Child Abuse & Neglect 50 (2015) 33–41

A systems approach to
addressing child maltreatment
in China
Jin Peng
Nationwide Children’s Hospital and The Ohio State University
Huiping Zhu ∗∗
Capital Medical University
Jianbo Shao, Wenyan Yao
Wuhan Children’s Hospital
Chuanhua Yu
Wuhan University
Hongyan Yao
Chinese Center for Disease Control and Prevention
Junxin Shi, Huiyun Xiang ∗
Nationwide Children’s Hospital

China needs a formalized child protection system

a r t i c l e i n f o

Article history:
Available online 26 September 2015

DOI of the original article:http://dx.doi.org/10.1016/j.chiabu.2015.05.015.

∗ Correspondence concerning this article should be addressed to Huiyun Xiang, Center for Pediatric Trauma Research, The
Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USA. Electronic mail may be
sent to huiyun.xiang@nationwidechildrens.org.
∗∗ Correspondence concerning this article should be addressed to Huiping Zhu, School of Public Health at Capital Medical
University, Beijing, The People’s Republic of China. Electronic mail may be sent to zhuhuiping@ccmu.edu.cn.
http://dx.doi.org/10.1016/j.chiabu.2015.08.008
0145-2134/© 2015 Elsevier Ltd. All rights reserved.
 Child Abuse & Neglect 50 (2015) 33–41
A
lthough child maltreatment may have a long
history in Chinese society, only as recently
as the early 1990s has it received societal
recognition. Despite the lack of national data,
an increasing number of child abuse cases have been
reported in Chinese media and in professional journals
in recent years. According to the China National Radio,
the number of abused children treated at a child protec-
tion center in Xi’an City increased steadily from 18 in
2006 to 361 in 2010. There is an urgent need to address
this issue. The question is: what child protection strate-
gies can effectively address child maltreatment in China?
Our research suggests that a systems approach has the
greatest potential to address child maltreatment in China.
A Systems Approach to Child
Maltreatment
Child protection efforts have historically focused on
single issues such as violence, neglect, child traffic-
king, street children, and child labor. In the absence
of an understanding of how each single issue relates to
the overall system, this diffused approach often results
in fragmented child protection response and ineffective
programs. This approach is neither sustainable nor capa-
ble of reaching all children who are in need of protection.
To be more effective in addressing child maltreatment,
a systems approach is recommended by many child
protection organizations such as the United Nations Chil-
dren’s Fund, the United Nations High Commissioner for
Refugees, and Save the Children. In a child protection
system, children, families, communities, and formal and
informal organizations are brought together through a
set of common goals.
Each child protection system has its unique
structures, functions, and capacities, based on the socio-
cultural context in which it operates. In some countries,
formal system structures are not appropriate because
parents, family members, and community members pro-
tect children through informal mechanisms. In other
contexts, formal system structures are necessary to coor-
dinate a variety of stakeholders within the system.
Common functions of a child protection system include
governance, management, and enforcement. Specific
functions usually fit with the overarching system goals.
Finally, capacity refers to human resources, funding, and
infrastructure. A well-functioning system is able to opti-
mize the use of resources to achieve its goals.
34
In addition to structures, functions, and capacities,
a child protection system often has an accountability
mechanism that incorporates data collection, research,
and communication with stakeholders (e.g., social work-
ers, the general public). Without accountability, it is hard
to know how well the system operates, how the con-
text has changed, and how to improve its structures,
functions, and capacities. Within a given context, the
boundary between a child protection system and other
formal systems (e.g., education, health) is an important
indicator of how that specific child protection system
defines its functions, capacities, and accountability.
The Nature of Child
Maltreatment in China
In this Directions article, we discuss key contribut-
ing factors to child maltreatment in China. These factors
were derived from feedback received on a survey and
in focus groups conducted with emergency department
physicians and nurses in 2013. In addition to providing a
better understanding of the knowledge base and the types
of experiences doctors and nurses have regarding child
maltreatment, the study provided insight into the role of
culture in how child maltreatment is addressed in China.
Indeed, this study pointed to major challenges that China
must address to effectively reduce child maltreatment.
Following a discussion of contributing factors, we
provide some preliminary recommendations of strate-
