Healthcare professionals' priorities for child abuse educational programming: A Delphi study

Child abuse reporting and intervening are a complex process. A comprehensive training program with targeted goals and priorities enables professionals to effectively address the needs of abused children and their families. The study purpose was to identify the content and priorities of health professional education in child abuse by integrating expert opinions and achieving consensus. A 3-round Delphi study was conducted with 25 multidisciplinary experts in health care, social welfare, psychology and counseling, and law and jurisdiction. Structured questionnaires collected expert opinion of appropriateness and importance of knowledge, subjective norms, attitudes, skills, team collaboration and teaching strategies. The expert response rates ranged from 96 to 100% for the 3 rounds, and consensus was achieved. Knowledge was regarded as the most important element. Two items on forensic evidence in the skill category received the highest importance score. Results provide a basis to develop educational programs achieving clinical competence in child abuse care.     

Mothers' and Fathers' Work Hours,Child Gender,and Behavior in Middle Childhood

This study examined the association between typical parental work hours (including nonemployed parents) and children's behavior in two‐parent heterosexual families. Child behavior was measured by the Child Behavior Checklist (CBCL) at ages 5, 8, and 10 in the Western Australian Pregnancy Cohort (Raine) Study (N = 4,201 child‐year observations). Compared to those whose fathers worked fewer hours per week, children whose fathers worked 55 hours or more per week had significantly higher levels of externalizing behavior. This association was not explained by father–child time during the week, poorer family functioning, or overreactive parenting practice. Further, when stratifying the analysis by child gender, this association appeared to exist only in boys. Mothers' work hours were unrelated to children's behavioral problems. The role of parent and child gender in the relationships between parental work hours and children's behavioral problems, together with mediating factors, warrants further investigation.     

Therapeutic Engagement of Adolescents with Emotional and Behavioral Disorders

Youth engagement is increasingly recognized as a preferred approach and often necessary step in the treatment of emotional and behavioral disorders. The purpose of this study was to explore the degree and quality of youth engagement in the therapeutic process, compare engagement scores between youth accessing residential and day treatment, and explore the association between engagement and interpersonal difficulties in a sample of youth with an emotional and/or behavior disorder in residential and day treatment programs based in Southern Ontario. Cross-sectional surveys of standardized measures were administered to youth and a separate survey to their Prime Workers. Relevant constructs included client engagement (as rated by youth and Prime Workers), and youth-rated behavioral screen, interpersonal problems and family functioning. Both Prime Workers and youth rated youth as moderately high in their level of engagement in therapy. Furthermore, Prime Worker and youth ratings did not significantly differ statistically, suggesting that youth may have actually engaged at a moderate level. Interpersonal problems were shown to be negatively associated with youth engagement, and family functioning approached significance for only youth in residential treatment. Assessing youth engagement during the treatment process as an intervention technique may highlight areas where greater clinical efforts are needed. Future considerations include testing methods of sharing and discussing results of an engagement measure within the context of a one-on-one clinical encounter with youth.     

Family Processes and Problem Behaviors in Middle‐Class African American Adolescents

This study examined the joint association between mothers’ and adolescents’ ratings of parental behavioral control and adolescents’ and observers’ ratings of mother – adolescent communication with adolescent problem behaviors in a sample of 86 middle‐class African American early adolescent boys and girls (age: M= 13.08 years, SD= 1.32) and their mothers. Consistent with hypotheses, greater adolescent‐rated parental behavioral control and better observer‐rated mother – adolescent communication were associated with lower levels of adolescent problem behavior, as examined using structural equation modeling. Furthermore, interrelationships between age and adolescent problem behavior were partially mediated by adolescents’ reports of parental behavioral control and observers’ ratings of positive mother – adolescent communication, which both decreased with adolescents’ age. Although the sample was primarily middle class, higher socioeconomic status was associated with more positive mother – adolescent communication, as rated by observers. Problem behavior was greater among boys than girls, but the hypothesized indirect effect of gender on problem behavior through associations with parenting was not observed. The findings demonstrate the utility of conceptually distinguishing between parenting and parent – adolescent relationships, and suggest that both have unique influences on middle‐class African American adolescents’ problem behavior.     

