Multi-sectoral responses to child abuse and neglect in Europe (Euro-CAN)

Logotype Euro-CanMulti-Sectoral Responses to Child Abuse and Neglect in Europe (Euro-CAN) is a COST Action network project with participants from a majority of European countries.

In Europe, millions of children experience abuse or neglect at the hands of those who should care for them. Yet, how many of these children get help, which services they receive by which agency remains largely unknown. Moreover, countries are hardly aware which maltreatment turns fatal. This constitutes a major knowledge gap that is likely due to inconsistent ways of surveying and reporting on child maltreatment services across Europe. Without this information, we cannot know how the systems work, what additional preventive efforts are required, if the interventions fit the victims’ needs or if the most vulnerable groups are properly identified.

The proposed project addresses this gap by creating a network of experts in child maltreatment and relevant stakeholders and links them in working groups, in order to promote the development of a rigorous, consistent, and comparable methodology for the collection of surveillance data on child maltreatment and maltreatment-related fatalities. Researchers, policymakers, administrators and practitioners will identify best-practice methods of surveillance and recommend efficient ways of implementing them across Europe.

Example of Euro-CAN outcomes

Book cover Participatory Research on Child Maltreatment with Children and Adult Survivors

Participatory Research on Child Maltreatment with Children and Adult Survivors

We are glad to announce that the working group 3 book Participatory Research on Child Maltreatment with Children and Adult Survivors edited by Maria Roth, Ravit Alfandari and Gemma Crous has been published.

You can download the book here

Front page of an scientific aricle

Clinical care of childhood sexual abuse: a systematic review andcritical appraisal of guidelines from European countries  

Only half of 34 surveyed European countries have national guidelines on how to provide clinical care and treatment to children who have experienced sexual abuse. This finding was revealed in a study led by researchers från Euro-Can.

Read the article in The Lancet Regional health here


Overview summary sheet

Comparative analysis of major classifications and definitions of child maltreatment

There is a lack of uniform, consensus-based definitions of child maltreatment, both within and across sectors and countries. This hinders attempts at consistent measurement of child maltreatment. Aim: to identify discrepancies and similarities contributing to consensus building.

Download the summary sheet here (PDF)


List of publications

A scoping review of participatory approaches in child maltreatment research across Europe

Participatory approaches in child maltreatment (CM) research increasingly focus on involving children, youth, and adults as co-researchers. However, little is known about their use in Europe. To review the European literature on participatory approaches in CM research. The study was undertaken by members of the Euro-CAN (COST Action 19,106) representing 35 countries in the European region. Focusing on the European research literature, we searched eight databases for studies investigating CM and using a participatory approach. The review followed scoping review guidelines and PRISMA-ScR, with thematic analysis for data synthesis.We identified 4927 potentially relevant articles, of which 307 were fully assessed for eligibility, and eight were ultimately included. The included studies addressed all types of CM; however, only two studies involved child and youth survivors of CM, while six involved children and youth from the community. Notably, no studies involving adult survivors were found. The findings indicate that children, youth, and adults can be involved in all stages of the research process, but the level of participation remains low. Eighteen different participatory methods were identified, and the ethical procedures and safeguarding of co-investigators varied significantly. Several barriers and challenges were identified, including issues related to adult gatekeeping behaviors, parental consent, confidentiality, and practical difficulties. The involvement of children, youth, and adults as co-researchers in CM research across Europe remains limited, with considerable variation in methods and procedures. These findings inform an ongoing e-Delphi study aimed at building consensus recommendations for participatory CM research.

Read the article (Child Abuse and Neglect)

Impact of COVID-19 pandemic on characteristics, extent and trends in child maltreatment in 34 Euro-CAN COST Action countries: a scoping review protocol

While the factors commonly associated with an increased risk of child maltreatment (CM) were found to be increased during COVID-19, reports of actual maltreatment showed varying trends. Similarly, evidence regarding the impact of COVID-19 on CM within the European Cooperation on Science and Technology and Network Collaborative (COST) Action countries remains inconsistent. This scoping review aims to explore the extent and nature of evidence pertaining to CM within the countries affiliated with the Child Abuse and Neglect in Europe Action Network (Euro-CAN), funded by the COST. Key electronic databases were searched to identify eligible papers, reports and other material published between January 2020 and April 2023: PubMed, EMBASE, PsycINFO, Social Policy and Practice, Scopus and Web of Science. To cover the breadth of evidence, a systematic and broad search strategy was applied using a combination of keywords and controlled vocabulary for four concepts: children, maltreatment, COVID-19 and Euro-CAN countries, without restrictions on study design or language. Grey literature was searched in OpenGrey and Google Scholar. Two reviewers will independently screen full-text publications for eligibility and undertake data extraction, using a customised grid. The screening criteria and data charting will be piloted by the research team. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews will be followed to present the results. Results will be summarised in a tabular form and narratively.

