- Email: [email protected]
Protecting Children from Abuse and Neglect
BOOK R E V I E W S
the specifics of the courtroom process and expert testimony is also particularly helpful in supplying specific guidelines for the clinician’s courtroom behavior and in clearly delineating several of the many sources of stress that are encountered in this setting by both clinician and patient. At 188 pages the work is certainly far from exhaustive and would not address well the needs of all clinicians. Those desiring a detailed examination of the relevant psychodynamic and psychodiagnostic issues might find the book inadequate in this respect because these issues are not comprehensively addressed. Clinicians interested in a thorough account of psychotherapeutic approaches to the traumatized child and family might also find the coverage to be superficial. However, the Clinical Handbook of Child Abuse and Neglect lives up to its title. First, it is indeed a book which can be held in one hand, unlike some of the tomes which bear the word “handbook’ in the title. Furthermore, it provides a succinct and eminently readable summary of the core clinical issues that must be addressed in working with these complex and challenging children and families. This excellent volume has something of value to offer practitioners at all levels of training and experience. David Mullen, M.D. Assistant Professor of Psychiatry Director, Adolescent Unit University of New Mexico Mental Health Center, Albuquerque
Protecting Children from Abuse and Neglect. Edited by
Gary B. Melton and Frank D. Barry. New York: Guilford Press, 1994, 451 pp., $40.00 (bardcover only). In 1990, the U.S. Advisory Board on Child Abuse and Neglect concluded that child abuse and neglect was in a state of “national emergency” and that the child protection system was “fiiling.” T h e Board noted that the system was overwhelmed by the sheer number of cases-3 million since the 1960s as opposed to the 300 originally estimated by Kempe and colleagues. It cited the human tragedy and cost of child abuse and called for a new national child protection strategy to deal with the scope of the problem. T h e Board’s ensuing proposals envisioned a “comprehensive, child-centered, neighborhood-based and family-focused’’ national strategy including reorienting the delivery of human services “so that it becomes as easy to provide services to prevent child maltreatment . . . as it is to place a child in foster care after the fact” (p. 9). This book represents a portion of the Board’s complete review of child abuse. Originally, its chapters were a series of papers commissioned by the Board from experts in the field to review program and community approaches to the
problem. Collected as a book, the chapters provide a thorough review of many aspects of child abuse/neglect and offer rhe reader an understanding of the ways by which the Board arrived at its newly oriented conclusions and recommendations. Most child psychiatrists know from their clinical work that there are problems with the current child protection system. However, they may not be aware of all the reasons behind those problems. Briefly, child abuse has proved to be a much more frequent and complex problem than once thought. Once conceived as physical battering only, the concept of child abuse now encompasses many forms: physical, sexual, and emotional, as well as neglect. If just a small fraction of reported incidents are true, its frequency is staggeringly high. T h e causes of child abuse and neglect are not simple. As one chapter explains, it became clear early in the development of the field that child abuse does not solely reflect individual psychopathology. Rather, a host of interconnected individual, social, and cultural conditions are involved. For example, from an economic viewpoint, “there is no single fact about child abuse better documented . . . [than its] strong relationship with poverty and low income” (p. 131). Furthermore, from the perspective and sociology there is the repeated observation that abusive and neglectful families are socially isolated. Both of these areas are very complex, however. Poverty and social disadvantages are interrelated, and practicing clinicians know that child abuse can occur in wealthy as well as in poor families. T h e book‘s review of these and other complex and difficult areas are scholarly and thorough. What emerges from them overall is that there are many important and interconnected factors relating to child abuse and that intervention can only be discussed in a broad multilevel context which includes large societal issues. The book charges that the current child “protection” system is not protective in a preventive sense-it only reacts to the worst cases of child abuse. Even then, any intervention that occurs is generally clinical and casefocused and does not address the larger issues critical to the problem. Important as it is to establish the preceding point, the book succeeds further by addressing intervention. Each chapter ends with specific recommendations for new communityand national-level intervention approaches drawn from that chapter’s area of review. For example, recommendations from the chapter on material factors (economics) include increasing the income of families to a point above the poverty level, providing national health care, providing universal day care, and so forth. In the perspective of the authors of this chapter, social service programs would “fill the gaps,” quite a departure from the primary role played by intervention programs in the current system. Some chapters of the book
J . A M . ACAD. C H I L D ADOLESC. PSYCHIATRY. 3 5 : 2 , FEBRUARY 1 9 9 6
