Outcomes and outputs affiliated with Children's Advocacy Centers in the United States: A scoping review.

BACKGROUND: The Children's Advocacy Center (CAC) model is the predominant multidisciplinary model that responds to child sexual abuse (CSA) in the United States (US). While the CAC model has made important contributions in case coordination and referrals for specialty services, little is known about child- or family-oriented outcomes. OBJECTIVE: Explore the trends and gaps involving outcome and output measures affiliated with CACs in the US. PARTICIPANTS & SETTING: A scoping review of the literature was conducted on English language articles published between 1985-2019 that involved CACs and children less than 18 years of age. METHODS: An electronic database search using the terms "Children's Advocacy Center(s)," "Child Advocacy Center(s)," and "CAC(s)" identified titles and abstracts. Data from articles selected for full text review were evaluated by a multidisciplinary team using a mixed methods approach. RESULTS: Measures of CAC impact frequently focus on service and programmatic outputs with person-centered outcomes left often reported. The most prevalent output measures related to case prosecution and forensic interviews. Person-centered outcomes most commonly emphasized child mental health and caregiver satisfaction. The majority of articles were limited by weak or unspecified study designs. CONCLUSION: The current literature on CACs suggests that while they are successful in coordinating services and facilitating referrals, little is known about how engagement with CACs impacts short- and long-term outcomes for children and families. Further research beyond cross sectional or quasi-experimental designs is necessary to better understand how variability in CAC structure, function, and resources can be optimized to meet the needs of the diverse communities that they serve. This is especially salient given the national dissemination of the CAC model. Without such additional studies, knowledge will remain limited regarding the enduring impacts of CACs on the lives of those impacted by CSA.

Prevalence and context of firearms-related problems in child protective service investigations.

BACKGROUND: Despite the significance of firearm safety, we need additional data to understand the prevalence and context surrounding firearm-related problems within the child welfare system. OBJECTIVE: Estimate proportion of cases reporting a firearm-related problem during case initiation and the contexts in which these problems exist. SAMPLE AND SETTING: 75,809 caseworker-written investigation summaries that represented all substantiated referrals of maltreatment in Michigan from 2015 to 2017. METHODS: We developed an expert dictionary of firearm-related terms to search investigation summaries. We retrieved summaries that contained any of the terms to confirm whether a firearm was present (construct accurate) and whether it posed a threat to the child. Finally, we coded summaries that contained firearm-related problems to identify contexts in which problems exist. RESULTS: Of the 75,809 substantiated cases, the dictionary flagged 2397 cases that used a firearm term (3.2 %), with a construct accuracy rate of 96 %. Among construct accurate cases, 79 % contained a firearm-related problem. The most common intent for a firearm-related problem was violence against a person (45 %). The co-occurrence of domestic violence and/or substance use with a firearm-related problem was high (41 % and 48 %, respectively). 49 % of summaries that contained a firearm-related problem did not provide information regarding storage. CONCLUSION: When caseworkers document a firearm within investigative summaries, a firearm-related risk to the child likely exists. Improved documentation of firearms and storage practices among investigated families may better identify families needing firearm-related services.

Possibilities of dissemination of specialist knowledge and acting capacity in the field of child protection in medicine: a qualitative survey.

Objective: The shortage of skilled workers and overloaded schedules make further training of health professionals difficult. In addition, child protection is not a systematic part of medical studies. The evaluation of an online course on child protection in medicine reveals positive feedback but also that the main reason for participants aborting the course is lack of time. Dissemination, as an active, targeted spreading of knowledge, can help to further spread knowledge about child protection in the target group. The aim of this article is to investigate whether and how the contents of the online course can be disseminated by professionals who have completed the online course. Methodology: The data were collected through a quantitative online evaluation and qualitative telephone interviews with doctors who had completed the online course and evaluated it using an interpretive-reductive analysis. Results: The respondents consider the need for further training and dissemination measures on the topic of child protection in medicine to be high. However, lack of time and insufficient relevance of the topic would present obstacles in the implementation of such measures. Meaningfulness and time off work or remuneration would in turn create incentives for implementation. Participants in dissemination measures could be motivated for example by further education points. In addition we were able to identify possible approaches for the implementation of such measures. Conclusion: Various parameters influence the motivation of doctors regarding the implementation/perception of dissemination measures. Based on these, recommendations for action are given for different areas of the health care system, such as supplementing the training curricula and providing ready-made materials for dissemination.

Tipping the Scales: Factors Influencing the Decision to Report Child Maltreatment in Primary Care.

