Dissertation Initial Proposal: Understanding Child Abuse

L600 Health And Social Care Management

Background

Background

Child abuse, commonly known as child maltreatment, refers to the sexual, physical or psychological neglect and maltreatment of children, by their parents and caregivers (Annerbäck et al. 2012). Child abuse therefore results in potential or actual damage to the child. Incidents of child abuse are commonly reported from home, schools, and organizations or within the community (Afifi et al. 2014). Although the terms child maltreatment and abuse used interchangeably, maltreatment denotes exploitation, trafficking and neglect (Thomas and Zimmer-Gembeck 2012). According to research evidences, every year, there are millions of children experiencing trauma. The rates of child abuse have increased over the past two decades, thereby affecting the lives of millions. History of child physical abuse were reported by more than 8% of the US-born individuals, selected by the research study (Sugaya et al. 2012). The World Health Organisation, states that there are 4 different types of child abuse namely, sexual abuse, physical abuse, neglect, emotional and psychological abuse (Who.int 2018). The term physical abuse refers to the intentional use of physical forces against children, which increases the likelihood of potential harm for survival, health, dignity and development of the children.

Most commonly, it includes beating, hitting, shaking, kicking, strangling, biting, buring, scalding, suffocating or poisoning (Ji and Finkelhor 2015). Most cases of physical violence are reported from homes, with the object of taking strict actions or punishing the children. On the other hand, sexual abuse refers to the abuse or ill treatment, which occurs due to sexual stimulation. Children are forcibly made to participate in sexual acts that aim towards financial profit or physical gratification of the culprit. These result in depression, self-blame, nightmares, flashbacks and insomnia among the children and often increase the risk of acquiring sexually transmitted diseases (Norman et al. 2012). In addition, neglect encompasses failure of the parents to fulfil their responsibility of taking care of their child, while providing adequate amount of foods, clothing, medical care, shelter and supervision, with the aim of improving the overall health, wellbeing and safety of the child (Sperry and Widom 2013). Such neglect may lead to delay in psychosocial and physical development and possibly results in impaired neuropsychological functions.

One of the first reports of child neglect and abuse was reported in the United States in 1874. The incident is commonly referred to as case of Mary Ellen Wilson, and involved abuse of an eight year old child Mary Ellen, by two perpetrators, Mary Connolly and her husband Francis Connolly. Upon registration of reports by their neighbour, the wife and husband were sent to prison, following which, Mary Ellen was placed into a safer home (Mallon 2013). The New York Society for the Prevention of Cruelty to Children (SPCC) was the first organization that began investigation of child abuse cases and started to advocate for the victimised children. Recently, the society has identified the need of protecting the children. The UK government plays a major role in identifying child abuse as a crime and works towards preventing such ill treatment towards children through enforcement of appropriate legislations and policies. The dissertation will try to evaluate the effectiveness of strategies that can be implemented by the government to reduce rates of child abuse by their parents.

Research Objectives

Child abuse is recognized as the topic of this dissertation owing to its high prevalence in the society (Lonne and Parton 2014). According to the National Society for the Prevention of Cruelty to Children (NSPCC) there were more than 58,000 children victims of child abuse in the UK in 2016 (Nspcc.org.uk 2018). Statistical data reveal that around 46% of child protection plans focus on child neglect and more than half of the total number of children are taken to care homes due to neglect or abuse. Furthermore, official statistics hint at providing support to over 22,000 children, against abuse, in Northern Ireland (Nspcc.org.uk 2018). The fight to reduce the incidence of child abuse and advocate for the wellbeing and safety of all children has been a struggle since the past decade. Several laws and legislations have also been imposed over the years, with the aim of ensuring children safety. However, most child abuse incidents go unreported due to the stigmas and stereotypes associated with this sensitive issue.

The primary objective of the research is related to identifying prevalence of child abuse and victimisation rates experienced by youth and adolescents in their childhood. The research will also aim to investigate underlying factors or reasons that create an influence on disclosure of such incidents to close relatives.

• Determination of whether incidents of child abuse and victimisation are reported by the victims in their adolescents and youth and estimating the prevalence of such incidents

Initially, incidents that occurred within the premises of one’s home were regarded as a private and family matter. Public usually excluded these incidents from monitoring and scrutiny. A sudden increase has been observed in awareness on seriousness and severity of such incidents that can be categorized as child neglect and abuse, since the past two decades (McElvaney 2015). It is recently considered not only as a crucial societal problem but as a major form of offense against childhood and innocence (Wood et al. 2012). This directly contributed to the increase in legislations and criminal processes that address such family violence. Child abuse is therefore a major problem throughout the world and the mistreatment demonstrated towards children is of huge concern. Owing to the fact that this issue impacts all people at some point of their lives and creates negative impact on the overall wellbeing of a child, it deserves attention (Louwers et al. 2012).

In recent years, practitioners and researchers of child maltreatment have recognized a complex connection of several factors that results in most child maltreatment incidents (Van der Kolk 2017). These factors encompass family history, personality, and community context. According to the widely accepted ecological theory, familial, individual, societal, and community factors interact with each other to elevate or reduce susceptibility to child maltreatment (Gilbert et al. 2012).

Research Aim

Thus, effective and prompt responses to child neglect and abuse are required to ameliorate children against the ill effects of such treatment. Abused children are likely to suffer from a plethora of psychological problems such as reduced cognitive development, depression, attention deficit disorders, and poor emotional stability (Cook et al. 2017). Therefore, there is a need to understand the rates at which children suffer from such maltreatment and victimisation, and what factors prevent them from disclosing such information to their parents or guardians. This will help in identifying the needs of the target population and providing adequate support to close the existing research gap.

Do the victims report incidents of child abuse in their youth, and how often do they experience such abuse related incidents?

Youth are found to discuss child maltreatment incidents that occurred during their early years on direct inquiry or with the use of self-administered surveys.

Literature review refers to texts of scholarly papers that include current knowledge, which encompasses methodological and theoretical data, in addition to substantial findings. In other words, it acts as secondary source of information and form the foundation of academic research (Machi and McEvoy 2016). Conducting a literature review presented findings that provided context for the research objectives. It involved an exhaustive search of 3 online databases namely, CINAHL, MEDLINE and PubMed. Inclusion criteria contained articles that were published in English and not prior to 2012. Abstracts, unpublished manuscripts and articles published in other languages, before 2012 were not included in the search. The search was conducted using several keywords such as, “child”, “children”, “infants”, “abuse”, “neglect”, “maltreatment”, “parents”, “elders”, “adults”, “caregivers”, “physical”, “sexual”, “emotional”, “mental”, “harm”, “injuries”, “disclosure”, “reveal”, “prevalence”, “self-reports”, “laws”, “policies”. The search was further narrowed using boolean operators, namely, ‘AND’, ‘OR’, and ‘NOT’. Use of these boolean operators helped in excluding articles that were not relevant to the research objective.

According to research studies, degree of reported family violence that results in child abuse is quite large and is most likely attributed to several years of improper socialization. Child abuse tolerance by one generation forces it upon the next (Sperry and Widom 2013). Barbara Lowenthal identified several signs and symptoms of physical and emotional abuse an article named, ‘Educational Implications of Child Abuse’. She confirmed presence of cuts, bites, welts, fractures, and burns as signs of physical abuse upon a child (Goldman and Bode 2012). Presence of any injury that is inconsistent with the nature of the sign or reports of such injuries made by a child caregiver is also regarded threatening. Evidences therefore suggest that incident such maltreatment and abuse make a child startled or extremely fearful (Widom, Czaja and Dutton 2014).

Problem Statement

Signs of emotional abuse among children are diagnosed as impairment in the sense of self worth, intense fears, failure to thrive adequately, depression, anger, delayed emotional and intellectual development, extreme aggression or passiveness. Thus, abused children are at an increased likelihood of feeling unworthy of themselves, which in turn isolates them and results in social withdrawal (Young and Widom 2014). Research findings indicate that more than 1 million cases of child abuse are reported on an annual basis, on a global scale. Researchers estimate the numbers to be higher, owing to the fact that such incidents are not always recognized on time, leading to a failure in reporting. While male and females are often found to be at a similar risk of experiencing abusive behaviours, differences in their perpetrator contribute to changes in the rates of child abuse. While boys are more likely to face abuse by teachers or other unfamiliar person, girls are susceptible to abuse by family members and care givers (MacMillan et al. 2013). Highest rates of victimization are faced by infants and children till 4 years of age. With an increase in age, children become less likely to abuse except when it encompasses inappropriate sexual behaviour (Hamilton?Giachritsis and Pellai 2017).

Furthermore, disabled children have been found to be four times more likely to physical and emotional abuse than non-disabled children. Researches elaborate on the fact that attitudes and false assumptions on disabled people often makes these abuses go unreported and unrecognized. Findings also indicate failure among such children to disclose whether they have been abused, which in turn worsens their symptoms (Annerbäck et al. 2012). Moreover, according to research studies, parents who have experienced abuse or trauma in childhood are more likely to abuse their children. Most common factors that contribute to abuse, as identified by researchers are namely, poverty, having closely spaced children, and teenage pregnancy. High conflict levels in one’s family and unrealistic expectations result in negative attitude towards children (Kanbay, Aslan and I?ik 2016).