gies for addressing child maltreatment in China. We
realize that child maltreatment is an important but con-
troversial social issue, and we do not portend to offer a
panacea. Rather, we hope that this article will help raise
public awareness of child maltreatment and improve the
understanding of child protection in the Chinese context.
Contributing Factors to Child
Maltreatment in China
Factor No. 1: Confucianism
Understanding child maltreatment in China requires
an awareness of cultural values such as filial piety (Xiao)
and Familism. Derived from Confucianism, filial piety
and familism emphasize hierarchical social structures,
family reputation, patriarchal authority, obedience, and
loyalty. Influenced by such values for thousands of years,
childrearing practices in Chinese society have developed
 Child Abuse & Neglect 50 (2015) 33–41
certain features that can be different from those of West-
ern societies. For example, Chinese culture emphasizes
parental authority, children’s obedience toward their
parents, and high expectations for children’s academic
performance.
Physical punishment has been historically used
among Chinese parents as a means to punish disobe-
dient children and reinforce filial piety. In 2008, Phil
Leung and colleagues surveyed 6,592 students in south-
ern China about their experiences of child maltreatment.
They found that children’s disobedience toward their
parents was the most common reason for child mal-
treatment, followed by poor academic performance and
parents quarreling. They further noted that children who
were perceived as disobedient and had poor academic
performance were at the highest risk of being physically
punished by their parents.
Because the intent of inflicting physical punishment
is to enhance children’s moral development or academic
success, Chinese people consider physical punishment
a means of displaying parental love and care to their
children rather than child maltreatment. For this reason,
Chinese parents often believe that physical punishment
should be tolerated or even appreciated by children. Such
deep-rooted cultural and social norms may prohibit chil-
dren from complaining or acting in opposition to their
parents. As a consequence, Chinese children are likely
not aware of being maltreated and therefore do not seek
help.
Factor No. 2: Socioeconomic
Changes
Left-behind Children. Since the late 1970s,
when China began economic reforms, many farmers
have migrated from rural areas to large cities to increase
family income and pursue better life opportunities. By
filling the demands for labor in the industrial and service
sectors in large cities, this rural-to-urban migration has
served as a critical driving force for China’s soaring eco-
nomic growth. However, it has also caused many social
problems, including left-behind children. In 2005, Chen-
grong Duan and his colleagues evaluated the impact of
this rural-to-urban migration. They found that 22 million
children were living with grandparents or other rela-
tives while their parents left to work in large cities. In
2006, Fangbiao Tao and his colleagues conducted a sur-
vey among 5,141 school-aged children, and found that
left-behind children were more likely to be physically
or emotionally abused than their peers who lived with
parents.
Changes in Family Structure. Family struc-
ture in China has changed dramatically since China
began its economic reforms. Indeed, family structures
that were rarely observed in traditional Chinese soci-
ety have become more common. China is experiencing
a steadily increasing divorce rate and has more single-
parent households.
These changes in family structure can result in many
social problems, including child maltreatment. In 2010,
Cuixia Liu and his colleagues conducted a survey among
1,154 children in Wuhan City and found that chil-
dren from single-parent families were at higher risk of
being neglected than children from two-parent families.
In 2004, Tao and his colleagues surveyed maltreat-
ment experiences among school-aged children in Anhui
Province and found that Children whose single parent
remarried were significantly more likely to be maltreated
by their stepparents.
Factor No. 3: Lack of Public
Awareness
China has a relatively low level of public awareness
regarding child maltreatment. In a comparative review
of data on child maltreatment collected in China and in
Canada, Colin Ross and his colleagues found that the
general public in China had significantly lower aware-
ness of child maltreatment compared to the general
public of Canada. In 2006, Cheng-Chao Zhou and his
colleagues conducted a survey about public attitudes
toward child maltreatment among 11,621 residents of
Weihai City. They found that 30.7% of the respondents
considered child abuse to be legal.
Cultural values such as filial piety may hamper
Chinese people’s ability to reason about what child mal-
treatment is, why it happens, and what effects it has.
Chinese people are often sympathetic to parents who use
physical punishment to teach their children the impor-
