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Documentation Centre - PublicationsIssues and ReportsIssues & Reports No 6. CHILD ABUSE prepared by Renaud Vill?
INTRODUCTION Background When the project entitled "Child abuse within the family: the situation in six European countries" commenced in 1993, the main interest lay in the fact that, following the adoption of the United Nations Convention on the Rights of the Child (CRC)(1), numerous countries started implementing legislative reforms and projects in the field of child protection, the prevention and control of violence against children, as well as on the repression of offences against minors(2). The project was also motivated by the proclamation of 1994 as the International Year of the Family(3). Parallel to the above-mentioned project, UNICRI also carried out a wider research project on violence in the family. This project was conducted within the framework of the International Year of the Family, but also for the Ninth United Nations Congress for the Prevention of Crime and the Treatment of Offenders (Cairo, 29 April - 8 May 1995) which included, among its four main topics, crime prevention strategies in urban areas, juvenile delinquency and violent crimes, and the problem of victims, as well as for the Fourth World Conference on Women (Beijing, 4-15 September 1995). The project involved the compilation of an international bibliography on violence in the family which was published by the Institute(4) and was presented in a summarised form at the relevant workshops held in Cairo and Beijing respectively(5). The international bibliography and literature analysis proved useful for the research project on child abuse in that it provided basic material for a comprehensive overview of problems related to violence within the family in general and child abuse in particular. Concepts & Methodology The objectives of the project were to describe the current situation concerning child abuse in six European countries, to present the responses to the problem adopted by the various parties, and to underline and discuss the main issues so as to provide, as far as possible, a comparative view of the situation. This would allow for the identification of deficiencies and problems related to interventions, as well as for a number of policy options. Although there are different contexts and situations in which the child is considered in danger - for example, in the area of prostitution or crime, in the work place, in institutions, or during armed conflicts - this study is limited to child abuse within the framework of the family. This choice rests on the fact that, in Western European countries, violence within the family is probably one of the most widespread (as well as the most hidden) forms of violence against children. The problem becomes even more dramatic when one considers that the family should represent the ideal framework for the harmonious development of the child, within a context of security, trust and protection. Unfortunately, the family itself is still too often a source of violence and abuse. There is much current debate about which types of behaviour should be considered as an abuse. The difficulty here lies in the fact that the idea of child abuse is strongly linked to, and defined by, both social and cultural contexts and can therefore vary across time and space. There is nevertheless a consensus on the global definition of the concept of child abuse, that is the placing at risk of the sound physical and emotional development of the child, whether intentionally or unintentionally. The numerous types of abuses are generally grouped under four categories: physical abuse, emotional abuse, sexual abuse and neglect (6). In order to cover the field in question, and taking into account some practical restrictions, the information needed for the study was collected from two main sources: from national experts and from institutions and agencies operating in the field of child abuse. Documentation available in UNICRI's library was also used. A first questionnaire was submitted to the selected experts in charge of the national reports and covered legal definitions, the reporting of abuse, the police, the judiciary, child protection, etc. In addition, some statistical data were collected as well as some personal, and therefore subjective, evaluations of the situation as provided by the experts. The second questionnaire was addressed to institutions and organisations working in the field of child abuse, and covered the aims, methods of work, and activities of those institutions and organisations operating in the field of child abuse protection. Statistical data were also collected, where possible. One of the objectives of the second questionnaire was to supplement the official information received by the national experts. The countries that participated in the study were: Belgium, Denmark, England & Wales, France, Italy and Switzerland. These countries were selected to ensure geographical coverage of Western Europe but are not to be considered representative of a region in any economic, cultural or other sense. The present paper draws on the information presented in the national and institutional reports received from the six participating countries and proposes an analysis and reflections concerning child abuse and related notions.
