Oct 24, 2017 - translated into Arabic, Hindi, Marathi, Spanish, Malay, French, Lingala' ... must understand that these risks are involved before beginning an interview. ... The question on shaking, when stratified to look at children less than 2,.
Child Abuse & Negled 33 (2009) 825-832
&ntents lists available
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Child Abuse & Neglect Irl
St'r\/TL'.R
The development and piloting of the ISPCAN Child Abuse Screening Tool-Parent version (ICAST-P)"
Du Daniel Yuen
Desmond K. Runyan",*, Michael P. DiptyJaine, Bernard céiUit"n, Mohammed Sham Kasimi, Wan Clemencia Ramirezk, Elena Volkovaj, Randa M. Youssefl
Bernadette Madridd, Andreva-Millerh. Bonnie Macfarlaneh'
,
a DeparùnenÉ olsæial Medicinc oûdtudiatria,The llnlversity oI North carotino" ChapelHill' Nc27599-7105' UsA b @tænsland llnivercity ofTæfualog1, BrLsbane' fu)strolia otNorth Carolirl.a. ChoFl Hi4 NC US4 'd Departmmt of Family Mdicine,The Univenity Depaîtment oI Pediatrics, The llnive6ity oJ the Philippines Monilo. Philippmes e Depotûreft of rediotrics, Gwemment Medicol college, Nogpw, India 1 llniverite' Saint-loseph, Befltil lzbonon s H'pital Jomot ol Yaoundê, Yoonde, Comerooa h Chui oblasf HospilaL Chui obtost KyrglTston i univeîsity ojMlloyo.Kuola ll/mpur, Mahysio j Nbhniy Novgorod stote Peitogogicol Univeriry' Nîzhniy Novgoto4 Russio k lJniversidad de los Ander Eogot6, Colombio
I
Alexondtio Faculty olMedicine Alel'andrio, E&nt
Department ofCommunity
^tedicinq
ABSTRACT
INFO
ARTICLE
Attlcle history: Received 15 May 2(x)g Received in revised form 16 August 20(Xl Accepted 14 September 2009 Available online 24 October 20og
for the Prevention ofChild Abuse and Neglect has developed insftumentation that may be used
Kepords:
with cross-culnrral and cross-national benchmarking by local investigators.
Child abuse Measurement survey research lnternational comParisons Cross-sectional Parent instrument
der the age
of
trument that lot work in 6
in op 20
(597 total).
ors directed . 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 cronbach's alpha in very good range (0.77-0.88) with the excePtion ofthe 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 objec! and 37% were spanked. Reports of choking and smothering were made by 2% ofparens.
f. +
This work has been conducted with the instnrmental and monetary support of the lntemational Society for the Prevention of Child Abuse and Neglect. Corresponding author.
0145-2134/J doi:
1
-
see
front matter
@
0.1016/j.chiabu.20O9.09.006
2009 Elsevier Ltd. All rights reserved.
D.K Runycn et ot
|
ûtilil
Abvse
t
Neelæt 33 (2009)
826'æt2
demonstratethatt ISFCAN hasbeendeveloped as a suwey instrumentto
These pilot data irL and PotentiallY harmful forms o I'ôctice imPtic.tions: The
a27
aptures variations Version (ICAST-P)
forthe assessment with ltwasdeveloped contexl andmulti-cultural of child maltreatmentinlmuiti-national i review' translation' and
broad testin study
pilot
lot testing are Presented This broad range of culftres and intemal consistency' languages with low rates of missing data and moderate to high @ 2009 Elsevier ttd' Alt rights reserved'
iterature since 1860 (Roche' n traced to the publication (Kenrpe' Silverrnan' Steele' and other European Kingdom, United the Canada, States, the United Omeg*mudkç & silucr, i9@). Extensive research in and even pattems or syndromes of consequences, factors, protective risk and epidemiologr, thâ documented countries have
recogniz modem of the Am in the SyndromeChild Battered Journat of'The
ofchild abuse and neglecthas been Fortin, Iabbé, Brown, & Chadwick zmS) lut the The problem
rld RePort (Pinheiro,
