Preventing child abuse; a review of community-based projects 1. Intervening on processes and outcome of reviews

Recent theories advocating ecological and developmental perspectives on child abuse and neglect are summarized. Reviews of community prevention programmes underline the importance of focusing on processes and viewing the developing child and their family in a broad context. The conclusions of the reviews are reported. Although the reviews suggest that some programmes to prevent physical and sexual abuse and bullying are at least to some degree effective, their impact has been reduced by a failure to encompass adequately the various influences that operate across difference domains of the child's life at different stages of their development. © 1997 John Wiley & Sons, Ltd.     

Parents' knowledge,attitudes and practices about preventing child sexual abuse: a literature review

Increased concern about high rates of child sexual abuse has led to the demand for more prevention programmes, particularly those aimed at parents. Research on how parents manage and reduce the risk of child sexual abuse can help plan programmes. This literature review explores published research on the knowledge, attitudes and practices of parents on the risk and prevention of child sexual abuse and identifies gaps and needs for further research. The majority of studies reviewed originated in North America and Asia, were quantitative, surveyed mainly mothers and were more than ten years old. Recommendations are made for more current and country specific research, further research to gain a deeper understanding of how parents manage the risk of child sexual abuse, more comprehensive research covering a range of knowledge, attitude and practice variables, and greater inclusion of fathers in research. Copyright © 2009 John Wiley & Sons, Ltd.     

Child abuse prevention: Blending research and practice

For over two decades, child abuse interventions have been plagued by poor definitions of what (or who) exactly is being treated, what constitutes ‘success’, and how services can be delivered in such a way as to minimize the harm to the child and to his/her family. Most recently, intervention/prevention programmes reflect the growing recognition that child maltreatment is the product of the interaction between the parent's abilities and resources and the child's emerging behavioural and emotional characteristics (i.e. the parent–child relationship), and place less emphasis on individual psychopathology. Accordingly, ways to strengthen this relationship offer considerably more promise than those aimed at correcting only one component (i.e. the parent) or treating only the visible symptoms of conflict. In an attempt to focus greater effort on prevention and early intervention, this paper reviews prominent risk factors that have been linked to physical abuse and neglect of children and their consequences. Major intervention targets are identified from this literature and discussed in reference to: (a) problems related to the family context; (b) child treatment needs; and (c) parent/caregiver treatment needs. The paper concludes with a discussion of promising developments in early intervention that are beginning to address problems in the early formation of the parent–child relationship (i.e. the pre-natal and infancy periods of development) and problems associated with parental competency and family support. Most notably, preventive efforts have been associated with more positive parenting knowledge, attitudes, skills, and behaviour, as well as fewer child injuries, emergency room visits, and reports to protective agencies among at-risk parents and children. Further evaluation and expansion of these programmes appears to be warranted by these data.     

Teachers' role in the primary prevention of child abuse dilemmas and problems

During the 1980s, many school-based primary prevention programmes were developed and adopted by schools. Much of the early enthusiasm which greeted these programmes dissipated in the light of often disappointing evaluations of the impact of the programmes on children. It is argued, however, that evaluating student outcomes should not occur before theextent of programme utilization is established. In this paper, an overview is given on the dilemmas and problems faced by teachers attempting to implement a primary prevention programme in South Australia. It is revealed that teachers selectively omit sections of the primary prevention programme as a way of resolving personal dilemmas presented by the programme. Some teachers are sensitive about teaching personal and controversial issues related to child abuse, while others deny the seriousness of child abuse in theirschool. The implications of the findings are that: (a) it cannot be assumed that primary prevention programmes are implemented by teachers in ways that are consistent with programme design; (b) teachers' personal beliefs, attitudes and feelings need to be addressed in any school-based primary prevention initiative; (c) training approaches and school support mechanisms need to focus on methods by which teachers can resolve the dilemmas raised by school-based primary prevention programmes in ways other than by radically dismembering the programme.     

Bullying behaviour in secondary schools: what roles do teachers play?

