Navigating Perceptions of Child Abuse with Culturally Diverse Families In A Trauma-Informed & Strengths-Based Way

Elizabeth K. Lee

In the United States, approximately 1 out of 7 children is identified as having experienced child abuse within the past year (Centers for Disease Control and Prevention, 2022). In 2021, this equated to approximately 600,000 children (National Children’s Alliance, 2023). A recent report by UNICEF (2021), estimated that globally, around 80% of children aged 1 to 14 years, experienced some form of psychological aggression and/or physical violence by a caregiver within the past month. Moreover, perpetrators of child abuse are most often family members (Kurniawan et al., 2019), and maltreatment is often a pattern of repeated violence and/or neglect, rather than a single traumatic event (Warmingham et al., 2019). As such, chronic abuse and/or neglect can be conceptualized as complex trauma which, in children, has been associated with long-term mental health impacts such as PTSD and depression, low school engagement, and increased engagement in risky behaviors (Voisin & Berringer, 2015; Yearwood et al., 2021).

Child abuse and neglect are defined as physical and emotional mistreatment and/or lack of care, including physical and sexual violence, physical and emotional neglect, and forms of exploitation that result in harm or potential harm to a child’s health, survival, development, or dignity (World Health Organization, 2023). More recently, there is also an emerging consensus that witnessing domestic and family violence constitutes a form of emotional trauma that should be included under the umbrella of child maltreatment (e.g., UK Domestic Abuse Act, 2021). Of the different forms of abuse, emotional maltreatment and neglect are the most prevalent, and both have greater negative long-term impacts on victim-survivors compared to physical or sexual abuse (Naughton et al., 2017; Shi, 2013; Strathearn et al., 2020). In most US states, adults in specific professions (e.g., mental health providers, teachers, social workers, nurses) are, by virtue of their occupation, designated as mandated reporters, meaning that if they learn or suspect that a child is experiencing maltreatment, they are required by law to report it to child protective services (Child Welfare Information Gateway, 2022). In other states, all adults are required by law to report abuse or neglect. Laws regulating the responsibility of reporting also vary internationally.

Understanding perceptions of what constitutes maltreatment and the severity of its impact vary considerably across cultural groups (Nguyen-Feng et al., 2023). Cultural groups can be construed as individuals who share various identities that influence the way they view and interact with the world (Hook et al., 2017). This broad definition implies that multiple facets of identity influence perceptions of maltreatment, including socioeconomic status, educational status, immigration status, race, ethnicity, and religion, to name but a few. Throughout the world, sexual and physical victimization are generally considered to be the most severe forms of child abuse (Fakunmoju et al., 2013; Nguyen-Feng et al., 2023), although some studies also suggest that emotional maltreatment is as detrimental to development and mental health (Vachon et al., 2015). Furthermore, the degree to which the offender is viewed as responsible for the abuse, the offender’s relationship with the child, and the amount of harm inflicted on the child have also been found to shape perceptions of abuse (Qiao & Xie, 2017). For example, in a study examining public perceptions of child abuse conducted in China, Qiao and Xie (2017) found that it was only when a parent frequently caused serious physical injury to a child that it was perceived as physical abuse. This difference in definitions of physical abuse was also highlighted in a cross-cultural comparative study of mothers from the United States, Japan, and Korea (Son et al., 2017). Specifically, mothers from the US were more likely to view physical punishment as abuse than mothers from Japan and Korea. Interestingly, mothers from all three countries in this study agreed on definitions of emotional abuse and neglect. Within the United States, studies have shown that perceptions of what is considered as physical punishment vary by region, generation, socioeconomic status, and education level (Finkelhor et al., 2019; Hoffman et al., 2017). For example, Hoffman and colleagues (2017) found that older individuals of lower socioeconomic status and lower education levels endorsed the use of physical punishment more than younger individuals of higher socioeconomic status and higher education level. Moreover, regarding regional differences, those who live in southern US states have been found to approve of the use of physical punishment more than those who live in northeastern states (Finkelhor et al., 2019). Lastly, the use of corporal punishment as an educational tool was common and acceptable in most Western countries up until the 1970s, when it began to be denounced, leading to the enactment of gradual legal prohibitions (Zolotor & Puzia, 2010). However, it remains prominent in some cultures. For example, in a study of Korean immigrant mothers living in the US, Park (2001) found that although the participants reported negative attitudes towards physical abuse, they also indicated positive attitudes about physical punishment in the context of ‘correcting’ a child’s behavior. Furthermore, this was viewed by mothers as a form of showing love to their child, which the author suggests stems from the belief that using physical punishment for discipline helps children learn. Interestingly, the use of physical discipline in the context of child-parent conflict was not generally sanctioned by the mothers in this sample. Similarly, in a study examining the attitudes of Black mothers/caregivers regarding the use of physical punishment, Taylor et al. (2011) found that the majority of participants considered the use of at least some corporal discipline with their children to be both necessary and expected, particularly when the child compromised their safety, was disrespectful, or did not respond to other types of discipline. Furthermore, physical discipline was seen as both instrumental and effective, as well as culturally normative. Finally, in line with Park’s study of Korean mothers (2001), the Black mothers/caregivers in this study emphasized that they used physical punishment for the child’s own good, and that it was not intended to harm the child.

