Elsevier

Child Abuse & Neglect

Volume 23, Issue 12, December 1999, Pages 1239-1252
Child Abuse & Neglect

Commentary
Abuse of children in foster and residential care

https://doi.org/10.1016/S0145-2134(99)00096-4Get rights and content

Abstract

Objective: There have recently been many debates in the UK about how to provide good care for children placed away from home. Professionals have realized that the level of child abuse in foster care and children’s homes is high. This research examines the characteristics of physical and sexual abuse of children in foster and residential care in a city in England. The number of cases of abuse reported by pediatricians in this group was compared to the number reported by the same pediatricians for the population of Leeds as a whole.

Method: This is a retrospective study of 158 children, fostered or in residential care who were involved in 191 episodes of alleged physical and/or sexual abuse assessed and reported by pediatricians over a 6 year period from 1990 to 1995 in Leeds, England. Details of the child including the reason for placement in care, their physical and mental health, abuse characteristics, including perpetrator and case management were studied.

Results: (see Table 1): 158 incidents of abuse in 133 children in foster/residential care are described.

  • In foster care, 42 children were physically abused, 76 were sexually abused, and 15 experienced both forms of abuse.

  • In residential care, 12 children were physically abused, 6 were sexually abused, and 6 experienced both forms of abuse.

  • In foster care 60% of sexual abuse involved girls and 60% of physical abuse involved boys.

  • In residential care almost twice as many boys as girls were reported to be abused.

  • Foster carers perpetrated the abuse for 41%, natural parents on contact for 23%, and children 20% of incidents.

  • A significant proportion of abuse was severe with 1 death, 8 children with burns, 18 with genital, and 34 with anal penetration.

  • Long-standing emotional, behavioral and learning difficulties were common. Most children (80%) had been abused prior to entry into care.

  • Foster children were 7–8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population.

Conclusions: Children in foster or residential care form an at risk group for maltreatment. Their special needs include additional measures to protect them from abuse.

Resumen

Objectif: Comment prodiguer de bons soins aux enfants qui sont placés à l’extérieur de leur foyer est un sujet de grande discussion au Royaume-Uni. Les interenants se rendent compte que les enfants en foyer d’accueil et dans les institutions sont souvent maltraités. Cette recherche porte sur les caractéristiques des mauvais traitements physiques et sexuels d’enfants en foyer d’accueil et en institution dans une ville anglaise. Les cas de mauvais traitements parmi ce groupe d’enfants, lesquels ont été signalés par des pédiatres, ont été comparés à des cas signalés par ces mêmes pédiatres dans l’ensemble de la population de la ville de Leeds.

Méthode: Ceci est une étude rétrospective comptant 158 enfants dans des foyers d’accueil ou dans des institutions, qui ont été victimes de 191 épisodes de présumés mauvais traitements physiques et/ou sexuels, échelonnés sur une période de 6 ans depuis 1990 à 1995 dans la ville de Leeds en Angleterre. On a étudié divers facteurs y compris les raisons pour lesquelles l’enfant fut placé, sa santé physique et mentale, les caractéristiques des mauvais traitements, l’agresseur et la gestion du cas.

Résultats (voir le tableau no. 1):

  • 158 incidents de mauvais traiatements affectant 133 enfants en foyer d’accueil ou en institution; en foyer d’accueil, 42 enfants ont été maltraités physiquement, 76 ont été maltraités physiquement, 76 ont été victimes d’agressions sexuelles et 15 ont connu les deux types de mauvais traitements; en institution, 12 enfants furent abusés physiquement, 6 furent abusés sexuellement et 6 ont été victimes des deux types de mauvais traitements; en foyer d’accueil, dans 60 p.c. des cas d’abus sexuels, les filles en furent les victimes tandis que 60 p.c. des cas d’abus physiques furent perpétrés envers les garçons; en institution, deux fois plus de garçons que de filles ont été maltraités; les familles d’accueil étaient responsables de 41 p.c. des mauvais traitements alors que les parents biologiques ont été les agresseurs dans 23% des cas et les enfants ont eux-mêmes agressé leurs pairs dans 20 p.c. des cas; une proportion importante de mauvais traitements fut considérés graves: on a constaté un décès, 7 enfants qui ont subi des brûlures, 18 enfants qui ont été victimes de pénétration génitale et 23 p.c. de pénétration anale; on a noté un grand nombre de difficultés émotionnelles, d’apprentissage et de comportement. La plupart des enfants (80 p.c.) Avaient déjà été vicimes de mauvais traitements avant d’arriver en foyer d’accueil ou en institution; les enfants des foyers d’accueil étaient 7 à 8 fois plus aptes à être jugés victimes de mauvais traitements par le pédiatre que les enfants de la population générale; pour ce qui est des enfants en institution, le taux était de 6 fois plus élevé.

