All health and human service professionals have a role in preventing abuse, but particularly those who provide care to children or dependent adults in facilities, agencies, and programs. Criminal background checks are usually an important first step in hiring new employees, along with checks of child abuse and sex offender registries when applicable.
The general public also needs greater awareness of the prevalence of child and dependent adult abuse, how to recognize the signs of abuse, and what to do when they suspect abuse. Professionals can help increase public awareness of this often-hidden crime.
Child maltreatment is a serious problem that can have lasting harmful effects on victims. The goal for child maltreatment prevention is clear—to stop child abuse and neglect from happening in the first place. Child abuse is a complex problem rooted in unhealthy relationships and environments. Safe, stable, and nurturing relationships and environments for all children and families can prevent child abuse. Preventing child abuse and neglect requires addressing factors at all levels of the social ecology—individual, relational, community, and societal levels (CDC, 2019d).
Effective prevention strategies focus on modifying policies, practices, and societal norms to create safe, stable, nurturing relationships and environments. The strategies and their corresponding approaches are presented in the table below.
Preventing Child Abuse and Neglect
Strengthen economic supports to families
Change social norms to support parents and positive parenting
Provide quality care and education early in life
Enhance parenting skills to promote healthy child development
Intervene to lessen harms and prevent future risk
Child abuse and neglect is preventable. Much progress has been made in understanding how to prevent child abuse and neglect. Child abuse and neglect is the result of the interaction of a number of individual, family, and environmental factors. Consequently, there is strong reason to believe that the prevention of child abuse and neglect requires a comprehensive focus that crosscuts key sectors of society (eg, public health, government, education, social services, justice). In addition, there is an urgent need to increase the capacity of state and local governments to implement and scale up effective interventions that can reduce child abuse and neglect.
Preventing child abuse and neglect can also prevent other forms of violence. Each of the various forms of violence are interrelated and share many risk and protective factors, consequences, and effective approaches to prevention. Given the overlap of the risk and protective factors for child abuse and neglect and other forms of violence, it stands to reason that the primary prevention of child abuse and neglect can prevent other forms of violence and abuse. Moreover, strategies that support the development of safe, stable, and nurturing relationships between parents or caregivers and their children could be key in preventing the early development of violent behavior in children.
Emerging evidence suggests that by stemming the early development of violent behavior, such relationships can also reduce many types of violence (eg, youth violence, intimate partner and dating violence, sexual violence, self-directed violence) from occurring in adolescence and early adulthood.
The Centers for Disease Control and Prevention (CDC) offers extensive information and links on child abuse prevention techniques and programs at its website. A number of studies and programs are particularly relevant to health care providers who may be involved with child abuse situations.
Infant Safe-Haven Laws
The focus of these laws is protecting newborns from endangerment by providing parents an alternative to criminal abandonment, and therefore the laws are generally limited to very young children.
Child Welfare Information Gateway (CWIG, 2016)
Texas was the first state, in 1999, to enact infant safe-haven legislation and today all fifty states, the District of Columbia, and Puerto Rico have enacted such legislation. State laws are not identical and vary as to the maximum allowable age of the infant, who can relinquish an infant, where an infant can be left, and whether the parent (or person leaving the infant) can retain confidentiality and immunity from prosecution for child abandonment, abuse, or neglect (CWIG, 2016).
Safe-haven legislation also specifies what a safe-haven location must do with any infant left with them. Locations are agreeing to accept emergency protective custody and to provide any immediate medical care the infant needs. Locations are generally limited to hospitals, emergency medical services providers, or healthcare facilities. Fire stations are also acceptable locations in 27 states and 5 states allow emergency providers responding to a 911 call to accept infants. Churches are also acceptable locations in 5 states, provided the person leaving the baby has verified that personnel are present at the time (CWIG, 2016).
Individual states determine who can leave a baby, what information they are supposed to provide, and any legal actions required. A safe-haven provider is required to notify the local child welfare entity that a baby has been left with them and that entity will retrieve the child and assume custody. The agency then has responsibility for placing the child, usually in a pre-adoptive home, and petitioning the court for termination of the parents’ parental rights. Some states may require the agency to make certain inquiries into parental rights and whether the child has been reported missing (CWIG, 2016).
Relinquishing a child under safe-haven laws thus has important consequences for the parents but is an undeniably better outcome for the infant than being left in a trash dumpster or suffering a childhood of abuse or neglect.
