Child Protection Referrals Research Articles

The cost-effectiveness and cost-consequences of a school-based social worker intervention: A within-trial economic evaluation

Schools are a significant source of referrals to Children’s Social Care (CSC) services. A within-trial economic evaluation estimated the cost-effectiveness of embedding social workers in schools (SWIS) in England compared to usual practice. Two hundred and sixty-eight schools comprising 277,888 students were randomised. The primary outcome of the trial was section 47 enquiries (i.e. child protection referrals to CSC services). The economic evaluation estimated the incremental cost-effectiveness of SWIS in reducing section 47 enquiries. Micro-costing approaches assessed the cost of the social worker intervention and addressed variability in key unit costs. Mean differences in costs and outcomes were estimated, with bootstrap 95% confidence intervals and scaling to incidence rate ratios per 1000 students per year. No statistically significant differences between trial arms were identified for any outcomes, costs or cost-effectiveness over a 23-month follow-up. The probability that SWIS is cost-effective was estimated for a range of willingness to pay values. At threshold values of £1000, £10,000 and £20,000, the probabilities for cost-effectiveness were estimated as 1.3%, 1.1% and 6.1%, respectively. This means SWIS had a low probability of being cost-effective.

Tailored Nurse Support Program Promoting Positive Parenting and Family Preservation.

Public health nurse home visiting is a promising approach for addressing the complex needs of families at risk of child maltreatment. The Colorado Nurse Support Program advances service provision by using evidence-based practices to provide tailored assessment and intervention to low-income, primiparous, and multiparous families with children under 18 years of age identified as high risk by county human service systems. This study aimed to test the effects of the Nurse Support Program on child protective services case characteristics between Nurse Support Program families and a demographically comparable reference group of families and evaluate changes in parenting outcomes from pre- to postprogram involvement for Nurse Support Program families. We used a matched comparison group quasi-experimental design in which families in the Nurse Support Program ( n = 48) were compared to families ( n = 150) who were identified using administrative data from Colorado's Comprehensive Child Welfare Information System. Outcomes were child protective case characteristics (child protection referrals, open assessments, founded assessments, open cases, and children's placement in out-of-home care) and parenting outcomes. Nurse Support Program families were less likely to have a child protection case opened or have their child placed in out-of-home care. There were no significant between-group differences in child protection referrals, open assessments, or founded assessments. Families in the Nurse Support Program showed improvements in parenting outcomes over time. Findings suggest that the Nurse Support Program is a successful public health nurse home-visiting approach to promote positive parenting and family preservation among families with complex needs. Implementing tailored public health nurse home-visiting programs, such as the Nurse Support Program, should continue to be evaluated and supported to mitigate the public health risk of child maltreatment.

Dental Neglect in Children: A Comprehensive Review of the Literature

The purpose of this review is to present the most recent bibliography regarding the etiology, risk factor indicators, types of dental neglect, and the epidemiological studies, showing the relationship between neglect and dental caries indices. Moreover, the review will focus on the role of oral healthcare professionals in evaluating such conditions. Untreated oral diseases, like dental caries, can lead to a variety of negative impacts on children including pain and infection. However, such complications can be prevented if a child's basic oral health needs are fulfilled. In addition, it is important to be aware that there are significant inequalities in accessing dental care and poverty, and such cases have to be distinguished from neglect. However, when there is adequate access to oral healthcare services and the parent or the guardian persistently fails to ensure appropriate medical care or treatment for his/her child, the possibility of dental neglect has to be seriously considered. Dental neglect can be apart of a child's general neglect with short-term complications, such as caries, as well as long-term consequences that extend to adulthood, such as poor growth and impaired quality of life. Early diagnosis of dental neglect plays an important role in avoiding adverse impacts on children. Signs and risk factors for dental neglect should alert the dental team in order to intervene in time and prevent suspected cases. Diagnosis of dental neglect can be difficult. However, identifying dental neglect at an early stage and making a child protection referral may safeguard the child and prevent further harm. For this reason, dentists should be informed about dental neglect and they should know how to deal with these cases. Effective education is necessary to increase knowledge and awareness of all aspects of child neglect.

