knowledge, attitude and practice (kap) of child protection

1

Knowledge, Attitude and Practice

(KAP) of child protection actors in

Italy, Lithuania and Poland

Data Analysis Report

Resilience Research Unit - RiRes

Dipartimento di Psicologia – Università Cattolica del Sacro Cuore di Milano

2

Implemented by

The content of this document represents the views of the author only and is

his/her sole responsibility. The European Commission does not accept any

responsibility for use that may be made of the information it contains.

This document was funded by the European Union’s Rights, Equality and

Citizenship Programme (2014-2020).

3


(KAP) of child protection actors in Italy,

Lithuania and Poland


Italian context: Knowledge, Attitude and Practice (KAP) of

professionals

Lithuanian context: Knowledge, Attitude and Practice (KAP)

of professionals

Poland context: Knowledge, Attitude and Practice (KAP) of

professionals

Conclusions

4






professionals

Section A: Professionals’ experience with children exposed to ACEs

General Information

Difficulties met by the child protection professionals in relating with caregivers

and children

Section B: Risk and protective factors for each developmental

milestones

The Perinatal Stage: risk and protective factors

The Postnatal Stage: risk and protective factors

The Kindergarten entry Stage: risk and protective factors

The Early dating Stage: risk and protective factors

Section C: Professionals’ Learning Gaps

5


professionals


General Information

Figure 1 reports the number of Italian professionals involved in the data collection, divided by

professional category.

Professional categories Number of each professional

categories (N)

Educators 6

Medical care practitioners 10

NGO experts 2

Policemen 4

Psychologist 3

Social service practitioners 3

Teachers/provider of early care and education 9

Figure 1. Number of Italian professionals involved in the data collection

In particular, figure 2 highlights the percentage of interviewees in each professional category

involved in the data collection process.

Figure 2. Percentage of professionals categories interviewed

Professionals who have been interviewed have an average of 17 years of experience (Figure 3).

Figure 3. Average of years of experience for each professional category

27%

24%

11%

8%

5%

8%

16% medical care practitioners

teachers/provider of early care and education

policemen

Social service practitioners

NGO experts

Psychologist

Educators

17.3324.80

9.5016.00 17.67 15.67 17.78

0.00

10.00

20.00

30.00

Educators medical carepractitioners

NGO experts policemen Psychologist Social servicepractitioners

teachers/providerof early care and

education

6

Figure 4 reports the percentage of interviewees in each professional category that have been in

contact with ACE cases.

Medical care practitioners, NGO experts and policemen have been involved with cases reporting

all types of ACE considered among other professionals. In particular, police professionals have

been involved with cases exposed to each and every ACE explored.

Neglect, Physical maltreatment and Psychological maltreatment are the most reported ACE, while

sexual abuse is the less reported.

Figure 4. The main types of ACE (adverse childhood experience) met by each professional category

All professional categories have been in contact with each ACE, except for NGO experts who have

never been in contact with cases of sexual abuse and psychological maltreatment. Social service

practitioners, educators and psychologist are the professionals who have been mostly in contact

with ACE cases: 100 % of social service practitioners and psychologists have been working with

children exposed to domestic violence, psychological maltreatment, neglect and physical

maltreatment. Furthermore, 100 % of educators have assisted beneficiaries reporting psychological

maltreatment and domestic violence. Italian teachers and policemen report more access to ACE

cases, comparing to the other countries. These results highlight the relevancy of the topics of the

training for each professional category. Indeed, when dealing with ACE cases it’s fundamental

to have general knowledge on the consequences of these experiences on beneficiaries’ mental

health and wellbeing and guidelines on how understanding and intervening with them.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%




education

Sexual abuse Physical maltreatment Neglect Psychological maltreatment Domestic violence/Assisted violence

7


and children

Figure 5. The main difficulties in the relationship with the caregivers

The 3 main difficulties reported by the interviewees in the relationship with the caregivers are the

tendency to deny/minimize violent episodes and/or distort the reality, the lack of awareness and

accountability and the difficulty in building trust with them (Figure 5).

Therefore, part of the training will be dedicated to explore and make meaning of the difficulty

in building trust with caregivers met by professionals and the related parents’ frequent

neglect regarding the abuse, their responsibility on it and the impact of the act on the child.

Questions like “Why this happens?”, “Why parents do not ask for help?” and “How can

professionals deal with this and create a trusting alliance with the caregivers?” will be raised.

Another important topic mainly highlighted by educators, social service practitioners and teachers,

is how to build an effective communication with caregivers, that may allow them not to feel

judged but rather to engage in the supporting process. Indeed, almost all professional categories

(i.e. more then 50 % of teachers, educators, social service practitioners, medical practitioners and

psychologists) perceive a caregivers’ negative attitude towards the child protection actors.

Policemen are the professional category reporting less problems in the relationship with caregivers.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Communicationdifficulties

Languagedifficulties/Cultural

barriers

Building trust Difficulty in reportingthe abuse

Negative attitudetowards operators

Lack of compliancewith the rules

Couple-Conflict Tendency todeny/minimize violent

episodes and/ordistort the reality

Lack of awareness andaccountability

Educators medical care practitioners

NGO experts policemen

Psychologist Social service practitioners


8

Figure 6. The main difficulties in the relationship with the children

The main difficulties met by professionals in the relationship with children are the child difficulties

in reporting the abuse, due to the feelings of fear, shame, guilt and hopelessness and the frequent

tendency secrecy or to deny/minimize violent episodes and/or distort the reality, mainly detected

by psychologists and social service practitioners (Figure 6).

Therefore, during the training it’ll be important exploring the different emotions associated with

ACE and make meaning of the children’ tendency to neglect and distort the reality.

