Outcomes and outputs affiliated with Children's Advocacy Centers in the United States: A scoping review.

BACKGROUND: The Children's Advocacy Center (CAC) model is the predominant multidisciplinary model that responds to child sexual abuse (CSA) in the United States (US). While the CAC model has made important contributions in case coordination and referrals for specialty services, little is known about child- or family-oriented outcomes. OBJECTIVE: Explore the trends and gaps involving outcome and output measures affiliated with CACs in the US. PARTICIPANTS & SETTING: A scoping review of the literature was conducted on English language articles published between 1985-2019 that involved CACs and children less than 18 years of age. METHODS: An electronic database search using the terms "Children's Advocacy Center(s)," "Child Advocacy Center(s)," and "CAC(s)" identified titles and abstracts. Data from articles selected for full text review were evaluated by a multidisciplinary team using a mixed methods approach. RESULTS: Measures of CAC impact frequently focus on service and programmatic outputs with person-centered outcomes left often reported. The most prevalent output measures related to case prosecution and forensic interviews. Person-centered outcomes most commonly emphasized child mental health and caregiver satisfaction. The majority of articles were limited by weak or unspecified study designs. CONCLUSION: The current literature on CACs suggests that while they are successful in coordinating services and facilitating referrals, little is known about how engagement with CACs impacts short- and long-term outcomes for children and families. Further research beyond cross sectional or quasi-experimental designs is necessary to better understand how variability in CAC structure, function, and resources can be optimized to meet the needs of the diverse communities that they serve. This is especially salient given the national dissemination of the CAC model. Without such additional studies, knowledge will remain limited regarding the enduring impacts of CACs on the lives of those impacted by CSA.

Uso de telepsiquiatría para apoyar la atención primaria de salud mental en el tratamiento de niños, niñas y adolescentes con vulneración de derechos: resultados preliminares / Use of telepsychiatry to support primary mental health care in the treatment of children and adolescents with rights violations: preliminary results

he aim of this study was to present preliminary results of a video-based consultation-liaison psychiatry service (telepsychiatry) to enhance the delivery of mental health services in primary health care (PHC) for institutionalized children and adolescents (ICA). A mixed-methods study was carried out at two PHC clinics in Quilpué, Chile, to assess the feasibility of a telepsychiatry service (TPS). TPS consisted of bimonthly, remotely conducted video-conference sessions between PHC teams and child and adolescent consultant psychiatrists located at the Psychiatric University Hospital in Santiago, to discuss mental health problems of ICA. During July to December 2018 thirteen TPS sessions were carried out, and a total of 15 ICA were discussed to elaborate diagnostic and/or therapeutic recommendations. The intervention was useful and acceptable to PHC providers. Participants perceived that better coordination between substitute care facilities and PHC clinics would be useful, and that training opportunities to address the mental health needs of ICA were required. A TPS to enhance the delivery of mental health services in PHC for ICA was feasible, further studies are needed to determine benefits for ICA. (AU)

Moving research beyond the spanking debate.

Despite numerous studies identifying a broad range of harms associated with the use of spanking and other types of physical punishment, debate continues about its use as a form of discipline. In this commentary, we recommend four strategies to move the field forward and beyond the spanking debate including: 1) use of methodological approaches that allow for stronger causal inference; 2) consideration of human rights issues; 3) a focus on understanding the causes of spanking and reasons for its decline in certain countries; and 4) more emphasis on evidence-based approaches to changing social norms to reject spanking as a form of discipline. Physical punishment needs to be recognized as an important public health problem.

Current issues and future directions in evidence-based child protection practices: a view from Romania.

The constantly changing nature of social care practice necessitates continuous development of educational programs to prepare current practitioners. Basing social work practice on methodologically sound research evidence is an appealing prospect for the child protection services. However, Romania, once considered an Eastern European model for child welfare policy and practice, is somehow lagging behind. In this article the author gives a short overview of where the Romanian Child Protection System currently stands in terms of evidence-based practice.

The mystery of missing female children in the Caucasus: an analysis of sex ratios by birth order.

