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The "State of the Art" in Child Abuse
Prevention
prepared by Andy Wachtel for the Family Violence
Prevention Unit, Health Canada.
Note to Readers This report provides an overview of the child abuse and neglect prevention agenda and an outline of how it was developed. It was created in the process of a larger and more ambitious project. A report on that larger project, entitled Current Directions in Child Abuse and Neglect Prevention and Intervention, is available, in English only, from United Way Research Services, Vancouver (see address below). It includes considerably more detail on the same agenda, and many examples of program initiatives that illuminate historical developments discussed here. It also contains extensive appendices that provide background and many additional references and citations. Order Information: Readers who are interested in further detail may wish to consult
the report from the larger project carried out by the United Way.
Copies, in English only and at a cost of $20.00 to cover printing
and handling, are available from United Way Research Services, 4543
Canada Way, Burnaby, B.C. V5G 4T4, Fax: (604) 293-0220. Acknowledegments and Disclaimer from the Author Special thanks to Katalin Kennedy, who initiated this project, and to David Allen, who inherited it. Their patience and encouragement were most welcome in what turned out to be a long project. My thanks as well to the many people who provided information and
those who were kind enough to comment on drafts of this paper. I
am sure that the report is better for their input, but, more than
in most instances, the conventional disclaimer is merited here:
any errors or omissions are those of the author. Table of Contents Abstract 7 Overview 8 A Focus on Canada 9 Part 1. Discovery and Evolution 9 Part 2. Driving Forces 15 Part 3. Synthesis: The Risk/Resiliency Model of Abuse Effects,
the Family Support Agenda and a Continuum of Prevention Programs
18 Part 4. New Directions: The Population Health Framework and
Community Development 30 Notes and References 37 Abstract Thirty years ago, child abuse and neglect were newly emergent social problems on our societal agenda, and a diverse and disjointed response system was trying to come to grips with the issues. Today, our response to child abuse and neglect faces a new challenge; it must assert its place within the broad sweep of a population health agenda. This paper traces the evolution of our response in four parts: Part 1 tries to demonstrate how our response to the prevention of child abuse and neglect fragmented as our definition of the problem and our understanding of its scope continually expanded and altered. Part 2 is about the various forces that have kept up a lively critique of this fragmented response and pressed for improvement. Pressure for change was maintained by reaction to periodic child abuse scandals, by the insights and activities of abuse survivors, and by the creative interplay between government and child advocacy non-governmental organizations (NGOs). Part 3 argues that a consensus about a prevention and intervention agenda finally began forming, based on a risk/resiliency model of the impact of child abuse and neglect. This model, which fits comfortably within a population health framework, provides real direction by identifying many potential intervention points to help prevent abuse. Our first attempts to use this new understanding have focused on a family support agenda. Part 4 carries that argument to the next level. As suggested by
a population health framework, the family support agenda itself
must be carried out within a larger community development approach.
That places child abuse and neglect prevention within a very large
program of fostering: optimum development for children; nurturing
families; and active, vigilant, healthy communities. Overview The central argument of this paper is that, during the 1990s, we have gone from a situation of considerable confusion and controversy over what should be the focus of our response, to a position of relative consensus on how to prevent child abuse and neglect.1 That consensus is built around a broad model of the lifelong impacts of child abuse and neglect on victimized children and on abuse survivors. This is a risk/resiliency model that indicates that outcomes for children are not simply a result of their reactions to the abuse itself but are modified by other experiences they have within the family and the wider community. That is, the risk/resiliency model uses what the social welfare field would term an ecological perspective, and is tied to what the broad health sector would call a population health framework. An outline of the model and comments on some of its more significant implications are found in Parts 3 and 4 below. Here, the key point is that the adoption of a risk/resiliency model has important benefits for child abuse and neglect prevention. Most critically, it suggests potential points for intervention and thereby allows us to identify programs and initiatives that address them. As well, it allows us to see those programs as parts of a prevention spectrum in which each program complements and enhances the others. Finally, it promotes collaboration because the same prevention agenda that works for child abuse and neglect is also key to the solution of other social concerns - preventing youth crime, school drop-out, child and adolescent mental health problems, and the like. Beyond this, the vision of an even broader prevention response
is emerging, based on a community development approach. This idea
of a healthy, valued child within a nurturing family, in a vibrant
and supportive community, further meshes child abuse and neglect
prevention with a number of other prevention agendas. That conjunction
potentially gives this (admittedly very ambitious) approach the
public and political support that it needs to succeed. A Focus on Canada To some extent, a focus of this paper is on federal government initiatives, especially those under the Child Sexual Abuse Initiative and the successive Family Violence Initiatives.2 This is not to detract from provincial and territorial activities; these are critical because child welfare in broad terms is fundamentally in these domains. Rather, this paper tries to recognize the federal role in fostering the exchange of ideas, building our knowledge base and developing a national perspective. Of course, child abuse and neglect prevention is a huge venture, with initiatives and influences coming not merely from governments but from many organizations and advocacy groups. Equally, child abuse and neglect is not confined to Canada but is a problem world-wide. Our understanding benefits from struggle with this issue in many countries. While it is hardly possible to cover all this ground, the discussion includes some instances of how Canadian initiatives fit into a continental or a transnational context. In that regard, some emphasis is placed on materials that can be
accessed on the Internet, fast becoming a key source of information
and exchange on child abuse and neglect prevention.3 Part 1 The Past as Prologue Our discussion starts before the current consensus formed. We begin with the re-emergence of child abuse on the public agenda back in the 1960s with the definition of the "battered child syndrome."4 This new way of identifying physically abused children sensitized many people to the presence of child abuse in our communities. Part 1 deals largely with the implications of two of the initial responses to this discovery: MANDATORY REPORTING LAWS and the DEFINITIONAL SPREAD that recognized more and more forms of child maltreatment. Mandatory Reporting Definitional Spread I: "Core" Categories Various aspects of PHYSICAL NEGLECT formed a second core category. Again, Saskatchewan provides a typical working definition: "Neglect occurs when a parent fails to provide supervision, guidance, medical care, food, clothing or shelter that might reasonably be expected of any parent." EMOTIONAL ABUSE & NEGLECT formed the third core category. New Brunswick guidelines note: "emotional maltreatment is the most difficult form of abuse and neglect to define and identify. Emotional abuse includes overt rejection, criticism, and excessive demands of performance for a child's age and ability. Emotional abuse refers to failure of the parent/caretaker to provide adequate psychological nurturance necessary for a child's growth and development." Because it is almost always easier to prove concurrent physical abuse or neglect, emotional abuse has remained a small category in child protection, even as it gained significance in planning intervention and treatment.7 The basic set of definitions was rounded out by a further "re-discovery," in the 1970s, that of CHILD SEXUAL ABUSE. Arguably this category was the last to be defined because of the high level of denial that it provoked.8 Yukon protocols state: "Sexual abuse may include intercourse, molestation, fondling, exhibitionism, sexual assault, harassment, and exploitation of a child for the purpose of pornography or prostitution." The working definition in the Northwest Territories emphasizes: "exposure of the child to sexual stimulation inappropriate for his age and role; the sexual exploitation of a child who is not developed mentally or capable of understanding or resisting the contact; or a child or adolescent who may be psychologically or socially dependent upon the perpetrator." Dramatic Increase in Reporting and Resultant Response System Stress
Although no national figures were available in Canada, the general trend in published provincial statistics was clear. In British Columbia, substantiated cases for the 10-year period 1974 to 1983 rose more than 1100%. The child abuse register in Manitoba showed an 8-year increase of 289% in the period 1979 to 1986. In the 1990s, reporting levels have remained high.10 Incidence statistics based on reported and substantiated cases have important limitations. For reports, persistent comparison difficulties are created by several factors (e.g. somewhat different definitions and reporting laws from jurisdiction to jurisdiction, differing perspectives on abuse by profession and by institutional sector, and varying effective thresholds for reporting). Substantiation rates depend critically on the particular investigative protocols, child protection staff skills and response capacities of child welfare authorities.11 In recognition of the limitations of reporting statistics, there has been ongoing interest in conducting prevalence surveys to try to establish the size of the affected population and to determine whether the problem was growing (or merely reflecting increased public and professional awareness). Statistics on reporting were supplemented by victimization surveys and by estimated prevalence rates based on surveys of professionals.12 In Canada, the Badgley Report in 1984 was an influential if somewhat controversial early example. It found that one third of males and one half of females had been the victim of at least one unwanted sexual act during childhood. While this finding is still often quoted, it was challenged at the time and re-analysis of the survey data was undertaken; that produced prevalence rates more in the order of 20% of females and 10% of males. Overall, prevalence studies are seen as subject to problems comparable to those that affect incidence studies. As noted, the level of child abuse and neglect reporting varies widely from jurisdiction to jurisdiction. The one thing these reporting levels have in common is that they all represent a forbidding challenge to the response system. In general, child protection system resources have not kept up
with the increase in caseloads. This pressure of numbers has various
serious implications for our response to child abuse and neglect.
