Lunch Sessions 11:45 Am to 12:45 M

Tuesday, January 30, 2017

A15-a. Developing a National Child Protection Policy in a Resource Constrained Context: Challenges and Process

Joan van Niekerk

Description

Information to come

A15-b. Child-Focused Joint Investigation of Child Abuse Cases: 20 Years' Experience in Hong Kong, Part 1

Kindy Yuk Ip Lam, Frances King Hei Lee, Nancy Ching Yee Chow, Sook Yee Chang-Lam

Description

With 20 years' effort, the Hong Kong model of joint investigation, interviewing protocol and witness support with an aim to balancing the legal justice and child's interests has developed a child-centered, multi-disciplinary and case manager approach successfully.

Learning Objectives

  1. To understand the background and practice of joint investigation of child abuse cases in Hong Kong.
  2. To learn the important ingredients of the good practice of joint investigation and video-recorded interviews with child witnesses in criminal proceedings.
  3. To understand the joint departmental training strategies on joint investigation and video-recorded interview.

Abstract

Hong Kong has been adopting a child-centred, multi-disciplinary and case manager approach to combat child abuse. In 1995, ordinances were amended to allow special measures to better protect children in criminal and court proceedings. For example, video-recorded interview with child witness are admissible to court for trial to replace the evidence-in-chief. Live TV link can be arranged for child witnesses to give evidence in court with the companion of a support person.

To enhance the protection of the child's interests during the investigation process, designated units in the Hong Kong Police Force have been set up while the manpower of specialized units in the Social Welfare Department have been strengthened. The police, government social workers, and, if applicable, clinical psychologists join hands in the investigation of serious cases such as intra-familial and organized sexual abuse cases and serious physical abuse cases for the whole process from receiving reports of child abuse to court proceedings. Video-recorded investigative interviews are also jointly conducted by trained police and government social worker/clinical psychologist according to the need of child witnesses, e.g. age, mental capability, etc.

With 20 years' effort, the Hong Kong model of joint investigation, interviewing protocol and witness support with an aim to balancing the legal justice and child's interests has been developed successfully. We would like to illustrate in this workshop our good practice using an intra-familial sexual abuse case. Strategies in joint departmental training for investigators and interviewers as well as for developing local trainers will also be highlighted. With the ever changing societal circumstances, new challenges in child protection, e.g. those being sexually exploited in compensated dating and production of indecent images, those with special needs and from different cultures, etc. will also be discussed.

Published Articles on Evidence-based Topics

  • Tsui, E., Lam, K. & Cheung, S.L. (2002, June). Investigative interviewing of child witness in Hong Kong: an Asian adaptation of British and American practice. Paper presented at the Investigative Psychology 7th International Conference, University of Liverpool, UK.
  • Chang Lam, S. Y. (2010, June). Understanding and handling child sexual abuse reports (in Chinese language). Presented and published in Ten-year Anniversary cum Academic Conference held by the Anti-Domestic Violence Network of the China Law Society, Beijing.
  • Cheung, K. M. (1997). Developing the interview protocol for video recorded child sexual abuse investigations: A training experience with police officers, social workers and clinical psychologists in Hong Kong. Child Abuse & Neglect, 21(3), 273–284.

A15-c. 10 Years of Advocacy on Child Abuse and Neglect by Chiild and Addolescent Psychiatrists

Marie-José van Hoof, Alfons Crijnen, Arielle de Ruiter

Description

Psychiatrists and the Dutch Knowledge Center advocated against abuse and neglect through research, a website for patients and professionals, presentations for professionals, and through advocacy at the political and legal arena.

Learning Objectives

  1. The importance of collaboration in the advocacy against child abuse and neglect.
  2. The role of child and adolescent psychiatrists in the prevention and treatment of abuse and neglect.
  3. Examples of different ways of successfully raising awareness by child psychiatrists for the prevention and treatment of abuse and neglect.

Abstract

An expert group of child and adolescent psychiatrists proactively advocated for reducing child abuse and neglect as well as for trauma treatment in close collaboration with the Dutch Knowledge Center for Child and Adolescent Psychiatry (http://www.kenniscentrum-kjp.nl) since 2007. The experts gathered all scientific, legal and practical information about prevention, diagnostic procedures, treatment, and the policies on child abuse and neglect, and made this knowledge base available to the general public as well as to their professional colleagues.
Advocacy addressed the following fields which will be discussed in the interactive session:

  • The Dutch Knowledge Center provides unique opportunities for the dissemination of information and the advocacy of child and adolescent psychiatry by engaging a broad network. Examples will be given about the collaboration with Dutch experts, about the opportunities for advocacy, and about the policies the Center uses to bring together the psychiatric professionals.
  • The experts increased professional and societal awareness by informing professionals in the legal, administrative and political field about consequences of legal procedures, and made a plea for finances for the prevention and treatment of abuse and neglect, etc.
  • The experts presented as a group on national and international psychiatric conferences about relevant topics concerning e.g. the primary prevention of abuse, screening for safety in families, attachment and trauma, etc.
  • With the influx of a large number of traumatized refugee children in recent years the importance of trauma-focused approach in the organization of mental health care for this specific population was advocated.

Published Articles on Evidence-based Topics

  • Hein, I. Children's competence to consent to medical treatment or research (Dissertation). Amsterdam University Press, Amsterdam (2015)
  • Mejdoubi J. et al. Effect of Nurse Home Visits vs. Usual Care on reducing intimate partner violence in young high-risk women: a randomized controlled trial. Plos One 2013: 8.10: e78185.
  • Mejdoubi J. et al. The effect of VoorZorg, the Dutch Nurse Family Partnership, on child maltreatment and development: a randomized controlled trial. Plos One, 2015: DOI 10.1371; e0120182.

