Health Care of Vulnerable Persons - Essay Example

?Introduction Great advances in information, research, and technology have led to leaps in the field of health care. More people now enjoy better health provisions, with significant improvements in mortality and morbidity statistics and quality of life. However, the enjoyment of these health care rights is still far from universal. There still exist certain populations, labelled vulnerable groups, which are still deprived of these rights. Vulnerable groups comprise those who, due to multiple factors, can be potentially harmed greatly by a stressor. Vulnerability depends on many things as Mechanic and Tanner (2007) describes. It can be due to individual capacities, such as level of educational attainment, income or wealth, and mental or physical capabilities. For example, those who have lower levels of educational attainment have significantly less knowledge or preparation to deal with disasters, and are thus vulnerable. The availability of support is also a significant factor in vulnerability. Those who have no families or social networks to rely on are more prone to being harmed than those who can draw support from others. Access to neighbourhood and community resources is also an important factor in assessing whether an individual or group is vulnerable. Other sources of vulnerability may include poverty and race and physical location. This is largely related to access to resources and care. This paper focuses on children who are victims of abuse as a vulnerable group. Children, due to their developmental state, are very fragile. They are usually weaker than adults, are less mentally developed, and have no or little means to defend themselves. Due to their age, physical and mental limitations, they are more dependent on others, making them susceptible to abuse and neglect (Reichert 2006). The Child Welfare Information Gateway (2009) defines child abuse as consisting of acts of parents or caretakers that result in death or harm of a child. It may also include the omission of certain acts, or neglect to do something. There are several types of abuse: physical, neglect or failure to provide for a child’s needs, sexual or exploitation, and emotional. Some states also include parental substance abuse as a form of child abuse. There are certain risk factors that make a child susceptible to abuse. Goldman et al (2003) describes four general categories of risk factors: parent or caregiver factors, family factors, child factors, and environmental factors. Parent factors include personality traits such as aggression, impatience, or dominance, and psychological disorders. A personal history of abuse, substance abuse, and faulty attitudes and knowledge are also factors. Families with single parents or constantly changing compositions have been found to be more prone to having abused children. Marital conflict and domestic violence, presence of stress, and flawed parent-child interactions are also risk factors. Child factors that contribute to child abuse are age, developmental stage, and presence of disabilities. Environmental factors include poverty, unemployment, social isolation, lack of social support, and being in dangerous neighbourhoods. This paper describes policies that work towards helping child abuse victims. It also goes into strategies that would prevent child abuse, offer help for victims, and address their vulnerabilities. Policies In 1989, the United Nations created the Convention on the Rights of the Child, which specifies the basic rights that every child, regardless of race or gender, should enjoy. Among these rights are: a right not to be discriminated against; a right to have best interests primarily considered; a right to a name, nationality, and parents; a right to have own views and freely express self; a right to be free from interference with privacy; a right to adequate health care, education, rest, and leisure; and, most relevant to this paper, a right to be protected from abuse (Reichert 2006). Since the creation of the Convention on the Rights of the Child, various policies and measures have been made by the United Nations, governments, and private organizations around the world. These policies and measures mainly aim to uphold the rights of children and offer protection from abuse. In the United Kingdom, the child protection system has been in place since the 1970s, with occasional revisions reflecting new information and new trends until the present. The policies, through evolutions, remained with these five objectives: (1) use of preventive approaches to reduce incidence of child abuse, (2) having a system of identifying children at risk, (3) preventing children from repeated harm, (4) addressing the effects of the harm already experienced, and (5) addressing the needs of the family members. Looking at the policies that evolved, the overall aims were focused at reducing the incidence and prevalence of child abuse and its negative outcomes (Devaney and Spratt 2009). In 2000, the UK government began to transform their policies to include wider concerns for child apart from protection. They adopted the term “safeguarding” in lieu of “child protection.” The definition of child abuse was gradually widened. Also, a new family policy was made the government, wherein neglectful