1. Child Abuse and Neglect Causes, Policies, Opportunities
Professor Mark A Bellis
UK WHO Focal Point for Violence and Injury Prevention
Director, Policy, Research & Development, Public Health Wales
Chair, World Health Organization Collaborating Centre for Violence Prevention, Liverpool

2. Child Abuse - Distribution and Focus
63 Child Homicides UK 2012/13
Under15’s Deaths assault or undetermined 44
Sexual offences against children 23,633 police UK 2012/13
36,202 NSPCC helpline abuse or neglect contacts in 2012/13
7,964 Cruelty & neglect offences
Police UK 2012/13.
42,500 Children looked after due to abuse
and neglect 31 March 2013.
10 -15yrs Violent crime 250,000
2012/13 (Est UK). 
Focus
Distribution 
5% Children
sexually abused 650,000
(Est. UK)
980,000 (11-17yrs) experienced
high levels of abuse/neglect
(est. UK)
Three in five people describe child abuse and neglect as “common” in the UK
Based on NSPCC

3. Adverse Childhood Experiences
Bellis et al, BMC Medicine, 2014
Aged 18 to 69 (n = 3,885)

4. Adverse Childhood Experiences
Troubled Families - Average 9 problems. 40% had 3 or more children
Bellis et al, BMC Medicine, 2014
Aged 18 to 69 (n = 3,885)

5. Differences are independent of Deprivation
Cumulative Proportion of Individuals
not diagnosed with a Major Disease with Age
Aged 18 to 69 (n = 3,885) Bellis et al, Journal of Public Health, 2014
35% have history of major disease
70% have history of major disease
Cancer
Type II Diabetes
Cardio Vascular Disease
Digestive/Liver Disease
Stroke
Respiratory Disease
Differences are independent of Deprivation

6. Risk Factors for Child Maltreatment
Victim of child abuse
Youth violence
Domestic and sexual violence
Perpetrator of child abuse
Impaired bonding
Poor parenting skills
Academic problems
Conduct disorder
Unemployment
Poor housing
High crime area
Pregnancy
Unplanned, Teenage, Parental conflict
Poor mental health Stress, Depression, Anxiety
Alcohol
Drugs
Based on Hughes & Bellis , WHO, 2013

7. www.preventviolence.info Child Maltreatment Studies
Globally 390 journal articles (2007- June 2014) - Primary Prevention
Child Maltreatment Studies
Parenting programmes 16 (39%)
Home visiting (24%)
Other* (37%)
USA (66%)
Europe (ex UK) 3 UK
* Child skills programmes, support groups, media campaigns, screening and referral, therapeutic approaches, parent/child/school programmes
Missing - systematic evidence on cornerstone of local early years programmes (universal health professional support by health visitors in the first two years of a child’s life)

8. £ Child Maltreatment Prevention – 1001 Days
Increasing evidence of programme cost-effectiveness especially taking a multi-agency approach
Debate over programme type and extent of targeting
Deprivation - Affluence
ACE Free Early Years
Based on Marmot Proportionate Universalism and WHO report on preventing child maltreatment
Legal framework, Safe guarding, Criminal Justice, Social Care
Universal Identification (e.g. maternal substance), support & referral - Enhanced Paediatrics
Cultural Change e.g. Social Norms and Capital Environmental Change e.g. Alcohol Access
Educational – Acute Harms - Shaken Baby
Media and Professional Work on Long Term Importance of Early Years
30:1
Home Visiting, Parenting Programmes
Targeted
Violence against children Risk Factor Poor early development

9. Integrated Intelligence for Prevention of Violence, Abuse and Neglect
1-2
3-5
6-10
Assault
Location
Number
1-4
5-9
>10
Area of residence
Number
Royal
Liverpool
AED
(TIIG 2008)
Integrated Intelligence for Prevention of
Violence, Abuse and Neglect

10. Local measures of other illegal behaviours are available (e. g
Local measures of other illegal behaviours are available (e.g. drug use) but not child maltreatment of domestic violence.

11. Abuse of Alcohol and its Consequences
≈ 1/3 of child abuse is under influence of alcohol – alcohol related 
USA model
1 less outlet per 1,000 people  severe violence towards children by 4%
10% increase in excise tax on beer  severe violence towards children by 2.3%
The habit of drinking to excess leads to the ruin of the families, disgust for work, poverty, misery, theft and crime.
Thousands of instances of cruelty to children occur annually in this City from the neglect and brutality of parents, often reduced to poverty through wasting their money on drink.
Local Action 1906
Abuse of Alcohol and its Consequences

12. MENTAL HEALTH AND SUBSTANCE USE
RESPONSIBLE BODIES
Community Safety Partnerships – Joint working, Data exchange, Joint services
Public Health England – Evidence
Director of Public Health – Local Authority Services, Joint Strategic Needs Assessment
Clinical Commissioning Groups – Commissioning
ADVERSE CHILDHOOD
EXPERIENCES
Contraceptive & Family Planning Services
Unwanted/Teenage Pregnancy
Maternity & Midwifery Services
Positive Parenting
Abuse identification, Safe-guarding
MENTAL HEALTH AND SUBSTANCE USE
Multisystemic Therapy
Cognitive Behavioural Therapy
Substance Use services
Other Mental Health Services
ALCOHOL
Prevention messages
Treatment & Care
Identification and Brief Motivation
Licensing and Inspection
Data exchange
OTHER SECTORS
Education
Immigration
Social inequalities
SERVICE QUALITY
Elder abuse
Patient care
MONITORING AND MILESTONES
Public Health Outcomes Framework
Domestic Violence
Violent Crime and Sexual Violence
Older People’s perception of Community Safety

13. International Leadership and Collaboration
Sixty-seventh World Health Assembly 24 May 2014 Strengthening role of health system in addressing violence, particularly against women and girls, and against children. Urges Member States to:
strengthen the role of health systems in addressing violence
ensure those at risk have timely, effective & affordable health services access
strengthen their contribution to prevention programmes
ensure health system engagement with education, justice, social services
strengthen the national response, improving data collection & dissemination
enhance capacities, including through training
WHO Child Maltreatment Prevention Plan 2014–2020
a life-course, evidence-informed, health and inter-sectoral approach
64th WHO Regional Committee for Europe
Global Status Report on Violence Prevention
Lancet/WHO series on Early Child Development

14. Summary Child Protection  Evidence Informed Prevention
Multi-departmental consideration of benefits & savings
National Campaign awareness of the long-term impacts
Professional awareness and training
Environmental issues e.g. role of alcohol
Intelligence targeted home visiting & parental support
R&D – delivery in Universal Health/Social systems
Integrated agenda child development and child abuse
Integrated response across all types of violence