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 m.a.bellis@bangor.ac.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 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

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

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)

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

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

www.preventviolence.info Child Maltreatment Studies Globally 390 journal articles (2007- June 2014) - Primary Prevention Child Maltreatment Studies Parenting programmes 16 (39%) Home visiting 10 (24%) Other* 8 (37%) 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)

£ 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

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

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.

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

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

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

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