Aron Shlonsky

School-based education programmes for the prevention of child sexual abuse.

BACKGROUNDnChild sexual abuse is a significant global problem in both magnitude and sequelae. The most widely used primary prevention strategy has been the provision of school-based education programmes. Although programmes have been taught in schools since the 1980s, their effectiveness requires ongoing scrutiny.nnnOBJECTIVESnTo systematically assess evidence of the effectiveness of school-based education programmes for the prevention of child sexual abuse. Specifically, to assess whether: programmes are effective in improving students protective behaviours and knowledge about sexual abuse prevention; behaviours and skills are retained over time; and participation results in disclosures of sexual abuse, produces harms, or both.nnnSEARCH METHODSnIn September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE and 11 other databases. We also searched two trials registers and screened the reference lists of previous reviews for additional trials.nnnSELECTION CRITERIAnWe selected randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of school-based education interventions for the prevention of child sexual abuse compared with another intervention or no intervention.nnnDATA COLLECTION AND ANALYSISnTwo review authors independently assessed the eligibility of trials for inclusion, extracted data, and assessed risk of bias. We summarised data for six outcomes: protective behaviours; knowledge of sexual abuse or sexual abuse prevention concepts; retention of protective behaviours over time; retention of knowledge over time; harm; and disclosures of sexual abuse.nnnMAIN RESULTSnThis is an update of a Cochrane Review that included 15 trials (up to August 2006). We identified 10 additional trials for the period to September 2014. We excluded one trial from the original review. Therefore, this update includes a total of 24 trials (5802 participants). We conducted several meta-analyses. More than half of the trials in each meta-analysis contained unit of analysis errors.1. Meta-analysis of two trials (n = 102) evaluating protective behaviours favoured intervention (odds ratio (OR) 5.71, 95% confidence interval (CI) 1.98 to 16.51), with borderline low to moderate heterogeneity (Chi² = 1.37, df = 1, P value = 0.24, I² = 27%, Tau² = 0.16). The results did not change when we made adjustments using intraclass correlation coefficients (ICCs) to correct errors made in studies where data were analysed without accounting for the clustering of students in classes or schools.2. Meta-analysis of 18 trials (n = 4657) evaluating questionnaire-based knowledge favoured intervention (standardised mean difference (SMD) 0.61, 95% CI 0.45 to 0.78), but there was substantial heterogeneity (Chi² = 104.76, df = 17, P value < 0.00001, I² = 84%, Tau² = 0.10). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.66, 95% CI 0.51 to 0.81; ICC: 0.2 SMD 0.63, 95% CI 0.50 to 0.77).3. Meta-analysis of 11 trials (n =1688) evaluating vignette-based knowledge favoured intervention (SMD 0.45, 95% CI 0.24 to 0.65), but there was substantial heterogeneity (Chi² = 34.25, df = 10, P value < 0.0002, I² = 71%, Tau² = 0.08). The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.53, 95% CI 0.32 to 0.74; ICC: 0.2 SMD 0.60, 95% CI 0.31 to 0.89).4. We included four trials in the meta-analysis for retention of knowledge over time. The effect of intervention seemed to persist beyond the immediate assessment (SMD 0.78, 95% CI 0.38 to 1.17; I² = 84%, Tau² = 0.13, P value = 0.0003; n = 956) to six months (SMD 0.69, 95% CI 0.51 to 0.87; I² = 25%; Tau² = 0.01, P value = 0.26; n = 929). The results did not change when adjustments were made using ICCs.5. We included three studies in the meta-analysis for adverse effects (harm) manifesting as child anxiety or fear. The results showed no increase or decrease in anxiety or fear in intervention participants (SMD -0.08, 95% CI -0.22 to 0.07; n = 795) and there was no heterogeneity (I² = 0%, P value = 0.79; n=795). The results did not change when adjustments were made using ICCs.6. We included three studies (n = 1788) in the meta-analysis for disclosure of previous or current sexual abuse. The results favoured intervention (OR 3.56, 95% CI 1.13 to 11.24), with no heterogeneity (I² = 0%, P value = 0.84). However, adjusting for the effect of clustering had the effect of widening the confidence intervals around the OR (ICC: 0.1 OR 3.04, 95% CI 0.75 to 12.33; ICC: 0.2 OR 2.95, 95% CI 0.69 to 12.61).Insufficient information was provided in the included studies to conduct planned subgroup analyses and there were insufficient studies to conduct meaningful analyses.The quality of evidence for all outcomes included in the meta-analyses was moderate owing to unclear risk of selection bias across most studies, high or unclear risk of detection bias across over half of included studies, and high or unclear risk of attrition bias across most studies. The results should be interpreted cautiously.nnnAUTHORS CONCLUSIONSnThe studies included in this review show evidence of improvements in protective behaviours and knowledge among children exposed to school-based programmes, regardless of the type of programme. The results might have differed had the true ICCs or cluster-adjusted results been available. There is evidence that childrens knowledge does not deteriorate over time, although this requires further research with longer-term follow-up. Programme participation does not generate increased or decreased child anxiety or fear, however there is a need for ongoing monitoring of both positive and negative short- and long-term effects. The results show that programme participation may increase the odds of disclosure, however there is a need for more programme evaluations to routinely collect such data. Further investigation of the moderators of programme effects is required along with longitudinal or data linkage studies that can assess actual prevention of child sexual abuse.

