Exploring Adults' Vigilance Behaviors within a Child's Caregiving Cluster

Saturday, 7 November 2015

Kate K. Chappell, MSN, BSN, APRN, CPNP
College of Nursing, University of South Carolina, Columbia, SC, USA

Introduction: Child sexual abuse has a significant and lasting impact on individuals and families [1]. Children who experience sexual victimization are more likely to  present adverse effects in childhood and adolescence, including Post-Traumatic Stress Disorder, substance abuse, and delinquent behavior [2, 3].  Child sexual abuse is an adverse childhood experience (ACE) associated with a higher incidence of certain adult health issues and behaviors, including depression, attempted suicide, cigarette smoking and illicit drug use [4]. The negative impact on the long-term health of individuals and families is significant, given that CSA is, for the most part, a preventable phenomenon [2]. 

     Vigilance around CSA by adult caregivers for children is conceptualized as sustained purposeful attention and behavior to anticipate a child’s safety and wellbeing needs [5-7].  Vigilance as behavior does not refer only to recognizing and avoiding placing child in risky situations. Other child protective behaviors include teaching the child about avoidance of risky situations and how to respond if a threat or event occurs.  Behaviors also include rules regarding safety and boundaries within a caregiving environment and what aspects of environments caregivers perceive as being protective that may decrease their drive for ongoing vigilance.

     The extant research related to children’s caregivers’ vigilance focuses primarily on the individual caregiver and often excludes fathers and stepparents [3, 8-13].   Furthermore, there is a limited, somewhat linear understanding of the factors that may potentially influence caregivers’ protective and preventive behaviors [8, 14-16].  Missing from the literature are examinations of the ways in which caregivers’ behaviors relate across and within the various levels of a child’s social ecology and how these behaviors relate to CSA risk and protection [17, 18].  Examining caregiver vigilance from a social ecological perspective reflects the view that CSA is a complex, dynamic, and social phenomenon and that caregiver vigilance is not restricted to one caregiver [1, 17-20].  Furthermore, a social ecology model promotes exploration of caregiver vigilance in multiple settings and via multiple caregiver roles[18]. 

Methods: Situated within a social ecology framework, this instrumental case study will explore vigilance within the context of one child’s caregiving cluster.  The research questions are:   How does vigilance around child sexual abuse exist within the caregiving cluster of a child’s social ecology?   What are the experiences of caregivers within a child’s social ecology pertaining to vigilance around child sexual abuse?

     Initially, I will identify a child with a caregiving cluster which meets the inclusion criteria of having a minimum of six English-proficient adult caregivers living within a specified geographic area. The child must be able to communicate through drawn, written, and/or verbal communication about the names and places in their life.  In collaboration with the child’s primary caregiver, I will identify other caregivers in the child’s social ecology; interacting directly with the child, we will ask the child to identify (through writing, drawing, and report) “the people who live at your house, the people who take care of you, the people who teach you.” From this initial list of members of the child’s caregiving cluster I will arrange with the primary caregiver access to the other potential participants.

     I will conduct individual, semi-structured interviews with at least two of the identified caregivers in the cluster, including at least one of the primary caregivers responsible for child’s daily care and supervision. I will conduct a focus group composed of 4 to 8 caregivers from the caregiving cluster. Interview and focus group questions will be open-ended and centered on participant perceptions of CSA risk locations and situations for child, approaches to teaching child about safety, and perception of actions to take if concerned about child’s safety or if child reported safety issue.  I will conduct a minimum of two field observations of situations involving child-caregiver interactions, ideally in public settings (i.e., park, school ground, public event).  A particular focus of the observations will be to identify safety and supervision messages and actions, physical contact/boundaries between the child and adults, and any other relevant behaviors or events.

Results: Data from the interviews, focus groups, and field observations will be analyzed using open and focused-coding, resulting in a descriptive thematic analysis.  A social ecology framework will inform the interpretation of the data.  Since these data represent the situation of one caregiving cluster, the interpretations and meanings will be presented as an instrumental case study. 

Discussion/Conclusions:  This exploratory instrumental case study of one child’s caregiving cluster will provide an in-depth understanding of how caregiver vigilance against CSA exists across and within levels of a child’s social ecology. This in-depth exploration of vigilance in one child’s caregiving cluster will also serve as measure of feasibility of a larger, more in-depth research project involving the exploration of multiple caregiving clusters.  Further explicating caregiver vigilance perspectives and practices may provide direction for the development of situation-specific interventions aimed and CSA prevention.   


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