PDF(Pubmed)
Abstract：
BACKGROUND: Research shows that only around half of all survivors of child sexual abuse (CSA) disclose the abuse during childhood and adolescence. This is worrying, as CSA is related to substantial suffering later in life. The proportion of children and adolescents who have been exposed to CSA is significantly higher in Child and Adolescent Psychiatry (CAP) than in the general population. Healthcare professionals report that uncovering CSA is a complex and challenging task. However, we know little about how they proceed when uncovering CSA. More knowledge of healthcare personnel\'s experience is therefore necessary to facilitate and increase CSA disclosure. The study aims to explore how CAP healthcare professionals in Norway proceed when assessing and detecting CSA, how they experience this work, and what hinders or facilitates their efforts.
METHODS: The study employed a mixed method approach. Data was collected through an anonymous online survey, generating both quantitative and qualitative data. The sample consisted of 111 healthcare professionals in CAP, of whom 84% were women, with a mean age of 40.7 years (range 24-72; sd = 10.8). Mean years of CAP clinical experience were 8.3 years (range 0-41; sd = 7.5). The quantitative data was analysed using descriptive statistics, correlations, and independent sample t-tests, while the qualitative data was analysed using a team-based qualitative content analysis.
RESULTS: The results showed that detection of CSA was viewed as an important, but complex task in CAP, and the existing procedures were deemed to be insufficient. The therapists mostly felt confident about how to proceed when they suspected or detected CSA, yet they seldom detected CSA. In their initial assessment they applied standardised procedures, but if their suspicion of possible CSA persisted, they seemed to rely more on clinical judgement. Specific challenges and facilitators for CSA detection were identified, both in the individual and in the organisation.
CONCLUSIONS: The study highlights the challenges and complexities healthcare professionals and the CAP system face when assessing CSA, which may account for the low detection rate. The results show that healthcare professionals believe room for clinical autonomy and targeted competence development may improve CSA detection. Additionally, the findings suggest a need for CAP to define roles and responsibilities within and between agencies.
METHODS: The study employed a mixed method approach. Data was collected through an anonymous online survey, generating both quantitative and qualitative data. The sample consisted of 111 healthcare professionals in CAP, of whom 84% were women, with a mean age of 40.7 years (range 24-72; sd = 10.8). Mean years of CAP clinical experience were 8.3 years (range 0-41; sd = 7.5). The quantitative data was analysed using descriptive statistics, correlations, and independent sample t-tests, while the qualitative data was analysed using a team-based qualitative content analysis.
RESULTS: The results showed that detection of CSA was viewed as an important, but complex task in CAP, and the existing procedures were deemed to be insufficient. The therapists mostly felt confident about how to proceed when they suspected or detected CSA, yet they seldom detected CSA. In their initial assessment they applied standardised procedures, but if their suspicion of possible CSA persisted, they seemed to rely more on clinical judgement. Specific challenges and facilitators for CSA detection were identified, both in the individual and in the organisation.
CONCLUSIONS: The study highlights the challenges and complexities healthcare professionals and the CAP system face when assessing CSA, which may account for the low detection rate. The results show that healthcare professionals believe room for clinical autonomy and targeted competence development may improve CSA detection. Additionally, the findings suggest a need for CAP to define roles and responsibilities within and between agencies.
摘要：
背景：研究表明，在儿童性虐待（CSA）的所有幸存者中，只有大约一半的人在儿童期和青春期发现了这种虐待。这令人担忧,因为CSA与以后生活中的大量痛苦有关。儿童和青少年精神病学（CAP）中暴露于CSA的儿童和青少年比例明显高于普通人群。医疗保健专业人士报告说，发现CSA是一项复杂而具有挑战性的任务。然而,我们对它们在发现CSA时是如何进行的知之甚少。因此，有必要更多地了解医疗保健人员的经验，以促进和增加CSA披露。该研究旨在探索挪威的CAP医疗保健专业人员在评估和检测CSA时如何进行，他们如何体验这项工作，以及阻碍或促进他们努力的因素。
方法：本研究采用混合方法。数据是通过匿名在线调查收集的，生成定量和定性数据。样本由CAP的111名医疗保健专业人员组成，其中84%是女性，平均年龄40.7岁（范围24-72；sd=10.8）。CAP临床经验的平均年数为8.3年（范围0-41；sd=7.5）。定量数据采用描述性统计分析，相关性，和独立样本t检验，而定性数据是使用基于团队的定性内容分析进行分析的。
结果：结果表明，CSA的检测被视为重要的，但是CAP中的复杂任务，现有程序被认为是不够的。当他们怀疑或检测到CSA时，治疗师大多对如何进行有信心，然而他们很少检测到CSA。在最初的评估中，他们采用了标准化的程序，但是如果他们对可能的CSA的怀疑持续存在，他们似乎更依赖临床判断。确定了CSA检测的具体挑战和促进者，在个人和组织中。
结论：该研究强调了医疗专业人员和CAP系统在评估CSA时面临的挑战和复杂性，这可能是低检测率的原因。结果表明，医疗保健专业人员认为，临床自主性和针对性能力发展的空间可能会改善CSA检测。此外,研究结果表明，CAP需要定义机构内部和机构之间的角色和责任。
方法：本研究采用混合方法。数据是通过匿名在线调查收集的，生成定量和定性数据。样本由CAP的111名医疗保健专业人员组成，其中84%是女性，平均年龄40.7岁（范围24-72；sd=10.8）。CAP临床经验的平均年数为8.3年（范围0-41；sd=7.5）。定量数据采用描述性统计分析，相关性，和独立样本t检验，而定性数据是使用基于团队的定性内容分析进行分析的。
结果：结果表明，CSA的检测被视为重要的，但是CAP中的复杂任务，现有程序被认为是不够的。当他们怀疑或检测到CSA时，治疗师大多对如何进行有信心，然而他们很少检测到CSA。在最初的评估中，他们采用了标准化的程序，但是如果他们对可能的CSA的怀疑持续存在，他们似乎更依赖临床判断。确定了CSA检测的具体挑战和促进者，在个人和组织中。
结论：该研究强调了医疗专业人员和CAP系统在评估CSA时面临的挑战和复杂性，这可能是低检测率的原因。结果表明，医疗保健专业人员认为，临床自主性和针对性能力发展的空间可能会改善CSA检测。此外,研究结果表明，CAP需要定义机构内部和机构之间的角色和责任。