Child maltreatment (CM) is an important public health issue linked to significant physical and mental health complications across the life span. Given the association between CM and health, general practitioners (GPs) and primary care nurses (PNs) are well-placed to identify and respond to this issue and are mandated to report suspected CM in many jurisdictions. Research has found that primary care doctors and nurses need support when responding to CM. This scoping review sought to answer the following question: What factors influence GPs and PNs decision to report CM when fulfilling their mandatory reporting duty? By exploring these factors, areas where support is needed were pinpointed. A systematic search was run across four databases: Medline (Ovid), PsycINFO, Embase, and CINAHL. Articles that reported on studies conducted in a location that had mandatory reporting legislation specific to CM and had a study population sampled from primary care were included in analysis. Thirty-three articles met the inclusion criteria. This review found that four principal factors influenced the decision to report CM: personal threshold of suspicion of abuse, relationship with the family, faith in the child protection system, and education and discussion. We conclude that improving the support and training to address these four areas may be beneficial for GPs and PNs in responding to CM.

Intensive Family Preservation Services to prevent out-of-home placement of children: A systematic review and meta-analysis.

BACKGROUND: Intensive Family Preservation Services (IFPS) are in-home crisis intervention services designed to help families with children at imminent risk of out-of-home placement. OBJECTIVES: To assess the evidence of the effectiveness and cost-effectiveness of IFPS in reducing the need for children to enter out-of-home care. PARTICIPANTS AND SETTING: Children <18 years and their families in the home setting. METHODS: A systematic review and meta-analysis was carried out by searching 12 databases and 16 websites for publications up to January 2019. RESULTS: 1948 potentially relevant papers were identified, of which 37 papers, relating to 33 studies, met our inclusion criteria. Studies reported outcomes at child or family level. There were significant reductions in relative risk (RR) of out-of-home placements in children who received IFPS compared with controls at child level at three, six, 12 and 24 months' follow-up (RR 0.57, 95 % CI 0.35 to 0.93, RR 0.51, 95 % CI 0.27 to 0.96, RR 0.60, 95 % CI 0.48 to 0.76, RR 0.51, 95 % CI 0.30 to 0.87 respectively). At family level, there was not a significant reduction in RR of placement. Economic evidence was limited to cost analyses or cost-cost offset analyses. CONCLUSION: The available evidence, at child level, suggests that IFPS are effective in preventing children from entering care up to 24 months after the intervention. Placement outcomes reported at family level did not demonstrate a significant reduction in out-of-home placements. The economic analyses suggest that IFPS could be cost-saving; however, evidence of cost-effectiveness generated by full economic evaluations is needed.

Sleep Problems, Daily Napping Behavior, and Social-Emotional Functioning among Young Children from Families Referred to Child Protective Services.

OBJECTIVE/BACKGROUND: Insufficient and/or poor-quality sleep may contribute to poor social-emotional well-being, and vice versa, among young children who have experienced maltreatment. This study examined longitudinal associations between sleep and social-emotional functioning among a sample of infants and toddlers from families involved with Child Protective Services (CPS) for maltreatment. PARTICIPANTS: Participants were 123 parents and their infant or toddler (baseline age 10 to 24 months) from families referred to CPS for maltreatment. METHODS: Data were collected at baseline and at 3, 6 and 9 months post-baseline. At all time points, parents completed a questionnaire about their child's social-emotional functioning including internalizing behavior, externalizing behavior, and competence in social-emotional skills and social relatedness. At 3 months post-baseline, parents reported about their child's sleep problems and daily napping behavior. RESULTS: Higher baseline externalizing behavior was associated with a greater propensity for sleep problems at 3 months post-baseline. Sleep problems at 3 months post-baseline were associated with higher internalizing and higher externalizing behavior at 9 months post-baseline. Daily napping at 3 months post-baseline was associated with lower internalizing behavior, lower externalizing behavior, and higher competence at 9 months post-baseline. CONCLUSIONS: Among this sample of young children from families involved with CPS for maltreatment, parents' concerns about their child having a sleep problem longitudinally associated with children's internalizing and externalizing behavior. Children's daily napping behavior longitudinally associated with later internalizing behavior, externalizing behavior, and competence.

Lessons from the field: An evidence-informed resiliency model for child abuse organizations.

