The consortium Early Prevention of Child Abuse aims to improve the early prevention of child abuse. The studies focus on both the improved guiding of families towards appropriate interventions and the greater effectiveness of those interventions.
The detection, risk estimation and determination of the care requirements of families in which child abuse is occurring, are not adequate enough, states Claudia van der Put. As a remeidal educationalist and researcher in forensic child and youth care at the University of Amsterdam, she leads the consortium Early Prevention of Child Abuse. ‘For example, too few reports are made to Veilig Thuis (Dutch Domestic Violence, Child Abuse & Elderly Abuse Hotline) and families who need help do not receive the right treatment. We want to improve both aspects.’
The researchers first of all carried out a meta-analysis into the effectiveness of internationally used interventions for supervising families with a risk of child abuse. This revealed four effective elements: stress reduction, increasing the self-confidence of parents, learning to regulate anger better and treating trauma-related symptoms. Together with professional practitioners, the researchers incorporated these elements into four modules.
Trained nurses now use the modules in their interventions for parents among whom there is a risk of child abuse. They apply these in two interventions with proven effectiveness: Stevig Ouderschap [Robust Parenting] and VoorZorg [Preventative Care]. Both of these interventions coach parents during home visits. But Stevig Ouderschap focuses on a broad group of parents and supervises them from the birth of their child or, ideally, already during the pregnancy, over a total of 6 to 14 home visits. The VoorZorg nurses frequently work with young mothers who have received little education, and who have to cope with an accumulation of psychosocial risk factors. They supervise them from the pregnancy up until two years after the birth of their first child.
With the four new modules, the nurses who supervise the families can apply the latest scientific insights in practice.
Merian Bouwmeester developed Stevig Ouderschap and works together with several colleagues at the Netherlands Centre for Youth Healthcare (NCJ) for the broader application of this intervention. The intervention is currently used by about 400 intervention nurses throughout the Netherlands. About 100 of them are trained in the use of the four new modules, says Bouwmeester. The intervention nurses like working with the modules and are pleased that, as a result of this, they can apply the latest insights into their professional practice. In turn, Bouwmeester is happy to be able to further develop Stevig Ouderschap.
Parents also respond positively to the modules, says Bouwmeester. ‘They find completing the questionnaires a worthwhile way of reflecting on their parenting.’ ‘But we cannot yet say whether the modules will definitely be included in the interventions’, says Van der Put. ‘We are still working on the data analysis and are measuring the entire package. By using various outcome measures, we can establish a relationship with the different elements. We can determine, for example, whether parents’ stress decreases or their feelings of competence increase.’
Researchers also approached parents, young people (14 to 21 years) and professionals via the institutions involved in the research, to ask them what they think can help to prevent child abuse. Van der Put thinks that their answers provide important information for policymakers, for example. ‘The young people thought that interventions should not only be aimed at parents but also at the children. Because, they said, if children are better equipped to deal with the situation, then they can raise the alarm and prevent child abuse.’ These young respondents most often mentioned awareness programmes at school as useful interventions. Parents also considered such programmes to be important. Both parents and their children felt that the detection of risk situations for abuse could be improved.
Young people say that interventions should not only be aimed at parents but also at their children.
In the Netherlands, there are various awareness programmes about child abuse, says Van der Put. As examples, she lists the special project on child abuse from Klokhuis (Dutch children’s television programme), the Safe you/safe me safety package, Schildje and programmes such as Marietje Kessels. The programmes explain what child abuse is, what children’s rights are, how children can better protect themselves and how they can identify a confidential counsellor. However, phone calls from the researchers to almost one hundred schools revealed that only one school uses such a programme.
‘Only a few Dutch programmes have been investigated for effectiveness’, says Van der Put. ‘An international meta-analysis by our researchers did, however, reveal that such programmes are effective. In particular, strengthening the socio-emotional skills, teaching childer that abuse is not their own fault and increasing their self-confidence, work well. Young people consider such programmes to be important, we know that they often work well, they are available, but they are not used.’
The researchers analysed data from various consortium partners, which were collected from parents and their children, to obtain more knowledge about what works for whom and why. They examined, for example, data from foster children, perpetrators of domestic violence, and children who had experienced neglect or abuse. Through innovative research techniques, including network analyses, they obtained more insight into how risk factors are correlated with each other, influence each other and what the most crucial risk factors are. ‘The idea is that if you can influence such a key factor, you can also influence other factors’, explains van der Put.