Teachers have an important role to play in the management and prevention of bullying. Although many anti‐bullying programmes advocate a ‘whole school approach’, they tend to focus on student‐student behaviours and rarely examine the nature of other relationships which exist in the school. This study examines bullying between students and teachers at two time points. Thirty per cent of students said they were bullied by teachers at both times. Numbers reporting they bullied teachers were 28 per cent and 16 per cent, respectively. The paper explores the important role that teachers play in dealing with bullying in a school setting by modelling appropriate behaviours and dealing with it effectively. If teachers are victimised by or engage in bullying students this has implications for the ethos within the school and may also impact on the success of anti‐bullying programmes. Copyright © 2008 John Wiley & Sons, Ltd.     

Mexican-American families: A psychoeducational approach for addressing chemical dependency and codependency

Chemical dependency and codependency are often referred to as family problems, and the ways in which families frame these problems may be influenced by their ethnic and cultural background. Increased efforts are being made to help families understand the problems that arise from alcohol and other drug abuse by utilizing approaches that take into consideration their unique cultural aspects. This article reviews some of the ways in which Mexican-American families, in particular, may view chemical dependency and codependency. More importantly, it describes the cultural adaptation of a psychoeducational program to help. Mexican-American parents, primarily mothers whose children are drug involved or who are considered to be at risk for drug use, better address these problems.     

Child sexual abuse: from prevention to self‐protection

There are a growing number of child abuse prevention and education programmes, including primarily group‐based parent and child education, which are taught by teachers within the school system. This article reviews some of the existing sexual abuse education and/or body safety programmes, as well as the research surrounding them. Advantages as well as criticisms of such programmes are reviewed. Issues such as target populations (i.e. children, teachers, parents), programme components and methodological limitations are addressed. Major findings include: children as young as three can be effectively taught self‐protection skills, parental and family involvement in training is important, and repeated exposure helps children maintain knowledge gains. The components of successful programmes include teaching children to identify and resist inappropriate touching, reassuring children that it is not their fault and learning the proper names of their genitals. Finally, future directions for programme development, research and policy are explored. Copyright © 2008 John Wiley & Sons, Ltd.     

Risk factors for involvement in cyber bullying: Victims, bullies and bully-victims

Objectives

The purpose of the current study was to examine the frequency of cyber bullying among youth by distinguishing among the three categories of involvement in cyber bullying: victims, bullies, and bully-victims, to compare these to a fourth category of students who are not involved in the three categories of cyber bullying and to explore the factors that contribute to involvement in cyber bullying.

Method

This study utilized a large and diverse sample of 2186 middle and high school students, who completed self report questionnaires during class time. We performed a Multinomial Logistic Regression to examine the relationship between the cyber bullying categories and our independent variables (gender, age, technology use, parental involvement and safety).

Results

Over 30% of the students in this study identified as involved in cyber bullying, as victims or perpetrators, and one in four of the students (25.7%) reported having been involved in cyber bullying as both bully and victim during the previous three months. Students who were involved in cyber bullying were more likely than others to report perpetration of violence toward peers, to use computers for more hours a day, and to give their password to friends. Other risk factors, such as gender, age and safety, were found to be specific only for one category of cyber bullying.

Conclusion

The findings revealed that students are highly involved in cyber bullying. Several unique characteristics emerged regarding the frequency and risk factors of students' involvement in cyber bullying. In traditional bullying the category of bully-victims represents the smallest and most vulnerable group of children, whereas in the current study the bully-victims category emerged as common. In addition, females were more likely than males to be bully-victims, in contrast to research on traditional bullying, in which more males than females are typically involved as bully-victims. In addition, several risk factors were common among the three groups of children, including the amount of hours per day students use the computer, and giving passwords to a friend. These results point to the need for further examination and to focus on the risk factors for students' cyber bullying involvement in each of the three categories.     

