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Background: To establish national prevalence of child maltreatment, reliable, valid and contextually appropriate measurement is needed. This paper outlines the refinement, adaptation and testing of child maltreatment sections of the Juvenile Victimization Questionnaire (JVQ)-R2 for use in the Australian context.Methods: Three phases were undertaken: 1) Conceptual analysis of the five forms of child maltreatment (physical abuse, sexual abuse, emotional or psychological abuse, neglect, and experience of domestic violence), item mapping and review, item development, and independent expert review; 2) Cognitive testing with members of the general population, and individuals who have experienced maltreatment; and 3) Pilot testing and quantitative psychometric assessment with a random sample of Australians aged 16–65+ years.Results: The final measure included a total of 17 child maltreatment screener items, assessing Physical Abuse (2 items), Sexual abuse (5 items (including 2 non-contact items and 3 contact items), Emotional Abuse (3 items), Neglect (3 items), and Experience of Domestic Violence (4 items). Screener items were also included on corporal punishment (1 item), and internet sexual victimization (2 items). The final 17-item revised JVQ had high face and conceptual validity and good internal reliability (α = 0.86 and Ω = 0.87). Test re-test reliability was moderate to high for individual screeners ranging from k = 0.45 to 0.89.Conclusions: Results indicate the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study) is a suitable instrument for assessing population-wide prevalence of maltreatment. It is congruent with conceptual models of maltreatment and shows good reliability and validity in this Australian sample.

To identify leading injury risk factors and jurisdictional differences in Australian and US child-related product safety regulatory responses to inform the development of Australian policy and reform priorities.The study established and evaluated a knowledge base of child-related product safety regulatory responses (recalls, bans, standards and warnings) made in Australia and the US over the period 2011-17 to identify risk factors and potential regulatory gaps.The research identified 1,540 Australian and US child-related product safety regulatory responses with the most common response type being product safety recall, and the leading product hazards in responses being choking, fire, fall, strangulation and chemical hazards. Jurisdictional differences identified potential regulatory gaps in Australia related to chemical hazards and high-risk durable infant and toddler products, and some data deficiencies in Australian responses.Priorities include the need to improve the prevention orientation of the Australian product safety framework, to create an intelligence platform to assess injury risks more precisely and to address regulatory gaps related to the use of toxic chemicals in children's products and high-risk durable infant and toddler products.The study demonstrates the identification of policy and reform priorities for child product safety using a public health lens.

Objectives To estimate the prevalence in Australia of each type of child maltreatment; to identify gender- and age group-related differences in prevalence. Design, setting Cross-sectional national survey; mobile telephone interviews using random digit dialling (computer-generated), Australia, 9 April – 11 October 2021. Retrospective self-report data using validated questionnaire (Juvenile Victimisation Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). Participants People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16–24 years and 1000 respondents each from five further age groups (25–34, 35–44, 45–54, 55–64, 65 years or more). Main outcome measures Proportions of respondents reporting physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence to age 18 years, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study), overall and by gender and age group, and weighted to reflect characteristics of the Australian population aged 16 years or more in 2016. Results Complete survey data were available for 8503 eligible participants (14% response rate). Physical abuse was reported by 32.0% of respondents (95% confidence interval [CI], 30.7–33.3%), sexual abuse by 28.5% (95% CI, 27.3–29.8%), emotional abuse by 30.9% (95% CI, 29.7–32.2%), neglect by 8.9% (95% CI, 8.1–9.7%), and exposure to domestic violence by 39.6% (95% CI, 38.3–40.9%). The proportions of respondents who reported sexual abuse, emotional abuse, or neglect were each statistically significantly larger for women than men. The reported prevalence of physical abuse by respondents aged 16–24 years was lower than for those aged 25–34 years, and that of sexual abuse was lower than for those aged 35–44 years, suggesting recent declines in the prevalence of these maltreatment types. Conclusions Child maltreatment is common in Australia, and larger proportions of women than men report having experienced sexual abuse, emotional abuse, and neglect during childhood. As physical and sexual abuse may have declined recently, public health policy and practice may have positive effects, justifying continued monitoring and prevention activities.

