Objectifs : Documenter la prévalence de possibles retards de développement sur les domaines cognitif-langagier, moteur et socio-affectif chez les jeunes enfants négligés suivis en protection de la jeunesse (PJ) au Québec. Explorer l’association entre les possibles retards de développement et les sous-types de négligence. Méthode : Cette étude transversale a utilisé un échantillon composé de 423 enfants tirés de la banque de données clinico-administratives des services PJ du Québec. Les critères de sélection étaient les suivants : 1) être âgé entre 0 et 5 ans au moment de la rétention du signalement à l’étape « évaluation-orientation » pour motif de négligence et 2) avoir été évalué à la Grille d’évaluation du développement de l’enfant (GED) par un intervenant des services PJ. Résultats : 66,44 % des enfants ont obtenu des scores au GED les situant dans une zone à risque dans au moins un domaine du développement du jeune enfant. Ces possibles retards se déclinent ainsi : 54,6 % cognitive-langagier, 37,1 % moteur et 30,4 % socio-affectif. Des analyses bivariées et de régression logistique ont été utilisées. La négligence de soins de santé était associée à un développement socio-affectif suspect. La négligence éducative était associée à de possibles retards sur le plan cognitif-langagier et moteur. Conclusion : La prévalence de possibles retards de développement chez les enfants négligés suivis en PJ au Québec est élevée. Certains sous-types de négligence apparaissent comme étant associés à de possibles retards dans des domaines spécifiques du développement. Ces constats appuient la nécessité de dépister les retards de développement chez les jeunes enfants négligés et de leur offrir rapidement des interventions précoces et spécialisées afin de leur permettre de rattraper les jalons de développement manquants. De plus amples recherches devront être réalisées pour mieux comprendre les sous-types de négligence et les mécanismes qui sous-tendent leur relation au développement de l’enfant. / Objectives: Estimate the prevalence of suspected developmental delay among neglected children in Quebec’s child welfare system and explore the relationship with neglect subtypes. Method: In a cross-sectional approach, this study used a sample of 423 young children drawn from the anonymized database of Quebec child protection services. Selection criteria were: 1) children 0-5 years of age when report was sustained 2) for reason of neglect and 3) were assessed with a French (GED) or English (CDAS) of a child development assessment tool specifically designed for use by child welfare workers. Results: 66,44% children scored in a problem-range in at least one developmental area; 54,6% in cognitive-language, 37,1% in motor skills and 30,4% in the socioemotional area. Bivariate and logistic regression analyses were used. Medical neglect was associated with suspected developmental delay in the socioemotional area. Educational neglect was associated with suspected developmental delay in the motor and cognitive-language areas. Conclusion: Developmental concerns are high among neglected children. Neglected subtype seems related to possible delay in specific developmental areas. This finding supports early detection of developmental delay among children in the child welfare system and puts emphasis on the need of early interventions to improve developmental outcomes. Further research is needed on neglect subtypes for a better understanding of their relationship with specific developmental domains.

