Development of the SAFE Checklist Tool for Assessing Site-Level Threats to Child Protection: Use of Delphi Methods and Application to Two Sites in India

Background: The child protection community is increasingly focused on developing tools to assess threats to child protection and the basic security needs and rights of children and families living in adverse circumstances. Although tremendous advances have been made to improve measurement of individual child health status or household functioning for use in low-resource settings, little attention has been paid to a more diverse array of settings in which many children in adversity spend time and how context contributes to threats to child protection. The SAFE model posits that insecurity in any of the following fundamental domains threatens security in the others: Safety/freedom from harm; Access to basic physiological needs and healthcare; Family and connection to others; Education and economic security. Site-level tools are needed in order to monitor the conditions that can dramatically undermine or support healthy child growth, development and emotional and behavioral health. From refugee camps and orphanages to schools and housing complexes, site-level threats exist that are not well captured by commonly used measures of child health and well-being or assessments of single households (e.g., SDQ, HOME). Methods: The present study presents a methodology and the development of a scale for assessing site-level child protection threats in various settings of adversity. A modified Delphi panel process was enhanced with two stages of expert review in core content areas as well as review by experts in instrument development, and field pilot testing. Results: Field testing in two diverse sites in India—a construction site and a railway station—revealed that the resulting SAFE instrument was sensitive to the differences between the sites from the standpoint of core child protection issues

SAFE items in rank order (from highest to lowest) of highest ranked by domain, second round.

<p>SAFE items in rank order (from highest to lowest) of highest ranked by domain, second round.</p

Adult caregivers interviewed at Jaipur and Delhi-NCR sites

<p>Adult caregivers interviewed at Jaipur and Delhi-NCR sites</p

Flowchart of the Delphi panel process

<p>Flowchart of the Delphi panel process</p

Comparison of Jaipur and Delhi-NCR on selected SAFE items.

<p>¹Response scale: 1 = None (0%), 2 = Few (1%-25%), 3 = Some (26–50%), 4 = Most (51%-75%), 5 = Almost all/All (76%-100%).</p><p>²Means of ordinal scales are provided only to assist in comparing Jaipur ratings to Delhi ratings.</p><p>³P-value for exact Mann-Whitney U.</p><p>Comparison of Jaipur and Delhi-NCR on selected SAFE items.</p