Child Protection. Freda Briggs

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СКАЧАТЬ was brought to the notice of medical professionals in 1961 when Dr Henry C. Kempe and his American colleagues presented a paper entitled, “The Battered Child Syndrome” at the 30th Annual Meeting of the American Academy of Paediatrics in Chicago (October 3rd). This paper was published in the Journal of the American Medical Association a year later (181-1:17-24). Kempe was concerned that children’s x-rays often showed unexplained fractures. He deliberately used the emotive term “baby-battering” to draw attention to a problem that he found to be far more widespread than was recognised. This gradually gave way to the more general term “child abuse” to include older children and sexual, physical and emotional abuse and neglect and damaging exploitation. Until that time, doctors were reluctant to accept that parents, least of all mothers, were capable of injuring their own sons and daughters.

      Kempe and colleagues surveyed 71 American hospitals and found 302 cases of battered children; 33 died and 85 were brain-damaged. Seventy-seven District Attorneys disclosed 447 cases in one year. Forty-five children died and 29 were brain-injured. Kempe emphasised that the problem was not confined to the poor but could be found across all social groups. Kempe’s article was later cited by the American Medical Association as one of the most important contributions to American medicine in the 20th century.

      In 1972, the National Center for the Prevention and Treatment of Child Abuse and Neglect was established at the University of Colorado as a national resource, later re-named the Kempe Children’s Center. In 1977 Kempe established the prestigious journal Child Abuse and Neglect: The International Journal published for ISPCAN, The International Society for the Prevention of Child Abuse and Neglect which offers annual conferences and training institutes worldwide.

      The first major Australian child protection initiative was a conference on “non-accidental injury” (1973) organised by the Princess Margaret Hospital, Perth⁷⁸ with Dr Henry Kempe as keynote speaker. The publicity surrounding the conference led to responsibility for child protection being transferred from charities to government departments, the emphasis remaining on physical abuse.

      ISPCAN held its 6th bi-annual Conference on Child Abuse and Neglect in Sydney in 1986 attended by a record 1600 people. By that time, child protection was no longer the sole domain of the medical profession. At that conference, psychiatrist Dr Roland Summit presented his influential paper, “The Child Sexual Abuse Accommodation Syndrome” explaining for the first time how children react to sexual abuse⁷⁹.

      Australian child protection pioneers

      Foremost among Australian child protection pioneers were Victoria’s long serving police surgeon Dr John Henry Winter Birrell and his paediatrician brother, Robert. In 1966 they published a paper entitled, “The Maltreatment Syndrome in Children” in the Medical Journal of Australia. They documented the non-accidental injuries of children admitted to Melbourne’s Royal Children’s Hospital. In the same issue was Dr Dora Bialestock’s paper on her examination of 289 babies who were consecutively admitted to the care of the state. This revealed significant developmental delay associated with neglect⁸⁰. The next influential article was again authored by the Birrell brothers⁸¹. This described the state of 42 maltreated children seen over an eleven-month period. The doctors also recorded parents’ incredible explanations for children’s serious injuries.

      The Birrells were ahead of their time in their recommendations. They accepted that punishment was not the answer given that many parents had themselves been abused in childhood and abuse was learned behaviour. They recommended psychiatric help for parents and child victims, the use of multi-disciplinary teams, a central register of abusers/victims, child abuse education for health workers and medical staff and the introduction of mandatory reporting legislation to make reporting compulsory. It took the Victorian Government another 25 years to respond to these recommendations.

      Their contention that child maltreatment was a widespread problem in Victoria received no support from the state government or even the Children’s Hospital. The suggestion that a child protection unit should be established was treated with derision. The hospital was known to have dismissed the problem of gonorrhoea in children as caused by “infected linen” and staff responded to the deliberate burning of children with “ongoing observations”⁸².

      Although the counting of child abuse cases began in Australia and New Zealand in 1972^83,84, there were no reliable studies that could estimate the extent of child abuse even in the 1980s and, furthermore, the Australian Research Council had no category of funding that included child abuse or protection. The lack of incidence and prevalence data made it easy for professionals and politicians to deny that child abuse occurred.

      The damaging long-term influence of Britain’s Poor Law

      Historians Dickey, Martin and Oxenberry⁸⁵ showed that prior to the 1960s, Australian policies and practices continued to reflect attitudes associated with the English Poor Law of 1834 which was abandoned in Britain in 1946 with the introduction of the National Health Service. In other words, they were based on the belief that poverty was self-inflicted and people were poor because they were “morally deficient” and idle. There was a widespread belief among the well-endowed that the poor could help themselves and, if they didn’t, they should be punished. Practical and financial assistance were discouraged. It was considered shameful to seek help from charities and charities in turn were accused of encouraging the morally deficient to relapse into idleness. While social welfare department annual reports gave the impression that management knew what was needed for healthy child development, there was little acknowledgement of a collective responsibility for assisting children in impoverished circumstances. The solution was to place them in vast institutions to be cared for by a succession of untrained or minimally trained workers. This practice continued into the early 1980s, more than a quarter of a century after John Bowlby (1951) and the World Health Organisation drew attention to the long-term damaging effects of the institutionalisation of children and the need for consistent, safe, affectionate care⁸⁶. The message was vividly brought to Australia by Drs James and Joyce Robertson who recorded on film the responses of children entering group care, foster care and hospitals⁸⁷. Their messages relating to children’s emotional needs, attachment, bonding, security and preparation for change were taken on board by hospitals but appear to have been largely ignored by Family Courts and those responsible for children in foster care.

      Dickey et al. (1986) confirmed that, in the meantime, although the Department gave lip-service to the importance of training for child welfare workers, the preferred qualification for children’s social workers in South Australia was membership of a centrally situated protestant church.

      American research initiatives

      Dr. Murray A. Straus founded the Family Violence Research Laboratory in 1975 at the University of New Hampshire at Durham. This unique centre gained international recognition for its seminal research into family violence. In the 1980s, Straus’ colleague, Dr. David Finkelhor, became co-director of Family Research and Director of the Crimes Against Children Research Centre which investigated and published findings on child sexual abuse. The University of New Hampshire takes a holistic view of family life, violence and abuse, including the physical, sexual and psychological abuse and physical punishment of children; domestic violence; intra-familial homicide; sibling and peer victimisation; pornography and missing and abducted children.

      The introduction of Rape Crisis Centres

      American rape crisis centres were established from 1972 in cities where women were politically active. Phone-ins were held to encourage victims to expose their abusive experiences and results were publicised. As more and more women broke their silence, a grassroots movement took shape with influential middle-class women taking part in political activism.

      State-funded centres opened in Australia. They too held phone-ins which, for the very first time, exposed the extent of father-daughter СКАЧАТЬ