CHILD ABUSE To speak about child abuse means to explore a large number of areas, situations and factors. Child abuse is rarely an isolated event; it is more often a situation that is prolonged over time. The abused child normally has to pass through various stages that form a long and traumatic course. This does not involve the period of abuse alone but also the period following the reporting of the maltreatment when various types of intervention are proposed or applied by the appropriate authorities and agencies. Unfortunately, it is not rare for a child who is the subject of intervention to experience it as a destabilising factor rather than as a source of help and support. This is normally due to the use of multiple forms of intervention, but also to the fact that these are sometimes contradictory, incomplete or inappropriate. Given the complex nature of family violence, it may be necessary to intervene in all existing risk and protective factors(7) of cultural, socio-economic, family and individual origins. Lack of, or inappropriate intervention in one aspect could limit the efficacy of the interventions as a whole. The ensuing discussion will focus on four selected notions. The first is the concept of the prevention and control of maltreatment as a social priority. This will be followed by an analysis of the problem of the visibility of child abuse, and by the role of the criminal justice system. Finally, the importance of training for personnel will be discussed. Prevention & Control of Abuse: a Social Priority The "discovery" of the phenomenon of child abuse is linked to changes in the child's status at the social level, which in turn condition the importance given to the prevention and control of abuse, in the sense that the child must be recognised both as an individual in the course of development and as a future investment for society. Society, by recognising the child as the basis of its future, becomes responsible for its sound development through the implementation of abuse prevention policies and by providing adequate responses to abuse. In a number of countries, child abuse - or more globally the concept of a child's rights - is not yet seen as a real and concrete social priority. Other social phenomena such as unemployment, poverty and security are given precedence. This precludes the much needed social reflection on the new status of the child in order to promote child protection as a social priority. It should be underlined that, at this point, the concept of social priority relates to the recognition of abuse and the range of measures used for its prevention and control at the social level rather than at the level of child abuse. The degree of priority assigned to child abuse can be estimated or evaluated through the analysis of four main indicators: ideological, normative, financial and organisational.
It should be stressed, however, that all these factors are linked in that the existence of an appropriate infrastructure depends on the recognition of the new status of the child and on legislative and financial support. In Belgium, Denmark, England & Wales, France, Italy and Switzerland the social reflection process on child abuse is at a highly developed level and it appears that the process of social recognition of the problem is well advanced. The link between the general level of social recognition and related action in the legislative area is strongly affected by a given family model which may promote or arrest the independence and responsibility of the child, the family, the state and other external agencies. Among the six countries, three groups could be discerned. Denmark and England & Wales give much importance to what the state can provide in terms of social services. The involvement of the state in family matters is therefore better accepted and to some extent expected in these countries. In Italy, a country with traditional family and related values (such as religion), the privacy of the family is still dominant. This can explain the delay with which, compared with the other countries, child issues have become a concern in Italy. Between these two groups, Belgium, France and Switzerland are characterized by a mixed approach. Concerning the legislative area, the six countries have at their disposal two main instruments: the (civil) child protection legislation and the criminal law. Although some laws are still obsolete and do not match the social and cultural reality, it should be highlighted that in all countries legislative adjustments and modifications were either introduced recently, or are about to be introduced (8). However, there are a number of problems which will be discussed in the following sections. The structure of the criminal law is similar in the six countries, in the sense that the various types of abuse against children are included in different sections of the criminal code. In the Swiss penal code, for example, three sections deal with the main forms of violence against children, the sections related to crimes against life and physical integrity, crimes against sexual integrity, and crimes against the family. In the context of the (civil) child protection legislation, the situation is characterized in the six countries by a jumble of much amended and partially repealed separate law. This multiplicity of legislation also increases in countries such as Belgium and Switzerland, where child protection is dealt with by local authorities using local legislation. With a view to replacing the numerous laws, England & Wales promulgated unique, and exemplary, civil child protection legislation, The Children Act 1989, which covers almost the whole range of public and private laws related to children, and came into force in 1991. Unfortunately, UNICRI's project was not able to fully explore the financial involvement of the six states in the prevention and control of child abuse. One can assume that this does not depend on the wealth of the country alone but, to a large extent, on its child welfare orientation. Yet, a good indication is found in the existing infrastructure for the prevention and control of child abuse. The organisational indicator provides the best measure of the degree of social prioritization. The recognition of child abuse as a social problem is made most tangible by initiatives at the local, regional and national levels. The mainly non-governmental bodies responsible for these initiatives, be they associations, foundations or institutions, are at the basis of activities and services covering the whole sphere of child abuse. Twenty organisations were selected for further analysis. Figure 1: The main activities of the agencies and institutions participating in the study
