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ISPCAN Child Abuse Screening Tool Children's version (ICAST-C): Instrument development and multi-national pilot testing

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To develop a child victimization survey among a diverse group of child protection experts and examine the performance of the instrument through a set of international pilot studies. The initial draft of the instrument was developed after input from scientists and practitioners representing 40 countries. Volunteers from the larger group of scientists participating in the Delphi review of the ICAST P and R reviewed the ICAST C by email in 2 rounds resulting in a final instrument. The ICAST C was then translated and back translated into six languages and field tested in four countries using a convenience sample of 571 children 12-17 years of age selected from schools and classrooms to which the investigators had easy access. The final ICAST C Home has 38 items and the ICAST C Institution has 44 items. These items serve as screeners and positive endorsements are followed by queries for frequency and perpetrator. Half of respondents were boys (49%). Endorsement for various forms of victimization ranged from 0 to 51%. Many children report violence exposure (51%), physical victimization (55%), psychological victimization (66%), sexual victimization (18%), and neglect in their homes (37%) in the last year. High rates of physical victimization (57%), psychological victimization (59%), and sexual victimization (22%) were also reported in schools in the last year. Internal consistency was moderate to high (alpha between .685 and .855) and missing data low (less than 1.5% for all but one item). In pilot testing, the ICAST C identifies high rates of child victimization in all domains. Rates of missing data are low, and internal consistency is moderate to high. Pilot testing demonstrated the feasibility of using child self-report as one strategy to assess child victimization. The ICAST C is a multi-national, multi-lingual, consensus-based survey instrument. It is available in six languages for international research to estimate child victimization. Assessing the prevalence of child victimization is critical in understanding the scope of the problem, setting national and local priorities, and garnering support for program and policy development aimed at child protection.
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Child Abuse & Neglect 33 (2009) 833–841
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Child Abuse & Neglect
ISPCAN Child Abuse Screening Tool Children’s Version (ICAST-C):
Instrument development and multi-national pilot testing
Adam J. Zolotora,, Desmond K. Runyana, Michael P. Dunneb, Dipty Jainc, Helga R. Pétursd,
Clemencia Ramireze, Elena Volkovaf, Sibnath Debg, Victoria Lidchih,
Tufail Muhammadi, Oksana Isaevaf
aUniversity of North Carolina, Chapel Hill, NC, USA
bQueensland University of Technology, Brisbane, Australia
cGovernment Medical College, Nagpur, India
dGovernment Agency for Child Protection, Reykjavik, Iceland
eUniversity of San Buenaventura, Bogotá, Colombia
fNizhniy Novgorod State Pedagogical Univeristy, Nizhniy Novgorod, Russia
gCalcutta University, Kolkata, India
hNoos Institute and Centre for Integrated Studies in Childhood, Adolescence, and Health, Brazil and Munroe Family Assessment Centre, London, UK
iPakistan Pediatric Association, Peshawar, Pakistan
article info
Article history:
Received 15 January 2009
Received in revised form 31 July 2009
Accepted 14 September 2009
Available online 25 October 2009
Keywords:
Abuse
Neglect
Child maltreatment
Methodology
abstract
Objective: To develop a child victimization survey among a diverse group of child protection
experts and examine the performance of the instrument through a set of international pilot
studies.
Methods: The initial draft of the instrument was developed after input from scientists
and practitioners representing 40 countries. Volunteers from the larger group of scientists
participating in the Delphi review of the ICAST P and R reviewed the ICAST C by email in 2
rounds resulting in a final instrument. The ICAST C was then translated and back translated
into six languages and field tested in four countries using a convenience sample of 571
children 12–17 years of age selected from schools and classrooms to which the investigators
had easy access.
Results: The final ICAST C Home has 38 items and the ICAST C Institution has 44 items. These
items serve as screeners and positive endorsements are followed by queries for frequency
and perpetrator. Half of respondents were boys (49%). Endorsement for various forms of
victimization ranged from 0 to 51%. Many children report violence exposure (51%), physi-
cal victimization (55%), psychological victimization (66%), sexual victimization (18%), and
neglect in their homes (37%) in the last year. High rates of physical victimization (57%), psy-
chological victimization (59%), and sexual victimization (22%) were also reported in schools
in the last year. Internal consistency was moderate to high (alpha between .685 and .855)
and missing data low (less than 1.5% for all but one item).
Conclusions: In pilot testing, the ICAST C identifies high rates of child victimization in all
domains. Rates of missing data are low, and internal consistency is moderate to high. Pilot
testing demonstrated the feasibility of using child self-report as one strategy to assess child
victimization.
