Preventing teacher violence against children: the need for a research agenda.

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Secondary distress in violence researchers: a randomised trial of the effectiveness of group debriefings.

BACKGROUND: Secondary distress including emotional distress, vicarious trauma (VT) and secondary traumatic stress (STS) due to exposure to primary trauma victims have been described in helping professionals and in violence researchers. To our knowledge, there are few prevalence studies, and no tailored interventions have been tested to reduce secondary distress in violence researchers. The study aims to (1) describe the epidemiology of secondary distress experienced by violence researchers; to (2) assess the effectiveness of group debriefings in mitigating secondary distress; to (3) assess risk and protective factors. METHODS: We conducted an un-blinded, individually randomised trial with parallel assignment. Eligible participants were 59 Ugandan researchers employed by the Good Schools Study to interview children who experienced violence in a district of Uganda. Fifty-three researchers agreed to participate and were randomly allocated. The intervention group (n = 26) participated in three group debriefings and the control group (n = 27) in three leisure sessions (film viewings). The primary outcome was change in levels of emotional distress (SRQ-20); secondary outcomes were levels of VT and STS at end-line. A paired t-test assessed the difference in mean baseline and end-line emotional distress. Un-paired t-tests compared the change in mean emotional distress (baseline vs. end-line), and compared levels of VT and STS at end-line. Separate logistic regression models tested the association between end-line emotional distress and a-priori risk or protective factors. RESULTS: Baseline and end-line levels of emotional distress were similar in control (p = 0.47) and intervention (p = 0.59) groups. The superiority of group debriefing over leisure activities in lowering levels of emotional distress in the intervention group (n = 26; difference in SRQ-20 = 0.23 [SD = 2.18]) compared to the control group (n = 26; difference in SRQ-20 = 0.23 [SD = 1.63]) could not be detected (p = 1). In regression analysis (n = 48), baseline distress increased the odds of end-line distress (OR = 16.1, 95%CI 2.82 to 92.7, p = 0.002). Perceived organisational support (OR = 0.09, 95%CI 0.01 to 0.69, p = 0.02) and belief in God (OR = 0.21, 95%CI 0.03 to 1.26, p = 09) was protective against end-line distress. CONCLUSION: We found no evidence that violence researchers experienced elevated emotional distress after doing violence research. There was no difference between group debriefings and leisure activities in reducing distress in our sample. However, the hypotheses presented should not be ruled out in other violence research settings. Our findings suggest that organisational support is a significant protective factor and belief in God may be an important coping mechanism. TRIAL REGISTRATION: Clinical Trials NCT02390778 . Retrospectively registered 19 March 2015. The Good Schools Trial was registered at ( NCT01678846 ), on August 24, 2012

Addressing silences in research on girls’ experiences of teacher sexual violence: insights from Uganda

Growing evidence from multiple countries in Africa documents sexual violence in schools. However, when that violence is committed by teachers it is shrouded in secrecy. This article identifies disconnects between quantitative and qualitative research, policy and practice, which have contributed to these silences. We address some of these silences through a dialogical analysis of mixed methods data from the Contexts of Violence in Adolescence Cohort study (CoVAC) with young people in Uganda. The analysis illuminates girls’ experiences of sexual violence by school staff, and patterns of discrimination and inequality that increase vulnerabilities. The data reveal how schools vary in their institutional responses and, in the absence of institutional support, girls develop strategies to resist sexual coercion. Overall, our analysis exposes significant disconnects between policies and practices of sexual exploitation in schools. We conclude that dialogical, mixed methods research approaches have strong potential to better understand and address silences in policy and practice on highly sensitive topics

Economic evaluation of the Good School Toolkit: an intervention for reducing violence in primary schools in Uganda.

INTRODUCTION: This paper presents the cost and cost-effectiveness of the Good School Toolkit (GST), a programme aimed at reducing physical violence perpetrated by school staff to students in Uganda. METHODS: The effectiveness of the Toolkit was tested with a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. A full economic costing evaluation and cost-effectiveness analysis were conducted alongside the trial. Both financial and economic costs were collected retrospectively from the provider's perspective to estimate total and unit costs. RESULTS: The total cost of setting up and running the Toolkit over the 18-month trial period is estimated at US397 233, excluding process monitor (M&E) activities. The cost to run the intervention is US7429 per school annually, or US$15 per primary school pupil annually, in the trial intervention schools. It is estimated that the intervention has averted 1620 cases of past-week physical violence during the 18-month implementation period. The total cost per case of violence averted is US$244, and the annual implementation cost is US$96 per case averted during the trial. CONCLUSIONS: The GST is a cost-effective intervention for reducing violence against pupils in primary schools in Uganda. It compares favourably against other violence reduction interventions in the region

"I never expected that it would happen, coming to ask me such questions":Ethical aspects of asking children about violence in resource poor settings.

