Child maltreatment is extremely prevalent and leads to a host of negative effects, both immediately and long term. Instances of maltreatment are often accompanied by deception, both by the perpetrator, as well as by the victim in order to avoid stigma and protect family. Thus, this study investigated social learning of deception through instances of maltreatment. 413 young adults completed an online survey assessing current attitudes toward deception, childhood maltreatment including child sexual abuse, child physical abuse, witnessing interparental violence, psychological abuse, neglect and parental addiction, social support, and participant addiction. Results indicated that neglect and psychological abuse during childhood, and current addiction were associated with a positive attitude toward deception. Severity of CSA and severity of neglect each interacted with role (agent or target) in the deceptive scenario to determine attitude toward deception. Severity of CPA interacted with perceived social support to determine attitude toward deception. Furthermore, victim's awareness of deception by perpetrators of CSA was associated with a more negative attitude toward deception. These findings support both attachment theory and social learning explanations for adulthood attitude toward deception. Attachment theory explains why neglected and psychologically abused individuals find their own deception more acceptable and other's deception less acceptable than their non-neglected counterparts, and why the opposite pattern is true for victims of CSA; and social learning theory's emphasis on attention and reinforcement to motivate behavior are supported by these findings.

With the increase in survival for children with cancer, part of the focus of current research is aimed towards evaluating how these children are adapting psychosocially. Neurocognitive deficits have been well established. However, there are multiple facets encompassing quality of life, including general mental health, lifestyles and health behaviors, and academic and cognitive functioning. The relationship between neurocognitive and psychosocial functioning has yet to be thoroughly evaluated. The purpose of this study was to investigate the relationship between neurocognitive and psychosocial functioning in survivors of brain tumors and acute lymphoblastic leukemia. Data was collected from existing archival database comprised of patients of the at Cook Children's Medical Center in Texas. The sample consisted of 177 patients between the ages of 3 and 12 who were at least two years post-diagnosis. Measures used included the NEPSY and the Behavioral Assessment for Children. Statistical analyses included a several one-way analysis of variances, an independent samples t-test, a univariate analysis of variance, a hierarchical multiple regression, and odds ratio analyses. Results indicated survivors treated with neurosurgery alone appear to be less at risk for developing behavior problems than other treatment modalities. Also, brain tumor survivors demonstrate more problematic behaviors than survivors of acute lymphoblastic leukemia. Visuospatial functioning, diagnosis, and type of treatment were found to be predictive variables of behavior problems. Attention, and perhaps language, deficits may predispose children to more problems in their behavior. It is concluded that there are other factors affecting behavior in this population that were not accounted for in this analysis. It is recommended for future studies to research the individual clinical scales of the Behavior Assessment System for Children, obtain information from multiple informants, study this relationship longitudinally, and research additional factors that may be influencing the relationship between neurocognitive and psychosocial functioning. This provides evidence of risk factors that should be monitored as the child returns home and to school.

During the second half of 2015, Sweden experienced the largest inflow of asylum-seekers in its history. Almost 163,000 people sought asylum in 2015, whereof approximately 70,000 children. The influx challenged the reception system and severe child protection concerns such as disappearances and sexual exploitation of unaccompanied minors were identified. Half of the children that arrived in 2015 came with families but this group have received less attention so far. The aim of this study was to explore the child protection systems around asylum-seeking and returning children in families by identifying child protection concerns and existing gaps in the services provided to this target group. Fourteen semi-structured interviews with twenty individuals belonging to various stakeholder groups such as staff at asylum accommodations, social workers, parents and, volunteer and staff from civil society organisations were conducted in two municipalities in Skåne, Sweden. The data was analysed using thematic analysis and the results are discussed in regards to the Protective Environment Framework. The results suggest that children in migration, with families, face multiple protection concerns in Sweden. Significant gaps exist in the services provided to these children and there are large disparities between accommodation centres. Many accommodations fail to provide a child-friendly environment and gender separated sanitation facilities. Furthermore, the results point out the importance of increasing competence of child protection among actors, and to increase preventive measure directed towards the parents in order to ensure a protective and safe environment for children.