Practice implications: The ICAST C is a multi-national, multi-lingual, consensus-based sur-
vey instrument. It is available in six languages for international research to estimate child
victimization. Assessing the prevalence of child victimization is critical in understanding
This project was made possible by the generous support of UNICEF.
Corresponding author address: Department of Family Medicine, CB #7595, University of North Carolina, Chapel Hill, NC 27599-7595, USA.
0145-2134/$ see front matter © 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chiabu.2009.09.004
834 A.J. Zolotor et al. / Child Abuse & Neglect 33 (2009) 833–841
the scope of the problem, setting national and local priorities, and garnering support for
program and policy development aimed at child protection.
© 2009 Elsevier Ltd. All rights reserved.
Introduction
The prevalence of various types of violence against children remains unknown throughout most of the world. In 1996,
the United Nations Secretary General called for a world study of violence against children. One of the products of this study
was the recommendation that scientists and policymakers develop a shared set of definitions and research tools to study
violence against children (Pinheiro, 2006). The International Society for the Prevention of Child Abuse and Neglect agreed to
take a lead role in developing and pilot testing a new set of shared instruments. The need for shared definitions and research
tools are predicated on the notion that access to common tools may be useful in (1) defining the scope of a problem in a
national context, (2) setting national priorities and benchmarks for comparison, and (3) establishing program and funding
priorities in national and international contexts.
The majority of data on the prevalence of child abuse and neglect come from tabulations of official reporting data where
such reports exist. Countries vary widely in their reporting laws and the maintenance, analysis, and reporting of official
statistics (Daro, 2006). In the US, where official statistics have been collected from local governments and monitored nation-
ally for three decades, there is widespread acceptance that this far under represents the true prevalence of abuse and neglect.
In fact, the US Department of Health and Human Services commissions an approximately decennial sentinel provider survey
to better estimate the prevalence of abuse and neglect, known as the National Incidence Study. Estimates of abuse and
neglect range from roughly 900,000 (official substantiated reports) (United States Children’s Bureau & Walter R. MacDonald
& Associates, 2008) to nearly 2.6 million considering risk of harm based on the endangerment standard in the sentinel
provider survey (Sedlak & Broadhurst, 1996). When population-based survey tools are used to estimate the prevalence of
child abuse and neglect, derived estimates may be 70 times higher than those derived from official reports (Theodore et
al., 2005). Survey research around the world yields wide ranging estimates of maltreatment. For example, a cross-sectional
survey of children in Egypt reported 37% of children were beaten or tied up and 26% sustained injuries such as fractures,
loss of consciousness, or permanent disability from beating in the last year (Youssef, Attia, & Kamel, 1998). In South Korea,
7% of children report severe violence in the last month (beating, burning, biting, throwing, or threatening with a knife or
gun) (Hahm & Guterman, 2001). Romanian children reported abuse at a rate of 4.6% (hit with an object, burning, deprived of
food) (World Health Organization, 2002). These few examples demonstrate the challenges of multi-national comparisons.
Authors use a variety of measures, definitions, time periods, and scales.
In any abusive relationship, the victim’s abuse may rise to the attention of authorities if the abuse or its consequences are
witnessed or the victim or perpetrator discloses the abuse. However, child abuse often occurs within the privacy of family
relationships or when the child is subject to control by other authority figures. Therefore, to get closer to true estimates of
the prevalence of abuse or neglect requires that we ask either the perpetrator or the victim.
Cross-sectional study of victimization can occur at the time of adulthood (Dube et al., 2001), early adulthood (Dunne et
al., 2009) and during childhood (Amaya-Jackson, Socolar, Hunter, Runyan, & Colindres, 2000; Finkelhor, Ormrod, Turner, &
Hamby, 2005). There are certain strengths to each of these approaches. It is easier both for practical reasons and to avoid
seeking informed consent that includes alerting participants about, and complying with, laws requiring reporting maltreated
children, to survey adults regarding earlier childhood experiences. However, retrospective questioning of adults is subject
to recall bias and may increase social desirability bias. It also increases the lag time from occurrence to measurement. That is
to say, if a government wants to study the effect of a national ban on corporal punishment with prevalence of abuse, waiting
until current (and future) children grow up may create an unacceptably long lag time for policy evaluation. On the other
hand, surveying children about victimization experiences has a unique set of ethical challenges. If abuse is disclosed, does it
need to be reported? What if a child has an emotional reaction or has flashbacks after taking a survey. These issues, reviewed
by King and Churchill (2000) should be carefully considered in any new cultural and legal context in which researchers and
policymakers are considering undertaking such research.
