A model to evaluate interprofessional training effectiveness: feasibility and five-year outcomes of a multi-site prospective cohort study

OBJECTIVES

Assessing the impact of interdisciplinary training programs is highly desirable and needed. However, there are currently no established methods to prospectively assess long-term outcomes of trainees compared to individuals who did not receive training. Our objective was to test the feasibility of a longitudinal, prospective cohort design to evaluate training outcomes, and to use this method to evaluate Leadership Education in Neurodevelopmental Disabilities and Related Disorders (LEND) training outcomes.

METHODS

LEND trainees were matched to comparison peers and followed annually for up to five years using a pre-existing outcomes survey. We assessed study feasibility using recruitment and retention data over five years. We then looked at preliminary efficacy of LEND training in LEND trainees compared to comparison peers using the pre-existing outcomes survey.

RESULTS

Overall, 68.3% of eligible trainees participated in the Outcomes Study across five years, and 66.0% were matched to comparison peers. On average, 84.4% of LEND trainees and 79.9% of comparison peers completed the outcomes survey annually. Attrition was low at 0.9% for LEND trainees and 2.6% for comparison peers over five years. LEND training demonstrated preliminary efficacy in promoting leadership development: LEND trainees began their careers engaged in more leadership activities than comparison peers, and the rate of growth in their participation in leadership activities was greater.

CONCLUSIONS

The design used to assess outcomes is a feasible approach that can be widely used to assess training program outcomes. Analyses suggest that LEND training is efficacious in increasing involvement in leadership activities over time after graduation.

Community-based multi-professional child protection decision making: Systematic narrative review

BACKGROUND

Multi-professional approach to child protection decision making is widely promoted by service organisations, although the conditions for this to be effective are little known.

OBJECTIVE

This systematic narrative literature review explored empirical evidence on the implementation of multi-professional child protection decision making in community settings. Of particular interest were the contextual conditions upon which joint working is build (inputs), aspects of interactional functioning (mediators), and the results of working together (outputs).

PARTICIPANTS AND SETTING

Five electronic bibliographic databases were selected for the search. The review was restricted to articles published in peer-reviewed journals, in the English language for ten years, from 1st January 2010 to 31st December 2019. Of the 6934 studies retrieved, 30 studies undertaken in six countries were included.

METHODS

The systematic approach to literature reviewing utilised was 'Systematic Narrative Review'. This approach starts with clearly formulated questions, employs systematic, explicit, and replicable processes for searching the literature to retrieve research, retains quality appraisal limited to publications in peer-reviewed journals, and uses a narrative synthesis.

RESULTS

The analysis outlined key building blocks that form the structure for collaborative decision making and identified cognitive, relational, and behavioural interactional properties that occur when making decisions together. Limitations of the published literature hinder the ability of making robust inferences about outcomes of collaborative decision-making practice.

CONCLUSION

The article discusses the next steps for research and implications for policy and practice for promoting useful multi-professional working in child protection decision making in the community.

Intervening in domestic violence: interprofessional collaboration among social and health care professionals and the police

Encountering domestic violence victims, perpetrators and witnesses in the multiprofessional fields of health and social care and policing includes various challenges. Each professional group perceives domestic violence from its own perspective, linked to its position in the field, core tasks, institutional practices and organizational structures. In this study, we examine interprofessional collaboration among Finnish social and health care professionals and police officers, focusing on the practices and conceptions concerning domestic violence interventions. The data consists of 16 focus group interviews, involving a total of 67 interviewees from social and health care professions and the police. The results indicate that successful interprofessional collaboration requires comprehensive knowledge and education on domestic violence as a phenomenon, on the tasks and the duties of different professionals, as well as tolerance and flexibility in their joint efforts. However, the emphasis on professional relationships often shifts the focus from the institutional and structural challenges of interprofessional collaboration to individual interactions. Organizational barriers and differences in goals may impede good intentions from being materialized into concrete outcomes. These findings challenge all organizations and professionals working on domestic violence intervention to reconsider their training, practices and organizational arrangements.

Possible Factors Supporting Cross-Agency Collaboration in Child Abuse Cases: A Scoping Review

Cross-agency collaboration for responding to child abuse cases is critical for the safety and wellbeing of children. However, working effectively across organizational boundaries can be difficult, especially where there are considerable disciplinary differences. Accordingly, many jurisdictions have put in place policies and processes to support cross-agency collaboration across groups responding to severe child abuse. The aim of this scoping review was to highlight key factors that may influence the quality of cross-agency collaboration in severe child abuse cases. A systematic search comprising 57 empirical studies examining the facilitators and/or barriers to cross-agency collaboration in child abuse cases was undertaken identifying eleven factors. This review found the most commonly cited factor was the need to reconcile the different roles/mandates of workers with their roles in a cross-agency response. A clear cross-agency protocol that establishes agreed procedures was also a commonly cited factor, along with cross-agency training, and communication and information sharing practices. This scoping review highlighted the lack of high-quality evidence that could be used to assess the effectiveness of policies and processes to support cross-agency collaboration for child abuse cases, and targeted areas for future research to enhance the quality of evidence for this common type of program/intervention.