tance of respecting and honoring parents. Social norms,
such as “family issues should be confined and resolved
within the family,” may also contribute to the lack of
public awareness regarding child maltreatment in China.
In traditional Chinese society, childrearing practices are
considered private family matters that should not be
judged or interfered with by outsiders or government
authorities. Influenced by such social norms, the general
35
 Child Abuse & Neglect 50 (2015) 33–41
public is often reluctant to report or intervene in child
maltreatment that occurs within the family.
Factor No. 4: Lack of Workable
Legislations/Laws
The constitution of the People’s Republic of China
states that children and youth are protected by law, and
thus child maltreatment is prohibited (Article 49). How-
ever, the constitution neither defines what constitutes
child maltreatment nor does it specify penalties for
committing offenses. The Protection of Minors of the
People’s Republic of China states that parents or care-
givers ought to educate their children with proper means
(Article 10). The law does not explicitly forbid parents
from practicing physical punishment.
The law does declare that a court may withdraw the
guardianship of the parents if they refuse to change their
abusive behavior toward their child or are not capable of
ensuring their child’s safety and well-being (Article 12).
The withdrawal of parents’ guardianship rarely happens
in China because few people are willing to file petitions.
Concerned adults (e.g., friends; neighbors) are unlikely
to file a petition for two reasons. First, they are often
sympathetic to parents who use physical punishment to
reinforce filial piety. Second, they often consider physi-
cal punishment to be a private family issue that should not
be judged or interfered with by outsiders or government
authorities.
Physicians and nurses also play an important role in
the detection and reporting of child maltreatment. Leg-
islation that requires medical professionals and other
professionals who interact with children to report child
abuse has been enacted in many Western countries. To
examine whether such mandatory reporting laws exist
in China, we conducted a survey among 304 emergency
department (ED) physicians and nurses from 15 large
children’s hospitals in December of 2013. All partici-
pants completed the survey questionnaire. About 40%
of ED physicians and nurses reported that they had
treated injured children whom they suspected were vic-
tims of physical abuse (see Table 1). Among those who
had encountered suspected child abuse, only 17% diag-
nosed and reported child abuse to a government agency.
Most ED physicians and nurses (73%) reported a lack of
knowledge regarding physical child abuse and that they
did not know how to diagnose physical child abuse. The
majority of ED physicians and nurses (96%) said that
they had never received training on how to identify, diag-
36
nose, and report physical child abuse. “Hiding/refusing
to report the circumstances of the injury by parents,”
“lack of training,” and “lack of guidelines/laws” were
reported by ED physicians and nurses as the top three
obstacles to reporting physical child abuse (see Table 2).
These findings showed that China lacks effective manda-
tory reporting laws regarding child abuse and Chinese
medical professionals lack knowledge and training on
the identification and reporting of physical child abuse.
This study suggests that many Chinese maltreated
children remain in danger because they are not identified
or reported.
Factor No. 5: Lack of Social and
Support Services
China has no formalized social services and limited
social supports to address child maltreatment. In other
countries, formalized social services include family
preservation services, housing and financial assistance,
child removal, and foster care. In the absence of these
social services, maltreated children do not have a place
to stay if the guardianship of their parents is withdrawn
by a court.
Other countries also have indirect social supports
which can help reduce the risk of child maltreatment.
These include services such as community programs
advocating appropriate parenting practices, neighbor-
hood centers offering child care services to stressed
parents, substance abuse treatment centers providing
services to parents who are addicted to drugs, and
school-based programs offering mentoring and counsel-
ing services to maltreated children. These programs, in
conjunction with formalized social services, can result
in the reduction of risk factors that contribute to child
maltreatment.
Recommendations
Based on our review of the literature and our own
research findings, some preliminary recommendations
are made here for establishing a child protection system
to improve the lives of children in the People’s Republic
of China. These recommendations include establishing
child protection agencies, enacting child protection leg-
islation, and implementing prevention and intervention
programs.
 Child Abuse & Neglect 50 (2015) 33–41