no official abuse or neglect (ISPCAN, 2006). The paucity ofdata on the among both lay people and occurrence and consequences of child abuse and neglect contribute to the lack of knowledge globally' be collected data Sood professionals in all parts ofthe world. It is essential would address that violence children and for the called In 1996, the uN secretary-General r LJN study of war on children. The onset violence against children irrhomes and schools in a and a ofthis stuày was delayed until 2002 when Professor Paulo Pinheiro ofBrazil was appointed the Independent Expert a non-governmental organizations established The Secretary-General in Geneva. established study was the Secretariatlor and better advisory board the study. The Secretary-General's report recommends addressing the need for more research measurement in for improvements called report The nations. in all maltreatment child data on the extent and nature of in policies and expanded efforts at surveillance to assess the extent of the problem and to monitor the impact of changes (ISPCAN) NegleA and Abuse of Child Prevention for the and senrices for children (Pinheiro, 2006). The International Society epidemiology the assess that could instruments of standard a set help develop and recommendation this on agreed to take of maltreatment of children. With UNICEF support,ISpCAN organized an international meeting in Brisbane in 2fl)4. Experts from 31 countries participated in a workshop to develop internationally valid instnrments. The assembled experts determined that a complement of three instuments were needed: an instrument that could be used to survey parents about disciplinary behaviors directed childat their own children in the past year that would assess incidence: a retrospective survey of young adults about their
for cre manner
hood to establish lifetime pievalence; and a third instrument to be completed by mature children to repoft the incidence of harsh treatment or maltreatment in either homes or institutions. The thtee instruments were called the ISPCAN Child Abuse Screening Tools and named the P for parent form, the Cl and CH for the "child-institutional" and "child-home" forms, .youth retrospective" forms. At the conclusion of the workshop, three working groups of investigators used and the n for to màOiry and improve the three instruments drafted at the Brisbane meeting. This paper addresses communication email the development and pilot results of the instmment developed to be administered to Parents, the ICAST-P-
Methods The Brisbane workshop attendees developing the parent instrument explicitly agreed not to develop new definitions of abuse or neglect that would be applied in all countries. These experts recognized that differences in language, culture, and history might alter the perspective in different parts of the globe about which parental acts might be regarded as abusive orneglectful. Instead, the attendees chose to focus on asking about the frequencies ofparent behaviors; in this they modeled their effort on the approach taken by Murray Straus and colleagues who developed the Conflict Tactic Scales (Straus, Hamby, Finkelhor, Moore, & Runyan, 1998). Attendees at the conference were encouraged to bring suwey questions that they were familiar with or which had been used in their own counùies. The conference participants did not seek to develop an exhaustive list of all possible forms of discipline but to focus on forms of discipline perceived to be most common in their countries or approaches that they perceived as carrying a high risk of harm for the children. The draft instnrments were then sent out to experts around the world for two rounds of a Delphi procedure in which input and modifications were requested (Edmunds, Haines, & Blair, 2005; Hackett, Masson, & Phillips, 2006). The exPerts involved in this Delphi procedure explicitly were selected, in large measure, from the southern hemisphere and non-western countries so that the final instruments could be said to be relevant to as many countries as possible. Candidate experts were identified by: (1) reviewing the authors from outside the USA, Canada. Australia, and New Zealand who had published in the intemational journal Child Abuse & Neglect between 2003 and 2005, (2) examining the list of ISPCAN faculty who lived
828
D'K Rlrnyon et
oL
/
chili!
