La somatisation est la manifestation de symptômes physiques en réponse à une détresse psychologique. Chez les enfants victimes d’agression sexuelle (AS), la somatisation et les facteurs associés sont peu documentés dans la littérature. Puisque la somatisation peut diminuer la qualité de vie, il est important d’identifier les facteurs qui seraient des cibles d’interventions. L'étude a pour objectif d’examiner les caractéristiques de l’AS, ainsi que les facteurs personnels, familiaux et environnementaux associés aux symptômes somatiques dans cette population. L'échantillon comprend 655 enfants (68,9 % de filles; M = 8,96, SD = 1,87) ayant dévoilé une AS. Des modèles de régression linéaire hiérarchique ont été utilisés pour étudier les associations entre les caractéristiques de l'AS, les facteurs personnels, familiaux et environnementaux et les symptômes somatiques. Les interactions avec le sexe ont été testées. La majorité (80 %) des enfants avaient au moins un symptôme somatique. En contrôlant pour le sexe et l'âge, le stress lié au dévoilement de l’AS (B = 0,17, IC à 95 % [0,10, 0,25], la détresse parentale (B = 0,22, IC à 95 % [0,14, 0,29]), le nombre d’évènements de vie stressants (B = 0,15, IC à 95 % [0,08, 0,23]) et la défavorisation sociale du quartier (B = 0,25, IC à 95 % [0,05, 0,45]), étaient indépendamment associés à plus de symptômes. Des interventions axées sur le contexte familial et environnemental peuvent être considérées pour atténuer les conséquences de l’AS sur les plaintes somatiques. / Somatization is the manifestation of physical symptoms as a response to psychological distress. In children victims of sexual abuse (SA), somatization and the associated risk and protective factors are understudied. Given that somatic symptoms can lead to functional impairment and decreased health-related quality of life, identifying areas of intervention at all levels of the child’s environment is essential. The study aimed to identify SA characteristics, personal, family, and environmental factors associated with somatic complaints among child victims of sexual abuse. The sample included 655 children (68.9% girls; M = 8.96 years, SD = 1.87) seeking services after SA disclosure. Hierarchical linear regression models were used to investigate the associations between SA characteristics, personal, family, and environmental factors, and somatic symptoms. Interactions with sex were systematically tested. In the sample, 80% of children reported at least one somatic symptom. After controlling for sex and age, stress related to the SA disclosure (B = 0.17, 95% CI [0.10, 0.25], parental distress (B = 0.22, 95% CI [0.14, 0.29]), the number of stressful life events (B = 0.15, 95% CI [0.08, 0.23]) and neighborhood social deprivation (B = 0.25, 95% CI [0.05, 0.45]), were independently associated with increasing somatic complaints. Children therefore depend on the support of adults around them and on their entire social environment to mitigate the consequences of SA on somatic complaints. Interventions focused on family and environmental factors should be considered to support this vulnerable population.

Background: Child abuse is a pervasive and serious problem in the United States. Over 3 million children are the victims of some kind of physical assault by adults. Due to their prolonged contact with children and opportunity to report, nurses should be trained to accurately assess, identify, and manage cases of child abuse. The purpose of this study was to examine student’s experiences with Child Protective Services, and explore their confidence and attitudes related to identifying and reporting child abuse. Factors associated with non-reporting were identified. Methodology: This was an exploratory, descriptive study. Students enrolled in the online Nursing Research course, NUR 3165, were asked to participate. Forty-four RN to BSN and Concurrent students completed the 27 questions survey on Qualtrics. It included demographic questions, questions regarding the participant’s beliefs about child abuse, The Child Abuse Reporting, Attitude and Experience Survey, and two vignettes. Survey data was analyzed using descriptive statistics. Results: There were total of 44 (6 males and 38 females) students who completed the survey; most of them were between the age of 20-24. Fourteen were RN to BSN students who have practiced nursing for more than a year and 30 were concurrent nursing students who are still working on their ASN degree. The results showed that nursing students had positive experiences with CPS and indicated that they had confidence in identifying child abuse. However, students felt that they have not received adequate professional education in this field. Many reported never receiving training regarding child abuse and 84.1% indicated never reporting a suspected case to CPS. When presented with vignettes describing scenarios related to abuse, participants were not able to positively identify cases of abuse versus cases that were ambiguous. Discussion: Nurses are mandatory child abuse reporters in Florida. Many nursing students indicated that they have never reported suspected cases of child abuse to CPS and some of the reasons for this could be the lack of experience, and proper training and education on child abuse. Regardless of the reason, nursing students should be given adequate education to improve their confidence and attitude in identification and reporting of child abuse cases. Nursing schools could focus on including more hands on activity such as case studies and simulation to improve knowledge. Employers could try to utilize protocols to help identify child abuse.

