Lippincott ® NursingCenter ® Wolters Kluwer Logo

The effectiveness of methods designed to identify child maltreatment in social and health care: a systematic review protocol

Source:

JBI Evidence Synthesis

January 2014, Volume :12 Number 1 , page 90 - 100 [Free]

Authors

  1. Paavilainen, Eija PhD
  2. Flinck, Aune PhD

Abstract

Review question/objective: The objective of this review is to synthesize the best available evidence regarding the effectiveness of methods in identifying child maltreatment in social and health care settings.

 

Background: Child maltreatment is a sensitive and complex issue both in terms of clinical practice and research. It is a matter of concern for both child protective services and health services. Health and social professionals may have knowledge of child maltreatment, but formal identification of the problem is complicated by its sensitive nature, on the job time pressures and the absence of uniform guidelines. Interventions of identifying child maltreatment may be further complicated by conceptions of family privacy, fear of false allegations and the ensuing client families' loss of trust in the services available.1,2,3 Social and health care professionals are often reluctant to identify maltreatment, or report or intervene in suspected cases of child maltreatment. Gilbert et al., have estimated that internationally, only 10% of child maltreatment cases are being identified.4

 

Child maltreatment can be defined as the physical or psychological abuse or neglect of young people, under 18 years of age. Very often, psychological abuse can also be referred to as emotional abuse. Physical abuse includes acts that cause a child physical pain or impairs a child's physical functioning either temporarily or permanently. This can include bruises, burns, head injuries, fractures, internal injuries and gashes. It may even result in the death of a child. In such cases, it has often been found that the abuse had persisted for a long period of time before the death.5 Psychological abuse may involve terrorizing or ridiculing a child, humiliation, belittling and other forms of psychological threat, to the extent that the child's emotional well-being and development are placed at risk. Physical punishment and other types of physical abuse are always associated with emotional abuse.6 Child neglect involves the failure to provide appropriate care or protection and failing to adequately provide for the child's physical and emotional needs. As a result, child neglect may impact the child's overall development.7 Neglect, as with other forms of maltreatment, can vary in type, severity, or duration.

 

Children subjected to violence usually do not seek help actively because they may regard the behavior of their family as normal. Even if they are aware of the abnormality of the violence being perpetrated, they lack the means to solve the problem and are often faithful to their family members. Help-seeking is further hindered by the secrecy and shame associated with maltreatment. Studies have shown that interventions in child maltreatment are often insufficient and lack determination and that for instance health professionals need continuous training, clinical supervision, attitude change at the individual level and coherent tools to identify cases of maltreatment and family violence in general.8 Interventions for identification of child maltreatment include the use of screening tools and questionnaires for children and families, observation, discussions with families, home visits and physical and psychological examination of children. Social welfare and health professionals, including social workers and nurses, are in a very good position to identify child maltreatment because they meet and examine children and families in settings, such as child welfare clinics or hospitals, where period and follow-up examinations take place and various injuries or symptoms of maltreatment are cared for. Other professionals, such as nursery and other teachers, are also in good position for identifying cases of child maltreatment.

 

In Finland, the National Nursing Guideline for identifying and intervening in child maltreatment, based on a systematic search and review,9 was published by the Nursing Research Foundation in 2008.10,11 This systematic search and review covered multidisciplinary research published between 1998-2007 on how to identify child maltreatment defined as physical or psychological abuse or neglect of young people under 18 years of age. In line with previous findings, home visits and different training programs have been shown to be promising in assisting social and health care professionals to identify child maltreatment.10,11 The main purpose of this guideline was to find methods with which it was possible to identify child maltreatment cases and following that, continue to help children and families by finding ways out of the situation. Also in other countries, such as in the UK, guidelines have been developed for multi-professional use.12 However, no systematic reviews of this specific topic were found by searching central databases, such as Cochrane, Campbell and Prospero. Research evidence from an effectiveness point of view is available, for example risk assessment scales,13,14,15,16 show potential in identifying child physical or emotional maltreatment and multi-professional work in the identification of child maltreatment.17

 

In 2012 a survey examining how public health nurses use the Finnish guideline found that the guideline was quite well-known and utilized,10,11 but multi-professional practices concerning identification practices were not very well developed.18 To further advance the research and development of these practices in social and health care settings globally, a more detailed synthesis of previous knowledge, especially concerning the effectiveness of identifying cases of child maltreatment, is needed.