BACKGROUND: International epidemiological research into violence against children is increasing in scope and frequency, but little has been written about practical management of the ethical aspects of conducting such research in low and middle-income countries. In this paper, we describe our study procedures and reflect on our experiences conducting a survey of more than 3,700 primary school children in Uganda as part of the Good Schools Study, a cluster randomised controlled trial of a school-based violence prevention intervention. Children were questioned extensively about their experiences of physical, sexual, and emotional violence from a range of different perpetrators. We describe our sensitisation and consent procedures, developed based on our previous research experience and requirements for our study setting. To respond to disclosures of abuse that occurred during our survey, we describe a referral algorithm developed in conjunction with local services. We then describe our experience of actually implementing these procedures in our 2012 survey, based on reflections of the research team. Drawing on 40 qualitative interviews, we describe children's experiences of participating in the survey and of being referred to local child protection services. RESULTS: Although we were able to implement much of our protocol in a straightforward manner, we also encountered major challenges in relation to the response of local services to children's disclosures of violence. The research team had to intervene to ensure that children were provided with appropriate support and that our ethical obligations were met. CONCLUSIONS: In resource poor settings, finding local services that can provide appropriate support for children may be challenging, and researchers need to have concrete plans and back-up plans in place to ensure that obligations can be met. The merits of mandatory reporting of children's disclosures to local services need to be considered on a case by case basis-in some places this has the potential to do harm. Research teams also must agree on what level of ancillary care will be provided, and budget accordingly. Further practical examples of how to address the challenges encountered in this work are needed, in order to build a consensus on best practices. TRIAL REGISTRATION: NCT01678846 (clinicaltrials.gov), August 24, 2012

Patterns and predictors of violence against children in Uganda: a latent class analysis.

OBJECTIVE: To explore patterns of physical, emotional and sexual violence against Ugandan children. DESIGN: Latent class and multinomial logistic regression analysis of cross-sectional data. SETTING: Luwero District, Uganda. PARTICIPANTS: In all, 3706 primary 5, 6 and 7 students attending 42 primary schools. MAIN OUTCOME AND MEASURE: To measure violence, we used the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool-Child Institutional. We used the Strengths and Difficulties Questionnaire to assess mental health and administered reading, spelling and maths tests. RESULTS: We identified three violence classes. Class 1 (N=696 18.8%) was characterised by emotional and physical violence by parents and relatives, and sexual and emotional abuse by boyfriends, girlfriends and unrelated adults outside school. Class 2 (N=975 26.3%) was characterised by physical, emotional and sexual violence by peers (male and female students). Children in Classes 1 and 2 also had a high probability of exposure to emotional and physical violence by school staff. Class 3 (N=2035 54.9%) was characterised by physical violence by school staff and a lower probability of all other forms of violence compared to Classes 1 and 2. Children in Classes 1 and 2 were more likely to have worked for money (Class 1 Relative Risk Ratio 1.97, 95% CI 1.54 to 2.51; Class 2 1.55, 1.29 to 1.86), been absent from school in the previous week (Class 1 1.31, 1.02 to 1.67; Class 2 1.34, 1.10 to 1.63) and to have more mental health difficulties (Class 1 1.09, 1.07 to 1.11; Class 2 1.11, 1.09 to 1.13) compared to children in Class 3. Female sex (3.44, 2.48 to 4.78) and number of children sharing a sleeping area predicted being in Class 1. CONCLUSIONS: Childhood violence in Uganda forms distinct patterns, clustered by perpetrator and setting. Research is needed to understand experiences of victimised children, and to develop mental health interventions for those with severe violence exposures. TRIAL REGISTRATION NUMBER: NCT01678846; Results

Does the Good Schools Toolkit Reduce Physical, Sexual and Emotional Violence, and Injuries, in Girls and Boys equally? A Cluster-Randomised Controlled Trial.

