Formative evaluation of a collaborative community-based child abuse prevention project

Facilitators and Barriers in Integrated Social Care for Families Facing Multiple and Complex Problems: A Scoping Review

Introduction

Families with multiple and complex problems often deal with multiple professionals and organizations for support. Integrated social care supposedly prevents the fragmentation of care that often occurs.We identified facilitators and barriers experienced by families receiving integrated social care and by the professionals who provide it.

Method

We performed a scoping review following Arksey and O'Malley's framework, using the following databases: PsycINFO, Web of Science Core Collection, Psychology and Behavioral Sciences Collection, CINAHL, PubMed, and Medline. Furthermore, conducted a thematic analysis. The results were divided into facilitators and barriers of integrated social care.

Results

We identified 278 studies and finally included sixteen in our scoping review. We identified facilitators, including: linking formal care with informal networks, promoting collaboration among professionals e.g., working in pairs, and professionals autonomy. We identified barriers, including: time constraints, tasks outside professionals' expertise, along with resistance to integrated collaboration among organizations. These findings can enhance the advancement of social integrated care as a promising approach to support families facing multiple and complex problems.

Conclusion

To empower families, integrated social care requires a systematic approach based on trust. It involves coordinated care, shared decision-making, informal networks and the participation of all family members, including children.

Better Together? A Review of Evidence for Multi-Disciplinary Teams Responding to Physical and Sexual Child Abuse

Multi-Disciplinary teams (MDTs) have often been presented as the key to dealing with a number of intractable problems associated with responding to allegations of physical and sexual child abuse. While these approaches have proliferated internationally, researchers have complained of the lack of a specific evidence base identifying the processes and structures supporting multi-disciplinary work and how these contribute to high-level outcomes. This systematic search of the literature aims to synthesize the existing state of knowledge on the effectiveness of MDTs. This review found that overall there is reasonable evidence to support the idea that MDTs are effective in improving criminal justice and mental health responses compared to standard agency practices. The next step toward developing a viable evidence base to inform these types of approaches seems to be to more clearly identify the mechanisms associated with effective MDTs in order to better inform how they are planned and implemented.

Accessible service delivery of child welfare services and differential response models

This article presents the results of a study of the impacts of accessible neighborhood and school service delivery formats for front-line child protection services within a flexible response model of child welfare in southwest Ontario, Canada. More specifically, this article looks at the contributions that these accessible service delivery models made to: (a) clients willingness to ask for help, (b) establishing constructive helping relationships, (c) accessing services and supports, (d) bridging the gap between mandated and supportive services, and (e) community engagement. The article also shows how the existing child protection service template constrained the accomplishments possible through these service delivery innovations. Accessible and central service delivery sites differed in notable ways in each of these areas.

Child welfare policy and practice on children's exposure to domestic violence

OBJECTIVES

This article reviews research, policy and programming in Australia, Canada and the US on the child welfare response to EDV.

METHOD

The review draws on searches of standard research databases, interviews with researchers and practitioners, and the authors' own research.

RESULTS

Although EDV is underreported, across studies 7% to 23% of youths in general population surveys experienced EDV, 36-39% of youth in DV cases have witnessed the violence, and 45-46% of primary caregivers in child maltreatment investigations have experienced DV. Mandatory reporting can increase the number of cases that come to the attention of child welfare, but without resources for training and programming can lead to inappropriate reports, lack of referral for further assessment, and strains on the child welfare system. Improving the child welfare response to EDV can include collaboration between child welfare workers and DV advocates; increased training on screening for DV; new protocols on DV; and dedicated DV staffing within child welfare agencies. In recent years, policy and program attention to EDV has also been embedded within broader national efforts to protect children from violence and maltreatment. Differential response models that eschew investigation in favor of assessment and service delivery hold promise for families with DV.

CONCLUSIONS

Empirical data are limited, but current research and practice experience suggest that child welfare agencies seeking to improve the response to EDV should collaborate with other disciplines involved with preventing and responding to DV, seek resources to support training and programming, consider methods that avoid stigmatizing parents, and build in a program evaluation component to increase knowledge about effective practice.

