Wednesday, 20 September 2017

Person-centred cultures in dementia care – learning to communicate ‘Beyond Words’

 
Dr Julie Watson is a registered nurse and a Research Fellow in the University of Edinburgh’s School of Health in Social Sciences. Her research focusses on relating to people with dementia until the end of life in care homes. She is the author of CRFR Research Briefing 86 Face-to-Face: Relating to people with dementia until the end of life in care homes.

Person-centred care is widely advocated within health and social care policy in the UK (Department of Health 2010, Scottish Government 2017). In practice, however, person-centred care is often reduced to person-centred ‘moments’ (McCormack and McCance 2017). The challenge is to create person-centred cultures within our health and social care settings, such as care homes, which move beyond those extraordinary person-centred moments that can happen during certain activities, such as a birthday party, to permeating the ordinary and everyday, including being helped to have a shower or a meal.

There is an extra layer of complexity when considering person-centred cultures within dementia care. In our hypercognitive culture, which places a high value on cognitive ability (Post 2000), the cognitive impairment brought on by a condition such as dementia can have serious consequences; when a person with dementia loses the ability to have a conversation or remember another person’s name, it can lead to them being seen as less of a person than they once were. They can experience the loss of relationships and social isolation, which ultimately leads to suffering if their needs are overlooked when they are unable to express them verbally. This prompts the philosophical, but inherently practical question, ‘what is a person?’

Moving beyond a purely cognitive view of personhood and recognising that human beings are more than a mind, but are also a spirit and a body, expands opportunities to hold people with dementia in relationship until the end of life - and find ways of alleviating their suffering. How we view people with dementia, whether we recognise their enduring personhood despite the effects of advancing dementia, will determine how we behave towards them. This short animation - Beyond Words (see link) - summarises some of the ways people with dementia continue to communicate and connect with others beyond words. It is based on research findings from a PhD study which aimed to appreciate the ways that people with dementia and care staff in a care home relate to each other (Watson 2015). Recognising the enduring personhood of people with dementia and learning to connect ‘beyond words’, is a fundamental prerequisite to creating cultures in dementia care which enable the person-centredness aspired to within policy and practice – a first step in making the ordinary extraordinary.

View 'Beyond Words' on the University of Edinburgh's Media Hopper site:
https://media.ed.ac.uk/media/Beyond+Words/1_3xuqvt2z/40609491

The animation ‘Beyond Words’ and other work by the staff and students of Edinburgh Centre for Research on the Experience of Dementia will be on show at the Explorathon at Leith Labs on 29th September 2017.

References

Department of Health (2010) Personalisation through Person-Centred Planning http://webarchive.nationalarchives.gov.uk/20130123201648/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_115175

Scottish Government (2017) Scotland’s National Dementia Strategy 2017-2020 http://www.gov.scot/Resource/0052/00521773.pdf

McCormack and McCance (2017) Person-centred Practice in Nursing and Health Care: Theory and Practice Wiley Blackwell: Oxford. Post, S.G. (2000) The Moral Challenge of Alzheimer Disease: Ethical issues from diagnosis to dying John Hopkins University Press: Baltimore and London

Watson (2015) Caring with Integrity: Developing the conceptual underpinning of relationship-centred palliative dementia care in care homes https://www.era.lib.ed.ac.uk/handle/1842/20458

Dr Julie Watson is the author of CRFR research briefing 86 Face-to-Face: Relating to people with dementia until the end of life in care homes.

Thursday, 14 September 2017

Transition, transition, successful transition: What is it anyway?

CRFR Associate Director Professor Divya Jindal-Snape writes about her research on transitions, from early years to higher education. 



Nurseries, schools, colleges and universities go to a lot of effort to make sure that learners have ‘successful transitions’. Similarly, families do their utmost to support children to have successful transitions. But what does ‘successful transition’ mean and from whose perspective? What does transition mean for that matter? These words are used without unpacking their meaning.

From our research it is clear that there is a lack of shared understanding about the concept of transitions. This can be illustrated by the different conceptualisation of transitions even within the same school or across the school cluster.

