Evaluation of the effectiveness of the stay safe primary prevention programme for child sexual abuse

OBJECTIVE: This child abuse prevention study aimed to evaluate the effectiveness of the Stay Safe Programme in training unscreened 7 and 10 year old children in personal safety skills. Subsidiary aims were to evaluate the program's impact on children's self-esteem and parents' and teachers' knowledge and attitudes of relevance to child abuse and protection. METHOD: Changes in safety knowledge and skills and self-esteem of 339 children who participated in the Stay Safe Programme were compared with those of 388 waiting list controls. Children in the training group were also followed up at 3 months. In addition, the knowledge and attitudes of parents and teachers of children who completed the program were evaluated before and after the program and 5 month follow-up data were collected from teachers only. RESULTS: Compared with waiting-list controls, trained children showed significant improvements in safety knowledge and skills and these gains were maintained at follow-up. The greatest gains were made by 7 year olds. Children who participated in the program also showed significant improvements in self-esteem which were maintained at 3 months follow-up but only the 7 year olds in the training group made significantly larger gains in self-esteem than their control group counterparts. Children with a higher socioeconomic status benefited more from the program than less privileged children. Both parents and teachers showed significant improvements in knowledge and attitudes concerning protection over the course of the program and for teachers, these gains were maintained at follow-up. CONCLUSION: The findings suggest that the Stay Safe Programme was effective in training children in safety skills and so may usefully be used as a primary prevention intervention for child abuse.     

Child extrafamilial sexual abuse: predicting parent and child functioning

Objective: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.Method: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.Results: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children’s perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers’ satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child’s internalizing behavior and mothers’ initial emotional functioning were significant predictors of longer-term emotional functioning.Conclusions: Results emphasize the need to address children’s abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Prediction and prevention of child abuse and neglect

Utilizing an interview, a questionnaire, and observations during labor, delivery, and the postpartum period, a sample of one hundred mothers was identified as at high risk for abnormal parenting practices. These mothers were randomly divided into a “High-Risk Intervene” group (N=50) and a “High-Risk Nonintervene” group (N=50). The “Intervene” group received comprehensive pediatric follow-up by a single physician, a lay health visitor, and/or a public health nurse in the home. The “Non-intervene” group received routine care, although the results of these screening procedures were shared with the physicians and nurses responsible for their ongoing care. Another group of 50 mothers, who delivered during the same time period and who were assessed as low risk in terms of abnormal parenting practices, served as controls. When the children were approximately two years old (mean age 26.8 months), 25 families in each of the three groups were chosen at random for detailed evaluation.     

An experimental evaluation of in-home child abuse prevention services

Perinatal child abuse prevention projects are rarely rigorously evaluated. Women were referred to the Child Parent Enrichment Project (CPEP) project during or just after pregnancy if identified as at-risk of engaging in child abuse by community professionals. Clients were randomly assigned to CPEP services (n = 97) or traditional community services (n = 94). CPEP services are based on ecological theory and involve six months of home visiting by paraprofessional women and linkage to other formal and informal community resources. No advantages on self-report measures for the CPEP group were measured at posttest, and follow-up reports of child abuse were similar for both groups. Consumer satisfaction indicates that clients highly valued the program. Some indication of greater success with families with less serious problems was observed. The results argue for caution regarding the capacities of perinatal child abuse prevention services to serve the high-risk clientele they often receive.     

The handicapped child and child abuse

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.     

