Maltrato infantil: aspectos jurídicos en México.

In Mexico, the complexity of the comprehensive care of a girl, boy or adolescent who is the victim of any form of child abuse requires the necessary legal knowledge for comprehensive management. Physicians probably lack sufficient knowledge of the laws to understand and correctly address the legal aspects immersed in the comprehensive care of this population group. Considering that child abuse has been characterized as a world-wide medical-social-legal problem, it is necessary to know the essential legal mechanisms to protect minors who are victims of it and understand the legal status of their families and of the probable aggressor. The purpose of this article is to present the existing legal framework in Mexico and the actions of world organizations in this area. It is necessary for the Political Constitution of the United Mexican States to be the basis on which legal behaviors related to child abuse, crime investigation and administration of justice are founded, as well as for international agreements on the subject, which have been signed by the government of Mexico, to be adhered to.

En México, la complejidad de la atención integral de una niña, niño o adolescente víctima de cualquier modalidad de maltrato infantil requiere el conocimiento jurídico indispensable para su manejo integral. Los médicos probablemente no tienen un conocimiento suficiente de las leyes para entender y atender correctamente los aspectos legales involucrados en la atención integral a este grupo de la población. Considerando que el maltrato infantil ha sido catalogado como un problema médico-social-legal de alcance mundial, se hace necesario el conocimiento de los mecanismos jurídicos indispensables para proteger a los menores que son víctimas y entender la condición legal de su familia y del probable agresor. El objetivo de este artículo es presentar el marco jurídico existente en México y las acciones en este rubro de las organizaciones mundiales. Se precisa que la Constitución Política de los Estados Unidos Mexicanos sea la base en la que se fundamenten las conductas legales vinculadas con el maltrato infantil, la investigación de delitos y la administración de justicia, así como los convenios internacionales sobre el tema, los cuales han sido suscritos por el gobierno de México.

In the eyes of the beholder: Parental and professional value mismatch in child risk and protection in two communities in Israel.

This paper aims to identify several of the mismatches at play when social workers encounter families belonging to diverse groups and assess risk, well-being and protection for children. Two minority groups in Israel were studied: the Ultra-Orthodox Jewish community and Jewish immigrants from Ethiopia. A context-informed approach was adopted to explore the subjective perceptions and constructions of "risk," "well-being," and "protection" among parents of the two communities (N = 60) and the social workers who work with them (N = 50). The social workers included some who belong to the minority groups they serve and others who are from the majority group. The analysis of the interviews yielded two main themes: (a) an understanding of the discrepancies in parents' and professionals' perceptions and constructions of "risk" and "protection" for children as the product of differences in the values, norms and contexts of these two groups; and (b) the implications of these discrepancies for the relationship between professionals/social service agencies and parents who are potential service users. Our findings call upon professionals to re-visit "universals" in the "risk" discourse while taking into account the realms of culture, ethnicity, religiosity, spirituality and community life when assessing risk and treating children and families of minority communities.

Protocolo de atención en salud integral de niñas y niños en situación de maltrato infantil / Comprehensive health care protocol for girls and boys in situations of child abuse

A partir de la premisa, que el maltrato infantil se está convirtiendo en un problema cada vez más serio a nivel nacional, situación que es avalada por la Organización Panamericana de la Salud (OPS) que considera que la violencia y sus diferentes manifestaciones son un problema que afectan a la salud y al desarrollo social y económico de amplios sectores de la población. Este protocolo considera que es importante que los proveedores de salud desarrollen habilidades y competencias que ayuden a detectar los casos de niños maltratados, así como conocer las mejores estrategias de intervención. El objetivo de este protocolo es proponer una herramienta que proporcione los elementos básicos a proveedores y proveedoras de salud para brindar atención de calidad en salud integral y realizar la notificación oportuna de los casos de maltrato infantil. Para ello han seleccionado un modelo basado en el triage del AIEPI (Atención Integral a las Enfermedades Prevalentes de la Infancia). Es una estrategia elaborada por la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (Unicef) presentada en 1996 como principal método para mejorar la salud en la niñez. La metodología del modelo se lleva a cabo por medio de tres componentes. El primero está dirigido a mejorar el desempeño del personal de salud para la prevención de enfermedades en la niñez y su tratamiento. El segundo se dirige a mejorar la organización y funcionamiento de los servicios de salud para que brinden atención de calidad apropiada; y el tercer componente está dirigido a mejorar las prácticas familiares y comunitarias de cuidado y atención de la niñez. Contiene un marco teórico, marco legal, así como una serie de anexos dirigidos a apoyar tanto el diagnóstico, como el seguimiento dado a las víctimas.

