State programs for medical diagnosis of child abuse and neglect: case studies of five established or fledgling programs

OBJECTIVE: To describe the programs for medical diagnosis of child abuse and neglect in three states and efforts to establish state-wide programs in two states. To describe common themes and issues that emerged related to the establishment and maintenance of these programs. METHODS: Five states were selected as case studies to represent a range of experience and type of function embodied in programs that address medical diagnosis of child abuse and neglect. Individuals knowledgeable about the programs or efforts to establish state-wide programs in their home states described these in detail. Inductive analysis was used to identify themes and issues that emerged across the states studied. FINDINGS: Themes emerged in three general areas: funding, services, and training. Findings related to funding were: 1) State funding was vital for initiation of statewide programs; 2) Alliances with other groups with parallel interests were successfully used to garner support for child abuse programs; 3) Services needed to be adequately reimbursed to be sustained; 4) Political climate often affected funding. With regard to services we found: 1) There was no optimal way to organize services, but rather many ways that worked well; 2) It was critical to address local service needs; 3) Provision of standardized quality services was essential. With regard to training: 1) Professional training was an integral part of all statewide programs; 2) New technologies, including televideo, have been explored and implemented to assist in training in statewide programs. CONCLUSIONS: Each state has taken a unique approach to programs for the medical diagnosis of child abuse and neglect. However, there are commonalities, particularly among the states that have been successful in establishing and maintaining comprehensive services and/or training.     

Factors associated with successful entry into therapy in child sexual abuse cases

Given the well-documented, long-term, negative mental health consequences of child sexual abuse, it is important that children receive counseling following abuse. Often, the social worker's responsibility is to insure that abused children are appropriately referred for counseling following disclosure of sexual abuse. There are multiple factors that could facilitate or hinder this process, and identification of these factors is important in assisting families in becoming engaged in therapy. The purpose of this study was to (1) determine the extent of the problem of sexual abuse victims failing to keep their first scheduled therapy appointment, and (2) identify factors associated with failure to attend. Subjects were 129 consecutive child sexual abuse clients referred to long-term therapy by counselors at a crisis intervention center. Those who attended their first therapy session (n = 84) were found to differ from those who did not (n = 45) on the basis of their race, the center to which they were referred (private or public), whether the family had a telephone in the home, and whether the child's mother agreed that the family needed counseling. Implications of this study for increasing attendance at therapy are presented and recommendations are made for further research.     

Rules, roles and tools: Activity theory and the comparative study of e-learning

Activity theory (AT) is a powerful tool for investigating 'artefacts in use', ie, the ways technologies interrelate with their local context. AT reveals the interfaces between e-learning at the macro- (strategy, policy, 'campus-wide' solutions) and the micro-organisational levels (everyday working practice, iterative change, individual adaptation). In AT, contexts are conceived of as activity systems in which human, technological and organisational elements are interrelated and largely inseparable. Both the subjects of the activity system (internal) and the wider community (external) mediate their activities through tools, rules and roles. This paper shows how a course management system (CMS) exerts an influence over all three of these mediators, though the exact nature of this influence depends on the particular configuration of each activity system. This is illustrated with reference to two case study programmes, both of which used Moodle as their CMS, but which had activity systems structured in quite different ways; the programmes also had different relationships with their external organisational environment.     

Sexual and reproductive health information sources preferred by out-of-school adolescents in rural southwest Uganda

This paper defines how out-of-school adolescents from Masaka District in rural southwest Uganda currently receive sexual and reproductive health information and how they would prefer to receive that information. Information adolescents feel they lack falls into three broad categories: sexual and reproductive health issues, the negotiation of sex and sexual relationships, and making the transition to adulthood. The preferred source for information depends on the type of information to be delivered, the overriding principle being that the source must be authoritative in that type of information. Current information sources including family, peers and media are perceived as either flawed or insufficient. Preferable sources fall into three categories based on the type of information provided: accurate sexual and reproductive health information should come from trained community and media-based rather than clinic-based health educators; information about negotiation of good relationships and the negotiation of sex and condom use within relationships should come from an up-skilled traditional source, ssenga (paternal aunt), particularly for young women; and social information about becoming a good adult should come from parents, grandparents, church and community leaders. All information should be positively framed and non-judgemental. Centrally coordinated community health promotions delivered by trained community-based health educators, ssenga and parents, guided and supported by existing radio and print media, are required.