This paper describes the survey development, ethical challenges, pilot testing, results, and instrument characteristics of
the ICAST Children’s instrument, one of three tools designed by an international panel of child maltreatment experts to study
the prevalence of childhood victimization. The other tools are designed to study child victimization from the perspective
of the parent on his or her child rearing and from the young adult on his or her childhood experiences (Dunne et al., 2009;
Runyan et al., 2009).
Methods
The initial instrument was developed with input from scientists from 40 countries. A working group met in Brisbane,
Australia, 2004, associated with the biannual meeting of ISPCAN. The scientists agreed to focus not on standards, definitions,
or thresholds for abuse and neglect but to focus on acts that could occur to a child and be potentially victimizing. Furthermore,
the experts agreed that it was important to assess victimization in the school or work place as well as in the home. Acts
were chosen for query because they were thought to be either common or serious. After the meeting, via rounds of email
A.J. Zolotor et al. / Child Abuse & Neglect 33 (2009) 833–841 835
and telephone communication, an initial draft of the instrument was written. The original instrument contains 82 screener
questions regarding potentially victimizing experiences at home and school or work. After 14 demographic questions, there
are 38 questions about home experience and 44 questions regarding experiences at school or work. We intended after pilot
testing that this instrument would be divided into two separate instruments depending on the goals of the agency collecting
data. These modules can be used either together or separately.
At the original expert meeting in Brisbane, all experts were presented with the Parent Child Conflict Tactics Scale (Straus,
Hamby, Finkelhor, Moore, & Runyan, 1998), the WorldSAFE survey (Sadowski, Hunter, Bangdiwala, & Mu˜
noz, 2004), and
the Juvenile Victimization Questionnaire (Finkelhor, Hamby, Ormrod, & Turner, 2005). The panel assigned to work on the
child instrument was further provided with the LONGSCAN Youth Self-Report measure (Amaya-Jackson et al., 2000). The
experts culled items and concepts from these instruments, focusing on the use of items that had been asked of children or
the adaptation of items that had been asked of adults to cover a range of salient victimization types across cultures. The panel
was also invited to cull items from other surveys that they were familiar with or from their national and cultural context
or to design items de novo felt to be important to child victimization not covered elsewhere. To our knowledge, no other
instruments were used. De novo questions were drafted to address the school environment by modifying questions from
the previously cited instruments. The Delphi process resulted in further modifications to the questions.
Screener questions about each type of victimization were designed to map to categories of assault or child maltreatment
conventionally used in legal, research, and programmatic settings. These include physical abuse, physical discipline, sexual
abuse, neglect, and psychological abuse for the home module. Institutional categories include sexual assault, physical assault,
and psychological victimization. All questions are asked of the respondent with reference to the past year. Children are
given the response options of “many times,” “sometimes,” “never” and “not in the past year but this has happened.” If
children respond affirmatively, they are asked to identify the perpetrator as “adult,” “another child or adolescent” or “both.”
Questions related to sexual abuse were originally followed by the response options of “more than 2 times,” and “once or
twice.” After feedback from the initial three pilot countries, we decided to use the previously mentioned categories (many
times, sometimes) for consistency in response options and to avoid unnecessary precision in measuring victimization which
might make survey response more difficult. Following the institutional section of questions on the initial pilot, children were
offered room for further description of the event with the phrase “please describe.” Based on feedback from the initial three
pilot countries, the phrase “would you like to say more” was added after all queries on both instruments as a free text option
followed by several lines. The sexual abuse questions were also followed by a question to assess familiarity “how well did
you know the person?” followed by the options “not at all,” “not very well,” and “very well.”
International investigators were sought for pilot studies in predominantly low- and middle-income countries with the
intent of ensuring diverse linguistic and cultural milieus. Relatively fewer international scientists were willing to field test the
ICAST C due to the consent issues associated with directly asking children about victimization history. Ultimately, researchers
from four countries, Columbia, Iceland, India, and Russia, indicated interest in conducting pilot studies in their countries and
indicated that the ethical considerations could be addressed appropriately in their countries.
The authors developed a field guide to be used for implementation of the study with attention to sampling, consent,
ethics, administration, and training. The final site to participate in the ICAST C was recruited several months after the other
sites had completed data collection. After the initial round of data collection, the three site principal investigators and the
coordinating investigators reviewed the instruments and preliminary results, making the slight changes reflected above.