Impact of COVID-19 lockdown: Domestic and child abuse in Bridgend

IntroductionFinancial stress, social stress and lack of support at home can precipitate domestic and child abuse (World Health Organization, 2020). These factors have been exacerbated by the COVID-19 pandemic (NSPCC, 2020b) (NSPCC, 2020a). We hypothesise an increase in Bridgend's domestic and child abuse during lockdown. MethodData was collected retrospectively from 23rd March to 30th September 2020 and compared to the same time period in 2019. Wales-wide data on domestic abuse was shared by the Welsh Government's Live Fear free helpline. Local data was shared by domestic abuse charity CALAN, the Emergency Department (ED) and Paediatric Department of Princess of Wales Hospital (POWH). ResultsDuring lockdown, Live Fear Free reported increasing average monthly contact across Wales in 2020 (511 April; 631 December). Locally, CALAN reported a 190% increase in self-referrals and a 198% increase in third party referrals, but there was a 36% decrease in referrals from Police for domestic abuse.The Paediatric Department observed a 67% decrease in child protection medical examinations (CPMEs) undertaken (52 vs. 17). 23 examinations in 2019 were referred from schools compared to 1 in 2020. There was a greater proportion of self-referrals for CPMEs in 2020. ED child protection referrals increased from 189 (2019) to 204 (2020). ConclusionThere was an increase in self-referrals to local support services for domestic and child abuse concerns and an increase in referrals from families/friends for child protection concerns. This was not the case with police, ED and schools/nurseries referrals. This suggests reduced engagement with public sector organisations during lockdown which services should consider.

Reports of Animal Abuse in Child Protection Referrals: A Study of Cases from One South Australian Service

Key Practitioner Messages There is a well‐established link between animal‐ and human‐directed violence. Reports of animal abuse in child protection referrals may indicate more severe cases of child abuse. Cross‐reporting of abuse is important, both in the context of child protection and animal welfare. ‘There is a well‐established link between animal‐ and human‐directed violence’

Judgements of health and social care professionals on a child protection referral of an unborn baby: Factorial survey

BackgroundMidwives and children’s services social workers have responsibilities to identify and support pregnant women where there are child protection concerns. Professionals seek to anticipate the risk of harm and initiate interventions to provide support to families. There is little research on how professionals prioritise risk factors and the challenges they face in protecting unborn babies. ObjectiveTo measure the impact of identified risk factors regarding child protection referrals of unborn babies on the professional judgements of midwives and children’s services social workers. MethodsA factorial survey design using vignettes with randomised factors within a standardised structure, administered digitally using Qualtrics software. Participants & settingMidwives (n = 250) and children’s services social workers (n = 88) from one Health and Social Care Trust in Northern Ireland. ResultsOne thousand and ninety-six vignettes were completed by 118 participants. Analysis using multiple regression showed that the risk factors together accounted for 44% of the variance in perceived risk of harm and of the variance on perceived need for a referral. The significant Independent Variables (IVs) in order included: drug use, alcohol use, age, antenatal care attendance, mental wellbeing, domestic violence and the pregnant woman’s childhood experiences. There were no significant differences between midwives and social workers regarding judgements about important risk factors. ConclusionsThis survey provided an ordering of major risk factors influencing decision making to protect an unborn baby from the perspective of experienced social workers and midwives. The study helps professionals in judging the seriousness of risk factors. The interaction effects between risks requires further research.

Who refers parents with intellectual disabilities to the child welfare system? An analysis of referral sources and substantiation

Parents with intellectual disabilities (ID) have higher rates of child welfare involvement than their non-disabled peers. One common explanation for the high rates of child welfare involvement is that they are more likely to be referred to child protection because of their substantial, ongoing involvement with professionals who are mandated reporters. Professionals are the largest overall source of child protection referrals in the United States, however prior to this study, there has not been any exploration into referral sources in cases specifically involving parents with ID in the United States. This study explored report sources to child welfare using the 2014 National Child Abuse and Neglect Data System data, comparing parents with ID, parents with other disabilities, and parents with no disabilities. Secondary data analysis showed that parents with ID and parents with other disabilities had higher odds of referral by social services personnel than parents without disabilities. Additionally, among cases that entered the system from both professional and non-professional report sources, caregivers with an ID had higher odds of case substantiation than those whose caregiver did not have an ID. Implications for practice, policy and future research are discussed.

