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Winqust A, Burduli E, Eddy LL, Landis T, Fraser J, Barbosa Leiker C. Associations between nurse characteristics, institutional characteristics and perceived nurse knowledge and self-efficacy of reporting suspected child abuse and neglect. J Clin Nurs 2024; 33:2662-2673. [PMID: 38366766 DOI: 10.1111/jocn.17026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 02/18/2024]
Abstract
AIM To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self-efficacy of reporting child abuse and neglect. DESIGN A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey. METHODS A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores. RESULTS Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self-efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self-efficacy of reporting child abuse and neglect. CONCLUSION This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters. IMPACT This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self-efficacy in reporting suspected child abuse and neglect. REPORTING METHODS The authors of this study have adhered to relevant EQUATOR guidelines: STROBE. PATIENT OR PUBLIC CONTRIBUTION There is no patient or public contribution as the study only looked at nurses.
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Affiliation(s)
- Anna Winqust
- College of Nursing, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Linda L Eddy
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Tullamora Landis
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Jennifer Fraser
- Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Kenny KS, Wall-Wieler E, Frank K, Courchene L, Burton M, Dreaver C, Champagne M, Bennett M, Rocke C, Brownell M, Anderson M, Urquia ML. Infant rates of child protective services contact and termination of parental rights by first nations status from 1998 to 2019: An example of intergenerational transmission of colonial harm. CHILD ABUSE & NEGLECT 2024:106760. [PMID: 38866661 DOI: 10.1016/j.chiabu.2024.106760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/25/2024] [Accepted: 03/18/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Rates of child removal by child protective services (CPS) in Manitoba are the highest in Canada with a profoundly disproportionate impact on First Nations families. Despite infants constituting the highest proportion of children affected, no research has examined population-level rates of infant contact with CPS. OBJECTIVE We examined the incidence of infant contact with different levels of CPS, including termination of parental rights (TPR), according to First Nations status. PARTICIPANTS We identified 217,261 infants (47,416 First Nations; 169,845 non-First Nations) born between 1998 and 2014 in Manitoba, Canada and residing in the province until at least age 5. METHODS We used linked administrative data to calculate population-level rates of contact with different levels of CPS by First Nations status, including an open file before age 1, out-of-home placement before age 1, and TPR before age 5. RESULTS Overall 35.8 % of First Nations infants had an open file, 8.5 % experienced out-of-home placement, and 5.4 % experienced TPR. Among other infants, 8.5 % had an open file, 1.3 % experienced out-of-home placement and 0.7 % experienced TPR. The rate of early-stage contact increased the fastest among First Nations infants, with a rise of 22.4 % in our study period, compared to a rise of 1.7 % among all other infants. CONCLUSIONS CPS contact was exceptionally high among First Nations infants compared to other infants, with early-stage contact accelerating most dramatically over time. Findings support calls to greatly reduce the disruption of system contact in the lives of First Nations families.
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Affiliation(s)
- Kathleen S Kenny
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada.
| | - Elizabeth Wall-Wieler
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada
| | - Kayla Frank
- First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg R3C 1K4, Canada
| | - Lindey Courchene
- First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg R3C 1K4, Canada
| | - Mary Burton
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, Manitoba R2W 5M3, Canada
| | - Cheryle Dreaver
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada
| | - Michael Champagne
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, Manitoba R2W 5M3, Canada
| | - Marlyn Bennett
- Faculty of Social Work, University of Calgary, 2500 University Dr NW MacKimmie Tower 301, Calgary, Alberta T2N 1N4, Canada
| | - Cathy Rocke
- Faculty of Social Work, University of Regina, Education Building 456, Regina, Saskatchewan S4S 0A2, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada
| | - Marcia Anderson
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada; Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, P122 Pathology Building, 770 Bannatyne Ave, Winnipeg, Manitoba R3W 0W3, Canada
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Canada
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Kimber M, McTavish J, Shouldice M, Ward MGK, MacMillan HL. Savoir détecter l'exposition des enfants à la violence entre partenaires intimes, qu'elle soit présumée ou divulguée, et savoir intervenir. Paediatr Child Health 2024; 29:174-188. [PMID: 38827373 PMCID: PMC11141609 DOI: 10.1093/pch/pxad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/17/2023] [Indexed: 06/04/2024] Open
Abstract
L'exposition des enfants à la violence entre partenaires intimes (EEVPI), qu'il s'agisse des parents ou d'autres proches, représente près de la moitié de tous les cas qui font l'objet d'une enquête et sont corroborés par les services de protection de l'enfance du Canada. Les atteintes affectives, physiques et comportementales associées à l'EEVPI sont semblables aux effets d'autres formes de maltraitance envers les enfants. Il peut être difficile d'établir quels enfants et adolescents sont exposés à la violence entre partenaires intimes (VPI) en raison des comportements non spécifiques parfois associés à une telle exposition, de même que de la stigmatisation et du secret entourant souvent ce type de violence. Par ailleurs, une intervention en toute sécurité auprès des enfants et des adolescents chez qui on présume une exposition à la VPI peut être compliquée par la nécessité d'également tenir compte de la sécurité et du bien-être d'un proche non contrevenant. Le présent document de principes propose une approche fondée sur des données probantes mise au point par le projet VEGA (Violence, Evidence, Guidance, Action ou violence, données probantes, conseils, action) pour détecter l'exposition des enfants et des adolescents à la VPI et intervenir en toute sécurité auprès d'eux.