Treatment failure in atopic dermatitis as a result of parental health belief.

The gold standard for treatment of atopic dermatitis is topical corticosteroids. Parental alternative health beliefs and fear of topical corticosteroids may lead to non-adherence and treatment failure. At the extreme end, such beliefs may result in neglect constituting reportable child maltreatment. We examine the legal repercussions of such abuse in the criminal case resulting from the death of Gloria Sam.

The use of paraphrasing in investigative interviews.

OBJECTIVE: Young children's descriptions of maltreatment are often sparse thus creating the need for techniques that elicit lengthier accounts. One technique that can be used by interviewers in an attempt to increase children's reports is "paraphrasing," or repeating information children have disclosed. Although we currently have a general understanding of how paraphrasing may influence children's reports, we do not have a clear description of how paraphrasing is actually used in the field. METHOD: The present study assessed the use of paraphrasing in 125 investigative interviews of allegations of maltreatment of children aged 4-16 years. Interviews were conducted by police officers and social workers. All interviewer prompts were coded into four different categories of paraphrasing. All children's reports were coded for the number of details in response to each paraphrasing statement. RESULTS: "Expansion paraphrasing" was used significantly more often and elicited significantly more details, while "yes/no paraphrasing" resulted in shorter descriptions from children, compared to other paraphrasing styles. Further, interviewers more often distorted children's words when using yes/no paraphrasing, and children rarely corrected interviewers when they paraphrased inaccurately. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Investigative interviewers in this sample frequently used paraphrasing with children of all ages and, though children's responses differed following the various styles of paraphrasing, the effects did not differ by the age of the child. The results suggest that paraphrasing affects the quality of statements by children. Implications for investigative interviewers will be discussed and recommendations offered for easy ways to use paraphrasing to increase the descriptiveness of children's reports of their experiences.

Young Children's Competency to Take the Oath: Effects of Task, Maltreatment, and Age.

This study examined maltreated and non-maltreated children's (N = 183) emerging understanding of "truth" and "lie," terms about which they are quizzed to qualify as competent to testify. Four- to six-year-old children were asked to accept or reject true and false (T/F) statements, label T/F statements as the "truth" or "a lie," label T/F statements as "good" or "bad," and label "truth" and "lie" as "good" or "bad." The youngest children were at ceiling in accepting/rejecting T/F statements. The labeling tasks revealed improvement with age and children performed similarly across the tasks. Most children were better able to evaluate "truth" than "lie." Maltreated children exhibited somewhat different response patterns, suggesting greater sensitivity to the immorality of lying.

Development and initial validation of the institutional child abuse processes and coping inventory among a sample of Irish adult survivors of institutional abuse.

OBJECTIVE: To develop a psychometric instrument to evaluate psychological processes associated with institutional abuse and coping strategies used to deal with such abuse. METHODS: As part of a comprehensive assessment protocol, an inventory containing theoretically derived multi-item rational scales which assessed institutional abuse-related psychological processes and coping strategies were administered to 247 Irish adult survivors of institutional child abuse. Exploratory and confirmatory factor analyses were used to derive 6-factor scales, the reliability and validity of which were assessed. RESULTS: Factor scales to assess the following constructs were developed (1) traumatization, (2) re-enactment, (3) spiritual disengagement, (4) positive coping, (5) coping by complying, and (6) avoidant coping. There were varying degrees of support for the validity of the scales with most support for the traumatization and re-enactment scales. CONCLUSIONS: The Institutional Child Abuse Processes and Coping Inventory (ICAPCI), particularly its traumatization and re-enactment scales, may be used in future research on adult survivors of institutional child abuse because they are currently the only scales that have been developed with this population to provide reliable and valid assessments of these constructs. PRACTICE IMPLICATIONS: The ICAPCI may be used, cautiously, to assess adult survivors of institutional child abuse.

Truth induction in young maltreated children: the effects of oath-taking and reassurance on true and false disclosures.