The site principal investigator for each site was asked to translate or arrange translation of the instrument, as well as
independent back-translation. The final site used a divided version of the instrument (home and institutional versions) for
translation. The other site principal investigators have since updated translations to include minor modifications and divide
the instruments with revised numbering into two versions. The ICAST C Home and Institutional versions are now available
from the International Society for the Prevention of Child Abuse and Neglect in Arabic, English, Hindi, Icelandic, Marathi,
and Spanish at www.ispcan.org.
We asked each site to conduct at least one focus group prior to field testing the questionnaire. The purpose of the focus
group was to ensure that the translated instrument was readily understood and represented a range of victimization types
that could be present in the local context.
Site principal investigators were asked to identify convenience sampling frames with an effort to reach a broad range
of study subjects with a goal sample size of 120 subjects. School classroom settings were recommended as a neutral venue
in which children would be captive and participation rates high. The survey was administered anonymously with study
personnel or teachers as proctors. Surveys were completed with pencil and paper in an anonymous fashion. This was felt to
be important in a multi-national context to keep costs low in less developed countries.
The data from paper surveys were entered into a data entry template designed using EpiInfo version 3.3.2 (CDC, Atlanta,
GA). Anonymous entered data were then sent electronically to the University of North Carolina for management and analysis.
Ethics
Given the ethical challenges associated with directly asking children about victimization experiences, clearance was
obtained at multiple levels. First, we decided to conduct the surveys using anonymous pencil and paper in classroom settings
so we could not know who had made which response. This obviated the need to consider and consent for child abuse
reporting to legal or social service authorities where available or required. Second, we asked all participants including site
836 A.J. Zolotor et al. / Child Abuse & Neglect 33 (2009) 833–841
principal investigators and staff to participate in an online training module on the ethical conduct of research (Collaborative
Institutional Training Initiative, 2008). Also, the decision to administer the instrument to children 12 and over was made
partially for ethical reasons. Study investigators felt that children under 12 were not emotionally mature enough for the
content of the survey. The instrument was distributed with a field guide with attention to the ethical implementation of
this research. The field guides reviewed the importance of confidentiality, anonymity, and right of refusal. Also, the field
guide asked all site principal investigators to make application to local ethics review boards who could review the study
protocol in the appropriate cultural and legal context. Three sites completed formal ethics review at their home university.
A fourth site principal investigator, in the absence of such a review board at her university, had the study protocol reviewed
by her institutions director and a group of colleagues. In addition, the study protocol was reviewed by the ethics board of the
International Society for the Prevention of Child Abuse and Neglect. The coordination of the study and analysis of anonymous
data was deemed exempt from local review by the Committee on Human Subjects at the University of North Carolina.
Analysis
The analyses were conducted using Stata 8.2 (Stata Corp, College Station, TX). Analyses examined frequencies of each
response by country and across countries. For the purpose of analysis and presentation, each set of questions was organized
into types of victimization. Home victimization includes physical, psychological, sexual, neglect, and violence exposure.
School or work victimization includes physical, psychological, and sexual. To assess reliability, we calculated Cronbach’s
alpha for each scale using a merged data file from all countries. Because the response options for some questions changed
for the fourth participating pilot site, we chose not to include that data for the psychometrics presented. We calculated
the frequency of reporting each victimization type by country and total across sites. We also calculated, along each scale,
the total percent of children reporting one or more types of victimization. To assess construct validity, a mean of the items
of each subscale was calculated. Bivariate analysis was conducted with each subscale mean to assess the relationship of
subscales with child age (using correlation coefficient) and gender (using a ttest). More complete demographic bivariate
and multivariate analyses were limited by the great variety of demographics among participating countries.
Bivariate association with age was assessed using pair-wise correlations and with gender using ttests comparing scale
means. These demographic items were chosen because they were available and consistently reported across sites and
because of previously identified associations with various types of maltreatment. For example, increasing child age has
been associated with increase risk of physical abuse, psychological abuse, and sexual abuse while increasing age has been
associated with less risk for neglect (Finkelhor, Hamby, et al., 2005; Straus et al., 1998; Theodore et al., 2005; United States
Children’s Bureau & Walter R. MacDonald & Associates, 2008). Similarly, previously studies have shown an association
between sexual abuse and female sex (Fergusson, Lynskey, & Horwood, 1996; Theodore et al., 2005).
