Innovative handheld technologies are changing the possibilities for delivering public health interventions. The present research describes a preliminary examination of the effects of iPhone™ both as an assessment tool for data collection and as an enhancement to an in-home child safety intervention. Three families with children under age seven were trained to use an iPhone to video targeted rooms in their homes following SafeCare® safety module intervention implementation during which rooms were secured for accessible safety and health hazards. The iPhone was used to communicate feedback, logistical information, and clarification of safety content. The effectiveness of iPhone and iPhone video was examined using a multiple baseline design across settings replicated across families. All rooms across subjects demonstrated significant decreases in home hazards. Face-to-face (F2F), in-home time of the home visitor was progressively reduced and replaced by video data collection over the course of the intervention. These data suggest that handheld technology tools are a promising means of data collection for in situ safety interventions and for augmenting interaction during intervention. Implications of these findings for reducing costs of F2F intervention as high-quality handheld video capabilities become increasingly ubiquitous and for engaging and retaining participants are discussed.

Parents who abuse drugs and alcohol are at increased risk of child maltreatment, including the neglect of their children’s health. The present research investigates the effectiveness of the SafeCare® Health module in training mothers with a history of substance abuse living in a residential treatment facility to correctly identify and treat their children’s illnesses. Three mothers of children ages 5-years-old and younger participated in the study. Using a multiple-baseline, single-case experimental design, the research team examined the participants’ ability to select the most appropriate course of action for addressing their children’s illnesses. Results indicate that parents’ skills increased steadily during the intervention, with two of the three participating parents demonstrating mastery of the skills presented. The results suggest that this intervention has great potential to be feasible and effective with this population in this setting. Future research should further investigate the relevance of this intervention with vulnerable populations living in a residential setting to examine whether the changes in targeted parenting skills result in changes in behavior that impact child maltreatment incidence reductions.

This study evaluated the impact of delivery of the Period of PURPLE Crying (PURPLE), in a group of first-time mothers. Frustration with crying is reported as a trigger for abusive head trauma (AHT).The primary objective was to determine whether there was a change in knowledge about crying and shaking after exposure to PURPLE. Factors associated with behavioral responses to crying were studied as was the utility of PURPLE. There was a significant increase in knowledge about infant crying (P = 0.001) after program delivery that was predicted by low baseline knowledge (P < 0.01). There was a non-significant negative change in shaking knowledge (P = 0.5), which may have been the consequence of high baseline knowledge of shaking. The PURPLE program was characterized as informative and useful by participants. Additional to evaluate the impact of program delivery on other caregivers and on the rates of AHT is recommended.

The purpose of this study was to explore the case, organizational, decision maker, and external factors that influence teaching professionals when deciding to report children suspected to be in need of protection. Teachers report 24%, or 175,920 cases to Children’s Aid Societies annually in Canada; researchers who have examined teacher reporting practices, speculate that teachers fail to report between 50 to 84%, or 87,960–147,773 cases of suspected cases to authorities.The conceptual framework for the study came from Baumann, Dalgleish, Fluke, and Kern’s (2011) decision-making ecology framework which claims that individuals consider case, organizational, external, and decision-maker factors when making a decision. Phase one included an analysis of 64 policies on reporting children suspected to be in need of protection from English speaking, public and Catholic school districts and geographically isolated school authorities. Crosson-Tower’s (2013) policy analysis framework was used to analyze education factors, the legal system, document properties, procedures, support systems, training opportunities, and community relationships. Phase two consisted of one hour, semi-structured interviews (n = 7) with individuals who are mandated to report, and who had made at least one report. Interview questions were based on the conceptual framework and from the findings from phase one. Results revealed that many school districts omitted information that could have been beneficial to teachers who were required to report. Throughout the province it also appeared that training opportunities were minimal. This study did not explore whether training actually took place in school districts. Interview data, although not generalizable due to the sample size, appeared to suggest a lack of communication between school districts and parents, and teachers and Children’s Aid Societies (CAS). Conclusion: More research is needed to see how much of the supports listed in school district policies, such as training opportunities and support systems, are actually implemented and the subsequent effect of these actions on teacher’s reporting practices. / Thesis (Master, Education) -- Queen's University, 2014-04-23 15:44:40.667

Child maltreatment (CM) and unintentional childhood injury affects millions of children and cost society billions of dollars annually. The population at risk for CM has congruent demographic characteristics as children that are more likely to have unintentional injuries. Preventing CM through evidence-based home-visiting programs has been shown effective and cost efficient, and the inclusion of home safety in such programs, demonstrates significant reduction of hazards in the home. The overarching goal of the current research is to make a statistical connection between the population at risk for CM and amount of hazards in the home; that these two populations have enough overlap to validate the inclusion of home safety components in CM prevention programs. This study uses data from an ongoing research project that braids two evidence-based parenting programs: SafeCare® and Parents as Teachers. Findings indicate that the correlation between potential for abuse, measured by BCAP scores, and hazards in the home, measured by the HAPI, show a significant correlation r = .23, p < .05. Other variables such as loneliness, distress, and marital status were also found to contribute to this relationship.