Effects of kinship care on behavioral problems by child age: A propensity score analysis

When a child must be removed from the family home, placement with a relative is often sought because kinship care is the least restrictive and most family-like out-of-home placement. Although kinship care has become a preferred option in most U.S. child welfare systems, this preference is often based on “soft evidence” rather than rigorous evaluation of the risks and benefits of kinship care. Therefore, an evaluation of the impact of kinship care on child behavioral problems is needed to guide child welfare practice and policy. In addition, given that children of different ages and in different developmental stages are likely to have varying placement experiences, the evaluation of kinship care should explore the effect of kinship care on child behavioral problems across age groups. To fill these knowledge gaps, we compare the behavioral problems of 584 children in kinship care with those of 470 children in non-kinship care. Moreover, we examine the impact of kinship care on behavioral problems in 2 age groups: younger children (0 to 5 years) and older children (6 to 17.5 years). The analysis uses data from Waves 1 and 2 of the National Survey of Child and Adolescent Wellbeing, and applies propensity score methods to account for selection bias. Results show that older children in kinship care had significant lower levels of externalizing, internalizing, and total behavior problems. However, for younger children, the effects of kinship care on child behavioral problems did not reach statistical significance. The implications for practice, research and policy are discussed.     

Effectiveness of ACT Raising Safe Kids Parenting Program in a developing country

The present study evaluated the effectiveness of the Adults and Children Together (ACT) Raising Safe Kids Parenting Program for violence prevention in a developing country. The specific objectives were the following: (i) to compare parenting practices according to the mothers' perceptions pre- and post-intervention and (ii) to compare child behavior problems and resources according to mothers' and other caregivers' perceptions pre- and post-intervention. The participants were 82 Brazilian mothers of 3- to 8-year-old children. Another caregiver of the child was included in the study as a second informer about child behavior (n = 72). Mothers participated in the ACT program and pre- and post-intervention evaluations. The other primary caregiver only participated in the two evaluations of child behavior. The results showed that parenting practices improved significantly from pre- to post-intervention. Mothers and the other primary caregivers reported a significant decrease in child behavior problems from pre- to post-intervention with regard to total behavioral difficulties, emotional symptoms, and peer relationship scales. Mothers also reported a significant decrease in scores for conduct problems and hyperactivity and improvements in child behavioral capabilities with regard to prosocial behavior. In conclusion, improvements on parenting practices and child behavior were observed after the ACT program.     

Association of caregiver social support with the safety,permanency, and well-being of children in child welfare

Focusing on families having contact with the child welfare system, this study aims to assess whether caregiver social support is associated with the three primary child welfare goals: child safety, permanency and well-being. The study uses a national probability sample of children having contact with the child welfare system and a prospective study design. It includes both caregiver and caseworker indicators of social support. Consistent with previous research, study results suggest that different indicators of caregiver social support are associated with different child welfare outcomes. Notably, when caregivers were more satisfied with their social support and caseworkers rated caregiver social support as adequate, children were less likely to be placed out of the home. Also, caregivers who had more people to call on for support rated their children as having less severe behavior problems. Implications for practice are addressed.     

Training family therapists to work with children and families: a modified Delphi study

This study examined child inclusion issues and training marriage and family therapists (MFTs) to treat children. This modified Delphi study utilized a panel of experts, and gathered data through questionnaires and qualitative interviews. Panelists believe children should participate in family therapy sessions for both child and adult problems, except when parents are discussing sex or sensitive issues. Child-focused courses should emphasize developmental issues, engaging techniques, theoretical issues, play therapy theory, MFT treatment for child disorders, and specific child/family problems. Panelists suggest numerous child-focused references, but reached consensus for only one. Key therapist attributes and skills were identified. Deductive and inductive training methods and the role of supervision were highlighted. Although therapist playfulness and creativity were emphasized, few play techniques were included in the final profile.     

Children placed in long-term family foster care: A longitudinal study into the development of problem behavior and associated factors

Due to prior experiences of trauma and abuse, many foster children have behavioral problems. The placement of the child in a family foster home is expected to reduce the behavioral problems. However, this expectation is seldom met and mostly behavioral problems increase or remain stable during placement. Research on the development of behavioral problems in foster children is scarce. Moreover, most of the research results are situated on a group level, which obscures the development of problem behavior on a case level. This study investigated the development of problem behavior of 49 foster children on a case level and the association of global, contextual, familial and child factors with the increase or decrease of problem behavior. Over a two year period 18 foster children had more, 23 just as much and 8 less problem behavior. An increase was associated with the use of more negative parenting strategies by the foster mothers. A decrease was related to the use of supportive parenting. Support of foster parents aiming at reducing the use of negative discipline practices and promoting the use of supportive parenting may have a positive effect on the development of foster children.     

