Abstract
Child abuse and neglect have a potentially deleterious impact on children’s physical, social, and psychological development. Preschool teachers may play a crucial role in the protection, early detection, and the intervention of child abuse and neglect, as they have the opportunity to establish a close contact with the families and to observe day-to-day changes in pupils’ behavior. The main purpose of this study is to investigate preschool teachers’ experiences and characteristics in relation to their awareness of possible child abuse and neglect signs. A questionnaire survey was designed and administered to 197 preschool teachers who work for the public preschools in the Izmir province of Turkey. In addition to the questionnaire items, a 34-item Likert-type scale measuring the level of familiarity with possible signs of child abuse and neglect was developed. This scale had an internal consistency of 0.94. The results revealed that 10.65% of preschool teachers had training regarding violence against children and 2.03% of them had training in child abuse and neglect. Overall, 35% of all teachers reported that they had prior experience with pupils who were exposed to child abuse and neglect. Moreover, statistical analyses indicated that being a parent and having training in child abuse and neglect, having experience with maltreated children, and having higher job status were significant factors in preschool teachers’ ability to recognize the possible signs of child abuse and neglect. Our results support that teacher training in child abuse and neglect can play an important role in preschool teachers’ awareness of the possible signs of child abuse and neglect.
Child abuse and neglect (or maltreatment) is a worldwide public health problem. Child maltreatment involves any act of commission or omission by a parent or other caregiver that causes harm, potential for harm, or threat of harm to a child (Leeb, Paulozzi, Melanson, Simon, & Arias, 2008). It includes four widely recognized subtypes: physical abuse, sexual abuse, emotional abuse, and neglect. The American Psychological Association (APA, 2002) has regarded child maltreatment as an important public health crisis due to its prevalence and capacity to produce deleterious effects on a child’s psychological health. According to international studies, one quarter to one half of all children report physical abuse depending on the country (World Health Organization [WHO] and International Society for Prevention of Child Abuse, 2006). In Turkey, child abuse and neglect is also a significant problem. In a large-scaled study of 4-year-old to 12-year-old children in Turkey, researchers reported that 33% of the children were abused (the mother used physical punishment) and this was even higher among 4- to 6-year-old children with 40.70% experiencing abuse (Bilir, Arı, Dönmez, & Güneysu, 1991).
Child maltreatment poses significant lifelong consequences for individuals, their families, and society. For example, it has been found to be related to some forms of alterations in the neurobiological systems involved in brain maturation, cognitive development, and emotional/behavioral regulations (Bayer, Hiscock, Ukoumunne, Price, & Wake, 2008; De Bellis, 2005). Likewise, in a recent review, Maas, Herrenkohl, and Sousa (2008) stated that there was compelling evidence showing the relationship between child maltreatment and later youth violence. High rates of delinquency, school failure, and substance abuse by the end of adolescence have also been reported as possible results of early maltreatment (Mersky, 2006). The long lasting effects of “maltreatment” in terms of school failure and subsequent limited job opportunities, psychiatric disorders, and criminal activities make child maltreatment costly for the society (Zielinsky, 2009).
Existing research on teachers’ knowledge about maltreatment has generally indicated that teachers have insufficient information about child abuse and neglect (Abrahams, Casey, & Daro, 1992; Briggs & Potter, 2004; Feng, Huang, & Wang, 2010; Kenny, 2001, 2004; Walsh, Farrell, Bridgstock, & Schweitzer, 2006). This deficiency of knowledge has an effect on the recognition and reporting of possible maltreatment cases. The gap between official statistics and the results of community-based surveys of maltreatment points to the reporting problems of real cases (Gilbert et al., 2009). According to Gilbert et al. (2009), limited awareness of the signs of maltreatment might be one of the reasons for underreporting. In addition, confidence over accurate identification of child abuse and neglect has had an effect on reporting decisions (Kenny, 2001, 2004; Walsh, Bridgstock, Farrell, Rassafiani, & Schweitzer, 2008).
