Les jeunes victimes de violence et de mauvais

Emotional Maltreatment: Results of the
Canadian Incidence Study of Reported
Child Abuse and Neglect Second Cycle
(CIS-2)
Claire Chamberland, Université de Montréal
Barbara Fallon, University of Toronto
Tara Black, University of Toronto
Nico Trocmé, McGill University
Martin Chabot, McGill University
CRCF Seminar Series
McGill University
L’abus psychologique et la maltraitance des enfants est à la fois
une omission et une commission qui sont jugées en fonction
des normes sociales et de l’expertise professionnelle à
propos de ce qui est dommageable pour ceux-ci. De telles
actions affectent immédiatement ou éventuellement le
fonctionnement comportemental, cognitif, émotif et physique de
l’enfant.
Hart, Brassard, Binggeli & Davidson 2002.
Loi sur la protection de la jeunesse
Loi telle que modifiée par le Projet de loi 125
Nature
Impact:
Mauvais traitements psychologique (MTP):
Lorsque l’enfant subit, de façon grave ou continue,
des comportements de nature à lui causer un
préjudice de la part de ses parents ou d’une autre
personne et que ses parents ne prennent pas les
moyens nécessaires pour mettre fin à la situation.
Ces comportements se traduisent notamment par de
l’indifférence, du dénigrement, du rejet affectif, de
l’isolement, des menaces, de l’exploitation, entre
autres si l’enfant est forcé à faire un travail
disproportionné par rapport à ses capacité, ou par
l’exposition à la violence conjugale ou familiale.
Pour nécessiter une intervention en protection de
la jeunesse, il faut que les comportements soient
graves ou continus. Il faudra aussi démontrer
qu’ils causent ou pourraient causer un préjudice à
l’enfant, ce qui implique l’évaluation de leurs
conséquences.
Pour évaluer l’exposition à la violence conjugale,
il faudra également prendre en considération les
moyens pris par la victime de violence pour
corriger la situation.
Compromised
needs
Physical &
emotional
security
Self-esteem &
acceptation
Developmentrelated
autonomy
Social
Integration
Types
Commission
Terrorizing,
threating or
intimidating
Omission
EA
Spurning,
degradating,
devaluating,
insulting, blaming,
excluding,
criticizing, ignoring
Inappropriate
expectancies and
responsibilities
Isolating: confining,
sequestering, limits
Opportunity for
social contact
EA
Indirect violence
Abandonment
Denying emotional
responsiveness:
being indifferent to
attempts of
interaction,
avoiding
affectional contact,
denying
psychological
needs
Exposure
to
domestic
violence
Suicide
attempts
and threats
EN
Exploitation
Alienation
Corruption
Mots utilisés pour illustrer l’atteinte
à l’intégrité psychologique (Gagné & Bouchard, 2001)
Idée de destruction:
Ça gruge, brise, casse, déchire, blesse, étouffe, écrase, détruit, démolit, abat, anéantit,
tue quelque chose à l’intérieur de la victime
Idée de dévalorisation:
Ça abaisse, rabaisse, diminue, déprécie, disqualifie la victime
Idée de perte:
Ça gâche la vie, ça fait perdre, ça coupe, ça enlève quelque chose à la victime
Idée d’impact, de séquelle:
Ça fait mal, ça fait souffrir, ça crée une blessure, ça laisse une cicatrice, c’est une
torture psychologique;
Ça rend pogné, trappé, en-dedans, ça bloque, ça reste dans l’âme, dans la tête, dans
le subconscient de la victime;
Ça traumatise, ça fait du tort, des dégâts, ça laisse des traces;
Ça touche, ébranle, débalance, désorganise la victime
Magnitude in the United States
Level I
PMT:
Level II
Reports to Child Protection Agency (1998)
4% of MT reports substantiated (1,5% children)
43 States
1.7/1,000 children (Hamarman, 2002)
Key informants (1996) (Sedlack & Breadhurst, 1996)
Emotional Abuse (EA)
Emotional Neglect (EN)
Level III
532,200 children
585,100 children
≈ 20% of MT
identified
Population survey (1991) (Vissing & al., 1991)
Emotional Abuse (EA)
•
•
•
63% on avg. 13 times + /year
27% on avg. 10 times + /year
11% on avg. 25 times + /year
Polyvictimization survey (Finkelhor & al., 2005)
139/1,000 children; 76% of MT
EA
neglect, victimization by peers, sexual assault, property crimes
Retrospective data
Between 30-37%, with or without co-occurrence
10-15% Severe (Gross & Keller, 1992; Moeller & al., 1993; Binggeli & al., 2001)
Magnitude in Canada/Quebec
Level I
Canadian Incidence Study (1998) (Trocmé & al., 2000)
3.64/1,000 children with co-occurrence + EDV
Level II Quebec Incidence Study (1998) (Tourigny & al., 2002)
2.5/1,000 children with co-occurrence + EDV (substantiated case of MT)
Level III Domestic Violence Survey (2004)
(2004 (Clément & al., 2005)
80% at least one incidence of EA during the previous year.