Given the complexity of the influence that culture has on the perceptions of, and the acceptability of child abuse, clinicians must be prepared to address child abuse in a culturally-informed manner. The first step in working with culturally diverse clients is adopting a multicultural orientation framework which includes cultural humility, cultural opportunities, and cultural comfort (Hook et al., 2017). Within this approach, the therapist does not simply attempt to achieve a finite level of cultural knowledge (i.e., competency) about the client’s cultural identity, but rather welcomes ongoing learning, and adopts an other-oriented perspective while working with clients (Hook et al., 2013; Hook et al., 2017). Cultural humility includes intrapersonal and interpersonal components. The interpersonal component is defined by the way in which the therapist maintains an open and curious stance regarding their client’s values and beliefs, especially when they differ from their own. Assuming a perspective of cultural humility in therapy is vital for therapists to be able to connect with their client’s most salient identities and to foster the therapeutic alliance. The intrapersonal component requires therapists to look inside themselves and reflect upon their own cultural identities including their biases, assumptions, and limitations. It is especially important for the therapist to consider their own perceptions of what constitutes child abuse and what parenting ‘should’ look like. Research has suggested that, despite their training, and research to the contrary (e.g., Vachon et al., 2015), mental health professionals tend to consider emotional abuse as less severe than physical and sexual abuse (Nguyen-Feng et al., 2023). Thus, part of adopting a cultural humility approach is recognizing that all the actors involved hold perceptions and values that are shaped by In sum, therapists who apply a cultural humility framework in their practice emphasize openness to their client’s beliefs and customs, as well as ongoing growth in themselves through self-reflection and autocritique (Hook et al., 2013). These are particularly important stances to adopt when working with culturally diverse clients who are engaging in child abuse, as they may feel judged and misunderstood by mental health providers, which could lead to a withdrawal from mental health and other supportive services, further jeopardizing the situation of the child. Moreover, refugee and migrant families may come from countries where the government does not get involved in family matters, and may already be reticent to work with healthcare professionals and the child welfare system (Earner, 2007). Studies support the effectiveness of adopting a cultural humility approach; for example, client’s perception of their therapist’s cultural humility has been shown to be a significant predictor of positive therapy outcomes (e.g., Owen et al., 2014).