Definitional Spread II: Continued Unfolding In time, this intense scrutiny of the family resulted in the differentiation of additional categories of concern. This continued "definitional spread" extended to a whole range of circumstances that placed children at risk. Concern about physical abuse placed a spotlight on harsh and inappropriate discipline. For example, working definitions in the Yukon speak about physical abuse as "any act or omission which results in or may potentially result in a non-accidental injury to a child and which exceeds that which could be considered reasonable discipline." This focus has fostered a debate on the issue of the appropriateness of corporal punishment for children.15 As child abuse issues came to intersect those of wife battering, there was a growing concern that "child witnesses to violence," who were exposed to the emotional, physical and sometimes sexual assaults on their mothers, represented another category of abused children. In some jurisdictions, witnessing violence became a reportable issue.16 Attention to intrafamilial child sexual abuse raised any number of further issues. Father-daughter abuse dominated the early literature and both provided the context for theory building and set the direction for intervention planning - be it criminal law intervention or treatment. Eventually, notice was also taken of boys as child sexual abuse victims, and of sibling incest.17 The latter in turn provided one important basis for starting to identify juvenile sex offenders, as well as sexual assault that takes place in the context of dating relationships. More recently, we have also begun to acknowledge much younger children who engage in sexually abusive behaviour.18 The child sexual abuse literature explored conditions of "family dysfunction" in which the child victim was isolated within the family, made complicit in maintaining the terrible family secret, and placed in a situation of role reversal in which the victim was perversely responsible for satisfying the needs of his or her caregivers. This description started to place a new construction on the situation of children in other sorts of dysfunctional families. These included children of parents with substance abuse problems, various chronic mental illnesses, and especially alcoholism. While parental alcoholism is not widely specified in child protection legislation, there is certainly increased emphasis on parental substance abuse as an issue in assessing child risk.19 Implications Child sexual abuse cases, in particular, involved the criminal justice system much more centrally in the response. While criminal justice intervention might be prompted by exceptional cases of physical abuse and neglect, it was the major societal tool in child sexual abuse cases.20 The legal response involved a great deal of innovation over a short period - new investigative and forensic techniques, protocols to sort out the joint and numerous investigative responsibilities of child protection and police services, reforms to the Criminal Code to redefine offences and enable children to testify, and support programs for those child witnesses.21 Once again, the implications for the response system extended beyond
the issue of child sexual abuse. Refocusing on Child Abuse beyond the Family By contrast, the criminal justice system, which was centrally involved in child sexual abuse cases, was not inherently focused on the family (and only a few offence categories were specific to intrafamilial abuse). In this regard, the rediscovery of intrafamilial child sexual abuse had within it an inevitable correction, the need to acknowledge and respond to extrafamilial sexual victimization of children. Similarly, it was clear that child physical abuse and neglect would also refocus to some extent on issues beyond the family. It was hardly a stretch to consider child abuse by caregivers other than parents or relatives and then go on to a larger category of persons "in positions of trust." Thus, attention had to be paid to baby sitters, foster parents, daycare staff, preschool and school teachers, coaches, medical personnel, and so on. Indeed, if one uses the prevalence data from retrospective surveys, the majority of sexual offenders are extra-familial.23 This definitional spread was reflected in the working definition of "family violence" adopted by the federal Interdepartmental Working Group on Family Violence, which included "intra-and extra-familial abuse of children and youth."24 A Typology of Institutional Abuse Compared to intrafamilial child abuse and neglect, institutional abuse has not been classified in a typology that has gained wide acceptance. However, based on the critiques that have been made over the years, various levels of institutional abuse can be defined. At issue is whether abuse arises because: The first point is not institutional abuse, but merely abuse that happens to occur within a particular institutional setting. The other points are institutional abuse; the higher levels often explaining the reasons for deficiencies and defects at the lower ones. Recognition of each of these types has prompted reforms and initiatives within the broad child- and youth-serving sector and the beginnings of some within society as a whole. Child-serving organizations have a much enlarged understanding of what it takes to meet care standards. We now expect these organizations to have in place proper policies regarding screening staff, protecting interactions with and between children, using only acceptable methods of discipline and reward, reporting suspected abuse and dealing with accusations of misconduct.26 At the very least, some of the scandals in schools and daycare centres have raised these issues. Inquiries into abuse in orphanages (notably Mt. Cashel in Newfoundland), training schools and institutions for children with various disabilities (notably Jericho School for the Deaf in British Columbia) push system abuse into the next level. Native Child Welfare Few issues have had such wide-ranging implications for our child welfare response system. In particular, two major changes have been the creation of special Native child adoption policies and the development of Native child welfare agencies. By the early 1990s, most provinces were negotiating parallel arrangements to serve both Native communities and also Native families in towns and cities.28 This is part of a long-term process of community rebuilding (see Part 4 below). Sexual Exploitation Violence in Society Refugee Applicants Issues Revisiting the Numbers Then, as definitional spread moved us toward a broad critique of society and how we nurture our children and youth, there was further impetus for getting a better handle on the size and scope of the problem. It has become more and more important to be able to look at child abuse and neglect across jurisdictions and over time to try to understand what demands are made on our response systems, how well these demands are met and what impact our efforts are having. This sort of information is especially critical if we are to mobilize credible prevention efforts. In Canada, this felt need has led to various initiatives, first to understand and acknowledge limitations in our information and then to work to improve our knowledge base. The Child Maltreatment Division of Health Canada has recently established the Canadian Incidence Study of Reported Child Abuse and Neglect. The study is designed to provide a better understanding of the dynamics and extent of child maltreatment in Canada.32 Summary Part 2 To this point, this discussion has emphasized a particular developmental line in our response to child abuse and neglect. From this perspective, we see that the uncovering of one form of child maltreatment sensitized us to other forms, and the acknowledgement of these in turn led us to generalize still further. Each new "discovery" prompted new reports and disclosures, and thus provoked further demands on the response system and fresh calls for additional resources. This history suggests that child abuse has evolved as a recognized social issue in interplay with a stressed but dynamic response system. In fact, the child abuse and neglect response system, because it brings together people from so many disciplines and includes many strong advocates for children, has generated many of the ideas, approaches and initiatives that have moved the issue forward. That said, it is also true that child abuse and neglect has evolved as a social issue in large measure because of other forces. Three main drivers are: A great deal of government initiative has been undertaken in active response to these forces. Child Deaths and Scandals Scandals are not merely played out in the media. Often, they result in commissions of inquiry or other public processes. Commission reports provide many of the most detailed and sweeping analyses of our response system. Because of their high profile and the prestige of the commissioners, they may help to reduce social denial and nurture the will for significant change.34 As well, in recent years, there has been a growth in the number of special offices established to investigate child deaths and recommend reforms.35 Survivors and Survivor Organizations Some survivor organizations also act as advocates for change in the response system. For example, the National Youth in Care Network was formed in the mid-1980s, with assistance from another advocacy organization, the Canadian Child Welfare Association. It worked on giving children in care a public voice, and produced reports and position papers on family violence from a youth perspective, the effects of coming into care and the needs of youth-in-care in transition to independence.36 Survivor groups bring a special perspective on issues and often seek to broaden the response. The leverage that survivor organizations have derived from their ability to make a morally compelling social critique. For example, the Native self-government movement in effect often acts like a survivor organization when it speaks to child welfare issues.37 Non-Governmental Organizations and Child Advocacy Groups
Much of this activity is meant to influence governments at various levels. Government action may be mobilized by scandals and by strong advocacy. In turn, governments sometimes seize opportunities to exercise leadership, promote change, and support initiatives. The declaration of an international year, the adoption of an international convention, the requirement to review some legislation - each provides openings. In the full-text version of this paper, a number of the federal initiatives that have moved forward the agenda on child abuse and neglect prevention are outlined.38 Government-Non-Governmental Organizations Interplay In late 1989, with the passage of the Convention imminent, the Canadian Council on Children and Youth helped form the Canadian Coalition for the Rights of Children, a group of NGOs joining together with the primary aim of getting ratification and implementation of the UN Convention. One of the Coalition's first steps was to meet to help plan a world summit to promote ratification.39 The UN Convention was passed by the UN General Assembly in November 1989. The Convention would have international force once 20 nations had ratified it. The Canadian government signed the Convention in May 1990 and worked with the provinces and territories (which had jurisdiction over many of the issues covered in the Convention) on reviewing their legislation and bringing each into accord with the Convention so that there could be agreement to ratify.40 In the fall of 1990, Prime Minister Mulroney co-chaired the UN World Summit for Children, the first gathering of world leaders focused on children. The Summit published a Plan for Action on implementing the Convention and enunciated the principle of a "first call for children." The Convention was ratified by Canada in December 1991.41 In 1992, the federal government published its initial report on implementation of the Convention - Brighter Futures: Canada's Action Plan for Children - with its slogan "Children Matter." Among other initiatives, the federal government announced a five-year $500 million Child Development Initiative, aimed at preventing and reducing conditions of risk among children.42 This "action plan" has been a spur to the development of various measures for child, family and community well-being. In addition to important federal government initiatives and work in the provinces and territories, advocacy groups have responded.43 For example, the Canadian Council on Social Development issued a report card, The Progress of Canada's Children 1996, emphasizing issues of poverty and the disadvantaged position of Native children.44 Shake-Up among Child Advocacy Non-Governmental Organizations
Summary Part 3 Introduction: The Search for "Causes" In part, this was because the causes of each type of child abuse and neglect are multi-factorial and complex. Single variables identify risk factors but do not produce a causal explanation of child maltreatment or clarify the inter-relationships among risk factors. As well, pure categories are not found in the real world: many abused children suffer from several types of maltreatment and live in families facing a variety of problems. Consequently, this research has not successfully uncovered causes. Rather, studies have catalogued correlates of child abuse.47 Building a Synthesis: An Ecological Approach With the clarity of hindsight, this general model can be seen as
largely inherent in the logic of the progressive definitional spread
and in the program initiatives upon which practitioners from different
parts of the response system converged. We cannot prove what causes
abuse and neglect. However, the whole range of risk factors, taken
together, do suggest ways to intervene that may prevent abuse, catch
it in its earliest stages or ameliorate its effects. This synthesis
developed through two phases: The first phase is discussed in Part 3, the second phase in Part 4. Achieving Synthesis: The Risk/Resiliency Model Equally important was a small but intriguing body of literature, going back many years, that looked at the characteristics of children who seemed highly resilient in difficult or traumatic experiences. The ability to recover from abuse depends on many qualities that individuals have in varying degrees. These resiliency factors include an even temperament, intelligence (especially critical thinking skills), sense of humour, other problem-solving and coping skills, a sense of self-efficacy, optimism and a sense of purpose.50 As well, there was some research on life circumstances and alternate resources that seem to offer children some protection from harms or to remediate the ill effects of abuse. These "protective factors" can be grouped into three major categories: caring and supportive relationships, positive and high expectations, and opportunities for meaningful participation.51 These findings could be combined with the literature on risk factors to create a much more powerful understanding of the effects of child maltreatment. It is this risk/resiliency model that is becoming the dominant perspective today.52 Indeed, we now have good summaries of this model presented for the general public. An admirable example is the recent publication of the National Crime Prevention Council (NCPC).53 The full-text version of this report features a lengthy quote from the NCPC report. This quote is included, even though it describes a crime prevention model, because the same description can be read virtually word-for-word as a child abuse and neglect prevention model. Implications Because the latter points are so critical to the wide adoption of this model, we discuss these three issues in reverse order. Key Alliances A Perspective on How to Respond A Prevention Continuum PRIMARY PREVENTION refers to activities designed to have some impact on the whole population and make child abuse less likely to occur in the first place.56 SECONDARY PREVENTION refers to activities aimed at specified high-risk groups to strengthen their capabilities, reduce risks and, at the very least, catch any child maltreatment at the earliest possible stage. TERTIARY PREVENTION refers to activities designed for known abusers and victims, aimed at rehabilitating them and preventing further instances of maltreatment. In effect, most primary prevention programs have a secondary prevention intent as well. And secondary prevention activities tend to merge with tertiary ones. For example, we hope that prevention programs aimed at the general population will not only assist, inform or mobilize people who already are pre-disposed to value and nurture children but will also reach those who are at risk of maltreating children. Moreover, we tend to use primary prevention programs as non-stigmatizing ways of screening the population to identify those who need higher levels of support or to motivate self-referral from those at risk. And, as noted in the definition of secondary prevention, the intent of those activities is also to catch abuse early and prevent re-occurrence. The rest of Part 3 considers programs at each of these levels in
turn. Primary Prevention Programs Primary prevention programs are of many different types, ranging from public awareness and public education campaigns, personal safety and life skills curricula, to parent education and home visiting programs. The latter often have a strong screening component and a secondary prevention aspect as well. Public Education Campaigns A major public education initiative in Canada resulted from a partnership between various federal government departments and the Canadian Association of Broadcasters. In 1994-95, the Speak Out Against Violence campaign was launched, with the slogan "Violence: You Can Make a Difference." Public service announcements ran on hundreds of private television and radio stations across the country. They were also translated into other languages for use on multicultural stations and were made available on TV with closed-captioning.58 In 1996, the second stage of this campaign focused more specifically on violence against women and against children. Each TV and radio spot featured a tip for action against violence. Government departments developed the materials, which included background fact sheets. Broadcasters broadened the use of these materials by including aspects of family violence as topics for talk shows, news broadcasts and magazine-format shows. Stations also offered the materials for use by local schools, service clubs and community groups.59 As noted, public education initiatives implicitly slide from primary through secondary prevention - aiming to strengthen positive and protective attitudes in the general population, teach victims that what they are suffering is indeed abuse and wrong, and confront abusers and potential abusers with a message that inhibits minimization and denial. Targeted Awareness Initiatives: Guidance in Detection and Reporting
One of the most important groups to sensitize and involve comprises decisionmakers and policymakers, those who can authorize child abuse and neglect prevention programs and direct resources to the larger family support agenda. There are some initiatives directed at these groupings - informal lobbying efforts, policy report cards - the sorts of advocacy efforts noted above in Part 2. However, there are also some more unusual sensitization efforts. For example, the Colorado Doll Project has placed thousands of life-sized cardboard dolls of children, dressed in real clothes, each with a story attached, in the offices of elected officials, business and community leaders to promote a public agenda for young people.61 Community Safety Programs Personal Safety Programs, Anti-Violence Curricula and Life Skills
Training Personal safety programs have been designed for preschoolers and on through childhood.62 Curricula based in the elementary school have been especially prominent. For example, the most widely used child sexual abuse prevention curriculum in Canada, Feeling Yes, Feeling No, was piloted in the mid-1980s by Green Thumb Children's Theatre in Vancouver and turned into a video by the National Film Board. Curricula for teens often stress issues that arise as youth enter relationships. Thus, there are many materials on relationship violence and "date rape."63 Another issue taken up with adolescents is the lure of street life and recruitment of youth into the sex trade. Anti-Violence Programs constitute another large set of mostly school-based initiatives. One of the best researched of these is the Montreal Longitudinal Experimental Study of Disruptive Kindergarten Boys.64 An Educational Agenda In preventive terms [the school's], responsibility would involve running compulsory protective behaviours programs... and the uniform teaching of life skills.. [The] latter should address the following issues: criminal law, victim empathy, gender and socialization, sexual education, sexual assault, child abuse, violence, domestic violence, and alcohol/drug abuse.. Life skills programs should aim to increase young people's awareness of the societal and personal factors (e.g., poverty, unemployment, stress, social isolation, and family structure) that underlie the perpetration of child maltreatment, equipping them to resist maltreatment and educating them about sources in the community and social support which may ameliorate the potential for abuse or neglect.65 Marriage Preparation Courses Prenatal Classes Parent Education Like many other primary prevention approaches, parent education can also be specially targeted at high-risk populations. Thus, for example, Health Canada, in cooperation with the provinces and territories, developed Nobody's Perfect in 1994, a support and educational program for parents of children from birth to age 5, aimed at young single parents with limited resources. Developed in Nova Scotia in the mid-1980s, this program is now in widespread use across Canada.68 Home Visiting Home visiting is a relatively old and established program model.