A15-d. Age at Sexual Debut. Does It Matter?

Asa Kastbom

Description

The time for sexual debut matters. An early sexual debut (13 years or younger) is associated with risk behaviors and adolescents with a late sexual debut seem to live a more stable and cautious life than their peers with an early sex debut.

Learning Objectives

  1. Learn more about early sex debut.
  2. Learn more about late sex debut.
  3. Learn about association between abuse and time of sexual debut.

Abstract

Background: Empirical research about late sexual debut and its consequences is limited why further research is needed.

Objective: To explore how students who had not had intercourse by the age of 18 differed in terms of sociodemographic factors, physical and psychological health, sexual behavior and history of sexual abuse from those who had.

Study design and methodology: This is a cross-sectional survey involving 3,380 Swedish 18 year olds.
Descriptive analyses were used to investigate different types of sexual behavior. Ordinal data concerning alcohol consumption, self-esteem, sexual and physical abuse, parental relationships, sense of coherence and health were analyzed and multiple regression was carried out to identify the most important factors associated with no sexual debut.

Results: Just under a quarter of the adolescents had not had oral, anal or vaginal sex by the age of 18 and they comprised the index group. They were characterized by being more likely to have caring fathers, parents born outside Europe, lower pornography consumption, lower alcohol and tobacco consumption, less antisocial behavior and above all lower sexual desire (sometimes aOR=3.8, never/seldom aOR=13.3) and fewer experiences of sexual abuse (aOR=25.5). Family structure and culture matters when it comes to the age of sexual debut.

Conclusion: Adolescents with no sexual debut at 18 years of age seemed to live a more stable and
cautious life than more sexual experienced peers exemplified by fewer antisocial acts, less smoking and alcohol/drug consumption, less sexual desire and less experience of sexual abuse.

A15-e. The Value of Histology in Forensic Pediatric Pathology

Vidija Soerdjbalie-Maikoe

Description

Misinterpretation of an accessory suture as a fracture has significant implications. An accessory suture, a rare entity, might not be differentiated from a fracture only by radiology.

Learning Objectives

  1. Histology is an unavoidable necessity in forensic autopsy.
  2. Accessory skull suture is rarely and pose a diagnostic challenge in SUDI.
  3. Be aware of adverse consequences in case of misdiagnosis.

Abstract

Sudden Unexpected Death in Infancy (SUDI) is any infant death that is sudden, unexpected and initially unexplained [1]. SUDI is a diagnostic challenge for health care professionals, whereby a multidisciplinary approach is indicated. Post-mortem radiology is established as an important auxiliary tool within such an approach. It is therefore advised to perform a radiological skeletal survey in all deceased children younger than four years of age (2). In the presented case, an accessory suture of the parietal bone was initially interpreted as a fracture during post-mortem radiological survey. Since such a misdiagnosis has significant adverse consequences, any health care professional or forensic specialist dealing with paediatric mechanical trauma should be aware of the existence of such rare anomalies. This article provides information on the incidence, aetiology and diagnosis of accessory skull sutures. Accessory skull sutures are rarely encountered anomalies that may pose a diagnostic challenge, especially when encountered in the context of sudden unexpected death in infancy. Misinterpretation of an accessory suture as a fracture has significant implications for parents, caregivers and society. An accessory suture might not be differentiated from a fracture on the basis of radiological findings only. In forensic contexts, autopsy including histological analysis is an unavoidable necessity. In clinical contexts, a careful follow-up is indicated.

Published Articles on Evidence-based Topics

  • Could SJ. Sudden Unexpected death in infancy. Current Diagnostic Pathology 2001. 7(1).
  • Sudden unexpected death in infancy, a multi-agency protocol for care and investigation. The Royal College of Pathologists and The Royal College of Paediatrics and Child Health.

Wednesday, February 1, 2017

F15-a. Gender Differences in the PRevalence of Adverse Childhood Experiences and Health-Risk Behaviors in Adults

Maha Al Muneef

Description

Adverse Childhood Experiences (ACEs) have been found to be linked to health-risk behaviors in adulthood.

Learning Objectives

  1. To identify the gender differences in the prevalence of ACEs and health-risk behaviors among adults.

Abstract

Objectives: Adverse Childhood Experiences (ACEs) have been found to be linked to health-risk behaviors in adulthood. Nevertheless, little research has been conducted to explore gender differences in the prevalence of ACEs and health-risk behaviors. The aim of this study is to identify the gender differences in the prevalence of ACEs and health-risk behaviors among adults.

Methods: A cross-sectional, national survey utilizing Adverse Childhood Experiences International
Questionnaire (ACE-IQ), supported by a grant from King Abdullah International Medical Research Center (KAIMRC) was conducted in 13 regions of Saudi Arabia. Adults (N=10,156) aged ≥18 years were invited to participate. Chi-square analysis was undertaken to examine the relationship between gender and prevalence of ACEs.

