A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

Nolan, Margretta; Carr, Alan; Fitzpatrick, Carol; O’Flaherty, Anne; Keary, Kay; Turner, Rhonda; O’Shea, Deirdre; Smyth, P.; Tobin, Genevieve

doi:10.1002/car.727

Cited by 37 publications

(55 citation statements)

References 15 publications

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“…Of the seven studies [174][175][176][177][178][179][180] evaluating psychotherapy/counselling, five studies 174-178 measured psychological distress outcomes, all but one 174 measured behaviour outcomes, five studies [175][176][177][178] looked at cognitive outcomes, and one study 177 looked at placement stability. One study 175 reported on the intervention's acceptability.…”

Section: Psychotherapy/counsellingmentioning

confidence: 99%

“…Four 155,174,178,179 studies assessed the effectiveness of psychotherapy without clearly describing their theoretical underpinnings. One 178 study explored the value added of group psychotherapy when added to individual psychotherapy.…”

Section: Psychotherapy/counsellingmentioning

confidence: 99%

“…Nolan et al 178 was conducted in Ireland, and Trowell et al 155 in the UK. The other six studies [174][175][176][177]179,180 were conducted in North America.…”

Section: Locationmentioning

confidence: 99%

“…Participants in the study by Nolan et al 178 were referred from eight urban and rural services for sexually abused children and adolescents. Those in the study by Trowell et al 155 were recruited from the authors' own clinics and from professionals' agencies in the community.…”

Section: Referralmentioning

confidence: 99%

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The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

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BackgroundChild maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.ObjectivesTo synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.Study designFor effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.ParticipantsChildren and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.InterventionsAny psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.Main outcome measuresPsychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.MethodsYoung Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.ResultsWe identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.ConclusionsIt is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.LimitationsStudies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.Future workStudies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.Study registrationThis study is registered as PROSPERO CRD42013003889.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Psychotherapy/counsellingmentioning

confidence: 99%

Section: Psychotherapy/counsellingmentioning

confidence: 99%

“…Nolan et al 178 was conducted in Ireland, and Trowell et al 155 in the UK. The other six studies [174][175][176][177]179,180 were conducted in North America.…”

Section: Locationmentioning

confidence: 99%

Section: Referralmentioning

confidence: 99%

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The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Macdonald

Livingstone

Hanratty

et al. 2016

Health Technol Assess

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“…However, only a small proportion of CSA survivors come into contact with assessment and treatment services Carr, 1999c, Nolan et al, 2002b;Nolan et al, 2002a). The effects, both short and long-term, of CSA on psychological functioning have been well documented.…”

Section: Introductionmentioning

confidence: 99%

Irish child sexual abuse victims attending a specialist centre

O'Riordan¹,

Carr

Turner

2003

Child Abuse Review

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We profiled a cohort of CSA cases referred for assessment to a specialist child sexual abuse (CSA) centre in a national paediatric hospital in Ireland. Historical and clinical data were drawn from records of 171 cases. The majority of cases were referred by social workers following purposeful disclosure of CSA. Three quarters of the cases were female with a mean age of 9 years. They were from a wide spectrum of socioeconomic groups and many had suffered a range of family adversities. In most cases, the abuse involved masturbation of the child by the abuser. Almost all of the perpetrators were male with a mean age of 28 years and in 60% of cases extrafamilial abuse had occurred. In 23% of cases, the perpetrator had a history of previous sexual offending. Anxiety was the most common emotional problem before disclosure and after disclosure the most common emotional problem was guilt. Before disclosure school refusal was the most common behavioural problem and after disclosure fighting was the most prevalent behavioural difficulty. The most common factors supporting the credibility of CSA allegations were labile mood, the child's ability to differentiate fact from fantasy and a detailed disclosure of contextual details. More adolescents showed deterioration in schoolwork after disclosure and for more pre school children clinginess following disclosure was a significant emotional problem. More primary school aged children were abused by perpetrators who had abused a number of children. For children abused by such perpetrators, vaginal intercourse was less common. Vaginal intercourse was more common in 6–11‐year‐old victims and those who were abused on a daily basis. The threat that disclosure posed to the integrity of the family structure was more often a factor hindering disclosure in victims abused by father figures and abused very frequently. Copyright © 2003 John Wiley & Sons, Ltd.

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Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis

Caro

Turner

Caldwell

et al. 2023

Cochrane Database of Systematic Reviews

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A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

Cited by 37 publications

References 15 publications

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

Irish child sexual abuse victims attending a specialist centre

Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis

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