How does COVID-19 impact intrafamilial child sexual abuse? Comparison analysis of reports by practitioners in Israel and the US

Experiences and responses of child protection professionals during COVID-19: Lessons learned from professionals around the globe

BACKGROUND

COVID-19 significantly worsened already challenging circumstances for children and their families and globally increased the likelihood of child maltreatment. This risk heightened the urgency of child protection professionals in preventing child maltreatment and defending children's rights. The vast and growing body of research on protecting children from child maltreatment during COVID-19 has emphasized practitioners' tremendous difficulty in this arena.

OBJECTIVE

The current international study sought to identify the experiences and responses of child protection professionals to child maltreatment during COVID-19.

PARTICIPANTS AND SETTING

Five real-time, virtual focus groups were conducted among professionals who work with children from countries around the globe.

METHOD

Reflexive thematic analysis was employed to analyze the focus group transcripts.

RESULTS

The participants identified their experiences and challenges in performing their role of protecting children. Additionally, they shared context-adapted and innovative responses to child maltreatment, while emphasizing self-care and their mental health.

CONCLUSIONS

The results highlighted that child protection was significantly more challenging during the COVID-19 pandemic. Furthermore, they underlined the importance of establishing practices and policies for child protection in crisis times as well as ensuring both children's and professionals' well-being and mental health.

EHealth for Sexual Assault: A Systematic Scoping Review

Providing efficient psychosocial support for survivors of sexual assault is of critical societal importance. Around the globe, technology-based solutions (eHealth) are increasingly being used to accomplish this task, especially following COVID-19. Despite increased importance and reliance on eHealth for sexual assault, minimal efforts have been made to systematically synthesize research in this area. The present study therefore sought to synthesize what is known about eHealth targeting sexual assault survivors' psychosocial needs using a systematic scoping review methodology. To this end, five databases (CINAHL, Embase, PsycINFO, MEDLINE, and Scopus) were systematically searched for studies published from 2010 onwards using terms such as "sexual assault", "eHealth", "digital health", "telehealth", and variations thereof. Of the 6,491 records screened for eligibility, 85 studies were included in the review. We included empirical studies from all countries pertaining to eHealth for sexual assault for survivors 13 years or older. Many innovative eHealth applications for sexual assault exist today, and the included studies suggested that survivors generally experience eHealth positively and seem to benefit from it. Nevertheless, much more clinical and empirical work is needed to ensure accessible and effective solutions for all.

"Secrets From the Children's Room": New Understandings of Inappropriate and Abusive Sexual Behavior Among Siblings after the COVID-19 Crisis in Israel

This article discusses the COVID-19 crisis's impact on inappropriate and abusive sexual behavior among siblings (IASBAS) and how perceptions of this phenomenon affect construction of the post-crisis reality in Israel. Sibling sexual abuse, the most frequent type of sexual assault against children, does not occur in a vacuum; it is affected by the environment in which children live and develop. The pandemic created situational risk factors and a "germination substrate" for risk of abuse in "normative" families and escalation in families in which it had previously occurred. The first part of the article, based on research data and reports, reviews the objective reality that emerged in Israel and worldwide due to the pandemic. Part two describes situational risk factors converging to a new dangerous situation for children's abuse and victimization that resulted from this crisis: domestic violence (direct, indirect, and sexual), at-risk children returning and staying at home, increased exposure to online sexual content, parental dysfunction, and lack of formal and informal support sources. These risk factors are mutually reinforcing, thus exacerbating the risk of sexual assault among siblings. Part three describes the etiology characterizing the complex phenomenon of IASBAS. Part four discusses the significance of the risk factors at various stages and conditions for its development, identification, prevention or preventing escalation, and providing professional support, all of which affect the post-crisis reality. Part five offers recommendations for prevention, detection, and intervention that help deal with the reality "the day after."

Child protective services and out-of-home Care for Children during COVID-19: A scoping review and thematic analysis

BACKGROUND

The COVID-19 pandemic challenged child protection and posed new risks for child maltreatment (CM). Moreover, governmental efforts worldwide prioritized mitigating the spread of the virus over ensuring the welfare and protection of families and children. This neglect caused hardship for many vulnerable children, including those in out-of-home care (OOHC), and challenged the functionality of child protective services (CPS). However, only limited research has investigated the impact of COVID-19 on OOHC and CPS and explored how CPS overcame the challenges of helping children in OOHC.

