Child maltreatment online education for healthcare and social service providers: Implications for the COVID-19 context and beyond

Pivoting Continuing Professional Development During the COVID-19 Pandemic: A Narrative Scoping Review of Adaptations and Innovations

INTRODUCTION

Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic.

METHODS

The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period.

RESULTS

Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives.

DISCUSSION

This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.

A Study on User-Oriented Subjects of Child Abuse on Wikipedia: Temporal Analysis of Wikipedia History Versions and Traffic Data

BACKGROUND

Many people turn to online open encyclopedias such as Wikipedia to seek knowledge about child abuse. However, the information available on this website is often disorganized and incomplete.

OBJECTIVE

The aim of this study is to analyze Wikipedia's coverage of child abuse and provide a more accessible way for users to browse child abuse-related content. The study explored the main themes and subjects related to child abuse on Wikipedia and proposed a multilayer user-oriented subject schema from the general users' perspective.

METHODS

The knowledge of child abuse on Wikipedia is presented in the child abuse-related articles on it. The study analyzed child abuse-related articles on Wikipedia, examining their history versions and yearly page views data to reveal the evolution of content and popularity. The themes and subjects were identified from the articles' text using the open coding, self-organizing map, and n-gram approaches. The subjects in different periods were compared to reveal changes in content.

RESULTS

This study collected and investigated 241 associated Wikipedia articles and their history versions and traffic data. Four facets were identified: (1) maltreatment behavior (n=118, 48.9%); (2) people and environment (n=28, 11.6%); (3) problems and risks (n=33, 13.7%); and (4) protection and support (n=62, 25.7%). A total of 8 themes and 51 subjects were generated from the text, and a user-oriented subject schema linking the facets, themes, subjects, and articles was created. Maltreatment behavior (number of total views = 1.15 × 10⁸) was the most popular facet viewed by users, while people and environment (number of total views = 2.42 × 10⁷) was the least popular. The popularity of child abuse increased from 2010 to 2014 but decreased after that.

CONCLUSIONS

The user-oriented subject schema provides an easier way for users to seek information and learn about child abuse. The knowledge of child abuse on Wikipedia covers the harms done to children, the problems caused by child abuse, the protection of children, and the people involved in child abuse. However, there was an inconsistency between the interests of general users and Wikipedia editors, and the child abuse knowledge on Wikipedia was found to be deficient, lacking content about typical child abuse types. To meet users' needs, health information creators need to generate more information to fill the knowledge gap.

Prolonged school closure during the pandemic time in successive waves of COVID-19- vulnerability of children to sexual abuses - A case study in Tamil Nadu, India

Objectives

The Tamil Nadu government mandated several stay-at-home orders, with restrictions of varying intensities, to contain the first two waves of the COVID-19 pandemic. This research investigates how such orders impacted child sexual abuse (CSA) by using counterfactual prediction to compare CSA statistics with those of other crimes. After adjusting for mobility, we investigate the relationship between situational factors and recorded levels of cases registered under the Protection of Children from Sexual Offences Act (POCSO). The situational factors include the victims' living environment, their access to relief agencies, and the competence and responsiveness of the police.

Methods

We adopt an auto-regressive neural network method to make a counterfactual forecast of CSA cases that represents a scenario without stay-at-home orders, relying on the eight-year daily count data of POCSO cases in Tamil Nadu. Using the insights from Google's COVID-19 Community Mobility Reports, we measure changes in mobility across various community spaces during the various phases of stay-at-home orders in both waves in 2020 and 2021.

Results

The steep falls in POCSO cases during strict stay-at-home periods, compared with the counterfactual estimates, were -72% (Cliff's delta -0.99) and -36% (Cliff's delta -0.65) during the first and second waves, respectively. However, in the post-lockdown phases, there were sharp increases of 68% (Cliff's delta 0.65) and 36% (Cliff's delta 0.56) in CSA cases during the first and second waves, with concomitantly quicker reporting of case registration.

Conclusions

Considering that the median delay in filing CSA complaints was above 30 days in the mild and post-intervention periods, the upsurge of cases in the more relaxed phases indicates increased occurrences of CSA during strict lockdowns. Overall, higher victimization numbers were observed during the prolonged lockdown-induced school closures. Our findings highlight the time gap between the incidents and their registration during the strict lockdown phases.

Knowledge, attitude, and practice regarding child maltreatment amongst Iranian medical students through internship course: an 18-month longitudinal study

BACKGROUND

Child maltreatment has been a major worldwide problem and has remained a persistent public health challenge in all countries. Physicians have a significant role in the prevention and intervention of child maltreatment. An educated physician that can effectively identify and report child maltreatment can fill one of the most significant gaps in reducing child abuse. This study was performed to examine the knowledge, attitude, and practice regarding child maltreatment among Iranian medical students through an internship course.

METHOD

All the medical students (235 students) of the Iran University of Medical Sciences who passed the internship entrance exam in the 2019-2020 academic year participated in this study. The participants completed a 49-item scale questionnaire built by combining three other validated questionnaires that evaluate their attitude, knowledge, and practice skills in the first month of their internship course and then completed the same questionnaire 18 months later, at the end-point of the internship period.

