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The Australian Child Maltreatment Study (ACMS) is a landmark study for our nation. The ACMS research team has generated the first nationally representative data on the prevalence of each of the five types of child maltreatment in Australia, and their associated health impacts through life. We also identified information about the context of maltreatment experiences, including how old children are when it occurs, and who inflicts it. This knowledge about which children are most at risk of which types of abuse and neglect, at which ages, and by whom, is needed to develop evidencebased population approaches required to reduce child maltreatment in Australia. The concerning prevalence of maltreatment and its devastating associated outcomes present an urgent imperative for nation-building reform to better protect Australian children and reduce associated costs to individuals, families, communities and broader society. The ACMS collected data from 8500 randomly selected Australians aged 16-65 years and older. We included an oversample of 3500 young people 16-24 years of aged to generate particularly strong data about child maltreatment in contemporary Australian society, to assess its associated impacts in adolescence and early adulthood, and to allow future prevalence studies to detect reductions in prevalence rates over time. Our participants aged 25 and over enabled us to understand prevalence trends at different times in Australian history, and to measure associated health outcomes through life. Participants provided information on childhood experiences of each of the five types of child abuse and neglect, and other childhood adversities, mental health disorders, health risk behaviours, health services utilisation, and more. Our findings provide the first nationally representative data on the prevalence of child maltreatment in Australia. Moreover, the ACMS is the first national study globally to examine maltreatment experiences and associated health and social outcomes of all five forms of child maltreatment. Taken together, our findings provide a deep understanding of the prevalence, context and impact of child abuse and neglect in Australia and make an important contribution to the international field. This brief report presents the main findings from the ACMS for a general public audience. These main findings are further detailed in seven peer-reviewed scholarly articles, published in a special edition of the Medical Journal of Australia, Australia’s leading medical journal. Forthcoming work will examine other important questions about the impacts of specific maltreatment experiences to generate additional evidence to inform governments and stakeholders about optimal prevention policy and practice. There is cause for hope. In recent years, there have been reductions in physical abuse, and in some types of sexual abuse. These reductions are extremely important. They mean that fewer children are suffering, and they indicate that change is possible. Policies and programs to reduce these types of maltreatment are having an effect. Yet, there are other concerning trends, with some types of maltreatment becoming even more common, including emotional abuse, some types of sexual abuse, and exposure to domestic violence. And new types of sexual victimisation are also emerging. As a society, we have much work to do. We know that child maltreatment can be reduced if we work together as governments, service sectors, and communities. We need to invest more, and invest better. It is a moral, social and economic imperative for Australian governments to develop a coordinated long-term plan for generational reform. We have found that: 1. Child maltreatment is widespread. 2. Girls experience particularly high rates of sexual abuse and emotional abuse. 3. Child maltreatment is a major problem affecting today’s Australian children and youth – it is not just something that happened in the past. 4. Child maltreatment is associated with severe mental health problems and behavioural harms, both in childhood and adulthood. 5. Child maltreatment is associated with severe health risk behaviours, both in childhood and adulthood. 6. Emotional abuse is particularly harmful, and is much more damaging than society has understood.

In this article we discuss evidence-based elements of effective in-home child welfare services as a foundation for advancing the evidence base for family-centered child welfare practice. In 2009 the U.S. Children’s Bureau established the National Resource Center for In-Home Services to build the capacity of state and tribal child welfare agencies to ensure the safety and well-being of children and youth in their homes, prevent their initial placement or re-entry into out-of-home care, and to support families in their role as primary caregivers. Through a nationwide assessment of in-home services conducted over four years of research and technical assistance, we developed a set of core elements for in-home services. These core elements are supported by empirical research and are congruent with evidence-based practices and programs. We review each of the elements with its underlying research base. We also discuss five evidence-supported in-home services interventions that share many of the elements. We conclude with a discussion of how evidence-based elements can be implemented to strengthen family centered child welfare practice.