OBJECTIVE: Two studies examined the effects of the oath or reassurance ("truth induction") on 5- to 7-year-old maltreated children's true and false reports of a minor transgression. METHODS: In both studies an interviewer elicited a promise to tell the truth, reassured children that they would not get in trouble for disclosing the transgression, or gave no instructions before questioning the child. In Study 1, children were encouraged to play with an attractive toy by a confederate, who then informed them that they might get in trouble for playing. In Study 2, a confederate engaged children in play, but did not play with the attractive toy. RESULTS: In Study 1, the oath and reassurance increased disclosure among children who would qualify as competent to take the oath. In Study 2 neither the oath nor reassurance increased false reports among children who would qualify as competent, whether yes/no questions or tag questions were asked. Among non-competent children, reassurance (but not the oath) increased false reports. Children were more likely to accuse the confederate of the transgression than to implicate themselves. CONCLUSIONS: The results suggest that a promise to tell the truth may increase true disclosures without increasing false allegations. Reassurance that specifically mentions the target activity also increases true disclosures, but may increase acquiescence among some children. PRACTICE IMPLICATIONS: A child-friendly version of the oath may be a useful addition to child interviews.

A community program to fight child abuse: the Fort Wayne Children's Foundation and Kids' Law.

This paper offers a brief review of child abuse in the United States and describes an example of a community program in Fort Wayne, Ind, to stop and reverse the adverse effects of child abuse. This commentary aims to offer resources, raise awareness, and stimulate research into child abuse incidence, type, and prevention.

Collaboration, integration and change in children's services: critical issues and key ingredients.

BACKGROUND: Government and state policy, irrespective of jurisdiction, increasingly require and indeed specify the nature of collaboration with regard to the delivery of child welfare services for maltreated children. The rationale for collaboration appears obvious in as much as it is aimed at promoting multidisciplinary practice in order to meet the needs of the vulnerable child. However, collaboration, whilst a useful and motivating concept, is in reality far from straightforward and contains complexities and ambiguities. AIM: The aim of this paper is to explore these complexities and ambiguities to provide an overview of key developmental frameworks relevant to the creation and maintenance of strategic high-level multiagency partnerships. COMMENTARY: The authors begin by exploring the characteristic features of different levels of multiagency collaboration that is communication, co-operation, co-ordination, coalition, and integration. As the emphasis in a variety of jurisdictions in the Western world is on the highest levels of collaboration namely coalition and service integration this is the focus of the paper. The authors synthesize the main literature in the field to consider the critical elements for effective collaborative endeavors at this level including predisposing factors, mandate, leadership, machinery, process, and outcomes. The paper concludes by recognizing that the drive towards integrated services is occurring in a climate of continuing change. The need to identify the impact of such an environment when managing multiagency partnerships is explored using five steps to change.

Using grounded theory to generate a theoretical understanding of the effects of child custody policy on women's health promotion in the context of intimate partner violence.

Women's health is frequently influenced by social and structural factors, largely beyond women's control, and often entrenched in public policy. Although health is acknowledged to be socially determined, the ways that social conditions affect health are rarely explicated. Grounded theory is a useful method for discovering how structural conditions influence patterns of behavior. We used grounded theory to generate a theoretical understanding of how justice system policy and services related to child custody influence health promotion processes of women and their children after leaving abusive male partners/fathers. In two diverse Canadian provinces, we interviewed single mothers who had left abusive partners as well as frontline workers and policymakers in the justice system. We identified the key dimensions of policy and services that influence the ways in which women and their children promote their health in the context of varying levels of ongoing intrusion as information, eligibility, accessibility, timeliness, human resources, safety, and diversity. In this article, the interplay between theses policy and service dimensions and women's health promotion after leaving abusive partners is discussed and suggestions are made for strengthening "healthy" custody policy.

Pediatric use of complementary therapies: ethical and policy choices.

