Common errors of reasoning in child protection work

Sibling sexual abuse: What do we know? What do we need to know? Stage 1 analysis of a 2-stage scoping review

BACKGROUND

Sibling sexual abuse is a common form of intra-familial sexual abuse, yet it remains under-studied and under-recognised, leaving many children unprotected and unsupported. Practitioners need rigorously conducted evidence syntheses to inform decision making in this complex practice area.

OBJECTIVE

A scoping review was conducted with the broad research question: What is known about sibling sexual abuse? in order to map the research and to establish areas of knowledge and gaps requiring attention.

METHOD

The review followed the guidelines of Arksey and O'Malley (2005), and through searches of 11 academic databases, 3 grey literature databases, journal handsearch and Google, identified 91 empirical papers for review.

RESULTS

While poorly and inconsistently defined, sibling sexual abuse is a common form of child sexual abuse with significant consequences for the whole family. It may involve children of any age and sex, entail the full range of sexual behaviours, and can take place in families from across the socioeconomic spectrum. Disclosure is uncommon during childhood, with multiple barriers including the nature of the caregiving environment in which sibling sexual abuse often takes place. Official records are likely to under-report the frequency and duration of the abuse.

CONCLUSIONS

There is considerable scope for further research across all aspects of sibling sexual abuse. This paper represents the most comprehensive (albeit not complete) overview of the current body of knowledge in this field to date, and presents key findings as well as a summary of practice and research recommendations.

Why do mothers stay? Challenging attitudes in decision making about children at risk because of domestic violence

BACKGROUND

This article reports findings from research commenced in 2019. Stage one assessed the attitudes and beliefs of child protection practitioners towards domestic violence. Stage two considered the impact of combining Structured Decision Making (SDM - the standard assessment approach) with Response Based Practice (RBP - a contemporary approach to understanding violence), on child protection decisions.

OBJECTIVE

To improve the child protection response to children who experience domestic violence. This article reports on stage three; considering the impact of practitioner attitudes and beliefs on child protection decisions and whether the combined assessment approach (SDM + RBP) moderated the impact of practitioner attitudes and beliefs.

PARTICIPANTS AND SETTING

1041 child protection practitioners participated in the research while attending one of 17 practice conferences across New South Wales, Australia.

METHODS

An innovative video vignette experiment with a between-subjects design was used, relying on professional actors to play the roles of practitioner and mother of the children reported. Participants watched a video interview of a safety assessment and completed a survey.

RESULTS

Practitioner attitudes and beliefs were not significantly correlated with assessments about the children's safety; but attitudes did impact decisions about the likelihood of the children being brought into care. Attitudes and beliefs moderated the impact of misinformed attitudes, to some extent.

CONCLUSIONS

The research confirms the value of the combined SDM + RBP approach to guide practitioners to a more holistic understanding of domestic violence. It also confirms that assessment approaches are only ever as good as the beliefs and attitudes of the people who apply them.

The evidence base for risk assessment tools used in U.S. child protection investigations: A systematic scoping review

BACKGROUND

Child protective services (CPS) agencies use risk assessment tools to augment decision making about alleged child maltreatment. Under the Family First Prevention Services Act, states and tribes are permitted to claim federal reimbursement for prevention services for children at imminent risk of entering foster care based on assessment tools and protocols. In this context, existing tools are being repurposed. It is critical to reassess the evidence supporting their use.

OBJECTIVE

We aimed to synthesize the evidence pertaining to validity and reliability of specific risk assessment tools designed for CPS agencies, summarize how this work has been carried out, and review the conceptual dimensions of risk included in each tool.

PARTICIPANTS AND SETTING

We included United States-based, quantitative evaluations of risk assessment tools published between 1990 and May 2021.

METHODS

We carried out a scoping review using a protocol in alignment with PRISMA-ScR. We used a multiphase selective screening approach with at least two screeners.

RESULTS

In total, 25 studies met inclusion criteria. Overall, research about the validity and reliability of risk assessment tools is dated and heterogeneous in methodology. The conceptualizations of risk assessment and the operationalization of risk also varied widely. There was a general dearth of evidence that supported the use of tools across demographic subgroups.

CONCLUSIONS

Heterogeneity of studies assessing tool validity and reliability suggests a lack of agreement about how to assess tools and makes it difficult to interpret findings across studies. Agencies should be cautious about overreliance on tools for which evidence is limited.

Natural language processing to identify case factors in child protection court proceedings

Social work case files hold rich detail about the lives and needs of vulnerable groups. Traditional case-reading studies to gain generalisable knowledge are resource-intensive, however, and sample sizes thereby limited. The advent of ‘big data’ technology, and vast repositories of centrally stored electronic records offer social work researchers novel alternatives, including data linkage and predictive risk modelling using administrative data. Free-text documents, however – including assessments, reports, and case chronologies – remain a largely untapped resource. This paper describes how 5000 social work court statements held by the Child and Family Court Advisory Support Service in England (Cafcass) were analysed using natural language processing (NLP) based on simple rules and mathematical principles. Thirteen factors relating to harm and risk to children involved in care proceedings in England were identified by automated computer techniques, and almost 90% agreement with professional readers achieved when the factors were clear-cut. The study represents an innovative approach for social work research on complex social problems. In conclusion, the paper discusses learning points; practical implications; future research avenues; and the technical and ethical challenges of NLP.