This study examined the association between poverty and child neglect. The existence of a general association has been established for some time. However, there is much debate, and little detailed research, on the specific processes that create this association. This study focused on the form of neglect that involves the most health risk for children—physical neglect. It was hypothesized that poverty should increase the likelihood of a specific type of physical neglect, neglect of safety and basic needs, occurring more than other types. Using official child protective services data from a national data set three types of physical neglect were examined: abandonment, lack of safety or basic needs, and inadequate supervision. Hypothesis 1 was that poverty increases the odds of safety/basic needs neglect more than it influences the odds of either abandonment neglect or inadequate supervision neglect, controlling for prior neglect. Hypothesis 2 focused on a test of whether the link between poverty and physical neglect is not direct, but is instead mediated by caregiver stress. Three waves of longitudinal data were used for this test to establish causal time order between poverty and stress, and between stress and physical neglect. This study analyzed data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), Assessments 0-3 from the National Data Archive on Child Abuse and Neglect at Cornell University. The data was analyzed using multinominal logistic regression for both models. The results did not confirm Hypothesis 1, though the analysis was limited somewhat due to low frequencies of some physical neglect types in certain age groups. Hypothesis 2 was confirmed showing that the effect of poverty on physical neglect was completely mediated by caregiver stress for the abandonment and safety/basic needs types of physical neglect. Implications of the results for research on the effects of poverty on child neglect, and for preventing child neglect are discussed. / Graduation date: 2012

Child maltreatment is not a new issue. It has existed in various forms in every society since the early days in history. However, it is only in the past four decades that abuse and neglect of children has attracted widespread interest among health professionals and the general public. There is now a large body of evidence that identifies four main maltreatment forms: physical, sexual, emotional maltreatment and neglect. Child maltreatment is a substantial public health problem, as it is associated with immediate and long-term health problems. Most research into child maltreatment has been conducted in English-speaking, developed countries. Although there has been a small but steady increase in the number of studies from less developed countries over the past decade, there remains a relative dearth of research in these populations, especially in Asia. Over the years, most research projects around the world tend to be focused on only one type of child maltreatment (usually either child sexual abuse or child physical maltreatment), and many studies do not examine risk factors in depth, or address the possible outcomes of various forms of maltreatment. Children have always held a very important place in the culture and traditions in Vietnam. In 1989, Vietnam was the first Asian country and the second country in the world to sign and ratify the United Nations Convention on the Rights of the Child. Since then Vietnam has adopted various measures to promote children's rights and particularly children's rights to be protected from abuse and exploitation. Despite strong political support for the rights of children, there is little formal research into child maltreatment. From the small amount of available evidence and media reports, it appears that children in Vietnam are vulnerable to maltreatment, just as they are all over the world. It is clear that information about the extent and health consequences of different forms of child maltreatment from scientifically sound studies is still far from sufficient. Thus, more research is essential to ensure effective and culturally appropriate responses to protect children from maltreatment. The primary aim of this research was to examine the nature and co-occurrence of four forms of child maltreatment including sexual, physical, emotional maltreatment and neglect among Vietnamese secondary and high school adolescents in both urban and rural settings, and determine the extent to which such adverse experiences impact on self-reported health risk behaviours and physical and mental health. A mixed methods design including qualitative interviews and focus group discussions, and a cross-sectional survey was employed in this study. Incorporation of qualitative inquiry added a cultural dimension on child maltreatment and informed to develop appropriate quantitative measures. Following 8 focus group discussions and 16 in-depth interviews as well as a pilot study of 299 adolescents in Vietnamese schools, a cross-sectional survey of 2,591 adolescents randomly selected from eight secondary and high schools in one urban district and one rural district was undertaken between 2004 and 2005. Data were collected by self-administered questionnaires in class rooms. Key information included demographics, family characteristics and environment, and four scales measuring sexual abuse, emotional and physical maltreatment and neglect as well as standard brief assessments of health related risk behaviours, mental and general physical health. The study clearly revealed that experiences of different forms and co-occurrence of child maltreatment among school adolescents were prevalent in Vietnam. The prevalence estimates of at least one type of physical and emotional maltreatment, neglect and sexual abuse were 47.5%, 39.5%, 29.3% and 19.7% respectively. A significant proportion of respondents (41.6%) was exposed to more than one form of child maltreatment, of which 14.5% and 6.3% experienced three or four maltreatment forms. Results from multivariate