AhLse
e Nqlect 33 (20æ) 826-a32 ren and Violence ctor ofISFCAN or help develoP the youth retrospective questionnaire' changes suggested by the scientists' a finalized
Lingala' translated into Arabic, Hindi, Marathi, Spanish, Malay, French, BackcountSt. in each locally arranged was nslation of the instrument translation. the of translation was reviewed by authors to assess fidelity The instrument The working group reviewed other extant The ICAST-p was an evolution of prior instruments in the field of child abuse.g), the Juvenile victimizntion Qtestionnaire
po ormond, (Finkelhor, Hamby, 20(x). participants were invit eiargea pool ofquestions
insrruments including the
(sadowski, Hunter, Bangdiwala, & Mufloz' work to the meeting. A working developed .nced to query about a varie\r ofparental behaviors. The authors "n shorten the instrument and to modifo the wording of tnis plpeithen edited the instrument. The Delphi process was used to ofcountries. varie$l so thafttre questions would be understandable in a practices used both to use in surveys ofparents àf.hildt.n less than 18 regarding disciplinary
The ICAST-p was designed parents are asked about omissions in care and about acts of discipline or violence over the last year and in ihe child's lifetime. parents are also asked about the use of the same set of behaviors committed by child. towards a randomly selected index (e.9., talking and beating the anorher parent or caregiver. eueries include both positive and negative discipline approaches together under a category "harsh" were agreed universally child). we grouped those forms of discipline that the authors ..harsh physiial discipline.' Another group of physical acts, which were not judged to be as harsh, were described as of ..moderatephysical discipline.- our intent was to ietindividual users of the instrument to define for themselves those acts of data which might be consideràd harsh or abusive but provide comparative data from other communities- The collection questions about in the pasi year allows calculation of incidence rates and examination of rates by child age. In addition to physical anâ psychological discipline, the parent is asked questions about the child's basic needs in order to assess rates of ,r.!r..r Child séxual abuse rates are estimated by asking tlte parent if he or she knows if the child has been touched in a physical seiual way or had intercourse with any adult No âttempt was made to subdivide other forms of discipline, besides
discipline, into moderate or harsh. The instrument has a total of 46 questions. Data collection and onolYsb
ln addition to the ICAST instruments, ISFCAN arranged for a data entry system and field guide to complement the instruments for a complete tool kit, developed inEpilnfo 3.0 (CDCP,2009). One of the authors (AJZ) programmed the data entry system to facilitate analysis. The Epilnfo datawere sent to the University of North Carolina for analysir Analysis includes simple summary statistics, limited demographic bivariate analysis, and Cronbach's alpha for internal consistency of subscalàs. To assess associations with gender and age, each item was assigned a value from 0 to 4 based on response as follows: never and not in the pastyear=0, 1-2 times=1, 3-5 times-2,6-10 times-3, and >10 times-4. Each behavioral domain was summarized as a mean of all items in that domain, yietding a mean score from 0 to 4 for each domain (i.e., psychological discipline). The means were examined by gender using t tests and by age using pair wise correlations. Stata 8.2 (College Statiôn, TX) was used for all analysis. No inferential statistics for comparisons between countries were calculated as there was no effort to prove or disprove differences between samples, given that these were small convenience samples. Human subjecF protections Considerable experience with asking sensitive questions about maltreatment and other subjects has accrued in many countries. Previous concerns about the risla of inducing suicide by asking about suicidal thoqhts have been allayed and this experience is a model for asking about reactions to malfeatrnent. Recent research suggests that the risk ofproducing intense psychological stress when asking about maltreabnent in the respondent is low with adults and with children of 12 or older (Knight et al.,2006). As many as 8(X of countries have mandated reporting for child abuse (ISFCAN,2m6). However, this reporting is limited in many locales in that it only applies to specified professionals. Many countries do not have a specialized child protection organization within government. Should children who report having been victims of child abuse in the context of a social suwey be reported? Reporting of research participants for legal violations clearly complicates the normal voluntary gift of information by a research participant to an investigator. The ethical principles of research include doing no harm to participants (King & Churchill, 2000). Since reporting to authorities could result in criminal prosecution or removal of a child from the home, participants must understand that these risks are involved before beginning an interview. However, others have argued that reporting children for services really is a benefit and not a risk as intervention is intended to protect them.
D.K lornyon et aL I
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t
Neglect 33
829
82H32
(20æ)
This controversy has not been resolved but anonlrmous the law related to mandated reporting without evidence Prior to piloting, investigators in all of the countries ethical review through an established or ad hoc indepe
respect for the rights ofparticipants are the central part ofthe ethics review board. Results
120 Investigators in 7 countries agreed to pilot the tcAST-p. Each investigator solicited a convenience sample ofabout parents endorsing parents. TÈe sample size was limited by resources but chosen to be adequate to estimate the Proportion of and of sufficient size that rarer spant18 years (up to 33) and l7%
ofr€spondents in
DRC
(up to 25 years).
