Interviews with health professionals about the National Child Protection Alert System.

AIM: The New Zealand National Child Protection Alert System is administered by multidisciplinary teams in every district health board. The aim of this study was to investigate the factors that influence multidisciplinary child protection teams' (MDTs') decisions about whether to place a child protection alert. METHOD: Members of the Child Protection Alert System teams were invited to participate in semi-structured interviews. Interview data were coded and grouped into themes using inductive thematic analysis. RESULTS: Six themes were identified: the system works well; a wide range of factors are considered in multidisciplinary team decision-making; there are some difficulties with multidisciplinary team meetings; there are problems with the administration of the system across district health boards; there is concern about the potential for the Child Protection Alert System to stigmatise families or cause unjustified responses; improvements can be made to the system. CONCLUSION: There is overall support for the National Child Protection Alert System and a consensus that the benefits outweigh any potential risks. There is a need for further improvements to the system, including consistent training, further standardisation and increased accessibility of the information to health professionals, including making information on the system available to primary healthcare.

Health professionals' perception of the New Zealand National Child Protection Alert System: An online survey.

AIM: To describe the multi-disciplinary child protection teams which administer the National Child Protection Alert System in District Health Boards in New Zealand and the understanding and perceptions of that system held by team members. METHODS: This is a mixed-method observational study. In December 2016 and January 2017, all child protection alert system multi-disciplinary team members were invited to participate in an online survey. Quantitative data were expressed with simple descriptive statistics. Qualitative findings were analysed using thematic analysis. RESULTS: Ninety-one (56.9%) of 160 team members nationwide completed the survey. All 20 District Health Boards and multiple disciplines were represented. Most respondents agreed that they received good information to make decisions (74/90, 82.2%), that it was usually easy to reach consensus (82/91, 90.1%), that the system helped to keep children safe (72/91, 79.1%) and that it did not stigmatise families (49/91, 53.9%). Qualitative analysis identified considerable variation in understanding of the system and a need for more training to support more consistent implementation of the system. CONCLUSIONS: Overall, health professionals responsible for the child protection alert system regard it positively but express a need for more training for team members and front-line staff to maximise the system's potential and minimise any risk of stigmatisation.

Family violence intervention within an emergency department: achieving change requires multifaceted processes to maximize safety.

INTRODUCTION: Family violence is common with significant long-term negative health effects. Health professionals are recognised as key providers of family violence intervention. In 2002, the Hawke's Bay District Health Board launched a Family Violence Intervention Programme in its emergency department. The intervention programme involved staff training, the development of resources and routine questioning for partner abuse within the social history for all women 16 years and over. The aim was to identify the barriers and enablers to routine questioning one year after the programme was launched to inform programme improvements. METHODS: Evaluation research using semi-structured interviews; eleven staff participated in either a single or a group interview. Content and thematic analysis, with triangulation of findings was used. RESULTS: The interviews revealed that routine questioning for partner abuse is difficult in the emergency department. Some staff screened routinely while others only offered intervention when overt abuse was identified. Barriers, enablers and solutions revealed by participants were either personal or organisational; all had the common theme of safety. DISCUSSION: Routine questioning for partner abuse is challenging and its introduction into practice requires a systems approach to achieve change. Barriers to questioning exist and by simultaneously addressing these and implementing enablers, at an organisational and personal level, barriers are eliminated or at least minimised. A link was evident between nurses' level of comfort and their rate of questioning. A multifaceted approach focusing on safety of all concerned can support change resulting in implementation of family violence intervention in the health sector.

Improving detection and quality of assessment of child abuse and partner abuse is achievable with a formal organisational change approach.

AIM: To improve detection and quality of assessment of child and partner abuse within a health service. METHODS: A formal organisational change approach was used to implement the New Zealand Family Violence Intervention Guidelines in a mid-sized regional health service. The approach includes obtaining senior management support, community collaboration, developing resources to support practice, research, evaluation and training. Formal pre-post evaluations were conducted of the training. Barriers and enablers of practice change were assessed through 85 interviews with 60 staff. More than 6000 clinical records were audited to assess rates of questioning for partner abuse. Identifications of partner abuse and referrals made were counted through the Family Violence Accessory File. Referrals to the Department of Child, Youth and Family Services (CYFS) were recorded routinely by the CYFS. Audits assessed quality of assessment of child and partner abuse, when identified. RESULTS: More than 700 staff were trained in dual assessment for child and partner abuse. Evaluations demonstrate improved confidence following training, though staff still need support. Barriers and enablers to asking about partner abuse were identified. Referrals from the health service to the CYFS increased from 10 per quarter to 70 per quarter. Identification of partner abuse increased from 30 to 80 per 6-month period. Routine questioning rates for partner abuse vary between services. CONCLUSION: Achieving and sustaining improved rates of identification and quality of assessment of child and partner abuse is possible with a formal organisational change approach.