Bullying among urban Mexican-heritage youth: Exploring risk for substance use by status as a bully,victim, and bully-victim

Little is known about adolescent bullying behavior and its relationship to substance use in ethnic minority populations. In a sample of youth of Mexican heritage, the current study aimed to examine the prevalence of bullying behavior subtypes and its co-occurrence with recent alcohol, cigarette, and inhalant use. Data come from a school-based substance use prevention study in the Southwestern U.S. (n = 809). We explored the prevalence of bullying behavior by status among youth classified as bullies, victims, bully-victims, and rarely-involved bully-victims in an urban context. We also investigated risk of past 30-day use of alcohol, cigarettes, and inhalants by bullying behavior status. Compared to non-involved youth, rarely-involved bully-victims were more likely to use alcohol, bullies were more likely to engage in alcohol and cigarette use, and bully-victims were more likely to use alcohol, cigarettes, and inhalants. In contrast, victims were not significantly at risk of substance use compared to non-involved youth. Chronic bullies and bully-victims are particularly at risk for substance use, with chronic bully-victims reflecting the greatest risk of using multiple substances. Prevention and early intervention programs aimed to reduce bullying can also work to decrease other risky behaviors, such as substance use, and should attend to the growing ethnic diversity among youth.     

Risk and protective factors, longitudinal research, and bullying prevention

This chapter presents the results from two systematic/meta-analytic reviews of longitudinal studies on the association of school bullying (perpetration and victimization) with adverse health and criminal outcomes later in life. Significant associations between the two predictors and the outcomes are found even after controlling for other major childhood risk factors that are measured before school bullying. The results indicate that effective antibullying programs should be encouraged. They could be viewed as a form of early crime prevention as well as an early form of public health promotion. The findings from a systematic/meta-analytic review on the effectiveness of antibullying programs are also presented. Overall, school-based antibullying programs are effective, leading to an average decrease in bullying of 20 to 23 percent and in victimization of 17 to 20 percent. The chapter emphasizes the lack of prospective longitudinal research in the area of school bullying, which does not allow examination of whether any given factor (individual, family,. or social) is a correlate, a predictor, or a possible cause for bullying. This has important implications for future antibullying initiatives, as well as implications for the refinement of theories of school bullying. It is necessary to extend the framework of the traditional risk-focused approach by incorporating the notion of resiliency and investigating possible protective factors against school bullying and its negative consequences.     

Cyberbullying and subjective health: A large-scale study of students in Stockholm,Sweden

The increase in the use of mobile phones and the Internet has given rise to new opportunities for people to meet and communicate. However, there are also dark sides to these new forms of communication. One of these is cyberbullying, i.e. bullying via mobile phone and the Internet. Given that cyberbullying is a relatively new phenomenon, empirical knowledge is still limited and particularly so in Sweden, which in international comparison has reported low rates of bullying in general. The aim of the study is to investigate: 1) the prevalence of cyberbullying among students in Stockholm, Sweden; 2) the overlap between cyberbullying and traditional forms of school bullying, and 3) the association between the experience of cyberbullying and subjective health. The study uses the Stockholm School Survey of 2008 which is a total population survey of students in grade 9 of compulsory school (i.e. aged 15–16) and in the second year of upper secondary school (i.e. aged 17–18) in Stockholm and eighteen of its surrounding municipalities (N = 22,544). About 5 % of the students are victims of cyberbullying, 4% are perpetrators, and 2% are both victims and perpetrators. There is some overlap between cyberbullying and traditional bullying: those who are victims of traditional bullying are at increased risk of also being victims of cyberbullying; while being a traditional bully is strongly associated with the likelihood of also being a cyberbully. However, many students who are involved in cyberbullying are not involved in traditional bullying. OLS regression analyses show that being a victim of cyberbullying remains associated with worse subjective health when being the victim of traditional bullying and socioeconomic factors are taken into account. In addition, perpetrators of cyberbullying as well as students who are both victims and bullies, have worse subjective health than those who are not involved in cyberbullying.     

