Sweden has an obligation to report child abuse suspicions to Social Services. According to Socialtjänstlagen (swedish constitution) 1 § Chapter 14, all employees in agencies affecting children, such as schools, have a responsibility to report their suspicions. Research shows that many abuses are not reported. The consequence of this is that Social Services does not hear about all cases of abused and harmed children. One profession where reporting is mandated is school counselors. The school counselor has a particular status in the educational community and meets many maltreated children, and children who injure themselves through their own behavior. The purpose of our study was to describe the circumstances that school counselors believe may affect their tendency to report. Using qualitative methods, we had eight interviews with school counselors from different municipalities who work with students of different ages, and who have different experiences within their profession. The result was related to the theoretical frames of the written composition by Stephen Webb’s (2006), The Rationality of Regulation and the Sociological Concepts of Formal and Informal Social Controls (Israel, 1968). Our study shows that all school counselors knew that a report had to be submitted even at the slightest suspicion, although several of them said that they in some cases avoided to report. The reasons for this, which all according to our interpretation means that the regulation and the social control of maltreated children does not always work, could have to do with the cooperation and response from the social services, or that they assumed that the involvement with the social services would not benefit the child. It could also be that the student’s situation was not serious enough to report, or that they wanted more information about the situation before reporting. Another reason could be that they assumed that there are better ways to sort out the students’ concerns within the school or other agencies, especially if it regards an older student. The study also shows that the school counselors felt there was a risk in losing the students trust when reporting their suspicions.

The purpose of this study has been to describe and analyze how former foster children experienced foster care which have been filled with maltreatment and neglect and how this has influenced their adult life when it comes to health, education and relationships. We also wanted to study how the former foster children coped with their placement. Furthermore we wanted to study whether there has been any turningpoints during their growth. Finally we wanted to describe how the former foster children experienced the authorities control. To make the purpose of this study complete we chose to use qualitative interviews with six former foster children as our research method. When we analyzed the results we used developmentalpsychopathology, sense of coherence and earlier research. Our results shows that former foster children who have been maltreated and neglected in foster care have health problems, both mental and physical, they enter adolescence with low education and they have problems with close relationships. Our results also shows that former foster children who have been in foster care for a longer timer tend to have lower Sense of coherence. Furthermore our study shows that our interviewees are satisfied with their lives today.

ABSTRACT

Les troubles de sommeil et les cauchemars occupent une position centrale dans le tableau clinique des victimes de traumatismes. Cette thèse, composée d’un article théorique et d’un article empirique, vise à clarifier le lien entre la fréquence et le contenu des cauchemars et l’exposition à un traumatisme. Plus spécifiquement, l’article théorique propose une synthèse des études sur la fréquence et le contenu de différents types de rêves que l’on retrouve dans la période post-traumatique. La fréquence des rêves, des mauvais rêves et des cauchemars est examinée en fonction des caractéristiques du traumatisme et des variables relatives à l’individu. Enfin, le contenu des rêves des victimes de différents types de traumatismes est décrit et exploré, afin de clarifier l’impact onirique d’un traumatisme. Quant à l’article empirique, il s’intéresse spécifiquement à la maltraitance qui fait partie des événements traumatiques les plus répandus au cours de l’enfance. L’étude réalisée examine la relation entre une histoire de maltraitance dans l'enfance, la fréquence des rêves troublants (c.-à-d. cauchemars et mauvais rêves), la détresse associée à ces rêves et la psychopathologie. Les participants de l’étude (n=352 femmes) ont répondu à des questionnaires évaluant le rappel de rêves, la fréquence des rêves troublants, la détresse associée aux cauchemars, le niveau de dépression et d’anxiété ainsi qu’un passé de maltraitance. Quatre groupes ont été formés selon le type et la sévérité des expériences d'abus ou de négligence vécues dans l’enfance. Les femmes qui ont subi les mauvais traitements les plus sévères rapportent davantage de rêves troublants et des scores plus élevés de psychopathologie. Les analyses démontrent que la détresse associée aux rêves troublants et le niveau de psychopathologie sont des médiateurs du lien entre les traumatismes subis et la fréquence des rêves troublants. Les implications des deux articles issus de cette thèse sont discutées à la lumière des