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

The mediating role of nurses' attitude towards reporting child abuse and neglect

PURPOSE

Attitudes towards reporting child abuse and neglect play a significant role in determining the tendency to report abuse and neglect. In addition, Cognitive Response Theory (Shen, 2020) suggests that individuals actively process messages by producing pro and/or counter arguments referred to as "Gain - loss thoughts". However, literature positioning the variable, attitudes towards reporting, as a mediator, as well as its importance, are limited. The purpose of the study was to investigate the mediating effect of pediatric nurses' attitudes between "gain-loss thoughts" and the tendency to report child abuse and neglect.

DESIGN AND METHODS

A cross-sectional study examined 124 pediatric nurses working in central Israel's hospital departments concerning nurses' tendency to report (tendency to report = TTR), attitudes towards reporting, and "gain-loss thoughts" (positive and negative consequences for the child).

RESULTS

Most of the nurses had professional experience of 11 years or more (n = 75; 62.5%). According to the findings, nurses' attitudes towards reporting mediate the effect of gain-loss on the TTR child abuse and neglect.

CONCLUSIONS

Findings from this study contributed to our understanding of the importance of pediatric nurses' attitudes in determining the TTR abuse and neglect. Only nurses' positive attitudes towards reporting child abuse had a mediating effect on TTR.

PRACTICE IMPLICATIONS

Understanding the importance of attitudes and gain-loss thoughts can serve as a strategy for training programs and in the assimilation of reporting obligations by health professionals in general and nurses in particular.

Detecting and preventing child maltreatment in primary care and PHNs' role-a cross-sectional study

BACKGROUND

Child maltreatment is a global problem that puts children at risk of mental illness, substance abuse, and premature death. Interdisciplinary collaboration is important in preventing and detecting child maltreatment. In Norway, children undergo universal preventive health assessments and receive complimentary follow-up care from specialized public health nurses in child and family health clinics. These nurses conduct regular check-ups and home visits to monitor children for signs of maltreatment.

OBJECTIVE

The objective of this study is to describe how public health nurses at child and family health clinics follow the National Clinical Guidelines to prevent and detect child maltreatment, with a particular focus on clinical procedures and interdisciplinary collaboration. Furthermore, we aim to determine factors that are associated with identification of child maltreatment.

DESIGN

A cross-sectional online survey was conducted among public health nurses working in primary care between October 24th and December 31st, 2022. Public health nurses who worked with children aged 0-5 years and had consultations with families were eligible to participate, resulting in 554 responses. The study employed descriptive analysis, including frequency, percentage and mean, as well as a two-step logistic regression analysis. The study was approved by the relevant authority, and informed consent was obtained through questionnaire completion.

RESULTS

The public health nurses in this study displayed strong adherence to the guidelines and utilized various comprehensive assessment procedures to monitor child well-being, growth, and development. However, there was limited and infrequent collaboration with other professionals, such as child protection services, general practitioners, and hospitals. Most public health nurses reported occasional suspicion of child maltreatment, with age and years of experience in child and family clinics influencing these suspicions. Older public health nurses were more likely to suspect physical violence, while those with less than two years of experience reported less experience in suspecting maltreatment. Additional education increased the probability of suspecting sexual violence.

CONCLUSIONS

This study provides insights into the practices of public health nurses in Norway regarding the detection and prevention of child maltreatment in child and family clinics. While adherence to guidelines is strong, suspicion of maltreatment is relatively rare. Collaboration across agencies is crucial in addressing child maltreatment. Age and experience may influence the detection of maltreatment. Improved collaboration, targeted guidelines, and ongoing professional development are needed to enhance child protection.

Reasons police respond in schools: An analysis of narrative data from police incident reports

BACKGROUND

Communities across the U.S. have acted to eliminate or curb police presence in schools. These efforts have primarily focused on School Resource Officers. However, school staff also call upon local police to respond in their buildings, for example by calling 911. The reasons that police are called upon to respond in schools has rarely been studied.

OBJECTIVE

The current study aimed to identify the primary reasons that local police were asked to respond to incidents in one urban school district, and the outcomes of those responses.

PARTICIPANTS AND SETTING

We analyzed 882 police incident report narratives, selected from a stratified sample of 57 schools in one urban school district during the 2017-18 school year. Incident reports, which were written by officers responding in schools, included narrative descriptions of officer intervention, the events precipitating police involvement, and outcomes of incidents.

METHODS

By coding incident report narratives, we identified categories describing the reasons for police response to events in schools and the outcomes of those events.

RESULTS

Most incident reports originating from school addresses (n = 730; 82.8 %) involved students. Among those reports, police most frequently responded to instances of sexual physical violence (17.5 %), physical assault (15.8 %), dysregulated behavior (11.2 %), threatening language (10.8 %), and threat of or actual school violence (4.4 %). Incidents involving students most often resulted in: (1) parents/guardians being contacted (57.3 %), (2) schools engaging in disciplinary actions (39.7 %) or school safety actions (27.0 %), and (3) child maltreatment reports being made to Crimes Against Children (a subdivision of the police department focused on child maltreatment; 26.0 %) or to the Department of Children and Families (26.2 %).

