Perpetration-Focused Prevention: The Perceptions of Victim-Survivors.

Policymakers are increasingly calling on victim-survivors of child sexual abuse to consult on prevention initiatives, including perpetration-focused prevention efforts like Stop it Now! However, very little is known about the perspectives of victim-survivors on perpetration-focused prevention and whether they support such initiatives. This study was informed by the research question: How do victim-survivors of child sexual abuse perceive perpetration-focused prevention, including the Stop it Now! program? Sixteen Australian victim-survivors participated in an individual, one-hour interview and the data were analysed according to thematic analysis. Four themes emerged through the data analysis: Core of repulsion; Doubt and dismissal; Conditions for congruence; and Arriving at acceptability. These themes are represented as a spiral from the first theme at the centre to the last at the outer edge, reflecting a process of rationalisation. Their initial reaction was a sense of revulsion to perpetration-focused prevention, but their final position was one of conditional support.

A rapid review of challenges and opportunities related to diversity and inclusion as experienced by early and mid-career academics in the medicine, dentistry and health sciences fields.

BACKGROUND: Early- and mid-career academics in medicine, dentistry and health sciences are integral to research, education and advancement of clinical professions, yet experience significant illbeing, high attrition and limited advancement opportunities. OBJECTIVES: Identify and synthesise published research investigating challenges and opportunities related to diversity and inclusion, as experienced by early and mid-career academics employed in medicine, dentistry and health sciences disciplines. DESIGN: Rapid review. DATA SOURCES: OVID Medline, Embase, APA PsycInfo, CINAHL and Scopus. METHODS: We systematically searched for peer reviewed published articles within the last five years, investigating challenges and opportunities related to diversity and inclusion, as experienced by early and mid-career academics employed in medicine, dentistry and health sciences. We screened and appraised articles, then extracted and synthesised data. RESULTS: Database searches identified 1162 articles, 11 met inclusion criteria. Studies varied in quality, primarily reporting concepts encompassed by professional identity. There were limited findings relating to social identity, with sexual orientation and disability being a particularly notable absence, and few findings relating to inclusion. Job insecurity, limited opportunities for advancement or professional development, and a sense of being undervalued in the workplace were evident for these academics. CONCLUSIONS: Our review identified overlap between academic models of wellbeing and key opportunities to foster inclusion. Challenges to professional identity such as job insecurity can contribute to development of illbeing. Future interventions to improve wellbeing in academia for early- and mid-career academics in these fields should consider addressing their social and professional identity, and foster their inclusion within the academic community. REGISTRATION: Open Science Framework ( https://doi.org/10.17605/OSF.IO/SA4HX ).

Personal barriers to addressing intimate partner abuse: a qualitative meta-synthesis of healthcare practitioners' experiences.

BACKGROUND: Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs' responses to IPA. METHODS: Five databases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden's thematic synthesis approach. RESULTS: Twenty-nine studies conducted in 20 countries informed the final review. A variety of HCPs and settings were represented. Three themes were developed that describe the personal barriers experienced by HCPs: I can't interfere (which describes the belief that IPA is a "private matter" and HCPs' fears of causing harm by intervening); I don't have control (highlighting HCPs' frustration when women do not follow their advice); and I won't take responsibility (which illuminates beliefs that addressing IPA should be someone else's job). CONCLUSION: This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to: encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs' trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.

Frontline Workers' Response to Harmful Sexual Behavior: Building Blocks For Promising Practice.

Frontline workers, including educators and health practitioners, play an important role in identifying and responding to harmful sexual behavior (HSB) carried out by children and young people. Despite this, there have been no reviews of the evidence about promising practice for how frontline workers could best manage this behavior. This article presents a scoping review of evidence exploring the research question: How can frontline professionals be trained and supported to better manage HSB carried out by children and young people? Multiple databases were searched in July 2020. Inclusion criteria included a focus on professional development or practice relating to children and young people displaying inappropriate sexual behavior or HSB; a population of frontline workers (teachers, health practitioners, coaches, childcare workers); and all study types, including gray literature. Two reviewers screened the articles, and findings from included papers were synthesized according to the method of thematic synthesis. Thirty-one papers were included in the review. Five themes were identified in response to the research question: process of identification and response, knowledge required to identify and respond, skills needed to identify and respond, organization-level supports, and system-level supports. The authors propose the "building blocks" for a promising practice model, which sets out the process of identification and response to HSB, and the knowledge required by frontline workers to support that process. Further, the model identifies the skills required by frontline workers to undertake the process of identification and response, as well as the organization-level and system-level scaffolding needed for good practice.

