Processes of Multiprofessional Child Protection Decision Making in Hospital Settings: Systematic Narrative Review

Abstract

The aim of this systematic narrative literature review is to explore empirical evidence as to how a multiprofessional approach to child protection decision making is implemented in hospitals settings. Child protection cases where there is a suspicious serious injury suspected sexual abuse or serious neglect are often investigated in hospital, involving a number of relevant professions. Five electronic bibliographic databases were used for the search. To be included in the review studies had to be published in a peer-reviewed journal, report on empirical research, be available full text in English, and have used an identifiable research design. The search was restricted to 10 years, from January 1, 2010, to December 31, 2019, and retrieved 6,934 studies. The review includes 26 studies undertaken in 10 countries. In all the hospital-based settings studied, child protection decision-making tasks were assigned to a designated multiprofessional team. However, there was remarkable diversity in models of team structure, regulation of workflow, structured procedures, and standardized tools through which practice was carried out. Research focused on evaluating the teams’ effectiveness in fulfilling their duties which were, first and foremost, the identification of possible child maltreatment. The analysis identifies various systemic approaches and quality improvement methods to promote effective team-based decision-making processes in hospitals. The interactional aspect of collaborative team-based practice was generally missing from the published research. This article discusses next steps for the development of practice, policy, and research to enhance useful multiprofessional child protection team working in hospitals.

A Qualitative Description of Resident Physicians’ Understanding of Child Maltreatment: Impacts, Recognition, and Response

“…Physicians who have access to expert consultation report feeling more secure in their decisions [ 30 , 32 ], which may be even more important for less experienced learners. A recent and compelling review by Alfandari and Taylor [ 81 ] offers important information about the state of the evidence regarding the implementation of multi-professional child protection decision-making teams in hospital-based settings, including their effectiveness, structure, and processes. Across the 26 studies from 10 different countries, the authors reported significant variability in team composition, role structure, and decision-making procedures.…”

“…Across the 26 studies from 10 different countries, the authors reported significant variability in team composition, role structure, and decision-making procedures. In addition, evaluations of team-based decision-making models have centred on CM identification, with no available data on the impacts of team-based decision making on the outcomes for children who have experienced CM and their families; this is an important area for future research [ 81 ]. Despite this, the authors offer important recommendations with respect to the need to honour teamwork as a “stand-alone skill that is acquired through education, training, and experience” (p. 15), and which can be fostered using low-stakes pedagogical approaches, such as case-based learning, prior to direct clinical encounters.…”

Institutional Violence against Hospitalized Children: The Perception of Nursing Professionals

“…Regarding the approach to IV in health by the United Nations and the World Health Organization, it is important to note that it has been discussed to a limited extent in such agendas, which further limits the mobilization of resources in actions related to monitoring and its coping. In addition to that, most of the studies related to child protection in health services proposed by several countries have focused on identifying and acting on the notification of cases of violence that reach such institutions; however, it appears that there is still a large gap in studies on violence in or by health services (5,(15)(16)(17)(18).…”

Judgements of physicians, nurses, and social workers regarding suspected Child maltreatment in community health care services

“…A review of the existing literature on HCPs' recognition and response to child maltreatment shows that most studies were carried out in hospital‐based services and Western countries that implement mandatory reporting laws, such as the United States, Australia, and Canada (Alfandari & Taylor, 2021a; Enosh et al, 2020; Gilbert et al, 2009; Mathews & Kenny, 2008; McTavish et al, 2017). In this section we argue that the preoccupation with practice experience in hospital settings bounded by mandatory reporting legislations, generates evidenced‐based knowledge that is skewed toward serious incidents of CAN, reporting practices, and HCPs' fidelity with rules and guidelines and which is insufficient to help HCPs working in community health care services make better decisions.…”

“…Together with the weight given in research and practice to establishing collaborative multi‐professional approaches to child protection decision making as a mean to promote children's safety and well‐being (Alfandari, 2019; Alfandari & Taylor, 2021a, 2021b), a more nuanced analysis of important variations in judgement making across professional groups is still required (Eisikovits et al, 2015; Svärd, 2017). For example, studies on multi‐professional child protection decision making by professionals representing different systems, e.g., child protection, mental health, and courts, indicated critical variations exist between professions in perceptions of thresholds for substantial harm and referrals to universal services or child protection interventions (Alfandari & Taylor, 2021b; Gilbert et al, 2009; Hood et al, 2017; Rouf et al, 2012).…”