Priorities for research in child maltreatment, intimate partner violence and resilience to violence exposures: results of an international Delphi consensus development process

Primary Affiliation

1. Researcher

77.3 (34)

66.0 (31)

2. Partner

20.5 (9)

21.3 (10)

3. Both

2.3 (1)

12.8 (6)

Work Setting

1. Academic Institution

70.5 (31)

66.0 (31)

2. Govt. dept/agency

11.4 (5)

14.9 (7)

3. Non-govt. organization

2.3 (1)

4.3 (2)

4. Research Institute

11.4 (5)

8.5 (4)

5. Other

0

6.4 (3)

Geographic Location

1. Canada

68.2 (30)

61.7 (29)

2. United States

13.6 (6)

14.9 (7)

3. Europe

11.4 (5)

14.9 (7)

4. Asia

0

2.1 (1)

5. Australia

6.8 (3)

4.3 (2)

6. Other

0

2.1 (1)

Examine the elements underpinning promising or successful programmes in resilience to discover the similarities, beliefs and values inherent in these programmes, so that they can be building blocks for intervention pilot work.

n/a

n/a

1

Determine the critical requirements for evidence-based resilience interventions at individual, family, community and policy levels.

5.43

1.45

2

Develop and evaluate interventions to promote resilience in those exposed to various kinds of violence.

5.71

1.53

3

Determine epidemiology of resilience for those exposed to CM and/or IPV.

5.62

1.34

4

Child Maltreatment Research (CM)

Round 1 Rating

Round 2 Ranking

(listed from highest to lowest Round 2 Rank; new priorities added after Round 1 do not have a Round 1 rating score; tied priorities are indicated by the same numerical rank in Round 2)

M

SD

Examine the elements underpinning promising or successful programmes in child maltreatment to discover the similarities, beliefs and values inherent in these programmes, so that they can be building blocks for intervention pilot work.

n/a

n/a

1

Development and evaluation of new interventions for primary prevention of child maltreatment (including, physical, sexual and emotional abuse, neglect and exposure to IPV) focused on children, families and offenders.

6.14

1.00

2

Development and evaluation of new interventions for preventing recurrence of, or impairment associated with, exposure to child maltreatment (including, physical, sexual and emotional abuse, neglect and exposure to IPV) focused on children, families and offenders.

6.12

.97

3

Determine methods to assess risk and protective factors for adverse consequences from child maltreatment, taking a lifespan approach (e.g. factors that prevent a maltreated child from experiencing negative outcomes in childhood, adolescence or adulthood.

n/a

n/a

3

Adaptation/application of existing evidence-based child maltreatment interventions (primary and secondary prevention, for children, families and offenders), including ongoing evaluation to understand which interventions work in which settings/contexts.

6.05

1.05

5

Development and evaluation of interventions to prevent recurrence of, or impairment from, child maltreatment located in specific settings or contexts (e.g., the child welfare system, the justice system, the health care system).

5.66

1.18

6

Develop definitions of CM including: i) definitions of neglect, ii) definitions of exposure to partner violence, iii) definitions of emotional/psychological abuse, iv) definitions of physical abuse, and v) definitions of sexual abuse.

n/a

n/a

7

Prevention of child maltreatment in First Nations communities.

n/a

n/a

7

Evaluate policy or structural interventions that may prevent CM.

n/a

n/a

9

Develop measures of CM including: i) definitions of neglect, ii) definitions of exposure to partner violence, iii) definitions of emotional/psychological abuse, iv) definitions of physical abuse, and v) definitions of sexual abuse.

n/a

n/a

10

Develop a better understanding of the overlap and differences between poor parenting, family dysfunction and family violence.

n/a

n/a

11

Develop prevention programmes for child maltreatment that are affordable for low and middle-income countries or adapt existing effective programmes in such a way as to ensure they are affordable in these countries.

n/a

n/a

11

Examine internet-facilitated child sexual abuse.

4.88

1.44

11

Controversial issues in child maltreatment.

n/a

n/a

14

Intimate Partner Violence Research (IPV)

Round 1 Rating

Round 2 Ranking

(listed from highest to lowest Round 2 Rank; new priorities added after Round 1 do not have a Round 1 rating score; tied priorities are indicated by the same numerical rank in Round 2)

M

SD

Examine the elements underpinning promising or successful programmes in IPV to discover the similarities, beliefs and values inherent in these programmes, so that they can be building blocks for intervention pilot work.

n/a

n/a

1

Develop and evaluate a primary prevention of IPV intervention directed at those at risk for perpetrating IPV (esp. male youth).

6.00

1.10

2

Develop and evaluate IPV intervention(s) using identified evidence-based “promising” models (e.g., advocacy-based models of coordinated service provision).

5.98

.98

3

Evaluate policy or structural interventions that may prevent IPV.

n/a

n/a

4

Evaluate effectiveness of existing IPV services, including shelters, programmes for abusers (male and female) and programmes for couples.