Results: Participant's mean age 34.3±11.3 years, and 52% male. Thirty eight percent college educated,
employed (51%), and married (59%). Prevalence of neglect (41%), psychological abuse (19%), physical
abuse (13%), and sexual abuse (14%). Twenty percent reported no ACEs while 80% reported at least 1
ACE. Of these, 29% reported ≥4 ACEs. Exposure to ≥4 ACEs were found to be higher in males whereas
low scores of ACEs were found to be higher in females (p< 0.05). In terms of health-risk behaviors, males were more likely to smoke (57% vs. 17%, p< 0.05), drinking alcohol (12% vs. 5%, p< 0.05), using drugs (11% vs. 5%, p< 0.05), and had pre-marital sexual relationship (26% vs. 8%, p< 0.05).

Conclusions: Further research is needed to determine plausible pathways linking ACEs and health- risk behaviors among males.

Published Articles on Evidence-based Topics

  • Associations Between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood. Campbell JA, Walker RJ, Egede LE., Am J Prev Med. 2016 Mar;50(3):344-52.
  • Adverse childhood experiences among Hawai'i adults: Findings from the 2010 Behavioral Risk Factor Survey., Ye D, Reyes-Salvail F.. Hawaii J Med Public Health. 2014 Jun;73(6):181-90.
  • Adverse childhood experiences and adult smoking, Nebraska, 2011., Yeoman K, Safranek T, Buss B, Cadwell BL, Mannino D., Prev Chronic Dis. 2013 Sep 19;10:E159.

F15-b. Child-Focused Joint Investigation of Child Abuse Cases: 20 Years' Experience in Hong Kong, Part 2

Kindy Yuk Ip Lam, Frances King Hei Lee, Nancy Ching Yee Chow, Sook Yee Chang-Lam

Description

This workshop will illustrate our good practice using an intra-familial sexual abuse case. Strategies in joint departmental training for investigators and interviewers as well as for developing local trainers.

Learning Objectives

  1. To understand the background and practice of joint investigation of child abuse cases in Hong Kong.
  2. To learn the important ingredients of the good practice of joint investigation and video-recorded interviews with child witnesses in criminal proceedings.
  3. To understand the joint departmental training strategies on joint investigation and video-recorded interview.

Abstract

Hong Kong has been adopting a child-centred, multi-disciplinary and case manager approach to combat child abuse. In 1995, ordinances were amended to allow special measures to better protect children in criminal and court proceedings. For example, video-recorded interview with child witness are admissible to court for trial to replace the evidence-in-chief. Live TV link can be arranged for child witnesses to give evidence in court with the companion of a support person.

To enhance the protection of the child's interests during the investigation process, designated units in the Hong Kong Police Force have been set up while the manpower of specialized units in the Social Welfare Department have been strengthened. The police, government social workers, and, if applicable, clinical psychologists join hands in the investigation of serious cases such as intra-familial and organized sexual abuse cases and serious physical abuse cases for the whole process from receiving reports of child abuse to court proceedings. Video-recorded investigative interviews are also jointly conducted by trained police and government social worker / clinical psychologist according to the need of child witnesses, e.g. age, mental capability, etc.

With 20 years' effort, the Hong Kong model of joint investigation, interviewing protocol and witness support with an aim to balancing the legal justice and child's interests has been developed successfully. We would like to illustrate in this workshop our good practice using an intra-familial sexual abuse case. Strategies in joint departmental training for investigators and interviewers as well as for developing local trainers will also be highlighted. With the ever changing societal circumstances, new challenges in child protection, e.g. those being sexually exploited in compensated dating and production of indecent images, those with special needs and from different cultures, etc. will also be discussed.

Published Articles on Evidence-based Topics

  • Tsui, E., Lam, K. & Cheung, S.L. (2002, June). Investigative interviewing of child witness in Hong Kong: an Asian adaptation of British and American practice. Paper presented at the Investigative Psychology 7th International Conference, University of Liverpool, UK.
  • Chang Lam, S. Y. (2010, June). Understanding and handling child sexual abuse reports (in Chinese language). Presented and published in Ten-years Anniversary cum Academic Conference held by the Anti-Domestic Violence Network of the China Law Society, Beijing.
  • Cheung, K. M. (1997). Developing the interview protocol for video recorded child sexual abuse investigations: A training experience with police officers, social workers and clinical psychologists in Hong Kong. Child Abuse & Neglect, 21(3), 273–284.

F15-c. Restoring Safety and Harm

Maria Andrews, Paul Baeten

Description

Changing the way of thinking and acting on behalf of the attack of child abuse in the region of Haaglanden in the Netherlands.

Learning Objectives

  1. View on latest dutch research results on the approach of domestic violence and child abuse and neglect.
  2. First results of practical pilots.
  3. View on the follow up of a three year program.

Abstract

In the Netherlands, we are in the middle of a huge transformation in youth care. There are a lot of practical and political choices made and changes initiated. Some of us intent to use this period full of innovation to improve our interventions. And to do this in such a way that the quality of life of the children involved and the outcome of the efforts made by the professionals will show a rising curve.

To do so we will use the experience of the last years and enforce the lessons learnt over the years national and international. Another important guideline will be the conclusions and recommendations of recent research on the current daily practice.

We have already started several projects that should lead to the desired main goal; letting our interventions truly lead to the improvement of the well-being of the children concerned. To be successful in the next three years we want to combine these initiatives into one program, where practice and research will be bridged.

The frame work of this starting program is the following;

Safe Home Haaglanden is committed to safety and recovery of damage as a result of her intervention in families and households. Important research has been done and the outcome is not what we hoped that it would be. In cases of domestic violence we saw that the violence reduces but one and a half year after the first report, the violence appears not to have been stopped in too many cases. In cases of child abuse, research showed that the quality of life of the children involved had decreased one year after the first report was made. These findings force us to look for improvement of our system.

