Three models of child abuse consultations: A qualitative study of inpatient child abuse consultation notes

Child abuse pediatricians have multiple roles in caring for abused children, including prevention, diagnosis, treatment, and, when needed, expert legal opinion. The child physical abuse consultation differs from the traditional medical consultation in that it has medical, investigative and legal audiences, all of whom have different information needs. How child abuse pediatricians approach their cases and how they document their initial inpatient consultations that will be used by such a diverse audience is currently unexplored. We used content analysis to examine 37 child physical abuse consultation notes from a national sample of child abuse pediatricians in order to understand physicians’ approaches to these consultations. Three commonly used models of child physical abuse consultation were identified in the data that we named the base model, the investigative model, and the family-dynamic model. While model types overlap, each is distinguished by key features including the approach used to gather information, the information recorded, and the language used in documentation. The base model most closely mirrors the traditional medical approach; the investigative model concentrates on triangulation of sources of information; and, the family-dynamic model concentrates on physician perceptions of family relationships. The three models of consultations for child physical abuse mirror the areas of child abuse pediatrics: diagnostic, forensic and therapeutic. These models are considered in relationship to best practice from other medical specialties with forensic components.     

Identifying families with complex needs after an initial child abuse investigation: A comparison of demographics and needs related to domestic violence,mental health,and substance use

Families with complex needs related to domestic violence, mental health, and substance use have some of the worst child protective services (CPS) outcomes. Although many of these families are identified during a CPS investigation and subsequently referred to home-based postinvestigation services (HBPS), many are re-reported to CPS, so it is important to understand the postinvestigation experiences of this vulnerable group. Therefore, this study compared families with and without complex needs to understand their uniquedemographics, needs, and postinvestigation outcomes.The sample consisted of 2008 caregivers who received HBPS following an initial CPS investigation. The Family Assessment Form (FAF) was used to measure family functioning in eight domains using a 1–5 scale with higher ratings representing worse functioning. Complex needs were indicated by a mean FAF score of 3 or higher for either domestic violence, mental health, or substance use. Using Pearson chi-square analyses and two-sample t-tests, comparisons were made between families with (n = 836) and without (n = 1172) complex needs. Half of caregivers with complex needs had a history of abuse, 25% had three to five needs, and nearly half had six to eight needs; 90% of caregivers without complex needs had zero to two needs. Furthermore, caregivers with complex needs had higher mean scores for concrete, educational, and clinical needs. These findings highlight the importance of recognizing variation among families referred to HBPS and accurate screening to ensure that families with complex needs are offered and receive services matched to their unique characteristics and needs.     

The association of intrafamilial violence against children with symptoms of atopic and non-atopic asthma: A cross-sectional study in Salvador,Brazil

This study aims to describe the types of intrafamilial violence perpetrated against children according to living conditions, family factors, and child characteristics, and to identify the association between types of intrafamilial violence and asthma symptoms in atopic and non-atopic children. A cross-sectional study was carried out with 1,370 caregivers as part of the Social Changes, Asthma and Allergy in Latin America (SCAALA) study, conducted in 2006 in Brazil. The study population was selected by random sampling. The main outcome measures were atopic and non-atopic asthma. We investigate the association between intrafamilial violence and asthma symptoms in atopic and non-atopic children. A backward multivariate logistic polytomous regression was performed to verify the main association. Nonviolent discipline (NVD) and maltreatment nonviolent discipline (MNVD) were positively associated with non-atopic asthma symptoms (NVD: odds ratio (OR) = 1.95/95% confidence interval (CI) = 1.17–3.25; MNVD: OR = 1.95/95% CI = 1.19–3.20). However, for the most severe intrafamilial violence, this association was not found after control of potential confounders. This study demonstrates the effect of types of intrafamilial violence on non-atopic asthma. Intrafamilial violence against children represents one more component in the determination of non-atopic asthma in Latin America.     