Planning for Medical Progress through Education. By Lowell T. Coggeshall,M.D. Evanston,Illinois: Association of American Medical Colleges, 1965. 107 pp. $2.00

Abstract

A 1980 study using the Delphi technique identified field instruction issues and research priorities. In this article, the author reports the findings of a study undertaken to determine if the issues and priorities have changed in the past decade. Twelve national experts reached a consensus on 29 of 61 statements/issues and on three research priorities for the next decade. As in 1980, the study participants viewed the Delphi technique as having strength in gaining consensus, allowing dialogue between geographically separated experts, and serving as an effective means of learning for participants. The prioritized research agenda developed by the experts in 1991 includes the need for empirical analysis of outcomes related to field education; models to ensure quality of field instruction; and processes to help field instructors assist students, especially in integrating classroom and field instruction.     

Disclosure and Psychological Well-Being of Sexually Abused Adolescents in Hong Kong

The role of disclosure on psychological well-being of adolescents with child sexual abuse experience was investigated in a subsample of 74 disclosers among 800 adolescents recruited in the community in Hong Kong. The results supported that CSA experiences have differential impact on adolescents’ psychological well-being. Family characteristics of the disclosers accounted for only a small amount of the variance in an array of psychological well-being measures. CSA characteristics were robust predictors of disclosers’ sexual eroticism and externalizing behavioral symptoms. Disclosers’ cognitive appraisal of CSA experience and quality of parental attachment were strong predictors of their self-esteem and internalizing behavioral problems. After controlling for the aforementioned factors, negative disclosure experience still significantly predicted lower self-esteem, higher sexual anxiety, more internalizing behavior, and more severe post-traumatic stress disorder responses. Research to understand the factors that generate negative disclosure experiences is needed for developing effective intervention strategies to mitigate the negative consequences of disclosure.     

Attitude theory and behavioral costs

The Fishbein and Ajzen reasoned action model is briefly introduced and some theoretical aspects of the model arc discussed. Based on a critical analysis of the act and behavioral category concepts in their model an alternative concept, ‘behavioral field’, is introduced. A behavioral field is defined as: ‘the total of acts that are perceived by the acting individual as leading to a common goal or valued state’. Then a distinction is made between goal acts and instrumental acts, Goal acts lead to goal attainment. Instrumental acts will bring the individual into the direction of his goal. It is argued that for acts that are predominantly instrumental other substitutable acts are available. The choice between suhstitutable instrumental acts is governed by both expected outcomes and the behavioral costs attached to the acts. Behavioral costs are defined as the behavioral price relative to the behavioral budget. The behavioral price is determined by tile time, psychic and physical task demand. The behavioral budget is a function of the goal importance of the behavioral field. Some further aspects of behavioral costs are then discussed. Several arguments to treat costs and outcomes separately in the explanation of behavior, are elaborated. Then some implications from the behavioral cost concept are drawn for attitude theory. Finally the entangling of costs and value is briefly discussed.     

Child protection decision-making: social workers’ perceptions

ABSTRACT

Decision-making is located at the heart of social work as a core professional activity, because much of what social workers do concerns decisions about future courses of action. Drawing on elements of the learning together systems model and Falkov’s Systemic Family Model, this study investigated social workers’ perceptions regarding how child protection decisions are made. Evidence was drawn from a constructivist–-interpretivist qualitative research design, involving 16 semi-structured interviews with qualified and experienced social workers and 20 direct, non-participant observations of child protection meetings. Evidence from the study suggests that professionals and family members do not rely entirely on the guidance on the threshold criterion of the likelihood and significance of risk of harm when making decisions. Instead, they use discretionary intuition and analytical judgement, involving multidimensional criteria which includes consensus between professionals and with family members; individual professional’s state of mind; other agencies and professionals’ priorities as well as external factors such as the availability of resources. Conclusion can be drawn that existing guidance on decision-making is inadequate, hence the discretionary use of a combination of intuitive heuristics and analytical thinking in a complementary manner. This study, therefore, contributes to considerable conceptual clarity regarding the complex child protection decision-making process.     

Challenging Parenting Behavior from Infancy to Toddlerhood: Etiology,Measurement, and Differences between Fathers and Mothers

Based on evidence that fathers show more challenging and physical play than mothers, it has been theorized that fathers have a different parenting role, more focused at stimulating exploration and taking chances. Challenging parenting behavior (CPB) may foster confidence and buffer against anxiety development in children. In this study, CPB was assessed in fathers and mothers at child ages of 4 months, 1 year, and 2.5 years, using newly developed questionnaires and observational tasks. Reliability of the questionnaire and observational measures was good, and fathers' and mothers' self‐rated CPB showed a similar factor structure. Modest and significant convergence between questionnaires and observations provided support for validity of CPB, whereas negative correlations with overprotection supported divergent validity. CPB correlated positively with warmth. We further found moderate to high stability of CPB from early infancy to toddlerhood, and interparental correspondence in CPB. Fathers and mothers did not differ in observed CPB, but fathers rated themselves higher than mothers in toddlerhood. It is concluded that the development of the instruments to assess CPB was successful. Overall, the results reveal similarities rather than differences between fathers' and mothers' CPB in early childhood. The potential relevance of CPB in child development and psychopathology is discussed.     