OBJECTIVE

This review aims to address this gap in the research to unveil the 'positive legacy' left by CPS in their work with children in OOHC during COVID-19.

METHOD

This review utilized three stages of analysis, including a scoping review followed by two rounds of thematic analysis. The scoping review was carried out in six languages: English, Hebrew, Arabic, French, Portuguese, and Spanish. The first round of thematic analysis found eight relevant articles for this review. The second round of thematic analysis found three themes related to this paper's aim in the context of COVID-19.

RESULTS

Three main themes were identified: 1) decision-making and OOHC, 2) difficulties in procedures related to OOHC placement, and 3) handling challenges of OOHC.

CONCLUSIONS

The discussion emphasizes the crucial role of preserving children's rights, hearing their voices and needs, and considering their safety and well-being when planning policies and practices to protect them. It also emphasizes society's responsibility to acknowledge contextual factors in child protection.

The global impact of COVID-19 on child protection professionals: A scoping review and thematic analysis

BACKGROUND

The COVID-19 pandemic triggered new risks for child maltreatment (CM) and exacerbated existing challenges for families and children, elevating the importance of child protection professionals (CPPs) while also adding barriers to their work. During the pandemic, many CPPs experienced increased workloads, a disrupted work environment, and personal pandemic-related hardships. However, the scope of how COVID-19 impacted CPPs globally, as well as their adopted coping strategies, have not been well explored.

OBJECTIVE

This study addresses these gaps in the research by conducting an international scoping review to explore and analyze these topics.

METHOD

The scoping review was performed in six languages: English, Hebrew, Arabic, French, Spanish, and Portuguese, across 16 databases. Sixteen manuscripts were included in the final thematic analysis of this review.

RESULTS

Two main themes were identified: 1) the impact of COVID-19 on CPPs, and 2) the coping and adaptation strategies employed by CPPs during COVID-19. This review revealed and emphasized the importance of CPPs' resilience during COVID-19, underpinned by the theoretical framework of the social ecology of resilience.

CONCLUSIONS

This study highlights the responsibility of social ecologies and organizational structures to create readiness for a rapid response in times of crisis as well as valuable evidence to inform how CPPs, children, and families may be better supported in the event of a future crisis.

Use of technology in evidence-based programs for child maltreatment and its impact on parent and child outcomes

Introduction

Technology has been used in evidence-based child maltreatment (CM) programs for over a decade. Although advancements have been made, the extent of the application of technology in these programs, and its influence on parental and child outcomes, remains unclear within the context of changes that emerged because of the COVID-19 pandemic. This scoping review provides a contextualized overview and summary of the use of technology in evidence-based parenting and child programs serving families impacted by child maltreatment and the effects of technology-enhanced programs on target outcomes.

Materials and methods

Using Arksey and O'Malley's methodological framework, we searched seven databases to identify peer-reviewed and grey literature published in English from 2000 to 2023 on evidence-based programs, according to the California Evidence-Based Clearinghouse (CEBC), that included technological supports for two populations: at-risk parents for child maltreatment prevention, and children and youth 0-18 years exposed to child maltreatment. All study designs were included.

Results

Eight evidence-based parenting programs and one evidence-based child trauma program were identified as using technology across a total of 25 peer-reviewed articles and 2 peer-reviewed abstracts meeting inclusion criteria (n = 19 on parent-level programs; n = 8 on child-level programs). Four studies were published in the context of COVID-19. Two main uses of technology emerged: (1) remote programmatic delivery (i.e., delivering all or part of the program virtually using technology) and (2) programmatic enhancement (i.e., augmenting program content with technology). Improvements across parenting and child mental health and behavioral outcomes were generally observed.

Discussion

Technology use in evidence-based child maltreatment programs is not new; however, the small sample since the start of the COVID-19 pandemic in this review that met inclusion criteria highlight the dearth of research published on the topic. Findings also suggest the need for the inclusion of implementation outcomes related to adoption and engagement, which could inform equitable dissemination and implementation of these programs. Additional considerations for research and practice are discussed.