Variants differ in terms of the staff who provide the service -
from health professionals such as public health nurses to paraprofessionals
to volunteers who are experienced mothers - and in terms of the
length and intensity of service. Overall, however, home visiting
is among the few prevention components that has built up a good
body of evaluation evidence for its effectiveness.71 Secondary Prevention Programs Secondary prevention programs target at-risk populations. That is, any problem, circumstance or attribute that research identifies as associated with increased risk for abuse and neglect is a potential target for secondary prevention programming. Cumulatively, these at-risk populations are very substantial. Various segments are also difficult to reach for particular service models. For example, most parent support programs in fact reach only a small proportion of fathers within the target population. Secondary prevention, therefore, requires a wide array of services and approaches.72 There is some evidence that this targeting is effective. However, the very wide range of needs captured under the term "at risk" means that it is difficult to demonstrate that any particular secondary prevention component has an impact on overall levels of abuse.73 Prenatal Nutrition Programs Healthiest Babies Possible is a widespread pregnancy outreach program (POP) for women at risk of having a low birth weight baby because of low income, substance abuse problems, heavy smoking, etc. Nutrition and lifestyle counselling, referral services, support, and provision of food and vitamin supplements are typical program components. The Canada Prenatal Nutrition Program supports similar projects in over 200 communities across Canada.75 Infant Development Programs Fetal Alcohol Syndrome or Fetal Alcohol Effects Support Programs
Family Support Services A second type includes immigrant and refugee settlement and support services, to help integrate families and mediate typical intergenerational conflicts and friction. The third category includes parent/teen conflict programs and teen parent support services, aimed at situations of apparent risk. Emergency daycare programs and residential crisis nurseries offer child care services to parents facing a crisis at home or at work. These programs also provide periods of respite to parents who are "on the edge".79 Head Start Aboriginal Head Start Initiative Remedial Schooling For children and youth whose emotional or behavioural problems mean that they cannot succeed in the regular school streams, alternate schools represent an important second chance to remain in school and stabilize their lives. Otherwise, children are strongly marginalized and thus at risk (and often also have some history of victimization that underlies or contributes to their difficulties). Anonymous Counselling and Referral The best example in Canada is Kids Help Phone (Jeunesse, J'écoute), a 24-hour-a-day, toll-free telephone counselling service which provides a confidential and professional response to calls from Canadian youth and children. The service started in 1990 and within two years was responding to between 800 and 1,200 calls daily. Many of the calls deal with abuse, including dating violence.83 Support Groups at Transition Points One of the most venerable of these programs is B.C. Parents in Crisis, founded in 1974. This society operates a province-wide network of self-help groups for parents. These Parent Support Circles are facilitated by trained volunteers and promote healthy parent-child relationships for the prevention of child abuse. Currently, 43 groups are active. As well, in Vancouver there are relatively new groups for parents from the Latin American, Filipino, Chinese and Indo-Canadian communities.85 Tertiary Prevention Programs Tertiary prevention includes most of the investigatory functions of the child abuse and neglect response system, most of the crisis intervention components, and a lot of the counselling, treatment and support services. For example, there is a range of hospital-based services, including risk assessment and screening programs in the maternity wards, SCAN programs in the emergency department to try to identify suspected child abuse and neglect, forensic examination services to help in case investigation, and often referral services to arrange for ongoing treatment or counselling.86 The intervention of the justice system introduces the need for various kinds of services, notably victim services and witness preparation and support programs for child witnesses.87 Then there are offender programs; any proper discussion of treatment models would require a report much longer than this one.88 While these tertiary prevention/intervention/treatment services are certainly critical, and indeed consume most of the energy, resources and concern that society expends on child abuse and neglect, they come into play very late in the day. Our broad prevention model seeks to rebalance our response to concentrate more on primary prevention (prevention in its common meaning) and on early intervention. Thus, the discussion here is limited to a trio of tertiary prevention programs that have attracted special attention as key elements in a family support agenda. These are parenting programs, family preservation programs, and services for children and youth who have experienced violence. Parenting Programs Parenting support programs generally involve parent education, other parent support services and often some form of infant stimulation: Mothers and children attend a day program in a group setting.. Social workers and family workers act as a team. The intervention takes a hands-on approach. The ordinary routines and child management are modelled by staff. There is meal-time preparation, lunch time and an outing. While the children nap there is a support group for the mothers, guided by a professional social worker. The discussion covers any issues the parents wish - parenting, assertiveness, or relationships. There is emphasis on discussing issues of sexuality and education, with an eye to preventing sexual abuse.. Monthly goals are set with each parent individually, around both personal issues and parenting issues. Evaluation results for these programs are mixed: One of the premises of family support is that benefits for the children follow from changes in parent behavior and attitudes. Parents are encouraged by program staff to interact differently with their children, but changing any habit is difficult, and changing patterns of behavior forged over many years is even harder. As a result, even in the best parenting program, positive benefits may take some time to emerge.90 Family Preservation Projects Family preservation programs are used as an alternate intervention of last resort in families where children would otherwise have to be apprehended because of abuse and neglect. Family preservation programs are also sometimes used to prepare high-risk families for re-unification where children have been taken into care temporarily. Often, their success is measured by the extent to which these interventions prevent removal of children. In fact, many jurisdictions fund these services explicitly out of monies that would otherwise go to foster care.92 Family preservation programs represent the highest level of intensity in family support services. A worker (coach - homemaker - advocate, etc.) is placed right in the home from several hours a day to virtually around the clock, depending on the level of family crisis and the specific program model. The services they offer are often concrete - building on whatever strengths there are in families, teaching practical skills and problem-solving techniques, and working step by step on small measurable successes. The model remains controversial within child welfare because these programs walk the edge in terms of being able to ensure child protection within an admittedly high-risk family environment. Critics argue their use should be restricted to moderate-risk families where there is no evidence of parental "antisocial personality disorder."93 Indeed, the evaluation results for family preservation programs used where children display serious emotional or behavioural problems are not convincing. For families where there is evidence of child abuse or neglect, some evaluation studies show that families receiving intensive family preservation services avoid having children removed (or require less lengthy periods of care for children who are apprehended), compared to control groups receiving ordinary levels of child protection services.94 Some of the most rigorous evaluations show either no difference or perhaps even a slight tendency for children in program families to come into care at a higher rate than controls. While these results seem disappointing on one level, at another level their implications are not. Families in these programs do receive much wider-ranging services on average than controls in the regular child protection stream. If a higher level of surveillance is achieved through family preservation programs, this becomes an expensive but certainly highly responsive and responsible approach to child protection. It would be better to reconsider family preservation approaches as secondary to tertiary prevention services, brought into play earlier for families in crisis rather than as a last resort. In that sense, these programs fit very well into an overall family support service continuum.95 Programs for Children Who Witness Violence National Longitudinal Survey of Children and Youth Results from the first survey cycle (released in November 1996) are already adding to our ability to determine what factors place children at risk and what factors are protective. Later waves will help establish how these factors play out in child and youth development. The data are also useful in providing a better profile of child well-being in Canada, and various NGOs and child and youth advocacy organizations are beginning to use the data set descriptively. In this first survey, abuse and neglect issues per se are not strong. In future cycles, however, analysis of abuse impacts may be strengthened.97 Risk Assessment The development of the risk/resiliency model of the impacts of child abuse and neglect provided a second impetus for risk assessment. As noted in this part of the report, this model helps us define a whole continuum of prevention programs. Indeed, this range is so wide that it is difficult, even for workers within the response system itself, to have a complete sense of it and find their way through it. Therefore, critical to successful prevention and intervention is the ability of the response system to identify needs and direct people to appropriate services along the continuum. Illinois was the first state in the United States to develop a risk assessment model. It set a pattern, defining 17 factors, most of which were incorporated into subsequent models in other jurisdictions. New York pioneered the use of a separate tool to look at immediate safety concerns.99 Variants of these tools were modified for use in various provinces in Canada.100 These developments have not been without controversy. Risk assessment in child welfare has traditionally been regarded as a professional skill, not something that can be routinized and reduced to a checklist or a paper and pencil questionnaire. However, risk assessment tools can genuinely support workers, both by ensuring that case planning is based on a consideration of all the relevant issues and by documenting the decision-making process in useful ways.101 These uses of risk assessment distinguish three (somewhat overlapping)
categories: Much of the work to date has been in refining tools in the second category - assessed risk for reabuse. Notably, there has been concerted evaluation of the Manitoba Risk Estimation System.102 Some risk assessment tools tried to define factors as more or less specific to particular types of abuse. (Thus, the profiles reflected in the Ontario incidence study103 could be used to assign different weights to issues as they arise in cases of neglect versus cases of physical abuse.) Various risk assessment tools also tried to identify benchmark acceptable values for each risk factor and some computed an overall risk score (e.g. various adaptations of the Child Welfare League of America's Child Well-being Scales). Until recently, however, there has only been spotty adoption of risk assessment systems across Canada. As the Ontario Child Mortality Task Force noted: Survey results indicate that the use of risk assessment tools by Children's Aid Societies (in Ontario) is inconsistent.. As of January 1, 1997, 28 of the 55 CASs in Ontario reported using risk assessment tools. Six different instruments or combinations of instruments are currently being used.104 Mandated use of risk assessment tools now seems to be coming. In 1996-97, the B.C. Ministry of Children and Families completely revamped a risk assessment tool originally developed in New York, and child protection social workers in British Columbia are in the process of implementing it.105 The Ontario Ministry of Community and Social Services, responding to the child fatality inquiry noted above, announced the implementation of another version of this risk assessment system.106 "Looking After Children" Summary Part 4 Introduction In Part 3, a look was taken at how our understanding of the impact of child abuse and neglect grew. Eventually, we had a conceptual framework - the risk/resiliency model - that captured the diverse factors. This model provides a way of thinking through the whole range of programs and services that we need: . to try to minimize risks and build up child and family strengths;
