Establishment of interdisciplinary child protection teams in Turkey 2002-2006: identifying the strongest link can make a difference!

Child Adversity and Trauma-Informed Care Teaching Interventions: A Systematic Review

OBJECTIVES

Health professionals need training to provide trauma-informed care (TIC) for children with adverse childhood experiences (ACEs), which can affect short- and long-term health. We summarize and evaluate published curricula for health professionals on ACEs and TIC.

METHODS

We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, PsychInfo, and MedEdPORTAL through January 2021. Studies meeting the following criteria were included: Described teaching interventions on ACEs, TIC, and child abuse and maltreatment; included health care providers or trainees as learners; were written in English; included an abstract; and described a curriculum and evaluation. We reviewed 2264 abstracts, abstracted data from 79 studies, and selected 51 studies for qualitative synthesis.

RESULTS

Studies focused on ACEs/TIC (27), child abuse (14), domestic/intimate partner violence (6), and child maltreatment/parental physical punishment (4). Among these 51 studies, 43 were published since 2010. Learners included a mix of health professionals (34) and students (17). Duration, content, and quality of the 51 curricula were highly variable. An analysis of 10 exemplar curricula on ACEs and/or TIC revealed high and very high quality for methods and moderate to very high quality for curriculum evaluation, suggesting that they may be good models for other educational programs. Four of the 10 exemplars used randomized controlled trials to evaluate efficacy. Studies were limited to English language and subject to publication bias.

CONCLUSIONS

ACEs and TIC are increasingly relevant to teaching health professionals, especially pediatricians, and related teaching curricula offer good examples for other programs.

Self-reported knowledge, attitudes, and practice of final-year dental students in relation to child abuse: A multi-centre study

BACKGROUND

The number of child abuse cases is increasing worldwide; therefore, it is important to educate individuals having contact with children about it. This includes dentists who play a pivotal role in detecting and reporting child abuse.

AIM

To identify and compare the final- year dental student's knowledge, attitudes, and practice in relation to child abuse.

DESIGN

A 38- item and four- part online questionnaire was distributed to students of 11 dental schools in 10 countries. SPSS and GraphPad Prism were used for data analysis. The levels of statistical significance were determined using a chi- square test. P ≤ .05 was considered to be statistically significant.

RESULTS

A total of 660 students completed the survey. Fifty- six percent of the students received formal training on child abuse, and 86% wanted additional training. The knowledge of child abuse was significantly higher in Australia, the United States, and Jordan compared with other countries. Internet (60.3%) was commonly used as an information source for child abuse.

CONCLUSIONS

The study showed that dental students lack knowledge and experience in recognizing and reporting child abuse. Most respondents indicated a desire for additional training; therefore, dental schools should review what they are currently teaching and make changes as appropriate.

Evaluation of Pediatric Forensic Cases Admitted to the Emergency Department in Turkey: A Retrospective Analysis

AIM

The aim of this study was to determine retrospectively the demographic characteristics of forensic cases aged 0-18 years who were admitted to the emergency department.

METHOD

A total of 14,352 pediatric forensic cases aged 0-18 years, who were admitted to the emergency department of a hospital, were analyzed retrospectively in terms of the date of presentation, age, gender, and type of case.

RESULTS

Among the pediatric cases presenting to the emergency department, 56% were due to falling, 19% were due to burns, 8.5% were due to poisoning, 7.4% were due to animal bites, 5.3% were due to traffic accidents, 3.4% were due to battery, and 0.4% were due to other phenomena (electric shock and sexual abuse). Examination of the distribution of cases in terms of age showed that falling (16.4%), burns (25.7%), and poisoning (28%) were more frequent in boys in the age group of 15-18 months and in girls in the age group of 0-12 months. Presenting to the emergency department because of sexual abuse was observed to be more frequent in girls in the age groups of 10-14 years (40%) and 15-18 years (26.7%).

CONCLUSION

The high rates of falling, burns, and poisoning cases among children observed in this study suggest that child neglect and abuse were high and reveal the necessity of the presence of forensic nurses in the emergency departments.

