Çocuk İstismarı ve İhmalini Önlemede Kanıta Dayalı Yaklaşımlar

Çocuk sağlığını her yönden olumsuz etkileyen çocuk istismarı, fiziksel istismar, cinsel istismar, duygusal istismar, çocuk ihmali ve ekonomik istis-mar olmak üzere farklı şekillerde görülebilmektedir. Hekimler için tanı ve tedavinin yanı sıra bildirim yükümlülüğü de olan bu sağlık sorununun çözümlenmesinde en akılcı yaklaşım sorun ortaya çıkmadan engellenmesi ve bunun için gerekli önlemlerin alınmasıdır. En kapsayıcı yaklaşım risk faktörlerinin belirlenmesi, ortadan kaldırılması, kaldırılamadığı durumlarda da önlenmesine yönelik yöntemlerin geliştirilmesidir. Bu amaçla dünyada uygulanan programların etkinliğine yönelik randomize kontrollü çalışmalar sınırlıdır. Bu yazı dünyada ve Türkiye’de uygulanan programların etkinli-ğini değerlendiren çalışmalar ışığında çocukla ilgilenen sağlık çalışanlarına çocuk istismarına önlemeye yönelik programlar ile ilgili kanıta dayalı veriler sunabilmeyi ve bu verilere dayalı önlemlerin geliştirilebilmesini amaçlamaktadır.

Evidence Based Approaches to Preventing Child Abuse

Child abuse, which affects children's health in every way, can be seen in different forms as physical abuse, sexual abuse, emotional abuse, child neglect and economic abuse. Child abuse is an obligation for physicians to diagnose and treat as well as to notify, The most rational approach to solving this health problem is to prevent child abuse and take necessary precautions. Firstly, risk factors should be identified and then removed. If they can not be removed, the children should be protected. There are limited randomized controlled studies on the effectiveness of the programs implemented in the world. This article aims to provide healthcare professionals who are concerned with children evidence-based approaches in the world and Turkey to prevent child abuse and to develop prevention for it.

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Birleşmiş Milletler Çocuk Haklarına Sözleş-mesi, (1990). http://www.unicef.org/turkey/crc/_cr23c.html (son erişim tarihi 12.06.2017)
Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and conse-quences of child maltreatment in high-income countries. Lancet 2009; 373: 68-81.
Hoft M, Haddad L. Screening children for abuse and neglect: a review of the literature. J Forensic Nurs 2017; 13: 26-34.
Garbarino J, Kostelny K. Child maltreatment as a community problem. Child Abuse Negl 1992; 16: 455-64.
Preventing child maltreatment: a guide to tak-ing action and generating evidence. http://apps.who.int/iris/bitstream/10665/43499/1/9241594365_eng.pdf (son erişim tarihi: 05/06/2017)
Trocmé N, Knoke D, Fallon B, Bruce Mac-Laurin. Differentiating between substantiated, suspected, and unsubstantiated maltreatment in Canada. Child Maltreat 2009; 14: 4-16.
Administration for Children and Families, Administrationon Children, Youth and Fami-lies, Children’s Bureau, U.S. Department of Health & Human Services. (2016). Child maltreatment 2015. https://www.acf.hhs.gov/cb/resource/childmaltreatment-2015 (son erişim tarihi: 20.06.2017)
Zoroğlu SS, Tüzün Ü, Şar V, Öztürk M, Kora ME, Alyanak B. Çocukluk dönemi istismar ve ihmalinin olası sonuçları. Anadolu Psikiyatri Dergisi 2001; 2: 69-78.
UNICEF, Türkiye’de Çocuk İstismarı ve Aile İçi Şiddet Araştırması, 2010. http://www.unicef.org.tr/files/bilgimerkezi/doc/cocuk-istismari-raporu-tr.pdf (son erişim ta-rihi: 19.06.2017)
Güvenlik Birimine Gelen veya Getirilen Ço-cuklar, 2015. http://www.tuik.gov.tr/PreHaberBultenleri.do?id=21544 (son erişim tarihi: 19.06.2017)
Çocukların Cinsel İstismarı Suç ve Karar Sa-yıları, TÜRKİYE (2005-2015) http://www.adlisicil.adalet.gov.tr/istatistik_2015/CEZA/48.pdf (son erişim tarihi: 19.06.2017)
Fluke J, Shusterman GR, Hollinshead DM, Yuan YY. Longitudinal analysis of repeated child abuse reporting and victimization: Mul-tistate analysis of associated factors. Child Maltreat 2008; 13: 76-88.
Cohen JA, Deblinger E, Mannarino AP, Steer RA. A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychi-atry 2004; 43: 393-402.
Dubowitz H, Feigelman S, Lane W, Kim J. Pediatric primary care to help prevent child maltreatment: The Safe Environment for Eve-ry Kid (SEEK) model. Pediatrics 2009; 123: 858-64.
Ozbaran B, Eremis S, Bukusoglu N, et al. So-cial and emotional outcomes of child sexual abuse: a clinical sample in Turkey. J Interpers Violence 2009; 24: 1478-93.
Felitti VJ, Anda RF, Nordenberg D, et al. Re-lationship of childhood abuse and household dysfunction tomany of the leading causes of death in adults: The adverse childhood expe-riences (ACE) study. Am J Prev Med 1998; 14: 245-58.
Yang BZ, Zhang H, Ge W, et al. Child abuse and epigenetic mechanisms of disease risk. Am J Prev Med 2013; 44: 101-7.
MacMillan HL, Wathen CN, Barlow J, et al. Interventions to prevent child maltreatment and associated impairment. Lancet 2009; 373: 250-66.
Bilukha O, Hahn RA, Crosby A, Fergusson DM, Leventhal JM, Taussig HN. The effec-tiveness of early childhood home visitation in preventing violence: a systematic review. Am J Prev Med 2005; 28: 11-39.
Olds DL, Kitzman H, Knudtson MD, Anson E, Smith JA, Cole R. Effect of home visiting by nurses on maternal and child mortality: re-sults of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatr 2014; 168: 800-6.
Kitzman H, Olds DL, Cole R, et al. Enduring effects of prenatal and infancy home visiting by nurses on children: age-12 follow-up of a randomized trial. Arch Pediatr Adolesc Med 2010; 164: 412-8.
Duggan A, Caldera D, Rodriguez K, Burrell L, Rohde C, Crowne SS. Impact of a statewide home visiting program to prevent child abuse. Child Abuse Negl 2007; 31: 801-27.
Fergusson DM, Grant H, Horwood LJ, Ridder EM. Randomized trial of the Early Start Pro-gram of home visitation. Pediatrics 2005; 116: e803-e9.
Bakermans-Kranenburg M, van IJzendoorn MH, Juffer F. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull 2003; 129: 195-215
Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ, Lutzker JR. Population-based prevention of child maltreatment: The U.S. Triple p sys-tem population trial. Prev Sci 2009; 10: 1-12.
Dias MS, Smith K, deGuchery K, Mazur P, Li V, Shaffer ML. Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. Pediatrics 2005; 115: e470-7.
Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bull World Health Organ 2009; 87: 353-61.
Knerr W, Gardner F, Cluver L. Improving po-sitive parenting skills and reducing harsh and abusive parenting in low- and middle-income countries: a systematic review. Prev Sci 2013; 14: 352-63.
Lieberman AF, Van Horn P, Ippen CG. To-ward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. J Am Acad Child Adolesc Psychiatr 2005; 44: 1241-8.
Barrera M, González-Castro F. A Heuristic framework for the cultural adaptation of inter-ventions. Clin Psychol Sci Prac 2006; 13: 311-6.
Chaffin M, Silovsky JF, Funderburk B, et al. Parent-child interaction therapy with physical-ly abusive parents: Efficacy for reducing fu-ture abuse reports. J Consult Clin Psychol 2004; 72: 500-10.