différents modèles théoriques accordant une fonction de régulation affective au processus onirique. Le rôle central des rêves dans l’adaptation des individus à la suite d’un traumatisme est mis en évidence ainsi que l’importance clinique et empirique d’évaluer la détresse associée aux rêves troublants indépendamment de la fréquence de ces rêves. / Sleep disturbances and nightmares play a prominent role in trauma victims’ clinical profile. This dissertation, consisting of a theoretical article and an empirical study, aims to clarify the relationship between the frequency and content of nightmares and exposure to trauma. Specifically, the first article presents a systematic review of the literature on the frequency and content of disturbing dreams following trauma exposure. The frequency of everyday dreams, bad dreams, and nightmares is examined as a function of trauma characteristics and variables related to the individual. Finally, the dream content reported by victims of specific types of trauma is reviewed and explored in order to clarify how dreams are impacted by different traumas. The second article presents the results of an original study that examined the relationship between a history of childhood maltreatment, the frequency of disturbing dreams (i.e. nightmares and bad dreams), their associated distress, and waking psychopathology. Participants (n = 352 women) completed questionnaires assessing dream recall, frequency of disturbing dreams, nightmare distress, level of depression and anxiety, and a history of childhood maltreatment. Four groups were formed and investigated based on the type and severity of childhood maltreatment experienced. Women reporting more severe forms of maltreatment reported higher frequencies of disturbing dreams, higher levels of nightmare distress, and greater psychopathology. Waking distress associated with disturbed dreaming and level of psychopathology mediated the association between childhood trauma and the frequency of disturbed dreaming. The implications of the literature review and empirical findings presented in the dissertation are discussed in light of theoretical models suggesting an emotional regulatory function to dreams. The central role of dreams in trauma adaptation is highlighted as is the clinical and empirical importance of assessing waking distress associated with nightmares independently of their frequency.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Bakgrund: Sjuksköterskor som arbetar på barnavårdcentral (BVC-sjuksköterskor) träffar 99,2 procent av alla barn. De har därför en viktig funktion när det gäller att upptäcka och rapportera barn som far illa. Trots anmälningsplikt är anmälningsfrekvensen låg. Det råder brist på studier kring hur det blir för BVC-sjuksköterskor efter att de har gjort en anmälan. Syfte: Att ur ett etiskt perspektiv undersöka BVC-sjuksköterskors upplevelser och erfarenheter efter att de har anmält till socialtjänsten att barn far illa. Metod: Semistrukturerade intervjuer genomfördes med sex BVC-sjuksköterskor. Intervjuerna analyserades med kvalitativ innehållsanalys på manifest nivå enligt Graneheim och Lundman. Resultat: BVC-sjuksköterskornas erfarenheter av samarbetet med socialtjänsten varierade. Alla informanterna menade dock att bristen på återkoppling var ett stort hinder. Relationen till föräldrarna kunde ibland bevaras eller fördjupas efter anmälan. Ibland skadades relationen och då ansågs byte av BVC-sjuksköterska som bra. Efter beslutet om anmälan fanns många känslor. Bland annat kände sig informanterna utsatta och var rädda för hot. Det fanns även en stor oro för barnet och moralisk stress förekom. Att anmäla upplevdes som att göra sin plikt. Stöd var viktigt och kunde göra tröskeln till ny anmälan mindre. Slutsats: BVC-sjuksköterskor upplever många svårigheter efter anmälan, vilket kan påverka anmälningsfrekvensen. Ett gott samarbete med socialtjänsten, handledning och tillräckligt med stöd efter anmälan, skulle kunna leda till fler anmälningar till socialtjänsten när barn far illa. / Background: Nurses working in primary child healthcare meet 99,2 percent of the children in Sweden. Therefore they have an important role in finding and reporting child abuse and neglect. Despite mandatory reporting according to the law, the rate of reports is low. There is a lack of research about experiences from nurses after they have made a report to the social welfare board. Aim: To, from an ethical perspective, explore the experiences from nurses working in primary child healthcare after they have made a report to the social welfare board about child abuse or neglect. Method: Semistructured interviews were conducted with six nurses working in primary childhealth care. The interviews were analysed using qualitative content analysis on a manifest level according to Graneheim and Lundman. Results: Nurses working in primary child healthcare had a varying experience of the contact with the social welfare board. All respondents however, thought that the lack of feedback from the social welfare board was a major obstacle. The relation to the parents were sometimes preserved or even deeper after the report. The relation could also be harmed and then a replacement of the nurse was considered to be good. After decision to report, there were a lot of emotions and some felt that they were in an exposed situation some feared threats. Further on there was a major concern for the child and some respondents perceived moral distress. To report was considered to do ones duty. To get support was important and could lower the threshold for making another report. Conclusion: Nurses working in primary child healthcare experience many difficulties after reporting to the social welfare board, which may influence the amounts of made reports. Good cooperation with the social welfare board, mentoring and sufficient support after reporting, may result in more reports to the social welfare board about child abuse or neglect.