Results
All results are presented by site and totals for the whole sample. Demographic characteristics are shown in Table 1. Sample
sizes raged from 110 to 122 with a wide distribution of ages from 11 to 18 years. Convenience samples were identified through
a limited number of local schools with convenient access to the site principal investigator. A small number of children were
less than 12 (34) and 18 years of age (10) were inadvertently including in the convenience sample. As these subjects should
not respond to these items in very different ways, they are included in the analysis of the pilot results. The majority of
children in each country lived with their mother (93–98%) and father (73–90%).
Missing data
Patterns of unanswered questions can indicate ambiguous questions that are not readily understood. This is particularly
concerning in a multi-national, multi-lingual, multi-cultural study. Furthermore, questions that are perceived as alarming,
threatening, or sensitive would be expected to lead to high rates of missing data. The overwhelming majority of questions
in both sections of the ICAST C had very low rates of missing data, indicating that children felt comfortable answering these
Table 1
Demographic characteristics, percent by country and total.
Columbia India Russia Iceland (home) Iceland (institution) Total Missing
N= 110 N= 122 N= 111 N= 116 N= 112 N= 571
Child gender % male 48 57 37 53 51 .1
Child age 12 37 29 10 30 33 0
Age>1214 29 34 39 69 67
Age>1416 23 17 47 1
Age>1618 14 30 5
Lives with mother 93 95 95 97 98 .5
Lives with father 73 90 81 73 79 3.0
A.J. Zolotor et al. / Child Abuse & Neglect 33 (2009) 833–841 837
Table 2
Cronbach’s alpha coefficients for subscales reflecting domains of victim-
ization as defined in this table and Table 3.
Construct Alpha Number
if items
Home
Violence exposure .69 7
Physical victimization .77 9
Psychological victimization .78 7
Sexual victimization .72 6
Neglect .83 6
School/work
Physical victimization .85 17
Psychological victimization .86 14
Sexual victimization .78 10
questions in the anonymous context. Missing data percentages are shown in Table 1. On average, sexual abuse questions
had slightly higher rates of missing data (up to 1.8%).
Internal consistency reliability
Internal consistency is a measure of how well items in a scale reflect a latent concept or latent variable (DeVellis, 1991).
Child maltreatment is often a repetitive experience or condition of childhood and not a single act. It is therefore important that
items designed to reflect the same latent variable should be closely related. However, some scientists have pointed out the in
cataloging real life experience; the concept of reliability may be less applicable (Straus et al., 1998; Turner & Wheaton, 1997).
Banks of questions such as those presented by the ICAST C may represent a series of unrelated victimization experiences or
alternative discipline choices reflecting different cultures.
We assessed reliability for ICAST-C scales using Cronbach’s alpha. With the exception of the violence exposure scale
(alpha = .69) which has a fair alpha, all other scales have alpha coefficients in the good to very good range (.72–.86). See
Table 2 for alpha coefficients and the number of items used for the calculation of alphas.
Home
Response percents by site and for total sample are displayed in Table 3. Please note that the labels which represent each
item are intended to summarize the concept, and do not represent the complete item or the context and set up for the item.
The complete instrument is available at www.ispcan.org. All responses are for the past year. A summative inventory for one
or more of the victimization types is listed at the top of each section. Fifty-one percent of respondents endorsed exposure
to one of the listed types of violence (range among samples: 30–67%). Two-thirds of children reported one or more types
of psychological victimization (range 48–81%). Nearly 40% of children (range 24–47%) reported going without something
essential in the past year. Over half of children (55%) reported being a victim of physical violence in the past year (range
27–70%). A total of 18% of children reported one or more types of sexual victimization in the past year (range 8–34%).
Institution
School and workplace violence is also commonly reported. Nearly 60% of children reported being the victim of physical
violence at school or work in the last year (57%; range 39–67%). Similarly, 59% of children reported psychological victim-
ization (range 43–71%). Twenty-two percent of children reported ore or more types of sexual victimization (range 8–49%).
Frequencies of school and workplace victimization are shown in Table 4.
Construct validity
We have no formal gold standard on which to base the validity of these measures (such as social service or medical
assessment). However, predictable correlations with non-instrument items on the survey are helpful in determining con-
struct validity. We are limited in this pilot testing to age and gender of child, because other demographic variables are not
comparable across cultures and countries. Bivariate analyses with means of each scale are shown in Table 5.
Sex
Sexual victimization shows a predictable approach’s significance with being more common among girls (p= .10). Boys are
more likely to report physical victimization in the work place (p= .01). Girls report approach significance with more sexual
victimization in the school and workplace (p= .07).