RESULTS

One-hundred thirty nine (59.1%) participants were female, and 96 (40.9%) were male. The mean age of the subjects was 24.35 ± 0.76. Only 7 (3%) of them formerly received any education about child maltreatment. There was a significant improvement in scores of the knowledge of prevention (p-value = 0.001), the practice of prevention (p-value < 0.001) and the general subscale of the practice section (p-value < 0.001) during the internship course. However, the performance of participants decreased significantly in the subscales of the attitude towards diagnosis (p-value = 0.001) and the attitude towards reporting (p-value < 0.001) of child maltreatment. At the end of the study, the result of graduated physicians was: The total knowledge and attitude of participants were satisfactory, and the majority were at reasonable levels. Although in the practice subscale, 70.6% of the participants didn't identify, 84.7% didn't refer, and 86.4% didn't report a child abuse case in the past year.

CONCLUSION

The knowledge and attitude of Iranian physicians regarding child maltreatment are at a satisfactory level. Although, the practice level has deficiencies. In addition, our findings show that Iranian interns have a shallow experience regarding child maltreatment, particularly despite the higher scores in attitude and knowledge, which can be the reason for deficiencies in the practice level.

Indigenous Cultural Safety in Recognizing and Responding to Family Violence: A Systematic Scoping Review

This systematic scoping review synthesizes the recommended approaches for providing culturally safe family violence interventions to Indigenous peoples in health care and social service settings. A total of 3783 sources were identified through our electronic database searches, hand-searching of Indigenous-focused journals, and backward and forward citation chaining. After screening those sources in duplicate, 28 papers were included for synthesis in June 2020. Forward citation chaining of these 28 included articles in June 2022 identified an additional 304 possible articles for inclusion; following the screening of those 304 articles, an additional 6 were retained in the review. Thus, a total of 34 articles were included for data extraction and narrative synthesis. Initial results were presented to members of the Six Nations of the Grand River Youth Mental Wellness Committee, and their feedback was incorporated into our inductive organization of findings. Our findings represent three thematic areas that reflect key recommendations for health care and social service provision to Indigenous families for whom family violence is a concern: (1) creating the conditions for cultural safety; (2) healing at the individual and community level; and (3) system-level change. These findings demonstrate the need to center Indigenous peoples and perspectives in the development and implementation of cultural safety approaches, to acknowledge and address historically contingent causes of past and present family violence including colonization and related state policies, and to transform knowledge and power relationships at the provider, organization, and government level.

Indigenous Service Provider Perspectives of an Online Education Module to Support Safe Clinical Encounters about Family Violence in Canada

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.

Prevalence, increase and predictors of family violence during the COVID-19 pandemic, using modern machine learning approaches

Background

We are facing an ongoing pandemic of coronavirus disease 2019 (COVID-19), which is causing detrimental effects on mental health, including disturbing consequences on child maltreatment and intimate partner violence.

Methods

We sought to identify predictors of child maltreatment and intimate partner violence from 380 participants (mean age 36.67 ± 10.61, 63.2% male; Time 3: June 2020) using modern machine learning analysis (random forest and SHAP values). We predicted that COVID-related factors (such as days in lockdown), parents' psychological distress during the pandemic (anxiety, depression), their personality traits, and their intimate partner relationship will be key contributors to child maltreatment. We also examined if there is an increase in family violence during the pandemic by using an additional cohort at two time points (Time 1: March 2020, N = 434; mean age 35.67 ± 9.85, 41.69% male; and Time 2: April 2020, N = 515; mean age 35.3 ± 9.5, 34.33%).

Results

Feature importance analysis revealed that parents' affective empathy, psychological well-being, outdoor activities with children as well as a reduction in physical fights between partners are strong predictors of a reduced risk of child maltreatment. We also found a significant increase in physical punishment (Time 3: 66.26%) toward children, as well as in physical (Time 3: 36.24%) and verbal fights (Time 3: 41.08%) among partners between different times.

Conclusion

Using modernized predictive algorithms, we present a spectrum of features that can have influential weight on prediction of child maltreatment. Increasing awareness about family violence consequences and promoting parenting programs centered around mental health are imperative.

Role of maternal emotion in child maltreatment risk during the COVID-19 pandemic

Purpose

Preliminary research early in the COVID-19 pandemic suggested children appeared to be at increased risk for child maltreatment, particularly as parents struggled with mental health and economic strains. Such strains were likely to influence parental emotions about their children, affecting their parent-child interactions to contribute to elevated maltreatment risk. To identify the potential affective elements that may contribute to such increased maltreatment risk, the current study focused on whether maternal worry about children's behavior specifically as well as maternal anger were related to increased risk for neglect or physical or psychological aggression six months into the pandemic.

Method

The racially diverse sample included 193 mothers who completed an online survey during the COVID-19 pandemic in late September-early October 2020.

Results

Mothers' reported increases in neglect and physical and psychological aggression during the pandemic were significantly related with established measures of maltreatment risk. Furthermore, path models indicated that maternal anger and worry about children's behavior, as well as their interaction, were significantly related to indicators of physical aggression risk and neglect during the pandemic, but only maternal anger related to increased psychological aggression during the pandemic.