Childhood maltreatment and poor functional outcomes at the transition to adulthood: a comparison of prospective informant- and retrospective self-reports of maltreatment

PurposeGrowing evidence suggests that prospective informant-reports and retrospective self-reports of childhood maltreatment may be differentially associated with adult psychopathology. However, it remains unknown how associations for these two maltreatment reporting types compare when considering functional outcomes. The present study compared associations between childhood maltreatment and functional outcomes at age 18 years using these two methods.MethodsWe used data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of 2232 children born in England and Wales in 1994–1995. Maltreatment prior to age 12 years was assessed prospectively (during multiple home visits between birth and age of 12 years based on interviews with caregivers, researcher observations, and information from practitioners where child protection referrals were made) and retrospectively (at age 18 via self-report on the Childhood Trauma Questionnaire). Nine functional outcomes were measured at age 18, forming two variables capturing: (i) psychosocial and (ii) vocational disadvantage.ResultsAmong the 2054 participants with available data, childhood maltreatment was associated with poorer functional outcomes regardless of whether this was reported only prospectively, only retrospectively, or both. Stronger associations with psychosocial disadvantage arose in the context of retrospective recall by participants (OR = 8.25, 95% CI 4.93–13.82) than prospective reports by informants (OR = 2.03, 95% CI 1.36–3.04) of maltreatment. Conversely, associations with vocational disadvantage were comparable for both prospective informant-reports (OR = 2.19, 95% CI 1.42–3.38) and retrospective self-reports (OR = 1.93, 95% CI 1.33–2.81) of maltreatment.ConclusionResults highlight the importance of considering the maltreatment report type used when interpreting the functional consequences of childhood maltreatment.

“Essential” services, risk, and child protection in the time of COVID-19: An opportunity to prioritize chronic need

In many North American jurisdictions, socioeconomically vulnerable families are more likely to be involved with child protection systems and experience ongoing challenges. The current public health response to the COVID-19 pandemic is having a disproportionate impact on these families via unemployment, “essential” work, isolation, and closures of childcare and schools, with negative implications for children’s developmental wellbeing. Experts warn that while child protection referrals have gone down, children who are at risk of maltreatment are less exposed to typical reporters (e.g., school professionals). At the same time, physical distancing measures are prompting many human service settings to shift toward virtual intervention with children and families. In this commentary, we suggest that a focus on short-term risk in the response to COVID-19 may obscure support for children’s long-term outcomes. We propose two policy considerations: (1) in the immediate term, that child protection workers be deemed “essential”; and (2) in the longer term, that permanent, universal basic income guarantees be implemented to support a baseline of predictability both in families’ material wellbeing and in fiscal budgets in the case of a future crisis. As we write, it is impossible to predict the longevity of these closures nor the extent of their impact on children and families. However, the present article mirrors commentary following previous crises noting the importance of going beyond immediate health risk mitigation to consider wellbeing with regard to children’s development and families’ socioeconomic needs in the long term.

Contact burns: the influence of agents and mechanisms of injury on anatomical burn locations in children

ObjectiveTo identify how causative agents and mechanisms of injury influence the location of an accidental contact burn in children and whether these factors differ in cases referred for child protection...

Role of the dental hospital-based paediatric liaison nurse in safeguarding children.

Aim Service evaluation of our dental hospital paediatric liaison nursing (DH-PLN) service which provides an additional route for information sharing about safeguarding concerns via an agreed pathway for two-way communication with public health nurses.Method Retrospective analysis of clinical records of all children referred by DH teams to PLN in the three months October-December 2016.Results One hundred and four children were referred; mean age was 6.2 years, 89.4% from Index of Multiple Deprivation (IMD) quintiles 4 and 5, and 70.2% were attending for dental general anaesthesia. The most common referral reason was dental neglect in 66.3%, followed by missed appointments in 50.0%. The PLN checked child health databases and shared information with health visitors and school nurses (46.2% and 53.8% respectively). Feedback retrieved included known child maltreatment risk factors in 7.7%. This prompted additional child protection referrals to children's social services for seven children (6.7%). Dental outcomes six months later were: treatment complete in 50.0%, treatment ongoing 28.8%, discharged to original referrer with treatment incomplete in 21.1%.Conclusion This DH-PLN service promotes integrated multidisciplinary working, helping overcome barriers to dentistry's involvement in safeguarding. It facilitates more accurate assessments of risk of harm to children receiving dental care and prompts additional child protection referrals to social services.