BACKGROUND: Increased adoption of off-the-shelf conversational agents (CAs) brings opportunities to integrate therapeutic interventions. Motivational Interviewing (MI) can then be integrated with CAs for cost-effective access to it. MI can be especially beneficial for parents who often have low motivation because of limited time and resources to eat healthy together with their children. OBJECTIVE: We developed a Motivational Interviewing Conversational Agent (MICA) to improve healthy eating in parents who serve as a proxy for health behavior change in their children. Proxy relationships involve a person serving as a catalyst for behavior change in another person. Parents, serving as proxies, can bring about behavior change in their children. METHODS: We conducted user test sessions of the MICA prototype to understand the perceived acceptability and usefulness of the MICA prototype by parents. A total of 24 parents of young children participated in 2 user test sessions with MICA, approximately 2 weeks apart. After parents' interaction with the MICA prototype in each user test session, we used qualitative interviews to understand parents' perceptions and suggestions for improvements in MICA. RESULTS: Findings showed participants' perceived usefulness of MICAs for helping them self-reflect and motivating them to adopt healthier eating habits together with their children. Participants further suggested various ways in which MICA can help them safely manage their children's eating behaviors and provide customized support for their proxy needs and goals. CONCLUSIONS: We have discussed how the user experience of CAs can be improved to uniquely offer support to parents who serve as proxies in changing the behavior of their children. We have concluded with implications for a larger context of designing MI-based CAs for supporting proxy relationships for health behavior change.

BACKGROUND: The Prevention of Mother-to-Child Transmission of HIV (PMTCT) program in India is one of the largest in the world. It uses outreach workers (ORWs) to facilitate patient uptake of services, however, the challenges faced by the ORWs, and their views about the effectiveness of this program are unknown. METHODS: The COMmunity-Home Based INDia (COMBIND) Prevention of Mother to Child Transmission of HIV study evaluated an integrated mobile health and behavioral intervention to enhance the capacity of ORWs in India. To understand the challenges faced by ORWs, and their perceptions of opportunities for program improvement, four group discussions were conducted among 60 ORW from four districts of Maharashtra, India, as part of the baseline assessment for COMBIND. Data were qualitatively analyzed using a thematic approach. RESULTS: Numerous personal-, social-, and structural-level challenges existed for ORW as they engaged with their patients. Personal-level challenges for ORWs included disclosure of their own HIV status and travelling costs for home visits. Personal-level challenges for patients included financial costs of travelling to ART centers, non-adherence to ART, loss of daily wages, non-affordability of infant formula, lack of awareness of the baby's needs, financial dependence on family, four time points (6weeks, 6 months, 12 months and 18 months) for HIV tests, and need for nevirapine (NVP) prophylaxis. Social-level challenges included lack of motivation by patients and/or health care staff, social stigma, and rude behavior of health care staff and their unwillingness to provide maternity services to women in the PMTCT programme. Structural-level challenges included cultural norms around infant feeding, shortages of HIV testing kits, shortages of antiretroviral drugs and infant NVP prophylaxis, and lack of training/knowledge related to PMTCT infant feeding guidelines by hospital staff. The consensus among ORWs was that there was a critical need for tools and training to improve their capacity to effectively engage with patients, and deliver appropriate care, and for motivation through periodic feedback. CONCLUSIONS: Given the significant challenges in PMTCT programme implementation reported by ORW, novel strategies to address these challenges are urgently needed to improve patient engagement, and access to and retention in care.