Conclusions: Les enfants vivant en foyer d’accueil ou en institution song un groupe à risque et leurs besoins spéciaux justifient la nécessité de prendre des mesures additionnelles pour les protéger.

Objetivo: Recientemente se ha debatido mucho en Inglaterra sobre cómo ofrecerle un buen cuidado a los niños colocados fuera de su hogar. Los profesionales se han dado cuenta de que el nivel de abuso a los niños es muy alto. Esta investigación examina las caracterı́sticas del abuso fı́sico y sexual en niños de cuidado sustituto e internamiento en una ciudad de Inglaterra. El número de casos de abuso reportado por pediatras en este grupo fue comparado con el número reportado por los mismos pediatras en toda la población de Leeds.

Método: Este es un estudio retrospectivo de 158 niños, de cuidado sustituto o residencial, quienes estuvieron envueltos en 191 episodios de alegatos de abuso fı́sico y/o sexual evaluados y reportados por pediatras en un perı́odo de 6 años del 1990 al 1995 en Leeds, Inglaterra. Se esutdiaron los detalles de los niños que incluyen la razón de estar en cuidado sustituto, su salud fı́sica y mental, caracterı́sticas del abuso, incluyendo el perpetrador y el manejo del caso.

Resultados: (vea Tabla 1) Se describen 158 incidentes de abuso en 133 niños en cuidado sustituto/residencial. En cuidado sustituto, 42 niños fueron fı́sicamente abusados, 76 fueron abusados sexualmente, y 15 sufrieron ambas formas de abuso. En cuidado residencial, 12 niños fueron fı́sicamente abusados, 6 fueron sexualmente abusados y 6 sufrieron amas formas de aabuso. En cuidado sustituto 60% del abuso sexual incluı́a a los varones. En cuidado residencial, casi el doble de los varones que de las hembras fueron reportados como abusados. Los cuidadores sustitutos le infligieron el abuso a 41%, los padres naturales en contacto al 23% y los niños el 20% de los incidentes. Una proporción significativa del abuso fue severa con 1 muerte, 7 niños con quemaduras, 18 con penetración genital y 34 con penetración anal. Ordinariamente se presentaban dificultades permanentes emocionales, conductuales y de aprendizaje. Muchos niños (80%) habı́an sido abusados antes de entrar en cuidado sustituto. Los niños en cuidado sustituto eran 7–8 veces y los de cuidado residencial 6 veces más propensos a ser evaluados por un pediatra por abuso que un niño en la población general.

Conclusión: Los niños en cuidado sustituto o residencial forman un grupo de riesgo para el maltrato. Sus necesidades especiales incluyen medidas adicionales para protegerlos del abuso.

Introduction

CHILDREN WHO ARE abused and neglected or those who cannot be cared for by their families for various reasons may be placed in the protective care of the local authority. There is an expectation that although there may be inherent difficulties of care within an official public system that at least children will be protected from further maltreatment. The converse however appears to be the case despite the duty put on the local authority that “children living away from home are entitled to the same level and standard of protection from harm as is provided for children in their own homes” (Working Together, 1991).

In England and Wales there are about 48,000 children “looked after” by the local authority, of who 31,800 are in foster care, and 8,000 in residential care. Both the number of children in children’s homes and the size of the homes have fallen with currently on average 10 children in each home: 65% of children were fostered in 1995 (58% in 1991).