parents were seen not as abusive but as requiring guidance. Instead of punitive measures, the social service for child abuse focused more on offering support to families so as to address child neglect. Apart from creating policies that centre on providing services for children especially needing protection, such as the “Every Child Matters” initiative, the government also worked towards improving the quality of such policies. The government developed systems of assessing the performance of such policies, ensuring that the goals were being achieved and public money was being put to good investment (Devaney and Spratt 2009). Viewing the problem of child abuse in UK as a complex problem has allowed policymakers to shift their approach from targeting points of crisis, such as a child already abused or a child already with multiple risk factors for abuse. Instead, policymakers have gradually started to look at the family as a starting point. Instead of pitting the child versus the abusive family, it might be better to see abuse not as merely a crime but a sickness that needs treatment and support. Thinking further, policymakers could then target the prevention of this sickness in the family level, before the appearance of risk factors such as substance abuse and domestic violence. This approach is more overarching and likely to have more long-term effects. Strategies In formulating strategies to help vulnerable groups such as the victims of child abuse, it is important to keep in mind that the problem is multifactorial. First, one should work within the framework of the issue of vulnerability. Vulnerable groups are, by definition, susceptible to harm and abuse because of their lack of resources and capabilities. Thus, they depend partly on external help and resources. Second, the roots of child abuse can be traced all the way to attitudes on education, health, and gender discrimination, and thus, it is important to have an encompassing view of the problem. Third, prevention is the best measure, and this could be done by targeting the risk factors. A good understanding of the determinants of vulnerability is thus important. Fourth, the best approach to a multifactorial problem is a multidisciplinary solution. Different aspects of the problem should be addressed simultaneously. Lastly, the best strategies are those that enable and empower the individuals themselves. While external help is definitely needed in the form of policies, social support, and multiagency cooperation, child abuse victims will benefit in the greatest way if they are given opportunities to develop their own strengths and capabilities. Providing for the needs of vulnerable groups. Mechanic and Tanner (2007) states that vulnerable communities, by definition, require interventions beyond health care. In the case of child abuse victims, they require more beyond just protection from their abusers. To really make a difference in uplifting vulnerable groups, measures must also be done in improving their living conditions and social economic status. Social economic status is a major determinant of vulnerability. Poor people have fewer resources, and are thus less likely to have good education and chances of employment. They have less access to institutions that provide basic care. They also do not have access to safe water and food. Poverty also dictates how safe a person’s environment is. Child abuse victims are usually those that live in unsafe environments. All of these disadvantages accumulate and affect them in the long-term, maintaining their status as vulnerable and readily susceptible to stressors. The challenge, thus, for governments and institutions is in creating policies and measures that intervene with the disadvantages that a low social economic status confers. Some may argue that people should have personal initiative to rise from their conditions. However, it must be reiterated that vulnerability by definition allows people little chance to improve their conditions without external help. While policies that uphold personal initiatives may be more attractive politically, it still favours those who are already a little bit better off than others. Policies that aim to make better opportunities for entire populations benefit everyone without increasing disparities. Addressing the roots of child abuse. Child abuse is a very complex social phenomenon. It roots from lapses from any of a number of systems. The United Nations Economic and Social Council (2008), for example, recognizes that for successful child protection to happen, roots of child abuse like education, health, and gender discrimination should be targeted. Lapses in education lead to faulty attitudes. It can be as simple as not knowing how to discipline a child, and thus resulting to physical abuse. It can be as complex as failures in the health system coupled with gender discrimination leading to a lack of proper reproductive health, in turn leading to the rise in number of young and uneducated mothers who become negligent with their children. There are so many ways that a culture of child abuse can be bred, thus making these roots an important target. UNESCO (2008) argues that child protection should be global and transnational. Child protection should be prioritized in all parts of the world, regardless of