Elena Volkova

ISPCAN Child Abuse Screening Tool Children's Version (ICAST-C): Instrument development and multi-national pilot testing

OBJECTIVEnTo develop a child victimization survey among a diverse group of child protection experts and examine the performance of the instrument through a set of international pilot studies.nnnMETHODSnThe initial draft of the instrument was developed after input from scientists and practitioners representing 40 countries. Volunteers from the larger group of scientists participating in the Delphi review of the ICAST P and R reviewed the ICAST C by email in 2 rounds resulting in a final instrument. The ICAST C was then translated and back translated into six languages and field tested in four countries using a convenience sample of 571 children 12-17 years of age selected from schools and classrooms to which the investigators had easy access.nnnRESULTSnThe final ICAST C Home has 38 items and the ICAST C Institution has 44 items. These items serve as screeners and positive endorsements are followed by queries for frequency and perpetrator. Half of respondents were boys (49%). Endorsement for various forms of victimization ranged from 0 to 51%. Many children report violence exposure (51%), physical victimization (55%), psychological victimization (66%), sexual victimization (18%), and neglect in their homes (37%) in the last year. High rates of physical victimization (57%), psychological victimization (59%), and sexual victimization (22%) were also reported in schools in the last year. Internal consistency was moderate to high (alpha between .685 and .855) and missing data low (less than 1.5% for all but one item).nnnCONCLUSIONSnIn pilot testing, the ICAST C identifies high rates of child victimization in all domains. Rates of missing data are low, and internal consistency is moderate to high. Pilot testing demonstrated the feasibility of using child self-report as one strategy to assess child victimization.nnnPRACTICE IMPLICATIONSnThe ICAST C is a multi-national, multi-lingual, consensus-based survey instrument. It is available in six languages for international research to estimate child victimization. Assessing the prevalence of child victimization is critical in understanding the scope of the problem, setting national and local priorities, and garnering support for program and policy development aimed at child protection.

ISPCAN Child Abuse Screening Tools Retrospective version (ICAST-R): Delphi study and field testing in seven countries

OBJECTIVESnTo gain consensus among an ethnically and linguistically diverse group of international child protection experts on the structure and content of a new survey tool for retrospective measurement of child abuse, and to determine the performance of the instrument through an international field trial with young adults.nnnMETHODSnThe questionnaire was developed through focus group discussions with international experts, and then subjected to a Delphi study in two waves to determine the perceived importance and translatability of items. The resultant questionnaire was translated into six languages and field tested in seven countries with convenient samples of young adults aged 18-26 years (N=842).nnnRESULTSnChild maltreatment experts from 28 countries provided input to questionnaire development. Satisfactory agreement on draft item inclusion and exclusion and the translatability of items was gained. The tool includes 15 primary questions about potentially abusive physical, sexual and emotional events, with follow-up questions about perpetrator characteristics, frequency of acts and periods in childhood when the recalled abuse occurred. The field test revealed lifetime prevalence per item usually exceeded 10% (11/15 items; range 2.1-49.5%). Internal consistency (Cronbachs alpha) was moderate to high for each of three item sub-sets (between .61 and .82) and the rates of missing data were low (less than 1.5% for 14 of 15 items). The great majority of respondents nominated either peer and/or adult perpetrators (between 82.3% and 98.2% depending upon the item), and among these, child/adolescent peers and non-family adults (including teachers for emotional and physical acts) were nominated often.nnnCONCLUSIONSnThe ICAST-R is based on consensus from international experts, translates clearly and has satisfactory properties for adoption as a survey tool to estimate prevalence and describe perpetrators and other contextual aspects of child abuse.nnnPRACTICE IMPLICATIONSnThis tool can be utilized in a broad range of cultures and languages and may contribute to improved research practice. Although the core items are limited to just 15 acts of maltreatment, if these behaviorally specific questions are adopted as key indicators and incorporated into comprehensive local, national or regional surveys, eventually there should be greater comparability in survey estimates.

The development and piloting of the ISPCAN Child Abuse Screening Tool—Parent version (ICAST-P) ☆