Objectives To examine associations between child maltreatment and health service use, both overall, by type and by the number of types of maltreatment reported. Design, setting Cross-sectional, retrospective survey using the Juvenile Victimization Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study); computer-assisted mobile telephone interviews using random digit dialling, Australia, 9 April – 11 October 2021. Participants Australians aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16–24 years and 1000 respondents each from the five age groups (25–34, 35–44, 45–54, 55–64, 65 years or more). Main outcome measures Self-reported health service use during the past twelve months: hospital admissions, length of stay, and reasons for admission; and numbers of consultations with health care professionals, overall and by type. Associations between maltreatment and health service use are reported as odds ratios adjusted for age group, gender, socio-economic status, financial hardship (childhood and current), and geographic remoteness. Results A total of 8503 participants completed the survey. Respondents who had experienced child maltreatment were significantly more likely than those who had not to report a hospital admission during the preceding twelve months (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.16–1.66), particularly admission with a mental disorder (aOR, 2.4; 95% CI, 1.03–5.6). The likelihood of six or more visits to general practitioners (aOR, 2.37; 95% CI, 1.87–3.02) or of a consultation with a mental health nurse (aOR, 2.67; 95% CI, 1.75–4.06), psychologist (aOR, 2.40; 95% CI, 2.00–2.88), or psychiatrist (aOR, 3.02; 95% CI, 2.25–4.04) were each higher for people who reported maltreatment during childhood. People who reported three or more maltreatment types were generally most likely to report greater health service use. Conclusions Child maltreatment has a major impact on health service use. Early, targeted interventions are vital, not only for supporting children directly, but also for their longer term wellbeing and reducing their health system use throughout life.

Objectives To describe the aims, design, methodology, and respondent sample representativeness of the Australian Child Maltreatment Study (ACMS). Design, setting Cross-sectional, retrospective survey; computer-assisted mobile telephone interviewing using random digit dialling (computer-generated), Australia, 9 April – 11 October 2021. Participants People aged 16 years or more. The target sample size was 8500 respondents: 3500 people aged 16–24 years and 1000 respondents each from five further age groups (25–34, 35–44, 45–54, 55–64, 65 years or more). Main outcome measures Primary outcomes: Emotional abuse, neglect, physical abuse, sexual abuse, exposure to domestic violence during childhood, assessed with the Juvenile Victimization Questionnaire-R2 Adapted Version (Australian Child Maltreatment Study). Secondary outcomes: selected mental disorder diagnoses (Mini International Neuropsychiatric Interview, MINI), selected physical health conditions, health risk behaviours, health service use. Results The demographic characteristics of the ACMS sample were similar to those of the Australian population in 2016 with respect to gender, Indigenous status, region and remoteness category of residence, and marital status, but larger proportions of participants were born in Australia, lived in areas of higher socio-economic status, had tertiary qualifications, and had income greater than $1250 per week. Population weights were derived to adjust for these differences. Associations between the number of calls required to recruit participants and maltreatment rates and health outcomes were not statistically significant. Conclusions The ACMS provides the first reliable estimates of the prevalence of each type of child maltreatment in Australia. These estimates, and those of associated mental health and health risk behaviours reported in this supplement can inform policy and practice initiatives for reducing the prevalence of child maltreatment and its consequences. Our benchmark study also provides baseline data for repeated waves of the ACMS that will assess the effectiveness of these initiatives.

Objectives To examine the associations between experiences of child maltreatment and mental disorders in the Australian population. Design Population-representative survey conducted by computer-assisted telephone interviewing. Setting, participants Australian residents aged 16 years and older. Main outcome measures Mental disorder diagnoses of lifetime major depressive disorder, current alcohol use disorder (mild, moderate and severe), current generalised anxiety disorder and current post-traumatic stress disorder. Results More than one in three Australians (3606/8503 surveyed participants; 38.0%; 95% CI, 36.7–39.3%) met the diagnostic criteria for a mental disorder. The prevalence of mental disorders in non-maltreated participants was 21.6% (95% CI, 19.9–23.3%; n = 851). This increased to 36.2% (95% CI, 33.5–38.9%; n = 764) for those who experienced a single type of maltreatment and 54.8% (95% CI, 52.6–56.9%; n = 1991) for participants who experienced multi-type maltreatment. Compared with non-maltreated Australians, maltreated participants had about three times the odds of any mental disorder (odds ratio [OR], 2.82; 95% CI, 2.47–3.22), generalised anxiety disorder (OR, 3.14; 95% CI, 2.48–3.97), major depressive disorder (OR, 3.19; 95% CI, 2.68–3.80) and severe alcohol use disorder (OR, 2.62; 95% CI, 1.83–3.76), and almost five times the odds of post-traumatic stress disorder (OR, 4.60; 95% CI, 3.00–7.07). Associations between experiences of child maltreatment and mental disorders were strongest for sexual abuse, emotional abuse and multi-type maltreatment. The strength of the associations did not differ by gender. Adjustment for childhood and current financial hardship and for current socio-economic status did not significantly attenuate the associations. Conclusions Mental disorders are significantly more likely to occur in individuals who experience child maltreatment, particularly multi-type maltreatment. Prevention of child maltreatment provides an opportunity to substantially reduce the prevalence of mental illness and improve the health of the Australian population.