Studies have recognized the importance of family strengthening and support, for the purpose of child abuse prevention. This in turn will help to avoid long-terms implications of child maltreatment. Thus, earlier a treatment begins, it will be more effective. This will also reduce rates of recurrence (Fergusson, McLeod and Horwood 2013). Families have been identified as a critical and integral component of several interventions, the primary objective of which is directed towards improving social and academic outcomes for infants and children. Therefore, implementation of family strengthening program that create opportunities for educating parents, develop social connections, and make children competent for providing emotional and social support to child victims, will help in creating a sustained and deliberate effort that will ensure presence of adequate opportunities, networks and relationships, to raise their children (Brook, McDonald and Yan 2012). These programs has been proved to exert positive impact on the relationship between parents and child, family environment, and family involvement, thereby enhancing child outcomes (Damashek, Nelson and Bonner 2013). Regular referral of child abuse incidents to the government or local council have shown been found to act as an effective early intervention system that ensures fulfilment of all behavioural and developmental needs of a child.

Rationale of the Study

According to research evidences, attainment of a sound understanding of the underlying factors that contribute to child abuse and neglect help in identification and implementation of effective response strategies. These responses are generally based on a systems perspective. Thus, recognition of child abuse as a global public health concern encompasses a plethora of embedded systems, which are engaged in a positive and negative manner with the aim of designing, sustaining, and giving a response to the issue (Joe-Akunne and Okoye 2017). These systems have been found to include family systems, individual development, service systems and social relationship systems that are regulated or governed by local or national organizations. Findings indicate the operation of interplay of complex and interdependent factors that help in solving efforts of the problem (Fallon et al. 2013).  

Several systems thinking approaches have been adopted for protection of children in their familiar surroundings, on a global scale. Researchers emphasise on the fact that children are considered in regards of being embedded or nested in respective communities and families that ct as interacting structures, thereby directly creating an impact. Conversely, consideration of all kinds of abuse related issues without focusing on a systems approach, results in an incomplete exercise (Mills et al. 2013). Thus, with respect to the perspectives of existing child protection systems, most systems working with the vulnerable population of children should work in collaboration for achieving effective results. According to research studies, failures in effective implementation of programs and policies result in failure of the entire system as a whole. Such failures have been attributed to unsustainable goals and objectives of the concerned system. Implementations of approach, which fail in achieving the intended results, contribute to unintended consequences. These consequences are most often found to worsen the initial problem of abuse.  Drift of goals, mis-specified ends, and low investment in capacity of the recognized framework and delay in obtaining appropriate benefits related to prevention of child abuse are the most common system failures (Norman et al. 2012).

Findings illustrate the fact that laws and legislations on child abuse and neglect vary in terms of their definition. While some countries define adult citizens irrespective of any factor, as the mandated reporters, there are certain countries that specify groups of professionals working with children as major reporters. Most often mandated reporters and other professionals have been found to be legally protected in the context of good faith reports. Failure to report incidents of child abuse results in prosecution of the person (Gould et al. 2012).

Research Question

According to research studies, physical abuse of children is considered a criminal offense unless the behaviour manifested by parents falls within exception for all kinds of corporal punishment. Thus, findings suggest that physical abuse cases are more likely to be categorised as misdemeanours. However, they are considered of criminal offense by most state laws when children get severely injured or die (Douglas and Mohn 2014). Research findings emphasise on consideration of failure to protect, supervise, or provide holistic care to a child as considerable amount of negligent treatment (Usakli 2012). This forms the foundation of laws that prosecute people involved in child neglect and endangerment (Herrenkohl et al. 2013).

However, several studies have been conducted that illustrate the fact that all cases of child neglect and abuse do not fall within the formulated definitions of criminal offense. This results in failure of complete investigation of such cases by the law enforcement, thereby preventing prosecution of the parents and caregivers. Such findings have been attributed to the fact that investigations and prosecutions most commonly focus on sexual abuse, thereby neglecting severe physical abuse incidents that inflict serious harm on children (Pelton 2015). According to the 1993 report by the National Research Council, issues related to child abuse and neglect were correlated to impact of socio-cultural factors that were marginally addressed. The report often implied that socio-economic and racial dimensions of child abuse represented cultural effect (National Research Council 2014).

Similar findings have been reported by other case studies that focus on child abuse laws concerned with parental misbehaviour such as, commission or omission, which places a child in jeopardy. Furthermore, failure to provide basic needs such as, adequate food, medical care, clothing, hygiene, safe shelter and school attendance have been recognized as major forms of child abuse. Key findings from several researches elaborate on the fact that impact of child abuse is most often externalized (Ensink et al. 2016). This makes the victim act out and the maltreatment directly affects their behaviour (Mersky, Topitzes and Reynolds 2013). On the other hand, internalized impact manifests itself in the form of social isolation, withdrawal and depression. According to various reports, child abuse and neglect inflicted upon them by their guardians or parents have been found to be associated with poorer emotional wellbeing of the children (Young and Widom 2014). This most commonly includes current thoughts on self-destructive behaviour, and suicidal ideation. Furthermore, witnessing domestic violence has also been correlated to poor emotional wellbeing. Similar findings were reported by other scientists who associated high levels of delinquent behaviour with experiences of physical violence from parents (Ji, Finkelhor and Dunne 2013). According to studies, children subjected to maltreatment are more likely to demonstrate suicidal ideation and more susceptible to manifest self-harm thoughts, later in life (Easton, Renner and O’Leary 2013). These findings established the fact that children act as poly-victims and are extremely vulnerable to abuse by their guardians (Cross et al. 2012).

Thesis Statement

Several studies have been conducted that identify specific time periods when child maltreatment reached significant high levels in the UK (Jaffee et al. 2013). These time periods have been accordingly recognized as from 1870s to 1914, mid 1960s to late 1980s, and from 2003 to the present day. This led to the development of the term ‘battered babies’ by Dr. Henry Kempe, an American paediatrician, who focused on presence of unrecognized trauma fracture (physical injuries such as, hematoma, contusions and fractures) among children exposed to abusive behaviour (Radford et al. 2013). Persistence of child maltreatment therefore have been considered as indicators of failure in meeting expressed commitment of the laws enforced by a state towards children rights. It has been argued that the UK is found at the bottom of the list based on strategies and policies directed towards safeguarding children, when compared to other countries, such as, Western Europe (Lonne and Parton 2014).

Evidences from several research studies have focused on the effectiveness of major interventions that target parents, found to be abusive. While few interventions have been found to explicitly prevent child maltreatment, almost all have illustrated the importance of programs that are directed towards assisting parents and guardians in developing appropriate expectations of their child, learning to treat them with nurturance and empathy, and implementing positive discipline in place of corporal punishment (Easton, Renner and O’Leary 2013). Studies have also investigated effectiveness of traditional child welfare approaches. Findings illustrate that these traditional approaches generally focus on physical injuries, child custody and risk of recurrent harms (Barth, Barth and Barth 2017). These approaches have been found to have strong orientation for criminal justice (Sugaya et al. 2012). Researchers agree on the fact that the proportion of vulnerable families is quite large and their inclusion under the law would directly facilitate all children to derive benefit from the existing supports and services (Sparks 2013). These laws and other social support networks have been found to foster formal and informal connections among children and their guardians, thereby facilitating development of family strength (Pérez-Fuentes et al. 2013). This in turn has reported significant positive impacts in lowering incidence rates of child neglect and abuse.

Furthermore, these legislations have been found to stress on parent education programs, in addition to implementation o abuse prevention acts. While some laws and policies operate at community levels, there are others, which adopt a direct approach for working in collaboration with individuals or small groups. However, despite the strict vigilance of these agencies, some incidents of abuse still go unreported. Some of the major factors that have been identified responsible for failure to report include poor nature and level of response towards the incident, inability to understand risks that a child subjected to abuse faces, and failure in sharing information (Leventhal and Krugman 2012).

Literature Review

This results in missed opportunities that prevent people from taking right decisions. Thus, child protection reforms are important in that they help in ensuring that all children are protected in the best possible way. These reforms emphasise on robust and strong social work practice that employs qualified and well trained workers to make correct decisions for the vulnerable children. There are three levels of skills and knowledge statement for matching the proposed reforms namely, practice supervisor, frontline practitioner and practice leader (McFadden, Campbell and Taylor 2014). Furthermore, the police are imperative in responding effectively against child abuse reports. Thus, it can be stated that formulation and implementation of child protection reforms and policies are essential to prevent parents from manifesting behaviour that causes physical, emotional or sexual harm to their children (Pietrantonio et al. 2013).

According to research findings conducting a literature study is necessary in order to gain a sound understanding of the meaning and nature of the purpose or problem, which has been identified in the research (Aveyard 2014). They specifically focused on prevention of child abuse and neglect. Furthermore, this review also helped in gathering information about the role of family members and family support in prevention of child maltreatment practices. The study was principally based on a qualitative research approach. A qualitative research design primarily focuses on an exhaustive interactive process between two people, namely the researcher and the subject (Lewis 2015). This forms the foundation of authenticity. Qualitative research approaches are also situational constrained, which is established by the fact that less number of subjects or cases are used in the research, and the researcher is completely involved during gathering of information or data (Lewis 2015).