838 A.J. Zolotor et al. / Child Abuse & Neglect 33 (2009) 833–841
Table 3
Response to home questions by county, percents.
Item Columbia India Russia Iceland Total Missing
N= 110 N= 122 N= 111 N= 116 N= 459
Violence exposure (total) 57 49 67 30 51
Adult used drugs then frightened (q1) 6 16 32 8 16 .2
Adults shouted in frightening way (q2) 30 21 48 12 28 0
Witnessed adults in home hit, kick, slap (q3) 10 25 20 1 14 0
Witnessed adults in home use weapons (q4) 6 8 10 0 6 0
Someone close got killed near home (q5) 6 15 5 2 7 0
Seen people being shot, bombs, fighting, or rioting (q6) 31 3 32 2 20 0
Something stolen from home (q7) 8 13 33 19 22 0
Psychological victimization (total) 64 72 81 48 66
Scream (q10) 43 62 63 34 51 1.5
Insulted (q11) 30 20 57 22 32 0
Made you feel embarrassed (q12) 28 20 32 12 25 .9
Wished you were dead q(13) 5 11 19 9 11 .2
Threatened to abandon (q14) 2 15 23 7 12 .2
Locked out of home (q15) 4 7 11 2 6 .2
Bullied by another child at home (q17) 22 43 44 6 29 .7
Neglect (total) 42 35 47 24 37
Went hungry or thirsty (q18) 7 7 6 2 6 1.5
Inadequate clothes (q19) 4 9 6 1 5 0
Unmet medical need (q20) 9 7 9 3 7 0
Felt not cared for (q21) 23 7 25 11 16 .4
Felt unimportant (q22) 21 12 37 14 21 .7
Inadequate support/help (q23) 25 16 34 14 22 1.3
Physical punishment (total) 54 70 68 27 55
Threatened to hurt or kill you (q16) 2 5 18 4 7 0
Pushed, grabbed, kicked (q24) 18 46 39 15 30 .2
Hit, beat, spanked with hand (q25) 41 60 51 9 40 .7
With object (q26) 15 30 34 5 20 0
Tried to choke, smother, or drown (q27) 2 7 8 2 5 .7
Burned or scalded (q28) 1 5 5 1 3 0
Locked in small place (q29) 1 4 4 0 2 .2
Pulled hair, pinched, twisted ear (q30) 13 50 23 9 24 0
Hold heavy load or exercise as punishment (q31) 2 15 11 1 7 .2
Threatened with knife or gun (q32) 2 5 5 1 3 .9
Sexual abuse (total) 8 20 34 8 18
Talked to you in a sexual way (q33) 4 16 14 3 9 .7
Showed pornography (q34) 2 9 13 1 6 .9
Touched private parts (q35) 2 8 28 2 10 .7
Made you look at their private parts or wanted to look at yours (q36) 3 7 14 4 7 .7
Made a sex video of you (q37) 0 9 3 0 3 .9
Tried to have sex with you (unwilling) (q38) 2 4 18 2 6 .7
Age
Older children reported more exposure to violence and psychological victimization in the home (p= .001). Physical victim-
ization also approaches significance in relationship to increasing age in both the home and workplace (p= .07). Psychological
victimization revealed a similar pattern (p= .05).
Discussion
The ICAST C is a new, multi-national, multi-cultural, and multi-lingual child abuse surveillance and research tool available
from the International Society for the Prevention of Child Abuse and Neglect. It is now available in six languages as two
modules (home and institutional). We have developed field guides and data entry templates for the ICAST C and its modules,
also available from ISPCAN. This represents a complete tool kit for researchers and policymakers seeking to better understand
child victimization anywhere in the world.
The ICAST C performed well on field testing. There were no reports by field testers of apparent adverse traumatic responses
from the nearly 600 children surveyed in four countries. Data anonymity was maintained, and thus there was no need to
report victimization where reporting laws exist. The very low rates of missing data support that the items were well-designed,
with minimal ambiguity and appropriate translation, literacy, developmental levels. Rates of endorsement are relatively
consistent between sites in the study and with prior experience asking children about victimization (Amaya-Jackson et
al., 2000; Finkelhor, Ormrod, et al., 2005). There are clearly some differences by site which may reflect cultural practices
A.J. Zolotor et al. / Child Abuse & Neglect 33 (2009) 833–841 839
Table 4
Responses to institutional questions by country, in percents.
