Search

Despite numerous studies identifying a broad range of harms associated with the use of spanking and other types of physical punishment, debate continues about its use as a form of discipline. In this commentary, we recommend four strategies to move the field forward and beyond the spanking debate including: 1) use of methodological approaches that allow for stronger causal inference; 2) consideration of human rights issues; 3) a focus on understanding the causes of spanking and reasons for its decline in certain countries; and 4) more emphasis on evidence-based approaches to changing social norms to reject spanking as a form of discipline. Physical punishment needs to be recognized as an important public health problem. [ABSTRACT FROM AUTHOR]

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design ( n = 23,395; household response rate = 79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR = 15.8; 95% CI = 10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse. [ABSTRACT FROM AUTHOR]

Children exposed to intimate partner violence (IPV) are at increased risk of experiencing behavioral difficulties including externalizing and internalizing problems. While there is mounting evidence about mental health problems in children exposed to IPV, most of the research to date focuses on IPV exposure as a unitary, homogeneous construct. The purpose of this study was to examine the association between subtypes of IPV exposure on child functioning and presence of harm within a child welfare sample. Given the evidence of the “double whammy” effect, co-occurring IPV exposure was also examined. Using data from the Canadian Incidence Study of Reported Child Abuse and Neglect – 2008 ( n = 2,184) we examined whether specific IPV exposure subtypes or their co-occurrence resulted in a greater risk of child maladjustment. Information was obtained from child welfare workers’ reports. Caregiver and household risk factors were also examined. Co-occurring IPV exposure resulted in the greatest risk for reported child maladjustment. Exposure to emotional IPV and direct physical IPV were significantly associated with increased risk of internalizing problems and presence of harm. Caregiver mental health and lack of social support emerged as significant risk factors for behavior problems. This study adds to the evidence that exposure to subtypes of IPV may be differentially related to child functioning. Given that risk factors and child functioning is part of the decision-making framework for case worker referrals, this study provides important preliminary evidence about how the child welfare system operates in practice with respect to sub-types of exposure to IPV. These findings suggest that intervening with children exposed to different types of IPV may require a tailored approach. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is endemic in societies around the world and detrimental to women's wellbeing. Abused women are frequent users of health services. Despite the recent World Health Organization guidelines on IPV and sexual violence, we need more evidence on effective responses to women in health care settings. Developing robust evidence with potential to inform policy and clinical practice requires greater clarity and consistency across studies in the selection and use of outcomes to evaluate interventions. Drawing on systematic reviews and individual trials aimed at reducing abuse and improving women's health, we discuss critical issues in respect of outcomes. We discuss primary, secondary, intermediate and proxy outcomes and measures used to evaluate interventions for women who experience IPV. We offer recommendations about which outcomes to assess and approaches to doing so within the context of trials in health care settings. [ABSTRACT FROM AUTHOR]

Abstract: Children's exposure to intimate partner violence (IPV) is increasingly recognized as a type of child maltreatment that has a level of impairment similar to other types of abuse and neglect. Despite advances in the area of IPV, the safety planning strategies recommended as part of the overall response to IPV need to be examined in terms of their implications for children. This article discusses these strategies within the context of child safety, comparing IPV safety planning with approaches aimed at reducing exposure to other types of violence such as child sexual abuse, as well as general child safety strategies. Despite the emphasis on safety planning in information available on responding to IPV, the actual effectiveness of such planning in improving safety and reducing violence is unknown. Safety planning provided to children by a parent experiencing IPV, especially when IPV is ongoing and not recognized by anyone outside the home, may lead to confusing messages for children, particularly if there is an emphasis on secrecy. While awaiting evidence about the effectiveness of specific safety planning strategies for children, we suggest basic principles and general strategies that emphasize universality in terms of education about any type of violence or abuse in the home being unacceptable, as well as the need to focus on safety in general. [Copyright &y& Elsevier]

Epidemiological surveys measuring the prevalence of child maltreatment generate essential knowledge that is required to enhance human rights, promote gender equality, and reduce child abuse and neglect and its effects. Yet, evidence suggests Institutional Review Boards (IRBs) may assess the risk of these studies using higher than normal thresholds, based on a perception they may cause high distress to participants. It is essential for IRBs and researchers to have an accurate understanding of the nature and extent of participant distress associated with these studies, and of the duties of researchers towards survey participants, so that meritorious research is endorsed and duties to participants discharged. Assessment by IRBs of the ethics of such research must be appropriately informed by scientific evidence, ethical principles, and legal requirements. This article adds to knowledge by considering participant distress in child maltreatment surveys and its appropriate ethical and operational treatment. We provide an updated overview of scientific evidence of the frequency and severity of distress in studies of child maltreatment, a review of ethical requirements including a focus on beneficence and participant welfare, and a new analysis of researchers' legal duties towards participants. Our analyses demonstrate that participant distress is infrequent and transitory, that researchers can satisfy ethical requirements towards participants, and that legal liability does not extend to emotional distress. Informed by these bodies of knowledge, we distil key principles of good epidemiological practice to provide solutions to operational requirements in these surveys, which both fulfil ethical requirements to participants, and demonstrate trauma-informed practice. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Exposure to child maltreatment is associated with physical, emotional, and social impairment, yet in Canada there is a paucity of community-based information about the extent of this problem and its determinants. We examined the prevalence of child physical and sexual abuse and the associations of child abuse with early contextual, family, and individual factors using a community-based sample in Ontario. Methods: The Ontario Child Health Study is a province-wide health survey of children aged 4 through 16 years. Conducted in 1983, a second wave was undertaken in 1987 and a third in 2000–2001. The third wave (N =1,928) included questions about exposure to physical and sexual abuse in childhood. Results: Males reported significantly more child physical abuse (33.7%), but not severe physical abuse (21.5%), than females (28.2% and 18.3%, respectively). Females reported significantly more child sexual abuse (22.1%) than males (8.3%). Growing up in an urban area, young maternal age at the time of the first child''s birth, and living in poverty, predicted child physical abuse (and the severe category), and sexual abuse. Childhood psychiatric disorder was associated with child physical abuse (and the severe category), while parental adversity was associated with child sexual abuse and severe physical abuse. Siblings of those who experienced either physical abuse or sexual abuse in childhood were at increased risk for the same abuse exposure; the risk was highest for physical abuse. Conclusions: These findings highlight important similarities and differences in risk factors for physical and sexual abuse in childhood. Such information is useful in considering approaches to prevention and early detection of child maltreatment. Clinicians who identify physical abuse or sexual abuse in children should be alert to the need to assess whether siblings have experienced similar exposures. This has important implications for assessment of other children in the home at the time of identification with the overall goal of reducing further occurrence of abuse. [Copyright &y& Elsevier]