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Affiliation(s)
- Melissa Kimber
- Société canadienne de pédiatrie, section de la prévention de la maltraitance d'enfants et d'adolescents, Ottawa (Ontario)Canada
| | - Jill McTavish
- Société canadienne de pédiatrie, section de la prévention de la maltraitance d'enfants et d'adolescents, Ottawa (Ontario)Canada
| | - Michelle Shouldice
- Société canadienne de pédiatrie, section de la prévention de la maltraitance d'enfants et d'adolescents, Ottawa (Ontario)Canada
| | - Michelle G K Ward
- Société canadienne de pédiatrie, section de la prévention de la maltraitance d'enfants et d'adolescents, Ottawa (Ontario)Canada
| | - Harriet L MacMillan
- Société canadienne de pédiatrie, section de la prévention de la maltraitance d'enfants et d'adolescents, Ottawa (Ontario)Canada
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Bahji A, Crockford D, Brasch J, Schutz C, Buckley L, Danilewitz M, Dubreucq S, Mak M, George TP. Training in Substance use Disorders, Part 1: Overview of Clinical Practice Recommendations. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:428-456. [PMID: 38613369 PMCID: PMC11107443 DOI: 10.1177/07067437241231128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Affiliation(s)
- Anees Bahji
- Clinical Assistant Professor, Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Crockford
- Clinical Professor, University of Calgary, Cumming School of Medicine, Department of Psychiatry, Calgary, AB, Canada; Hotchkiss Brain Institute & Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, AB, Canada
| | - Jennifer Brasch
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Lead, Addiction Psychiatry, St. Joseph's Healthcare, Hamilton, ON, Canada; Past-President, Canadian Society of Addiction Medicine, Calgary, AB, Canada
| | - Christian Schutz
- Professor, Institute of Mental Health, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Research Lead Adult Mental Health and Substance Use, Provincial Health Service Authority, Vancouver, BC, Canada
| | - Leslie Buckley
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Marlon Danilewitz
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Associate Medical Director, General Psychiatry, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
| | - Simon Dubreucq
- Psychiatrist, Department of Addiction Medicine, CHUM, Montreal, QC, Canada; Assistant Professor, Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Michael Mak
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Adjunct Assistant Professor, Department of Medicine, McMaster University, Hamilton, ON, Canada; Adjunct Research Professor, Department of Psychiatry, Western University, London, ON, Canada
| | - Tony P George
- Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Khazanchi R, South EC, Cabrera KI, Winkelman TNA, Vasan A. Health Care Access and Use Among U.S. Children Exposed to Neighborhood Violence. Am J Prev Med 2024; 66:936-947. [PMID: 38416088 DOI: 10.1016/j.amepre.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Neighborhood violence is an adverse childhood experience which impacts millions of U.S. children and is associated with poor health outcomes across the life course. These effects may be mitigated by access to care. Yet, the ways in which exposure to neighborhood violence shapes children's health care access have been understudied. METHODS This is a cross-sectional analysis of 16,083 children (weighted N=67,214,201) ages 1 to <18 years from the 2019 and 2021 National Health Interview Survey. Guardians were asked about preventive care access, unmet health needs, and health care utilization in the last year. Changes associated with exposure to neighborhood violence were estimated using marginal effects from multivariable logistic regression models adjusted for year, age, sex, race/ethnicity, parental education, family structure, rurality, income, insurance type, insurance discontinuity, and overall reported health. RESULTS Of 16,083 sample children, 863 (weighted 5.3% [95% CI 4.8-5.7]) reported exposure to neighborhood violence, representing a weighted population of ∼3.5 million. In adjusted analyses, exposure to violence was associated with forgone prescriptions (adjusted difference 1.2 percentage-points (pp) [95%CI 0.1-2.3]; weighted national population impact 42,833 children), trouble paying medical bills (7.7pp [4.4-11.0]; 271,735), delayed medical (1.5pp [0.2-2.9]; 54,063) and mental health care (2.8pp [1.1-4.6]; 98,627), and increased urgent care (4.5pp [0.9-8.1]; 158,246) and emergency department utilization (6.4pp [3.1-9.8]; 227,373). CONCLUSIONS In this nationally representative study, neighborhood violence exposure among children was associated with unmet health needs and increased acute care utilization. Evidence-based interventions to improve access to care and reduce economic precarity in communities impacted by violence are needed to mitigate downstream physical and mental health consequences.
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Affiliation(s)
- Rohan Khazanchi
- Harvard Internal Medicine-Pediatrics Residency Program at Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center, Boston, Massachusetts; FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts; Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
| | - Eugenia C South
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keven I Cabrera
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tyler N A Winkelman
- Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Kimber M, McTavish J, Shouldice M, Ward MGK, MacMillan HL. Recognizing and responding to children with suspected exposure to intimate partner violence between caregivers. Paediatr Child Health 2024; 29:174-188. [PMID: 38827374 PMCID: PMC11141601 DOI: 10.1093/pch/pxad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/17/2023] [Indexed: 06/04/2024] Open
Abstract
Children's exposure to intimate partner violence (CEIPV) between parents and other caregivers accounts for nearly half of all cases investigated and substantiated by child welfare authorities in Canada. The emotional, physical, and behavioural impairments associated with CEIPV are similar to effects of other forms of child maltreatment. The identification of children and youth who have been exposed to intimate partner violence (IPV) can be challenging due to the non-specific behaviours sometimes associated with such exposure, and the stigma and secrecy that often characterize IPV. Also, responding safely to children and youth with suspected CEIPV can be complicated by the need to consider the safety and well-being of a non-offending caregiver. This position statement presents an evidence-informed approach developed by the Violence, Evidence, Guidance, Action (VEGA) Project for the safe recognition and response to children and youth who are suspected of being exposed to IPV.