Interventions with Survivors of Abuse
After an assessment and evaluation, services may be recommended for the victim of abuse, that person’s family, or a caretaker. Professionals, relatives, and others seeking to help the dependent adult need to consider whether the person will accept these services, and whether the person is of sound mind to give consent.
As discussed earlier, research on the maltreatment of elders and other dependent adults has tended to lag behind but promising studies on interventions are beginning to point toward the efficacy of multidimensional and multidisciplinary approaches that include social supports and education for both victims and perpetrators (NCEA, 2019).
Some experts have suggested that issue-specific interventions are more effective than generalized “elder abuse prevention” programs. Looking at the three dimensions of risk: victim or at-risk person, caregiver, and their specific context or setting, can help identify specific risk factors that can then be modified, thus suggesting intervention strategies that might address one factor or multiple factors depending on the situation (OBSSR, 2016).
Of course, older adults can accept or refuse services offered to them and they may make decisions that are not in their own best interest, which interveners can do nothing about. Additional challenges for professionals operating within a medical or social-service setting include the need to adapt interventions to institutional governing regulations as well as their own available time and skills (OBSSR, 2016).
It is useful to remember that the intervener’s role is to help stop the abuse, not to change anyone’s lifestyle or personality. Solutions may be imperfect but if everyone does the best they can, the results will certainly be better than the alternative. If your agency has established protocols for responding to dependent adult abuse, be sure to follow them when developing a response in an individual case of dependent adult abuse.
While intervention is about preventing re-occurrence and prevention is about preventing occurrence, they have things in common and may both be at play in the same situation. The emphases on multi-dimensionality and multi-disciplinarity are important across the board. The Administration for Community Living (ACL) even uses the term elder abuse prevention intervention. Some demonstration projects the ACL is currently funding include partnerships among community, healthcare, legal, and financial organizations, and address diverse issues including financial exploitation, improving medication adherence, education in Alzheimer’s care, preventing abuse of dementia patients, and evaluating new model care protocols for use by APS and police departments (ACL, 2017c).
Determining Possible Interventions
In regard to interventions, there are generally three possible scenarios: the dependent adult accepts services, lacks the decision-making capacity to give consent, or refuses services. Each of these requires different actions to protect the welfare of the dependent adult and will need to conform to the laws of the state where the person resides. The following are general guidelines for each scenario. Not all are options in every state or municipality. Be sure to follow the laws of your location and the protocols of the applicable institution or agency.
Adult accepts services
- Implement a safety plan such as relocation, a protective order, or admission to a hospital.
- Alleviate causes of mistreatment through “voluntary services.”
- Provide written information on emergency numbers and make appropriate referrals.
- Get assistance in legal/financial matters.
- If abuse is determined to have taken place, the local city or county attorney may bring criminal charges against the perpetrator.
Adult lacks capacity to give consent
- Power of attorney, which must be pre-existing because once a person lacks capacity they cannot sign such an agreement
- Involuntary commitment of abuser or victim
- Special court order—injunctions, restraining orders
- Family member/guardian/case worker may want to consider social services, legal, or financial management assistance for the dependent adult
- If abuse is determined to have taken place, the perpetrator may be prosecuted.
Adult refuses services
- Provide written information on emergency numbers and make appropriate referrals.
- Develop contingency safety plan.
- If there is immediate danger, consider involuntary relocation of the victim or perpetrator, or protective order, or commitment, if that is within the purview of your state’s laws and your agency’s mission.
- Do not enforce your decision without first taking the proper legal steps.
- If abuse is determined to have taken place, the perpetrator may be prosecuted.
Effective Post Trauma Responses
The following responses are designed to aid the victim in coping with abuse or neglect:
- Assess the victim’s psychological response to the abuse/neglect and his or her ability to cope with the situation.
- Tell the victim about services immediately available, such as hotlines, protective services, police, and legal actions.
- The victim should be encouraged to make his or her own decisions. Maintain a nonjudgmental attitude throughout the discussion.
- Depending on the type of abuse, counseling may be available through a geriatric program, a rape counseling program, a domestic violence center, or an adult abuse program.
- Inform the person about appropriate advocacy groups such as legal services programs, protection and advocacy programs, the local area agencies on aging, or other relevant programs.
Anyone can help raise public awareness about dependent adult abuse. Resources include:
- Work with local area agencies on aging and related government departments on their public awareness campaigns. Put up flyers or notices around your workplace, talk to friends and colleagues, or encourage local radio and TV stations to broadcast public service announcements.