 

Article Content

Inclusion criteria

Types of participants

This review will consider studies that include social welfare and health care settings, as well as others where children and their families visit (including child welfare clinics, maternity clinics, schools, nursery schools and day-care, physicians' reception, children's and adolescents' wards at hospital and child protection) and professionals (including nurses, public health nurses, school health nurses, physicians, social workers, nursery and other school teachers, physiotherapists, speech therapists and psychologists) who take care of children, adolescents and their families in those settings. Also children (up to 18 years of age) and families themselves will be considered as participants.

 

Types of interventions

This review will consider studies that evaluate methods designed to identify physical or psychological abuse and/or neglect of children aged up to 18 years of age, including screening tools, questionnaires, discussion with families, observations, home visits, physical and psychological examination, risk evaluation and other kinds of multi-professional working practices targeted at identifying child maltreatment or evaluation of the family situation. Identifying child maltreatment is the main issue and is followed by intervening in the situation.

 

Comparator: No intervention or usual care. Usual care here means that the professionals do not identify maltreatment or risk of it, they just do those tasks they usually do, such as vaccinating children, routine follow-up of growth and development of a child; taking care of their wounds or bruises etc., without thinking that those may be consequences of child maltreatment.

 

Types of outcomes

This review will consider studies that include the following outcome measures: confirmed or accurate occurrence of child maltreatment (physical, psychological abuse or neglect). For example family home circumstances and their living conditions, diagnosis of physical abuse or observation of neglect, delay in the development of the child physically or mentally, risk behavior by parents (physically or psychologically abusive). As an outcome there may also be 'no identification'.

 

Types of studies

This review will consider both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies, concerning effective identification methods of physical or psychological abuse or neglect of children aged 0-18 years, for inclusion.

 

Exclusion criteria: studies on sexual abuse, therapies and prevention will be excluded from the review. Sexual abuse is different by its nature than the other types of abuse chosen as the focus of this review. Including studies of sexual abuse would therefore broaden the scope of this review too much.

 

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE and CINAHL will be undertaken, followed by analysis of the text words contained in the title and abstract and of the index terms used to describe the article. This search has already been conducted to establish whether studies presenting effective identification practices could be found. This was useful. A second search using relevant identified keywords and index terms, as well as database-specific keywords and subject headings, will then be undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles will be searched for additional studies. Studies published in English, Finnish and Swedish will be considered for inclusion in this review. Studies published between 2003 and 2013 will be considered for inclusion in this review.

 

The databases to be searched include:

 

Cinahl, Medline, PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Campbell Library, PsycInfo, ERIC, Applied Social Sciences Index and Abstracts, SocIndex with Fulltext, Social Care Online, ProQuest Dissertations and Theses A&I: The Humanities and Social Sciences Collaboration, Sociological Abstracts, Social Services Abstracts, Proquest Health Management, PROSPERO and the Finnish databases MEDIC and MELINDA.

 

The search for unpublished studies will include:

 

Papers that have not been commercially published such as theses and dissertations, reports, blogs, technical notes, non-independent research or other documents produced and published by government agencies, academic institutions and other groups that are not distributed or indexed by commercial publishers.

 

Initial keywords to be used will be as follows; search strategies modified by database:

 

1. child abuse/

 

2. (child* violence or child*abuse or child*maltreatment or child*neglect).mp.

 

3. 1 or 2

 

4. (violence* or physical abuse * or emotional abuse* or psychological abuse*).mp.

 

5. (child* or adolescen*).mp (mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier)

 

6. 4 and 5

 

7. 3 or 6

 

8. prevent* or interven* or diagnos* or screen* or identif* or recogn* or monitor* or scale* or evaluat* or measur*). mp.

 

9. 7 and 8

 

10. (impact* or effective* or influen*).mp.

 

11. 9 and 10

 

12. (systematic review* or controlled trial* or meta-analysis* or quasi-experiments* or before and after*).mp.

 

13. 11 and 12

 

14. 9 and 12

 

15. limit 14 to yr="2003 - Current, 2013", providing about 10 years period of time.

 

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.

 

Data collection

Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI (Appendix II). The data extracted will include specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives.

 

Data synthesis

Quantitative data will, where possible, be pooled in statistical meta-analysis using JBI-MAStARI. All results will be subject to double data entry. Effect sizes expressed as odds ratios (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals will be calculated for analysis. Heterogeneity will be assessed statistically using the standard chi-square and also explored using subgroup analyses based on the different study designs included in this review. Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

 

Conflicts of interest

There are no conflicts of interest.

