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Suspecting child maltreatment

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... Tüm bu zorluklara rağmen cinsel istismarın dünya genelindeki yaygınlığının kadınlarda % 15 ile % 30, erkeklerde % 5 ile % 15 arasında değiştiği ifade edilmektedir. Fiziksel istismarın dünyada % 25 ile % 50 arasında olduğu, ciddi duygusal istismarın % 4 ile % 25 arasında değiştiği ve ihmalin ise % 45'e kadar çıkabileceği düşünülmektedir (Baker & Maiorino, 2010;Glaser, 2008;Raa & Lux, 2012;WHO, 2010). Türkiye istismarın sıklık ve yaygınlığına dair yapılan çalışmalar incelendiğinde ise farklı çalışmalarda duygusal istismarın toplum örnekleminde % 15.8'den % 93' e, fiziksel istismarın % 13.5'ten % 87.4'e, cinsel istismarın % 10.7'den % 95.7'ye kadar uzanan bir yelpazede dağıldığı görülmektedir (Alikaşifoğlu, vd., 2006;Güler, Uzun, Boztaş & Aydoğan, 2002;Zoroğlu, vd., 2001). ...
... Geleneksel olarak cinsel istismar aile yapısı içerisinde gerçekleştiğinde buna ensest, aile üyeleri dışında biri (kendinde daha büyük bir çocuk, komşu, aile dostu…) tarafından gerçekleştirildiğinde ise cinsel saldırı olarak tanımlanır (Hartman & Burgess 1989). Ancak günümüzde ensest kavramı sadece kan bağı olan kişiler arasında kurulan ilişkiden çok çocuğa bakmakla yükümlü tüm bireyler (öz anne baba, dede, amca, hala, teyze, üvey anne baba, enişte vb.) veya çocuk ile aynı aile ortamında güven temelli sürekli duygusal bağ kuran kişiler (öz kardeş, üvey kardeşler vb.) ile çocuk arasında gerçekleşen cinsel ilişkileri tanımlamaktadır (Çavlin-Bozbeyoğlu, 2009;Polat, 2007 (Chambers & Belicki, 1998;Glaser, 2008;Wingo, vd., 2010). ...
... İstismarın olduğu ailelerde aile fonksiyonlarının sorunlu olduğu, aile içi iletişim ve etkileşimin yetersiz ve düzensiz olduğu ifade edilebilir. Bunun yanı sıra tek ebeveynli, parçalanmış, üvey anne babalı, geniş veya aile içi şiddetin olduğu ailelerin istismar ve ihmal için risk oluşturduğu söylenebilir (Glaser, 2008;McCoy & Keen, 2009;NRC, 2013;Olive, 2007;Stith, vd., 2009 ...
... The consequences can be both severe and long-lasting (5,6), and may further increase an individual's risk of developing psychological disorders later in life (2,7). The literature generally refers to four categories of child maltreatment: i) physical abuse; ii) sexual abuse; iii) emotional abuse; and iv) physical and emotional neglect (8)(9)(10). However, there are some limitations to the use of these categories in child abuse research. ...
... A possible reason for this is that these types of abuse are harder to detect and often under-reported to the authorities (9,15). For example, it is difficult to recognize the effects of emotional abuse on a child, despite the observable elements of this type of maltreatment (e.g., damaging interactions) (8,9,16). ...
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Objective: The present study investigated the relationship between different types of childhood maltreatment (emotional abuse, sexual abuse, multiple abuse types, and no abuse) and the occurrence of later traumatic events during later adolescence and young adulthood. Method: Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4718 young adults who were 24 years old was randomly selected using the total birth cohort of children born in 1984. A structured interview was conducted during which participants were asked about a range of traumatic and abusive experiences. Results: A response rate of 63% was achieved for a total sample size of 2980. Chi-squared analyses revealed significant relationships between all child maltreatment groups and direct exposure to 10 of the 13 traumatic events; there were also significant relationships between all child maltreatment groups and indirect exposure to 12 of the 13 traumatic events. Conclusion: The results showed that childhood maltreatment was associated with increased risk of exposure to traumatic events, both directly and indirectly, during adolescence and young adulthood. The findings of this study suggest there is an increased risk of being exposed to both direct and indirect traumas during later adolescence and young adulthood after any form of child maltreatment.
... [9] The United Kingdom's guidelines (2009) strive to increase health care professionals' awareness of their duties and functions with abused children and their families. [22,23] Norway has an electronic handbook on physical abuse, which specifically targets those working in somatic specialized health services with assessment, diagnosis and follow-up of children who may have been subjected to abuse. [24] This handbook is aimed at doctors, but is also useful for nurses. ...
