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The first effectiveness study in the Netherlands of a multidisciplinary approach to child maltreatment, the Resolutions Approach.


- candidate number28015
- NTR NumberNTR6757
- ISRCTNISRCTN no longer applicable
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR16-okt-2017
- Secondary IDsZonMw 70-74100-98-002;  ZonMw; LAB Ethics Review Board, Faculty of Social and Behavioral Sciences
- Public TitleThe first effectiveness study in the Netherlands of a multidisciplinary approach to child maltreatment, the Resolutions Approach.
- Scientific TitleThe first effectiveness study in the Netherlands of a multidisciplinary approach to child maltreatment, the Resolutions Approach.
- ACRONYM
- hypothesisWe investigate the effectiveness of a multidisciplinary treatment Resolutions Approach (RA) in families with alleged child abuse supplemented with the assessment form of Turnell (Turnell et al., 2009). We investigate the effects of RA on the primary and secondary outcome measures of new incidents of child maltreatment, child’s emotional and behavioural problems (including posttraumatic stress symptoms), parental stress feelings, and the bond between the child and the parent(s). We make use of the Single Case Experimental Design (SCED) method and regular, personalised assessments related to family treatment goals. SCED is a valuable alternative for RCTs to test (novel) intervention effects in youth and families in which heterogeneity of the problems is rather a rule than an exception.
The secondary objective of this study is to explore potential mechanisms of change behind RA effects. Most families keep the maltreatment undisclosed because they are ashamed or anxious for out of home placement of their children. Theories (Turnell et al., 2010) and clinical practice suggest that breaking through the secrecy of child maltreatment and domestic violence, and increasing openness of communication (aims of RA) about maltreatment, often lead to fewer incidents of child maltreatment after RA.
Also, treatment integrity (adherence to RA treatment protocol) will be monitored.
- Healt Condition(s) or Problem(s) studiedChild abuse, Child abuse, Neglect
- Inclusion criteriaParticipants are 15 families with children between 8 and 18 years old. Families meeting the following criteria can join this study:
a) There are specific signs of child maltreatment seen by more than one informant. Informants can be people who have seen children and families. Informants may consist of people knowing child or family (members of the social network of the family, doctors, teachers, police and other professionals)
b) (One of the) parents (partially) deny that they have maltreated their children.
c) Parents are willing to participate in the intervention and research.
d) Working towards safety within the family seems to be an achievable goal for all concerned. If the parents, the referrer, children over the age of twelve or the case manager finds this unsafe or impossible the cannot use the intervention.
e) It is financially and physically possible for the family to travel to the institution.
f) There is a safety family network of at least one person. If the parents do not want to involve certain people from the social network in the treatment, they can still participate. The involvement of an existing but absent network is one of the goals of the RA.
g) The case manager can be present at the multidisciplinary meetings.
- Exclusion criteriaExclusion criteria are:
- Not Dutch speaking families.
- Parents who do not have a permanent residence.
- mec approval receivedno
- multicenter trialyes
- randomisedno
- group[default]
- TypeSingle arm
- Studytypeintervention
- planned startdate 30-mei-2017
- planned closingdate1-apr-2019
- Target number of participants15
- InterventionsThe Resolutions Approach (Turnell, 2010)(RA) in families with alleged child abuse. In this study, the actual signals of child maltreatment are mapped using the assessment form of Turnell (Turnell et al., 2009), as is the case with the Signs of Safety method.
- Primary outcomePrimary outcome: Incidents of child abuse and domestic violence.
The quantitative measures will be assessed at five measurement points (T0 – T4): start of the baseline phase (T0), start of the treatment phase (T1), end of the treatment phase (T2), first follow-up meeting after three months (T3) and second follow-up meeting after six months (T4). Clinically relevant change in the client symptoms relative to the normgroup will be analysed using the outcomes on the extensive measurements and the reliable change index (RCI) (Jacobson & Truax, 1991). The RCI is a method to determine whether the symptom change within the participant is statistically reliable and represents a real improvement. This is the case if the RCI is greater than 1.96.
The child abuse and domestic violence will be measured through various informants, as there is often denial in parents. Children will complete the Dutch translation of the Childhood Trauma Questionnaire (CTQ). This is a self-report instrument to determine child abuse and neglect. The CTQ consists of 28 items, covering five types of maltreatment: emotional and physical neglect, emotional and physical abuse, as well as sexual abuse. Both children and parents fill in the Conflict Tactics Scale Parent-Child (CTS-PC) (Dutch translation), which is a self-report tool to measure the presence and degree of child abuse. It measures psychological and physical child abuse and neglect (Straus, 1998). The parents also complete the Revised Conflict Tactics Scale between partners (CTS2). This is a self-report questionnaire consisting of 78 items divided in five scales: psychological -, physical -, sexual violence and injuries due to a fight with the (ex-)partner.
- Secondary outcomeSecondary outcome: Parental stress, Children's posttraumatic stress reactions, Emotional and behavioral problems in children, Parent-child relationship.
Parental stress will be measured by The Nijmeegse Ouderlijke Stress Index (NOSIK). The NOSIK is a self-report questionnaire that consists of 25 items, answered on a 6-point scale and is suitable for parents of children between 2 and 13 years old. A high overall score means a high level of parental stress.

