ARCHIVED -  Canadian Incidence Study of Reported Child Abuse and Neglect 2008

Chapter 4 - Characteristics of Substantiated Maltreatment

Nico Trocmé, Barbara Fallon, Bruce MacLaurin, Vandna Sinha, Tara Black, Elizabeth Fast, Caroline Felstiner, Sonia Hélie, Daniel Turcotte, Pamela Weightman, Janet Douglas, and Jill Holroyd

The CIS-2008 definition of child maltreatment includes 32 forms of maltreatment subsumed under five categories: physical abuse, sexual abuse, neglect, emotional maltreatment, and exposure to intimate partner violence (see Question 31: Maltreatment Codes in Appendix F). The 32 forms of maltreatment tracked by the CIS are defined in the detailed sections on the five categories of maltreatment in this chapter.

Data collection forms required a minimum of one and a maximum of three forms of maltreatment for each investigation. In cases involving more than three forms of maltreatment, workers were asked to select the three forms that best described the reason for investigation. More than one category of maltreatment was identified for 18% of substantiated child maltreatment investigations (Table 4-2). The primary category of maltreatment was the form that best described the investigated maltreatment. In cases where there were two or more forms of maltreatment and only one was substantiated, the substantiated form was selected as the primary form.²⁵

This chapter describes the characteristics of maltreatment in terms of type, harm and duration. The estimates are derived from child maltreatment investigations from a representative sample of child welfare sites in 2008. The sampling design and weighting procedures specific to the study should be considered before inferences are drawn from these estimates. The estimates do not include (1) incidents that were not reported to child welfare, (2) reported cases that were screened out by child welfare before being fully investigated, (3) new reports on cases already opened by the child welfare sites, (4) cases that were investigated only by the police, and (5) cases that were investigated only because of concerns about future risk of maltreatment (see Chapter 2 for a full description of the inclusion and exclusion criteria for investigations). Readers are cautioned that the findings presented in this chapter are not directly comparable to findings presented in the CIS-2003 and CIS-1998 reports (Chapter 1).

Primary Categories of Maltreatment

There were an estimated 85,440 substantiated child maltreatment investigations in Canada in 2008 (14.19 investigations per 1,000 children). Table 4-1 presents the estimates and incidence rates for the five primary categories of substantiated maltreatment in Canada in 2008. The maltreatment typology in the CIS-2008 uses five major categories of maltreatment: physical abuse; sexual abuse; neglect, emotional maltreatment and exposure to intimate partner violence. Physical abuse was comprised of six forms: shake, push, grab or throw, hit with hand, punch kick or bite, hit with object, choking or poisoning or stabbing, and 'other physical abuse'. Sexual abuse contained nine forms: penetration, attempted penetration, oral sex, fondling, sex talk or images, voyeurism, exhibitionism, exploitation, and 'other sexual abuse'. Neglect was comprised of eight forms: failure to supervise: physical harm, failure to supervise: sexual abuse, permitting criminal behaviour, physical neglect, medical neglect (including dental), failure to provide psychiatric or psychological treatment, abandonment, and educational neglect. Emotional maltreatment included six forms: terrorizing or threat of violence, verbal abuse or belittling, isolation or confinement, inadequate nurturing or affection, exploiting or corrupting behaviour, and exposure to non-partner physical violence.26 Exposure to intimate partner violence was comprised of three forms: direct witness to physical violence, indirect exposure to physical violence, and exposure to emotional violence. See CIS-2008 Guidebook (Appendix G) for specific definitions of each maltreatment form.

Exposure to intimate partner violence and neglect represented the largest proportion of substantiated investigations: 34% of substantiated investigations identified exposure to intimate partner violence as the primary type of maltreatment, an estimated 29,259 investigations (4.86 investigations per 1,000 children). In another 34% of substantiated investigations, neglect was the overriding concern, an estimated 28,939 investigations (4.81 investigations per 1,000 children). In 20% of substantiated investigations, or an estimated 17,212 cases, the primary category of maltreatment identified was physical abuse (2.86 investigations per 1,000 children). Emotional maltreatment was identified as the primary category of maltreatment in 9% of substantiated investigations (an estimated 7,423 investigations or 1.23 investigations per 1,000 children) and sexual abuse was identified as the primary maltreatment form in 3% of substantiated investigations (an estimated 2,607 investigations or 0.43 investigations per 1,000 children).

Single and Multiple Categories of Maltreatment

The CIS tracked up to three forms of maltreatment; while Table 4-1 describes the primary category of substantiated maltreatment, Table 4-2 describes cases of substantiated maltreatment involving multiple categories of maltreatment.