Background: Few studies have examined stress reactivity and its relationship to major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) among maltreated youth. We examined differences between maltreated and control participants in heart rate and cortisol resting and reactivity levels in response to a psychosocial stressor. Methods: We recruited 67 female youths aged 12 to 16 with no prior history of depression from child protection agencies and a control group of 25 youths matched on age and postal code. Child maltreatment was measured with two self-report instruments. Psychiatric status was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children. Results: Piecewise multilevel growth curve analysis was used to model group differences in resting and reactivity cortisol levels and heart rate in response to the Trier Social Stress Test (TSST). During the resting period, both the maltreated and control groups showed a similar decline in levels of cortisol. During the reactivity phase, youth in the control group showed an increase in cortisol levels following the TSST and a gradual flattening over time; maltreated youth exhibited an attenuated response. This blunted reactivity was not associated with current symptoms of MDD or PTSD. There were no group differences in resting and reactivity levels of heart rate. Conclusions: These findings provide further support for hypothalamic-pituitary-adrenal axis dysregulation among maltreated youth. Since the ability to respond to acute stressors by raising cortisol is important for health, these findings may assist in understanding the vulnerability of maltreated youth to experience physical and mental health problems. [Copyright &y& Elsevier]

Objective: This study presents evaluative data on the Childhood Experiences of Violence Questionnaire (CEVQ), a brief, self-report measure of youth victimization. Methods: Literature reviews, expert consultations and qualitative interviews informed the development of the CEVQ. Test–retest reliability of the preliminary and final versions of the CEVQ was examined. Child welfare workers (n =11) assessed content validity. Construct validity was assessed by comparing levels of emotional and behavioral problems of youth with self-reports (n =177) of victimization. Criterion validity was tested by comparing clinicians’ judgment of child physical abuse (PA) and child sexual abuse (SA) with youths’ self-reports (n =93). Results: In general, test–retest intra-class correlations (ICCs) for the preliminary version of the questionnaire were good to excellent. Reliability estimates for the stem questions in the final version of the CEVQ were excellent, except for peer violence items which showed fair to good agreement. ICCs for PA, severe PA, SA, and severe SA of the CEVQ were .85, .77, .92, and .87, respectively. Youth with self-reported victimization had significantly higher scores for most categories of emotional and behavioral disorders. Experts classified victimization items as relevant. Kappa coefficients comparing clinician's judgments and youth's self-reports for PA, severe PA, SA, and severe SA were .67, .64, .70, and .50, respectively. Conclusions: The present findings provide preliminary evidence that the CEVQ is a brief, reliable, valid and informative instrument for assessing exposure to victimization and maltreatment among youth. Practice implications: Although this instrument is not appropriate for clinical use at this time, its psychometric properties will make it useful in conducting further epidemiological research and studies evaluating interventions aimed at reducing victimization. [Copyright &y& Elsevier]

Objective: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada.Method: The sample consisted of 8,472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined.Results: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem.Conclusions: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families. [Copyright &y& Elsevier]

Objective: This study uses results from a large community survey to examine the relationship between a history of child maltreatment and self-reports of contact with Child Protection Services (CPS).Methods: The Ontario Health Supplement was a province-wide, probability-based survey of household dwellings in the province of Ontario, Canada. A random sample of residents aged 15 and older participated in the Ontario Health Supplement (N=9,953). A face-to-face interview included a question about contact with Child Protection Services (CPS), and the Child Maltreatment History Self-Report, a self-administered questionnaire, was used to assess history of child physical and sexual abuse.Results: Only a very small percentage of respondents with a history of child abuse reported contact with CPS; 5.1% of those with a history of physical abuse, and 8.7% of those with a history of sexual abuse. Contact with CPS was associated with younger age of respondent for both types of abuse and female gender for physical abuse. In the case of sexual abuse, younger respondents whose parental employment classification was in the lower socioeconomic group were more likely to have contact with CPS.Conclusions: Interventions that target only those who come in contact with CPS will not reach most persons exposed to child abuse. [Copyright &y& Elsevier]

Objective: The study's goal was to examine the relationship between a history of parental psychiatric disorder and a history of child abuse in a general population sample of Ontario residents. Method: A representative community sample of 8548 respondents who participated in the Ontario Mental Health Supplement (OHSUP) were interviewed about parental psychiatric history and completed a self-report measure of childhood physical and sexual abuse. Results: The lifetime prevalence of either parent with a psychiatric disorder was as follows: 14.1% for depression, 3.7% for manic depression, 2.4% for schizophrenia, 2.4% for antisocial behavior, and 17.3% for any parental psychiatric disorder. Respondents reporting a parental history of depression, mania, or schizophrenia had a two to threefold increase in the rates of physical, sexual, or any abuse. Parental history of antisocial disorder increased the risk of exposure to physical abuse (adjusted odds ratios [OR 6.1] and any abuse [OR 7.5]). There was no statistically significant difference between parental psychiatric disorder and childhood physical or sexual abuse by gender of the respondent There was a trend for increasing risk associated with father only, mother only, and both parents having any psychiatric disorder. Conclusions: The elevated risk for physical and sexual abuse among respondents reporting a parental history of psychiatric illness highlights the need to examine the mechanism for this association. Such information is important in developing approaches to assist families where the risk of child maltreatment is increased. [ABSTRACT FROM AUTHOR]