Multi-level determinants of retention in a home-visiting child abuse prevention program

OBJECTIVE: This exploratory study investigated how attributes from multiple domains influence retention in a voluntary home-visiting child abuse prevention program. METHOD: A sample of 1093 "at-risk" families participated in a home-visiting child abuse prevention program. A total of 71 Family Support Workers (FSWs) provided home visitation services in 12 different communities. Hierarchical general linear modeling (HGLM) was used to examine the community, home visitor, and maternal attributes that predicted retention in the program beyond 1 year. RESULTS: Multi-level analyses (HGLM) revealed significant community, home visitor, and maternal level effects. Families were less likely to remain in a home-visiting child abuse prevention program for at least 1 year if they lived in an area with high community violence. Families were more likely to remain when the home visitor received more hours of direct supervision. Older mothers were more likely to remain for at least 1 year than were younger mothers. Hispanic mothers were more likely to remain than were White non-Hispanic mothers. CONCLUSIONS: These findings demonstrate the utility of looking across multiple levels of influence when examining retention in home-visiting child abuse prevention programs. To increase retention rates home visitors will need to be adaptable to fit the needs of families in violent communities. Supervisors can influence retention rates by providing more hours of direct supervision. Other strategies that may contribute to program retention include meeting the scheduling needs of younger mothers and involving the families of younger mothers more effectively.     

Formative evaluation of a collaborative community-based child abuse prevention project

OBJECTIVE: Together for Kids is a child abuse prevention project that serves children and families in two neighboring communities in a mid-sized Canadian city. The project, a collaborative endeavor of various agencies in the health, social services, and law enforcement sectors, focuses on preventing child abuse and neglect through family support and programming. This article presents the results of a formative evaluation of the project focusing on client and team member views on project implementation. METHOD: The evaluation strategy was primarily qualitative. In-person interviews following a semi-structured format were conducted with 17 clients and 10 team members by an external evaluator. In addition a review of all client records was conducted. RESULTS: The community-based approach, the multidisciplinary composition of the team, the ability to seek services when needed, the immediacy of the response time and the availability of support during stressful times were all aspects of the project that clients found beneficial. The most beneficial aspect of the project, however, was the informal support received from team members who were accepting, non-threatening, and non-judgmental. Team members found the collaborative approach made access to services easier for clients, particularly for those who were more socially isolated. CONCLUSIONS: Multidisciplinary, community-based models of service delivery contribute to a more effective and compassionate response to vulnerable families. Attention to the variables identified as important aspects of the project from the clients' perspective in this evaluation may assist others in developing similar programs.     

Examining the effectiveness of home-based parent aide services to reduce risk for physical child abuse and neglect: Six-month findings from a randomized clinical trial

Objective

This study set out to carry out a feasible, real-world, randomized clinical trial to examine the benefits of home-based paraprofessional parent aide services in reducing physical abuse and neglect risk in high-risk parents.

Methods

Families were randomly assigned to receive either parent aide plus case management services (n = 73) or case management services only (n = 65), collecting in-home data on physical child abuse and neglect and proximal risk and protective factors, just prior to service initiation, and again after six months of services.

Results

Mothers receiving parent aide and case management services reported significant improvements from baseline to six-month follow-up in self-reported indicators of physical child abuse risk, as well as improvements on parental stress, mastery, depression, and anxiety, whereas mothers receiving only case management services did not. The slopes of such observed changes across groups, however, were not found to be statistically significantly different. No discernable improvements were found with regard to indicators of risk for child neglect.

Conclusions

As the first randomized clinical trial examining the effectiveness of parent aide services, this study provides the first controlled evidence examining the potential benefits of this service modality. This study suggests promising trends regarding the benefit of parent aide services with respect to physical child abuse risk reduction and related predictors, but evidence does not appear to suggest that such services, as they are presently delivered, reduce child neglect.

Practice implications

These findings support the continued use of parent aide services in cases of physical child abuse and also suggest careful consideration of the ways such services may be better configured to extend their impact, particularly with respect to child neglect risk.     