Besides the significant changes in findings there are also changes in vision and approach. In spite of a fresh
new law, there are ongoing discussions on mandatory reporting. For many years the Netherlands were known because of its medical model: the confidential doctors were responsible for the initial reception of reports of child abuse. They investigated the reports and headed families to the professionals who could offer them support, assistance en treatment. In 2000 the medical model was exchanged for the approach from the youth care.

In terms of partner violence the approach in recent years has changed dramatically. In cooperation with chain partners and municipalities the Safe Forward Teams were developed. Safe home Haaglanden provides an important contribution to this development. The GGD Den Haag initiates a lot of projects and monitors the results of each of them.
Concerning the approach to child abuse the results seems worse than those for partner violence. That leads to the awareness that we have to make dramatic improvements. Several impulses have been made. In 2015, we started with the following projects:

  • Pilot in which the possibilities are examined to arrive at so called routine outcome measurement: determination of the results of the approach on a child level. The behavioral experts of Safe Home are in consultation with the Trimbos Institute (research) and with the Augeo foundation started this pilot. The results and follow-up will be expected tob e clear in the first half of 2016.
  • Project Support in Education. In cooperation with schools, the Augeo Foundation and GGD Haaglanden Safe Home performs this project the aim of which is: every child going through drastic events at home, feels safe at school and knows that there is someone with whom he can turn to; -Encompass: a Project to start in 2016, also in collaboration with Augeo, educational partners and the police, focused on direct support to children who have witnessed domestic violence.
  • The Children Safe and Restored Program: a three-year program that will be the umbrella for all projects and research. In this program in cooperation with chain partners, municipalities and nationwide operating organizations a process will be developed that results in demonstrable security and recovery of children at the end of the interference of of Safe Home.

In this workshop we will discuss the research results that led to the understanding that change is needed and the first results of our practical efforts in 2016. And finally we will clarify the follow up of the program.

F15-d. Attachment, Trauma, Emotion Regulation in Child and Adolescent Psychiatry

Marie-José van Hoof

Description

Workshop on attachment- and trauma-informed diagnostics and treatment in youth care and child psychiatric settings.

Learning Objectives

  1. To increase awareness of the significance of the concepts of attachment, trauma and emotion regulation for child and parent well-being in the field of mental health and youth care.
  2. To update knowledge to the current state-of-the-art standard.
  3. To discuss different perspectives from diverse contexts on use of diagnostics and treatment.

Abstract

Context: The concepts of attachment, trauma and emotion regulation are partially overlapping, partially distinct. They are significant to the work of professionals in health and youth care, in particular child and adolescent psychiatrist. However, an integrated diagnostic and treatment approach and use of attachment and trauma-informed care in child psychiatry and the broader field of youth care is rare due to lack of knowledge about these concepts, diagnostics and treatment options.

Purpose: Therefore we present state of the art knowledge and experience regarding attachment, trauma and emotion regulation: its concepts, diagnostics and treatment options.

Desired outcomes: increased attention for an integrated attachment- and trauma-informed approach to care conceptualization and delivery and services.

Published Articles on Evidence-based Topics

  • Mejdoubi J., van den Heijkant SC, van Leerdam FJ, Heymans MW, Hirasing RA and Crijnen AA. Effect of Nurse Home Visits vs. Usual Care on reducing intimate partner violence in young high-risk women: a randomized controlled trial. Plos One 2013: 8.10: e78185 10.1371; e0120182.
  • Mejdoubi J. et al. The effect of VoorZorg, the Dutch Nurse Family Partnership, on child maltreatment and development: a randomized controlled trial. Plos One, 2015: DOI 10.1371; e0120182.
  • Riem, M.M.E., Alink, L.R.A., Out, D., Van Ijzendoorn, M.H., & Bakermans-Kranenburg, M.J. (2015). Beating the brain about abuse: Empirical and meta-analytic studies of the association between maltreatment and hippocampal volume across childhood and adolescence. Development and Psychopathology, 27, 507–520. Doi:10.1017/S0954579415000127.
  • Van Hoof MJ, van Lang NJA, Speekenbrink S, van Ijzendoorn MH and Vermeiren RRJM. Adult Attachment Interview differentiates adolescents with Childhood Sexual Abuse from those with clinical depression and non-clinical controls. Attachment & Human Development, 2015, 17(4), 354-375.

F15-e. Bullying and Cyberbullying in the Arab Region

Bernard Gerbaka

Description

Discussion of  emerging issues.

F15-f. Dental Health and Child Welfare Services, for the Child's Best Interest

Ingfrid Vaksdal Brattabø

Description

This presentation will give an insight of what and how the dental service can contribute in child protection issues.
Findings from a study conducted among dental personnel in Norway will be presented.

Learning Objectives

  1. Give an understanding of what and how dental health service can contribute in child protection.
  2. Reveal what makes dental personnel concerned for their patients and what triggers a report of concern.
  3. Highlight how cooperation between the services can strengthen child protection.

Abstract

Background:
One of the many challenges in regard to combat child-maltreatment is to identify the children at risk and those already being a victim. Dental personnel are in a unique position to detect child-maltreatment, as they treat most children on a regular basis. In Norway, do all children under the age of 19 have a statutory right to free and regular treatment at the public dental service. Further has Norwegian health personnel a mandatory obligation to report to child welfare services if they suspect child-maltreatment.

Purpose:
To present findings from a national study conducted among public dental health personnel in Norway, and give an insight of how the dental service can contribute in child protection issues.

