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

"I got to say two or three lines"-A systematic review of children's participation in child protective services

BACKGROUND

Although children's right to participate in decisions that influence their lives is widely recognized, it is rarely present in the assessment and decision-making processes in child protective services (CPS).

OBJECTIVE

The aim of this systematic review was to examine children's views and experiences of participating in CPS cases of child abuse and neglect and to identify the gap in scientific knowledge.

METHODS

The systematic review follows the PRISMA statement and includes 13 peer-reviewed articles published in several academic journals from 2016 to 2023 reporting primary research with abused and neglected children registered in CPS.

RESULTS

Thematic analysis identified five main themes: participation: assessment and decision-making, information and understanding, interaction and relationships, children vs parents, and experience of younger children. The findings show that although a few children reported instances of meaningful participation, overall, children's participation was often reduced to a tokenistic engagement, with limited influence on the decision-making processes. Children, especially younger children, receive insufficient information and struggle to understand the proceedings. Examples of prioritizing parents' views, needs, and rights rather than centering the children's perspectives are reported.

CONCLUSIONS

The findings highlight a need for significant changes in how child participation is conceptualized and operationalized within CPS. Implications for practice, policy, and research are discussed to foster children's participation in CPS to contribute to the effective care and protection of children experiencing child abuse and neglect.

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.

A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response

Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents’ understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.