development, stability, or prevailing attitudes. It should not take a backseat in areas in crisis where other concerns may be deemed more pressing and should not be lax in stable places as well. In order to be successful, UNESCO (2008) outlines the following five strategies: 1. Strengthen national protection systems; 2. Support social change; 3. Promote child protection in conflict and natural disasters; 4. Evidence-building and knowledge-management; 5. Convening and catalysing agents of change. All of these strategies address the encompassing roots of child abuse. Strengthening national protection systems can be achieved by having a high level of governmental commitment. Government officials should have an advocacy to fight child abuse, and should be creative in making policies. Policies should not be one-dimensional; it should cover all aspects of child abuse and recognize that it is a multifaceted problem with overarching causes. Policies should incorporate new bodies of knowledge, and thus should be continuously updated in order to be relevant. To carry out these policies, there should be a strict legislation and enforcement in place. The government should provide both basic and targeted services, and have a provision for monitoring and oversight. Social change can be achieved by increasing knowledge and data collection. The more people know about child abuse, the greater are the chances that it will not be committed unknowingly and there will be greater incidence of reporting and execution. Social change can also be achieved by strengthening the protective role of families. The government should implement culturally appropriate and gender-sensitive parenting and care-giving programmes, which in turn would increase understanding among parents regarding child abuse, and promote non-violent relationships. This can be as simple as promoting parenting education, which would teach parents alternatives to violence, for example. The ultimate goal is for social change to lead to attitudes, behaviours, traditions, and customs that abhor child abuse and uplift the well-being of children. During times of conflict and natural disasters, the well-being of children sometimes takes a backseat to other concerns. It is important to stop this practice and give more priority to child protection even during such times. Knowledge is one of the most important tools against child abuse. Knowledge encompasses information about the incidence, risk factors, outcomes, and processes to be undertaken, among others. Knowledge can be used to increase public awareness about the perils of child abuse. It can be used to alter attitudes that lead to child abuse. It can also be used to make policies and programs relevant to the problem. Lastly, to successfully address the roots of child abuse, it is important to work as a team in a large scale. Child abuse is an issue where almost everyone is a stakeholder: the government, the private institutions, the community, the family, and the child. Everyone must take part in solving the problem. Prevention is the most important intervention. Success of child protection is dependent on its prevention. Goldman et al. (2003) reiterates that programs for the prevention of child abuse should focus on eliminating risk factors. As discussed previously, there are four domains of risk factors: parent, family, child, and environment factors. All of these should be addressed in the prevention of child abuse. Programs that address parental factors include substance abuse treatment programs and parent education programs and support groups. Parent education programs are particularly useful because, if done properly, they have the potential to eliminate wrong attitudes and behaviours. Parent education programs could foster non-violent approaches to disciplining, for example, and improve parent-children interactions. Programs that target child factors include care programs for children with disabilities and programs for adopted children. Adopted children will be less prone to child abuse if they are matched correctly to their adoptive parents. Monitoring the outcomes of adoptions will also be helpful. There are also ways to eliminate environment and family factors that lead to child abuse. Better security is a good start. Access to institutions that provide help is also important. Programs that promote healthful and safe activities within the community may also protect against child abuse. Home visitation programs can also be beneficial. There are times when an abuser is mainly ignorant. Home visitation programs will enable officials or knowledgeable volunteers to observe young mothers, for example, and immediately correct wrong practices that can later on lead to abusive practices. Home visitation programs can also lead to higher reporting of child abuse incidents. A multidisciplinary approach is needed. As mentioned earlier, everyone should be concerned about the problem of child abuse. Various institutions should all have a hand in preventing child abuse and helping victims. The government’s big role has already been discussed. Other institutions that should play a role include, but are not limited to, the following: health care providers, schools, religious institutions, and the media. Health care providers often play a big role in child abuse. They may