Previous studies suggest that children in foster and residential care form an “at risk” group as a consequence of earlier abuse, neglect, abandonment and inadequate care at home Benedict et al 1994, Bolton et al 1981. Ball (1991) estimated that 66% of “looked after” children had been previously abused, and Chernoff (1994) in looking at the reason for placement described a history of abuse in 81% of their sample. Certain children are more vulnerable. These include young children, children with disability, and children with behavioral and emotional difficulties (Utting, 1997). These problems are often greater in children in residential care (Polnay, Glaser, & Rao, 1996). Many children entering care have already been harmed psychologically and emotionally and have developed difficult behaviors experienced as dysfunctional to new carers. Foster carers may also care for more than one foster child with such difficulties and sometimes care for many such children. Their experience, training, and support will be crucial to any success in meeting these children’s long-term and complex needs. Risks may increase in long-term foster care had particularly where the foster carers have had care of the child for a long time, and may have been less well supervised (Utting, 1997). A further factor which may reduce protection for these children is a criminal justice system which is not working “in a way which protects children against abuse” (Utting, 1997)

Recently extensive abuse has been uncovered in children’s homes in North Wales. People who wish to exploit children seek occupation or voluntary work, which gives them easy access to their prey (Utting, 1997). The Warner Report (1992) focused on tighter regulations around the appointment of staff but many of the recommendations were not implemented. Previous reports (Utting, 1991) have looked at safeguards for children in residential settings but again not all the recommendations were implemented. However it is now expected that with current changes in practice, the North Wales situation will not be repeated. Finally it should be noted that many of the confirmed reports of maltreatment in out-of-home placements are serious in nature (Rosenthal, Motz, Edmondson, & Groze, 1991).

Pediatricians in Leeds, a large city in the North of England, became aware that they were being asked to see an increasing number of children who were in foster or residential care where there were concerns that they may have been abused, either physically or sexually or both. A small number of high profile cases included one in 1986 and one in 1995 where a child who was fostered was killed by a foster carer. The question was asked whether these children suffer increased vulnerability to abuse?

Leeds is part of West Yorkshire, which has rates of referrals for legal proceedings under the Children Act 1989 above the national average (Children Act Advisory Committee, 1993). No evidence was found, however, on review by a senior judge of over-reporting of cases to the legal system.

The study aimed to determine the frequency and pattern of abuse and neglect of children seen by pediatricians and who were placed in foster or residential homes over a 6-year period.

The reasons for placement of the child in care and problems the child was experiencing were also studied. Comparison of the frequency of referred cases of children in foster and residential care with those referred from the general population to the same pediatricians was made. In addition the interagency response to these children was examined in terms of investigation, protection, and management.

Children in foster or residential care in whom there were concerns regarding physical or sexual abuse over the 6-year period 1990–1995 were identified retrospectively from medical reports written following full assessments by pediatricians experienced and specially trained in this work. Information was extracted from the reports and case records and analyzed. It is the local inter-agency policy that children with inadequately explained, unusual, or repeated injuries are referred to the specialized pediatric team for assessment as soon as such injury is recognized. Pediatric follow-up appointments at the clinic provide continuing assessment and support with on-going care. At the follow-up appointment a further physical examination is carried out if there are worrying symptoms or signs, for example, bruising, vaginal soreness, specific behaviors (sexualized or an unexpected change in behavior).

The details of the author’s diagnostic approach to both physical and sexual abuse have been dealt with in previous publications (Hobbs, Hanks, & Wynne, 1993). The diagnosis is constructed in the same way as a jigsaw puzzle with information being added until a picture is assembled.

Section snippets

Results (Tables 1–3)

Discussion

The majority of children looked after by local authorities in the United Kingdom are placed in foster care. On 31st March 1995, 49,000 children were being looked after by social services departments in England of whom 31,800 (65%) were fostered (Social Services Inspectorate—Department of Health, 1996, Inspection of Local Authority Fostering, 1995–1996).

The local authority fostering service is a major component of services provided for children and families under the Children Act 1989. There has

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