The study aimed to assess dental personnel's experience with suspicion of child-maltreatment, reporting to and cooperation with the child welfare services.

Material and methods:
Cross-sectional study. An electronic questionnaire was sent to 1542 public dental hygienists and dentists in Norway.

Results:
77.8% (1200) of the dental personnel responded upon the survey. A total of 60.0 % reported to have filed a report of concern during their career, while 32.6% had suspected child-maltreatment but failed to report it to child welfare service.

Conclusions:
Dental service is an important contributor in child protection. Mandatory reporting is challenging, therefore a mutual cooperation between the services is recommended.

Desired outcomes:
Inspire to enhance multidisciplinary cooperation, by raising the knowledge on:
- What and how the dental service can contribute in child protection issues.
- How the child welfare service can contribute to increase dental personnel's reporting frequency.
- How both services actively can take use of each other.

Published Articles on Evidence-based Topics


Thursday, February 2, 2017

William Friedrich Memorial Luncheon and Lecture featuring Francien Lamers-Winkelman

 

Ellen Case, Francien Lamers-Winkelman

Description

The similarities and differences in sexual behavior of children, as observed by parents in the USA using the original Child Sexual Behavior Inventory (CSBI) and Dutch parents, using the Dutch CSBI  will be presented and discussed.

Learning Objectives

  1. To learn to be aware of cultural differences in sexual behaviors in children.
  2. To understand that "sexuality"depends on how people are familiar with their own body and non sexual body contact.
  3. To understand that it is possible that attitudes with regard to child sexual behaviors could have changed since 1997.

Abstract

The Child Sexual Behavior Inventory (CSBI; Friedrich, 1997) is a 38-item checklist designed to detect abnormal sexual behavior that can be an expression of sexual abuse in children aged 2 to 12. The Dutch translation of the CSBI was made available for professionals in 1998, with the permission of Bill Friedrich.

However, up till now, Dutch professionals were using the norms for American children. Nearly 20 years after the publication of the American Professional Manual of the CSBI (Friedrich, 1997), the Dutch Professional Manual has been published (Verlinden & Lamers-Winkelman, 2016).

Using data of 2853 Dutch children (the normative group), data of 491 sexually abused children, 177 children with functional abdominal pain, constipation or fecal incontinence (not sexually abused), and 224 children who were victims/witnesses of interparental violence (not sexually abused), we composed Dutch norms for the developmental Related Sexual Behavior Scale (DRSB) and the Sexual Abuse Specific Items Scale (SASI).

In this presentation we will present the Dutch CSBI, and especially discuss the (huge) differences and similarities between the sexual behavior as observed by the parents in the USA and the Netherlands.

Moreover, we will compare the Dutch and USA data with those collected in other European countries, and discuss whether the differences are due to a change in how people think about sexuality and especially sexuality in (young) children since 1997.

Published Articles on Evidence-based Topics

  • Visser, M., & Kim Schoemaker, K., de Schipper, K., Lamers-Winkelman, F., & Finkenauer, C. (2015; published online). Interparental Violence and the Mediating Role of Parental Availability in Children's Trauma Related Symptoms. Journ. Child. Adol. Trauma DOI 10.1007/s40653-015-0071-y
  • Snoeren, F., Hoefnagels, C., Evers, S.M.A.A., & Lamers-Winkelman, F. (2013). Design of a prospective study on mental health and quality of life of maltreated children (aged 5–16 years) after a report to an advice and reporting center on child abuse and neglect. BMC Public Health, 13, 942, http://www.biomedcentral.com/1471-2458/13/942
  • Rinne-Albers, M.A.W., Van der Wee, N.J.A., Lamers-Winkelman, F., & Vermeiren, R.J.M. (2013). Neuroimaging in children, adolescents and young adults with psychological trauma. European Child & Adolescent Psychiatry, 22(12), 745-755. DOI 10.1007/s00787-013-0410-1.

K15-a. Establishing Services for Complainants of Sexual Assault in the West Bank, State of Palestine: A United Nations Office on Drugs and Crime Project

Catherine White, David Wells

Description

A needs assessment and development of a service infrastructure to improve the medical and social interventions for complainants of sexual violence in the West Bank, State of Palestine.

Learning Objectives

  1. Discuss the current picture of sexual violence in the West Bank.
  2. Explore the process of building capacity of sexual violence services within the West Bank
  3. Explore the lessons learned in delivering training when trainees and trainers are from differen cultures.

Abstract

Responses to victims of sexual violence in the West Bank, State of Palestine have been under developed.  The United Nations Office on Drugs and Crime (UNODC), with financial support of Global Affairs Canada, is implementing the project entitled "Forensic Human Resource and Governance Development Assistance for the Palestinian Authority".

One aspect of this was to build the capacity of the forensic medical response available to victims of sexual violence in the West Bank. Working with local professionals, the UNODC team conducted a needs assessment, drew up an action plan, and commenced implementation.

This presentation will describe the journey so far including the production of a monograph for the forensic clinicians and the establishment of sexual assault clinics. Whilst some aspects of the project will be unique to the West Bank setting, many of the opportunities and challenges will be similar to those encountered when advancing medico-legal services in other settings including nations where violence may be endemic, there are economic barriers, religious and cultural divides and limited access or capacity of medical, policing and legal services. Forensic medicine and its practitioners have the potential to make significant contributions in this field.

K15-b. Preventative Work in the Area of Incest and Sexual Abuse

Silje Braastad, Sophie Hysing-Dahl

Description

Let's Talk About It": An educational program for elementary school aged children.

