Decision making by the child protection team of a medical center.

Abstract

The article Decision Making by the Child Protection Team of a Medical Center by Benbenishty and Chen in this issue (pp. 285-293) describes an interesting study from Israel examining the decision-making process of hospital-based child protection teams (CPT). These teams are mandated by the Israeli Ministry of Health. The authors noted that social workers, nurses, and physicians are regular members of these teams. The authors looked at information cues (constructed from a literature review) that professionals used in making the decision whether to intervene in a situation of suspected child abuse or neglect. Three experienced social workers rated the charts of 139 children referred, presumably by hospital personnel, to the CPT; 98 children were subsequently referred to a child protection officer (CPO), and 41 were not. The study determined that family characteristics such as inadequate parental explanation of the child's injury, immigrant status, and poverty had high probability of resulting in a referral to the CPO. The authors noted that they did not intend to study whether these decisions were accurate. However, in the introduction to the article, they commented that unnecessary referrals cause pain and may cause more harm than good. We agree and note that allocating resources to studying decision making without considering whether the outcomes were bad or good for families and children is of limited use. Although it is interesting to study the decision-making processes of a team of professionals in a hospital over a period of time and find that decision making has been consistent, it is more important to find out whether families and children benefited flora the process. Consistency of decision making does not necessarily result in good outcomes or even fair process. For example, racism and classism can be consistently practiced. This study's findings confirmed that in this hospital, with this CPT, new immigrant families who did not own homes or have steady incomes were referred to the child protection system more often than others. The question that this finding raises is whether the decisions were correct or if they reflected consistent, but problematic practices on the part of the CPT. The authors did not examine whether language was a factor in the finding related to new immigrants. Research in the United States has found that non-English speaking people may look more confused and evasive if they are not communicating in their own language. This is especially so for sensitive topics (Malgady & Zayas, 2001). The authors offered several interpretations of their findings related to nontraditional, poor, and immigrant families. …