Balkan Epidemiological Study on Child Abuse & Neglect (BECAN) Project Overview & Progress

1. Balkan Epidemiological Study on Child Abuse & Neglect (BECAN) ProjectOverview & Progress George Nikolaidis1 1Department of Mental Health and Social Welfare, Institute of Child Health, Greece

2. Project’s Identity • Co-funding: Research Directorate General EC & 9 Balkan Participating Organizations • Duration: 36 months • October2009 - September 2012 • Participating countries • Albania • Bosnia & Herzegovina • Bulgaria • Croatia • Former Yugoslav Republic of Macedonia • Greece • Romania • Serbia • Turkey • Contract Number: HEALTH-F2-2009-223478 • Type of Project: Collaborative • Call: FP7-HEALTH-2007-B

3. BECAN Consortium

4. BECAN Project: Structure & Activities

5. Main aim of the BECAN Project • Mapping of CAN incidence and prevalence for children 11-16 years old in 9 Balkan countries • Valid & representative data creation of a robust basis for • Evaluation of CAN preventive policies and interventions • Harmonization of CAN screening and surveillance processes in the Balkan area • Development of evidence-based recommendations for improvement of national policies concerning CAN administration  More effective CAN prevention

6. WP1 Networking Activities • Aim: build national networks of experts and child welfare services in all of the participating countries • Process: definition of eligibility criteria, identification of potential members, invitation of members, building National Networks for CAN prevention • Current National Networks • Activation of national networks • Organizing network meetings • Planning common activities towards CAN-intervention & prevention • Disseminating information

7. WP1 Set up of National e-Fora • Aim: the best functioning of the national networks and project • Process: setting up 9 national fora (+1 BECAN Managerial forum); drafting and disseminating a users’ guide including “Instructions for members of the CAN Network forum” • Current status:

8. WP2 Capacity Building Activitiesa. Development of research tools Research tools related to WP3 (Epidemiological Survey) • Obtaining permission from ISPCAN to translate, culturally adapt, modify & use the ICAST tools • Translation, adaptation and cultural validation into 10 Balkan languages of • ICAST-CH tool • ICAST-P tool • Epidemiological field survey protocol • Informed consent and parent info sheet • Child assent form Research tools related to WP4 (Case-based Surveillance) • Development of the CBSS extraction methodology & tools • CBSS protocol • Operations' booklet • Extraction form part I (Agency related information) • Extraction form part II (CAN cases-related information) • SPSS files & codification notes • Translation and adaptation into 9 Balkan languages

9. WP2 Cultural validation of ICAST tools • Focus Groups Number of participants in the FG/country/children’s age cluster

10. WP2 Capacity Building Activitiesb. Training Training related to WP3 (Epidemiological Survey) • Train the trainers on ICAST delivery field survey to research methodologyto be able to train their national research groups • Train the research groups Training related to WP4 (Case-based Surveillance) • Train the trainers on case-based surveillance to research methodology to be able to train their national research groups • Train the research groups

11. WP3 WP4 BECAN Research Activities • Case-based surveillance study • Target group: • Children 11-16 years old • School status: • Children attending school • Children who have dropped out • Methods: • Extraction of CAN data from available archives/databases derived from agencies belonging to the health-, welfare-, justice- and public order-sectors as well as related NGOs • Epidemiological Survey • Target group: • Children 11-16 years old • School status: • Children attending school • Children who have dropped out • Methods: • Distribution of the ICAST-CH and ICAST-P questionnaires to a sample of ~40,000children and their parents to explore and measure CAN cases for a 12-month time period (previous year)

12. WP3 WP4 Scheduling of Research ActivitiesPreparatory Phase-Completed • Epidemiological survey • Train-the-field researchers’ national workshops: Aim: to adequately and uniformly implement the field survey in schools • Trained trainers • on the basis of adapted & translated material • Duration: 16 hours • Workshops’ evaluation • Modification of material/process on the basis of evaluation results (where needed) • Case-based Surveillance • Train-the-field researchers’ national workshops: Aim: to adequately and uniformly extract data and code them • Facilitators: Trained trainers • One 2-day workshop/country • Content of training • CBSS Protocol • CBSS Extraction Forms & Operations’ booklet • Process of extracting data available in existing archives/databases • Mock extraction (3 cases)