Of these, 31% = 6 times+ /year
Among the 31% EA 6 times+ /year:
39%
35% EA
o
0.9 EA nly
% E with
A w psy
ith
c
sev holog
ere
ic
vio al vio
len
l
ce ence
21%
scream/yell
4%
swear
3%
threat/spank
3%
called stupid/lazy
0.3%
threat of abandonment/placement
EIQ (1998) and Schneider & al., (2005) Comparison
Exposition
to Domestic
Violence
Rejection
Emotional
Neglect
Rejection
EDV +
Intimidation/
Terrorism
Autonomy/
Restriction
Intimidation
/Terrorism
Quebec Incidence Study
[EIQ] (1998)
Schneider & al., 2005
Victimization Continuum
Subabusive Situations
Situations of abuse
Non-violent aggressions
Violence
Maltreatment/Abuse
___________________________________________________________________
Evaluation Parameters:
Severity of the acts and aggressions
Intentionnality
Frequency
Stability/Chronicity
Simultaneous presence of various forms
Perceived and manifest impact
Effects on youth
Low self-esteem,
dysphoria, rejection
Emotional
instability,
anxiety,
depression,
nightmares, fear,
aggressivity,
passivity,
delinquency,
violent
behaviour when
adult, homicide
Lack of social skills, withdrawal,
mistrust, lack of empathy
Family and
Social
Relationships
SelfPresentation
Identity
Emotional and
Behavioural
Development
Lack of
confidence,
inappropriate
behaviour
Child
Development
Education
Developmental delay (language), academic
underachievement, problem-solving deficiencies
Dependence,
risk behaviour
Ability to Take
Care of Oneself
Health
Injury, malnutrition,
infections, encopresis,
enuresis, self-mutilation,
suicide/death, nonorganic incapacity to
grow/develop
Mediating Factors
Emotional maltreatment
Consequences
Mediators
(Risk Factors and Resilience)
Negative Factors
• Emotions
1) Self: shame, low self-esteem, doubt
(trauma
2) Others: mistrust/dependency, abandonment, solitude, losses
and
3) Attachment system: internal representation of relationships
losses)
4) Primitive defence mechanisms: projection, denial, dissociation, acting out
5) Depression, anxiety, hostility, anger, low tolerance for negative emotions
• Cognitions 1) Internalized cognitions: criticism/rejection association
2) Causal and blame attributional style
• Behaviours 1) Helplessness
2) Avoidance
• Family
1) Intergenerational alliance
2) Triangulation
• Environment 1) Daily negative stress
Resilience Factors
Self-esteem
Reframing and giving sense, personal and social abilities
Social support
Objectives of the study
1.
Evolution of the PMT incidence rate between 1998 & 2003
in Canada
2.
Incidence of emotional abuse (EA), emotional neglect
problems with or without co-occurrence
3.
Identify MT features, child, parents/families and
interventions that feature:
A.
B.
C.
D.