Furthermore, it’s fundamental illustrating how professionals can help children dealing with

their negative emotions and relying on professionals without feeling guilty for that. Indeed,

building trust appears one of the most frequent difficulty reported by each professional category

(i.e. 100% of NGO experts and social service practitioners and more then 50% of psychologists,

50 % policemen and 33% of teachers and educators).

Finally, most of professionals reported difficulties in communicating, make meaning of past

experiences (i.e. 100 % of social service practitioners, 67% of educators, 50% of policemen, 40%

of medical care practitioners and 33% of teachers) and in accompanying children in sharing the

negative memories (i.e. 100% of psychologists, 67% of educators and social service practitioners,

50% of policemen, 40 % of medical care practitioners and 22% of teachers). Therefore, it’ll be

important training practitioners on communicating effectively with children and on

accompanying them in disclosing their negative memories and in dealing with the related

negative emotions without being shattered by them.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Communication and makemeaning difficulties

Difficulty to share negative andviolent episodes/accompany the

process of sharing

Building trust Fear/shame/guilt/hopelessness Dealing with negative emotionsand behaviours

Attitude towards operators Tendency to secrecy or todeny/minimize violent episodes

and/or distort the reality

Educators medical care practitioners NGO experts

policemen Psychologist Social service practitioners


1


milestone

The following graphs (Figure 7,8,9,10) report the percentage of interviewees in each professional

category that has been in contact with each developmental milestone.

Figure 7. Access to Perinatal stage by professional category

Figure 8. Access to Post-Natal stage by professional category

Figure 9. Access to Kindergarten stage by professional category

Figure 10. Access to Early dating stage by professional category

33%

20%

100%

67% 67% 67%

22%

0%

20%

40%

60%

80%

100%




education

33%20%

100%

50%

67% 67%

22%

0%

20%

40%

60%

80%

100%




education

100%

70%

100% 100% 100%

67%56%

0%

20%

40%

60%

80%

100%




education

83% 80%

100%

75%

100% 100%

67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



teachers/provider ofearly care and

education

2

Kindergarten entry and early dating developmental milestones are the developmental milestones

where most of the professional categories are involved: more than 56% of each professional

category have access to both stages; furthermore 100% of the interviewed educators, NGO experts,

policemen and psychologists have met kindergarten entry ACE cases, while 100 % of NGO experts,

psychologists and social service practitioners have met early dating ACE beneficiaries.

100% of the NGO experts and more then 50% of the interviewed policemen, psychologists and

social service practitioners have access to each and every developmental milestone. This highlights

the importance of training professionals on the specificity of ACE in each developmental

milestone and the related risk and protection that may shape the resilience process in each

target of beneficiaries.

The following graphs report the main risk and protective factors indicated by interviewees, related

to each developmental milestone.


Figure 11. Perinatal stage – risk factors

Figure 12. Perinatal stage – protective factors

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Low educationallevel

Childhoodexperiences of

rejection, violence,or abuse

Lack ofinterpersonalrelationships

Disadvantagedsocial context

Parents’ lacking accountability

Undesirablematernity and

pregnancy

Parents’ abuse of alcohol and/or

drugs

Parents’ emotional difficulties

Difficult relationships with personal and/or partner’s family

Couple-conflict Domestic violence Husband/partnerfeeling left out

SOCIAL AND CULTURAL RISK FACTORS PARENTAL RISK FACTORS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Knowledge and access tothe family counselling and

support services in theneighborhood

Family with a socialsupporting network

Family and/or friendssupport

Trauma recovery from parents’ childhood

experiences of rejection, violence and/or abuse

Parents reporting theviolence and asking for

help

Parents sharing a familyproject

Ability to take on theparental responsibilities

SOCIAL AND CULTURAL PROTECTIVE FACTORS PARENTAL PROTECTIVE FACTORS

3

Regarding the perinatal stage, few relevant risk and protective factors have been indicated by

professionals (i.e. less than 20% of each reported factor) (Figure 11, 12). Further investigation on

the relevant risks and protections in the cases dealing with each developmental milestone will be

done during the training.


Figure 13. Post natal stage – risk factors

Figure 14. Post natal stage – protective factors

In the post-natal developmental milestone, at-risk parents appear to lack interpersonal

relationships and social integration. Furthermore, problems of addictions have been observed in

caregivers, together with post-partum depression or baby blues and undesirable pregnancy and

couple conflicts. In line with this, facilitating the caregivers’ access to the family counseling

and supporting services in the neighborhood, and strengthening the friends and family

networks which may accompany them in assuming their role of caregivers are relevant protective

factors when supporting ACE families during the postnatal stage (Figure 13,14).

0%10%20%30%40%50%60%70%80%90%

100%

Lack of trust ininstitutions andin social norms

Chronic poverty Low educationallevel


rejection,violence, or

abuse


drugs

Intergenerationaltransmission of

violence

Parents’ impulsiveness

Domesticviolence



Difficulttemperament

SOCIAL AND CULTURAL RISK FACTORS PARENTAL RISK FACTORS CHILD RISKFACTORS

0%10%20%30%40%50%60%70%80%90%

100%


Knowledge andaccess to the family

counselling andsupport services inthe neighborhood

Family and/orfriends support

Striving to be a goodparent and/or toimprove oneself

Capacity to manageconflicts

Parentalresponsibility

Child with a socialsupporting network

SOCIAL AND CULTURAL PROTECTIVEFACTORS

PARENTAL PROTECTIVE FACTORS CHILD PROTECTIVEFACTORS

4


Figure 15. Kindergarten entry stage – risk factors

Figure 16. Kindergarten entry stage – protective factors

Again, the presence of social supporting network for both family and child and the access to family

counseling and other supportive services play a fundamental role in the support of at risk families

during the kindergarten entry stage. Furthermore, it is crucial in this stage where the parent-child

attachment is still forming helping caregivers to encourage parental responsibility, building

empathy in caregivers and parental mutual esteem and prompt their capacity to manage conflicts

(Figure 15,16).