OBJECTIVE: Many pediatricians and parents are beginning to integrate use of complementary and alternative medical (CAM) therapies with conventional care. This article addresses ethical and policy issues involving parental choices of CAM therapies for their children. METHODS: We conducted a literature search to assess existing law involving parental choice of CAM therapies for their children. We also selected a convenience sample of 18 states of varying sizes and geographic locations. In each state, we inquired within the Department of Health and Human Services whether staff were aware of (1) any internal policies concerning these issues or (2) any cases in the previous 5 years in which either (a) the state initiated proceedings against parents for using CAM therapies for their children or (b) the department received telephone calls or other information reporting abuse and neglect in this domain. We asked the American Academy of Pediatrics and the leading CAM professional organizations concerning any relevant, reported cases. RESULTS: Of the 18 state Departments of Health and Human Services departments surveyed, 6 reported being aware of cases in the previous 5 years. Of 9 reported cases in these 6 states, 3 involved restrictive dietary practices (eg, limiting children variously to a watermelon or raw foods diet), 1 involved dietary supplements, 3 involved children with terminal cancer, and 2 involved religious practices rather than CAM per se. None of the professional organizations surveyed had initiated proceedings or received telephone calls regarding abuse or neglect concerning parental use of CAM therapies. CONCLUSIONS: Pediatric use of CAM therapies raises complex issues. Clinicians, hospitals, state agencies, courts, and professional organizations may benefit from a policy framework to help guide decision making.

Complementary therapies in pediatrics: a legal perspective.

Increasing use of complementary and alternative medicine (CAM) therapies such as chiropractic, massage therapy, and herbal medicine, raises questions about the clinically appropriate use of CAM in pediatrics. Nonjudicious use of CAM therapies may cause either direct harm or, by creating an unwarranted financial and emotional burden, indirect harm. When advising patients concerning CAM therapies, pediatricians face 2 major legal risks: medical malpractice and professional discipline. Pediatricians can incorporate these considerations into advising and clinical decision-making about CAM therapies to address the best interest of the pediatric patient while helping to manage potential liability risk. This article provides a suggested framework, including asking the following questions: (1) Do parents elect to abandon effective care when the child's condition is serious or life-threatening? (2) Will use of the CAM therapy otherwise divert the child from imminently necessary conventional treatment? (3) Are the CAM therapies selected known to be unsafe and/or ineffective? (4) Have the proper parties consented to the use of the CAM therapy? (5) Is the risk-benefit ratio of the proposed CAM therapy acceptable to a reasonable, similarly situated clinician, and does the therapy have at least minority acceptance or support in the medical literature? Such an approach ideally can help guide the pediatrician toward clinical conduct that is clinically responsible, ethically appropriate, and legally defensible.

Corporal punishment of children in England and the United States: current issues.

Proverbs has eight sets of instructions on beating children, but that book does not contain the often cited proverbial "spare the rod and spoil the child." This form of discipline, which is thousands of years old, has only recently been abandoned and forbidden in many states in the US, and in much of Europe. It is still legal in Britain and some US states, and remains a controversial issue.

Maternal infanticide associated with mental illness: prevention and the promise of saved lives.

OBJECTIVE: Although maternal infanticide is a rare event, a high proportion of cases occurs in the context of postpartum mental illness. The author reviews historical, legislative, and contemporary psychiatric perspectives on infanticide and discusses ways in which the psychiatric community can improve prevention of infanticide and promote appropriate treatment of mentally ill women who commit infanticide. METHOD: The case of Texas v. Andrea Yates, involving a mother with mental illness who drowned her five children, is used to illustrate society's complicated reactions to infanticide in the context of postpartum mental illness. RESULTS: In the United States, the complexity of the response to infanticide is demonstrated by the judicial system's reaction to such cases. Whereas England's Infanticide Law provides probation and mandates psychiatric treatment for mothers with mental illness who commit infanticide, "killer mothers" may face the death penalty in the United States. Contemporary neuroscientific findings support the position that a woman with postpartum psychosis who commits infanticide needs treatment rather than punishment and that appropriate treatment will deter her from killing again. Psychiatrists have a vital role in recognizing the signs and symptoms of peripartum psychiatric disorders, particularly postpartum psychosis, and in early identification of and intervention with at-risk mothers. CONCLUSIONS: The absence of formal DSM-IV diagnostic criteria for postpartum psychiatric disorders promotes disparate treatment under the law. The psychiatric community should develop guidelines for the treatment of postpartum disorders, foster sharing of knowledge between psychiatry and the law, and do more to enlighten society about the effects of mental illness on thought and behavior so that decisions about the treatment and punishment of mentally ill persons will not be left exclusively in the hands of the judicial system.