- Publicize hotlines for information on elder abuse and for reporting dependent adult abuse whether it occurs in the community or in facilities or programs, or when it involves Medicaid fraud.
- Encourage people to volunteer in healthcare facilities, at domestic violence shelters, and as respite caretakers.
- Invite a speaker with professional experience with dependent adults to speak to an organization to which you belong.
- Encourage people to identify dependent or older adults in the community who may be at risk of abuse.
Ten Tips for Preventing Abuse
The following list suggests actions that are designed to prevent abuse and to help the family and caretaker develop effective coping mechanisms and support systems:
- Assess the person for signs of abuse/neglect. Early identification is essential to break a pattern of abuse or neglect.
- Assess the family at risk for abuse or neglect, and intervene as necessary before abuse occurs. Identifying high-risk families can stop abuse before it starts.
- Develop a trusting relationship with the dependent adult and their relatives. This promotes open discussion of difficulties.
- Offer guidance in caregiving. The caretaker may lack information on how to properly care for the person.
- Provide information about community resources and alternative living arrangements before an older person moves in with an adult child. Knowledge of options and services can help avoid situations that may lead to abuse.
- Encourage the caretaker to join a self-help group and/or to use respite services. Discussion groups provide education and support. They also help relieve frustration.
- Emphasize the importance of social involvement. Using multiple support sources lessens the caretaker’s responsibilities and increases the older adult’s sense of independence.
- Report suspected abuse accurately. Use direct quotes and give specific descriptions of physical findings. Sketches and photographs of injuries may be extremely helpful. Accurate and comprehensive documentation is essential for diagnosis and intervention by legal or social services.
- Consult a social worker about referring the person to community agencies or providing alternative living arrangements. This encourages her/him to choose formal support services that maximize independence and enhance well-being.
- Discuss the possibility of alternative living arrangements to prevent abuse or neglect. If appropriate, the dependent adult may need to relocate to live with relatives, friends, or in a boarding home, retirement community, or healthcare facility.
Legal and Other Responses to Abuse
State legislation relevant to child abuse will often appear in multiple sections of the legal code. Not every state organizes their statutes in the same way and relevant laws often do not appear all together in one section.
Criminal code usually defines specific crimes and provides for the prosecution of alleged perpetrators of a criminal act. Here you are likely to find laws defining all the details of child abuse as a crime.
Another body of laws will be concerned with the reporting of child abuse: designating a central authority, defining reporting requirements and mandatory reporters, providing for a central registry for reports and incidents, and defining penalties for infractions of those reporting laws.
Additional code will define the process for investigation of abuse reports and all the possible actions that may be taken if abuse is discovered. Others govern the operation of state government departments, including health and welfare departments, while others define the operation of professional licensing boards. Juvenile justice laws may be the means by which protective actions or custody are provided to at-risk children. And safe-haven laws many be found in yet another section.
A complete compilation of state laws is usually available online, often as part of a state legislature’s website. While one can search these compilations for such terms as “child abuse,” it may be more direct to check the websites of health departments, legal aid resources, professional licensing boards, professional associations, and advocacy organizations, many of which provide listings of or direct links to the relevant body of statutes.
Dependent Adult Abuse
Keep in mind that everything said above about state statutes relevant to child abuse applies to those governing dependent adult abuse.
Conservatorship, Guardianship, Power of Attorney
Under a conservatorship or guardianship, another person has court-ordered authority and responsibility to manage financial or healthcare decisions for another person who is no longer able to make them for themselves. Each state has legislation regarding the availability and functioning of these powers (NOLO, 2019).
Planning ahead and preparing powers of attorney prior to becoming incapacitated can help a person avoid a conservatorship or guardianship and allow them to choose the representative who will manage their affairs. A power of attorney is a legal document by which one person (the principal) gives to another person (the attorney in fact) the authority to act on the principal’s behalf in one or more matters. The principal, who is giving the power to the attorney in fact, must be able to understand the agreement into which they are entering. There are several types, including:
- General powers—financial
- Limited powers or temporary
- Health care
Protective, restraining, and injunctive orders are intended to protect an abuse victim from physical harm and to prevent further abuse. These orders may evict the perpetrator from the victim’s home, bar the perpetrator from any contact with the victim, require the perpetrator to provide an accounting of the victim’s assets, prevent the perpetrator from transferring the victim’s property, or prohibit any violation under the dependent adult abuse statute. When victims lack decision-making capacity or are in an emergency situation, they may be able to receive help from adult protective services programs. Check with your state and local adult protective and legal resource agencies for information.