However, to be able to detect possible child abuse and neglect cases and to counteract the problem effectively, teachers must have sound professional knowledge and experience. With adequate professional education, teachers can contribute much to this issue by improving children’s resilience (Gootman, 1996). Hence, one of the most important factors associated with better knowledge of maltreatment may be training about it. Although the results are mixed (Kenny, 2004; Walsh et al., 2008), previous research has indicated that training increases teachers’ confidence over recognition of indicators and intensifies their awareness of child abuse and neglect (Baginsky, 2003; Baginsky & Macpherson, 2005; Hawkins & McCallum, 2001). Another important factor regarding teachers’ better knowledge about maltreatment might be related to their previous work experience with maltreated children. Walsh and Farrell (2008) reported that when teachers had insufficient training about maltreatment, they improved their knowledge through reading, listening, and discussing with well-informed colleagues. Some research also has indicated that teachers’ past experiences of reporting maltreatment might have some effects on future detection and reporting of maltreatment (see, for example, O’Toole, Webster, O’Toole, & Lucal, 1999; Walsh et al., 2008).
The preschool stage is important for tackling child abuse and neglect for several reasons. First of all, child abuse and neglect is more common among preschool children in comparison with other age groups (Bilir et al., 1991; U.S. Department of Health and Human Services, 2006). Second, very young children experience more fatalities due to child abuse in comparison with older age groups (WHO, 2002). Third, as Dozier et al. (2006) stated, it may be more important to detect maltreatment earlier as age matters in the prevention and treatment of the consequences of maltreatment. Therefore, in terms of early detection, intervention, and prevention of child maltreatment, preschool teachers play a special role as they spend a considerable amount of time with children at this crucial age. Moreover, they have the opportunity to observe daily changes in children.
Although there is some research available about teachers’ knowledge of maltreatment, to our best knowledge, very little research has been carried out with preschool teachers (Briggs & Potter, 2004; Erol, 2007; Feng et al., 2010; Walsh & Farrell, 2008). Briggs and Potter (2004) examined Singaporean early childhood teachers’ responses to myths about child sexual abuse and emotional abuse. The aim of their study was to determine the accuracy of teachers’ knowledge of child abuse and neglect versus the impact of universal myths. One example of the myths they studied was that “telling children they are unlovable or a nuisance will make their behavior better.” They concluded that teachers in Singapore depended extensively on dangerous myths and they had insufficient knowledge to recognize, handle, and report child abuse. Furthermore, Feng et al. (2010) investigated the factors related to reporting child abuse among kindergarten teachers in Taiwan. Although their main aim was to investigate the determinants of reporting child abuse, they provided descriptive information indicating that insufficiency in the current training programs might have affected reporting failures of real cases. In addition, Walsh and Farrell (2008) conducted a qualitative research with eight early childhood teachers about their knowledge of child abuse and neglect. The participants in Walsh and Farrell’s study reported that they would benefit from more adequate preparation and specialist knowledge with regard to child abuse and neglect. Moreover, Erol (2007) investigated the awareness of preschool teachers regarding signs of physical abuse in Turkey. She found significant correlations between the teachers’ ability to detect possible signs of physical abuse and their service year, school of graduation, and level of knowledge.
However, except for Erol’s (2007) study, none of the above-mentioned studies exclusively focused on the factors that relate to the knowledge of possible indicators of maltreatment. In addition, Erol’s study was limited to only awareness of physical abuse. The present study using survey data involves recognition of signs for all types of possible child abuse and neglect.
The main purpose of this study was to examine preschool teachers’ awareness of the possible signs of child abuse and neglect in terms of the following factors: Whether the teachers themselves had children; the teachers’ training in child abuse and neglect; the teachers’ prior experience with abused and neglected children; and the teachers’ job position (working as a head teacher, working under a permanent or a temporary contract, working as an hourly paid teacher, a skilled trainer, or other). For this purpose, the following hypotheses were formulated:
Second, in this study, we developed an instrument that might help briefly to evaluate a teacher’s knowledge of the indicators of possible child abuse and neglect. As far as we know, in Turkey such an instrument does not exist. Awareness of the warning signs of various kinds of maltreatment is important for professionals to help improve children’s health, safety, and welfare (Gilbert et al., 2009). Our study then aims to contribute to the field by examining early childhood teachers’ ability to recognize the signs that might relate to maltreatment of children in a Turkish setting.
