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

全球每年有9500万儿童成为身体、情感和性虐待的受害者。虐待儿童会对一生产生影响，包括医疗创伤、精神健康困扰、疾病、辍学和失业。我们知道，几代人之间也存在着暴力的循环。换句话说，儿童虐待的受害者更有可能犯下暴力犯罪并虐待自己的孩子。他们也更有可能再次成为暴力的受害者，无论是在童年还是在成年后的关系中。由于疾病和残疾，虐待儿童对社会也有隐藏但巨大的影响，在美国每年造成的损失估计为1240亿美元。但是，为什么虐待儿童的比率仍然居高不下呢？虐待儿童是一个涉及家庭和社区的复杂问题。为了打击虐待儿童，我们需要了解有多少儿童受到影响，他们在哪里，谁面临的风险最大。然后，我们需要有效的干预措施来预防和减少虐待儿童。然而，我们对两者都知之甚少。少数高收入国家拥有社会服务数据，但这些数据只反映了冰山一角；大多数虐待儿童的行为从未向服务机构报告。为了发现所有人的虐待行为，我们需要进行调查。话虽如此，唯一可用的虐待儿童措施冗长而详细，因此在全国范围内执行起来代价高昂。如果存在短期虐待儿童措施，可将其纳入定期进行的大型调查（例如人口与健康调查或人口普查）。干预措施的目的是预防和减少虐待，但目前没有儿童虐待措施可以测试这些干预措施是否有效。需要设计一种措施，以发现虐待行为发生的严重程度和频率的变化。目前，研究人员经常使用替代方法来衡量虐待行为，比如养育压力。本研究有两个目的：(1)制定一个简短的儿童虐待措施，以纳入大型调查；(2)测试和验证一个敏感的儿童虐待措施，用于干预评估研究。然后将免费提供这些资料和用户手册。为了打击虐待儿童，我们需要在研究和政策之间进行强有力的合作。我已经在儿童保护方面与一些学术机构和国际组织建立了牢固的伙伴关系。我已经为干预测试开发了一个测量的原型，并在南非，坦桑尼亚，刚果民主共和国和菲律宾的3800名参与者的六项研究中得到了应用。我的合作者将分享这些数据，允许我对该措施如何以及是否有效进行统计分析。我还将进行分析，测试该工具是否在不同文化中度量相同的概念。最后，我将与儿童保护的主要利益相关者进行定性研究，以找到短期虐待儿童措施的最佳问题。为了补充这一点，我将在汇集的数据集上使用统计技术来确定可用于调查的问题。这个项目可以对全球防止虐待儿童的努力产生重大影响。它将帮助研究人员和决策者准确衡量受影响儿童的数量，并确定干预措施是否真的有效。这是为保护世界儿童创造高质量证据的重要一步。

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.