Consensus building on definitions and types of child maltreatment to improve recording and surveillance in Europe: protocol for a multi-sectoral, European, electronic Delphi study.

INTRODUCTION: Child maltreatment (CM) is a complex global public health issue with potentially devastating effects on individuals' physical and mental health and well-being throughout the life course. A lack of uniform definitions hinders attempts to identify, measure, respond to, and prevent CM. The aim of this electronic Delphi (e-Delphi) study is to build consensus on definitions and types of CM for use in surveillance and multi-sectoral research in the 34 countries in the Euro-CAN (Multi-Sectoral Responses to Child Abuse and Neglect in Europe) project (COST Action CA19106). METHODS AND ANALYSIS: The e-Delphi study will consist of a maximum of three rounds conducted using an online data collection platform. A multi-disciplinary expert panel consisting of researchers, child protection professionals (health and social care), police, legal professionals and adult survivors of CM will be purposefully recruited. We will approach approximately 100 experts, with between 50 and 60 of these anticipated to take part. Participants will rate their agreement with a range of statements relating to operational definitions and types of CM, and free-text comments on each of the statements to give further detail about their responses and areas of uncertainty. Consensus has been defined a priori as ≥70% of the panel agreeing or disagreeing with the statement after the final round. The responses to the open-ended questions will be analysed using a 'codebook' approach to thematic analysis, and used to refine the statements between rounds where no consensus is reached. ETHICS AND DISSEMINATION: Ethical approval has been granted from the Cardiff University School of Medicine ethics committee (reference number SMREC22/96). Results will be submitted for publication in a peer-reviewed journal and presented at workshops (including for the participants) and international academic conferences. The Euro-CAN network will also be used to disseminate the results, with results briefings and presentations to key public health and other relevant organisations in the field.

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.

Understanding health outcomes following workplace aggression: A social exchange perspective.

This study explored health outcomes following workplace aggression among social workers in Israel. Grounded in the social exchange theory, a relationship-based perspective was used to explain the mechanism through which exposure to workplace aggression results in employee outcomes. Reports of employees and managers were analysed with respect to the impact of varied forms of aggressive behaviours perpetrated by clients and co-workers on posttraumatic stress and somatic symptoms. The intervening effects on symptoms of two forms of perceived organisational support, organisational procedural support and interpersonal co-worker support operationalised as team trust were examined. Overall, 548 employees and 89 managers in 31 social services departments completed self-report questionnaires. Results revealed positive associations between exposure to both co-worker and client aggression, and posttraumatic stress and somatic symptoms. Importantly, while perceived organisational support is often equated with social support, this study found that two elements, organisational procedural support and team trust, had differing impacts on somatic and posttraumatic stress symptoms following WPA. Specifically, team trust was negatively associated with symptoms, while organisational procedural support showed no effect. This study has important implications for timely prevention measures to deal with workplace aggressions and valuable directions for future studies.

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.

Applying intersectionality theory to understand female Arab art-therapists' experiences with child maltreatment mandatory reporting.

This study moved away from the usual empirical and moral discussion about all-encompassing child maltreatment mandatory reporting outcomes toward a much more detailed and nuanced investigation of its implementation in a minority group. We focused on female Arab art-therapists in Israel working in their community. Twelve female Arab art-therapists participated in semi-structured interviews. Data were analysed using grounded theory. Participants' extreme vulnerability was an emergent quality of analysis and facilitated intersectional framing to account for the findings. The convergence of gender, ethno-culture and occupational status constituted unique obstacles to reporting. Participants described an array of systemic barriers to reporting, some of which could jeopardise their safety and that of their family and job. They raised doubts about the benefits of reporting outweighing the harm. Creating a climate in which reporting is possible and acceptable is the responsibility of the society, rather than that of individuals.

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.

Mandatory reporting between legal requirements and personal interpretations: Community healthcare professionals' reporting of child maltreatment.

BACKGROUND: Healthcare professionals working at community-based services have a crucial position in raising concerns about possible child maltreatment. Yet, barriers exist to healthcare professionals adhering to mandatory reporting rules and regulations. OBJECTIVE: The current study investigated the various forms by which healthcare professionals working in community services manage mandatory reporting, their reasoning and experience with formal requirements. The study has utilized the decision-making-ecology model as a conceptual framework. PARTICIPANTS AND SETTING: The study was carried out in the largest district of the largest health-management organization in Israel, across fourteen sites located at seven cities. Eighteen healthcare professionals of various occupational groups participated in in-depth semi-structured interviews. RESULTS: The results reveal that out of the of 52 recent cases that have been suspected for possible child maltreatment, only 58 % were reported as legally required. Yet, about half were reported in delay. Practitioners were more likely to report after additional evidence accumulated and increased the level of suspicion or after failing to manage the issue by other means of support. The analysis identified multiple factors that combined to impact the decision-making regarding reporting. Those were clustered around the individual case, healthcare professional, organizational setting, and external context. CONCLUSIONS: Our results emphasize the importance of workplace-environmental conditions in promoting optimal reporting behaviors, including working in multi-disciplinary teams, availability of rapid expert consultation, provision of emotional-support, and reciprocal exchange of information with child-protection-services.

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.