OBJECTIVEnChild maltreatment is a problem that has longer recognition in the northern hemisphere and in high-income countries. Recent work has highlighted the nearly universal nature of the problem in other countries but demonstrated the lack of comparability of studies because of the variations in definitions and measures used. The International Society for the Prevention of Child Abuse and Neglect has developed instrumentation that may be used with cross-cultural and cross-national benchmarking by local investigators. DESIGN AND SAMPLING: The instrument design began with a team of expert in Brisbane in 2004. A large bank of questions were subjected to two rounds of Delphi review to develop the fielded version of the instrument. Convenience samples included approximately 120 parent respondents with children under the age of 18 in each of six countries (697 total).nnnRESULTSnThis paper presents an instrument that measures parental behaviors directed at children and reports data from pilot work in 6 countries and 7 languages. Patterns of response revealed few missing values and distributions of responses that generally were similar in the six countries. Subscales performed well in terms of internal consistency with Cronbachs alpha in very good range (0.77-0.88) with the exception of the neglect and sex abuse subscales. Results varied by child age and gender in expected directions but with large variations among the samples. About 15% of children were shaken, 24% hit on the buttocks with an object, and 37% were spanked. Reports of choking and smothering were made by 2% of parents.nnnCONCLUSIONnThese pilot data demonstrate that the instrument is well tolerated and captures variations in, and potentially harmful forms of child discipline.nnnPRACTICE IMPLICATIONSnThe ISPCAN Child Abuse Screening Tool - Parent Version (ICAST-P) has been developed as a survey instrument to be administered to parents for the assessment of child maltreatment in a multi-national and multi-cultural context. It was developed with broad input from international experts and subjected to Dephi review, translation, and pilot testing in six countries. The results of the Delphi study and pilot testing are presented. This study demonstrates that a single instrument can be used in a broad range of cultures and languages with low rates of missing data and moderate to high internal consistency.

Women's alcohol consumption and risk for alcohol-exposed pregnancies in Russia.

AIMSnAlcohol-exposed pregnancies (AEP) are the direct cause of fetal alcohol spectrum disorders (FASD). This study examines drinking patterns among pregnant and non-pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world.nnnDESIGNnCross-sectional survey.nnnSETTINGnSeven public womens clinics in two locations: St Petersburg (SPB) and the Nizhny Novgorod region (NNR).nnnPARTICIPANTSnA total of 648 pregnant and non-pregnant childbearing-age women.nnnMEASUREMENTSnA face-to-face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition.nnnFINDINGSnEighty-nine per cent of non-pregnant women reported consuming alcohol and 65% reported binge drinking in the past 3 months; 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at risk for AEP. There was a significant decline in drinking after pregnancy identification. Twenty per cent of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive.nnnCONCLUSIONSnRussian women substantially reduce drinking after pregnancy recognition compared to pre-pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The pre-conception period presents a risk window and, therefore, a prevention opportunity.

Brief FASD prevention intervention: physicians' skills demonstrated in a clinical trial in Russia

BackgroundAlcohol consumption during pregnancy can result in a range of adverse pregnancy outcomes including Fetal Alcohol Spectrum Disorders (FASD). Risky drinking among Russian women constitutes a significant risk for alcohol-exposed pregnancies (AEP). Russian women report that obstetrics and gynecology (OB/GYN) physicians are the most important source of information about alcohol consumption during pregnancy and developing effective prevention interventions by OB/GYNs is indicated. This is the first study focused on implementation of an AEP prevention intervention at women’s clinics in Russia.MethodThe paper describes the intervention protocol and addresses questions about the feasibility of a brief FASD prevention intervention delivered by OB/GYNs at women’s clinics in Russia. Brief physician intervention guidelines and two evidence-based FASD prevention interventions were utilized to design a brief dual-focused physician intervention (DFBPI) appropriate to Russian OB/GYN care. The questions answered were whether trained OB/GYN physicians could deliver DFBPI during women’s routine clinic visits, whether they maintained skills over time in clinical settings, and which specific intervention components were better maintained. Data were collected as part of a larger study aimed at evaluating effectiveness of DFBPI in reducing AEP risk in non-pregnant women. Methods of monitoring the intervention delivery included fidelity check lists (FCL) with the key components of the intervention completed by physicians and patients and live and audio taped observations of intervention sessions. Physicians (N = 23) and women (N = 372) independently completed FCL, and 78 audiotapes were coded.ResultsThe differences between women’s and physicians’ reports on individual items were not significant. Although the majority of physician and patient reports were consistent (N = 305), a discrepancy existed between the reports in 57 cases. Women reported more intervention components missing compared to physicians (p < 0.001). Discussing barriers was the most difficult component for physicians to implement, and OB/GYN demonstrated difficulties in discussing contraception methods.ConclusionsThe results supported the feasibility of the DFBPI in Russia. OB/GYN physicians trained in the DFBPI, monitored, and supported were able to implement and maintain skills during the study. In addition to the alcohol focus, DFBPI training needs to have a sufficient component to improve physicians’ skills in discussing contraception use.

Using a single binge drinking question to identify Russian women at risk for an alcohol-exposed pregnancy

INTRODUCTIONnLow rates of contraception and at-risk drinking place many Russian women at risk of an alcohol-exposed pregnancy (AEP). The only realistic way to determine when women are at risk of AEP is by self-reports. A U.S. study found that a single binge-drinking question (SBD) effectively identified nearly all women whose drinking placed them at risk of AEP.nnnMETHODSnThe present study replicated the U.S.nnnSTUDYnParticipants were 689 non-pregnant Russian women of childbearing age who were at AEP risk. Their answers to SBD, During the previous three months, how often did you have four or more drinks on one occasion, were compared with their reports of binge drinking on a 90-day Timeline Followback (TLFB) calendar.nnnRESULTSnThe SBD identified 99% of at-risk Russian women as binge drinkers, replicating U.S.nnnFINDINGSnOnly 8% of the women were identified at-risk using a second AEP criterion of ≥8 drinks on average per week. Although Russian women did not report heavy weekly drinking and two-thirds did not meet AUDIT criteria for problem drinking, when they did drink, 40% of the time it was binge drinking.nnnCONCLUSIONSnAlmost all Russian women who were at risk of an AEP were identified by a single binge-drinking question. Results from this study suggest that Russian health care practitioners can use SBD to successfully screen women for AEP risk. SBD identified 99% of Russian women who were at AEP risk. Consequently, it is recommended that SBD be incorporated into routine health care screenings at OB/GYN clinic visits.

