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Study works to counteract child abuse The following article describes one of many poster presentations set for this year’s faculty convocation Aug. 22. The Catalyst will highlight some of the presentations on MUSC’s international clinical, educational and research opportunities and outreach. by Heather Woolwine Public Relations The world can no longer deny the existence, prevalence and life-altering effects of child abuse. With that self-awareness comes an understanding of both sides to humanity and a need to bring those shrouded in its dark side into the light.   Cynthia Cupit Swenson, Ph.D., MUSC Family Services Research Center director and Department of Psychiatry associate professor, is part of a clinical trial in Eastern Australia that is working to bring families involved with child protection services out of the dark and into the light by keeping them together.   The efforts stem from an alarming rate in the number of children harmed and killed by the very people who were supposed to protect them.   In Australia, the health care and law enforcement communities noticed a sharp increase in the number of child physical abuse and neglect cases in the last decade, including an increased number in child fatalities. A countrywide report two years ago, “Crime and Misconduct,” recommended drastic changes in the child protection system. As a result of the study, funds became available to study the trend and ways to counteract child abuse.   Crime and Misconduct was released while Swenson was speaking at an international child abuse and neglect conference in Brisbane. While there, Swenson met two psychiatric physicians who were grappling with the growing problem on their continent. The psychiatrists had been trying for years to bring multi-systemic therapy (MST) to the area in an effort to study and help treat families struggling with serious clinical problems. Swenson, who is an expert on the therapy and promotes its use through her work at MUSC, recalled: “It was incredible timing. Australia is not seeing the numbers that we are in terms of child abuse and neglect, but their numbers are on the rise. This treatment study will show us whether a community-based treatment is the way to help families heal in terms of physical abuse and neglect.”   MST is technically defined as a family- and community-based treatment for antisocial youths and their families. Based on favorable long-term outcomes achieved in several rigorous evaluations such as reduced criminal behavior, drug use and out-of-home placements, MST has received accolades from numerous federal and private entities and academic reviewers (U.S. Surgeon General, National Institutes of Health, Center for Substance Abuse Treatment and the Annie E. Casey Foundation), according to the research center.   The approach in Australia is to frame the therapy around adults who are having problems dealing with anger, depression, substance abuse/use issues and other life stressors that contribute to the abuse and/or neglect of their children, Swenson said. The families that participate in the study also are at risk of losing their children to foster care due to violence or neglect. MST views individuals as nested within a complex network of interconnected systems that encompass individual, family and extra familial factors (peer, culture, neighborhood). Intervention may be necessary in any one or a combination of these systems. It promotes behavior change in the individual’s natural environment, using the strengths of each system to facilitate change. According to the research center, its goal “is to empower parents with the skills and resources needed to independently address the difficulties that arise in raising children and to empower youth to cope with family, peer, school and neighborhood problems.”   MST uses a home-based model of delivery, which helps to overcome barriers to service access, increase family retention in treatment, allow for the provision of intensive services, and enhance the maintenance of treatment gains.   “We want to keep families together in a safe environment. We look at each family’s risk factors to prevent more instances of physical abuse or neglect from happening,” Swenson said. One of those risk factors on the rise in Australia and the United States is increased substance abuse among parents.   But translating MST to Australian society has produced challenges. In delivering MST, study investigators had to address cultural and training differences that exist between Australian and U.S. college curricula for health care professionals.   “We’ve spent the first part of the project figuring out what tools the therapists needed to treat with MST in that area. For example, one of the components of MST is 24-hour on-call and that is not typical of most medical services in that country. The families are different culturally, but their needs aren’t any different from anywhere else in the world, in my experience,” Swenson said. “A number of the families in the trial are indigenous Australian families [i.e., Aborigines] and we’re also working with a population of Vietnamese immigrants. The indigenous families have been very receptive to the therapy. Years ago, children from those families were removed and raised in camps where they suffered all types of abuse and neglect. That generation is referred to as the ‘stolen generation.’ Having children removed from homes and placed in foster care feels like that whole process is occurring all over again, so MST and keeping the family together resonate with this particular culture.”   Until the 1960s, political interference with the lives of indigenous people by the Aborigines Welfare Board resulted in failed policies that contributed to the destruction of the Aboriginal community. The board expressed its authority by separating children from their parents to assimilate them into white Australian society. In one region of Australia alone, as many as 20,000 of these people known as “the stolen generation” still are looking for their estranged families, according to several online sources.   In another year, Swenson said that she and her Australian colleagues will pursue more funding to continue the work. While Swenson is involved with the project, child psychiatrist and associate professor Brett McDermott, M.D., and child psychiatrist William Bor, M.D., serve as the principal investigators for the trial. Australians Helen Stallman and Erica Lee also serve as co-investigators. The work is based out of the Mater Hospital in Brisbane.   “The first year has really been about working out all the kinks, getting referrals, meshing systems of care together,” Swenson said. “I thought we’d have the system changes happen sooner than we did, but the system is stressed and overwhelmed. They are getting an increasing number of cases and there are acts of violence in the waiting room every day. [The child protection caseworkers] know we’re there to help, but sometimes it’s still difficult for them to reach for that help when they can barely keep their heads above water. We’ve had to prove to them that the help is there to stay.”   For more information about MST, go to http://www.musc.edu/psychiatry/research/fsrc/mst.htm.     Friday, Aug. 4, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.