Table 1
Surveyed emergency department physicians’ and nurses’ knowledge and experiences of reporting physical child abuse in China.

Physician Nurse Total

n (%) n (%) n (%)

Total 154 150 304

Knowledge of physical child abuse
No knowledge 20 (13.0) 18 (12.0) 38 (12.5)
Know little but do not know how to diagnose 89 (57.8) 96 (64.0) 185 (60.9)
Know how to diagnose but do not know how to report to government agency 34 (22.1) 27 (18.0) 61 (20.1)
Know how to diagnose and how to report to government agency 9 (5.8) 8 (5.3) 17 (5.6)
Unknown 2 (1.3) 1 (0.7) 3 (1.0)
Ever treated children whom you suspected were victims of physical abuse
Yes 60 (39.0) 64 (42.7) 124 (40.8)
No 94 (61.0) 86 (57.3) 180 (59.2)
In your practice, if you have ever treated patients whom you suspected were victims of physical child abuse, what have you typically done?
Asked caregiver about injury but did not write notes on medical records 18 (30.0) 29 (45.3) 47 (37.9)
Asked caregiver injury and wrote notes on medical records 17 (28.3) 12 (18.8) 29 (23.4)
Asked caregiver, diagnosed child abuse and reported to government agency 12 (20.0) 9 (14.1) 21 (16.9)
Suspected but did not ask caregiver about the injury 13 (21.7) 14 (21.9) 27 (21.8)
Knowledge of head injuries caused by physical child abuse
No knowledge 21 (13.6) 19 (12.7) 40 (13.2)
Know little but do not know how to diagnose 81 (52.6) 86 (57.3) 167 (54.9)
Know how to diagnose but do not know how to report to government agency 30 (19.5) 25 (16.7) 55 (18.1)
Know how to diagnose and how to report to government agency 10 (6.5) 8 (5.3) 18 (5.9)
Unknown 12 (7.8) 12 (8.0) 24 (7.9)
Ever treated head injuries that you suspected were caused by physical child abuse
Yes 50 (32.5) 43 (28.7) 93 (30.6)
No 104 (67.5) 107 (71.3) 211 (69.4)
In your practice, if you have ever treated head injuries that you suspected were caused by physical child abuse, what have you done?
Asked caregiver about injury but did not write notes on medical records 18 (37.5) 21 (50.0) 39 (43.3)
Asked caregiver about injury and wrote notes on medical records 13 (27.1) 9 (21.4) 22 (24.4)
Asked caregiver, diagnosed child abuse and reported to government agency 11 (22.9) 5 (11.9) 16 (17.8)
Suspected but did not ask caregiver about the injury 6 (12.5) 7 (16.7) 13 (14.4)
Based on your knowledge and experience, which of the following groups of children is at the highest risk of head injury caused by physical
child abuse?
Less than 6 years old 113 (73.4) 118 (78.7) 231 (76.0)
6–9 years old 31 (20.1) 26 (17.3) 57 (18.8)
10–14 years old 9 (5.8) 4 (2.7) 13 (4.3)
Unknown 1 (0.6) 2 (1.3) 3 (1.0)

Recommendation 1: Establish Child grants to stimulate innovative research, and disseminate