This statement is supported by other studies which state that a qualitative approach is conducted in order to describe a social reality, taking the perception and point of view of the respondents or participants, staying within the system that is being studied for the research (Maxwell 2012). The research design assumed that the participants, young people and adolescents who form the target population of suffering from abuse are a crucial part of the social situation and the best candidates to inform the researchers about their views and experiences in relation to success of prevalence of child abuse and its subsequent disclosure. From this qualitative perspective, the research was concerned with providing a thorough understanding and description of the rates at which children are victimised on a global scale and the factors that make them disclose about the events. It also aimed to conduct a subjective exploration of the existing reality from the perspectives of the children regarded their perpetrators (known or unknown) who are responsible for abusing or maltreating the victims. The study was therefore focused on the qualitative approach of conducting a systematic review for gaining a deeper insight into prevalence of child maltreatment and abuse, association of their frequency with gender differences and the potential reasons that might result in a delay reporting such events to parents or guardians.

The qualitative research method will focus on 2 major parts, namely, data collection and data analysis procedure. Before conducting the research different approaches related to data collection methods were explored, such as, systematic reviews, interviews, surveys. Their strengths and weaknesses were taken into consideration before selecting systematic review as the data collection tool. Since a qualitative research is based on an exploratory research design that helps in gaining a sound understanding of the opinions, or underlying reasons in relation to a topic of interest, this approach was adopted for the dissertation. It helped in providing an overview of the opinions and thoughts of the recruited sample, in relation to the formulated research question. A qualitative systematic review helped in bringing together relevant information on the topic by conducting a systematic search of research evidences, collected from primary qualitative findings (Lambert and Lambert 2012). The research was based on conducting a systematic review of articles that contained information of population-based surveys or direct inquiry of child abuse reports that were faced by the adolescent or youth in their childhood. The method aimed to examine and provide answers to questions regarding characteristics of the perpetrators and whether they are known by the victims in most cases.

The research method was based on collection of relevant data about the prevalence of child abuse and neglect. The research worked on the collected data and organized it to uphold the information again the prevailing ideas regarding the perpetrators and disclosure of relevant information on this sensitive issue. Data collection and analysis were conducted simultaneously. The responses present in the articles were analysed to get a sound understanding of the questions that were intended to be addressed. The findings were further categorized into different themes in order to obtain a clear understanding of the topic.

This part of the dissertation will illustrate the different stages that must be encompassed or addressed while a research strategy is being developed. On viewing the research onion, each stage or layer of the onion describes the stages encompassed by the research process in details. Moreover, the research onion will also help in providing a clear description of the way by which the research will progress, following designing of an appropriate methodology (Saunders et al. 2015). Thus, the research onion will be followed in this context to provide an accurate description of the stages that are supposed to be included in this systematic review.

A research philosophy encompasses the beliefs that are related to nature of the reality that is being investigated (Scotland 2012). Thus, it helps in revealing the underlying definition of the research knowledge. This will provide a justification of the research that is being conducted. The selection of particular research philosophy is determined by the practical implications of the research in real-time settings. The philosophy selected in this case focuses on realism. Realism based research philosophy focuses on the idea of independent reality. This assumes a scientific approach for developing knowledge (Mkansi and Acheampong 2012). The philosophy to be used in this dissertation will encompass direct realism that will portray the world with the use of real human senses. Thus, this branch of epistemology shows similarity with positivism approach in that a scientific method is applied while developing knowledge related to youth reports of child abuse.

The systematic review will find evidences from studies that contain responses of adolescents or youths regarding childhood abuse experiences that occurred in their childhood, either in the form of direct interaction or self-administered surveys. Use of realism based research philosophy can be ascertained by the fact that self-report studies make the respondents read specific questions and select their responses without interference from the researchers or any other person (Weigold, Weigold and Russell 2013). Thus, these surveys help in providing real results about the feelings, perceptions and attitudes of the respondents. Direct inquiries also have realistic basis as responses are given with respect to the questions that are asked by a single or group of individuals.

This forms the second layer and often encompasses a deductive or inductive approach that fits with the philosophy identified earlier (Saunders et al. 2015). Research approach will generally provide comprehensive details of the observations that are essential for forming a view related to the outcome of the systematic review (Arghode 2012). In this dissertation that research approach focuses on drawing conclusions about reports of child abuse by adolescent and youth, as experienced in their childhood. An inductive approach will be applied for this qualitative research as there is lack of an accurate theory that informs about the research process. It will help in analysis of the collected data, followed by generation of significant results (Frels and Onwuegbuzie 2013). Thus, the dissertation will focus on an inductive approach that will utilise primary research sources as their data. Results will be drawn from published academic articles and government surveys. The approach will involve a critical analysis of multiple research articles that are relevant to the research question. Thus, the inductive approach will focus on working on the title of the dissertation. The description and analysis of included articles will help in drawing a theory at the end.

The research strategy will encompass conduction of a systematic review, a method of secondary research that will involve creating a summary, or collation of existing evidences (Saunders et al. 2015). There is a growing body of research that aims at estimating the rates and severity of child abuse or maltreatment worldwide (Easton et al. 2013). Child maltreatment is considered as a public health issues that poses several problems during its quantification. History of child abuse is found to act as a major barrier in development during the adolescent years and has also been recognised as a major contributor of increased rates of morbidity and mortality (Sperry and Widom 2013). Several population based surveys and trials have been conducted that aimed to unravel the mechanics of child abuse and its potential relation with adverse health outcomes (Iffland et al. 2013). This dissertation will therefore be based on a grounded theory approach. It will draw on the inductive approach, and help in deriving patterns from the collected data. Survey and direct interaction responses will be coded and grouped to demonstrate factors that are common in the articles. The results of systematic review will be fundamentally derived and used to draw conclusions.

This forms the next layer of the research onion and refers to the time framework that is planned for completion of the project or research. The research onion encompasses cross-sectional and longitudinal time horizons (Saunders et al. 2015). The dissertation will use a longitudinal time horizon where it will involve use of repeated studies/trials over a period of time, for identifying whether reports of child abuse by the youth or adolescents.

The processes of data collection and analysis are found to be largely dependent on the kind of methodological approach employed by a study. This process is most commonly used in a research onion as it helps in establishing the validity and reliability of a study. Regardless of the research approach employed in a project, data collection methods can be categorized into two classes namely, primary data and secondary data (Palinkas et al. 2015). The dissertation will be based on secondary data collection where opinions and conclusions will be derived from studies conducted by other authors in primary research such as trials or surveys. The secondary method of data collection will be focused on conduction of a systematic review where information that have already been presented by a researcher, will be analysed with regards to the research objective (Terrell 2012). The basic advantage of using secondary research as the data collection tool is related its cost-effectiveness. Analysis of already existing information will make the entire research rapid. It will help in aligning the focus of the research on a wider scale and will identify answers to the research question.

Research design refers to the description of the way by which a research process intends to get completed (Lewis 2015). In other words, it can be defined as the framework that includes several considerations, which in turn facilitate adoption of an appropriate research methodology. The systematic review will be based on a descriptive research design (Bryman 2015). The first step while conducting this systematic review will focus on creating an appropriate or structured question that will guide the entire systematic review. This is followed by the second step that will comprise of performing an exhaustive and thorough search of literature or articles that contain information on self-report of youth for incidents related to child abuse that occurred in their childhood. This will be followed by a section that will list detailed information on the databases that were searched for retrieving relevant articles. The abstracts and titles of the extracted articles will be checked against certain pre-determined criteria that helped in assessment of relevance and eligibility of the included studies, thereby forming an inclusion set. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement will be used for retrieving the articles. PRISMA refers to an evidence-based approach that focuses on minimum set of items needed for conducting a systematic review or meta-analysis (Moher et al. 2015). PRISMA most commonly focuses on reporting results from randomized controlled trials but evaluating randomized trials, but can also be utilized as the foundation of reporting systematic reviews that are based on other kinds of research, such as, surveys. The PRISMA tool was used to improve reporting of the articles that were included in the review.

A search for articles that were peer-reviewed ones and published from January 2008 through February 2018 was conducted. Electronic databases such as, PubMed, Medline, and ProQuest Public Health were searched for retrieving the essential articles. The search strategy adopted a wide approach of using free texts owing to the difficulty in locating relevant research articles related to surveys or direct interaction, in the aforementioned electronic databases. Search terms used for article extraction included child, childhood, maltreatment, abuse, youth, adolescent, neglect, rape, assault, surveys, national, inquiry, reports, and violence. Several boolean operators such as, “AND” and “OR”, were used for combining the key words, while searching the individual databases.

The “OR” boolean operator helped in retrieving information that contained either search term, such as, abuse OR maltreatment. This broadened the search hits and extracted all articles available on the topic, regardless of the key terms. “AND” boolean operator helped in searching articles that contained information relevant to the search terms. This helped in narrowing the search results and gave search hits that contained articles with the major concepts relevant to the essay (McGowan et al. 2016). The articles obtained from the databases after feeding in the search terms with the aforementioned boolean operators were reviewed according to the specific inclusion and exclusion criteria. References lists of the extracted articles were also searched for identifying relevant articles that might have been excluded while searching the databases.

