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Glucklich T, Attrash-Najjar A, Massarweh N, Katz C. What do adults who experienced child sexual abuse want to convey about therapy? CHILD ABUSE & NEGLECT 2023; 146:106435. [PMID: 37722294 DOI: 10.1016/j.chiabu.2023.106435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Child sexual abuse (CSA) studies have significantly advanced the understanding of its prevalence and adverse consequences. Tremendous efforts worldwide have been devoted to CSA interventions. However, surprisingly, there is a lack of research dedicated to learning about experiences with therapy among adults who experienced CSA. OBJECTIVE This study was designed to address this gap by exploring the perspectives and experiences with therapy among adults who experienced CSA. METHODS Thirty-nine written testimonies comprised the current sample. All of the testimonies were provided to the Israeli Independent Public Inquiry into CSA by adults who experienced CSA and received therapy at one point in their lives. A qualitative inductive thematic analysis guided the exploration of the testimonies. RESULTS The testimonies provided an important glance into significant characteristics of therapy, such as the timing and reasons leading to therapy, and perceptions regarding what constitutes appropriate therapy. Although beneficial and rehabilitating therapy experiences were mentioned by some of the participants, the majority of the testimonies focused on experiences related to the obstacles and challenges to accessing and engaging in therapy faced by those who experienced CSA. CONCLUSIONS The testimonies not only addressed essential aspects of therapy, but also highlighted the importance of thoroughly comprehending the broad context of a person's life that leads them to seek therapy. The discussion points to grave social and policy lacunas that prevent people who experienced CSA from receiving therapy that is accessible, timely, subsidized, stigma-free and multifaceted.
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Affiliation(s)
- Talia Glucklich
- The Haruv Institute, The Hebrew University, Mount Scopus, Jerusalem 9765418, Israel
| | - Afnan Attrash-Najjar
- The Bob Shapell School of Social Work at Tel Aviv University, Tel Aviv 69978, Israel
| | - Nadia Massarweh
- The Al-Qasemi Educational College of Education, Baqa-El-Gharbia 3010000, P.O. Box 124, Israel
| | - Carmit Katz
- The Bob Shapell School of Social Work at Tel Aviv University, Tel Aviv 69978, Israel.
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Wamser-Nanney R, Campbell CL. Factors associated with caregiver help seeking behavior among at-risk children. CHILD ABUSE & NEGLECT 2022; 134:105937. [PMID: 36327764 DOI: 10.1016/j.chiabu.2022.105937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/15/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few at-risk school-age children receive needed psychological help, and our understanding of predictors of service use in this population is limited. Many broader contextual factors have received little attention including caregiver's trauma history and social support, father involvement, family functioning, and neighborhood satisfaction. The links between types of and cumulative maltreatment have also been inconsistent, and prior work has not always accounted for children's symptoms. OBJECTIVE The current study examined child, caregiver, family, neighborhood, and maltreatment factors in relation to past-year mental health service use among at-risk eight-year-old children. Cumulative and types of maltreatment were both investigated to help elucidate the role of these experiences. PARTICIPANTS/SETTING/METHOD Eight hundred and forty-five eight-year-old at-risk children (48.3 % male; 59.5 % Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) were included. RESULTS A small portion of children (12.4 %) received psychological help in the previous year. Children's externalizing symptoms, residing with a non-biological caregiver, cumulative maltreatment and sexual and emotional abuse were associated with seeking psychological services, whereas physical abuse, neglect, and domestic violence exposure were not. Other caregiver factors, and family and neighborhood factors were also unrelated. CONCLUSIONS Non-biological caregivers as well as caregivers of children with higher levels of externalizing symptoms may be more inclined to seek out mental health services, along with greater, and specific, maltreatment experiences. These findings indicate that child factors may be key in understanding help seeking, however, it is important to further consider other broader contextual factors in future work.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA.