The number of older persons is growing at a shocking rate. In spite of this reality, the South African health care sector does not prioritise older persons, causing their health to be poorly managed. Not only does poor health management affect the health of the older person, but also economic factors. This causes a high burden on the public health sector of South Africa, with specific reference to the Primary Health Care (PHC) clinics. PHC clinics in this country are not only overcrowded due to staff shortages, but also owing to the rapidly ageing population and the large number of younger persons affected by the high unemployment rate of South Africa. The above-mentioned factors keep the professional nurses in the clinic from spending time on proper physical examinations and provision of health education to older persons. This causes older persons to lack knowledge regarding self-care, potentially leading to unintentional self-neglect, which decreases their quality of life. Studies conducted on older persons concluded that the older person wants to be involved in health promotion, but needs the necessary knowledge to take care of him- or herself. Therefore, the researcher's overarching aim with this study was to develop guidelines to facilitate self-care amongst older persons. Such guidelines aim at constituting an indirect approach to promote the health of the older person. Health education on self-care should be conducted in self-care support groups, since community experience teaches that some older persons in the community do not apply self-care skills learned without some form of support. The aim with these guidelines is to decrease unintentional self-neglect by empowering the older person to make autonomous decisions regarding self-care, in order to increase quality of life. RESEARCH AIM AND OBJECTIVES In order to reach the overarching aim of this study, which comprises the development of guidelines to facilitate self-care amongst the older persons in the Potchefstroom district, the study firstly includes a literature review to understand self-care and related constructs from a theoretical perspective. Secondly, the Appraisal of self-care agency scale-A (ASA-A) and Exercise of self-care agency scale (ESCA) were used as questionnaires to assess the self-care of the selected older persons. Lastly, after determining the self-care of the older persons, the study investigates the relationship between these two questionnaires through correlational analysis. RESEARCH DESIGN A quantitative, descriptive, correlational and contextual design was used in this study to .reach the overarching aim and respective objectives. RESEARCH METHOD The researcher firstly conducted a literature review to understand self-care and related constructs. Thereafter the researcher employed two structured questionnaires, the ASA-A and ESCA, were employed to collect data. The questionnaires were developed to measure self-care (self-care is determined by measuring the self-care agency). These questionnaires were based on Dorothea OrenYs self-care deficit theory of nursing, the same theory that this research study is based on. Minor adaptations were made to both the questionnaires prior to administration to the predominantly Setswana-speaking older population. The study formed part of the larger Multinational Prospective Urban and Rural Epidemiological study (PURE-SA study - ethical approval number 04M10). All the older persons identified in the peri-urban population of the PURE-SA study living in the Potchefstroom district and who were willing to participate were included in the sample. Trained fieldworkers assisted the researcher in data collection. Of the 198 older persons, 192 participated, accumulating to a 98% response rate. Lastly the researcher correlated the ASA-A and ESCA to determine their relationship as an added benefit to this research study. RESULTS The findings indicate that although the studied older population was of a lower socio-economic status with a lower literacy level, their overall self-care was relatively good. Seven self-care deficits were identified namely time management skills affecting self-care, energy deficit affecting self-care, sleep deprivation, lack of knowledge and ability to acquire knowledge with regard to health and self-care, lack of a rest, exercise and self-care programme, self-care deficit caused by physical deterioration and, lastly, the lack of performance of activities to prevent/decrease self-care deficits. These identified self-care deficits supported the development of guidelines to facilitate self-care amongst older persons, together with Menon's psychological health empowerment model, as well as an in-depth literature review on self-care and related constructs to understand self-care from a theoretical perspective. Furthermore, the study compared the ASA-A and ESCA questionnaires to determine the relationship between these questionnaires. The two questionnaires had a very good correlation with each other, conclusion that either of these two questionnaires could be used to measure self-care of a population. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010.