The generalizability of this model is its biggest strength. The set of programs and services designed to prevent child abuse and neglect are essentially the same as those that help to strengthen families, foster educational achievement, prevent youth crime and create a competent, productive citizenry. Thus, a family support agenda makes sense from many perspectives.108 In this final chapter, this model is taken a step further. As prevention models have been developing, so too has a broad analysis of the "determinants of health." The Population Health perspective flows from this analysis. It helps us see that the risk/resiliency model of the effects of child abuse and neglect extends far beyond family support issues to take in the community and the larger society as determinants of child and youth well-being. Some implications of this perspective are explored below. In particular, a look is taken at recent findings from research on brain development that are underlining the importance of services for infants and parents, and the renewed interest in building community capacity to support families and nurture children and youth. At this point, however, this emerging understanding is not yet matched by decisive social action. Neither child abuse and neglect prevention nor the larger societal well-being agenda in which it fits have been seriously adopted for implementation. Therefore, this chapter also considers a number of other agendas that are shaping our child abuse and neglect response system. A Population Health Framework Thus, the definitional spread traced in Part 1 and the risk/resiliency model covered in Part 3 were increasingly understood as showing that the harms represented by child abuse and neglect are inherently developmental. Abuse not only sets back development in the short term but also represents a long-term risk of limiting or distorting the child's development. Because each advance depends on the child or youth having a good foundation in place, the earlier the disruption, the greater the potential long-term harm. By the same logic, the earlier we detect abuse and the more skillfully we intervene to remediate harm, the quicker and more complete the recovery will be.111 Indeed, time is a crucial variable in understanding the impacts of abuse and neglect. Each developmental competency has a period during which it must be acquired. Some of these periods of special sensitivity are relatively long and flexible and early deficits can be made up. Some are more critical, and failures of development within these periods may retard development thereafter through the individual's entire life.112 By the same token, each developmental period requires its own appropriate response; failure to support adolescents erodes the gains they may have made in childhood.113 Micro Level Analysis - New Research on the Development of the
Brain "Deprived of a stimulating environment, a child's brain suffers.. Children who don't play much or are rarely touched develop brains that are 30% smaller than normal for their age.. The data underscore the importance of hands-on parenting, of finding the time to cuddle a baby, talk with a toddler, and provide infants with stimulating experiences.. By the age of three, a child who is neglected or abused bears marks that, if not indelible, are exceedingly difficult to erase."115 Abuse and neglect in infancy tend to result in failure of the child to form secure attachments to parents (or special caregivers). Such attachment failures not only limit the child's ability to trust, but also impact on the entire repertoire of coping skills.116 Related research on abuse and neglect-induced stress as a factor that limits brain development has led to further concern about the care that children receive in the earliest years.117 Macro Level Analysis - Societal Well-Being A relatively new research agenda, championed in Canada by the Canadian Institute for Advanced Research, takes the argument full circle: societal wealth is a factor in the health of the population and, in turn, a healthy population represents social capital that is critical to economic and social development.119 Population health research leads to a broader concern for the health and prosperity of communities and the nation as a whole. The public/political will within a society to redirect resources to foster the health of communities depends on the level of shared values and active public commitment. This quality of social inclusion, citizen engagement and social cohesion is characteristic of a civic society.120 Community Development Approaches and the Civic Society Another important strand in Canada is the notion of the sustainable community, one which is characterized by self-reliance, an ecological perspective, community economic development activities and a sense of shared community culture - collective expression of values, perceptions and social organization.122 Ideas complementary to these are suggested in a host of current programs - Caring Communities, Bright Beginnings, Best Start, etc.123 As part of Brighter Futures' implementation, the federal government announced a five-year Child Development Initiative aimed at children from birth to age six. It was based on four "Ps" - prevention, promotion, protection and partnerships. The program that married this initiative with a community development approach was the Community Action Program for Children (CAPC), designed to provide ongoing support to innovative community-based collaborations. Brighter Futures and CAPC, in association with provincial and territorial governments, funded projects across Canada, in particular assisting many community consortia to develop family resource centres as the focus for a range of efforts to improve community capacity to support families and children. The Canada Prenatal Nutrition Program (CPNP), another program under the Child Development Initiative, also involves community partnerships and federal and provincial or territorial co-management.124 Some initiatives have been explicit about community-level factors that fit into a risk/resiliency model. This leads to an approach that emphasizes assistance to parents in building stronger and more supportive personal social networks that are based in the community and connect them with formal service providers, informal natural helpers in the community, and other parents, for mutual support. In addition, the idea is to improve and integrate community infrastructure and enhance the sense that the neighbourhood is a good place in which to bring up children.125 Research/Demonstration Projects Aimed at Child-Centred Community
Mobilization Better Beginnings, Better Futures is a 25-year longitudinal prevention policy, research and demonstration project being implemented in 12 communities (several of them reserves) across Ontario. The project's goals are to prevent developmental problems in young children (aged 0 to 8), promote healthy child development and enhance capacities in socially and economically disadvantaged communities. Better Beginnings, Better Futures focuses on infant and preschool initiatives and on the transition to primary school (i.e. emphasizing home visiting and head start approaches). Children receive up to four years of programming and will be tracked until they reach their mid-20s. As well, the five-to seven-year planning and demonstration period is designed to help develop community capacities. Improved service integration and community development approaches are stressed.128 In Montreal, 1-2-3 GO! is a comparable program initiated by Centraide (United Way) and various partners from business, labour and the public sector. It aims to engage communities in giving central place to the well-being of young children and their parents. Neighbourhoods that are under-serviced and have relatively high numbers of low-income families with young children were encouraged to form consortia and put forward proposals. Community proposals follow a community development approach. Initiatives include fostering self-help groups, clothing and toy exchanges, community kitchens and cooperative restaurants, baby-sitting cooperatives, parent drop-ins, improved parks and public amenities that accommodate children of various ages, etc.129 It is not yet clear whether these initiatives, although relatively ambitious in scope, are comprehensive enough to achieve the critical mass of community development necessary to significantly improve the life chances of children and youth and help families become more dynamic. Community-Building Perspectives in Child Welfare Native Child Welfare and the Notion of Community Development
Moreover, these efforts focus on community as the level at which problems of child abuse and neglect must be addressed. Prevention and intervention must take into account the need of the whole community to heal. Concretely, this has led to an emphasis on following the connections among abuse, victimization, and personal, family and community decay; trying to reintegrate offenders within the community rather than separating them from it; and using holistic and inclusive approaches to healing, based, for instance, on the image of the medicine wheel and the healing circle.130 Family Group Conferences as an Expression of Community In Canada, the main experiment with this approach has been in Newfoundland. In Newfoundland and Labrador, the model is being tested by the Family Group Decision Making Project, a demonstration project taking place in Nain (an Inuit community in Labrador), the Port au Port Peninsula (a rural Newfoundland region) and St. John's: Skilled facilitation is required to help organize the meeting, ensure that family and community participants have all the facts and understand what options and resources are available, and help translate the family group plan into a timeframe and agreed-upon responsibilities for action. Out of this, however, can come communities mobilized around specific families. Measures to stop family violence are more effective when they develop out of the strengths of the community and the culture in which the family lives. Family violence can only be resolved by building supportive networks and resources and by educating communities to plan and advocate for necessary services.. In effect, a program of community policing develops in which members consent to safeguard each other with the support and protection of the police and other authorities..132 Various jurisdictions across Canada have been keenly interested in this approach.133 Regionalization: Bringing Services Closer to Home? From a population health perspective, it is certainly appropriate that services to protect the well-being of children within a family and community context should be planned, controlled and implemented at the community level. The main concern in these initiatives is whether community capacity building is genuinely at their core. Communities of Interest - Child Abuse and Neglect Prevention
within an Inclusive Mandate This is an unprecedented situation: a common agenda that can be championed by those interested in crime prevention, literacy, mental health, community economic development, the elimination of poverty, a more effective work force, etc. Many interests see the community health perspective and the risk/resiliency model as forwarding their work, and a small flood of reports, discussion papers and action plans are appearing.135 However, it is worth noting that very few of these reports or community development initiatives noted above situate child abuse and neglect prevention at their core. Child abuse and neglect have faded from public attention in the
past and many people worry that our resolve to respond strongly
and effectively could erode once again. To some extent, that fear
has limited the willingness of advocates in this field to ally themselves
with others; they do not want the focus on child abuse and neglect
to waver. Now, however, the connections between abuse and
neglect prevention and a wider social agenda are impossible to ignore.
Still, for the health of this evolving community of interest that
champions a child-centred vision of society, it is also important
that each advocacy grouping within it sees its own agenda moving
forward. That is, it is critical for community building that each
group: Advocates for the prevention of child abuse and neglect need to
take the same opportunity to keep attention focused on their goals.
If "it takes a whole village to raise a child," it is equally true
that "what's good for the child is good for all of society." Notes and References 1 For an overview of these controversies, see Wachtel, A.D. (1989) "Child Abuse: A discussion paper." Prepared for Working Together: The 1989 National Forum on Family Violence. Ottawa: NCFV; May 1989. For an early synthesis of the prevention agenda, see Daro, D.A. (1988) Confronting Child Abuse: Research for effective program design. New York: Free Press. 2 See FVPD (1994) "Family Violence and Child Sexual Abuse: A Summary of Projects Funded in Aboriginal Communities, 1986-1991." Ottawa: Health Canada, Family Violence Prevention Unit; Ryerse, Catherine (1994) Child Sexual Abuse - Professional Training and Public Education - A Review of Projects Funded by the Family Violence Prevention Unit, Health Canada, 1990-93. Ottawa: Health Canada; Torjman, Sherri (1989) Child Sexual Abuse Overview: A Summary of 26 Literature Reviews and Special Projects. Ottawa: Health & Welfare Canada; Wachtel, A.D. (1994a) "Child Abuse and Neglect: A Discussion Paper and Overview of Topically Related Projects." Ottawa: Family Violence Prevention Unit, Health and Welfare Canada; and Wachtel, A.D. (1994b) "Improving Child and Family Welfare: A Summary and Reconsideration of Eleven Recent National Welfare Grant Demonstration Projects." Ottawa: Health and Welfare Canada. 3 For a start, see NCFV (1997) "National Clearinghouse on Family Violence" available on its Homepage: http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/index.html; the National Child Protection Clearinghouse in Australia at http://www.aifs.org.au; and the Virtual Hospital Website: http://www.vh.org. Various other good sources are noted below. 4 See Kempe, C.H. et al. (1962) "The Battered Child Syndrome." Journal of the American Medical Association, 181; pp. 17-24; and Helfer, R.E. and Kempe, C.H., eds (1978)Child Abuse and Neglect. Boston: Ballinger. For an understanding of the rise and decline of societal awareness of child abuse and neglect, see De Francis, V. (1987) "Landmarks in the Development of Child Protective Services." Protecting Children, 4,3, pp. 3-5; and Pfohl, S.J. (1977) "The 'Discovery' of Child Abuse" Social Problems, 24,2; pp. 310-323. 5 See Falconer, N.E. and Swift, K. (1983) Preparing for Practice:
The fundamentals of child protection. Toronto: Toronto Children's
Aid Society; Hepworth, H.P. (1975) "Services for Abused and Battered
Children." Social Services in Canada, vol. 3, CCSD; and Chisholm,
B.A. (1978) "Questions of Social Policy - A Canadian Perspective."