BACKGROUND: Child abuse organizations are keenly aware of the impact helping abused and neglected children has on the people who do that work. In their efforts to address this issue, they look to their colleagues for recommendations on what works. Of particular value is testimony from those who have used evidence-informed programs to mitigate the impact on staff, so services to children do not suffer. OBJECTIVE, PARTICIPANTS AND SETTING, RESULTS: The Resiliency Project provided that evidence-informed program, one that was developed for and by the child abuse field in 2009. With funding from the Office for Victims of Crime, The University of Texas at Austin team of researchers, educators and practitioners developed the Organizational Resiliency Model (ORM) specifically for the child abuse field. The model draws from research on strengths individuals who are resilient have, and offers strategies for organizations to use to build resiliency in their staff. The ORM was piloted with 24 leaders from the field, including children's advocacy centers (CACs); court-appointed special advocate (CASA) programs; and government-based child welfare agencies. This article reviews the research basis for the ORM and new research supporting the model, and offers lessons learned through structured interviews with 10 child abuse leaders who piloted the ORM and continue to use it ten years later. CONCLUSIONS: Using the ORM, based on evidence available at the time, supported by new research and attested to by child abuse leaders who have sustained the model in their organizations, can promote a healthy and resilient workforce.

What is known about the LGBTQ perspective in child welfare services? A scoping review protocol.

INTRODUCTION: In previous studies, it is estimated that sexual minorities (eg, lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals) are overrepresented in the child welfare system. However, the numbers are unclear, and there are limited studies in this field. No systematic review of LGBTQ issues across a broader context (ie, youth, foster parents and service providers) of child welfare services exists. The overall objective of this scoping review is to systematically scope the existing research on LGBTQ issues in the context of child welfare services, including policy, practice, service providers and users' perspectives. METHODS AND ANALYSIS: The scoping review framework outlined by the Joanna Briggs Institute (JBI) based on previous work by Arksey and O'Malley and Levac and colleagues will guide this review. In addition, the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation will be used throughout the process. We will search electronic databases (PubMed, EMBASE, PsycINFO, Web of Science and Idunn) and grey literature sources to identify studies that are appropriate for inclusion in this review. Using inclusion and exclusion criteria based on the 'Population-Concept-Context' framework, two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Any qualitative, quantitative and mixed-method study of LGBTQ issues in the child welfare context will be described and synthesised using a thematic synthesis approach. ETHICS AND DISSEMINATION: A scoping review is a secondary analysis of published literature and does not require ethics approval. This scoping review is meant to provide an overview of the existing literature, aiming to expand policy-makers' and practitioners' knowledge of LGBTQ issues in a child welfare context and identify research gaps that can be used as a basis for further research. The results will be disseminated through a peer-reviewed publication, a conference presentation and a presentation to the key stakeholders.

Improving Information Sharing for Youth in Foster Care.

There are ∼443 000 children in child protective custody (ie, foster care) in the United States. Children in protective custody have more medical, behavioral, and developmental problems that require health care services than the general population. These health problems are compounded by poor information exchange impeding care coordination. Health care providers often do not know which of their patients are in protective custody and are not privy to the critical social history collected by child protective services, including placement history and maltreatment history. Meanwhile, the custodial child protection agency and designated caregivers (ie, foster caregivers and kinship providers) often lack vital elements of the health history of children in their care, which can result in poor health care delivery such as medication lapses, immunization delay, and poor chronic disease management. In this case study, we address this critical component of health care delivery for a vulnerable population by describing a process of developing an information sharing system between health care and child welfare organizations in collaboration with child protection community partners. Lessons learned include recommended steps for improved information sharing: (1) develop shared community vision, (2) determine shareable information components, (3) implement and analyze information sharing approaches, and (4) evaluate information sharing efforts. A successful example of advocating for improvement of information sharing for youth in protective custody is explored to highlight these steps. In collaboration with child protective services, pediatricians can improve information sharing to impact both health care delivery and child protection outcomes.

Private vs public child welfare systems: A comparative analysis of national safety outcome performance.

BACKGROUND: Ensuring the safety of American children is one of the chief mandates of the U.S. Child Welfare System. Yet system differences, including privatization remain an area of concern for whether safety of children is achieved. OBJECTIVE: This study examined the effect of privatization policy on the performance of state child welfare systems in terms of achieving national safety outcome standards. PARTICIPANTS AND SETTING: N1 = 10 states systems (5 privatized and 5 public systems) with N2 = 118,761 foster care cases located throughout the U.S. METHOD: Using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS), safety outcome performance measures were assessed, as were child-/case factors to predict the likelihood of the system types meeting the national safety outcome standards. RESULTS: Logistic regression models of child, case, and system factors predicting the likelihood state systems met national safety outcome performance standards were statistically significant. Private systems, compared to non-private systems, were found to have lower odds of meeting the safety outcome 1 standard (OR = 0.41, 95% CI = 0.40-0.42), but greater odds of meeting the safety outcome 2 standard (OR = 6.79, 95% CI = 6.56-7.02). CONCLUSIONS: The implementation of privatization policy in state child welfare/foster care service delivery was found to have mixed results in terms of the national safety outcome standards.