| | - Claudia L Campbell
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
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Wamser-Nanney R, Campbell CL. Correlates of caregiver's help seeking behavior among young maltreated children. CHILD ABUSE & NEGLECT 2022; 126:105520. [PMID: 35091133 DOI: 10.1016/j.chiabu.2022.105520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Relatively few maltreated children receive mental health services, despite the importance of treatment in combating the deleterious impact of maltreatment. Characteristics of the child, caregiver, and family have been investigated in relation to caregiver's help seeking behavior for children's psychological difficulties; yet, these associations have been inconsistent, and are very understudied among younger maltreated children. Other aspects of the child's environment, such as father involvement, negative life events, and neighborhood risk and satisfaction have not been examined. It is also uncertain how cumulative maltreatment and the specific forms of maltreatment - sexual, physical, and emotional abuse, neglect, and domestic violence, are associated with mental health consultation. OBJECTIVE The aim of the current study was to utilize an ecological model that included child, caregiver, family, neighborhood, and maltreatment factors to better understand caregiver's help seeking behavior. PARTICIPANTS/SETTING/METHOD The study relied upon 448 six-year-old maltreated children (47.5% male; 48.7% Black) from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study. RESULTS Several factors, including child's gender and externalizing symptoms, and caregiver educational attainment and depression and were associated with mental health consultation. Cumulative maltreatment, however, was unrelated. When the specific forms of maltreatment were included, none of the individual maltreatment types were tied to help seeking behavior. CONCLUSIONS Child and caregiver factors, such as child's level of behavioral challenges as caregiver's level of education and depression, may contribute to decisions regarding seeking services for young, maltreated children. However, neither cumulative nor the forms of maltreatment may correspond with help seeking among young, maltreated children.
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Affiliation(s)
- Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA.
| | - Claudia L Campbell
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
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Asgeirsdottir BB, Huffhines L, Sigurvinsdottir R, Wherry JN. Dyadic Reports Using the Parental Support after Child Sexual Abuse Measure: Psychometrics and Associations with Post-Traumatic Stress Disorder Symptoms. CHILD ABUSE REVIEW (CHICHESTER, ENGLAND : 1992) 2021; 30:576-593. [PMID: 37304461 PMCID: PMC10254746 DOI: 10.1002/car.2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
This study assessed the psychometric properties of a new measure, the Parental Support after Child Sexual Abuse (PSCSA) survey, and tested the association between parents' and children's parental support reports and children's post-traumatic stress disorder (PTSD) symptoms. A total of 99 Icelandic children (86.5% girls, 6-18 years old, M = 13.9 years) starting therapy for child sexual abuse (CSA) and 98 non-offending parents (90.6% mothers, 23-58 years old, M = 41.2 years) participated in the study. Participants completed questionnaires on parental support (PSCSA) and children's PTSD symptom severity (University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition). A total of 18 items were considered for the PSCSA parent version and nine for the PSCSA child version. Five reliable factors emerged for the parent version (Emotional support, Instrumental support, Self-blame, Child blame and Disbelief) using 16 items and one factor (combined Emotional and instrumental support) emerged for the child's version using eight items. On average, ratings for both Emotional and Instrumental support were higher for parents than their children. Emotional support reported by both parents and children was negatively associated with PTSD symptom severity. The PSCSA survey is a promising dyadic measure for future research and clinical use in children's advocacy centres.