CONTEXT: Official data on sex ratios at birth suggest a rise in sex-selective abortions in some post-Soviet states following the introduction of ultrasonography. However, questions remain about the validity of official data in these nations as well as whether the high sex ratios at birth are a statistical artifact. METHODS: Trends in sex ratios at birth from 1985 to 2009 for 12 post-Soviet states were examined using vital registration data. For the three countries that had had a Demographic and Health Survey (DHS) in 2005-2010 (Armenia, Azerbaijan and Moldova), survey data were used to calculate sex ratios at birth according to birth order, and vital registration data for 2010 were used to estimate the number of "missing" female births (if any). RESULTS: Official data revealed elevated sex ratios at birth in Armenia (117), Azerbaijan (116) and Georgia (121), but not in other post-Soviet states. According to DHS data, sex ratios were high in Armenia and Azerbaijan for first births (138 and 113, respectively); if the first child was a girl, the sex ratio in Armenia was even higher for the second birth (154). Overall, the number of girls born in these countries in 2010 was 10% lower than expected, consistent with 1,972 sex-selective abortions in Armenia and 8,381 in Azerbaijan. Sex ratios did not vary by birth order in Moldova. CONCLUSION: Sex-selective abortion appears to be common in Azerbaijan and Armenia. Family planning and legal interventions are needed to address this issue.

The child's interests and the case for the permissibility of male infant circumcision.

Circumcision of a male child was recently ruled illegal by a court in Germany on the grounds that it violates the child's rights to bodily integrity and self-determination. This paper begins by challenging the applicability of these rights to the circumcision debate. It argues that, rather than a sweeping appeal to rights, a moral analysis of the practice of circumcision will require a careful examination of the interests of the child. I consider three of these interests in some detail. The first is the interest in avoiding a moderate decrease in expected future sexual pleasure. I argue that even if such a decrease were to occur, it is not wholly unreasonable to think that this might actually be a good thing for the child. Second, I consider the interest in self-determination. I argue that this interest is not as strong as it might appear because the adult's circumcision decision is subject to a variety of biases and a significant lack of information. Finally, I consider the child's interest in avoiding the future costs of adult circumcision. I argue that this interest becomes much stronger in the religious case because the child is quite likely to choose to become circumcised as an adult. The likelihood of the child choosing circumcision in the religious case also reduces the extent to which infant circumcision violates his interest in self-determination. I conclude that male infant circumcision falls within the prerogative of parental decision-making in the secular case and even more clearly so in the religious case. Finally, I distinguish male circumcision from female genital cutting in several important respects and argue that we can coherently hold that male circumcision is permissible without also endorsing all forms of female genital cutting.

Factores protecotres en la prevención de soncumo de drogas en los adolescentes en riesgo / Protective factors in the prevention of drug use in adolescents at risk

El presente trabajo, hace alusión a los factores de protección personal, familiar y comunal que atribuyen al no consumo de drogas por parte de los adolescentes que participan en el programa de los Centro de Actividades Juveniles de la Ciudad Capital de la provincia de La Rioja en el año 2008. Para ello, se presenta un marco teórico referencial a partir del cual se analiza y sustenta la investigación, al amparo de un marco institucional desde el cual se estudia el tema. El diseño de investigación fue exploratorio-descriptivo, aplicándose la Encuesta auto dirigida y la Entrevista semi estructurada como instrumento de recolección a una muestra de 172 personas distribuidas en 164 adolescentes, 2 coordinadores de los CAJ y 6 profesionales integrantes del equipo técnico de los CAJ que serian los que constituyen la unidad de análisis. Los datos obtenidos fueron volcados en informes, dando lugar a las conclusiones, que posteriormente generaron la discusión de los resultados permitiéndonos conocer los factores protectores personales, familiares y comunales de los adolescentes en riego para el no consumo de drogas

