Philosophiae Doctor - PhD / The primary intent of this study was to seek solutions to the practical problems experienced by practitioners in their management of child abuse cases. A fundamental problem regarding the current management of child abuse is that there is no guarantee that a child entering the child protective system will be dealt with in terms of a set procedure and/or protected against further abuse. To address this problem in the Western Cape, the Intervention Research (IR) methodology (Rothman & Thomas, 1994) was used to develop a Protocol for the Multi- Disciplinary Management of Child Abuse and Neglect. IV The protocol was designed for agencies that intervene in instances of child abuse. It establishes criteria and procedures for interdisciplinary co-ordination and effective case management, delineates the professional roles and responsibilities and provides step-by-step intervention procedures. The Intervention Research Design and Development methodology provided a useful framework to apply social science research methods to child protective practice and policy reform. IR focuses on the design of practice guidelines for intervention and policy reform. It can be conducted in a diversity of practice settings and therefore enhances collaborative efforts and inter-agency exchange among practitioners and among practitioners and universities. The study evolved through six phases involving inter-as well as intra-disciplinary activities. These activities were guided by systematic and deliberate research procedures, techniques and instruments. The research phases included: problem analysis; information gathering and synthesis; the development and design of the protocol; testing the protocol through a process of workshops and finally, the launch and dissemination of the protocol. http://etd.uwc.ac.za A core element of the study was the active participation and collaboration of a broad range of key stakeholders, including: victims of child abuse, their families, service providers, and policy makers. The methods and instruments used were therefore designed to enhance participation and included interviews, workshops and observation of court processes. The bottom-up approach and collaborative design enhanced the level of contextual relevance, ownership and the commitment of stakeholders. As a demonstration of this commitment, the protocol has been endorsed by the Ministry of Justice and the Ministry of Health and Social Services of the Western Cape. The Department of Social Services has committed financial support to the project and is pilot testing it in three districts. The study cautions that protocols alone cannot eradicate and solve all the problems in the child protective field and asserts that there is an urgent and critical need to develop and to implement a National Strategy on Child Abuse. Such a National strategy should include legislation that supports and enforces all aspects of a national policy on child abuse. At minimum, national policy should ensure consistent political will and leadership. This means that broad statements about the obligations of politicians and state officials is not enough. These should be followed by specific accountability and measuring mechanisms for enforcement. State policy should also provide guidelines for standardized and appropriate working conditions, recruitment and training of staff. Furthermore, it should provide for a broad array of effective and accessible services to all children and families and the co-ordination of such services. Finally, legislation should include specific obligations regarding the appropriation of adequate and flexible funding to see that commitments made to children are realized

Currently sibling research is burgeoning, yet there is virtually no literature regarding outcomes associated with witnessing the abuse of a sibling. The present study aimed to address this gap in the literature. A sample of 284 university students were surveyed regarding traumatic experiences in childhood and adulthood, the quality of childhood sibling relationships, and the experience of trauma symptoms in adulthood. Regression and moderation analyses were conducted to examine the relationship between witnessing the abuse of a sibling in childhood and trauma symptoms in adulthood and to assess whether sibling relationship quality moderates the association between sibling abuse and trauma symptomology. Results showed that witnessing the abuse of a sibling was associated with depression symptoms in the overall sample and for females reporting about a brother. Also, sibling conflict moderated the relationship between witnessed sibling abuse and externalization in sister-sister dyads. These associations should be considered in terms of the systemic abuse to which participants were exposed. Implications for clinical practice working with sibling-related victimization are discussed.