Learning Objectives

  1. The preventative benefits of early intervention.
  2. How to implement the educational program in practice.
  3. The pitfalls, challenges, and program evaluation.

Abstract

Abstract:
The Centre for Survivors of Incest and Sexual Abuse (SMISO Hordaland) is an organization that provides supportive counseling to survivors of incest and sexual abuse. Within its field, SMISO is also one of the leading agencies in Norway in conducting preventative work amongst school aged children.

Incest and sexual abuse are often rarely discussed issues, which in itself perpetuates the problem. Particularly in cases of incest, the perpetrator often relies on the secretive nature of the topic to facilitate the abuse. SMISO's intensions, therefore, are to empower children by providing a safe, professional and supportive forum where they are able to talk about topics that might otherwise be subjected to secrecy.

Since 2010 SMISO has successfully presented an educational program called, "Let's Talk About It" to Norwegian children between the ages of eleven and twelve (in the 6th grade).

Within a safe environment the educational program aims to:

  • Enhance children's knowledge about incest and sexual abuse.
  • Enhance their ability to recognize early signs of grooming and transboundary behavior,
  • Provide young children with the adequate skills to seek help if necessary.
  • Prevent transboundary behavior in adolescence

Description:

  • Based on an open-ended dialog between children and professionals.
  • Session duration: two hours.
  • Topics covered: positive/negative touch and emotions, good/bad secrets, the body, private parts and sexuality, incest and sexual abuse,,substance abuse, domestic violence, physical and mental illness, children's rights, criminal offences and safe caregivers.

K15-c. Detection of Child Abuse in Out-of-Hours Primary Care: To Screen or Not to Screen?

Maartje Schouten

Description

Child abuse is often unrecognized at Out-of-hours Primary Care locations (OPC). Screening instruments can assist physicians in recognizing child abuse at an early stage. The most efficient screening instrument for child abuse consists of two questions, with a high clinical applicability for physicians.

Learning Objectives

  1. The screening instrument SPUTOVAMO-R2 has a low detection rate of child abuse at the OPC, with a high false positive rate.
  2. The most efficient screening instrument for child abuse consists of two questions, with a high clinical applicability for physicians.

Abstract

Background: The primary aim of this study was to assess the diagnostic value of the screening instrument SPUTOVAMO-R2 (checklist) for child abuse for Out-of-hours Primary Care locations (OPC), by comparing the test outcome with information from Child Protection Services (CPS). The secondary aim was to determine if reducing the length of the checklist is possible without compromising the diagnostic value.

Methods: All children attending one of the five participating OPC's in the region of Utrecht, the Netherlands, in a year time, were included. The checklist is an obligatory field in the electronic patient file and was filled in for all children. CPS provided data on all checklist positives and a sample of 5500 checklist negatives (dataset). The test outcome was compared with a report to CPS in 10 months follow up after the OPC visit.

Results: The checklist was filled in for 50671 children; 108 (0.2%) were positive. Within the dataset,
emotional neglect was the most frequent type of abuse reported to CPS (32.8%). The Positive Predictive Value (PPV) of the checklist for child abuse was 8.3 (95% CI 3.9 to 15.2), with 9 correct positives. The Negative Predictive Value (NPV) was 99.1 (98.8 to 99.3), with 52 false negatives. When the length of the checklist was reduced to two questions of the original five questions (SPUTOVAMO-R3), the PPV increased to 9.1 (3.7 to 17.8) and the NPV remained 99.1 (98.7 to 99.3). These two questions are on the injury in relation to the history, and the interaction between and with parents/child.

Conclusions: The checklist has a low detection rate of child abuse, with a high false positive rate. The
checklist can be reduced to two questions with a high clinical applicability and comparable diagnostic
value (SPUTOVAMO-R3). When the checklist classifies positive, thorough diagnostic evaluation is

necessary to reduce the high number of false positive screens.

Published Articles on Evidence-based Topics

  • Louwers EC, Affourtit MJ, Moll HA, De Koning HJ, Korfage IJ. Screening for child abuse at emergency departments: a systematic review. Arch Dis Child 2010 Mar;95(3):214-8.
  • Louwers EC, Korfage IJ, Affourtit MJ, Ruige M, van den Elzen AP, De Koning HJ, et al. Accuracy of a screening instrument to identify potential child abuse in emergency departments. Child Abuse Negl 2014 Jul;38(7):1275-81.
  • Sittig JS. Child abuse: the value of systematic screening at Emergency Rooms. Ridderkerk: Ridderprint BV. 2015.

K15-d. Child and Murder, Part 1: Disclosure and Diagnosis

Alfons Crijnen

Description

Witnessing the murder of your parent—unthinkable, but it overcomes some children. Which response is to be expected? How will the child respond on treatment?

Learning Objectives

  1. To understand the emotional response with anxiety, anger and grief of children after intense trauma.
  2. To understand the medical interviewing techniques facilitating disclosure and emotional recognition and the therapeutic procedures and their impact on the child.
  3. To understand the key importance of mourning and how this is disturbed by the traumatic response.

Abstract

What if a child witnessed the murder of his parents? Is a child able to speak about it? What if the child doesn't tell you anything – did it really see nothing? What if the child shares his experience with you—is this really helpful or will this be counterproductive? What if the child dares to confront itself with the recollection in therapy?

At the moment itself or in the months following the murder, therapists are confronted with these and other questions. Feelings of intense anxiety and anger are in the way of sorrow and grief; recollections are so overwhelming that they can't be shared; the life of the child is disorganised and there is often disturbed mourning.