We aimed to investigate whether the Good School Toolkit reduced emotional violence, severe physical violence, sexual violence and injuries from school staff to students, as well as emotional, physical and sexual violence between peers, in Ugandan primary schools. We performed a two-arm cluster randomised controlled trial with parallel assignment. Forty-two schools in one district were allocated to intervention (n = 21) or wait-list control (n = 21) arms in 2012. We did cross-sectional baseline and endline surveys in 2012 and 2014, and the Good School Toolkit intervention was implemented for 18 months between surveys. Analyses were by intention to treat and are adjusted for clustering within schools and for baseline school-level proportions of outcomes. The Toolkit was associated with an overall reduction in any form of violence from staff and/or peers in the past week towards both male (aOR = 0.34, 95%CI 0.22-0.53) and female students (aOR = 0.55, 95%CI 0.36-0.84). Injuries as a result of violence from school staff were also lower in male (aOR = 0.36, 95%CI 0.20-0.65) and female students (aOR = 0.51, 95%CI 0.29-0.90). Although the Toolkit seems to be effective at reducing violence in both sexes, there is some suggestion that the Toolkit may have stronger effects in boys than girls. The Toolkit is a promising intervention to reduce a wide range of different forms of violence from school staff and between peers in schools, and should be urgently considered for scale-up. Further research is needed to investigate how the intervention could engage more successfully with girls

Are school-level factors associated with primary school students' experience of physical violence from school staff in Uganda?

BACKGROUND: The nature and structure of the school environment has the potential to shape children's health and well being. Few studies have explored the importance of school-level factors in explaining a child's likelihood of experiencing violence from school staff, particularly in low-resource settings such as Uganda. METHODS: To quantify to what extent a student's risk of violence is determined by school-level factors we fitted multilevel logistic regression models to investigate associations and present between-school variance partition coefficients. School structural factors, academic and supportive environment are explored. RESULTS: 53% of students reported physical violence from staff. Only 6% of variation in students' experience of violence was due to differences between schools and half the variation was explained by the school-level factors modelled. Schools with a higher proportion of girls are associated with increased odds of physical violence from staff. Students in schools with a high level of student perceptions of school connectedness have a 36% reduced odds of experiencing physical violence from staff, but no other school-level factor was significantly associated. CONCLUSION: Our findings suggest that physical violence by school staff is widespread across different types of schools in this setting, but interventions that improve students' school connectedness should be considered

Effects of a violence prevention intervention in schools and surrounding communities: Secondary analysis of a cluster randomised-controlled trial in Uganda.

The Good School Toolkit is effective in reducing staff violence against children in Ugandan primary schools. A secondary analysis of cluster-randomised trial data was conducted to investigate intervention effects on school operational culture, and on normative beliefs and violence against children from caregivers outside of school. Students and staff completed cross-sectional surveys at baseline in 2012 and follow-up in 2014. Students' caregivers completed follow-up surveys only. Data from 3820 students, 597 staff, and 799 caregivers were included in cross-sectional analyses at follow-up. Statistically significant intervention effects were observed for aspects of school operational culture, including students' greater perceived emotional support from teachers and peers, students' greater identification with their school, students' and staffs' lower acceptance of physical discipline practices in school, and students' and staffs' greater perceived involvement in school operations. Outside the school, the intervention was associated with significantly lower normative beliefs accepting the use of physical discipline practices in schools (adjusted mean difference, AMD: -0.77; 95%CI: -0.89 to -0.66; p < 0.001) and at home (AMD: -0.67; 95%CI: -0.80 to -0.54; p < 0.001), based on aggregated caregiver reports. No differences between groups were observed in past-week violence against children at home. This intervention shows promise as a platform for addressing violence against children within the school environment and surrounding community

Violence against children perpetrated by peers: A cross-sectional school-based survey in Uganda.

Violence against children by peers is a global public health problem. We aimed to assess factors associated with peer violence victimization among primary school children in Uganda. We conducted multilevel multivariable logistic regression analyses of cross-sectional data from 3706 primary students in 42 Ugandan primary schools. Among primary school students, 29% and 34% had ever experienced physical and emotional violence perpetrated by their peers, respectively. Factors strongly associated with both physical and emotional violence were similar and overlapping, and included exposure to interparental violence, having an attitude supportive of violence against children from school staff, not living with biological parents, working for payment, and higher SDQ score. However, we found that younger age, sharing sleeping area with an adult and achieving a higher educational performance score, were specifically associated with physical violence. On the other hand, being female, walking to school, reporting disability and eating one meal on the previous day, were particularly associated with emotional violence. Interventions to reduce peer violence should focus on family contexts, school environments and those with poor socio-economic status may need extra support