The consortium is still conducting a pilot into improving the decision-making process in the case of suspected child abuse. For this, the researchers are using a validated instrument: Actuarial Risk Taxation Instrument Youth Protection (Dutch: Actuarieel Risicotaxatie Instrument Jeugdbescherming - acronym ARIJ). Van der Put: ‘ARIJ is part of the selection tool and the decision-making model in the support package (the Risk-Needs-Responsivity model) that we are testing. In the selection tool, the professional can, amongst other things, click on the most urgent problems in the family, for example, a problematic partner relationship in combination with the internalisation of problems by the child, and financial difficulties. Subsequently, the tool provides the professional with an overview of all interventions that focus on those problems.’
Finally, the consortium is investigating the long-term effects of preventative interventions. For this, they are linking previously collected data from an impact study to data from Statistics Netherlands. This allows them to investigate different outcomes from the entire research group. ‘For example, we are examining the youth protection measures deployed, preventative help and reports of child abuse,’ explains Van der Put. She concludes: ‘All our subprojects are therefore aimed at increasing knowledge about what works for whom and why. That will enable the professional to deploy appropriate interventions even more effectively.’
In the consortia Effectiveness of Psychosocial Interventions Youth, researchers and youth care organisations are exploring new possibilities for seven larger substantive themes related to growing up and parenting. The research provides knowledge about which (aspects of) interventions can best be used when, for who and by which persons. The key elements of interventions with proven effectiveness are the starting point for these interventions. Through innovative impact studies, the consortia provide answers to questions such as: What actually makes an intervention effective? Are there effective factors that can be found in all interventions? How can the care provider exert an influence on the impact? And: which interventions or aspects of these are cost-effective? Realising impact studies in an appropriate form is a challenge. Each consortium takes a different approach, but they work together to ensure that their approaches are well aligned with each other. The research from the consortia must improve the interventions and enable professionals and municipalities to choose an effective approach. The outcomes will make it possible to improve the effectiveness of professional practice and provide better help to children and families.
The consortia Effectiveness of Psychosocial Interventions Youth are working on these seven themes:
In the consortia, key elements of interventions will be investigated. But what exactly are those key elements? Key elements are the things that a care provider can do to teach desired behaviour to young people or their parents, guardians or carers. Or to diminish undesirable behaviour. This is given various names in the literature (e.g. components, elements, ingredients, kernels and techniques). We have chosen the term “key element” because this is used by most of the consortia and ties in well with the literature. As it is often not yet clear whether the element actually works, we ought to use the term “potentially effective key elements”. However, that is quite a mouthful. A collection of these key elements defines an intervention. Structural elements also play a role in defining an intervention. For example, the sequence, frequency and intensity of the key elements involved.
The aim of the consortium is to increase the effectiveness of early help in the case of (risks of) child abuse. Seven sub-studies must provide the necessary knowledge for this. In the first sub-study, the researchers will examine how the detection of child abuse by schools, GPs, mental healthcare services for adults and for children and young people (Dutch abbreviations GGZ and JGZ) can be improved and how the awareness programmes for children and young people at school can be improved. Sub-study 2 focuses on the effectiveness of applying the Risk-Needs-Responsivity (RNR) model and preventative child and youth support. In sub-study 3, the researchers are analysing existing datasets about the long-term effect of several interventions. In sub-study 4, they are using diverse ROM data to investigate what works for whom and under which circumstances. The fifth sub-study consists of an extensive meta-analysis into effective elements. After that, in sub-study 6, several of these elements will be assessed in a series of experiments (microtrials). With the help of the findings of these six sub-studies, the researchers will develop a selection tool in sub-study 7. This is an instrument to help professionals choose which interventions they can best deploy in a given situation.
The research results will provide various groups of professionals with tangible starting points and suggestions for the better detection of (the risk of) child abuse and for improving the awareness programmes at schools. They will be given the tools they need to be able to apply the RNR model in child and youth support. It is expected that with these tools, professionals will be able to better prevent child abuse and the removal of children and young people from their family because they can better estimate the risks, identify the most urgent risk factors and select appropriate interventions. The professionals will also acquire more knowledge about the long-term effects of interventions and about the “five W’s”: What Works When for Whom and Why. The development of widely deployable modules is expected to improve both the effectiveness and efficiency of interventions. With the selection tool, professionals will be able to quickly determine which intervention they can best use when, and what its effective elements are.
Text Veronique Huijbregts. Translation Dave Thomas. Portrait Merian Sannaz Moghaddam. Photography header Studio Oostrum.