In J.M. Eekelaar and S.N. Katz, eds., Family Violence: An international
and interdisciplinary study. Toronto: Butterworths; pp. 318-328.
For a current view, see BCMCF (1996a) "Helpline for Children: Zenith
1234." Available on the Government of B.C. Homepage: http://www.ssrv.gov.bc.ca/docs;
and FPWG. (1994) Child Welfare in Canada: The Role of Provincial
and Territorial Authorities in Cases of Child Abuse. Ottawa: Federal-Provincial
Working Group on Child and Family Services Information. 7 See Garbarino, J. et al. (1986) The Psychologically Battered Child. San Francisco: Jossey-Bass; Daro, D.A. (1994) "Prevention of Child Sexual Abuse." The Future of Children, 4,2, pp. 198-223; and Nicholas, K.B. and Bieber, S.L. (1996) "Parental Abusive versus Supportive Behaviors and Their Relation to Hostility and Aggression in Young Adults." Child Abuse and Neglect, 20,12, pp. 1195-1211. 8 See Sgroi, S.M. (1975) "Sexual Molestation of Children: The Last Frontier in Child Abuse." Children Today, May-June, pp. 18-21; Conte, J.R. (1994) "Child Sexual Abuse: Awareness and Backlash." The Future of Children, 4,2, pp. 224-232; and Olafson, E. et al. (1993) "Modern History of Child Sexual Abuse Awareness: Cycles of Discovery and Suppression." Child Abuse and Neglect, 17, pp. 7-24. 9 See Besharov, D.J. (1988) "The Need to Narrow the Grounds for State Intervention." In D.J. Besharov, ed., Protecting Children from Abuse and Neglect: Policy and Practice. Springfield: Charles Thomas; pp. 327-331; AAPC (1986) Highlights of Official Child Neglect and Abuse Reporting, 1984. Denver: American Association for Protecting Children; and Daro, 1988, cited at 1 supra. 10 BCMHR (1976) Annual Report of the Ministry of Human Resources, 1976. Victoria: Government Printer; BCMHR (1980) Annual Report, 1980. Victoria: Government Printer; BCMHR (1984) Supplement to the Annual Report, 1984. Victoria: Government Printer; Manitoba Child Abuse Registry (1987) "Report on Physically and Sexually Abused Children in Manitoba, 1986." Winnipeg: MCAR, April 1987; and for more recent statistics, FPWG. (1996) Child and Family Services Annual Statistical Report - 1992-93 to 1994-95. Ottawa: Federal-Provincial Working Group on Child and Family Services Information. April 1996. 11 See Chisholm, 1978 cited at 5 supra; Robertshaw, C. (1981) "Child Protection in Canada." Ottawa: Health and Welfare Canada; and for an overview, Lewit, E.M. (1994) "Reported Child Abuse and Neglect." The Future of Children, 4,2, pp. 233-242. 12 Badgley, R. et al. (1984) Sexual Offences Against Children: Report of the Committee on Sexual Offences against Children and Youths. Volumes 1 and 2. Ottawa: Ministries of Justice, Attorney General, and Health and Welfare. See Finkelhor, D. (1979) "Sexual Victimization of Children in a Normal Population." in D. Finkelhor, Sexual Victimized Children. New York: Free Press; and Sarafino, E. (1979) "An Estimate of Nationwide Incidence of Sexual Offenses Against Children." Child Welfare, lviii,2, 127-134. For an overview, see Finkelhor, D. (1994) "Current Information on the Scope and Nature of Child Sexual Abuse." The Future of Children, 4,2, pp. 31-53. 13 See National Institute for Social Work (1994) "Child Protection: Strategic Issues" London: NISW, Policy briefing no. 5, July 1994 available online: http://www.nisw.org.uk/polb/fulltext/niswpl5.html (28/07/98]]. 14 See Tomison, Adam (1995b) "Spotlight on Child Neglect." Issues in Child Abuse Prevention, 4, Winter 1995; available at the AIFS National Child Protection Clearing House Homepage: http://www.aifs.org.au/nch/issues4.html [28/07/98]. 15 The definition comes from FPWG, 1994 cited at 5 supra; emphasis added. And see CCCY (1989b) "Punishment is not Discipline: Corporal Punishment in Canada." For Canada's Children, 1,5, Sept. 1989; Miller, A. (1988) For Your Own Good: The roots of violence in child-rearing. London: Virago; Straus, M.A. (1994) Beating the Devil Out of Them: Corporal Punishment in American Families. New York: Lexington Books; Matthews, F. (1997) The Invisible Boy: Revisioning the Victimization of Male Children and Teens. Ottawa: Health Canada, National Clearinghouse on Family Violence discussion paper; Ramsburg, D. (1997) "The Debate over Spanking." ERIC Digest, available at the ERIC/EECE Clearinghouse Homepage; SCYBC (1994) "Children and Corporal Punishment." Society for Children and Youth of B.C., position statement 4, May 1994 in SCYBC (1997) A Kit about the UN Convention on the Rights of the Child. Vancouver: Society for Children and Youth of B.C.; and for an overview, Durrant, J. and Rose-Krasnor, L. (1995) "Corporal Punishment: Research Review and Policy Recommendations." Winnipeg: University of Manitoba, Department of Family Studies. 16 See Wolfe, D.A. et al. (1986) "Child Witnesses to Violence between Parents: Critical issues in behavioral and social adjustment." Journal of Abnormal Child Psychology, 14; 95-104; 156. Jaffe, P. et al. (1990) Children of Battered Women. Newbury Park, CA: Sage Press; Ilen, B. (1990) "Different Factions, Same Struggle - Can All the Forces Fighting Family Violence Learn to Work Together?" Vis-à-vis, 8,3, pp. 1,4; Allen, B. (1991) "Wife Abuse - The Impact on Children." Ottawa: National Clearinghouse on Family Violence fact sheet; Rodgers, K. (1994) "Wife Assault: The Findings of a National Survey." Juristat, 14,9; and for an overview, James, marianne (1994c) "Domestic Violence as a Form of Child Abuse: Identification and Prevention." In Issues in Child Abuse Prevention, 2, July 1994; available at the AIFS National Child Protection Clearing House Homepage: http://www.aifs.org.au/external/nch/issues2.html [28/07/98]. For some examples of definitions, see FPWG, 1994, cited at 5 supra. 17 Re boys as victims, see Oates, R.K. (1990) Understanding and Managing Child Sexual Abuse. New York: Harcourt, Brace and Jovanovitch; and VISAC (1993a) When Boys Have Been Sexually Abused. Vancouver: Family Services of Greater Vancouver. Re Sibling incest, see Meiselman, K. (1978) Incest: A Psychological Study of Causes and Effects with Treatment Recommendations. London: Jossey-Bass; Finkelhor, D. (1980) "Sex among Siblings: A survey of the prevalence, variety, and effects." Archives of Sexual Behavior, 9, pp. 171-194; and VISAC (1995) Sibling Sexual Abuse: A Guide for Parents. Vancouver: Family Services of Greater Vancouver. For an overview, see Matthews, 1997 cited at 15 supra. 18 For a review of the early literature, see Wachtel, A.D. (1992) Sexually Intrusive Children: A Review of the Literature. Vancouver: Greater Vancouver Mental Health Service Society. And see VISAC (1993b) When Children Act Out Sexually. Vancouver: Family Services of Greater Vancouver; and Hall, D.K. and Matthews, F. (1996) The Development of Sexual Behaviour Problems in Children and Youth. Toronto: Central Toronto Youth Services and The Crèche Child and Family Centre. 19 See Woititz, J.G. (1990) "The 13 Characteristics of Adult Children." Reprinted from Adult Children of Alcoholics, Expanded Edition. Health Communications, Inc. Available on "Dr. Jan's Place" Homepage: http://www.intac.com; Brave, L. (1991) "Healing Circle for Addictions Addresses Family Violence." Vis-à-vis, 8,4, p. 6; and, for an overview, Tomison, Adam (1996f) "Child Maltreatment and Substance Abuse." National Child Protection Clearing House, Discussion Paper #2; available at the AIFS National Child Protection Clearing House Homepage: http://www.aifs.org.au/external/nch/discussion2.html [28/07/98]. 20 But see Smith, B.E. (1995) "Prosecuting Child [Physical] Abuse Cases: Lessons Learned from the San Diego Experience." Summary available online: National Criminal Justice Reference Service. http://www.ncjrs.org/victchld.htm [28/07/98]. 21 For a review of the legislative changes, see Rogers, Rix (1990) Reaching for Solutions: Report of the Special Advisor to the Minister of National Health and Welfare on Child Sexual Abuse in Canada. Ottawa: Health and Welfare Canada; and CCSD (1990a) "News..." Vis-à-vis, 8,1, p. 3. For various initiatives to support child witnesses, see the work of the London Family Court Clinic: Jaffe, P.G. et al. (1986) "Promoting changes in attitudes and understanding of conflict among child witnesses of Family Violence." Canadian Journal of Behavioral Science, 18; 356-380; Sas, L. et al. (1991) Reducing the System-Induced Trauma for Child Sexual Abuse Victims. London, ON: London Family Court Clinic; and Sas, L. et al. (1993) Three Years After the Verdict: A longitudinal study of the social and psychological adjustment of child witnesses referred to the Child Witness Project. London, ON: London Family Court Clinic. Also see Campbell Research Associates (1992) Program Review of the Child Victim-Witness Support Project. Ottawa: Justice Canada, Research and Development Directorate; Sanfacon, D. et al. (1992) Processing Child Sexual Abuse Cases in Selected Sites in Quebec. Ottawa: Justice Canada, Research and Development Directorate; Ursel, E.J. (1994) "The Winnipeg Family Violence Court." Juristat, 14,12; Harvey, W. and Dauns, P.J. (1993) Child Witness Preparation Manual. Vancouver: Justice Institute of B.C.; Avison, N.H. (1994) Fragile Witnesses, Fragile Truths: A background paper on helping child witnesses. Report prepared for the Children's Bureau, Health Canada; McGee, S.A. (1996) "Helping Children Successfully Navigate the Justice System." NRCCSA News, 5,3, p. 6; and Wachtel, A.D. (1997) Court Design Issues Affecting Children and Other Vulnerable Witnesses: A Background Study. Vancouver: United Way of the Lower Mainland. 22 Tomison, 1995b cited at 14 supra. 23 For example, see McIllfaterick, T. (1994) "On Violence Against Women in Sport." Vis-à-vis, 11,4, p. 8; Tomison, Adam (1996b) "Child Maltreatment and Disability" in Issues in Child Abuse Prevention, 7, Summer 1996; available online: AIFS National Child Protection Clearing House: http://www.aifs.org.au/external/nch/issues7.html [28/07/98]. 24 Canadian Centre for Justice Statistics (1994) Family Violence in Canada - Current National Data. Ottawa: CCJS and Statistics Canada, June 1994. 25 Gil, E. (1982) "Institutional abuse of children in out-of-home care." In R. Hanson, ed., Institutional Abuse of Children and Youth. New York: Haworth Press. And see James, Marianne (1994a) "Child Abuse and Neglect: Incidence and Prevention." Issues in Child Abuse Prevention, no. 1, Jan. 1994 (Australian Institute for Family Studies, National Child Protection Clearing House) available at the AIFS National Child Protection Clearing House Homepage: http://www.aifs.org.au/external/nch/issues1.html [28/07/98]. 