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Cette thèse a pour but de mieux comprendre le recours aux médicaments psychotropes chez les enfants hébergés en Centre jeunesse, une population qui compte parmi les plus médicalisées. Afin d’y parvenir, les caractéristiques sociodémographiques, anamnestiques et psychopathologiques des enfants placés qui reçoivent des psychopharmacoprescriptions ont été analysées. L’échantillon se compose de 101 enfants de 6 à 12 ans placés en foyer de groupe ou centre de réadaptation, dont 71 recevant des médicaments psychotropes. Les données ont été obtenues par le biais de questionnaires remplis par les éducateurs, par une entrevue semi-structurée réalisée auprès des enfants et une analyse du dossier. Sur le plan de la structure, cet ouvrage comprend une introduction, quatre articles et une conclusion. Le premier article comporte une recension des écrits sur l’usage de la psychopharmacothérapie chez les jeunes placés dans les services de la protection de la jeunesse. Il a été constaté que les taux de prescriptions peuvent varier entre 13% et 77%, selon le type de placement et les régions à l’étude. La symptomatologie des enfants placés qui reçoivent des médicaments psychotropes est caractérisée par des problèmes extériorisés et des troubles psychotiques. Les corrélats du recours à la prescription concernent à la fois la sévérité du tableau clinique, mais aussi le type et l’instabilité du placement, l’âge et le sexe de l’enfant ainsi que la formation des intervenants. Enfin, les écrits recensés font état de l’influence des neurosciences dans les milieux médicaux sur les décisions de prescrire. Le deuxième article présente la prévalence des psychopharmacoprescriptions chez les enfants de 6 à 12 ans placés hors d’un milieu familial. Les résultats indiquent que 70,3% des jeunes reçoivent au moins une prescription, le plus souvent signées par des médecins spécialistes. La plupart se composent de psychostimulants et d’antipsychotiques atypiques, prescrits pour des troubles de l’attention avec hyperactivité. Le troisième article cherche à préciser les caractéristiques sociodémographiques et anamnestiques des enfants placés qui prennent des médicaments psychotropes. Les résultats indiquent que les sujets médicamentés et non médicamentés ont vécu des stresseurs psychosociaux similaires. Par contre, les enfants placés qui reçoivent une psychopharmacothérapie ont été retirés de leur milieu familial à un plus jeune âge. Le quatrième article consiste à cibler leur portrait psychopathologique et à connaître leur niveau de fonctionnement global. Il s’intéresse également aux connaissances et aux perceptions des éducateurs sur la psychopharmacothérapie. Les résultats révèlent que les enfants médicamentés ont plus souvent un diagnostic de trouble mental inscrit à leur dossier. Selon les éducateurs, ils présentent davantage de problèmes extériorisés et intériorisés. À partir de données autorévélées, aucune distinction ne peut être établie entre les sujets, puisque les uns et les autres rapportent un niveau comparable de symptômes et de signes diagnostiques. Enfin, les symptômes de stress post-traumatique et l’opinion favorable des éducateurs sur la psychopharmacothérapie constituent des prédicteurs significatifs de la probabilité de recourir à un traitement médicamenteux. En conclusion, l’apport des résultats de cette recherche est analysé à la lumière des études antérieures. Les retombées cliniques sont discutées et des pistes de recherche futures sont suggérées. . / Summary The present thesis aims to better understand the use of psychotropic medication among children in foster care, a population, which appears to be particularly subject to psychopharmacotherapy. In order to achieve this goal, the sociodemographic, anamnestic and psychopathological characteristics of children who receive psychopharmacotherapy will be analyzed. The sample consists of 101 children in care, including 71 children receiving psychotropic medications. These data were obtained through questionnaires completed by the educators responsible for these youths. In terms of structure, this work of research consists of an introduction, four articles, and a conclusion. The first article includes a review of the literature on the use of psychopharmacotherapy in children placed in youth protection care. It has been found that prescription rates can vary between 13% and 77%, depending on the type of placement and geographical areas studied. The symptomatology of children receiving psychotropic medication is mainly characterized by externalizing problems and psychotic disorders. The correlates of prescription rates involve the severity of the clinical portrait, the type and instability of placement, child age and gender, and workers’ training. Finally, the literature