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Lack of socialintegration



rejection,violence, or

abuse

Culturalacceptance ofviolence and

severepunishments


Couple-conflict Domesticviolence


violence


drugs

Parents’ low frustration tolerance


Childrendifficulty tocomply with

parental rules

SOCIAL AND CULTURAL RISK FACTORS PARENTAL RISK FACTORS CHILD RISK FACTORS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Family with asocial supporting

network

Knowledge andaccess to the

family counsellingand support

services in theneighborhood



Empathy Striving to be agood parent

and/or toimprove oneself

Capacity tomanage conflicts

Parental mutualesteem

Child with a socialsupporting

network

SOCIAL AND CULTURALPROTECTIVE FACTORS

PARENTAL PROTECTIVE FACTORS CHILDPROTECTIVE

FACTORS

5


Figure 17. Early dating stage – risk factors

Figure 18. Early dating stage – protective factors

During the early dating stage, the risk factors increase in relevance. In particular, parental risk

factors grow making the family environment more toxic and hard to be tolerated by adolescents,

who show high levels of difficulty to comply with it and difficult temperaments. Furthermore the

disadvantage nature of the context remain highly present, together with the low social integration

and the prevalence of childhood experiences of rejection violence or abuse among caregivers

(Figure 17). Therefore, even though the early dating cases are adolescents, working on caregivers

emotional and social functioning and on their motivation to be good parents and/or to improve

themselves appear still fundamental. Finally, strengthening the formal and informal social

supporting network remains fundamental both for the parents and for the child (Figure 18).

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Lack of socialintegration


rejection,violence, or abuse


Domestic violence Couple-conflict Intergenerationaltransmission of

violence


drugs


Parents’ social deviance

Children difficultyto comply withparental rules


SOCIAL AND CULTURAL RISK FACTORS PARENTAL RISK FACTOR SOCIAL AND CULTURALPROTECTIVE FACTORS

0%

10%

20%

30%

40%

50%

60%

70%

80%

Knowledge and access tothe family counselling and

support services in theneighborhood


Family and/or friendssupport

Striving to be a good parentand/or to improve oneself

Child with a socialsupporting network

Child reporting the violenceand asking for help

SOCIAL AND CULTURAL PROTECTIVE FACTORS PARENTAL PROTECTIVE FACTORS CHILD PROTECTIVE FACTORS

6


Nearly all professional categories collaborate with a multidisciplinary network they refer to when

dealing with cases of ACEs. Only 30% of medical practitioners and 11% of teachers/provider of

early care and education affirmed they don't collaborate with a multidisciplinary network for ACE

cases referral.

Figure 19. The main child protection actors in the professional referrals

In Italy, the referral process appears to be widespread among professional figures involved in the

child protection network. In particular, social service practitioners, psychologists and policemen

are the members of the network other professionals mainly refer to in cases of at risk cases.

Moreover, family counseling, children communities, social workers and child protective services

mainly refer to NGO experts. Finally, medical care practitioners are highly in contact with social

services and social workers (Figure 19). Those results highlight the deep unbalance among the

professionals considered for referral and, therefore, the need to create a more integrated network

of the child protection system.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MEDICAL STAFF (Pediatrician,child neuropsychiatric, midwife,

nurse, gynecologist, Ersprofessionals)

Social services Psychologist (school psychologist,ATS psychologist)

School/Teachers/educationalpersonel

Family counselling/family centers Children community Social worker Police Honorary judge/lawyer/legalservices

Child protective services (CPS) Anti-violence center

Educators medical care practitioners NGO experts policemen Psychologist Social service practitioners teachers/provider of early care and education

MEDICAL STAFF

(Pediatrician, child

neuropsychiatric,

midwife, nurse,

gynecologist, Ers

Social services

Psychologist (school

psychologist, ATS

psychologist)

School/Teach

ers/education

al personel

Family

counselling/famil

y centers

Children

community

Social worker Police Honorary

judge/lawyer/legal

services

Child

protective

services (CPS)

Anti-violence center

7

Figure 20. Main learning gaps in ACE

Figure 21. Main learning gaps in ACE – divided per professional category

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Knowledge ontrauma and itsconsequences

Appropriate and culturally relevant

instruments to inform an

effective and appropriate

child behaviors’ observation

Knowledge onpotential signalsof risk in case ofmaltreatment or

abuse

Knowledge onthe child

protectionreferral pathway

Knowledge andcollaborationwith the child

protectionnetwork in the

area

Empathy andcommunication

skills andcounselin with

caregivers


skills andcounseling with

children

Tailoredintervention for

ACE children

Specific trainingon pscyhologic

topics

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Appropriate and culturally relevant

instruments to inform an

effective and appropriate



abuse





area


skills andcounselin with

caregivers



children


ACE children

Specific trainingon pscyhologic

topics




8

Figure 22. Main learning gaps in ACE detected in other professional categories

Figure 23. Main learning gaps in ACE detected in other professional categories – divided per professional category

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Appropriate instruments to

inform an effective and appropriate child behaviors’

observation


ACE children

Knowledge onpotential signals of

risk in case ofmaltreatment or

abuse

Knowledge on thechild protectionreferral pathway

Knowledge andcollaboration with

the childprotection

network in thearea


skills withcaregivers


skills withchildren

Specific trainingon psychology

field

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



inform an effective and

appropriate child behaviors’

observation


ACE children


abuse





area




skills withchildren


field




9

The graphs (Figure 20,21,22,23) highlight the following points:

• The overall learning gaps of each professional category, when dealing with ACE cases, are

the need of specific trainings on psychological functioning of families exposed to ACEs,

particularly on the potential signs of risk in case of maltreatment or abuse, empathy

and communication skills with children and caregivers. These appear to be the largest

learning gaps among policemen. Moreover, interviewees introduced two more categories

that are unique to Italian context: “Appropriate and culturally relevant instrument to

inform an effective and appropriate child behavior’s observation” and “Tailored

intervention for ACE children”. This suggests the need of acquiring specific culturally

relevant tools that may help professionals to better perform in their work with foreign

families and to acquire knowledge that may allow them to properly intervene with at-risk

children and their caregivers.