13. WP3 WP4 Scheduling of research activitiesTimetable/Tasks • completed • ongoing • pending • Case-based surveillance • Identification of eligible organizations and agencies • Tracing of respectful databases, archives, records • Recording of characteristics of pre-existing databases • Maintaining access to datasets • Development of the research team • Scheduling and supervision methodology • Preparation of materials • Scheduling of in situ visitation to organizations • CAN related data collection • Data extraction on the basis of a specific form • Coding and data cross-checking • Statistical analysis • Results’ reporting • Epidemiological Survey • Official Permission • Collection of data for sampling • Sampling • Securing access to schools • Development of the research team • Scheduling and supervision methodology • Preparation of materials • Focus Groups • Pilot Studies • Core Field Surveys data collection • Children and their parents • School drop outs and their parents • Coding and data cross-checking • Statistical analysis • Results’ reporting

14. Translating ICAST in national languages Focus Groups for culturally validation of ICAST Final national ICAST-CH ICAST-P Applying and obtaining permission for ICAST usage to ISPCAN Developing Training Manuals for tools’ usage by Field Researches Conducting Sampling Training Field Researchers Conducting Pilot Studies Conducting School Drop outs’ Focus Groups Applying and obtaining official permission(s) to implement research in schools Conducting main body “core” field research Conducting School Drop outs’ Survey Developing Coding Files and set of data entry codification instructions Results’ data entry Results’ statistical analysis and interpretation WP3 Epidemiological Survey-Implementation Flowchart

15. WP4 CBSS-Implementation Flowchart

16. WP3 initial sampling

17. Research progress insofar

18. Some examples of WP3’s progress insofar: Greece • Sample size: 19.411 children and their parents • Percentage of the representative sample: 5% of the children’s population • Insofar coverage: 12.631 children and their parents • Children’s response rate: ≈65% (higher in 11y.o., relatively lower in 16y.o. especially in vocational high schools; higher in rural and lower in urban regions) • Parent’s response rate: ≈40% of the sample ≈70% of the participating children’s sample

19. Some examples of WP3’s progress insofar: Albania • Sample size: 4.561 children and their parents • Percentage of the representative sample: 3% of the children’s population • Children’s response rate: 3.467 ICAST-CH (76% RR; 73% urban RR, 78% rural RR) • Parent’s response rate: 2.512 ICAST-P (55% sample RR, 76% children’s RR)

20. Some examples of WP3’s progress insofar: Croatia • Sample size: 5.006 children and their parents • Percentage of the representative sample: 2% of the children’s population • Children’s response rate: 3.688 ICAST-CH (73,67% overall RR; 69,24% 11y.o. and 13y.o.; 84,12% 16y.o.)

21. Some examples of WP3’s progress insofar: FYROM • Sample size: 1.850 children and their parents • Percentage of the representative sample: 3% of the children’s population • Children’s response rate: 47% 11y.o.; 45% 13y.o.; 97% 16y.o. • Parent’s sample response rate: 31% 11y.o.; 30,5% 13y.o.; 66% 16y.o.

22. WP4’s progress insofar: Greece

23. WP5 Dissemination Activities • Aim: disseminate the existence of the project, its aims, methodology, results of the studies and all the deliverables to the authorities of the Balkan countries and other entities working on CAN in the Balkans and worldwide • Process: a press office was set up at the beginning of the project; a dissemination plan was drafted; the website of the project was developed • Results: • national BECAN conference(s) (in certain countries up to today) • several Press Releases both in English and in national languages • development of newsletters, leaflets and information material (in certain countries) • >5 oral presentations in international Conferences • >15 in national major scientific events Conferences • a significant number of web-based publications on scientific websites • a significant number of web-based publications on informative general public websites • 2 brief communications to the EU summarizing the project’s progress (3rd & 15th month) • other communications briefly summarizing the objectives and progress of the project were sent to respectful EU’s agencies to be uploaded on EU-Internet applications (CORDIS etc.) • BECAN Consortium decided to prepare for publication the process and outcome of WP2 as well as WP8 (modification of ICAST tools, development of CBSS extraction tools and innovative solutions for various ethical issues in conducting field research on CAN respectfully)

