Updated | In Montenegro, university students who reported experiencing four or more traumatic events as children were 138 times more likely to attempt suicide than those who reported none, according to a 2013 survey. They were also 10 times more likely to use illicit drugs or struggle with alcohol abuse.
These results laid bare the lifelong impact of so-called “adverse childhood experiences” (ACEs) – stressful events occurring in childhood such as physical abuse or emotional neglect. Working alongside international organisations including the WHO and UNICEF, Montenegro has developed a strategy across government to protect its kids from such traumatic events. This includes changes to laws, schools, primary health care and social services.
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So what can policymakers do to reduce ACEs, and how much progress have they made in Montenegro?
Abuse of children in Montenegro is pervasive, and so are the attitudes which support it. One in four adults in the country report having been physically abused as children, while more than three quarters of citizens believe that parents should not allow children to question their decisions.
Around one in two citizens still find corporal punishment acceptable
But a major breakthrough came in 2016 when violence against children, including corporal punishment, was banned in all settings. Inevitably, though, such a law is difficult to implement. It’s thought about nine in 10 instances of child abuse go unreported around the world.
Two major tools used by policymakers in Montenegro to ensure the law has impact have been a public information campaign and a national child abuse helpline.
The “End Violence” Campaign, initiated by the Montenegro government and UNICEF with support from the EU, was launched by the Prime Minister in July 2016 to raise awareness of the issue. Using mass media, it aimed to spark a public debate, promoting the benefits of raising children without violence. Though it’s difficult to measure the impact, from 2016 to 2017 there was a 19% increase in cases reported.
Meanwhile, in 2015 the Ministry of Labour and Social Welfare launched a nationwide, free, 24-hour hotline for parents who need counselling, based in Podgorica, Montenegro’s capital city. After 11 months, around 41% of parents were aware of the helpline, according to UNICEF data shared with Apolitical. Though it’s only early days, the hotline received about 320 calls in 2017.
But at-risk families need to be identified and supported before issues arise. Montenegro’s health ministry runs a program where nurses visit the homes of newborn children to assist their mothers. At the moment, the nurses are “fully concentrated on health issues,” said Nela Krnic, a Child Protection Officer at UNICEF Montenegro, but they would be “uniquely positioned to identify risks within the community” and provide preventative care.
“Where we need to focus is in building the network of support at a community-level,” said Krnic, and UNICEF is working with the government to map out the role which nurses can play. During their home visits, nurses could watch for any indications of neglect and maltreatment, monitor which families might need extra support and refer them to the relevant help.
“Only at around session six or seven do parents realise their behaviour with the child might be contributing to the problem”
This may take time: like in the rest of Europe, nurses are in short supply, and such a system will require substantial investment. The need for it, though, was highlighted in 2018 by three high-profile murders of children. In January, a 15-month-old child was murdered by his stepfather, and a few months later a mother suffocated her six-month-old baby. Another parent threw her baby in a river. An effective nurse home visiting service may have detected these cases before the murders happened.
Meanwhile, Family Centre, an NGO, is running a more intensive home-visiting system targeted at parents who are struggling with child-rearing responsibilities. Its outreach workers have been visiting families in six of Montenegro’s 23 municipalities since 2015.
With support from social work centres which identify vulnerable families and develop care plans, the program has supported 126 families with over 300 children since its inception in 2014, said Krnic. The Ministry for Labour and Social Welfare has committed to expanding the Family Centre service to all municipalities by 2021.
Meanwhile, parenting classes are being piloted for people with kids aged two to nine years old. Called Parenting for Lifelong Health (PLH), the 12-week intensive course was developed in South Africa where it led to a significant drop in parental physical and emotional abuse.
Groups of 10 to 15 parents attend weekly workshops for a couple of hours, where they are taught by trained professionals in methods of positive parenting, including role-playing and homework assignments. The program has been implemented by four health centres, one kindergarten and three NGOs, and 65 parents have completed the course.
Early evidence has suggested a decrease in child behaviour difficulties, parents’ overreactions, and even parental depression, said Ida Ferdinandi, also a UNICEF Child Protection Officer. “Only at around session six or seven do parents realise their behaviour with the child might be contributing to the problem,” she said. They realise that they may have been too negative or neglected their children.
Despite this, changing attitudes on a large scale takes time. Around one in two citizens still find corporal punishment acceptable, in spite of the law change. “It’s a long-term process,” said Krnic. “In other countries it has taken decades.”
During a child’s first few years of development, trauma has a particularly dramatic impact on future educational, health and social outcomes. Although children in their early years are included in parenting and home-visiting programs, there are important gaps in terms of the provision, take-up and quality of services for kids under six.
In response, the Montenegro government has agreed to a new comprehensive early childhood development strategy. With the technical support of UNICEF, and expected financial support from the European Union, the strategy is anticipated in 2019.
Meanwhile, alongside the targeted home visiting and parenting programs, UNICEF is working with the government to find an effective broad-based parenting program to be introduced.
Though progress so far has been slow, the past few years have thrown ACEs into the spotlight in Montenegro. Now the government is taking ownership of the issue, small-scale pilots could be transformed into large-scale solutions. Avoiding traumatic experiences for children will prevent long-term issues for adults. — Jack Graham
This piece was updated to clarify that the hotline was for parental counselling, as opposed to violence victims, and that broad-based programs will be introduced on top of targeted programs.
(Picture credit: UN Photo/Martine Perret)