EA vs. EN in unique form
EA only/EN only vs. other type of MT only
EA only/EN only vs. co-occurrent EA/EN
EAC/ENC vs. other co-occurrence
METHODOLOGY
Methodology
Canadian Incidence Study
(ECI-2, 2003)
Modified version of the ECI-1 instrument (1998)
Nature of the abuse:
Emotional harm, duration, aggressor
Child characteristics:
Age, gender, problems
Parents/families characteristics:
Problems with mothers and/or fathers, revenue, housing, moving…
Child Welfare response:
Source and status of report, open case, placement, justice approach
Referral to other services/programs
Methodology
Canadian Incidence Study
(ECI-2, 2003)
Sample
10,132 reported cases
936 stakeholders
55 sites throughout Canada
8 sites in Quebec
Weighted analyses
represent 190,240 reported cases
Methodology
Groups set-up
1. Emotional Abuse only (EA)
2. Emotional Neglect only (EN)
3. Other maltreatment only (OMT)
4. Emotional Abuse in Co-occurrence (EAC)
5. Emotional Neglect in Co-occurrence (ENC)
6. Other Maltreatment in Co-occurrence (OMTC)
Secondary forms must be substantiated
NOT INCLUDED are substianted reports of Exposition to Domestic
Violence that are not co-occurring with OMT
Methodology
LIMITATIONS
⌧ Reports to child protection services
⌧ Data from Quebec are incomplete
⌧ Lack of provincial comparisons
⌧ Lack of longitudinal data
Analysis
Expanded analysis
representative of reporting in the population
GROUP COMPARISON
Chi-square (Χ2 )
Analysis of variance: age of child
MEASUREMENT OF THE DEGREE OF ASSOCIATION BETWEEN
VARIABLES
V Tests by Cramer & Phi (if p<0.05
variables excluded)
GROUP MEMBERSHIP PREDICTION
Logistic regression (input method using hierarchical
RESULTS
Evolution of the incidence
reporting rates 1998-2003
EA
1998
2003
Rate/1,000
children
Rate/1,000 children
Level
of sig.
0.96
2.42
***
0.39
1.08
**
13.19
19.32
ns
2.88
5.9
**
0.92
2.0
**
4.17
8.52
**
Emotional Abuse Only
EN
Emotional Neglect Only
OMT
Other maltreatment Only
EAC
EA in co-occurrence
ENC
EN in co-occurrence
OMTC
OMT in co-occurrence
Level of significance
p < 0.05; **p < 0.01; *** p < 0.01
Magnitude
Number of substantiated reports
EA
Emotional Abuse Only
EN
Emotional Neglect Only
OMT
Other Maltreatment Only
EAC
Emotional Abuse in co-occurrence
ENC
Emotional Neglect in co-occurrence
OMTC
Other Maltreatment in co-occurrence
Expanded Data
%
375
7,143
9.4
141
2,230
2.9
2,495
46,288
60.7
603
10,282
13.5
195
2,725
3.6
421
7,551
9.9
Emotional Abuse (EA) > Emotional Neglect (EN)
Psychological Maltreatment ONLY (PMT) = 12%
PMT with or without co-occurrence = 30%
Results
Co-occurrence of Psychological Maltreatment (PMT) and
Other Maltreatments (OMT)
17% of substantiated reports
Sexual
Abuse
Sexual
Abuse
Physical Abuse
Negligence
OMT
Physical
Abuse
Exposition
to Domestic
Violence
Exposition
to Domestic
Violence
Neglect
Other
Maltreatments
(OMT)
Emotional Abuse:
Rejection, hostility, terror
Emotional Neglect:
Indifference
Emotional Abuse (EA) associated to domestic violence
Emotional Neglect (EN) associated to neglect
PA
Résultats
Statut de compromission
60
Non- fondé
Soupçonné
50
Fondé
40
30
20
10
0
AE
NE
AMT
AEC
NEC
AMTC
Abus Émotionnel
Fondé
Négligence Émotionnelle
