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“I never expected that it would happen, coming to ask me such questions”:Ethical aspects of asking children about violence in resource poor settings
Background
International epidemiological research into violence against children is increasing in scope and frequency, but little has been written about practical management of the ethical aspects of conducting such research in low and middle-income countries. In this paper, we describe our study procedures and reflect on our experiences conducting a survey of more than 3,700 primary school children in Uganda as part of the Good Schools Study, a cluster randomised controlled trial of a school-based violence prevention intervention. Children were questioned extensively about their experiences of physical, sexual, and emotional violence from a range of different perpetrators. We describe our sensitisation and consent procedures, developed based on our previous research experience and requirements for our study setting. To respond to disclosures of abuse that occurred during our survey, we describe a referral algorithm developed in conjunction with local services. We then describe our experience of actually implementing these procedures in our 2012 survey, based on reflections of the research team. Drawing on 40 qualitative interviews, we describe children’s experiences of participating in the survey and of being referred to local child protection services.
Results
Although we were able to implement much of our protocol in a straightforward manner, we also encountered major challenges in relation to the response of local services to children’s disclosures of violence. The research team had to intervene to ensure that children were provided with appropriate support and that our ethical obligations were met.
Conclusions
In resource poor settings, finding local services that can provide appropriate support for children may be challenging, and researchers need to have concrete plans and back-up plans in place to ensure that obligations can be met. The merits of mandatory reporting of children’s disclosures to local services need to be considered on a case by case basis—in some places this has the potential to do harm. Research teams also must agree on what level of ancillary care will be provided, and budget accordingly. Further practical examples of how to address the challenges encountered in this work are needed, in order to build a consensus on best practices.
Trial registration
NCT01678846
(clinicaltrials.gov), August 24, 2012
Journal Article
The Impact of Early Life Trauma on Health and Disease
There is now ample evidence from the preclinical and clinical fields that early life trauma has both dramatic and long-lasting effects on neurobiological systems and functions that are involved in different forms of psychopathology as well as on health in general. To date, a comprehensive review of the recent research on the effects of early and later life trauma is lacking. This book fills an obvious gap in academic and clinical literature by providing reviews which summarize and synthesize these findings. Topics considered and discussed include the possible biological and neuropsychological effects of trauma at different epochs and their effect on health. This book will be essential reading for psychiatrists, clinical psychologists, mental health professionals, social workers, pediatricians and specialists in child development.
eBook
Tell Me What Happened
Represents a scholarly and ambitious attempt to improve the quality of interviews received by the courts and minimize the risks of miscarriages of justice, for victims and defendants This book updates the previous review of research on children's testimony-reexamining and readdressing how the quality of information provided by young witnesses is affected by the way they are questioned. Drawing upon both experimental and field studies conducted in different countries, it summarizes evidence supporting the effectiveness of the National Institute for Child Health and Human Development (NICHD) Protocol and showcases the Protocol's superiority over other current interviewing techniques for eliciting detailed and forensically useful content from child complainants. Written with both child protection professionals and researchers in mind, Tell Me What Happened: Questioning Children About Abuse offers advice and opinions drawn from actual investigative interviews as well as academic research. Its insightful chapters cover: children's testimony; interview and questioning strategies; how investigators typically interview alleged victims; the NICHD Investigative Interview Protocols; the impact that following the Protocol has on interviews and children's responses; interviewing victims under the age of six; interviewing children with developmental disabilities; using tools and props to complement the Protocol; training and maintaining good interviewing practices; and more. Provides a primary source of guidance practitioners and professionals involved in child protection Updates guidance for interviewers by adding consideration of emotional and motivational factors to better understand children's behavior during interviews Integrates the substantial body of research published over the last decade and reflects upon questions that the field should continue to address Tell Me What Happened: Questioning Children About Abuse deserves to be read by all practitioners involved in child protection, whether as investigators, interviewers, judges, or lawyers.
eBook
Effective child protection
This is an essential guide for anyone concerned with improving child protection practice. This second edition provides a deeper understanding of how practice judgements and decisions can be improved in child protection work.
Book
Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys
Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders.
To examine joint associations of 12 childhood adversities with first onset of 20 DSM-IV disorders in World Mental Health (WMH) Surveys in 21 countries.
Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM-IV disorders with the WHO Composite International Diagnostic Interview (CIDI).
Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries.
Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.
Journal Article
Childhood maltreatment and adult suicidality: a comprehensive systematic review with meta-analysis
This comprehensive systematic review and meta-analysis aims to quantify the association between different types of childhood maltreatment and suicidality. We searched five bibliographic databases, including Medline, PsychINFO, Embase, Web of Science and CINAHL, until January 2018. Random-effects meta-analysis was employed followed by univariable and multivariable meta-regressions. Heterogeneity was quantified using the I2 statistic and formal publication bias tests were undertaken. The methodological quality of the studies was critically appraised and accounted in the meta-regression analyses. Data from 68 studies based on n = 261.660 adults were pooled. All different types of childhood maltreatment including sexual abuse [odds ratio (OR) 3.17, 95% confidence interval (CI) 2.76–3.64], physical abuse (OR 2.52, 95% CI 2.09–3.04) and emotional abuse (OR 2.49, 95% CI 1.64–3.77) were associated with two- to three-fold increased risk for suicide attempts. Similar results were found for the association between childhood maltreatment and suicidal ideation. Complex childhood abuse was associated with a particularly high risk for suicide attempts in adults (OR 5.18, 95% CI 2.52–10.63). Variations across the studies in terms of demographic and clinical characteristics of the participants and other core methodological factors did not affect the findings of the main analyses. We conclude that there is solid evidence that childhood maltreatment is associated with increased odds for suicidality in adults. The main outstanding challenge is to better understand the mechanisms which underpin the development of suicidality in people exposed to childhood maltreatment because current evidence is scarce.
Journal Article