In the professional treatment of children who witnessed the murder of their parent the following issues are recognized: disclosure and recognition, the management of stress and intense emotions, the development of psychopathology, the impact on the family, therapeutic interventions and treatment, and finally mourning.

In the workshop video clips of interviews of two 4- and 10-year-old children by a police officer directly after the murder and by a child and adolescent psychiatrist seeing the children for diagnosis and treatment at three months and three years after the murder will be shown. Theory and practice will be brought together and guidelines for treatment provided.

Published Articles on Evidence-based Topics

  • Crijnen AAM & Kraan HF: The medical interview in mental health care: effects on the patient and the physician (1987).
  • Spuij, M., Deković, M., & Boelen, P. A. (2015). An open trial of "Grief-Help": A cognitive behavioural treatment for prolonged grief in children and adolescents. Clinical Psychology & Psychotherapy, 22, 185-192. doi: 10.1002/cpp.1877.
  • Van Denderen M, de Keijser M, Gerlsma J, Huisman M & Boelen PA.: Revenge and psychological adjustment after homicidal loss. Aggressive Behavior; 40: 504-511 (2014)..

K15-e. The Promise of Europe: Spreading and Promoting European Centers as in Children's Advocacy Centers adn Barnahus Model

Janet van Bavel

Description

An overview of the European project supporting the European Child-Friendly Centers as in the Barnahus Model and Chadwick Center. Involves the cooperation between European countries, inspired by Kempe, USA Child Advocacy Centers and Family Justice Centers. Also highlights of some developments within the Netherlands specifically.

Learning Objectives

  1. Highlights of European project supporting research, advocacy, training and implementing Child Friendly Centers throughout Europe.
  2. Highlights and challenges of Netherlands approaches in within this context.

Abstract

Workshop is about the progress of the in 2015 started European project called PROMISE, supporting Child Friendly Centers throughout Europe based on the BARNAHUS model. Involves cooperation between 24 European countries, inspired by both USA Child Advocacy Centers and Family Justice Centers.

Background: The Secretariat of the Council of the Baltic Sea States (CBSS) was awarded an European Union grant to conduct the project: PROMISE Promoting Multidisciplinary Interagency Services for Child Victims of Violence in 2015. The partnering countries of this project include Iceland, Sweden, Netherlands, United Kingdom, and Belgium. 12 Pilot Countries benefit directly within the project and 24 European States are involved and have access to deliverables such as the reports, scorecard, website and webinars. This workshop is to introduce to the audience the objectives, methodologies, and expected outcomes ofPROMISE.

Additionally, an update will be given on progress in the Netherlands National network of One Stop Shop Approaches in tackling Child Maltreatment and Domestic Violence, as started by signing the 2014 San Diego Declaration, combining forces and change Netherlands policy and care provisions to achieve a nationwide network.

Speaker is EU project leader at Verwey-Jonker Instituut, Netherlands and Service Exchange Coordinator within PROMISE; Promoting Multidisciplinary Interagency Services for Child Victims of Violence. He is also Chairman of the Board of NeSPCAN and Counsillor at ISPCAN.


Friday Plenary Sessions

P15-a. Association Between Sexual Abuse and Mental Health Disorger and Health Risk Behaviors in Adults

Sereen Al Madani, Maha Al Muneef, Hassan Saleheen, Nathalie Elchoueiry

Description

Examine the association between sexual abuse (one type of Adverse Childhood Experiences (ACE) among Saudi nationals and subsequent mental health disorders and risky behaviors.

Learning Objectives

  1. Sexual abuse association with risky health behaviors.
  2. Sexual abuse association with mental health.

Abstract

Back ground: Childhood sexual abuse can hinder normal social growth and be a cause of many different psychosocial problems. A number of studies have explored the relationship between childhood trauma and later health concerns. However, few researchers have explored this association among Saudi Arabian adults.

Objective: to examine the association between sexual abuse (one type of Adverse Childhood Experiences
(ACE) among Saudi nationals and subsequent mental health disorders and risky behaviors. Methods: In 2013, a cross-sectional study, supported by a grant from King Abdullah International Medical Research Center was conducted among 10,156 adults ≤18 years in 13 regions across KSA using a modified Arabic version of the World Health Organization-ACE-International Questionnaire (ACE-IQ). This tool has been widely used across many countries and in KSA (unpublished data). Adjusted odds ratios (OR) and chi-square analysis were calculated to assess the relationship between sexual abuse, mental health and risky behaviors.

Results: The results revealed a strong association between overall ACE, mental health and risky behaviors. People reporting 4 or more adverse childhood experiences were significantly more likely to complain of mental health disorders and health risk behaviors. The total number of respondents in this study was 10156. 12% (1218) of the participants reported being exposed to sexual abuse in their childhood, with a mean age of 33.7±10.9 years. The majority (61%) were males, employed (53%), and married (54%) and 31% were college educated. Compared to non-sexually abused, people who had a history of sexual abuse were more likely to have depression (OR=2.5), anxiety (OR=2.0) and mental illness (OR=3.6). Sexually abused people were also more likely to become smokers (OR=1.8), addicted to alcohol (OR=4.8) and drug addicts (OR=5.4).

Conclusion: To prevent mental health disorder and health risk behaviors among adults in Saudi Arabia, more attention is needed to prevent child sexual abuse.

