.
3) information and actual programmes to help families in distress, not necessarily provided by Government agencies. N.G.O's and The Voluntary Section should be encouraged to provide such services since such a system has been proved to be cost effective in other countries such as U.K., Holland and Spain and other countries in the European Community and U.S.A.
Information and out-reach programmes should be directed towards the prevention of abuse. Information about high risk families is needed, together with information about the early signs of violence.
Outreach, crisis prevention and information programmes, which can locate and detect violence at an early stage, and which can help families during particular times of stress, may include the use of day care facilities, part-time baby sitters, single mother network systems and other social structures.
It should be pointed out, however, that there exists a number of untreatable families who require the removal of the child from the life-threatening situation of its home environment.
Treatment Approaches
A variety of approaches to the treatment of child abuse have been developed; some seek to improve management of the child's behaviour; while others attempt to help the abusers with management of their aggressive feelings and responses. The two can be applied in an overall package, tailored to the needs of the individual case. Some families where child abuse has recurred can be helped by home-based treatment programmes.
Child abuse and neglect cases require a creative combination of approaches. Services must be co-ordinated, of high intensity, continuous, and involve follow-up.
Furthermore, they should be multidimensional, being directed at the various components of family functioning, multidisciplinary involving professionals and workers from a variety of disciplines, and multimodel, offering a combination of approaches. Child abuse and child neglect cases require treatment on four categories of intervention:
1. Individual
2. Familiar
3. Community
4. Societal and cultural (Wolfe 1987)
One of the developments has been the growth of community based flexible comprehensive programmes (Maluccio & Marlow 1972; Whittaker 1979; Schroeder 1978) that offer a continuation of care in which children and parents can receive the most appropriate level of care without getting lost in the system as their needs change.
The inter-disciplinary team composed of a social worker, a paediatrician , a health visitor, a representative of the police, a lawyer and a psychologist or psychiatrist work together on three distinct phases in management of child abuse:
2. - Carrying out these plans;
3. - Evaluating the work done, carrying out research into the family and its remedies.
Recommendations
To formulate formal procedures on child abuse on a national level; and to set up networks and protocols between departments and agencies dealing with these cases both in Malta and abroad.
To make available a combination of approaches and to provide consultancy services to professionals operating in this sector.
To provide adequate resources allowing flexibility of the use of professional and community resources to ensure protection, care and treatment in order to provide each child with an individual package of care which gives families every chance to remain together. If this fails, a secure, permanent or long term alternative must be available. In such cases, residential care should be a temporary stepping-stone towards foster-care.
To formulate and implement a Code of Practice for professionals in order to set and establish the level of social work needed for an appropriate and effective service to abused or neglected children and their families. This Code of Practice would set standards for qualifications, training, supervision, commitment to clients, recording, reviews, investigations and other areas.
To formulate and implement on-going training programmes by a centrilised body on a national level for all professionals operating in this sector.
That all residential facilities operate under license and conform themselves to the standards set for such establishments by the national centralised body.
To establish an inspectorate mechanism for residential and day facilities to ensure that standards are upheld.
To create a national data-base
accessible to all professionals to facilitate research in this field.
Conclusion
Notwithstanding all the efforts made by the professionals concerned, there are a number of parents who will never be able to assume their parental responsibilities. The United Nations Convention on the Rights of the Child, of which Malta is a signatory, declares that every child has a right to live in a family environment. Legislation which permits the freeing of children for adoption, foster-care, and supervision orders need to be enacted in order to empower professionals to safeguard children at risk and also to enable professionals to conform with the charter.
This paper urges policy makers and practitioners to act towards the achievements of policies, structures and systems which guarantee a better future for these children. Let us not forget that the child of today is the parent of tomorrow.
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