Objective To estimate associations between all five types of child maltreatment (emotional abuse, neglect, physical abuse, sexual abuse, and exposure to domestic violence) and health risk behaviours and conditions. Design, setting, participants Nationally representative survey of Australian residents aged 16 years and older conducted by computer-assisted telephone interviewing. Main outcome measures Associations between child maltreatment and the following health risk behaviours and conditions: current smoker, binge drinking (at least weekly in past 12 months), cannabis dependence (according to the Cannabis Severity of Dependence Scale), obesity (based on body mass index), self-harm in past 12 months, and suicide attempt in past 12 months. Results A total of 8503 participants completed the survey. All five types of child maltreatment were associated with increased rates of all of the health risk behaviours and conditions that we considered. The strongest associations were in the youngest age group (16–24-year-olds). Sexual abuse and emotional abuse were associated with the highest odds of health risk behaviours and conditions. Cannabis dependence, self-harm and suicide attempts were most strongly associated with child maltreatment. Experiencing more than one type of child maltreatment was associated with higher rates of health risk behaviours and conditions than experiencing one type of child maltreatment. Conclusions Child maltreatment is associated with substantially increased rates of health risk behaviours and conditions. Prevention and intervention efforts should be informed by trauma histories, and holistic psychosocial care should be incorporated into programs focusing on behaviour change.

Objectives To determine the prevalence in Australia of multi-type child maltreatment, defined as two or more maltreatment types (physical abuse, sexual abuse, emotional abuse, neglect, or exposure to domestic violence) and to examine its nature, family risk factors, and gender and age cohort differences. Design Retrospective cross-sectional survey using a validated questionnaire. Setting and participants Mobile phone random digit-dial sample of the Australian population aged 16 years and older. Main outcome measures National estimates of multi-type child maltreatment up to age 18 years using the Juvenile Victimisation Questionnaire-R2: Adapted Version (Australian Child Maltreatment Study). Results Of 8503 participants, 62.2% (95% CI, 60.9–63.6%) experienced one or more types of child maltreatment. Prevalence of single-type maltreatment was 22.8% (95% CI, 21.7–24.0%), whereas 39.4% (95% CI, 38.1–40.7%) of participants reported multi-type maltreatment and 3.5% (95% CI, 3.0–4.0%) reported all five types. Multi-type maltreatment was more common for gender diverse participants (66.1% [95% CI, 53.7–78.7%]) and women (43.2% [95% CI, 41.3–45.1%]) than for men (34.9% [95% CI, 33.0–36.7%]). Multi-type maltreatment prevalence was highest for those aged 25–44 years. Family-related adverse childhood experiences — especially mental illness and alcohol or substance misuse — increased risk. Exposure to domestic violence was the maltreatment type most often present in multi-type maltreatment patterns. Conclusions Multi-type child maltreatment is prevalent in Australia and more common in women and gender diverse individuals. Child protection services, health practitioners, and prevention and intervention services must assess and manage multi-type maltreatment in children and address its health consequences across the lifespan. Public health policy should consider prevention services or strategies that target multi-type child maltreatment.

When paramedics attend incidents of domestic violence, and children are present, they are simultaneously positioned to identify and respond to children exposed to domestic violence. Few paramedics report children exposed to domestic violence to either domestic violence or child protection services, typically citing uncertainty over reporting and referral responsibility. The spectrum of repercussions for children creates challenges as well as opportunities for paramedics to be educated and trained on optimal ways to respond. This article considers the role of the paramedic when they encounter children exposed to domestic violence. It is informed by research on parental characteristics related to mental illness, drug and alcohol misuse and domestic violence that often accompany other forms of child maltreatment. The article reports the results of a qualitative study of Queensland Ambulance Service paramedics, examining challenges and barriers impacting paramedics when they encounter children exposed to domestic violence. Research participants revealed key barriers to effective responses, these included breaching the privacy of families, their interpretation of mandatory reporting laws, limited time on scene and uncertainty on how to respond based on an absence of clear policy guidelines and training on child maltreatment in the context of domestic violence. Analysis of the experiences, and the ways paramedics understand child exposure to domestic violence, provides an opportunity to consider strategies to respond in such situations. Recommendations are made for ambulance services to develop policy incorporating education and training on the role of paramedics when they encounter children exposed to domestic violence.