Children less than one year of age are a vulnerable population. Injury, and child abuse and neglect (child maltreatment) are causes of morbidity and mortality in this population. The literature suggests that the family characteristics of both sub-populations are similar and they may be the same sub-population (Peterson and Brown 1994). Large scale studies have revealed that there are multiple risk markers that are predictive of child abuse and neglect (Browne 1995, Sidebotham et al. 2001, 2002). There is mixed evidence as to whether home visiting can have an impact on preventing injury and child abuse and neglect. This study aims to show that children who are injured and maltreated are the same sub-population. The study also examines the impact of child, family and societal risk markers on the likelihood of a child presenting for an injury or child maltreatment, and the effect of home visiting on the outcomes of injury and/or child maltreatment. This study is a retrospective cohort study using administrative data from three administrative data systems. The data from these systems were merged as part of a work project and de-identified. The de-identified data set contained data at an individual child level and formed the study sample. There were 11,821 children in the sample who lived within the Royal Children's Hospital Health Service District. Variables included demographic data, family characteristics, service contacts which included injury and Child Advocacy Service contacts (a proxy for child maltreatment). The main results of the study indicate there is a small cross-over of the sub-populations and these children are an extremely at-risk sub-population with a very high prevalence of risk markers. The research found that for children less than one year of age the 4.1% of the study sample presented for an injury contact and 1.1% of the study sample has a Child Advocacy Service (CAS) contact. There was 5.17% of the injury sub-population, compared to 0.93% of the non-injured population who had a CAS contact. Nineteen percent (19 %) of children who had a CAS contact also had an injury contact. The study also found that sole parents, mothers with an intellectual disability, and mothers who live in temporary/rental housing are predictors of injury and child maltreatment. Another finding is that an injury contact is a significant predictor of child maltreatment. A child who had an injury was 9 times more likely to attend for a CAS contact than a non-injured child (AOR 9.087 significant at 95% confidence interval (CI), (4.863-17.073). The introduction of home visiting into the model was examined and it was found that more than one home visit has the potential to reduce the likelihood of a child having child maltreatment contact if the mother is a sole parent, less than 20 years of age, abused as a child, lives in a family violence situation, has a mental health problem, is intellectual disabled or uses illicit substances. Whilst the results show a reduction, the impact clinically would be that home visiting as a single strategy will not prevent a CAS contact. The service implications of the study revealed that, there is a high usage of Department of Emergency Medicine (DEM) of Triage Category 4 and 5 clients. This presents an opportunity to look at alterative service model for these clients. Not all CAS clients were seen by the Primary Care Program, this also presents an opportunity to develop a pathway back to preventative health care services for this vulnerable group. The practice implications are that further research is required to identify the decision making process within DEM for injury presentation to identiy the indicators that DEM staff use to make a referral to the CAS. The identification of risk by Child Health Nurses requires further research to identify if the low occurrence of family risk variables in the study sample is a result of interview skills or data recording. The study has identified that there is a cross-over sub-population of injured and maltreated children. The research findings will provide information not previously available in the Australian context. At a service level the findings provide data to improve practice and service delivery.