1. Association fran?aise d'information et de recherche sur l'enfance maltrait? (FR); 2. Association suisse de la protection de l'enfance (CH); 3. Centro di aiuto al bambino e alla famiglia in crisi (I); 4. Centro studi Hansel e Gretel (I); 5. Commission cantonale (vaudoise) pour la pr?vention des mauvais traitements envers les enfants (CH); 6.Ecoute enfants Bruxelles / Brabant Wallon (B); 7. End Physical Punishment of Children (UK); 8. Fondation pour l'enfance (FR); 9. Institut de l'enfance et de la famille (FR); 10. Joint Council on Child Issues (DK); 11. Jugendsekretariat des Bezirks Dielsdorf: Jugend- und Familienberatung (CH); 12. Kind & Gezin (B); 13. Observatoire de la sant? du Brabant Wallon (B); 14. Office de la naissance et de l'enfance (B); 15. Save the Children Fund (UK); 16. SOS enfants (CH); 17. SOS enfants Mons-Borinage (B); 18. Syndrome de l'enfant battu et n?glig? (B); 19. T?l?-acceuil (B); 20. Telefono Azzurro (I). Although Figure 1 is neither representative nor exhaustive, it provides a synoptic view of the different activities undertaken by the organisations that participated in the study. An activity that is common to all 20 organisations is that related to the provision of information. Obviously, this does not mean that the dissemination of information represents the main activity of the organisations, but that it is an essential element. While this activity involves numerous aspects, its main objective is to fight ignorance and preconceived ideas and to increase the population's level of awareness of child abuse. The importance attributed to information is confirmed by the fact that the second most commonly practiced activity of the 20 agencies is counselling, followed by training provided to personnel of the various agencies (i.e. criminal justice system, schools, hospitals) in contact with children. The importance of training of personnel will be discussed later on. This increased awareness of the population through information and training campaigns is a prerequisite for making the child abuse phenomena visible, and therefore a subject of potential interventions. Visibility of Child Abuse Although the visibility of abuse depends on the existence of signs and on contacts between the child and the world outside the family, it should be made clear that the fact that abuse becomes visible does not always lead to its identification, and even less so to its being reported. Three distinct phases can be identified in the process that goes from the abusive act to its being reported. The first stage corresponds to the existence or not of signs (physical, behavioural, environmental, psychological) that can be grasped by persons not involved in the abusive situation. However, to grasp the sign does not automatically mean analysing or evaluating it correctly, and this leads to the second stage, that is a proper identification of the abusive situation. Reporting action rests on a mix of personal, family or community factors. Less frequent, but not less worrisome, are the cases of false reporting, that is, violence being reported although it did not take place. An abuse is usually reported to three different types of agencies which represent points on the continuum of the levels of visibility: the first help services; the youth/child protection agencies; and the criminal justice system. It is important to differentiate the level of first help visibility from that of social visibility mainly because the first help services, such as shelters and Hot Lines, are characterized by a "one shot" intervention which limits the visibility of the abuse to the involved service and/or organisation, which is not the case with the child protection agencies. For them, to intervene means to implement a set of mid- and long-term interventions. The link between the help and support services and the child protection agencies rests on the fact that the first help services also serve as intermediaries between the victim and the child protection agencies, in that they should provide information and advice as to which agencies can intervene in the personal, family and socio-economic situation of the victim. In terms of the level of visibility, one should also mention the abuse which is exposed by the mass media and therefore becomes public knowledge. These different levels of visibility are presented in Figure 2. In the light of this problem, most countries have adopted legislation aimed at clarifying the responsibility of the citizen to report cases on the one hand, and, on the other, defining those cases in which professionals can be exempted from keeping oaths of secrecy. Figure 2: The various levels of visibility of child abuse