Child maltreatment rates remain unacceptably high and rates are likely to escalate as COVID-related economic problems continue. A comprehensive and evidence-building approach is needed to prevent, detect and intervene where child maltreatment occurs. This review identifies key challenges in definitions, overviews the latest data on prevalence rates, reviews risk and protective factors, and examines common long-term mental health outcomes for children who experience maltreatment. The review takes a systems approach to child maltreatment outcomes through its focus on the overall burden of disease, gene-environment interactions, neurobiological mechanisms and social ecologies linking maltreatment to mental ill-health. Five recommendations relating to the accurate measurement of trends, research on brain structures and processes, improving the reach and impact of teleservices for detecting, preventing and treating child maladjustment, community-based approaches, and building population-focused multidisciplinary alliances and think tanks are presented.

BACKGROUND: Many nations require child‐serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed. OBJECTIVES: To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list. SELECTION CRITERIA: All randomised controlled trials (RCTs), quasi‐RCTs, and controlled before‐and‐after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect). DATA COLLECTION AND ANALYSIS: We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta‐analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence. MAIN RESULTS: We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high‐income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face‐to‐face workshops or seminars, and in 3 trials interventions were delivered as self‐paced e‐learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants’ self‐report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low‐certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants’ responses to hypothetical case vignettes immediately after training. A meta‐analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low‐certainty evidence). We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals’ knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low‐certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta‐analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low‐certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta‐analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low‐certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non‐reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low‐certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low‐certainty evidence). AUTHORS' CONCLUSIONS: The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child‐serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.

Legal Epidemiology Author Ben Mathews Studies of the prevalence of child maltreatment respond to a public policy imperative to better understand and prevent child abuse and neglect. These studies span domains of law, public health, and legal epidemiology. When conducting them, researchers must comply with legal duties to protect research participants. Australia has a complex legal environment, with additional challenges when participants are children, or are in danger. Duties arise in three bodies of law, vary across States and Territories, and require statutory interpretation, conceptual analysis, and operationalisation. This article conducts the first comprehensive analysis of researchers’ legal duties to protect participants in child maltreatment surveys. It contributes new understandings of the operation of mandatory reporting duties in child protection law, duties to report child abuse offences in criminal law, and the duty of care in negligence law. The analysis informs conclusions about the applicability of these duties, and indicates a legally compliant, ethically sound, and operationally practicable approach. Findings are relevant to multiple settings.

Legal and clinical complexities surrounding consent to medical treatment for trans and gender diverse (TGD) youth in Australia continue to develop. New Australian Standards of Care and Treatment Guidelines have also introduced substantial clinical developments. Significant changes to legal principles from court decisions require doctors and health authorities, youth and parents, and legal advisors, to make and administer treatment decisions in compliance with the new legal requirements. Recent developments in the law relating to consent for medical treatment of TGD youth are clarified, with focus on the 2017 case Re: Kelvin and its implications for clinical practice. This article presents a new medico-legal analysis of clinical practice for treating TGD youth, mapping Australian clinical guidelines and legal principles against three stages of clinical treatment. Clinical scenarios are used to demonstrate situations where the legal framework no longer presents a barrier to clinical practice, as well as those where ambiguity remains. The aim of this paper is to ensure that clinicians working with TGD youth understand what the law currently requires in term of consent, with reference to the stages of treatment, and where the law fails to provide clear guidance for patients, parents and health professionals. Residual uncertainty in the applicable legal principles requires legislative or judicial resolution and policy clarity.

