Adverse Childhood Experiences Among 28,047 Norwegian Adults From a General Population

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Walking Children Through a Minefield: How Professionals Experience Exploring Adverse Childhood Experiences

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Possible paths to increase detection of child sexual abuse in child and adolescent psychiatry: a meta-synthesis of survivors’ and health professionals’ experiences of addressing child sexual abuse

Background: Efforts are directed both towards prevention and early detection of Child sexual abuse (CSA). Yet, only about 50% of CSA survivors disclose before adulthood, and health professionals rarely are the first disclosure recipients. Increasing the detection rate of CSA within the context of Child and Adolescent Psychiatry (CAP) therefore represents a significant secondary prevention strategy. However, facilitating CSA disclosure when the survivor is reluctant to tell is a highly complex and emotionally demanding clinical task. We therefore argue that efforts to increase detection rates of CSA within CAP need to rest on knowledge of how both survivors and health professionals experience addressing CSA. Method: Using meta-ethnography as method, we present separate sub-syntheses as well an overarching joint synthesis of how survivors and health professionals experience addressing CSA. Results: Results show how both survivors and health professionals facing CSA disclosure feel deeply isolated, they experience the consequences of addressing CSA as highly unpredictable, and they need support from others to counteract the negative impact of CSA. Conclusion: The results indicate that adapting the organization of CAP to knowledge of how the survivors and health professionals experience addressing CSA is critical to facilitate earlier disclosure of CSA within CAP.publishedVersio

Walking children through a minefield. : Qualitative studies of professionals’ experiences addressing abuse in child interviews.

Background: Ample research document that child abuse is widespread and that it is harmful to victims’ physical, psychological and social well-being. Protecting the victims from further abuse and offering them restorative care can reverse these negative effects, but evidence suggests that numerous children exposed to child abuse remain undetected, even if they have been in contact with health or social services. Further, research on explaining why professionals fail to reveal child abuse seem scarce. The aim of this thesis is to explore aspects important to better understand professionals’ lived experiences of addressing abuse in child interviews. Methods: We conducted two qualitative studies to realize this aim. The first study was a metasynthesis of international empirical, qualitative research on professionals’ experiences addressing child adversity, where our systematic literature search yielded eight eligible studies (paper I). We utilized meta-ethnographic comparative method and performed reciprocal translations by principles of thematic analysis and interpretative translation, as well as a line-of-argument synthesis. In the second study, we performed in-depth interviews With ten social workers in child protective services (CPS) and nine psychologists in child and adolescent mental health services (CAMS) (papers II and III). We approached the Research interviews within a hermeneutic phenomenological epistemology and used interpretive description to examine the data. Results: To convey the participants’ struggles exploring child abuse, we developed the metaphor “walking children through a minefield” in paper I. Three overarching themes supported the metaphor: (a) feeling inadequate, (b) fear of making it worse, and (c) facing evil. Metaphorically, the participants felt exploring child abuse resembled maneuvering through an unknown minefield without knowledge or training in how to avoid or to defuse mines. They felt lacking in competence, organizational support and/or recourses. Addressing abuse, the participants risked hurting both themselves and the child because they lacked control over outcomes. Moreover, they reported strong negative emotions exploring abuse and subsequent avoidance patterns. Because a dominant feature in our interview data was the participants’ negative reactions to explorative work, we explored their emotional experiences addressing child abuse in paper II. We captured the participants’ experiences in five themes: (a) facing children’s suffering caused by adults, (b) feeling mean, (c) doubting one’s ability and skills, (d) feeling one is betraying children, and (e) being obstructed by heavy workload and dysfunctional structure. Findings in paper II is illustrated with the image that addressing child abuse felt like plunging into a dark sea of emotions. Encountering emotion-provoking challenges both within themselves and from their environment made the participants feel guilty for not providing children the standards of care and support they believed the children needed and deserved. In paper III, we explored the participants’ experiences with facilitators to address abuse in child interviews. Based on the participants’ accounts we revealed that various facilitators relative to the stage of the skill development and intrinsic motivation of the professional ease explorative work. We developed five themes to convey these facilitators: (a) alleviating personal choice, (b) collective accountability, (c) sharing vulnerability, (d) finding your own way, and (e) doing it for the right reasons. The findings suggest that professionals’ facilitators for addressing abuse are two-dimensional; some facilitators alleviate their emotional strain and doubt, while other facilitators promote their job satisfaction. Conclusion: Overall, our findings show that addressing child abuse is challenging work due to its inherent complexity, unpredictability, and lack of control, and because it involves children’s suffering. These challenges inflict professionals with doubt, guilt, and frustration. To support professionals and reduce their challenges, it is important to offer help that can alleviate their emotional strain and promote their job satisfaction. Firstly, to remedy the situation organizations should be adapted to meet children’s needs, offer a supportive culture with shared vulnerability, and develop a culture and an organizational structure that promotes professionals’ autonomy. Secondly, services should implement goal-directed reflective practice with feedback on performance, as well as train professionals in adaptive emotion regulation strategies and relationship-building skills

Entering an emotional minefield: professionals’ experiences with facilitators to address abuse in child interviews.