Interdisciplinary collaboration needed in obtaining high-quality medical information in child abuse investigations.

BACKGROUND: Despite reporting legislation, healthcare providers (HCPs) do not always report and collaborate in cases of suspected child abuse. Recognizing this leaves children at risk, the Wisconsin Child Abuse Network (WI CAN) sought to understand barriers to mandated reporting and collaboration with child abuse investigators. OBJECTIVE: The purpose of the study was to investigate barriers for professionals in providing and obtaining high-quality medical information in child abuse investigations. PARTICIPANTS AND SETTING: Participants included five discipline-specific focus groups: HCPs, child protective services (CPS), law enforcement, lawyers, and judges. All professionals had been directly involved in Wisconsin child abuse cases. METHODS: This qualitative study consisted of discipline-specific focus groups, directed by open-ended interview questions. Data analysis was completed through the narrative inquiry methodology. RESULTS: Barriers to providing and obtaining high-quality medical information in child abuse investigations were both discipline-specific and universal amongst all groups. Discipline-specific barriers included: HCPs' discomfort with uncertainty; CPS' perception of disrespect and mistrust by HCPs; law enforcement's concerns with HCPs' overstepping professional boundaries; lawyers' concern of HCPs' discomfort with court proceedings; and judges' perception of a lack of understanding between all disciplines. Universal barriers included: value of high-quality medical information in child abuse investigations, burden of time and money; unequal resources between counties; a need for protocols, and a need for interdisciplinary collaboration. CONCLUSION: Findings from this study suggest several ways to address identified barriers. Possible interventions include equalizing resources between urban and rural counties (specifically financial resources and access to child abuse experts); protocolizing reporting and investigations; and, increasing interprofessional education.

From Child Protection to Paradigm Protection-The Genesis, Development, and Defense of a Scientific Paradigm.

A scientific paradigm typically embraces research norms and values, such as truth-seeking, critical thinking, disinterestedness, and good scientific practice. These values should prevent a paradigm from introducing defective assumptions. But sometimes, scientists who are also physicians develop clinical norms that are in conflict with the scientific enterprise. As an example of such a conflict, we have analyzed the genesis and development of the shaken baby syndrome (SBS) paradigm. The point of departure of the analysis is a recently conducted systematic literature review, which concluded that there is very low scientific evidence for the basic assumption held by Child Protection Teams: when certain signs are present (and no other "acceptable" explanations are provided) the infant has been violently shaken. We suggest that such teams have developed more value-based than scientific-based criteria when classifying SBS cases. Further, we suggest that the teams are victims of "groupthink," aggravating the difficulties in considering critics' questioning the criteria established by the teams.

An assessment of child protection in Bangladesh: How effective is NGO-led Child-Friendly Space?

Many underprivileged Bangladeshi children are vulnerable to child trafficking, abuse, and exploitation. Child-Friendly Space (CFS) is a semi-permanent house space where vulnerable children are given the support to have a safe environment to survive and thrive. The purpose of this study is to evaluate the role of CFS in providing a protective environment for the children in Bangladesh. A set of secondary and primary data was used to review child protection situation in Bangladesh, and to evaluate the effectiveness of the CFS within a community. An evaluation of child development among the children who attend in the CFS and who do not attend in the CFS was conducted. CFS was found to benefit vulnerable children and communities in terms of protective environment and child development. Children attending in the CFS had better performance at almost every child development indicator. At the community level, child labor decreased in the areas where CFS exists. To respond to the continuing threats of child insecurity, this study presents a set of recommendations for the sustainability of the CFS in the community.

Action research improves services for child sexual abuse in one Caribbean nation: An example of good practice.

BACKGROUND: Child sexual abuse (CSA) is a multi-dimensional problem. The search for best practice must consider the complexities surrounding CSA and its management in any particular society. OBJECTIVE: Data previously gathered from service providers on CSA service provision in Trinidad and Tobago identified key deficient issues in policy and practice. In this paper, researchers aimed to bridge the gaps identified, and effect changes to improve services for CSA using an action research methodology. PARTICIPANTS AND SETTING: Service providers from all sectors in governmental and non-governmental organizations in Trinidad and Tobago, who work with children at risk of CSA were involved in the process. METHODS: Researchers led the service providers into an awareness of their own practice through critical discussion of, and reflection on, the key deficient issues. The new knowledge generated, with guided input from evidenced-based best practice, led to the development of guidelines for management. Discussion of the practicability of the guidelines by service providers in multiple sectors generated more new knowledge that refined the management approach. RESULTS: The contextual knowledge obtained from service providers resulted in best practice guidelines for service providers that were culturally relevant and context-sensitive, adaptive and implementable, and allowed a seamless multidisciplinary response to CSA in Trinidad and Tobago within prevailing constraints. CONCLUSIONS: Action research offers an effective approach to improve services for CSA through mobilization of service providers and changes in policy and practice. It is applicable in any setting and likely to be effective in any socio-cultural context.