Tensions in the therapeutic relationship: emotional labour in the response to child abuse and neglect in primary healthcare.

BACKGROUND: Child abuse and neglect (child abuse) is a prevalent public health issue linked to survivors experiencing a higher risk of health issues such as obesity, heart disease and major depression. Given the significant impact of child abuse on health, general practitioners (GPs) and primary care nurses (nurses) are well-placed to respond to child abuse. However, research shows that responding to child abuse is difficult for health practitioners, especially the act of reporting child abuse. The present study aimed to understand how GPs and nurses experience the response to child abuse in primary healthcare. METHODS: This study employed qualitative methods. Twenty-six in-depth individual and group interviews were conducted with 30 GPs and nurses. The interviews were audio recorded with consent, transcribed verbatim and thematically analysed. RESULTS: The participants were mostly metropolitan-based female GPs. Participants were sampled from two settings: private general practice and community health; and Doctors in Secondary Schools, a program that places GPs and nurses in high schools. Thematic analysis generated four themes: blowing trust out of the water; riding the reaction wave; opening a hornet's nest; and battling emotions. Participants felt that, in considering child abuse, they were betraying the trust of the therapeutic relationship and thus, had to manage their patients' reactions to preserve the therapeutic relationship. They used strategies that created shifts in perception in both themselves and their patients to help maintain the therapeutic relationship. Participants often felt that they had to compromise their professional code of ethics to fulfil their mandatory reporting obligations. Thus, they experienced internal emotional battles when responding which led to some experiencing burnout or vicarious trauma and others resilience. This complex interplay of relationship and emotional management was placed in the context of emotional labour theory. We contend that our participants undertook emotional labour across three levels: internal, organisational and systemic. CONCLUSIONS: We conclude that the emotional labour exerted in the response to child abuse can be diminished by: developing strategies for therapeutic relationship management; undertaking an internal, organisational and systemic values assessment; and facilitating communication between health professionals and the child protection system.

Future directions in child sexual abuse prevention: An Australian perspective.

BACKGROUND: Child sexual abuse is a problem of significant proportion in Australia and globally. Prevention efforts have tended to occur on an ad hoc basis and to be poorly evaluated. A measured, evidence-based public health approach to preventing child sexual abuse is necessary to enhance the prevention agenda. OBJECTIVE: The objective of this paper was to engage with the work of Letourneau and colleagues about a public health approach to child sexual abuse prevention from an Australian perspective. METHODS: In this commentary paper, following on from Letourneau and colleagues, policy resistance to addressing the problem of child sexual abuse and its prevention in the Australian context is explored. Promising pockets of research, policy and practice are described that indicate greater readiness and a lessening policy resistance to address child sexual abuse through a comprehensive public health approach. Finally, ideas for enhancing primary, secondary, and tertiary prevention strategies in Australia are highlighted. CONCLUSIONS: The Australian child sexual abuse prevention agenda would benefit from adopting a measured public health approach involving the design, implementation, and evaluation of primary, secondary, and tertiary interventions. Early intervention strategies are particularly underdeveloped in an Australian context.

Tipping the Scales: Factors Influencing the Decision to Report Child Maltreatment in Primary Care.

Child maltreatment (CM) is an important public health issue linked to significant physical and mental health complications across the life span. Given the association between CM and health, general practitioners (GPs) and primary care nurses (PNs) are well-placed to identify and respond to this issue and are mandated to report suspected CM in many jurisdictions. Research has found that primary care doctors and nurses need support when responding to CM. This scoping review sought to answer the following question: What factors influence GPs and PNs decision to report CM when fulfilling their mandatory reporting duty? By exploring these factors, areas where support is needed were pinpointed. A systematic search was run across four databases: Medline (Ovid), PsycINFO, Embase, and CINAHL. Articles that reported on studies conducted in a location that had mandatory reporting legislation specific to CM and had a study population sampled from primary care were included in analysis. Thirty-three articles met the inclusion criteria. This review found that four principal factors influenced the decision to report CM: personal threshold of suspicion of abuse, relationship with the family, faith in the child protection system, and education and discussion. We conclude that improving the support and training to address these four areas may be beneficial for GPs and PNs in responding to CM.