Finding a Suitable Object for Intervention: On Community-Based Violence Prevention in Sweden

In Sweden, local municipalities, working in collaboration with the police, are assigned an important role in community-based crime prevention and the promotion of safer neighbourhoods/cities. The strategies adopted are supposed to be informed by the policies of national advisory bodies, which emphasize surveying the current situation, problem analyses, systematic planning of interventions and evaluation of efforts. This paper reports on a three-year research project that studied local crime prevention/safer community practices in four so-called ‘particularly vulnerable areas’ (PVAs) using meeting observations and stakeholder interviews. The analysis shows that when constructing intervention strategies, the actors involved had to navigate between different organizational logics and found it difficult to demarcate a suitable object for joint efforts. When they were able to find an object to be targeted, such as youth at risk of drug abuse or low-level criminality, they could rely on a collective mindset, but they struggled in situations where a joint effort was not possible, such as when dealing with the risk of aggravated violence or when the operations got close to more organized crime—both elements that form part of the definition of PVAs. This failure may partly be explained by competing logics dominated by idiosyncratic action in line with bureaucratic rules and routines. This finding raises questions about a putative but non-articulated limit to crime prevention and whether a predetermined approach aligns with the prescribed sequence of survey, analysis, intervention planning and evaluation when faced with more brutish violence.

Assessing, Consulting, Reporting Heuristics in Professional Decision-Making Regarding Suspected Child Maltreatment in Community Healthcare Services

This study investigated child protection decision-making practices of healthcare-professionals in community-health-services. We examined the effect of heuristics in professional judgments regarding suspected maltreatment, as affected by the child's ethnicity, gender, and family socioeconomic-status, as well as the healthcare-worker's workload-stress, and personal and professional background. Furthermore, we examined how these variables influence judgments regarding suspected maltreatment and intentions to consult and report child-maltreatment. We used an experimental survey design including vignettes manipulating the child's characteristics. Data was collected from 412 professionals employed at various community-health-service-clinics of the largest health-management organization in northern Israel. Findings show that all subjective factors have a significant effect on suspected child-maltreatment assessment, which appears as a significant predictor of later decisions regarding consultation and reporting. This study lends support to prior research indicating that healthcare-professionals' decisions may incorporate biases, and suggests how the effects of these biases' are mediated through a sequence of decisions. Recommendations focus on providing regular consultation opportunities for practitioners.

Personalizing Child Protection: The Value of Responsivity Factors

Personalization is an important strategy for enhancing the effectiveness of treatment that is aimed at reducing the risk of child maltreatment. In recent years, a growing body of research has appeared on how child protection can benefit from the principles of the Risk-Need-Responsivity model, but no attention has yet been paid to the implementation of the responsivity principle in child protection. Put simply, this principle states that treatment must be tailored to individual characteristics of clients to optimize its effectiveness. This study was the first to address how the responsivity principle can be of value in child protection. First, a systematic review of responsivity factors in forensic care was performed. Second, the relevance of applying each factor in child protection was examined through interviews with clinical professionals working in the field, who also provided suggestions on how treatment can be tailored to each of these factors. This resulted in an overview of seven responsivity factors all related to caregiver characteristics: problem denial, motivation to cooperate with treatment, psychological problems, cognitive abilities, cultural background, practical barriers such as financial problems and social support, and barriers to specific treatment types such as group therapy. Implications and recommendations for strengthening clinical practice are discussed.

Navigating complexity of child abuse through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

BACKGROUND

Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. In these contexts, CYHC-practitioners use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are necessary in healthcare. This study aims to unravel how intuition is perceived and used by Dutch CYHC-practitioners when identifying and working with cases of child abuse, and how this relates to their evidence-based guidelines.

METHODS

A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-physicians focused on perceptions on intuition, which were followed by a survey amongst CYHC-practitioners on the recognition and use of the concept.

RESULTS

The majority of CYHC-practitioners recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition to 1) sense that something is 'off', 2) differentiate between 'normal' and 'abnormal', 3) assess risks, 4) weigh secondary information and 5) communicate with parents. At the same time, they warn of its dangers, as it may lead to 'tunnel vision' and false accusations.

CONCLUSION

Intuition is experienced as an integral part of the work of CYHC-practitioners. It is understood as particularly useful in cases of child abuse, which are inherently complex, as signs and evidence of abuse are often hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. There is an opportunity for guidelines to support reflection and intuition as a 'good care' practice.

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (M_age children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.

"I Know Correlation Doesn't Prove Causation, but . . .": Are We Jumping to Unfounded Conclusions About the Causes of Sexual Offending?

Identifying causes of sexual offending is the foundation of effective and efficient assessment, intervention, and policy aimed at reducing sexual offending. However, studies vary in methodological rigor and the inferences they support, and there are differences of opinion about the conclusions that can be drawn from ambiguous evidence. To explore how researchers in this area interpret the available empirical evidence, we asked authors of articles published in relevant specialized journals to identify (a) an important factor that may lead to sexual offending, (b) a study providing evidence of a relationship between that factor and sexual offending, and (c) the inferences supported by that study. Many participants seemed to endorse causal interpretations and conclusions that went beyond the methodological rigor of the study they identified. Our findings suggest that some researchers may not be adequately considering methodological issues when making inferences about the causes of sexual offending. Although it is difficult to conduct research in this area and all research designs can provide valuable information, sensitivity to the limits methodology places on inferences is important for the sake of accuracy and integrity, and to stimulate more informative research. We propose that increasing attention to methodology in the research community through better training and standards will advance scientific knowledge about the causes of sexual offending, and improve the effectiveness and efficiency of practice and policy.

