151 For The Parent, By The Parent: Defining the Characteristics of a Novel Program to Empower Parents of Refugee Background Using the Participatory Approaches

Primary Subject area Developmental Paediatrics Background With more than 28 million individuals of refugee or asylum-seeking background globally, the current situation has been described as one of the largest humanitarian crises of all time. Families of refugee background have complex, multigenerational mental health and developmental needs that are not accounted for in current programming frameworks. Difficulties in resettlement have been further compounded by COVID-19-related lockdowns, straining parental mental health and placing children at an increased risk for developmental or behavioural problems. Providing appropriate support services and educational resources that address the multigenerational concerns of families of refugee background will address these challenges, allowing for improved parental mental health, family cohesion, and developmental outcomes for children. Objectives To gather data about the experiences, resources, referral pathways and barriers that impact the experience of parents of refugee background in the Greater Toronto Area (GTA) and to develop a novel, multi-dimensional parenting program model using Community-Based Participatory Research (CBPR) principles. Design/Methods This was a qualitative community-based participatory study using a formative research framework, in accordance with COREQ guidelines. In-depth interviews (IDIs) were conducted with parents of refugee background and care providers that work closely with this population. Data were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders. A peer debriefing strategy was used to verify the coding approach and interpretation of findings in accordance with the RATS (relevancy, appropriateness, transparency and soundness) guidelines for qualitative research. Results A total of 20 IDIs were conducted (7 parents and 13 care providers). The main topics that were identified to be incorporated into the program include features of child development, how to address resettlement issues, child advocacy, and parenting in the Canadian context. Participants felt that tackling the language barriers, addressing the overlapping responsibilities of the mothers attending the sessions, providing incentives, increasing awareness of the program, and using an anti-racist and anti-oppressive approach is key to the program’s success. Participants emphasized the need for trauma-informed mental health support within the program model. Conclusion This study describes the key considerations for a novel parenting program for families of refugee background, by engaging them as key stakeholders in the program design process. Future iteration of this project would involve a pilot and evaluation of the program.

Child Sexual Abuse

The sexual abuse of children is not a new phenomenon, but the traumatic short- and long-term mental health consequences make it essential to study and, ultimately, prevent. The labels for child sexual abuse (CSA) vary and have changed over time, examples being “child sexual abuse,” “child sexual assault,” “child sexual exploitation” and “unwanted sexual experiences.” Each has slightly different meanings and implications. Researchers, practitioners, criminal justice personnel, and policymakers also differ on how to define other aspects of CSA (e.g., age of the child, age differential between child and offender, what acts constitute CSA [touch or penetration only, or non-touch such as exposure to pornography], and risk factors that may become targets of prevention strategies). Such definitional debates impact all aspects of studying the concept, such as examining prevalence, assessment, and clinical interventions. Whether the perpetrators are known to the child (true in the majority of cases) or are strangers affects the length of time that the child is victimized sexually and whether and how they disclose the abuse. The sexual abuse of boys, while a relatively small proportion of sexual victimizations, was not given the attention it warranted until relatively recently. Perpetrators are both males and females (an estimated 20 percent), but the type of CSA differs based on the sex of the offender. Special circumstances in which CSA occurs include the abuse of children in institutions and the CSA of children with disabilities. Disclosing CSA is difficult for many children and, rather than directly disclosing, many mention the abuse indirectly or much later on. Once disclosed, intervention typically consists of child protection services assessment and trauma-focused counseling. Child advocacy centers (CACs) have become the standard agencies to investigate and support CSA victims and non-offending family members. There are a number of ways to provide CSA prevention programs, such as media education, but the most common approach is educating children about the risks and teaching them strategies that may assist them in avoiding abusers or seeking assistance early on. The launch of the Internet has introduced new ways to sexually abuse children, with easier access to child pornography, abuse in real time, and trafficking children for commercial sexual exploitation.