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BOOK R E V I E W S
describe and review existing “model” programs for interventions at community and neighborhood levels. The tone of the book is set in chapter 1 , where the editors assert that “what is needed is no less than a rebuilding of our society” (p. 11). Between this overarching call for action and the detailed recommendations at the end of the chapters, the editors present some specific guidelines for governmental and community initiative by reviewing elements of the Board’s 1993 national strategy. Briefly, these are the following: strengthening neighborhoods, reorienting human services delivery, improving the role of government in child protection, reorienting societal values, and broadening knowledge about child maltreatment. This is not an easy book to read. It is exhaustively detailed, and major points and recommendations are sometimes buried in the text. But it is a book that states frankly what is known and what is not known about the field. Although one chapter provides an excellent review of developmental perspectives on abuse and interventions, the book is not about child abuse treatment at a clinical level. Overall, the book maintains a broad program focus, as its editors and authors intended. Some child psychiatrists, probably those involved in program planning or administration, will find this to be a good sourcebook. This reviewer tends to agree, though, with a book-jacket comment that the book will appeal primarily to “policy makers, research workers and graduate students who will find much valuable information [in it].” This book is an excellent text for anyone wanting to review the field from a program-planning viewpoint. John Gale, Ph.D., M.D. Assistant Clinical Professor of Psychiatry Oregon Health Sciences University, Portland
Young, Poor, and Pregnant: T h e Psychology of Teenage Motherhood. By juditb S. Musick. New Haven, C E Yale University Press, 1993, 272 pp., $30 (hardcover), $14 (softcover). Mr. Gingrich and others in Congress have concluded that teenagers will stop having babies if they stop making money from doing so, which makes this book both exciting and disturbing to read. It is exciting because Dr. Musick, a wise and compassionate scholar, has told us something that child psychiatrists already know: that teenage girls becoming pregnant and having babies, especially in poor minority communities, is a very complicated phenomenon. She also teaches that it is a potentially understandable one. Judith Musick is a developmental psychologist who is the vice chairman of the Ounce of Prevention Fund, a publicprivate venture founded in 1981 to serve disadvantaged youths. She bases her book on an anthropological style of
256
research, rather than statistical analyses, but nicely places her qualitative work within the context of data from large quantitative studies. Data collected by Musick come from nine data sets, including follow-up interviews with 25 adolescent mothers who participated in the programs in four urban sites, interviews with community-based providers, and diaries and journals of adolescent mothers, as well as data from larger interview studies. Her sample included teenage girls who were white, Hispanic, and African-American, and who lived in small towns, rural areas, and cities in the Midwest and Southeast. All of the subjects were from working-class, working-poor, or welfare-dependent families. This book contains much information on the social problem of teenage pregnancy, but its primary focus is on the does a pregnancy psychology of teenage pregnancy-what “do” for a girl or young woman? In describing the reasons she has encountered, Musick makes the case that pregnancy is currently so good at satisfying some compelling needs that financial incentives would have little impact. First she places teenage pregnancy within the context of adolescent development, looking at numerous tasks of adolescence and how pregnancy helps teenagers master those tasks adaptively or maladaptively. For example, she sees pregnancy and motherhood as a solidification of identity, especially if the girl is feeling empty or confused about who she is in an anxiety-provoking world. T h e identity of being pregnant helps her feel protected and special; her family and boyfriend may fuss over her and buy her special things. ‘I’his point is illustrated by diary entries quoted in the book: “I like it when people notice I’m having a baby. It gives me a good feeling inside and makes me feel important.” “Baby will be here any day now and I will be a proud Teen Mom with my head held high” (pp. 110-1 11). Having children also establishes the teenager as an adult woman in her community and allows her to consolidate her identification with her mother. In addition, for a very needy teenager a baby is something that is only hers: “Cause it’s going to be my baby and I get to spoil it and tell it what to do. I can spank its butt and not have to worry about somebody saying ‘Don’t whup my child.’ [I can] teach it things, good and bad parts of life” (p. 123). However, because in this study pregnancy and childbearing usually result in the teenager’s staying with her own family rather than moving in with the baby’s father, teenage pregnancy may interrupt the process of separation and individuation which these girls may find especially hard. Because they often have not had enough of their needs met within their family, pregnancy provides a means for slowing the separation process while still allowing them to achieve a partial adult identity. In this regard, Musick takes a special look at the “stars” of the community who were “going
