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

Lead Research Organisation: University of Edinburgh
Department Name: Sch of Social and Political Science

Abstract

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.

Planned Impact

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).

Publications

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publication icon
Dunne MP (2020) Childhood adversity and death of young adults in an affluent society. in Lancet (London, England)

Related Projects

Project Reference Relationship Related To Start End Award Value
ES/N017447/1 01/06/2017 31/07/2019 £171,896
ES/N017447/2 Transfer ES/N017447/1 01/08/2019 30/11/2019 £24,029
 
Description Multiple databases have been created to psychometrically test the ICAST-child abuse measure. The ICAST-Trial, was developed by the PI to measure child abuse in intervention studies. The evaluation showed that the ICAST-Trial is a psychometrically valid child abuse measure that is sensitive enough to measure change in intervention studies. The PI also investigated whether the ICAST-Child abuse measure (parent and child form) measures child abuse at the same level across multiple countries. The child form shows partial scalar invariance which means that it can be used to validly compare levels of physical, emotional and sexual abuse, neglect and witnessing violence in school-aged children across countries. The parent version ICAST-P is about to be published (proofs received) and found that the measure consists of an underlying general abuse factor consisting of physical and emotional abuse and two group factors, sexual abuse and neglect.

Two COSMIN systematic reviews of the psychometric properties of child abuse self-report measures were also completed and are about to be submitted. One, on child abuse self-report measures found that few child abuse measures conducted content validity testing with children themselves. Content validity was only tested for a very limited number of measures and other psychometric information was also limited in quality and nature. The best evidence was available for the ICAST, in part also because of the work conducted for as part of this award. The second review focused on adult retrospective child abuse measures and found few studies focused on content validity but a more robust body of evidence for the psychometric properties of the available measures. A flow chart within the reviews help investigators select the measure that has the best fit for their research question. The ICAST-Short Form paper is still under development.

Considering the lack of content validity studies for child abuse self-report measures, this award was also used to generate more evidence on the content validity of the ICAST with adolescents. This strand of research was not originally part of the award and replaces the measurement invariance work planned for the ICAST Trial. This was the first in-depth study to investigate the content validity of the ICAST, or any other child abuse measure, using cognitive interviews with 45 adolescents in South Africa, Romania and the Philippines. We found that adolescents have to overcome quite complicated cognitive processes in a) understanding the question correctly, b) understanding the response options and c) determining how much violence they have experienced in the past year and across a lifetime. Adolescents also made multiple suggestions in how to improve the ICAST in terms of lay-out, response options and definitions for certain types of abuse such as neglect. Further, we investigated the feelings associated with being asked questions about violence and found that adolescents experienced an array of feelings throughout the research process, from curiosity, upset, sadness to happiness. They saw the use of a child abuse measure primarily as a means to raise awareness that these types of violence happen to children, and as a means to acquire vocabulary for experiences they have had, for which they have lacked words to describe them and suggested ways in which to improve research protocol: mainly having a one-on-one debrief following the interview to discuss the content of the questionnaire and any help that may be needed which is contrary to most researcher's current practice where the questionnaire is filled in anonymously in the classroom setting.
Exploitation Route My findings have the potential for large scale impact through uptake by academics in research projects, uptake by third sector organisations and policy makers for monitoring and evaluation of child abuse prevention efforts.
Sectors Communities and Social Services/Policy,Healthcare

 
Description The findings and knowledge generated from this award (although not all work has been published) have led to multiple invitations to join advisory committees. The PI has been asked to advise the German Independent Commissioner on Child Sexual Abuse on how to conduct regular national prevalence studies on child abuse victimisation in Germany and is advising on all issues related to measurement. The ICAST-Trial is used as a standard monitoring and evaluation tool by NGOs for their parenting interventions in over 30 countries.
First Year Of Impact 2018
Sector Communities and Social Services/Policy,Healthcare
Impact Types Societal,Policy & public services

 
Description Asked to be expert member of National Advisory Committee on Child Sexual Abuse for German Commissioner on Child Sexual Abuse
Geographic Reach Europe 
Policy Influence Type Participation in a advisory committee
Impact On the basis of my advice the German Commissioner on Child Sexual Abuse is advising the German Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ) on moving ahead with a national prevalence study on child maltreatment using adolescent respondents in Germany.
 
Description citation in Beyond Masks Societal impacts of COVID-19 and accelerated solutions for children and adolescents
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in other policy documents
Impact I wrote the evidence-review for child abuse for this rapid evidence-review and was cited by the UNICEF Innocenti published "Beyond MasksSocietal impacts of COVID-19 and accelerated solutions for children and adolescents" to summarise evidence-based approaches to child protection under COVID19.
URL https://www.unicef-irc.org/publications/pdf/UNICEF-Beyond-Masks-Report-Societal-impacts-of-COVID-19....
 