Social workers’ challenges in the assessment of child abuse and maltreatment: intersections of class and ethnicity in child protection cases

Defining and assessing child abuse and maltreatment has long been a challenge to both researchers and practitioners in social work. Taking an intersectional perspective, this article explores the meaning of class and ethnicity in professionals’ investigations and assessments in child protection referrals. Overall, findings show that class power was particularly actualised for caseworkers facing parents with high social status. In these cases, the parents often resisted the investigation and the caseworkers therefore had difficulties in disclosing or defining the abuse. In comparison, culture was often made relevant in cases involving minority ethnic parents, where abuse was often actualised as corporal punishment. This practice tended to be seen as a cultural issue rather than related to social problems. In these cases, class power was not articulated. The article sheds light on intersections of class and ethnicity that may affect social work practice with children at risk of abuse and maltreatment.

What’s in the Numbers? Child Welfare Statistics and the Children (Northern Ireland) Order

ABSTRACTThis article draws attention to the importance of routinely collected administrative data as an important source for understanding the characteristics of the Northern Ireland child welfare system as it has developed since the Children (Northern Ireland) Order 1995 became its legislative base. The article argues that the availability of such data is a strength of the Northern Ireland child welfare system and urges local politicians, lobbyists, researchers, policy-makers, operational managers, practitioners and service user groups to make more use of them. The main sources of administrative data are identified. Illustration of how these can be used to understand and to ask questions about the system is provided by considering some of the trends since the Children Order was enacted. The “protection” principle of the Children Order provides the focus for the illustration. The statistical trends considered relate to child protection referrals, investigations and registrations and to children and young people looked after under a range of court orders available to ensure their protection and well-being.

Child abuse and fabricated or induced illness in the ENT setting: a systematic review.

Child maltreatment is persistently under-recognised. Given that a third of maltreated children may return with serious or fatal injuries, it is imperative that otolaryngologists who are in frequent contact with children are able to detect maltreatment at first presentation. This review aims to identify ENT injuries, signs or symptoms that are indicative of physical abuse or fabricated or induced illness (child maltreatment). Systematic review. An all-language search, developed in Medline Ovid and consisting of 76 key words, was conducted of published and grey literature across 10 databases from inception to July 2015, for primary observational studies involving children aged <18years. Each relevant article underwent two independent reviews with full critical appraisal, applying strict quality standards. Of the 2448 studies identified and screened, 371 underwent full review, resulting in 38 included studies that detailed 122 maltreated children. Pharyngeal perforations (n=20) were the most frequent abusive ENT injury, predominantly affecting neonates and infants, presenting with dysphagia, drooling, haemoptysis and surgical emphysema. At least 52% of children with abusive pharyngeal injuries had additional co-existent injuries. The majority of ear injuries were inflicted to the external ear (n=11) and included auricular deformity, abrasions, petechiae, lacerations and burns. Fabricated or induced illness cases presented most commonly with recurrent, unexplained otorrhoea or ENT lesions that failed to heal despite appropriate therapy. All clinicians should be familiar with the signs of child maltreatment. Pharyngeal injuries, or injuries to the external ear, presenting in young children without an explicit history of witnessed injury should prompt a child protection referral for full evaluation. Likewise, children who present with recurrent, or apparently intractable symptoms and signs despite appropriate treatment, should raise the possibility of fabricated or induced illness, and discussion with a child protection specialist is advised. Early recognition of possible child maltreatment and instigation of appropriate safeguarding measures are essential to prevent repetition and escalation of injury. This is of paramount importance to otolaryngologists, who have the potential to identify these children in their practice.

Clinical Audit of Children's Missed Dental Appointments in a City‐Wide Salaried Community Dental Service in Relation to Guidance on When to Suspect Child Maltreatment