8
DJ( ff'nryan et Teblê 2 Discipline practices,
eitler parent
aL
I
Child Abuse
(Russia only for one parent), values in
Columbia BracttEe
N=12O
on-violent dLsciplin4total) Explained (q8) Told to stop something (qg) Time out (ql0) Took away prMleges (q29) Distracted (q14)
98
N
Hit on buttocks wiobject (ql2) Hit elsewhere w/object (ql3) Twisted ear(ql5) Knuckled back of head (q16)
Kicked (q21) Choked (q26) Smother (q35) Burn (q36) B€at up (q37) Threaten w/knife or gun (q38) Gave drug, alcohol (q40)
52 45
1,)
79 55
30 26 51
l4
33
18
36
1
2
0 54
8
l9 l3
55
10
Severe phy si'cal disciP line
sbonk .hild 2 Yearsxql 1 )
Neglect 33
percentl
Esypt
96 95 84
91
e
rV--l?9
99 98 97 91 97 83 58 30 5665662 83 53 75 83 33 34 28 28 13 32 3335268 13 20 222A412 13 10 11 4 60 37 33 28 5122621 211788 67%{3) ot2) 71047 2227 1320 7720 15906 2201 1200 91 94 10 39 87 81 272514 19 11 278527 9267 38 39 51 58 131691 10816 2841472 131100 8100 7200 7900 40lo 4010 o000
àt-125
79 70 70 14
99
95
94
9t)
1.6
98 47
2.9
22 46 15 15 14
66
85 34 52 55
63 15
29
17
4.O
3.5
69
23
30 24
15
18
27 20 19
2 2 13 11
33
7
6
0 42 49
4
2.6 1.0 1.4 7.7
2.5 2.4 2.9 3.6
37
13
25 25
2.2 2.O
15
4auls)
o(1,)
282{2s.1 2 2 4
32 15 23
86
10
9
11 11
17
77
49 57
7-4 2.3 2.7
8
2.9 3.0 3.5
1
43
0.5
4.0
79 18 72 10
2.9 o.9 3.0
l8
3.O
13
3.5 3.6 2.7 4.2
4 39 42
23 5 23
3.9 5.2
8
J
t.2
4 4
1.0 1.O
2 2
13
02
1.O
(0.010 vs. be reported as the victims of sexual abuse but this was not statistically significant across all countries combined versus. score of 0.094 with a mean punishment 0.00i, p =.2g). Boys were far more likely to be victims of harsh physical (p punishment .0oo). at r 0.626 = physical = moderate with punishment physical correlated 0.0zlo (p = .007). The use of harsh lncreaied age was signincant preàiitor of psychological discipline (p -.002). Child age did not prdict neglect, sexual abuse, moderate punishment, nor harsh Punishment. We examined internal consistency of subscales with Cronbach's alpha and found that the subscales for non-violent all discipline, all physical discipline, harih physical disciple, physical discipline minus harsh, and psychological discipline (see 3). poorer Table alphas much had abuse and sex Neglect .77-.88). achiéved very goôd internafconsisrencylaipha
Discussion We report here the development of a parent instrument asking about child discipline that has been piloted successfully in 6 counlries. The instrum"nt had benefited ftom input by experts from 40 countries. The bebaviors it taps are not the entire range of disciplinary behaviors but behaviors thought to be common or important by the contributing exPerts. The
D.K
P.nf'lyan et aL
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Neslzct 33
(2uts) U6-832
Tablc 3 Alpha coefficients.
Cons$uct
Alpha
Number if items
Non-violent disciPline Physical discipline (an) Physical discipline (minus harsh)
o.77 0.88 0.85
5 19 12
Harsh physical disciPline Psychological Punishment Neglect sex abuse
o.81
o.77
038 0.29
10 3 2
parent instrument appeared ofresponses to individual ite with minimal difficultY. The The instrument and all currently trenslations are available The sample sizes are too small for more formal testing o parents. While the rates of the use of samples were not intended to be repre used in some cultures or communities This instrument is well positioned as a relatively brief s apPears to have face valid n companson with child or youth self-reports with the same piloted. We have no data dren. It has benefited from the input of many child protection children or mental health the piloting suggests that it captures differences in patterns and experts in both high and low or middle-income countries its utility for describing parenting around the world. ate to demons needed will be work Further bewveen countries.