Description Exploring government level-interventions to mitigate childhood adversity in South Africa
Amount £60,000 (GBP)
Funding ID 2397634 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 09/2020 
End 03/2024
 
Description Policy and Practice Responses to Families living with Domestic Violence & Abuse under Covid-19 in 4 Countries: Generating Knowledge to Inform Recovery
Amount £185,242 (GBP)
Funding ID ES/V015850/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 11/2020 
End 01/2022
 
Title ICAST Trial 
Description Developed the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool (ICAST) for use in intervention studies - ICAST Trial. The previous ICAST was developed for the use in prevalence studies whereas this new measure is sensitive enough to measure change in abusive behaviour following an intervention. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2018 
Provided To Others? Yes  
Impact The measure is being used in the evaluation of the WHO/UNICEF/Oxford Parenting for Lifelong Health parenting intervention in 23 countries with 250,000 participants. It was also used in the randomised trials of the Parenting for Lifelong Health Interventions for adolescents and children in South Africa. The paper validating the measure was published in 2018 and has been cited 24 times. It is freely available as part of the original publication 
URL https://www.sciencedirect.com/science/article/pii/S014521341830228X
 
Description ACCELERATE HUB 
Organisation North-West University
Country South Africa 
Sector Academic/University 
PI Contribution Co-Investigator in a UKRI GCRF Hub: Accelerating Achievement for Africa's Adolescents - contributed to the grant application and am just setting up a study in one of the work packages - designed the study which is part of the work package
Collaborator Contribution the PI is based at Oxford and wrote the bid and won it Colleagues at North-West University contributed to the conceptualisation of my sub-study and will be the fieldwork parter and collaborate on publications.
Impact funded grant application - one publication under review
Start Year 2018
 
Description ACCELERATE HUB 
Organisation University of Oxford
Department Department of Social Policy and Intervention
Country United Kingdom 
Sector Academic/University 
PI Contribution Co-Investigator in a UKRI GCRF Hub: Accelerating Achievement for Africa's Adolescents - contributed to the grant application and am just setting up a study in one of the work packages - designed the study which is part of the work package
Collaborator Contribution the PI is based at Oxford and wrote the bid and won it Colleagues at North-West University contributed to the conceptualisation of my sub-study and will be the fieldwork parter and collaborate on publications.
Impact funded grant application - one publication under review
Start Year 2018
 
Description BECAN 
Organisation University College London
Department Institute of Child Health
Country United Kingdom 
Sector Academic/University 
PI Contribution Contributed towards a journal article with advice on analyses and interpretation of results. Currently in the process of working on joint analyses to publish two papers on measurement invariance of the ICAST across 9 Balkan countries. Paper one is under review, paper two will hopefully be submitted by April.
Collaborator Contribution Provided BECAN dataset which contains child abuse prevalence data of 40,000 children and their caregivers using the ICAST instrument in nine Balkan countries.
Impact 10.1186/s13034-017-0208-x, publication is multi-disciplinary spanning social work, public health, epidemiology, psychology and medical sociology
Start Year 2017
 
Description DAHLIA-19 
Organisation Trinity College Dublin
Country Ireland 
Sector Academic/University 
PI Contribution Input into grant application and co-lead for the research in Scotland. This is to map and evaluate policy and initiatives to domestic abuse under COVID19.
Collaborator Contribution UCLAN are the lead of the research project, Melbourne, Trinity and Witwatersrand are international country partners
Impact abstract for European Domestic Violence Conference
Start Year 2020
 
Description DAHLIA-19 
Organisation University of Central Lancashire
Country United Kingdom 
Sector Academic/University 
PI Contribution Input into grant application and co-lead for the research in Scotland. This is to map and evaluate policy and initiatives to domestic abuse under COVID19.
Collaborator Contribution UCLAN are the lead of the research project, Melbourne, Trinity and Witwatersrand are international country partners
Impact abstract for European Domestic Violence Conference
Start Year 2020
 
Description DAHLIA-19 
Organisation University of Melbourne
Country Australia 
Sector Academic/University 
PI Contribution Input into grant application and co-lead for the research in Scotland. This is to map and evaluate policy and initiatives to domestic abuse under COVID19.
Collaborator Contribution UCLAN are the lead of the research project, Melbourne, Trinity and Witwatersrand are international country partners
Impact abstract for European Domestic Violence Conference
Start Year 2020
 
Description DAHLIA-19 
Organisation University of the Witwatersrand
Country South Africa 
Sector Academic/University 
PI Contribution Input into grant application and co-lead for the research in Scotland. This is to map and evaluate policy and initiatives to domestic abuse under COVID19.
Collaborator Contribution UCLAN are the lead of the research project, Melbourne, Trinity and Witwatersrand are international country partners
Impact abstract for European Domestic Violence Conference
Start Year 2020
 