Inclusion criteria:

• Articles published in English
• Articles published not prior to January 2008
• Primary study (without editorials and reviews)
• Articles that contained representative population surveys conducted in communities or homes
• Articles that explored disclosure of child abuse incidents from the perspective of the victims
• Articles that were published in peer-reviewed journals
• Age range of the respondents of the articles should be from 10-24
• Age of the victims at the time of maltreatment or abuse should not have been more than 18 years
• Reported perpetrator must have been parents or caregivers (except for sexual abuse)

Exclusion criteria:

• Articles published in foreign languages
• Articles published before 2008
• Abstracts or unpublished manuscripts
• Studies without adequate information on age of victims
• Book chapters
• Dissertations
• Case studies

The figure given below shows the process involved in selecting and extracting relevant articles that have been include in the systematic review. A thorough search of the three databases helped in identification of 879 articles that were later on reviewed for assessing whether they met the inclusion criteria. Articles that were present several times in the search were manually removed. This was followed by adding the number of articles that were screened. The abstracts and titles of the articles that are relevant to the study question were screened and any article that appeared irrelevant or inadequate to meet the requirements of the research questions were excluded. Removing duplicates from the initial hits yielded 325 articles, screening of the titles and abstracts of which led to 50 articles. On assessing full text relevant articles for their eligibility, 10 published articles were retrieved. Articles that addressed retrospective accounts of adults regarding reports of their childhood abuse incidents. Articles containing information from newspapers, conferences, or letter to the editor were also excluded to refine the search results.

Several ethical aspects must be taken into account while discussing about child maltreatment or abuse. The systematic review contained analysis of surveys or direct responses that dealt with a sensitive matter of child abuse and consequential adverse effects that the incident might have on the respondents. Ethical considerations included review of the fact whether the articles or surveys took appropriate strategies to maintain confidentiality of the respondents or provided them adequate support to ease their emotional distress (Keddell 2015). Further ethical considerations were related to evaluating presence of privacy measures, active or passive consent, voluntary withdrawal or willingness of the participants to respond to the trials that were included in the systematic review. Articles that failed to demonstrate maintenance of accurate ethical standards, were not included in the study.

There exist several limitations in and inconsistencies in the measures of child abuse in the survey articles or direct disclosure studies that were assessed for the systematic review. Insufficient methodological information present in some articles made it difficult to include them made it difficult to include them in the review.

An analysis of the articles that were included in the reports suggested that child maltreatment is a major social problem existing in almost all countries of the world. The sensational account of such abuse incidents often resulted in serious injuries, emotional distress, or death among the victims. Little information was drawn about the interaction of the victims and their families or communities. The review helped in identifying the fact that a plethora of challenges exist while conducting research in child maltreatment. Most of the included articles provided evidence for the fact that it often results in behaviour and psychological problems among the victims. Moreover, all respondents were found to display high sensitivity towards the emotion of other individuals, such as, their care givers and family members. Several themes were identified in the review that focused on prevalence of child abuse or maltreatment, disclosing information, characteristics of perpetrators and multiple victimisation.

The review also helped in identifying the different forms of maltreatment that were experienced by the victims. Most common response suggested that forms of physical abuse involved being slapped hard, beaten, punched or subjected to physical punishment. The youth who acted as the respondents also reported having experienced emotional maltreatment in the form of being verbally abused, terrorised, threatened, put in confinement as a punishment or isolated from the family. The articles also contained information on sexual abuse reports that the youth or adolescents had been subjected to sexual abuse as well. Most responses of the articles contained reports of attempted rape, online victimisation, or caressing, and fondling, as a part of child maltreatment. The findings of the systematic review were reflective of the extensive effort that was taken for measuring the prevalence of child abuse on a global scale. A summary of the result findings are given in the appendix.

The results are focused on a total of 10 research studies, conducted over a time period of 10 years. The responses of the participants or respondents were analyzed and later on categorized into different themes. Of the individuals who were enrolled in the surveys or selected for direct interaction, all of them were within 24 years of age and disclosed about abuse or maltreatment incidents that occurred in their childhood.

Most of the studies included in the review provided evidence for a high child abuse prevalence rates in the population. Responses from a study conducted by Chan et al. (2013) showed that boys represented a higher percentage of encountering different forms of sexual abuse, upon comparison with girls who were included in the study. Boys in the study also reported higher rates of victimisation. Prevalence rates as established by another study suggested that 438 children (24.4%) experience physical abuse in their childhood. Rates of emotional and sexual abuse were found among 51 (2.8%) and 396 (22.1%) respondents, respectively. This study also demonstrated similar findings in that the male respondents more frequently experienced rates of child abuse in their childhood (56.6%), when compared to girls (43.4%). A study conducted by Jackson, Browne and Joseph (2016) also provided information on extrafamilial victimization prevalence rates. 86.5% males and 82.8% females reported exposure to abuse or victimization in their childhood. The study showed that there was an increased prevalence of sexual abuse among females (18.3%) than male respondents (7.8%) who were recruited for the purpose of conducting a research. Another survey article provided evidence for maximum prevalence rates of parental neglect during lifetime of the respondents. High rates of sexual abuse were reported by girls (20.1%), in their adolescent years. Sexual abuse rates were reported by 3.7% males and 13.2% females aged 15-17 years, in their childhood (Radford et al. 2013).

Highest rates of physical abuse were found to occur during the adolescent years (aged 14-17 years old) among the respondents (6.4%). However, abuse rates were found to be lower in home with two biological parents (2.8%), compared to single parent homes (6.3%) (Finkelhor et al. 2014). Another study failed to determine any significant differences in the prevalence rates based on gender of the victims. However, the responses indicated that prevalence of child abuse was higher in families that had more number of children. Child abuse incidents were calculated to be approximately 48.2% for females, and 51.8% for males (Mahram et al. 2013). Reports of bullying and assault were reported by 47% participants in their childhood. Boys were found to be at an increased likelihood of suffering assault except when their peer or siblings were the perpetrator. Girls reported higher rates of sexual victimization in their childhood. Moreover, maltreatment was reported by 13% participants in the course of their lifetime (Cyr et al. 2013). According to another study, 15.2% respondents gave a positive response related to experiencing some form of physical abuse such as, hitting by their parents and caregivers (Annerbäck et al. 2010).

The study conducted by Schaeffer, Leventhal and Asnes (2011) contained information on the underlying factors that might have made the respondents report instances of abuse or maltreatment that occurred in their childhood. The article recognized role of internal stimuli that created emotional distress in the respondents as the primary reason that made them disclose information to their parents. Feeling of guilt, and lowering of self-esteem were found to play a major role. Threats made by the perpetrators related to killing or offering monetary benefits often made the respondents wait for a long time before disclosing about their abuse. Rates of child abuse incident disclosures were also evaluated by another study that measured association between the confidants and the rate of disclosure.

Maximum disclosure about childhood maltreatment incidents were found to be facilitated when peers acted as the sole confidants. That accounted for 96.2% abuse disclosure rates, followed by 61.5% in case of parents. Immediate disclosure was found to occur in higher proportions in case of peers, parents, siblings, and other relatives at rates of 23.1%, 19.2%, 11.5% and 3.9% (Schönbucher et al. 2012). The respondents were also found to report a lack of willingness on their part in letting people know about their sufferings, as demonstrated by results of another included study. Non-disclosure of the incidents in front of confidants was recognized as a process that encompassed active withholding of relevant information. The article reported only the family members were found to know of the abuse incidents in more than a quarter of the respondents who were interviewed. Internal stimuli such as, emotional distress was also identified as a major factor that contributed to disclosure of maltreatment information. The respondents were often found to report difficulties in coping with the mental and psychological distress that they suffered from, and experienced trauma and extreme emotional pressure. Choice of confidant was also identified as a major aspect and the respondents replied that most often they considered their close friends, and parents as the probable individuals in whom they could confide their distress (McElvaney, Green and Hogan, 2011).

According to the study conducted by Jackson, Browne and Joseph (2016) reply of the respondents in the survey suggested that the perpetrators largely responsible for causing emotional, physical or sexual abuse to the victims in their childhood were largely known to them, except in cases that involved kidnapping, where the culprits were complete strangers. In case of abuse that occurred due to dating violence, most common perpetrators were found to be boyfriends or partners of the adolescent victims. Known acquaintances acted as the perpertrators in 59.9% cases related to physical victimization, 83.5% cases of peer victimization, and 57.0% cases of sexual abuse. Moreover, the study responses also accurately identified that more than 80.5% sexual abuse incidents occurred where the number of perpetrator was one. 25.1% incidents of physical abuse involved three or more culprits. Further responses indicated that 50.0% and 46.2% cases occurred where the perpetrators were of the same age in case of emotional abuse and physical abuse incidents, respectively. Furthermore, another study demonstrated that 65.9% were recognized as the perpetrators in most sexual abuse cases. The survey responses helped in drawing the conclusion that siblings or peers were most commonly involved in victimization.