Safeguarding Capabilities in Preventing Child Sexual Abuse: Exploratory Factor Analysis of a Scale Measuring Safeguarding Capabilities in Youth-Serving Organizations Workers

Media reports and government enquiries have shone a spotlight on institutional child sexual abuse (CSA) globally. With youth-serving organizations seeking to identify how to improve policies and procedures developed to protect children, a gap exists in research and organizational quality assurance procedures. A new tool is needed to measure the capability of workers to implement and support effective child-safeguarding policies and practices. To address this, our aim was to develop the Safeguarding Capabilities in Preventing Child Sexual Abuse Scale. Participants (n = 345) from a range of youth-serving sectors in Australia answered 128 questions. Using exploratory factor analysis to assess the underlying factor structure and refine the item pool, items loaded onto four factors. Reliability coefficients ranged from .68 to .95. Results showed that knowledge, attitudes, self-efficacy to take action, and awareness are all key capabilities related to creating conditions of safety for children and young people and preventing CSA in youth-serving organizations.

Interdisciplinary Training Program (ITP) in child abuse and neglect: Long term effects

BACKGROUND

University of Oklahoma Health Sciences Center has offered Interdisciplinary Training Program (ITP) for Child Abuse and Neglect since 1987. However, there are limited evaluations on multidisciplinary/interprofessional training for early professionals in the field of child abuse and neglect.

OBJECTIVE

This study aimed to examine the effects of the ITP on young professionals in developing their careers and taking leadership roles in the field of child abuse and neglect.

METHODS

The anonymous online survey was conducted for students who completed in the ITP from 1989 to 2016 (n = 405, with contact information out of total 508 graduates). One hundred seventy nine alumni (44.2%) responded to the survey.

RESULTS

Satisfaction for the ITP was high (m = 9.3, sd = 0.97 on a 10 point scale with higher numbers being positive). Their current contributions to the field of child abuse and neglect were widely seen in child advocacy (43.0%), clinical treatment (39.1%), primary prevention (29.6%), or research (27.9%). Graduates reported they made 133 presentations to civic or professional groups and published 69 articles since they finished the ITP.

CONCLUSION

The ITP trainees have made significant contributions to the field in clinical treatment, research, and child advocacy. Alumni were highly satisfied with their experience and continue to see the importance of the ITP to their jobs and career.

At the Front Lines: Effectively Training Community Stakeholders to Recognize and Report Child Abuse and Neglect

In states with universal mandatory reporting of child abuse and neglect (CAN), it is essential that people who work with children and youth in a community be appropriately trained to recognize and report CAN. The primary goal of CAN training is early detection and intervention with a secondary purpose of impacting rates of violence, disease, drug use, and teen pregnancies in the community. The purpose of this project was to implement a standardized, community-tailored CAN training for laypersons and a train-the-trainer program in a rural Oklahoma community. The CAN training was evaluated on knowledge, confidence, training satisfaction, and willingness to participate in the train-the-trainer session. The train-the-trainer session was evaluated on confidence and training satisfaction. Participant knowledge and confidence was measured by comparing pretest scores to immediate and 4 months after the training posttest scores. Posttest scores indicated increase in knowledge at the posttest (p < .001) and posttest 2 (p < .001). There was a significant increase in confidence at the posttest (p < .001) and posttest 2 (p = .009).

A national survey of characteristics of child advocacy centers in the United States: Do the flagship models match those in broader practice?

Child Advocacy Centers (CAC) emphasize developing effective cross-agency collaborations between workers involved in serious abuse investigations to foster improvements in agency outcomes, and to minimize distress, confusion and uncertainty for children and families. This study examined the characteristics of CACs, whether models in practice match the predominant model presented in the research literature. Directors of CACs in the United States that were members of the National Children's Alliance (NCA) mailing list (n=361) completed an online survey in 2016. While some core characteristics were ubiquitous across CACs, the data suggests that different types of CACs exist defined by characteristics that are not prescribed under NCA principles, but which are arguably relevant to the quality of the response. From the results of a cluster analysis, the researchers propose a typology of CACs that reflects the development and integration of centers: (a) core CAC services (i.e. interviewing & cross-agency case review); (b) an aggregator of external services, and (c) a more centralized full-service CAC. Further research is needed to understand how these variations may impact practice and outcomes; this is particularly important considering many CACs do not match the full-service models most commonly examined in the research literature, which limits the degree to which these findings apply to CACs generally. This article proposes further research framed by the need to better understand how different parts of the response impact on outcomes for children and families affected by abuse.

