Understanding Child Abuse Prevalence

This assignment delves into the topic of child abuse, examining its prevalence rates across different types (physical, emotional, sexual, neglect) and victimization experiences. It synthesizes data from multiple studies, including those by Radford et al., Finkelhor et al., Schönbucher et al., Schaeffer et al., McElvaney et al., Mahram et al., and Cyr et al. The analysis highlights the significant number of children who have experienced abuse, the factors influencing disclosure, and the need for further research and intervention strategies.

Running head- HEALTH AND SOCIAL CARE MANAGEMENT
A systematic review to increase an understanding of child abuse as disclosed by victims on direct
inquiry or during surveys
Name of the Student
Name of the University
Author Note

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Abstract
Children are subjected to incidents of child abuse, every year, throughout the world. Physical
abuse occurs when adults cause non-accidental bodily harm to children, which may result in
bruises or cuts. Adults have also been found to use children for sexual excitement and
gratification that results in sexual child abuse. On the other hand, any kind of attitude that
disrupts the social and mental development of a child is considered as emotional abuse. This
often alters the child’s behaviour and has long lasting impacts. Owing to the increased
prevalence of child abuse increased attention are being given on several legislations and laws for
safeguarding children. These laws facilitate easy identification of children who are at an
increased likelihood of abuse and take all possible measures to protect those children from their
parents and caregivers. This dissertation is based on a qualitative study that will try to evaluate
prevalence of child abuse and victimisation, on a global basis. It will conduct a systematic
review that will retrieve articles and analyse the findings to understand the prevalence of abuse
related incidents and also investigate probable reasons that create an impact on disclosure.
Keywords: children, abuse, physical, emotional, sexual, parents, laws, prevalence, disclosure

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Table of Contents
Chapter 1: Introduction....................................................................................................................5
Background..................................................................................................................................5
Research objectives.....................................................................................................................6
Research aim................................................................................................................................7
Problem statement.......................................................................................................................7
Rationale of the study..................................................................................................................8
Research question........................................................................................................................8
Thesis statement...........................................................................................................................9
Chapter 2: Literature Review.........................................................................................................10
Chapter 3: Methodology................................................................................................................18
Introduction................................................................................................................................18
Method outline...........................................................................................................................19
Research Onion..........................................................................................................................20
The research philosophy........................................................................................................21
Research approach.................................................................................................................22
Research strategy...................................................................................................................22
Time horizon..........................................................................................................................23
Data collection and analysis..................................................................................................23

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Research design.....................................................................................................................24
Research sampling.................................................................................................................25
Data collection.......................................................................................................................27
Ethical considerations............................................................................................................28
Limitations.............................................................................................................................29
Chapter 4: Results..........................................................................................................................30
Introduction................................................................................................................................30
Results........................................................................................................................................31
Prevalence of child abuse/maltreatment................................................................................31
Disclosure of abuse................................................................................................................32
Perpetrator characteristics......................................................................................................34
Multiple maltreatment or victimization.................................................................................35
Chapter 5: Conclusion and Recommendations..............................................................................36
Discussion..................................................................................................................................36
Limitations.................................................................................................................................40
Recommendations......................................................................................................................42
Research priority 1.................................................................................................................45
Research priority 2.................................................................................................................45
Research priority 3.................................................................................................................45
Research priority 4.................................................................................................................46

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Research priority 5.................................................................................................................46
Research priority 6.................................................................................................................46
References......................................................................................................................................48
Appendix........................................................................................................................................61

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Chapter 1: Introduction
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,

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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

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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.
Research aim
 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
Problem statement
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

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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).
Rationale of the study
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).
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.

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

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Chapter 2: Literature Review
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

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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).
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

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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 Işik 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.
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.

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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).

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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).
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

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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).
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

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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

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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).
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).

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Chapter 3: Methodology
Introduction
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

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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.
Method outline
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

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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.
Research Onion
Figure 1- Research Onion

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Source- (Saunders et al. 2015)
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.
The research philosophy
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,

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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.
Research approach
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.

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Research strategy
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.
Time horizon
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.

24HEALTH AND SOCIAL CARE MANAGEMENT
Data collection and analysis
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
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

25HEALTH AND SOCIAL CARE MANAGEMENT
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.
Research sampling
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

26HEALTH AND SOCIAL CARE MANAGEMENT
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

27HEALTH AND SOCIAL CARE MANAGEMENT
 Articles published before 2008
 Abstracts or unpublished manuscripts
 Studies without adequate information on age of victims
 Book chapters
 Dissertations
 Case studies
Data collection
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.

28HEALTH AND SOCIAL CARE MANAGEMENT
Figure 2- PRISMA flow diagram for the systematic review
Ethical considerations
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

29HEALTH AND SOCIAL CARE MANAGEMENT
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.
Limitations
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.