Maternal adverse childhood experiences (ACEs) are associated with difficulties in parent-child relationships; however, current research has primarily used cross-sectional designs. Parent and child behavior may be differentially affected by ACEs as children develop and caregiving demands change. Furthermore, diminished executive function (EF) is associated with both ACEs and parenting difficulties and may be a mechanism underlying the intergenerational effects of ACEs. This study examined longitudinal associations between maternal ACEs, maternal EF, and patterns of change in maternal and child emotional availability (EA). Mother-child dyads (N = 114) participated in five assessments over a 5-year period. Maternal ACEs were measured retrospectively at 3 months, maternal EF was assessed at 8 months, and mother-child interactions were videotaped at 18, 36 and 60 months postpartum. Multilevel modelling was used to model growth curves. Maternal EA did not significantly change, while child EA increased from 18 to 60 months postpartum. Maternal ACEs were negatively associated with maternal and child EA at 18 months postpartum; this effect was not significant at 60 months postpartum. In contrast, there was a persistent, positive effect of maternal EF on EA trajectories. Maternal EF did not mediate the association between ACEs and EA. There were also significant within-dyad associations between maternal and child EA. The effects of maternal ACEs on parenting are not necessarily persistent. Findings also support sustained relations between maternal EF and mother-child interactions across early childhood, suggesting the utility of EF as an intervention target. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are increasingly recognized as important predictors of poor health outcomes. In response, there is increasing application of ACEs questionnaires in clinical practice and population health surveys. Such efforts are often justified as approaches to identify ACEs, components of trauma-informed care, and/or measures to determine prevalence within epidemiological research. Unfortunately, such measures are often used without evaluating the strengths and limitations of the measures themselves. One of the most commonly used ACEs questionnaires is a ten-question version (ACEs-10), that is composed of two clusters - one asking about different types of child maltreatment, and the other asking select questions about household challenges. Unfortunately, both this questionnaire and its derivatives have substantial drawbacks that warrant careful consideration about their use. Problems include limited item coverage, collapsing of items and response options, a simplistic scoring approach, and the lack of psychometric assessment. These deficiencies are inconsistent with the standards expected for use of measures in healthcare services and research. Given these deficiencies, we recommend that these limitations are addressed before further use of ACEs-10, and its derivatives, for either clinical or research purposes. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a prevalent exposure with potentially serious, negative health consequences, including post-traumatic stress disorder (PTSD) and its symptomatology. To conduct a systematic and critical review in order to investigate the relationship between CSA disclosure patterns and PTSD. Studies included clinical, college and community-based samples of adults' and children's experiences of CSA. We conducted systematic searches in five databases (Medline, Embase, PyscINFO, CINAHL, ERIC, Sociological Abstracts) from database inception to October 17, 2017 using index terms and keywords for CSA, disclosure, and PTSD. We included any English-language, primary studies involving children or adults with experiences of CSA that used quantitative research designs to explore the relationship between disclosure and PTSD. We used systematic critical review methodology in order to investigate the relationship between disclosure and PTSD symptoms and disorders. We also investigated factors that explained the relationship between disclosure and PTSD, such as individual, exposure or environmental factors. Twenty-two articles reporting 20 studies were included in this review. Studies assessing the relationship between CSA and PTSD tended to account for personal (e.g., gender) and CSA exposure variables (e.g., severity of CSA) only. While authors generally used validated measures to assess for PTSD symptoms and disorders, they tended to use author-generated or unvalidated measures to assess for disclosure process variables. The relationship between factors that affect disclosure, and responses to disclosure, are not well theorized in quantitative literature. Study findings suggest important avenues for future research, such as the need to assess disclosure longitudinally. [ABSTRACT FROM AUTHOR]

Child development in low and middle income countries (LMIC) is compromised by multiple risk factors. Reducing children’s exposure to harmful events is essential for early childhood development (ECD). In particular, preventing violence against children – a highly prevalent risk factor that negatively affects optimal child development – should be an intervention priority. We used the Child Health and Nutrition Initiative (CHNRI) method for the setting of research priorities in integrated Early Childhood Development and violence prevention programs (ECD+). An expert group was identified and invited to systematically list and score research questions. A total of 186 stakeholders were asked to contribute five research questions each, and contributions were received from 81 respondents. These were subsequently evaluated using a set of five criteria: answerability; effectiveness; feasibility and/or affordability; applicability and impact; and equity. Of the 400 questions generated, a composite group of 50 were scored by 55 respondents. The highest scoring research questions related to the training of Community Health Workers (CHW’s) to deliver ECD+ interventions effectively and whether ECD+ interventions could be integrated within existing delivery platforms such as HIV, nutrition or mental health platforms. The priority research questions can direct new research initiatives, mainly in focusing on the effectiveness of an ECD+ approach, as well as on service delivery questions. To the best of our knowledge, this is the first systematic exercise of its kind in the field of ECD+. The findings from this research priority setting exercise can help guide donors and other development actors towards funding priorities for important future research related to ECD and violence prevention. [ABSTRACT FROM AUTHOR]