24. WP5 Dissemination activities: presentations • Nikolaidis, G. & Petroulaki, K. Real World Research on Child Abuse and Neglect: the case of Greece and the Balkans. 11th Biennial International EUSARF Conference, 22-25 Sep 2010, Groningen-The Netherlands • Nikolaidis, G. Cross National Child Maltreatment Survey through self report studies. 18th International ISPCAN Conference, 26-29 Sep 2010, Honolulu-Hawaii • Nikolaidis, G. Cross National Comparisons in youth population surveys about child maltreatment. 18th International ISPCAN Conference, 26-29 Sep 2010, Honolulu-Hawaii • Petroulaki, K., Ntinapogias S., Tsirigoti, A., Hatzinikolaou, K., Nikolaidis, G. BECAN project. 8th National Congress on Public Health & Health Services “Social Epidemics”. 15-17 Mar 2010, Athens-Greece • Petroulaki, K., Tsirigoti, A., Stavrianaki, M., Georgoulas, S., Nikolaidis, G. Real world research on child abuse and neglect the case of Greece and the Balkans. 8th National Congress on Public Health & Health Services “Social Epidemics”. 15-17 Mar 2010, Athens-Greece • Petroulaki, K., Tsirigoti, A., Fatsea, E., Milioni, F., Nikolaidis, G. For the Development of a National Unified System of Report of CAN in Greece.8th National Congress on Public Health & Health Services “Social Epidemics”. 15-17 Mar 2010, Athens-Greece • Ntinapogias, S. Case-based Surveillance Study in the Attica Prefecture (BECAN WP4). National Congress on Child Abuse and Neglect. Institute of Child Health, Dept of Mental Health and Social Welfare. 9-10 May 2011, Athens-Greece • Dimitrokali, A., Vasilakopoulou, A., Papageorgopoulos, G., Tsouvelas, G., Ntinapogias, S. Field survey: Facilitators and barriers during the implementation of case-based surveillance study. National Congress on Child Abuse and Neglect. Institute of Child Health, Dept of Mental Health and Social Welfare. 9-10 May 2011, Athens-Greece

25. WP5 Dissemination activities: presentations • Zorec, L., Rimac, I., Ogresta, E. Application of the focus group method in pilot studies: Experiences from the project BECAN. 3rd scientific-expert conference dedicated to the questions of violence: psychosocial aspects of violence in modern society–a challenge to the family, school and community. 27 Nov 2010, Zagreb-Croatia • Ajdukovic, M., Rajter, M., Sušac, N. Specifics of the research ethics of violence against children. 3rd scientific-expert conference dedicated to the questions of violence: psychosocial aspects of violence in modern society–a challenge to the family, school and community. 27 Nov 2010, Zagreb-Croatia • Ajdukovic, M. Ethics of professional conduct in cases of violence. 3rd scientific-expert conference dedicated to the questions of violence: psychosocial aspects of violence in modern society–a challenge to the family, school and community. 27 Nov 2010, Zagreb-Croatia • Croatian Team. BECAN Project. 3rd scientific-expert conference dedicated to the questions of violence: psychosocial aspects of violence in modern society–a challenge to the family, school and community. 27 Nov 2010, Zagreb-Croatia • Raleva, M. Progress in Violence prevention initiatives in the Republic of Macedonia.Third Global Meeting of WHO Violence and Injury Prevention Focal Points, 20-21 Sept 2010, London-UK • Raleva, M. BECAN Project. Global Conference on Safety, 21-24 Sep 2010, London-UK • Raleva, M. Methodology of the BECAN research study. Meeting of National Coordinative Body on Combating Domestic Violence.23 Nov 2010. UCP-FYR Macedonia • Vlajkovic, A., Hanak, N., Tenjovic, L., Ispanovic-Radojkovic. V. Balkanska epidemioloska stija o zlostavljanju I zanemarivanju dece. 2nd Congress of Society of Child & Adolescent Psychiatry, 22-25 Apr 2010, Zlatibor-Serbia • Serbian Team. Balkanska epidemioloska studija o zlostavljanju I zanemarivanju dece. Annual Conference of the Serbian Victimology Society, Serbia