logistic regression analyses showed that the prevalence of child physical and emotional maltreatment and neglect among adolescents was not statistically different between urban and rural districts. However, children from rural schools were more likely to report unwanted sexual experiences than their counterparts in urban schools. There was no significant gender difference in reports of adverse sexual experiences. In contrast, girls were more likely to report emotional maltreatment and neglect whereas boys were more likely to experience physical maltreatment. Furthermore, family environment assessed by parental quarrelling, fighting, perceived quality of parental relationship and emotional support appeared to be the most consistent factors significantly predicting each form of child maltreatment. After controlling for a wide range of potential confounding factors, many significant correlates between each type of maltreatment, each level of maltreatment co-occurrence and each health risk behaviour were found. In general, the pattern of correlations between child maltreatment and health risk behaviours was similar for females and males. Emotional maltreatment significantly correlated with most behaviours examined. Physical maltreatment seems more likely to be associated with involvement in physical fights and being threatened. Sexual abuse was significantly related to smoking, drinking, being drunk, and involvement in fighting. Statistically significant associations between neglect and self-harm such as involvement in fighting, feeling sad and hopeless, suicidal thoughts and attempts were found. Clearly, co-occurrence of child maltreatment was significantly associated with almost all examined health risk behaviours and a dose-response relationship was observed in most of the dependent variables. Regarding continuous measures of mental and physical health, multivariate regression analyses revealed that presence of four types of child maltreatment explained a small but significant proportion of variance (from 5% to 9%), controlling for a wide range of background variables. Additionally, while each form of child maltreatment had independent effects on depression, anxiety problems, low self-esteem and poor physical health emotional maltreatment appeared to be the strongest influence on mental and physical health of both female and male adolescents. Analysis of variance also clearly suggested that exposure to increasing numbers of maltreatment forms significantly increased the risk of mental and physical health problems in a dose-response fashion. The present study extends a small body of previous research examining poly-victimization in developed nations to an Asian country. The data contribute new knowledge on cross-cultural child maltreatment problems. Considerable commonalities as well as some differences in the findings in Vietnam compared with earlier research were found. One important conclusion concerns the significant independent associations between various types of child maltreatment, as well as the cumulative effects of poly-victimization on a wide range of health risk behaviours, depression, anxiety, self-esteem, and general physical health. This pioneering research in Vietnam provides timely and substantial evidence that can be used to raise public awareness of the nature of child maltreatment and the harmful effects of not only sexual and physical abuse but also other forms of emotional maltreatment and neglect which have not received attention before. These results from a community-based sample have demonstrated the urgent need for prevention programs. The current study provides an impetus for more comprehensive research in this sensitive area in the near future so that culturally and politically relevant evidence-based responses to child maltreatment can be developed in Vietnam.

The co-occurrence of domestic violence (DV) and child maltreatment is high. Response to both problems has historically been via two different systems. However, child protection workers are increasingly asked to respond to this co-occurrence since research has identified that exposure to DV can negatively impact on children and that child maltreatment often co-occurs with DV. This study looks at child protection systems response to families affected by DV by using two research methods. First, a systematic review was conducted using research papers focusing on child protection workers response to families experiencing DV. Second, a critical discourse analysis of current Australian child protection policies was conducted. Findings from the systematic review show that child protection workers' response to abused mothers went from treating them as 'mad' in the 1980s, to labelling them 'failure to protect' in the 1990s and early 2000. These findings showed continued focus on abused mothers rather than on perpetrators of DV. Some contradictions were found around child removal data. However, important links were found between re-notification of children and subsequent removal. Findings from the Australian policy analysis revealed that most policies referred to DV as a child protection issue and used a feminist definition of DV. However, not all states had detailed guidelines on how to intervene safely and effectively with families affected by DV. Discussions and recommendations focus around the pressing need for more DV expertise within child protection systems. It also discusses the issue of responsibility placed on abused mothers while perpetrators of DV remain invisible. Finally, it discusses the response to children exposed to DV compared to the response to children exposed to DV who are also victim of direct child maltreatment. The key recommendations of this study are to have DV expertise within the child protection systems, to empower abused mothers rather than blaming them, which implies putting the responsibility back on the perpetrator of DV and to have resources and systems in place before responding to child exposure to DV as child maltreatment per se.