Heuristic decision-making in foster care matching: Evidence from a think-aloud study

Complex decisions are often based on heuristics, which are shortcuts or simple 'rules of thumb'. Since the matching decision in family foster care is often made in a less-than-ideal setting and riddled with uncertainty, heuristics are expected to be applied in that field of child and youth care on a daily basis. However, the use of heuristics in the matching decision has not been studied empirically until now. This research explores how decision-making heuristics are used by practitioners to determine which foster family is the best fit for a child. A number of 20 matching practitioners from the Netherlands were interviewed using vignettes and a 'think-aloud' methodology to generate an understanding of their reasoning. Two types of vignettes were created: hypothetical children and hypothetical foster families. The interviews were analyzed using a qualitative deductive content analysis focusing on key indicators of three classes of heuristics: recognition heuristics, one-reason heuristics, and trade-off heuristics. The results show that recognition heuristics did not play a decisive role in the matching process; practitioners considered more than one family before making a final decision. The findings for the one-reason heuristics reveal conjunctive decision-making rules; families were rejected based on one negative premise. The analysis of the trade-off heuristics demonstrates that the number of positive premises and the ratio between positive and negative premises predicted the matching decision. However, the total number of premises also predicted the matching decision, which might indicate confirmation bias.

Reasons for placement decisions in a case of suspected child abuse: The role of reasoning, work experience and attitudes in decision-making

Child welfare and child protection workers regularly make placement decisions in child abuse cases, but how they reach these decisions is not well understood. This study focuses on workers' rationales. The aim was to investigate the kinds of arguments provided in placement decisions and whether these arguments were predictors for the decision, in addition to the decision-makers' risk assessment, work experience and attitudes towards placement. The sample consisted of 214 professionals and 381 students from the Netherlands. The participants were presented with a vignette describing a case of alleged child abuse and were asked to determine whether the abuse was substantiated, to assess risks and to recommend an intervention. The participants' placement attitudes were assessed using a structured questionnaire. We found that the participants provided a wide range of arguments, but that core arguments - such as the suspected abuse, parenting and parent-child interaction - were often missing. Regression analyses showed that the higher the perceived danger to the child and the more positive the participants' attitudes towards placement, the more likely the participants would be to propose placing the child in care. Arguments related to the severity of the problems (i.e., suspected abuse, parenting and the child's development) as well as the parents' perceived cooperation also influenced placement decisions. The findings indicate trends in the decision-making process, in the sense that participants who decided to place the child out-of-home emphasized different arguments and had different attitudes towards out-of-home placement than those who did not. We discuss the implications of our findings.

The Sibling Relationship in the Context of Child Maltreatment: What Do We Know? What Are the Directions for the Future?

Siblings share a common and unique bond. It is one of the most enduring relationships during an individual's life span. Thus, the impact of child maltreatment on sibling relationships is an important area of research to explore. The current article carries out a scoping review targeted at determining the existing knowledge and then identifying research priorities within the field of sibling relationship in the context of child maltreatment. The method elaborates on the various stages that were taken to perform the scoping review, and later, the article provides three results for the readers: The first result is a detailed mapping of the existing literature in the area of sibling relationship in the context of maltreatment. The second result is a thorough thematic analysis that was carried out on this literature that focused on several relevant domains: sibling exposure to intimate partner violence, sibling relationship and experiences in the context of child maltreatment, risk assessment for siblings following maltreatment, and sibling relationships and out-of-home placement. The third result is a set of conclusions targeted mainly at recommending future directions to researchers.

‘Mental capacity’, ‘sufficient maturity’, and ‘capable of understanding’ in relation to children: how should health professionals interpret these terms?

South Africa’s Children’s Act 38 of 2005 requires health professionals to determine whether a child possesses ‘sufficient maturity’ and ‘mental capacity’ to make decisions about themselves in relation to surgery, treatment, and HIV testing. Similarly, the National Health Act 61 of 2003 requires a child to be ‘capable of understanding’ to provide informed consent in research. However, neither the Children’s Act nor the National Health Act defines these terms. Moreover, there is no common definition of ‘sufficient maturity’ among healthcare professionals in South Africa. Appreciating how foreign law interprets ‘mental capacity’ and how different healthcare professionals evaluate ‘maturity’ could prove illuminative in respect to how these terms could be interpreted by health professionals in South Africa, and elsewhere.

Predicting child maltreatment: A meta-analysis of the predictive validity of risk assessment instruments

Risk assessment is crucial in preventing child maltreatment since it can identify high-risk cases in need of child protection intervention. Despite widespread use of risk assessment instruments in child welfare, it is unknown how well these instruments predict maltreatment and what instrument characteristics are associated with higher levels of predictive validity. Therefore, a multilevel meta-analysis was conducted to examine the predictive accuracy of (characteristics of) risk assessment instruments. A literature search yielded 30 independent studies (N=87,329) examining the predictive validity of 27 different risk assessment instruments. From these studies, 67 effect sizes could be extracted. Overall, a medium significant effect was found (AUC=0.681), indicating a moderate predictive accuracy. Moderator analyses revealed that onset of maltreatment can be better predicted than recurrence of maltreatment, which is a promising finding for early detection and prevention of child maltreatment. In addition, actuarial instruments were found to outperform clinical instruments. To bring risk and needs assessment in child welfare to a higher level, actuarial instruments should be further developed and strengthened by distinguishing risk assessment from needs assessment and by integrating risk assessment with case management.