26. WP5 Dissemination activities: presentations • Hanak, N., Vlajkovic, A., Tenjovic, L., Ispanovic-Radojkovic. V. Istrazivanje zlostavljanja I zanemarinvanja dece: Iskustva u primeni ICAST upitnika. Conference of the Association of Psychologist of Serbia, 28 May 2010, Zlatibor-Serbia • Serbian Team. Balkanska epidemioloska studija o zlostavljanju I zanemarivanju dece. (Poster). Council for Children’s Rights Conference • Stancheva-Popkostantinova, V. From Adolescence to Adulthood: normality and pathology. 8-12 Sept 2010, Larnaca-Cyprus • Stancheva-Popkostantinova, V. Evidence-based approaches for prevention of CAN. Contribution of project BECAN. Bulgarian Scientific Society on Child Neurology, Psychiatry and Developmental Psychology. 21-23 Oct 2010, Sofia-Bulgaria • Stancheva-Popkostantinova, V. Current approaches for prevention of CAN. Contribution of project BECAN. National Conference of Lecturers in Social Work. 3-4 Dec 2010. Stara Zagora-Bulgaria • Stancheva-Popkostantinova, V. Ministry of Education, Agency for Social Suport, State Agency for Child Protection, Educational Directorates in Blagoevgrad, Veliko Tyrnovo, Varna-Bulgaria • Stancheva-Popkostantinova, V. Balkan research network in the prevention of child abuse and neglect. The contribution of project BECAN (FP7). International University Seminar for Balkan Studies and Specialization South-West University "Neofit Rilski“ • Oral, R. SARSILMIŞ. BEBEK SENDROMU. İstismara Bağlı Kafa Travması. COCUK ISTISMARINI VE IHMALINI ONLEME KONGRESI. 26-28 Mayis 2010. Ankara-Turkey • Sofuoglu, T. Significance of Case –Based Surveillance Study in WP4. 1st National Congress of Paediatric Emergency and Ambulatory Pediatrics. 3-5 Nov 2010, Kusadasi, Izmir-Turkey • Sofuoglu, T., Olmezoglu, Z. BECAN project: Aim, Scope and Expectations. Child Abuse and Neglect Symposium- EgeUniversity. 13 Dec 2010, Izmir-Turkey • Olmezoglu, Z. BECAN project. International AGEAN Ambulance Rally, 16-19 Sep 2010, Izmi-Turkey

27. WP5 Dissemination activities: presentations in the context of the current event • 12th ISPCAN European Regional Conference on Child Abuse and Neglect Challenging Social Responsibilities for Child Abuse and Neglect.18-21 September 2011, Tampere, Finland • Round Table: Ethical and Methodological Issues on Child Abuse and Neglect Research • Nikolaidis, G., Salvanou, A. Ethical challenges in conducting field research in Greece • Browne, K. Ethical dilemmas in the prevalence studies of child abuse and neglect • Roth, M., Antal, I., Tonk, G., Kacso, A.Consent request from parents for CAN surveys completion by children 10-14. A nonsense • Rajter, M., Ajduković, M., Sušac, N. Ethical and Methodological Issues on Child abuse and Neglect Research in Croatia • Round Table: Epidemiological Field Research and Administrative Data Case-Surveillance Studies on Child Abuse and Neglect • Nikolaidis, G., Petroulaki, K., Ntinapogias, S., Tsirigoti, A., Zarokosta, F. Representative sample’s randomized epidemiological field research in Greece • Cenko, E., Hazhiymeri, E., Hazizaj, A., Coku, B. The adaptation and piloting of the ISPCAN Child Abuse Screening Tool Children’s Version in Albanian • Rajter, M., Sušac, N., Rimac, I., Ogresta, J., Skokandić, L., Ajduković, M. Epidemiological field research in Croatia • Antal, I., Tonk, G., Roth, M., David-Kacso, A., Voicu, K., Mezei, E., Szasz R. Field epidemiology in Romania: the BECAN project

28. WP5 BECAN website www.becan.eu • Useful links • Greece • Bulgaria • Romania • Albania • Former Yugoslav Republic of Macedonia • Turkey • Croatia • Serbia • Bosnia & Herzegovina • Global • BECAN Project • Identity • Coordinator • Concept and objectives • Consortium • Funding • Methodology & Workplan • Potential Impact • Ethical Issues • Gender aspects • Work Packages • WP1: Coordination and Networking • WP2: Instruments & Training on Methodology • WP3: Epidemiological Studies • WP4: Case-based Surveillance • WP5: Dissemination • WP6: Sustainability • WP7: Evaluation • WP8: Supervision of Ethical Issues • Primary links • Forum • Contact us • Search • Sitemap • Disclaimer