School-Based Education Programs for the Prevention of Child Sexual Abuse: A Cochrane Systematic Review and Meta-Analysis.

Objective: To assess evidence of the effectiveness of school-based education programs for the prevention of child sexual abuse (CSA). The programs deliver information about CSA and strategies to help children avoid it and encourage help seeking. Methods: Systematic review including meta-analysis of randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs. Results: Twenty-four studies with 5,802 participants were included. Child self-protective skills, odds ratio = 5.71, confidence interval = [1.98, 16.51]; factual, standardized mean difference (SMD) = 0.61 [0.45, 0.78]; and applied knowledge, SMD = 0.45 [0.24, 0.65], increased in the intervention group, and knowledge gains were retained at 6 months, SMD = 0.69 [0.51, 0.87]. There were no differences in anxiety or fear, SMD = −0.08 [0.22, 0.07], and findings regarding disclosure of abuse were inconclusive. Conclusion: Children’s self-protective skills and knowledge can be increased by participation in school-based sexual abuse prevention programs. However, it is unknown whether gains in skills and knowledge actually decrease the likelihood of CSA.

Acting Like It Matters: A Scoping Review of Simulation in Child Welfare Training

Simulation-based training is often used to prepare health practitioners and is increasingly employed to train child welfare workers. This scoping review systematically searched the published and grey literature for studies that evaluated training for child welfare practitioners and used simulation methods that included standardized actors. Three studies met inclusion criteria, all documenting improvement in participants use of specific skills. Other outcomes were mixed, possibly reflecting the heterogeneity of samples, study methods, measures, training of actors, theoretical frameworks, and content areas. Though results were mostly positive, the small number of studies indicates a substantial need for further research.

Methodological pluralism in the age of evidence-informed practice and policy

The use of evidence in practice and policy in public health and social services is a tricky endeavour. While virtually every practitioner, manager, or policy maker would agree that evidence should be used, there is disagreement about the nature of evidence and which evidence should be used, how, when, in what circumstances, and for whom. Within these disagreements, however, can be found some essential truths: (1) scientific knowledge evolves over time; (2) different types of evidence are needed for different purposes; (3) evidence has a range of quality; (4) synthesising multiple forms of evidence is difficult and inevitably includes some level of subjectivity; and (5) effective implementation of evidence is as important as the decision to use evidence in the first place. This paper will discuss the use of evidence in practice in what is arguably the most complex helping environment – social services – detailing the emergence and evolution of evidence-informed practice, dispelling some myths about its structure and application, and linking it to the broader origins and structure of the social and governmental systems in which it operates. Using this expanded view, the paper will then describe some useful approaches for incorporating these larger considerations into the use of evidence in practice.

A Randomized Trial of Wraparound Facilitation Versus Usual Child Protection Services

Objective: To evaluate whether the addition of a wraparound facilitator to regular child protection services improved child and family functioning over 20 months. Method: A single blind randomized controlled trial with concealment and stratification across three sites (N = 135 eligible families with substantiated maltreatment). Results: Based on 2 × 2 mixed analysis of variance and intention to treat, both groups improved in child impairments, d = −.60 [−.81, −.39], caregiver psychological distress, d = −.33 [−.52, −.13], and family resources, d = .44 [.27, .62]. No measurable benefit was associated with the intervention (e.g., child impairments, d = .14 [−.12, .52]). However, treatment fidelity analysis revealed that many components of wraparound were either missing or present in both groups. Conclusions: The presence of a facilitator alone did not appear to improve child or family functioning if the various components of wraparound were not adequately implemented.

Parenting Interventions for Indigenous Child Psychosocial Functioning: A Scoping Review.