 

References

 

1 Paavilainen E, Merikanto J, Astedt-Kurki P, Laippala P, Tammentie T, Paunonen-Ilmonen M. 2002a. Identification of child maltreatment while caring for them in a university hospital. International Journal of Nursing Studies 39, 287-294. [Context Link]

 

2 Paavilainen E, Astedt-Kurki P, Paunonen-Ilmonen M, Laippala P. 2002b. Caring for maltreated children: a challenge for health care education. Journal of Advanced Nursing 37, 551-557. [Context Link]

 

3 Paavilainen E, Lepisto S, Flinck A. 2014. Ethical issues in family violence research in health care settings. Nursing Ethics 21, 43-52. Doi: 10.1177/0969733013486794.[Context Link]

 

4 Gilbert R, Kemp A, Thoburn J, Sidebotham P, Radford L, Glaser D, MacMillan H. 2009. Recognizing and responding to child maltreatment. Lancet 373, 167-180. [Context Link]

 

5 Loiselle J. 2002. Physical abuse. In: Giardino A, Giardino E. (eds.) Recognition of child abuse. 3rd ed. G.W. Medical Publishing, Inc. St. Louis, Missouri. [Context Link]

 

6 Hart S, Brassard M, Karlson H. 1996. Psychological maltreatment. In: Briere J, Berliner L, Bulkley J, Jenny C, Reid T. (eds.). The APSAC Handbook on Child Maltreatment. Sage, Thousand Oaks, 72-89. [Context Link]

 

7 Dubowitz H, Pitts S, Black M. 2004. Measurement of three major subtypes of neglect. Child Maltreatment 9: 344-356. [Context Link]

 

8 Leppakoski T, Paavilainen E. 2012. Interventions for women exposed to acute intimate partner violence: emergency professionals' perspective. Journal of Clinical Nursing, 2013, vol 22, pages 2273-2285 [Context Link]

 

9 Grant M Booth A. 2009. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information and Libraries Journal 26, 91-108. [Context Link]

 

10 Paavilainen E, Flinck A. Identification of and intervention in child maltreatment: a clinical practice guideline. Nursing Research Foundation. http://www.hotus.fi/hotus-en/completed(September 2013).[Context Link]

 

11 Paavilainen E, Flinck A. 2013. National clinical nursing guideline for identifying and intervening in child maltreatment within the family in Finland. Child Abuse Review 22, 209-220. Doi: 10.1002/car.2207 [Context Link]

 

12 Appleton J, Glaser D. 2009. Suspecting child maltreatment. Community Practitioner 82(9): 34-35. [Context Link]

 

13 Kent A, Waller G. 1998. The impact of childhood emotional abuse: an extension of the Child Abuse Trauma Scale. Child Abuse & Neglect 22, 393-399. [Context Link]

 

14 Dunne M, Zolotor A, Runyan D, Andreva-Miller I, Choo W, Dunne S. 2009. ISPCAN Child Abuse Screening Tools Retrospective Version. Child Abuse & Neglect 33, 815-825. [Context Link]

 

15 Chan K. 2012. Evaluating the risk of child abuse: the Child Abuse Risk Assessment Scale (CARAS). Journal of Interpersonal Violence 27, 951-973. [Context Link]

 

16 Louwers E Korfage I, Affourtit M, Scheewe D, van der Merwe M, Vooijs-Moulaert A. 2012. Effects of systematic screening ad detection of child abuse in emergency departments. Pediatrics 130, 457-464. [Context Link]

 

17 Harr C, Souza L, Fairchild S. 2008, International models of hospital interdisciplinary teams for the identification, assessment, and treatment of child abuse. Social Work in Health Care 46(4), 1-16. [Context Link]

 

18 Paavilainen E, Helminen M, Lehtomaki L, Flinck A. How public health nurses identify and intervene in child maltreatment based on the national clinical guideline: a survey in Finland, manuscript. [Context Link]

Appendix I: Appraisal instruments

MAStARI appraisal instrument[Context Link]

Appendix II: Data extraction instruments

MAStARI data extraction instrument[Context Link]

 

Keywords: child abuse; violence; physical abuse; emotional abuse

FIND YOUR NEXT JOB WITH NURSING JOBSPLUS

CE Resources

Nursing Resources

About NursingCenter

 

© 2025 Wolters Kluwer Health, Inc. and/or its subsidiaries. All rights reserved. – Terms & Conditions – Privacy Policy – Disclaimer – Your California Privacy Choices -- v10.11.00.01