For example, two primary school head teachers consider transition to be:

‘A seamless move from primary to secondary with a clear focus on teaching and learning’

‘Any move between stages or establishment or settings or even classes’


The first focusses on moving institutions whereas the second suggests that children experience transition within the same institution. A guidance teacher highlighted that transition is about holistic adaptation:

‘Transition is physical, social and emotional adaption to new environments and stressors’

This view regards transition as stressful, perhaps not surprising as a guidance teacher might mainly see learners who are affected negatively by transitions. In actual fact, most children/young people, whether starting primary school or university, thrive during transitions. Why shouldn't they? For most it is a marker of growing up, being more independent, and getting more (and better) choices and opportunities. For some though, it can be challenging and stressful. Transition is dynamic and chances are that some aspects of transitions will be going very well whereas others might not. So we can define transition as (i) an ongoing process of psychological, social and educational adaptation (ii) over time (iii) due to changes in context, interpersonal relationships and identity, (iv) which can be both exciting and worrying at the same or different times, and (v) requires ongoing support.

What do we consider to be successful transition? A lot of research has focussed on the dip in attainment and motivation at the time of transitions. Is that surprising? If you measure academic aspects at a time when children and young people, and of course their families, are mainly focussed on making friends and getting the relationships right, is it any surprise that there is a dip in 'academic' attainment or motivation? Would we find different results if we focussed on motivation to make new friends and develop good relationships with staff? This difference in focus on academic or friendship aspects comes from a difference in views about what successful transition is. For some it is about having no dip in attainment and in fact the learners excelling. For others, it is about having a sense of belonging and positive identification with the new environment. Perhaps the vision of successful transition needs to be more holistic and it may be that success at different times can be conceptualised differently.

More importantly, shouldn't ‘success’ be about what that individual considers to be a successful transition? Have we asked children and young people about this? According to our research what children and young people look forward to the most, and also worry about, is making new friends. So if they are able to make new friends easily, they consider it to be a successful transition. This of course changes over time; precisely because transition is an ongoing and dynamic process. Institutions put support systems in place when children/young people start school or university. Our longitudinal studies show that there are some for whom transition might be going very well at the start but after a few months things might start going wrong. In a longitudinal study over three school years we found that most children reported that they were continuing to have successful transitions, some had issues initially but were now feeling that things were going well for them, but for some problems arose in the third year with no one supporting them. As one boy said,

‘There’s nothing (no transition support) because they think we've settled in enough’


Children and young people also highlight repeatedly that they get most support from families and friends during transition. This is not surprising as during times of change, they might be their only consistent support. However, it is worth remembering that as children and young people go through multiple transitions (new physical and social environment, change in teaching approaches, change in organisational culture, change in expectations of others etc.), their transitions trigger transitions for significant others such as their families, friends, staff etc. Similarly, when significant others in their network experience transitions, they trigger the child/young person's transitions. This has been conceptualised within a theoretical model of Multiple and Multi-dimensional Transitions (MMT, Jindal-Snape, 2012, 2016), which can be visualised as a Rubik's cube with one small change for one person leading to unexpected, and unplanned for, changes for others. So not only do the children/young people need to be supported through their ongoing transitions, the significant others need to be supported too.

Until education and other professionals understand the complex, dynamic and ongoing nature of transitions, they will find it difficult to support learners and families. Also, they need to be mindful of their own transition support needs. There is more to be done in terms of their training as our research has repeatedly demonstrated that professionals are not provided adequate opportunities to consider transitions during either qualifying programmes and or post-qualifying Continuous Professional Development (CPD).




Divya Jindal-Snape is Professor of Education, Inclusion and Life Transitions. She is the Director of Transformative Change: Educational and Life Transitions Research Centre at the University of Dundee. She has published extensively in this field across the life span. She has authored and edited the following books:

Jindal-Snape, D. (Editor) (2010). Educational Transitions: Moving Stories from around the world. New York & London: Routledge.

Jindal-Snape, D. (2016). A-Z of Transitions (Professional Keywords Series). Basingstoke: Palgrave.


Jindal-Snape, D., & Rienties, B. (Editors) (2016). Multidimensional transitions of international students to Higher Education. New York: Routledge.


Rubik’s Cube® used by permission Rubik’s Brand Ltd. www.rubiks.com






Monday, 3 July 2017

Buying Sex in Scotland: Understanding the motives and incentives for paying for sexual services

CRFR is delighted to welcome Dr Holly Davis, British Academy Postdoctoral Fellow at the University of Edinburgh, as an associate researcher. In this post, Holly introduces her research on why individuals pay for sexual services and reflects on the relevance of this within the context of the proposed changes to prostitution laws in Scotland.