Women’s receptivity to Fetal Alcohol Spectrum Disorders prevention approaches: A case study of two regions in Russia

AIMSnThis study obtained data to inform the development of programs for prevention of Fetal Alcohol Spectrum Disorders (FASD) by examining Russian womens perceptions about the determinants of their decisions regarding alcohol consumption during pregnancy; the importance of educating professionals and community about FASD; and the credibility of various sources of information.nnnDESIGNnCross-sectional survey.nnnSETTINGnSeven womens clinics in St. Petersburg and the Nizhny Novgorod region in Russia.nnnPARTICIPANTSnSix hundred and forty-eight pregnant and non-pregnant women of childbearing age.nnnMEASURESnA face-to-face structured interview assessed demographic characteristics, pregnancy status, alcohol consumption, and level of trust in and receptivity to FASD prevention messages.nnnFINDINGSnThe most influential contributor to womens decisions regarding alcohol consumption during pregnancy was their own knowledge, followed by information from an obstetrician/gynecologist or nurse. It was most important to women that obstetrics and gynecology professionals and husbands or partners were knowledgeable about the effects of drinking during pregnancy. Physicians recommendations and research data were regarded by the women as the most credible sources of information. There were significant variations in responses by socio-demographic characteristics and alcohol consumption levels. Younger women were more likely to report the contributions of husbands, mothers, and friends or coworkers to their decisions about alcohol consumption and indicated the importance of educating these people. Women at risk for alcohol use during pregnancy reported greater influence of husbands or partners and warning labels on containers on their alcohol consumption.nnnCONCLUSIONSnThis study emphasizes the importance of broadly disseminating information about FASD, particularly research data, through education of health professionals and the general public in Russia. Womens socio-demographic characteristics and alcohol consumption levels should be considered in designing prevention programs.

Do attitudes and knowledge predict at-risk drinking among Russian women?

ABSTRACT Background: Drinking patterns among Russian women indicate substantial risk for alcohol-exposed pregnancies. Data about women’s knowledge and attitudes related to alcohol consumption during pregnancy and the extent to which women’s knowledge and attitudes affect their alcohol use remain limited. Objectives: To describe Russian women’s knowledge and attitudes and assess whether women’s knowledge and attitudes were associated with their risky drinking. Methods: A cross-sectional survey was administered to women of childbearing age (n = 648). Participants were recruited at women’s health clinics and asked about their alcohol consumption, pregnancy status, attitudes, and knowledge about effects of alcohol and Fetal Alcohol Syndrome (FAS). Results: 40% of the women surveyed believed or were uncertain whether alcohol consumption during pregnancy was acceptable. Although 34% had heard of FAS, only 8% possessed accurate knowledge. Correct knowledge was associated with decreased alcohol consumption among pregnant women, but there was no association between knowledge and risky drinking in nonpregnant women, including those who were at risk for an unplanned pregnancy or were trying to conceive. However attitudes were strongly associated with risky drinking by nonpregnant women across levels of knowledge about FAS and any alcohol use by pregnant women. Conclusions: Russian women had limited knowledge and several misconceptions about the effects of alcohol on the fetus, and risky alcohol consumption was strongly associated with women’s attitudes and knowledge. The study provides strong evidence to support continuing public health education about effects of alcohol use during pregnancy. Correcting specific misconceptions and targeting the preconceptional period in health communications are necessary to reduce at-risk drinking and the risk for alcohol-exposed pregnancies.

A screening and brief intervention for women in OB/GYN care

Background Alcohol consumption levels in Russia are among the highest in the world [1]. Fetal Alcohol Spectrum Disorders in children are completely preventable by avoiding alcohol use during pregnancy [2]; yet, substantial numbers of women around the world consume alcohol during pregnancy mostly prior to pregnancy recognition [3-5]. A U.S. prevention model, Project CHOICES, utilized a pre-conceptional approach consisting of four counseling sessions and a family planning clinic visit [6]. A brief intervention protocol [7] and the CHOICES were adapted by the research team to design a brief intervention for implementation in public OB/GYN clinics in two regions in Russia. The objective of this study was to evaluate impact of the adapted protocol in reducing the risk for alcohol-exposed pregnancies (AEP) and alcohol consumption in general.