Evidence-based child abuse prevention: Developing measures for observation and evaluation in a global context

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Globally, 95 million children become victims of physical, emotional and sexual child abuse every year. Child abuse has lifetime impacts including medical trauma, mental health distress, illness, school drop-out and unemployment. We know there is also a cycle of violence across generations. In other words, victims of child abuse are more likely to commit violent crime and to abuse their own children. They are also more likely to become a victim of violence again, both in childhood and in their adult relationships. Child abuse also has a hidden but massive impact on society because of illness and disability, costing an estimated 124 billion USD a year in the United States.But why do child abuse rates remain so inexplicably high? Child abuse is a complex problem that reaches across the home and community. In order to combat child abuse, we need to understand how many children are affected, where they are and who is most at risk. Then we need effective interventions to prevent and reduce child abuse. However, we know very little about either. A small number of high-income countries have social services data but these only identify the tip of the iceberg; most child abuse is never reported to services. To detect abuse within the whole population, we need to conduct surveys. That being said, the only child abuse measures available are lengthy and detailed, and they are therefore costly to carry out nationally. If a short child abuse measure existed, it could be included in larger, regularly conducted surveys (e.g. Demographic and Health Surveys or census). Interventions aim to prevent and reduce abuse, but there is currently no child abuse measure that can test whether such interventions have worked. A measure needs to be designed to detect changes in how severe and how often abusive behaviours occur. At the moment, researchers often use proxy measures for abuse, such as parenting stress.This study has two aims: (1) to develop a brief child abuse measure for the inclusion in large surveys, and (2) to test and validate a sensitive child abuse measure for use in intervention evaluation research. These will then be made available, together with a user manual, at no cost.To combat child abuse, we need strong collaborations between research and policy. I have already established strong partnerships with a number of academic institutions and international organisations in child protection. I have developed a prototype of the measure for intervention testing, and this is being used in six studies with 3800 participants in South Africa, Tanzania, the Democratic Republic of Congo and the Philippines. My collaborators will share the data, allowing me to conduct statistical analysis on how and whether the measure works. I will also conduct analyses testing whether the tool measures the same concepts across cultures. Finally, I will carry out qualitative research with key stakeholders in child protection to find the best questions for the short child abuse measure. To complement this, I will use statistical techniques on the pooled dataset to identify questions that can be used in surveys.This project can have a large impact on global child abuse prevention efforts. It will help researchers and policy-makers to measure accurately the number of children affected and determine whether interventions really work. It is an essential step in creating high quality evidence for protecting the world's children.