According to the reports received from the countries participating in the study, there are different approaches to the problem of reporting. In England & Wales, there is no law that obliges people who become aware of child abuse to report the case to the competent authorities. In the same context, some people may be obliged by their role or for other reasons to maintain professional confidentiality (9). In Belgium there is an obligation to report for citizens (art. 30 of the Code d'instruction criminelle) and professionals (art. 20 CIC), although it is not systematically put into practice. For the professionals (mainly medical practitioners and social workers) the situation is complex in that they are obliged to respect professional confidentiality (art. 458 of the Penal Code) on the one hand, and the obligation to assist a person at risk (art. 422 bis of the Penal Code) on the other(10). The situation in Denmark is characterized by an obligation to report (11) taking precedence over any rule of professional confidentiality. In France the obligation to respect professional confidentiality (art. 226.13 of the New Penal Code)(12) is not applicable in cases of maltreatment or deprivation of vulnerable persons and in all cases of sexual abuse (art. 236.4 of the New Penal Code). In Italy all civil servants informed of abuses are obliged to report the case, and non-reporting is punishable (arts. 361 and 362 of the Penal Code). The situation is the same for medical personnel (art. 365 of the Penal Code). There is no obligation to report cases of abuse in Switzerland, but in the interest of the minor, persons subjected to professional confidentiality (arts. 320 and 321 of the Penal Code) have the right to inform the competent authorities about the offences committed against the minor (art. 358 ter of the Penal Code). Two general comments on this issue are in order. The first is that even when the law obliges reporting, citizens are not practically and strongly motivated to do so. A person who decides to report a case of abuse usually does this on his/her own initiative even when not obliged to do so by any law. The second comment regards the professionals, who generally are left to decide whether to report or not, by weighing two principles: professional confidentiality and the duty to assist a person at risk. Although a willingness to report a case of abuse is essential, it is equally important for there to be an adequate infrastructure where to record the reports. In other words, the persons who want to report should know where to go and be able to choose the agency they consider appropriate. Figures 3 and 4 illustrate this diversity between reporters and recording agencies. Both figures concern the origins of recorded reports, the first by the SOS Children Teams in Belgium (institutions in charge of detecting and treating child abuse), and the second by the Hot Line of the Centro di Aiuto al Bambino Maltrattato e alla Famiglia in Crisi (CAF) in Italy. While almost two-thirds of the reports to the Hot Line came from non-professionals, be it the abused child, a member of the extended family or a citizen, the opposite is true for the reports to the SOS Children Team institutions: more than two-thirds of the reports were made by professionals. Figure 3: Origins of reports recorded by the SOS Children teams of the French Community of Belgium (13)
Notes : Calculated on the basis of the 2026 reports of abuses recorded in 1990. Total exceed 100% because several cases were reported by different persons. It is therefore essential, to respond to the needs of the different potential reporters, that an appropriate infrastructure be created that is composed of a variety of different institutions and organisations in charge of recording the reports. The existence of this network of institutions is also one of the numerous factors that might explain the increasing trend among the population to report child abuse. Others are related to personal, social and historical aspects. Figure 4: Origins of reports recorded in 1993 by the Centro di Aiuto al
Bambino Maltrattato e alla Famiglia in Crisi (CAF) in Italy, through its 24h Hot Line (14) Notes : Data (rounded) based on 240 valid reports recorded through January and December 1993. Concerned persons means the abused child and extended family. One factor is obviously the increased individual and social awareness of the existence and dimensions of the phenomenon of abuse and therefore of the need for the community's greater involvement in its prevention. Although, on the basis of official statistics received from the six participating countries, it is impossible to show an increase in the actual number of abused children, it is reasonable to suppose that awareness of the phenomenon and of each individual's role in the prevention, treatment and control of this form of violence has been revealed by an increase in the number of reports. It can also be observed that resolution of the conflict has become more and more the responsibility of agencies and authorities that are external to the family. This tendency to turn towards external services and the state is paralleled by a tendency to criminalise and penalise abuse, i.e. there is not simply a new awareness of the existence and gravity of this type of violence, but also of the state's responsibility to intervene in, and deal with the problem. Among the various types of interventions, those provided by the child protection agencies are of great importance and are applied when the sound physical, psychological, emotional and social development of a child is placed at risk and when a family is not capable alone of taking care of the child's basic education and upbringing, and/or is seen as jeopardizing the child's development. While priority of child protection measures is given to the welfare of the child, importance is still attached to the maintenance of the unity (or reunification) of the family and this remains an important objective. Despite all the efforts made by the child protection agencies, their interventions do not always appear sufficient to provide an adequate response to the various aspects of the problem, especially in cases of severe abuses. In these cases criminal justice interventions are also required.
