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- Engstrom, Maria
(författare)
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BarnSäkert : Studies of the Safe Environment for Every Kid model in the Swedish Child Health Services for early identification of psychosocial risk factors in the home environment of young children
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psychosocial risk factors in the home environment may impair children’s health and development and increase the risk of child maltreatment. The Swedish child health services (CHS), provide health-promoting and primary preventive services for all children 0-6 years of age. However, the national CHS lack evidence-based tools to universally screen for the most common psychosocial risk factors. The Safe Environment for Every Kid (SEEK) model provides a method for identifying children who live in families with economic worries, depressive symptoms, parental stress, intimate partner violence (IPV) and alcohol misuse in order to offer relevant support and assistance to the family. The overarching aim of this thesis was to assess validity, clinical utility and outcomes of the Safe Environment for Every Kid model when applied in the Swedish Child Health Services setting. The SEEK model has been tested in a cluster randomized controlled trial within the CHS in the county of Dalarna. Studies I and II examined CHS nurses’ perception of their routine assessment of psychosocial risk factors in the family environment as well as their self-reported competence and the present organizational conditions in this context. Both studies used the same mixed method design, including surveys and focus group interviews. Study II analyzed the experiences of CHS nurses using the SEEK model in contrast to those using current standard practice. CHS nurses had extensive experience in dealing with the targeted risk factors, but using the SEEK model strengthened their sense of competence in identifying and responding to the needs of families with such problems. Using the SEEK model seems to have narrowed the gap between the nurses’ perception that it is both important and suitable to address psychosocial risk factors within the CHS and their previously limited ability to do so. Study III evaluated the psychometric properties of the Swedish version of the Parent Screening Questionnaire (PSQ-S) using data from surveys answered by parents (n=611). The PSQ-S was compared to standardized instruments for the targeted psychosocial risk factors. The PSQ-S showed a sensitivity of 93%, specificity of 52% and a positive and negative predictive values of 67% and 87%, respectively. Study IV examined the self-reported rates of the targeted risk factors among parents who completed the PSQ-S at age-specific CHS visits during the intervention period. A total of 7483 PSQ-S were analysed. Over half of the PSQ-S had a positive screen for at least one risk factor. The problems were common throughout the child’s first five years of life and were about as common among mothers and fathers. The proportion of PSQ-S with a positive screen decreased significantly from the beginning to the end of the intervention.The results suggest that the SEEK model, as applied in these studies, shows a high degree of validity and clinical utility in the CHS setting. The experience of SEEK nurses showed that the model was helpful in their daily work. There is room for improvement with respect to sensitivity regarding IPV and how the nurses address parents with alcohol misuse. Many parents were willing to disclose the targeted risk factors in the context of the CHS visits and use of the SEEK model likely provided opportunities for assistance that may otherwise have been missed.
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| 2. |
- Engström, Maria, et al.
(författare)
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Validation of the Swedish Version of the Safe Environment for Every Kid (SEEK) Parent Screening Questionnaire
- 2023
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Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPsychosocial risk factors in the home may impair children’s health and development and increase their risk of maltreatment. The Safe Environment for Every Kid (SEEK) model helps address these problems, and aims to strengthen families, support parents and parenting, and thereby promote children’s health, development, wellbeing and safety. The SEEK model includes use of the Parent Screening Questionnaire (SEEK-PSQ) at routine preventive child health visits, assessment of their responses and, when indicated, referral to relevant services. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the SEEK-PSQ (PSQ-S). MethodsThis study is part of a cluster-randomised controlled trial of SEEK in the Swedish child health services. To validate the PSQ-S, parents (n=852) with children 0-18 months of age were invited to complete a survey comprising the PSQ-S as well as evidence-based standardized instruments for the targeted psychosocial risk factors. Data from 611 (72%) parents were analysed regarding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each risk factor.ResultsAs a whole, the PSQ-S had a sensitivity of 93%, specificity of 52%, PPV of 67% and NPV of 87%. For mothers and fathers combined, sensitivity was 80% for economic worries, 89% for depressive symptoms, 78% for parental stress, 47% for intimate partner violence (IPV) and 70% for alcohol misuse. Specificity was highest for IPV and alcohol misuse (91%) and lowest for depressive symptoms (64%). NPV values were high (81-99%) and PPV values were low to moderate (22-69%) for the targeted problems. Sensitivity was higher for mothers compared to fathers for economic worries, depressive symptoms and IPV. This difference was particularly evident for IPV (52% for mothers, 27% for fathers). ConclusionThe SEEK-PSQ-S demonstrated good psychometric properties for identifying economic worries, depressive symptoms, parental stress and alcohol misuse but low sensitivity for IPV. The PSQ-S as a whole showed high sensitivity and NPV, indicating that most parents with or without the targeted psychosocial risk factors were correctly identified.Trial registrationISRCTN registry, study record 14429952 (https://doi.org/10.1186/ISRCTN14429952)Registration date 27/05/2020.