Description EU COST Action ' Multi-sectoral Responses to Child Abuse and Neglect in Europe: Incidence and Trends" Euro-CAN 
Organisation Babes-Bolyai University
Country Romania 
Sector Academic/University 
PI Contribution Expertise on child participation in child maltreatment data collection
Collaborator Contribution The partners applied for the funding for this EU cost action and are hosting the events. They are also bringing together all partners from approx 30 different universities across Europe to discuss issues in child maltreatment data collection.
Impact A combined abstract for the ISPCAN conference on child participation Collaboration is multi-disciplinary and includes partners in social work, psychology, psychiatry and epidemiology.
Start Year 2021
 
Description EU COST Action ' Multi-sectoral Responses to Child Abuse and Neglect in Europe: Incidence and Trends" Euro-CAN 
Organisation Institute of Child Health
Country Greece 
Sector Hospitals 
PI Contribution Expertise on child participation in child maltreatment data collection
Collaborator Contribution The partners applied for the funding for this EU cost action and are hosting the events. They are also bringing together all partners from approx 30 different universities across Europe to discuss issues in child maltreatment data collection.
Impact A combined abstract for the ISPCAN conference on child participation Collaboration is multi-disciplinary and includes partners in social work, psychology, psychiatry and epidemiology.
Start Year 2021
 
Description EU COST Action ' Multi-sectoral Responses to Child Abuse and Neglect in Europe: Incidence and Trends" Euro-CAN 
Organisation University Hospital Center of Dijon
Country France 
Sector Hospitals 
PI Contribution Expertise on child participation in child maltreatment data collection
Collaborator Contribution The partners applied for the funding for this EU cost action and are hosting the events. They are also bringing together all partners from approx 30 different universities across Europe to discuss issues in child maltreatment data collection.
Impact A combined abstract for the ISPCAN conference on child participation Collaboration is multi-disciplinary and includes partners in social work, psychology, psychiatry and epidemiology.
Start Year 2021
 
Description EU COST Action ' Multi-sectoral Responses to Child Abuse and Neglect in Europe: Incidence and Trends" Euro-CAN 
Organisation University of Ulm
Country Germany 
Sector Academic/University 
PI Contribution Expertise on child participation in child maltreatment data collection
Collaborator Contribution The partners applied for the funding for this EU cost action and are hosting the events. They are also bringing together all partners from approx 30 different universities across Europe to discuss issues in child maltreatment data collection.
Impact A combined abstract for the ISPCAN conference on child participation Collaboration is multi-disciplinary and includes partners in social work, psychology, psychiatry and epidemiology.
Start Year 2021
 
Description EU COST Action ' Multi-sectoral Responses to Child Abuse and Neglect in Europe: Incidence and Trends" Euro-CAN 
Organisation Uppsala University
Country Sweden 
Sector Academic/University 
PI Contribution Expertise on child participation in child maltreatment data collection
Collaborator Contribution The partners applied for the funding for this EU cost action and are hosting the events. They are also bringing together all partners from approx 30 different universities across Europe to discuss issues in child maltreatment data collection.
Impact A combined abstract for the ISPCAN conference on child participation Collaboration is multi-disciplinary and includes partners in social work, psychology, psychiatry and epidemiology.
Start Year 2021
 
Description INTERRUPT_VIOLENCE 
Organisation University of the Witwatersrand
Department School of Public Health
Country South Africa 
Sector Academic/University 
PI Contribution 2018 Application to the European Research Council for an ERC Starting Grant to investigate the Intergenerational Transmission of Violence in South Africa - funded in 2019 I wrote the bid and had the idea, colleagues at Wits School of Public Health are research partners for fieldwork and publications
Collaborator Contribution Contributed to the proposal and will be contributing as a fieldwork partner and to publications
Impact Funded ERC Starting Grant 2019 'INTERRUPT_VIOLENCE' - social work, public health and psychology
Start Year 2018
 
Description Queensland University of Technology 
Organisation Queensland University of Technology (QUT)
Department School of Public Health and Social Work
Country Australia 
Sector Academic/University 
PI Contribution Expertise in child abuse prevalence studies and child abuse measurement towards an ongoing grant application at QUT. The grant was funded by the Austrilan National Health and Medical Research Council. Collaborative development of research hypotheses, research tools including child abuse measures and journal papers.
Collaborator Contribution Professor Michael Dunne has been actively involved in one completed and three ongoing publications providing expertise as one of the original developers of the ICAST tool.
Impact One publication 10.7189/jogh.07.010410 has led to Grant application in 2018 to NHMRC Australia for a national prevalence study of child abuse and neglect in Australia, these are multidisciplinary outputs and outcomes which span social work, public health, epidemiology and medical sociology - this has been funded in 2019 and we are in the process of cognitively testing the measures Collaboration involves Psychiatrists, Psychologists, Lawyers, Public Health Researchers and Social Work One publication on the ICAST published in 2018 - doi.org/10.1016/j.chiabu.2018.05.022 - multi-disciplinary collaboration of sociologists, public health researchers, social workers and psychologists
Start Year 2017