26 See CCCY (1989f) "Responding to Abuse: National Youth Serving Organizations Put the Child First." For Canada's Children, 1,5, Sept. 1989; p. 3; and BCMAG (1994) Help Stop Child Abuse: A Handbook for Employers and Volunteer Coordinators. Victoria: BC Ministry of Attorney General, June 1994. 27 See MacDonald, A. (1993) "Holistic Healing." Vis-à-vis, 10,4, pp. 5-6; Maracle, S. (1993) "A Historical Viewpoint." Vis-à-vis, 10,4, pp. 1,4; and White, L. and Jacobs, E. (1992) Liberating Our Children - Liberating Our Nations. Report of the Aboriginal Committee, Community Panel, Family and Children's Services Legislation Review in British Columbia. Victoria: Ministry of Social Services. 28 For example, see FPWG, 1994 cited at 5 supra; and BCMSS (1996a) Ministry of Social Services Annual Report, 1995/96. Available on the B.C. Ministry of Human Resources Website: http://www.mhr.gov.bc.ca/publicat/reports/ar9596.htm [28/07/98]. 29 See FPTWGP (1995) "Results of the National Consultation on Prostitution in Selected Jurisdictions: Interim Report." Ottawa: Federal-Provincial-Territorial Working group on Prostitution, October 1995; BCPIC (1997a) "Child Prostitution Deemed Sexual Abuse." B.C. Parents in Crisis Newsletter, 21,2; p. 15; and RCMP (1997c) "Protecting Children from Inappropriate Material on the Internet" [Online]. Available: http://www.rcmp-ccaps.com/parents.html. For some international context, see O'Brien, M. (1996) "The International Legal Framework and Current National Legislative and Enforcement Responses" Paper for the World Congress against Commercial Sexual Exploitation of Children; [online]. Available: http://www.childhub.chwebpub/scechome/2156.htm [28/07/98]. The State of the World's Children 1997; Focus on Child Labour. New York: Oxford University Press; and Hechler, David (1995) "Child Sex Tourism." [Online]. Available: http://childhub.ch/ webpub/scechome/2156.htm [28/07/98]. 30 See Smith, M.E. (1993) "Television Violence and Behavior: A Research Summary." ERIC Digest, ERIC Clearinghouse on Information and Technology, available on the ERIC Homepage; and Josephson, W.L. (1995) Television Violence: A Review of the Effects in Children of Different Ages. Ottawa: Heritage Canada. 31 Ellis, D. and DeKeseredy, W. (1995) Pre-Test Report on the Frequency, Severity and Patterning of Sibling Violence in Canadian Families. Toronto: LaMarsh Research Centre, York University. 32 See FPWG, 1994 cited at 5 supra; FPWG, 1996 cited at 10 supra; CCJS, 1994 cited at 24 supra; and Trocme, N. et al. (1994) The Ontario Incidence Study of Reported Child Abuse and Neglect. Toronto: Institute for the Prevention of Child Abuse. 33 Krugman, R.D. (1996) "The Media and Public Awareness of Child Abuse and Neglect: It's Time for a Change." Child Abuse and Neglect, 20,4, pp. 259-260. 34 For example, see Gove, T.J. (1995) Report of the Gove Inquiry into Child Protection in British Columbia, A Commission of Inquiry into the adequacy of the services, policies, and practices of the Ministry of Social Services as they relate to the apparent neglect, abuse, and death of Matthew John Vaudreuil. Vol. 3; executive summary. Victoria: BC Ministry of Social Services. Available at: http://bbs.qp.gov.bc.ca 35 See Morton, C. (1996) British Columbia's Child, Youth and Family Services System; Recommendations for Change. Report to Premier Glen Clark. Victoria; Queen's Printer for British Columbia; Morton, C. (1997) Report of the Children's Commissioner, The First Three Months. Executive summary available on the B.C. Children's Commission Homepage: http://www.childservices.gov.bc.ca; Ontario Child Mortality Task Force (1997a) Interim Report. Toronto: Ontario Association of Children's Aid Societies and the Office of the Chief Coroner, March 1997; Ontario Child Mortality Task Force (1997b) Final Report. Toronto: Ontario Association of Children's Aid Societies and the Office of the Chief Coroner, July 1997; Reid, G. et al. (1995) Basic Issues Concerning the Assessment of Risk in Child Welfare Work. Winnipeg: University of Manitoba, Faculties of Social Work and Medicine; and Advisory Board on Child Abuse and Neglect, U.S. Dept. of Health and Human Services (1996) A Nation's Shame: Fatal Child Abuse and Neglect in the United States: Executive Summary. At the Virtual Hospital Website: http://www.vh.org 36 See MacDonald, M. (1989) "News from the National Youth in Care Network." CCWA Newsletter, 4,1, pp. 4-5; and Raychaba, B. (1991) "National Youth in Care Network News." CCWA Newsletter, 4,2, p. 6. 37 For example, see White and Jacobs, 1992 cited at 27 supra. 38 See Rogers, 1990 cited at 21 supra; NCFV, 1986 cited at 21 aupra; CCCY (1990c) "Federal Children's Bureau to be Established" for Canada's Children, 2,5, Nov. 1990, p. 1; and PARD (1994) Report on the Interdepartmental Evaluation of the 1991-95 Family Violence Initiative. Ottawa: Program Audit and Review Directorate, Health and Welfare Canada. 39 CCWA (1989b) "International Congress on Working for Children's Rights." CCWA Newsletter, 4,2, p. 5. 40 CCCY, 1989f cited at 26 supra; Clark, D. and Clarke, M. (1990) "The United Nations Convention on the Rights of the Child." CCWA Newsletter, Summer 1990, p. 3; and CCCY (1990b) "Convention on the Rights of the Child: The priority of the 1990s." For Canada's Children, 2,1, Jan. 1990, pp. 1-2. 41 CCSD (1991a) "New Family Violence Initiative." Vis-à-vis, 9,2, p. 3. 42 Government of Canada (1992) Brighter Futures: Canada's action plan for children. Ottawa: Health and Welfare Canada. 43 Prilleltensky, I. (1994) "The United Nations Convention on the Rights of the Child: Implications for Children's Mental Health." Canadian Journal of Community Mental Health, 13,2, pp. 77-93. 44 CCSD (1996) The Progress of Canada's Children 1996. Ottawa: Canadian Council on Social Development. 45 Bagley, C. and Thurston, W.E. (1996) "Decreasing Child Sexual Abuse" in What Determines Health? Paper prepared for the National Forum on Health; summary available online: http://wwwnfh. hc-sc.gc.ca/publicat/execsumm/idxexsum.htm [30/07/98]. 46 See CWLC (1994) "Working Together for Canada's Children." Brochure. Ottawa: Child Welfare League of Canada. In 1994, the Child Welfare League of Canada amalgamated the collections of the CCCY, the CCWA, Children Enfants Jeunesse Youth, the Canadian Coalition for the Rights of Children, and its own resource library. CRCCY (1994) "Brochure." Ottawa: Canadian Resource Centre on Children and Youth; Child Welfare League of Canada. 47 Tomison, Adam (1996a) "Child Maltreatment and Family Structure." National Child Protection Clearing House, Australia; Discussion Paper #1, Winter 1996. Available at the AIES National Child Protection Clearing House Homepage: http://www.aifs.org.au/external/nch/discussionl.html [30/07/98] 48 Wolfe, D.A. (1996) "Prevention of Child Abuse and Neglect." Paper prepared for the National Forum on Health; summary available on its Homepage: http://www.nfh.phac-aspc.gc.ca 49 Landy, S. and Tam, K.K. (1996) "Yes, Parenting Does Make a Difference to the Development of Children in Canada." In HDRC (1996); Widom, C.S. (1995) "Victims of Childhood Sexual Abuse - Later Criminal Consequences." Available on the Justice Information Center Website: http://www.ncjrs.org/victhld.htm 50 See Bernard, B. (1995) "Fostering Resilience in Children" ERIC Digest, available at the ERIC/EECE Clearinghouse Homepage; and Steinhauer, P.D. (1996) "Developing Resiliency in Children from Disadvantaged Populations." Paper prepared for the National Forum on Health; summary available on its Homepage: http://wwwnfh.phac-aspc.gc.ca/ publicat/excsumm/idexsum.htm 51 Litty, C.G. et al. (1996) "Moderating Effects of Physical Abuse and Perceived Social Support on the Potential to Abuse." Child Abuse and Neglect, 20,4, pp. 305-314. 52 See Briere, J.N. and Elliott, D.M. (1994) "Immediate and Long-term Impacts of Child Sexual Abuse." The Future of Children, 4,2, pp. 54-69; BCPIC (1997b) "Alberta: Early Intervention and Juvenile Delinquency." B.C. Parents in Crisis Newsletter, 21,2, p. 14; and Wachtel, A.D. (1990) "Generic versus Targeted Approaches to Child Abuse Prevention." Canada's Mental Health, 38, 2/3, p. 27. 53 National Crime Prevention Council, Canada (1996) Preventing Crime by Investing in Families: An Integrated Approach to Promote Positive Outcomes in Children. Ottawa: National Crime Prevention Council, June 1996. 54 Rae Grant, N. (1994) "Preventive Interventions for Children and Adolescents: Where are we now and how far have we come?" Canadian Journal of Community Mental Health, 3,2, pp. 17-36; National Institute of Justice (1996) "The Cycle of Violence Revisited." [A prospective study]. NIJ Research Preview; available on its Website: http://www.ncjrs. org/victchld.htm [30/07/98] 55 Rae Grant, N. 1994 at 54 supra; Calvert, G. (1993) Preventing Child Abuse and Neglect: The National Strategy. Canberra: National Child Protection Council; and MacKillop, B. and Clarke, M. (1989) Safer Tomorrows Begin Today: Promoting Safer, Healthier Communities Through Early Investment in Children. Ottawa: CCCY. 56 For a discussion of these definitions as they apply to child abuse and neglect, see Daro 1994 cited in 7 supra. 57 Calvert, 1993 at 55 supra. 58 CAB (1995) "Speak Out Against Violence" available on the Canadian Association of Broadcasters Homepage: http://www. cab-acr.ca/about/news/private_bcasters.htm 59 CAB (1996a) "Violence: You Can Make a Difference" available on the Canadian Association of Broadcasters Homepage: http://www.cab-acr.ca/about/news/violence.htm [27/07/98] 60 For example, see CCSD (1990b) "Child Abuse and Neglect: A Handbook for Community Health Nurses." Vis-à-vis, 8,2, p. 12; CCSD (1990c) "Guidelines for Health Care Related to Abuse, Assault, Neglect, and Family Violence." Vis-à-vis, 8,2, p. 3; CCSD (1990d) "Breaking the Cycle of Family Violence." Vis-à-vis, 8,1, p. 3; CCSD (1990e) "Child Sexual Abuse - Guidelines for Community Workers" Vis-à-vis, 8,2; p. 3; BCMAG, 1994 cited at 26 supra; CCSD (1990f) "What to Do if a Child Tells You of Sexual Violence." Vis-à-vis, 8,1; p. 3; and SHRN (1997) "Supporting Families in Preventing Sexual Abuse: A New Resource from the Sexual Health Resource Network" B.C. Institute on Family Violence Newsletter, 6,1, Winter 1997; p. 11. 