Child Maltreatment During COVID-19: Key Conclusions and Future Directions Based on a Systematic Literature Review

The COVID-19 pandemic has had a far-ranging impact. As societies struggled to minimize infection, questions arose regarding the consequences for children. Initial research reported the urgent need for child protective services worldwide to adapt existing policies and practices to protect children from maltreatment during this time, which is the rationale for the current systematic literature review. This review examined studies published in peer-reviewed journals from March 2020 to October 2020 on child maltreatment (CM) in the context of COVID-19. Twenty-five manuscripts met the inclusion criteria and were predominantly from the United States, with three international studies. The majority of the studies included CM reports during COVID-19 based on official data. The results clearly demonstrated an increased risk for children alongside a worrisome international decrease in CM reports. Only two studies addressed interventions during the pandemic. The current review highlights that, along with the obligation of scholars to advance the protection of children during COVID-19, there is much that is unknown. Future studies should examine the impact of the pandemic on children and their surrounding systems as well as child protective services' responses, which face enormous challenges during a pandemic. An additional conclusion is that, since children were not identified as a health risk group during the pandemic, their protection rights may have been jeopardized. Furthermore, the variance identified in the policies of different countries pinpoints the urgent need to establish an international protocol for protecting children from maltreatment during COVID-19, a protocol that will hopefully be a basis for policymakers worldwide.

The Perceived Job Performance of Child Welfare Workers During the COVID-19 Pandemic

While the evidence on the adverse impact of the COVID-19 pandemic on the well-being of frontline social workers is emerging, the research on the impact of the pandemic on their performance is scarce. The presented study explores how the relationship between work environment predictors and perceived stress explains the job performance of child welfare social workers during the pandemic using survey responses of 878 child welfare social workers. The findings revealed the mechanism through which environment predictors and perceived stress interacted in explaining job performance during a time of large-scale crisis. We found that C.W. social workers who experienced greater COVID-19-related service restrictions reported poorer job performance, that perceived stress disrupted workers' supervision and autonomy, and that supervision and job autonomy protected C.W. social workers from the adverse effects of perceived stress and workload on their job performance. Conclusions included the importance of autonomy and supervision in mitigating job-related stressors and the need to adapt and enhance child welfare supervision during times of national crisis.

The prevalences, changes, and related factors of child maltreatment during the COVID-19 pandemic: A systematic review

BACKGROUND

The impact of the COVID-19 pandemic has been extensive and drastic during the twenty-first century. The increasing phenomenon of child maltreatment during the pandemic is a significant public health concern.

OBJECTIVE

This study is the first systematic review to analyze and summarize the prevalence rates, risk factors, and protective factors related to child maltreatment during the COVID-19 pandemic.

METHODS

Four electronic databases (PubMed, Web of Science, Scopus, Embase) were systematically searched. Some potential studies were also identified from the reference lists of previously included articles. The quality of the included studies was assessed by the National Institutes of Health (NIH) Quality Assessment Tool and Critical Appraisal Skills Program (CASP) Quality Assessment Tool.

RESULTS

A total of 35 articles were included in the analysis, with 16 having prevalence information and 22 having factor information. Sixteen studies were conducted in the US, the other 17 studies were from 12 countries, and only two studies contained mixed countries. The prevalences of child maltreatment during the pandemic varied widely in different types and measurements. The pandemic rates of physical abuse, psychological abuse, neglect, and sexual abuse were 0.1 %-71.2 %, and 4.9 %-61.8 %, 7.3 %-40 % and 1.4 %-19.5 %, respectively. There was a decline in allegations of child maltreatment and an increase in severe cases of child maltreatment during the COVID-19 pandemic. Lockdown measures and their side effects were the main risk factors contributing to child maltreatment.

CONCLUSIONS

This review calls for targeted measures to prevent child maltreatment during the COVID-19 pandemic and current and future lockdowns and more future replication studies conducted in countries other than the US.

Child abuse and neglect in Brussels during the COVID-19-lockdown

BACKGROUND

It is likely that the circumstances during the COVID-19-lockdown in Belgium increased the incidence and prevalence of child abuse and neglect (CAN) due to exacerbated risk factors and new COVID-19-related stressors. However, traditional reporters had less contact with children which could lead to undetected cases of CAN.

OBJECTIVE

Gain insight into the number and profile of CAN reports filed to the Brussels Confidential Center of Child Abuse and Neglect (CCCAN) during the COVID-19-lockdown.

PARTICIPANTS AND SETTING

A dataset comprising 536 CAN reports from periods before (N = 442) and during the lockdown (N = 94).

METHODS

Characteristics about the report, reporter, victim and his/her family, perpetrator(s) and the trajectory with the CCCAN were registered. The number and characteristics of reports during the lockdown were compared to those of reports before the lockdown.