CRIMINAL JUSTICE SYSTEM Increased efforts have been made to assist and support children who become victims of violence and their families. In all the agencies - those providing listening services, reception, therapeutic treatment, protection, and so on - a variety of interventions have been implemented. There is a clear tendency to prefer social and psycho-social interventions rather than penal ones. Yet, as mentioned above, there is also a trend towards an increase in the criminalisation of violent acts against children. Despite the apparent contradiction of these two trends, this is not really the case because they are situated at two different levels. Although violence towards children has never been completely absent in the penal codes of the different countries, the legislation in this sphere has evolved considerably during the last few years, both from the quantitative and qualitative points of view. This evolution has been accelerated by two phenomena: the change in the status of the child and renewed discussion about its interactions with adults. The child is now recognized as an individual and is no longer only perceived through its parents or family. It should be noted that this new status of the child is also one of the elements on which the actual trend, at least in some developed countries, to reduce the age of criminal responsibility is based. The child therefore receives greater protection as a vulnerable person on the one hand, but, on the other, is held more responsible in that it is considered to have adult responsibility at an earlier age. This has led to a reconsideration of the value given to acts and/or interactions between the child and the adult. In the light of this new situation, the authorities have had to create specific instruments to provide solutions to the problem of the child that also take into account changes in mentality, attitudes and ideology. The increased importance given to criminal justice has become an important indication of the prioritization of child abuse. Nevertheless, preference is given to non-penal
intervention mainly due to its non-repressive nature as well as to the fact that the criminal justice system and its personnel are generally ill-equipped to intervene within the family sphere and provide the child
victim with adequate and appropriate treatment or support. The two phases of the penal intervention in which the child victim plays an active and essential role are during the investigation and as a witness during the trial. Despite the problems faced by criminal justice personnel during their contact with the child and the recognised traumatic effects of the hearing session on the child, none of the six countries have enacted any special laws in this area. However, co-operation between the members of the criminal justice system and the professionals of the non-legal agencies has continued to increase, as has the use, although in an unsystematic way, of audiovisual recording of testimony in such countries as England & Wales and France. Although situated at different levels - procedural and instrumental - the increasing co-operation among organisations and the use of audiovisual means during hearings have identical objectives. The first objective is to facilitate the conduct of the interview. The second one is to limit, as far as possible, contacts between the child and the criminal justice system to a single hearing. The final objective is to increase the validity of the collected information and hence the credibility of the evidence (15). The methodology of a hearing session is not sufficient to guarantee the credibility of the child's testimony, because the characteristics of the child also have to be taken into account. Although a child victim of an abuse has the right to bear witness before a court of justice, the value of the testimony it gives depends mainly on its level of discernment, irrespective of age. On this point, legislation from Belgium, Denmark, England & Wales, France, Italy and Switzerland leave the judge free to decide upon the child witness' level of discernment, and thus on the value of its testimony. The criminal justice system faces difficulties in obtaining sufficient evidence with which to initiate prosecution. Although the existence of physical traces of violence is an important element, it is not always sufficient because the marks might have faded or disappeared over time, thus leaving the judge without any tangible evidence. Therefore, only the most serious cases - those with a greater chance of resulting in a conviction - are dealt with by the courts of justice. There is heated debate on how much value should be given to the child's testimony because, in cases where there is no corroborative evidence, there is a possibility that the child has been manipulated by an adult (as may occur in cases of divorce or separation), or is inventing a story. This fear can be illustrated by the famous "Cleveland crisis" case, which occurred in England in 1987, when a wave of allegations (true, false and unfounded) of abuse