The model for large-scale violence against children surveys in middle schools in Yixing, China

Background Aim to build the model for large-scale violence against children (VAC) surveys in middle schools to get comprehensive prevalence data for intervention strategies and activities in Yixing as the only area focus on exploring VAC control and prevention in ‘2016-2020 children injury prevention program’ funded by United Nations International Children's Emergency Fund. Methods Research protocol and model report underwent rigorous ethical review. Survey teams including investigators, psychological consultants and child health development consultant were recruited and trained in field investigation and intervention, consistently executed seven principle. Crisis cases were defined in full compliance with four criterias. Key considerations for appropriate mode was identified through trial and formal surveys to map crisis cases treatment procedures flow chart. Results Standard model for large-scale VAC surveys in Yixing had been established, called ‘Yixing model’, could offer enough psychological protection and guidance for all children in the VAC research. 20863 children participated and occurred different kinds of respondents. 20509 children were general normal and completed their questionnaires. 208 children rejected questionnaries. 3 and 143 crisis cases respectively occurred in field investigation and questionnaries, got intervention according with standard treatment procedures. Discussion ‘Yixing model’ was not only participation of investigators and psychological consultants in field investigation, but also extended psychological guidance and intervention from local psychological teams ultimately developing the sustainable intervention mechanism. ‘Yixing model’ would deserve to promote and replicate in some other related nations or areas.

Discussion 'Yixing model' was not only participation of investigators and psychological consultants in field investigation, but also extended psychological guidance and intervention from local psychological teams ultimately developing the sustainable intervention mechanism. 'Yixing model' would deserve to promote and replicate in some other related nations or areas. 3 Background Violence against children (VAC) including child maltreatment in all forms (physical, sexual, emotional abuse and neglect) is a widespread issue with far-reaching social and economic consequences [1][2][3][4]. In recent years, VAC has received substantial attention, resulting in government initiatives to reduce VAC by strengthening data collection. Media reporting typically focuses on extreme cases, such as death or rape, and collecting reliable data on VAC is a complex undertaking that raises considerable methodological challenges [5]. The researches on VAC are barely beginning in China in recent years.
Large-scale survey and comprehensive data on the prevalence of VAC have never been carried out and reported.
Yixing locates in the centre of the Yangtze River Delta Urban Agglomeration in China, has population of over 1.2 million. 44 middle schools with total of about 40000 students were in Yixing in 2018. Yixing has participated in two rounds of programs about injury funded by United Nations International Children's Emergency Fund (UNICEF) in the past ten years [6] and third round '2016-2020 children injury prevention program', as the only area focus on VAC control and prevention in China. We aim to build the model for large-scale VAC measurement surveys in middle school to get comprehensive prevalence data for undertaking intervention strategies and activities.

Ethical approval and consent
The research was carried out and allowed to publish with permission from the Ethics The surveys got informed consents from children's parents or other legal guardians.
Children participated could quit at any phase of survey if he or she wanted.

School and Children
25 of 44 middle schools in Yixing were chosen to paticapate the research by random sampling methods from April 2018 to April 2019. All children in 25 middle schools were field questionnair investigated, while students in third grade senior middle school were excluded. The definition of the Children in the research means human beings below the age of 18 years. Principle 6: All information must be strictly confidential.

Investigators and psychological consultants
Principle 7: All investigation and intervention must end up with positive meaning and guidance.

6
Burden for the collection of information is estimated to average 60 minutes per child, including time for reviewing instruction and answering questionnaire, gathering and maintaining the data.
The questionnaire was made by Center for Chronic Noncommunicable Diseases, Chinese CDC and divided into two parts.

Identification of crisis case
The following criterias for identification crisis cases were formulated according to

Survey teams
At least one investigator and one psychological consultant together took charge of one class in field investigation. Another one investigator or psychological consultant was in charge of one teaching building floor. A general leader who was the most experienced investigator and also psychological consultant been trained, called child health development consultant, charged of the investgation and following intervention including contacting with questionnaire crisis cases and overall assessment.

Standard procedures
In the beginning of field investigaton, child involved in the research got informed consent When the children appeared emotional or behavioral reactions defined as cirsis cases with four criterias during the field investigation, investigators must ensure no body could see their questionnaire during the break to maintain confidentiality, psychological consultants must timely carry out scene psychological intervention following above seven principles to relax their emotions and ask if they would like to make appointment for psychological intervention next time. If the children were still emotionally unstable or unable to continue to answer questions, psychological consultant must ask if they would like to make appointment for answering the questionnaire again or psychological intervention. Violence discipline at home remains a largely unacknowledged form of VAC, although corporal punishment in educational settings was prohibitten in China now. 146 crisis cases have occured in the large-scale violence surveys, that is less frequent than we expected, but not means with minor impact. In part, VAC remains hidden because of current social background, such as physical punishment at home and bullying peers, often socially accepted or tacitly condoned. Reluctance on the part of victims to report their incidents poses a challenge to exposing the true extent and nature of VAC.
Only 5 in 143 crisis cases intended to ask for help in their questionnaries have replied and participate psychological intervention, that may because of normally reticent culture tradition of Chinese, widely perceived as a social taboo, relate to the level of trust of children, maturity of intervention means of school bullying, suggest ensuring that violence in all its forms is documented through solid data is a first step towards its elimination, general violence-related children would through a long way of from think to seek help to cope with the experience or take action to protect themselves from further victimization.

Consent for publication
Not applicable.

Availability of data and material
All data analysed during this study are included in this published article.

Competing interests
The authors declare no potential conflicts of interest with respect to the research, authorship and publication of this article. All authors have read and agreed on its content and are accountable for all aspects of the accuracy and integrity of the manuscript.

Funding
We wish to thank UNICEF China, Jiangsu provincial CDC and Yixing CDC for the financial supports.  including "appointment investigation again", "refeeral government organization",