Childhood exposure to intimate partner violence (IPV) is associated with emotional-behavioural problems. However, little is known about children's emotional-behavioural outcomes following exposure to different long-term patterns of IPV. The current study aimed to investigate the emotional-behavioural functioning of children at 10 years of age following exposure to different patterns of IPV across the first 10 years of life. Data for this study was drawn from the Mothers' and Young People's Study- a longitudinal study of 1507 first time mothers and their first born child. Women were recruited during pregnancy from six public hospitals in Victoria, Australia. Data was collected during pregnancy, and at one, four and ten years postpartum. Four patterns of IPV exposure were previously identified: (a) minimal IPV exposure; (b) early IPV; (c) Increasing IPV; and (d) persistent IPV. Logistic regression was used to assess associations between IPV exposure and emotional-behavioural outcomes. Exposure to early, increasing, or persistent IPV was associated with increased odds of experiencing emotional-behavioural difficulties (OR 2.15–2.97). Children exposed to a persistent pattern of IPV experienced over 6 times the odds of conduct problems (OR = 6.15 CI = 2.3–16.44). Children exposed to early, increasing, or persistent IPV experienced increased odds of emotional-behavioural problems at age 10, regardless of the duration or type of violence they were exposed to. However, children exposed to persistent IPV across childhood appeared to experience the highest odds of emotional-behavioural difficulties. [ABSTRACT FROM AUTHOR]

Abstract: It has been suggested that family violence is associated with gambling problems. However, to date, this relationship has not been thoroughly investigated using representative data. The purpose of the current study was to analyze the relationship between gambling problems and the perpetration and victimization of intimate partner violence (including dating and marital violence) and child maltreatment (including minor child assault and severe child abuse) using nationally representative data. Data were drawn from the US National Comorbidity Survey Replication (n =3334; 18years and older). Multiple logistic and multinomial logistic regression models were used to examine the relationships between gambling and the perpetration and victimization of dating violence, marital violence, and child maltreatment. The results indicated that problem gambling was associated with increased odds of the perpetration of dating violence (Adjusted Odds Ratios (AORs) ranged from 2.2 to 4.2), while pathological gambling was associated with increased odds of the perpetration of dating violence (AORs ranged from 5.7 to 11.9), severe marital violence (AOR=20.4), and severe child abuse (AOR=13.2). Additionally, dating violence, marital violence, and severe child abuse victimization were associated with increased odds of gambling problems. The results were attenuated when adjusted for lifetime mental disorders. These findings can be used as evidence-based research to inform healthy public gambling polices and inform prevention and intervention efforts. [Copyright &y& Elsevier]

Background: Intimate partner violence (IPV) against women is prevalent and has significant physical and mental health consequences; accurate identification of IPV in health settings can be an important first step in appropriate response and referral to services for women. Methods: As part of a randomized controlled trial assessing IPV screening, we assessed exposure to IPV in the past year in 5,607 women visiting one of 26 health care sites across Ontario, Canada, between August 2005 and December 2006. Women completed both the brief (8-item) Woman Abuse Screening Tool (WAST) and the longer (30-item) Composite Abuse Scale (CAS), which served as the criterion standard. This paper describes the agreement between these 2 instruments, and identifies covariates associated with being positive on both the screen and the criterion standard versus positive on the screen only. Results: The WAST identified 22.1% of women as experiencing past year abuse, in contrast with the CAS, which identified 14.4% (κ = .63; standard error [SE], .01). Women were more likely to have the following characteristics when identified as IPV positive on both the WAST and CAS than on the WAST alone: being married (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.3–5.5; p = .009), having a mental health issue (OR, 2.3; 95% CI, 1.3–4.0; p = .002), having a drug problem (OR, 1.7; 95% CI, 1.1–2.9; p = .036), and having a partner with a substance problem (OR, 2.0; 95% CI, 1.2–3.2; p = .006). Conclusion: Screening in health care settings may overidentify IPV and care needs to be taken in decisions regarding how abuse is identified. However, screening alone may underidentify specific characteristics of women, partners, and relationships that could enable more accurate identification of abuse and specific mental health concerns through clinical case finding. [Copyright &y& Elsevier]

Objectives: To present a framework for classifying research-practice gaps to increase clarity in the discourse on evidence-informed practice and policy as it applies to child mental health.Method: The development of the framework was informed by the research literature about the effectiveness of clinic- and community-based interventions for the prevention and treatment of child mental health problems, patterns of uptake of these interventions, and the research literature about evidence-informed practice and policy.Results: Four types of research-practice gaps are proposed: (1) the failure to implement interventions found to be effective, and the implementation of interventions (2) that have been demonstrated to cause harm, (3) that have evidence of no effect, and (4) where the effectiveness is unknown because of the lack of rigorous evaluation. Examples from child mental health are provided for each type.Conclusions: This framework could guide an agenda aimed at reducing research-practice gaps in child mental health. A range of strategies may be required to address the different types of gaps. [ABSTRACT FROM AUTHOR]

Abstract: Objective:: This exploratory study examined the discriminant validity of 10 human-figure features commonly used by many proponents of the draw-a-person (DAP) projective technique as evidence of childhood sexual abuse. Two exploratory features were also examined. Method:: Rather than drawing human figures, 64 children (M =8 years, 9 months), including 19 sexually abused children, 26 nonsexually abused but emotionally/behaviourally troubled children, and 19 nonabused, nonclinical children, were instructed to build male and female figures using groups of prefabricated pieces of human-figure body parts. Unbeknownst to the children, each group of parts contained a potential sexual abuse feature (or features). Results:: None of the human-figure features under examination, either individually, or in combination, distinguished the sexually abused group from the other two groups of children. Conclusions:: In accordance with years worth of DAP projective technique research, no support for the validity of the human-figure features under examination as evidence of childhood sexual abuse, was found. [Copyright &y& Elsevier]