Parents and caregivers acted as the potential perpetrators among a large minority of the victims (Radford et al. 2013). Responses of the participants suggested that in 55% cases, the perpetrators were men such as, father or partners of the child’s mother. 45% cases reported abuse done by females (Annerbäck et al. 2010). Relationship with the perpetrators was also established by another study that showed an increased likelihood among males (26) to victimize children. Females were not reported as the culprits in any of the responses given during the direct disclosure of abuse incidents. Prevalence of biological fathers, partners, boyfriends and parents of peers or friends were also established by the responses. Several responses were also obtained during the direct interaction that suggested that the perpetrators had been involved in abusing another young member of the same family (siblings) earlier. Close relationship of such perpetrators with the victim’s family often made the latter fear talking about the abuse, to prevent disruption of the family (Schönbucher et al. 2012).  

The study by Finkelhor et al. (2014) provided evidences from the responses which indicated that fathers were responsible for more than 36% of childhood abuses experienced by the victims. 22% mothers and similar proportion of live-in relatives were recognized as the known perpetrators for the incidents. 63% male perpetrators were found to outnumber 37% females in the responses. Moreover, more than 80% children reported facing an abuse incident in their homes. Further evidences suggested that mothers acted as perpetrators in 45% cases of emotional abuse in childhood. Relatively lower rates were observed among fathers (34%). Responses for sexual abuse suggested that 54% fathers, 20% of male live-in relatives, and 12% male live-out acquaintances. Thus, 96% rates of abuse were found to occur due to known male perpetrators. Siblings were also identified as perpetrators of physical victimization in another study (Chan, Yan, Brownridge and Ip 2013).

Responses from a study suggested that 12.1% of the respondents had been victims of abuse of one form in the previous year. 23% of abused children, who formed 2.8% of the sample reported instances where they experienced two or more kinds of abuse in their lifetime. Three or more maltreatment instances were found to occur in 0.6% of the sample. Increased risks of suffering from different types of maltreatment were observed among the victims. Moreover, the results reported a 7 times increased likelihood of experiencing emotional abuse, and 4 times likelihood of neglect and custodial interference (Finkelhor et al. 2014). Multiple victimization of children were observed across a range of domains such as, their community, schools, and within the family. This made the victims provide responses that indicated their feelings of being unsafe at known places as well (Cyr et al. 2013). Approximately 6.4% of the sample reported experiences of multiple abuse (Annerbäck et al. 2010). The study conducted by Jackson, Browne and Joseph (2016) was successfully able to recognize prevalence of 74.9% cases of cumulative and multiple extrafamilial victimization on an average. 2.8 different victimization types and 2.2 types of victimization categories was commonly experienced by the youth.

Conclusion and Recommendations

The primary objective of the systematic review was to assess prevalence of child abuse among children as reported by the youth in later years and the impact it created on their life experiences. It also wanted to explore the reasons behind not disclosing information about such incidents to the family. The systematic review was successful in gathering information from a diverse sample, located at different geographical regions over the world. It was able to capture relevant information from a wide number of youth based service or direct interaction studies that wanted to investigate the prevalence and severity of child abuse or maltreatment incidents that occurred in the target population. The systematic review reveals that there is a hard prevalence of all forms of child abuse, physical emotional and sexual among children, regardless of their gender, which often continues to exert negative impacts on the emotional well being of the victims in their adulthood. Some studies showed the difference with the above statement in that they found an increase the likelihood of child abuse incidents in girls. This can be attributed to the fact that female predominance in child abuse incidents can often result due to under-reporting and failures of recognising such incidents among boys (Buckingham and Daniolos 2013). One of the primary reasons that can be correlated with the aforementioned statement focuses on the fact that many boys are not aware of sexual victimization during their early years (Alaggia and Mishna 2014). However, analysis of the included articles also suggests that there is a higher rate of victimization faced by boys such as physical assault, sibling or peer victimization. This can be correlated with other findings, which state that chronic victimization of boys by their peers is considered as a significant issue during their school years. These kinds of assaults have recently been considered as an important public health issue and refer to repeated intentional on negative behaviour, displayed by one or more person (Van der Kolk 2017).

 Such abusive behaviors are directed against a particular child who faces difficulty in defending himself. This can also be associated with the fact that boys have been found to report more cases of pushing hitting choking kicking or experiencing incidents where the perpetrator forcefully takes something from them (Fox et al. 2014). Malicious teasing, name calling, threatening, and taunting are also different forms of victimization, which can be considered as abuse related events. Less problems of sexual abuse among girls, are often reported due to the fact that girls are always under the supervision of their parents that reduces the likelihood for them to experience sexual victimization by known people (Jena 2013) . Evidences included in the systematic review which reported prevalence of sexual assault by unknown acquaintances or family members are in line with previous findings that child abuse victims of an report having been sexually assaulted by we are known family members are unrelated men. One probable explanation is that siblings can also access perpetrators. However, increased rates of child abuse in families with more number of children occur due to dispersal of the resources of the parents, such as, economic support and care. This makes each child more susceptible and vulnerable to child maltreatment or victimization. Consistent with previous findings, victimization was also reported by children who lived in homes with one parent (MacMillan et al. 2013). Such instances reduces supervision and monitoring on the children, which in turn makes them more vulnerable to experience abuse related events. Therefore, parental supervision, interference and conflict, family violence and less parental warmth are directly responsible for increasing rates of child abuse. There exists a huge difference between the rates of child abuse incident that come to the attention of the local authorities and government, and cases where the youth and adolescence self-report about such even when enquire directly or through social service. According to research evidences, a negligible number of child maltreatment cases come to the attention of the local authorities or government agency (1 in 30) (Louwers et al. 2012).  This indicates the high level of disparity that exists among the rates of child abuse incidence and their recognition on a global scale.

Higher rates of sexual victimization among adolescence aged 11 to 15 years, as reported by the articles included in the systematic review can be related to the fact that peer-to-peer sexual victimization has become a major concern in recent time. Several studies have been conducted to evaluate dimensions of sexual harassment faced by adolescents and provided evidences for the existence of a two-dimensional structure for such abuse related incidents in both genders (Modelli, Galvão and Pratesi 2012). While one particular dimension of victimization reflex different forms of verbal and visible sexual assault and harrassment, the 2nd dimension in this context focused on physical forms of violence. Such forms of peer victimization can be defined as experience is among children who becomes targets of aggressive behaviour demonstrated by other children, not necessarily age mate or siblings. Research evidences of also proven association of peer victimization incidents with lower school achievement, poor self-esteem, poor confidence, depression, school avoidance, and learned helplessness (McMahon et al. 2012). This kind of victimization rate, as commonly experienced by boys are prevalent during their middle school years, which creates impact in future adulthood. Increased vulnerability to peer rejection often occurs due to strong needs of intimacy and belonging during early adolescence years. Evidences from the literature included in the study also suggested that a minority of children were able to disclose information related to child abuse even immediately to their close people. Several reasons were established that resulted in a delay in disclosure. Disclosing the fact that a child has been abused creates an opportunity for the parents to provide them immediate comfort and support and to assist in protecting the child from future incidence (Zajac et al. 2015).

The process of disclosure encompasses seeking support from close people in order to reduce the negative impacts that these events can have on the psychological and emotional well being of a child. Delays and disclosure were linked to a range of factors that included concerns regarding potential consequences of dissolution, feeling of guilt, threats from the perpetrators, and fear of losing reputation of oneself and the family. Findings of the included literature show consistency with other research studies that attempted to investigate the ways by which the children disclose about abuse. Most of the ways by which abuses are disclosed include accidental or indirect events (Easton 2013). Indirect attempts are taken by the victims to alert their adults or close relatives that they are being or have been abused. This is generally done by changing their behaviour or making ambiguous verbal statements related to such incidents. However, the youth have been found to indirectly attempt disclosing or coping with the abuse by developing risky behaviors such as suicidal ideation, inflicting self-harm or disordered eating behaviour (Godbout et al. 2014). Results from the articles also demonstrated that most youth and adolescents disclosed about such events when they were asked for during a survey or during direct enquiry. Further findings also suggested that most victims initially denied that they have been mistreated when asked directly. Probable reasons given by them to support their statements include forgetting about the incidents, only to disclose them later on. Furthermore, the results also suggested that after disclosure, the victims often retracted from what they had said. Fear of not being believed by others, embarrassment,  stigmatization, and relationship to the perpetrator were considered as the primary reasons that made be used on adolescence retract from their disclosure or delay revealing such incidents to close ones.

Although the findings are successful in providing compelling evidence that child abuse or maltreatment is a significant health problem in almost all countries of the world, there are certain limitations in the study, which might have resulted in bias. The systematic review was principally based on self-report (surveys) and direct interaction. This might have contributed to recall bias that can lead to significant impact on the results (Sedgwick 2012). One major factor that probably contributed to recall bias can be correlated with the period that was used to measure all forms of abuse and maltreatment, among the victims included in the study. According to previous research findings 1 year is often considered as a long period over which victimization recall occurs more frequently. Moreover, it is also a relatively short time period, within which the victims are able to recall such incidents (Fang et al. 2012). Parenting method, effects of mental health of the parents, and family aspects were not considered in the studies that were included in the systematic review. Prevalence of mental disorders in parents have often been correlated with or behavior that makes them demonstrate neglect on maltreatment towards their children. Therefore, it was necessary to investigate whether incidents related to neglect and physical abuse caused by parents were a direct manifestation of some prevailing mental illness among the elders. While most data presented in the articles on the impact and prevalence of child abuse and victimization had been collected using cross sectional studies, they were unable to establish potential correlation between trauma symptoms and victimization among the children. Findings of the study fail to provide explanation for the potential underlying factors that lead to victimization of the sample.