review shows the influence of neuroscience on the medical community’s decisions to prescribe. The second article presents the prevalence of psychopharmacological prescriptions in children ages 6 to 12 years, who are placed in foster group homes or rehabilitation centers. It also identifies the classes of molecules used, the reasons for prescribing and the training of the prescribing physician. The results indicate that 70.3% of young people receive at least one prescription, most often signed by specialized physicians. These data mostly consist of psycho-stimulant and antipsychotic drugs prescribed for Attention Deficit Disorder with Hyperactivity (ADHD). The third article seeks to identify the sociodemographic and anamnestic characteristics of children receiving psychotropic medication. Medicated youths (n = 71) were compared to non-medicated ones (n = 30). The results indicate that both groups experienced psychosocial stressors prior to their placement. However, foster children who received psychopharmacotherapy were removed from their home at a younger age, and experienced more family life changes before the age of 6, in comparison to non-medicated children. The fourth article aimed to target the psychopathology portrait of children receiving psychotropic medication, and to clarify their overall level of functioning. It also focuses on educators’ knowledge and perceptions of psychopharmacotherapy. The results showed that medicated had a mental disorder diagnosis recorded in their files more often than non-medicated children. As perceived by educators, these children had more externalized and internalized problems. However, according to self-reported data, no distinction can be made between medicated and non-medicated children, since both groups reported comparable levels of symptoms and diagnostic signs. Finally, the results indicate that post-traumatic stress symptoms and educators’ favorable opinion concerning pharmacotherapy are significant predictors of the probability of medication use. In conclusion, the inputs of these research findings are analyzed in light of previous studies. The clinical implications are discussed and future research directions will be suggested

Child protective services begin with an intake (screening) decision to accept or reject maltreatment reports. This crucial decision may lead to significant positive or negative outcomes for children and families. Little is known about characteristics that intake decision-makers share or factors that influence the decision-making process. Racially-biased intake practices have been blamed for contributing to African American children’s disproportionate overrepresentation in the child welfare system. Concerns have emerged that social workers may hold negative stereotypes about African Americans and parents who use drugs. Stereotypical biases may influence decisions in reports alleging parental drug use and/or involving African American families. This study was conducted to examine the influence of race and parental drug-use allegations on intake decision-making. It was also conducted to identify factors that influence decision-making and to determine whether concepts drawn from naturalistic decision theory and attribution theory are relevant to intake decision-making. A conceptual model for describing decision-making was proposed and tested. Equivalent materials design was employed. Respondents completed an on-line questionnaire that included 24 vignettes describing hypothetical maltreatment concerns. Race and drug use were manipulated between two instrument versions. Respondents completed a 45-item scale measuring racial and parental drug use bias. They also described their application of policy to decision-making and the degree to which they engaged in different types of mental simulation (a naturalistic decision theory strategy) in making decisions. Eighty-seven child protective services intake decision-makers in Virginia participated (67% response rate). The findings suggest that respondents’ decisions were not influenced by racial bias but were influenced by parental drug use bias. Respondents’ parental drug use bias scores were higher than their racial bias scores. Social workers’ racial bias scores were higher than other respondents’ scores. A set of nine primary decision-factors used frequently in decision-making was identified. Finally, respondents reported using their discretion in adhering to CPS policy depending upon their concern for children’s safety. The research contributes to understanding the intake decision-making process. Findings related to worker characteristics, relevant decision-factors, and decision-making behaviors may influence practice and future research. Findings also suggest that naturalistic decision theory concepts warrant further attention and study.