A history of child maltreatment increases the vulnerability to the development of Major Depressive Disorder (MDD) and/or Posttraumatic Stress Disorder (PTSD), especially in females. Both MDD and PTSD are associated with a dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. Dysregulation of the HPA axis may be an important etiological link between child maltreatment and subsequent psychiatric disorder, yet little is known about the relationship between exposure and outcome. The aim of this review is to explore the role of HPA axis dysregulation in the link between child maltreatment and MDD/PTSD among women. Studies of females with MDD frequently indicate a hyperactivity of the HPA axis, and contribute to our understanding of the underlying mechanisms involved in mood dysregulation. Evidence for HPA axis dysregulation in PTSD is less convincing and suggests that timing of the stressful experience as well as the type of the trauma may influence the outcome. The strongest evidence to date suggesting that the development of the HPA axis may be affected by early life stressful experiences comes from pre-clinical animal studies. Together these studies add to our understanding of the role of the HPA axis in psychiatric disorders in relation to stress. The literature on HPA axis function in both children and adults following child maltreatment further highlights the potential relevance of early stress to later onset of major psychiatric disorders. Such knowledge may also contribute to the development of early interventions targeted at primary prevention. [Copyright &y& Elsevier]

Research from high-income countries shows that witnessing intimate partner violence (IPV) between caregivers is experienced by up to a third of all children and is related to poor mental health outcomes. Much less is known about the burden of witnessing IPV in low- and middle-income countries. This study seeks to explore the magnitude of witnessing IPV between caregivers, its association with other types of violence and the relationship between witnessing IPV in the past and current mental distress. Representative data from the Violence against Children Surveys (VACS) from Cambodia (N = 2373), Malawi (N = 2147) and Nigeria (N = 4098) are employed. Logistic regression was applied to assess the association between witnessing IPV in childhood and mental distress in adulthood. Between 22.4 % and 34.3 % of participants witnessed IPV between their caregivers during childhood. Respondents who witnessed IPV had higher odds of mental distress, compared to those who did not witness IPV in Cambodia (OR 2.73 [2.02, 3.72] for females, OR 2.38 [1.67, 3.41] for males) and Malawi (OR 2.48 [1.43, 4.28] for females, OR 1.66 [1.11, 2.48] for males). In Nigeria only male respondents who witnessed IPV had higher odds of mental distress (OR 2.12 [1.60, 2.80]), but females had no significant association (OR 0.91 [0.68, 1.20]). The findings highlight the association of negative mental health consequences faced by children living in households with intimate partner violence for selected low- and middle-income countries. Children's exposure to IPV should be considered when providing support to survivors of IPV. Special considerations should be made to provide culturally and resource-appropriate support. [ABSTRACT FROM AUTHOR]

Religious affiliation may account for some variance in parenting behaviors used for disciplinary intent. However, most reported studies of this relationship are limited to high-income countries focused on Christianity. This study aimed to determine whether parenting behaviors vary by religion in a low- and middle-income country between Protestant, Catholic, and Muslim groups. It was hypothesized that Protestant households would have higher odds of select parenting behaviors. Data from the 2014 Cameroonian Multiple Indicator Cluster Survey, containing a nationally representative household sample, were used. Adult caregivers in selected households with a child aged 1–14 years of age participated in interviews containing a standardized disciplinary measure asking about the exposure of one randomly selected child to a series of parent behaviors in the preceding month. Of the 4978 households, 41.6 % were Catholic, 30.9 % Protestant and 27.6 % Muslim. Spanking was the most common of the six types of physical punishments across groups with no association with household religion. In contrast, children in Protestant households had higher odds of being hit with an object compared to the other two groups, but only for younger children. Children in Protestant households also had higher odds of exposure to a combined approach, i.e., use of physical, psychological, and non-violent parent behaviors. This study advances the examination of the potential influence of household religion on parenting behavior, however further inquiry is needed to examine these patterns in other settings with additional indices of religiosity and disciplinary beliefs. [ABSTRACT FROM AUTHOR]

Abstract Background Increasingly, evidence-based treatment guidelines emphasize the role of parents in first-line treatment approaches for child and adolescent psychiatric disorders. Yet there are no best practice guidelines for practitioners on the identification and reporting of suspicions and disclosures of child maltreatment to child protection services (CPS) in these circumstances. This is particularly concerning given that undetected and unreported child maltreatment may exacerbate the vulnerabilities of youth with mental illness. Objective The objective of this study is to describe family-based practitioners' experiences of reporting child emotional abuse (CEA) and child exposure to intimate partner violence (CEIPV) to CPS. Participants and Setting Data from 30 practitioners based in five countries were included in this study. Methods We use deductive framework analysis of qualitative interviews with practitioners providing family-based treatment to youth diagnosed with eating disorders. Interviews for the primary study elicited participants' perceptions and experiences of identifying and responding to CEA and CEIPV in practice. All transcripts were analysed by two authors using constructs identified by a qualitative meta-synthesis of mandatory reporting experiences among service providers. Results Three participants identified as male, 27 as female. Practitioners described negative experiences when reporting CEA and CEIPV to CPS, as well as variable CPS responses to their reports. Findings confirm the need for additional training for mental health practitioners to recognize and report CEA and CEIPV. Conclusions Management of CEA and CEIPV while delivering family-based treatment remains an important area of practice that requires further inquiry. [ABSTRACT FROM AUTHOR]

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative adult samples. To address these limitations, the current study investigated the relationship between individual-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. The objectives of the present study were to: 1) compute the prevalence of mental health indicators by child maltreatment types, 2) estimate the prevalence of overall good, moderate, and poor mental health by child maltreatment types; and 3) examine the relationship between individual-level factors and overall mental health status of adolescents with and without a history of maltreatment. Data were from the National Comorbidity Survey of Adolescents (NCS-A; n  = 10,123; data collection 2001–2004); a large, cross-sectional, nationally representative sample of adolescents aged 13–17 years from the United States. All types of child maltreatment were significantly associated with increased odds of having poor mental health (adjusted odds ratios ranged from 3.2 to 9.5). The individual-level factors significantly associated with increased odds of good mental health status included: being physically active in the winter; utilizing positive coping strategies; having positive self-esteem; and internal locus of control (adjusted odds ratios ranged from 1.7 to 38.2). Interventions targeted to adolescents with a history of child maltreatment may want to test for the efficacy of the factors identified above. [ABSTRACT FROM AUTHOR]