The best current estimates suggest that between 11-18% of the adult male population in the UK regularly pays for sexual services. These numbers suggest that paying for sexual services is not as rare, or deviant, as many would assume.

There is limited research on the 'demand' side of prostitution which creates a gap in the ongoing academic and policy discourses within and beyond Scotland. The absence of the voices and perspectives of those who purchase sex greatly limits the scope and understanding of the demand that drives sex work markets. In order to gain a more comprehensive grasp of the complex issues of purchasing sex, it is imperative that the voices, opinions, and practices of those who constitute the demand be included.

This topic becomes relevant when we consider the various proposed changes to prostitution laws in Scotland over the past few years.

My research is focusing on individuals who pay for sexual services ('punters') in Scotland, gathering data regarding their attitudes, experiences, and motivations. This project is specifically examining the customers of individuals who work in prostitution.

Two competing notions are evident in the literature - one which reduces the purchase of sex solely to simple acts of sexual gratification and convenience, and another which unapologetically demonizes punters as perpetrators of sexual violence. Moving beyond these oversimplifications, a more nuanced approach will be taken to examine the motivations and experiences of punters to explore the more complex incentives for purchasing sex and to personify these social actors.

The first phase of this research includes preliminary interviews with key stakeholders who can offer further perspectives and insights about punters and prostitution within Scotland. Interviews will be sought from police, local officials, NGO workers, and advocacy groups. Following the recommendations and advice of stakeholders, approaches to recruitment methods, and interview questions would be developed. After finalizing the development of methods and locations, this research will utilize both in-depth interviews and questionnaires with at least twenty-five individuals who purchase sex in Scotland.

The core aim is to generate data to contribute to forthcoming debates about, and understandings of, prostitution in Scotland and abroad. The gathering of rigorous and contextually rich data directly from punters would provide invaluable insights to the broader academic and policy fields. For example, exposing the motives and incentives of punters’ behaviour would in turn offer new perspectives for clearer and more workable legal frameworks. This research will be highly salient for policymakers, politicians, police, medical and educational professionals, and the voluntary sector. Also, this work would explore questions pertaining to sex trafficking and customers’ awareness of these issues which would have great relevance to current efforts aimed at curb trafficking within sex service markets and industries.


Holly will provide further updates for the CRFR blog as her research findings emerge.

Tuesday, 27 June 2017

“A cup of tea and a fag”: doing family in the context of imprisonment.

We are delighted to welcome Dr Cara Jardine to the CRFR research network. Cara is a Research Associate at the University of Strathclyde. Here she reflects on her PhD research which examined what it means to be a family in the context of imprisonment, how these relationships are constructed and maintained, and how those affected by the imprisonment of a family member interact with the criminal justice system.

When a person receives a prison sentence, the impact upon their family can be profound and serious. In addition to causing considerable emotional distress, the imprisonment of a family member can disrupt housing, finances and childcare arrangements. Where the family choose to support the person in custody, this can come with significant costs as families attempt to provide the visits, phone calls, clothing and financial support that will lessen the worst pains of the prison environment. This often requires regular interaction between the family and prison itself, a process which can be confusing, time consuming and upsetting. Importantly, as many families affected by imprisonment are already experiencing poverty and social marginalisation, these additional burdens are often carried by families with few resources to spare.

Over the last ten years, families affected by imprisonment have become increasingly visible to both researchers and policy makers. This has led to a range of welcome initiatives to support families affected by imprisonment, such as designated children’s visits, homework clubs or family days. These often have children and partners at their centre, reflecting that much of this research interest to date has largely focused on nuclear models of the family. However, this contrasts starkly with the rapid changes in family life over recent decades, such as the increasing popularity of cohabitation, the legalisation of same-sex marriage, a growth of single person house-holds, rising numbers of “blended” families including children from previous relationships, and a growing recognition that friends can be an important part of family life.

Indeed, my own research with families affected by imprisonment in Scotland found that the impact of this form of punishment is felt across a wide range of relationships, including parents, siblings, nieces and nephews, step-children, and grandparents, often in highly individual ways. Rather than relying on nuclear models of the family when attempting to understand the experiences of families affected by imprisonment, it is therefore more fruitful to conceptualise family relationships as something we actively “do”.