Read the article (BMJ Open)

The Nature and Scope of Reported Child Maltreatment in Euro-CAN Countries: Current Evidence and Future Opportunities

Most European Cooperation on Science and Technology (COST) affiliated countries aim to advance the goal of protecting children from maltreatment. However, despite the increasing numbers of population-based surveys, the development of administrative data systems has lagged. In this study, we aimed to examine the current state of development of administrative data systems in a sample of countries represented in the COST Action 19106 network, Multi-Sectoral Responses to Child Abuse and Neglect in Europe: Incidence and Trends (Euro-CAN). A structured questionnaire was distributed to researchers and professionals within Euro-CAN-affiliated countries, which captured economic, legislative, systemic, and data infrastructure characteristics. Thematic trends for 13 sampled countries were presented descriptively. The implementation of legislative measures such as banning corporal punishment varied substantially, with some countries decades apart. Almost all sampled countries mandate reports of suspected child maltreatment for all or some professionals in contact with children. In most countries, public child protection, health, or law enforcement systems are decentralized, and unsubstantiated/inconclusive incidents of suspected child maltreatment are not systematically collected at the national level. Child maltreatment data is not routinely collected in health sectors in all sampled countries. Where data is collected in different sectors, such as police and child protection agencies, different descriptions are often used. Systematic data linkage remains a seldom occurrence with only a few countries offering this capability. The call for Euro-CAN countries to develop multi-sectoral data systems to capture recorded instances of child maltreatment remains relevant.

 

Read the article (International Journal of Child Maltreatment: Research, Policy and Practice

Hospitalisations for physical abuse in infants and children less than 5 years, 2013–2021: a multinational cohort study using administrative data from five European countries

Child physical abuse (CPA) is a global public health problem associated with lifelong negative consequences, yet reliable epidemiologic data are lacking. This multinational cohort study analyses trends in CPA hospitalisations from 2013 to 2021. We used medico-administrative databases to identify children aged one month to five years hospitalised in Denmark, England, France, Ireland, and Wales. We identified CPA using a validated algorithm based on ICD-10 codes. We calculated the number, proportion, and incidence rate of children hospitalised for CPA, and the number and proportion of total hospitalisations for CPA, by year and age group (<1 and <5). We determined the proportion of CPA hospitalisations recorded using different ICD-10 codes, by country. The pooled incidence rate of infants <1 year hospitalised for CPA was stable over time (around 42/100,000 per year), ranging on average from 33 to 48/100,000 between countries. The pooled proportion of infant hospitalisations for CPA was around 0.17% (N = 750) per year (range 0.15–0.21%, N range 674–785), increasing significantly during the COVID-19 pandemic in 2020 (0.21%, N = 674). In children <5, the incidence rate (around 18/100,000 per year) and proportion of CPA hospitalisations (around 0.11% per year (N = 1600), range 0.10–0.14% (N range 1341–1657) were lower than in infants, but also increased in 2020 (0.14%, N = 1341). There were national differences in the distribution of ICD-10 codes used to record CPA and differences in year-on-year trends between countries. Comparing temporal trends in CPA hospitalisations between countries is feasible. Hospital data are one of several valuable sources for CPA surveillance.

Read the article (Tha Lancet)

 

Appraisal of published guidelines in European countries addressing the clinical care of childhood sexual abuse: protocol for a systematic review

Introduction Childhood sexual abuse (CSA) is a global public health problem with potentially severe health and mental health consequences. Healthcare professionals (HCPs) should be familiar with risk factors and potential indicators of CSA, and able to provide appropriate medical management. The WHO issued global guidelines for the clinical care of children with CSA, based on rigorous review of the evidence base. The current systematic review identifies existing CSA guidelines issued by government agencies and academic societies in the European Region and assesses their quality and clarity to illuminate strengths and identify opportunities for improvement.

 

Methods and analysis This 10-database systematic review will be conducted according to the Centre for Reviews and Dissemination guidelines and will be reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Guidance for HCPs regarding CSA, written by a national governmental agency or academic society of HCPs within 34 COST Action 19106 Network Countries (CANC) and published in peer-reviewed or grey literature between January 2012 and November 2022, is eligible for inclusion. Two independent researchers will search the international literature, screen, review and extract data. Included guidelines will be assessed for completeness and clarity, compared with the WHO 2017/2019 guidelines on CSA, and evaluated for consistency between the CANC guidelines. The Appraisal of Guidelines for Research and Evaluation II tool and Grading of Recommendations Assessment, Development and Evaluation methodology will be used to evaluate CANC guidelines. Descriptive statistics will summarise content similarities and differences between the WHO guidelines and national guidelines; data will be summarised using counts, frequencies, proportions and per cent agreement between country-specific guidelines and the WHO 2017/2019 guidelines.

