Andreas Jud

Quality of life in maltreated children and adult survivors of child maltreatment: a systematic review

PurposeTo review data on health-related quality of life (HRQoL) in individuals with childhood trauma, including psychological maltreatment, physical maltreatment, sexual abuse, and neglect.MethodsThe literature search was conducted with pre-defined keywords using the following electronic bibliographic databases: EMBASE, PubMed, MEDLINE, CINAHL, PsyINFO, PSYNDEX, and Cochrane Database of Systematic Reviews. Further databases were searched for relevant dissertations. Study selection and data extraction were completed by two independent reviewers.ResultsThe literature search yielded 1568 entries. Nineteen articles met all inclusion criteria and were retained for further analysis. Findings quite consistently showed significant negative associations between child maltreatment and both self- and proxy-rated HRQoL. Effect sizes range from small to large. Number of types of maltreatment and HRQoL were found to be negatively related.ConclusionData on HRQoL for maltreated children are still rare. Studies often investigate adult survivors of child maltreatment. Considering HRQoL in children and adolescents who suffered maltreatment would allow the planning of effective interventions and the evaluation of treatments to improve HRQoL of these children.

Opportunities for prevention and intervention with young children: lessons from the Canadian incidence study of reported child abuse and neglect

BackgroundThe most effective way to provide support to caregivers with infants in order to promote good health, social, emotional and developmental outcomes is the subject of numerous debates in the literature. In Canada, each province adopts a different approach which range from universal to targeted programs. Nonetheless, each year a group of vulnerable infants is identified to the child welfare system with concerns about their well-being and safety. This study examines maltreatment-related investigations in Canada involving children under the age of one year to identify which factors determine service provision at the conclusion of the investigation.MethodsA secondary analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect CIS-2008 (PHAC, 2010) dataset was conducted. Multivariate analyses were conducted to understand the profile of investigations involving infants (n=1,203) and which predictors were significant in the decision to transfer a case to ongoing services at the conclusion of the investigation. Logistic Regression and Classification and Regression Trees (CART) were conducted to examine the relationship between the outcome and predictors.ResultsThe results suggest that there are three main sources that refer infants to the Canadian child welfare system: hospital, police, and non-professionals. Infant maltreatment-related investigations involve young caregivers who struggle with poverty, single-parenthood, drug/solvent and alcohol abuse, mental health issues, lack of social supports, and intimate partner violence. Across the three referral sources, primary caregiver risk factors are the strongest predictor of the decision to transfer a case to ongoing services.ConclusionsMultivariate analyses indicate that the presence of infant concerns does not predict ongoing service provision, except when the infant is identified with positive toxicology at birth. The opportunity for early intervention and the need to tailor interventions for specific caregiver risk factors is discussed.

On the incidence and prevalence of child maltreatment: a research agenda.

Research on child maltreatment epidemiology has primarily been focused on population surveys with adult respondents. Far less attention has been paid to analyzing reported incidents of alleged child maltreatment and corresponding agency responses. This type of research is however indispensable to know how well a child protection system works and if the most vulnerable are identified and served. Notable findings of child maltreatment epidemiological research are summarized and directions for future studies discussed.

The tip of the iceberg. Incidence of disclosed cases of child sexual abuse in Switzerland: results from a nationwide agency survey

ObjectivesChild sexual abuse (CSA) is considered a major risk factor for a variety of health problems both in childhood and in later adult life. While population-based surveys aim to establish the real incidence rates of CSA by interviewing potential (past) victims, agency surveys focus on the rates of CSA reported to the authorities.MethodsWe conducted a nationwide agency survey of CSA in Switzerland. Data were collected from 350 agencies through an anonymous online form during a 6-month period. For data collection, we used a modified version of the case reporting form translated from the American National Incidence Study (NIS-4).ResultsAbout 2.68 cases of CSA per 1,000 children per year are disclosed to agencies (1.11 in males, 4.33 in females). This is roughly twice the average incidence rate reported in methodologically similar studies from Canada, the US, and Australia.ConclusionsIn Switzerland, the majority of disclosed cases of CSA are handled by specialized yet semi-public agencies instead of public child welfare agencies or penal authorities. This fact might explain the higher disclosure rates.

On the nature and scope of reported child maltreatment in high-income countries: opportunities for improving the evidence base

Abstract Although high-income countries share and value the goal of protecting children from harm, national data on child maltreatment and the involvement of social services, the judiciary and health services remain relatively scarce. To explore potential reasons for this, a number of high-income countries across the world (Belgium, Canada, Germany, the Netherlands, New Zealand, South Korea, Switzerland and the United States) were compared. Amongst other aspects, the impact of service orientation (child protection-vs-family-services-orientated), the complexity of systems, and the role of social work as a lead profession in child welfare are discussed. Special consideration is given to indigenous and minority populations. The call for high-income countries to collect national data on child maltreatment is to promote research to better understand the risks to children. Its remit ranges well beyond these issues and reflects a major gap in a critical resource to increase prevention and intervention in these complex social situations. Fortunately, initiatives to close this gap are increasing.