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Background: Child abuse is a serious global problem with long-lasting consequences for the child and his/her family. Nurses are in a position to stop the abuse, to detect and initiate care. The aim of this study was to describe nurses' experiences when they had suspected child abuse in their encounters with children and their families in various health care contexts. Child abuse is understood as a lack of care, neglect, physical or psychological, and sexual abuse according to World Health Organization and previous research. Methods: Descriptive exploratory research design that uses content analysis. Eight nurses were interviewed individually and were chosen to represent a strategic sample of Norwegian health care units. Results: The responsibility of the nurses was challenged and in many cases neglected when child abuse was suspected by the nurses. The child and his or her family lingered heavily in their minds regardless of whether they had acted on their suspicion or not. They doubted what they saw and what it meant, and they feared the consequences for the child and the family when acting on their suspicion. The fear of consequences included themselves. Uncertainty and anxiety haunted the nurses, and they felt little support for their actions from their colleagues and leaders. The nurses felt that their knowledge of the signs of child abuse, documentation and report routines was insufficient. Conclusions: Nurses need to raise their awareness, responsibility, and courage to act when they encounter suspected child abuse. Nurses therefore need more knowledge about child abuse but also ethical reflection, collegial and management support, and interprofessional collaboration.
... Also in other countries, such as in the UK, guidelines have been developed for multi-professional use. 12 However, no systematic reviews of this specific topic were found by searching central databases, such as Cochrane, Campbell and Prospero. ...
Article
Review question/objective: The objective of this review is to synthesize the best available evidence regarding the effectiveness of methods in identifying child maltreatment in social and health care settings. Inclusion criteria: Types of participants: This review will consider studies that include social welfare and health care settings, as well as others where children and their families visit (including child welfare clinics, maternity clinics, schools, nursery schools and day-care, physicians' reception, children's and adolescents' wards at hospital and child protection) and professionals (including nurses, public health nurses, school health nurses, physicians, social workers, nursery and other school teachers, physiotherapists, speech therapists and psychologists) who take care of children, adolescents and their families in those settings. Also children (up to 18 years of age) and families themselves will be considered as participants. Types of interventions: This review will consider studies that evaluate methods designed to identify physical or psychological abuse and/or neglect of children aged up to 18 years of age, including screening tools, questionnaires, discussion with families, observations, home visits, physical and psychological examination, risk evaluation and other kinds of multi-professional working practices targeted at identifying child maltreatment or evaluation of the family situation. Identifying child maltreatment is the main issue and is followed by intervening in the situation. Comparator: No intervention or usual care. Usual care here means that the professionals do not identify maltreatment or risk of it, they just do those tasks they usually do, such as vaccinating children, routine follow-up of growth and development of a child; taking care of their wounds or bruises etc., without thinking that those may be consequences of child maltreatment. Types of outcomes: This review will consider studies that include the following outcome measures: confirmed or accurate occurrence of child maltreatment (physical, psychological abuse or neglect). For example family home circumstances and their living conditions, diagnosis of physical abuse or observation of neglect, delay in the development of the child physically or mentally, risk behavior by parents (physically or psychologically abusive). As an outcome there may also be 'no identification'.
... Awareness of the serious long-term consequences should encourage better identification of those at risk and the development of effective interventions to protect children from violence [1,14]. In the UK, the National Institute for Health and Clinical Excellence (NICE) guidance was developed to raise healthcare professionals' awareness of the alerting features of child maltreatment [15]. In Finland a guideline has also been written [10] concerning identifying and intervening in child maltreatment, based on a systematic literature review [16]. ...
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Objectives. To describe how Finnish public health nurses identify and intervene in child maltreatment and how they implement the National Clinical Guideline in their work. Design and Sample. Cross-sectional survey of 367 public health nurses in Finland. Measures. A web-based questionnaire developed based on the content areas of the guideline: identifying, intervening, and implementing. Results. The respondents reported they identify child maltreatment moderately (mean 3.38), intervene in it better (4.15), and implement the guideline moderately (3.43, scale between 1 and 6). Those with experience of working with maltreated children reported they identify them better (P < 0.001), intervene better (P < 0.001), and implement the guideline better (P < 0.001) than those with no experience. This difference was also found for those who were aware of the guideline, had read it, and participated in training on child maltreatment, as compared to those who were not aware of the guideline, had not read it, or had not participated in such training. Conclusions. The public health nurses worked quite well with children who had experienced maltreatment and families. However, the results point out several developmental targets for increasing training on child maltreatment, for devising recommendations for child maltreatment, and for applying these recommendations systematically in practice.