Promoting resilience and wellbeing in children exposed to intimate partner violence: A qualitative study with mothers

BackgroundChildren exposed to intimate partner violence (IPV) are at increased risk of disruptions to their health and development. Few studies have explored mothers’ perceptions of what helps their children cope throughout this experience.ObjectiveThe aim of the study was to explore mothers’ perceptions of their children’s resilience and coping following IPV exposure, and the strategies they have used to support their children and promote resilience.MethodsIn depth semi-structured interviews were conducted with nine women from the Maternal Health Study (MHS), a prospective study of women during pregnancy and following the birth of their first child. All women involved in the qualitative interviews reported experiencing IPV during their involvement in the MHS. Transcribed interviews were analysed using interpretative phenomenological analysis which has a focus on how individuals make meaning of their experience.ResultsWomen discussed parenting strategies such as role modelling, stable and consistent parenting, and talking with their children about healthy relationships to promote their children’s resilience. Mothers also spoke about the ways they tried to reduce their child’s direct exposure to IPV, as well as reflecting on the difficulty of attending to their child emotionally when they were experiencing distress.ConclusionsThis study highlights that there are many strategies used by mothers who experience IPV to promote resilience and wellbeing in their children. Understanding what mothers see as useful for their children is essential in providing appropriate services to families following experiences of family violence.     

Child abuse in Pakistan: A qualitative study of knowledge,attitudes and practice amongst health professionals

Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects can be profound and life altering for victims. There is substantial literature from high income countries about signs of abuse, but a dearth of data from low and middle income countries like Pakistan. Healthcare professionals (HCP) are ideally placed to detect abuse, but, to inform interventions, an understanding of their experiences, training needs and cultural beliefs is needed. This study aimed to: (1) Explore the challenges that HCP face when managing cases of abuse; (2) Explore cultural beliefs and understand how these shape practice and (3) Identify training needs. A qualitative study using a phenomenological design was conducted. In-depth interviews were conducted with doctors, nurses and security staff in the emergency department of a large private hospital in Pakistan (n = 15). Interviews were undertaken in Urdu, translated into English and analysed using an inductive thematic approach. Multiple challenges were identified. The process of referral to legal services was poorly understood and further training and guidelines was suggested by participants. As the legal system in Pakistan does not allow HCP to keep potentially abused patients in their custody, they felt restricted in their ability to advocate and concerned about the safety of both the identified children and themselves. HCP have potential to detect abuse early; however, in Pakistan there are numerous challenges. HCP require support through training, as well as clear institutional frameworks and legal support to undertake this role.     

Reporting possible sexual abuse: a qualitative study on children's perspectives and the context for disclosure

OBJECTIVE: The present study investigated the context in which children were able to report their child sexual abuse experiences and the children's views as to what made it difficult to talk about abuse and what helped them in the disclosing process. The aim was to study disclosures as they were occurring in their natural settings. METHOD: Data were obtained from therapeutic sessions and follow-up interviews from 20 families with 22 children. These children had said something that made their caregivers concerned about ongoing child sexual abuse. Qualitative analysis was conducted to capture the children's and caregiver's perspectives of the disclosure process. RESULTS: The children felt it was difficult to find situations containing enough privacy and prompts that they could share their experiences. They also were sensitive to others reactions, and whether their disclosures would be misinterpreted. When the children did disclose they did it in situations where the theme of child sexual abuse was in some form addressed or activated. The results indicate that disclosure is a fundamentally dialogical process that becomes less difficult if the children perceive that there is an opportunity to talk, and a purpose for speaking, and a connection has been established to what they are talking about. CONCLUSIONS: It is difficult for children to initiate a conversation about something secret, confusing and distressful, and where there are few conversational routines in a family for talking about such themes. Children also are sensitive to the needs of their caregivers and fear consequences for their family and offender. Children need a supportive structure or scaffold in order to reveal their experiences of child sexual abuse.     