Soupçonnée
Mauvais Traitement en Cooccurrence
Fondé
Résultats
Âge
12
Âge moyen
(écart-type)
9
7,59
6
8,44
8,31
(5,13)
(4,35)
8,85
(4,32)
8,85
(4,94)
7,88
(4,55)
(4,30)
3
0
AE
NE
Seul
AMT
AEC
NEC
AMTC
Cooccurrence
AE
plus jeune
MTPC
plus vieux
NE ≠ AMT
Résultats
Sexe de l’enfant
70
60
50
Fille
40
Garçon
30
20
10
0
AE
NE
AMT
AEC
NEC
AMTC
♀ plus victimes de négligence émotionnelle (NE)
Résultats
Indice de sévérité: chronicité/ atteinte
60
50
40
+ de 6 mois
30
Traitement
requis
20
10
0
AE
NE
AMT
AEC
AE & NE
plus chronique
NE
atteinte psychologique
MTPC
plus grave
NEC
AMTC
Résultats
Lien avec l’agresseur
Mère
Bio
Mère
bio
AMT
NE
AE
Père
Bio
0
40
80
AMTC
NEC
AEC
0
40
Abus émotionnel
plus père
Négligence émotionnelle
plus mère
80
Résultats
Problèmes chez les enfants
75
75
50
50
25
0
25
AE
NE
AMT
AEC
Prob. comportement
NEC
AMTC
0
AE
NE
AMT
AEC
NEC
AMTC
Prob. en général
NE
+ pairs négatifs, absentéisme, problèmes d’apprentissage
NEC
prévalence + de prob. cognitifs, psychologiques et comportementaux
Résultats
Problèmes chez la mère
70
AE
AMT
NEC
NE
AEC
AMTC
70
35
35
0
0
Alcool
NE
AE
Drogue
Santé
Mentale
Violence conjugale
Isolement
Toxico, santé mentale, violence conjugale, isolement
Violence conjugale
Résultats
Problèmes chez le père
AE
AMT
NEC
40
NE
AEC
AMTC
40
20
20
0
0
Alcool
Drogue
NE
Criminalité
NE-C
Alcool
+ Drogue, criminalité
AE
Violence conjugale
Violence Conjugale
Résultats
Caractéristiques des familles
40
40
20
20
0
AE
NE
AMT
AEC
Aide sociale/ chômage
NE
NEC
AMTC
0
AE
NE
AMT
AEC
Logement social
reliée à conditions de vie + précaires
NEC
AMTC
Résultats
Intervention en contexte de protection de la jeunesse
100
100
AE
AMT
NEC
50
0
NE
AEC
AMTC
50
Cas ouvert dans
passé
Cas ouvert
Négligence émotionnelle
0
Placement
Judiciarisation
envisagée et effective
Associée à + d’intervention
Résultats
LES SIGNALANTS
45
45
30
30
15
15
0
Parents
Police
Négligence émotionnelle
Abus émotionnel
Autre mauvais traitement
0
AE
NE
AMT
AEC
NEC
AMTC
École
parents
police, école
école
SSS
Résultats
Investigation policière
60
50
40
30
AE seul
AMT seul
NE seule
20
10
0
Signalement
non-fondé
Signalement
fondé
NE seule
AMT seul
AE seul
Résultats
Références suggérées
100
AE
AMT
NEC
NE
AEC
AMTC
50
0
100
50
Counselling Programme
familial
toxicomanie
parental
Services en
VC
0
Services
psychiatrie psycho
Au moins une
référence
Group Memberships Predictions
Results
Prediction EN vs. EA (ref)
Exp (B)
Sig.
Parents/family
Maternal Drug Abuse
0.397
**
(p = 0.006)
Public Housing
0.292
**
(p = 0.003)
Case stay open
0.419
**
(p = 0.007)
Parent/Family Program
0.449
**
Alcool/Drug Program
0.295
*
Services
Level of Significance
(p = 0.001)
p < 0.05; **p < 0.01; *** p < 0.001
EN + complex than EA
(p = 0.018)
Results
Prediction OMT vs. EA (ref)
Exp (B)
Sig.
Severity
Emotional harm
1.981
**
Duration ( > 6 months)
3.114
*** (p=0.000)
0.651
*
(p=0.045)
2.076
**
(p=0.002)
2.059
ns (p=0.052)
(p=0.012)
Child
Boys
Parents/family
Mental Health of Mothers
Services
Ref. Psychology/Psych services
Level of Significance
p < 0.05; **p < 0.01; *** p < 0.001
EA > OMT
•
•
•
Severity
+ than ♀
Mental health of mothers
Results
Prediction OMT vs. EN (ref)
Exp (B)
Sig.