Despite being a primary response to child abuse, it is currently unknown whether contact with child protection services (CPS) does more good than harm. The aim of the current study was to examine whether contact with CPS is associated with improved mental health outcomes among adult respondents who reported experiencing child abuse, after adjusting for sociodemographic factors and abuse severity. The data were drawn from the 2012 Canadian Community Health Survey-Mental Health (CCHS-2012), which used a multistage stratified cluster design (household-level response rate = 79.8%). Included in this study were individuals aged 18 years and older living in the 10 Canadian provinces (N = 23,395). Child abuse included physical abuse, sexual abuse, and exposure to intimate partner violence (IPV). Mental health outcomes included lifetime mental disorders, lifetime and past year suicidal ideation, plans, and attempts, and current psychological well-being and functioning and distress. All models were adjusted for sociodemographic factors and severity of child abuse. For the majority of outcomes, there were no statistically significant differences between adults with a child abuse history who had CPS contact compared to those without CPS contact. However, those with CPS contact were more likely to report lifetime suicide attempts. These findings suggest that CPS contact is not associated with improved mental health outcomes. Implications are discussed. [ABSTRACT FROM AUTHOR]

Increasingly recognized as a distinct form of childhood maltreatment, children’s exposure to intimate partner violence (IPV) has been shown to be associated with an array of negative psychosocial outcomes, including elevated risk for additional violence over the life course. Although studies have identified child exposure to IPV as a predictor of IPV perpetration in adulthood, no review has critically evaluated the methodology of this quantitative work. The present study examines the association between childhood exposure to IPV and the perpetration of IPV in adulthood based on a systematic review of the literature from inception to January 4, 2016. Databases searched included Medline, Embase, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, Sociological Abstracts and ERIC. Database searches were complemented with backward and forward citation chaining. Studies were critically appraised using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Of 5601 articles identified by the search, 19 studies were included for data extraction. Sixteen of these studies found that child exposure to IPV was significantly and positively associated with adult IPV perpetration; three studies reported null findings. The methodological quality of the studies was low. Work thus far has tended to focus on child exposure to physical IPV and the perpetration of physical IPV within heterosexual contexts. In addition, measures of child exposure to IPV vary in their classification of what exposure entails. We critically discuss the strengths and limitations of the existing evidence and the theoretical frameworks informing this work. [ABSTRACT FROM AUTHOR]

Adverse Childhood Experiences (ACEs) such as child abuse are related to poor health outcomes. Spanking has indicated a similar association with health outcomes, but to date has not been considered an ACE. Physical and emotional abuse have been shown in previous research to correlate highly and may be similar in nature to spanking. To determine if spanking should be considered an ACE, this study aimed to examine 1): the grouping of spanking with physical and emotional abuse; and 2) if spanking has similar associations with poor adult health problems and accounts for additional model variance. Adult mental health problems included depressive affect, suicide attempts, moderate to heavy drinking, and street drug use. Data were from the CDC-Kaiser ACE study ( N = 8316, response rate = 65%). Spanking loaded on the same factor as the physical and emotional abuse items. Additionally, spanking was associated with increased odds of suicide attempts (Adjusted Odds Ratios (AOR) = 1.37; 95% CI = 1.02 to1.86), moderate to heavy drinking (AOR) = 1.23; 95% CI = 1.07 to 1.41), and the use of street drugs (AOR) = 1.32; 95% CI = 1.4 to 1.52) in adulthood over and above experiencing physical and emotional abuse. This indicates spanking accounts for additional model variance and improves our understanding of these outcomes. Thus, spanking is empirically similar to physical and emotional abuse and including spanking with abuse adds to our understanding of these mental health problems. Spanking should also be considered an ACE and addressed in efforts to prevent violence. [ABSTRACT FROM AUTHOR]

Research on factors associated with good mental health following child maltreatment is often based on unrepresentative samples and focuses on individual-level factors. To address these gaps, the present study examined the association between relationship- and community-level factors and overall mental health status among adolescents with and without a history of maltreatment in a representative sample. Data were drawn from the National Comorbidity Survey of Adolescents (NCS-A; n = 10,148; data collection 2001–2004); a large, cross-sectional, nationally representative sample of adolescents aged 13–17 years from the United States. Having supportive parent and family relationships were significantly associated with good mental health (AOR ranging from 2.1 to 7.1). Positive community and school experiences were also significantly associated with good mental health (AOR ranging from 2.0 to 9.8). In most models, support from friends and siblings was not related to better mental health. Factors to be tested for efficacy in interventions targeted to adolescents with a history of child maltreatment include encouraging supportive parent and family relationships, and fostering positive community and school experiences. [ABSTRACT FROM AUTHOR]