Item/construct Columbia India Russia Iceland Total Missing
N= 110 N= 122 N= 111 N=112 N= 455
Physical victimization (total) 55 67 39 64 57
Anyone hurt you (q41) 14 31 37 10 24 1.5
Slap head or face (q42) 6 34 13 7 15 .2
Slap hand or arm (q43) 12 43 25 12 24 0
Twist ear (q44) 2 34 14 3 14 .2
Pull hair (q45) 3 25 14 9 13 .2
Throw object at you (q46) 12 20 27 15 19 .7
Hit you (q47) 13 20 34 9 16 .2
Kick you (q48) 17 11 23 14 17 .2
Crush fingers (q49) 0 14 7 5 7 .2
Wash mouth with soap or pepper (q50) 0 3 2 0 1 0
Stand/kneel for punishment (q51) 3 25 1 1 8 0
Stay out in cold or heat for punishment (q52) 38 16 3 4 15 .2
Burn (q53) 1 5 3 0 2 .7
Put you in cold or hot water (q54) 0 6 1 0 2 .7
Choke you (q57) 0 9 4 4 4 .2
Tie you up (q58) 1 5 0 2 2 .4
Cut you with sharp object (q59) 5 4 9 1 5 .2
Psychological victimization (total) 67 43 55 71 59
Take food away (q55) 0 8 8 4 8 .9
Make you do something dangerous (q56) 2 7 24 7 10 1.1
Curse at you (q60) 29 15 48 23 28 .4
Insult you (q61) 30 13 29 42 28 .7
Embarrass you (q62) 22 19 33 22 24 .7
Call you rude or hurtful names (q63) 10 24 52 25 28 .7
Make you feel stupid (q64) 13 18 31 20 20 .7
Hurtful prejudice (gender, race, ethnicity, etc.) (q65) 5 14 7 5 8 1.1
Hurtful prejudice against health problem (q66) 9 10 9 5 8 1.1
Isolate you (q67) 12 13 12 11 12 .7
Embarrass you b/c you are an orphan (q68) 1 5 5 0 3 .7
Embarrass you b/c you are poor (q69) 5 13 11 5 8 .9
Steal from you or break belongings (q70) 25 18 32 11 21 1.1
Threatened you with undeserved bad marks (q71) 1 10 41 10 15 .7
Sexual victimization (total) 15 8 48 22 22
Touch you in a sexual way that made you uncomfortable (q72) 4 3 10 4 8 .7
Showed you pornography (q73) 8 6 29 11 13 1.3
Made you take off clothes (q74) 0 3 5 2 2 .9
Take their own clothes off when they should not have (q75) 3 3 7 2 4 1.5
Made you have sex with them (q76) 0 1 5 2 2 1.3
Made you touch their private parts (q77) 0 2 7 2 3 1.3
Unwanted touch to private parts (q78) 1 2 21 4 7 1.8
Gave you money for sexual things (q79) 1 1 1 1 1 1.1
Involved you in making pornography (q80) 0 2 2 2 2 0
Unwanted kiss (q81) 4 4 24 7 10 0
and idiosyncratic sampling frames. The internal consistency reliability is quite good compared to similar instruments used
to query adults and children (Finkelhor, Hamby, et al., 2005; Straus et al., 1998). Finally, the bivariate analysis presented
supports, at least to a limited extent, construct validity. Studies of childhood victimization generally show higher rates of
sexual abuse among girls (Dunne, Purdie, Cook, Boyle, & Najman, 2003; Finkelhor, Ormrod, et al., 2005; Halpérin et al., 1996;
Martin, Bergen, Richardson, Roeger, & Allison, 2004; Putnam, 2003). Studies have reached inconsistent conclusions regarding
gender and age risk for physical and psychological victimization (Benbenishty, Zeira, & Astor, 2002; Finkelhor, Ormrod, et
al., 2005; Sheikhattari et al., 2006).