RESULTS

The number of advisory questions (p = .506, d = .377) and allegations (p = .095, d = 1.206) remained unchanged. During the lockdown, the risk assessment of advisory questions was higher (p = .011, d = .280), they evolved more into social exigency investigations (p < .001, φ = .246) and were referred more often to judicial authorities (p = .010, φ = .163). Allegations were filed more often by the helpline, police and judicial authorities (p < .001, φ = .590) during the lockdown and involved more Dutch-speaking (p = .016, φ = .166) victims.

CONCLUSIONS

The number of CAN reports remained the same during the lockdown but their profile changed.

Child sexual abuse survivors: Differential complex multimodal treatment outcomes for pre-COVID and COVID era cohorts

BACKGROUND

Child sexual abuse (CSA) is a form of early-life trauma that affects youth worldwide. In the midst of the current COVID-19 pandemic, it is imperative to investigate the potential impact of added stress on already vulnerable populations.

OBJECTIVE

The aim of this study was to evaluate the effectiveness of a multimodal treatment program on mental health outcomes for youth CSA survivors aged 8-17. Secondary to this, we explored the potential impact of the COVID-19 on treatment outcomes.

PARTICIPANTS AND SETTING

Participants of this study were children and youth aged 8-17 who were engaged in a complex multimodal treatment program specifically designed for youth CSA survivors.

METHODS

Participants were asked to complete self-report surveys at baseline and at the end of two subsequent treatment rounds. Surveys consisted of measures pertaining to: (1) PTSD, (2) depression, (3) anxiety, (4) quality of life, and (5) self-esteem.

RESULTS

Median scores improved for all groups at all timepoints for all five domains. For the pre-Covid participants, the largest improvements in the child program were reported in depression (36.6 %, p = 0.05); in the adolescent program anxiety showed the largest improvement (-35.7 %, p = 0.006). Improvements were generally maintained or increased at the end of round two. In almost every domain, the improvements of the pre-COVID group were greater than those of the COVID-I group.

CONCLUSIONS

A complex multimodal treatment program specifically designed for youth CSA survivors has the capacity to improve a number of relevant determinants of mental health and well-being. The COVID-19 pandemic may have retraumatized participants, resulting in treatment resistance.

Child protective services during COVID-19 and doubly marginalized children: International perspectives

BACKGROUND

Alongside deficits in children's wellbeing, the COVID-19 pandemic has created an elevated risk for child maltreatment and challenges for child protective services worldwide. Therefore, some children might be doubly marginalized, as prior inequalities become exacerbated and new risk factors arise.

OBJECTIVE

To provide initial insight into international researchers' identification of children who might have been overlooked or excluded from services during the pandemic.

PARTICIPANTS AND SETTING

This study was part of an international collaboration involving researchers from Brazil, Canada, Colombia, Israel, South Africa, Uganda, the UK and the USA. Researchers from each country provided a written narrative in response to the three research questions in focus, which integrated the available data from their countries.

METHOD

Three main questions were explored: 1) Who are the children that were doubly marginalized? 2) What possible mechanisms may be at the root? and 3) In what ways were children doubly marginalized? The international scholars provided information regarding the three questions. A thematic analysis was employed using the intersectional theoretical framework to highlight the impact of children's various identities.

RESULTS

The analysis yielded three domains: (1) five categories of doubly marginalized children at increased risk of maltreatment, (2) mechanisms of neglect consisting of unplanned, discriminatory and inadequate actions, and (3) children were doubly marginalized through exclusion in policy and practice and the challenges faced by belonging to vulnerable groups.

CONCLUSION

The COVID-19 pandemic can be used as a case study to illustrate the protection of children from maltreatment during worldwide crises. Findings generated the understanding that child protective systems worldwide must adhere to an intersectionality framework to protect all children and promote quality child protection services.