Background: Extensive research documents that child abuse is widespread and that it has detrimental effects on victims’ physical, psychological and social well-being. Efforts to help abused children by removing stressors and administering restorative care can reverse these negative effects, but the evidence suggests that professionals often fail to expose child abuse. This study aims to generate insight into professionals’ experiences with facilitators in handling the challenges of addressing abuse in child interviews. We expect that this knowledge can improve interventions that qualify professionals in the identification, protection and care of abused children. Methods: Within the qualitative approach and an Interpretive Description framework, we performed in-depth interviews with nineteen participants from southern Norway, specifically ten social workers from child protective services and nine psychologists from child mental health services. Then, Interpretive Description analysis was performed by using constant comparison, reflexive and critical examinations, and contextualized theoretical interpretations. Results: The participants’ accounts revealed that various facilitators relative to the stages of the skill development and intrinsic motivation of the practitioner enhance the explorative work of the professional. We identified the following five main themes: (a) alleviating personal choice; (b) collective accountability; (c) sharing vulnerability; (d) finding your own way; and (e) doing it for the right reasons. Conclusions: To facilitate explorative work, our findings suggest that competence development should apply goal-directed reflective practice combined with positive feedback on performance. Furthermore, our results indicate that developing personal competence is contingent on supporting individual choice and volition while decreasing demands towards following rules and guidelines. To promote the relatedness and the emotion regulation of professionals, we suggest endorsing shared vulnerability with colleagues and promoting an organizational culture that supports openness and allows professionals to discuss their emotions when addressing difficult and complex issues. It is also advisable to promote autonomy by helping professionals to find meaning in their work that is compatible with their personal values

Walking Children Through a Minefield: How Professionals Experience Exploring Adverse Childhood Experiences

Understanding the challenges of professionals in addressing child adversity is key to improving the detection, protection, and care of exposed children. We aimed to synthesize findings from qualitative studies of professionals’ lived experience of addressing child adversity. Through a systematic search, we identified eight qualitative studies and synthesized them using metaethnography. We generated three themes, “feeling inadequate,” “fear of making it worse,” and “facing evil,” and one overarching metaphor, “walking children through a minefield.” The professionals felt that they lacked the means necessary to explore child adversity, that they were apprehensive of worsening the child’s situation, and that their work with child adversity induced emotional discomfort. This metasynthesis indicated that the professionals’ efficiency in exploring abuse relied upon their ability to manage emotional and moral distress and complexity. To support children at risk, we propose developing professionals’ ability to build relationships, skills in emotion regulation, and proficiency in reflective practice

Walking Children Through a Minefield: How Professionals Experience Exploring Adverse Childhood Experiences

Understanding the challenges of professionals in addressing child adversity is key to improving the detection, protection, and care of exposed children. We aimed to synthesize findings from qualitative studies of professionals’ lived experience of addressing child adversity. Through a systematic search, we identified eight qualitative studies and synthesized them using metaethnography. We generated three themes, “feeling inadequate,” “fear of making it worse,” and “facing evil,” and one overarching metaphor, “walking children through a minefield.” The professionals felt that they lacked the means necessary to explore child adversity, that they were apprehensive of worsening the child’s situation, and that their work with child adversity induced emotional discomfort. This metasynthesis indicated that the professionals’ efficiency in exploring abuse relied upon their ability to manage emotional and moral distress and complexity. To support children at risk, we propose developing professionals’ ability to build relationships, skills in emotion regulation, and proficiency in reflective practice

Adverse Childhood Experiences Among 28,047 Norwegian Adults From a General Population

Aim: The purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among Norwegian adults from a general population and to identify potential associations with demographic and socioeconomic characteristics. Methods: A randomly drawn sample (N = 61,611) from the public registry of inhabitants was invited to participate in the Norwegian Counties Public Health Survey. The present study was based on online responses from 28,047 adults ≥18 years (mean age: 46.9 years, SD = 16.03). Log-link binomial regression analyses were performed to examine associations between four measures of ACEs (family conflict, lack of adult support, bad memories, and difficult childhood) and demographic (age, gender, civil status, parental divorce) and socioeconomic characteristics (education level, perceived financial situation, and welfare benefits). Results: Single individuals and those with parents that divorced during childhood were at elevated risk of all four ACEs. The risk varied to some degree between the sexes. The prevalence of ACEs declined with increasing age. We found a consistent social gradient that corresponded to the frequency of ACEs for all three socioeconomic characteristics investigated. The risks were highest for those in the lowest socioeconomic levels (RR: 1.53, 95% CI: 1.32–1.78 to RR: 4.95, CI: 4.27–5.74). Conclusions: Public health strategies should direct more attention to the interplay between ACEs and socioeconomic factors. Welfare services should be sensitive to ACEs among their service recipients