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Affiliation(s)
| | - Lindsay Huffhines
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA Bradley/Hasbro Children’s Research Center, E. P. Bradley Hospital, East Providence, Rhode Island, USA
| | | | - Jeffrey N. Wherry
- Williamson County Children’s Advocacy Center, Round Rock, Texas, USA
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Herbert JL, Bromfield LM. A quasi-experimental study of the Multi-Agency Investigation & Support Team (MIST): A collaborative response to child sexual abuse. CHILD ABUSE & NEGLECT 2021; 111:104827. [PMID: 33250277 DOI: 10.1016/j.chiabu.2020.104827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
To improve the holistic response to child sexual abuse in Perth, Western Australia, a group consisting of government and community support agencies developed a new co-located approach that combined support services with investigations, called the Multi-agency Investigation & Support Team (MIST). The model was comparable to the prominent Children's Advocacy Centre approach, with adaptations for Australian conditions. This study evaluated the fidelity with which this new program was delivered and examined whether it resulted in improved criminal justice, child protection, and service outcomes compared to existing practice. Drawing on service data linked across participating agencies the study found MIST was delivered with reasonable fidelity to its planned procedure, but with some challenges for delivery of the program due to the relative workload for staff in the MIST condition. The service demonstrated high levels of caregiver satisfaction with the response and high rates of children's engagement with therapy. A quasi-experimental comparison between MIST (n = 126) and Practice as Usual (n = 276) found MIST was significantly faster throughout the criminal justice and child protection processes, but the conditions did not differ in the rate of arrest or child protection actions. While embedding support services within the investigation process may not have a dramatic influence on criminal justice and child protection outcomes, the high rates of uptake of therapeutic services and parental satisfaction suggest other benefits that require future exploration.
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Affiliation(s)
- James Leslie Herbert
- Australian Centre for Child Protection, University of South Australia, Australia.
| | - Leah Marie Bromfield
- Australian Centre for Child Protection, University of South Australia, Australia
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Westphaln KK, Regoeczi W, Masotya M, Vazquez-Westphaln B, Lounsbury K, McDavid L, Lee H, Johnson J, Ronis S. Outcomes and outputs affiliated with Children's Advocacy Centers in the United States: A scoping review. CHILD ABUSE & NEGLECT 2021; 111:104828. [PMID: 33339637 DOI: 10.1016/j.chiabu.2020.104828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Children's Advocacy Center (CAC) model is the predominant multidisciplinary model that responds to child sexual abuse (CSA) in the United States (US). While the CAC model has made important contributions in case coordination and referrals for specialty services, little is known about child- or family-oriented outcomes. OBJECTIVE Explore the trends and gaps involving outcome and output measures affiliated with CACs in the US. PARTICIPANTS & SETTING A scoping review of the literature was conducted on English language articles published between 1985-2019 that involved CACs and children less than 18 years of age. METHODS An electronic database search using the terms "Children's Advocacy Center(s)," "Child Advocacy Center(s)," and "CAC(s)" identified titles and abstracts. Data from articles selected for full text review were evaluated by a multidisciplinary team using a mixed methods approach. RESULTS Measures of CAC impact frequently focus on service and programmatic outputs with person-centered outcomes left often reported. The most prevalent output measures related to case prosecution and forensic interviews. Person-centered outcomes most commonly emphasized child mental health and caregiver satisfaction. The majority of articles were limited by weak or unspecified study designs. CONCLUSION The current literature on CACs suggests that while they are successful in coordinating services and facilitating referrals, little is known about how engagement with CACs impacts short- and long-term outcomes for children and families. Further research beyond cross sectional or quasi-experimental designs is necessary to better understand how variability in CAC structure, function, and resources can be optimized to meet the needs of the diverse communities that they serve. This is especially salient given the national dissemination of the CAC model. Without such additional studies, knowledge will remain limited regarding the enduring impacts of CACs on the lives of those impacted by CSA.
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Affiliation(s)
- Kristi K Westphaln
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, OH, USA; UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | - Wendy Regoeczi
- College of Liberal Arts and Social Sciences, Cleveland State University, Cleveland, OH, USA.
| | - Marie Masotya
- UH Rainbow Center for Child Health and Policy, Cleveland, OH, USA.
| | | | | | - Lolita McDavid
- UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA; Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - HaeNim Lee
- Department of Social Welfare and Counseling, Dongguk University, South Korea.
| | | | - Sarah Ronis
- UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA; UH Rainbow Center for Child Health and Policy, Cleveland, OH, USA; Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Stefanidou T, Hughes E, Kester K, Edmondson A, Majeed-Ariss R, Smith C, Ariss S, Brooker C, Gilchrist G, Kendal S, Lucock M, Maxted F, Perot C, Shallcross R, Trevillion K, Lloyd-Evans B. The identification and treatment of mental health and substance misuse problems in sexual assault services: A systematic review. PLoS One 2020; 15:e0231260. [PMID: 32275695 PMCID: PMC7147790 DOI: 10.1371/journal.pone.0231260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders' views and policy recommendations about optimal SARC practice. METHODS A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted. RESULTS We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services. CONCLUSIONS This review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required. PROSPERO registration number: CRD42018119706.