Sexual Inviolability of Minors in Central Kazakhstan: A Forensic Medical Analysis

Abstract Child sexual abuse is a social phenomenon that requires special attention from society, as it leads to the suffering of the most vulnerable part of the world's population. Child sexual abuse around the world not only persists, but also continues to grow, despite the active measures of the world community against it. Taking into account the high latency of crimes against sexual inviolability and sexual freedom of the person, measures for their detection and prevention are of particular relevance. All this requires constant monitoring of the current situation not only in the world or in the country, but also in each region of the country separately. Forensic medical examination of victims of sexual violence plays an important role in the analysis of the situation on this problem, not only in the legal, but also in the medical aspect.  Research aim: Analysis of quantitative and qualitative indicators of crimes against the sexual inviolability of minors on the territory of Central Kazakhstan for the formation of indicators for assessing the current situation in the region and recommendations for the prevention of these types of crimes. Methods A retrospective analysis of the situation on the number and structure of sexual crimes committed against children from 2018 to 2021 was carried out, and their dynamics was studied. There were investigated 1252 forensic medical examinations on cases of sexual crimes against the sexual inviolability of the person on the territory of Central Kazakhstan. Methods of applied statistical analysis were used to analyz obtained results. Results A detailed analysis made it possible to assess the structure and peculiarities of sexual crimes committed against children on the territory of Central Kazakhstan over the specified period of time. The number of sexual crimes against minors in the region is increasing every year. Statistically significant age characteristics of victims and specific indicators characterizing the socio-psychological aspects of sexual crimes in the region were revealed. It has been established that in most cases the aggressor is part of the victim's family or is very close to it. The analysis of the age structure of children showed that boys from 6 to 14 years old and girls over 14 are more likely to become victims. In the studied territory, the number of sexual harassment of children is more often committed by one person, often known to them, and in most cases occurs in enclosed spaces than on the street. Conclusion The progressive growth of crimes against the sexual inviolability of children in the region requires strengthening measures to improve legal means of countering sexual crimes against minors. A detailed study of the issue made it possible to identify lacks (organizational, tactical, diagnostic) and give the forensic medical examination of sexual conditions a qualitatively new level. The strategy of combating sexual crimes against minors should be based on active preventive work. Key words: forensic medical examination, sexual violence, Central Kazakhstan, children, minors.

Nurturing care during COVID-19: a rapid review of early evidence

OBJECTIVES

The COVID-19 pandemic has brought significant changes to family life, society and essential health and other services. A rapid review of evidence was conducted to examine emerging evidence on the effects of the pandemic on three components of nurturing care, including responsive caregiving, early learning, and safety and security.

DESIGN

Two academic databases, organisational websites and reference lists were searched for original studies published between 1 January and 25 October 2020. A single reviewer completed the study selection and data extraction with verification by a second reviewer.

INTERVENTIONS

We included studies with a complete methodology and reporting on quantitative or qualitative evidence related to nurturing care during the pandemic.

PRIMARY AND SECONDARY OUTCOME MEASURES

Studies reporting on outcomes related to responsive caregiving, early learning, and safety and security were included.

RESULTS

The search yielded 4410 citations in total, and 112 studies from over 30 countries met our eligibility criteria. The early evidence base is weighted towards studies in high-income countries, studies related to caregiver mental health and those using quantitative survey designs. Studies reveal issues of concern related to increases in parent and caregiver stress and mental health difficulties during the pandemic, which was linked to harsher and less warm or responsive parenting in some studies. A relatively large number of studies examined child safety and security and indicate a reduction in maltreatment referrals. Lastly, studies suggest that fathers' engagement in caregiving increased during the early phase of the pandemic, children's outdoor play and physical activity decreased (while screen time increased), and emergency room visits for child injuries decreased.

CONCLUSION

The results highlight key evidence gaps (ie, breastfeeding support and opportunities for early learning) and suggest the need for increased support and evidence-based interventions to ensure young children and other caregivers are supported and protected during the pandemic.

"The Global Sense of Disaster was Synchronized With my Own Disaster": Implications of the COVID-19 Crisis on the Wellbeing of Survivors of Sexual Violence

The present study is designed to improve our understanding of the impact of the COVID-19 pandemic, as collective trauma, on the wellbeing of survivors of sexual violence (SV). The data are based on an online qualitative survey about the experiences of 39 survivors and a thematic analysis of ten in-depth interviews with service providers in Israel. The findings reveal that the pandemic and restrictive measures are associated with increased risk for participants' wellbeing, caused directly by pandemic characteristics, as well as indirectly through the denial of access to coping resources. Paradoxically, the pandemic also offers relief, given the widespread restrictions imposed on the entire population and the general crisis atmosphere. The service providers' perspective indicates an increased demand for services as well as for their adjustment. These findings highlight the vulnerability of individuals with a history of SV and the need for accommodation of frontline SV services for health crises.