ABSTRACT: The present work refers to personal protective factors, family and community that is not attributed to drug use by adolescents in the program of the Youth Activity Center of the Capital City of the province of La Rioja 2008. To this end, we present referenceframework from which analyzes and supports the research, under an institutional framework from which to study the issue. The research design was exploratory descriptive,elfdirected applied Survey and semi-structured interview as a means of collecting a sample of 172 people distributed in 164 adolescents, 2 coordinators and 6 CAJ professional technical team to the CAJ which would constitute the unit of analysis. The data obtained were turned in reports, leading to conclusions, which then generated the discussion of the results allowing us to know personal protective factors, family and community of adolescents at risk for drug failure

Ejerciendo los derechos de las niñas y niños desde la primera infancia / Exercising the rights of girls and boys from early childhood

La base del estudio ha consistido en revisar la situación previa y la actual, luego de un proceso de intervencion de cinco años. De esta forma detenerte y mirar el recorrido es sustancial para enfocar lo que sigue: ampliar la cobertura de atención de niñas y niños, perfeccionar las técnicas empleadas, empoderar más a las comunidades, familias e instituciones consolidar las alianzas estratégicas y transferir modelos de gestión a los gobiernos municipios, en un tema prioritario: la atención de la primara infancia.

The CRC 20 years: An overview of some of the major achievements and remaining challenges.

On 20 November 1989, the General Assembly of the United Nations adopted the Convention on the Rights of the Child (CRC). It entered into force on 2 September 1990 and has by now been ratified by 193 States, making the most universally ratified human rights treaty. This overview will present and discuss the impact of this treaty both at the international and the national level, an overview which necessarily has to be limited to some of the developments as a result of the implementation of the CRC. The first part of this paper will be devoted to the impact the CRC had and still has on the setting and development of the international agenda for the promotion and protection of the rights and welfare of children. Special attention will given to developments, achievements, and remaining challenges at the international level with regard to protection of children in armed conflict; prevention and the protection of children from sexual exploitation; and from all forms of violence. This will include some information on the impact of these international developments and actions at the national level, for example, in the area of legislation. The second part will focus on the impact at the national level. Given the wide scope of the CRC this part will be limited to some of the General Measures of Implementation (law reform, national programmes, and independent monitoring) and the General Principles (non-discrimination, best interest, right to be heard) of the CRC. This will be based on reports of States on the implementation of the CRC submitted to the CRC Committee and the Concluding Observations of this Committee and on a number of studies. The conclusion will provide remarks on poverty as one of the major remaining challenges for the implementation of children's rights.

The need for a General Comment for Article 19 of the UN Convention on the Rights of the Child: Toward enlightenment and progress for child protection.

OBJECTIVE: To present the need and plan for development of a General Comment for the UN Convention on the Rights of the Child Article 19 which has the potential to transform and advance child protection through the infusion of a child rights approach. METHODS: The Committee on the Rights of the Child (Committee) authorized ISPCAN and IICRD to draft a General Comment for CRC Article 19 (GC19) and to introduce implementation supports. An international working group (GC19WG), Expert Advisory Panel (EAP), and GC19 Focal Group of Committee members (GC19 CRC FG) have been organized to help guide and carry out the program of development. Analyses of relevant histories and knowledge, including effective and promising child protection strategies, are being applied to guide formulation of the GC and high priority implementation components. Consultations on the draft and supportive products will be conducted in cooperation with UNICEF, WHO, the NGO Group for the CRC, and other NGOs. Advice is to be solicited from interested parties and organizations in person and through distance communication throughout the world. RESULTS: In addition to the GC19, numerous implementation supports will be planned and some will be produced and piloted during the program of development. Under consideration are an implementation guide and resources; commentary; accountability models, indicators, measures and evaluation systems; a clearing house and resource website; a child-appropriate version of GC19; and education/training curricula and programs. PRACTICE IMPLICATIONS: GC19 has the potential to transform child protection by fostering a paradigm shift in its conceptualization, theory, research, and practice. Article 19 encourages an interpretation and application beyond narrow child protection conceptualizations and practices which have been found seriously inadequate. The General Comment can advance effective prevention of maltreatment and protection of personal security by promoting the child's rights, well-being, health, and development in all aspects of child protection. GC19 will provide support to the Committee on the Rights of the Child in its monitoring and guiding functions, and to States Parties, professionals, and civil society agents concerned with the protection and well-being of children.