• The crosscutting learning gap among other professional categories involved in the child

protection systems is the lack of knowledge and collaboration with the local child

protection network. PEALRS for children targets this need, through strengthening a

multidisciplinary group of child protection workers. An interviewed teacher stated: “I

feel that I’m not part of a network and all my observations are lost”. Likewise, a

gynecologist affirmed: “I notice a lack of network and collaboration with other

professionals on cases; patient is often left alone and send to professionals that sometimes

do not collaborate”.

• Worth mentioning, NGO experts believe that there is a deep educational gap on psychology

field among other child protection workers. In particular, they highlighted their need of

acquiring appropriate instruments to inform an effective and appropriate child behaviors’

observation, of gaining more knowledge on potential signs of risk in case of maltreatment

or abuse and on knowledge on trauma and its consequences and of developing empathy and

communication skills when dealing with ACE children and caregivers.

10



Italy, Lithuania and Polland



of professionals


General Information


and children


milestones






11


of professionals

Section A: Professionals’ experience with children exposed to ACE

General Information

Figure 1 reports the number of Lithuanian professionals involved in the data collection, divided by

professional category.


categories (N)


NGO experts 3

Policemen 7

Psychologist 2


Teachers/provider of early care and education 8

Figure 1. Number of Lithuanian professionals involved in the data collection

In particular, figure 2 highlights the percentage of interviewees involved in the data collection

process, belonging to each professional category


19%

8%

19%27%

22%

5%Medical care practitioners

NGO experts

policemen



Psychologist

12

Participants who have been interviewed have an overall average of 12,59 years of experience (Fig.

3).


Figure 4 reports the percentage of interviewees in each professional category that has been in

contact with ACE cases.


Each professional category reported different experience in dealing with cases exposed to ACE.

Social service practitioners have high access to each type of ACE, while policemen and NGO

experts reported fewer contacts. Domestic violence is the less indicated ACE, while psychological

and physical maltreatment are the more frequently reported.

12

.29

10

.00

9.5

7 12

.17

12

.50 1

9.0

0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

medical carepractitioners

NGO experts policemen Social servicepractitioners


education

Psychologist

Neglect Psychological maltreatment Domestic violence (Observed) Sexual abuse Physical maltreatment

13


and children


The three main difficulties reported by the interviewees when interacting with caregivers are the

tendency to deny, minimize violent episodes and distort the reality, their lack of awareness and

accountability and the communication difficulties they found in interacting with them (Figure 5).

Therefore, one of the issue that needs to be addressed during the training is to illustrate and

make meaning of parents’ frequent intentional or unintentional neglect regarding the abuse,

its consequences and impact on children and their responsibility on this regard. Why this

happens? Why parents do not ask for help? How can professionals deal with this and create an

alliance with the caregivers?

According to the above findings, another key issue to be discussed is raising professionals’

awareness on how to communicate with caregivers to make them feel supported rather than

judged.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Languagedifficulties

Lack ofawareness andaccountability

Building trust Difficulty inreporting the

abuse

Attitude towardsoperators

Lack ofcompliance with

the rules

Couple-Conflict Tendency todeny/minimizeviolent episodesand/or distort

the reality


medical care practitioners NGO experts policemen Social service practitioners teachers/provider of early care and education Psychologist

14

Figure 6. The main difficulties in the relationship with children exposed to ACE

Figure 6 highlights the child difficulties in building trust, due to the fear and the frequent tendency

to secrecy, deny or minimize violent episodes and to distort the reality.

The findings also suggest that the need of explaining why children tend to act in certain ways

and how professionals can help them dealing with their fears, embrace their memories, and

sharing their experiences without being shattered by it . This may help building trust and as

the result the child could rely on professional’s guilt free.

Similarly, communication difficulties appear to be a relevant issue to be addressed, which

highlights the professionals’ need to be trained on child friendly means of communications and

strategies that may allow professionals to connect with clients exposed to ACE.

Social service practitioners, teachers, policemen and medical care practitioners are the categories

reporting more difficulties in relating with the child.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Difficulty toshare negative

and violentepisodes

Dealing withnegative

emotions andbehaviours

Fear Attitudetowards

operators

Caregiverseparation

issues

Tendency tosecrecy or to

deny/minimizeviolent episodesand/or distort

the reality


the rules

Building trust

medical care practitioners NGO experts policemen Social service practitioners teachers/provider of early care and education Psychologist

15


milestones

The following graphs (Figure 7,8,9,10) represent the professionals access to each developmental

millstone.

Figure 7. Access to Perinatal stage by professional category

Figure 8. Access to Post-Natal stage by professional category

Figure 9. Access to Kindergarten stage by professional category

29%

100%

50%

33% 38%

0%0%

20%

40%

60%

80%

100%


NGO experts Policemen Social servicepractitioners


education

Psychologist

43%33% 29% 30%

50% 50%

0%

20%

40%

60%

80%

100%




education

Psychologist

43%

67% 71%

50% 50% 50%

0%

20%

40%

60%

80%

100%




education

Psychologist

16

Figure 10. Access to Early dating stage by professional category

Early dating developmental milestone is the stage where most of the professional categories are

involved (100% of the interviewed medical care practitioners and NGO experts; 86% of policemen;

80% of social service practitioners and 75% of teachers), expect for psychologists, who reported

no contact with early dating cases. In contrast, in the perinatal and post-natal stage professionals

are less in contact with the target population, except for NGO experts, whose 100% reported to

have contacts with mothers during the perinatal stage. Concerning kindergarten entry, the access

for each professional category is around 50%.