Background: Informal caregivers are those providing care, which exceeds that which is typically provided, to a relative or friend with care needs. Informal caregiving constitutes the backbone of a society’s care supply and with ageing populations the need for informal care is growing. We know little as to why caregivers start caring and continue doing so, yet understanding of motivations and willingness to provide care is important if informal caregivers are to be supported. However, both motivations and willingness are inconsistently defined making it difficult to compare the empirical findings that do exist.Methods: This paper reviews and synthesises thinking about the theoretical constructs of motivations to provide care and willingness to perform informal care, and presents those in relation to existing theoretical and empirical literature.Results and Conclusions: Theoretical reflections based on various motivational frameworks and available empirical data are presented to illustrate that: caregiving motivations should be conceptualised as multifaceted and multiply determined; intrinsic and extrinsic motivations should not be treated as antagonistic and can occur simultaneously; the commonly applied model of extrinsic/intrinsic motivations is oversimplified and omits consideration of the diversity of caregiver motives; other motivational models can be discerned in the context of the empirical research; there are differences between motivations and willingness to provide care with the latter being more consequent to the motives; both should be considered dynamic in nature; and finally, that the two constructs may not inevitably lead to actual caregiver behaviour. The implications of these theoretical reflections for methodology and research as well as their relevance for practice and policy are indicated.

The selection of appropriate outcomes is crucial when designing clinical trials in order to compare the effects of different interventions directly. For the findings to influence policy and practice, the outcomes need to be relevant and important to key stakeholders including patients and the public, health care professionals and others making decisions about health care. It is now widely acknowledged that insufficient attention has been paid to the choice of outcomes measured in clinical trials. Researchers are increasingly addressing this issue through the development and use of a core outcome set, an agreed standardised collection of outcomes which should be measured and reported, as a minimum, in all trials for a specific clinical area.Accumulating work in this area has identified the need for guidance on the development, implementation, evaluation and updating of core outcome sets. This Handbook, developed by the COMET Initiative, brings together current thinking and methodological research regarding those issues. We recommend a four-step process to develop a core outcome set. The aim is to update the contents of the Handbook as further research is identified.

Purpose This paper aims to investigate the motivations of social entrepreneurs in East Africa to create a social enterprise and their identified links to successful social entrepreneurship in East Africa. Design/methodology/approach The authors employed a qualitative method by performing thematic analysis on a set of interviews on social entrepreneurs from East Africa who are Ashoka fellows. Findings The findings suggest that intense personal experiences linked to past-life events as well as a high achievement orientation towards improving livelihoods and creating impact serve as key triggers for social entrepreneurship. Successful entrepreneurship focusses on system change at national and local levels. Their success is also seen when the social entrepreneurs have achieved their mission and are no longer needed; thus, they become irrelevant. The paper discusses the implications of these findings on the model used for sustainable social entrepreneurship in East Africa. Practical implications Based on an exploratory research on Ashoka fellows, the study adds insight to their motivations and success which can be used in a wider scale study of the same. Originality/value The authors advance the scarce empirical research on East African social entrepreneurs, link success factors of social entrepreneurship to a recent framework on motivation to engage in social entrepreneurship and stimulate further research in the area. The study contributes to the literature on social entrepreneurship by linking success factors of social entrepreneurship to a recent framework on motivation to engage in social entrepreneurship.

Millennium Development Goals (MDGs) are unlikely to be met in most low- and middle-income countries (LMIC). Smartphones and smartphone proxy systems using simpler phones, equipped with the capabilities to identify location/time and link to the web, are increasingly available and likely to provide an excellent platform to support healthcare self-management, delivery, quality, and supervision. Smart phones allow information to be delivered by voice, texts, pictures, and videos as well as be triggered by location and date. Prompts and reminders, as well as real-time monitoring, can improve quality of health care. We propose a three-tier model for designing platforms for both professional and paraprofessional health providers and families: (1) foundational functions (informing, training, monitoring, shaping, supporting, and linking to care); (2) content-specific targets (e.g., for MDG; developmentally related tasks); (3) local cultural adaptations (e.g., language). We utilize the Maternal and Child Health (MCH) MDG in order to demonstrate how the existing literature can be organized and leveraged on open-source platforms and provide examples using our own experience in Africa over the last 8 years.