Read the article (BMJ Open)

 

Clinical care of childhood sexual abuse: a systematic review and critical appraisal of guidelines from European countries

The clinical management of Child sexual abuse (CSA) demands specialised skills from healthcare professionals due to its sensitivity, legal implications, and serious physical health and mental health effects. Standardised, comprehensive clinical practice guidelines (CPGs) may be pivotal. In this systematic review, we examined existing CSA national CPGs (NCPGs) from European countries to assess their quality and reporting. We systematically searched six international databases and multiple grey literature sources, reporting by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligible guidelines were CSA guidance from national health agencies or societies in 34 COST Action 19106 Network Countries (CANC), published between January 2012 and November 2022. Two independent researchers searched, screened, reviewed, and extracted data. NCPGs were compared for completeness with reference WHO 2017 and 2019 guidelines. We used the Appraisal of Guidelines for Research and Evaluation (AGREE II) to appraise quality and reporting. PROSPERO: CRD42022320747. Of 2919 records identified by database searches, none met inclusion criteria. Of 4714 records identified by other methods, 24 NCPGs from 17 (50%) of CANC countries were included. In 17 (50%) of eligible countries, no NCPGs were found. Content varied significantly within and between countries. NCPGs lacked many components in state-of-the art clinical practice compared to WHO reference standards, particularly in safety and risk assessment, interactions with caregivers, and mental health interventions. Appraisal by AGREE II revealed shortcomings in NCPG development, regarding scientific rigour, stakeholder involvement, implementation and evaluation. A notable number of European countries lack an NCPG; existing NCPGs often fall short. The healthcare response to CSA in Europe requires a coordinated approach to develop and implement high-quality CPGs. We advocate for a multidisciplinary team to develop a pan-European CSA guideline to ensure quality care for survivors.

Read the aricle (The Lancet)

 

Current issues and challenges in the definition and operationalization of child maltreatment: A scoping review

Studies show considerable variability in the definitions and operationalization of child maltreatment (CM), which limits research, policy formation, surveillance, and cross-country and cross-sector comparisons.

To review the recent literature (2011–2021) to understand current issues and challenges in defining CM, to assist in the planning, testing and implementing of CM conceptualizations.

We searched eight international databases. Articles were included if the substantive content was related to issues, challenges, and debates in defining CM, and the article was an original study, review, commentary, report, or guideline. The review followed methodological guidance for the conduct of scoping reviews and was reported in accordance with the PRISMA-ScR checklist. Four experts in CM conducted a thematic analysis to summarize findings. Methodological rigor of the included studies was not formally assessed.

We identified 7372 potentially relevant articles; 55 full-text studies were assessed for eligibility, 25 satisfied the inclusion criteria. We identified three themes: 1) strategies to define CM, including the integration of child and victim perspectives; 2) difficulties in defining specific CM types; and 3) real-world implications for research, prevention and policy.

Despite longstanding concerns, challenges regarding the definitions of CM persist. A small minority of studies have tested and implemented CM definitions and operationalizations in practice. The findings will inform international multi-sectoral processes to develop uniform definitions of CM, for example by highlighting the need to acknowledge challenges in defining some CM types and emphasizing the importance of considering the perspectives of children and CM survivors.

Read the article (Child Abuse and Neglect)

Defining child maltreatment for research and surveillance: an international,multi-sectoral, Delphi consensus study in 34 countries in Europe and surrounding regions

Child maltreatment is a complex public health issue that has consequences across the life-course. Studies to quantify child maltreatment and identify interventions and services are constrained by a lack of uniform definitions. We conducted a European Delphi study to reach consensus on types and characteristics of child maltreatment for use in surveillance and research. Statements were developed following a scoping review and identification of key concepts by an international expert team (n = 19). A multidisciplinary expert panel (n = 70) from 34 countries completed three rounds of an online survey. We defined consensus as ≥70% agreement or disagreement with each statement after the final round. Consensus was reached on 26/31 statements (participant retention rate 94%). From the statements, we propose a unified definition of child maltreatment to improve measurement and surveillance in Europe. Concerted efforts are now required to test and refine the definition further prior to real-world operationalisation.