Method
Participants
Participants in the study consisted of 197 preschool teachers who work for public preschools (for children aged 3 to 6) located in diverse socio-economic districts (low, medium, and high) in the Izmir region of Turkey. The study’s aim was to reach all public preschool teachers in this region. All participants were recruited voluntarily. The aim of reaching all public preschool teachers was successful with the exception of three preschool teachers who were on sick leave. Among those we reached, four did not participate in the study. The respondents in this sample were predominantly female (n = 191), with only six of them being male, which is close to the female/male ratio for nationwide Turkish preschool teachers (females 92.93%; males 7.07%; National Education Statistics 2012-2013, 2013). Participants varied in age from 19 to 52 years with the mean age being 32.61 years (SD = 7.29) with 81% having a university degree or above. Among the participants, 44% had a permanent post as a teacher. The average teaching experience for the sample was 9.76 years, of which 2.85 years was at their current work place. More than half of the participants (59.40%) had children and 53% of participants with children had only one child.
Research Instruments
To investigate some characteristics of preschool teachers and their awareness of possible child abuse and neglect indicators, a questionnaire was designed. The questionnaire included two parts. The first part was a scale called Child Abuse and Neglect Signs Scale (CANSS) and was developed to measure teachers’ recognition of signs that might indicate child maltreatment. The second part of the questionnaire was composed of open- and closed-ended questions regarding the demographics of the respondents; parental status (Have you got children?); training in child abuse and neglect (Have you taken a training course in child abuse and neglect? If you have, please give the name of the course); prior experience with cases of maltreated children (In your professional life have you ever worked with children who were abused and/or neglected); and job status (Are you currently working as a head teacher, under permanent contract, under temporary contract, as an hourly paid teacher, as a skilled trainer or other).
The CANSS
This is a 34-item, 5-point Likert-type scale with responses ranging from strongly agree to not agree (5 to 1) in relation to the degree in which each statement may represent child maltreatment. In the present study, the aim was to measure recognition levels of all types of possible child abuse and neglect signs in one survey instrument as it might provide a brief picture of all types of possible maltreatment. Therefore, the instrument was composed of items regarding different types of child maltreatment signs (physical abuse, emotional abuse, sexual abuse, and neglect). Subtypes of maltreatment may often coexist (see, for example, Walsh & Mathews, 2010) and signs and symptoms of various kinds of maltreatment may overlap. For these reasons, we did not divide the items into subscales. However, care was taken to include signs and indicators of different types of child abuse and neglect as it is important for teachers to be aware of various types of maltreatment (Walsh et al., 2008). Likewise, some items in the current scale may indicate a specific subtype (e.g., being dressed inappropriately for the season: neglect), whereas some other items may belong to more than one subtype (e.g., a child’s passiveness, silence, docility, and apathy: neglect, emotional abuse, and/or sexual abuse).
Development of the scale
The instrument was designed by the research team of this study using a number of strategies. First of all, the literature on child abuse and neglect indicators (e.g., Brown, 2007; Crosson-Tower, 2003; İnsan Hakları Derneği, 2008) was surveyed and relevant signs of child abuse and neglect were collected and then listed. Three experts (from the fields of health care, psychology, and child development) checked the items for appropriateness to indicate maltreatment for children. As much as possible, more concrete items were preferred to general items. Some items were omitted on the ground that they were repetitive. After examination and discussion, only items agreed upon by all three experts were included in the scale.
The CANSS was initially prepared as 40 statements including four filler items to prevent response bias (Paulhus, 1991). An example of a filler item was “applying traditional treatment methods to a child without harm.” These 40 statements were administered to 30 teachers to provide feedback on item wording. After a few corrections, we administered the scale to a total of 197 teachers.
An exploratory factor analysis with SPSS using varimax rotation was conducted to explore the factor structure of the scale. An examination of the scree plot showed that a single factor should be retained. The eigen value of this factor was 12.12. It accounted for 35.65% of variance. Two items that had factor loadings of less than 3.20 (Tabachnick & Fidell, 2001) were eliminated (e.g., child’s parents’ rejecting medical care due to religious beliefs; child, in general, being unclean and having inadequate personal hygiene).
The scale demonstrated a strong internal consistency with the Cronbach alpha coefficient being α = .94.