Screening for potential child maltreatment in parents of a newborn baby: The predictive validity of an Instrument for early identification of Parents At Risk for child Abuse and Neglect (IPARAN)

For preventive purposes it is important to be able to identify families with a high risk of child maltreatment at an early stage. Therefore we developed an actuarial instrument for screening families with a newborn baby, the Instrument for identification of Parents At Risk for child Abuse and Neglect (IPARAN). The aim of this study was to assess the predictive validity of the IPARAN and to examine whether combining actuarial and clinical methods leads to an improvement of the predictive validity. We examined the predictive validity by calculating several performance indicators (i.e., sensitivity, specificity and the Area Under the receiver operating characteristic Curve [AUC]) in a sample of 4692 Dutch families with newborns. The outcome measure was a report of child maltreatment at Child Protection Services during a follow-up of 3 years. For 17 children (.4%) a report of maltreatment was registered. The predictive validity of the IPARAN was significantly better than chance (AUC=.700, 95% CI [.567-.832]), in contrast to a low value for clinical judgement of nurses of the Youth Health Care Centers (AUC=.591, 95% CI [.422-.759]). The combination of the IPARAN and clinical judgement resulted in the highest predictive validity (AUC=.720, 95% CI [.593-.847]), however, the difference between the methods did not reach statistical significance. The good predictive validity of the IPARAN in combination with clinical judgment of the nurse enables professionals to assess risks at an early stage and to make referrals to early intervention programs.

ASSESSING PARENTING IN THE CONTEXT OF REUNIFICATION OF INFANTS/TODDLERS AND THEIR FAMILIES: HOW TO FACE THE CHALLENGES?

Since a substantial portion of infants and toddlers reenter care after reunification, the question of whether family reunification is feasible needs to be answered very cautiously. How parenting is assessed is of major importance in answering this question, but the quality of these assessments is often poor. With an eye to improving current practice, we conducted an integrative review, in which we analyzed the challenges related to the assessment of parenting vis-à-vis reunification and linked relevant knowledge from research with significant know-how from practice. The challenges appear to be embedded in the struggle to define (especially good enough) parenting and the complex context of child protection. As an answer to the challenges, the integrative review resulted in a framework of four key components required for sufficient parenting-assessment practice: (a) the use and development of expertise; and (b) providing families aiming for reunification with an intervention that is intensive, (c) flexible, and (d) organized as teamwork. Providing families with such an intervention gives them the opportunity to make substantial changes in their parenting and helps professionals assess the capacity of parents to grow to an acceptable level of caretaking for their child. Further implications for research and practice are discussed.

Systemic barriers to effective utilization of decision making tools in child protection practice

This qualitative research was designed to evaluate the extent to which a national reform in Israeli child protection decision making committees was achieving its aim to strengthen professional judgment through introducing a new standard tools package into practice. Twenty-one case studies of families referred to the committee were investigated and followed up after six months. Data were collected through interviews with social workers, field observations of the committees' discussions and document review. Using a systems approach as a conceptual framework, everyday practice was studied within its organizational context. A key finding of the research was a very limited utilization of the tools in practice. Evidence showed no advanced performance in the few cases where the tools were used, and that when they were used they mainly operated to record customary practice. Follow up data provided limited evidence of improvement in the safety and well-being of vulnerable children. The analysis revealed several systemic factors that interfered with the tools being fully and successfully implemented, including pressure of workloads, practitioners' inadequate skills, limited professional support, and an organizational culture that discouraged sound practice. The research directs attention to the organizational changes needed in order to enhance the provision of effective help for children and families.

The family health, functioning, social support and child maltreatment risk of families expecting a baby

AIMS AND OBJECTIVES

To describe the family health, functioning, social support and child maltreatment risk and associations between them in families expecting a baby.

BACKGROUND

Finland was one of the first countries in banning corporal punishment against children over 30 years ago. Despite of this, studies have shown that parents physically abuse their children. In addition, professionals struggle in intervention of this phenomenon. Abusive parents should be recognised and helped before actual violent behaviour.

DESIGN

A follow-up case-control study, with a supportive intervention in the case group (families with a heightened risk) in maternity and child welfare clinics. The baseline results of families are described here.

METHODS

Child maltreatment risk in families expecting a baby was measured by Child Abuse Potential Inventory. The health and functioning was measured by Family Health, Functioning and Social Support Scale. Data included 380 families.

RESULTS

A total of 78 families had increased risk for child maltreatment. Heightened risk was associated with partners' age, mothers' education, partners' father's mental health problems, mothers' worry about partners' drinking and mothers' difficulties in talking about the family's problems. Risk was associated with family functioning and health. Families with risk received a less support from maternity clinics. Families with child maltreatment risk and related factors were found.

CONCLUSIONS

This knowledge can be applied for supporting families both during pregnancy and after the baby is born. Professionals working with families in maternity clinics need tools to recognise families with risk and aid a discussion with them about the family life situation. The Child Abuse Potential, as a part of evaluating the family life situation, seems to prove a useful tool in identifying families at risk.