The number of older persons is growing at a shocking rate. In spite of this reality, the South African health care sector does not prioritise older persons, causing their health to be poorly managed. Not only does poor health management affect the health of the older person, but also economic factors. This causes a high burden on the public health sector of South Africa, with specific reference to the Primary Health Care (PHC) clinics. PHC clinics in this country are not only overcrowded due to staff shortages, but also owing to the rapidly ageing population and the large number of younger persons affected by the high unemployment rate of South Africa. The above-mentioned factors keep the professional nurses in the clinic from spending time on proper physical examinations and provision of health education to older persons. This causes older persons to lack knowledge regarding self-care, potentially leading to unintentional self-neglect, which decreases their quality of life. Studies conducted on older persons concluded that the older person wants to be involved in health promotion, but needs the necessary knowledge to take care of him- or herself. Therefore, the researcher's overarching aim with this study was to develop guidelines to facilitate self-care amongst older persons. Such guidelines aim at constituting an indirect approach to promote the health of the older person. Health education on self-care should be conducted in self-care support groups, since community experience teaches that some older persons in the community do not apply self-care skills learned without some form of support. The aim with these guidelines is to decrease unintentional self-neglect by empowering the older person to make autonomous decisions regarding self-care, in order to increase quality of life. RESEARCH AIM AND OBJECTIVES In order to reach the overarching aim of this study, which comprises the development of guidelines to facilitate self-care amongst the older persons in the Potchefstroom district, the study firstly includes a literature review to understand self-care and related constructs from a theoretical perspective. Secondly, the Appraisal of self-care agency scale-A (ASA-A) and Exercise of self-care agency scale (ESCA) were used as questionnaires to assess the self-care of the selected older persons. Lastly, after determining the self-care of the older persons, the study investigates the relationship between these two questionnaires through correlational analysis. RESEARCH DESIGN A quantitative, descriptive, correlational and contextual design was used in this study to .reach the overarching aim and respective objectives. RESEARCH METHOD The researcher firstly conducted a literature review to understand self-care and related constructs. Thereafter the researcher employed two structured questionnaires, the ASA-A and ESCA, were employed to collect data. The questionnaires were developed to measure self-care (self-care is determined by measuring the self-care agency). These questionnaires were based on Dorothea OrenYs self-care deficit theory of nursing, the same theory that this research study is based on. Minor adaptations were made to both the questionnaires prior to administration to the predominantly Setswana-speaking older population. The study formed part of the larger Multinational Prospective Urban and Rural Epidemiological study (PURE-SA study - ethical approval number 04M10). All the older persons identified in the peri-urban population of the PURE-SA study living in the Potchefstroom district and who were willing to participate were included in the sample. Trained fieldworkers assisted the researcher in data collection. Of the 198 older persons, 192 participated, accumulating to a 98% response rate. Lastly the researcher correlated the ASA-A and ESCA to determine their relationship as an added benefit to this research study. RESULTS The findings indicate that although the studied older population was of a lower socio-economic status with a lower literacy level, their overall self-care was relatively good. Seven self-care deficits were identified namely time management skills affecting self-care, energy deficit affecting self-care, sleep deprivation, lack of knowledge and ability to acquire knowledge with regard to health and self-care, lack of a rest, exercise and self-care programme, self-care deficit caused by physical deterioration and, lastly, the lack of performance of activities to prevent/decrease self-care deficits. These identified self-care deficits supported the development of guidelines to facilitate self-care amongst older persons, together with Menon's psychological health empowerment model, as well as an in-depth literature review on self-care and related constructs to understand self-care from a theoretical perspective. Furthermore, the study compared the ASA-A and ESCA questionnaires to determine the relationship between these questionnaires. The two questionnaires had a very good correlation with each other, conclusion that either of these two questionnaires could be used to measure self-care of a population. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010.