IntroductionChild maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence) is widely understood to be associated with multiple mental health disorders, physical health problems and health risk behaviours throughout life. However, Australia lacks fundamental evidence about the prevalence and characteristics of child maltreatment, its associations with mental disorders and physical health, and the associated burden of disease. These evidence gaps impede the development of public health strategies to better prevent and respond to child maltreatment. The aims of this research are to generate the first comprehensive population-based national data on the prevalence of child maltreatment in Australia, identify associations with mental disorders and physical health conditions and other adverse consequences, estimate attributable burden of disease and indicate targeted areas for future optimal public health prevention strategies.Methods and analysisThe Australian Child Maltreatment Study (ACMS) is a nationwide, cross-sectional study of Australia’s population aged 16 years and over. A survey of approximately 10 000 Australians will capture retrospective self-reported data on the experience in childhood of all five types of maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence). A customised, multimodule survey instrument has been designed to obtain information including: the prevalence and characteristics of these experiences; diagnostic screening of common mental health disorders; physical health; health risk behaviours and health service utilisation. The survey will be administered in March–November 2021 to a random sample of the nationwide population, recruited through mobile phone numbers. Participants will be surveyed using computer-assisted telephone interviews, conducted by trained interviewers from the Social Research Centre, an agency with extensive experience in studies of health and adversity. Rigorous protocols protect the safety of both participants and interviewers, and comply with all ethical and legal requirements. Analysis will include descriptive statistics reporting the prevalence of individual and multitype child maltreatment, multiple logistic and linear regression analyses to determine associations with mental disorders and physical health problems. We will calculate the population attributable fractions of these putative outcomes to enable an estimation of the disease burden attributable to child maltreatment.Ethics and disseminationThe study has been approved by the Queensland University of Technology Human Research Ethics Committee (#1900000477, 16 August 2019). Results will be published to the scientific community in peer-reviewed journals, scientific meetings and through targeted networks. Findings and recommendations will be shared with government policymakers and community and organisational stakeholders through diverse engagement activities, a dedicated Advisory Board and a systematic knowledge translation strategy. Results will be communicated to the public through an organised media strategy and the ACMS website.

Background Child sexual abuse (CSA) remains an ongoing threat to the wellbeing of children who might be victimized, to the liberty of individuals who might engage in abusive behavior, and to the reputations and livelihood of organizations in which abuse might occur. In the U.S., millions of children participate in youth-serving organizations (YSOs), and it is known that a proportion of CSA occurs in these settings. Despite the severity of these threats, there is little knowledge of the steps that organizations take to prevent and respond to CSA. Objective Our study aimed to index current measures to prevent and respond to CSA in organizational settings, using four of the largest U.S.-based YSOs as exemplars. Methods In partnership with our partner YSOs, we completed a qualitative analysis of 74 organizational documents including written policies, codes of conduct, trainings, and other documents that formalize these four organizations’ current CSA prevention and intervention efforts. Results These organizations collectively implement hundreds of distinct measures aimed at preventing, detecting, and responding to CSA. These measures were categorized under eight overarching themes, including: overall commitment to child safety, code of conduct, training and education, assessment, implementation and monitoring, screening and hiring, reporting and responding to child sexual abuse, youth problem sexual behavior, and boundaries for teen leaders and young adult staff. Conclusion Findings from the current study, outlining key prevention and policy areas undertaken by participating YSOs, offer a starting point for discussion about core elements needed to keep children safe from sexual abuse in YSO settings.

Background Child abuse and neglect is a public health concern around the world, with well-established impacts and costs to children, families, and society. While mandated reporters make the majority of reports, child abuse is still under-reported and many mandated reporters fail to report known and suspected cases. Objective This study was designed to evaluate the content of US state-sponsored online mandated reporter training in order to identify gaps and need for improvement in mandated reporter training. Methods A deductive qualitative content analysis of the publicly available curricula was conducted. Variables coded were identified through a literature review and consultation with experts. Results Numerous gaps were identified in the curricula including: few trainings identified reasons why reports should be made, only about one fourth included a definition, indicators, and examples of each type of maltreatment, the average number of suggestions for responding to a disclosure made by a child was 3, and few curricula addressed barriers to reporting or the impact of reporting on the reporter. Conclusions The trainings as a whole are not providing mandated reporters with comprehensive information about definitions, examples, and indicators of the major types of childhood maltreatment. In addition, the trainings contain only limited information to motivate reporters to see their role as part of a collective endeavor to protect children, and they are failing to adequately address reluctance about reporting. However, improvements are readily achievable. A partnership approach to curriculum design and delivery is recommended to develop effective training that will promote sound reporting.

