Inter-professional working in child protection with families with long-term and complex needs

Within the United Kingdom there is growing awareness of the need to identify and support the small number of children who are living in families experiencing multiple problems. Research indicates that adverse experiences in childhood can result in poor outcomes in adulthood in terms of lack of employment, poorer physical and mental health and increases in social problems experienced. It is acknowledged that most of these children are known to child welfare professionals and that some are referred to social services, subsequently entering the child protection system. This paper reports research conducted with twenty-eight experienced child welfare professionals. It explores their views about families known to the child protection system with long-term and complex needs in relation to the characteristics of children and their families; the process of intervention with families; and the effects of organisational arrangements on practice. The research indicates that these families are characterised by the range and depth of the problems experienced by the adults, such as domestic violence, mental health difficulties and substance misuse problems, and the need for professionals to have good inter-personal skills and access to specialist therapeutic services if families are to be supported to address their problems.

Chronic child abuse and domestic violence: Children and families with long-term and complex needs

It is estimated that up to one million children may have been exposed to domestic violence in the UK, with significant consequences for their social and emotional development in childhood and later life. At a time when the central and devolved administrations in the UK have developed strategies to tackle domestic violence, this paper reports the findings from a study conducted on children in the child protection system with long-term and complex needs as a result of experiencing domestic violence. The research identifies the characteristics of the children and their families and tracks their careers through the child protection system. The findings indicate that professionals have an awareness of domestic violence, and that younger children with younger parents are most likely to experience prolonged periods in the child protection system. Domestic violence in this context typically co-exists in families experiencing other difficulties such as substance misuse and socio-economic deprivation. In conclusion, the paper argues that Government policy and professional practice should primarily be concerned with assessing the risk that men present, rather than the risk that children are at. By reframing professional interventions, men are more likely to be challenged to accept responsibility for their behaviour and the consequences for their families.

Recognising the co-occurance of domestic and child abuse: a comparison of community and hospital-based midwives

This study aimed to compare and contrast how midwives working in either hospital or community settings are currently responding to the cooccurrence of domestic and child abuse (CA), their perceived role and willingness to identify abuse, record keeping, reporting of suspected or definite cases of CA and training received. A survey questionnaire was sent to 861 hospital and community midwives throughout Northern Ireland which resulted in 488 midwives completing the questionnaire, leading to a 57% response rate. Comparisons were made using descriptive statistics and cross-tabulation, and the questionnaire was validated using exploratory factor analysis. Community midwives reported receiving more training on domestic and CA. Although a high percent of both hospital and community midwives acknowledged a link between domestic violence (DV) and CA, it was the community midwives who encountered more suspected and definite (P <0.001) cases of CA. More community midwives reported to be aware of the mechanisms for reporting CA. However, an important finding is that although 12% of community midwives encountered a definite case of CA, only 2% reported the abuse, leaving a 10% gap between reporting and identifying definite cases of CA. Findings suggest that lack of education and training was a problem as only a quarter of hospital-based midwives reported to have received training on DV and 40% on CA. This was significantly less than that received by community midwives, as 57% received training on DV, and 62% on CA. The study suggests that midwives need training on how to interact with abused mothers using non-coercive, supportive and empowering mechanisms. Many women may not spontaneously disclose the issues of child or domestic abuse in their lives, but often respond honestly to a sensitively asked question. This issue is important as only 13% of the sample actually asked a woman a direct question about DV.

Child abuse and neglect: Training needs of student teachers

Increasing awareness of child abuse and neglect (CAN) raises questions about how well teachers are prepared for their role in child protection. This paper assesses and differentiates training needs of first-year students (n = 216) in Northern Ireland. Multiplechoice tests were used to assess knowledge of CAN statistics; recognising and reporting; policies, procedures, and legislative frameworks; and direct work with children. Considerable gaps in knowledge were found. Results between student groups varied and provide evidence of the need to develop pre-service child protection training. The importance of differentiation between student groups in terms of training content is emphasised.