A national educational campaign to raise awareness of child physical abuse among health care professionals

Education is necessary to improve child physical abuse detection and management. A few studies have described national child abuse training programs, but none has measured changes in knowledge among participants. A collaboration of child abuse experts from the USA, an academic pediatric department, and a non-governmental organization in child protection aimed at (a) training hospital physicians in a train-the-trainer course for the detection and management of child physical abuse and (b) conducting workshops and measuring attendance and gain of knowledge of participants. A train-the-trainer and a national curriculum were created. A 78-item and a 20-item knowledge questionnaire were used pre and post the train-the-trainer course and all workshops, respectively. Nineteen physicians from all pediatric departments of the seven medical schools in Greece attended the course. Eight workshops in seven cities took place with a total attendance of 1220 health care professionals. Gain of knowledge was demonstrated for participants in the train-the-trainer course (p = 0.0015) and local workshops (p < 0.001).Conclusion: We successfully engaged physicians from all medical schools in Greece and conducted a train-the-trainer module and eight workshops in major cities that improved the participants' knowledge in child physical abuse. This approach may help address physician deficiencies in emerging areas of child abuse clinical practice. What is Known: • Education is necessary to improve child physical abuse detection and management. • Although national training programs have been described, none has measured participants' changes in knowledge. What is New: • A collaboration of child abuse experts, all medical schools in Greece, and a non-governmental organization resulted in a national educational campaign in child physical abuse and gains in knowledge for participants. • This approach may help address deficiencies in emerging areas of clinical practice.

Assessment of knowledge and attitudes of dental students in regard to child abuse in Turkey

INTRODUCTION

Child abuse is a serious public problem. Signs of abuse are often present in the oro-facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to investigate dental students' knowledge about and attitudes towards child abuse.

MATERIAL AND METHODS

This study was performed at the Faculty of Dentistry of the Ondokuz Mayis University. The data were collected through a self-report questionnaire administered to dental students (137 female/111 male) in three different dental classes (third, fourth and fifth study years) and grouped by considering those students who have been training in the school year of 2013. The definition of physical and social indicators of abuse, awareness regarding legal and ethical responsibilities, students' experience and requests made by students were evaluated by the students' response to questions put in the questionnaire. Descriptive statistics and chi-square tests were performed to analyse the questionnaire data.

RESULTS

The questionnaire completion rate was 100%. About 67.74% of the third year, 40.71% of the fourth year and 16.67% of the fifth year believed that they could detect child abuse cases. However, results indicated a major lack of knowledge of social indicators, signs of physical abuse and reporting procedure amongst all respondents. The assessment of the total correct answers exhibited significant differences amongst third-, fourth- and fifth-year students' answers. Fifth-year students had the highest rate of correct responses (P < 0.05). Most students wanted to receive more knowledge about this topic.

CONCLUSION

Dental students in Turkey are not sufficiently prepared for their role in diagnosing suspected cases of child abuse.

Strategies to promote uptake and use of intimate partner violence and child maltreatment knowledge: an integrative review

BACKGROUND

Intimate partner violence (IPV) and child maltreatment (CM) are major social and public health problems. Knowledge translation (KT) of best available research evidence has been suggested as a strategy to improve the care of those exposed to violence, however research on how best to promote the uptake and use of IPV and CM evidence for policy and practice is limited. Our research asked: 1) What is the extent of IPV/CM-specific KT research? 2) What KT strategies effectively translate IPV/CM knowledge? and 3) What are the barriers and facilitators relevant to translating IPV/CM-specific knowledge?

METHODS

We conducted an integrative review to summarize and synthesize the available evidence regarding IPV/CM-specific KT research. We employed multiple search methods, including database searches of Embase, CINAHL, ERIC, PsycInfo, Sociological Abstracts, and Medline (through April, 2013). Eligibility and quality assessments for each article were conducted by at least two team members. Included articles were analyzed quantitatively using descriptive statistics and qualitatively using descriptive content analysis.