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| 3. |
- Tindberg, Ylva, et al.
(författare)
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Unintentional Injuries Are Associated with Self-Reported Child Maltreatment among Swedish Adolescents
- 2023
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:7
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Tidskriftsartikel (refereegranskat)abstract
- Injuries constitute a large share of childhood morbidity and mortality. This study examines whether adolescents with self-reported experiences of different types of child maltreatment more frequently reported unintentional injury events requiring health- or dental care during the last year and/or hospitalization at any time during childhood. Cross-sectional data from a Swedish national representative school survey (2016) including 4741 adolescents were used (78.5% response rate). Data were analyzed with univariate tests and multiple logistic regression. Statistically significant associations between reported experiences of physical, psychological and sexual abuse, neglect, and witnessing partner violence during childhood and reported unintentional injuries requiring health- or dental care during the last year were found (aOR:s between 1.39-1.77). The corresponding association for poly-victimization was aOR 1.91 (95% CI 1.39-2.62). Furthermore, a linear-by-linear association was seen for degree of victimization and number of episodes of unintentional injuries that required care in the last year (p = 0.000), as well as lifetime hospitalizations (p = 0.000). This study shows significant associations between child maltreatment and unintentional injuries requiring health- and/or dental care and hospitalization. To improve both injury and child maltreatment prevention, healthcare professionals need to pay particular attention to children and adolescents who repeatedly seek healthcare services due to injurious events.
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| 4. |
- Almén Uvnäs, Ingrid, et al.
(författare)
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Fortsatta brister i ST-läkares utbildning om barn som far illa : »Socialpediatrik, barn som far illa« bör vara ett separat delmål i ST-utbildning i pediatrik
- 2022
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Ingår i: Läkartidningen. - : Läkartidningen Förlag. - 0023-7205 .- 1652-7518. ; 119
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Tidskriftsartikel (refereegranskat)abstract
- Great need of improved training of paediatricians on children at risk of abuseIn 2009 the Swedish Paediatric Society carried out a national survey that examined the training of paediatric specialty registrars concerning child abuse and neglect. The survey was repeated in 2016. Both surveys highlighted considerable deficits. In 2020 a slightly revised version of the original survey was sent to training leads for paediatrics and paediatric surgery in Sweden. The results showed that most paediatric specialty registrars received their clinical training in social paediatrics with actual patients. Most of the clinics cooperated with a Children's Advocacy Centre (»Barnahus« in Swedish) and some were situated in an area with a Child Protection Team. Similar results were obtained for specialty registrars in paediatric surgery. Our survey shows that the training has partly improved and that university hospital clinics perform better than other paediatric clinics. Major educational investments are needed to obtain an equivalent education throughout the country.
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| 5. |
- Jernbro, Carolina, 1976-, et al.
(författare)
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High risk of severe child abuse and poly-victimisation in families with parental substance misuse : results from a swedish school-based survey
- 2022
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Ingår i: Child Abuse Review. - : John Wiley & Sons. - 0952-9136 .- 1099-0852. ; 31:3
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Tidskriftsartikel (refereegranskat)abstract
- Child abuse is a widespread public health problem, potentially leading to long-term consequences for the exposed individuals and society. By learning more about the major risk factors, child abuse can be prevented. The objective of this study was to examine the pattern and severity of maltreatment in adolescents reporting parental alcohol and/or other drug problems. Cross-sectional data from a Swedish national school survey including 4,741 pupils (15- and 17-year-olds) conducted in 2016 were analysed using univariate tests (chi-squared) and binomial logistic regression models. Results showed that parental alcohol or other drug misuse, reported by the adolescents, was significantly associated with all types of child maltreatment. There was a particularly increased risk of severe child abuse, including witnessing recurrent physical intimate partner violence (adjusted odds ratio (adj. OR) 11.01; confidence interval (CI) 6.61-18.35) and poly-victimisation (adj. OR 7.82; CI 5.50-11.13), in families with parental alcohol and/or other drug problems compared to families without these problems. These results call for preventive measures, such as restrictive alcohol and drug policies, and early recognition of alcohol or other drug misuse among parents. In addition, professionals working with children and with substance-using parents need to identify and support these children.