Procedure
The Ege University Faculty of Education Ethics Committee approved the study and the Ministry of Education Izmir Branch gave Permission for data collection. Upon arrangement with the schools beforehand, the researchers collected data through self-administered questionnaires. Initially, respondents were informed broadly about who was conducting the research, what respondents were expected to do, and the purpose and content of the research. We used careful wording and avoided giving detailed information about the purpose of the research to prevent respondent bias. Respondents were also assured their confidentiality and anonymity. The participant teachers filled in the questionnaires individually in an empty room on the school premises. The researchers were ready for any questions asked by participants regarding the questionnaires. All data collection was finished in 5 weeks.
Results and Discussion
Teacher Characteristics Regarding Education in Maltreatment and Experience With Maltreated Children
The data were analyzed by using software SPSS 13.0. Initially, the percentage scores of the respondents regarding having training in violence toward children, training in child abuse and neglect, types of training, and having previous experience with children exposed to violence were documented in Table 1. Some universities in Turkey give elective courses under the name of “violence and/toward children” while some others offer courses under the name of “child abuse and neglect.” Therefore, we gave the percentages of respondents who specified their training as violence against children and child abuse and neglect separately. Among the entire group of participants only 12.70% answered yes to the question “Have you ever had education in child abuse and neglect?” Of them, 84% named their training as violence against children and 16% named their training as child abuse and neglect. These results are not surprising, as preschool teachers may have pre-service training in child maltreatment only by chance in Turkey. In other words, there is no standardized curriculum regarding child maltreatment in the country.
Percentages of Teachers’ Characteristics.
This included both courses called “child abuse and neglect” and “violence and/toward children.
According to statements of teachers.
Of the participants, 35% reported that, in their earlier professional lives, they had experiences with children who were exposed to violence. Although various kinds of violence often coexist, the majority of participants specified physical violence (69%) as the most common type of violence exposure. This finding is not completely surprising as a great deal of Turkish parents regard physical abuse (beating children) as an acceptable disciplinary method (Simsek-Orhon, Ulukol, Bingoler, & Baskan-Gulnar, 2006). Also, Turkish parents have a tendency toward spanking children together with shouting and threatening them to discourage inappropriate behavior (Kırcaali-Iftar, 2005). Although in the country an increased level of education renders corporal punishment less likely, “this cultural background predisposes the society to what is considered to be physical abuse in many other societies” (Oral et al., 2001, p. 1). However, it should be added that, in Turkey, although corporal punishment is not illegal and has been accepted as a disciplinary method traditionally, currently children are protected by government laws. The Turkish Penal Code has legal definitions of child abuse and neglect. 1 Intentional physical harm and threat of harm to children and failure of parents to provide care, support, or the educational needs of a child is subject to punishment (for detailed information, see Konanç, 1991; Şahin & Beyazova, 2010, p. 88).
In addition, Turkey accepted the UN Convention on the Rights of the Child on September 14, 1990, and ratified it on December 9, 1994. Accordingly, the articles regarding children in Turkish law have been amended (see Republic of Turkey Ministry of Foreign Affairs, 2012). Moreover, according to the Turkish Criminal Code, if a teacher sees lesions or bruises on a child’s face or body and suspects child abuse or neglect, he/she is required to inform the social services and legal offices. If a teacher does not do so, he/she can be punished by 6 months to 2 years in jail. However, in practice this code has not been enforced strictly in the country. To use this code effectively, teachers should be educated comprehensively about maltreatment and where and how the code applies. Other researchers have also pointed out that teachers need to be educated in this area in Turkey (e.g., Değirmenci, 2006).
Measurement Items
Table 2 shows the mean scores of teachers’ responses to statements of possible child abuse and neglect signs. Generally teachers gave high ranks to the statements in which abuse was clearly expressed and the statements where damaging behaviors were obvious (e.g., “a child manifesting bite marks, cuts, or fractures,” M = 4.56). Statements that had the lowest average points were related to disciplinary applications for daily routines and to caregiver behaviors (e.g., “Parents’ and caregivers’ excessive interest in a child,” M = 2.98). These findings are in line with previous research implying that obvious signs of physical maltreatment were more likely to be recognized by teachers (see Walsh et al., 2008). On the other hand, statements with low level ratings seem more prone to alternative explanations as well as maltreatment. For example, they might be considered culturally acceptable parental behaviors by participants as societal context plays a part in defining and therefore recognizing maltreatment (Reading et al., 2009).