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Affiliation(s)
- Melissa Kimber
- Canadian Paediatric Society, Child and Youth Maltreatment Section, Ottawa, Ontario, Canada
| | - Jill McTavish
- Canadian Paediatric Society, Child and Youth Maltreatment Section, Ottawa, Ontario, Canada
| | - Michelle Shouldice
- Canadian Paediatric Society, Child and Youth Maltreatment Section, Ottawa, Ontario, Canada
| | - Michelle G K Ward
- Canadian Paediatric Society, Child and Youth Maltreatment Section, Ottawa, Ontario, Canada
| | - Harriet L MacMillan
- Canadian Paediatric Society, Child and Youth Maltreatment Section, Ottawa, Ontario, Canada
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Cavallaro F, Clery A, Gilbert R, van der Meulen J, Kendall S, Kennedy E, Phillips C, Harron K. Evaluating the real-world implementation of the Family Nurse Partnership in England: a data linkage study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-223. [PMID: 38784984 DOI: 10.3310/bvdw6447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Background/objectives The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. Design We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. Setting One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Participants Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). Interventions The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Main outcome measures Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Data sources Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Results Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Limitations Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. Conclusions This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future work Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. Study registration The study is registered as NIHR CRN Portfolio (42900). Funding This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Amanda Clery
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jan van der Meulen
- UCL Great Ormond Street Institute of Child Health, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sally Kendall
- UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Eilis Kennedy
- UCL Great Ormond Street Institute of Child Health, London, UK
- Eilis Kennedy, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Catherine Phillips
- UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, London, UK
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Howarth E, Feder G, Barter C, Powell C. Harmonising outcome measurement for child focused domestic abuse interventions. Reflections on the development and implementation of a core outcome set. Front Psychiatry 2024; 15:1296437. [PMID: 38528980 PMCID: PMC10961467 DOI: 10.3389/fpsyt.2024.1296437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024] Open
Abstract
There is appetite in the UK to better measure the impact of domestic violence and abuse (DVA) interventions on children. The spread of outcomes-based commissioning means outcome measurement is no longer just the territory of academic researchers but is now firmly within the purview of practitioners and policy makers. However, outcomes measured in trials only partially represent the views of those delivering and using services with respect to how success should be defined and captured. Even within trials there is huge inconsistency in the definition and measurement of important endpoints. This yields a body of evidence that is difficult to make sense of, defeating the ends for which it was produced - to improve the response to children and families who have experienced abuse. Development of Core Outcome Sets (COS) is seen as a solution to this problem, by establishing consensus across key stakeholder groups regarding a minimum standard for outcome measurement in trials, and increasingly in service delivery contexts. To date COS development has addressed outcomes relating to health conditions or interventions, with limited application to public health challenges. We reflect on our efforts to develop a COS to evaluate psychosocial interventions for children and families experiencing DVA. We highlight the value of COS development as a mechanism for improving evidence quality and the response to families experiencing abuse. Finally, we make recommendations to researchers and COS guideline developers to support this broader application of COS methodology.
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Affiliation(s)
- Emma Howarth
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Gene Feder
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Christine Barter
- Connect Centre for International Research on Interpersonal Violence and Harm, School of Health, Social Work and Sport, University of Central Lancashire, Preston, United Kingdom
| | - Claire Powell
- Institute of Child Health, University College London (UCL), London, United Kingdom
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Winquist A, Leiker CB, Landis T, Fraser J, Eddy LL, Burduli E. Development and psychometric evaluation of the reporting suspected child abuse and neglect (RSCAN) scale for United States registered nurses. J Pediatr Nurs 2023; 73:e319-e326. [PMID: 37863784 DOI: 10.1016/j.pedn.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE In the United States (US), nurses have a mandated duty to report child abuse and neglect (CAN). Despite comprising the highest proportion of the US healthcare workforce, limited research has explored the institutional barriers they face in reporting suspected CAN. Furthermore, there is no existing valid and reliable measure of reporting relevant to US. The purpose of this research is to develop and psychometrically evaluate a scale to measure nurse knowledge and self-efficacy as CAN mandated reporters. DESIGN AND METHODS The Reporting Suspected Child Abuse and Neglect (RSCAN) tool was developed from two existing international tools to examine institutional barriers and facilitators to US nurses' professional knowledge and reporting of CAN. A convenience sample of one hundred and sixty-six US nurses primarily from the Pacific Northwest responded to an online survey. An exploratory factor analysis (EFA) and Cronbach's α were used to examine validity and internal consistency, respectively, of an initial 16-item scale. RESULTS A two-factor model consisting of eight items indicated good model fit (CFI = 0.986, RMSEA = 0.049, and SRMR = 0.028) and was internally consistent (Cronbach's α = 0.822). CONCLUSION RSCAN is the first US instrument to reliably measure nurses' professional knowledge and self-efficacy of reporting suspected CAN. PRACTICE IMPLICATIONS Future research can build upon these findings to recognize and support nurses in their mandated role to report CAN.
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Affiliation(s)
- Anna Winquist
- University of Colorado Anschutz, College of Nursing, Aurora, CO 80045, USA.
| | - Celestina Barbosa Leiker
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
| | - Tullamora Landis
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
| | - Jennifer Fraser
- University of Sydney, Medicine and Health, Sydney, NSW 2006, Australia.
| | - Linda L Eddy
- Washington State University, College of Nursing, 14204 NE Salmon Creek Ave, Vancouver, WA 98686, USA.
| | - Ekaterina Burduli
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
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Cavallaro FL, Cannings-John R, Lugg-Widger F, Gilbert R, Kennedy E, Kendall S, Robling M, Harron KL. Lessons learned from using linked administrative data to evaluate the Family Nurse Partnership in England and Scotland. Int J Popul Data Sci 2023; 8:2113. [PMID: 37670953 PMCID: PMC10476150 DOI: 10.23889/ijpds.v8i1.2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Introduction "Big data" - including linked administrative data - can be exploited to evaluate interventions for maternal and child health, providing time- and cost-effective alternatives to randomised controlled trials. However, using these data to evaluate population-level interventions can be challenging. Objectives We aimed to inform future evaluations of complex interventions by describing sources of bias, lessons learned, and suggestions for improvements, based on two observational studies using linked administrative data from health, education and social care sectors to evaluate the Family Nurse Partnership (FNP) in England and Scotland. Methods We first considered how different sources of potential bias within the administrative data could affect results of the evaluations. We explored how each study design addressed these sources of bias using maternal confounders captured in the data. We then determined what additional information could be captured at each step of the complex intervention to enable analysts to minimise bias and maximise comparability between intervention and usual care groups, so that any observed differences can be attributed to the intervention. Results Lessons learned include the need for i) detailed data on intervention activity (dates/geography) and usual care; ii) improved information on data linkage quality to accurately characterise control groups; iii) more efficient provision of linked data to ensure timeliness of results; iv) better measurement of confounding characteristics affecting who is eligible, approached and enrolled. Conclusions Linked administrative data are a valuable resource for evaluations of the FNP national programme and other complex population-level interventions. However, information on local programme delivery and usual care are required to account for biases that characterise those who receive the intervention, and to inform understanding of mechanisms of effect. National, ongoing, robust evaluations of complex public health evaluations would be more achievable if programme implementation was integrated with improved national and local data collection, and robust quasi-experimental designs.