Protection Agencies
A central child protection agency should be estab-
lished within the government to serve as a focal point
for national efforts to address child maltreatment. Its
missions may include improving the safety and well-
being of children, supporting essential child protection
services, and maintaining productive partnerships with
local child protection agencies. To fulfill these missions,
the central child protection agency should provide funds
to support local child protection services, offer training
and technical support to improve service delivery, award
research findings to help child protection agencies and
other providers improve their services.
In addition, local child protective services (CPS)
should be established to handle reports of suspi-
cious child maltreatment from medical professionals
or the general public. As the central child protection
agency, CPS can assume a variety of responsibili-
ties. Generally, it is accountable for receiving reports
of child maltreatment, conducting initial and fam-
ily assessment, providing direct services to maltreated
children and at-risk families, and coordinating ser-
vices provided by other professionals or providers. CPS

37
 Child Abuse & Neglect 50 (2015) 33–41

Table 2
Perceived barriers for identifying, diagnosing and reporting physical child abuse among surveyed emergency department physicians and nurses in
China.

Physician Nurse Total

n (%) n (%) n (%)

Total 154 150 304

Are you aware of any standardized protocol of identifying and diagnosing physical child abuse in China?
Yes 21 (13.6) 21 (14.0) 42 (13.8)
No 133 (86.4) 129 (86.0) 262 (86.2)
Are you aware of any standardized protocol of reporting physical child abuse cases to the government agencies in China?
Yes 20 (13.0) 22 (14.7) 42 (13.8)
No 134 (87.0) 128 (85.3) 262 (86.2)
Have you received any training on how to identify and diagnose physical child abuse?
Yes 8 (5.2) 3 (2.0) 11 (3.6)
No 145 (94.2) 147 (98.0) 292 (96.1)
Unknown 1 (0.6) 0 (0.0) 1 (0.3)
Would you like to receive formal training in the next 12 months regarding how to diagnose and report physical child abuse?
Yes 148 (96.1) 144 (96.0) 292 (96.1)
No, my knowledge and skills are sufficient 4 (2.6) 4 (2.7) 8 (2.6)
No, I feel it is not relevant to my practice 1 (0.6) 2 (1.3) 3 (1.0)
Unknown 1 (0.6) 0 (0.0) 1 (0.3)
Barriers for reporting physical child abuse
Hiding/refusing to report the circumstances of the injury by parents 101 (65.6) 84 (56.0) 185 (60.9)
Physicians/nurses lack motive, experience, knowledge and training 66 (42.9) 69 (46.0) 135 (44.4)
There’re no guideline/law, don’t know how to report 58 (37.7) 53 (35.3) 111 (36.5)
Children cannot report because of young age 19 (12.3) 24 (16.0) 43 (14.1)
Lack of attention or support from government, society and law enforcement 15 (9.7) 10 (6.7) 25 (8.2)
Child has mental problems 2 (1.3) 1 (0.7) 3 (1.0)
Injury is too severe to report 0 (0.0) 2 (1.3) 2 (0.7)
Guardians/parents have mental problems 1 (0.6) 1 (0.7) 2 (0.7)
Physicians/nurses have too much work-load 1 (0.6) 0 (0.0) 1 (0.3)