61 Colorado's Children's Campaign (1997) "Neighbors Working Together to Benefit Children" [Online]. National Association for the Education of Young Children. Available: http://www.naeyc.org/eyly/1996/eyly9610.htm [22/05/98]. 62 See Bettcher, C. and Rivkin, S. (1994) "Let's Talk about Touching: A Training Program for Early Childhood Educators." Vis-à-vis, 12,3, p. 9; and for a current listing of programs across Canada, RCMP (1997b) "Street Proofing Indices" available on the RCMP crime prevention/victim services Website: http://www.rcmp-ccaps. com/cpvs.htm [30/07/98] 63 For example, see CCSD (1991b) "Curriculum on Relationship Violence." Vis-à-vis, 9,4, p. 6-7; CCSD (1992c) "Dating Violence: A Discussion Guide." Vis-à-vis, 9,4, p. 11; CCSD (1992a) "Saying No...Is Saying Yes to Self-Respect." Vis-à-vis, 9,4, p. 5; CCSD (1991d) "Just a Kiss - A Photo Novella on Dating Violence." Vis-à-vis, 9,4; pp. 4-5; CCSD (1991c) "Violence in the Intimate Relationships of Teens: the VIRAJ Prevention Program." Vis-à-vis, 9,4, p. 6; RCMP (1997a) "Face It! Dating Violence is Not Love" available on the RCMP crime prevention/victim services Website: http://www.rcmp-ccaps.com/cpvs.htm and on the program Homepage: http://www.rcmp-ccaps.com/cpvs.htm and on the program Homepage: http://faceit.cyberus.ca; and CCSD (1991e) "Preventing Teen Dating Violence - Resources." Vis-à-vis, 9,4, 1991; p. 11. 64 See Manitoba Women's Directorate (1991) "Resources." Vis-à-vis, 9,4; p. 11; Royer, L. (1991) "Teaching Children Violence Prevention Through Conflict Resolution." Vis-à-vis, 9,3, 1991, pp. 8-9; Webster, H.L. and Parker, L. (1994) "Taming the Dragon: Does Anger Management Work with Preschool Children?" Vis-à-vis, 12,3, p. 5; Kalpatoo, T. and Newman, D. (1996a) Peer Mediation: A Manual for Elementary Schools. Surrey, B.C.: Conflict Resolution Centre; Maracle, 1993 cited at 27 supra; Tremblay, R. et al. (1994) "Can Physically Aggressive Boys Survive in School? A longitudinal study from kindergarten to high school." Toronto: Canadian Institute for Advanced Research, Working Paper HDWP-4, June 1994; Kalpatoo, T. and Newman, D. (1996b) Peer Mediation: A Manual for Secondary Schools. Surrey, B.C.: Conflict Resolution Centre; Gottlieb, B.H. (1996) "Strategies to Promote the Optimal Development of Canada's Youth." Paper prepared for the National Forum on Health; summary available on its Homepage: http://www.nfh.hc-sc.gc.ca/ publicat/execsumm/idxexsum.htm [30/07/98]; BCIFV (1994a) "First Nations Youth Violence Prevention Program." B.C. Institute on Family Violence Newsletter, 3,3, p. 6; Proulx, B.Z. (1996) "Leave Out Violence Photojournalism Project." Vis-à-vis, 13,2, p. 6; Pepler, D.J. et al. (1994) "An Evaluation of an Anti-Bullying Intervention in Toronto Schools, Canadian Journal of Community Mental Health, 13,2, pp. 95-110; and BCMSS (1996c) "If It's Too Good to be True" in Ministry of Social Services Annual Report, 1995/96. Available on the B.C. Ministry of Human Resources Website: http://www.mhr.gov.bc.ca/ publicat/reports/ar9596.htm [30/07/98] 65 James, Marianne (1994b) "Child Abuse Prevention: A Perspective on Parent Enhancement Programs from the United States." Issues in Child Abuse Prevention, 3, Dec. 1994; available at the AIES National Child Protection Clearing House Homepage: http://www. aifs.org.au/external/nch/issues3.html [28/07/98] 66 Haw, C.F. and Farnden, R. (1991) "Family Violence Prevention Through Marriage Preparation." Vis-à-vis, 9,3, pp. 6-7. 67 See Wolfe, D.A. (1991) Preventing Physical and Emotional Abuse of Children. New York: The Guildford Press; and Health Canada (1997a) "Minister Dingwall Launches Good Parenting Video." News release 1997-21, Mar. 21, 1997. Available on the Health Canada Webpage: http://www.phac-aspc.gc.ca/main/hc/web/english/archives/96-97/97_21e.htm [30/07/98] 68 See Merriam, B. (1994b) "Nobody's Perfect." Vis-à-vis, 12,3, p. 3; and BCMoH (1995) British Columbia Ministry of Health, Annual Report 1994/95. Available on the ministry Homepage: http://www.hlth. gov.bc.ca/cpa/annual/index.html [30/07/98] 69 Wolfe, 1996 cited at 48 supra. 70 James, 1994a cited at 25 supra; National Council of Welfare (1997) Healthy Parents, Healthy Babies. Ottawa: NCW; Steinhauer, 1996 cited at 50 supra; and OCMTF, 1997b cited at 35 supra. 71 MacKillop and Clarke, 1989 cited at 55 supra; Bertrand, J.E. (1996) "Enriching the Preschool Experiences of Children." Paper prepared for the National Forum on Health; summary available on its Homepage: http://www.nfh.phac-aspc.gc.ca/ publicat/execsumm/idxexsuf.htm [30/07/98]; and Minow, M. (1994) "Revisiting the Issues: Home Visiting." The Future of Children, 4,2, pp. 243-246. 72 ABCAN, 1996 cited at 35 supra. 73 James, 1994a cited at 70 supra. 74 BCRCHCandC (1991) Closer to Home: The Report of the British Columbia Royal Commission on Health Care and Costs [Seaton Report]. Victoria: Crown Publications; and Steinhauer, 1996 cited at 50 supra. 75 See NFHS (1997) "Healthy Choices, Healthy Babies." Available on the Northern Family Health Society, Prince George, Healthiest Babies Possible Website: http://members.pgonline.com/~nfhsbp/ [30/07/98]; BCMoH, 1995 cited at 68 supra; and Health Canada (1997b) "Community Action Program for Children and the Canada Prenatal Nutrition Program. Information sheet, February 1997. Available on the Health Canada Website: http://www.phac-aspc.gc.ca/ hppb/cny/cbp.html 76 For example, see IDP, Prince George (1997) "Infant Development Program" available on its Homepage: http://members.pgonline.com/~idpfam/index.html 77 See FAS/E Nation (1995) Newsletter of the B.C. FAS Resource Library; available at http://www.ccsa.ca/fasenatn.htm; FAS/E (1997) "The Fetal Alcohol Syndrome/Effects Homepage" at: http://members.aol.com/jshawdna/fashome.htm; and Health Canada (1996a) "Background information on FAS/FAE." News release 1996-72, October 16, 1996. Available on the Health Canada Website: http://www.hc-sc.gc.ca/main/hc/web/english/archives/96-97/96_72e.htm [24/07/98]. 78 CCCY (1990a) "Resource Services for Children." For Canada's Children, 2,1, Jan., 1990, p. 2. 79 Mayor's Task Force, 1991 cited at 13 supra. 80 Schweinhart, J.L. et al. (1986) "Consequences of three preschool curriculum models through age 15." Early Childhood Research Quarterly, 1,1, pp. 15-45. High Scope/Perry Preschool continued to produce educational materials and training aids for its model of preschool enrichment. 81 See AHSI (1995) "Aboriginal Head Start Initiative." Pamphlet; AHSI (1996a) "Aboriginal Head Start Initiative." AHSI Newsletter, 1,2, Spring 1996; and AHSI (1996b) "Summer Pilot Project." AHSI Newsletter, 1,2, p. 7. 82 Mosteller, F. (1995) "The Tennessee Study of Class Size in Early School Grades." The Future of Children, 5,2, Summer/Fall 1995, pp. 113-127; and BCPIC, 1997a cited at 29 supra. 83 Beaton, P. (1992) "Kids Help Phone Talks to Teens Involved in Dating Violence." Vis-à-vis, 9,4; p. 7. 84 Parents Anonymous, Inc. (1997) "About Parents Anonymous" available on the Kids Campaign Homepage: http://www.kidscampaigns.org/map.html; Gottlieb, 1996 cited at 64 supra. 85 BCPIC (1997f) [Masthead] B.C. Parents in Crisis Newsletter, 21,2; p. 2. 86 See Hopper, James (1997) "Sexual Abuse of Males: Prevalence, Lasting Effects, and Resources." [Online]. Available: http://www.jimhopper.com/male-ab [22/05/98]; and Legislative Analysts' Office, State of California (1996) Child Abuse and Neglect in California. (6 Parts), [Online]. Legislative Analysts' Office. Available: http://www.lao.ca.gov/cw11096toc.html [22/05/98]. 87 See note 21 supra. 88 See Bagley and Thurston, 1996 cited at 48 supra; Barbaree, H. et al. (1993) The Juvenile Sex Offender. New York: Guilford; and Becker, J.V. (1994) "Offenders: Characteristics and Treatment." The Future of Children, 4,2, pp. 176-197. 89 See Wolfe, 1996 cited at 48 supra. 90 This and the following quote are from Gomby, D.S. et al. (1995) "Long-Term Outcomes of Early Childhood Programs." The Future of Children, 5,3, Winter 1995, [Online]. Available: http://www.futureofchildren.org/ [22/05/98]. 91 Lawton, K.A. (1997) "Controversial Approach Aims to End Abuse, Keep Families Intact." American News Service, #HS89, available to subscribers on the ANS Homepage: http://www.americannews.com 92 BTFPS (1997) "Family Preservation Services." [Online]. Boys Town Family Preservation Services Division, National Resource and Training Center, Boys Town, NE. Available: http://www.ffbh.boystown.org/TourStore/nonjava_sites/newengln.html [22/05/98]; Washington State (1996) "Definition of Family Preservation Services" RCW 74.14C.020, [Online]. Washington State Legislature. Available: http://www.leg.wa.gov/pub/rcw/title_74/ chapter_014c/rcw_74_14c_020 [22/05/98]; Westat, Inc. et al. (1995) "A Review of Family Preservation and Family Reunification Programs." Background paper for the National Evaluation of Family Preservation Services, for the U.S. Department of Health and Human Services. 93 Lawton, 1997 cited at 91 supra. 94 Coleman, H. and Collins, D. (1997) "2-B-2: A long-term follow-up of ungovernable and abused children in a family preservation program: executive summary" [Online]. Wyoming Department of Health. Available: http://wdhfs.state.wy.us/~sross/2B2.HTM [22/05/98]; Littell, J.H. and Schuerman, J.R. (1995) "A Synthesis of Research on Family Preservation and Family Reunification Programs." Background paper for the National Evaluation of Family Preservation Services, for the U.S. Department of Health and Human Services. Westat, Inc. et al. 95 ABCAN, 1996 cited at 35 supra. 96 CCSD (1990h) "News..." Vis-à-vis, 8,3, p. 3; Buckel, K. (1995) "Hopes for the Next Generation: Working With Children and Youth." Vis-à-vis, 12,4; pp. 8-9; Merriam, B. (1996) "It's a Matter of Good Health: Stop Youth Violence." Vis-à-vis, 13,2, pp. 2-3; and Emberg, E. (1990) "Reception Classroom: Sensitivity toward mothers while providing a service for the children." Vis-à-vis, 8,3, pp. 5,7. For some additional examples, see James, 1994c cited at 16 supra. 