Sexual misconduct by school staff, which we refer to as educator sexual misconduct (ESM), is a serious and damaging violation of the trust that parents and students put in the educational system. After reviewing the prevalence and consequences of ESM for all parties involved, the authors propose standards of practice based on the Situational Crime Prevention framework to prevent sexual abuse by altering the environment and reducing opportunities for offending. The strategies offered in this paper can help create a comprehensive approach to reducing sexual victimization of students by staff. The standards serve as an operational framework for prevention and reduce the likelihood of ESM and institutional legal liability. The seven standards include safe screening and hiring practices for staff, codes of conduct, ensuring safe environments, staff-student communication policy (including electronic communication), training staff, parents and students, monitoring and supervision, along with reporting questionable conduct. By implementing these standards, educational institutions can help ensure better protection of children from ESM.

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.

The Australian Royal Commission Into Institutional Responses to Child Sexual Abuse has identified multiple systemic failures to protect children in government and non-government organizations providing educational, religious, welfare, sporting, cultural, arts and recreational activities. Its recommendations for reform will aim to ensure organizations adopt more effective and ethical measures to prevent, identify and respond to child sexual abuse. However, apart from the question of what measures institutions should adopt, an under-explored question is how to implement and regulate those measures. Major challenges confronting reform include the diversity of organizations providing services to children; organizational resistance; and the need for effective oversight. Failure to adopt theoretically sound strategies to overcome implementation barriers will jeopardize reform and compromise reduction of institutional child sexual abuse. This article first explains the nature of the Royal Commission, and focuses on key findings from case studies and data analysis. It then analyzes public health theory and regulatory theory to present a novel analysis of theoretically justified approaches to the implementation of measures to prevent, identify and respond to CSA, while isolating challenges to implementation. The article reviews literature on challenges to reform and compliance, and on prevention of institutional CSA and situational crime prevention, to identify measures which have attracted emerging consensus as recommended practice. Finally, it applies its novel integration of regulatory theory and public health theory to the context of CSA in institutional contexts, to develop a theoretical basis for a model of implementation and regulation, and to indicate the nature and functions of a regulatory body for this context.

Psychologists’ role as mandated reporters of child maltreatment is an important responsibility. This article will provide direction to psychologists in interpreting U.S> state laws as well as practical and clinical guidance when confronted with making a report of child abuse. A review of the U.S. laws on child maltreatment reporting as they pertain to psychologists is provided. Psychologists will be guided through the process of making a report and how to handle this responsibility professionally and clinically. Important considerations are discussed with regard to psychologists maintaining compliance with their legal responsibilities and protecting children from harm. Recommendations for future training are provided.

Objectives Child maltreatment through physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence, causes substantial adverse health, educational and behavioural consequences through the lifespan. The generation of reliable data on the prevalence and characteristics of child maltreatment in nationwide populations is essential to plan and evaluate public health interventions to reduce maltreatment. Measurement of child maltreatment must overcome numerous methodological challenges. Little is known to date about the extent, nature and methodological quality of these national studies. This study aimed to systematically review the most comprehensive national studies of the prevalence of child maltreatment, and critically appraise their methodologies to help inform the design of future studies. Methods Guided by PRISMA and following a published protocol, we searched 22 databases from inception to 31 May 2019 to identify nationwide studies of the prevalence of either all five or at least four forms of child maltreatment. We conducted a formal quality assessment and critical analysis of study design. Results This review identified 30 national prevalence studies of all five or at least four forms of child maltreatment, in 22 countries. While sound approaches are available for different settings, methodologies varied widely in nature and robustness. Some instruments are more reliable and obtain more detailed and useful information about the characteristics of the maltreatment, including its nature, frequency, and the relationship between the child and the person who inflicted the maltreatment. Almost all studies had limitations, especially in the level of detail captured about maltreatment, and the adequacy of constructs of maltreatment types. Conclusions Countries must invest in rigorous national studies of the prevalence of child maltreatment. Studies should use a sound instrument containing appropriate maltreatment constructs, and obtain nuanced information about its nature.