Engagement across three social media platforms: An exploratory study of a cause-related PR campaign

This study analyzed a social media campaign promoting child welfare to explore the associations among people's social media use, their engagement with different social media platforms (blog, Facebook page, Twitter account), and three intended behavioral outcomes (social media behavior, offline communication behavior, and helping behavior). An online survey of 73 participants shows that people's use of each social media platform was significantly related to their engagement with it at a bivariate level (when the other control variables were not considered). Social media use was also related to all three behavioral outcomes. Additionally, users’ engagement played a significant mediating role in the relationship between their social media use and their offline communication behavior.     

Child abuse, early maladaptive schemas, and risky sexual behavior in college women

Previous research suggests that individuals abused as children are more likely to engage in risky sexual behavior during adulthood. The present study examined early maladaptive schemas as mediators of the child abuse-risky sexual behavior relationship among 653 college women. Self-report surveys assessed three forms of child abuse: Sexual, physical, and emotional, and assessed early maladaptive schemas within two domains: Disconnection/rejection and Other-Directedness. Disconnection/rejection schemas fully mediated the relation between child emotional abuse and number of sexual partners and partially mediated the relationship for sexual and physical abuse. However, when frequency of specific risky sexual acts (e.g., sex without contraception) was examined in the previous six months, only abandonment was a partial mediator. Implications for intervention and future research are discussed.     

Child Abuse,Early Maladaptive Schemas,and Risky Sexual Behavior in College Women

Previous research suggests that individuals abused as children are more likely to engage in risky sexual behavior during adulthood. The present study examined early maladaptive schemas as mediators of the child abuse–risky sexual behavior relationship among 653 college women. Self-report surveys assessed three forms of child abuse: Sexual, physical, and emotional, and assessed early maladaptive schemas within two domains: Disconnection/rejection and Other-Directedness. Disconnection/rejection schemas fully mediated the relation between child emotional abuse and number of sexual partners and partially mediated the relationship for sexual and physical abuse. However, when frequency of specific risky sexual acts (e.g., sex without contraception) was examined in the previous six months, only abandonment was a partial mediator. Implications for intervention and future research are discussed.     

Participant responses to retrospective surveys of child maltreatment: does mode of assessment matter?

This study examines the impact that different methods of assessing child maltreatment history may have on adult participants. A total of 334 female undergraduate students were randomly assigned to complete a retrospective measure of child sexual and physical abuse in one of three conditions: paper-and-pencil questionnaire, face-to-face interview, or computer-administered survey. Disclosure rates of abuse, psychological distress and mood change, preferences for assessment format, and perceptions of confidentiality were examined across the three assessment formats. Although disclosure did not vary by condition, participants with a history of abuse reported more distress and mood change than did nonvictims, particularly in the computer condition. Nevertheless, the computer condition was rated as the most preferred format and was viewed by participants as the most confidential means of assessing maltreatment history. Participants reporting abuse through interviews were more likely than those in other conditions to state a preference for another type of assessment format. The implications of these findings for abuse history research are discussed.     

Child care improvement on a shoestring: evaluating a low-cost approach to improving the availability of quality child care

The Philadelphia Early Childhood Collaborative (the Collaborative) was designed to improve the quality of child care by increasing coordination among organizations that locally deliver professional resources to child care providers. The evaluation examined the implementation of the Collaborative, utilization of its services, and the impact of service use on child care quality. Child care providers reported gains in their professional knowledge and behavior from using Collaborative resources and rated the resources highly. No long-term effects on provider behavior, knowledge, or attitudes were observed. Although the original organizations were able to function collaboratively and Collaborative services were widely used, more intensive interventions may be required to change the availability of quality child care.     

Perceptions of Children’s Parental Preferences in Lesbian Two‐Mother Households

This study explores how lesbian mothers perceive their 3½‐year‐old children’s parental preferences in families in which one mother is genetically linked to the child. Thirty lesbian couples (60 women) were interviewed about their children’s parental preferences, their explanations of why preferences for one parent existed (or not), and their affective and behavioral reactions to such preferences. Many women acknowledged that their children, as infants, preferred their birth mothers due to biological factors (i.e., breastfeeding) or differential time spent with the child. Despite this initial preference, most women perceived little stability in children’s preferences over time, such that children preferred both mothers equally. Findings support the power of “social motherhood” in fostering maternal connections that transcend biological relatedness over time.