Protecting infants and toddlers from domestic violence: Development of a diagnostic protocol for infant and toddler abuse and neglect and its implementation to the public health system.

Beginning in 1977, the Department of Mental Health and Social Welfare (formerly the Department of Family Relations) has been carrying out research and action research and offering continuing education programmes for professionals and specialized services to families and institutions. The main scientific aim of the Department is the study of intra-family violence against children (active and passive), and the prevention of victimization of children.

As a result of its specialization in child abuse and neglect, since 1988 the Department has been operating as a Centre for the Study and Prevention of Abuse - Neglect (CAN Centre) according to decision 2350/14-11-88 of the Minister of Health and Welfare.

Specifically, the objectives of the policies/priorities related to children who suffer from violent behaviour in their family environment have led this Department to conduct quantitative and qualitative research, with emphasis on primary, secondary and tertiary prevention:

Primary, secondary and tertiary prevention programmes

• Education and sensitization of professionals encountering child abuse and neglect in their everyday practice
• Sensitization of the public to child abuse and neglect and modification of relevant social attitudes and behaviours
• Bringing together research data and social policy through cooperation with the Ministries of Health and Social Welfare, Justice and Internal Affairs so that effective legislation/institutional measures are adopted.
• Collaboration with European Institutions in carrying out international research projects on the violations of children’s rights

Concurrently, action research is being carried out on the effects of child maltreatment, and on the general functioning of the family, while, in parallel, identification and treatment services are offered and evaluated. Research on the child protection services in Greece is being conducted; empirical data stemming from this kind of research have already been used as a basis for the design and implementation of intervention programmes in relevant institutions, and for the creation of innovative projects. In addition, novel “education-action” programmes have been developed, such as the support-through-counselling programme for professionals, aimed at preparing them for handling difficult cases of intra-family violence against children.

The Department, following the international appeal for the protection of children’s rights, and in response to the UN Convention (1989) and the Greek Law (Ν2101, ΦΕΚ192/2.12.92), has developed a special interest in this field and has developed a framework programme for the promotion of children’s rights in Greece and Europe, which includes various activities all around Greece, in cooperation with primary school teachers. The Department also collaborates with European institutions concerning mobilization through political lobbying aimed at empowering the positions of children as a distinct social category in  European Union conventions.

The educational initiatives of the Department consist of publications of relevant scientific material, organization of conferences and seminars, production of audiovisual material and participation in the continuing education programmes of other institutions. The Department functions as an information centre for international and national bodies working on issues related to child abuse and neglect and child protection in general, and runs a specialist library, which is open to professionals and university students.

The phenomena of interpersonal and intra-family violence and violence against minors constitute critical points for articulating health education policies at the international level. The critical nature of these phenomena and the alerting of the relevant international organizations can be understood from the following data:

• In 1998, 2.3 million people died from violence
• The World Health Organization (WHO) has adopted scientific estimations that predict that in 2020 interpersonal violence will rise from the 19th to the 12th position in the list of the 30 most important causes of death worldwide
• A study carried out in Sweden reports that one in five women has suffered abuse, more often during adolescence and childhood
• The WHO estimates that 40,000,000 children become victims of violence worldwide
• Studies in various industrialized and developed countries have estimated that violence against under-age children ranges from 3% to 29% for boys and from 7% to 36% for girls.

The inclusion by WHO, in 1996, of child abuse and neglect and its adverse effects among public health problems underlines the importance of education in addressing this issue and instituting preventive measures. The UN Convention on the Rights of the Child and other international efforts to promote health at individual and societal levels have set a new basis for child protection in the family. The main message of this Convention is that every child should be considered as a subject with rights, rather than as an object that needs protection. The right of individuals to protection from all forms of exploitation and the right to live in a happy family should be the goal of every law-abiding society.

The Institute of Child Health, according to Presidential Decree (P.D. 867/1979), has always been an innovative institution based on the principles of multidisciplinary cooperation, combining clinical practice, research and epidemiology. Currently the Institute is undergoing scientific re-structuring, especially after the change of its legal status according to the Law 3370/11.07.05, and its subsequent transformation into a Research Institute (under the Law 1514), supervised by the Ministry of Health and Social Solidarity and the Ministry of Development (General Secretariat for Research and Technology).

The Department of Mental Health and Social Welfare (previously known as the Department of Family Relations), since its foundation in 1979, has focused on child abuse and neglect issues by:

• Conducting research (epidemiological/demographic and clinical)
• Promoting health education and sensitization of the public
• Offering continuing education programmes for professionals
• Offering counselling and organizing support actions for institutions and professionals
• Providing specialized services

In this context, the Department, through its multidisciplinary constitution, combines the diverse approach of a wide variety of scientific perspectives (Psychiatry, Social Work, Clinical Psychology, Sociology, Criminology, Psychodynamic Theory, Public Health and Social Anthropology). Specifically, the scope of the Department includes the following:

• Study and promotion of healthy family relationships and children’s rights
• Study of Greek families in psycho-social crisis related to children’s victimization
• Development of methodologies for the identification of parental risk
• Epidemiological and clinical approach to child abuse and neglect as a public health problem
• Development of community-based prevention programmes
• Promotion of health and children’s rights in the family, school and community

These interests are approached through research and clinical and educational work. This body of work includes quantitative studies on intra-family sexual violation issues and the use of physical punishment in children’s education, identification of high-risk factors for child abuse and neglect, and qualitative studies on incest and sexual violation within the family.

To date, the Department has carried out research on:

child abuse and neglect, intra-family sexual violation, incest, use of corporal punishment in children’s education, dystrophy of non-organic causes, prediction of the level of risk of families predisposed to violence (Bridge ALERT), identification of predictive factors for child abuse and neglect, attitudes and intervention practices carried out by health professionals, and on the effects of institutionalization on children.

In addition it has pioneered clinical work on the identification and management of all types of child abuse and neglect.