Background: Online victimisation during adolescence is associated with adverse outcomes across multiple domains. However, previous research has demonstrated that some adolescents are at greater risk of experiencing online victimisation than others. Literature on traditional peer victimisation has highlighted the importance of children’s early experiences and the family context but it is unclear how these factors relate to online victimisation. The first study reviews the evidence for associations between the phenomenon of cyber-victimisation (CV) and parenting behaviours, whereas the second study investigates online victimisation which includes experiences of online harassment and unwanted contact of a sexual or offensive nature. Aim: A systematic review was conducted to determine whether positive parenting behaviours protect against CV during adolescence. An empirical study investigated whether experiences of childhood maltreatment were associated with online victimisation and whether this relationship was mediated by attachment insecurity and risky electronic communication in an adolescent sample. Method: A systematic review of the literature identified seventeen studies which met inclusion criteria. Parenting behaviours were categorised into offline and online parenting behaviours and the findings from each study were reported. Studies were also assessed against 15 quality criteria. In the second study, 123 students aged 12- 16 were recruited. Five self-report questionnaires were administered measuring experiences of childhood maltreatment, attachment, risky electronic communication, electronic media use and online victimisation. Results: Offline parenting behaviours, particularly general monitoring, may reduce the likelihood of adolescents experiencing CV. There was greater variation in the findings relating to online parental mediation strategies, but in general these strategies did not consistently predict a significant increase nor a reduction in CV. The empirical study found that whilst attachment anxiety partially mediated the relationship between childhood maltreatment and online victimisation, attachment avoidance and risky electronic communication did not. However, childhood maltreatment and risky electronic communication were significant predictors of online victimisation. Conclusion: Parenting behaviours and early childhood experiences may play an important role in the victimisation of adolescents online. Interventions which promote positive parenting and attachment security may help to protect young people against online victimisation. However, more empirically rigorous and longitudinal studies are needed to enhance our understanding of the risk factors and the protective factors involved.

Background: Maltreated children, including those who are looked after away from home, are amongst the most vulnerable members of society. Due to the relational trauma that most looked after children have experienced they are at increased risk of attachment and mental health difficulties, which can impede their ability to form close relationships with new carers. Indeed, many such children behave in ways that fail to elicit caregiving or even as if they do not need caregivers, and providing sensitive, therapeutic care to these vulnerable children can be a considerable challenge. Aims: The aims of this thesis were threefold: to review the impact of maltreatment experiences on children’s executive functioning, to investigate the prevalence of attachment and trauma-related difficulties in children in foster care, and their impact on the parenting task of foster carers. Methods: Aims are addressed in two journal articles. To address the first aim, a systematic review of research regarding the association between maltreatment and executive function in children and adolescents is presented in journal article one. Subsequent aims are addressed in journal article two, a cross-sectional study with foster carers of children in care aged 3-12 years who completed self-report measures investigating the emotional, behavioural, attachment and trauma related difficulties of their foster child, the perceived quality of the relationship, and levels of parenting stress and sense of competence. Results: The systematic review revealed that the majority of studies demonstrated a significant impairment in one or more areas of executive ability in maltreated children, with particular support for impairments in inhibitory control, executive working memory and decision making. However, there was only limited support for impairments in cognitive flexibility, planning/problem solving, and fluency. Furthermore, there was considerable variability between studies in the specific deficits reported. Results from the empirical study highlight the prevalence of attachment and trauma-related difficulties in children in foster care. Hierarchical regression analyses revealed that levels of foster carer-rated inhibited attachment behaviour was a significant predictor of quality of the foster carer-child relationship and parenting stress. The level of emotional and behavioural difficulties also emerged as a significant predictor of quality of the foster carer-child relationship, and parenting sense of competence. Conclusions: This thesis highlights the pervasive impact of relational trauma on children. Results of the systematic review indicate its impact on children’s executive ability. The empirical study reveals the high prevalence of attachment and trauma-related difficulties in children in foster care, and provides insight into factors related to quality of the foster carer-child relationship, and the stress and sense of competence of foster carers. Implications for interventions and service provision regarding maltreated children who become looked after away from home, and their carers, are discussed.

Although a history of childhood maltreatment is widely considered to be a risk factor for the perpetration of abuse or neglect in successive generations, the intergenerational transmission theory of child maltreatment has demonstrated mixed support over more than three decades of research. Using a prospective, longitudinal design, this study sought to investigate adolescent, young adult, and reproductive risk factors for the intergenerational continuity of child maltreatment, analyzing data from a sample of 147 women with a history of childhood maltreatment and child welfare services involvement (CWS), juvenile justice system (JJS) involvement, and out-of-home placements. The participants were originally recruited in adolescence for a randomized control trial (RCT) assessing the impact of the Treatment Foster Care Oregon (TFCO) intervention. Maltreatment continuity was measured using both official CWS records and participant self-report of contact with CWS. More than half the sample (n = 79, 53.7%) demonstrated maltreatment discontinuity (MD), indicating no evidence of maltreatment of offspring, and under half demonstrated maltreatment continuity (MC; n = 68, 46.3%). Using separate logistic regression analyses to test three models, results indicated that higher levels of hard drug use in adolescence increased the likelihood of maltreatment continuity at young adult follow-up by 47%. Partner risk in young adulthood was a strong predictor of maltreatment continuity, increasing the likelihood of maltreatment of offspring by over 2 times, or 103%. Marijuana use in young adulthood also emerged as strong predictor of MC, but not in the expected direction: higher levels of marijuana use were associated with a 56% decreased likelihood of MC. An older age at first birth significantly predicted a 52% decreased likelihood of maltreating offspring. Study limitations, future directions, and implications for interventions are discussed.