Children's posttraumatic stress reactions will be measured with the Dutch version of the Impact of Event Scale (Schokverwerkingslijst voor Kinderen; SVLK). Both parents and children fill out the questionnaire. Participants are asked to describe a specific stressful life event that the child has experienced in the past. Additionally, they will complete 34 items about the event and other items that directly correspond to the PTSD symptoms from the DSM-IV. It is scored on a 5-point scale ranging from “not at all” (0) to “extremely” (4).

Emotional and behavioural problems in children will be measured by the Dutch translation of the Strenghts and Difficulties Questionnaire (SDQ). The SDQ is a self-assessment questionnaire to measure the social-emotional health of children and adolescents (3-17 years). It consists of 25 items, which are answered on a three-point scale. The questionnaire consists of five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviour. The overall score of the SDQ gives an indication of the extent of the socio-emotional problems.

The closeness of the relationship between children and their parents will be measured with The Inclusion of Other in the Self Scale (IOS). It is a single-item, pictorial measure. The child has to choose one image that represents their relationship with the parent. The images consist of two circles, which increase in the degree of overlap. The more overlap, the more closeness.
Idiosyncratic assessment
In addition to the extensive measurements at the five measure points, we will repeatedly assess the most distressing problems of parents and children. It is a personalized questionnaire that consists of 5 to 10 items. These items are derived from three completed questionnaires, filled out at the first measurement point (T0). The three questionnaires that will be used for the selection are about incidents of child abuse and domestic violence (CTS2 and CTS-CP), and about parental stress (NOSIK).

Qualitative interview
Semi-structured interviews with children, parents and therapists will be taken at the end of the treatment. The purpose of this interview is to understand the experience of the clients and to learn more about the mechanism underlying the RA. Topics are:
- Did the family members reach their goals?
- Has the safety of the children been improved?
- Which elements helped to achieve the goals?
- Collaboration between professionals and the family and collaboration between professionals.

Multidisciplinary network meetings: VAS and SUS scale
There will be multidisciplinary network meetings around every six weeks during the intervention period (T1 – T2). At the end of every meeting, therapist and case managers will score the changes in the secrecy within the family on a VAS-scale. Parents, the social-, and professional network members will score the subjective safety of this family at the end of the multidisciplinary network meetings, using the Subjective Unit of Safety scale (SUS). The SUS is a 10-point scale where 0 means: “the situation is extremely unsafe, the child has to be taken out of home immediately”. If it is scored 6-7 for a long time, the situation is safe enough to let the child return home.
- TimepointsThe quantitative measures will be assessed at five measurement points (T0 – T4): start of the baseline phase (T0), start of the treatment phase (T1), end of the treatment phase (T2), first follow-up meeting after three months (T3) and second follow-up meeting after six months (T4). Clinically relevant change in the client symptoms relative to the normgroup will be analysed using the outcomes on the extensive measurements and the reliable change index (RCI) (Jacobson & Truax, 1991). The RCI is a method to determine whether the symptom change within the participant is statistically reliable and represents a real improvement. This is the case if the RCI is greater than 1.96.
- Trial web site
- status[default]
- CONTACT FOR PUBLIC QUERIES J.W. Sepers
- CONTACT for SCIENTIFIC QUERIES M. Maric
- Sponsor/Initiator University of Amsterdam, Department of Developmental Psychology, Arq Psychotrauma Expert Group
- Funding
(Source(s) of Monetary or Material Support)
ZonMw
- Publications
- Brief summaryWe investigate the effectiveness of the Resolutions Approach in 15 families with children aged 8-13 years, alleged of child maltreatment. We use the Single-Case Experimental Design (SCED) methodology. We investigate whether the Resolutions Approach is effective in preventing new incidents of child abuse, reducing parental stress and reducing children's internalising and externalising problems and strengthening the relationship between parents and children. Also, we look at the potentially active mechanism behind the Resolutions Approach. We investigate whether the breakthrough of secrecy within the family is related to the decline in the number of incidents of child abuse within the family. The results of this study will be disseminated and implemented through existing partnerships with different training centres, supervision of colleagues and (inter) national congresses and publications.
- Main changes (audit trail)
- RECORD16-okt-2017 - 4-nov-2017


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