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

Lead Research Organisation: University of Oxford
Department Name: Social Policy and Intervention

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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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 analyses for the ICAST-parent version, and the ICAST-Trial version are not yet published and neither is the systematic review nor the ICAST- short form paper.
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

 
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 Comissioner on Child Sexual Abuse on how to conduct regular national prevalence studies on child abuse victimisation in Germany and has advised extensively on measures. 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
Impact Types Policy & public services

 
Description Better Care Network
Geographic Reach Africa 
Policy Influence Type Participation in a national consultation
URL https://www.bettercarenetwork.org/sites/default/files/VAC%20in%20All%20Care%20Settings%20Africa%20Co...
 
Description Future directions of child abuse research in Germany
Geographic Reach Europe 
Policy Influence Type Participation in a national consultation
 
Description Global consultation New Delhi
Geographic Reach Asia 
Policy Influence Type Participation in a national consultation
 
Description South African Adolescent & Youth Health Policy 2017-2021
Geographic Reach Africa 
Policy Influence Type Participation in a advisory committee
 
Description WHO expert group on child maltreatment prevention
Geographic Reach Europe 
Policy Influence Type Participation in a advisory committee
URL http://www.euro.who.int/__data/assets/pdf_file/0017/381140/wh12-ecm-rep-eng.pdf?ua=1
 
Description GCRF Accelerating Achievement for Africa's Adolescents Hub
Amount £18,531,197 (GBP)
Funding ID ES/S008101/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 02/2019 
End 04/2024
 
Description Interrupting the Intergenerational Transmission of Violence: A mixed-methods longitudinal study in South Africa
Amount € 1,499,000 (EUR)
Funding ID INTERUPT_VIOLENCE 852787 
Organisation European Research Council (ERC) 
Sector Public
Country Belgium
Start 04/2020 
End 03/2025
 
Description Project Grant
Amount $2,311,217 (AUD)
Funding ID APP1158750 
Organisation National Health and Medical Research Council 
Sector Public
Country Australia
Start 01/2019 
End 12/2023
 
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 DJI 
Organisation German Youth Institute
Country Germany 
Sector Charity/Non Profit 
PI Contribution Analysis of their dataset of the Kid 0-3 'Kinder in Deutschland - Children in Germany' study. Provided my expertise on measurement evaluation.
Collaborator Contribution Provided the dataset and intellectual input on the resulting paper.
Impact A report on the psychometric properties of the Child Abuse Potential Inventory among German mothers an fathers. Journal article is now published https://www.ncbi.nlm.nih.gov/pubmed/30620919
Start Year 2017
 
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
 
Description BBC World Service and BBC Radio Scotland 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Multiple radio interviews on the ongoing national crisis of violence against children in South Africa.
Year(s) Of Engagement Activity 2017
 
Description Better Care Network 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Expert consultation on prevention and reduction of violence against children in all care settings. Contribution to the Declaration on the Prevention of Violence Against Children in all Care Settings for member states of the African Union. Approximately 60 people present but declaration was shared widely among policy makers in the WHO African Region.
Year(s) Of Engagement Activity 2017
URL https://www.bettercarenetwork.org/sites/default/files/VAC%20in%20All%20Care%20Settings%20Africa%20Co...
 
Description Child maltreatment data collection 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact 14 participants attended this special expert discussion on conducting prevalence studies of child maltreatment in Muscat, Oman. The ministry in Oman reported increased interest in conducting a prevalence study.
Year(s) Of Engagement Activity 2019
 
Description Department of Social Development Mpumalanga 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact 25 professionals, policy makers and leaders of third sector organisations attended this workshop on violence prevention and measurement, which sparked questions and discussion. The organiser requested further information and has invited me to come back this year for another workshop.
Year(s) Of Engagement Activity 2018
 
Description Future directions of child abuse research in Germany 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Five government officials attended discussion to inform the German Independent Commissioner on Child Sexual Abuse about the design and practicalities of conducting large scale epidemiological studies in Germany.
Year(s) Of Engagement Activity 2017
 
Description German Independent Commissioner on Child Sexual Abuse 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Based on work with WHO on child maltreatment surveillance, I was asked to give a keynote followed by a discussion on how to monitor child abuse using national prevalence studies in Germany. The audience has used this talk to inform their understanding of different methodologies to monitor child abuse prevalence rates and will be making a decision of which types of study should be carried out in Germany over the next few years
Year(s) Of Engagement Activity 2020
 
Description Global consultation (New Delhi) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact 35 representatives from third sector organizations attended the Global Consultation on Comprehensive Strategies for Addressing Violence in Childhood. I briefly presented my research findings which then sparked questions and discussions on the applicability and implementation challenges in the local context. Afterwards multiple participants approached me requesting our tools.
Year(s) Of Engagement Activity 2018
 
Description ISPCAN 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact 80 representatives of third sector organizations and research institutions attended the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) working group on data collection. We had a lively debate and discussion about the use of child abuse measures in intervention studies and I had multiple requests to share the prototype tools afterwards and collaborate in future work with them.
Year(s) Of Engagement Activity 2017
 
Description Measuring child abuse victimisation (Ulm Germany) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 60 health and social care professionals attended talk on the measurement of child maltreatment. Lots of discussions and questions afterwards and requests for the sharing of measures.
Year(s) Of Engagement Activity 2017