Risks and Benefits of Intervention

Because society only recently recognized the problem of child abuse, there has been little time to evaluate the effects of different responses to abuse. Three types of responses have been attempted: (1) those designed to prevent abuse; (2) those designed to deal with the psychological consequences of abuse; and (3) those designed to punish offenders.

Preventive programs are difficult to evaluate because of almost insurmountable ethical and methodological problems (Conte). Abuse is a hidden problem. Assessing whether heightened awareness of the problem leads to increased reporting or decreased occurrence would require intrusive evaluation and follow-up for enormous numbers of people (Reppucci and Haugaard; Fink and McCloskey). Generally, studies focus on surrogate outcome measures, such as "ability to discriminate safe from unsafe situations," rather than on actual decreases in the incidence of sexual abuse (Hazzard et al., p. 134).

Intervention for children who have suffered abuse requires a delicate balance between trying to protect the child, trying to help the parents, and trying to preserve the family. Parents who abuse children often have been abused themselves, and may have a higher incidence of psychiatric problems (Steele and Pollack). Many parents regret their actions, desire psychiatric help, and comply with treatment programs. However, 5 to 30 percent of abused children who stay in their family are subject to further episodes of abuse (Jellinek et al.). At present, there are no reliable indicators of which parents will continue to abuse their children and which are likely to respond to therapy. Furthermore, any data that might address this issue will necessarily be probabilistic. Thus, decisions about the value of such data in an individual case will incorporate normative values about the degree of risk appropriate for a particular child facing a particular custody decision.

Programs designed to punish child abusers are driven less by considerations of the risks and benefits of interventions and more by the dictates of the legal system. Evidence against alleged abusers seldom establishes guilt beyond a reasonable doubt. As a result, criminal prosecution is rare, and conviction even rarer (Peters). Furthermore, it is unclear whether stricter laws or harsher punishments decrease the incidence of child abuse. As in other areas of criminal law, the justification for criminal prosecution seems to derive more from a notion of punitive justice than from a calculation of the degree to which punishment of offenders deters potential future offenders. Debate about this issue must take place in the context of more general debates about the morality of incarceration or the potential for rehabilitation in any criminal situation.

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