Objectives: To scope evaluations of Indigenous parenting programs designed to improve child psychosocial outcomes. Methods: Electronic databases, gray literature, Indigenous websites and journals, and reference lists were searched. The search was restricted to high-income countries with a history of colonialism. Results: Sixteen studies describing evaluations of 13 programs were found. Most were controlled studies from United States and Australia, targeting child social, emotional, behavioral and mental health outcomes, and these were delivered to groups of parents. Program content focused most often on child development and learning, child behavior management, and parent–child interactions. Some studies reported improvements in child and parent outcomes, though the majority used self-report measures and some were noncontrolled studies. Conclusions: This scoping review provides the first known map of evaluations of programs targeting parents of Indigenous children. There were few rigorous evaluations of effectiveness. A rigorous systematic review is needed to evaluate the strength and extent of these findings.

Psychosocial Interventions for Parents with Incurable End-Stage Cancer: A Rapid Evidence Assessment

Objective Parenting is a primary concern for patients with minor children facing palliative‐stage cancer, yet psychosocial support addressing parenting concerns during end‐stage cancer is not routinely provided in the healthcare setting. The purpose of this review is to: (a) identify evaluation studies describing psychosocial interventions for parents with incurable end‐stage cancer; and (b) review the effectiveness evidence. Method This review was based on a rapid evidence assessment using transparent and comprehensive search terms and narrative synthesis. Inclusion criteria were broad and consisted of qualitative, quantitative, and mixed method studies that focused on psychosocial interventions for parents with advanced cancer. Results Four studies were identified, but only one of these reported results specific to parents with end‐stage cancer. A child‐centred and family‐focused approach was central to all program interventions. All programs encompassed a structured format with the majority being dedicated to providing both individual and family sessions. The studies varied in methodological quality and all used small, non‐representative samples limiting the generalisability of the findings. There were no high quality quantitative studies that specifically address outcomes for this parent group and few qualitative studies that detail parents’ intervention experience. Conclusions The findings suggest that targeted, child‐centred, family‐focused psychosocial interventions are sometimes used to support adult patients with parenting during end‐stage cancer. These purport to promote child‐parent communication and to contribute to parent psychosocial wellbeing. Further research using larger parent populations from diverse sociodemographic backgrounds is required. More importantly, comparative effectiveness studies are needed that test the timing, delivery, and content of these interventions.

Current status and prospects for improving decision making research in child protection: a commentary

ndividual child protection decisions are some of the most important and least understood processes in the provision of attention paid to risk assessment instrumentation and, to a lesser extent, how caseworkers assess risk, there has been insufficient empirical attention paid to how decisions are made, the nature and extent of influence of individual child welfare services. Although there has been a fairly substantial degree of rigorous empirical

Age and other risk factors related to reentry to care from kin guardian homes

Although kinship guardianship is an increasingly important foster care exit pathway for children in the United States, research on the factors leading to kinship guardianship breakdown is lacking. This study examines the factors associated with guardianship breakdown for children who exited foster care to kinship guardianship in California between 2003 and 2010 (Nu202f=u202f18,831). Specifying time-dependent Cox relative risk models, childrens age trajectories are directly accounted for in the analysis. This allows differentiation between duration dependence (i.e., time spent in guardianship) and childrens development (expressed as age). Overall, 17.3% of children reentered care by 2017. Early adolescents, age 13-15 years (HRu202f=u202f1.63, pu202f<u202f.001), and late adolescents, age 16-17 years (HRu202f=u202f1.93, pu202f<u202f.001), had an increased hazard of reentry compared with children under the age of six. Children with a history of mental health concerns had more than twice the hazard of reentering than children without such a history (HRu202f=u202f2.18, pu202f<u202f.001). Our findings indicate that transition to adolescence was associated with increased risk of reentry into care, highlighting the need for guardianship support services leading up to, and during, this child developmental stage.

Increasing rigor and reducing bias in qualitative research: A document analysis of parliamentary debates using applied thematic analysis

Qualitative research methods have traditionally been criticised for lacking rigor, and impressionistic and biased results. Subsequently, as qualitative methods have been increasingly used in social work inquiry, efforts to address these criticisms have also increased. Applied thematic analysis provides structure and integrates reflexivity in qualitative research using textual data. In this article, we describe how applied thematic analysis was operationalised in a document analysis of the official records of parliamentary debates in the Australian State of Victoria relating to the introduction of Permanent Care Orders, an alternative to adoption for children residing out-of-home and unable to be safely reunified with their parents. We present this example to extend the knowledge base regarding applied thematic analysis and to demonstrate how step-by-step implementation of a purposeful methodology using trustworthy documentary data can effectively increase rigor and transparency, thereby reducing potential bias, in a qualitative analysis. First, we clarify key terms; then discuss the challenges of analysing textual data; consider the value of parliamentary debates as a textual data source; and provide a detailed description of the processes undertaken in the document analysis. Finally, we reflect on the application of applied thematic analysis in our study, highlighting its value in strengthening qualitative social work research using document analysis.