Increased number of activated T cells in lymphocyte subsets of maltreated children: Data from a pilot study

OBJECTIVE Maltreatment in childhood has been related to enduring changes in the immune system of adults, such as increased cell-mediated immune response. PURPOSE Due to the lack of data in children, this study examined lymphocyte subset numbers and distribution during youth. METHODS In 27 cases of 42 healthy but maltreated children, fully participating at follow-up 1-3years after the intervention of child protection team, and 19 cases of previously matched controls, analysis of blood samples by fluorescent activated cell sorter was consented. RESULTS With regard to age references, total lymphocyte counts were aberrant in maltreated children but not in controls. When compared to controls, the percentages and absolute numbers of activated (HLA-DR+) CD4+helper and CD8+cytotoxic T cells were significantly higher in maltreated children. CONCLUSIONS According to the typical distribution of HLA-DR+cells we assumed an increased stimulated cell-mediated immune function in maltreated children.

Methodological challenges in following up patients of a hospital child protection team: is there a recruitment bias?

BackgroundThe aims of this study are to describe the methodological challenges in recruiting a follow-up sample of children referred to an interdisciplinary hospital child protection team (CPT) and to compare participating versus non-participating groups on several demographic variables and maltreatment characteristics.MethodsOf the 319 in- and outpatients referred to the CPT at University Childrens Hospital Zurich from 2005–2006 a sample of 180 children was drawn to contact for a follow-up. The children and their parents were asked to participate in a face-to-face interview at the hospital; in 42 cases the children and parents consented to do so. Alternatively, the parents could take part in a telephone interview (n = 39). Non-participation resulted because no contact or adequate communication in German, French, or English could be established (n = 49) or because the parents or children refused to participate (n = 50).ResultsParticipants and non-participants did not differ significantly in mean child age at follow-up, gender, family status, place of residence, certainty and type of maltreatment, and type of perpetrator. However, the childs nationality had a significant impact: Percentages of foreign nationals were higher in the fully participating group (45%; n = 19) and the non-contactable group (53%; n = 26) and significantly lower in the refusal (26%; n = 10) and the telephone interview group (18%; n = 9). Although a high percentage of families had moved in the few years since the CPT intervention (32%; n = 57), the percentage of moves was not significantly higher in non-participants compared to participants.ConclusionsFurther research is needed to support these results in different national backgrounds and to test for biases in variables not included – especially socioeconomic status. This includes gathering more detailed information on non-participants, while respecting ethical boundaries. Overall, the fact that only childs nationality was unevenly distributed between participants and non-participants is encouraging.

Structure and Challenges of Child Protection in Switzerland

This chapter aims at providing an overview on legislation, organizational structure and processes of child protection in Switzerland. For a relatively small country, the number of services is rather vast. This diversity arises from 26 cantonal and sub-cantonal variations of organizing child protection and is amplified by Switzerland’s cultural and linguistic variety. The roles in public child protection differ into risk assessment, deciding on child protection orders, and providing mandated services. They are assigned to at least two different types of organizations. Penal agencies are responsible for prosecuting child maltreatment offenses. Federal legislation entitles victims of crimes to support free-of-charge. Many private or semi-private agencies, such as specialized psychosocial counselling services or interdisciplinary child protection teams, are recognized as victim aid agencies and are therefore able to fund a part of the victim’s support through federal money. The new Child and Adult Protection Law, implemented in 2013, mandates professional sentinels to report to a child protection authority when a “person needs assistance”. Challenges discussed pertain, for example, to increasing the degree of standardization of risk assessment across cantons and to a lack of surveillance and shared data. Moreover, corporal punishment has still not been banned completely.

Mobilizing agencies for incidence surveys on child maltreatment: successful participation in Switzerland and lessons learned

BackgroundMany countries around the world lack data on the epidemiology of agency response to child maltreatment. They therefore lack information on how many children in need get help and protection or if children stand equal chances across regions to get services. However, it has proven difficult to commit child protection agencies to participation in incidence studies.MethodsThe Optimus Study invested in a continuous collaborative effort between research and practice to develop a data collection for the first national study on the incidence of agency responses to all forms of child maltreatment in Switzerland. An innovative approach of utilizing individual agencies’ standardized data reduced work burden for participation respectably: any arbitrary excerpt of data on new cases between September 1 and November 30, 2016, could be uploaded to a secured web-based data integration platform. It was then mapped automatically to fit the study’s definitions and operationalizations.ResultsThis strategy has led to a largely successful participation rate of 76% of agencies in the nationwide sample. 253 agencies from the social and health sector, public child protection, and the penal sector have provided data.ConclusionsValuing agencies context-specific knowledge and expertise instead of viewing them as mere providers of data is a precondition for representativeness of incidence data on agency responses to child maltreatment. Potential investigators of future similar studies might benefit from the lessons learned of the presented project.

Standards in der Dokumentation bei sexuellem Kindesmissbrauch

Eine gut gefuhrte Dokumentation von Verdachtsmomenten, Hinweisen und medizinischen Befunden erfullt in Fallen von sexuellem Missbrauch verschiedene wichtige Funktionen. Der Autor beschreibt in seinem Beitrag die Grunde fur die Notwendigkeit einer guten Dokumentation und gibt praktische Hinweise, welche Grundsatze bei der Dokumentation beachtet werden mussen.