P15-b. Project on the Use of Investigative Interviews in Cases of Child Sexual Abuse

María Paz Rutte, Maurizio Sovino

Description

Given the lack of regulations in Chile and the need for the use of investigative interviews, Fundación Amparo y Justicia, in collaboration with the Prosecutor's Office, has designed a pilot project in cases of child sexual abuse.

Learning Objectives

  1. Learn about the design of public policies in this field.
  2. Provide a model that can be replicated not only domestically, but internationally (essentially in other Latin American countries given our shared legal traditions).

P15-c. "Let Me Help You Help Me" Dealing With People With a Learning Disability ina Sexual Assault

Therese Kvist

Description

Improving the screening and identification of people with a learning disability and subsequent communication and management of this vulnerable group by staff dealing with victims of sexual violence.

Learning Objectives

  1. Improve the screening and identification of people with learning disability including assessment of capacity.
  2. Discuss how to improve communication, both face to face and other media e.g. leaflets and website.
  3. Explore how to tailor services to maximise accessibility and acceptability for those with learning disabilities.

Abstract

A routine case review at St Mary's Sexual Assault Referral Centre, Manchester, UK, indicated that there was room for improvement in services provided for sexual violence victims with a learning disability (LD).  A subsequent audit and staff survey revealed that the identification of people with LD was not consistent and staff often lacked confidence in communicating with this group. Moreover the take up of follow on services for those with LD was much lower than for patients without LD. The presentation will explore how the St Mary's team, working in collaboration with people with LD, sought to address these issues including how to improve the screening and identification, communication and management of those with LD.

P15-d. An Oral Health Perspective on Child Maltreatment

Catherine White

Description

To prevent poor oral health, early detection of dental disease and adequate support are essential. Also, early detection of child maltreatment is essential to protect children from harm.

Learning Objectives

  1. Dental neglect is a form of child maltreatment that is important to consider in child protection and child welfare.
  2. Collaboration and educational approaches between dental health services and child welfare is essential.
  3. Dental professionals must assess social factors when dental disease and/or attendance behaviors are not explained by other reasonable causes.

Abstract

Children who are exposed to child maltreatment are at risk of developing physical and mental ill-health and of expressing risk-taking behaviors. In addition these children are likely to have neglected dentitions, dental health service avoidance as well as head and neck injuries and intra- oral injuries. To prevent poor oral health, early detection of dental disease and adequate support are essential. Also, early detection of child maltreatment is essential to protect children from harm.

Purpose: To present how oral health and use of dental health service can indicate broader family dysfunction or child maltreatment and to provide clinical recommendations for how to manage a suspicion.

Desired outcomes: To understand how social factors affect children's oral health and why dental professionals are important to incorporate in child welfare and child protection.

Published Articles on Evidence-based Topics

  • Kvist T, Annerbäck EM, Sahlqvist L, Flodmark O, Dahllöf G. Association between adolescents' self-perceived oral health and self-reported experiences of abuse. Eur J Oral Sci 2013; 121: 594–599.
  • Kvist T, Wickström A, Miglis I, Dahllöf G. The dilemma of reporting child maltreatment in pediatric dentistry. Eur J Oral Sci 2014; 122: 332–338.
  • Kvist T, Cocozza M, Annerbäck EM, Dahllöf G. Child maltreatment- prevalence and characteristics of mandatory reports from dental professionals to the Social Services. Int J Paediatr Dent 2016; DOI: 10.1111/ipd.12230.

P15-e. Child and Murder, Part 2: Treatment

Alfons Crijnen

Description

Witnessing the murder of your parent – unthinkable, but it overcomes some children. Which response is to be expected? How will the child respond on treatment?

Learning Objectives

  1. To understand the emotional response with anxiety, anger and grief of children after intense trauma.
  2. To understand the medical interviewing techniques facilitating disclosure and emotional recognition and the therapeutic procedures and their impact on the child.
  3. To understand the key importance of mourning and how this is disturbed by the traumatic response.

Abstract

What if a child witnessed the murder of his parents? Is a child able to speak about it? What if the child doesn't tell you anything—did it really see nothing? What if the child shares his experience with you—is this really helpful or will this be counterproductive? What if the child dares to confront itself with the recollection in therapy?

At the moment itself or in the months following the murder, therapists are confronted with these and other questions. Feelings of intense anxiety and anger are in the way of sorrow and grief; recollections are so overwhelming that they can't be shared; the life of the child is disorganised and there is often disturbed mourning.

In the professional treatment of children who witnessed the murder of their parent the following issues are recognized: disclosure and recognition, the management of stress and intense emotions, the development of psychopathology, the impact on the family, therapeutic interventions and treatment, and finally mourning.

In the workshop video clips of interviews of two 4- and 10-year-old children by a police officer directly after the murder and by a child and adolescent psychiatrist seeing the children for diagnosis and treatment at three months and three years after the murder will be shown. Theory and practice will be brought together and guidelines for treatment provided.

Published Articles on Evidence-based Topics

  • Crijnen AAM & Kraan HF: The medical interview in mental health care: effects on the patient and the physician (1987).
  • Spuij, M., Deković, M., & Boelen, P. A. (2015). An open trial of "Grief-Help": A cognitive behavioural treatment for prolonged grief in children and adolescents. Clinical Psychology & Psychotherapy, 22, 185-192. doi: 10.1002/cpp.1877.
  • Van Denderen M, de Keijser M, Gerlsma J, Huisman M & Boelen PA.: Revenge and psychological adjustment after homicidal loss. Aggressive Behavior; 40: 504-511 (2014).

 


top