plays the leading role in coordinating communication
and collaboration among the various professionals
responsible for addressing child maltreatment. Such
professionals may include child care providers, tea-
chers, physicians, nurses, mental health professionals,
substance abuse treatment providers, law enforcement
personnel, judicial system personnel, and social workers.
Recommendation 2: Improve Child
Protection Laws
Constitutional laws should be established to protect
children’s rights, prohibit child abuse and neglect, and
explicitly define what constitutes child maltreatment.
Domestic laws should set out entitlements in sufficient
detail to enable effective remedies for families. Crimi-
nal laws should specify penalties for those who commit
child maltreatment. Municipal laws should emphasize
local child protection agencies’ duty and power to act on
behalf of a child when parents are unable or unwilling
38
to provide sufficient care to their children. Furthermore,
professionals whose work involves children (e.g., tea-
chers; physicians) should be mandated by law to report
suspected cases. The mandatory reporting law should
identify agencies accountable for responding to reports
of child maltreatment, specify mandatory reporters,
provide guidelines for both mandatory reporters and
voluntary reporters, protect reporters’ legal rights, and
specify penalties for failure to report or false reporting.
Recommendation 3: Implement
Three Levels of Prevention (Primary,
Secondary, and Tertiary)
Primary Prevention. Primary prevention pro-
grams target the general public with the goal of
preventing child maltreatment before it occurs. As pre-
viously mentioned, China has a relatively low level
of public awareness regarding child abuse. Legisla-
tion is likely to have little effect in addressing child
 Child Abuse & Neglect 50 (2015) 33–41
maltreatment without a raised public awareness of the
problem. Two primary prevention strategies are often
used to raise public awareness of child maltreatment:
public awareness campaigns and open discussions.
Public awareness campaigns target the general pub-
lic. The primary goal of public awareness campaigns is
to enhance the general public’s knowledge about what
constitutes child maltreatment, why it happens, and what
effects it has. Public awareness campaigns also seek to
encourage the general public to report child maltreatment
and to inform concerned citizens about where and how
to report suspected cases. Open discussions (on the radio
or television) target parents and caregivers. The goal is to
help parents and caregivers recognize the negative effects
of physical punishment on children’s physical and men-
tal development and to encourage them to use proper
means of child discipline.
It can be very challenging for parents to accept new
parenting styles that directly contradict their existing
values and beliefs. To effectively change Chinese par-
ents’ childrearing practices, open discussions ought to
recognize the influence of cultural values in shaping
Chinese parents’ beliefs and behaviors. For example,
open discussions may incorporate teachings from East-
ern philosophies that are treasured among the Chinese,
such as Buddhism and Confucianism. Both Buddhism
and Confucianism emphasize the end of violence and
development of harmony. By using such Eastern prin-
ciples, open discussions could be more effective in
convincing Chinese parents to avoid violent means of
child discipline.
Secondary Prevention. Secondary prevention
focuses efforts and resources on helping children who
are at risk of maltreatment. Research has recognized a
number of risk factors commonly associated with child
maltreatment such as substance abuse, young maternal
age, child disabilities, and poverty. Children living in
families where these factors exist are at higher risk of
experiencing maltreatment. The goal of secondary pre-
vention is to reduce these risk factors to prevent child
maltreatment before it occurs. Examples of secondary
prevention strategies include substance abuse treatment
programs, parent education classes, respite care cen-
ters, home visitations, family preservation services, and
school-based programs.
Tertiary Prevention. Tertiary prevention
focuses efforts and resources on families in which child
maltreatment has already occurred. The goal of tertiary
prevention is to minimize negative consequences of
maltreatment and prevent future maltreatment. Tertiary
prevention provides a continuum of child protective ser-
vices, from identifying child maltreatment to reunifying
maltreated children and their families. Typical child pro-
tective services include receiving reports of suspected
cases, initial assessment, family assessment, service
provision, and evaluation of child protection progress.
Effective delivery of child protective services requires
seamless coordination and collaboration among a
variety of responsible professionals, such as physicians,
teachers, child protective services caseworkers, social
workers, and law enforcement personnel. CPS should
be the agency to lead and coordinate these services. The
role of each stakeholder involved needs to be discussed
and agreed upon before a formal protocol is established.
Funding and other resources from national and local
government are essential for operating an effective and
sustainable program.
Recommendation 4: Identify,
Report, and Assess
Identification and Reporting. Identification
and reporting of child maltreatment are initial steps
in the process of delivering child protective services.
CPS should be held accountable for responding to the
reports of child maltreatment. A central reporting net-
work should be established within CPS to simplify the
reporting process of child maltreatment.
Concerned citizens (e.g., friends, neighbors) should
be encouraged to report suspected child maltreatment,
