Intervening in severe physical child abuse cases: mental health, legal, and social services.
OBJECTIVE
To examine the child protection process in cases of severe physical abuse, to compare characteristics of the families with risk factors previously reported in the published literature, and to develop recommendations about the use of mental health professionals in such cases.


METHODS
Reviewers examined 30 case records of severely physically abused children under age 5, nominated by child protection workers and mental health providers. The reviewers recorded demographic, clinical, and case process information such as mental health and other referrals, reunification status, and frequency of criminal prosecution. A case study was described.


RESULTS
The parents displayed a range of psychological characteristics (e.g., depression, anxiety, personality disorders) and life problems (e.g., domestic violence, substance abuse, abused as child). The majority of parents denied the abuse. The children were very young (more than half under 6 months old) and many had difficult births or medical problems prior to the abuse. The most common services offered were individual psychotherapy and parenting classes. More than half of the children reunified with at least one parent within I year. Forty percent of the cases involved criminal prosecution.


CONCLUSIONS
Reunification occurred more quickly and more often than expected based on the severity of the injuries. The system often relies on psychotherapy to correct the abusive behavior, even when the perpetrator remains unknown and specific risks such as substance abuse or domestic violence are present. The authors advise utilizing multidisciplinary teams for recommendations regarding reunification.
Miller
B V
BV
Treatment and Evaluation Resource Management, Juvenile Forensic Services, Health and Human Services Agency, County of San Diego, San Diego, CA 92123, USA.
Fox
B R
BR
Garcia-Beckwith
L
L
D000293:Adolescent; D000328:Adult; D002649:Child Abuse / Q000331:legislation & jurisprudence / Q000523:psychology / Q000628:therapy; D002669:Child Welfare; D002675:Child, Preschool; D003717:Denial, Psychological; D017579:Domestic Violence; D005195:Family Relations; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010287:Parent-Child Relations; D011613:Psychotherapy; D012307:Risk Factors; D012947:Social Work