created serious social problems (16). Since contacts between the child and the criminal justice system - during the child's examination or when it appears as a witness before the court - can be a traumatic experience for the child, it should be allowed to be accompanied (normally by a legal representative) and assisted (by a social worker, psychologist, etc.), and should also be protected by applying special measures and procedures that take into account the fragility, weakness and particular characteristics of the child. Although legal and psychological assistance is envisaged in all the countries, it is not yet provided in a systematic manner, and many gaps still exist as far as the qualifications and authority of the people in charge of assisting the child are concerned. With respect to the specific measures and procedures that have been introduced to respond to the needs of the child, in all the countries the judge has the power to order a closed hearing (particularly in cases of a sexual offence) so as to protect the identity of the child. In both Denmark and England & Wales the child is sometimes allowed to participate in the hearings through the use of audiovisual aids, without having to appear personally before the court. Sexual and - to some extent - physical violence are most commonly dealt with by the criminal justice system. Other forms of violence have also received attention both by the public and by intervening parties and authorities. In all the countries there is a scale of seriousness of violence, and hence of the resulting sentences. This is based, particularly in France and Italy, on the number of days of incapacity experienced by the child following the victimisation, in other words, on the duration of the after-effects. In general, those acts of violence that compromise the child's physical well-being, health and sound development are punishable. Despite the existence of norms in this field, physical violence will continue to be subjected to personal evaluations, since a tacit and unofficial acceptance of a limited use of violence as a means of education will continue to exist at the social level. The phenomenon cannot be treated adequately as long as "a slap never hurt anyone" or "spare the rod and spoil the child" continues to be accepted, both within the family and elsewhere (17). Notwithstanding a recognition of the existence of psychological and emotional violence, none of the penal codes of the countries participating in the study deal explicitly with this form of abuse. It is usually taken into consideration within the context of other offences. In cases of psychological and emotional violence the enormous difficulties in proving that such acts were in fact committed makes it difficult for a trial to take place. These cases, and to some extent those of neglect, are dealt with by child protection agencies rather than by the criminal justice system. It should also be noted that these forms of violence are rarely isolated, but are often accompanied by physical or sexual violence. One of the main problems regarding the penal treatment of various forms of child abuse is the lack of sentencing options at the judge's disposal. The rigidity of the criminal justice system prevents it from responding adequately to the problem of family violence in general and child abuse in particular. In addition, preference is still given to incarceration rather than to alternative measures or to the implementation of therapies and treatment for the offenders. Although therapeutic treatment exists in all the participating countries, either as a sentence or as a complement or condition for offenders convicted mostly of sexual offences against children, its application is the object of debate for three main reasons:
Even though it is not compulsory in case of imprisonment, sexual offenders should have access to, and, in appropriate cases, be required to receive psychological assistance. However, in none of the six countries are such programmes systematically implemented within the prison system. Therapeutic treatment should also be viewed as one of the requirements for a possible reunification of the family and for the prevention of recidivism. It should however be recognised that efforts have been made, in cases of so-called "minor" acts of violence or following a positive evaluation of the offender, to make greater provision for non-custodial measures. The utility and importance of the criminal justice system and its response to child abuse need not be demonstrated. However, the nature of child abuse within the family often requires that non-penal intervention be given priority. As for all types of child abuse intervention, there is still a lack of co-operation and collaboration among the various intervening parties. Penal interventions should be integrated appropriately within the whole range of interventions to be applied. One of the best ways to improve the quality of both single interventions and of a series of interventions is still that of training all personnel in charge of intervention.
