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 ways that issues of race, ethnicity, and culture have been included in studies of treatment for abused children. It presents the evidence for the role of culture in treatment. It explains the limitations of the studies that have been conducted so far on culture and treatment. And it offers directions for future research in this area.

There is some evidence that ethnicity may play a role in the nature and severity of symptoms children have following abuse. For example, one study cited in this article found that Asian-American children who had been sexually abused reported more thoughts of suicide and less anger and sexual acting-out than white, Latino, or African-American children. The authors write, however, that it is unknown whether the treatment needs of maltreated children vary based on ethnicity alone.

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 need services do not get them.

Conducting research that examines the role of race is difficult. For example, if there are not enough children available to study in a given racial group, researchers would not be able to uncover differences between groups, unless the differences are very large ones. Further, the standard research tools 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, 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.