EFFICACY OF FAMILY THERAPY FOR DRUG ABUSE: PROMISING BUT NOT DEFINITIVE

Drug abuse is an enormous public health problem with consequences not only for individuals using drugs but also for families, communities, and society. Moreover, research evidence and clinical experience agree that drug abuse is one of the more difficult problems to treat. Despite considerable research on the connection between family factors and drug use, and the existence of family therapy models for drug abuse, comparatively few controlled efficacy studies have been conducted. This article presents a critical review of controlled treatment outcome research in the area of family therapy for drug abuse in both adults and adolescents. A number of studies from different clinical research groups demonstrate that different versions of family intevention can engage and retain drug users and their families in treatment, significantly reduce drug use and other related problem behaviors, and enhace particular domains of prosocial functioning. Moreover, a smaller number of comparative efficacy studies have shown family therapy to be more effective than nonfamily therapies. Family therapy of adolescent drug abuse is more developed at present than family therapy of adult drug abuse. Although the results of the reviewed studies are promising, a blanket confirmation of family therapy's efficacy for drug abuse cannot be made at this time because of the relatively small number of studies and the noted methodological limitations of the studies published to date. Nonetheless, substantial progress in this clinical research area has occurred, and if research and funding support continue or can expand, significant breakthroughs in the treamtment of drug abuse with family-based treatments are possible.     

Youth and violence: Phenomena and international data

The topic of youth, violence, and disintegration needs addressing because young women and men are the world's greatest capital. They have the energy, talent, and creativity for building a future. But this group also suffers grave vulnerabilities. The time of adolescence includes important and difficult periods of life (for example, becoming more independent from the family, finding an adequate position in society, and starting a family of one's own). All of these points are strongly correlated with social integration, employment, and a place in the labor market--important factors in this context.This article gives an overview of the international development and the actual situation of socially harmful behavior among youths--both fatal violence (homicide) and nonfatal violence (such as bullying, fighting, and carrying weapons). The author shows that different kinds of youth violence represent social problems in every society. The data show that youths are not only perpetrators but also the group with the highest risk of becoming victims of violence. Furthermore, the data from around the world show that their vulnerability is not limited to this sphere. It arises also from their social conditions, especially their high risk of being disintegrated from the labor market. The parallels in the data underline the significance of a functioning institutional structure without positing a deterministic relationship between the risk of economic disintegration and violent behavior.     

Multi‐type maltreatment and the long‐term adjustment of adults

Multi‐type maltreatment refers to the experience of more than one form of child maltreatment (sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence). Researchers have largely ignored the presence of other types of child abuse and neglect when examining the adjustment problems associated with a particular form of maltreatment. The association between ‘multi‐type maltreatment’ and adjustment was explored in the current study. Retrospective data were obtained on (a) the degree to which maltreatment types co‐occurred, (b) childhood family characteristics and (c) adjustment problems in adulthood in an Australian self‐selected community sample (N=175). As hypothesized, a large degree of overlap was reported in the experience of the five types of maltreatment. Family characteristics—particularly family cohesion and adaptability—discriminated between respondents reporting single‐type and multi‐type maltreatment. Greater adjustment problems were associated with reports of a larger number of different maltreatment types. Multi‐type maltreatment should be recognized as a crucial aspect of the nature and impact of child maltreatment and considered in the development of programmes for the prevention and treatment of child abuse and neglect. Copyright © 2000 John Wiley & Sons, Ltd.     

When the levee breaks: treating adolescents and families in the aftermath of hurricane katrina

Hurricane Katrina brought to the surface serious questions about the capacity of the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the model's effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.     

Prevention of Child Sexual Abuse within the Family System: Guidelines for an Educational Social Group Work Program

Children have the right to be brought up in safe environments. However, this right is often infringed by people who are supposed to provide love, care, and protection to children. These people can include biological fathers, step-fathers, brothers, cousins, aunts, mothers, and uncles. Violation of children takes place in a variety of ways, however, for the purpose of this paper, the focus is on child sexual abuse within the family system. A literature review is adopted as the methodology for the discussions in this paper. The purpose of this paper is firstly to demonstrate that child sexual abuse happens within the family system in South Africa, and secondly, to argue that the prevention of child sexual abuse should start within the family system and this can be achieved by conducting educational social group work sessions on child sexual abuse with the family members.     