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Affiliation(s)
- Francesca L. Cavallaro
- UCL Great Ormond Street Institute of Child Health, London, UK
- The Health Foundation, 8 Salisbury Square, London, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Fiona Lugg-Widger
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ruth Gilbert
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Eilis Kennedy
- Children, Young Adults and Families Directorate, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Michael Robling
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Katie L. Harron
- UCL Great Ormond Street Institute of Child Health, London, UK
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11
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Wekerle C, McQueen KCD, Barker B, Acai A, Smith S, Allice I, Kimber M. Indigenous Service Provider Perspectives of an Online Education Module to Support Safe Clinical Encounters about Family Violence in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16061. [PMID: 36498135 PMCID: PMC9736319 DOI: 10.3390/ijerph192316061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Given colonial genocide, Indigenous peoples are rightfully reticent to disclose their experiences of family violence to practitioners working within mainstream health care and social services. Health care and social service providers (HSSPs) have varied formal education on providing trauma-and-violence informed care to Indigenous and non-Indigenous families affected by family violence, including intimate partner violence and child maltreatment. The purpose of this study is to understand and describe the perspectives of Six Nations of the Grand River community members on the relevance of an education module to support HSSPs to provide physically and emotionally safe care to Indigenous families affected by family violence. Two-Eyed Seeing and Two Row Wampum approaches guided our qualitative study. Twenty-one (66.7% women) Indigenous HSSPs completed a semi-structured interview; 15 identified as a regulated HSSP, nine as a Knowledge Keeper/Cultural Holder, and three as a HSSP trainees. Conventional content analysis guided the development of codes and categories. The Violence, Evidence, Guidance, Action (VEGA)-Creating Safety education module was described as having elements consistent with Indigenous experiences and values, and supportive of Indigenous peoples seeking care from HSSPs for family violence related concerns. Participants described several suggestions to better adapt and align the module content with the diversity of values and beliefs of different Indigenous Nations. Collectively, the Creating Safety module may be used as an educational adjunct to Indigenous-focused, cultural safety training that can support HSSPs to provide physically, emotionally, and psychologically safe care to Indigenous peoples who have experienced family violence. Future work needs to consider the perspectives of other Indigenous communities and Nations.
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Affiliation(s)
- Christine Wekerle
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
- Optentia Research Unit, North-West University, Potchefstroom 2520, South Africa
- Offord Centre for Child Studies, McMaster University, BAHT 132, Hamilton, ON L8S 4L8, Canada
| | | | - Bronwyn Barker
- Offord Centre for Child Studies, McMaster University, BAHT 132, Hamilton, ON L8S 4L8, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Anita Acai
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Savanah Smith
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ilana Allice
- Offord Centre for Child Studies, McMaster University, BAHT 132, Hamilton, ON L8S 4L8, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Melissa Kimber
- Offord Centre for Child Studies, McMaster University, BAHT 132, Hamilton, ON L8S 4L8, Canada
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
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12
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Berthold O, Clemens V, Levi BH, Jarczok M, Fegert JM, Jud A. Survey on Reporting of Child Abuse by Pediatricians: Intrapersonal Inconsistencies Influence Reporting Behavior More than Legislation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15568. [PMID: 36497644 PMCID: PMC9738942 DOI: 10.3390/ijerph192315568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
Background: Internationally, various laws govern reporting of child abuse to child protection services by medical professionals. Whether mandatory reporting laws are in place or not, medical professionals need internal thresholds for suspicion of abuse to even consider a report ("reasonable suspicion" in US law, "gewichtige Anhaltspunkte" in German law). Objective: To compare internal thresholds for suspicion of abuse among US and German pediatricians, i.e., from two countries with and without mandatory reporting laws. Participants and Setting: In Germany, 1581 pediatricians participated in a nationwide survey among child health professionals. In the US, a survey was mailed to all Pennsylvania pediatricians, and 1249 participated. Methods: Both samples were asked how high in their rank order of differential diagnoses child abuse would have to be when confronted with a child's injuries to qualify for reasonable suspicion/gewichtige Anhaltspunkte (differential diagnosis scale, DDS). In a second step, both had to mark a 10-point likelihood scale (0-100%) corresponding to reasonable suspicion/gewichtige Anhaltspunkte (estimated probability scale, EPS). Results: While for almost two-thirds of German pediatricians (62.4%), child abuse had to be among the top three differential diagnoses for gewichtige Anhaltspunkte, over half of the US respondents (48.1%) had a lower threshold for reasonable suspicion. On the estimated probability scale, over 65% in both samples indicated that the probability of abuse had to exceed 50% for reasonable suspicion/gewichtige Anhaltspunkte. There was great variability between the two countries. Conclusions: There are similar uncertainties in assessing cases of suspected child abuse in different legal systems. There is a need for debates on thresholds among medical professionals in both countries.
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Affiliation(s)
- Oliver Berthold
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Vera Clemens
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Benjamin H. Levi
- Departments of Humanities and Pediatrics, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA
| | - Marion Jarczok
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
| | - Andreas Jud
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075 Ulm, Germany
- School of Social Work, Lucerne University of Applied Sciences and Arts, Werftestrasse 1, 6002 Lucerne, Switzerland
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13
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Russell A, Clements K, Duschinsky R, Howarth E, Mayes T, Reisel A, Coughlan B. Domestic violence and abuse in local child safeguarding policy: How is the problem represented? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3871-e3884. [PMID: 36282145 PMCID: PMC10092451 DOI: 10.1111/hsc.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/02/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Within the United Kingdom, domestic violence and abuse (DVA) is the most commonly identified factor within child in need assessments, with rates increasing in recent years in addition to 'lockdown'-related spikes. This article examines the representation of DVA in local child safeguarding policies using Bacchi's (2009) 'What is the problem represented to be?' approach. Policies were collected from the websites of all the child safeguarding partnerships of England in July 2021. In total, we identified 59 policies. These policies are designed to guide local responses to DVA across services and thus have potential for substantial impact on practice across health and social care. Our results suggest that local DVA policy in England exists within a conceptual framework which spotlights the individual and lacks attention to their context. We argue that these policies focus on adults, neglecting attention to children within their own safeguarding policies. This is through children being peripheralized within the conceptualisation of 'victim' and the assessed adult risk being used as a proxy measure for the risk to child. Demographic discussions build an image of DVA as an issue that can affect anyone, but with little acknowledgement of the vulnerabilities facing proportions of the population and their complexities - when such vulnerabilities are discussed, they are individualised and viewed in absence of their societal causes, potentially eclipsing critical elements of a child's experience of DVA. The implications of our results are wide-ranging but suggest a need to refocus on children and their context within local DVA policy.