RESULTS

Of 1230 identified articles, 62 were included in the review, including 5 review articles. KT strategies were generally successful at improving various knowledge/attitude and behavioural/behavioural intention outcomes, but the heterogeneity among KT strategies, recipients, study designs and measured outcomes made it difficult to draw specific conclusions. Four key themes were identified: existing measurement tools and promising/effective KT strategies are underused, KT efforts are rarely linked to health-related outcomes for those exposed to violence, there is a lack of evidence regarding the long-term effectiveness of KT interventions, and authors' inferences about barriers, facilitators, and effective/ineffective KT strategies are often not supported by data. The emotional and sometimes contested nature of the knowledge appears to be an important barrier unique to IPV/CM KT.

CONCLUSIONS

To direct future KT in this area, we present a guiding framework that highlights the need for implementers to use/adapt promising KT strategies that carefully consider contextual factors, including the fact that content in IPV/CM may be more difficult to engage with than other health topics. The framework also provides guidance regarding use of measurement tools and designs to more effectively evaluate and report on KT efforts.

Child abuse and neglect in Turkey: professional, governmental and non-governmental achievements in improving the national child protection system

Since ratification of the United Nations Convention on the Rights of the Child in 1995, significant efforts were made in Turkey to improve protection of children from abuse and neglect. The government took steps to amend relevant laws. Several state departments recognized the need for professional in-service training of relevant governmental agency staff. University hospitals established numerous hospital-based multidisciplinary child protection centres. The government established an Interministerial Higher Council, which has been overseeing the foundation of 13 child advocacy centres for a multidisciplinary and interagency response to child sexual abuse. In addition to undertaking research, non-governmental organizations contributed to this process by instituting professional and public education. These ground-breaking developments in the last decade give promise of even further improvement in the national child protection system from investigative, child protective and rehabilitative perspectives.

Group psychotherapy in women with a history of sexual abuse: what did they find helpful?

AIMS AND OBJECTIVES

To define the effects of group psychotherapy in women with a history of sexual abuse, to find possible predictors for dropout and treatment outcome rates and to find which therapeutic factors of group psychotherapy are perceived by group members to be most helpful.

BACKGROUND

Sexual abuse of women is a global concern and causes many psychiatric and psychological sequelae. Group psychotherapy is one of the preferred treatment modalities.

DESIGN

Prospective cohort study.

METHODS

Forty-seven women with a history of childhood and/or adulthood sexual abuse were recruited for weekly 12-session group psychotherapy. Subjects were given the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Clinician Administered Post-traumatic Stress Disorder Scale, the Dissociative Experiences Scale, the Childhood Trauma Questionnaire and the Group Therapeutic Factors Questionnaire. Re-evaluations were made after the 6th and 12th session and also at a six-month follow-up session.

RESULTS

Group psychotherapy significantly reduced participants' levels of depression (screening/12th session mean scores, 22.45/11.10), anxiety (15.45/4.32) and symptoms of post-traumatic stress disorder (42.27/9.32), and this decline became statistically significant at the 6th session and tended to persist at the six-month follow-up. Higher levels of dissociative symptoms at baseline were associated with less response to treatment, but higher levels of attendance at group sessions. Group members rated existential factors (41.40 ± 12.39), cohesiveness (37.42 ± 8.32) and universalism (37.56 ± 7.11) as the most helpful therapeutic factors.

CONCLUSION

Group psychotherapy was significantly effective in reducing levels of depression, anxiety and posttraumatic stress disorder symptoms in this sample of women. Dissociation had a significant effect on both treatment outcome and treatment adherence. For this sample of women, group psychotherapy was most helpful for reducing feelings of stigma, isolation and shame.

RELEVANCE TO CLINICAL PRACTICE

Group psychotherapy can be used as a preferred treatment method for women from different cultural backgrounds with a history of sexual abuse.

