Tackling the effects of poverty, or enabling parents to cope with them, are key components of many primary prevention interventions. While it is particularly difficult to demonstrate the cost-effectiveness of primary preventive strategies, this problem eases as we target interventions at those most at risk of developing particular problems. Essentially this is the rationale for screening groups at high risk within health services. Of course, the benefit of this approach depends on our ability to accurately identify those at risk, and to be able to provide effective preventive services. Our improved, as yet imperfect knowledge, of some of the factors which interact to increase the risk of child abuse and neglect, affords an opportunity to design interventions which, at least conceptually, have a chance of effecting change in areas over which we have some influence.

This is one reason for placing an emphasis on secondary prevention. Others include: (i) our limited success with post-maltreatment interventions (tertiary prevention) means it remains preferable to Endeavour to pre-empt the development of problems. This also maximizes the chances of good developmental outcomes for children (Jones, 2004. Pg 12). Children in poverty: Child development and public policy. Cambridge, MA: Cambridge University Press.; (ii) in some circumstances this can be done without reference to child protection services, thereby maintaining the positive emphasis on child and family well-being that makes primary prevention such an attractive option; (iii) we now have some promising indicators that some interventions can affect the changes we are seeking, and reduce the incidence of child maltreatment. Not surprisingly, we again encounter some problems in this literature. Whilst we may be better able to identify some individuals and groups as being at risk of maltreatment, it seems that as we move into the areas of secondary and tertiary prevention problems arise in relation to the families recruited to the studies. Distinctions between those 'at risk' and those who are deemed to have in fact physically or psychologically mistreated their children can become rather blurred, particularly as one moves away from physical injury per se. Many studies feature 'mixed' samples rather than samples which fall wholly into an 'at risk' or 'abusive' category, not least because many studies rely on referrals to and from child protection agencies where the categorization of families is often a difficult professional judgment (Huston, 2003-page 12). The technical challenges of conducting research in this field may make these problems difficult to avoid, but again it means that one has to be cautious in interpreting the results.

In several programs, case managers struggle to bring together their role in relation to a single client, such as a teen mother or a school age child, with their role in relation to the family as a whole. In these successful examples, case managers reported integrating those roles to see the child in a family context rather than advocating for one family member against another, but not all experiences were as successful. In addition, case managers operated with quite different levels of training in child development and family functioning; again, the examples illustrated in this paper show what is possible with training and, in several cases, expert backup support.

3. The following discusses the societal changes that should be made to protect children in the twenty-first century.

References:

Crosson-Tower, C. (2010). Understanding Child Abuse and Neglect Eighth Edition. Boston: Pearson Education Inc.

Jones, E.D. (2004). The North Lawndale Family Support Initiative: Findings from the interim process evaluation. Chicago, IL: National Center on Child Abuse Prevention Research Report.

Wolock, L, & Horowitz, B. (October 1984). Child maltreatment as a social problem: The neglect of neglect. American Journal of Orthopsychiatry, 54, 530-543.

Children who are growing up in poverty or other kinds of need are likely to come into contact with other large public agencies besides the welfare system (Crosson, 2010. Pg 206): the public schools, community health clinics or city hospitals, and, perhaps, sadly, the state's child protective services agency. What are the implications of the findings presented here for the other large public agencies that see poor children and families? To put the question slightly differently, what principles would we apply to each system if we wanted to create a coherent network of services to children? While this study was not designed to investigate other service systems in any detail, the research sites do suggest several intriguing speculations. First, other agencies besides the welfare department can and should consider what it means to be two-generational. As the research sites and the evidence of...

Pg 11). A number of program examples from the site visits and other sources illustrate what it means for service providers other than the welfare department to be two-generational in their focus:
The PACE program in Kentucky, with its combination of adult literacy and preschool education operates within the public schools. In addition to offering two-generational services to families that are directly enrolled in PACE, the program director sees PACE as a vehicle for changing the thinking of the public schools toward a greater inclusion of parents and other family members.

Child protective services workers in several of the research sites found that working with intensive case managers helped them appreciate the demands on parents that made it difficult for the latter, in turn, to respond to the needs of the child. This insight lies behind a variety of family support and family preservation programs now being deployed as part of the child welfare services continuum in a number of states. The aim of these programs is to offer services to both parent and child to improve family functioning and enable the child to stay in the home (Wolock, 1984. 541). Visiting nurse programs enable health care providers to see parents and children together and serve the whole family. Maternal and child health clinics with other collocated services also offer the opportunity to meet the needs of several family members.

In several locations in New England, Head Start programs are planning or already operating programs jointly with education and training programs for mothers on welfare. These programs include cooperative projects with vocational high schools and with a community training agency. The ways in which welfare agencies have overcome these barriers may well offer insights to other agencies (Jones, 2004). For example, welfare agencies at the successful sites have overcome the limitations of their initial mandate by developing a clear and sustainable mission that makes dear why services to children and families are part of the welfare agency's job. In order to expand services, schools, health clinics, and child protective services agencies may similarly need to articulate connections between an initial, narrower mission and the broader, family-centered mission that they would like to achieve (Crosson, 2010. Pg 16). Thus, schools may conclude that they cannot teach children without a collaborative relationship with parents, that they cannot teach children without addressing the problems that keep them from being ready to learn, or that they cannot teach teen mothers effectively without addressing their roles as parents as well as students. Child protective services agencies may conclude that functions such as enhancing family stability and averting foster care are more effective over the long run than providing after-the-fact treatment.

4. Discuss the key similarities and the differences between the residual effects of neglect, physical abuse, and sexual abuse. What implications does this knowledge have for future prevention, intervention and treatment efforts?