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Affiliation(s)
| | | | - Robbie Duschinsky
- Department of Public Health and Primary Care, Primary Care Unit, University of CambridgeCambridgeUK
| | - Emma Howarth
- School of Psychology, University of East LondonLondonUK
| | - Tammy Mayes
- Lived experience, parent advocate & activist of numerous charitiesGuildfordUK
| | | | - Barry Coughlan
- Department of Public Health and Primary Care, Primary Care Unit, University of CambridgeCambridgeUK
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14
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Cavallaro FL, Gilbert R, Wijlaars LP, Kennedy E, Howarth E, Kendall S, van der Meulen J, Calin MA, Reed L, Harron K. Characteristics of enrolment in an intensive home-visiting programme among eligible first-time adolescent mothers in England: a linked administrative data cohort study. J Epidemiol Community Health 2022; 76:991-998. [PMID: 36198485 DOI: 10.1136/jech-2021-217986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/24/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intensive home visiting for adolescent mothers may help reduce health disparities. Given limited resources, such interventions need to be effectively targeted. We evaluated which mothers were enrolled in the Family Nurse Partnership (FNP), an intensive home-visiting service for first-time young mothers commissioned in >130 local authorities in England since 2007. METHODS We created a population-based cohort of first-time mothers aged 13-19 years giving birth in English National Health Service hospitals between 1 April 2010 and 31 March 2017, using administrative hospital data linked with FNP programme, educational and social care data. Mothers living in a local authority with an active FNP site were eligible. We described variation in enrolment rates across sites, and identified maternal and FNP site characteristics associated with enrolment. RESULTS Of 110 520 eligible mothers, 25 680 (23.2% (95% CI: 23.0% to 23.5%)) were enrolled. Enrolment rates varied substantially across 122 sites (range: 11%-68%), and areas with greater numbers of first-time adolescent mothers achieved lower enrolment rates. Mothers aged 13-15 years were most likely to be enrolled (52%). However, only 26% of adolescent mothers with markers of vulnerability (including living in the most deprived areas and ever having been looked after as a child) were enrolled. CONCLUSION A substantial proportion of first-time adolescent mothers with vulnerability markers were not enrolled in FNP. Variation in enrolment across sites indicates insufficient commissioning of places that is not proportional to level of need, with mothers in areas with large numbers of other adolescent mothers least likely to receive support.
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Affiliation(s)
- Francesca L Cavallaro
- Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ruth Gilbert
- Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Linda Pmm Wijlaars
- Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Eilis Kennedy
- Children, Young Adults and Families Directorate, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Emma Howarth
- School of Psychology, University of East London, London, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Maria Andreea Calin
- Family Nurse Partnership and Intensive Parenting National Unit, Office for Health Improvement and Disparities, London, UK
| | - Lynne Reed
- Family Nurse Partnership and Intensive Parenting National Unit, Office for Health Improvement and Disparities, London, UK
| | - Katie Harron
- Population Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
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15
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Burduli E, Winquist A, Smith CL, Brooks O, Chiou M, Balsiger D, Shogan M, McPherson SM, Barbosa-Leiker C, Jones HE. Supporting perinatal individuals with opioid use disorder and their newborns experiencing neonatal abstinence syndrome: impressions from patients and healthcare providers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:596-605. [PMID: 36166744 PMCID: PMC9645816 DOI: 10.1080/00952990.2022.2122483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Facilitating maternal-newborn involvement and care is critical for improving outcomes for perinatal individuals receiving opioid agonist therapy (OAT) and newborns experiencing Neonatal Abstinence Syndrome (NAS). Comprehensive education strategies are needed to prepare pregnant individuals receiving OAT for navigating the perinatal period.Objectives: Identify facilitators to successful care of perinatal individuals receiving OAT and newborns experiencing NAS via interviews with perinatal individuals and healthcare providers. The goal of identifying this information is to inform a future educational tool development.Methods: Ten perinatal individuals receiving OAT and ten healthcare providers participated in interviews conducted via phone or video conference using semi-structured, open-ended questions. Data were analyzed separately for the two groups and later merged across samples using a qualitative descriptive content analysis approach to identify themes.Results: Under the overarching theme of empowerment to improve outcomes for perinatal women, four themes arose from perinatal and provider interviews: 1) Preparation for Child Protective Services (CPS) involvement, 2) Healthcare providers shape experience through stigma and support 3) Caring for newborns with NAS, and 4) Managing health and resources during postpartum.Conclusion: Perinatal participants emphasized the importance of self-advocacy while navigating healthcare and social systems. Providers highlighted the importance of communicating expectations to empower patients. Education is needed for pregnant individuals receiving OAT on what to expect during pregnancy and postpartum, as well as for providers to help them optimally support their perinatal patients receiving OAT.
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Affiliation(s)
- Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, USA,Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Anna Winquist
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Crystal Lederhos Smith
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Olivia Brooks
- College of Nursing, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Michelle Chiou
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Danica Balsiger
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Maureen Shogan
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Sterling M. McPherson
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Celestina Barbosa-Leiker
- College of Nursing, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, UNC Horizons, University of North Carolina, Chapel Hill, NC, USA
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16
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Kimber M, Vanstone M, Dimitropoulos G, Collin-Vézina D, Stewart D. Researching the Impact of Service provider Education (RISE) Project - a multiphase mixed methods protocol to evaluate implementation acceptability and feasibility. Pilot Feasibility Stud 2022; 8:135. [PMID: 35780156 PMCID: PMC9250197 DOI: 10.1186/s40814-022-01096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health and social service providers receive limited education on recognizing and responding to family violence. With adequate education, providers could be prepared to identify individuals subjected to family violence and help reduce the risk of associated impairment. Informed by the Active Implementation Frameworks, our research will determine the scope of strategies needed for the uptake and sustainability of educational interventions focused on family violence for providers. It will also determine the acceptability, feasibility, and proof-of-concept for a new educational intervention, called VEGA (Violence, Evidence, Guidance, Action), for developing and improving primary care provider knowledge and skills in family violence. METHODS This paper details the protocol for the Researching the Impact of Service provider Education (RISE) Project. The RISE Project follows a sequential multiphase mixed method research design; qualitative and quantitative data are being collected and integrated over three conceptually and methodologically linked research phases. Activities primarily occur in Ontario, Alberta, and Quebec. Phase 1 uses a sequential exploratory mixed method research design to characterize the scope and salience of learning and implementation needs and preferences for family violence education. Phase 2 will use an embedded mixed method research design to determine whether VEGA technology supports providers to achieve their family violence learning goals with effectiveness, efficiency, and satisfaction. Phase 3 will use a concurrent mixed method research design to determine acceptability, feasibility, and proof-of-concept for evaluating whether VEGA improves primary care providers' knowledge and skills in family violence. This final phase will provide information on implementation strategies for family violence education in the "real world." It will also generate data on provider recruitment, retention, and data completeness, as well as exploratory estimates of the effect for provider outcome measures proposed for a randomized controlled trial. DISCUSSION The RISE Project comprehensively integrates an implementation approach to improve family violence education for the health and social service professions. It will provide important information about factors that could influence the uptake and effectiveness of a health profession's educational intervention into the real world, as well as provide foundational evidence concerning the tenability of using a randomized controlled trial to evaluate the impact of VEGA in primary care settings.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, McMaster University, BAHT 132, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St West, Hamilton, ON, Canada.