O objetivo deste trabalho foi fazer a tradução e a adaptação do conteúdo do software “Módulo de Apoyo a la Gestión del Riesgo Social en la Infancia y la Adolescencia (MSGR)” para o contexto brasileiro. Por sua vez, o software visa auxiliar profissionais de diversas áreas a identificar e a como proceder diante de casos de suspeitas de maus tratos contra crianças e adolescentes. Foram realizados dois estudos empíricos. O primeiro estudo refere-se à tradução e à adaptação dos itens presentes no software, divididos em duas fases: (1) tradução dos itens, através do método backtranslation; e (2) validação por juízes, a fim de avaliar o nível de adequação dos itens originais, e grupos de discussão, para discutir os itens que não tiveram concordância igual ou superior a 80% entre os juízes e propor uma ação recomendada para cada tipo de gravidade. Participaram como juízes cinco profissionais especialistas na temática de maus tratos. Nos grupos de discussão participaram quatro profissionais que têm experiência no atendimento a crianças e adolescentes vítimas de violência. Os resultados da avaliação dos juízes apontaram 40 itens do software como não tendo o índice de concordância mínimo de 80% esperado. O grupo de discussão, por sua vez, decidiu o formato final de tais itens. Além disso, sugeriu a troca de nomenclaturas, além de propor o acionamento de diversos serviços de proteção para cada gravidade detectada. Discutem-se as mudanças realizadas, os diferentes serviços da rede de proteção, assim como o Estatuto da Criança e do Adolescente. O segundo estudo foi a aplicação piloto do software, já traduzido e adaptado. Participaram desta etapa 16 adultos, selecionados por conveniência,com idades entre 22 e 55 anos. Estes foram instruídos a responder a três estudos de caso fictícios, apontando as dúvidas de compreensão dos itens, além de suas opiniões quanto ao manejo e a utilidade do software. Os resultados indicaram dificuldades de compreensão de algumas palavras, especialmente entre os participantes que tinham somente o Ensino Médio completo. Também houve dúvidas quanto à ambiguidade de itens, além de tentativas de indução de respostas, mesmo quando as observações correspondentes não estavam contempladas no estudo de caso. Discutem-se aspectos relativos a facilitar o entendimento das questões e ao uso do software, além da importância deste para o auxílio na notificação das suspeitas. Por fim, ressalta-se a relevância da divulgação dos conhecimentos científicos acerca da identificação de maus tratos para a população, assim como o desenvolvimento de novas ferramentas para a utilização na proteção dos direitos da infância e adolescência. / The aim of this work was to translate and adapt to the Brazilian context the content of the software “Módulo de Apoyo a la Gestión del Riesgo Social en la Infancia y la Adolescencia (MSGR)”. This software aims to help professionals of many fields to identify and proceed when facing cases that involve suspicion of child and adolescent abuse. Two empirical studies were performed: The first study concerns the translation and adaptation of the software’s items in two stages: (1) translation of the items through the backtranslation method; and (2) validation from the judges to evaluate the level of adequacy of the original items, and discussion groups to discuss the items which did not reach 80% or more of agreement among the judges and to propose recommended actions for each severity level. Five professionals who are experts in this subject participated as judges. Four professionals who have experience in care service for children and adolescents who have been victims of abuse were part of the discussion groups. The results of the judges’ evaluation point 40 software items which have not achieved the expected minimum of 80%. The discussion group, in turn, made decisions about the final arrangement of those items. Besides that, the group suggested terminology changes, and the activation of several protection services for each level of severity detected. It discussed the changes, the child protection network’s different services, and also the Child and Adolescent Statute. The second study was the pilot application of the software after it had been translated and adapted. Sixteen adults participated in this stage. The selection criterion was convenience, and their ages ranged from 22 to 55 years old. They were instructed to answer three fictitious case studies, pointing doubts regarding the items and voicing their opinions regarding the handling and the utility of the software. The results show the difficulties to understand certain words, especially among participants who had only finished secondary school. There were also doubts regarding the ambiguity of some items, and some attempts to induce answers even when the corresponding observations were not considered by the case study. Aspects related to helping understand the issues raised and to the use of the software were discussed, as well as the importance of the software for notifying suspicion. Finally, we highlight the relevance of disseminating scientific knowledge related to the identification of abuse, as well as the development of new tools for protecting the rights of children and adolescents.