The inclusion of open-ended questions on quantitative surveys of children: Dealing with unanticipated responses relating to child abuse and neglect

Web surveys have been shown to be a viable, and relatively inexpensive, method of data collection with children. For this reason, the Kids’ Life and Times (KLT) was developed as an annual online survey of 10 and 11 year old children. Each year, approximately 4,000 children participate in the survey. Throughout the six years that KLT has been running, a range of questions has been asked that are both policy-relevant and important to the lives of children. Given the method employed by the survey, no extremely sensitive questions that might cause the children distress are included. The majority of questions on KLT are closed yielding quantitative data that are analysed statistically; however, one regular open-ended question is included at the end of KLT each year so that the children can suggest questions that they think should be asked on the survey the following year. While most of the responses are innocuous, each year a small minority of children suggest questions on child abuse and neglect. This paper reports the responses to this question and reflects on how researchers can, and should, deal with this issue from both a methodological and an ethical perspective.

Decision making in child protection: An international comparative study on maltreatment substantiation, risk assessment and interventions recommendations, and the role of professionals’ child welfare attitudes

Child welfare professionals regularly make crucial decisions that have a significant impact on children and their families. The present study presents the Judgments and Decision Processes in Context model (JUDPIC) and uses it to examine the relationships between three indepndent domains: case characteristic (mother’s wish with regard to removal), practitioner characteristic (child welfare attitudes), and protective system context (four countries: Israel, the Netherlands, Northern Ireland and Spain); and three dependent factors: substantiation of maltreatment, risk assessment, and intervention recommendation.
The sample consisted of 828 practitioners from four countries. Participants were presented with a vignette of a case of alleged child maltreatment and were asked to determine whether maltreatment was substantiated, assess risk and recommend an intervention using structured instruments. Participants’ child welfare attitudes were assessed.
The case characteristic of mother’s wish with regard to removal had no impact on judgments and decisions. In contrast, practitioners’ child welfare attitudes were associated with substantiation, risk assessments and recommendations. There were significant country differences on most measures.
The findings support most of the predictions derived from the JUDPIC model. The significant differences between practitioners from different countries underscore the importance of context in child protection decision making. Training should enhance practitioners’ awareness of the impact that their attitudes and the context in which they are embedded have on their judgments and decisions.

The relationship between poverty, child abuse and neglect: an evidence review.

The review aimed to investigate two central issues.
1.To what extent is there evidence that poverty increases the amount of child abuse and neglect (CAN), and/or affects the nature of child abuse and neglect? How does this occur, how large are these effects and to whom do they apply?
2.To what extent is there evidence that CAN increases poverty later in life, how large are these effects and to whom do they apply?
Within these two issues evidence about equality and diversity, and cost were considered throughout.

Child abuse: underlying mechanisms

Exposure to traumatic stress during childhood, in the form of abuse or neglect, is related to an increased vulnerability resulting in the development of several pathologies, this relation has been confi rmed by epidemiological studies; however, the neural mechanisms underlying such abnormalities are still unknown. Most of the research done has focused on the effects in the infant, and only recently it has begun to focus on the neurobiological changes in the abusive parents. In this article, I review some of the studies using animal models of early adverse trauma and present some of the data on neural changes. Further studies of brain abnormalities in abusive parents are still needed.

Constructing meanings and identities in child protection practice

Examines a contemporary and contentious social problem, child maltreatment, and the policy and practice in response to it, child protection.

Multiple forms of child abuse and neglect: adult retrospective reports

There are few research reports of the experience of multiple forms of child abuse and neglect (multi-type maltreatment). A critical review is presented of 29 studies in which adult retrospective reports of more than one form of child maltreatment (sexual abuse, physical abuse, psychological maltreatment, neglect, or witnessing family violence) are assessed. Empirical investigations of the extent and impact of multi-type maltreatment are identified. Data on the relationship between the different forms of maltreatment and the adjustment problems associated with each type of maltreatment are critiqued. As well as using dichotomous measures of maltreatment, an important methodological problem was the failure of researchers to assess all child maltreatment types, the relationship between multi-type maltreatment and adjustment, and the role of variables influencing the occurrence or impact of maltreatment. Considerable overlap was found in the occurrence of maltreatment types. The compounding or interacting effects of experiencing multi-type maltreatment were ignored in many studies. Where an assessment was made of the specific impact of multi-type maltreatment, it was associated with greater impairment than single forms of abuse or neglect. A multi-dimensional approach to prevention and treatment of child abuse and neglect is required in which children's vulnerability to multi-type maltreatment is addressed.