RELEVANCE TO CLINICAL PRACTICE

The results offer a valid and useful tool for recognising families with risk and provide knowledge about high-risk family situations.

Detection of unsafety in families with parental and/or child developmental problems at the start of family support

BACKGROUND

Risk assessment is crucial in preventing child maltreatment as it can identify high-risk cases in need of child protection intervention. Despite this importance, there have been no validated risk assessment instruments available in the Netherlands for assessing the risk of child maltreatment. Therefore, the predictive validity of the California Family Risk Assessment (CFRA) was examined in Dutch families who received family support. In addition, the added value of a number of experimental items was examined. Finally, it was examined whether the predictive value of the instrument could be improved by modifying the scoring procedure.

METHODS

Dutch families who experienced parenting and/or child developmental problems and were referred by the Centres for Youth and Family for family support between July 2009 and March 2011 were included. This led to a sample of 491 families. The predictive validity of the CFRA and the added value of the experimental items were examined by calculating AUC values. A CHAID analysis was performed to examine whether the scoring procedure could be improved.

RESULTS

About half of the individual CFRA items were not related to future reports of child maltreatment. The predictive validity of the CFRA in predicting future reports of child maltreatment was found to be modest (AUC = .693). The addition of some of the experimental items and the modification of the scoring procedure by including only items that were significantly associated with future maltreatment reports resulted in a 'high' predictive validity (AUC = .795).

CONCLUSIONS

This new set of items might be a valuable instrument that also saves time because only variables that uniquely contribute to the prediction of future reports of child maltreatment are included. Furthermore, items that are perceived as difficult to assess by professionals, such as parental mental health problems or parents' history of abuse/neglect, could be omitted without compromising predictive validity. However, it is important to examine the psychometric properties of this new set of items in a new dataset.

Deciding on child maltreatment: A literature review on methods that improve decision-making

Assessment and decision-making in child maltreatment cases is difficult. Practitioners face many uncertainties and obstacles during their assessment and decision-making process. Research exhibits shortcomings in this decision-making process. The purpose of this literature review is to identify and discuss methods to overcome these shortcomings. We conducted a systematic review of the published literature on decision-making using PsychINFO and MEDLINE from 2000 through May 2014. We included reviews and quantitative research studies that investigated methods aimed at improving professional decision-making on child abuse and neglect in child welfare and child protection. Although many researchers have published articles on decision-making including ideas and theories to improve professional decision-making, empirical research on these improvements is scarce. Available studies have shown promising results. Structured decision-making has created a greater child-centred and holistic approach that takes the child's family and environment into account, which has made practitioners work more systematically and improved the analysis of complex situations. However, this approach has not improved inter-rater agreement on decisions made. Shared decision-making may improve the participation of parents and children and the quality of decisions by taking client treatment preferences into account in addition to scientific evidence and clinical experience. A number of interesting developments appear in recent research literature; however, child welfare and child protection must find additional inspiration from other areas, e.g., mental health services, because research on decision-making processes in child welfare and child protection is still rare.

The decision of out-of-home placement in residential care after parental neglect: Empirically testing a psychosocial model

Out-of-home placement decisions in residential care are complex, ambiguous and full of uncertainty, especially in cases of parental neglect. Literature on this topic is so far unable to understand and demonstrate the source of errors involved in those decisions and still fails to focus on professional's decision making process. Therefore, this work intends to test a socio-psychological model of decision-making that is a more integrated, dualistic and ecological version of the Theory of Planned Behavior's model. It describes the process through which the decision maker takes into account personal, contextual and social factors of the Decision-Making Ecology in the definition of his/her decision threshold. One hundred and ninety-five professionals from different Children and Youth Protection Units, throughout the Portuguese territory, participated in this online study. After reading a vignette of a (psychological and physical) neglect case toward a one-year-old child, participants were presented with a group of questions that measured worker's assessment of risk, intention, attitude, subjective norm, behavior control and beliefs toward residential care placement decision, as well as worker's behavior experience, emotions and family/child-related-values involved in that decision. A set of structural equation modeling analyses have proven the good fit of the proposed model. The intention to propose a residential care placement decision was determined by cognitive, social, affective, value-laden and experience variables and the perceived risk. Altogether our model explained 61% of professional's decision toward a parental neglect case. The theoretical and practical implications of these results are discussed, namely the importance of raising awareness about the existence of these biased psychosocial determinants.

Risk factors for child maltreatment recurrence: An updated systematic review

OBJECTIVES

Children who have been maltreated are at increased risk of further maltreatment. Identification of those at highest risk of further maltreatment is a priority for professionals working in child protection services. The current study is intended to consolidate and expand on previous work on recurrence of child maltreatment. It has sought to identify risk factors for maltreatment recurrence in the recent literature in the expectation that this may help in the practical identification of children at risk.

METHODS

We conducted a systematic review of cohort studies published between 2003 and 2009, identifying factors associated with maltreatment recurrence in children. Studies included demonstrated differing levels of substantiation of maltreatment.

RESULTS

Fifteen studies met inclusion criteria but showed significant heterogeneity, varying in setting, recruitment of subjects, types of maltreatment considered and length of follow-up. Previous findings were replicated and expanded in the current study in relation to a range of factors, including rates of maltreatment recurrence, maltreatment types, frequency of previous episodes of maltreatment, child and family considerations, home environment and service provision. Factors were identified irrespective of level of maltreatment substantiation.

