Child abuse and neglect in American Indian communities.

Child abuse and neglect have recently been found to occur among American Indians at rates comparable to other American population groups. Little is known about the clinical spectrum of Indian maltreatment, the psychodynamics and effective treatment modalities. Cultural misunderstanding, modernization, poverty, situational stress, poor parenting skills because of early break-up of Indian families, alcoholism, unusual perceptions of children, handicapped children, and divorce constitute factors associated with maltreatment in cases cited. Old solutions of removing children from families were largely inappropriate and ineffective and are being replaced by local efforts to develop foster homes, supportive family services, and legal procedures to protect children. Communication between agencies involved and mistrust of outsiders plus a lack of trained personnel and available community resources continue to pose major barriers to effective treatment and prevention efforts. Recent federal policies and laws clearly place the responsibility for child welfare in the hands of Indian tribes and tribal courts. The non-Indian health professional has an important but limited role in providing technical expertise and in aiding development of community resources, taking care to support but not usurp the emerging leadership of Indian people.