Neurosciences, Main Nurses Home, Great Ormond Street Hospital for Children, London, England, UK.
Child Abuse Negl. 2011 Oct;35(10):866-75. doi: 10.1016/j.chiabu.2011.08.002. Epub 2011 Oct 19.
To develop further the understanding of emotional abuse and neglect.
Building on previous work, this paper describes the further development of a conceptual framework for the recognition and management of emotional abuse and neglect. Training in this framework is currently being evaluated. The paper also briefly reviews more recent work on aspects of the definition, harm caused by emotional abuse and neglect and threshold.
The paper arrives at a working definition as 'persistent, non-physical, harmful interactions with the child by the caregiver, which include both commission and omission.' There are many forms of harmful caregiver-child interactions, which can be placed in five categories, each category reflecting the fulfillment of one of the child's basic psycho-social needs and requiring a different therapeutic approach for its alleviation. The caregiver-child relationship is embedded within a psycho-social context. It is suggested that greater clarity can be gained about the child and family when information is sorted into the appropriate tiers of concerns: Tier 0 - Social & environmental factors, Tier I - Caregiver risk factors, Tier II - Caregiver-child interactions and Tier III - Child's functioning. It is further suggested that while intervention is required, this is directed towards protection, rather than providing immediate protection of the child. The work takes the form of a time-limited trial of therapeutic work to gauge the capacity of the caregivers to change. This initial work focuses Tiers 0-II. Statutory steps might be required in order to encourage the caregivers to engage. If insufficient progress is achieved, active child protection may be required which might include placing the child in an alternative family. However, some, usually older, children will remain in the emotionally abusive environment and they will require ongoing help and support.
While a greater understanding of emotional abuse and neglect is now possible, further evaluation of the utility of this framework is suggested.
进一步了解情感虐待和忽视。
基于先前的工作，本文描述了进一步开发识别和管理情感虐待和忽视的概念框架。目前正在评估该框架的培训。本文还简要回顾了最近关于情感虐待和忽视的定义、造成的伤害和阈值的更多工作。
本文提出了一个工作定义，即“照顾者对儿童的持续、非身体、有害的互动，包括作为和不作为”。照顾者与儿童的互动有许多形式，可以分为五类，每一类都反映了儿童的一种基本心理社会需求的满足，需要不同的治疗方法来缓解。照顾者与儿童的关系嵌入在心理社会环境中。建议将信息分类到适当的关注层级，可以更清楚地了解儿童和家庭：第 0 层-社会和环境因素，第 I 层-照顾者风险因素，第 II 层-照顾者与儿童的互动，第 III 层-儿童的功能。进一步建议，虽然需要干预，但干预的目的是保护，而不是立即保护儿童。这项工作采取了限时治疗试验的形式，以衡量照顾者改变的能力。这项初步工作侧重于第 0-2 层。可能需要采取法定步骤来鼓励照顾者参与。如果进展不足，可能需要采取积极的儿童保护措施，包括将儿童安置在替代家庭中。然而，一些，通常是年龄较大的儿童，将继续留在情感虐待环境中，他们将需要持续的帮助和支持。
虽然现在可以更好地理解情感虐待和忽视，但建议进一步评估该框架的实用性。
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