[Truncated abstract] The primary aims of this thesis were to investigate health indicators of child maltreatment, as well as pathways into the child protection system using routinely collected government databases, enabling a preventative health approach to child abuse and neglect. This thesis aims to improve understanding of the trends in child maltreatment and the factors, at the child and family level, which increase or reduce vulnerability to child maltreatment so more effective prevention policies and practices can be developed. This project uses longitudinal de-identified population data from the Western Australian Government Departments of Child Protection, Health and Disability Services. These data contained information on demographic, clinical, social and child protection outcomes of children and their families. Record linkage of administrative data was undertaken to: investigate health indicators of abuse and neglect using Hospital Morbidity data to enable the monitoring of population trends in abuse and neglect; compare proportion of cases obtained using health indicators with the Department of Child Protection data, and describe the physical, psychological and social characteristics of abused and/or neglected children and families. Statistical techniques utilised include logistic and Cox regression to investigate risk of adverse child outcomes, taking into account potential confounding and time to event. The main findings include: There has been an increase in assault and maltreatment related hospital admissions over the last 25 years. ... There has been a marked increase in the birth prevalence of Neonatal Withdrawal Syndrome (NWS) in Western Australia over the last 25 years, from 1 per 10,000 live births in 1980, to 31 per 10,000 live births in 2005. Specific maternal characteristics associated with having a child with NWS are identified and these children have an increased risk of child protection involvement. A population level analysis of child and parental factors determined the estimated increase in risk of substantiated child maltreatment for child intellectual disability, parental admissions for mental health, substance use, and assault, as well as greater socio-economic disadvantage. Conclusions This is the first body of research which has extensively used longitudinal, population level linked health and child protection data to investigate health indicators of child abuse and neglect and antecedent causal pathways. Monitoring injuries and conditions associated with child abuse and neglect in routinely collected data and using multiple sources of ascertainment are important initiatives in child maltreatment surveillance. Health indicators of child abuse and neglect are not subject to the same definitional and policy issues as child protection data and therefore provide a more valid comparison over time and between jurisdictions. The identification of factors which increase vulnerability for children and families to child maltreatment is essential in the implementation of prevention strategies including universal public health approaches as well as the identification of at-risk families for targeted intervention.

This diploma thesis deals with a teacher at an elementary school and the CAN syndrome. The first chapter shows the relation between domestic violence and the syndrome. The second chapter explains the issues of the syndrome - definition, forms of the syndrome, syndrome consequences, describes who the victim is and who the perpetrator is and how to recognize a child with the syndrome. The third chapter is focused on the teacher and the elementary school - there is described professional "portrait" of the educator, basic types of the prevention of the syndrome and syndrome prevention in elementary school. Chapter Four presents the research itself assesing the level of awareness of the teachers about the syndrome. This chapter also includes methodology, data analysis and subsequent interpretation of the results, verify hypothese, and the final summary.