Sammanfattning   Bakgrund Skolsköterskan träffar alla barn under skolgången vid minst tre planerade tillfällen för hälsobesök. Tillsammans med andra professioner i skolan har skolsköterskan möjlighet att identifiera barn som far illa och har lagstadgad anmälningsplikt. Vid misstanke om samt anmälan av barn som far illa finns det risk för att skolsköterskor utsätts för stress och kan uppleva olika etiska dilemman. Detta gör det angeläget att ta reda på deras erfarenheter inom området. Syfte Att beskriva skolsköterskors erfarenheter av etiska dilemman vid misstanke om att barn far illa samt anmälan därav. Metod Studien genomfördes i två kommuner i sydsverige. Materialet samlades in vid elva intervjuer med skolsköterskor och analyserades med kvalitativ manifest innehållsanalys. Resultat De etiska dilemman som skolsköterskorna upplevde kategoriserades i fyra kategorier och elva underkategorier. Att bygga upp och bevara förtroendefulla relationer med barnen och föräldrarna var viktigt för skolsköterskorna. Viljan att göra rätt upplevdes som en svår uppgift eftersom det innebar att identifiera barn som far illa, att göra sin plikt, men även att göra nytta och inte skada. Skolsköterskorna kunde känna sig ensamma och utsatta i sin profession samt i behov av stöd, både från kollegor men även från andra professioner. De saknade återkoppling från socialtjänsten och önskade att de hade ett bättre samarbete. Slutsats Skolsköterskorna upplevde etiska dilemman i mötet med barn som far illa samt vid lagstadgad anmälan. Handledning, stöd under hela processen samt bättre samarbete med socialtjänsten skulle kunna leda till fler anmälningar. Utbildning samt standardiserade bedömningsinstrument bör kunna medföra att fler barn som far illa identifieras.   Nyckelord Skolsköterskor, barn som far illa, etiska dilemman, anmälningsskyldighet / Abstract Background The school nurse sees all children at least three times during their school years in connection to planned health visits. Together with other school professionals the nurse has the possibility to identify maltreated children and is obligated by law to report it. Suspecting and reporting child maltreatment might implicate an exposure to stress and dealing with various ethical dilemmas. It is therefore important to investigate the school nurses’ experiences concerning this issue. Aim To describe the school nurses’ experiences of ethical dilemmas when suspecting and reporting child maltreatment. Method The study was conducted in two counties in southern Sweden. Data was collected by interviewing eleven school nurses and analyzed by using a qualitative manifest content analysis. Results The ethical dilemmas experienced by the school nurses were categorized in four categories and eleven subcategories. Building and maintaining trustful relationships with the children and their parents was important for the school nurses. The wish to do right was experienced as difficult since it meant to identify maltreated children, to report it, and at the same do good and do no harm. The school nurses felt alone and vulnerable in this situation and needed support both from colleagues and other professionals. They lacked feedback from the child protection services and were yearning for a better collaboration. Conclusion The school nurses experienced ethical dilemmas when meeting maltreated children and being obligated to report it. Supervision, support during the process and a better teamwork with the child protection services may increase the reporting rate. Education and standard assessment instruments might increase the number of identified maltreated children.   Keywords School nurses, child maltreatment, ethical dilemmas, mandatory reporting