Introduction Estimating the national prevalence of child sexual abuse (CSA) and its association with health and developmental outcomes is the first step in developing prevention strategies. While such data are available from many countries, less is known about the epidemiology of CSA in Japan. Methods For this systematic review, we searched English databases: Embase, Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), Ovid OLDMEDLINE(R), PsycINFO, and Japanese databases: Cinii, J-Stage, Children’s Rainbow Center Japan, Japan Child and Family Research Institute, Japanese Journal of Child Abuse and Neglect to identify articles published before July 2015 examining the lifetime prevalence of CSA in Japan using non-clinical samples. Data were extracted from published reports. Results We initially identified 606 citations and after abstract review, retrieved 120 publications. Six studies that met the selection criteria and additional two relevant studies were reviewed. The range of contact CSA for females was 10.4%–60.7%, and the prevalence of this type of CSA for males was 4.1%. The range of penetrative CSA for females was 1.3%–8.3% and that for males was 0.5%–1.3%. A number of methodological issues were identified, including a lack of validated measures of CSA, and low response rates. Conclusion In contrast to a lower prevalence of penetrative CSA, the prevalence of contact CSA among Japanese females may be comparable or higher in relation to international estimates. Future research on children's perceptions of and exposure to sexual abuse, crime and exploitation in Japan is discussed. [ABSTRACT FROM AUTHOR]

Extensive research seeks to understand the intergenerational impact of child maltreatment. However, it remains unclear how parent's history of child maltreatment (PCM) is associated with child mental health, after accounting for children's experiences of maltreatment and other proximal risk factors. This study examines the associations between PCM and youth internalizing and externalizing problems, while accounting for youth experiences of maltreatment (YM), and parent mental health and positive parenting. Youth aged 14 to 17 years (N = 2266) participated in the 2014 Ontario Child Heath Study. Parents and youth reported their experiences of child maltreatment. Parent-report and self-reports of youth internalizing and externalizing problems were also collected. Number of subtypes of maltreatment and specific subtypes of maltreatment were examined. Parents reported their own mental health problems and positive parenting practices. Regarding number of maltreatment subtypes, initially PCM was associated with parent-reported, but not self-reported, youth internalizing and externalizing problems. After accounting for YM, parent mental health problems and positive parenting, only YM remained significant. Regarding specific subtypes of maltreatment, both parent and youth emotional abuse were related to parent- and youth-reported internalizing and externalizing problems, after controlling for other maltreatment subtypes. However, the effects of parent emotional abuse became nonsignificant after accounting for YM and proximal risk factors. Findings indicate: 1) the unique associations between specific PCM and YM subtypes and youth mental health problems; 2) the role of proximal risk factors in explaining the association between PCM and youth mental health; and 3) the importance of multiple informants of youth mental health problems. [ABSTRACT FROM AUTHOR]

Children of girls and young women experiencing socioeconomic disadvantage are at risk of maltreatment and associated health and developmental problems. Nurse-Family Partnership (NFP) is an early intervention program designed to improve child and maternal health outcomes. The effectiveness of NFP is being evaluated in British Columbia (BC) through a randomized controlled trial, augmented by a process evaluation to identify influences on how NFP was implemented. To describe how public health nurses providing NFP perceived their interactions with child protection professionals. Forty-seven public health nurses across BC. The principles of interpretive description informed the qualitative component of the process evaluation. Data from interviews and focus groups were analyzed using the framework analysis approach. A thematic framework was generated through processes of coding, charting and mapping, with a focus on organizational and systems influences. Nurses' practice in supporting families often involved engagement with child protection services. Four themes about the nature of this work were identified: 1) developing a deeper understanding of the disciplinary perspectives of child protection, 2) striving for strengthened collaboration, 3) navigating change and uncertainty, and 4) responding to family and community complexity. Participants valued the contribution of child protection professionals and expressed willingness to collaborate to support families. However, collaboration was constrained by multiple structural barriers. Collaborative models offer possibilities for integrated practice, although can be difficult to implement within current health and child protection systems and child protection regulatory contexts. [ABSTRACT FROM AUTHOR]

Abstract: Background: Previous research has shown that various childhood risk factors are related to depression and chronic physical conditions (CPCs) later in life. However, little is known about risk factors associated with comorbidity for these conditions. The purpose of this study was to examine the association between individual (school performance, childhood physical and sexual abuse) and family risk variables (socioeconomic status, parental mental health, medical condition, and functional limitation) with depression only, chronic pain conditions (back pain and headaches) or other CPCs (respiratory, cardiovascular and digestive disorders, and diabetes) and the comorbidity of either CPC category with depression assessed in early adulthood. Methods: We used data from the Ontario Child Health Study, a prospective, population-based study of 3294 children (ages 4–16) enrolled in 1983 and meeting inclusion criteria at follow-up in 2001 (N = 1475; ages 21–35 years). Results: Using multinomial logistic regression models, controlling for sex and age, childhood history of physical abuse was associated with most outcomes (OR = 1.86, 95% confidence interval [CI] 1.16–2.97to 4.36, 95% CI, 1.74–10.97). Parental mental health, childhood functional limitation, childhood history of sexual abuse and family functioning were all related to comorbid depression and chronic pain conditions. Parental mental health was also related to increased risk of other CPCs (ORs = 1.66; 95% CI, 1.08–2.55). Conclusion: We found that the greatest disease risk (comorbid depression and chronic pain conditions) was related to the greatest number of childhood risk factors. Although there was some evidence of specificity, there was overlap in childhood physical abuse predicting almost all outcomes. Efforts targeting the prevention and treatment of childhood maltreatment are critical in order to prevent the long lasting impact of childhood adversity on mental and physical outcomes in early adulthood. [Copyright &y& Elsevier]

Background: Emotional/psychological child maltreatment (ECM) is a major public health problem with serious consequences including emotional and behavioral problems. Nevertheless, ECM is an understudied area. Objectives: The aims of this review are to identify measures of ECM and to evaluate their psychometric properties and utilities. We provide a summary of ECM measures that have been tested for their reliability and validity, evaluate the quality of these assessments and suggest directions for future research. Methods: We searched PsycINFO and Medline databases from 2000 to 2010 in addition to a hand search of retrieved references; 2344 were identified and the abstracts reviewed independently by two authors to identify relevant articles. Using pre-established criteria, 144 of those articles were selected and reviewed in full to assess whether the instruments included a separate measure of ECM and its psychometric properties. Results: Forty-five articles examining 33 measures met the inclusion criteria and were selected for further review. The majority of measures demonstrated acceptable reliability; fewer measures had evaluated one or more types of validity. Conclusion: Both reliability and validity testing are required in order to establish more accurate measures of ECM. Practice implications: Reliable and valid measures are necessary to enhance our limited knowledge about the distribution, determinants and consequences of ECM. [Copyright &y& Elsevier]