Nyckelord: Barnmisshandel, akutmottagning, sjuksköterska, upptäcka, svårigheter   SAMMANFATTNING Bakgrund: Barnmisshandel är ett hälsoproblem som förekommer över hela världen. Globalt sett är 7 % av barn med skador som söker vård på akutmottagningar utsatta för övergrepp. Forskning visar att många barn som är utsatta för övergrepp eller omsorgssvikt besöker barnakutmottagningar utan att deras utsatthet uppdagas och anmäls till myndigheter. En bidragande orsak anses vara sjuksköterskors bristande kunskap hur barnmisshandel upptäcks.  Syfte: Syftet var att undersöka sjuksköterskors upplevda svårigheter att upptäcka barn som far illa i samband med besök på barnakutmottagning och i pediatrisk slutenvård. Metod: Litteraturöversikt med en deduktiv ansats. Artiklar har sökts i databaserna: Psycinfo, Pubmed och Cinahl. I översikten har 14 vetenskapliga artiklar inkluderats.  Resultat: Resultatet visar på flera brister såsom tidsbrist och hög arbetsbelastning samt avsaknaden av rutiner och riktlinjer. Detta är försvårade för sjuksköterskans bedömningsprocess av barnet. Erfarenhet gjorde att sjuksköterskan vågade lita på sin intuition och samtidigt vara professionell i mötet med föräldrar. Närmare kontakt och samarbete med barnrättsinstitutioner för att få mer kunskap om barnmisshandel efterfrågades. Sjuksköterskor ville vara barnets advokat men oroades ofta över vem som skulle få betala priset vid en anmälan. Slutsats: Konsekvenserna av fysisk och/eller psykisk misshandel under barn och ungdomars uppväxt kan bli svåra och bestående. Trots att lagen om anmälningsskyldighet vid misstanke om att ett barn far illa är enkel att förstå upplever många barnsjuksköterskor att lagen kan vara svår att efterleva. Riktlinjer, utbildning och rutiner på arbetsplatsen om barn som far illa är avgörande för barnsjuksköterskan för att kunna upptäcka och förhindra förekomsten av barnmisshandel.

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Submitted in fulfillment of the requirements for the degree of Master of Education in the Department of Educational Psychology and Special Education in the Faculty of Education at the University of Zululand, South Africa, 2000. / Die navorsing ondersoek die opvoedingsnood van die mishandelde kind met die klem op die vennootskap tussen die opvoeder en die mishandelde kind in sy opweg- wees na volwassenheid. Daar word ook gelet op die persepsie van die voorstander van kinderregte van die mishandelde kind se verhouding met homself, ander, idees en dinge en Godfn god binne sy eie leefwereld. Aandag word geskenk aan problematiese opvoedingsgebeure waaraan die kind blootgestel mag word en die invloed wat hierdie gebeure op die onderaktualisering van die psigiese lewe mag he. Die wordingsdoeleindes van die kind onder die opskrifte: betekeniswereld, adekwate self en toebehorenheid word bespreek. Een van die opvoeder se take is onder andere om die kind in staat te stel om homself in die wereld te onenteer sodat hy sy eie leefwereld kan konstitueer. Deur relasies met homself, ander, idees en dinge en Godfn god te vorm, konstitueer hy 'n betekenisvolle leefwereld. 'n Selfgestruktureerde vraelys is as. meetinstrument gebruik. Die opstel, verspreiding en voltooiing daarvan word volledig behandel. Die aanbieding en ontleding van data word bespreek. Waar nodig, word van beskrywende statistiek gebruik gemaak. Uit die analise van die data het dit geblyk dat die mishandelde kind oor die algemeen nie baie gelukkig is nie, hy slaap nie rustig nie en hy neem oor die algemeen 'n aggressiewe houding in en is nie vriendelik nie. 'n Groot aantal het gevoel dat daar nie regtig goed in hulle steek nie en dat hulle die mi~handeling waaraan hulle blootgestel is, verdien. Wat die verhouding met ander betref, het dit geblyk dat daar tog op een van die ouers of versorgers se liefde en ondersteuning staatgemaak kan word, dat daar vertroue in die voorstander van kinderregte is en dat 'n klein persentasie van mishandelde kinders goed met volwassenes oor die weg kom. Oor die algemeen is verhoudings met huidiqe vriende goed. Ongelukkig het dit geblyk dat min mishandelde kinders 'n goeie toekonisperspektief het. Wat die relasiedimensie met Godfn god betref, het min kinders hierdie verhouding as 'n prioriteit in hul lewens gestel. Ter afsluiting word daar enkele aanbevelings aan die hand gedoen: • Oat die ouer/versorger se opvoedings- en onderrigtaak deur aile partye (staat, kerk, skool, ensovoorts) aandag behoort te geniet. • Oat ouers/versorgers - as prirnere opvoeders -van hulle verantwoordelikhede bewus gemaak behoort te word by wyse van werkswinkels, ondersteuning en kommunikasie tussen die skool en die huis. • Oat die kerk as infonnele opvoeder, kinders genoegsaam geestelik onderrig. Die hoop word uitgespreek dat hierdie beskeie bydrae 'n sinvolle bydrae tot die leefwereld van die mishandelde kind sal maak. = During this study research was conducted pertaining to the educational need of the abused child, with the emphasis on the partnership between the educator and the abused child on his way- to maturity- . Attention was also focused on the perception of the Protector of children's rights on the life world of the abused child.. A self-constructed questionnaire was used as measuring instrument. The construction, distribution and completion of the questionnaire were discussed in detail. The presentation and analysis of data was also discussed. Where necessary descriptive statistics were used to analyse data. From the analysis of the data it became clear that the abused child is not a happy child, he does not sleep well, becomes aggressive often and is not very fiiendly. A large number ofabused children were under the impression that they deserved the abuse they had experienced. Regarding the relationship with others, most children indicated that they trusted and i or loved at least one of their parents. They also trusted the Protector of children's rights. Few experienced meaningful relations with adults or a positive perspective on the future. Pertaining to their relationship to God! a god, very few expressed this relationship as a priority. Based on the accumulated findings of the research the following recommendations were made: • That parent's educational responsibilities be recognised by the government, churches and school. • Parents as primary educator's responsibilities should be emphasised by means of . workshops, support groups and meaningful communication between home and school • That the church as informal educator should provide sufficient support to the abused child. It is hoped that this study will make a meaningful contribution towards the life world of the abused child.

