Child Protection and Disability

Ethical, methodological and practical challenges for research

• Publisher: Dunedin Academic Press
• Year: 2017
• ISBN:
  9781780465753
• Topic: Sozialwissenschaften
• Subtopic: Behinderungen in der Soziologie

The contributors to this edited volume explore the ethical, methodological, and practical challenges in conducting child protection research with deaf and disabled children and young people. What are the child protection concerns for deaf and disabled children and young people? What are their views about the child protection system? How can we measure if we have made a difference in ending child abuse and neglect? These questions and others are at the forefront of policy, practice and research debates internationally. Contributions draw on examples of child protection and disability research from an international spectrum of leading research in both the child protection and the disability fields.As with other titles in this series the book is written for postgraduate students and academics from a range of disciplines, particularly in health, social care and education.

CHAPTER 1

Violence against children with disabilities: Evidence from around the world

Deborah Fry

Lecturer in Child Protection, Moray House School of Education, University of Edinburgh

Introduction

Data from around the world highlights how children with disabilities are at increased risk of experiencing all forms of violence when compared to their peers without disabilities. According to the UNCRC definition ‘violence against children’ (United Nations General Assembly, 1989) includes violence perpetrated by adults or other children and young people in a variety of settings including the home, schools, institutions and in the community (Pinheiro, 2006).

Despite the increased vulnerability of children with disabilities to experiencing violence, very little research has been conducted on child protection and disability and most of this research comes from high-income countries. Studies that do exist show barriers in accessing care and preventative responses. Recent global and regional recommendations were made for children with disabilities to be made visible in all strategies to tackle violence against children, emphasising both the need for them to be included in general violence-prevention initiatives and in disability-specific ones. The SDGs present an opportunity to take forward many of these recommendations over the next fifteen years as part of national and global policy agendas. However, these global, regional and national commitments require data to measure progress against key recommendations and obligations. This chapter sets the stage for the remaining chapters of this book that highlight the ethical and methodological challenges with planning, collecting, analysing and dissemination in order to improve data-collection efforts for preventing and responding to violence against children with disabilities.

Prevalence of violence against children with disabilities

Globally, 150 million children are estimated to be living with a disability, the majority of whom are in low-and middle-income countries (LMICs) (WHO and World Bank, 2011). Data on the prevalence of violence against children with disabilities is limited, especially in LMICs. A recent meta-analysis of seventeen studies of violence against children with disabilities from high-income countries has shown that children with disabilities are three to four times more likely to be abused than their peers without disabilities (Jones et al., 2012). The meta-analysis concluded that 26.7% of children with disabilities are victims of more than one type of violence in their lifetime. More than 20% experience physical violence and nearly 14% experience sexual violence (Jones et al., 2012). This echoes results from an earlier US study of all the child protection case records in Nebraska, which found that children with disabilities were 3.4 times more likely to be abused than their peers without disabilities, with incidence rates of 31% and 9% respectively (Sullivan and Knutson, 2000). In Asia, a large study of 5,841 school-aged children in Hong Kong also reported a higher prevalence of child maltreatment among children with disabilities compared to their peers without disabilities (Chan et al., 2014).

These findings are replicated in LMICs: in South Africa, for example, it has been discovered that children with physical disabilities are three to four times more likely to be abused than children without disabilities (Lamprecht, 2003). The Good School Study in Uganda, an evaluation of a school-based violence-prevention programme, randomly sampled approximately 3,800 children and adolescents aged 11–14 from forty-two primary schools in Luwero District. Among those in the control arm (n = 1,737), 84% of children with disabilities had experienced some form of violence at school in the past week compared to 54% of children without disabilities (Kuper et al., 2016). This study also found that girls with disabilities experienced twice as much sexual violence versus girls without disabilities (Devries et al., 2014). For boys, levels of sexual violence were nearly double those of boys without disabilities, but given the low prevalence of sexual violence in boys overall this difference was not statistically significant in the findings. Levels of emotional violence and neglect were noted to be similar between boys and girls with and without disabilities (Devries et al., 2014; see Chapter 4 for more on this study).