and, as previously mentioned, professionals (e.g., physi-
cians; teachers) whose work involves direct and ongoing
contact with children should be mandatory reporters
of child maltreatment. Mandatory reporting laws, how-
ever, cannot be effective if these professionals do not
know how to carry out their roles. Two strategies can
be particularly helpful to enhance mandatory reporters’
ability to identify and report child maltreatment. First,
continued education programs should be provided to
improve mandatory reporters’ knowledge and skills in
identifying and reporting child maltreatment. Second,
reporting protocols and guidelines should be developed
and implemented to promote standardized identification
and reporting of child maltreatment.
Assessment. Once CPS receives reports of child
maltreatment, CPS caseworkers should conduct an initial
39
 Child Abuse & Neglect 50 (2015) 33–41
assessment to identify the occurrence of child maltreat-
ment and investigate family conditions. This assessment
should be followed by a family assessment, should
the initial assessment suggest that ongoing services
are needed. Whereas the aim of the initial assess-
ment is to identify problems, family assessment gains
a greater understanding of needs and resources. To
be effective, family assessment must acknowledge the
diversity of families and respect each family’s values
and beliefs. Upon the completion of family assessment,
CPS caseworkers should have identified critical factors
contributing to the maltreatment and services needed
to reduce the risk of future maltreatment. These results
can then be translated into the best possible intervention
plans.
Once individualized intervention plans are estab-
lished, CPS caseworkers should provide or request
services suggested in the plans to help strengthen fami-
lies’ capacity to provide sufficient care for their children.
Depending on the target of specific services, intervention
services provided by CPS can be classified into three
categories: services provided to the entire family (e.g.,
financial aid, housing assistance), services provided to
parents or caregivers (e.g., parent education, substance
abuse treatment, psychological treatment), and services
provided to maltreated children (e.g., medical treatment,
counseling services, life skills education). In addition,
intervention services may be provided according to the
family’s level of risk for child maltreatment. For fami-
lies at low risk for child maltreatment, general support
services (e.g., parent education) can be provided to pre-
vent child maltreatment before it occurs. For families at
moderate risk for maltreatment, individualized remedial
services (e.g., counseling services) should be provided
to reduce the risk for future maltreatment. For families
whose children are at great risk for future maltreatment,
adoption or foster care services may be required to ensure
the child’s safety and well-being.
Finally, the family’s progress should be evaluated
to ensure the effectiveness of the services provided
and to decide whether additional intervention services
are needed or ongoing interventions can be terminated.
Evaluation of family progress should begin as soon as
interventions are implemented and continue at regular
intervals until expected outcomes have been achieved.
The evaluation of family progress should address the
following issues: What changes have occurred to the
family’s level of risk for child maltreatment?, Has the
risk of maltreatment been reduced to a level that the
40
parents or caregivers are capable of providing suffi-
cient care to their children, allowing the interventions
to be terminated?, If not, what adjustments need to be
made to further reduce risk factors of maltreatment?,
and If the maltreated child was removed from home,
is family unification possible or is an alternative plan
needed?
Conclusions and Implications
for Future Research
Addressing child maltreatment is a difficult task in
any society. A systems approach has proven to be the
most effective in preventing child maltreatment world-
wide. To effectively address child maltreatment in China,
a formalized child protection system needs to be estab-
lished. To be most effective and sustainable, this child
protection system should be tailored to reflect China’s
unique cultural and socioeconomic characteristics.
Upon the establishment of an effective child protec-
tion system, the Chinese government should implement
evaluation programs to monitor the progress of child pro-
tection services with the goal of determining whether
a particular child prevention or intervention service is
effective, what improvements should be made to the
service, and what adjustments need to be made to
improve the delivery of the service. All evaluation pro-
grams should seek to identify the positive and negative
effects that child protection services may have on chil-
dren’s safety and well-being.
To better understand the potential for improved well-
being of Chinese children, more research will be needed.
The government should offer more funding opportunities
to promote research about child maltreatment and the
child protection system in China. Future research efforts
should be directed toward generating more innovative
intervention programs. In particular, efforts should be
focused on developing culturally responsive programs
that take into consideration China’s unique cultural and
socioeconomic characteristics.
Research projects are unlikely to be successful with-
out the availability of systematic baseline data. Thus, the
government should develop national databases to allow
the estimation of the prevalence, patterns, and trends
of child maltreatment in China. These data could be
obtained by conducting national surveys or collecting
reports from local child protection agencies.
 Child Abuse & Neglect 50 (2015) 33–41

