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Barn som riskerar att fara illa i sin hemmiljö: Utmaningar i ett förebyggande perspektiv
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. (Folkhälsovetenskap)
2013 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Children at risk of maltreatment : Challenges in a preventive perspective (English)
Abstract [sv]

Baksidestext

Barnmisshandel är ett omfattande folkhälsoproblem med långsiktiga negativa konsekvenser för den enskilda individen och för samhället i stort. Förebyggande insatser kan vara livsavgörande för de utsatta barnen. Denna avhandlings övergripande syfte var att öka kunskapen om barn som riskerar att fara illa i sin hemmiljö samt att identifiera utmaningar i ett förebyggande perspektiv. Två områden har studerats:

(1) Våld mot barn med långvarig sjukdom/funktionsnedsättning

(2) Förskolan som upptäckande och stödjande arena

Gemensamt för inriktningarna är att barn med långvarig sjukdom/funktionsnedsättning och barn i förskoleåldern utgör särskilt sårbara grupper, som löper ökad risk att fara illa i sin hemmiljö. De har också unik kontakt med professionella med möjlighet att upptäcka och agera vid oro.

Avhandlingen bygger på fyra delstudier; en nationell kartläggning riktad till skolelever, en intervjustudie med föräldrar samt två förskolestudier. Resultaten från studierna diskuteras utifrån identifierade utmaningar i ett förebyggande perspektiv. Utmaningarna inkluderar emotionella hinder samt behov av ett mer nyanserat och proaktivt förhållningssätt för att kunna utveckla tidiga insatser till barn och föräldrar.

Abstract [en]

The aim with this thesis was to increase the knowledge about children at risk of maltreatment and to identify challenges in a preventive perspective. Two areas have been studied; Physical abuse of children with chronic conditions/disabilities and Detection and support within the pre-school environment. 

Four data sets were used: a national survey of school children (I), an in-depth interview study with parents (II) and two pre-school studies (III, IV).

I-II: Chronic conditions in children increase the risk for physical abuse, but vary with socio-economic circumstances. The highest risk for physical abuse was found among children with chronic conditions born outside Sweden. The subsequent study revealed direct risk factors related to parent and child (emotional demands in precarious situations), and indirect risk factors related to parent and professional (gradual shift in responsibility and emotionally closed environment) and social norms (taboo on talking about abuse).

III-IV: Preschool staff suspected child maltreatment for two percent of the preschool children. In less than half of the cases, the parents were informed and a report to social services was made in a third of the cases. The most common reason for not making a report was that the staff believed that the pre-school had sufficient resources to help the child. In the subsequent study, preschool teachers’ concerns about the child’s home environment were explored in a broader perspective over a one year period. The study showed that concern for the children’s home situation related to increased concern for several aspects of children’s health and development, increased need of special support in preschool, insufficient contact with parents, and lower parental socioeconomic status.

The results are discussed according to identified challenges in a preventive perspective. These include emotional obstacles for prevention and a need for a more nuanced and proactive professional approach to enable early support to children at risk of maltreatment and their parents.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2013.
Series
Karlstad University Studies, ISSN 1403-8099 ; 2013:13
Keyword [en]
Children at risk of maltreatment, Child abuse, prevention, pre-school, chronic health condition, disabilities, detection, support
National Category
Medical and Health Sciences
Research subject
Public Health Science
Identifiers
URN: urn:nbn:se:kau:diva-26456ISBN: 978-91-7063-488-8 (print)OAI: oai:DiVA.org:kau-26456DiVA: diva2:607231
Public defence
2013-04-26, Lagerlöfsalen, 1A 305, Karlstads universitet, Karlstad, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-05 Created: 2013-02-22 Last updated: 2013-04-05Bibliographically approved
List of papers
1. Chronic conditions in children increase the risk for physical abuse – but vary with socio-economic circumstances
Open this publication in new window or tab >>Chronic conditions in children increase the risk for physical abuse – but vary with socio-economic circumstances
2011 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, 407-412 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To explore whether children (age 10, 12 and 15 years) with self-reported chronic conditions are at higher risk of physical abuse and⁄or exposure to intimate-partner violence than other children, while considering the importance of demographic factors.

Methods: A national cross-sectional study of 2771 pupils in grades 4, 6 and 9 from 44 schools in Sweden (91% response rate). Conflict Tactic Scales were used to measure physical abuse and separate questions measured exposure to intimate-partner violence. A list of 13 diagnoses was used to estimate chronic conditions.

Results: Children with chronic conditions had an increased risk for physical abuse (CPA) only (OR 1.67) as well as in combination with exposure to intimate-partner violence (IPV) (OR 2.54), but not to IPV only, compared to children without chronic conditions. Furthermore, when chronic conditions were combined with country of birth other than Sweden and living in low-income areas, the risk for CPA increased even more, indicating interactive effects.

Conclusions: A wide range of chronic health conditions in children increased the risk for physical abuse. This indicates that certain factors unite this group of children, irrespective of the type of disability or degree of severity, but where a combination with socio-economic circumstances is of importance.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011
Keyword
Child physical abuse, Chronic health conditions
National Category
Medical and Health Sciences Social Sciences
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-13133 (URN)10.1111/j.1651-2227.2010.02029.x (DOI)000286837700020 ()
Projects
Avhandlingsarbete i folkhälsovetenskap
Available from: 2012-10-31 Created: 2012-04-30 Last updated: 2017-12-07Bibliographically approved
2. Exploring risk for abuse of children with chronic conditions or disabilities: parent’s perceptions of stressors and the role of professionals
Open this publication in new window or tab >>Exploring risk for abuse of children with chronic conditions or disabilities: parent’s perceptions of stressors and the role of professionals
2013 (English)In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 39, no 6, 887-893 p.Article in journal (Refereed) Published
Abstract [en]

Background: Children with chronic conditions or disabilities are at an increased risk for abuse. High-levels of parental stress have been identified as possible trigger for abuse, where a combination of several factors are of importance, such as lack of social support and limited resources in the neighborhood. Suggestions for preventive measures have merely focused on parenting strategies and targeted intervention programs. So far, little attention has been paid to how the risk for abuse might relate to parent’s perceptions of stressors and the role of professionals. The purpose of the current study was therefore to explore risk factors for abuse with focus on both parent-child and parent-professional relationships.