Update on child abuse prevention

PURPOSE OF REVIEW

Child abuse remains a significant problem in the United States with 2.9 million reports and 825 000 indicated cases in 2005. This report will highlight recent efforts toward child abuse prevention, focusing on home visiting programs, abusive head trauma primary prevention, parent training programs, sexual abuse prevention, and the effectiveness of laws banning corporal punishment.

RECENT FINDINGS

Most home visitation programs have demonstrated a lack of effectiveness in recent randomized trials. One exception is the Nurse Family Partnership, which remains the most effective and longest enduring intervention for high-risk families. Child sexual abuse prevention programs and parent training programs need further evaluation with more rigorous methodology and outcome measures. Providing universal parent education about coping with crying infants appears to be effective in lowering the incidence of abusive head trauma. Although advocated for, further study will determine the effectiveness of laws banning corporal punishment or mandating abusive head trauma education to parents of newborns.

SUMMARY

Pediatricians play an important role in the prevention of child maltreatment. Their knowledge of the effectiveness of different programs can help guide parents toward appropriate services.

Primary prevention of child physical abuse and neglect: gaps and promising directions

Reviews on primary prevention have identified effective strategies to prevent child maltreatment but have ignored potentially promising interventions that have not yet been evaluated as well as gaps in the development of programs. The goal of this review was to identify these gaps and recommend future directions for developing interventions from a public health perspective. To this end, a systematic review of the literature for 1980-2004 utilizing existing databases and found 188 primary prevention interventions that addressed a broad range of risk factors was conducted. However, few had been rigorously evaluated, and only a handful demonstrated impact on child maltreatment or its risk factors. From a public health perspective, interventions that target prevalent and neglected risk factors such as poverty, partner violence, teenage pregnancy, and social norms tolerating violence toward children need to be developed and evaluated. In addition, more attention should be given to low cost interventions delivered to the public, by society, or that require minimal effort from recipients.

Implementing Community-Based Prevention Programming: A Review of the Literature

In this review of literature we identify consensually validated conclusions and recommendations for implementing community based prevention programming. The general recommendations identified from the literature are as follows: (1) a community must be ready for a prevention program, (2) effective community coalitions must be developed, (3) programming must fit the community, (4) program fidelity should be maintained, and (5) adequate resources, training, technical assistance, and attention to evaluation are necessary. The existing research and expert opinion in the field of prevention science indicate that when these crucial recommendations are incorporated into community prevention practice, the effectiveness of prevention efforts is optimized.

Findings From an Elder Abuse Forensic Center

PURPOSE

The first Elder Abuse Forensic Center (EAFC) in the United States was instituted in 2003. People from a variety of disciplines, including Adult Protective Services social workers, law enforcement, the district attorney's office, a medical response team, public guardian deputies, ombudsmen, mental health services, a victim advocate, and a domestic violence expert work cooperatively on cases of elder and dependent-adult mistreatment. Researchers conducted an assessment of the EAFC's impact on the efficiency and effectiveness of the collaboration.

DESIGN AND METHODS

Mixed quantitative and qualitative methods included statistical analysis of data from outcome surveys of EAFC collaborators and illustrative case studies developed from case files and structured interviews.

RESULTS

Mean survey scores evaluating the efficiency and effectiveness of the collaboration were significantly better than neutral responses. Case studies show efficient and effective case management through cooperation of the collaborating agencies. Survey results clearly support perceptions exemplified in case studies.

IMPLICATIONS

An EAFC enhances the efficiency and effectiveness of those who address elder abuse in one community, which in turn leads to improved outcomes. Continued analysis to identify strengths, weaknesses, and cost effectiveness of the EAFC model is ongoing.

Family Preservation Services on the Canary Islands

This article describes the results of a parenting program “Apoyo Personal y Familiar,” (APF; Personal and Family Support program) targeted at parents of families at high psychosocial risk. APF aims at preventing unnecessary placement of children from vulnerable families into foster-care by increasing parental competence in order to improve their autonomous functioning. The program is implemented through group meetings in community centers. The method involves exposing the parents to parental views and practices in specific child-rearing episodes and encouraging them to reflect on their own views and the consequences on child development. In the Intervention group 144 mothers completed the pretest and posttest measures and 155 mothers were in a waiting-list comparison group. Self-report measures on parental implicit theories, child-rearing practices, and personal agency were used to perform the evaluation. Group discourse and the monitor's behavior observed during the sessions were used as predictors of the program's efficacy. Compared to control mothers, program mothers endorsed less simple views on child development, reported positive changes in their child-rearing practices, and had more confidence in their personal resources and a more accurate view of their parental role. Group effect sizes on the outcome measures were predicted by the type of group discourse and the type of group management observed during the sessions. The use of a perspectivist discourse was positive for promoting complex ideas and actions, whereas a self-centered discourse was positive for improving personal agency and for reporting less use of permissive practices. The role of the monitor was particularly relevant for reinforcing the mothers' sense of confidence in their own resources and for facilitating changes in child-rearing tactics.