Bakgrund: Barn har rätt att växa upp under trygga förhållanden utan utnyttjande eller våld. Tyvärr far barn illa på många sätt, vilka är en utmaning att identifiera. Distriktssköterskan har en skyldighet enligt lag att orosanmäla till socialtjänsten då ett barn misstänks fara illa, dock finns det försvårande faktorer som påverkar anmälningsbenägenheten. Det är svårt att identifiera riskfaktorer för barn i fara under korta vårdmöten på vårdcentral. Samtidigt åligger det distriktssköterskan att arbeta på ett familjecentrerat sätt och ta hela familjens mående i beaktande. Syfte: att beskriva distriktssköterskors erfarenheter av att få kännedom om eller misstänka att ett barn far illa. Metod: Kvalitativ intervjustudie med induktiv ansats, som analyserades med konventionell innehållsanalys. Individuella intervjuer över telefon eller video hölls med 12 distriktssköterskor från varierande arbetsplatser inom primärvården, med erfarenhet från vårdcentral. Resultat: I resultatet framkom ett övegripande tema: barn i fara är ett komplext ämne för distriktssköterskan. Två kategorier framträdde i resultatet: distriktssköterskans samlade kompetens om barn som far illa samt faktorer som påverkar anmälningsbenägenheten negativt. Distriktssköterskorna såg orosanmälan som en plikt, ibland saknades dock rätt förutsättningar. Det gjorde att distriktssköterskorna kunde tvivla på bedömningen och undvika orosanmälningar. Ett familjecentrerat arbetssätt underlättade. Slutsats: Inför beslut om orosanmälan behöver distriktssköterskan kartlägga familjens situation och barnets utsatthet, eftersom det oftast inte är tydligt att barnet far illa. För att känna trygghet i professionen behöver distriktssköterskan rätt förutsättningar på arbetsplatsen. Arbetsmomentet underlättas om distriktssköterskan har färdigheter i kommunikationstekniker med barn och föräldrar. Ytterligare insatser i form av samverkan med socialtjänsten behövs för att stärka distriktssköterskans anmälningsbenägenhet.

Several organizations actively work for children's rights to a safe and secure upbringing (WHO, 2022b; UNICEF, 2021). Despite this, over 1 billion children were exposed to physical, sexual, or psychological/emotional harm in 2021 (WHO, 2022c). Children exposed to maltreatment, abuse, and neglect during childhood are affected in their attachment, self-esteem, and trust. They are also at risk for higher vulnerability to physical illness, mental illness, eating disorders, alcohol- or drug abuse, and developing criminal behavior. The current systematic literature review aims to provide further knowledge about how professionals identify child maltreatment and which influencing factors affect the professionals’ actions to the suspicions. The study reviews nine articles together with a literature background to identify patterns and shortcomings. The current study highlights that indications of maltreatment are recognizable, despite if the definition of maltreatment is occasionally viewed as non-specific. Recognized indications are, among other things, visible changes, damage to the body, and changes in behavior and actions. The study also shows that professionals often lack knowledge and awareness of child maltreatment. Factors that inhibit action include culture, values, fear of misjudging the situation, or negative impact on the relationship with the child's network. It could also be due to organizational deficiencies such as time and resources. / Barns rättigheter till en trygg och säker uppväxt, arbetar flera organisationer aktivt för (WHO, 2022b; UNICEF, 2021). Trots detta utsattes över 1000 miljarder barn för fysisk-, sexuellt-, eller psykiskt/känslomässigt skada, under 2021 (WHO, 2022c). Barn som exponeras för misshandel och försummelse under dess uppväxt, påverkas såväl i deras anknytning, självkänsla och tillit. De löper även högre risk för fysiska sjukdomar, psykisk ohälsa, ätstörning, alkohol- och drogmissbruk samt utveckla kriminellt beteende. Aktuell systematiska litteraturöversikt syftar till att tillgodose ytterligare kunskap om hur yrkesverksamma identifierar barnmisshandel samt vilka faktorer som påverkar dess agerande på misstankarna. Studien granskar nio forskningsartiklar, tillsammans med bakgrunds litteratur för att identifiera mönster och brister. Aktuell studie påvisar att indikationer på misshandel är igenkännbara, trots att definitionen utav misshandel ibland ses som ospecifik. Indikationerna är bland annat synliga förändringar och skador på kroppen samt förändringar i beteende och agerande. Studien påvisar också att yrkesverksamma saknar kunskap och medvetenhet om barnmisshandel. Faktorer som hämmar agerande var bland annat kultur, värderingar, rädsla att missbedöma situationen eller negativ påverkan på relation till barnets nätverk. Det kunde även vara utifrån organisatoriska brister så som tid och resurser.