Abstract: Children under one year of age are highly vulnerable to child maltreatment, which can lead to serious immediate and long-term physical and mental health consequences. Child welfare workers encounter unique challenges when assessing allegations of maltreatment involving infants. This study identifies correlates of maltreatment substantiation in a sample of 793 infants less than one year of age investigated by child welfare. It is based on data from the 2003 Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003), a national study of reports of child maltreatment. The analysis consisted of two stages. First, bivariate analyses were conducted using unadjusted odds ratios and chi-square tests on variables known to be associated with substantiation. In the second stage, a logistic regression was performed to examine these associations in a multivariate model. Multivariate findings suggest that certain vulnerabilities present in the primary caregiver, such as substance abuse and few social supports, as well as the child''s positive toxicology at birth are associated with substantiated infant maltreatment. Exposure to domestic violence, which is reported mostly by the police, and physical harm stemming from maltreatment are strongly associated with substantiation, whereas reports of physical abuse and neglect have an inverse relationship. The authors discuss these results and implications for policy and programs. [Copyright &y& Elsevier]

Abstract: Background: Although, a large population-based literature exists on the relationship between childhood adversity and Axis I mental disorders, research on the link between childhood adversity and Axis II personality disorders (PDs) relies mainly on clinical samples. The purpose of the current study was to examine the relationship between a range of childhood adversities and PDs in a nationally representative sample while adjusting for Axis I mental disorders. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n =34,653; data collection 2004–2005); a nationally representative sample of the United States population aged 20 years and older. Results: The results indicated that many types of childhood adversity were highly prevalent among individuals with PDs in the general population and childhood adversity was most consistently associated with schizotypal, antisocial, borderline, and narcissistic PDs. The most robust childhood adversity findings were for child abuse and neglect with cluster A and cluster B PDs after adjusting for all other types of childhood adversity, mood disorders, anxiety disorders, substance use disorders, other PD clusters, and sociodemographic variables (Odd Ratios ranging from 1.22 to 1.63). In these models, mood disorders, anxiety disorders, and substance use disorders also remained significantly associated with PD clusters (Odds Ratios ranging from 1.26 to 2.38). Conclusions: Further research is necessary to understand whether such exposure has a causal role in the association with PDs. In addition to preventing child maltreatment, it is important to determine ways to prevent impairment among those exposed to adversity, as this may reduce the development of PDs. [Copyright &y& Elsevier]

Objective: For child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse—teen dating violence link. Methods: A random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales. Results: Over 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63–67%) and nearly half of males (44–49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings. Conclusions: These results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others. Practice implications: The present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatolgy among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths’ conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for long-term, unique impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare. [Copyright &y& Elsevier]

Abstract: Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women''s adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15–64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women—those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to $775 (95% CI $504–$1045) compared to a mean cost of $400 with no abuse (95% CI $357–$443). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to $314 (95% CI $220–$429), compared to $138 (95% CI $132–$169) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

In this manuscript, we summarize the findings of a systematic review that informed the development of the World Health Organization's recommendations related to psychosocial interventions for child and adolescent sexual abuse. Systematic searches across 14 databases were conducted to retrieve any published randomized controlled trials of psychosocial interventions addressing mental health outcomes among children and adolescents exposed to sexual abuse who have experienced symptoms. We assessed study risk of bias using the Cochrane Risk of Bias tool and certainty of the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Twenty-four articles representing fifteen studies were included in the systematic review. Only two studies were conducted in low- or middle-income countries. Few studies could be pooled together because of differences in interventions and comparators. Due to the small numbers of participants and very serious concerns with risk of bias, we are very uncertain about the benefits of interventions provided to children alone and without the involvement of their caregivers. However, cognitive behavior therapy (CBT) with a trauma focus provided to children and involving their caregivers may reduce some mental health symptoms associated with sexual abuse experiences. The findings suggest that more and larger studies are needed to evaluate the effects of psychosocial interventions for children and adolescents exposed to sexual abuse who preside in low- and middle-income countries. PROSPERO registration number: CRD42016039656 [ABSTRACT FROM AUTHOR]

Despite a range of interventions available to treat mental health symptoms experienced by youth with a history of child sexual abuse (CSA), limited empirical work has examined practitioner delivery of these interventions in real-world practice. This paper aimed to qualitatively explore the delivery of trauma-based interventions in community settings in Ontario, Canada. Using qualitative description, a purposeful sample of service providers (N = 51; 92 % female) were recruited from nine community-based organizations located in Southern Ontario, Canada providing psychotherapeutic trauma-based interventions to youth with a history of child sexual abuse. Semi-structured one-on-one (n = 17), joint (n = 3) and focus group (n = 5) interviews elicited provider descriptions of their strategies and approaches for addressing trauma-related symptoms in this population. Data were interpreted using conventional content analyses. Eclectic delivery of interventions and multifactorial decision-making processes were identified as core elements of treatment planning and intervention delivery among providers. Eclectic treatment was described to involve the consideration of four core elements (provider judgement; youth voice; youth characteristics; and clinical team discussion) of intervention and three key principles (meeting youth needs; providing client-centered care; addressing safety and stability). Research capable of characterizing the efficacy of client-centered, eclectic approaches to treat symptoms experienced by youth with a history of CSA is needed. [ABSTRACT FROM AUTHOR]