Estamos realmente detectando violência familiar contra a criança em serviços de saúde? A experiência de um serviço público do Rio de Janeiro, Brasil

A violência familiar é considerada uma questão prioritária em saúde pública, sendo o problema ainda mais marcante na infância. Informações referentes à morbidade deste agravo podem estar subdimensionadas devido a entraves na detecção de casos. O objetivo deste estudo é contrastar a magnitude da violência contra a criança, aferida ativamente em um ambulatório, com a casuística espontânea do serviço. Foram realizadas 245 entrevistas entre abril e junho de 2001, utilizando-se as Conflict Tactics Scales: Parent-Child Version (CTSPC) e a Revised Conflict Tactics Scales (CTS2) para aferir os eventos violentos. Os casos encaminhados ao Serviço Social representaram a casuística do serviço no período da busca ativa (12 meses). Encontrou-se uma elevada prevalência de violência física entre o casal, com eventos graves ocorrendo em 17,0% das famílias. Em relação à criança, agressões físicas "menores" foram referidas em 46,0% de famílias, porquanto a forma grave, em 9,9%. A prevalência identificada espontaneamente foi de 3,3%. Este estudo de caso mostra as oportunidades perdidas de detecção e chama-se a atenção para a necessidade de rever a abordagem da violência familiar em serviços de saúde.

The social marketing approach: a way to increase reporting and treatment of sexual assault

OBJECTIVE

Too often communities remain silent in response to cases of sexual assault of children. Members of the community are afraid to report such incidents and victims are reluctant to seek and accept treatment. The purpose of the paper is to examine whether application of a social marketing approach may serve as an effective means for motivating communities to report and victims to seek professional treatment.

METHODS

The paper is based on a case study of an ultra-orthodox Jewish community in Israel, where an informal campaign of silence developed. Using content analysis of documents and in-depth interviews, the research examines the implementation of a social marketing approach by a multidisciplinary team of professionals in the community. It focuses on developments in the community's attitude to sexual abuse, especially with regard to reporting assault and seeking and accepting treatment.

RESULTS

The findings show a considerable reduction in the fear that victims and other members of the community felt with regard to exposing the issue; a change among the community leaders, some of whom initially objected to reporting and treatment; introduction of an alternative community dialogue that advocated reporting and treatment; and a rise in the number of reports and of people in treatment.

CONCLUSION

The paper recommends the integration of principles of social marketing in community programs aimed at dealing with sexual assault. In particular, it suggests the identification of competing groups in the community, construction of specific programs for different segments, addressing the no-monetary prices that the change may incur on the different groups, location of appropriate places for distribution of messages, and use of effective personal, as well as public means of communication and promotion.

Examination of racial imbalance for children in foster care: implications for training

Concerned with the high number of African American children in out-of-home care in an East Texas county, the regional administrator of a state public child welfare agency asked its IV-E partnered university to examine the kinds of training the agency might need to address the problem. A semi-annual time-series model from January 1997 to June 1999 was constructed to track the proportion of African American children at three critical case junctures: investigation, case opening, and removal of the child to out-of-home care. In addition, the study analyzed characteristics of the county's population, including racial changes and poverty. The study found that African American children were referred to public child welfare at twice the rate of Anglo children, with the ratio increasing during case progression. The study also found a higher proportion of African American children in the community and a higher poverty rate, particularly for African American children, than what was previously understood. The study not only provided details of racial distribution over time and over case disposition, but also highlighted the importance of understanding problems within a community and organizational context. The study further suggests that training include generalist and advanced generalist social work education, considering practice with systems of all sizes, to assess, prevent, treat and evaluate interventions designed for the safety, permanency and well-being of children.