Method:Semi-structured in-depth interviews with 15 parents of children with chronic conditions or disabilities were collected and analysed according to qualitative content analysis.

Findings:Three major themes were found that could be seen as risk factors for child abuse: 1) Emotional demands in precarious situations between parent and child. 2) Gradual shift in responsibility from professionals to parents concerning access to and coordination of service and support. 3) Emotionally closed environment between professionals and parents and taboo on talking about abuse. The gradual shift in responsibility had emotional implications, which could reinforce parental stress and thereby also indirect increase the risk of child abuse. The gradual shift in responsibility also seemed to generate an emotionally closed environment and reinforce the taboo on talking about abuse, which in turn hindered preventive measures. 2

Conclusions:In the light of parent’s perceptions of stressors and the role of professionals the findings indicate that abuse against children with chronic conditions or disability is not only a family matter, but also depending on qualities in service, professional support and social norms. The result pinpoints three challenges for preventive measures, all with emotional implications; parental strategies, organisational efforts and cultural awareness.

Keyword
abuse, child disability, chronic health condition, prevention
National Category
Medical and Health Sciences
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-26455 (URN)10.1111/cch.12030 (DOI)000325138300017 ()23461758 (Scopus ID)
Available from: 2013-02-22 Created: 2013-02-22 Last updated: 2017-12-06Bibliographically approved
3. Suspected Child Maltreatment: Preschool Staff in a Conflict of Loyalty
Open this publication in new window or tab >>Suspected Child Maltreatment: Preschool Staff in a Conflict of Loyalty
2008 (English)In: Early Childhood Education Journal, ISSN 1082-3301, E-ISSN 1573-1707, Vol. 36, no 1, 25-31 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the actions of Swedish preschool staff when suspecting the maltreatment of children in their domestic environment, and the staff’s further experiences and relations to the family members.

Methods A questionnaire in 2005 to the staff of 189 child groups in community preschools, including 3,100 children.

Results: A report to Child Protective Agency (CPA) was submitted in 30% of the cases where maltreatment was suspected. The staff’s decisions as well as their working situation, and how they estimated the parents’ benefits from CPA support were deeply affected by their different relations to the families. The staff had their best contact with the children and their most insecure and vulnerable contact with the fathers.

Conclusions: In situations with suspected child maltreatment the staff face conflicts of loyalty, mostly based on insecure relations, which could become an impediment to supporting and educating the children.

Place, publisher, year, edition, pages
Springer Netherlands, 2008
Keyword
Child maltreatment, Early childhood
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-13132 (URN)10.1007/s10643-008-0248-1 (DOI)
Projects
Avhandlingsarbete i folkhälsovetenskap
Available from: 2012-10-31 Created: 2012-04-30 Last updated: 2017-12-07Bibliographically approved
4. Children at risk of maltreatment: Factors associated with pre-school teacher’s temporary and lasting concern for children’s home situation and support within the pre-school activities
Open this publication in new window or tab >>Children at risk of maltreatment: Factors associated with pre-school teacher’s temporary and lasting concern for children’s home situation and support within the pre-school activities
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim: The aim was to investigate factors related to pre-school teacher’s temporary and lasting concern for children’s home situation and the extent to which these children are in need of special support in preschool and/or are reported to the CPA.

Method:Data were used from a Swedish prospective study (the SOFIA-study) on children’s health and development concerning 2,121 pre-school children’s, born during 3 years (2005-2007). Questionnaires were answered by pre-school teachers and parents in a baseline study in 2010 and a follow up in 2011. Four groups were compared: no concern for the children’s home situation (85 %), newly arising concern (6 %), past concern (5 %) and lasting concern (4 %).

Result:When pre-school teachers express concern for the children´s home situation they also more often express concern for the children´s health and development as well as a lower quality of the contact with the parents. Concern for the children´s home situation was also related to lower socio-demographic status of the families, i.e., the families had a lower SES, parents were more often born outside of Sweden, and they had lower education. According to all these factors, there were stepwise differences from no concern, over temporary concern (newly arising or past concern) to lasting concern for the children’s home situation. The same pattern was also seen for the frequency of need of special support in preschool with 7% in the no concern group, 20% in the temporary concern and 37% in the lasting concern group. Reports to the Child Protection Agency were made in a minority of the cases, and most frequent when there was a lasting concern for the children’s home situation (23 %).

Conclusion:Pre-school teachers’ temporary and lasting concern for children’s home situation can be understood from a broad perspective on the children’s health and development, as well as different aspects in the contact between pre-school teachers and parents and the socio-demographic status of the families. Need of special support in pre-school were common when concern for the children’s home situation, which highlight the possibility to also develop and integrate support to the parents within the pre-school activities.

Keyword
Child maltreatment, pre-school, prevention
National Category
Other Social Sciences
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-26454 (URN)
Available from: 2013-02-22 Created: 2013-02-22 Last updated: 2014-03-19Bibliographically approved

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Output format
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