The aim of this study was to analyze narratives of violence and explore how this relates to one's own violence. By means of the theory of differential associations and social learning theory, the development of violent behavior was understood and interpreted. Through a hermeneutic approach, seven life stories from the Stockholm Life-Course Project, were interpreted, where child maltreatment and own use of violence had occurred. The main results showed that the individuals experienced that the childhood had characterized their lives and that they developed a behavior of violence. The violence has been interpreted for strategic purposes but also of pure instinct. The results were problematized with the previous research. The study's conclusion is that exposure to child maltreatment constitutes a risk factor for developing violent behavior. However, the relationship is complex and no causal statements can be made based on our research method and our sample. / Vårt syfte med denna studie var att med utgångspunkt från narrativ analysmetod analysera berättelser om våldsutsatthet och dess relation till egen våldsutövning. Teorin om differentiella associationer och social inlärningsteori användes för att skapa förståelse för utvecklingen av ett våldsamt beteende. Med ett hermeneutiskt angreppssätt tolkades sju intervjuer från The Stockholm Life-Course Project. Studiens främsta resultat visade att individerna upplevt att barndomen präglat deras liv och att de anammat ett våldsbeteende. När de själva utövat våld beskrivs detta ha utförts strategiskt och målinriktat, men även instinktivt då våldet utförts på ren impuls. Tidigare forskning bidrog till att problematisera resultatet i förhållande till berättelser som strider mot ovanstående narrativ och de teoretiska resonemangen. Studiens slutsats är att utsatthet för våld under barndomen utgör en riskfaktor för att utveckla ett våldsamt beteende. Relationen är dock komplex och inga kausala uttalanden kan göras baserat på vår forskningsmetod och vårt urval.

I denna studie har tio semistrukturerade intervjuer genomförts med yrkesverksamma dagbarnvårdare som arbetar i en kommun i Sverige. Syftet med studien är att utforska dagbarnvårdares förhållningssätt och inställning till sin anmälningsskyldighet och om det finns faktorer som påverkar deras beslut att göra en orosanmälan. Med hjälp av en tematisk analys på intervjumaterialet framkom fyra huvudteman: Var går gränsen, Organisationens stöd, Privat och professionell och Svart på vitt. Var går gränsen handlar om att det finns en svårighet i att veta när det är dags att göra en orosanmälan till socialtjänsten och hur man upptäcker att ett barn far illa. Organisationens stöd innefattas av chefens och kollegornas stöd i anmälningsprocessen. Privat och professionell handlar om det upplevda dilemmat av att vara privat och professionell på samma gång. Svart på vitt belyser behovet av att mer kunskap och utbildning kring anmälningsplikt såväl som kring tecken på att barn bar illa. Resultatet kopplas till tidigare forskning samt handlingsteori och handlingsutrymme. / In this study ten qualitative interviews were conducted with professional home daycare providers in a Swedish municipality. The aim of the study is to explore home daycare providers approach and attitudes towards their mandatory reporting and to find out if there are any factors that affects their decision of reporting to the child protective service. With a thematic analysis four main themes were found; Where is the limit, The support from the organization, Private and professional and Black on white. Where is the limit implies that there is a difficulty of making a decision when to report child maltreatment to the child protective service and how to discover child maltreatment. The support of the organization includes support from the manager and colleagues in the process of reporting. Privat and professional includes the experienced dilemma of being private and professional at the same time. Black on white intend to discuss the need of getting more knowledge and education regarding mandatory reporting as well as signs of maltreatment. The result has been analyzed with previous research and the theory of action and discretion.