Evidence-based child abuse prevention: Developing measures for observation and evaluation in a global context

Globally, 95 million children become victims of physical, emotional and sexual child abuse every year. Child abuse has lifetime impacts including medical trauma, mental health distress, illness, school drop-out and unemployment. We know there is also a cycle of violence across generations. In other words, victims of child abuse are more likely to commit violent crime and to abuse their own children. They are also more likely to become a victim of violence again, both in childhood and in their adult relationships. Child abuse also has a hidden but massive impact on society because of illness and disability, costing an estimated 124 billion USD a year in the United States.

But why do child abuse rates remain so inexplicably high? Child abuse is a complex problem that reaches across the home and community. In order to combat child abuse, we need to understand how many children are affected, where they are and who is most at risk. Then we need effective interventions to prevent and reduce child abuse. However, we know very little about either. A small number of high-income countries have social services data but these only identify the tip of the iceberg; most child abuse is never reported to services. To detect abuse within the whole population, we need to conduct surveys. That being said, the only child abuse measures available are lengthy and detailed, and they are therefore costly to carry out nationally. If a short child abuse measure existed, it could be included in larger, regularly conducted surveys (e.g. Demographic and Health Surveys or census).

Interventions aim to prevent and reduce abuse, but there is currently no child abuse measure that can test whether such interventions have worked. A measure needs to be designed to detect changes in how severe and how often abusive behaviours occur. At the moment, researchers often use proxy measures for abuse, such as parenting stress.

This study has two aims: (1) to develop a brief child abuse measure for the inclusion in large surveys, and (2) to test and validate a sensitive child abuse measure for use in intervention evaluation research. These will then be made available, together with a user manual, at no cost.

To combat child abuse, we need strong collaborations between research and policy. I have already established strong partnerships with a number of academic institutions and international organisations in child protection. I have developed a prototype of the measure for intervention testing, and this is being used in six studies with 3800 participants in South Africa, Tanzania, the Democratic Republic of Congo and the Philippines. My collaborators will share the data, allowing me to conduct statistical analysis on how and whether the measure works. I will also conduct analyses testing whether the tool measures the same concepts across cultures. Finally, I will carry out qualitative research with key stakeholders in child protection to find the best questions for the short child abuse measure. To complement this, I will use statistical techniques on the pooled dataset to identify questions that can be used in surveys.

This project can have a large impact on global child abuse prevention efforts. It will help researchers and policy-makers to measure accurately the number of children affected and determine whether interventions really work. It is an essential step in creating high quality evidence for protecting the world's children.

The research has been planned and developed, and will be undertaken in direct collaboration with major policy-makers in the field of child abuse. Thus, the process of the research itself will raise awareness and build key skills amongst important international agencies and policy-makers. Large and sustainable impact is ensured by the research's direct response to needs identified by the policy world and its offer of joint ownership of the research process and outputs.

The impact of this research is aimed at three main groups. The first are international-level policy-makers, in particular international agencies and major multi-country funding organizations such as World Health Organization (WHO), UNICEF and Save the Children. The second is the academic community, which has identified the need for adequate research tools in order to identify risk factors and outcomes of child abuse victimisation as well as the need to develop and evaluate evidence-based intervention studies for prevention and protection. Finally, this research aims to impact practitioners working directly with at-risk families through evidence-based policies and active dissemination. By contributing towards a better evidence base, we can enable accurate assessment, demonstrate demand for services and increase support.

Impact will be achieved through four pathways:

Pathway 1: Building an international knowledge exchange collaboration
Strong partnerships with key stakeholders are essential for this research to have major impact. I have carefully built partnerships over the past few years with the WHO and UNICEF, which have become important collaborators and members of the advisory group. Collaborations were developed through an internship, multiple presentations, consultancy work and membership in the Parenting for Lifelong Health Initiative, a collaboration to develop affordable parenting programmes to prevent child abuse. UNICEF and WHO have and will be involved in all aspects of the research, from initial planning through development and dissemination.

Pathway 2: Establishing an advisory group - CAMEO (Child Abuse Measures for Evaluation and Observation)
The CAMEO Group includes academics as well as policy-makers and international organisations. It has been supporting the project from its inception. The non-academic stakeholders will provide expert support on the research processes. They are also placed strategically to publicise the research through their networks and push for the use of the measures.

Pathway 3: Knowledge exchange through research and dissemination
I will carry out four key impact-targeted activities over the course of this fellowship. First, the qualitative element of the research effectively constitutes knowledge exchange by elucidating opinions on tools. It will encourage discussion and awareness of the tools by the audience that will make use of the new measures: NGO staff, advocates, survey researchers, policy-makers and practitioners. Second, findings will be disseminated at international conferences, which are attended by academic and non-academic stakeholders. Third, plain language policy briefs and a short guide to the measurements will be designed in close collaboration with WHO and made available online. Fourth, a series of webinars will be developed to target practitioners and policy-makers in low-income countries.

Pathway 4: Expanding knowledge exchange
Throughout the research process, I will conduct regular Skype meetings with existing contacts established during my DPhil and post-doctoral research. These include senior officials within organisations such as USAID, Save the Children and Plan International. They will be asked for feedback and contacted for dissemination purposes at the end of the project.

This impact proposal is ambitious but achievable given my track record and commitment to knowledge exchange and impact as integral parts of the research process (see Pathways to Impact).