Including all articles that were based on longitudinal study design would have been able to discover emotional problems and victimization association. One major limitation was the fact that most causes of child maltreatment do not get this close to researchers or investigators. The abuse incidents that have not been disclosed in the included studies could have created significant impacts on the findings and change the overall result, upon inclusion (McElvaney 2015). Most of the studies that were added to the systematic review fail to provide an explanation for exhaustive measurements of maltreatment. Another limitation is associated with inconsistency in research definitions of child abuse. Inconsistency also exists in the quality and breadth of instrumentation that is chosen for undertaking the research studies. This results in incomplete maltreatment study (Stalker and McArthur 2012). Further limitations are based on the fact that a considerable proportion of the respondents who participated in the service or direct interaction programs might not be in a position to understand whether maltreatment or abused related incidents had occurred. This can be correlated with the fact that respondents, who are ignorant about custodial interference by the parents or caretakers, might not recall this incident, while giving their responses (Finkelhor et al. 2014). Furthermore, not all articles measured severity of the incidents that were reported by the youth.

The findings from this study have been successful in illustrating perceptions of child abuse in the society. The dissertation has been able to answer several questions related to experiences of child maltreatment and abused faced by most children, to a certain extent. Problems related to child abuse, domestic violence, sexual abuse and victimization by peers or relatives have generated thousands of different interventions in the arena of health, law enforcement and social service (Albert 2017). Formulation of interventions have been triggered by the emergency in recognising different types of needs of children and adolescence and the wide range of violence that they are vulnerable to experiencing. Responses of advocates, close relatives and community members are also imperative for conducting research on child maltreatment (Jenny, Crawford-Jakubiak and Committee on Child Abuse and Neglect 2013). Most interventions that try to recognize prevalence of child maltreatment and the underlying factors that contribute to its high rates focus on identification of the incidents, its prevalence, and development of appropriate prevention strategies. Thousands of intervention programs and services have been associated with each prevention strategy and are found to represent a huge body of experience and expertise that is required for conducting a systematic scientific study.

Such studies will be able to guide design of the services, treatment or prevention program. However, one major challenge that exists in the field of conducting research on the aforementioned subject is related to development of appropriate framework that will enhance a critical analysis of the already existing strategy, programs or interventions across the globe (Earley et al. 2014). Several complexities are associated with the ways by which interventions for family violence are characterized. Therefore, there is a need to carefully considered development related to the sensitive issue in future research. This can be facilitated by adopting collaborative effort between all service providers and researchers. Interventions and research investigations should be conducted in all communities, across all nations in a way that the isolated and discrete aspects of child maltreatment are addressed properly. Research studies on child abuse suggest that most interventions have not been completely implemented until date due to organisational barriers and limited funding opportunities in this sensitive issue (Ford 2017). Thus, it is uncertain as to whether research studies can determine effectiveness of particular prevention strategies that will deter perpetrators from committing such events.  Most prevention strategies might not have yet realize sufficient strength that is needed for achieving intended impacts of reducing prevalence rate of child abuse across all nations. Despite high prevalence of child maltreatment on a global scale, the significance and magnitude of the social issue has not been successful in formulating adequate research in this area.

One of the most challenging tasks are related to understanding the complexity is associated with child maltreatment. A wide plethora of research methods are required to be put into action for clarifying the multiple dimensions existing in relation to this phenomenon of abuse or maltreatment. A considerable amount of research has been conducted over the past three decades that have provided information on the prevalence rate, the nature of victimization, and characteristics of potential perpetrators responsible for the incident (Fergusson, McLeod and Horwood 2013). However, there is a lack of organised an integrated basic knowledge in this field. An accurate data collection measure is essential for informing about the research practice to all members of the society. Such appropriate measures will help in guiding development and formulation of several policies and programs that are relevant to the sensitive issue. Therefore, one major recommendation would be related to conducting research programs in diverse areas that will help in exploring promising directions related to child abuse. Moreover, an analysis of the studies included in the systematic reviews suggests that adequate amount of coordination, guidance and leadership is required for organising the research base (Widom, Czaja and DuMont 2015). This will facilitate cultivating future generation of well-trained and informed researchers who will be able to get adequate information on evolution of research studies in this field. Several federal agencies have established the fact that leadership is an essential criteria for fostering and organising training and research in the arena of child development and family system study.  In other words, it can be stated that institutional support is crucial for providing necessary help that will foster development of research studies on child maltreatment.

Future recommendations include clarifying the scope and nature of abuse faced by children. Such clarification will generally be guided by research definitions and measures that have been well formulated. A clear understanding needs to be gained on the origin and risk factor that makes a child vulnerable to experiencing these events. Potential consequences of child maltreatment on the physical and emotional well being of a child should also be understood.  Research studies must also take into consideration future government programs and policies to address the global problem. This will improve the scope of research. Empirical information also needs to be provided regarding the limitations and strengths of interventions that aim to prevent or treat child maltreatment. This will guide the research and will help in development of more effective research strategies, related to intervention programs. The ability of a research group or the government authorities to diagnose prevent or treat child maltreatment largely depends on the quality of measurement tools that are selected for addressing the problem (Norman et al. 2012). Appropriate measurement tools will help in providing consistent characterization of the phenomena related to abuse that is being investigated. This will help in eliminating all kinds of bias in the result and will provide an opportunity of replicating are extending the reported results. It will further assist conduction of a critical comparative analysis between the research findings. The aforementioned variations that exist in definition and inadequate instrumentation are found to import high quality research, and restrain development of appropriate evaluation regarding the intervention programs. Therefore, instrumentation and definitions need to be improved for facilitating development of small and large-scale investigation that focus on epidemiology of child abuse. This will help in clarifying essential dimensions and etiological even that is crucial for gaining a deeper understanding of the scope and nature of neglect on maltreatment faced by the victims. The research priorities that should be undertaken in future practice are given below:

 Research priority 1- Developing consensus on research definition that need to be established for addressing the different kinds of child maltreatment and abuse which exist. This will require a major professional commitment towards an evolutionary and dynamic process that will be guided by a series of multidisciplinary panel and will seek help from agencies that support research in this particular field. The research definitions should therefore be culturally competent, developmentally appropriate, have well-defined inclusion and exclusion criteria, and provide adequate guidance on the seniority, frequent and duration of maltreatment.

Research priority 2- Develop valid and reliable clinical research and diagnostic instruments that will measure child maltreatment. This encompasses formulation of effective questioning strategies and conduction of instrumentation studies, in the form of pilot trials in a wide range of private and public settings.

Research priority 3- Examine the processes by which family, individual, social factors and the community interact with each other, thereby improving understanding of the underlined risk factors. The primary objective should be endorsement of diverse models that are incorporated with the use of a variety of research strategy. These models will help in gaining information about the mechanism that protect or activate against individual child abuse and will help in distinguishing between the immediate and long-term factors associated with such events. Future research should also consider effects of individual parent characteristics, unemployment, poverty, and conditions of the neighborhood in increasing likelihood of a child from suffering abuse.

Research priority 4- More investigations should be carried out in the field of epidemiology that will help in identifying prevalence and incidence of child abuse. Such epidemiological studies should encompass children belonging to different cultural organic background, and different age groups for addressing the appropriate research questions. This will have significant implication in developing knowledge in the field. It will also improve work on equality and will provide a clear insight regarding the extent to which training must be provided to educators, healthcare professionals, social services staff, and law enforcement personnel.

Research priority 5- Support should be provided to research studies that aim towards investigating or assessing outcomes of combined or specific types of abuse. This will help in revealing complexities associated to outcomes of general and specific types of child abuse, and will address the role of gender differences in manifestation and vulnerability of problem behaviour. This can be facilitated by conduction of cross sectional study in the field.

Research priority 6- The research quality needs to be improved in relation to studies that focus on similarities and dissimilarities that exist in the consequence and etiology of various kinds of child maltreatment across ethnic and cultural groups existing in different nations. This will help in any preventing harmful consequences on the victims.

Addressing all the aforementioned research priorities, in future research studies will help to retrieve more information on prevalence of child abuse and the different responsible factors. However, researchers should be conducted in a way that is able to resolve ethical dilemmas and problems associated with recruitment of respondents, maintain their privacy and confidentiality, and demonstrate adequate respect towards their autonomy.

References

Afifi, T.O., MacMillan, H.L., Boyle, M., Taillieu, T., Cheung, K. and Sareen, J., 2014. Child abuse and mental disorders in Canada. Canadian Medical Association Journal, pp.cmaj-131792.

Alaggia, R. and Mishna, F., 2014. Self psychology and male child sexual abuse: Healing relational betrayal. Clinical Social Work Journal, 42(1), pp.41-48.

Albert, V., 2017. From child abuse to permanency planning: Child welfare services pathways and placements. Routledge, pp.59-78.