'When it comes to relational trauma, you need people at the table': Therapist experiences of online therapy for families with a prior disclosure of sibling sexual abuse during Covid-19 pandemic lockdowns

This study aims to contribute to the evaluation of online therapy during Covid-19 pandemic lockdowns, by exploring family therapists' experiences of therapy for twelve Sibling Sexual Abuse (SSA) families in the Netherlands. Seven transcripts of interviews with highly specialised Dutch family therapists were analysed using thematic analysis (TA). Two main findings emerged from this study. First, the Dutch therapists reported no acute worries about their clients' sexual safety during the pandemic lockdowns. Nonetheless, the switch to online therapy for the SSA families created concern regarding victim safety in speaking out freely at home. Second, while the sudden switch to online therapy enabled SSA therapists to stay connected with their SSA families, therapists experienced a decline in therapy quality and in their own well-being. In the therapists' experience, it was almost impossible to conduct their most fundamental interventions online, such as intervening in family relationships.

The Short- and Long-Term Impact of COVID-19 Lockdown on Child Maltreatment

Background: The COVID-19 pandemic has brought a new threat to child health and safety. Some studies suggest that social isolation and economic stress have exacerbated child abuse and neglect, whereas other studies argue that orders to stay at home are likely to promote parent–child relationships during this stressful time. Due to a lack of prospective studies including before–during–after lockdown assessments, the impacts of lockdown measures on child maltreatment are unclear. Methods: This study retrospectively investigated child maltreatment of 2821 Chinese children and adolescents from 12 to 18 (female, 59%) before, during and after lockdown, and identified risk factors. Potential predictors including socio-economic and individual mental health status were collected. Results: During Chinese lockdown, children and adolescents reported that the proportions of decrease (range 18–47.5%) in emotional abuse and neglect, physical abuse and neglect, sexual abuse, and witnessing domestic violence were greater than that of increase (range 5.1–9.1%). Compared with before lockdown (1.6%), the prevalence of sexual abuse significantly increased 8 months (2.9%) after the lifting of lockdown (p = 0.002). Being male, suffering from depression, state anhedonia, and experiencing psychotic symptoms at baseline were associated with increased sexual abuse after lockdown. Conclusions: The impact of lockdown on child maltreatment was beneficial in the short-term but detrimental in the long-term in China.

The effect of child neglect and abuse information studies on parents' awareness levels during the COVID-19 pandemic

The research was conducted in order to increase the knowledge and awareness of parents with children between the ages of 4-6 during the COVID-19 pandemic process, through social media applications and programs. The research was designed as a quasi-experimental study with pre-testing, post-testing, and control groups using a quantitative research method. There are 67 parents in the study group, 32 of which are experimental, and 35 are of a controlled group. Data was obtained using The Personal Information Form, Child Neglect and Abuse Awareness Scale for Parents, and Parental Abuse Scale. The "Child Neglect and Abuse WhatsApp and Online Education Program" was applied to the participants in the experimental group. Each day, three messages were sent to the participants in the experimental group on the subjects of child neglect, physical abuse, emotional abuse and sexual abuse, respectively. In addition, online training was given on the same subjects and in the same order in four sessions over the Zoom application. The participants in the control group did not receive any intervention. Before and after the implementation of the Child Neglect and Abuse WhatsApp and Online Education Program, data collection tools were given to the participants in the experimental and control groups. Paired samples t Test, Wilcoxon Signed Ranks Test were used to analyze the data. As a result of the study, there was no statistically significant difference between the pre-test scores and the post test scores of the parents in the control group. When the differences between the pre and post test scores of the parents in the experimental group and the pre and post tests scores of the parents in the experimental and control groups were compared, it was observed that there was a significant difference in favor of the experimental group. In line with this result, it can be said that the education applied has had an impact on the parents' knowledge and awareness of child neglect and abuse.

Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study

Background

Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa—where sexual education is still taboo—that would be engaging, effective, and acceptable to parents and caretakers.

Objective

This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention.

Methods

 HappyToto children’s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game’s interface, storylines, and options. To validate the application’s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game.

Results

Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities.

Conclusions

The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education.