A healthy start: promoting mental health and well-being in the early primary school years

Mental health problems in children represent a significant international health concern, with up to one in five children using mental health services during the course of any given year. Identifying the processes of what prevents social, emotional and behaviour difficulties (SEBD) and promotes healthy development from an early age can make a significant contribution to the promotion of positive mental health in children. This article describes a longitudinal study which sought to identify the risk and promotive factors as young children move from the early to junior years in primary school. Multilevel analysis was used to identify the individual, classroom, school, home and community factors that predict change in SEBD and in prosocial behaviour in the early school years. It also calculated the cumulative effect of the various risk and promotive factors on the pupils’ well-being and mental health. The article presents the windows of vulnerability and opportunity for young children’s healthy development, proposing a trajectory for healthy development in early and middle childhood.     

The relationship between student learning process,study success and the nature of assessment: A qualitative study

Assessment has an important role in affecting students’ learning, but qualitative studies regarding this relationship are rather scarce. In addition, course grades do not necessarily reflect the quality of learning outcomes. The aim is to qualitatively examine why high and low achieving students in the same course study differently according to the assessment method and how they explain their behaviour. Altogether 24 students were interviewed in this study. Analyses were conducted with inductive content analysis. The results indicate that course grades do not necessarily reflect qualitative learning outcomes due to the nature of the assessment. In addition, the present study suggests that self-regulation and motivation are important factors in studying and might prevent the negative effect of inappropriate assessment.     

Institutional abuse of children in the Austrian Catholic Church: Types of abuse and impact on adult survivors’ current mental health

The aim of this study was to explore the nature and dimensions of institutional child abuse (IA) by the Austrian Catholic Church and to investigate the current mental health of adult survivors. Data were collected in two steps. First, documents of 448 adult survivors of IA (M = 55.1 years, 75.7% men) who had disclosed their abuse history to a victim protection commission were collected. Different types of abuse, perpetrator characteristics, and family related risk factors were investigated. Second, a sample of 185 adult survivors completed the Posttraumatic Stress Disorder Checklist (PCL-C) and the Brief Symptom Inventory (BSI). Participants reported an enormous diversity of acts of violent physical, sexual, and emotional abuse that had occurred in their childhood. The majority of adult survivors (83.3%) experienced emotional abuse. Rates of sexual (68.8%) and physical abuse (68.3%) were almost equally high. The prevalence of PTSD was 48.6% and 84.9% showed clinically relevant symptoms in at least one 1 of 10 symptom dimensions (9 BSI subscales and PTSD). No specific pre-IA influence was found to influence the development of PTSD in later life (e.g. poverty, domestic violence). However, survivors with PTSD reported a significantly higher total number of family related risk factors (d = 0.33). We conclude that childhood IA includes a wide spectrum of violent acts, and has a massive negative impact on the current mental health of adult survivors. We address the long-term effects of these traumatic experiences in addition to trauma re-activation in adulthood as both bear great challenges for professionals working with survivors.     

The social impact of schooling on students with dyslexia: A systematic review of the qualitative research on the primary and secondary education of dyslexic students

This systematic review of the qualitative research on the formal school education of children with dyslexia addresses three main questions: 1) What is known about the educational experiences of children with dyslexia? 2) What is known about the role that parents/guardians play in their child's schooling? 3) What is known about the role of teachers and administrators in supporting children with Dyslexia? Student and parent-focused studies indicate little awareness of and support for dyslexia in schools, and a strong reliance on parental support. Limited understanding of dyslexia, lack of training, and communication issues were identified as key themes in the small number of teacher-focused studies. The analysis points to a majority of studies not having a firm theoretical grounding and the neglect of teachers and school administrator's perspectives as central issues in the reviewed research. Based on these findings, it is argued that to further understandings of the systematic effects of schools' responses to dyslexic students, research should draw more heavily on socio-cultural models of disability.     

