School-based abuse prevention for children with communicative and/or cognitive disabilities : guidelines for program implementation

Abstract

Children with communicative and/or cognitive disabilities are at high risk of experiencing abuse, which can have life-long effects on their health and well-being. Primary abuse prevention programs, pitched at school-level with the aim of stopping abuse perpetrated by adults against children before it occurs, have been found to be effective in increasing children’s knowledge of abuse and safety skills. This can decrease their risk of being abused significantly. Such programs have, however, been designed for typically developed children, with a paucity of evidence-based guidelines on how teachers, with the support of principals, could adapt these programs to address the needs of children with communicative and/or cognitive disabilities. Therefore, the purpose of this study is to explore the key components, teaching methods and information that should be included in school-based abuse prevention programs and to subsequently develop and evaluate guidelines for teachers, supported by principals, to guide them in adapting school-based abuse prevention programs for 7–12-year-old children with communicative and/or cognitive disabilities. This was achieved through a three-phase exploratory sequential mixed methods research design. Phase 1 (i.e., the development phase) included three different data sources, published as independent studies. The first data source consisted of a scoping review of school-based abuse prevention programs for 7–12-year-old children that included more than one type of abuse (i.e., both physical and sexual abuse) and was taught by teachers in a school setting. The review explored key components, outcome measures and evaluation methods of such programs. The second data source included focus groups with teachers (n = 7) and practitioners (n = 5) as well as semi-structured interviews with parents of children with communicative and/or cognitive disabilities (n = 6). This data source also focused on identifying key components and teaching methods, specifically for children with communicative and/or cognitive disabilities. The third data source entailed a rapid review of the extant literature regarding potential signs of abuse in children with disabilities followed by the social validation of these signs by an international expert panel (n = 39). Despite some differences in the perceived accuracy of the signs, post-traumatic stress disorder (PTSD) was rated as the most accurate. Phase 2 of the study (i.e., the development phase) included the development of guidelines for adaptations of school-based abuse prevention programs for the target population by integrating Phase 1’s data using a recursive abstractive thematic analysis approach. The theoretical and conceptual frameworks of the thesis underpinned the guideline development process and highlighted the need for a multi-systemic approach to abuse prevention. The resulting guidelines included recommendations for how teachers, with the support of principals, could conduct adaptations of school-based abuse prevention programs to suit the needs of 7–12-year-old children with communicative and/or cognitive disabilities. Finally, Phase 3 (i.e., the evaluation phase) explored the feasibility and social validity of the guidelines developed in Phase 2 by conducting an online survey and email interviews with three stakeholder groups, namely teachers (n = 6), principals (n = 3) and content experts (n = 10). The results demonstrated that the participants perceived the guidelines as feasible and socially valid and of an overall high quality and importance for children with communicative and/or cognitive disabilities. The overall quality of the guidelines was highly rated by the participants (5.67 out of 7). Some of the participants raised a few concerns regarding the design and structure of the guidelines and also alluded to a lack of resources as well as the need for additional time and funding to implement such a program. All the participants, however, agreed that they would recommend the guidelines for use.