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 1280 Main St West, Hamilton, ON, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, MacKimmie Tower 413, 2500 University Dr NW, Calgary, AB, Canada
| | - Delphine Collin-Vézina
- School of Social Work, McGill University, 3506 Rue University #300, Montréal, QC, Canada.,Department of Pediatrics, McGill University, 1001 Decarie Blvd, Montréal, QC, Canada
| | - Donna Stewart
- Centre for Mental Health, University of Toronto and University Health Network, EN-7-229, 200 Elizabeth Street, Toronto, ON, Canada
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17
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Stoklosa H, Alhajji L, Finch L, Williams S, Prakash J, Sfakianaki AK, Duthely LM, Potter JE. "Because the resources aren't there, then we fail. We fail as a society": A Qualitative Analysis of Human Trafficking Provider Perceptions of Child Welfare Involvement among Trafficked Mothers. Matern Child Health J 2022; 26:623-631. [PMID: 35015174 DOI: 10.1007/s10995-021-03342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is understood about child welfare involvement (CWI) in cases where the birth mother has experienced human trafficking. OBJECTIVES The aim of this study was to explore provider perceptions of the impact of CWI for the trafficked mother. METHODS Participants were selected among providers caring for trafficked birth mothers. Semi-structured interviews were conducted with providers and qualitative content analysis was conducted. RESULTS Interviewees reported reasons for CWI, positive and negative impacts of CWI and provided recommendations for systems improvement. CONCLUSION FOR PRACTICE Recommendations from this exploratory study include mechanisms to support trafficked mothers, train hospital social workers, and systems change. During the prenatal period, strategies to support the trafficked mother may include addressing gaps in social determinants of health, ensuring appropriate medical and mental health care, early screening and referral to substance use treatment services, enhancing community support, and working to develop safety plans for survivors and their families. Enhanced engagement of social workers and all providers to improve understanding of the unique complexity of trafficked mothers is needed. Education should include an understanding that judgement of a caretaker's ability to parent should be current and holistic and not reflexive based on history in the electronic medical record. An exploration of the child welfare system itself should also be undertaken to identify and modify discriminatory laws and policies. Finally, efforts to address social determinants of health in the community and enhance the trauma-informed nature of child welfare referrals could improve the lives of trafficked mothers.
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Affiliation(s)
- Hanni Stoklosa
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
- HEAL Trafficking, Los Angeles, USA.
| | - Lujain Alhajji
- Department of Psychiatry & Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - Lindsey Finch
- Jackson Health System, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - Sacha Williams
- Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | | | - Anna K Sfakianaki
- Section of Maternal-Fetal Medicine, Gynecology and Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - Lunthita M Duthely
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - JoNell E Potter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
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18
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Mandatory Reporting “will Paralyze People” or “Without it, People Would not Report”: Understanding Perspectives from Within the Child Protection System. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Loveday S, Hall T, Constable L, Paton K, Sanci L, Goldfeld S, Hiscock H. Screening for Adverse Childhood Experiences in Children: A Systematic Review. Pediatrics 2022; 149:184549. [PMID: 35104358 PMCID: PMC9677935 DOI: 10.1542/peds.2021-051884] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
CONTEXT Adverse childhood experiences (ACEs) are associated with increased risk of poor mental health outcomes. Although there is interest in screening for ACEs for early identification and intervention, it is not known whether screening improves outcomes for children. OBJECTIVE To systematically review whether screening for ACEs in children leads to an increase in (1) identification of ACEs, (2) referrals to services, (3) increased uptake of services, and (4) improved mental health outcomes for children and parents. DATA SOURCES Ovid Medline, PsycINFO, CINAHL, and Center for Clinical and Translational Research electronic databases were searched between 2009 and 2021. STUDY SELECTION Studies were included if researchers screened for current ACEs in children aged 0 to 12 years and they had a control comparison. DATA EXTRACTION Information was extracted, including study characteristics, sample demographics, screening tool characteristics, referral rates to services, uptake rates, and mental health outcomes. RESULTS A total of 5816 articles were screened, with 4 articles meeting inclusion criteria. Screening for ACEs increases identification of adversity and may increase referrals to services. There are limited data about whether this leads to an increase in referral uptake by families. There are no reported data addressing mental health outcomes. LIMITATIONS There are few published control trials of moderate quality. CONCLUSIONS There is limited evidence that screening for ACEs improves identification of childhood adversity and may improve referrals. If we are to realize the hypothesized benefits of ACEs screening on child and parent mental health, it is essential to understand the barriers for families taking up referrals.
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Affiliation(s)
- Sarah Loveday
- Health Services,Centre for Community Child Health, The Royal Children’s Hospital, Melbourne, Victoria, Australia,Address correspondence to Sarah Loveday, MBChB, Murdoch Children’s Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia. E-mail:
| | | | | | | | | | - Sharon Goldfeld
- Policy and Equity, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Paediatrics, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia,Centre for Community Child Health, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Health Services,Paediatrics, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia,Centre for Community Child Health, The Royal Children’s Hospital, Melbourne, Victoria, Australia
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20
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Salminen-Tuomaala M, Tiainen J, Paavilainen E. Identification of Child and Youth Maltreatment as Experienced by Prehospital Emergency Care Providers. Issues Ment Health Nurs 2021; 42:1064-1072. [PMID: 33979250 DOI: 10.1080/01612840.2021.1913682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This mixed method study explores 200 prehospital emergency care providers' experiences of identifying child and youth maltreatment. The data were collected in Finland in 2019-2020 using an online survey tool and analysed using SPSS statistics and inductive content analysis. Respondents had encountered signs of physical and psychosocial maltreatment, and family challenges, contexts, and economic and social problems indicative of maltreatment. It is important for the early intervention and prevention of long-term mental health problems that prehospital emergency care providers receive continuing education on the identification of child maltreatment.