Impacts of adverse childhood experiences on health,mental health,and substance use in early adulthood: A cohort study of an urban,minority sample in the U.S.

Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health-related outcomes in later life. Less is known about the consequences of ACEs in early adulthood or among diverse samples. Therefore, we investigated the impacts of differential exposure to ACEs on an urban, minority sample of young adults. Health, mental health, and substance use outcomes were examined alone and in aggregate. Potential moderating effects of sex were also explored. Data were derived from the Chicago Longitudinal Study, a panel investigation of individuals who were born in 1979 or 1980. Main-effect analyses were conducted with multivariate logistic and OLS regression. Sex differences were explored with stratified analysis, followed by tests of interaction effects with the full sample. Results confirmed that there was a robust association between ACEs and poor outcomes in early adulthood. Greater levels of adversity were associated with poorer self-rated health and life satisfaction, as well as more frequent depressive symptoms, anxiety, tobacco use, alcohol use, and marijuana use. Cumulative adversity also was associated with cumulative effects across domains. For instance, compared to individuals without an ACE, individuals exposed to multiple ACEs were more likely to have three or more poor outcomes (OR range = 2.75–10.15) and four or more poor outcomes (OR range = 3.93–15.18). No significant differences between males and females were detected. Given that the consequences of ACEs in early adulthood may lead to later morbidity and mortality, increased investment in programs and policies that prevent ACEs and ameliorate their impacts is warranted.     

Prevalence of family violence and mental health and their relation to peer victimization: A representative study of adolescent students in Southwestern Uganda

BackgroundDespite global efforts to end violence against children in all settings, reports reveal that violence against children is still highly prevalent, especially in low-and middle- income countries. Violence in childhood is associated with a host of negative outcomes, and exposure in one setting can easily spill over to other contexts. For instance, exposure to family violence was not only related to mental health problems but also seems to be a risk factor for peer victimization.ObjectivesThe present study aimed to examine the prevalence of maltreatment within the family and adolescents’ mental health problems and their relation to peer victimization. We also aimed to gain new insights into the perceptions of adolescents concerning maltreatment within their families.MethodsData were collected from April to November 2017 in a representative sample of 702 students from 12 public secondary schools in Southwestern Uganda who responded to self-administered questionnaires.ResultsOverall, 95% of the students experienced at least one type of family violence in the past month. Students (81.3%) had endorsed some level of acceptance of violent discipline as a valid strategy in response to any misbehavior. Maltreatment within the family was related to peer victimization (β = .47) and this relation was mediated by mental health problems (0.002, 95%-CI: 0.001–0.004).ConclusionsThe results indicated a high prevalence of maltreatment within Ugandan families that was associated with peer victimization. This underscores the need to implement interventions aiming to reduce maltreatment and violence in order to protect children from potentially negative consequences.     

Disentangling the mental health impact of childhood abuse and neglect: A replication and extension study in a Brazilian sample of high-risk youth

Childhood maltreatment is a key predictor of mental health problems across the life span. Yet, how maltreatment types independently and jointly influence the risk for psychiatric problems remains unclear. The aim of the study was two-fold: first, to replicate recent findings regarding the impact of maltreatment types on youth psychiatric symptoms, based on a Brazilian sample of high-risk adolescents (n = 347; age range = 11–17 yrs), and second, to extend existing findings by examining whether this relationship is mediated by bullying victimization and/or perpetration. Measures included self-report ratings of childhood maltreatment and peer victimization, as well as multi-informant reports of internalizing and externalizing symptoms. Consistent with prior research, we found that: (i) maltreatment types often co-occurred; (ii) there was a linear association between number of maltreatment types experienced and symptom severity (i.e. cumulative effect); and (iii) emotional abuse emerged as the most consistent independent predictor of poor mental health across domains, raters, and gender. Additionally, this study extends previous findings by showing that the influence of maltreatment on psychiatric outcomes is partially mediated by peer victimization, but not by bullying perpetration. In conclusion, these findings expand our understanding of the heterogeneity in individual responses to maltreatment as well as highlighting emotional abuse as an important predictor of poor mental health.     