Drawing on Janet Finch’s concept of “displaying family”, I argue that families affected by imprisonment adopt a range of individual and often highly creative ways for maintaining their relationships. These often go beyond the obvious strategies of visiting and making regular phone calls, although these are important. For example, families described establishing new routines, sharing favourite foods, maintaining old traditions or watching the same television programs as the person in custody as a means of fostering feelings of connection and closeness. These strategies also highlight the far-reaching impact of imprisonment, which can impact on the smallest and most seemingly unremarkable elements of family life, as one participant described:

   "My dad says that he really misses having a cup of tea and a fag with my mum because that is what we did every morning, because my mum and dad didn’t do big things together – like they went on holiday but they didn’t go out drinking or anything so it was just a little thing that was part of their routine…..these are just little things but they mean the world to us"


However, examples such this are remarkable, as they demonstrate that some strategies for “doing family” (such as homework clubs) are more easily recognised as such than others (a cup of tea and a fag). The status and recognition of different ways of “doing family” are influenced by class, gender and race. Where families fit most comfortably into dominant (nuclear and middle class) narratives of family life, they are more able to continue the everyday practices that support these relationships. Consequently, it is vital that the most marginalised families are sought out and included in the growing discussions surrounding families affected by imprisonment amongst both academics and policy makers. A failure to do so contributes to a perception that the criminal justice system not only punishes these families who feel that they “do the sentence too”, but that it is indifferent to their voices, needs and experiences.


Publication:
Cara Jardine; Constructing and Maintaining Family in The Context of Imprisonment. Br J Criminol 2017 azx005. doi: 10.1093/bjc/azx005 [open access]

Image: ©iStock.com/sebastianosecondi

Monday, 19 June 2017

Researching love can illuminate ongoing obstacles to fathers’ involvement

Dr. Alexandra Macht recently completed her PhD in Sociology at the University of Edinburgh where she was supported by the Centre for Research for Families and Relationships. In this post, Alexandra reports on some of the findings of her research into fatherhood and love.

 
There is very little research on the subject of the love shared between parents and children, and the contemporary father’s role in relation to masculinity. My research looked at a specific group of fathers, who are present (‘involved’) in the lives of their children, and their experiences of love. I considered involved fathers as embedded within and dependent upon an intimate network of relationships: to their children, their partner and their own parents. In my interviews with 47 fathers from Scotland and Romania from working-class and middle-class backgrounds, I explored the fathers’ love for their children:  How do they describe it? How does it compare to other kinds of love? How do they show it? What do fathers think love looks like in their countries?

I found that involved fathers understand love as a verb (it is something they do) in which both love and power are intermingled. The majority of fathers, had a hierarchical understanding of love in which the child was granted a distinct focus; some even distinguished between unconditional love for their children and the - at times - conditional love for their partner. Culturally, the fathers described love and said they expressed it in similar ways, with some minor differences: Scottish fathers thought love made their children warmer to others, while Romanian fathers thought it gave their children confidence to do things.

In order to maintain loving relationships with their children, involved fathers also had to work at communicating their love through speech and through their physical activities, as having ‘quality time’ was sparse and required planning. Financial and material resources were important in how men showed love and this is one reason why class differences continued to matter. Across both cultures, the importance of ‘providing’ persisted but it was deeply influenced by how society portrays the role of fathers. The image of the new father who is very loving is also something that is sold to men through advertising, in the process of spreading certain values globally from the Western part of Europe to the Eastern part.

Men as fathers build their identities on a mixture of beliefs about how they should be as men and as fathers, and sometimes there is tension between these roles. Shifting between the two roles is an emotional process I have called ‘emotional bordering’ - developed from Barrie Thorne’s concept of gender borders (1993), in which fathers adapt their communication and behaviour according to social circumstances and to how others respond to them. This new term helps explain a process of give-and-take which builds a man’s identity in close relationships. For involved fathers love appeared from spending time daily with their children, which can have further implications for family policies. By reducing involved fathers’ time with their children to merely two weeks of paternity leave, as it stands at the moment in the UK, the time to build a close, meaningful and loving relationship is also diminished. Flexible and state-supported provisions that increase the length of the parenting leave, could contribute to the emotional wellbeing and relational stability of fathers, their children and their partners.