Parents in prison: A child abuse and neglect prevention strategy

Parents in Prison is an innovative family support service housed at the Tennessee State Prison for Men. Developed in response to inmates' recognition of the need for child abuse and neglect prevention services relevant to men who are in prison, the program model has potential for becoming a major service delivery strategy. Leadership for Parents in Prison is provided by an inmate committee which receives consultation and assistance from a community advisory board and an institutional sponsor. Program components--correspondence and classroom courses, monthly events featuring community guest speakers, and family-focused social activities and projects--address family needs during incarceration and upon return to community living. These diverse components and the flexible service delivery format permit widespread inmate participation not readily available in a prison setting. Parents in Prison successes demonstrate that the period of incarceration can be used to improve parental skills and knowledge and to strengthen family relationships. They also demonstrate the viability of a family support service which relies on inmate leadership, community volunteer participation, and institutional support. The future success of this model depends on replication in other prison settings, dissemination of the program products which have been and continue to be developed, and rigorous, systematic examination of the impact that participation has on child abuse and neglect problems associated with a father's incarceration.     

Child abuse in South Africa: an examination of how child abuse and neglect are defined

OBJECTIVE: The purpose of this study was to explore which of 17 categories of child maltreatment South Africans evaluated as most serious and to determine if those working with abuse and neglect evaluated abuse and neglect differently from those who did not. METHOD: A revised version of Giovannoni and Becerra's [Giovannoni, J., & Becerra, R. (1979). Defining child abuse. New York: The Free Press] questionnaire exploring the definition of abuse and neglect was completed by 181 residents of Cape Town, South Africa. The new form had 17 categories of child maltreatment, including 4 categories of societal abuse. Respondents were social workers (n = 57), human service workers (n = 42), laypersons (n = 65), and members of the child protection unit of the South African Police (n = 18). ANOVA was used to compare the groups' responses. When significant differences among groups were found, a Bonferroni post hoc test was run to determine differences between groups. RESULTS: The respondents ranked sexual abuse and child prostitution as most serious and housing and child labor as least serious of the 17 categories. There was a significant difference (p < or = .01) between groups on nine categories. When post hoc tests were run, differences were found for eight categories with laypersons generally evaluating categories as significantly more serious than social workers. CONCLUSIONS: Reasons for the order of the rankings are discussed, but concern remains that differences in the evaluation of child maltreatment will lead to difficulty in implementing a protocol for identifying and responding to incidents of abuse and neglect.     

The ability of elementary school children to learn child sexual abuse prevention concepts.

This research was designed to address several of the methodological problems in the current body of knowledge on the efficacy of child abuse prevention programs for elementary school-aged children. A new measure, the Children's Knowledge of Abuse Questionnaire (C.K.A.Q.) was developed, and its psychometric properties assessed. In total, 400 children were tested in four groups. Half of the sample participated in a child abuse prevention program Touching, and the other half were in a waiting list control group. Half of each group were pretested, and the other half were not, in order to determine whether the pretesting sensitized the students. All children were tested again 5 months afterward to investigate the long-term retention of prevention concepts. Results showed that children who participated in the prevention program scored significantly higher on the C.K.A.Q. than children in the control condition. Age was a critical factor, with significant improvements as age increased between the kindergarten, Grade 1, Grade 3 and Grade 6 students. All participants maintained their level of knowledge after 5 months had passed. The relevance and practical implications which stem from this research are discussed.     

Maternal use of physical punishment in response to child misbehavior: implications for child abuse prevention

OBJECTIVE: The objective was to examine the roles of cognition and affect in maternal use of physical punishment. METHOD: Through a review of the literature, distal and proximal predictors (cognitive and affective) of physical punishment use were identified. One hundred and ten mothers of 3-year-old children were interviewed regarding two disciplinary situations that occurred during the previous 2-week period that elicited their strongest reactions: one which resulted in the use of physical punishment (if this occurred) and one which did not. The individual and combined contributions of the predictors of physical punishment use were analyzed through logistic regression. RESULTS: The predictors of physical punishment following individual analyses were: maternal attitude toward physical punishment, maternal perception of the seriousness and intent of the child misbehavior, and maternal anger in response to the child misbehavior. Through multivariate analysis 54% of the variance in physical punishment use was explained. CONCLUSIONS: Both cognitive and affective factors affect the decision to use physical punishment with children. These findings can be useful in establishing parenting educational programming that is directed at decreasing the rates of physical punishment and subsequently child physical abuse.