Running head: CHILD MALTREATMENT 1

Healthy People 2020: Injury and Violence Prevention

Stacy Teran

Chamberlain College of Nursing

NR 503: Population Health Epidemiology and Statistical Principles

September 2020
CHILD MALTREATMENT 2

According to Healthy People 2020, injury and violence prevention are very important to

the health of our society. The subgroup that I will be focusing on is child maltreatment in the

state of New Jersey (NJ). Child maltreatment is a serious public health issue that affects children

under 18 years of age. This is just an umbrella term that includes physical and emotional abuse,

neglect, sexual abuse, and/or others exploits that puts the child's life in harm's way (Moyer et al.,

2018). In this paper, I will be discussing child maltreatment, reviewing the Healthy people 2020

objectives and interventions related to preventing child maltreatment from parents or caregivers.

Overview, Background, and Significance of Problem

Child maltreatment is a global problem that can have serious detrimental consequences.

Healthy People 2020 divides this topic into fatal and nonfatal. According to the World Health

Organization (WHO) (2020), nearly 3 in 4 children aged 2-4 years suffer some form of physical

or emotional abuse. They also report that 1 in 5 women and 1 in 13 men have stated to be

sexually abused as a child (WHO, 2020). In 2017, there were 6,698 victims of abuse or neglect

in NJ, which is a rate of 3.4 per 1,000; of these, "79.9% were neglected, 13.7% were physically

abused, and 10.7% were sexually abused" (Child Welfare League of America, 2019, p.1).

CWLA (2019) reports that in 2017 there were 13 child deaths from abuse or neglect in NJ. The

consequences of child maltreatment are immeasurable by either scaring the child's life or ending

their life. There can be behavioral, physical, and mental health consequences, such as depression,

smoking, alcohol, and drug misuse, etc. (WHO, 2020).

Epidemiological Data

On a national level, 28.7% of maltreatment is less than three years old, with the highest

rate being less than one year old (Administration for Children and Families (ACF), 2018). In

2018 that data shows that females were affected 9.6 out of 1,000, while males were 8.7 per 1,000
CHILD MALTREATMENT 3

(ACF, 2018). Most victims could be categorized into three races/ethnicities: White (44.5%),

Hispanic (22.6%), or African American (20.6%) (ACF, 2018). Risk factors for caregivers were

found to be more significant if they abused alcohol and drugs; others include having been abused

as a child and difficulty bonding with the newborn (WHO, 2020). For the actual child, some risk

factors include being under the age of four, being unwanted by parents, having special needs or

disabilities, crying always, and/or having a different sexual orientation (WHO, 2020).

Application of Healthy People 2020

The focus of Healthy People 2020 on injury and violence prevention is education and

bringing to light what is going to communities. They do this by providing information regarding

signs to look out for, resources that can provide protection, and involve all community health

institutions. The plan is to improve overall data collection for everyone involved, to identify risk

and protective factors, and to develop preventable strategies (Office of Disease Prevention and

Health Promotion (ODPHP), 2020). The objectives for child maltreatment are to "reduce

nonfatal child maltreatment" and "reduce child maltreatment deaths" (ODPHP, 2020, p.1). There

is not a specific screening tool that I could find. Stanford Medicine (2020) recommends the

overall picture by interviewing parents and children separately and observing for specific signs

and symptoms. A red flag can usually be considered when a parent refuses to allow a child to

alone or does not allow them to speak for themselves.

Shakil et al. (2018) validated the Pediatric Hurt-Insult-Threaten-Scream-Sex (PedHITSS)

tool for identifying child abuse. PedHITSS allows providers to screen confidently and report

suspected cases. The screening tool proved to be reliable and valid for children aged 0-12 years

old (Shakil et al., 2018). Cotter et al. (2018) assessed the most used Parent-Child Conflict Tactics

Scale (CTSPC), which is a method in which parent's behaviors are taken into account using self-
CHILD MALTREATMENT 4

report. They found that the CTSPC can be accurate in determining if parents are abusing their

children by the way that they answer the questions provided (Cotter et al., 2018). However, it is a

very long questionnaire and does not guide how to follow up, unlike the PedHITSS, which has a

cutoff score and recommendations on how to proceed (Shakil et al., 2018). Therefore, I believe

that the PedHITSS tool would be more beneficial and accurate, detecting child maltreatment in

the pediatric population.

Population-Level Planning

According to the Department of Children and Families (DCF) (2019), school staff

members are the primary reporters of child abuse and are, therefore, the primary partners in

prevention and intervention. They are to report any suspicion of missing children or possible

abuse when suspected. Training is provided for all staff members to be competent in this matter

and how to file a report (DCF, 2019). DCF also promotes child abuse prevention through

education and community resources. This includes April as awareness month, having parents and

families sign a promise to prevent child abuse, coping strategies, etc. in hopes of preventing and

providing support to parents or family members with these intentions (DCF, 2019). "The goal of

child abuse and neglect data tracking or "surveillance" is to systematically collect, analyze, and

interpret data to inform an effective response to child maltreatment at the population level"

(Medina et al., 2018, p.2). By developing such systems there could be an increase in awareness

of child maltreatment and allow for open conversations and maximize resources available.

Ongoing surveillance can also lead to policy changes or the development of new ones.
CHILD MALTREATMENT 5

References

Administration for Children and Families (ACF). (2018). Child maltreatment

2018. https://www.acf.hhs.gov/sites/default/files/cb/cm2018

Child Welfare League of America (CWLA). (2019). New Jersey's

children. https://www.cwla.org/wp-content/uploads/2019/04/New-Jersey-2019.pdf

Cotter, A., Proctor, K. B., & Brestan-Knight, E. (2018). Assessing child physical abuse: An

examination of the factor structure and validity of the parent-child conflict tactics scale

(CTSPC). Children and Youth Services Review, 88, 467-

475. https://doi.org/10.1016/j.childyouth.2018.03.044

Department of Children and Families (DCF). (2019). Child abuse, neglect & missing children.

The Official Web Site for The State of New

Jersey. https://www.state.nj.us/education/students/safety/socservices/abuse/

Medina, S., Sell, K., Kavanagh, J., Curtis, C., & Wood, J. (2018). Tracking child abuse and

neglect: The role of multiple data sources in improving child safety. Children's Hospital

of Philadelphia, 22(8), 1-4. https://policylab.chop.edu/evidence-action-brief/tracking-

child-abuse-and-neglect-role-multiple-data-sources-improving-child

Moyer, V. A. (2018). Primary care interventions to prevent child maltreatment: US Preventive

Services Task Force recommendation statement. Annals of Internal Medicine, 159(4),

289. https://doi.org/10.7326/0003-4819-159-4-201308200-00667

Office of Disease Prevention and Health Promotion (ODPHP). (2020). Injury and violence

prevention. https://www.healthypeople.gov/2020/topics-objectives/topic/Injury-and-

Violence-Prevention/objectives#4775
CHILD MALTREATMENT 6

Shakil, A., Day, P. G., Chu, J., Woods, S. B., & Bridges, K. (2018). PedHITSS: A screening tool

to detect childhood abuse in clinical settings. Family Medicine, 50(10), 763-

769. https://doi.org/10.22454/fammed.2018.778329

Stanford Medicine. (2020). Screening children. Child

Abuse. https://childabuse.stanford.edu/screening/children.html

World Health Organization (WHO). (2020). Child maltreatment. https://www.who.int/news-

room/fact-sheets/detail/child-maltreatment