UA Open Access Publishing Fund / This study examined associations between alcohol misuse and childhood maltreatment and out-of-home placement among urban lesbian, gay, and bisexual (referred to as two-spirit) American Indian and Alaska Native adults. In a multi-site study, data were obtained from 294 individuals who consumed alcohol during the past year. The results indicated that 72.3% of men and 62.4% of women engaged in hazardous and harmful alcohol use and 50.8% of men and 48.7% of women met criteria for past-year alcohol dependence. The most common types of childhood maltreatment were physical abuse among male drinkers (62.7%) and emotional abuse (71.8%) among female drinkers. Men and women reported high percentages of out-of-home placement (39% and 47%, respectively). Logistic multiple regressions found that for male drinkers boarding school attendance and foster care placement were significant predictors of past-year alcohol dependence. For female drinkers, being adopted was significantly associated with a decreased risk of past-year drinking binge or spree. Dose-response relationships, using number of childhood exposures as a predictor, were not significant. The results highlight the need for alcohol and violence prevention and intervention strategies among urban two-spirit individuals.

Child abuse and neglect is a significant social issue with long term consequences for affected children and young people, including increased risk of emotional and social difficulties. Models of the impacts of maltreatment outline a developmental process in which maltreating parent-child relationships affect the development of neural networks, which in turn undermine developing cognitive processes, including emotion regulation and social understanding, thereby increasing risk of emotional and social difficulties. This study explores a subset of these cognitive processes in a sample of adolescents in long-term out-of-home care as a result of maltreatment, relative to a sample of non-maltreated peers, including situation selection (conditioned avoidance and risk-taking), attentional deployment (attention biases and attention control) and cognitive change (interpretation bias), as well as aspects of social understanding (mentalising, emotion understanding and prosocial responding). Further, the relative effects of maltreatment factors, and the relationship between emotion regulation and social understanding with adolescent adjustment was also explored. Results demonstrated maltreatment-related effects in conditioned avoidance, risk-taking, attention processes and social understanding, and explored the relative effect of exposure to physical abuse on the development of these processes, differences in such processes did not appear to significantly predict poor or normative adjustment of maltreated adolescents. These results are discussed with respect to models of maltreatment, emotion regulation and social understanding, with implications for the development and implementation of interventions.

Background: Child maltreatment is a serious health concern in the United States (U.S.) affecting as many as one in four children throughout their lifetime (Finkelhor, Turner, Ormond, & Hamby, 2013). In 2013, a reported 678, 932 victims of child maltreatment were reported to Child Protective Services (CPS), and of those cases 1,520 were fatal (CDC, 2015a). Out of all the various types of child maltreatment, Shaken Baby Syndrome (SBS) is the leading cause of child abuse deaths in the U.S. (CDC, n.d.). While current research has focused on validating the effectiveness of educational interventions, very few studies have analyzed the efficacy of individualized, patient-centered action plans. Such data would be beneficial to assess the usefulness of action plans in preparing caregivers for coping with an inconsolable infant at home. Purpose: To enhance caregiver knowledge about SBS and to provide parents with the skills and resources necessary to cope effectively and efficiently at home when unable to console their infant. Methods: This study utilized a quasi-experimental pre-test/post-test design. Participants were recruited from the Franciscan Women’s Health Associates located at St. Joseph Medical Center in Tacoma, Washington and were members of the Centering prenatal groups. The entirety of the study was completed during these groups including the pre-test, intervention, action plan, and post-test. Data was analyzed through the utilization of descriptive statistics as well as a paired t test. Results: Overall, results revealed that participant (n=26) knowledge significantly improved after the educational intervention (p=0.000) with a mean score of 87.56% on the pre-test and a mean score of 95.38% on the post-test. In addition, a majority of participants (57.5%) found both the action plan and the education to be extremely useful. Discussion: The results of this study were consistent with current evidence indicating that education on SBS, the dangers of shaking, and healthy coping mechanisms significantly impacts caregiver knowledge. In addition, a majority of participants viewed the action plans favorably identifying that they would be beneficial if they felt frustrated. Future research is warranted to gather more information on the long-term outcomes of educational interventions as well as individualized action plans.