A thesis submitted in fulfilment of the requirements for the degree of PHD in Psychology in the Department of Psychology, University of Zululand, 2006. / South Africa is faced with the social problems of teenage pregnancy; HIV/AIDS and child abuse/rape. In order to address these problems the government has implemented a primary intervention strategy namely, introducing the teaching of sexuality education to learners at school. The Department of Education embarked on a Sexuality Education Programme (SEP) that formed part of the Life Orientation Learning Area in the year 2002. Numerous media reports have been questioning the effectiveness of this programme. Accusations were made that the school/educators were not doing enough or were shirking their responsibilities. The programme was blamed for making learners more promiscuous and adding to the existing problems of teenage pregnancy and HIV/AIDS. This led the researcher to undertake an evaluation study of the SEP. The purpose of the evaluation was to investigate whether the needs of the facilitators (educators) and the target population (learners) were being met by the programme. The methodology used was based on Michael Scriven's goal free evaluation which essentially focuses on needs assessment. The method employed was an interpretative phenomenological analysis (IPA). The sample population was chosen by using purposive sampling. The sample consisted of 11 Grade Ten learners and nine educators (primary and secondary school). Data were collected via written narratives and focus group interviews. The data was then subjected to thematic analysis. To ensure validity two independent researchers analysed the data thematicaly. The common emergent themes were translated into met and unmet needs as well as solutions to unmet needs. It was found that while the SEP was meeting some of the needs of educators and learners a large number of needs were unmet Learners were satisfied with the knowledge component of the programme and acknowledged that the SEP was having a positive impact on their lives. However, amongst other things, learners unmet needs were a lack of and accessibility to resources, creative/interesting teaching methods, acquisition of skills to deal with sexuality related problems, time constraints of the programme, parental involvement at school level. The educators found the National Policy on Sexuality Education useful but stated that the programme needed more structure in terms of what should be taught in the different grades. They were unhappy with the type of training they had received to teach sexuality education. Their needs mainly revolved around the various aspects of teacher training, overcoming barriers to learning and teaching, involvement of various stakeholders. Concerns were also raised on issues related to relationships, peer education and teachers'/learners' characteristics. Based on these findings recommendations were made to the Department of Education, schools, teachers, parents, learners and community organisations. The study was limited due to the small sample size used and hence the results cannot be generalised. Notwithstanding this, the study could be used as a springboard to conduct a large scale survey using the identified needs o£ learners and educators. The results of the survey could then be used to strengthen/improve the SEP currently being implemented.