be the first ones who become aware of child abuse incidents, probably when they see patients who are victims. Apart from their role in giving utmost health services, they should also play a role in reporting to officials. Health care providers should have a good eye in determining child abuse cases, and doing the necessary processes. Oftentimes parents may report physical injuries as caused by accidents. Health care providers should know when to be suspicious and should alert the necessary officials. Schools are also forefront in helping child abuse victims. Children spend considerable time in schools, under the guidance of teachers and other adults. Schools can include skills-based curriculum that enables children to develop safety and protection skills. Children can also be educated, for example, on how to distinguish appropriate touching from sexual abuse. Teachers also play a big role in reporting incidents of child abuse. Religious institutions are among the most influential institutions in society. People who are religious more often than not imbibe the teachings of religious heads. They are thus in a good place to shape the attitudes and behaviours of people that would promote child protection. Lastly, mass media is possibly the most influential entity that can influence the fight against child abuse. It can raise public awareness through campaigns and advocacies. It adds to information to child abuse. It should be a powerful tool used to help stop child abuse. Enabling and empowering the children. Children are vulnerable and need the help of external sources so that they could defend themselves. However, they are not altogether weak and hopeless. Measures can be done to enable and empower children. Schools, as mentioned above, can include curricula that give children skills they need for safety and protection. Children can also be educated early as to what is proper. They can also be provided with access to entities that can help them in times of danger. Victims of child abuse can also benefit with long-term support. Consultations with child psychologists can have long-term effects on their well-being. Providing adequate health care for them is also important. Conclusion This paper aimed to discuss the concepts of vulnerability and vulnerable groups. It focused on victims of child abuse. To assess who are vulnerable to child abuse, one must look into their risk factors. Incidence of child abuse is highly correlated with social economic status, as poverty and lack of education has consistently been shown to contribute to child abuse. Focusing on risk factors in assessing vulnerable children will also help to prevent child abuse, which is the most important aspect in management. In order to identify children who are vulnerable, one must also have an understanding of what child abuse entails. Child abuse can consist of physical, emotional, and sexual abuse. Neglect or failure to give what a child needs is also considered abuse. Policies are continuously being created and shaped presently. Governments and international institutions are actively trying to target the roots of child abuse by spending considerable time and resources in research and information. Knowledge about child abuse continuously allows them to create and improve existing programs, all of which are aimed at decreasing the incidence of child abuse and improving the lives of vulnerable children. The management strategies presented took into consideration a number of factors: that the child abuse victims are vulnerable, that it is important to have an encompassing view of the problem, that prevention is the best measure, that a multidisciplinary approach is needed, and that it is important to enable and empower the children. In conclusion, this paper gave an overview of the determinants of child abuse and how it can be prevented. Governments and international institutions are currently demonstrating a deep advocacy in preventing child abuse and targeting its roots. What needs improvement, probably, is the participation of different entities such as schools, religious institutions, and the media. Only with a united effort against it will child abuse be solved. References Child Welfare Information Gateway, 2009. Definitions of child abuse and neglect: summary of state laws. [online] Available at < http://www.childwelfare.gov/systemwide/laws_policies/statutes/define.pdf> [Accessed 23 July 2011] Devaney, J. and Spratt, T., 2009. Child abuse as a complex and wicked problem: Reflecting on policy developments in the United Kingdom in working with children and families with multiple problems. Children and Youth Services Review, doi: 10.1016/j.childyouth.2008.12.003. Goldman, J., Salus, M., Wolcott, D., and Kennedy, K., 2003. A coordinated response to child abuse and neglect: the foundation for practice. Washington: National Clearinghouse on Child Abuse and Neglect Information. Mechanic, D. and Tanner, J., 2007. Vulnerable people, groups, and populations: societal view. Health Affairs, 26(5), pp.1220-1230. Reichert, E., 2006. Understanding human rights: an exercise book. California: Sage. United Nations Economic and Social Council, 2008. United Nations Children’s Fund Executive Board Annual Session: UNICEF Child protection strategy. 3-5 June 2008. New York: United Nations. Read More