Eija Paavilainen

How to identify families expecting a baby and having child maltreatment risk?- Intervention study in Finland

13th April, 2015

Eija Paavilainen, PhD, Professor

School of Health Sciences

University of Tampere,

Research Group: Noora Ellonen, Sari Lepistö and Mika Helminen

FINLAND

http://www.uta.fi/hes/en/contact/paavilainen/index.html

Eija Paavilainen

• about 18 members• aims to add understanding on family violence (especially child

maltreatment and intimate partner violence), and develop identification, early intervention and prevention practices

• focuses on effective, violence preventing interventions and follow up research on families with children and violence

• funded by Academy of Finland (2006-2008), Hospital Districts (from 1999-) and National Institute of Health and Welfare (2011-2013), and different Foundations

• National Guideline on identification of child maltreatment (2008): www.hotus.fi

(Now being updated, ready in 2015)

Research by Family Violence Research Group, from 1994 -

Eija Paavilainen

In Finland

• Corporal punishment and all abuse and neglect towards children has been forbidden by legislation since 1984

• Every professional and also all citizens, are responsible for making a child protection notification when they think that a child is in danger

• Services for families with children are free of charge and eveyone uses them: Good possibiity to ”see” violence e.g. in maternity and child clinics

• Legislation in Finland is at a quite good level in general, concerning child protection and violence issues

• In Finland, mild violence has decreased in 20 years, and severe violence has stayed on the same level

• Attitudes for using corporal punishment have been developed towards better direction

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Aim & Method of the Study

• Aims to find families with child maltreatment risk, at maternity clinics• Aims to prevention, by supportive discussion intervention (about

child rearing, family life and giving help) for families with risk, when expecting a baby

• Applies a follow-up, case-control design, with an intervention in the case group

• Describes the risk level, family health, functioning and support they get in maternity and child clinic

• Going on at maternity and child welfare clinics at two sites in Finland• Includes follow-up when the baby is 12 months

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Instruments

• CAP (Child Abuse Potential Inventory), developed by professor Joel Milner, USA => identifies families with risk (also follow-up)

• Risk level varies from 0 to 486 (risk counted with the CAPSCORE Program)

• FAFHES (Family Health, Functioning and Social Support), developed by professor Eija Paavilainen & Team, Finland => describes and follows families’ situation and support they get

Today results concerning baseline data will be presented

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Results

• N=380 families (360 mothers and 301 spouses)• 89% were married or cohabiting• 32% were living with the spouse and 59% with the spouse and

children, 66% were in their first intimate relationship• 78 families were with risk: 66 in one parent and 12 in both• Internal consistency of the Abuse Scale was good (0.85/0.80)

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Conclusion

• Early identifiction of families at risk and supporting them is crucial, and possible with CAP, followed by strengthening the families and supporting in the way they need

• It is easier to help before the pattern of violence has developed within the family

• We should ask about family violence in different services• We should be aware of, notice and discuss about family risks and

markers of abuse in children in all services of families with children• We should tell to parents how violence affects to children• We need attitude change for everyone

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…continued…

• In Finland, we have now large dscussion about how to prevent child maltreatment and e.g. also family killings (we have had quite many in past years)

• Our service system and legislation are basically quite good but could work much better

• We aim to find ways how multiprofessional collaboration could work better than nowadays, especially exchanging information between professionals, especially concerning children but also individuals and families in general

• Educating professionals will be developed in family violence issues

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More results coming out later concerning this study…• Ellonen N, Lepistö S, Helminen M, Paavilainen E. Cross-cultural

validation of the Child Abuse Potential Inventory in Finland: Preliminary findings of the study among parents expecting a baby (manuscript submitted)

• Lepistö S, Ellonen N, Helminen M, Paavilainen E. The Family Health, Functioning, Social Support and child maltreatment risk of families expecting a baby (manuscript submitted)

• Lepistö S, Ellonen N, Helminen M, Paavilainen E. Child maltreatment risk level and family welfare changes: from pregnancy until the child is 12 months of age (manuscript to be submitted)

Eija Paavilainen

Other publications of Family Violence Research Group (excamples)…• Inkilä J, Flinck A, Luukkaala T, Åstedt-Kurki P, Paavilainen E.

Interprofessional collaboration in the detection of and early intervention in child maltreatment: Employees’ experiences. Nursing Research and Practice, Volume 2013, Article ID 186414, 10 pages. http://dx.doi.org/10.1155/2013/186414

• Lepistö S, Åstedt-Kurki P, Joronen K, Luukkaala T, Paavilainen E. Adolescents’ experiences of coping with domestic violence. Journal of Advanced Nursing 2010; 66: 1232-1245.

• Lepistö S, Luukkaala T, Paavilainen E. Witnessing and experiencing domestic violence: A descriptive study of adolescents. Scandinavian Journal of Caring Sciences 2010; 25: 70-80.

• Lepistö S, Paavilainen E. The Association between Child Maltreatment and Coping Strategies among Finnish 9th Graders. Child Welfare 2013; 91(6): 103-123.

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…continues…

• Leppäkoski T, Flinck A, Paavilainen E, Ala-aho S. The role of interprofessional collaboration for intimate partner violence in psychiatric care: A research and development project. Journal of Interprofessional Care (early view): DOI: 10.3109/13561820.2013.763776

• Leppäkoski T, Flinck A, Paavilainen E. Assessing and enhancing health care providers’ response to domestic violence. Nursing Research and Practice, Volume 2014, Article ID 759682. http://dx.doi.org/10.1155/2014/759682

• Paavilainen E, Flinck A. National nursing guideline for identifying and intervening in child maltreatment in Finland. Child Abuse Review 2013; 22: 209-220.

• Paavilainen E, Lepistö S, Flinck A. Ethical issues in family violence research in health care settings. Nursing Ethics 2014; 21(1): 43-52.

• Paavilainen E, Helminen M, Flinck A, Lehtomäki L. How public health nurses identify and intervene in child maltreatment based on the national clinical guideline. Nursing Research and Pratice, Volume 2014, Article ID 425460, 7 pages. http://dx.doi.org/10.1155/2014/425460