Meta-Analysis Review

Authors: Kerryann Walsh, Elizabeth Eggins, Lorelei Hine...

BACKGROUND

Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed.

OBJECTIVES

To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list.

SELECTION CRITERIA

All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect).

DATA COLLECTION AND ANALYSIS

We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence.

MAIN RESULTS

We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants' self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants' responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence).  We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals' knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence).

AUTHORS' CONCLUSIONS

The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.

Topics: Child; Child Abuse; Family; Health Personnel; Humans; Mandatory Reporting; Systematic Reviews as Topic

PubMed: 35788913
DOI: 10.1002/14651858.CD011775.pub2

Authors: Owen Bradfield

Topics: Humans; Mandatory Reporting; Students, Medical; Delivery of Health Care

PubMed: 38049128
DOI: 10.31128/AJGP-07-23-6892

Review

Authors: Lil Tonmyr, Ben Mathews, Margot E Shields...

BACKGROUND

Within Canadian provinces over the past half-century, legislation has been enacted to increase child protection organization (CPO) involvement in situations of child maltreatment (CM). This study had two objectives: 1) to document enactment dates of legislation for mandatory reporting of CM; 2) to examine reported CPO involvement among people reporting a CM history in relation to the timing of these legislative changes.

METHODS

The history of mandatory reporting of CM was compiled using secondary sources and doctrinal legal review of provincial legislation. The 2012 Canadian Community Health Survey - Mental Health (CCHS-MH) with n = 18,561 was analyzed using birth cohorts to assess associations between the timing of legislation enactment and contact with CPO.

RESULTS

All Canadian provinces currently have mandatory reporting of physical and sexual abuse; 8 out of 10 provinces have mandatory reporting for children's exposure to intimate partner violence. Increases in reporting CM to CPOs paralleled these laws' enactment, particularly for severe and frequent CM.

CONCLUSIONS

These findings show that mandatory reporting laws increase reporting contact with CPO, particularly for severe and frequent CM. Whether they have had the intended effect of improving children's lives remains an important, unanswered question.

Topics: Canada; Child; Child Abuse; Child Protective Services; Humans; Mandatory Reporting

PubMed: 30115126
DOI: 10.1186/s12889-018-5864-0

Authors: Marian Jarlenski, Sarah Minney, Caroline Hogan...

OBJECTIVE

In many states, health care providers are legally required to report pregnant women who use substances, or infants affected by prenatal substance use, to child welfare authorities. The objective of this study was to characterize obstetric and pediatric providers' perceptions of and experiences with policies requiring mandatory reporting of prenatal substance use to child welfare authorities.

METHODS

We conducted a qualitative interview study among 20 obstetric and pediatric providers to elicit participants' perspectives about and experience with current policy requiring mandatory reporting of prenatal substance use. Two investigators used an iterative content analysis approach to code interview transcripts and identify themes.

RESULTS

Study participants included obstetrician/gynecologists (N = 7), midwives (N = 5), and pediatricians (N = 8). Providers noted that implementation of the policy was often targeted and that targeted screening can be biased. Most providers reported that they incorporated information about mandatory reporting policies into patient counseling about substance use. They described not knowing what happens to patients after mandatory reporting and concerns regarding unintended consequences. Providers indicated that changes are needed to improve outcomes for patients and their families and suggested increased research into best practices, more funding for social services, and eliminating the policy altogether.

CONCLUSIONS

Health care providers expressed concern about the targeted screening process used to identify women with substance use whose children are reported to child welfare authorities. Most providers believed that mandatory reporting processes could be modified in ways that would support the health of women and children.