The following graphs report the main risk and protective factors indicated by interviewees, related

to each developmental milestone.



100% 100% 86% 80% 75%

0%0%

20%40%60%80%

100%




education

Psychologist

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Chronic poverty Single-parentfamily


drugs


violence

Domestic violence


17


Parents at risk during the perinatal stage, often belong to poor socio-economical contexts; they lack

access to formal or informal supporting networks and often have been exposed to childhood

traumatic experiences that may have compromised their emotional, relational and social

functioning (Fig. 11). Building strong supporting networks inside the family, with friends and with

services creates a fundamental protection for these parents. In particular, it is important to intercept

at risk families from the early stages and help them relying on and building trust with services.

Finally, strengthening the parents’ ability to manage conflicts and enhancing their parental

responsibility turns out to be crucial (Fig. 12).


Figure 13. Post-natal stage – risk factors

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


network







Satisfactoryrelationships with

at least onemember of the

family

Parents reportingthe violence andasking for help


PARENTAL PROTECTIVE FACTORS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Chronic poverty Young mother Single-parentfamily

Lack of knowledgeand interest on

child development


drugs

Mother post-partum

depression/babyblues


Neonatal diseases


18

Figure 14. Post-natal stage – protective factors

In the post-natal developmental milestone, at-risk parents need to be accompanied in

acknowledging their role as caregivers and participate in designing a family project. In Lithuania,

there are often have young single-mothers coming from vulnerable contexts, lacking access to

social supporting networks and struggling with the post-partum stage, especially in cases of

neonatal diseases (Figure 13,14).



0%10%20%30%40%50%60%70%80%90%

100%

Family with a social supportingnetwork

Knowledge and access to thefamily counselling and supportservices in the neighborhood

Parents sharing a family project

SOCIAL AND CULTURAL PROTECTIVE FACTORS PARENTAL PROTECTIVEFACTORS

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Lack ofknowledge and

interest on childdevelopment


drugs

Domestic violence Parents’ lacking accountability


Parents’ social deviance


violence


Parents’ low frustration tolerance

Children difficultyto comply with

parental/educator rules


SOCIAL ANDCULTURAL RISK

FACTORS

PARENTAL RISK FACTORS CHILD RISK FACTORS

19


During the kindergarten entry, while distal social and cultural risks lose predominance, the

parental risk factors get exacerbated: the ones related to the previous stages remain stable (domestic

violence, abuse of alcohol and drugs, lack of accountability), while new problems related to

parents’ social, emotional and behavioral functioning significantly increase (Figure 15).

Building healthy trustful relationships for both parents and children remain of key

importance. Furthermore, strengthening caregivers parenting skills, build parental mutual esteem

and prompt their motivation to improve and become a responsive and careful parent. This is crucial

in this stage where the most of parent-child attachment and bonding is forming. Finally, data

suggests that strengthening child self-esteem during the kindergarten entry stage plays an important

protective role (Figure 16).

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


familycounsellingand support


Family with asocial

supportingnetwork

Parentssharing a

family project


Parentsreporting theviolence and

asking for help

Parentalmutual esteem

Ability to takeon the parentalresponsibilities

Striving to be agood parent

and/or toimproveoneself

Capacity tomanageconflicts

Responsiveand careful

parents


Child with asocial

supportingnetwork

Child reportingthe violence

and asking forhelp

Child’s adequate self-esteem levels


PARENTAL PROTECTIVE FACTORS CHILD PROTECTIVE FACTORS

20




When children grow, the impact of social context gains back its predominance: in particular, lack

of social integration and previous unsolved experiences of avoidance, violence and abuse appear

pivotal risk factors. These factors, during the early dating stage, complement the parental risk

factors that remain stable from the previous milestone (Figure 17). Regarding the protective factors,

working with parents lose relevance, while strengthening child self-esteem, their ability to rely on

healthy relationships and facilitating their access to social services become more essential, in

Lithuanian setting (Figure 18).

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Knowledge and access to thefamily counselling and supportservices in the neighborhood

Parental responsibility Child reporting the violence andasking for help



PARENTAL PROTECTIVEFACTORS

CHILD PROTECTIVE FACTORS

21


Nearly all professional categories collaborate with a multidisciplinary child protection network

they refer to when dealing with cases exposed to ACEs. Only 37% of teachers, 29% affirmed of

medical care practitioners and 10% of social service practitioners affirm they don't collaborate with

a multidisciplinary network for professionals’ referral, while 100% of psychologists, policemen

and NGO experts refer the vulnerable cases to other professionals.

Figure 19. The main child protection actors in the professional referrals

In Lithuania medical care practitioners and social service practitioners and teachers are

considered by all interviewees as the main categories of professional they refer to in cases of

families exposed to ACEs. Instead, only child protective services, social workers and medical care

practitioners refer cases to Ngo experts, while only child protective services refer cases to

policemen (Figure 19). These results reflect the unbalanced and various levels of collaboration

among professionals concerning referrals. For this reason, it’s essential to create a more

integrated network for the child protection systems.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%




education

Pediatrician, child neuropsychiatric, midwife, nurse, gynecologistSocial servicesChild protective services (CPS)Social worker PoliceHonorary judge/ Court expert

22



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Knowledge onadversity,

trauma and theirpsychologicalconsequences

Appropriateinstruments to

inform aneffective andappropriate

child behaviorobservation


abuse




topics

Empathy,communication


caregivers



children


protectionnetwork

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%







abuse



Specific trainingonpsychology

topics



caregivers



children


protectionnetwork

medical care practitioners NGO experts

policemen Psychologist

Social service practitioners teachers/provider of early care and education

23

Learning gaps are high among each professional category (Figure 20,21). In particular, more than

50 % of interviewees reported a lack of knowledge on potential indicators of risk in case of abuse

and maltreatment, the need to deepen their knowledge on adversity, trauma and their psychological

consequences and the lack of empathy, communication and counseling skills. Therefore, in

Lithuania, ways to observe (indicators of risk), understand (knowledge on adversity, trauma and

their psychological consequences) and respond (empathy and communication and counseling

skills) to the cases exposed to ACEs will be a fundamental topic to be raised during the ToR

training. In particular, interviewees highlighted the need for some specialists to overcome the fear

and discomfort while accompanying the children disclosure, to be aware of their attitude and

avoid blaming instead of supporting, to be active in their role and increase their motivation

in supporting vulnerable clients and to acquire knowledge on strategies for building a

supporting relationship with children.