Systematic review of organisation-wide, trauma-informed care models in out-of-home care (OoHC) settings.

Trauma in early childhood has been shown to adversely affect children's social, emotional, and physical development. Children living in out-of-home care (OoHC) have better outcomes when care providers are present for children, physically, psychologically, and emotionally. Unfortunately, the high turnover of out-of-home carers, due to vicarious trauma (frequently resulting in burnout and exhaustion) can result in a child's trauma being re-enacted during their placement in OoHC. Organisation-wide therapeutic care models (encompassing the whole organisation, from the CEO to all workers including administration staff) that are trauma-informed have been developed to respond to the complex issues of abuse and neglect experienced by children who have been placed in OoHC. These models incorporate a range of therapeutic techniques, and provide an overarching approach and common language that is employed across all levels of the organisation. The aim of this study was to investigate the current empirical evidence for organisation-wide, trauma-informed therapeutic care models in OoHC. A systematic review searching leading databases was conducted for evidence of organisation-wide, trauma-informed, out-of-home care studies, between 2002 and 2017. Seven articles were identified covering three organisational models. Three of the articles assessed the Attachment Regulation and Competency framework (ARC), one study assessed the Children and Residential Experiences programme (CARE), and three studies assessed The Sanctuary Model. Risk of bias was high in six of the seven studies. Only limited information was provided on the effectiveness of the models identified through this systematic review, although the evidence did suggest that trauma-informed care models may have significantly positive outcomes for children in OoHC. Future research should focus on evaluating components of trauma-informed care models and assessing the efficacy of the various organisational care models currently available.

ON EXACTITUDE IN SCIENCE: A MAP OF THE EMPIRE THE SIZE OF THE EMPIRE.

In the service of children's best interests, we argue for a sharpening of the evidentiary standards used in family court decision making, from preponderance of (occasionally substandard) evidence to "beyond a reasonable doubt." Second, we call for a move in child protection cases from static diagnoses (e.g., attachment classifications) to assessments of the potential for enhanced parenting. Finally, informed by the implications of the replication crisis in the biomedical and psychological sciences, we applaud the move of the attachment field forward to large-scale, collective research agendas and goals.

A changing child welfare workforce: What worker characteristics are valued in child welfare?

A child welfare system is responsible for making difficult decisions. Child welfare workers are charged with assessing and determining when a child is in need of protection, including when it is necessary to intervene on behalf of children when their caregivers' abilities and/or situation is deemed to put them at risk of abuse or neglect. Although the child welfare workforce in Ontario attended to an estimated 125,281 child maltreatment investigations in 2013, little is known about the skills, education, and experiences of these investigating workers. Notwithstanding assumptions about the qualifications and characteristics necessary for effective child welfare practice, few studies explicitly link the specific characteristics of workers to children, youth, and families achieving positive case outcomes. These assumptions have been shaped by a multitude of factors including knowledge of human resources, professional standards, and educational requriements. This study examined data from five cycles over twenty years of Ontario Incidence Studies (-1993, -1998, -2003, -2008, -2013) to provide a profile of child welfare workers. This is the first study to examine the changing profile of child welfare workers in any province in Canada and provides a foundation for developing effective recruitment and professional development strategies, and promoting a positive work environment. Policy and practice implications for the changing needs of these families are discussed.

'It's a necessary evil': Experiences and perceptions of mandatory reporting of child abuse in Victorian general practice

BACKGROUND AND OBJECTIVE: General practitioners (GPs) and practice nurses (PNs) are mandated to report child abuse; however, only 2­4% of reports are made by Victorian health professionals. This is concerning, given that the estimated prevalence of physical child abuse alone in Australia is 5­18%. The aim of this study was to explore GPs' and PNs' experiences and perceptions of mandatory reporting of child abuse in Victoria. METHODS: Semi-structured interviews with 17 Victorian GPs and PNs were undertaken and thematically analysed. RESULTS: Participants had limited understanding of mandatory reporting in Victoria, struggled with negotiating the risks of reporting child abuse and felt unsupported by their practice and Child Protection Services. DISCUSSION: GPs and PNs must negotiate their legal obligation, with the emotional burden associated with the decision to report. Updated education on reporting processes and more support for GPs and PNs are recommended.

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.