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Single Categories of Maltreatment: In 82% of substantiated cases, one category of maltreatment was identified, involving an estimated 69,850 child investigations (11.60 investigations per 1,000 children). Physical abuse was identified as the single category of maltreatment in 15% of investigations; sexual abuse in 2%; neglect in 28%; emotional maltreatment in 6%; and exposure to intimate partner violence in 31%.

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Multiple Categories of Maltreatment: Eighteen percent of substantiated investigations involved more than one category of substantiated maltreatment, an estimated 15,590 child investigations (2.59 investigations per 1,000 children). The most frequently identified combinations were neglect and exposure to intimate partner violence (3,773 investigations), emotional maltreatment and exposure to intimate partner violence (2,367 investigations), neglect and emotional maltreatment (2,295 investigations), physical abuse and emotional maltreatment (2,281 investigations), and physical abuse and exposure to intimate partner violence (1,484 investigations). Sexual abuse was rarely found in combination with other categories of maltreatment. Estimates of substantiated investigations involving multiple forms of maltreatment should be interpreted with caution due to their high coefficient of variation (Appendix K).

Physical Harm

The CIS-2008 tracked physical harm suspected or known to have been caused by the investigated maltreatment. Information on physical harm was collected with two items, one describing the nature of the harm (Table 4-3) and one describing severity of harm as measured by the need for medical treatment (Table 4-4).

Workers were asked to document the nature of physical harm that was suspected or known to have been caused by the investigated maltreatment. These ratings were based on the information routinely collected during the maltreatment investigation. While investigation protocols require careful examination of any physical injuries and may include a medical examination, it should be noted that children are not necessarily examined by a medical practitioner. Seven possible types of injury or health conditions were documented:

No Harm: there was no apparent evidence of physical harm to the child as a result of maltreatment.

Bruises/Cuts/Scrapes: The child suffered various physical hurts visible for at least 48 hours.

Burns and Scalds: The child suffered burns and scalds visible for at least 48 hours.

Broken Bones: The child suffered fractured bones.

Head Trauma: The child was a victim of head trauma (note that in shaken infant cases the major trauma is to the head, not to the neck).

Other Health Conditions: The child suffered from other physical health conditions, such as complications from untreated asthma, failure to thrive, or a sexually transmitted disease.

Fatal: Child has died; maltreatment was suspected during the investigation as the cause of death. Included cases where maltreatment was eventually unfounded.

Table 4-3 presents six types of physical harm as well as no physical harm for investigations reported in the CIS-2008. Physical harm was documented in 8% of cases of substantiated maltreatment involving an estimated 7,069 children (1.17 investigations per 1,000 children). Physical harm primarily involved bruises, cuts, and scrapes (6%) and other health conditions (2%). Less than 1% of physical harm situations involved head trauma, burns and scalds, or broken bones. Because of the high coefficient of variation for burns and scalds, broken bones, and head trauma, the estimates presented in Table 4-3 should be interpreted with caution.

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Physical Harm and Medical Treatment

In 5% of cases (an estimated 4,643 substantiated investigations or 0.77 investigations per 1,000 children) harm was noted but no treatment was required. In 3% of cases (an estimated 2,414 substantiated investigations or 0.40 investigations per 1,000 children), harm was sufficiently severe to require treatment (Table 4-4).

Physical Abuse: Physical harm was indicated in 26% of investigations where physical abuse was the primary substantiated maltreatment, an estimated 4,492 child investigations. In 21% of cases a physical injury had been documented but was not severe enough to require medical treatment. In the other 5% of cases, medical treatment was required. The fact that no physical harm was noted in 74% of physical abuse cases may seem surprising to some readers. It is important to understand that most jurisdictions consider that physical abuse includes caregiver behaviours that seriously endanger children, as well as those that lead to injuries.

Sexual Abuse: Physical harm was identified in 11% of investigations where sexual abuse was the primary substantiated concern, with 8% of cases requiring medical treatment.

Neglect: Although physical harm was indicated in 6% of investigations where neglect was the primary substantiated maltreatment, most of these cases involved injuries that were severe enough to require medical treatment (4% of substantiated neglect cases). As a result, there were more victims of neglect requiring medical treatment (an estimated 1,073 victims of neglect or 0.18 investigations per 1,000 children) than for any other category of maltreatment.

Emotional Maltreatment: Physical harm was identified in 3% of investigations where emotional maltreatment was the primary substantiated concern. Estimates of physical harm requiring medical treatment in substantiated emotional maltreatment investigations are too low to report reliably.