Bakgrund: Idag är det många barn som i hemmet inte får tillräckligt god omvårdnad. För att få rätt stöd och hjälp behöver dessa barn komma till socialtjänstens kännedom. Dock förekommer en underrapportering från hälso- och sjukvårdens sida av barn som far illa, trots att en anmälningsplikt föreligger. Syfte: Att beskriva skolsköterskans upplevelse av processen att göra en anmälan till socialtjänsten vid misstanke om att barn far illa. Metod: Studien genomfördes med en kvalitativ metod med en fenomenologisk ansats, där 13 skolsköterskor via e-post fick skriva ner sina berättelser. Datamaterialet analyserades med innebördsanalys. Resultat: Skolsköterskornas upplevelser i samband med en orosanmälan sammanställdes i fem teman; att bli känslomässigt berörd av barnets situation, att uppleva obehag i samband med en anmälan, att uppleva trygghet i samband med en anmälan, Att samverka med socialtjänsten påverkar samt att det fanns upplevelser av att hantera egna känslor i olika forum. Slutsats: Skolsköterskorna upplever att det finns komplexa omständigheter i samband med en orosanmälan. Resultatet visar därmed angelägenheten om att få ökad kunskap om detta för att antingen kunna förändra eller ytterligare förbättra arbetet med att göra en orosanmälan när barn far illa. / Background: Today, it is common that many children do not receive proper care in their own homes. In order to obtain proper support and help, the Social Welfare Services needs to be alerted as to the predicament of these children. Unfortunately, medical and health care personnel too often fail to report maltreatment, even though it is their obligation to do so. Aim: The aim of this study is to describe the experience of the school nurses in the process reporting child maltreatment. Method: The study was conducted using a qualitative method with a phenomenological approach, where 13 school nurses participated and shared their experiences via email correspondance. The data was analyzed by meaning analysis. Result: The experiences of the school nurses in connection with reporting suspicions of maltreatment were summarized into five different categories: experiencing emotional involvement in the child's situation, experiencing discomfort associated with reporting, experiencing a sense of security in the reporting process, experiencing that cooperation with Social Welfare Services has impact, and experiences of dealing with their own emotions in various forums. Conclusion: The school nurses experienced complex circumstances in connection with reporting suspicions of maltreatment. The result therefore shows the need for increased knowledge regarding this, in order to either change or further improve upon the work of reporting child maltreatment.

Background: Child maltreatment has since 1979 been a punishable crime according to Swedish law but is still occurring in society today. All sorts of physical, psychological, sexual violence, neglect and exploitation of an individual under 18 years old was qualified as child maltreatment. Previous research has found an insecurity among nurses when they met children exposed to maltreatment. Nurses can encounter these children and are obligated through duty to notify and report when they suspect child maltreatment. Aim: The aim of this study was to illustrate nurses´ experiences of suspected child maltreatment or child maltreatment. Method: A literature review was conducted with a qualitative approach. Ten qualitative studies from Cinahl and Pubmed was reviewed for quality assurance and analyzed by Friberg's five-step analysis. Result: The analyze of the study resulted in three themes and eight subthemes. The first theme, Complex meetings, was about experiences in being a professional and challenges in the meeting. The second theme, Complicated assignments, described how nurse's experienced to assess the child's situation, to make a report and the cooperation with authorities. The third and last theme, Inhibitory and promotional activities, exposed the nurse's view on receiving support and education and the support for children and parents. Conclusion: Nurses experienced that it was important to be available and to build a relation with the child so the child could feel safe to tell about the mistreatment. It has also been shown that the nurse experienced complex emotions in the meeting with both the child and the parents and that it was not always clear to the nurse when to report child maltreatment. There was a need for more information and education for the nurse within the topic of child maltreatment. Also, the nurse experienced a need for better cooperation with the authorities that oversees cases of child maltreatment. / Att komma i kontakt med barn som far illa är något som alla sjuksköterskor kan komma att göra. Detta är en litteraturbaserad studie med analys av kvalitativa artiklar som visar att det utifrån flera perspektiv är både svårt och komplext. Denna studies resultat visar att sjuksköterskor upplever att det finns både viktiga och svåra delar i mötet och att det kan vara svårt att vara professionell, även om det eftersträvas. Det upplevs som att det finns faktorer som både kan underlätta och försvåra en bedömning och likaså som påverkar om sjuksköterskan utfärdar en anmälan. Att göra en anmälan har en känslomässig påverkan på sjuksköterskan och samverkan med myndigheter upplevs som svår och bristande. Sjuksköterskan har erfarenheter av att stödet är otillräckligt och upplever att de vill ha mer support från både kollegor och professionellt stöd. För att kunna känna sig mer trygga inför dessa situationer önskar de få mer utbildning kring barn som far illa. Sjuksköterskan ser också att det finns ett stödbehov hos familjerna och barnen. Att kunna ge stöd upplevs viktigt men ibland svårt om familjen inte vill ta emot det eller när åtgärder riskerade att bryta barnets förtroende för sjuksköterskan. Verksamheter och supportgrupper upplevs vara ett bra stöd och att samarbete med skola kan underlätta för barnet.