There are several methodological issues involved in measuring the prevalence of violence against children, and research has shown that some of the variance between study findings may in fact be due to methodological issues (Pereda et al., 2009). Some of the key difficulties in measurement can be found in the definitions of both disability and violence and in questions asked, the sampling designs, the age of the respondent and the type of study conducted. Also, for the first time, this book presents emerging findings that show the importance of who is asked about disability and time variance in measuring the prevalence of disability in a longitudinal study using parent–child dyads (see Chapter 4).

Evidence from a global meta-synthesis of 111 studies on physical abuse found that studies using a broad definition of child physical abuse, those that measured physical abuse across childhood (from 0–18 years) and research that included several questions on physical abuse led to higher self-reported prevalence rates (Stoltenborgh et al., 2013). The number of questions asked and measuring across childhood also increased reporting of sexual abuse according to another global meta-analysis of 217 studies on child sexual abuse (Stoltenborgh et al., 2011). However, for measuring emotional abuse prevalence, a global meta-analysis of studies found that type of instrument (face to face vs paper-and-pencil questionnaires among other approaches), whether or not the study used validated instruments, the number of questions or the sample size did not significantly impact on prevalence estimates (Stoltenborgh et al., 2012). One of the only methodological considerations that led to underreporting for emotional abuse was sampling design with lower reported prevalence rates in randomised studies than those using convenience samples (Stoltenborgh et al., 2012). In Chapter 2, we explore some of these key methodological challenges and the specific aspects that impact on the measurement of the prevalence of violence against children with disabilities.

Studies show that children with disabilities are vulnerable to many different forms of violence. There are many reasons for this increased vulnerability including: close and often intimate proximity to adults who act as caretakers; some physical and communication impairments that make it more difficult for children to disclose experiences of violence; legal and criminal justice systems, because of burden-of-proof standards, which make it more difficult to prosecute perpetration of violence against children with disabilities; and stigma and social norms that create environments where children with disabilities are discriminated against and are more isolated from potential protective factors.

In a qualitative study from Ethiopia, children with disabilities told their stories of experiencing neglect, forced labour and abandonment (Boersma, 2008). Research by Save the Children and Handicap International in Burundi, Madagascar, Mozambique and Zanzibar highlighted the increased vulnerability of children with disabilities to sexual violence (Save the Children and Handicap International, 2011). In a national survey of deaf adults in Norway, girls were twice as likely to be victims of sexual abuse, and boys three times as likely, as peers who had no disability (Kvam, 2000).

Recent research undertaken by Terre des Hommes in three countries in East Africa also highlights the increased violence against children with disabilities (Stöpler, 2007). In Kenya 15–20% of children with disabilities were exposed to severe levels of physical and sexual violence, with girls with learning disabilities being particularly vulnerable (ibid.) This is comparable to two studies from the Philippines showing an increased risk for sexual violence of children with disabilities (Terol, 2009; Hulipas, 2005).

Research has also shown that children with particular forms of impairment may be more at risk than others. Those with communication impairments, behavioural disorders, learning disabilities and sensory impairments are most vulnerable to maltreatment (Stalker and McArthur, 2012). In Uganda, children who self-reported having difficulties with self-care or communication were significantly more likely to mention severe injuries and sexual violence perpetrated by school staff compared to children without these difficulties (Kuper et al., 2016). These studies also highlight how disclosure is often delayed with most violence experiences of children who lack communication skills (mostly those with ‘moderate’ intellectual difficulties) being discovered only through noticeable symptoms such as a dishevelled appearance, physical marks, crumpled hair, soiled clothing and an unusually distressed condition (Terol, 2009).

International research has shown that non-verbal disclosure is not unique to children with disabilities. A recent qualitative study conducted in the UK on disclosure found that the majority of young adults who experienced violence during childhood attempted to disclose through their actions that they were experiencing violence during childhood but that adults often did not ‘hear’ or act upon these disclosures (Allnock and Miller, 2013; Taylor et al., 2015a). Research has highlighted that children with disabilities may not disclose violence as frequently as their peers because of a number of barriers (Stalker and McArthur, 2012) (see Chapter 2 for a discussion of these factors). In these cases, the risk factors for violence, especially sexual violence, are compounded including the vulnerability of the child combined with increased accessibility to time alone with the child (most of these children were not in school) and delayed or non-disclosure because of the child’s disability.