Substance Abuse/Mental Health Commitment
In some states both perpetrators of dependent adult abuse and victims of self-neglect may be involuntarily committed to a facility or hospital. Check with your state and local adult protective and legal resource agencies for information.
Long-Term Care Ombudsman’s Office
The national long-term care ombudsman serves as an advocate for the residents of long-term care facilities or assisted-living programs. The ombudsman is charged with the duty of investigation and resolving complaints in long-term care facilities that may adversely affect the health, safety, welfare, or rights of residents. The national office maintains a resource center supporting state programs, many of which support local programs (see Resources).
In most states these services may be offered regardless of whether a report is made or abuse is determined to have taken place. Voluntary services are social services needed to protect the dependent adult or assist the adult toward independence. People with the capacity to consent have the right to refuse such services. These services might include homemaker service, personal care assistance, adult day care, transportation, legal assistance (restraining orders, restitution), financial management assistance (bill paying, insurance counseling, representative payee), admission to hospital, and assistance with applying for Medicare or Medicaid.
Other remedies might include direct deposit of Social Security and pension checks directly into the person’s bank account to help prevent theft of a dependent adult’s income; some states and localities have a representative payee program to provide a financial protective service to assist older or disabled low-income people unable to manage their bills and other financial obligations.
Further investigation and action may be indicated by the Medicaid Fraud Control Unit; crime victim assistance programs; domestic abuse hotlines; Medicare Fraud Hotline; professional licensing boards; Social Security Administration; or Veterans’ Benefits (see Resources).
In some situations, civil actions may be appropriate to address charges for such things as conversion, replevin, or breach of contract, and to recover property or damages. Check with your state and local adult protective and legal resource agencies for information.
Administration on Aging (USDHHS)
Comprehensive resources including the Office of Supportive and Caregiver Services, Office of Nutrition and Health Promotion Programs, Office of Elder Justice and Adult Protective Services, Office for American Indian, Alaska Natives and Native Hawaiian Programs, Office of Long-term Care Ombudsman Programs, and Older Americans Act and Aging Network
Annie E. Casey Foundation
The Annie E. Casey Foundation is a private charitable organization that uses its resources to partner with and forge collaborations among institutions, agencies, decision makers, and community leaders so they can work together to transform tough places to raise families. We fund research, technical assistance, and multi-site demonstrations that help service and support systems like public schools, juvenile justice agencies, and child welfare systems get better results for kids and families. We directly deliver exemplary services, identify and measure what works, and share lessons learned to demonstrate the potential of reforming public policies and services on behalf of children and their families.
410 547 6600
410 547 6624 (fax)
Centers for Disease Control and Prevention
Child Abuse and Neglect Prevention
Center for Law and Social Policy
Develops and advocates for federal, state, and local policies to strengthen families and create pathways to education and work.
202 906 8000
Child Welfare Information Gateway / U.S. Department of Health Human Services
Resources on child abuse prevention, protecting children from risk of abuse, and strengthening families. Includes information on supporting families, protective factors, public awareness, community activities, positive parenting, prevention programs, and more.
Child Welfare League of America
A coalition of hundreds of private and public agencies serving vulnerable children and families since 1920. Provides expertise, leadership and innovation on policies, programs, and practices help improve the lives of millions of children in all fifty states.
202 688 4200
Department of Justice (US DOJ)
Elder Justice Initiative
National Adult Protective Services Association
1612 K Street NW, #200
Washington, DC 20006
202 370 6292
National Center on Elder Abuse
c/o University of Southern California Keck School of Medicine
Department of Family Medicine and Geriatrics
1000 South Fremont Avenue, Unit 22, Building A-6
Alhambra, CA 91803
855 500 3537 (855 500 ELDR)
626 457 4090 (fax)
The NCEA provides the latest information regarding research, training, best practices, news and resources on elder abuse, neglect and exploitation to professionals and the public.
National Long-Term Care Ombudsman Resource Center
1001 Connecticut Avenue, NW, Suite 632
Washington, DC 20036
(phone) 202 332 2275
(fax) 202 332 2949 (fax)
National Institute on Aging