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| 6. |
- Lucas, Steven, 1965-, et al.
(författare)
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Childhood exposure to physical and emotional violence over a 57-year period in Sweden
- 2022
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 50:8, s. 1172-1178
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of the present study was to examine the prevalence of childhood experiences of physical violence (CPV) and emotional violence (CEV) at the hands of parents over a 57-year period among adults born between 1937 and 1993.Methods: In 2012, a survey among women and men aged 18–74 years in Sweden was undertaken to examine the lifetime prevalence of physical, psychological and sexual violence and associations with current health in adulthood. Questionnaires were based on the Adverse Childhood Experiences study and a previous national survey of violence exposure. Descriptive statistics were used to analyse the frequency of exposure to CPV and CEV, and changes over time were analysed using analysis of variance and logistic regression.Results: A total of 10,337 individuals participated (response rates: 56% for women and 48% for men). CPV decreased significantly over the time period studied, particularly for those born after 1983. This decrease was more evident for male respondents. Throughout the time period studied, the proportion of women reporting CEV was higher than for men. Among both genders there was a steady rise in CEV rates from those born in the late 1930s to those born in the mid-1980s, after which there was a decline that was more marked for men.Conclusions: A significant group of children in Sweden experience violence at the hands of parents. However, our data corroborate previous national studies that children’s exposure to violence has decreased. Clear gender differences indicate that these changes have affected girls and boys differently.
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| 7. |
- Haque, Md Atiqul, et al.
(författare)
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Children's exposure to psychological abuse and neglect : A population-based study in rural Bangladesh
- 2021
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:1, s. 257-264
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Tidskriftsartikel (refereegranskat)abstract
- Aim: We aimed to estimate the prevalence and risk factors of child psychological abuse and neglect in a rural area of Bangladesh.Methods: Data were obtained from interviewing 1416 children aged 11-17 years administering the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool for Children between March and April 2017. Linear regression analysis was used to estimate the risks of child psychological abuse and neglect.Results: The prevalence rates of at least one form of psychological abuse both in the past year and lifetime were more than 97 per cent. Moreover, the rates of at least one form of neglect were about 58 per cent during the past year and 78 per cent over lifetime. Living separately from parents posed children to significant risks of neglect and psychological abuse. Working children and greater number of siblings in a family were risk factors for neglect, whereas witnessing family violence and being bullied were risk factors for psychological abuse. Children with more years of schooling experienced less neglect and psychological abuse.Conclusion: The high prevalence of child psychological abuse and neglect in this study shows child maltreatment as an ignored issue in Bangladesh.
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| 9. |
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| 10. |
- Haque, M. Atiqul, 1970-, et al.
(författare)
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Child Maltreatment Portrayed in Bangladeshi Newspapers
- 2020
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Ingår i: Child Abuse Review. - : WILEY. - 0952-9136 .- 1099-0852. ; 29:5, s. 448-462
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Tidskriftsartikel (refereegranskat)abstract
- As in most low-income countries, there is a lack of scientific information on the incidence and pattern of child maltreatment (CM) in Bangladesh. However, the role of the media to disclose CM and to develop public awareness in society is noteworthy. The present study assessed newspaper reports about CM by type and socio-demographics of victims and perpetrators in Bangladesh. In total, 790 news articles were collected retrospectively from four Bengali- and two English-language newspapers from October to December 2014. Among all reported incidents, almost half of the CM cases concerned alleged physical abuse (26%) and sexual abuse (22%). Neglect and emotional or psychological abuse received less coverage. Female children were to a high degree (90%) victims of sexual abuse. The main perpetrators were males, and they were often known to the victims. Approximately 32 per cent of the reported abuse cases resulted in death and were related to rape, family violence, administrative negligence, abduction and ransom demand. Some of these deaths were suicides. News stories concerning CM were often reported in an unethical way by identifying the victim and not respecting child rights. Further, the stories seldom discussed the individual or social consequences of CM, or how maltreatment could be prevented. 'The present study assessed newspaper reports about CM by type and socio-demographics of victims and perpetrators in Bangladesh' Key Practitioner Messages The main types of reported cases of CM in Bangladeshi print media are physical abuse and sexual abuse, and there is a high proportion of fatal consequences. The perpetrators are often known to the victims. The identity of the victim is frequently reported, potentially putting the child at risk and violating child rights. Bangladeshi print media seldom discusses individual or societal consequences of CM, or how it could be prevented.
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