J . A M . A C A D . C H I L D A D O L E S C . P S Y C H I A T R Y , 3 5 : 2 , F E B R U A R Y 1996
the specifics of the courtroom process and expert testimony is also particularly helpful in supplying specific guidelines for the clinician’s courtroom behavior and in clearly delineating several of the many sources of stress that are encountered in this setting by both clinician and patient. At 188 pages the work is certainly far from exhaustive and would not address well the needs of all clinicians. Those desiring a detailed examination of the relevant psychodynamic and psychodiagnostic issues might find the book inadequate in this respect because these issues are not comprehensively addressed. Clinicians interested in a thorough account of psychotherapeutic approaches to the traumatized child and family might also find the coverage to be superficial. However, the Clinical Handbook of Child Abuse and Neglect lives up to its title. First, it is indeed a book which can be held in one hand, unlike some of the tomes which bear the word “handbook’ in the title. Furthermore, it provides a succinct and eminently readable summary of the core clinical issues that must be addressed in working with these complex and challenging children and families. This excellent volume has something of value to offer practitioners at all levels of training and experience. David Mullen, M.D. Assistant Professor of Psychiatry Director, Adolescent Unit University of New Mexico Mental Health Center, Albuquerque
Protecting Children from Abuse and Neglect. Edited by
Gary B. Melton and Frank D. Barry. New York: Guilford Press, 1994, 451 pp., $40.00 (bardcover only). In 1990, the U.S. Advisory Board on Child Abuse and Neglect concluded that child abuse and neglect was in a state of “national emergency” and that the child protection system was “fiiling.” T h e Board noted that the system was overwhelmed by the sheer number of cases-3 million since the 1960s as opposed to the 300 originally estimated by Kempe and colleagues. It cited the human tragedy and cost of child abuse and called for a new national child protection strategy to deal with the scope of the problem. T h e Board’s ensuing proposals envisioned a “comprehensive, child-centered, neighborhood-based and family-focused’’ national strategy including reorienting the delivery of human services “so that it becomes as easy to provide services to prevent child maltreatment . . . as it is to place a child in foster care after the fact” (p. 9). This book represents a portion of the Board’s complete review of child abuse. Originally, its chapters were a series of papers commissioned by the Board from experts in the field to review program and community approaches to the
problem. Collected as a book, the chapters provide a thorough review of many aspects of child abuse/neglect and offer rhe reader an understanding of the ways by which the Board arrived at its newly oriented conclusions and recommendations. Most child psychiatrists know from their clinical work that there are problems with the current child protection system. However, they may not be aware of all the reasons behind those problems. Briefly, child abuse has proved to be a much more frequent and complex problem than once thought. Once conceived as physical battering only, the concept of child abuse now encompasses many forms: physical, sexual, and emotional, as well as neglect. If just a small fraction of reported incidents are true, its frequency is staggeringly high. T h e causes of child abuse and neglect are not simple. As one chapter explains, it became clear early in the development of the field that child abuse does not solely reflect individual psychopathology. Rather, a host of interconnected individual, social, and cultural conditions are involved. For example, from an economic viewpoint, “there is no single fact about child abuse better documented . . . [than its] strong relationship with poverty and low income” (p. 131). Furthermore, from the perspective and sociology there is the repeated observation that abusive and neglectful families are socially isolated. Both of these areas are very complex, however. Poverty and social disadvantages are interrelated, and practicing clinicians know that child abuse can occur in wealthy as well as in poor families. T h e book‘s review of these and other complex and difficult areas are scholarly and thorough. What emerges from them overall is that there are many important and interconnected factors relating to child abuse and that intervention can only be discussed in a broad multilevel context which includes large societal issues. The book charges that the current child “protection” system is not protective in a preventive sense-it only reacts to the worst cases of child abuse. Even then, any intervention that occurs is generally clinical and casefocused and does not address the larger issues critical to the problem. Important as it is to establish the preceding point, the book succeeds further by addressing intervention. Each chapter ends with specific recommendations for new communityand national-level intervention approaches drawn from that chapter’s area of review. For example, recommendations from the chapter on material factors (economics) include increasing the income of families to a point above the poverty level, providing national health care, providing universal day care, and so forth. In the perspective of the authors of this chapter, social service programs would “fill the gaps,” quite a departure from the primary role played by intervention programs in the current system. Some chapters of the book
J . A M . ACAD. C H I L D ADOLESC. PSYCHIATRY. 3 5 : 2 , FEBRUARY 1 9 9 6
255
BOOK R E V I E W S