We will publish a research briefing based on Dr Alexandra Macht’s PhD research later this year. To keep up-to-date with news of CRFR’s publications and events follow us on Twitter, Facebook or by joining our mailing list.

Dr. Alexandra Macht is an early career researcher and newly appointed Lecturer in Sociology at Oxford Brookes University. Her sociological interests are emotions, intimacy, gender (particularly men and masculinities), culture and globalization. She holds a BA in Psychology from University of Bucharest, an MSc with Distinction in Child and Adolescent Mental Health and a PhD in Sociology from The University of Edinburgh. She has previously worked at the Centre for Research on Families and Relationships in Edinburgh, and is currently assistant editor for the International Review of Leave Policies and Research. The research detailed above has been generously funded by a grant provided from the prestigious UK Economic and Social Research Council. Alexandra uses the Twitter handle (@Alexandra_Macht)

Father and child image: ©iStock.com/FatCamera

Thursday, 15 June 2017

Research as an intervention: A case study on violence against children in Peru

CRFR co-director Dr Sarah Morton, and colleague Tabitha Casey, share some of their findings from the recently published report, which examined the impact of a research programme aiming to prevent violence against children in Peru.


Preventing violence against children is becoming more of a focus for policy makers, with the United Nation’s Sustainable Development Goals including targets that aim to eliminate violence everywhere. How governments can achieve this is not so straightforward, however.

In 2014, UNICEF Office of Research- Innocenti and partners launched the Multi-Country Study on the Drivers of Violence Affecting Children in order to help governments understand and address this issue. The Study focused on four countries – Italy, Zimbabwe, Viet Nam and Peru – and partnered with Dr Debi Fry, Moray House School of Education, and Young Lives, based at the University of Oxford. Two years later we undertook a joint impact assessment with UNICEF to examine the impact of this research programme in Peru.

Few impact evaluations are carried out in low-and-middle-income countries (LMIC), especially on violence prevention research. Our aim was to assess the outcomes of the Multi-Country Study in Peru and also to test the Research Contribution Framework (RCF) (Morton, 2015), developed to examine how research uptake and use ‘contributes’ to policy and practice change, in a LMIC.

The RCF requires key partners to agree the main mechanisms through which the research might impact on policy or practice, which are then tested, along with key risks and assumptions. We collated all existing evidence (e.g. media, downloads, email testimonial), assessed the gaps in evidence and then took a field trip to Peru to gather more material. In Peru we conducted a range of stakeholder interviews with government, academic and UNICEF partners to assess whether the Study contributed to changes in awareness, knowledge, skills, behaviour, policy and practice among key stakeholders.

The impact assessment found that the multi-partner, relationships-driven approach of the Multi-Country Study helped to maximise impact in Peru. It was also important that the Study was nationally-led: this made sure that the findings were specific to Peru, which was key, considering the country’s geographic diversity and multi-culturalism, and also helped ensure national ownership and data sovereignty.

By using this approach, the Multi-Country Study contributed to a number of policy and programme changes in Peru, including the passage of a law banning corporal punishment in all settings. By focusing on capacity-building and awareness raising activities, the Study also helped to give violence against children a higher political priority, and study partners are committed to keeping it on the political agenda.

Recommendations from the impact assessment include:
  • Plan sufficient timing – as well as flexibility - into the research design in order to build effective, trusting partnerships.
  • Define and support key actors to take knowledge-brokering roles in order to ensure clear communication and engagement among study partners in complex projects.
  • Plan an impact strategy from the start. Strategies should address complexity from the beginning, and also identify key monitoring criteria as well as risks and assumptions.

The RCF used here could be used both as an evaluation method and a planning tool to develop an impact strategy. Through this impact assessment, we found that the framework is adaptable and effective in a LMIC, and could be used to assess research impact in other contexts.


For more on the Multi-Country Study on the Drivers of Violence Affecting Children, visit the study site at: https://www.unicef-irc.org/research/274/

More information about the Peru study can be found here (in Spanish): https://www.unicef.org/peru/spanish/resources_33614.html

Sarah Morton (2015) Progressing research impact assessment: A ‘contributions’ approach. Res Eval 2015; 24 (4): 405-419. doi: 10.1093/reseval/rvv016


Tuesday, 18 April 2017

When is it safe to disclose childhood sexual abuse?