Furthermore 51% of interviewees express the need to be trained on the psychological functioning

of at risk children and to gain knowledge on the protocols to be followed with children and

families exposed to ACEs. This last topic needs to be included in the cascade trainings

professionals will deliver. Indeed, once professionals are informed on the steps they need to follow,

they may feel more confident to assume acknowledge vital roles in the child protection network.

The learning gaps vary greatly per topic and professional category. Policemen, medical care

practitioners and psychologists are the professional categories that reported higher levels of

learning gaps. 100% of the psychologists interviewed show the need to increase their knowledge

on trauma topics, on the potential indicators of risk in case of abuse and maltreatment, on empathy

and communication and counseling skills to be employed with caregivers and, generally speaking,

on psychology topics. Furthermore, 100 % of medical care practitioners show the need to learn

more on the potential indicators of risk in case of abuse and maltreatment, while 100% of policemen

indicate the need to be trained on empathy and child-friendly communication skills for building

effective interactions with children and adolescents.


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%







abuse





caregivers



children


topics


protectionnetwork

24


The crosscutting learning gaps attributed to other professionals involved in the child protection

network are empathy and child-friendly communication skills, which have been reported by more

than 50 % of the interviewees.

Specifically, psychologists believe that the other members of the child protection network mainly

lack empathy and child-friendly communication skills, while policemen believe they mainly lack

knowledge on the specific protocols to be followed in the child protection allegation and they

should increase collaboration between the child protection network professionals. and are the two

main topics reported (Figure 22,23).

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%







abuse





caregivers



children


topics


protectionnetwork

medical care practitioners NGO experts policemen Psychologist Social service practitioners teachers/provider of early care and education

25






professionals


General Information


and children


milestones






26


professionals

Section A: Professionals’ experience with children exposed to ACEs.

General Information

Figure 1 reports the number of professionals involved in the data collection, divided by professional

category.


categories (N)

Educators 2


NGO experts 6

Policemen 4


Teachers/provider of early care and education

9

Figure 1. Number of Italian professionals involved in the data collection

In particular, figure 2 highlights the percentage of interviewees in each professional category

involved in the data collection process.


Participants who have been interviewed have an overall average of 16 years of experience (Figure

3).

5%

25%

17%

11%

17%

25% Educators

medical care practitioners

NGO experts

policemen



27


Figure 4 reports the percentage of interviewees in each professional category that has been in

contact with each type of ACE.

Medical care practitioners, NGO experts and policemen have been in contact with cases reporting

each ACE considered. In particular, policemen are the professional category more in contact with

cases exposed to ACEs.

Neglect, Physical maltreatment and Psychological maltreatment are the most reported ACE. Sexual

abuse appears to be the less reported ACE.


19.518.4

16.6715.22 14.89 14.75

0

5

10

15

20

25

Educators Social servicepractitioners

NGO experts teachers/providerof early care and

education


policemen

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



teachers/provider ofearly care and education

Sexual abuse Physical maltreatment Neglect Psychological maltreatment Domestic violence

28


and children


The three main difficulties reported by interviewees in the relationship with the caregivers are the

tendency to deny or minimize violent episodes and to distort the reality, their lack of awareness

and accountability and the difficulty in reporting the abuse (Figure 5).

Hence, illustrating and understanding parents’ neglect regarding abuse, its impact and

awareness of their responsibility of their harmful act on children. Why this happens? Why

parents do not ask for help? How can professionals deal with this and create an alliance with the

caregivers?

Another important topic is how to build an effective communication with caregivers that may

allow them not to feel judged but rather to engage in the supporting process.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Father absence Difficulty inreporting the

abuse


Tendency todeny/minimizeviolent episodesand/or distort

the reality


the rules

Couple-Conflict




29

Figure 6. The main difficulties in the relationship with the children

Figure 6 highlights the child difficulties in reporting the abuse, due to the fear and the frequent

tendency to secrecy, deny or minimize violent episodes and to distort the reality.

Another relevant topic to be raised in the training is explaining why children tend to act in certain

ways and how professionals can help them dealing with their fears, getting in contact with

their memories without being shattered by it and relying on professionals without having a

sense of guilt or shame.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Difficulty to sharenegative and violent

episodes

Building trust Fear Dealing with negativeemotions and

behaviours

Tendency to secrecy orto deny/minimizeviolent episodes

and/or distort thereality




30


milestones

The following graphs (Figure 7,8,9,10) report the percentage of interviewees in each professional

category that has been in contact with each developmental milestone.

Figure 7. Access to Perinatal stage by professionals

Figure 8. Access to Post-natal stage by professionals

Figure 9. Access to Kindergarten stage by professionals

Figure 10. Access to Early dating stage by professionals

100% 100% 100% 100% 100%

67%

0%

20%

40%

60%

80%

100%




education

100%

56%67%

25%

83%

33%

0%

20%

40%

60%

80%

100%




education

50% 56%

83%

50%

83%

56%

0%20%40%60%80%

100%




education

100%

56%

83%

100%

83%

56%

0%

20%

40%

60%

80%

100%




education

31

Perinatal developmental milestone is the stage where most of the professional categories are

involved (100% of the interviewed educators, medical care practitioners, NGO experts, policeman

and social service practitioners; 67% of teachers and providers of early care education). This is an

important information, as it highlights the possibility of intercepting at risk parents before the

delivery of the child and, thus, preventing eventual future abuse.