The Influence of Adverse Childhood Experiences (ACEs), Including the COVID-19 Pandemic, and Toxic Stress on Development and Health Outcomes of Latinx Children in the USA: a Review of the Literature

The purpose of this review is to synthesize existing literature to analyze the influence of the Adverse Childhood Experiences (ACEs), including the COVID-19 pandemic, and toxic stress on child development and lifelong health outcomes of Latinx children in the USA, utilizing the ACE framework. Without adequate protective factors, children’s early experiences with adversity and toxic stress have implications for their physiological, psychological, and social health. The COVID-19 pandemic has shown to exacerbate childhood adversity and toxic stress and has disproportionately harmed Latinx communities. In applying the ACE framework to US-Latinx populations, relevant findings concerning a potential failure of ACEs to accurately capture Latinx experiences of adversity were highlighted, as well as the need to classify the COVID-19 pandemic as an ACE. Research suggest that first-generation Latinx immigrants report lower-than-average rates of ACEs despite the various disparities ethnic minorities face in the USA. A discussion on whether this health paradox arises because of the failure of ACEs to properly identify adverse experiences unique to immigrants or if it is related with immigrant families’ protective cultural factors. The compounding experiences of discrimination, immigration anxieties, and now also pandemic-related hardship that have the potential to harm Latinx children’s cognitive, emotional, and physical development were highlighted. Evidence-based interventions that were discussed in this report include promotion of resiliency through healthy adult relationships, policies that screen for ACEs early on in a child’s life, trauma-informed care and innovative treatment programs, and strengthening existing protective services through financial and political support.

COVID-19 and violence against children: A review of early studies

BACKGROUND

Throughout the course of the COVID-19 pandemic, researchers across the globe have attempted to understand how the health and socioeconomic crisis brought about by the coronavirus is affecting children's exposure to violence. Since containment measures have disrupted many data collection and research efforts, studies have had to rely on existing data or design new approaches to gathering relevant information.

OBJECTIVE

This article reviews the literature that has been produced on children's exposure to violence during the pandemic to understand emerging patterns and critically appraise methodologies to help inform the design of future studies. The article concludes with recommendations for future research.

PARTICIPANTS AND SETTING

The study entailed a search of working papers, technical reports, and journal articles.

METHODS

The search used a combination of search terms to identify relevant articles and reports published between March 1 and December 31, 2020. The sources were assessed according to scope and study design.

RESULTS

The review identified 48 recent working papers, technical reports, and journal articles on the impact of COVID-19 on violence against children. In terms of scope and methods, the review led to three main findings: 1) Studies have focused on physical or psychological violence at home and less attention has been paid to other forms of violence against children, 2) most studies have relied on administrative records, while other data sources, such as surveys or big data, were less commonly employed, and 3) different definitions and study designs were used to gather data directly, resulting in findings that are hardly generalizable. With respect to children's experience of violence, the review led to four main findings: 1) Studies found a decrease in police reports and referrals to child protective services, 2) mixed results were found with respect to the number of calls to police or domestic violence helplines, 3) articles showed an increase in child abuse-related injuries treated in hospitals, and 4) surveys reported an increase in family violence.

CONCLUSIONS

This review underscores the persistent challenges affecting the availability and quality of data on violence against children, including the absence of standards for measuring this sensitive issue as well as the limited availability of baseline data. Future research on COVID-19 and violence against children should address some of the gaps identified in this review.

Sexual Violence and Trauma in Childhood: A Case Report Based on Strategic Counseling

Children and adolescents are too often victims of sexual abuse and harassment. According to the World Health Organization (WHO), approximately 150 million girls and 73 million children <18 have been victims of violence and sexual exploitation during their childhood. Data show that females are more likely to be a victim of abuse and violence than males (20% vs. 5–10%). Such abuses lead to long-term psychophysical and relational consequences and victims are often afraid of asking for support from both parents and professionals. This case report shows the story of a 17-year-old adolescent, Sara, involved by her mother in a strategic counseling process, to solve BDSM-type sexual addiction (slavery and discipline, domination and submission, sadism and masochism), self-aggressive behavior, and alcohol abuse issues. The strategic counseling process is structured in 15 sessions and was based on problem-solving techniques and corrective behavioral strategies. During the sessions, it emerged that Sara had been a victim of sexual violence at the age of 6 and that she had never talked about the rape with anyone. At the age of 12, she began to experience social anxiety and shame, feelings that led her to use alcohol and seek violent sexual partners and bondage relationships. During the counseling sessions, Sara elaborated on her trauma, becoming more aware of her resources and her desires, and she learned to manage the sense of guilt and shame associated with the violence suffered, through alternative strategies. At the end of the process, Sara normalized her relationship with sex and alcohol, regaining her identity.