Sexual Risk-Taking among High-Risk Urban Women with and without Histories of Childhood Sexual Abuse: Mediating Effects of Contextual Factors

This study investigated the mechanisms of risk for urban women at high risk for HIV with and without childhood sexual abuse histories. Childhood sexual abuse survivors reported more unprotected intercourse and sexually transmitted infections (STIs). The association of STI locus of control with frequency of unprotected sex was fully mediated by being intoxicated during sex and engaging in sex work, whereas the association between relational control and unprotected sex was not mediated by contextual factors for the childhood sexual abuse group. The mechanisms of risk are different for those with divergent childhood sexual abuse histories and thus interventions should be developed to educate women with a history of childhood sexual abuse about ways to avoid revictimization, particularly within a context of poverty, prostitution, and drug use.     

Trauma reactions of bystanders and victims to repetitive abuse experiences

This study investigated psychological distress as measured by the Impact of Events Scale-Revised and physiological reactivity as measured by skin conductance and heart rate in bystanders as compared to direct victims of prevalent forms of repetitive abuse (e.g., bullying). Participants (N = 77) were interviewed twice: once to recall witnessing another person be abused repeatedly over time, and again to recall similar experiences as a victim. Present levels for bystander and victim distress were not significantly different, but distress levels were significantly greater for victim experiences at the time the repetitive abuse occurred. Scores for both groups were comparable to or exceeded scores associated with natural disasters and other life threatening experiences reported in the literature. Findings suggest repetitive abuse may affect bystanders and victims in similarly serious ways at the time the events occur and later in life.     

Pediatric Emergency Department Visits for Mental Health Crisis: Prevalence of Cyber-Bullying in Suicidal Youth

The objective of this work is to (1) study the prevalence of cyber-bullying amongst adolescents referred by Pediatric Emergency Department (PED) for urgent psychiatric assessment and (2) to examine the association between cyber-bullying and suicidal behavior to assist emergency department professionals in screening for risk and triage. This is a retrospective study of patients referred by PED to an urgent psychiatric clinic. Data was extracted for those with bullying victimization. Clinical variables included demographics, reason for referral, type of bullying, substance use, abuse, past psychiatric history, diagnosis and outcome. The cyber-bullying group was compared to those with traditional bullying and a group with no-bullying. Data analysis was conducted using Chi squares, multinomial and bimodal logistic regression. The urgent psychiatric clinic assessed 805 patients in 24 months, the prevalence of bullying was 26.9 % (n = 217). The prevalence of Cyber-bullying was 13.5 % (n = 109) and traditional bullying was 13.4 % (n = 108). Cyber-bullying victims have more suicidal ideation (χ² = 7.82, p = .005; 85.3  vs. 69.4 %), more sexual abuse (χ² = 5.75, p = .02; 29.4  vs. 15.7 %), more emotional abuse (χ² = 10.8, p = .01; 30.3  vs. 12.0 %) and physical abuse (χ² = 6.13, p = .01; 27.5  vs. 13.9 %) and a higher inpatient admission rate. Suicidal ideation is the presenting problem in more than two-thirds of patients, especially females, with history of cyber-bullying who present to the PED. Screening questions about cyber-bullying could assist emergency room professionals in establishing risk and making triage decisions.     

Abuse and deaf children: Some factors to consider

Deaf children are uniquely disadvantaged in terms of access to information on safety and abuse. This is often due to misunderstood linguistic and cultural needs which relate to the deaf community. Consequently, a greater number of children who are deaf are placed in potentially abusive situations when compared to their non-deaf peer group. A high percentage of deaf children have also acquired negative self-concepts. This is often due to external influences such as educational experiences and family communication. Many deaf children believe that abuse is part of their being deaf. The implications of this are that deaf children are at risk of neglect and abuse as well as long-term damage to their emotional development and self-esteem. A number of survivors of physical and sexual abuse have been referred to the National Centre for Mental Health and Deafness, Preston. Some of these referrals have been inappropriate and due to a dearth of local resources. Extremely little support is available for deaf people who have been or are being abused. There are few appropriately trained counsellors equipped with the necessary skills in communicating with deaf people and even fewer trained in deaf awareness. A number of risk factors have been identified and are illustrated in this article. Three case studies are described to highlight the issues involved.