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Affiliation(s)
- Mari Salminen-Tuomaala
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | - Juha Tiainen
- Kuusiokunnat Federation of Municipalities in Social and Health Services, Seinäjoki, Finland
| | - Eija Paavilainen
- Faculty of Social Sciences, Health Sciences Unit, South Ostrobothnia Hospital District, Tampere University, Tampere, Finland
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21
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Adams C, Hooker L, Taft A. Threads of Practice: Enhanced Maternal and Child Health Nurses Working With Women Experiencing Family Violence. Glob Qual Nurs Res 2021; 8:23333936211051703. [PMID: 34692921 PMCID: PMC8532206 DOI: 10.1177/23333936211051703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Family violence is a serious public health issue with significant health consequences for women and children. Enhanced Maternal and Child Health nurses (EMCH) in Victoria, Australia, work with women experiencing family violence; however, scholarly examination of the clinical work of nurses has not occurred. This qualitative study explored how EMCH nurses work with women experiencing abuse, describing the personal and professional challenges for nurses undertaking family violence work. Twenty-five nurses participated in semi-structured interviews. Using interpretive description methodology has enabled an insight into nurses' family violence work. Threads of practice identified included (1) Validating/Reframing; (2) Non-judgmental support/Safeguarding and (3) Following/Leading. The nurses highlighted the diversity of experience for women experiencing abuse and nurses' roles in family violence nurse practice. The research contributes to understanding how EMCH nurses traverse threads of practice to support women experiencing family violence.
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Affiliation(s)
- Catina Adams
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Leesa Hooker
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia.,Rural Department of Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Angela Taft
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
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22
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Roberts SCM, Thompson TA, Taylor KJ. Dismantling the legacy of failed policy approaches to pregnant people's use of alcohol and drugs. Int Rev Psychiatry 2021; 33:502-513. [PMID: 34238098 DOI: 10.1080/09540261.2021.1905616] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Most U.S. states have one or more pregnancy-specific alcohol or drug policies. However, research evidence indicates that some of these policies lead to increases in adverse birth outcomes, including low-birthweight and preterm birth. We offer explanations for why these ineffective policies related to pregnant people's use of alcohol and drugs in the U.S. exist, including: abortion politics; racism and the 'War on Drugs'; the design and application of scientific evidence; and lack of a pro-active vision. We propose alternative processes and concepts to guide strategies for developing new policy approaches that will support the health and well-being of pregnant people who use alcohol and drugs and their children. Processes include: involving people most affected by pregnancy-specific alcohol and drug policies in developing alternative policy and practice approaches as well as future research initiatives. Additionally, we propose that research funding support the development of policies and practices that bolster health and well-being rather than primarily documenting the harms of different substances. Concepts include accepting that policies adopted in response to pregnant people's use of alcohol and drugs cause harms and working to do better, as well as connecting to efforts that re-envision the child welfare system in the U.S.
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Affiliation(s)
- Sarah C M Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, Oakland, CA, USA
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23
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Howarth E, Powell C, Woodman J, Walker E, Chesters H, Szilassy E, Gilbert R, Feder G. Protocol for developing core outcome sets for evaluation of psychosocial interventions for children and families with experience or at risk of child maltreatment or domestic abuse. BMJ Open 2021; 11:e044431. [PMID: 34426460 PMCID: PMC8383853 DOI: 10.1136/bmjopen-2020-044431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/31/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Recognition that child maltreatment (CM) and domestic violence and abuse (DVA) are common and have serious and long-term adverse health consequences has resulted in policies and programmes to ensure that services respond to and safeguard children and their families. However, high-quality evidence about how services can effectively intervene is scant. The value of the current evidence base is limited partly because of the variety of outcomes and measures used in evaluative studies. One way of addressing this limitation is to develop a core outcome set (COS) which is measured and reported as a minimum standard in the context of trials and other types of evaluative research. The study described in this protocol aims to develop two discrete COSs for use in future evaluation of psychosocial interventions aimed at improving outcomes for children and families at risk or with experience of (1) CM or (2) DVA. METHODS AND ANALYSIS A two-phase mixed methods design: (1) rapid reviews of evidence, stakeholder workshops and semistructured interviews with adult survivors of CM/DVA and parents of children who have experienced CM/DVA and (2) a three panel adapted E-Delphi Study and consensus meeting. This study protocol adheres to reporting guidance for COS protocols and has been registered on the Core Outcome Measures for Effectiveness Trials (COMET) database. ETHICS AND DISSEMINATION We will disseminate our findings through peer-reviewed and open access publications, the COMET website and presentations at international conferences. We will engage with research networks, journal editors and funding agencies to promote awareness of the CM-COS and DVA-COS. We will work with advisory and survivor and public involvement groups to coproduce a range of survivor, policy and practice facing outputs.Approval for this study has been granted by the Research Ethics Committee at University College London.
