Summary: Cohen JA, Deblinger E, Mannarino AP, and De Arellano MA. "The importance of culture in treating abused and neglected children: An empirical review," Child Maltreatment vol 6(2): 148-157. 2001.

This article reviews the inclusion of race, ethnicity, and culture in studies of treatment for abused children. It presents the evidence for the role of culture in treatment, explains the limitations of the studies that have been conducted, and offers directions for future research in this area.

Culture may have a role to play in terms of whether people seek treatment for their abused children. To the extent that different groups feel that having a psychiatric condition or seeking help from mental health professionals is shameful or stigmatizing, they may not try to access services. Providing services through a primary care setting-a medical clinic or office rather than a mental health clinic-has been shown to be more acceptable to minority populations in a number of studies. Barriers to seeking treatment are not always self-imposed, however. For example, African-American and Latino children are less likely to have health insurance that offers mental health services than their white counterparts. Therefore, it's likely that many of these children who are in need of services fail to get them.

In terms of treatment, few studies have specifically looked at the role that race may play. The studies that have included race as one of the many characteristics-sex, age, and nature or severity of abuse-that might influence outcome, have found conflicting results. Some showed no measurable difference, while others found differences following the end of treatment. For example, one of the studies reviewed found that African-American children had improved less in the area of social competence than white children in the study. This meant that their parents reported less involvement by their children in community or school activities or with friends and family. But as the authors point out, the reasons for their lower ratings of social competence could be quite complex, and not at all due to race alone.

Conducting research that examines the role of race is difficult for a variety of reasons. If there are not enough children in a given racial group, researchers would not be able to uncover differences, unless they are very large ones. Further, the standard research instruments that are used may not be relevant among minority populations. Some authors note that racial differences between researchers and the children being studied may limit open communication on the part of the children. Finally, it may be that characteristics of the abuse itself, as well as such factors as the child's own thoughts and feelings about the abuse and parental support, have more of a role to play than race.

Whatever future research tells us about the role of race, culture, and ethnicity in treatment for child abuse, the authors note that therapists clearly have a responsibility to develop cultural sensitivity in the treatment of their clients. Sexual abuse and physical abuse raise issues about sensitive topics-sexuality, discipline practices, privacy, parent-child relations, and so on-that are culturally shaped. Having an understanding of different cultures' approaches to such topics can enhance treatment and, hopefully, recovery.