Turkey is a country where the recognition, management and treatment of child abuse and neglect needs to be improved – and where a recent collaboration between American and Turkish professionals has made strides in doing just that.

Certainly, the structures for child protection have begun to develop in Turkey in the last two decades. In 1988, a national society for the prevention of child abuse and neglect was created, and in 1995 Turkey ratified the UN Convention on the Rights of the Child.

Although these were important moves, Turkish child protection services still suffer from a lack of resources, unclear legal definitions, and little awareness of child abuse and neglect among both the public and professionals. For example, there are only 3,260 social workers to serve a population of 70 million – and those workers are responsible for all the full range of social supports, not just child protection issues.

So from 2002-2006, the University of Iowa Child Protection Program collaborated with Turkish professionals with the aim of helping them to improve recognition, management and treatment of child abuse and neglect.

The results – the creation of new multidisciplinary teams (MDTs), better case management, and more reporting and follow-up – support the argument for “culturally competent” collaboration between child protection professionals in developed and developing nations. This is the conclusion made by the authors of a recent paper in Child Abuse & Neglect, including almost 80 participants from Turkish medical schools and hospitals.

How Iowa and Turkey worked together
At the start of the five-year collaboration between the University of Iowa and Turkish medical professionals, a team of instructors was established, which then offered training activities in Ankara and several other regions. Each year, two “train the trainers” courses were held to improve the structure of the MDTs, plus large annual symposia to improve professional awareness.

Over five years, the number of MDTs more than tripled, from 4 to 14. In total, 3,570 professionals attended training activities.

This improvement in formal structures for child protection was accompanied by a dramatic increase in detection: the establishment of the new MDTs “increased referral and assessment of suspected cases of child abuse and neglect by five times,” the authors said.

Finally, 10 MDTs established databases to track the cases of children who were abused or neglected. This was a revolutionary move, as there are no national or hospital databases on child abuse and neglect in Turkey.

From 2000-2006, according to these databases, 593 cases of abuse were confirmed, although the authors note that a lack of designated data entry staff means that some cases were not recorded. Many of these children suffered multiple types of abuse. About half of victims were abused sexually; 29% were abused physically, 26% were abused emotionally, and 22% were neglected.

The increase in diagnoses across these years was very encouraging – but the action taken after abuse or neglect was diagnosed makes for depressing reading. A huge 31.4 % of victims confirmed by physicians to be abused or neglected were not reported to any child protection agency – the result, the authors suggest, of a lack of confidence by medical professionals in the ability of police and child protection services to manage cases of child abuse and neglect.

Next steps: policy partnerships
This collaboration between the University of Iowa and Turkish professionals adds to a growing body of research – including studies in other geographies such as Eastern Europe – showing how helpful collaboration across countries at different economic levels can be for child abuse prevention and management.

In Turkey, the increase in the number of assessed cases, together with better interdisciplinary management of cases among medical professionals and community collaborators, indicates a way forward for a “structured approach to the clinical management of child abuse and neglect.”

But, as the authors conclude, the members of the new MDTs will also need to look beyond their own bounds: they must develop partnerships with policymakers. The “punitive” approach of Turkish law toward human services issues – an approach that discourages reporting and follow-up – needs to change if the new multidisciplinary teams are to fulfil their potential to recognize and manage child abuse and neglect.

References
Agirtan, Canan A., et al. 2009. “Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!” Child Abuse & Neglect 33(4): 247–255.

Lewis, Owen, John Sargent, Mark Chaffin, William N. Friedrich, Nicholas Cunningham, Pamela Cantor, Pamela Sumner Coffey, Susan Villani, Philip R. Beard, Mary Ann Clifft, and David Greenspun. 2004. “Progress report on the development of child abuse prevention, identification, and treatment systems in Eastern Europe.” Child Abuse & Neglect 28(1): 93–111.