ÇOCUK İSTİSMARINDA AİLE DİNAMİKLERİNE YÖNELİK RİSK FAKTÖRLERİ VE KORUYUCU- ÖNLEYİCİ MÜDAHALELER

The main purpose of the study is to discuss the risk factors associated with family dynamics, protective and preventive approaches in child abuse. In its simplest definition, child abuse, is physical, sexual, and/or psychological maltreatment or neglect of a child or children. Child abuse has been increasing in our country and in the world in recent years. Child abuse, which negatively affects the development of the child in all aspects, also constitutes an important obstacle to raising healthy societies. Many factors such as parents' attitudes and behaviors, personality traits, health conditions, levels of knowledge and skills in raising children, socio-economic status, and education level sare important components of the child'sex posure to abuse in terms of family dynamics. Primary health care services, schools, and Child Advocacy Centers are very important in determining family-based risk factors, evaluating them in a holistic manner and monitoring them, as well as protective and preventive studies of child abuse. Within the scope of the study, national and international studies on child abuse were scrutinized, protective and preventive interventions, family dynamics of children who were victims of abuse were evaluated. In this context, evaluation of family-based risk factors in primary health care services, assessment of parents by counseling teachers in schools, Child Advocacy Centers are the most important steps in determining the risks. It is thought that; categorizing at-risk groups and making the necessary interventions and guidance according to risk priority, increasing the awareness of parents, implementing protective and preventive interventions with a multidisciplinary team understanding within a comprehensive and standardized program and evaluating the effectiveness of interventions through academic studies will be a guide in determining familyrelated risk factors and combating the serisks in child abuse.

“How many times did I not want to live a life because of him”: the complex connections between child sexual abuse, disclosure, and self-injurious thoughts and behaviors

Background Meta-analyses have confirmed an association between child sexual abuse (CSA) and non-suicidal and suicidal self-injurious thoughts and behaviors (SITB), yet the mechanisms linking these factors are, to date, poorly understood. The goal of the current study is to explore one potential influencing factor acting in the association between CSA and SITB, which is the disclosure experience. Disclosure has been identified as a prominent factor in the healing process of survivors, with a lack of support following disclosures heightening negative outcomes. Exploring the impact of CSA disclosure on SITB is necessary to build effective prevention and intervention strategies. Methods This qualitative study is part of a larger initiative spanning diverse research sites in Canada and in Ireland and aiming to lend voice to young people who were sexually abused in childhood/adolescence. Participants were recruited from community-based sexual abuse/assault agencies, hospital-based specialized clinics and child advocacy centres. The Long Interview Method, based on a branch of phenomenology, was used to guide research design and data collection. The current thematic analysis, informed by a stress-diathesis model, is based on a sample comprised of 21 ethnically diverse youth aged 15 to 25 who self-reported a sexual abuse experience in their childhood or teenage years and who, as part of the interview on their disclosure processes, revealed past or current SITB. Results The thematic analysis led to the identification of four main themes that both confirmed past research and conceptual models on SITB, and provided new insights. Participants perceived a clear link between their CSA experience and SITB and other mental health issues. They offered their views on the meanings of SITB for CSA victims: to cope with abuse; to end the abuse; to express self-hatred and loneliness; and to let people know about their suffering. They described how negative disclosure experiences led to more nonsuicidal and suicidal SITB. Yet, participants also revealed that receiving support for their SITB created opportunities for CSA disclosure and support. Conclusions This study showed complex connections between CSA experiences, disclosure and nonsuicidal and suicidal SITB. Understanding the reciprocal influences between SITB, CSA disclosure and help-seeking could better equip mental health professionals and caregivers to provide support and foster healing and recovery in CSA victims.

Off to a Jump Start: Using Immersive Activities to Integrate Continuity Clinic and Advocacy

BACKGROUND Training in advocacy is an important component of graduate medical education. Several models have been implemented by residency programs to address this objective. Little has been published regarding application of immersive advocacy activities integrated into continuity clinic. OBJECTIVE To create an Integrated Community Health and Child Advocacy Curriculum (ICHCA) by integrating advocacy activities that were immersive and contextualized in a continuity clinic setting and to familiarize interns with continuity clinic immediately at the beginning of their training. METHODS We utilized a socio-constructivist lens, Kern's Six-step curriculum development and a published curriculum mapping tool to create the curriculum. Twenty residents completed ICHCA in 2019. Evaluations from key stakeholders including participants, support staff and attendings were analyzed on four levels of Kirkpatrick's model. We compared results before intervention, immediately following intervention and ten months following intervention. RESULTS We demonstrated improvement in learner satisfaction, knowledge and behaviors with respect to advocacy in the clinical environment. Response rate was 70% (7/10) for attendings, 75% for support staff (15/20) and 72.5% for residents (29/40). Our intervention was feasible, no cost, and required no additional materials or training as it relied on learning in real time. CONCLUSIONS An integrated advocacy curriculum utilizing the mapping tool for curricular design and evaluation is feasible and has value demonstrated by improvements in reaction, knowledge, and behaviors. This model improves understanding of social responsibility and can be implemented similarly in other residency programs.