Moreover, the majority of the professional are involved in the early dating developmental

milestone, too (100% of the interviewed educators and policemen, 83% NGO experts and social

service practitioners, and 56% of medical care practitioners and teachers). Regarding kindergarten

entry the access for each professional category is around 50%, except for NGO experts and social

service practitioners who are around 80%. Finally, compared to the other stages, it is notable the

little involvement of policemen in the post-natal stage (25%), while educators (100%) and social

service practitioners (83%) appears to be highly involved.

The following graphs reported the main risk and protective factors indicated by interviewees,

related to each developmental milestone.



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



rejection, violence, orabuse

Parents’ abuse of alcohol and/or drugs




violence

Domestic violence


32


The data shows that Polish at-risk parents during the perinatal stage often abuse alcohol and/or

drugs. Most of them have low educational levels and have been exposed to childhood traumatic

experiences that may have compromised their emotional and relational functioning and may lead

to an intergenerational transmission of violence (Figure 11).

Building strong supporting networks inside the family, with friends and with services appear to be

a fundamental protection for Polish vulnerable parents. In particular, it is important to intercept

these at-risk cases from an early stage and help them relying on and building trust with services.

Strengthening the parents’ ability to manage conflicts and enhancing their parental responsibility

and empathy appear to be crucial when supporting these parents (Figure 12).

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





Striving to be a goodparent and/or toimprove oneself


Empathy Satisfactoryrelationships with atleast one member of

the family


PARENTAL PROTECTIVE FACTORS

33


Figure 13. Post-natal stage – risk factors

Figure 14. Post-natal stage – protective factors

In the post-natal developmental milestone, at-risk parents appear to be isolated in a disadvantaged

context, where violence, rejection and abuse seem to proliferate, creating a vicious circle of abuse

and harmful behaviors (domestic violence, parents’ impulsiveness, parents’ abuse of alcohol and

drugs), that may increase in cases of difficult temperament of the newborn. Moreover, professionals

highlighted the lack of trust that at-risk parents have in institution and social norms. Therefore,

the topic of building trust with caregivers turns out to be relevant to be raised and discussed

with professionals. Furthermore, facilitating the parents’ access to services and integrating them

in a social supporting network, which may accompany them in assuming their role of caregivers

and the responsibilities connected with (Figure 14,15) turns out to be a fundamental supporting

action.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Lack of trust ininstitutions andin social norms

Chronic poverty Low educationallevel


rejection,violence, or abuse


drugs


violence


Domesticviolence





0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


network





and/or to improveoneself




network



FACTORS

34




In passing time, risk factors in vulnerable families augment, particularly the parental ones. This

data highlights the importance of connecting at-risk parents to a social supporting network since

the early stages. During the kindergarten entry, among the distal social and cultural risk factors,

which remain highly relevant, professionals highlighted parents’ lack of knowledge and interest on

child development and a cultural acceptance of violence. Results show a significant increase of

parental risk factors, not only in terms of numbers (couple-conflict category was added) but also

and mostly on their prevalence (Figure 15). The data reflects the fact that if those risks are not

addressed, they may increase over time and lead to a greater risk around children, that may

lead to consequent impairments.

Building healthy trustful relationships for both parents and children remain of key

importance. Furthermore, helping caregivers to strengthen their parenting skills, build

parental mutual esteem and prompt their capacity to manage conflicts is crucial in this stage

where the parent-child attachment is forming (Figure 16).

0%10%20%30%40%50%60%70%80%90%

100%

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0%

10%

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30%40%

50%

60%

70%80%

90%

100%


network






Empathy Striving to be agood parent

and/or to improveoneself




network



FACTORS

35




When children grow, social context gains back its predominance: in particular, living in a

disadvantage social context, low educational level and lack of trust in institutions appear pivotal

risk factors. In parallel, parental risk factors increase making the family environment more

toxic and hard to be tolerated by adolescents, who show high levels of difficulty to comply with

it and difficult temperaments (Figure 17). Regarding the protective factors, once again it is crucial

working with parents by enhancing their capacity to manage conflicts, the parental mutual

esteem and the motivation to improve themselves and to assume the parental responsibilities.

In the meanwhile it is important supporting the adolescents to enhance their self-esteem. Finally,

strengthening the formal and informal social supporting network remains fundamental both for the

parents and for the child (Figure 18).

0%10%20%30%40%50%60%70%80%90%

100%

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adva

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les

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ficu

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eram

ent


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Family with asocial

supportingnetwork


familycounselling and

supportservices in theneighborhood


Capacity tomanageconflicts

Satisfactoryrelationships

with at least onemember of the

family



and/or toimprove oneself


Ability to takeon the parentalresponsibilities

Trauma recovery from

parents’ childhood

experiences of rejection,

violence and/or abuse

Child with asocial

supportingnetwork



PARENTAL PROTECTIVE FACTORS CHILD PROTECTIVE FACTORS

36


Almost all professional categories collaborate with a multidisciplinary network they refer to when

dealing with cases of ACEs. Only 22% of medical practitioners affirmed they don't collaborate

with a multidisciplinary network for ACE cases referral.

Figure 19. The main child protection actor in the professional referrals

In Poland, psychologists and social workers are the most approached professionals for referral of

at-risk cases. Moreover, both educators and policemen refer cases mainly to family court, while

NGO experts and social service practitioners do not. Finally policemen are key referral points for

social service practitioners and for medical care practitioners, but not for educators (Figure 19).