A Review and Assessment of Intimate Partner Violence Interventions and Trainings for Service Providers and Frontline Staff

Despite a long history of various service providers' interactions with the survivors of intimate partner violence (IPV), previous reviews of interventions for service providers addressing IPV have only focused on those employed in medical settings. This review closely examines evidence related to interventions for service providers and frontline staff in nonmedical settings to identify effective interventions to address IPV and assist IPV survivors. Using explicit criteria, 16 studies were included in this review. This review offers a synthesis of the 16 studies by illuminating types of the interventions, outcomes and their effectiveness, settings of the interventions, and their quality of design. Specific implications are discussed to guide future practice, research, and policy.

Training on domestic violence and child safeguarding in general practice: a mixed method evaluation of a pilot intervention

Background

Children’s exposure to domestic violence is a type of child maltreatment, yet many general practice clinicians remain uncertain of their child safeguarding responsibilities in the context of domestic violence. We developed an evidence-based pilot training on domestic violence and child safeguarding for general practice teams. The aim of this study was to test and evaluate its feasibility, acceptability and the direction of change in short-term outcome measures.

Methods

We used a mixed method design which included a pre-post questionnaire survey, qualitative analysis of free-text comments, training observations, and post-training interviews with trainers and participants. The questionnaire survey used a validated scale to measure participants’ knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding in the context of domestic violence.

Results

Eleven UK general practices were recruited (response rate 55%) and 88 clinicians attended the pilot training. Thirty-seven participants (42%) completed all pre-post questionnaires and nine were interviewed. All training sessions were observed. All six trainers were interviewed. General practice clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by local trainers from both health and children’s social services. The training elicited positive changes in total outcome score and knowledge and confidence/ self-efficacy sub scores which remained at 3-month follow up. However, the mean sub score of beliefs and attitudes did not change and the qualitative results were mixed. Two interviewees described changes in their clinical practice. Participants’ suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple socio economic disadvantages, and addressing multi-agency collaboration in the context of changing and under-resourced services for children.

Conclusions

The pilot training for general practice on child safeguarding in the context of domestic violence was feasible and acceptable. It elicited positive changes in clinicians’ knowledge and confidence/ self-esteem. The extent to which clinical behaviour changed is unclear, but there are indications of changes in practice by some clinicians. The pilot training requires further refinement and evaluation before implementation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-017-0603-7) contains supplementary material, which is available to authorized users.

Interventions to Improve the Response of Professionals to Children Exposed to Domestic Violence and Abuse: A Systematic Review

Exposure of children to domestic violence and abuse (DVA) is a form of child maltreatment with short- and long-term behavioural and mental health impact. Health care professionals are generally uncertain about how to respond to domestic violence and are particularly unclear about best practice with regards to children's exposure and their role in a multiagency response. In this systematic review, we report educational and structural or whole-system interventions that aim to improve professionals' understanding of, and response to, DVA survivors and their children. We searched 22 bibliographic databases and contacted topic experts for studies reporting quantitative outcomes for any type of intervention aiming to improve professional responses to disclosure of DVA with child involvement. We included interventions for physicians, nurses, social workers and teachers. Twenty-one studies met the inclusion criteria: three randomised controlled trials (RCTs), 18 pre-post intervention surveys. There were 18 training and three system-level interventions. Training interventions generally had positive effects on participants' knowledge, attitudes towards DVA and clinical competence. The results from the RCTs were consistent with the before-after surveys. Results from system-level interventions aimed to change organisational practice and inter-organisational collaboration demonstrates the benefit of coordinating system change in child welfare agencies with primary health care and other organisations. Implications for policy and research are discussed. © 2015 The Authors. Child Abuse Review published by John Wiley & Sons Ltd. 'We searched 22 bibliographic databases and contacted topic experts'.

KEY PRACTITIONER MESSAGES

We reviewed published evidence on interventions aimed at improving professionals' practice with domestic violence survivors and their children.Training programmes were found to improve participants' knowledge, attitudes and clinical competence up to a year after delivery.Key elements of successful training include interactive discussion, booster sessions and involving specialist domestic violence practitioners.Whole-system approaches aiming to promote coordination and collaboration across agencies appear promising but require funding and high levels of commitment from partners. 'Training programmes were found to improve participants' knowledge, attitudes and clinical competence up to a year after delivery'.