Annerbäck, E.M., Sahlqvist, L., Svedin, C.G., Wingren, G. and Gustafsson, P.A., 2012. Child physical abuse and concurrence of other types of child abuse in Sweden—Associations with health and risk behaviors. Child abuse & neglect, 36(7-8), pp.585-595.

Annerbäck, E.M., Wingren, G., Svedin, C.G. and Gustafsson, P.A., 2010. Prevalence and characteristics of child physical abuse in Sweden–findings from a population?based youth survey. Acta paediatrica, 99(8), pp.1229-1236.

Arghode, V., 2012. Qualitative and Quantitative Research: Paradigmatic Differences. Global Education Journal, 2012(4), pp155-163.

Aveyard, H., 2014. Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK), pp.1-18.

Barth, R.P., Barth, R.P. and Barth, R.P., 2017. The child welfare challenge: Policy, practice, and research. Routledge, pp.57-79.

Brook, J., McDonald, T.P. and Yan, Y., 2012. An analysis of the impact of the Strengthening Families Program on family reunification in child welfare. Children and Youth Services Review, 34(4), pp.691-695.

Bryman, A., 2015. Social research methods. Oxford university press, pp.373-619.

Buckingham, E.T. and Daniolos, P., 2013. Longitudinal outcomes for victims of child abuse. Current psychiatry reports, 15(2), p.342.

Chan, K.L., Yan, E., Brownridge, D.A. and Ip, P., 2013. Associating child sexual abuse with child victimization in China. The Journal of pediatrics, 162(5), pp.1028-1034.

Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., DeRosa, R., Hubbard, R., Kagan, R., Liautaud, J. and Mallah, K., 2017. Complex trauma in children and adolescents. Psychiatric annals, 35(5), pp.390-398.

Cyr, K., Chamberland, C., Clément, M.È., Lessard, G., Wemmers, J.A., Collin-Vézina, D. and Damant, D., 2013. Polyvictimization and victimization of children and youth: Results from a populational survey. Child Abuse & Neglect, 37(10), pp.814-820.

Damashek, A., Nelson, M.M. and Bonner, B.L., 2013. Fatal child maltreatment: Characteristics of deaths from physical abuse versus neglect. Child abuse & neglect, 37(10), pp.735-744.

Douglas, E.M. and Mohn, B.L., 2014. Fatal and non-fatal child maltreatment in the US: An analysis of child, caregiver, and service utilization with the National Child Abuse and Neglect Data Set. Child Abuse & Neglect, 38(1), pp.42-51.

Earley, M.D., Chesney, M.A., Frye, J., Greene, P.A., Berman, B. and Kimbrough, E., 2014. Mindfulness intervention for child abuse survivors: A 2.5?year follow?up. Journal of clinical psychology, 70(10), pp.933-941.

Easton, S.D., 2013. Disclosure of child sexual abuse among adult male survivors. Clinical Social Work Journal, 41(4), pp.344-355.

Easton, S.D., Renner, L.M. and O’Leary, P., 2013. Suicide attempts among men with histories of child sexual abuse: Examining abuse severity, mental health, and masculine norms. Child Abuse & Neglect, 37(6), pp.380-387.

Ensink, K., Bégin, M., Normandin, L. and Fonagy, P., 2016. Maternal and child reflective functioning in the context of child sexual abuse: pathways to depression and externalising difficulties. European journal of psychotraumatology, 7(1), p.30611.

Fallon, B., Chabot, M., Fluke, J., Blackstock, C., MacLaurin, B. and Tonmyr, L., 2013. Placement decisions and disparities among Aboriginal children: Further analysis of the Canadian incidence study of reported child abuse and neglect part A: Comparisons of the 1998 and 2003 surveys. Child abuse & neglect, 37(1), pp.47-60.

Fang, X., Brown, D.S., Florence, C.S. and Mercy, J.A., 2012. The economic burden of child maltreatment in the United States and implications for prevention. Child abuse & neglect, 36(2), pp.156-165.

Fergusson, D.M., McLeod, G.F. and Horwood, L.J., 2013. Childhood sexual abuse and adult developmental outcomes: Findings from a 30-year longitudinal study in New Zealand. Child abuse & neglect, 37(9), pp.664-674.

Finkelhor, D., Shattuck, A., Turner, H.A. and Hamby, S.L., 2014. The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. Journal of Adolescent Health, 55(3), pp.329-333.

Finkelhor, D., Vanderminden, J., Turner, H., Hamby, S. and Shattuck, A., 2014. Child maltreatment rates assessed in a national household survey of caregivers and youth. Child abuse & neglect, 38(9), pp.1421-1435.

Ford, J.D., 2017. Treatment implications of altered affect regulation and information processing following child maltreatment. Psychiatric Annals, 35(5), pp.410-419.

Fox, C.L., Corr, M.L., Gadd, D. and Butler, I., 2014. Young teenagers’ experiences of domestic abuse. Journal of Youth Studies, 17(4), pp.510-526.

Frels, R.K. and Onwuegbuzie, A.J., 2013. Administering quantitative instruments with qualitative interviews: A mixed research approach. Journal of Counseling & Development, 91(2), pp.184-194.

Gilbert, R., Fluke, J., O’Donnell, M., Gonzalez-Izquierdo, A., Brownell, M., Gulliver, P., Janson, S. and Sidebotham, P., 2012. Child maltreatment: variation in trends and policies in six developed countries. The Lancet, 379(9817), pp.758-772.

Godbout, N., Briere, J., Sabourin, S. and Lussier, Y., 2014. Child sexual abuse and subsequent relational and personal functioning: The role of parental support. Child Abuse & Neglect, 38(2), pp.317-325.

Goldman, J.D. and Bode, A., 2012. Female survivors’ perceptions of lifelong impact on their education of child abuse suffered in orphanages. International Journal of Lifelong Education, 31(2), pp.203-221.

Gould, F., Clarke, J., Heim, C., Harvey, P.D., Majer, M. and Nemeroff, C.B., 2012. The effects of child abuse and neglect on cognitive functioning in adulthood. Journal of psychiatric research, 46(4), pp.500-506.

Hamilton?Giachritsis, C. and Pellai, A., 2017. Child Abuse and Neglect. The Wiley Handbook of What Works in Child Maltreatment: An Evidence?Based Approach to Assessment and Intervention in Child Protection, pp.29-47.

Herrenkohl, T.I., Hong, S., Klika, J.B., Herrenkohl, R.C. and Russo, M.J., 2013. Developmental impacts of child abuse and neglect related to adult mental health, substance use, and physical health. Journal of family violence, 28(2), pp.191-199.

Iffland, B., Brähler, E., Neuner, F., Häuser, W. and Glaesmer, H., 2013. Frequency of child maltreatment in a representative sample of the German population. BMC public health, 13(1), p.980.

Jackson, V., Browne, K. and Joseph, S., 2016. The prevalence of childhood victimization experienced outside of the family: findings from an English prevalence study. Child abuse & neglect, 51, pp.343-357.

Jaffee, S.R., Bowes, L., Ouellet-Morin, I., Fisher, H.L., Moffitt, T.E., Merrick, M.T. and Arseneault, L., 2013. Safe, stable, nurturing relationships break the intergenerational cycle of abuse: A prospective nationally representative cohort of children in the United Kingdom. Journal of Adolescent Health, 53(4), pp.S4-S10.

Jena, P.P., 2013. Sniff of child abuse: Need for precautionary strategies of society and school. Asian Journal of Multidisciplinary Studies, 1(4), pp.55-66.

Jenny, C., Crawford-Jakubiak, J.E. and Committee on Child Abuse and Neglect, 2013. The evaluation of children in the primary care setting when sexual abuse is suspected. Pediatrics, 132(2), pp.e558-e567.

Ji, K. and Finkelhor, D., 2015. A meta-analysis of child physical abuse prevalence in China. Child abuse & neglect, 43, pp.61-72.

Ji, K., Finkelhor, D. and Dunne, M., 2013. Child sexual abuse in China: a meta-analysis of 27 studies. Child Abuse & Neglect, 37(9), pp.613-622.

Joe-Akunne, C.O. and Okoye, C.A., 2017. Child Abuse And Neglect. Practicum Psychologia, 3(1), pp.77-86.

Kanbay, Y., Aslan, Ö. and I?ik, E., 2016. Child Abuse and Neglect.-. International Journal of Health Sciences and Research (IJHSR), 6(8), pp.352-357.

Keddell, E., 2015. The ethics of predictive risk modelling in the Aotearoa/New Zealand child welfare context: Child abuse prevention or neo-liberal tool?. Critical Social Policy, 35(1), pp.69-88.

Lambert, V.A. and Lambert, C.E., 2012. Qualitative descriptive research: An acceptable design. Pacific Rim International Journal of Nursing Research, 16(4), pp.255-256.

Leventhal, J.M. and Krugman, R.D., 2012. “The Battered-Child Syndrome” 50 Years Later: Much Accomplished, Much Left to Do. Jama, 308(1), pp.35-36.

Lewis, S., 2015. Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), pp.473-475.

Lonne, B. and Parton, N., 2014. Portrayals of child abuse scandals in the media in Australia and England: Impacts on practice, policy, and systems. Child abuse & neglect, 38(5), pp.822-836.