Conclusions

Maternal worry and anger about children's behavior may have exacerbated risk for maltreatment under the stressful conditions of the COVID-19 pandemic. Findings suggest affective reactions of both parental worry and anger focused on child behavior warrants greater empirical attention and consideration in intervention efforts both during the pandemic and potentially post-pandemic.

A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response

Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents’ understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.

Professionals' Digital Training for Child Maltreatment Prevention in the COVID-19 Era: A Pan-European Model

The responsiveness of professionals working with children and families is of key importance for child maltreatment early identification. However, this might be undermined when multifaceted circumstances, such as the COVID-19 pandemic, reduce interdisciplinary educational activities. Thanks to technological developments, digital platforms seem promising in dealing with new challenges for professionals’ training. We examined a digital approach to child maltreatment training through the ERICA project experience (Stopping Child Maltreatment through Pan-European Multiprofessional Training Programme). ERICA has been piloted during the pandemic in seven European centers involving interconnected sectors of professionals working with children and families. The training consisted of interactive modules embedded in a digital learning framework. Different aspects (technology, interaction, and organization) were evaluated and trainers’ feedback on digital features was sought. Technical issues were the main barrier, however, these did not significantly disrupt the training. The trainers perceived reduced interaction between participants, although distinct factors were uncovered as potential favorable mediators. Based on participants’ subjective experiences and perspectives, digital learning frameworks for professionals working with children and families (such as the ERICA model nested in its indispensable adaptation to an e-learning mode) can represent a novel interactive approach to empower trainers and trainees to tackle child maltreatment during critical times such as a pandemic, and as an alternative to more traditional learning frameworks.

A Gap Between Children's Rights and Curricular Content in Health, Social Care, and Teacher Education Programs: An Exploratory Cross-Sectional Study

INTRODUCTION

Exposure to child maltreatment is a social and public health challenge that will require interprofessional collaboration to overcome. Evidence indicates that professional students in health, social care, and teacher education programs receive inadequate training in recognizing and responding to child maltreatment. The aims are to 1) assess the extent to which these students found that their uniprofessional education and a large-scale interprofessional learning (IPL) course had taught them about children in general, children's rights, and vulnerable/at-risk children; and 2) explore differences in student responses according to age and educational background.

METHODS

A cross-sectional study. Students (n=2811) completed questionnaires prior to or after IPL courses held in 2019 and 2020 (hybrid case-based, small-group, on-campus courses targeting children, young people, and their families as end users).

FINDINGS

The majority (>90%) agreed that it was important to learn about child-related topics. Only 4.3% disagreed that it was important to learn about vulnerable/at-risk children. Health and social care students enhanced their insight into all the child-related topics (p<0.001) after the IPL course. Teacher education and child welfare students reported decreased insight into children in general (p<0.001 in 2019 and p=0.008 in 2020) but increased insight into vulnerable/at-risk children in 2020 (p=0.001). According to stratified analyses, there was a significantly increased insight into all child-related topics among physiotherapy and Mensendieck physiotherapy students (p<0.001), decreased insight into children in general among teacher education students (p<0.02), and increased insight into vulnerable/at-risk children among teacher education students (p ≤ 0.001) in both 2019 and 2020. Age was of minor importance. The response rates ranged from 16.0% to 36.0%.

CONCLUSION

After the IPL course, the health and social care students significantly enhanced their insight into child-related topics, whereas the students in teacher education and child welfare gained increased insight into vulnerable/at-risk children.

Identification of Child and Youth Maltreatment as Experienced by Prehospital Emergency Care Providers

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.

The Refugee and Immigrant Core Stressors Toolkit (RICST): Understanding the Multifaceted Needs of Refugee and Immigrant Youth and Families Through a Four Core Stressors Framework

Research indicates that refugee and immigrant youth commonly face four core stressors during resettlement in a new country and culture: trauma, acculturative stress, resettlement stress, and isolation. This Four Core Stressors framework can be used to educate providers about these populations’ unique needs and support assessment of relevant socioecological factors influencing health. To facilitate education, training, and dissemination of this framework and complement existing provider resources, we developed the Refugee & Immigrant Core Stressors Toolkit (RICST), a free, web-based toolkit that provides an overview of the Four Core Stressors framework, assessment questions across the four domains, scaffolding to identify needs and points of triage, and recommended interventions. Public hosting of the RICST via REDCap began in March 2018. In addition to the toolkit, users are prompted to provide location of service delivery, intended purpose of use, and interface feedback. Between March 2018 and October 2020, the RICST was used over 2300 times across 6 continents. Most providers used the toolkit to learn more about the needs of refugee and immigrant youth in general, and several noted that it is a valuable educational tool for staff unfamiliar with these populations. Open-ended qualitative feedback indicated high usability. Amidst historically high levels of forced displacement, tools to support provider effectiveness in working with these populations are increasingly needed. The RICST shows promise as an educational, assessment, and treatment-planning tool for providers working with refugee and immigrant families globally. Future directions include location-specific resource mapping and culture-specific intervention strategies.