Background: The number of children abused in Sweden has increased in last years. All children have the right to live a safe life and receive a good development during their upbringing. It is important that the child's basic needs are met for the child to have a good development. Being a victim of child abuse can lead to enormous consequences in the future for the child's physical and mental health. Aim: This study aimed to illuminate the nurse's experiences in suspected child maltreatment Method: A literature study based on analysis of qualitative studies according to Friberg´s five step model. Results: The results of the studies showed that responding and helping children who live in child abuse was a difficult task for the nurses to perform. The nurses were aware of their obligation to maintain the child's safety. The nurses described the basis of their experience that they encountered personal and work-related obstacles to be able to identify, remedy and report when children were suspected of being abused. The result is presented under three themes. The first theme highlights how nurses are emotionally affected. The second theme is about experiences about collaboration with other authorities. The third theme describes the nurses' need for professional development. Conclusion: The nurses should be able to give the child the right care to ensure the safety of the child and be able to give advice to the child's family. A prerequisite for providing adequate nursing needs nurses have good health science knowledge. / Antalet barn som far illa i Sverige ökar. Sjuksköterskor har skyldighet att anmäla vid misstanke om barn som far illa. Forskning visar att barn som far illa väljer att inte berätta för en vuxen eller en professionell person om misshandeln. Forskning visar även att sjuksköterskans beteende kan hindra eller stimulera patientens delaktighet samt att vårdkultur kan bidra till ett vårdlidande. Konsekvensen av att leva med utsatthet som barn kan resultera i fysisk och psykisk ohälsa senare i livet. Resultat av denna litteraturstudie baseras på sammanställning av nio kvalitativa studier. Resultatet visar att sjuksköterskornas emotionella påverkan har sin inflytande på arbetet. Sjuksköterskorna förstår sitt ansvar att reagera och hjälpa det utsatta barnet, för att sjuksköterskorna ska kunna utöva sitt ansvar krävs det en fungerande samverkan med andra verksamheter. Sjuksköterskorna upplever frustration över bristande samverkan med andra vårdenheter och myndigheter. Sjuksköterskorna uttrycker även ett behov av mer kunskap och professionell utveckling samt tydliga rutiner för att kunna upptäcka varningstecken och därefter kunna vidta relevanta åtgärder i syfte att barnets säkerhet säkerställas i god tid. Slutsatsen av detta examensarbete är att sjuksköterskorna stöter på hinder under processen att hjälpa barn och deras familj. För att sjuksköterskorna ska kunna tidigt upptäcka och vidta rätta åtgärder vid misstanke om barn som far illa krävs det förutsättningar för sjuksköterskorna att utveckla sin kunskap, en fungerande samverkan med alla berörda, samt rätt stöd för att bearbeta den emotionella påverkan som uppstår.