5.91

.85

4

Determine methods to assess risk and protective factors for adverse consequences from IPV, taking a lifespan approach (e.g., factors that prevent a maltreated child for experiencing negative outcomes in childhood, adolescence or adulthood).

n/a

n/a

6

Conduct a review and prepare an inventory of the better prevention programmes for IPV in low and middle-income countries.

n/a

n/a

7

Develop measures of IPV including: i) definitions of exposure to partner violence, ii) definitions of emotional/psychological abuse, iii) definitions of physical abuse, and iv) definitions of sexual abuse.

n/a

n/a

8

Develop definitions of IPV including: i) definitions of exposure to partner violence, ii) definitions of emotional/psychological abuse, iii) definitions of physical abuse, and iv) definitions of sexual abuse.

n/a

n/a

9

Develop prevention programmes for IPV that are affordable for low and middle-income countries or adapt existing effective programmes in such a way as to ensure they are affordable in these countries.

n/a

n/a

10

Controversial issues in IPV.

n/a

n/a

11

Cross-cutting Issues (CC)

Round 1 Rating

Round 2 Ranking

(listed from highest to lowest Round 2 Rank; new priorities added after Round 1 do not have a Round 1 rating score; tied priorities are indicated by the same numerical rank in Round 2; some priorities were consolidated and/or re-distributed to specific content areas for Round 2, as indicated by *)

M

SD

Integrate violence questions in national and international surveys.

6.12

1.11

1

Evaluate inter-relationships between CM, IPV and other forms of violence across the lifespan; consider a lifespan approach to violence exposures.

5.76

1.08

2

Assess factors that impact policy decisions including capacity to implement evidence-based CM and IPV prevention on a scale commensurate with these problems - especially in resource-poor settings - and how to increase this capacity.

n/a

n/a

3

Examine mechanisms (mediators/moderators) in the relationship between exposure to violence and mental health outcomes (including substance abuse) or the continuity of violence.

n/a

n/a

3

Develop and test models of coordinated care for victims of violence - across community and health settings and including inter-service and interdisciplinary coordination.

n/a

n/a

5

Develop methods to capture gene-environment and individual environment interactions.

4.66

1.26

6

Use of information technology for tracking, researching and integrating services.

n/a

n/a

6

Conduct a review, and prepare an inventory of the better prevention programmes (IPV and CM) in low and middle-income countries.

5.50

1.42

*

Examine the elements underpinning promising or successful programmes (in CM, IPV and/or resilience) to discover the similarities, beliefs and values inherent in these programmes, so that they can be building blocks for intervention pilot work.

6.22

.99

*

Determine methods to assess risk and protective factors for adverse consequences from CM & IPV, taking a lifespan approach (e.g., factors that prevent a maltreated child from experiencing negative outcomes in childhood, adolescence or adulthood).

5.93

.89

*

Develop universally acceptable definitions of CM & IPV including neglect, emotional/psychological abuse and approaches to measure these concepts; these should be reflective of culture and societal shifts and otherwise context-specific.

5.71

1.07

*

Research Methods (RM)

Round 1 Rating

Round 2 Ranking

(listed from highest to lowest Round 2 Rank)

M

SD

Investigate methods for collecting and collating datasets to link data (e.g., child welfare data and mental health data) and conducting pooled, meta and sub-group analyses to identify which interventions might be promising for which groups.

6.10

1.01

1

Determine ways to evaluate studies that do not meet the usual standards of evidence in Evidence-Based Medicine hierarchies; e.g., how to include observational and qualitative studies.

5.00

1.50

2

1.

Examine the elements underpinning promising or successful programmes in resilience to discover the similarities, beliefs and values inherent in these programmes, so that they can be building blocks for intervention pilot work.

2.

Determine the critical requirements for evidence-based resilience interventions at individual, family, community and policy levels.

3.

Develop and evaluate interventions to promote resilience in those exposed to CM and/or IPV.

Child Maltreatment Priorities

1. 

Examine the elements underpinning promising or successful interventions in child maltreatment to identify common elements based on scientific evidence, so that they can be building blocks of pilot work for interventions (including programmatic, structural and policy-based approaches).

2.

Develop and evaluate new interventions for prevention of child maltreatment: 1) before its occurrence, 2) its recurrence and 3) associated impairment. Child maltreatment includes physical, sexual and emotional abuse, neglect and exposure to IPV; interventions may be focused on one or more of the following: children, families and offenders.

3.

Determine methods to assess risk and protective factors for adverse consequences from child maltreatment, taking a lifespan approach (e.g. factors that prevent a maltreated child from experiencing negative outcomes in childhood, adolescence or adulthood). This includes understanding the distinction among: poor parenting, family dysfunction and family violence.

4.

Adapt/apply existing evidence-based child-maltreatment interventions (primary and secondary prevention for children, families and offenders), including ongoing evaluation to understand which interventions work in which settings/contexts.¹

Intimate Partner Violence Priorities

1.

Examine the elements underpinning promising or successful models and/or programmes in IPV to discover the similarities, beliefs and values inherent in these programmes, so that they can be building blocks for intervention pilot work, including primary prevention efforts.