30HEALTH AND SOCIAL CARE MANAGEMENT
Chapter 4: Results
Introduction
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

31HEALTH AND SOCIAL CARE MANAGEMENT
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.
Results
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.
Prevalence of child abuse/maltreatment
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

32HEALTH AND SOCIAL CARE MANAGEMENT
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).
Disclosure of abuse
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

33HEALTH AND SOCIAL CARE MANAGEMENT
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).

34HEALTH AND SOCIAL CARE MANAGEMENT
Perpetrator characteristics
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

35HEALTH AND SOCIAL CARE MANAGEMENT
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).
Multiple maltreatment or victimization
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

36HEALTH AND SOCIAL CARE MANAGEMENT
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.
Chapter 5: Conclusion and Recommendations
Discussion
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

37HEALTH AND SOCIAL CARE MANAGEMENT
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,

38HEALTH AND SOCIAL CARE MANAGEMENT
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

39HEALTH AND SOCIAL CARE MANAGEMENT
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

40HEALTH AND SOCIAL CARE MANAGEMENT
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.
Limitations
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

41HEALTH AND SOCIAL CARE MANAGEMENT
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.

42HEALTH AND SOCIAL CARE MANAGEMENT
Recommendations
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

43HEALTH AND SOCIAL CARE MANAGEMENT
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

44HEALTH AND SOCIAL CARE MANAGEMENT
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.

45HEALTH AND SOCIAL CARE MANAGEMENT
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

46HEALTH AND SOCIAL CARE MANAGEMENT
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.

47HEALTH AND SOCIAL CARE MANAGEMENT
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.

48HEALTH AND SOCIAL CARE MANAGEMENT
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Appendix
Summary table illustrating the findings
Authors Aim Sample Measures Results
Annerbäck et al.
2010
Investigate
prevalence of child
physical abuse
rates,
characteristics and
disclosure patterns
Pupils from 3
grades in schools
located at
Södermanland
County, Sweden
Population-
based youth
survey selected
for asking about
exposure to
violence and its
experience. Bi
and multi-variate
models used.
Abuse incidents
reported by
15.2% sample.
Disclosure to
authorities has
been made by
7% children.
Strong relation
established
between risk
factors and
abuse rates
Chan et al. 2013 Provide
comprehensive
profile of
prevalence of child
abuse in China and
examine its
relation with
18341 students
from grade 9-12
from 150
schools,
following
randomisation
Demographic
background,
child abuse and
victimization
experiences
were assessed
and examined
8.0% lifetime
child abuse
prevalence and
6.4% preceding-
year prevalence
was found from
the responses.

62HEALTH AND SOCIAL CARE MANAGEMENT
demographic
factors.
after controlling
major variables
Significant
impact of gender
differences,
parental
influence, and
unemployment
also established.
Jackson,
Browne and
Joseph 2016
Examine
prevalence of
extrafamilial
victimization/abuse
among youth
730 youth aged
13-16 years from
a UK county
Demographic
questionnaire,
juvenile
victimization
questionnaire
were distributed
to collect
relevant
information
from the sample
84.1% sample
experienced
indirect
victimization
over lifetime and
67.2% in the
previous year.
Results also
provided
evidence for
prevalence of
property
victimization,
bullying,
physical abuse,
and indirect

63HEALTH AND SOCIAL CARE MANAGEMENT
abuse.
Radford et al.
2013
To measure
prevalence of
abuse and other
victimization types
among youth,
children, and
young adults
1761 young
adults, 2160
parents and
caregivers, and
2275 children
and youth
Computer-
assisted self-
administered
interviews were
conducted that
assessed
experiences of
childhood
victimization
Physical,
emotional and
sexual abuse
were reported by
2.5% children
under 11 years
and 6% youth
aged 11-17
years. High rates
of sexual
victimization
were also
reported by the
children and
young adults.
Finkelhor et al.
2014
It measured the
national estimates
of child abuse and
maltreatment
across the nation.
4503 children
and youth
Population-wide
national survey
conducted in
2011
12.1% of the
sample reported
experiences of
child abuse. Two
or more types of
abuse were
reported by 2.8%

64HEALTH AND SOCIAL CARE MANAGEMENT
sample. High
rates of
emotional and
sexual abuse by
caregivers were
also reported.
Schönbucher et
al. 2012
Investigated the
disclosure process
by conducting an
examination of
youth and
adolescents having
experienced sexual
abuse
26 sexually
abused
adolescent
victims
Face-to-face
interview on
disclosure and
its associated
factors, followed
by qualitative
content analysis
Less than 1/3rd
participants
immediately
disclosed such
incidents. High
rates of sample
were found to
never disclose
about abuse
related events to
parents. Main
motives for
delay in
disclosure were
also found.
Schaeffer,
Leventhal and
Aimed to directly
inquire about
327 children Forensic
interviews that
Effect of internal
stimuli, outside