Background Research on child maltreatment is imperative to inform evidence-based prevention and intervention efforts. Nonetheless, researchers continue to face barriers due to the perceived sensitivity and possibility of harm when asking about these experiences. While studies have started to explore reactions to participating in research on sensitive topics, there are notable limitations and fewer have focused on child maltreatment. Objective The objective of this study was to better understand adult respondents’ identification of, and reactions to, potentially upsetting questions in the context of a well-being and experiences survey, with a focus on child maltreatment. Methods Data were from the first wave of the Well-Being and Experiences Study in Manitoba, Canada: a computerized self-reported community-based survey of adolescents and their parents/caregivers administered individually at a research facility. The current study focused on parents/caregivers’ responses (N = 1000). The study utilized a mixed methods approach with descriptive statistics and qualitative thematic analyses of open-ended responses of their perceptions of upsetting questions. Results Overall, few respondents (15.1 %) identified any questions as upsetting. Ten themes emerged in respondents’ recall of upsetting questions, including maltreatment and other themes often perceived as less sensitive. Only 4% identified maltreatment-related questions as upsetting. Among those who identified any questions or maltreatment-specific questions as upsetting, most felt they were important to ask and should not be removed (92.7 %–97.5 %). These findings suggest that retrospective survey questions about experiences of child maltreatment involving adult samples are not associated with major upset and should be included in future health and social surveys.

Empirical analysis has found that mandatory reporting legislation has positive effects on case identification of child sexual abuse both initially and over the long term. However, there is little analysis of the initial and ongoing impact on child protection systems of the rate of reports that are made if a reporting duty for child sexual abuse is introduced, especially when compared with rates of reports for other kinds of child maltreatment. This research analysed government administrative data at the unique child level over a seven-year period to examine trends in reports of child sexual abuse, compared with child physical abuse, in two Australian states having different socio-legal dimensions. Data mining generated descriptive statistics and rates per 100,000 children involved in reports per annum, and time trend sequences in the seven-year period. The first state, Western Australia, introduced the legislative reporting duty in the middle of the seven-year period, and only for sexual abuse. The second state, Victoria, had possessed mandatory reporting duties for both sexual and physical abuse for over a decade. Our analysis identified substantial intra-state increases in the reporting of child sexual abuse attributable to the introduction of a new legislative reporting duty, and heightened public awareness resulting from major social events. Victoria experienced nearly three times as many reports of physical abuse as Western Australia. The relative burden on the child protection system was most clearly different in Victoria, where reports of physical abuse were relatively stable and two and a half times higher than for sexual abuse. Rates of children in reports, even at their single year peak, indicate sustainable levels of reporting for child welfare agencies. Substantial proportions of reports were made by both legislatively mandated reporters, and non-mandated community members, suggesting that government agencies would benefit from engaging with communities and professions to enhance a desirable reporting practice Refereed/Peer-reviewed

Public health law developed over centuries in a fashion distinct from historic child protection law. Public health law, with its focus on the health and safety of whole populations and lesser attention to individual rights and liberties, has been a core element in the development and practice of modern public health. Public health law reflects public health itself through its focus on science and evidence-based policies, support for the utilization of both population-based intervention and prevention, but also its endorsement of limited use of targeted campaigns and clinical interventions directed at specifically identified individuals that have taken place from the local to a global scale. Individual rights have become more prominent in many countries over the past few centuries, for example during the advent of HIV. Nevertheless, more than many other governmental activities, public health policy and practice are science-based and the legitimacy and power of public health laws rest primarily on their support by science. Along with a foundation of science, public health practitioners have inherited and practiced the medical ethos of reviewing their regulations and activities to determine effects, identify possible errors, and embed accountability for all of their efforts through continuing self-examination, and utilization of recent biological, chemical, environmental and behavioral research. Finally, law itself is not only a means of articulating public health powers and limitations, but the effects of laws can be an important variable to research and consider when efforts are made to advance the public’s health. A related question is the extent to which the training of lawyers enhances or detracts from their ability to advance public health by understanding and endorsing public health science versus attacking its science by using legal tactics.

The problem of defining “child sexual abuse” (CSA), and the need to define this concept, has been recognized by major policy bodies and leading researchers since the 1970s. Recent demands for a more theoretically robust, explicit definition of CSA show this challenge remains urgent. In this article, we identify problems caused by variance in definitions of CSA for five domains: research and knowledge formation, legal frameworks and principles, prevention efforts, policy responses, and the establishment of social norms. We review and analyze definitions used in leading international epidemiological studies, national and international policy documents, social science literature, and legal systems in the United States, Canada, and Australia to demonstrate the continuing use of different concepts of CSA and identify key areas of conceptual disagreement. Informed by our literature review, we use a methodology of conceptual analysis to develop a conceptual model of CSA. The purpose of this model is to propose a more robust, theoretically sound concept of CSA, which clarifies its defining characteristics and distinguishes it from other concepts. Finally, we provide operational examples of the conceptual model to indicate how it would translate to a classificatory framework of typologies of acts and experiences. A sound conceptual model and classificatory system offers the prospect of more appropriate and effective methods of research, response, regulation, and prevention. While total consensus is unattainable, this analysis may assist in developing understanding and advancing more coherent approaches to the conceptual foundation of CSA and its operationalization.