Best practice recommendations for working with families and children who have experienced maltreatment include adopting a trauma-informed (SAMHSA, 2014) and strengths-based approach (Asay et al., 2014; Rashid, 2015). A trauma-informed approach is broadly defined by SAMHSA (2014) as consisting of six key principles: 1) safety, 2) trustworthiness and transparency, 3) peer support, 4) collaboration and mutuality, 5) empowerment, voice, and choice, and 6) cultural, historical, and gender issues. Therefore, when working with families, clinicians should consciously cultivate a sense of safety and trust, including by being transparent with their clients, approaching treatment as a collaboration and empowering their clients, as well as recognizing the cultural, historical, and gender issues that underpin their clients’ context. Moreover, a trauma-informed approach is based on four key assumptions wherein the clinician realizes the widespread impact of trauma (e.g., use of various coping strategies, distress and mental illness); recognizes the signs and symptoms of trauma (e.g., re-experiencing or avoidance); responds by integrating trauma knowledge into their practice (e.g., evidenced-based trauma practices); and actively resists re-traumatization of their client during the therapeutic process (e.g., triggering painful memories).

A strengths-based approach is based on the premise that everyone has talents, capabilities, and skills that can be harnessed to reach therapeutic treatment goals (Cox, 2006). Moreover, a strengths-based approach seeks to further foster existing family and child strengths, in order to improve well-being for the child and the family (Asay et al., 2014). When recognizing families’ strengths, it is also important to acknowledge how their culture has informed existing strengths, and how culture can be used to further enhance treatment. A specific culture focused tool that may be helpful in developing a working treatment plan in these contexts is Koramoa and colleagues’ (2002) continuum of child-rearing practices. This approach suggests that child-rearing practices and traditions can be viewed on a continuum comprising those that are undeniably harmful (e.g., female circumcision) to those that are beneficial (e.g., Inuit gentle parenting), and as such harmful practices can be targeted for elimination and those that are beneficial can be encouraged. One way a clinician may approach limiting harmful cultural practices is by suggesting alternatives, for example, age-appropriate time-outs could be suggested in lieu of physical punishments. The spectrum of child-rearing practices also includes harmless cultural practices, these should not be targeted for intervention as there is no justifiable reason to warrant their elimination. On the contrary, the therapist should work on understanding and respecting these practices as the objective of these interventions is the protection of children from maltreatment, not the homogenization of practices across cultures. Finally, Koramoa et al. (2002) also note that the clinician may engage in some evidence-based education in the case of practices that are potentially harmful (e.g., traditional scarification). Thus overall, a strengths-based approach, in conjunction with a trauma-informed framework is recommended as it consolidates what parents and children are already doing well, leading to increased self-efficacy, enhanced therapeutic alliance, and increased hope (Rashid, 2015).

In conclusion, clinicians working with children of diverse backgrounds should be aware of the various ways a child’s cultural context influences their well-being. Clinicians should adopt a cultural humility perspective by being aware of how their own culture influences their work and being open and non-judgmental with clients of different backgrounds. The continuum of child-rearing practices (Koramoa et al., 2002), in conjunction with the legal definitions of abuse in the clinician’s jurisdiction, may be beneficial in determining whether a child is being harmed. Finally, adopting a trauma-informed and strengths-based approach is recommended.

Biography/Positionality Statement

ELIZABETH K LEE: Mindful that this article provides suggestions on how to conceptualize cultural perceptions of childhood abuse, I wish to provide the reader with information on my background. I am a second-year Clinical Counseling Psychology Master’s student at the University of Minnesota Duluth, a Graduate Research Assistant, a Graduate Research Mentor, and the Research Team Coordinator in the Mind Body Trauma Care Lab. I was motivated to write this article because of my involvement in a past study exploring perceptions of childhood emotional abuse in the general public, psychologists, and college students, as well as my involvement in an ongoing study exploring perceptions of childhood emotional abuse across countries and cultures. I write this article as a White, heterosexual, cis-gender woman, born and raised in Minnesota, and a first-generation college student. I have six years of experience working with victim-survivors of interpersonal trauma, including youth, as an advocate, researcher, and practitioner. As a practitioner, I am drawn to trauma-informed, mindfulness-based, and embodiment-based approaches.

Citation: Lee, E. K. (2024).Navigating perceptions of child abuse with culturally diverse families in a trauma-informed a strengths-based way. Trauma Psychology News, 19(1), 18-22. https://traumapsychnews.com