Louwers, E.C., Korfage, I.J., Affourtit, M.J., Scheewe, D.J., van de Merwe, M.H., Vooijs-Moulaert, A.F.S., van den Elzen, A.P., Jongejan, M.H., Ruige, M., Manaï, B.H. and Looman, C.W., 2012. Effects of systematic screening and detection of child abuse in emergency departments. Pediatrics, 130(3), pp.457-464.

Machi, L.A. and McEvoy, B.T., 2016. The literature review: Six steps to success. Corwin Press, p.5.

MacMillan, H.L., Tanaka, M., Duku, E., Vaillancourt, T. and Boyle, M.H., 2013. Child physical and sexual abuse in a community sample of young adults: Results from the Ontario Child Health Study. Child Abuse & Neglect, 37(1), pp.14-21.

Mahram, M., Hosseinkhani, Z., Nedjat, S. and Aflatouni, A., 2013. Epidemiologic evaluation of child abuse and neglect in school-aged children of qazvin province, iran. Iranian journal of pediatrics, 23(2), p.159.

Mallon, G.P., 2013. From the Editor: The Legend of Mary Ellen Wilson and Etta Wheeler: Child Maltreatment and Protection Today. Child welfare, 92(2), p.9.

Maxwell, J.A., 2012. Qualitative research design: An interactive approach (Vol. 41). Sage publications, pp.45-67.

McElvaney, R., 2015. Disclosure of child sexual abuse: Delays, non?disclosure and partial disclosure. What the research tells us and implications for practice. Child Abuse Review, 24(3), pp.159-169.

McElvaney, R., Greene, S. and Hogan, D., 2012. Containing the secret of child sexual abuse. Journal of interpersonal violence, 27(6), pp.1155-1175.

McFadden, P., Campbell, A. and Taylor, B., 2014. Resilience and burnout in child protection social work: Individual and organisational themes from a systematic literature review. The British Journal of Social Work, 45(5), pp.1546-1563.

McGowan, J., Sampson, M., Salzwedel, D.M., Cogo, E., Foerster, V. and Lefebvre, C., 2016. PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of clinical epidemiology, 75, pp.40-46.

McMahon, E.M., Reulbach, U., Keeley, H., Perry, I.J. and Arensman, E., 2012. Reprint of: Bullying victimisation, self harm and associated factors in Irish adolescent boys. Social science & medicine, 74(4), pp.490-497.

Mersky, J.P., Topitzes, J. and Reynolds, A.J., 2013. Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: a cohort study of an urban, minority sample in the US. Child abuse & neglect, 37(11), pp.917-925.

Mills, R., Scott, J., Alati, R., O’Callaghan, M., Najman, J.M. and Strathearn, L., 2013. Child maltreatment and adolescent mental health problems in a large birth cohort. Child abuse & neglect, 37(5), pp.292-302.

Mkansi, M. and Acheampong, E.A., 2012. Research philosophy debates and classifications: students’ dilemma. Electronic journal of business research methods, 10(2), pp.132-140.

Modelli, M.E., Galvão, M.F. and Pratesi, R., 2012. Child sexual abuse. Forensic science international, 217(1-3), pp.1-4.

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P. and Stewart, L.A., 2015. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), p.1.

National Research Council, 2014. New directions in child abuse and neglect research. National Academies Press, pp.54-79.

Norman, R.E., Byambaa, M., De, R., Butchart, A., Scott, J. and Vos, T., 2012. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS medicine, 9(11), p.e1001349.

Nspcc.org.uk (2018). Statistics on child abuse. [online] NSPCC. Available at: https://www.nspcc.org.uk/services-and-resources/research-and-resources/statistics/ [Accessed 27 Jan. 2018].

Nspcc.org.uk (2018). Statistics. [online] NSPCC. Available at: https://www.nspcc.org.uk/preventing-abuse/child-protection-system/northern-ireland/statistics/ [Accessed 27 Jan. 2018].

Palinkas, L.A., Horwitz, S.M., Green, C.A., Wisdom, J.P., Duan, N. and Hoagwood, K., 2015. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), pp.533-544.

Pelton, L.H., 2015. The continuing role of material factors in child maltreatment and placement. Child Abuse & Neglect, 41, pp.30-39.

Pérez-Fuentes, G., Olfson, M., Villegas, L., Morcillo, C., Wang, S. and Blanco, C., 2013. Prevalence and correlates of child sexual abuse: a national study. Comprehensive psychiatry, 54(1), pp.16-27.

Pietrantonio, A.M., Wright, E., Gibson, K.N., Alldred, T., Jacobson, D. and Niec, A., 2013. Mandatory reporting of child abuse and neglect: Crafting a positive process for health professionals and caregivers. Child Abuse & Neglect, 37(2-3), pp.102-109.

Radford, L., Corral, S., Bradley, C. and Fisher, H.L., 2013. The prevalence and impact of child maltreatment and other types of victimization in the UK: Findings from a population survey of caregivers, children and young people and young adults. Child abuse & neglect, 37(10), pp.801-813.

Saunders, M.N., Lewis, P., Thornhill, A. and Bristow, A., 2015. Understanding research philosophy and approaches to theory development. Research Methods for Business Students. Harlow: Pearson Education, pp. 122–161.

Schaeffer, P., Leventhal, J.M. and Asnes, A.G., 2011. Children’s disclosures of sexual abuse: Learning from direct inquiry. Child abuse & neglect, 35(5), pp.343-352.

Schönbucher, V., Maier, T., Mohler-Kuo, M., Schnyder, U. and Landolt, M.A., 2012. Disclosure of child sexual abuse by adolescents: A qualitative in-depth study. Journal of Interpersonal Violence, 27(17), pp.3486-3513.

Scotland, J., 2012. Exploring the philosophical underpinnings of research: Relating ontology and epistemology to the methodology and methods of the scientific, interpretive, and critical research paradigms. English Language Teaching, 5(9), p.9.

Sedgwick, P., 2012. What is recall bias?. BMJ, 344, p.e3519.

Silverman, D., 2013. Doing qualitative research: A practical handbook. SAGE Publications Limited, pp.120-141.

Sparks, E., 2013. Introduction. In Patterns of Child Abuse. Routledge, pp. 19-34.

Sperry, D.M. and Widom, C.S., 2013. Child abuse and neglect, social support, and psychopathology in adulthood: A prospective investigation. Child abuse & neglect, 37(6), pp.415-425.

Stalker, K. and McArthur, K., 2012. Child abuse, child protection and disabled children: A review of recent research. Child Abuse Review, 21(1), pp.24-40.

Strøm, A. and Fagermoen, M.S., 2012. Systematic data integration—A method for combined analyses of field notes and interview texts. International journal of qualitative methods, 11(5), pp.534-546.

Sugaya, L., Hasin, D.S., Olfson, M., Lin, K.H., Grant, B.F. and Blanco, C., 2012. Child physical abuse and adult mental health: a national study. Journal of traumatic stress, 25(4), pp.384-392.

Terrell, S.R., 2012. Mixed-methods research methodologies. The qualitative report, 17(1), pp.254-280.

Thomas, R. and Zimmer-Gembeck, M.J., 2012. Parent–Child Interaction Therapy: An evidence-based treatment for child maltreatment. Child maltreatment, 17(3), pp.253-266.

Usakli, H., 2012. The School Counselors’ Ideas on Features, Determinant and Intervention on Child Negligence and Abuse Cases. Online Submission, 2(3), pp.63-74.

Van der Kolk, B.A., 2017. Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric annals, 35(5), pp.401-408.

Van der Kolk, B.A., 2017. This Issue: Child Abuse & Victimization. Psychiatric Annals, 35(5), pp.374-378.

Weigold, A., Weigold, I.K. and Russell, E.J., 2013. Examination of the equivalence of self-report survey-based paper-and-pencil and internet data collection methods. Psychological methods, 18(1), p.53.

Who.int (2018). WHO | Child maltreatment. [online] Who.int. Available at: https://www.who.int/topics/child_abuse/en/ [Accessed 27 Jan. 2018].

Widom, C.S., Czaja, S. and Dutton, M.A., 2014. Child abuse and neglect and intimate partner violence victimization and perpetration: A prospective investigation. Child abuse & neglect, 38(4), pp.650-663.

Widom, C.S., Czaja, S.J. and DuMont, K.A., 2015. Intergenerational transmission of child abuse and neglect: Real or detection bias?. Science, 347(6229), pp.1480-1485.

Wood, J.N., Medina, S.P., Feudtner, C., Luan, X., Localio, R., Fieldston, E.S. and Rubin, D.M., 2012. Local macroeconomic trends and hospital admissions for child abuse, 2000–2009. Pediatrics, 130(2), pp.e358-e364.

Young, J.C. and Widom, C.S., 2014. Long-term effects of child abuse and neglect on emotion processing in adulthood. Child abuse & neglect, 38(8), pp.1369-1381.

Zajac, K., Ralston, M.E. and Smith, D.W., 2015. Maternal support following childhood sexual abuse: Associations with children’s adjustment post-disclosure and at 9-month follow-up. Child abuse & neglect, 44, pp.66-75.