Responding to violence against children: The need for inclusive child protection systems

Despite the increased vulnerability of children and young people with disabilities to child maltreatment, very little research has been conducted on child protection and disability and most of this research comes from high-income countries. In a survey of seventy-three Area Child Protection Committees in the UK, Cooke and Standen (2002) found that, following case conferences (where child protection concerns are interrogated by the multidisciplinary team and which should include representation from family), children with disabilities were ‘significantly’ less likely than children without disabilities to be placed on child protection registers or have protection plans put in place. There is evidence internationally that the abuse of children with disabilities often goes undetected and, even when suspected, may be underreported (Kvam, 2004; Hershkowitz et al., 2007).

In many countries, children with disabilities continue to be placed in institutions, as highlighted by the global UN Study on Violence against Children (Pinheiro, 2006). The care provided in institutions is often insufficient because standards of appropriate care for children with disabilities are lacking or are not monitored and enforced (UNICEF, 2013). Qualitative research in Northern Ireland involved interviews with sixty-three children and young people with disabilities in out-of-home care, their parents and support professionals, and found that the process of admission into foster care or residential care was often traumatic for the child, and that many were placed in care due to abuse or neglect, but few had access to therapeutic and counselling services in care (Kelly et al., 2016). Under the Convention on the Rights of the Child (UNCRC), children with and without disabilities have the right to be cared for by their parents (Article 7) and not to be separated from their parents unless this is deemed by a competent authority to be in the child’s best interest (Article 9). The CRPD reinforces this in Article 23, which states that where the immediate family is unable to care for a child with disabilities, State parties must take every measure to provide alternative care within the extended family or community (UNICEF, 2013). As a result, there is a global movement by family and relatives to promote deinstitutionalisation and care of children.

Child protection response often involves complex decision-making environments characterised by incomplete information. Research has shown that when working on issues related to child protection and disability, professionals may struggle in key areas (Kelly and Dowling, 2015). Working with children with communication impairments is seen as particularly challenging (Stalker et al, 2010; Taylor et al, 2014). The diagnostic system for assessing significant risk may also be broader and less accurate for children with disabilities than for children without disabilities (Taylor et al., 2014). Professionals highlight that the difficulty in assessing risk is due in part to children with disabilities being more dependent on support from parents/carers and their greater vulnerability as a result, increased parental stress and complex family environments, and having multiple carers and care in different settings (ibid.).

In relation to thresholds, or when something moves from being an initial child protection concern to action within the child protection system, there is increasing evidence that professionals may apply higher thresholds for triggering a child protection response than are used with children without disabilities (Taylor et al., 2014; Stalker et al., 2010; Kelly and Dowling, 2015). In part this had been explained by a tendency of professionals to over-empathise with the parent and to be more tolerant of some behaviours than they would be of parents of children without disabilities (Stalker et al., 2010). Research highlights that while interagency working is very positive in providing support around complex cases there is often very little opportunity for professionals to reflect on practice (Munro, 2011) particularly in relation to child protection and disability (Taylor et al., 2014).

Preventing violence against children with disabilities

The landmark UN study on violence against children highlighted that ‘no violence against children is justifiable. All violence against children is preventable’ (Pinheiro, 2006). Furthermore, this report led to a thematic study on the issue of violence against children with disabilities, which concluded that while all children are at risk those with disabilities are at significantly increased risk (UNICEF, 2005). Recommendations were made for children with disabilities to be made visible in all strategies to tackle violence against children, emphasising both the need for them to be included in general violence-prevention initiatives and in disability-specific ones (Pinheiro, 2006).

In the UN general comment on children with disabilities from the Committee on the Rights of the Child, the obligations of governments include providing appropriate care and responses in the home, schools and institutions: for example, by making provision for education and support for parents, adopting measures to reduce bullying and abuse in schools and ensuring appropriate training, staffing and standards of care in childcare institutions. In addition, governments should provide access to complaints mechanisms, effective sanctions against and removal of abusers, and systems...