Mean Scores of Teacher Ratings on Statements About Child Abuse and Neglect Signs.
It is important to mention that recognizing child abuse and neglect is a complicated issue as the indicators of abuse and neglect are often indistinguishable from other childhood problems (Besharov, 1990; Walsh & Mathews, 2010). In this context, items included in the instrument might well indicate some other kinds of childhood problems such as autism, anxiety problems, defiant disorder, attention deficit disorder or even some organic diseases apart from maltreatment. Therefore, it can be suggested that teachers should also be aware of wider risk factors (e.g., individual characteristics, parent–child relationships, family characteristics, substance abuse, extreme poverty, etc.) to evaluate possible maltreatment. On the other hand, recognizing signs (sometimes less obvious) that could be indicators of developmentally important problems in children’s lives would also benefit children’s well-being whether or not they are related to maltreatment.
Comparisons on the Awareness of Child Maltreatment Signs According to Parental Status, Having Received Training in Maltreatment, Having Prior Experience With Maltreated Children, and Job Status
A series of independent t tests were conducted to examine the mean score differences for the recognition of possible child abuse and neglect signs in terms of having children, having received training in violence and/or child abuse and neglect, and having prior experience with abused and/or neglected children (see Table 3). The results regarding the hypotheses are given below.
Mean Differences of Possible Child Abuse and Neglect Signs Identification Scores With Respect to Participants’ Various Characteristics.
This included both courses called “child abuse and neglect” and “violence and/toward children.”
According to the results of the t test, there was a significant difference between participants who had at least one child and those who had no children (see Hypothesis 1). Participants with children had higher scores on the possible CANSS, t(195) = 2.776, p< .01. One possible interpretation of this result is that having a child or children might sensitize preschool teachers toward the signs and symptoms that have developmental importance for children as parents themselves are very much concerned about their own children’s safety, welfare, and development. However, this finding conflicts with findings of earlier research (O’Toole et al., 1999; Walsh et al., 2008), and therefore it needs further clarification by research with the number of children being taken into account as O’Toole et al. (1999) suggested that having a higher number of children might render teachers more tolerant about the signs of maltreatment.
We predicted that awareness of possible child abuse and neglect signs would differ based on the teachers’ education in maltreatment (see Hypothesis 2). The scores of recognizing potential abuse and neglect signs varied, depending on whether the participants had received education in violence and child abuse and neglect in general. The scores of participants who had education about violence (participants who specified the name of education as child abuse and neglect were excluded) did not significantly differ from those who did not have any education in maltreatment at all, t(188) = −1.784, p> .05. This may be related to the curriculum regarding violence education as such a curriculum might focus mainly on physical and emotional violence while excluding neglect. On the other hand, with respect to the awareness of possible child abuse and neglect signs, participants who had education in maltreatment either in the name of “child abuse and neglect” or in the name of “violence and/toward children” had significantly higher scores than those who did not have any education in maltreatment at all, t(195) = 2.346, p< .05. This finding is in line with the findings of Hawkins and McCallum (2001), Erol (2007), and O’Toole et al. (1999), indicating that education in the topic increased the level of recognition of child abuse.
According to the t test results, teachers who had prior experiences with abused and neglected children had higher awareness scores than the teachers who did not, t(195) = 3.558, p< 00 (see Hypothesis 3). These results are in line with existing research findings (O’Toole et al., 1999; Walsh et al., 2008) implying that experience with previous cases of children who were exposed to violence and were abused or neglected might help increase teachers’ familiarity and knowledge about maltreatment. This may be due to less experienced teachers’ requesting help from experienced colleagues and other professionals and to investigating and reading more about the issues on their own. This represents a kind of learning through experience.