TRAINING OF PERSONNEL A large number of intervening parties or professionals can potentially come into contact with cases of child abuse, and therefore play a vital role at the level of prevention, detection, reporting and intervention. Often, however, the potential of their role is limited by a general lack of information and specific skills. This is very unfortunate because certain professions which are not specialised in child abuse are often the first to become involved when intervention is required. One of the basic fields in which training courses are required concerns the identification of the symptoms related to the various forms of abuse. Often the person who could potentially report an abuse is not trained to recognise and identify the symptoms. This fact is very well illustrated by Figure 6 which shows the discrepancy between the reasons why a person reported an abuse to the SOS Children teams of the French community of Belgium and the diagnosis of the case made by the teams. A more general comment is that more than a quarter of the abuses were identified wrongly by the person who reported the case to the institution. But only four per cent of the reports proved to be neither an abuse nor a situation at risk. All the others, even when wrongly identified in terms of type of abuse, proved to be an abuse or situation at risk for the child. In order to give a clearer picture of the importance of training in the prevention and control of child abuse, the role of the teacher in the educational system, that of the nurse or doctor in the health system, and that of the police officer in the criminal justice system will be discussed, based on the situation in the six countries studied. As far as the criminal justice personnel is concerned, and particularly police officers and judges, training in the field of child abuse seems to be somewhat neglected in that it is either non-existent or provided on an ad hoc basis and often at the level of local initiatives (by NGOs). Although the police have a certain number of tools at their disposal to collect evidence in the process of interaction with the child, they often lack the training needed to use them. Correct police behaviour is also essential during their first help intervention and they should therefore receive appropriate training. To fill in this gap, the criminal justice personnel often use external experts (psychologists, pedagogues, social workers, etc.) to assist them during their interaction with the child and to support the victim during his or her contacts with the criminal justice system. Figure 5: Comparison between reasons for reporting to and diagnosis by the SOS Children teams of the French community of Belgium
(18)
Notes : Calculated based on the 2471 reports (concerning 2277 children) recorded in 1989. The report and the diagnosis may concern more than one reason for the same case, that explains the difference between the data. The situation is somewhat better with respect to health personnel. In the majority of the countries courses on child abuse have been included in the mandatory curriculum of medical schools. There are also specialised courses but these are normally not mandatory. This means, in practice, that training in the field is relatively limited. The main role of the health personnel in the field of child abuse consists of detection and diagnosis of maltreatment. An appropriate intervention depends mainly on the quality and precision of the diagnosis, and improved training in this area would help to avoid the diagnosis of wounds as resulting from an accident when they are really the result of maltreatment. Despite their daily contacts
with children, the school personnel of the six countries have, in general, received inadequate training in dealing with child abuse. Nevertheless, this situation has been compensated to some extent by the
implementation, at the local level, of projects aimed at sensitising school personnel, and by the appointment of a person (or the creation of an office) to deal with problems related to infancy. The role of school
personnel in abuse prevention and control should be stressed because the duration of their contact with the child (sometimes for several years) places them in an advantaged position to detect abused children, to control
their development over time, to maintain contacts with their parents and to warn the competent assistance and support agencies.
CONCLUDING REMARKS Following the above reflections on the current situation with regard to child abuse in the six European countries, it is opportune to propose steps to be taken, to underline some important aspects, to recommend interventions in certain areas in which deficiencies still seem to exist, and to identify prevention and control measures for child abuse. In order to do this, three key notions should be highlighted again:
A maltreated child who is not identified and reported to the assistance and support agencies and, if necessary, to the competent administrative and criminal justice authorities, is a child who will probably remain in an abusive environment for many years and who will be unable to receive any type of assistance. It is essential, therefore, that information and awareness policies should aim at sensitising people about their personal responsibility to report such cases. Every effort should be made to record reported cases in a correct manner, and to deal with them in a positive environment by adequately trained professionals. This is because, still too often, problems are unintentionally (or intentionally) created by interventions and during the treatment of cases of abuse. Given the fragile nature of the child victim, child abuse within the family is a very delicate area and requires the intervention of specially trained personnel so as to avoid worsening the situation and to work for the well-being and in the interest of the child. Another instrument aimed at improving interventions is the multidisciplinary approach with its two main components: co-ordination among the agencies and institutions responsible for implementing abuse prevention and control policies, and co-operation among the different intervening experts. The advantages of such an approach lie in the fact that it permits an overall view of the situation and therefore more adequate and appropriate forms of intervention, by eliminating or at least reducing the negative effects on the child of multiple interventions. Furthermore, it also results in the optimal and rational utilisation of what are often scarce human and material resources. In conclusion, it should be kept in mind that one of the greatest barriers to intervention in the field of child abuse within the family is not linked to legislation but to its implementation, nor are they related to a lack of instruments because these are available. The greatest barrier to efficient interventions is the human factor. An official recognition of the problem of abuse is not sufficient, although it is an important step forward. Changes in mentality, an increased awareness of the problem and the general involvement of citizens in the prevention and control of abuse are essential, in the interest of the child.
FOOTNOTES
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