This chapter first discusses a range of contemporary cultural challenges regarding child sexual abuse, some of which have existed for thousands of years, and some of which are of more recent origin. It discusses child marriage, and female genital mutilation/cutting, covering their nature and consequences. It poses the question of whether they constitute species of child sexual abuse, and whether or not they do, refers to concepts of rights to explain why action can legitimately be taken to end these practices. Then, it considers the more recent phenomenon of child sex tourism. For these three cultural problems, it considers recent progress and responses, which have occurred through legal and regulatory responses, community involvement, the generation of new social norms, and multinational cooperation. The second part of this chapter considers recent and emerging technological challenges: online sexual abuse and child pornography; sexting and coercive online practices; and robotics. It considers recent progress and responses to these phenomena, noting new criminal prohibitions, and prevention considerations. It then considers the need to develop a new ethic of technology to respond to the new digital epoch, incorporating a consideration of the responsibilities of individuals, of social systems such as schools, and corporate responsibility and regulation. Key messages of this chapter are that some cultural challenges such as FGM/C have recently witnessed seismic reform, influenced by new conceptions of rights, legal protections, the involvement of women and communities, and scientific understanding. Others, however, such as child marriage, have not yet experienced significant change, and require ongoing multidimensional efforts responding to root causes. Technological challenges are substantial and growing, and legal regulation of individuals and corporations is necessary but not sufficient. There is a need for a public health approach to have a greater focus on prevention, requiring education from early childhood to enhance gender equality, skills and attitudes, and develop a new ethic of technology.

This chapter discusses law’s role in preventing, detecting and responding to child sexual abuse. It first notes the historical absence of children’s legal rights and protections, and comments on the gradual social and legal change that has occurred. It identifies how political theory and public health theory translate into social norms, legal entitlements and protections, noting the recognition of children’s rights by international law. Then, it focuses on the nature of national legal systems, conceiving domestic law as a social system required to protect individuals’ personal security, and within this, performing the key role of recognising children’s rights. It identifies law’s role in the prevention, detection and response to child sexual abuse, and places this role in the context of the major sources of law: legislation, common law and international law. It then highlights key general principles from criminal law, civil law, and child protection law relevant to the context of child sexual abuse. It explores public health law and its range of mechanisms that are capable of preventing, detecting and responding to sexual abuse. Finally, it covers regulatory theory, an important consideration in any regulatory effort, and provides insights into institutional regulation; this is particularly relevant for institutional sexual abuse prevention and response. The key message of this chapter is that every society’s legal system has a broad range of tools to create rights, obligations and remedies, and to set social norms, regarding child sexual abuse. Moreover, consistent with political theory and public health theory, every legitimate society has a responsibility to use these tools to protect its vulnerable citizens, including children, and to take reasonable actions to prevent, identify and respond to child sexual abuse.

This chapter first focuses on major challenges confronting child and youth-serving organisations and high-risk settings. It then discusses the nature, key findings and major recommendations of Australia’s Royal Commission Into Institutional Responses to Child Sexual Abuse, a landmark public inquiry into institutional sexual abuse, including a special focus on the Roman Catholic Church. The chapter then focuses on several recent examples of progress in responses to major problems presented by child sexual abuse in institutional and non-institutional settings. Developments from Australia in particular, but also from other countries, will show how new public health law responses, including through civil law, and with various emphases on primary prevention and secondary prevention, can create frameworks for enhanced prevention, identification, and response to cases of child sexual abuse. Some of these responses, such as redress schemes, reportable conduct schemes and child safe standards legislation, have specific application to institutional settings. Other responses, such as the abolition of statutes of limitation for civil claims for injuries caused by sexual abuse, and other kinds of legislative reporting duties, have broader application across society, as they apply to sexual abuse in all settings, whether within institutions, families, private settings, or other community settings. These responses are of broad application regarding prevention of child sexual abuse, early identification of child sexual offending, and ensuring appropriate responses once it is known or suspected. They are particularly relevant when dealing with high risk institutional settings and prolific individual offenders, both of which present especially urgent examples of the need for an appropriate societal approach to child sexual abuse informed by public health and social justice.