These results highlight the various levels of collaboration among the professionals concerning

referrals and, therefore, there is a need to create a more integrated network of the child protection

circles and systems.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%




education

Pediatrician, child neuropsychiatric, midwife, nurse, gynecologist Social worker

Police NGO acting in the field of child protecion

Family Court Attorney

Psychologist or pedagogue

37



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



inform an effective and appropriate


Knowledge onpotential signs

of risk in case ofmaltreatment or

abuse

knowledge onthe child

protectionreferralpathway



area




skills withchildren

Professionals-Motivation andCommittment

Specific trainingon this field

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



inform an effective and

appropriate child behaviors’

observation

Knowledge onpotential signs of

risk in case ofmaltreatment or

abuse

knowledge on thechild protectionreferral pathway

Knowledge andcollaboration with

the childprotection

network in thearea




skills withchildren

Professionals-Motivation andCommittment





38



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





Knowledge onpotential signs

of risk in case ofmaltreatment or

abuse





area




skills withchildren


Professionals-Motivation and

Commitment

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%






abuse





area




skills withchildren


Professionals-Motivation and

Commitment




39

The graphs (Figure 20,21,22,23) highlight the following points:

- The crosscutting learning gap of each professional category is the knowledge on the

specific protocol to be followed in the child protection referral pathway. This topic

needs to be included in both ToR training and in the following cascade trainings

professionals will deliver. Indeed, once professionals are informed on the steps they need

to follow, they may feel as key actors in the child protection network.

- Child protection network needs to be strengthened among all professional categories.

PEALRS FOR CHILDREN targets this need, through strengthening a multidisciplinary

group of child protection workers. “ I believe that there should be much stronger

cooperation between social workers - pedagogues/school psychologists and police officers.

Quick exchange of information between these three institutions and mutual openness and

cooperation would significantly increase the effectiveness of assistance activities towards

children. I consider raising awareness of the importance of this cooperation as a priority

in preparing to help children”.

- All professional categories, except for policemen and educators, believe they may benefit

from trainings on psychology topics, particularly on psychological trauma, indicators on

child behaviors’ observation and empathy and communication skills. However, policemen

believe that mostly other professional categories would need to have specific training on

psychology topics. Raising awareness on the importance of being trained on

psychological core concepts, when dealing with ACE cases appear to be relevant,

particularly with policemen and educators.

- Policemen and educators turned out to be low motivated and engaged in building

supporting relationships with ACE cases due to the “Lack of willingness and time to lean

into the child's problem” and the “Hope that maybe someone else will notice and solve the

problem, taking the responsibility away”. Therefore, the ToR training needs to work on

their motivation and encourage their engagement in assuming the Tutor of Resilience

role with their target beneficiaries.

- Medical care practitioners reported educational gaps in each topic mentioned in the

interview, both for their own professional category and the other ones. This result highlights

both their engagement in filling the gaps and acquiring relevant skills and the central role

other professionals assign them in the child protection network.

- Teachers and NGO experts recognize a strong need to be trained on potential signs of risks

in ACE cases.

40

Conclusions

• The cross-sectional lack of knowledge on the child protection referral pathway, suggests to

dedicate a section of the training on it, preferably conducted by local partner, in which

relevant local informative documents and tools are shared.

• Building up a strong multi-disciplinary network of child protection professionals turned out

to be a high priority in each country. Therefore it’s important to deliver the training with a

participatory approach, through team-building activities. Furthermore an adequate

knowledge on the different actors of the child protection network (e.g. by creating and

sharing a local service map) may facilitate the professionals’ fundamental task of

facilitating at-risk families’ access to the local supporting services and break their isolation.

• The ToR training needs to work on the motivation and encourage the engagement of each

child protection network actor in filling the gaps and acquiring relevant skills to assume the

role of Tutor of Resilience with their target beneficiaries. Indeed most of the interviewed

professionals highlight their need to overcome the fear of accompanying the children’

disclosure, to change their attitude from blaming to supportive, and to be active in their role

and increase their motivation in supporting ACE cases.

• The widespread access of all professional categories in each developmental milestone

highlights the need to train professionals on the specificity of ACE in each developmental

milestones and the related risks and protections that may shape the resilience process in

beneficiaries.

• Each child protection professional category involved in the interviews stated the need to

widen knowledge on the psychological functioning of the ACE children and families,

and to acquire general guidelines and specific tools on ways to observe, understand

and respond properly to such cases. In particular:

• Observation skills, are mainly related to the knowledge on potential signs of risk in

case of abuse and maltreatment. Indeed, most of the professionals feel incapable to

identify the child protection cases that require immediate intervention.

• Understanding and make meaning of specific emotions, behaviors and attitudes

frequently adopted by at-risk family members is also fundamental to successfully

address the issue. In particular, results show the importance of explaining the reasons

of caregivers’ and children’ frequent tendency to secrecy, deny or minimize violent

episodes and to distort the reality and their reluctance to collaborate, comply and rely

on supporting networks. As a result, professionals may help them dealing with their

41

fears, accessing their memories without being shattered by them and seeking for

support.

• A successful response and intervention with ACE cases require professionals to build

empathy, bridge connections and apply adequate communication and counseling skills

with the people of concern. In particular, a reflection should be conducted with

participants on successful ways to build trust with both children and caregivers, in order

not to feel judged but rather engaged in the supporting process. Furthermore, results

show the relevance of collaborating and strengthening the caregivers’ role throughout

the different developmental milestones.

• Finally, qualitative data highlights some relevant topics for each country that will be

included in the training. In particular:

- The Italian professionals stressed the need to acquire appropriate and culturally

relevant instrument to inform an effective and appropriate child behavior’s

observation and to implement tailored interventions with ACE children.

- The Polish sample pointed out the need to increase the professionals’ motivation and

commitment in building resilience in ACE families and children, especially in some

professional categories such as policemen and educators

- The Lithuania sample required specific counseling skills that child protection actors

may need to accompany and support families exposed to ACEs.

knowledge, attitude and practice (kap) of child protection

Documents