Exposure to Intimate Partner Violence: Physical harm was identified in 1% of cases where exposure to intimate partner violence was the primary form of substantiated maltreatment. In less than 1% of cases where physical harm was documented, no medical treatment was required, and in 1% of cases the victims required medical treatment.

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Documented Emotional Harm

Considerable research indicates that child maltreatment can lead to emotional harm. Child welfare workers are often among the first to be aware of the emotional effects of maltreatment, either through their observations or through contact with allied professionals. However, since the information collected in the CIS-2008 was limited to the initial assessment period, it may have underestimated emotional harm. If maltreatment was substantiated, workers were asked to indicate whether the child was showing signs of mental or emotional harm (e.g., nightmares, bed wetting or social withdrawal) following the maltreatment incident(s). These maltreatment-specific descriptions of emotional harm are not to be confused with the general child functioning ratings that are presented in Chapter 5.

It is also important to note that while many victims may not show symptoms of emotional harm at the time of the investigation, the effects of the maltreatment may have manifested later. Therefore, the emotional harm documented here has likely underestimated the emotional effects of maltreatment.

Table 4-5 presents emotional harm identified during the child maltreatment investigation, by primary category of maltreatment. In order to rate the severity of mental/emotional harm, workers indicated whether the child required treatment to manage symptoms of mental or emotional harm. Emotional harm was noted in 29% of all substantiated maltreatment investigations, involving an estimated 24,425 substantiated investigations. In 17% of substantiated cases (2.44 investigations per 1,000 children) symptoms were severe enough to require treatment, in the worker’s opinion.

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Physical Abuse: Emotional harm was noted in 26% of cases where physical abuse was the primary substantiated maltreatment; in half of those cases (13%), symptoms were severe enough to require treatment.

Sexual Abuse: Emotional harm was noted in 47% of investigations where sexual abuse was the primary substantiated concern; in most of these (44%), harm was sufficiently severe to require treatment. These cases accounted for 8% (1,138/14,720) of substantiated maltreatment cases where emotional harm was believed to require therapeutic intervention. As noted above, the CIS-2008 tracked harm that could be associated with observable symptoms. It is likely that many sexually abused children may have been harmed in ways that were not readily apparent to the worker.

Neglect: Emotional harm was identified in 30% of investigations where neglect was the primary substantiated maltreatment; in 18% of cases harm was sufficiently severe to require treatment.

Emotional Maltreatment: Emotional harm was identified in 36% of investigations where substantiated emotional maltreatment was the primary concern, and was sufficiently severe to require treatment in 23% of cases. While it may appear surprising to some readers that no emotional harm had been documented for such a large proportion of emotionally maltreated children, it is important to understand that the determination of emotional maltreatment includes parental behaviours that would be considered emotionally abusive or neglectful even though the child shows no symptoms of harm.

Exposure to Intimate Partner Violence: Emotional harm was identified in 26% of investigations where exposure to intimate partner violence was the primary substantiated maltreatment; in 15% of cases harm was sufficiently severe to require treatment.

Duration of Maltreatment

Workers were asked to describe the duration of maltreatment by classifying substantiated investigations as single incident or multiple incident cases. Given the length restrictions for the CIS-2008 questionnaire, it was not possible to gather additional information on the frequency of maltreatment in order to distinguish between long-term situations with infrequent maltreatment and long-term situations with frequent maltreatment.

Table 4-6 shows that 42% of substantiated investigations (an estimated 35,025 child investigations or 5.82 investigations per 1,000 children) involved single incidents of maltreatment and 58% involved multiple incidents of maltreatment (an estimated 49,341 child investigations or 8.19 investigations per 1,000 children).

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Physical Abuse: Maltreatment was indicated as a single incident in 55% of cases with physical abuse as the primary substantiated concern, and multiple incidents in 45% of abuse cases.

Sexual Abuse: Maltreatment was indicated as a single incident in 49% of cases where sexual abuse was the primary substantiated concern, and multiple incidents in 51% of sexual abuse investigations.

Neglect: In contrast with abuse, single incidents of neglect occurred in 32% of cases where neglect was the primary substantiated maltreatment. Neglect involved multiple incidents in 68% of these cases.

Emotional Maltreatment: As with neglect, emotional maltreatment investigations involved more multiple than singleincident cases. Thirty-three percent of cases involving emotional maltreatment as the primary category of substantiated concern involved a single incident, 67% involved multiple incidents.

Exposure to Intimate Partner Violence: Forty-four percent of cases with exposure to intimate partner violence as the primary substantiated maltreatment were single incident cases, 56% involved multiple incidents.