Development of a screening tool enabling identification of infants and toddlers at risk of family abuse and neglect: a feasibility study from three South European countries

The Development of a Screening Tool for Childcare Professionals to Detect and Refer Infant and Toddler Maltreatment and Trauma: A Tale of Four Countries

Child maltreatment is considered a pressing social question, compromising the present and future mental and physical health of one in four children in Europe. While children younger than three years of age are especially vulnerable, few screening instruments are available for the detection of risk in this age group. The purpose of this research was to develop a screening tool for childcare professionals working in public and private daycare settings to support them in the early identification and referral of infants and toddlers exposed to emotional and physical abuse and neglect by primary caregivers, to be used in different settings across four European countries: Belgium, Italy, Latvia, and Hungary.

METHOD

A stratified process was used to create the screening tool: We started by using Living lab methodology to co-create the screening tool with its final users, which was followed by testing the tool with a total of 120 childcare professionals from the four participating countries.

RESULTS

During the Living Lab phase, a screening tool with three layers was developed. The initial layer includes five "red flags" that signal particular concern and require immediate action. The second layer is a quick screener with twelve items focused on four areas: neglect of basic needs, delays in development, unusual behaviors, and interaction with caregivers. The third layer is an in-depth questionnaire that aids in formalizing a thorough observation of twenty-five items within the same four areas as the quick screener. After a one-day training session, 120 childcare professionals caring for children aged 0-3 from four countries assessed the screening tool and their overall training experience. Childcare professionals reported great satisfaction with the three-layered structure, which made the tool versatile, and agreed on its content, which was considered helpful in the daycare setting for the regular evaluation of the behavior of children and their primary caregivers, thus improving the early observation of change from the normal behavior of the infant or toddler.

CONCLUSION

The three-layered screening tool was reported as feasible, practical, and with great content validity by childcare professionals working in four European countries.

Screening Tools for Child Abuse Used by Healthcare Providers: A Systematic Review

BACKGROUND

The early detection of child abuse is essential for children at risk. Healthcare professionals working at hospitals and in the community are often the first to encounter suspected cases of child abuse. Therefore, an accurate identification of child abuse is critical for intervention. However, there is no consensus on the best method to screen for child abuse.

PURPOSE

This systematic review was designed to evaluate the relevant psychometric properties and critically appraise the methodological quality of child abuse screening tools used by healthcare providers with children less than 18 years old.

METHODS

We searched the Cochrane Library, MEDLINE, Embase, CINAHL, Education Resources Information Center, PubMed, Airiti Library, and OpenGray databases for studies on screening tools used to identify abuse in children published through October 2019 in English or Chinese. Information regarding populations, assessment methods, and accuracy parameters were extracted. Study quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and Grading of Recommendation, Assessment, Development, and Evaluation criteria.

RESULTS

Nine hundred thirty-nine abstracts and 23 full-text articles were reviewed for eligibility, and 15 screening tools for child abuse used by healthcare providers were identified. Screening tools often assess the presence of more than one form of abuse, but no single tool covered all forms. Of these, 10 tools screened for a single, discrete type of abuse, including nine physical abuse screening tools (three abusive head trauma tools) and one sexual abuse tool. Eighty percent (n = 12) of the screening tools had a moderate-to-high quality of evidence based on the Grading of Recommendation, Assessment, Development, and Evaluation criteria. However, none of these screening tools achieved an adequate level of evidence based on the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

In this systematic literature review, 15 assessment tools of child abuse used by healthcare providers were identified, of which nine screened for physical abuse. Screening tools must be valid, succinct, user-friendly, and amenable for use with children at every point of care in the healthcare system. Because of the paucity of informative and practical studies in the literature, findings related to the quality of child abuse screening tools were inconclusive. Therefore, future research should focus on the use of screening tools in the healthcare system to identify effective screening interventions that may help healthcare providers identify child abuse cases as early as possible.

Development and content validation of an instrument to support pharmaceutical counselling for dispensing of prescribed medicines

RATIONALE, AIMS, AND OBJECTIVES

Counselling is essential in drug dispensing, since it enables patients to receive and understand the information to correctly use their medicines. Although counselling is a quality indicator on drug dispensing, models that guide pharmacists in this practice are scarce. Thus, this study aimed to develop and validate the content of an instrument to support pharmaceutical counselling for dispensing of prescribed medicines.

METHOD

A two-stage validation study was conducted out from February to October 2017. The first stage involved the development of the instrument, and the second involved content validation. Instrument development included the following three steps: (1) drafting of the prototype; (2) an academic brainstorming meeting, and (3) a pre-Delphi process. Content validation was then conducted using the Delphi technique. At this stage, 40 pharmacists who were experts in drug dispensing, were invited to assess the instrument. Consensus among experts was calculated according to the content validity index (CVI).

RESULTS

The development stage generated three versions of the instrument: the prototype, Version 1 (modified after brainstorming meeting), and Version 2 (modified after the pre-Delphi process). Version 2 underwent the content validation process, in which 29 pharmacists participated during the first round (rate of return: 72.5%) and 23 of these during the second round (rate of return: 79.31%). All items obtained CVI > 0.82 and were thus considered to be validated. The final instrument comprised three components: suggestions for questions, dispensing process reasoning, and suggestions for counselling, and other conduct in 11 stages, each representing a step in the clinical reasoning process.

CONCLUSIONS

An instrument was developed to support pharmaceutical counselling for dispensing of prescribed medicines, suggesting main questions, counselling, and conduct to be taken by pharmacists, and its content validity was verified.