Ending Violence Against Children: A Global Initiative

The statistics about violence against children are staggering. Across the globe, 1 billion children under age 18 experienced physical, sexual, or emotional violence last year (Hillis et al., cited by WHO, May, 2016). Root causes of this violence include complex cultural and community-level factors as well as dysfunction and cruelty within the family home. The consequences of child maltreatment are well known to psychiatric-mental health nurses, because we see the sequelae daily in our clinical practice: in the adults who exhibit depression, anxiety, substance misuse, tragically reduced potential for success in schooling and careers, and/or replication of the childhood aggression and violence toward others (their intimate partners, their own children).

Violence against children is preventable, and the United Nations member states have endorsed the goal of ending it within 15 years. At the May 27, 2106 meeting of the World Health Assembly, the specific focus on children was included in a historic resolution calling for “a multisectoral response to address interpersonal violence, in particular against women and girls, and against children” (WHO, May, 2016).

Released in July was INSPIRE: Seven Strategies for Ending Violence Against Children,” a World Health Organization document outlining a plethora of prevention and response strategies, listed in 7 categories: (1) implementation and enforcement of laws: (2) norms and values; (3) safe environments; (4) parent and caregiver support; (5) income and economic strengthening; (6) response and support services; and (7) education and life skills. Examples are given throughout the document of concrete actions that can be taken by governments, health professionals, teachers, lay workers, and others.

Of most interest here are the model interventions with demonstrated effectiveness (i.e., in randomized controlled trials) or favorable evidence of effectiveness derived from high quality quasi-experimental or qualitative studies (termed promising or prudent interventions) (WHO, July, 2016). Nearly 200 citations of scholarly literature are included, enabling readers to retrieve and scrutinize the actual studies. Particularly interesting to me were the studies conducted in low- and middle-income countries where the majority (80%) of the world's children live.

Space permits inclusion of only a few of the successful laws/projects/interventions that address various facets of violence against children:

• In Sweden, the first country to ban corporal punishment of children in 1979, follow-up study in 2009 showed a decrease from 90% to 10% in number of children being hit.

• In South Africa, after enactment of stricter firearm licensing, steep reductions occurred in deaths among 15-to-29-year-old males.

• In Uganda, after a training program for male and female community activists, physical violence against female intimate partners decreased by 52% and witnessing of IPV by children decreased by 64%.

• In USA, a long-standing program of home-visiting by registered nurses to young, low-income, first-time mothers resulted in 48% reduction in child abuse and neglect (compared to control group at 15-year follow-up).

• In Zambia, trauma symptoms of boys and girls ages 5–18 were reduced by 82% in a group receiving trauma-focused cognitive-behavioral therapy delivered by trained lay counselors (compared to a 21% reduction in group receiving usual treatment).

• In Croatia, the Safe and Enabling School Environment Programme cut peer violence in primary schools in half.

The commitment of the United Nations to ending violence against children must be taken up and translated into additional preventive and interventive actions by legislators, philanthropists, faith-based organizations, researchers, and clinicians—all of us who care about children. Complicating the picture is the lack of adequate data about acts of violence against children because only a small proportion of such acts are reported (WHO, July, 2016). Further complicating the picture is insufficient research to demonstrate whether lay counselors will work well in countries other than Zambia, whether home visiting by nurses will work in countries other than the United States—in short, the substantive issues of adapting successful interventions to cultural norms and maintaining program fidelity. The INSPIRE document reminds us that every country and local community must consider its own sociocultural context when selecting interventions for violence reduction against children. I see many roles for psychiatric-mental health nurses in selection of appropriate programs for their treatment settings and communities, in selection of measurable objectives and outcomes, and in delivery of psychoeducational and therapeutic interventions to children and their parents.

Declaration of Interest: The author reports no conflict of interest. The author alone is responsible for the content and writing of this paper.