CONCLUSION

This study provides further systematic evidence of the existence of a number of factors associated with child maltreatment recurrence. It points to the possibility of practical application of its findings within the wider context of decision making in child protection services, with the ultimate aim of reducing recurrence of maltreatment in individual cases.

Improving practice in safeguarding at the interface between hospital services and children’s social care: a mixed-methods case study

Background

Hospital settings have an important impact on children harmed by parents and carers. Concern arises from the capacity of these settings to respond effectively to individual needs despite increased NHS policy awareness and actions on safeguarding. Patient safety initiatives have rarely modelled in detail the social and cultural dynamics of child health settings and children’s safeguarding. This study is focused on supporting and evaluating clinician-led service design in an acute trust. A suite of initiatives and artefacts has been designed, based on sociotechnical principles, on the premise that only a thorough understanding of human, social and organisational challenges will afford effective solutions.

Objectives

The study addresses the following primary question: ‘Can a safeguarding culture be designed within the hospital environment that will provide the conditions for the detection of children at risk of abuse and support protective actions before discharge, including collaboration with external agencies?’ Objectives include the development of a sociologically rich understanding of why diagnostic failures and communication breakdowns occur; the design of a suite of integrated interventions for promoting a positive safety culture, following a user-centred approach; and the evaluation of the effectiveness of this package, including its generalisability across sites.

Design

The study took place in two sites: the primary site where the initiatives were developed and a further site with the original intention of transferring developments. The investigation follows a broaddesign scienceapproach. The evaluation of a design intervention relies on a rigorous understanding of the realities of everyday practice, and the study thus draws on mixed methods to examine the impact of service redesign on cultures and practices.

Findings

The data suggest that safeguarding children can become mainstream patient safety business. Board support is vital. In our primary site, there has been a steady integration of learning from serious case reviews and other child protection-related processes with ‘patient safety’-related incidents, with growing recognition that similar systemic issues impact on both domains. Making use of a familiar vocabulary to redescribesafeguardingas asafetyissue, and thus as something fundamental to the functions of an acute hospital, has been part of the success. The data suggest that persistence, resilience and vigilance from the safeguarding leadership and executive teams are crucial. Current policy includes the development of the Child Protection Information Sharing project, which is intended to improve information flow between the NHS, particularly hospitals and children’s social care. The findings from this study suggest the importance of good design, piloting, incrementalism and a thorough empirical engagement with everyday practices during implementation of this and any future information systems based reform.

Conclusions

Safeguarding takes place in a complex system and even minor changes within any part of that system can impact on the rest in unpredictable ways. It is important that managers adopt a ‘design attitude’ and seek to mitigate unintended consequences through careful experimentation. The findings suggest the need for the design of systems to enhance communication and not simply to ‘share information’. Technological solutions impact on everyday decision-making and can have unintended consequences. Attention to forces of change and stasis in health settings, the factors affecting technology transfer and the impact of the configuration of local authority services are suggested as a key priorities for future research.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

The influence of differential response on decision-making in child protective service agencies

Differential response (DR) profoundly changes the decision pathways of public child welfare systems, yet little is known about how DR shapes the experiences of children whose reports receive an investigation rather than an alternate response. Using data from the National Child Abuse and Neglect Data System (NCANDS), this study examined the relationship between DR implementation and decision outcomes in neglect cases, as measured by investigation, substantiation, and removal rates in 297 U.S. counties. Multivariate regression models included county-level measures of child poverty and proportions of African American children. Path analyses were also conducted to identify mediating effects of prior decision points and moderating effects of DR on poverty and race's influence on decision outcomes. Results indicate that compared to non-DR counties, those implementing DR have significantly lower investigation and substantiation rates within county populations but higher substantiation rates among investigated cases. Regression models showed significant reductions in removal rates associated with DR implementation, but these effects became insignificant in path models that accounted for mediation effects of previous decision points. Findings also suggest that DR implementation may reduce the positive association between child poverty rates and investigation rates, but additional studies with larger samples are needed to confirm this moderation effect. Two methods of calculating decision outcomes, population- and decision-based enumeration, were used, and policy and research implications of each are discussed. This study demonstrates that despite their inherit complexity, large administrative datasets such as NCANDS can be used to assess the impact of wide-scale system change across jurisdictions.

Child protection decision making: a factorial analysis using case vignettes

This study explored decision making by child protection social workers in the province of British Columbia, Canada. A factorial survey method was used in which case vignettes were constructed by randomly assigning a number of key characteristics associated with decision making in child protection. Child protection social workers (n = 118) assessed case vignettes (n = 327) for risk, service provision, and importance of client contact. In British Columbia, child protection social workers are expected to make decisions using a risk assessment model. However, as social workers begin to work with clients to facilitate change, relationship factors such as home visits and client contact also become important. The research indicated that social workers made decisions through an integration of objective, procedural, and experiential knowledge. Decisions about risk and service provision were influenced by technocratic knowledge, such as the risk assessment model. Decisions related to the amount of contact with clients and other supportive functions were influenced by individual characteristics of the social workers. The results suggest that in child protection decision making, social workers are moving beyond a reliance on objective tools such as risk assessment to also use internalized subjective knowledge.