2.

Develop and evaluate IPV primary prevention interventions directed at those at risk for perpetrating IPV (esp. male youth).

3.

Evaluate effectiveness of existing IPV services.

4.

Evaluate (broad) policy or structural interventions that may prevent IPV and/or its consequences.

5.

Conduct a review and prepare an inventory of the better prevention programmes for IPV in low and middle-income countries (LMICs); ultimately, develop and test prevention programmes that are affordable for LMICs or adapt existing effective programmes so that they are affordable in LMICs.

Cross-Cutting Priorities

1.

Integrate violence questions in national and international surveys, as well as administrative data.

2.

Evaluate inter-relationships between CM, IPV and other forms of violence across the lifespan; consider a lifespan approach to violence exposures.

3.

Assess factors that impact policy decisions including capacity to implement evidence-based CM and IPV prevention on a scale commensurate with these problems - especially in resource-poor settings - and how to increase this capacity.

4.

Examine mechanisms (mediators/moderators) in the relationship between exposure to violence and mental health outcomes (including substance abuse) on the continuity of violence.

5.

Develop and test models of coordinated care for victims of violence - across community and health settings and including inter-service and interdisciplinary coordination.

Research Methods Priorities

1.

Investigate approaches for developing the infrastructure necessary to conduct child maltreatment research* including determining methods for collecting and collating datasets to link data (e.g. child welfare data and mental health data), use of information technology for tracking and integrating services and conducting pooled, meta and sub-group analyses to identify which interventions might be promising for which groups.

2.

Determine ways to evaluate studies that do not meet the usual standards of evidence in Evidence-Based Medicine hierarchies (e.g. how to include observational and qualitative studies).

Feasibility re: Conduct of Research

Defining and operationalizing concepts, methods and measures

“I'm not sure we'll ever reach consensus on definitions but measurement is a very important issue that requires quite a bit of additional work. Perhaps we would have better success developing common measures that would lead us to widely accepted indicators rather than definitions.” “Few of these services have been formally evaluated. This would provide information useful in developing and testing new interventions.” “These kinds of methods have been developed in other contexts … and those methods could be reviewed for applicability to [violence, gender and mental health] studies.” “Data-driven definition is important, what is goal about definition, if definition is not accompanied by operationalization it won’t move the field forward.” “I think spending a lot of time on definitions and measures would be redundant with other work that has already been done.”

Conducting research (including costs)

“More attention should be paid to observational and qualitative studies - and to small-scale or local interventions which might deserve a high rating for quality. Also, these studies could provide insights into cultural appropriateness, and variations in culture-specific approaches.” “Data linkage is relatively inexpensive, fosters collaboration, and can address policy questions.” “To conduct interaction studies a very large N size is needed and no one study will be able to handle all levels of contexts … Prudent designs that consider one population vs. another population (e.g. communities with high maltreatment vs. low maltreatment) can assist in capturing these complex models to test.”

Building the evidence base, not re-creating the wheel

“CDC has used a consensus building process to develop uniform definitions and data elements for child maltreatment, intimate partner violence and sexual violence. So, it seems like re-creating the wheel to start from scratch on definitions.” “I know that other groups are working on this…we should use their work and adapt it to our fields, rather than working on this from the ground up” “I think there is already some evidence and more is always useful but perhaps this is not so vital as other priorities.” “Child maltreatment in First Nations communities is definitely a priority – however the work in this area has to support and build on the work that First Nations communities are already doing.” “Given how few tested interventions exist, there may be something to learn from a review of ‘best practices’ in community programs, including any evaluative studies which have been done”

Feasibility re: Implementation of Research

Implementing interventions (including costs)

“Many of the effective and promising programmes developed in high-income countries are prohibitively expensive for low- and middle-income countries, which make up the vast majority of the world's population.” “Developing effective interventions is only half the battle, they then have to be successfully and sustainably implemented on a large enough scale and this too is an important area of research.” “Tailor programs to fit culturally diverse communities.”

Partnering and advocacy

“Changes such as these are hard to achieve unless there is a will to do so at the senior levels of government. We should begin lobbying for this now, understanding that taking on this agenda may be a long-term project.” “I know that WHO is very interested in this and we should try to help.” “I do think that a coordinated effort with child welfare agencies to prevent recurrence and improve parenting should be undertaken.” “This is an important global priority that could be encouraged by PreVAiL, esp. partners, but since it’s not primary research, may be slightly outside the scope of PreVAiL’s main mandate”

Other Feasibility Considerations

Being realistic (re: timeframes, expertise and the broader research context)

“Extremely interesting but feasibility with our current investigators is very limited.” “Any information on promising prevention programs would be most welcomed but I don’t see this necessarily as PreVAiL’s strength…more like UNIFEM or other [international] NGOs.” “Might be possible to do research and evaluation within the time frame, in very specific settings.” “Given the long-range time span for this item, it might be difficult to do appropriate research in 3 – 5 years.” “Seems like we have methods to do this already, but we lack the commitment of funders for the long haul – funding longitudinal follow-up.”