describe and review existing “model” programs for interventions at community and neighborhood levels. The tone of the book is set in chapter 1 , where the editors assert that “what is needed is no less than a rebuilding of our society” (p. 11). Between this overarching call for action and the detailed recommendations at the end of the chapters, the editors present some specific guidelines for governmental and community initiative by reviewing elements of the Board’s 1993 national strategy. Briefly, these are the following: strengthening neighborhoods, reorienting human services delivery, improving the role of government in child protection, reorienting societal values, and broadening knowledge about child maltreatment. This is not an easy book to read. It is exhaustively detailed, and major points and recommendations are sometimes buried in the text. But it is a book that states frankly what is known and what is not known about the field. Although one chapter provides an excellent review of developmental perspectives on abuse and interventions, the book is not about child abuse treatment at a clinical level. Overall, the book maintains a broad program focus, as its editors and authors intended. Some child psychiatrists, probably those involved in program planning or administration, will find this to be a good sourcebook. This reviewer tends to agree, though, with a book-jacket comment that the book will appeal primarily to “policy makers, research workers and graduate students who will find much valuable information [in it].” This book is an excellent text for anyone wanting to review the field from a program-planning viewpoint. John Gale, Ph.D., M.D. Assistant Clinical Professor of Psychiatry Oregon Health Sciences University, Portland
Young, Poor, and Pregnant: T h e Psychology of Teenage Motherhood. By juditb S. Musick. New Haven, C E Yale University Press, 1993, 272 pp., $30 (hardcover), $14 (softcover). Mr. Gingrich and others in Congress have concluded that teenagers will stop having babies if they stop making money from doing so, which makes this book both exciting and disturbing to read. It is exciting because Dr. Musick, a wise and compassionate scholar, has told us something that child psychiatrists already know: that teenage girls becoming pregnant and having babies, especially in poor minority communities, is a very complicated phenomenon. She also teaches that it is a potentially understandable one. Judith Musick is a developmental psychologist who is the vice chairman of the Ounce of Prevention Fund, a publicprivate venture founded in 1981 to serve disadvantaged youths. She bases her book on an anthropological style of
256
research, rather than statistical analyses, but nicely places her qualitative work within the context of data from large quantitative studies. Data collected by Musick come from nine data sets, including follow-up interviews with 25 adolescent mothers who participated in the programs in four urban sites, interviews with community-based providers, and diaries and journals of adolescent mothers, as well as data from larger interview studies. Her sample included teenage girls who were white, Hispanic, and African-American, and who lived in small towns, rural areas, and cities in the Midwest and Southeast. All of the subjects were from working-class, working-poor, or welfare-dependent families. This book contains much information on the social problem of teenage pregnancy, but its primary focus is on the does a pregnancy psychology of teenage pregnancy-what “do” for a girl or young woman? In describing the reasons she has encountered, Musick makes the case that pregnancy is currently so good at satisfying some compelling needs that financial incentives would have little impact. First she places teenage pregnancy within the context of adolescent development, looking at numerous tasks of adolescence and how pregnancy helps teenagers master those tasks adaptively or maladaptively. For example, she sees pregnancy and motherhood as a solidification of identity, especially if the girl is feeling empty or confused about who she is in an anxiety-provoking world. T h e identity of being pregnant helps her feel protected and special; her family and boyfriend may fuss over her and buy her special things. ‘I’his point is illustrated by diary entries quoted in the book: “I like it when people notice I’m having a baby. It gives me a good feeling inside and makes me feel important.” “Baby will be here any day now and I will be a proud Teen Mom with my head held high” (pp. 110-1 11). Having children also establishes the teenager as an adult woman in her community and allows her to consolidate her identification with her mother. In addition, for a very needy teenager a baby is something that is only hers: “Cause it’s going to be my baby and I get to spoil it and tell it what to do. I can spank its butt and not have to worry about somebody saying ‘Don’t whup my child.’ [I can] teach it things, good and bad parts of life” (p. 123). However, because in this study pregnancy and childbearing usually result in the teenager’s staying with her own family rather than moving in with the baby’s father, teenage pregnancy may interrupt the process of separation and individuation which these girls may find especially hard. Because they often have not had enough of their needs met within their family, pregnancy provides a means for slowing the separation process while still allowing them to achieve a partial adult identity. In this regard, Musick takes a special look at the “stars” of the community who were “going
J . A M . A C A D . C H I L D A D O L E S C . P S Y C H I A T R Y , 3 5 : 2 , F E B R U A R Y 1996