Acknowledgements are colleagues who In addition to the authors above who led the pilot efforts described in this paper, the following names this study: used with instrument ICAST helped develop the
. Arlen. Eva Affitiation,
SCF-Sweden Country, Sweden o Azevedo. Maria Amélia Affiliation, University of Sâo Paulo Country, Brazil . Balagopal, GopalanAfhliation, UNICEF Country' USA . Bequele, Assefa Affiliation, The African Child Policy Forum Country' Ethiopia e Bonner, Barbara Affiliation, OHSC-Center on Child Abuse and Neglect Countrlr, USA . Conte, Jon Afn[ation, University of Washington Country, USA o Corso, Phaedra Affiliation, CDC Country, USA o Daro, Deborah Affiliation, University of Chicago Country, USA r Dawes, Andy Affiliation, UNICEF Countryr, South Africa o Deb. Sibnath Affiliation, Calcutta University Country, India . Dulyakasem, Uthai Amliation, Watailak University Country, Thailand o Engelhardt, Kay Affiliation, UNICEF . Essali, Adib Affiliation, Rainbow for a better Childhood Country, Syria r Furniss, Tilman H. Affiliation, University Hospital Munster Country, Germany . Gillespie, Amaya Affiliation, SG Study on Violence Against Children, Guerra, Viviane Countqt, Brazil r Hassall, Ian Affiliation, Auckland University of Technology Country, New Zealand r Haj-Yahia, Muhammad Affiliation, The Hebrew University of Jerusalem Country, Israel o Huong, Nguyen Thanh Affiliation, Hanoi School of Public Health Country, Vietnam o Intebi, Irene Affiliation, Familias del Nuevo Siglo Country, Spain r Jahshan, Hani Affiliation, National Institute of Forensic Medicine Country,Jorden . Jing$, Chen Affiliation, Peking University r Keller-Hamela, Maria Affiliation, Nobody's Children Foundation Country, Poland r Kim, Hyojin Affiliation, Soolmyung Women's University country, South Korea . Kiro, Cindy Affiliation, Massey University Counry, New Zealand e loaiza, Edilberto Affiliation, UNICEF Country, USA . Lynch, Margaret A. Affiliation, Institute of Child Health London Country' UK . Mian, Marcellina Affiliation, ISPCAN/University of Toronto
. Mohlenkamp, Matthew Affiliation, ISFCAN Country, USA . Muhammad, Tufail Affiliation, Pakistan Pediatric Association Country, Pakistan . Ngambi, Wilbroad Affiliation, AMPCAN Country, Uganda
D'K' Rwryan et
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Child Abuse
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QWg) 826-832
. Van Niekerk,Joan Affiliation, SASPCAN Country, South Africa . Nkanga, Iyanda Affiliation, ISPCAN Country, USA/DR Congo o Norton-Staal, Sarah Affiliation' UNICEF Counry, Kenya . pinheiro, Paulo Affiliation, sG's study on children and Violence country, Brazil . soonets. Rooth Affiliation, Tarfir university children's Hospial country, Estonia o Svevo, Kimberly Affiliation, ISPCAN Country' USA . Tapanya, sombât Rffiliation, Chiang Mai University Country, Thailand . tsiriUangu, M. Marcel Affiliation, tUS ETVITA(NGo) Country' D'R Congo . Wedgewood, Kate Affiliation, SCF-UKCountry, china o Wolfe, David A. Affiliation, McGill University Country, Canada . zelrtinoglu, Sezen Affiliation, Ege University Country, Turkey
Refetences Accessed l4'5'(Xl' Centerr for Disease Control and Preventior (2fi)g). Epirnto 3.0, Atlanta, GA http://cdc.gov/epiinfo/' puiblic health dâta for school entrants in London: child Health Edmunds, s., Haines, r-, e ghi., M-izùs).'oeveiopment oriqr".tiànn"ir"io cottect Assessmint at School Entry (CffASE) projecÈ Chitd Corq Heslth and ævelopmelt, 3 t(l ), 89-97. questionnaire: Reliability, validity, and national norms' Child Abuse Finkelhor, D., Hamby, S. L, Ormond, R, & Turner, H. (2fl)5). TheJuvenile Victimization E{ Neglecr, 29(4), 383412. gacXett,5., Uasson, H., e phillips, S.(2fl)6). 51
