Childhood Experience of Care and Abuse (CECA) Interview – introduction and background

The CECA is a measure of childhood and adolescent experience of neglect and abuse. It has been developed and used over a 20 year period. It original use was by researchers to investigate lifetime risk factors for psychological disorder.

The CECA has been used in a large number of research contexts. Although its original purpose to examine lifespan factors in the genesis of depression and anxiety disorders, it has since been used to study a range of clinical disorders, including conduct disorders, substance abuse, bi-polar disorder, personality disorders and schizophrenia and psychotic symptoms. Results show that childhood adversity increase risk of many such disorders, with causal models developed to explore mediating and moderating disorders specific to different outcomes.

Increasingly the CECA is being used as an assessment tool in clinical, forensic and social work practice. For example, ongoing action research by the CATS centre with St Christopher’s Fellowship is utilising the CECA in assessing young people in residential care as part of their SHARP intervention and scoring information from both interviews and case file information. This together with face-to-face interview on their attachment style and self-esteem allows for a comprehensive coverage of their psychosocial risks and resilience factors. As another example, an evaluation was carried out on the use of the CECA in Royal Borough of Kingston’s Child Safeguarding Services. The study trained 8 social workers in the CECA and examined how it can be used to inform chronologies for court proceedings and the categorization of maltreatment and severity ratings for care planning.

The CECA interview has also been used internationally, not only in the USA and Canada, but also in Belgium, Italy, Portugal and Germany, and therefore exists in translation.

The Questionnaire: CECA.Q2

A brief self-report version has been validated against the interview. This assesses loss of parents, neglect, antipathy from main carers and physical and sexual abuse. Support in childhood is also included. The measure shows acceptable sensitivity and specificity against the interview measure, and published cut-off scores are available. The CECA.Q has been translated into a number of languages, including Italian, German, Spanish, Portuguese, Chinese, and has been used in Europe, USA, Canada, South America and the Far East.

The measure is associated with both the Parental Bonding Instrument and the Childhood Trauma Questionnaire3, but has wider coverage of maltreatment, shows a dose-response effect in relation to lifetime clinical depression and has improved improved prediction of disorder.

CECA.Q3 is a version of the original CECA Questionnaire that offers additional sections of psychological abuse and role reversal. These are included in the later version because of their key relationship to later depression and self-harm behaviour in adolescents.

Download CECA.Q (the original questionnaire) here.
Download CECA.Q3 (with added psych abuse and role reversal) here.
Download CECA Questionnaire Scoring Guide here.

Key CECA publications

Bifulco A & Moran P (1998) Wednesday’s Child: Research into women’s experience of neglect and abuse in childhood and adult depression. Routledge, London, New York. link

Bifulco A, Bernazzani O, Moran PM & Jacobs C (2005) Childhood Experience of Care and Abuse Questionnaire (CECA.Q) Validation in a community series. British Journal of Clinical Psychology, 44: 563-581. link

Bifulco A, Moran PM, Baines R, et al. (2002) Exploring Psychological Abuse in Childhood: II. Association with Other Abuse and Clinical Depression. Bulletin of the Menninger Institute, vol 66(3) 240-258. link

Bifulco A, Moran PM, Ball C, et al. (2002) Childhood adversity, parental vulnerability and disorder: Examining inter-generational transmission of risk. Journal of Child Psychology and Psychiatry; 43, 1075-1086. link

Bifulco A, Brown GW, Lillie A et al. (1997) Memories of childhood neglect and abuse. Corroboration in a series of sisters. Journal of child psychology and psychiatry; 38: 365-374. link

Bifulco A, Brown GW & Harris TO (1994) Childhood Experience of Care and Abuse (CECA): A retrospective interview measure. Journal of Child Psychology and Psychiatry; 35 (8), 1419-1435. link

Moran PM, Bifulco A, Ball C, et al. (2002) Exploring Psychological Abuse in Childhood: I. Developing a New Interview Scale. Bulletin of the Menninger Institute, vol 66(3), 213-240. link

Troop NA & Bifulco A (2002) Childhood social arena and cognitive sets in eating disorders: A preliminary investigation. British Journal of Clinical Psychology; 41: 205-21. link