Severity
Emotional harm
2.488
Duration ( > 6 month)
2.942
**
(p = 0.003)
0.480
*
(p = 0.011)
Maternal Mental Health
2.275
**
(p = 0.001)
Maternal Drug Abuse
2.750
**
(p = 0.003)
Public Housing
2.405
*
(p = 0.041)
Child stay open
3.290
***
(p = 0.000)
Case opened in the past
0.565
*
(p = 0.047)
Parent/Family Program
1.708
*
(p = 0.026)
(p = 0.052)
Child
Boys
Parents/family
Child Welfare
response/referrals
Level of Significance
Emotional Neglect
p < 0.05; **p < 0.01; *** p < 0.001
MOST CONCERNING ISSUE
Results
Prediction EAC vs. EA (ref)
Exp (B)
Sig.
Severity
Emotional harm
0,443
** (p = 0.008)
0.310
*** (p = 0.000)
0.376
*** (p = 0.000)
0.285
**
(p = 0.003)
0.338
*
(p = 0.018)
Parents/ family
Paternal Alcool/Drug
Alcool/Drug Abuse
Services
Parent/Family Program
Alcool/Drug
Alcool/Drug Program
Other referral
Level of Significance
p < 0.05; **p < 0.01; *** p < 0.001
EA in co-occurrence + complex
Issues
Paternal Drug Abuse
Results
Prediction ENC vs. EN (ref)
Exp (B)
Sig.
Severity
Emotional harm
0.274
* (p = 0.015)
Case opened in the past
0.264
* (p = 0.011)
Ref. psychology/psych services
0.413
* (p = 0.015)
Child Welfare
Welfare Responses/Referrals
Responses/Referrals
Level of Significance
p < 0.05; **p < 0.01; *** p < 0.001
EN in co-occurrence is a + complex issue
Reoccurrence of reporting
Results
Prediction OMTC vs. ENC (ref.)
Exp (B)
Sig.
Severity
5.345
* * (p = 0.004)
Child previoulsly open
2.392
* (p = 0.030)
Other referral
0.441
* (p = 0.017)
Emotional harm
Child Welfare Responses/Referrals
Responses/Referrals
Level of significance
p < 0.05; **p < 0.01; *** p < 0.001
In context of co-occurrence, and when with EN,
+ Child Welfare cases
Results
Prediction of OMTC (ref. EAC) for variables associated
with severity, parents/family and referred services
Exp (B)
Sig.
Severity
Emotional Injury
2.825
** (p = 0.010)
0.419
* (p = 0.032)
0.540
** (p = 0.006)
2.297
** (p = 0.005)
Parents/ family
Public Housing
Child Welfare Responses
Case stay open
Alcool/Drug
Alcool/Drug Program
Level of Significance
p < 0.05; **p < 0.01; *** p < 0.001
In context of co-occurrence, when there is EA
less Child Welfare cases
more Referrals for Alcool/Drug
programs
IN SHORT…
Emotional Neglect
Social and Personal Helplessness Dynamics
FEATURES
CoCo-occurrence with physical, educational and supervision neglect
Severity
Problems with child
Daughter
Mother involved
Maternal alcool/drug
alcool/drug abuse
Difficult living conditions
REPORTING
Suspected Cases (fuzzy problem)
Reporting individual
parent
SERVICES
Childhood/ youth/ family
• Child Welfare + involved
• Referral to parental/family support services
Adult network
• Referral to mental health and alcool/drug
alcool/drug abuse services
INDIFFERENT
PARENT/CHILD
RELATIONSHIP
Emotional Abuse
Dynamics of Violence
PROBLEMS
CoCo-occurrence between physical abuse and exposition to domestic violence
violence
Younger child
Mental health of mothers
Father involved
Paternal alcool/drug
alcool/drug abuse
Domestic Violence
REPORTING
than 2.5% between 19981998-2003
Police, school
SERVICES
Psychology/psychiatry services
Alcool/drug
Alcool/drug programs
PARENT/CHILD RELATIONSHIP
• terrorizing
• intimidating
• hostile
Conclusions:
1. Problem detection is harder (higher chronicity)
2. Acute problems
3. Emotional Abuse
especially emotional neglect
dynamics of violence/terrorism
4. Emotional Neglect
dynamics of negligence
5. Possible multiform dynamics:
Terrorizing
Hostile
fear/intimidation
rejection/denigration
Indifferent
absence of emotional response
6. Importance of intervention on the traumatic impacts (ÊTRE, Éthier, L.)
7. Compensational relationship with a significant other
8. Need for network-based intervention, complex issues: mental health, social distress
and poverty (AIDES)