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Affiliation(s)
- Emma Howarth
- School of Psychology, University of East London, London, UK
- Institute of Child Health, University College London, London, UK
| | - Claire Powell
- Institute of Child Health, University College London, London, UK
| | - Jenny Woodman
- Institute of Education, University College London, London, UK
| | - Erin Walker
- UCL Partners, University College London, London, UK
| | - Heather Chesters
- Institute of Child Health, University College London, London, UK
| | - Eszter Szilassy
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Ruth Gilbert
- Centre for Paediatric Epidemiology and Biostatistics, University College London Institute of Child Health, London, UK
| | - Gene Feder
- Community Based Medicine, University of Bristol Medical School, Bristol, UK
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24
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Kimber M, McTavish JR, Vanstone M, Stewart DE, MacMillan HL. Child maltreatment online education for healthcare and social service providers: Implications for the COVID-19 context and beyond. CHILD ABUSE & NEGLECT 2021; 116:104743. [PMID: 32980151 PMCID: PMC7513691 DOI: 10.1016/j.chiabu.2020.104743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 05/12/2023]
Abstract
Evidence indicates that healthcare and social service providers (HSSPs) receive inadequate education related to recognizing and responding to child maltreatment. This is despite the fact HSSPs are identified as an important factor in the primary, secondary, and tertiary prevention of this childhood exposure. The need for online education for HSSPs' is highlighted during the COVID-19 pandemic restrictions and will continue to be relevant afterward. The objective of this commentary is to provide an overview of: (a) educational interventions for HSSPs' related to recognizing and responding to child maltreatment; (b) the development of VEGA (Violence, Evidence, Guidance, Action), which is an online platform of educational resources to support HSSPs to recognize and respond to child maltreatment; and (c) the RISE (Researching the Impact of Service provider Education) project, which is an ongoing multi-province evaluation of VEGA in Canada. It is important to consider ongoing ways that HSSPs can receive education related to recognizing and responding to child maltreatment. The virtual implementation of VEGA and the RISE Project provide a necessary opportunity to continue to increase the capacity of Canada's HSSPs to adequately and safely recognize and respond to child maltreatment, while simultaneously advancing education scholarship for the field of child maltreatment and which will have relevance for the COVID-19 context and beyond.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada.
| | - Jill R McTavish
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 1280 Main Street West, DBHSC 5003E, Hamilton, ON, L8S 4K1, Canada
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto and University Health Network, 200 Elizabeth Street, EN-7-229, Toronto, ON, M5G 2C4, Canada
| | - Harriet L MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, and Department of Pediatrics, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
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25
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MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:339-361. [PMID: 33206200 DOI: 10.1007/s00127-020-01976-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/24/2020] [Indexed: 01/28/2023]
Abstract
Worldwide, growing concern with young people's mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11-30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes-initiating contact with mental health services; characteristics of services' response; and youths' and carers' appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths' pathways to them. It underlines the need for grounding reform in youths' and carers' perspectives and needs.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, Canada. .,Douglas Research Centre, Montreal, Canada. .,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada. .,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada.
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
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26
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Kimber M, Gonzalez A, MacMillan HL. Recognizing and Responding to Child Maltreatment: Strategies to Apply When Delivering Family-Based Treatment for Eating Disorders. Front Psychiatry 2020; 11:678. [PMID: 32754071 PMCID: PMC7366365 DOI: 10.3389/fpsyt.2020.00678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/29/2020] [Indexed: 11/29/2022] Open
Abstract
Child maltreatment encompasses a constellation of adverse parental behaviors that include physical, sexual, or emotional abuse, physical or emotional neglect, as well as exposure to violence between parents. A growing body of literature indicates that exposure to child maltreatment is a significant risk factor for the development and maintenance of eating disorders (EDs) and that practitioners experience challenges related to recognizing and responding to various forms of child maltreatment in their practice. Parent-child interactions signifying possible child maltreatment can be subtle; furthermore, the emotional and behavioral symptoms associated with an ED can overlap with those linked with child maltreatment, making it difficult for practitioners to distinguish whether children's symptoms are attributable to underlying psychopathology versus exposure to child maltreatment. This challenge can be further complicated in the context of delivering family-based treatment (FBT); FBT reaffirms that there is no single cause of EDs and asserts the leadership role of parents in their child's recovery process-both of which may lead practitioners to inadvertently miss indicators of child maltreatment. In this article, we provide an overview of the evidence linking child maltreatment to EDs among children and adolescents, as well as evidence-informed strategies for practitioners to safely recognize and respond to suspected child maltreatment when delivering FBT to children and adolescents in their practice.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Harriet L. MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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27
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McTavish JR, Gonzalez A, Santesso N, MacGregor JCD, McKee C, MacMillan HL. Identifying children exposed to maltreatment: a systematic review update. BMC Pediatr 2020; 20:113. [PMID: 32145740 PMCID: PMC7060650 DOI: 10.1186/s12887-020-2015-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment. Methods We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies—where the population and setting matched known prevalence estimates in an emergency department setting—we calculated false positives and negatives. We assessed risk of bias using QUADAS-2. Results We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified. Conclusions There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).
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Affiliation(s)
- Jill R McTavish
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada.
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
| | - Nancy Santesso
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, ON, L8S 4K1, Canada
| | - Jennifer C D MacGregor
- Faculty of Information & Media Studies, Western University, FIMS & Nursing Building, Room 2050, London, ON, N6A 5B9, Canada
| | - Chris McKee
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
| | - Harriet L MacMillan
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada.,Department of Pediatrics, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
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28
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Parikh R, Michelson D, Sapru M, Sahu R, Singh A, Cuijpers P, Patel V. Priorities and preferences for school-based mental health services in India: a multi-stakeholder study with adolescents, parents, school staff, and mental health providers. Glob Ment Health (Camb) 2019; 6:e18. [PMID: 31531228 PMCID: PMC6737585 DOI: 10.1017/gmh.2019.16] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/31/2019] [Accepted: 07/10/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs. METHODS We completed semi-structured interviews and focus group discussions with adolescents (n = 191), parents (n = 9), teachers (n = 78), school counsellors (n = 15), clinical psychologists/psychiatrists (n = 7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers. RESULTS All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents. CONCLUSION SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.
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Affiliation(s)
- R. Parikh
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorstraat 1, Amsterdam, The Netherlands
| | - D. Michelson
- School of Psychology, University of Sussex, Falmer, Brighton, UK
| | - M. Sapru
- Evalueserve.com Private Limited, Tower 6, 8th Floor, Candor Gurgaon One Realty Projects Pvt. Ltd., IT/ITES SEZ, Candor TechSpace, Tikri, Sector-48, Gurgaon, Haryana, India
| | - R. Sahu
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
| | - A. Singh
- International Rescue Committee, No 69/54, Oat Tha Phaya Street, Kyaikkasan Quarter, Bahan Township, Yangon, Myanmar
| | - P. Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorstraat 1, Amsterdam, The Netherlands
| | - V. Patel
- Sangath, C-1/52, 1st Floor, Safdarjung Development Area, New Delhi, Delhi, India
- Department of Global Health and Social Medicine, Harvard Medical School, 641, Huntington Avenue, Boston, MA, USA
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