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Affiliation(s)
| | - Elizabeth Hughes
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Katherine Kester
- Division of Psychiatry, University College London, London, United Kingdom
| | - Amanda Edmondson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom
| | - Rabiya Majeed-Ariss
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Christine Smith
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom
| | - Steven Ariss
- Centre for Assistive Technology and Connected Healthcare (CATCH) and School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Charlie Brooker
- Centre for Criminology and Sociology, Royal Holloway University of London, Surrey, United Kingdom
| | - Gail Gilchrist
- Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sarah Kendal
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Mike Lucock
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom
| | - Fay Maxted
- The Survivors Trust, Rugby, Warwickshire, United Kingdom
| | - Concetta Perot
- Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rebekah Shallcross
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Kylee Trevillion
- Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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Macdonald G, Livingstone N, Hanratty J, McCartan C, Cotmore R, Cary M, Glaser D, Byford S, Welton NJ, Bosqui T, Bowes L, Audrey S, Mezey G, Fisher HL, Riches W, Churchill R. The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis. Health Technol Assess 2018; 20:1-508. [PMID: 27678342 DOI: 10.3310/hta20690] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003889. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geraldine Macdonald
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK.,School for Policy Studies, University of Bristol, Bristol, UK
| | - Nuala Livingstone
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Jennifer Hanratty
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Claire McCartan
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Richard Cotmore
- Evaluation Department, National Society for the Prevention of Cruelty to Children (NSPCC), London, UK
| | - Maria Cary
- King's Health Economics, King's College London, London, UK
| | - Danya Glaser
- University College London and Great Ormond Street Hospital for Sick Children, London, UK
| | - Sarah Byford
- King's Health Economics, King's College London, London, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tania Bosqui
- Institute of Child Care Research, School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, UK
| | - Lucy Bowes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Suzanne Audrey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gill Mezey
- Population Health Sciences and Education, St George's, University of London, London, UK
| | - Helen L Fisher
- King's Health Economics, King's College London, London, UK
| | - Wendy Riches
- Riches and Ullman Limited Liability Partnership, London, UK
| | - Rachel Churchill
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Simon VA, Barnett D, Smith E, Mucka L, Willis D. Caregivers' abuse stigmatization and their views of mental health treatment following child sexual abuse. CHILD ABUSE & NEGLECT 2017; 70:331-341. [PMID: 28683373 PMCID: PMC5600842 DOI: 10.1016/j.chiabu.2017.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/20/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
Many families do not utilize mental health services after the discovery of child sexual abuse (CSA), even when trauma-focused treatments are offered at low or no cost. Non-offending caregivers frequently serve as gatekeepers to youths' treatment, and their reactions to CSA may figure into decisions about treatment engagement. The current study examined caregivers' abuse stigmatization (i.e., self-blame and shame about their children's CSA) and associations with two factors predictive of treatment engagement (motivation, obstacles). Participants were recruited from a Child Advocacy Center where they received forensic interviews and were offered services following CSA discovery. Participating caregiver-child dyads included 52 non-offending caregivers (83% biological parents) and their children (69% girls; Mage=10.94, SDage=2.62). Caregiver abuse stigmatization was associated with higher motivation for treatment but also more obstacles to treatment. Further, abuse stigmatization moderated associations between children's PTSD symptoms and perceived obstacles to treatment with medium effect sizes (M f2=0.287). Among caregivers experiencing high abuse stigmatization, greater child PTSD symptoms were associated with more obstacles to treatment. Among caregivers experiencing low stigmatization, child PTSD was either associated with fewer treatment obstacles or was unrelated to treatment obstacles. Results highlight the potential significance of reducing parents' abuse stigmatization for increasing mental health service utilization following CSA discovery, especially for more symptomatic youth.
