Identifying children exposed to maltreatment: a systematic review update

Abstract

Background: Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment. Methods: We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies-where the population and setting matched known prevalence estimates in an emergency department setting-we calculated false positives and negatives. We assessed risk of bias using QUADAS-2. Results: We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified. Conclusions: There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).

Identifying and responding to child maltreatment when delivering family‐based treatment—A qualitative study

“…However, it is important to reflect upon the suggestion from participants in this study that issues of family violence are unlikely to be reported or identified at the outset of the therapeutic relationship. In addition, the World Health Organization Mental Health Gap Action Programme (World Health Organization, ) as well as recent reviews by Bailhache, Leroy, Pillet, and Salmi (), and McTavish, Gonzalez, et al () and McTavish, Kimber, et al () indicate insufficient evidence detailing whether the utilization of such screening tools does more good than harm. Similarly, evaluation of these tools' sensitivity and specificity suggests that a large proportion of children are falsely identified as being maltreated when using these tools and these tools rarely evaluate CEA and CEIPV (McTavish et al, McTavish, Gonzalez, et al, , McTavish, Kimber, et al, ).…”

Recognizing and Responding to Child Maltreatment: Strategies to Apply When Delivering Family-Based Treatment for Eating Disorders

“…First, universal screening for child maltreatment is not recommended at any point during FBT. There is no evidence that universal screening for child maltreatment leads to reduced harm, reduced exposure, or optimal outcomes among those who have experienced child maltreatment (60)(61)(62)(63). Second, an explicit discussion about the limits of confidentiality with each family member is needed.…”

If we Ask, Will they Tell? (and Then, What?): Screening for Sexual Violence against Children in Kenya

“…Nearly a decade later, McTavish et al (2020, p. 10) confirm that the situation remains unchanged: '[I]t is still difficult to assess the accuracy of instruments to identify potential child maltreatment as there is no gold standard for identifying child maltreatment'. The systematic reviews carried out by Bailhache et al (2013) and McTavish et al (2020) align with regard to the fact that high numbers of false positives and negatives resulted from the use of screening tools for identifying potential child maltreatment.…”

“…Hoft andHaddad (2017) also note that SVAC screening tools in particular (those available between 1995 and 2016) had a tendency to draw on assessment domains that were not definitive for such abuse, raising questions about their reliability. McTavish et al (2020) extend the conversation beyond screening tools alone, reminding us that the process and context in which screening occurs are as important as the tools themselves. As they emphasise: '[I]t is unclear how these tools are being used in practice, or how they will in the future be used in practice.…”