Preliminary validation of the Child Abuse Potential Inventory in Turkey

This study aims to provide preliminary findings on the validity of Child Abuse Potential Inventory (CAP Inventory) on Turkish sample of 23 abuser and 47 nonabuser parents. To investigate validity in two groups, Minnesota Multiphasic Personality Inventory (MMPI) Psychopathic Deviate (MMPI-PD) scale is also used along with CAP. The results show that, with the 200.5 cutoff point, which is the average score of the whole Turkish sample, Abuse Scale correctly classified 83% of the participants in the abuse group and 78.8% of the participants in the control group, which gives 21.2% false-positive result. MMPI-PD to all group and Pearson correlation coefficient analysis is found to be significant for both groups. These results show us high reliability and validity of the abuse scale for Turkey.

A case with unexplained bleeding from multiple sites: munchausen syndrome by proxy

Munchausen syndrome by proxy (MBP) is an extreme form of child abuse where children were unnecessarily treated or investigated for medical conditions that were falsified by their caregivers. Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother. Extensive investigation revealed no organic etiologies for bleeding. The diagnosis of MBP was put by a multidisciplinary team. The diagnosis of MBP must be kept in mind in conditions where there is no underlying organic pathology in a bleeding patient.

Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde

OBJETIVOS: descrever o perfil e a conduta dos fonoaudiólogos das redes pública, filantrópica e privada conveniada com o SUS da cidade do Recife, Pernambuco, diante dos casos suspeitos e/ou confirmados de violência contra crianças e adolescentes, de agosto a outubro de 2008. MÉTODOS: estudo descritivo de corte transversal que envolveu os fonoaudiólogos da rede do SUS com mais de um ano de formação. Constituíram variáveis do estudo as características sociodemográficas, área de atuação profissional, informações sobre o perfil acadêmico dos profissionais e dos casos suspeitos e/ou confirmados de violência por eles relatados, obtidas a partir da utilização de questionário estruturado, analisados posteriormente através de frequências simples e sumarizadas pelo teste de quiquadrado e teste Exato de Fisher. RESULTADOS: dos 89 fonoaudiólogos, 43,8% (39)atenderam casos suspeitos e/ou confirmados de violência, sendo a violência física a mais frequente (35%). Dos 70 casos relatados, 2,9% (2) foram denunciados aos órgãos competentes. A maioria encaminhou os casos para atendimento pelo serviço social ou psicológico (34,3%). Cerca de 50% dos casos abandonou o tratamento. CONCLUSÕES: verificou-se um reduzido número de notificações de violência ocasionado, possivelmente, pela pouca informação dos fonoaudiólogos sobre as medidas a serem tomadas, o que sugere a necessidadede capacitação profissional para uma melhor identificação e conduta frente aos casos de violência.

Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome)

Pediatric condition falsification (PCF), also known as Munchausen syndrome by Proxy or Medical Child Abuse, is a somewhat rare form of child abuse and neglect. Its association with a history of adult factitious disorder (AFD) or Munchausen syndrome in the perpetrator is also well known. Exogenous insulin injection to cause hypoglycemia both in the context of PCF and AFD has been reported in the literature. However, the coexistence of both conditions via insulin injection in the same family has not been reported in the literature. This paper presents a family, in which the mother was diagnosed with AFD and her three children with PCF perpetrated by their mother via exogenous insulin injection.

Commentary: Prevention of violence against children: a framework for progress in low- and middle-income countries

Violence against children has been the least reported, studied, and understood area of child injuries. Initial awareness emerged from international conferences and resolutions, followed by national policies and statements. More effective responses around the world will require action. Although previous calls for action have pointed to important activities (gathering of baseline data, passing of legal reforms, and providing services to those who experience violence), the agenda is limited. Data collection needs to be continuous, systematic, and sustainable, and should enable ongoing evaluation of intervention programs. An inter-sectoral approach to violence against children incorporating public health, criminal justice, social services, education, non-governmental organizations, media, and businesses is imperative if the growing burden is to be mitigated. Thus we offer a framework, building on earlier recommendations, to focus on four domains: national surveillance, intervention research, legislation and policy, and partnerships and collaboration.