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Fong HF, Bennett CE, Mondestin V, Scribano PV, Mollen C, Wood JN. Caregiver perceptions about mental health services after child sexual abuse. CHILD ABUSE & NEGLECT 2016; 51:284-294. [PMID: 26602155 DOI: 10.1016/j.chiabu.2015.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/03/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
The objective of this study was to describe caregiver perceptions about mental health services (MHS) after child sexual abuse (CSA) and to explore factors that affected whether their children linked to services. We conducted semi-structured, in-person interviews with 22 non-offending caregivers of suspected CSA victims<13 years old seen at a child advocacy center in Philadelphia. Purposive sampling was used to recruit caregivers who had (n=12) and had not (n=10) linked their children to MHS. Guided by the Health Belief Model framework, interviews assessed perceptions about: CSA severity, the child's susceptibility for adverse outcomes, the benefits of MHS, and the facilitators and barriers to MHS. Interviews were audio-recorded, transcribed, coded, and analyzed using modified grounded theory. Recruitment ended when thematic saturation was reached. Caregivers expressed strong reactions to CSA and multiple concerns about adverse child outcomes. Most caregivers reported that MHS were generally necessary for children after CSA. Caregivers who had not linked to MHS, however, believed MHS were not necessary for their children, most commonly because they were not exhibiting behavioral symptoms. Caregivers described multiple access barriers to MHS, but caregivers who had not linked reported that they could have overcome these barriers if they believed MHS were necessary for their children. Caregivers who had not linked to services also expressed concerns about MHS being re-traumatizing and stigmatizing. Interventions to increase MHS linkage should focus on improving communication with caregivers about the specific benefits of MHS for their children and proactively addressing caregiver concerns about MHS.
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Affiliation(s)
- Hiu-fai Fong
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, 13th Floor, Philadelphia, PA 19104, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104, USA; Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, 12th Floor Northwest, Philadelphia, PA 19104, USA
| | - Colleen E Bennett
- Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Valerie Mondestin
- Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, 12th Floor Northwest, Philadelphia, PA 19104, USA; PolicyLab, The Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Philip V Scribano
- Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, 12th Floor Northwest, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Cynthia Mollen
- Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA; PolicyLab, The Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104, USA; Division of Emergency Medicine, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Joanne N Wood
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104, USA; Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, 12th Floor Northwest, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA; PolicyLab, The Children's Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104, USA
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Collings SJ. Where the streets have no names: factors associated with the provision of counselling and social work services for child rape survivors in KwaZulu-Natal, South Africa. J Child Adolesc Ment Health 2009; 21:139-46. [PMID: 25865723 DOI: 10.2989/jcamh.2009.21.2.5.1013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to audit the provision of state-assisted counselling and social work services to child rape survivors presenting for medico-legal assessment at a state hospital in KwaZulu- Natal, South Africa. METHOD A prospective design was used to collect data from the social and medical case files of 200 consecutive cases of child rape referred for medico-legal assessment to a state hospital located to the north of the City of Durban (South Africa). For each case, information was obtained regarding survivor and offender demographics, the nature and duration of abuse, and the extent and nature of counselling and social work services provided. RESULTS Only 49% of survivors benefited from state-supported counselling and social work services, with the provision of such services being frequently delayed (by periods of up to six months), and with service provision being restricted to a single intake interview in all but one case. Social work service provision was significantly less likely in cases where the survivor resided in an informal dwelling (OR = 0.507) and where the child presented for medico-legal assessment outside of normal working hours (OR = 0.625). From observations made during the study, it would appear that patterns of professional collaboration in relation to service provision for child rape survivors falls somewhat short of the ideal of effective multi-sectoral engagement. CONCLUSIONS Levels of service provision observed in the study are unacceptably low, with there being a clear need for the development and implementation of carefully considered multi-sectoral protocols which are designed to effectively meet the needs of all child rape survivors.
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Affiliation(s)
- Steven J Collings
- a School of Psychology , Howard College Campus, University of KwaZulu-Natal , Durban , 4041 , South Africa
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