CONCLUSIONS

Findings indicate that many events leading to police responses in schools are related to maltreatment and behavioral health. These events rarely result in a criminal justice response, and most often result in action by families and schools (e.g., contacting parents/guardians, school disciplinary/safety actions), and filed reports of maltreatment. Additional supports in these areas may have the potential to reduce the perceived need to call upon police and to provide more direct access to services for students.

Processes of Multiprofessional Child Protection Decision Making in Hospital Settings: Systematic Narrative Review

The aim of this systematic narrative literature review is to explore empirical evidence as to how a multiprofessional approach to child protection decision making is implemented in hospitals settings. Child protection cases where there is a suspicious serious injury suspected sexual abuse or serious neglect are often investigated in hospital, involving a number of relevant professions. Five electronic bibliographic databases were used for the search. To be included in the review studies had to be published in a peer-reviewed journal, report on empirical research, be available full text in English, and have used an identifiable research design. The search was restricted to 10 years, from January 1, 2010, to December 31, 2019, and retrieved 6,934 studies. The review includes 26 studies undertaken in 10 countries. In all the hospital-based settings studied, child protection decision-making tasks were assigned to a designated multiprofessional team. However, there was remarkable diversity in models of team structure, regulation of workflow, structured procedures, and standardized tools through which practice was carried out. Research focused on evaluating the teams' effectiveness in fulfilling their duties which were, first and foremost, the identification of possible child maltreatment. The analysis identifies various systemic approaches and quality improvement methods to promote effective team-based decision-making processes in hospitals. The interactional aspect of collaborative team-based practice was generally missing from the published research. This article discusses next steps for the development of practice, policy, and research to enhance useful multiprofessional child protection team working in hospitals.

Judgements of physicians, nurses, and social workers regarding suspected Child maltreatment in community health care services

This study investigated how physicians, nurses, and social workers in community health care services make judgements about possible child maltreatment in ambiguous situations. We examined the influences of social biases (i.e., perceptions linking ethnicity, gender, and family socioeconomic status to child maltreatment) and belonging to distinctive occupational groups (i.e., physicians, nurses, and social workers) on professionals' assessment of suspected child maltreatment, intention to consult with others, and reporting. We used an experimental survey design including vignettes presenting a child's history inspired by real-life clinical cases. Data were collected from 397 health care professionals-170 physicians, 179 nurses, and 48 social workers-employed at community health care clinics in northern Israel. Findings show that the child's gender and family socioeconomic status had significant effects on assessment of possible child maltreatment. Also, professionals' occupational group had significant effects on assessment of child maltreatment and intention to pursue consultation. Another key finding was the significant effects of judgements about child maltreatment assessment, consultation, and reporting on one another. The study reinforces efforts to improve health care professionals' management of suspected child maltreatment that include the development of clinical decision support systems that use routinely collected electronic medical record data.

Mechanisms of Inequity: The Impact of Instrumental Biases in the Child Protection System

The structural risk perspective conceptualizes the causes of inequities in child protection system contact as unequal exposure to the structural causes of child abuse risk, combined with biases in the responses of child welfare workers and reporters. This conceptual article proposes a third mechanism of inequity: instrumental biases. It is proposed that instrumental biases operate as a third group of mechanisms that inequitably increase the involvement of some groups and not others. Instrumental biases operate through institutional structures, interpretive concepts and risk proxies that affect how risk is coded and becomes attached to particular people. Against the background of the notify-investigate model that creates poor conditions for decision making, and shapes institutional structures, instrumental biases include the miscalibration of the demand and supply of services (an institutional cause); family-specific surveillance bias and a reliance on prior case histories (a risk proxy cause); widening legal definitions of serious harm (an interpretive concept cause); and complex responses to intimate partner violence that minimize theories of IPV and the social context it occurs within (concept and risk proxy causes). It is argued that within the decision-making context of the child protection system, how services are structured and risk becomes codified has disproportionate impacts on some communities compared to others. Examples from Aotearoa New Zealand, with reference to Māori and people living in high-deprivation areas, are used to illustrate these concepts.

An Ecological Model for High-Risk Professional Decision-Making in Mental Health: International Perspectives

Mental health professionals are frequently presented with situations in which they must assess the risk that a client will cause harm to themselves or others. Troublingly, however, predictions of risk are remarkably inaccurate even when made by those who are highly skilled and highly trained. Consequently, many jurisdictions have moved to impose standardized decision-making tools aimed at improving outcomes. Using a decision-making ecology framework, this conceptual paper presents research on professional decision-making in situations of risk, using qualitative, survey, and experimental designs conducted in three countries. Results reveal that while risk assessment tools focus on client factors that contribute to the risk of harm to self or others, the nature of professional decision-making is far more complex. That is, the manner in which professionals interpret and describe features of the client and their situation, is influenced by the worker's own personal and professional experiences, and the organizational and societal context in which they are located. Although part of the rationale of standardized approaches is to reduce complexity, our collective work demonstrates that the power of personal and social processes to shape decision-making often overwhelm the intention to simplify and standardize. Implications for policy and practice are discussed.