Psychotherapeutic care for sexually-victimized children – Do service providers meet the need? Multilevel analysis |
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| Institution: | 1. Child Protection Team, University Children''s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland;2. Department of Psychosomatics and Psychiatry, University Children''s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland;3. Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Binzmuhlestrasse 14, 8050 Zurich, Switzerland;4. School of Social Work, Lucerne University of Applied Sciences and Arts, Werftestrasse 1, Postfach 2945, 6002 Lucerne, Switzerland;5. Psychiatric Services of St. Gallen North, Zurcherstrasse 30, 9501 Wil, Switzerland;6. Epidemiology, Statistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland;7. Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091 Zurich, Switzerland;1. Southwest Institute for Research on Women, University of Arizona, 181 S. Tucson Blvd., Suite 101, Tucson, AZ 85716, United States;2. Roswell Park Cancer Institute, Office of Cancer Health Disparities Research, Cancer Prevention and Control, Elm & Carlton Streets, Buffalo, NY 14263, United States;1. School of Social Work, California State University, San Bernardino, USA;2. School of Social Work, University of Southern California. USA |
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| Abstract: | ObjectivesSurprisingly little is known on the decision to refer sexually-victimized children to psychotherapy. Previous research on service provisions for victims of child maltreatment has analyzed the impact of case characteristics, like child or caregiver functional levels, lack of social support, and socioeconomic status. Findings, however, show that the decision to provide services is not only needs-driven, but also affected by external factors like provincial legislation, institutional policies, and the availability and accessibility of services. By analyzing characteristics behind the decision to refer sexually-victimized children to psychotherapy at the case and institutional level, we aimed to disentangle the complex interplay of factors driving this decision.MethodsThe data for this analysis were drawn from the first nationally-representative agency survey on reported child sexual victimization (CSV) in Switzerland. Over a 6-month data-collection period, 165 child protective services, 87 penal authorities and 98 agencies in the health and social sector documented a total of 911 incidents of CSV. Multilevel logistic regression was applied to analyze factors at both the case and contextual level.ResultsThe main finding was that the severity of consequences was strongly associated with the probability of psychotherapeutic service referrals (OR = 10.4; p < 0.001). However, one bias was identified at the individual level: sexually-victimized children born in Switzerland were more likely to be referred to psychotherapy than immigrant children. Institutional disparities in the decision to refer a sexually-victimized child to psychotherapy were large (median OR = 3.83), with penal authorities referring significantly fewer cases to psychotherapy than specialized agencies in the health and social sector. What exactly was driving the difference between psychotherapy referral in different types of agency remains largely unexplained.ConclusionsFuture research should invest in scrutinizing contextual factors of child protective service decisions. As we operationalize the need for psychotherapy as proxy-rated consequences of victimization, routine screening for mental health needs using standardized measures for children in contact with child protection agencies should be implemented, to help frontline workers to identify the psychotherapeutic needs of victimized children. |
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