The importance of degree versus type of maltreatment: a cluster analysis of child abuse types

The author conducted secondary data analysis of 3 previously reported studies (D. J. Higgins & M. P McCabe, 1998, 20(K)b, 2(X)3) to examine whether respondents are best classified according to their experience of separate maltreatment types (sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence) or whether their experience reflects a single unifying concept: child maltreatment.

Nurses' perceived training needs in child protection issues

Purpose – The purpose of this research is to explore nurses' perceptions of their current skills and knowledge and training needs to identify cases of child abuse and their understanding of their roles and responsibilities in relation to child abuse. Nurses, including health visitors and midwives, have been recognised as having a key role in the protection and care of children, especially in identifying and referring possible cases of child abuse and neglect.

Design/methodology/approach – A structured questionnaire concerning knowledge and training needs in child protection was sent to all nurses employed in a Scottish NHS Primary Care Trust (approximately 1,900), of whom one-third (667) responded. These survey results were complemented by semi-structured interviews with 99 members of the nursing workforce.

Findings – Almost all training in child protection had been confined to health visitors, resulting in the Trust giving an implicit message that child protection is not a role in which other nurses need have any involvement. In general, those nurses who both worked with children and had involvement in child protection issues, considered themselves to be most in need of knowledge around child protection work, to have the greatest level of knowledge and to consider further training a priority.

Research limitations/implications – Nurses who had an interest or involvement in child protection work were more likely to participate in the research, which may have biased the results.

Practical implications – Training strategies need to address the diversity of nurses' involvements in child protection work through the development of training programmes which are appropriate for different workplaces and different occupational groupings. Nurses in some settings will need to be first convinced they have the potential to play an important role in protecting children from abuse and neglect.

Originality/value – Many NHS Trusts have in recent years introduced mandatory training in child protection for all staff in contact with children. However, previously published studies have considered training issues only in respect of nurses identified as working directly with children, whereas this study explores child protection issues for all nurses employed in a primary care NHS Trust.

Including teachers as 'real' partners in child protection

Simultaneous downsizing of child protection services and increasing numbers of child abuse notifications often result in many notifications remaining un-investigated. One possible solution to this problem is to extend the capacity of the child protection system by delegating some of the tasks commonly undertaken by child protection workers to allied professionals. One such group of allied professionals is teachers. In the past, teachers have been recognised for their unique role in notifying suspicions of abuse, however, education professionals are often overlooked for their potential to contribute more than they currently do to child protection. In this paper we suggest that teachers can be included as 'real' and credible partners in the child protection process in a way not previously considered possible.

Clinical supervision in child protection for community nurses

Community nurses have been recognized as having a key role in the protection and care of children, particularly in relation to the identification and detection of child abuse. In order to fulfill this role in a competent manner, they need to have access to appropriate supervision. The aim of this paper is to explore community nurses' and health care managers' understanding and experience of clinical supervision in child protection. The findings presented here were collected as part of a larger study commissioned by the Greater Glasgow Primary Health Care National Health Service (NHS) Trust. Ninety-nine nurses and nursing managers were interviewed, either individually or in groups, about their professional involvement in child protection issues and support for their involvement in child protection work, as well as their current knowledge and perceived training needs. The interview data was subjected to a thematic analysis. A lack of consensus was found among nurses and managers in Glasgow as to what constitutes clinical supervision and a good deal of variation in nurses' experiences of clinical supervision in the field of child protection. The historical difficulties with regard to supervision were attributed to several aspects of nursing culture. However, both nurses and managers emphasized the need for formal, regular, systematic supervision for all nurses regardless of their specific role with regard to child protection.