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Background: Depressive symptoms and child maltreatment are both global public health problems among young adults. This study aimed to investigate the associations between five types of child maltreatment and depressive symptoms among Chinese college students, with a focus on potential sex differences. Methods: A cross-sectional study of a nationally representative sample of Chinese college students was conducted from March to June 2019 with a multistage, stratified cluster, random sampling method. In total, 30,179 college students from 60 colleges of 10 Chinese province-level regions completed standard questionnaires, including a history of child maltreatment and current depressive symptoms. Results: The prevalence of depressive symptoms among college students in China was 7.3%. After adjusting for control variables, physical abuse (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI] = 1.17–1.23), emotional abuse (aOR = 1.21, 95% CI = 1.19–1.23), sexual abuse (aOR = 1.19, 95% CI = 1.16–1.22), physical neglect (aOR = 1.14, 95% CI = 1.12–1.16) and emotional neglect (aOR = 1.08, 95% CI = 1.07–1.09) were all positively associated with depressive symptoms. Notably, a cumulative effect of child maltreatment on depressive symptoms among Chinese college students was observed. Moreover, sex differences in the associations of emotional abuse, emotional neglect, and the number of maltreatment types with depressive symptoms were statistically significant ( P < 0.05). Further stratification analyses showed that female students who experienced emotional abuse and emotional neglect had a higher risk of depressive symptoms than male students, and the cumulative effect of maltreatment types was stronger for females than males. Conclusion: Five types of child maltreatment and their co-occurrence were associated with an increased risk of depressive symptoms among college students. Furthermore, the effects of emotional abuse, emotional neglect and the number of maltreatment types on depressive symptoms were stronger for females than for males. These findings can promote understanding of the effects of child maltreatment on depressive symptoms, and prevention and intervention strategies for depressive symptoms should consider the type of child maltreatment and sex differences.
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The purpose of the present study was to adopt the Multidimensional Neglectful Behavior Scale – Child Report (10–15 Years) into Turkish and to examine the psychometric properties of the Turkish version. The participants of the study were a total number of 160 children (81 female and 71 male) between the ages of 10 and 15 who were recruited from a primary, a secondary and a high school in Nicosia, north Cyprus which is the Turkish population of the island. In terms of the validity analysis, construct and criterion related validity analysis were both conducted. Confirmatory factor analysis revealed a construct of 6 factors and 35 items for the Mother Form and a construct of 7 factors and 41 items for the Father Form of the scale. In the criterion-related validity analysis, both the Mother and the Father Forms were found to be significantly correlated (p < 0.05) with the criteria measures. In terms of the reliability analysis, the internal consistency coefficients were computed by employing the KR-20 method. The reliability coefficient was found to be .832 for the total neglect score of the Mother Form and .908 for the total neglect score of the Father Form. According to these results, the Turkish version of the MNBS-CR (10–15 Years) is a reliable, valid and psychometrically sound instrument that can be used for assessing child neglect in a Turkish sample.
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The purpose of this article is to present the clinical nursing guideline we developed to help nurses to identify and intervene in child maltreatment, defined as physical and psychological abuse and neglect. The guideline is based on a review of 77 research articles and review and discussion papers searched systematically from databases. According to this review, child maltreatment is associated with risk factors which may manifest themselves in the child, the parents or in the whole family. Knowledge and assessment of these risk factors are of the utmost importance. Particular attention needs to be paid to the accumulation of risks in the family. Physical and other signs caused by maltreatment are central to the identification of maltreatment. Important opportunities for identification and intervention are home visits to families with children, and during clinic visits, with questions and discussion about child-rearing practices, the parents' or carers' relationship and violence which might be present in family life. ‘Particular attention needs to be paid to the accumulation of risks in the family’ The guideline summarises the most compelling multidisciplinary research evidence in order to make recommendations which guide nurses and other professionals on providing care to families with children and in developing identification and intervention practices. Copyright
Article
OBJECTIVES: The objective of the study was to examine the Parenting Support Needs Assessment (PSNA) for content validity, internal consistency reliability, and clinical usefulness. The PSNA was designed for use by primary care clinicians who care for young children and their families, to identify families with risk factors for child maltreatment. METHODS: Phase I of the study consisted of the content validity assessment by child maltreatment experts, and phase II was a pilot test of the PSNA and referral algorithm by nurse practitioners (NPs) for clinical usefulness. Data obtained during the pilot testing were used to examine individual PSNA items, establishing an estimate of internal consistency reliability and identify the instrument's clinical usefulness. RESULTS: The PSNA instrument and referral algorithm was found to have content validity and clinical usefulness. The number of referrals to family support social service agencies increased from 4 to 22 over the pre-PSNA use (with different children) and the instrument exceeded the internal consistency reliability threshold of .80. CONCLUSIONS: The PSNA instrument was found to be valid, reliable, and clinically useful in the primary care setting. The PSNA represents a significant step forward in screening for child maltreatment risk in families of young children during routine primary care.
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Professionals in child health, primary care, mental health, schools, social services, and law-enforcement services all contribute to the recognition of and response to child maltreatment. In all sectors, children suspected of being maltreated are under-reported to child-protection agencies. Lack of awareness of the signs of child maltreatment and processes for reporting to child-protection agencies, and a perception that reporting might do more harm than good, are among the reasons for not reporting. Strategies to improve recognition, mainly used in paediatric practice, include training, use of questionnaires for asking children and parents about maltreatment, and evidence-based guidelines for who should be assessed by child-protection specialists. Internationally, studies suggest that policies emphasising substantiation of maltreatment without concomitant attention to welfare needs lead to less service provision for maltreated children than do those in systems for which child maltreatment is part of a broad child and family welfare response.