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Child Abuse and Neglect Causes, Policies, Opportunities Professor Mark A Bellis UK WHO Focal Point for Violence and Injury Prevention Director, Policy,

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Presentation on theme: "Child Abuse and Neglect Causes, Policies, Opportunities Professor Mark A Bellis UK WHO Focal Point for Violence and Injury Prevention Director, Policy,"— Presentation transcript:

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 Based on NSPCC 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 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 yrs Violent crime 250, /13 (Est UK).  Focus Distribution 

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

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

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

6 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 Pregnancy Unplanned, Teenage, Parental conflict Poor mental health Stress, Depression, Anxiety Based on Hughes & Bellis, WHO, 2013 AlcoholDrugs Risk Factors for Child Maltreatment

7 Globally 390 journal articles (2007- June 2014) - Primary Prevention  Parenting programmes16 (39%)  Home visiting 10 (24%)  Other* 8 (37%) Child Maltreatment Studies  USA 27 (66%)  Europe (ex UK) 3  UK 1 * 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 Universal Identification (e.g. maternal substance), support & referral - Enhanced Paediatrics Media and Professional Work on Long Term Importance of Early Years Legal framework, Safe guarding, Criminal Justice, Social Care Violence against children Risk Factor Poor early development Cultural Change e.g. Social Norms and Capital Environmental Change e.g. Alcohol Access Deprivation - Affluence ACE Free Early Years Based on Marmot Proportionate Universalism and WHO report on preventing child maltreatment Targeted Home Visiting, Parenting Programmes Educational – Acute Harms - Shaken Baby 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 30:1

9 Royal Liverpool AED (TIIG 2008) Assault Location Number >10 Area of residence Number Integrated Intelligence for Prevention of Violence, Abuse and Neglect

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

11 ≈ 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 ADVERSE CHILDHOOD EXPERIENCES Contraceptive & Family Planning Services Unwanted/Teenage Pregnancy Maternity & Midwifery Services Positive Parenting Abuse identification, Safe-guarding SERVICE QUALITY Elder abuse Patient care ALCOHOL Prevention messages Treatment & Care Identification and Brief Motivation Licensing and Inspection Data exchange MENTAL HEALTH AND SUBSTANCE USE Multisystemic Therapy Cognitive Behavioural Therapy Substance Use services Other Mental Health Services OTHER SECTORS Education Immigration Social inequalities 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 MONITORING AND MILESTONES Public Health Outcomes Framework Domestic Violence Violent Crime and Sexual Violence Older People’s perception of Community Safety

13 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 64 th WHO Regional Committee for Europe Global Status Report on Violence Prevention Lancet/WHO series on Early Child Development International Leadership and Collaboration

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


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