Child maltreatment investigations involving parents with cognitive impairments in Canada

The authors examined decision making and service referral in child maltreatment investigations involving children of parents with cognitive impairments using the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2003) core-data. The CIS-2003 includes process and outcome data on a total of 1,243 child investigations (n = 1,170 weighted) in which parental cognitive impairment was noted. Employing binary logistic regression analyses, the authors found that perceived parent noncooperation was the most potent predictor of court application. Alternative dispute resolution was rarely utilized. The findings from this study highlight the need for development and utilization of alternative dispute resolution strategies, worker training, dissemination of evidence-based parent training programs, and implementation of strategies to alleviate poverty and strengthen the social relationships of parents with cognitive impairments and promote a healthy start to life for their children.

Caseworker-perceived caregiver substance abuse and child protective services outcomes

The authors used data from the National Survey of Child and Adolescent Well-Being to examine associations of child protective services (CPS) caseworkers' perceptions of caregiver substance abuse with their perceptions of the severity of risk and harm a child experienced as a result of alleged maltreatment, as well as with whether a family experienced a range of CPS outcomes.The outcomes included whether the family received services from CPS, was substantiated for maltreatment, experienced child removal, and was subject to a termination of parental rights (TPR) petition. The authors also compared the magnitude of the association between caseworker-perceived caregiver substance abuse and each outcome to that of the association between other maltreatment-related risk factors and each outcome. Findings suggest that, all else equal, caseworker-perceived caregiver substance abuse is associated with increased caseworker perceptions that children have experienced severe risk and harm and also with an increased probability of each of the CPS outcomes except TPR. Moreover, these associations are equal in magnitude or larger than those between the other risk factors and the outcomes. These findings imply that CPS decisions are heavily influenced by caseworker perceptions of caregiver substance abuse, regardless of the presence of other risk factors for child maltreatment.

A review of social factors in the investigation and assessment of non-accidental head injury to children

Investigation and assessment work in non-accidental head injury cases is complex and challenging. This article discusses briefly the professional systems involved and the conditions necessary for effective practice. It then reviews briefly the literature on social factors in serious and fatal child abuse in order to provide a context for discussion of recent UK studies of non-accidental head injuries/shaken baby syndrome. The findings on social factors are compared and areas for further research are suggested. The article then considers how best to use the existing knowledge base about these cases within assessment frameworks currently in use and considers issues in presenting assessment conclusions to decision-makers.

Recognizing the co-occurrence of domestic and child abuse: a comparison of community- and hospital-based midwives

This study aimed to compare and contrast how midwives working in either hospital or community settings are currently responding to the co-occurrence of domestic and child abuse (CA), their perceived role and willingness to identify abuse, record keeping, reporting of suspected or definite cases of CA and training received. A survey questionnaire was sent to 861 hospital and community midwives throughout Northern Ireland which resulted in 488 midwives completing the questionnaire, leading to a 57% response rate. Comparisons were made using descriptive statistics and cross-tabulation, and the questionnaire was validated using exploratory factor analysis. Community midwives reported receiving more training on domestic and CA. Although a high percent of both hospital and community midwives acknowledged a link between domestic violence (DV) and CA, it was the community midwives who encountered more suspected and definite (P < 0.001) cases of CA. More community midwives reported to be aware of the mechanisms for reporting CA. However, an important finding is that although 12% of community midwives encountered a definite case of CA, only 2% reported the abuse, leaving a 10% gap between reporting and identifying definite cases of CA. Findings suggest that lack of education and training was a problem as only a quarter of hospital-based midwives reported to have received training on DV and 40% on CA. This was significantly less than that received by community midwives, as 57% received training on DV, and 62% on CA. The study suggests that midwives need training on how to interact with abused mothers using non-coercive, supportive and empowering mechanisms. Many women may not spontaneously disclose the issues of child or domestic abuse in their lives, but often respond honestly to a sensitively asked question. This issue is important as only 13% of the sample actually asked a woman a direct question about DV.

Managing societal and institutional risk in child protection

Public sector services have been reshaped by two interacting factors: the growing dominance of risk management and the growing demands for transparency and accountability. For the caring professions, these have provoked radical reform. Using the child protection service as a case study, this article explores the impact of the changes on a service that deals with conflicting risks and has a poorly articulated knowledge base. Drawing on Rothstein et al.'s distinction between societal and institutional risks, it is argued that difficulties in managing societal risks are creating serious institutional risks. The latter are then being prioritized in the way the system operates. The preoccupation with such risks has been translated into concerted efforts to formalize the work of front line practitioners to make it transparent and auditable. Although done, in part, with the good intention of spreading good practice standards, this formalization has gone beyond the evidenced knowledge base to the extent that it is creating a new picture of "good practice" that omits significant dimensions of work and is distinct from measures of children's safety or welfare. Moreover, the process of formalization acts as an impediment to knowledge development in disciplines where such learning is urgently needed.

Evaluation of documentation in potential abusive head injury of infants in a Paediatric Emergency Department

AIM

The aim is to evaluate medical record documentation regarding potential abusive head injury (AHI) in infants presenting to a Paediatric Emergency Department (ED) with certain primary complaints known to be associated with AHI.

METHODS

A database search was performed to find all medical records over a period of one year relating to those children who had one AHI-related primary complaint and who had had a CT head-scan performed in conjunction with admission. Each medical record was reviewed, in order to assess whether potential abuse had been investigated and documented. Each CT-scan image was re-evaluated for missed indications of potential injuries attributable to AHI.