A model child abuse and neglect reporting policy and procedure was developed which Utah school districts could use in preparing their own district specific policies and procedures for use by district personnel. The development of the model policy was carried out using two groups of consultants for evaluating the model's format, content, and usability. A third group of consultants, the superintendent or a designee in each of the 40 Utah school districts, was asked to evaluate the model policy for completeness, format, and adoptability. The evaluation was made with a questionnaire developed by the researcher and mailed to the 40 Utah superintendents. Accompanying each questionnaire was a letter of transmittal and a self-addressed, stamped, return envelope. Three mailings were utilized to achieve a usable 92.5%return. Examination of the data collected from the superintendents or a designee showed the following: 1. Averaging the questions regarding the completeness of the model policy, 82 . 5% of the respondents rated the overall model policy as being complete. 2. Seventy-six percent of the respondents felt that the format of the model policy would not cause a problem with existing policy format in their districts. 3 . Seventy percent of the respondents would adopt the model policy for use in their district. (Three districts have a policy dealing with child abuse and neglect and two respondents would recommend adoption.)

An assessment was made to determine the level of awareness among Utah public school special educators concerning the state's child abuse reporting laws and procedures. The assessment was made with a questionnaire developed by the author and mailed to those teachers involved with programs for the learning disabled, the emotionally disturbed, and the trainable and educable mentally retarded. Accompanying each questionnaire was a letter of transmittal and a self-addressed, stamped, return envelope. Two mailings were utilized, fourteen days apart, to achieve a useable 81.9% return. The data collected showed the following: (1) More than half of the population knew only one of nine salient and important points of Utah's child abuse statutes, and for that one question only 57.2% knew the correct answer. (2) Slightly more than half of the population claimed to have ever been exposed to the subject of child abuse. (3) About 2/3 of the population claimed to have suspected cases of child abuse. (4) About 1/4 of the population claimed to have reported cases of child abuse.

This is a descriptive study of the community process by which a complaint is made to a protective service agency. It is by this process that deviant child care is first identified and the decision to take action is made. The study develops a typology of the complaint process and identifies seven elements as significant in complaints that reach community agencies. The elements were: the complaint situation, the precipitating events that brought the complaint situation to the attention of someone outside the nuclear family, the relationship between the complainant and family, the complainant's motivation for responding to the complaint situation, the complainant's justification for making the complaint, the social support for making the complaint sought and received by the complainant, and the complainant's knowledge of an established channel of communication for making the complaint. Essentially the question asked was who complains about what to whom and why. Data were obtained from questionnaires representing l01 complaints about ninety-six families. These questionnaires were completed with information from the Women's Protective Division of the Portland Police Bureau, the Multnomah County Juvenile Court, and the Multnomah County Public Welfare Commission on complaints received primarily during a one month period. Statistical analyses consisted of computer cross tabulations of the study variables. Two - thirds of the complainants were from the private sector of the community while one-third were agency personnel. Private individuals usually knew of the complaint situation through first hand observation over a period of time. A vast majority of the relatives and one -fourth of the non-relatives who complained had cared for the children in the past. Although only one - fourth of the complainants actually suggested an investigation, three - fourths of the referrals were accepted for service and investigated. It was found that all of the complaint situations could be classified as neglect, abuse, or inadequate supervision. Abuse situations were rated highly serious for the child(ren) involved while inadequate supervision situations were rated least serious. In half of the situations reported a breakdown in or a lack of a child care arrangement led to the complaint, usually of inadequate supervision. The data suggested that a primary element of a successful complaint process is social confirmation and support, especially in situations of neglect which were the most difficult for complainants to evaluate. Motivations for complaints fell into three categories: concern for the child, self concern, and mixed concern. Child concern was most prevalent in situations determined to be highly serious. A universal characteristic was the complainant's need to legitimize the complaint through discrediting the parents involved-- "discrediting information" is defined as information which was negative and unrelated to the complaint situation. Strong evidence of discrediting information, however, was associated with neglect rather than with either abuse or inadequate supervision. The evidence converged on a typology of the complaint process in which each different complaint situation involved a different profile of the complaint process. The essential element of a successful abuse complaint was a highly serious situation; for a successful neglect complaint it was the presentation of discrediting information; and for a complaint of inadequate supervision it was the lack of a child care arrangement. Knowledge of the complainant's early diagnosis and motivation for action is essential to the building of a system that will facilitate the reporting of neglect and abuse.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20053号 / 医博第4161号 / 新制||医||1018(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 佐藤 俊哉, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM