Amand, A., Bard, D., & Silovsky, J. (2008). Meta-analysis of treatment for child sexual behavior problems: Practice elements and outcomes. Child Maltreatment, 13(2), 145-166.
This study, conducted by researchers at Laval University in Quebec and the University of Oklahoma Health Sciences Centre in Oklahoma, looked at the outcomes of treatments given to Canadian and American children between the ages of 3 and 12 with sexual behaviour problems (SBP). This study represents the only known attempt to examine the impact of sexual behaviour problems at the level of practice elements.1 The researchers used a mixed linear model meta-analysis to review 11 treatment outcome studies exploring the relationship among child characteristics, treatment characteristics and short-term outcomes (i.e. change in sexual behaviour problems and general behaviour problems).
Results showed that both SBP-focused and trauma-focused interventions reduced SBP. The caregiver practice element 'Parenting/Behaviour Management Skills' was by far the practice element most strongly associated with reduced sexual behaviour problems. Other significant practice elements were:
- three other parent elements (Rules about Sexual Behaviour, Sex Education, and Abuse Prevention Skills),
- one child element (Self-Control Skills),
- family involvement, and
- preschool-age group.
The results call into question the validity of the current clinical approach of using practice elements originally designed for adolescent or adult sexual offenders (child components of relapse prevention, assault cycle, and arousal reconditioning) to treat SBP in children. Only two of the tested treatments included these practice elements, and the elements were not significant predictors of the effect size for SBP.
Limitations of the meta-analysis included the limited number of treatment outcome studies that met the criteria for inclusion, and the quality of these studies: few randomized clinical trials have been conducted in SBP treatment. In addition, because of the small number of treatment groups identified, the analysis collapsed or aggregated some covariates. The scope of the search strategy
and the rigour of the screening methods were less than optimal, possibly
introducing bias into the review. Generalizing these results to all future SBP trials should be done with caution.
1. A practice element can be defined as a discrete clinical technique or strategy used as part of a larger intervention.
Gonzalez , M., Durrant, J., Chabot, M., Trocmé, N., & Brown, J. (2008). What predicts injury from physical punishment? A test of the typologies of violence hypothesis. Child Abuse & Neglect, 32, 752-765.
In this study, researchers from the University of Manitoba, McGill University, and the University of Western Ontario looked at extent to which injuries to children in cases of reported child physical abuse could be predicted by characteristics of the children, the characteristics of the perpetrators, or their socio-economic characteristics. The study tested the assumption that physically injurious incidents of child physical abuse are qualitatively different from those that do not result in injury. Working with a Canadian Incidence Study data set of 8,164 substantiated cases of physical maltreatment by at least one birth parent in which an investigative case worker deemed there had been inappropriate punishment, the researchers constructed various models to try to predict injury. Injury was initially recorded as physical harm in various categories but, because there were relatively few injuries, this study only looked at predicting whether a child had been injured (i.e., type of injury could not be predicted).
Results showed more than half of the abuse incidents did not result in physical injury to the child, and that none of the potential predictors (child age, gender of perpetrator, child functioning, parent functioning, economic stress and social stress) predicted injury to the child. The findings suggest that injurious physical abuse cannot be distinguished from non-injurious physical abuse on the basis of the personal characteristics or circumstances of the child or the perpetrator.
Practice implications: Child welfare workers are often called upon to predict whether a child is at risk of injury when making decisions as to whether to intervene in situations of potential maltreatment. The findings of this study suggest that in substantiated cases of parental abuse in the context of punishment, injury cannot be predicted by many of the factors that child welfare workers take into consideration, such as the physical vulnerability of the child, the psychological functioning of the child or parent, or by social stress. This suggests that the prediction of injury using these simple factors as an intervention criterion may have questionable validity.
Laporte, Lise (2007). Un défi de taille pour les centres jeunesse. Intervenir auprès des parents ayant un trouble de personnalité limite. Santé mentale au Québec, 32(2), 97-114.
An explanatory survey conducted among 68 child welfare workers of the Montreal Youth Centre - Research Institute reveals that 39% of the 1030 children in their charge have at least one parent suffering from a mental health problem. Among these parents, 48% of mothers and 30% of fathers have a personality disorder, the majority of them suffering from a borderline personality disorder. This problem is of a strong concern because of its magnitude, its impact on children and workers, and the difficulties to intervene on parents in the context of authority and among an improperly adapted organization. A few benchmarks are presented to guide such intervention as well as future challenges and implications.