Acknowledgement Keywords: child maltreatment; physical child abuse;

child protection system; culturally responsive interven-
This study was funded by the Ohio State University tions
International Affairs Gateway Research Seed (Grant PI:
Dr. Huiyun Xiang). Dr. Huiping Zhu was supported by
the National Natural Science Foundation of China (Grant
#: 81402688). The views expressed here are solely the
responsibility of the authors and do not necessarily
reflect the official views of the funding agencies.

Suggestions for Further Reading

Duan, C., & Zhou, F. (2005). Wo guo liu shou er tong zhuang kuang yan jiu [Research on the left-behind children
in China]. Population Research, 29, 29–36.
Goldman, J., Salus, M. K., Wolcott, D., & Kennedy, K. Y. (2003). A coordinated response to child abuse and
neglect: The foundation for practice. Child abuse and neglect user manual series. Washington, DC: United
States of America: Office on Child Abuse and Neglect, U.S. Department of Health and Human Services.
Leung, P. W. S., Wong, W. C. W., Chen, W. Q., & Tang, C. S. K. (2008). Prevalence and determinants of child
maltreatment among high school students in Southern China: A large-scale school based survey. Child and
Adolescent Psychiatry and Mental Health, 2, 27–48.
Liao, M., Lee, A. S., Roberts-Lewis, A. C., Hong, J. S., & Jiao, K. (2011). Child maltreatment in China: An
ecological review of the literature. Children and Youth Services Review, 33, 1709–1719.
Liu, C., Jiang, Q., Luo, X., Chen, G., Zhang, D., & Xiang, G. (2010). Wu han shi cheng qu xue ling qian er tong
hu shi xiang zhuang ji qi ying xiang yin su fen xi [Analysis on the influencing factors of child neglect among
preschool children in Urban Wuhan]. Chinese Journal School Health, 31, 307–308.
Qiao, D. P., & Chan, Y. C. (2005). Child abuse in China: a yet-to-be-acknowledged ‘social problem’ in the Chinese
Mainland. Child & Family Social Work, 10, 21–27.
Ross, C. A., Keyes, B. B., Xiao, Z., Yan, H., Wang, Z., & Zou, Z. (2005). Childhood physical and sexual abuse
in China. Journal of Child Sexual Abuse, 14, 115–126.
Tao, F., Xie, Q., Kim, S., Huang, K., Sun, Y., & Zhang, Ch. (2006). Qin shao nian tongnian qi fan fu shen ti he
qing gan nue dai jing li ji qi xiang guang yin su yan jiu [A study of childhood physical and emotional abuse
among Chinese adolescents]. Chinese Journal School Health, 27, 310–314.
Tao, F., Zhang, H., Wang, D., Yang, Sh., Su, P., & Feng, E. (2004). She hui wen hua yin su dui An Hui sheng nong
cun er tong ti fa xing wei de ying xiang [The influences of socio-cultural factors on the prevalence of physical
punishment among children from rural areas in An Hui province]. Chinese General Practice, 7, 172–174.
Wulczyn, F., Daro, D., Fluke, J., Feldman, S., Glodek, C., & Lifanda, K. (2010). Adapting a systems approach to
child protection: Key concepts and considerations. New York, NY: United Nations Children’s Fund.
Zhou, C., Song, X., Wang, J., Sun, H., Wang, X., & Zhang, X. (2006). Wei hai shi ju min er tong nue dai tai du
ji qi ying xiang yin su fen xi [A study on attitude of child abuse and influencing factors among residents in
Weihai City]. Chinese Journal of Child Health Care, 14, 276–278.

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