Ethical Dilemmas in Online Research and Treatment of Sexually Abused Adolescents

Lange, Alfred; Ruwaard, Jeroen

doi:10.2196/jmir.1455

Cited by 14 publications

(29 citation statements)

References 37 publications

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“…The remainder were in Canada (four studies 170,[658][659][660][661] ), the UK (14 studies 145,169,481,511,538,[662][663][664][665][666][667][668][669][670] ) and elsewhere in Europe: the Netherlands (three studies 497,671,672 ), Norway (three studies [673][674][675] ) and Sweden (one study 676 ), with one multisite review of services 145,146,640,[665][666][667][668][669][670] across Italy, the Netherlands and the UK. A small number of studies were based outside North America and Europe: Australia (two studies 506,677 ), Brazil (one study 678 ), India (one study 679 ) and the Philippines (one study 680 ).…”

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

“…621,629 ) to a large national sample of n = 1085. 634 The majority of sample sizes were < 50 cases (40 studies 169,175,497,504,506,510,511,526,533,538,621,629,[636][637][638][639][641][642][643]645,646,648,651,652,658,[661][662][663]665,666,[668][669][670]675,677,678,680 ), between 50 and 100 cases (15 studies 107,170,176,481,482,492,505,644,647,…”

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

“…Sexual abuse was the most commonly cited type of abuse across the acceptability studies (33 studies 161,[169][170][171]189,492,497,505,506,526,533,538,621,633,[636][637][638][640][641][642][643]645,647,648,653,657,660,662,664,668,673,[677][678][679][680] ) and some intervention categories reported data for only this population group [systemic interventions, 526,533,621,673,678 psychoeducational interventions, 161,538,647,664 peer mentoring 660 (note: there was only one study in this category)]. Three studies 510,639,65...…”

Section: Description Of Included Acceptability Studiesmentioning

confidence: 99%

“…Lange and Ruwaard 497 explored the impact and acceptability of a web-based version of cognitive/behavioural approaches with no face-to-face contact at all between therapist and client. Fraynt et al 632 reported variable attendance rates which differed in relation to ethnicity, the focus of treatment (family treatment vs. no family treatment), group treatment compared with no group treatment, and location of treatment (office vs. community).…”

Section: Interventionsmentioning

confidence: 99%

“…In Lange and Ruwaard 497 there remained a high level (77%) of pre-treatment withdrawal (82 out of 106 applicants not excluded by the research team), despite the steps taken to minimise it, namely no randomisation, parental consent required only for children of < 16 years rather than < 18 years (Dutch law for RCTs of new interventions), raising the upper age level for participants from 18 to 25 years, and providing the alternative of a structured interview by 'chat' if they were reticent to answer screening questions on the telephone. Data available to the researchers indicated that pre-treatment withdrawal was strongly correlated with biographic questions, suggesting that anonymity may be an important factor, although whether for treatment or as an artefact of the study is not clear.…”

Section: Pre-treatment Withdrawalmentioning

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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