Read the article (The Lancet)

 

Webinar: Defining child Maltreatment for research and surveillance

Training schools

Information about the 1st Training School

The first Euro-CAN Training School for early-career researchers took place from August 16–18, 2021, in Lucerne, Switzerland. Organized under the Euro-CAN COST Action 19106 initiative, the event gathered researchers and professionals across Europe to develop skills in planning and preparing epidemiological studies on agency responses to child maltreatment.

Over the course of 2.5 days, participants took part in interactive modules, practical sessions, and trainee-led discussions designed to foster collaboration, methodological rigor, and ethical awareness in child maltreatment research. The training combined theoretical input with real-world challenges in research practice, and encouraged participants to refine their own project ideas through peer feedback and expert guidance.

Key highlights included:

  • Sessions on developing research questions and designing multi-sectoral studies using administrative and agency data.
  • Hands-on learning on questionnaire development, sector-specific responses (health, welfare, justice), and cross-national data collection challenges.
  • Ethical considerations in conducting sensitive research, including cultural sensitivity, participatory approaches, and data protection.
  • “Snack Discussions” — informal, trainee-led sessions where participants shared challenges from their own research for group discussion and problem-solving.

The Lucerne training school laid the foundation for strengthening interdisciplinary and international research on child maltreatment and helped build a network of emerging scholars committed to advancing knowledge and practice in this crucial field.


Information about the 2nd Training School

The second Euro-CAN Training School for early-career researchers, was held from September 9-11, 2024, in Warsaw, Poland. This event, organized under the Euro-CAN COST Action 19106 initiative, brought together early-career researchers, professionals, and academics from across Europe to focus on analyzing and promoting the need for data on agency responses to child maltreatment.

Over 3 days, participants engaged in interactive sessions, hands-on workshops, and insightful discussions with experts, gaining knowledge on accessing administrative data, developing guidelines, research methodology, and advancing skills in research-policy transfer. The event provided a unique opportunity for participants to exchange ideas and collaborate on research aimed at improving child protection services across Europe.

Key highlights included:

  •  In-depth discussions on the need for consensus in defining child maltreatment for research and surveillance purposes, as well as the challenges of developing clinical guidelines.
  •  Accessing administrative datasets on child maltreatment for research and overcoming barriers.
  • Discussions on the impact of COVID-19 on child protection and child maltreatment in Europe.
  • Insights into participatory research and practical advice on disseminating findings to policymakers and publishing studies.

This event not only strengthened the capacity of early-career researchers but also emphasized the critical need for collaboration between researchers and policymakers to improve outcomes in child protection.


Euro Can objectives

A pair of friends Photo credit Flashpop

  • Establish the bases for ultimately mapping and evaluating agency responses to child maltreatment across European countries and across different health and social protection systems.
  • Create an open, interdisciplinary network for practitioners, researchers, survivors, administrators and policymakers.
  • Compile knowledge on national data collection efforts and document changes in national and pan-European legislation and policy related to CMS.
  • Support policymakers and researchers in improving comparability of data collection between (disciplinary) sectors of the child protection system and across countries.
  • Focus on the main capacity-building goal of advocating for and implementing an evidence base for national policies to combat child maltreatment.

Organisation

Action leadership positions

Action Chair

Prof Andreas Jud, Germany

Action Vice Chair

Dr Gabriel Otterman, Sweden

WG 1- Definition and operationalisation of child maltreatment

Prof Leonor Bettencourt Rodrigues, Portugal
Dr Ulugbek Nurmatov, United Kingdom

WG2 - Promoting secondary analyses

Prof Catherine Quantin, France
Dr Laura Cowley, United Kingdom

WG 3- Promoting participatory approaches to child maltreatment surveillance

Prof Maria Roth, Romania
Dr Enila Cenko, Albania

WG 4 - Dissemination and multiplication

Ms Joanna Wlodarczyk, Poland

WG 5 - Covid 19

Dr Eva Mora-Theuer, Austria
Dr Chryssa Grylli, Austria


Grant Holder Scientific Representative

Dr Georgios Nikolaidis, Greece


Science Communication Manager

Prof Laura Korhonen, Sweden


STSM Coordinator

Dr Miroslav Rajter, Croatia


ITC Conference Grants Manager

Mr Athanasios Ntinapogias, Greece

Funding

Logotype EU Cost ActionCOST (European Cooperation in Science and Technology) is a funding organisation for research and innovation networks.

Our Actions help connect research initiatives across Europe and beyond and enable researchers and innovators to grow their ideas in any science and technology field by sharing them with their peers. COST Actions are bottom-up networks with a duration of four years that boost research, innovation and careers.


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