The influence of speech perception,oral language ability,the home literacy environment,and pre-reading knowledge on the growth of phonological sensitivity: A one-year longitudinal investigation

Individual differences in phonologicalsensitivity are among the most powerfulpredictors of early word decoding ability and adeficit in phonological sensitivity is thoughtto be the primary stumbling block for thosechildren who have difficulty learning to read. However, only recently have researchers begunto search for the potential causes andcorrelates in phonological sensitivitydevelopment. In the present one-yearlongitudinal study, the influences of speechperception, oral language ability, emergentliteracy, and the home literacy environment(HLE) on the growth of phonological sensitivitywere examined in a group of 115 four- andfive-year-old children. When the variables wereentered simultaneously into a multipleregression equation, emergent literacy, orallanguage, and the HLE contributed significantunique variance. However, when theautoregressor was controlled, only phonologicalsensitivity at Time 1 and HLE contributedsignificant unique variance to predictinggrowth in phonological sensitivity. Resultsare discussed in terms of their implicationsfor the education of preschool as well asschool-aged children.     

Identifying and evaluating teachers’ knowledge in relation to child abuse and neglect: A qualitative study with Australian early childhood teachers

Child abuse and neglect are serious social problems that make extraordinary demands on teachers’ knowledge and professionalism. Yet the field of education has been slow to develop a discipline-specific knowledge base about child abuse and neglect for teachers and teacher education programmes and there is a paucity empirical research into teachers’ knowledge in relation to child abuse and neglect. This paper describes a qualitative study of eight purposively selected early childhood teachers. To identify and evaluate their child abuse and neglect knowledge, Grossman's [(1990). The making of a teacher: Teacher knowledge and teacher education. New York: Teachers College Press; (1995). Teachers’ knowledge. In L. W. Anderson (Ed.), International encyclopedia of teaching and teacher education (2nd ed., pp. 20–24). Tarrytown, NY: Pergamon] typology of teachers’ knowledge is used as an analytic framework on which to map the teachers’ interview data. Findings reveal that, in the absence of preservice and inservice education specifically about child abuse and neglect, early childhood teachers held and deployed knowledge in resourceful ways. They used, as a basis, their existing early childhood knowledge and adapted this knowledge by augmenting it with a range of personal and professional knowledge resources to fit their particular challenges and situations. This approach, however competent and innovative, also reveals shortfalls in knowledge. Implications of this research are drawn for child abuse and neglect curriculum development in initial and continuing teacher education including the case for specialist knowledge needed to establish teachers’ professional reputation for dealing capably with cases of child abuse and neglect.     

The mental health and psychological well-being of refugee children and young people: an exploration of risk,resilience and protective factors

This research investigates the perceptions of refugee children, refugee parents and school staff regarding the positive adaptation of refugee children in a new social context and the effects on mental health and psychological well-being. This included an exploration of resilience and the role of risk and protective factors. Few studies have focused on views from a resilience perspective, and these have tended to use quantitative rather than qualitative measures. This mixed methods piece of “real world” research adopted a “what’s working well” perspective and explored the important voices of these children, parents and school staff. Staff, parent and child responses were triangulated to provide a rich picture of the potential protective factors operating within the school and family environment. Implications for practice are discussed.     