Rusan Lateef, MSW, RSW is a social worker employed in the criminal justice system with adult male offenders in Ontario, Canada. She is a researcher on the “Make Resilience Matter” project examining childhood exposure to domestic violence at the Factor-Inwentash Faculty of Social Work, University of Toronto, a project that involves collaboration with CRFR Co-Director Sarah Morton. 

Here, Rusan shares some of the findings from a recently published article on childhood sexual abuse disclosures, which she co-authored.


There have been on-going efforts to improve the identification of children who have been sexually abused and to encourage disclosures. It is important to consider, however, if disclosing actually promotes well-being and resilience among survivors of childhood sexual abuse (CSA). If it does, how can we promote disclosures, and with that resilience, with children who have been sexually abused? A previous CRFR blog post by Dr Sarah Nelson provided insight into child-centred ways to facilitate CSA disclosures: http://crfrblog.blogspot.ca/2016/11/silencing-and-disclosure-in-child.html

Disclosure is usually the first step toward a child being linked with supportive resources that could initiate their healing and prevent the adverse consequences of CSA. Unfortunately, disclosing can lead to anything but healing when the environment in which a disclosure takes place is not supportive. Some researchers have even found that it is risky to tell in childhood as unsuccessful disclosures may result in children experiencing further helplessness (Jonzon & Lindblad, 2004). The media provides multiple examples of individuals who have disclosed sexual abuse and have not received support from the general public or from family and friends – experiencing victim blaming and lack of validation for their experiences. It is easy to see how this could discourage survivors to disclose. Aside from negative media examples, the literature review by Alaggia, Collin-Vézina & Lateef (2017) identified various other barriers to CSA disclosure including, but not limited to:

Internal factors
• Internalized victim blaming
• Immature development at onset of abuse
• Gender
• Shame
• Self-blame
• Fear
• Perception that one will not be believed by people outside of their family

Family characteristics
• Rigidly fixed patriarchal based roles
• Power imbalances
• Domestic violence
• Chaotic family organization
• Dysfunctional communication
• Social isolation
• Preserving the family reputation
• Relationship of the perpetrator to the child victim

Sociocultural factors

• Negative labelling of sexual abuse victims
• Taboos surrounding sexuality and talking about sex
• Promotion of hyper-masculinity
• Patriarchal attitudes
• Views that boys and men cannot be victimized
• Homophobic attitudes
• Sexualization and objectification of girls and women
• Devaluation of women
• Lack of school involvement in providing a supportive environment

When encouraging CSA disclosures, it is important to be informing the public about the numerous barriers children experience, meanwhile creating awareness of the type of environment and factors that encourage disclosures, and how to properly support a child post-disclosure. Facilitators of CSA disclosures were also identified in the review and included:

Internal factors
• Symptoms that become unbearable
• Older age
• Increased developmental efficacy
• Realizing that an offence was committed

Environmental factors
• Child discloses after evidence provided or eye-witnessing has occurred
• Settings that provide opportunities for disclosure (ex. counselling, interviews); prevention programs
• Culturally sensitive probes and questions
• Creating openness in relational contexts; close relationships
• Supportive family members and individuals close to the child victim

Finally, it is important to recognize that there are CSA survivors who are resilient and function adaptively --both those who have and have not disclosed. Domhardt and colleagues (2015) in their review identified important factors associated with greater resilience among CSA survivors that include:

• Education
• Interpersonal and emotional competence
• Control beliefs
• Active coping
• Optimism
• Social attachment
• External attribution of blame
• Support from the family and the wider social environment

In summary, research has identified what factors encourage and discourage disclosures, as well as what factors promote resilience among CSA survivors. Taken together, these findings could help facilitate safe disclosures and positive post-disclosure outcomes.



References

Alaggia, R., Collin-Vézina, D., Lateef, R. (2017). Facilitators and Barriers to Child Sexual Abuse (CSA) Disclosures: A Research Update (2000-2016). Trauma, Violence & Abuse. DOI: 10.1177/1524838017697312

Domhardt, M., Münzer, A., Fegert, J., & Goldbeck, L. (2015). Resilience in survivors of CSA: A systematic review of the literature. Trauma, Violence, & Abuse, 16(4), 476-493.

Jonzon, E., & Lindblad, F. (2004). Disclosure, reactions, and social support: Findings from a sample of adult victims of CSA. Child Maltreatment, 9(2), 190-200.