97 HDRC (1996a) Growing Up in Canada: National Longitudinal Survey of Children and Youth. Ottawa: Human Resources Development Canada and Statistics Canada; HRDC (1996b) National Longitudinal Survey of Children and Youth: Evaluation Report. Ottawa: Human Resources Development Canada, October 1996; HRDC (1997b) "Growing Up in Canada: A detailed portrait of children and young people." Summary available on the NLSCY Homepage: http://www.hrdc-drhc.gc.ca/hrdc/corp/stratpol/arbsite/publish/backgr-f.html [24/07/98]. 98 Schene, P. (1996) "The Risk Assessment Roundtables: A Ten-Year Perspective." Protecting Children, 12,2, pp. 4-8; and English, D.T. (1996) "The Promise and Reality of Risk Assessment" Protecting Children, 12,2, pp. 9-14. 99 Schene, 1996 cited at 98 supra. 100 OCMTF, 1997b cited at 35 supra. 101 English, 1996 cited at 98 supra. 102 Reid et al., 1995 cited at 35 supra; Reid, G. et al., (1996) "Risk Assessment: Some Canadian Findings." Protecting Children, 12,2, pp. 24-31. 103 Trocme et al., 1994 cited at 32 supra. 104 OCMTF, 1997b cited at 35 supra. 105 BCMCF (1996b) The Risk Assessment model for Child Protection in British Columbia. Victoria: Government Printer; BCMCF (1997a) "Backgrounder: Initiative to Strengthen Child Protection in B.C." News release 97:066, Aug. 28, 1997. Available on the B.C. government Website: http://www.gov.bc.ca/newswire 106 MCSS, Ontario (1997) "New System to Help Prevent Child Abuse and Neglect." Ministry of Community and Social Services, Press Release 97-11, July 3, 1997; available on the Ontario Provincial Government Homepage: http://www.gov.on.ca/css/page/news/jul397.html [30/07/98] 107 U.K. Department of Health (1996) "Looking After Children: Good Parenting, Good Outcomes." Information Sheet. And see the risk reduction management plan section in BCMCF, 1996b cites at 105 supra. 108 Frank, J.W. and Mustard, J.F. (1995) "The Determinants of Health from a Historical Perspective." Daedalus, 123,4; available on the Metro Task Force on Services to Young Children and Families Website: http://children.metrotor.on.ca/taskforce/must.html [30/07/98]; and Wolfe, 1996 cited at 48 supra. 109 Health and Welfare, Canada (1986) Achieving health for all: A framework for health promotion. [Epp Report] Ottawa: Queen's Printer; WHO et al. (1986) The Ottawa Charter. Ottawa: WHO, Canadian Public Health Association, and Health and Welfare Canada. In fact, the policy language until the mid-1990s was health promotion, not population health. While both share a common conceptual basis, going back to the Lalonde Report, there has been considerable tension in the shift in terminology and emphasis that has occurred. For an attempt to bridge the two sets of concepts, see: Hamilton, Nancy and Bhatti, Tariqu (1996) "Population Health Promotion: An integrated model of population health and health promotion." Ottawa: Health Promotion Development Division, Health Canada. Available on the Health Canada Website: http://www. hc-sc.gc.ca/main/hppb/healthpromotiondevelopment. 110 For example, see CICH (1990) "The Health of Canada's Children: A CICH Profile Calls for a Comprehensive National Child Health Policy." CICH Newsletter, 12,1, pp. 1-2. 111 Cicchetti, D. (1989) "How Research on Child Maltreatment Has Informed the Study of Child Development." In D. Cicchetti and V. Carlson, eds., Child Maltreatment: Theory and research on the causes and consequences of child abuse and neglect. New York: Cambridge University Press. 112 Frank and Mustard, 1995 cited at 108 supra. 113 Mustard, J.F. (1996) "Major Technological Change..., Socio-Economic Changes..., and Health and Well-Being." Paper for the WHO/International Centre for Health and Society, UCL Workshop, Helsinki, June 8-9, 1996; National Council of Welfare, 1997 cited at 70 supra; and Gottlieb, 1996 cited at 64 supra. 114 Kotulak, R. (1996) Inside the Brain: Revolutionary Discoveries on How the Mind Works. Kansas City: Andrews and McNeal; Families and Work Institute (1996) "Rethinking the Brain - New Insights into Early Development," Conference Report - Brain Development in Young Children; New Frontiers for Research, Policy, and Practice, June 1996. 115 Nash, J.M. (1997) "Fertile Minds." Time, 149,5, Feb. 3, 1997 cover story. 116 Federal, Provincial and Territorial Advisory Committee on Population Health (1994) Strategies for Population Health: Investing in the Health of Canadians. Position paper for a meeting of the Ministers of Health, Halifax, September 1994. 117 Zero to Three (1992) "Heart Start: The Emotional Foundations of School Readiness." Summary [Online]. Available: http://www.zerotothree.org/sch_read.html [22/05/98]; and I Am Your Child (1997) "Brain Facts" [Online]. Available: http://www.iamyourchild.org/docs/bf-0.html [22/05/98]. 118 For example, see British Columbia, Provincial Health
Officer (1994) A Report on the Health of British Columbians: Provincial
Health Officer's Annual Report, 1994. Victoria: Ministry of Health
and Ministry Responsible for Seniors; and HRDC (1997a) "Linking
Home Environment and Child Development" in HRDC Applied Research
Bulletin, 3,1, Winter/Spring 1997; Available Online: HRDC.http:/www.hrdc-hrdc.gc.ca/hrdc/corp/stratpol/arbsite/publish/bulletin/vol3n1/V3n1C2e.html
[28/07/98]. 120 National Institute for Social Work (1996) "Social Exclusion, Civil Society, and Social Work: Strategic Issues." London: NISW, Policy briefing no. 18, Sept. 1996, available on the NISW Homepage: http://www.nisw.org.uk/polb/fulltext/niswb18.html [30/07/98] 121 Ontario Healthy Communities Coalition (1997) "History" [Online]. Available: http://www.opc.on.ca/ohcc/ [22/05/98]; and BCMoH, 1995 cited at 68 supra. 122 Nozick, M. (1992) No Place Like Home: Building Sustainable Communities. Ottawa: Canadian Council for Social Development. 123 NCREL (1993) "Integrating Community Services for Young Children and Their Families," a policy brief available at the North Central Regional Educational Laboratory Homepage: http://www.ncrel. org/sdrs/pbriefs/pbriefs/93/93-3huma.htm [30/07/98]; Best Start Project (1996) "Best Start: A Progress Report." Best Start: Community Action for Healthy Babies - Newsletter, Winter 1996/97, available through the Ontario Prevention Clearinghouse Homepage: http://www. opc.on.ca/beststart/newsletters/newsltr.htm; Government of Canada, 1992 cited at 42 supra; Steinhauer, 1996 cited at 50 supra. 124 BCCYS (1994a) "B.C. Community Action Program for Children: The CAPC Challenge." B.C. Child and Youth Secretariat Newsletter, Winter 94/95; pp. 1-3; Health Canada, 1997b cited at 75 supra. 125 See Garbarino, J. and Sherman, D. (1980) "High Risk Neighborhoods and High Risk Families: The human ecology of child maltreatment." Child Development, 51, pp. 188-198; Garbarino, J. (1982) Children and Families in the Social Environment. New York: Aldine; Lustig, D. and Fuchs, D. (1992) Building on the Strengths of Local Neighborhood: Social Network Ties for the Prevention of Child Maltreatment. Final report of the Neighborhood Parenting Support Project, Child and Family Service Research Group, Faculty of Social Work, University of Manitoba; and Steinhauer, 1996 cited at 50 supra. 126 Healthy Child Development Project, 1995 cited at 119 supra. 127 Febbraro, A. (1994) "Single Mothers 'At Risk' for Child Maltreatment." Canadian Journal of Community Mental Health, 13,4, pp. 47-60. 128 See Better Beginnings, Better Futures (1997) "What is Better Beginnings, Better Futures?" [Online]. Ontario Prevention Clearinghouse. Available: http://www.opc.on.ca/bbbf/ [22/05/98]; and Peters, R. (1994) "Better Beginnings, Better Futures: A Community-Based Approach to Primary Prevention." Canadian Journal of Community Mental Health, 13,2, pp. 183-188. 129 Centraide du Grand Montréal (1994) "1,2,3 GO! une Initiative d'Aide à la Petite Enfance." Background paper, December 1994; Bouchard, C. (1997) "The Community as a Participative Learning Environment: The Case of Centraide of Greater Montreal's 1,2,3 GO! Project." In C. Hertzman, ed. (forthcoming); and Bertrand, 1996 cited at 71 supra. 130 See Martens, T. et al. (1988) The Spirit Weeps. Edmonton: Nechi Institute; Van Bibber, R. and McLean, C. (1990) "Council for Yukon Indians Family Violence Project." Vis-à-vis, 8,3, pp. 7-8; Hodgson, M. (1990) "Support and Treatment for Victims and Offenders." Vis-à-vis, 7,4, pp. 5-6; Diabo, R. (1993) "Responsibility: An Alternative to Rights." Vis-à-vis, 10,4, p. 7; Graham, E. (1993) "Let the Healing Begin." Vis-à-vis, 10,4, p. 10; BCIFV (1994b) "Hey-way'-noqu' Healing Circle for Addictions Society." B.C. Institute on Family Violence Newsletter, 3,3, p. 8; and BCIFV (1994c) "Circle of Harmony Healing Society: Native Solutions to Native Problems by Native Peoples." B.C. Institute on Family Violence Newsletter, 3,3, p. 11. 131 Pennell, J. and Burford, G. (1994) "Widening the Circle: Family Group Decision Making." Journal of Child and Youth Care, 9,1, pp. 1-11; Burford, C. and Pennell, J. (1995) Family Group Decision-Making Project: Implementation Report Summary. St. John's: Memorial University, School of Social Work. 132 Pennell and Burford, 1994 cited at 131 supra. 133 For example, see HCDP, 1995; "Family SOS," cited at 119 supra; Community Panel... (1992) Making Changes - A Place to Start. Victoria: Community Panel Family and Children's Services Legislation Review in British Columbia. 134 BCMSS (1996b) "B.C. Child Protection System Overhauled to Better Ensure Safety of Children." B.C. Ministry of Social Services news release, Sept. 27, 1996. Available on the B.C. Government Homepage: http://www.ssrv.gov.bc.ca/ docs/Newsindx.htm [30/07/98] 135 National Forum on Health (1997) Canada Health Action: Building on the Legacy. 2 vols. Ottawa: NFH; British Columbia, Provincial Health Officer (1997) A Report on the Health of British Columbians: Provincial Health Officer's Annual Report, 1996. Victoria: Ministry of Health and Ministry Responsible for Seniors; Campaign 2000 (1996) Child Poverty in Canada: Report Card 1996. Toronto: Family Service Association; Canadian Public Health Association (1997) Health Impacts of Social and Economic Conditions: Implications for Public Policy. Ottawa: CPHA. Available on the Child and Family Homepage of CPHA: http://cfc_efc. ca/docs/0000/070.htm [30/07/98]; CWLC et al. (1997) Investing in Children - A Framework for Action. Ottawa: Child Welfare League of Canada, Ontario Association of Children's Aid Societies, Canadian Teachers' Association, Ottawa-Carleton Children's Aid Society, and Kid's Help Phone, Feb. 1997. |
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