Patterns of childhood maltreatment and intimate partner violence,emotion dysregulation,and mental health symptoms among lesbian,gay, and bisexual emerging adults: A three-step latent class approach

BackgroundChildhood abuse and neglect (CAN) and intimate partner violence victimization (IPV) is prevalent among lesbian, gay, and bisexual individuals (LGB). Identification of distinct patterns of childhood and adult victimization, including technology-mediated and face-to-face IPV, and their cumulative relations to mental/behavioral health challenges, among LGB people is needed to facilitate identification of at-risk individuals.ObjectiveUsing latent class analysis, we first sought to identify patterns of lifetime interpersonal victimization, primarily five types of CAN and IPV in LGB emerging adults. Second, we examined if LGB-status and race/ethnicity predicted class-membership; third, we assessed differences between the latent classes on emotion dysregulation, depressive and anxiety symptoms, and alcohol use.ParticipantsParticipants were 288 LGB adults between 18–29 years (M = 25.35, SD = 2.76; 41.7% gay/lesbian) recruited via Amazon MTurk.Methods and resultsThe 3-step LCA identified five-latent classes: high victimization, childhood emotional abuse and neglect, cybervictimization, adult face-to-face IPV, and lower victimization. People of color (including Hispanics) were more likely to be in the high victimization class, and bisexual individuals, especially bisexual women, in the childhood emotional abuse and neglect class. High victimization and childhood emotional abuse and neglect classes had elevated emotion dysregulation levels and depression and anxiety symptoms, and the high victimization class reported the highest levels of alcohol use.ConclusionFindings suggest a detrimental effect of cumulative interpersonal victimization on emotion dysregulation and the mental/behavioral health of LGB emerging adults, with bisexuals and LGB-people of color at heightened risk of cumulative victimization and of related mental/behavioral health challenges.     

A prospective,longitudinal cohort study: The impact of child maltreatment on delinquency among South Korean youth in middle and high school

BackgroundCultural groups vary in how they understand child maltreatment and children's misbehavior and these cultural variations may impact the relationship between maltreatment and delinquency.ObjectiveThis study investigated the impact of maltreatment on delinquency among South Korean youth. Participants and Setting: Using Korean Children and Youth Panel Survey data, this study followed two cohorts of middle (n = 2,275) and high (n = 2,272) school youth for their first self-reported delinquency over 4 years.MethodDiscrete-time hazard model was used for the analyses.ResultsApproximately 19% of middle and 11% of high school youth engaged in delinquency for 4 years. Maltreatment is associated with delinquency only for high school youth (HR = 1.42). In both cohorts, male youth with high levels of aggression were more likely to engage in delinquency. Additional risk factors included high levels of depression (HR = 1.36) and negative attitudes toward school rules (HR = 0.68), father's education less than high school (HR = 0.63), low levels of self-control (HR = 0.63). Findings also identified culturally unique factors that place Korean youth at heightened risk of delinquency: mother's education more than high school (HR = 1.49) and higher family income (HR = 1.93).ConclusionPreventive interventions need to identify culturally specific risk factors for youth at increased risk of delinquency and thus these preventive interventions should be culturally tailored.     

The role of the school climate in high school students’ mental health and identity formation: A South Australian study

The well‐documented increase in student mental health issues in Australia and growing recognition of the need for education to play a part in students’ identity formation prompted this study. The research reported in this article sought to identify specific elements of the school climate that were likely to influence the interplay of adolescent health and development and students’ identity formation. The aim was two‐fold. First, the study examined the relationships between students’ perceptions of the school climate and self‐reports of wellbeing, resilience and moral identity; and, second, the interrelationships between the three outcome variables were explored. Two surveys, one to assess students’ perceptions of features of the school climate, and another to assess students’ wellbeing, resilience and moral identity, were administered to 618 Year 11 students from 15 independent schools in South Australia. Structural equation modelling was used to investigate hypothesised relationships between students’ perceptions of their school climate and self‐reports of wellbeing, resilience and moral identity. Our results indicated statistically significant and positive relationships between school‐climate factors and each of the three outcome variables. Further, indirect relationships (mediated largely by resilience) were found between school‐climate factors and students’ wellbeing. Our findings could be used to guide schools in building tangible, purposeful environments that engender well‐balanced, positive, resilient citizens with strong moral identities.