29. http://www.becan.eu/node/21 WP6 Sustainability • Objectives: • Provide the scientific and strategic basis for annual evaluation of CAN issues in each Balkan partner country development of a strategic plan for the prevention of CAN at national and Balkan levels • Provide an open forum for continuing discussion on CAN issues for interested parties and the public WP6 objectives will be achieved through • synergies with other relevant WPs via • horizontal actions such as networking CAN-related professionals, organizations and agencies in all participant countries • widely disseminating the current situation on CAN in each participant country • For example: National Reports on the current situation regarding CAN have been widely circulated • maintenance of website and forums

30. WP6 Sustainability: WP interconnection WP1 Provide information for the 9 National Networks & maintain the BECAN portal WP6 AIM Based on information provided by WP1, 3, 4 & 5, the Strategic Plan for the development of a permanent CAN Monitoring System in 9 Balkan countries Activities towards Sustainability • to promote the strategic plan to be used for systematic annual national evaluation of CAN issues aiming at: • follow up on the rates and characteristics of CAN in 9 Balkan countries • creation of a basis for future assessments of the effectiveness and efficiency of any CAN-related preventive, legal or other intervention • to invite relevant national Organizations (and Authorities) to continue the CAN surveillance at national level after the end of the BECAN project WP3-WP4 Provide results (WP3) protocol and database for the recording of CAN cases WP(4) (13th month) Provide information on the results for national statistical & child protection services WP5 Maintain the BECAN website Disseminate the Strategic Plan

31. WP6 Potential content of an initial version of the Strategic Plan • Part 1: The need & the aim of permanent National CAN Monitoring Systems • Why there is a need for permanent national CAN Monitoring Systems • Aim & Objectives • Part 2: How to achieve the objectives • Technical specifications for following up CAN at a national level via • BECAN project’s available tools • Additional tools (proposed to be developed) • Part 3: CAN-Registration Toolkit • ANNEX with a complete set of ready-to-use available tools (protocol, database, instructions)

32. WP6 Activities towards feasibility • Development of the Strategic Plan for the creation of a permanent CAN registration system • Adaptation of the content of the initial version of the strategic plan for each country-specific characteristics and translation • Dissemination/communication plan for the strategic plan (WP6 & WP5) • Implementation of dissemination and lobbying for the strategic plan at national level • Lobbying towards sustainability

33. WP7 Evaluation • Responsible Organization: Istituto degli Innocenti • Objectives: • Process monitoring, evaluation and corrective interventions • Evaluation of achievement of the project’s main objectives • Impact and outcome evaluation • Results and progress insofar • development of a comprehensive plan of constant monitoring and evaluation of the project; the strategy applied was multi-level, addressing the various aspects of the evaluation process: • a combination of process and outcome evaluation approach utilizing indicators from both perspectives in order to cover the project’s implementation more globally, • a combination of 5 major axis-criteria namely Efficiency, Effectiveness, Relevance, Sustainability/Consistency and Utility to be applied sequentially in regards to the project’s unfolding over time and • a combination of input for evaluation, collaboration with the consortium, attending project meetings and communicating directly with other stakeholders to get as much genuine feedback as possible by the Evaluator

34. WP7 Overall illustration of evaluation results

35. WP8 Ethics • Objectives • Monitoring and evaluation of ethical issues, and corrective interventions • Securing the rights of children and adults participating in the study • Results: • all partners formed their National Advisory Boards on Ethical issues (NAB) • the Central Independent Ethical Advisory Board was formed to supervise the whole project in terms of ethics, with the participation of internationally recognized professionals and experts in the field of CAN research and prevention • All NABs were provided with material and guidelines on ethical issues by the BECAN Coordinator and were informed in detail about the methodology as well as the ethical requirements of the project

36. WP8 Informed consent: Example of main ethical issue • Field epidemiological survey: • the situation appeared quite differentiated in terms of legal and/or regulatory provisos for conducting research involving children • other perplexities

37. BECAN Website & Forumwww.becan.eu