Topics: Female; Health Personnel; Health Policy; Humans; Infant; Interviews as Topic; Mandatory Reporting; Maternal Exposure; Obstetrics; Pediatrics; Practice Patterns, Physicians'; Pregnancy; Qualitative Research; Substance Abuse Detection; Substance-Related Disorders

PubMed: 30550393
DOI: 10.1097/ADM.0000000000000489

Authors: Abigail English

Human trafficking, including both sex and labor trafficking, has profound consequences for the safety, health, and well-being of victims and survivors. Efforts to address human trafficking through prevention, protection, and prosecution are growing but remain insufficient. Mandatory reporting has the potential to bring victims and survivors to the attention of social service and law enforcement agencies but may discourage trafficked persons from seeking help, thereby limiting the ability of health care professionals to establish trust and provide needed care. States' experience in implementing child abuse laws can be useful in assessing the potential risks and benefits of mandatory reporting of human trafficking.

Topics: Crime Victims; Delivery of Health Care; Ethics, Clinical; Health Personnel; Human Trafficking; Humans; Mandatory Reporting; Patient Acceptance of Health Care; Professional-Patient Relations; Risk Assessment; Survivors; Trust

PubMed: 28107156
DOI: 10.1001/journalofethics.2017.19.1.pfor1-1701

Authors: María Concepción Ruiz Gippini, Raquel Rodríguez Lagares, Carlos Llanes Álvarez...

Topics: Aggression; Bullying; Humans; Mandatory Reporting; Power, Psychological; Schools; Spain

PubMed: 30709641
DOI: 10.1016/j.aprim.2018.05.015

Authors: Jonathan Spiegel, Gregory Cohan, E Christine Brousseau...

The opioid epidemic has renewed debate about how to structure laws, agency policies and hospital protocols for mandatory reporting of illicit substances during pregnancy. This paper analyzes the ethics of Rhode Island's approach to mandatory reporting - in particular, reporting of positive maternal and newborn drug tests at time of delivery. Given that state intervention is generally perceived by pregnant people as punitive and threatening to their family, we consider how four elements often used to justify punitive action by the state - retribution, deterrence, rehabilitation, and incapacitation (societal protection) - apply to Rhode Island's policy and approach to prenatal substance use. In addition, the paper considers the equity implications of Rhode Island's approach. It concludes that, given the potential for the policy to do more harm than good, investment of resources would be better spent on clinical and community services that support substance using parents and their newborns.

Topics: Female; Humans; Infant, Newborn; Mandatory Reporting; Parents; Policy; Pregnancy; Substance Abuse Detection; Substance-Related Disorders

PubMed: 35349617
DOI: No ID Found

Authors: Sharmila Parks

Topics: Child Abuse; General Practice; Humans; Mandatory Reporting

PubMed: 25452520
DOI: 10.3399/bjgp14X682705

Authors: Yasmina Ouharzoune

Topics: Civil Rights; Female; Humans; Interpersonal Relations; Male; Mandatory Reporting; Occupational Exposure; Sex Offenses; Sexual Harassment; Social Justice; Women's Rights

PubMed: 29773246
DOI: 10.1016/j.soin.2018.03.016

Review

Authors: Megan H Bair-Merritt

After completing this article, readers should: 1. Know the prevalence of intimate partner violence and childhood exposure to intimate partner violence. 2. Identify risk factors associated with intimate partner violence. 3. Understand that child maltreatment is significantly more likely in the setting of intimate partner violence. 4. Recognize the impact of intimate partner violence exposure on children's social-emotional and physical health, and on their health care use. 5. Understand strategies for screening and responding to intimate partner violence in the pediatric setting. You are seeing a healthy, previously full-term 4 month old for well child care. As a part of your routine social history, you inquire about intimate partner violence (IPV). The infant's mother discloses that her partner frequently yells at her, pushes her and makes her feel afraid. Upon further questioning, you find that she describes the infant as “fussy.” His physical exam is unremarkable, but you note that he missed his two month visit and is behind on his immunizations. How do you proceed?

Topics: Child; Child Abuse; Child Health Services; Child Welfare; Documentation; Domestic Violence; Female; Humans; Mandatory Reporting; Professional-Family Relations

PubMed: 20360408
DOI: 10.1542/pir.31-4-145