Health practitioners' readiness to address domestic violence and abuse: A qualitative meta-synthesis.

Health practitioners play an important role in identifying and responding to domestic violence and abuse (DVA). Despite a large amount of evidence about barriers and facilitators influencing health practitioners' care of survivors of DVA, evidence about their readiness to address DVA has not been synthesised. This article reports a meta-synthesis of qualitative studies exploring the research question: What do health practitioners perceive enhances their readiness to address domestic violence and abuse? Multiple data bases were searched in June 2018. Inclusion criteria included: qualitative design; population of health practitioners in clinical settings; and a focus on intimate partner violence. Two reviewers independently screened articles and findings from included papers were synthesised according to the method of thematic synthesis. Forty-seven articles were included in the final sample, spanning 41 individual studies, four systematic reviews and two theses between the years of 1992 and 2018; mostly from high income countries. Five themes were identified as enhancing readiness of health practitioners to address DVA: Having a commitment; Adopting an advocacy approach; Trusting the relationship; Collaborating with a team; and Being supported by the health system. We then propose a health practitioners' readiness framework called the CATCH Model (Commitment, Advocacy, Trust, Collaboration, Health system support). Applying this model to health practitioners' different readiness for change (using Stage of Change framework) allows us to tailor facilitating strategies in the health setting to enable greater readiness to deal with intimate partner abuse.

"Talking about child sexual abuse would have helped me": Young people who sexually abused reflect on preventing harmful sexual behavior.

Harmful sexual behavior carried out by children and young people accounts for about half of all child sexual abuse perpetration. The aim of this study was to draw on the insights of young people who had been sexually abusive to enhance the current prevention agenda. The study involved semi-structured interviews with 14 young people and six treatment-providing workers. Sampling was purposive and the young people had previously completed a treatment program for harmful sexual behaviour in Victoria, Australia. The young people were approached as experts based on their previous experience of engaging in harmful sexual behavior. At the same time, their past abusive behavior was not condoned or minimised. Constructivist Grounded Theory was used to analyse the qualitative data. Opportunities for preventing harmful sexual behavior were the focus of the interviews with young people and workers. The research identified three opportunities for prevention, which involved acting on behalf of children and young people to: reform their sexuality education; redress their victimization experiences; and help their management of pornography. These opportunities could inform the design of initiatives to enhance the prevention agenda.

Prevention-enhancing interactions: a Critical Interpretive Synthesis of the evidence about children who sexually abuse other children.

There is a growing interest in English-speaking jurisdictions, including Australia, North America, Canada, the United Kingdom and New Zealand, about the prevention of sexual abuse perpetrated by children against other children. The aim of this review was to identify opportunities for research, policy and practice which could enhance the prevention agenda relating to the perpetration of sexual abuse by children through conducting a Critical Interpretive Synthesis. Eleven electronic databases were searched in the period from 22 April to 23 May 2013 and included: SocINDEX, Social Services Abstracts, Applied Social Sciences Index and Abstracts, Family and Society Studies Worldwide, Project Muse, PsychINFO, Family and Society Plus, Jstor, Expanded Academic ASAP, Web of Science and Google Scholar. Key individual journals were also searched, including Child Abuse and Neglect and the Journal of Interpersonal Violence, as well as the grey literature. The search was guided by the research question: How could the prevention agenda relating to sexual abuse perpetrated by children be enhanced? The systematic literature search yielded 3323 titles, and 34 of these papers were included in the final synthesis. The authors identified five domains operating in the evidence base: characteristics, causes, communications, interventions and treatments. A synthesising construct emerged from the review: prevention-enhancing interactions. This construct referred to the potential for enhancing the prevention agenda which exists as the evidence domains interact with one another, and with the public health model of prevention. The authors consider this review to be a timely contribution to the current agenda pertaining to sexual abuse perpetrated by children. It provides researchers, policy makers and practitioners in the field with an evidence-informed conceptualisation of opportunities for enhancing prevention work.