To examine the effect of preschool teachers’ job positions on the possible child abuse and neglect signs recognition scores, an ANOVA test in which the teachers’ job positions served as an independent variable and the child abuse and neglect signs identification scores served as a dependent variable was performed (see Hypothesis 4). ANOVA results revealed that a teacher’s work position had a significant effect on possible child abuse and neglect recognition scores, F(5, 173) = 6.194, p< .05, η2 = .93. Post hoc comparisons through Dunnett C indicated that temporarily employed teachers (M = 121.09, 95% confidence interval [CI] = [115.95, 126.24]) and head teachers (administrational post; M = 134. 35, 95% CI [129.09, 139.61]) differed in recognition of possible child abuse and neglect signs. Also, temporarily employed teachers and permanent teachers (M = 128.97, 95% CI = [124.41, 133.53.]) significantly differed in their scores. However, other groups did not differ significantly. This can be explained by the fact that head teachers and permanent teachers might be spending all their working hours mostly at their work place while temporarily employed teachers work only when they are needed. This may give temporary teachers less opportunity to gain experience in evaluating indicators in children that might have developmentally negative effects. Also, head teachers might have more opportunity to be educated on the subject of child abuse and maltreatment.
Conclusion
This study aimed to evaluate the recognition levels of potential child abuse and neglect signs of preschool teachers in relation to some variables such as teachers’ having their own children, having training in child abuse and neglect, the teacher’s job position, and his/her previous experiences with abused and neglected children. In addition, we developed an instrument for the purpose of the study. The findings of this study demonstrated that a very small proportion of teachers had education about violence against children and child abuse and neglect in general. The respondents’ scores were higher for statements involving obvious and physical signs of maltreatment. The study also found that teachers having prior training in child abuse and neglect, teachers who had children of their own, teachers who had previous job experience with maltreated children, and teachers who had a higher level job position, such as head teacher, rated higher on recognition of the possible signs of maltreatment than others.
As it is not expected for preschool children to disclose the maltreatment that they are exposed to we believe that especially preschool teachers should be more vigilant about signs of maltreatment in their pupils. Early and accurate recognition of child abuse and neglect, with appropriate actions being taken afterward (close family contact and guidance, reporting, cooperation with helping organizations, etc.), may prevent further and perhaps severe damage to children. Early detection has been identified as a second important factor by the WHO and International Society for Prevention of Child Abuse (2006) after early prevention efforts to safeguard children against the damages of child maltreatment.
Based on these results, we believe that all preschool teachers in Turkey should be provided with standardized, well-designed effective pre-service and in-service training about maltreatment. As the results of the present study suggest, teachers who do not have prior training about child abuse and neglect, who have less experience with prior cases of child abuse and neglect, who have no children of their own, and who have a lower level job position might be in greater need for prioritization for maltreatment training.
One of the limitations of the present study relates to its sample that is gathered from rather homogenous population. That is, the sample covered only preschool teachers in Izmir, which is a relatively more developed region of Turkey. Moreover, participants in the current study were from state-owned preschool establishments only. Privately run preschool teachers might differ from publicly run preschools teachers due to varying employment criteria. In this respect, it would be interesting to collect data from different contexts such as other provinces, privately owned preschool establishments, and primary and secondary school teachers as well to have more conclusive results. Second, the current study relied only on self-reported data (e.g., In your professional life have you ever worked with abused and neglected children?). No second data source, such as official records, was included. Therefore, it shares the shortcomings of self-reported data in general, for example, memory biases and social desirability, and so on. Another limitation is related to the instrument itself. While intended to measure preschool teachers’ familiarity with child abuse and neglect signs, the instrument is preliminary and needs further validation. Also, indicators of child abuse and neglect and symptoms of some psychiatric disorders of childhood can be similar. Such kinds of items (e.g., having fears and phobias) included in the current study might have confounding effects on the results. Some statements in the instrument might be viewed as warning signs for teachers to investigate further for children who may be at risk of maltreatment or other factors rather than solely as indicators of child abuse and neglect due to the complexity of the issue.
On the whole, if the instrument is further tested on psychometric properties, it may have some utility for research and educational purposes. The instrument could possibly be used as an evaluation tool for child maltreatment awareness training. Subsequently, it could be used as a quick, handy screening tool to select teachers who are in greater need of participating in maltreatment training programs. In the same vein, the utility of the instrument could be expanded for use by various groups of professionals who work with children (e.g., professional caregivers, social workers, primary school teachers, etc.) to assess and improve awareness of the signs that might indicate possible maltreatment.
Footnotes
Acknowledgements
The authors would like to thank Pier Roberts and Eminegül Kapçı for their comments on an earlier draft. In addition, the authors are grateful to the anonomous reviewers for their suggestions.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