RESULTS

Forty-seven such medical records were found. Of these, 87% showed the diagnosis to be head injuries. The largest group of children was in the age group 0-3 months (38%). Of the children admitted to the Paediatric ED due to a head injury, 54% had a history deemed to raise suspicions of abuse but only five of them had had a documented investigation of child abuse. The re-evaluation of the CT-scans showed no missed cases.

CONCLUSION

In this study we found that among children with known risk factors for AHI, only a few had documentation regarding potential child abuse. The use of a standardized protocol could be helpful in the important work to help staff discover potential AHI.

Caseworker assessments of risk for recurrent maltreatment: association with case-specific risk factors and re-reports

OBJECTIVE

This article focuses on caseworkers' assessments of risk of maltreatment recurrence among families in contact with social services. Specifically, the article has two primary goals: (1) to examine the association between caseworkers' risk assessments and demographic, child, parent and family-level risk factors; and (2) to examine agreement between caseworkers' risk assessments and any subsequent report, or reports, of maltreatment.

METHOD

Data are from the baseline, 12-month, and 18-month assessments of the National Survey for Child and Adolescent Well-Being (NSCAW), a nationally representative sample of youth and families who were the subjects of allegations of maltreatment investigated by child welfare agencies. The sample consisted of a subset of NSCAW participants: cases with a report of child physical abuse or neglect who were not placed in out-of-home care (N=2,139).

RESULTS

Analyses indicated that parent-level risk factors and a prior report of maltreatment were most strongly associated with caseworkers' assessments of risk for both physical abuse and neglect cases. A smaller set of factors, which varied by the type of maltreatment, were associated with a subsequent report of maltreatment. Despite some overlap in correlates of risk assessment and subsequent reports, analyses indicated that agreement between caseworkers' assessments of risk and re-reports was low.

CONCLUSIONS

Findings suggest that although caseworkers' assessments were associated with a limited set of risk factors from the literature, few of these factors also were associated with a recurrent report of maltreatment. Correspondence between caseworkers' assessments of risk and a subsequent report of maltreatment was low, suggesting that considerable work may be needed to improve accuracy and identification of cases most at risk.

PRACTICE IMPLICATIONS

This study provides information to assist caseworkers, administrators, and policymakers in thinking critically about risk assessment policies and procedures. Although caseworkers' assessments of risk were associated with some of the empirical predictors of recurrent maltreatment, their assessments were only slightly better than guessing. Agreement between caseworkers' risk assessments and actual subsequent reports was better for low-risk cases, but primarily because the majority of cases did not have a subsequent report during the study period. Clearly, considerable improvement in risk assessment is needed so that at-risk families can be better identified and the limited services available can be directed toward those most in need.

Risk and safety assessment in child welfare: instrument comparisons

The assessment of risk is a critical part of child welfare agency practice. This review of the research literature on different instruments for assessing risk and safety in child welfare focuses on instrument reliability, validity, outcomes, and use with children and families of color. The findings suggest that the current actuarial instruments have stronger predictive validity than consensus-based instruments. This review was limited by the variability in definitions and measures across studies, the relatively small number of studies examining risk assessment instruments, and the lack of studies on case decision points other than the initial investigation.

[Child sexual abuse]

The present paper gives an overview on the development of professional discourse on sexual abuse over the last 20 years in the field of child protection. After the introduction, definitions from different professional perspectives (civil law, criminal law, psychotherapy, counseling, etc.) are given. Based on these definitions an epidemiological range of prevalence figures is described. In the literature, rates ranging from 6 to 25 % in girls and 2 to 8 % in boy as victims of sexual abuse can be observed. Psychiatric consequences of sexual abuse are described based on an overview of the literature. Diagnostic approaches to posttraumatic problems are discussed and distinguished from obsolete measures. Some neurobiological findings are presented. Finally the foundations of counseling, psychotherapy and pharmacotherapy of behavioral of symptoms and PTSD are discussed on the bases of a literature review of controlled clinical trials. In conclusion, further developments in psychotherapy and research are discussed for the German practical child protection field.

Recognizing and reporting child physical abuse: a survey of primary healthcare professionals

AIM

This paper reports a study of the self-reported ability and behaviours of primary healthcare professionals in Northern Ireland to recognise child physical abuse. A secondary aim was to assess the educational and training needs of these professionals.

BACKGROUND

In the United Kingdom, 7% of children suffer serious physical abuse by a parent or carer, and two children aged under 15 years die from abuse each week. Recognizing child physical abuse depends on the knowledge and skills of a variety of healthcare professionals.

METHODS

A stratified random sample of 979 nurses, doctors, and dentists working in primary care in Northern Ireland were sent a postal questionnaire; 419 responded, giving a 43% response rate. The data were collected in 2002-2003.

FINDINGS

In their working lives 60% (251) said that they had seen a suspicious child physical abuse case; however, only 47% (201) had reported a suspicious case to the authorities, leaving a 13% gap in reporting. Although 74% (310) of respondents were aware of some of the mechanisms for reporting child physical abuse, 79% (332) requested further education on this topic. Ability to recognize and willingness to report abuse cases discriminated between the three professional groups. Compared with doctors or dentists, community nurses were statistically significantly more likely to recognize and report suspicions of child physical abuse, and were the group most aware of child abuse issues and the most willing to become involved in abuse cases.

CONCLUSIONS

The findings suggest that professional fears and anxieties and lack of knowledge act as barriers to recognizing and reporting abuse and that more specific education and support for primary care professionals is required.