Limitations
The most important limitation of this study is its inability to estimate true prevalence rates for specific victimizations or
classes of victimization in each of the countries that participated. All four samples were small and convenient; none were
intended to be representative samples of the countries involved. We asked site principal investigators to recruit children from
a variety of socio-economic and cultural settings to best pilot the instrument, but these should not be thought to represent
the rates of victimization encountered in any of these countries and we have therefore chosen not to use inferential statistics
to make comparisons between countries, as such are not justified. A second limitation was presented by using a group of
experts to design a survey by consensus. We started with a process of nominating items. As the item list grew, it became
apparent that we would also need to limit the total number of items in order to limit the length of the survey. In doing
840 A.J. Zolotor et al. / Child Abuse & Neglect 33 (2009) 833–841
Table 5
Bivariate analysis scale means by age (correlation) and gender (ttest).
pvalue
Home
Violence
exposure
R2with age .15 .001***
Boys m(SD) .35 (.42) .05*
Girls m(SD) .44 (.50)
Psychological
victimization
R2with age .11 .02*
Boys m(SD) .50 (.49) .02*
Girls m(SD) .62 (.63)
Neglect R2with age .07 .14
Boys m(SD) .24 (.39) .002**
Girls m(SD) .38 (.52)
Physical victimization R2with age .07 .11
Boys m(SD) .35 (.40) .79
Girls m(SD) .34 (.41)
Sexual victimization R2with age .05 .28
Boys m(SD) .14 (.36) .10
Girls m(SD) .20 (.44)
Institutional
Physical victimization R2with age .09 .07
Boys m(SD) .33 (.41) .01**
Girls m(SD) .24 (.33)
Psychological victimization R2with age .09 .05*
Boys m(SD) .37 (.49) .41
Girls m(SD) .41 (.45)
Sexual victimization R2with age .08 .08
Boys m(SD) .10 (.24) .07
Girls m(SD) .14 (.31)
*p.05.
** p.01.
*** p.001.
so, some items were combined, in effect creating a double-barreled question despite attempts to be behaviorally specific.
For example, we have two items that include a query about hitting, beating or spanking, the first without an object and
the second with an object. One could argue that in some contexts, beating and spanking have very different meanings, in
other contexts these may be very similar parent behaviors. Our intent was to measure actions with less attention to values
and judgments about the intent or severity. Another item queries about pinching, hair pulling, and ear twisting. These are
clearly behaviorally distinct actions, but the expert panel deemed them similar in intensity of violence, such that combining
them was felt to be appropriate. Though this is clearly a limitation in the instrument, by combining behaviorally similar
items, we achieve screening questions with higher rates of endorsement. This is quite useful in population-based survey
research and will allow for meaning full comparisons across cultures. It does however, limited the richness of data for a more
detailed understanding of the causes and consequences of such behaviors. Similar challenges are seen in other victimization
instruments, with an apparent tension between length and behavioral specificity (Finkelhor, Hamby, et al., 2005; Straus et
al., 1998).
A third limitation is the mid-course change in instrument. We feel that these changes were minimal and reflected the
process of working with a multi-national team of investigators. In certain cases in the analysis, we have combined data
to reflect overall totals and bivariate associations. In testing for internal consistency reliability, we chose not to include
data from the last pilot site because of slight changes in the response options. It is worth noting, that we did re-calculate
Cronbach’s alpha on the complete merged data set (all four countries) and it was essentially identical. Furthermore, we
elected to collect and analyze limited demographic information because of the complexity of assessing concepts such as
race, ethnicity, religion, region, and economic status across countries. We recommend that, in the future, investigators
should develop an addendum module for the ICAST C to assess and analyzes these concepts in the context appropriate for
the study. Our conclusions about validity are limited. We did not measure test–retest reliability. Because the demographic
questions varied widely by setting, we had limited ability to test construct validity. We also did not assess trauma symptoms
or psychopathology using standardized interviews (Finkelhor, Hamby, et al., 2005; Smith, Lam, Bifulco, & Checkley, 2002).
This would have enhanced the conclusions about construct validity.
Implications
The ICAST C, Home and Institutional Modules, represent a toolkit including instruments, field guides, and data entry tem-
plates available from the International Society for the Prevention of Child Abuse and Neglect. The instruments are available
A.J. Zolotor et al. / Child Abuse & Neglect 33 (2009) 833–841 841
in six languages for assessing the prevalence of victimization across settings, types, and perpetrators for children 12–17.
Future implementation of these tools should include careful assessment of the ethics of asking children about victimization
in the cultural and legal context in which application is being considered. Furthermore, future assessment of instrument
strengths and limitations should include extensive evaluation of construct validity and test–retest reliability. Assessing the
prevalence of child victimization is critical in understanding the scope of the problem, setting national and local priorities,
and garnering support for program and policy development aimed at child protection.
Acknowledgements
This study would not have been possible without the leadership of Kimberly Svevo and the coordination of George
Parlamattan of the International Society for the Prevention of Child Abuse and Neglect. We would also like to acknowledge
the assistance of Jón Björnsson for his assistance with data collection and field work in Iceland.
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