Children's missed healthcare appointments may be an alerting feature of neglect so it is essential that concerns are shared with other professionals. The aim of this clinical audit was to investigate the management of missed dental appointments for children in a city‐wide salaried community dental service. Standards for communication with (a) the family, (b) other professionals and (c) child protection referral to social care were developed using NICE Clinical Guidance 89: When to suspect child maltreatment and the British Society of Paediatric Dentistry's policy document on dental neglect. Information collected from a random sample of 100 clinical records included communication actions within six months of a missed appointment and dental outcome. After reporting the first‐cycle (C1) results, procedures were modified and staff training provided. Sampling and data collection were repeated annually for two further cycles (C2, C3). Communication standards were not fully met in any cycle. The missed appointment rate was 11–12 per cent. An initial small increase in interprofessional communication, including two child protection referrals to social care, was achieved in C2 together with a reduction in unresolved dental outcomes. However, omissions still occurred and improvements were not maintained in the third cycle, demonstrating insufficient consistency to ensure the protection of vulnerable children.‘The aim of this clinical audit was to investigate the management of missed dental appointments for children’Key Practitioner Messages This paper describes a method of auditing the management of missed dental appointments in relation to maltreatment guidance. We achieved initial small improvements in interprofessional communication and dental outcomes but also identified lapses which might indicate children at risk of neglect who could ‘slip through the net’. Dental services, other healthcare services and children's social care must work together to develop better communication pathways. ‘Dental services, other healthcare services and children's social care must work together to develop better communication pathways’

Parcours et devenir de 128 enfants admis avant l’âge de quatre ans en pouponnière sociale

The purpose of this study was to determine the institutional trajectory and future of young children in child welfare. A catamnestic study - based on data from the child welfare office in Maine and Loire, France, from 1994 to 2001 - was conducted by a child psychiatrist and a psychologist. Medical, judicial, and educational data (development, health, pathways in child protection services) were collected and analyzed regarding the status of these children 15 years later, adding information gathered by interviewing the child welfare and foster family consultant. We included 128 children admitted to the child welfare office before 4 years of age. Admission to the child welfare system suffers from care delays (a mean of 13.1 months between the first child protection referral and placement) with an average entry age of 17 months and frequent cases of child abuse (e.g., seven Silverman syndrome cases). The physical and mental health status of these children was poor (poorly monitored pregnancies, prematurity, low birth weight). More than one third of the children had growth failure at admission, with catch-up in half of the cases. The average length of stay in the child welfare system was 13.2±4.6 years. At the end of the follow-up, there were specific measures to safeguard vulnerable adults: "young adult" (24 cases), "major protection" (eight cases) and "disabled living allowance" (nine cases). One hundred and sixteen children suffered from psychiatric disorders at entry and 98 at the end. The general functioning of children as assessed by the Children's Global Assessment Scale (CGAS) showed a statistically significant improvement. One out of two young adults showed problems integrating socially with chaotic pathways: many foster placements, unsuccessful return to the family, and academic failures. The clinical situations of children in the child welfare office and their long-term progression confirm the importance of this public health problem. Although the measures can greatly improve their physical and psychological recovery, with evidence of thriving, this remains limited: only a few of these children are well integrated socially and academically.

G77(P) Improving the recognition of domestic violence in an urban emergency department

Aim Domestic violence (DV), substance misuse and psychiatric disorders are major risk factors that substantially increase the likelihood of child abuse or neglect. DV is common but rates of detection are low among emergency professionals, who are often the first port of call for victims. Our project aimed to improve awareness and recognition of DV in an urban emergency department. Methods A retrospective notes audit of women aged 16–65 years presenting with injury or assault was conducted over two, two-month periods (1st phase and 2nd phase), with detailed analysis of patient notes done in two two-week sampling frames during each phase. Between these two phases a diagnostic algorithm was introduced to remind clinicians to consider DV and inquire about children at home. Training sessions for emergency staff were organised. The algorithm was inserted into the notes in the form of stickers by the triage nurse. Clinicians attending the injured women would then complete the algorithm and make the appropriate DV and child protection referrals. Results 743 eligible patient notes were reviewed. 373 women presented to the emergency department with injury or assault in the 1st phase and 370 in the 2nd phase. There was an initial low uptake of the algorithm and barriers to its use were identified via staff questionnaire. This resulted in supplementary training sessions and email reminders. Although overall comparison between the 1st and 2nd phases of data collection showed no significant increase in the identification of DV, after addressing staff concerns, there was a significant increase in the use of the algorithm in the last 2 weeks of the 2nd phase with the diagnosis of DV increasing from 5 to 10% (p ≤ 0.048). 31% of women identified with DV in the 2nd phase had children, which were then referred to social care. Conclusion The use of a diagnostic algorithm together with regular staff training sessions has the potential to increase identification of DV. This will not only help protect vulnerable women but also their children, and offers the opportunity for early support and referral to the appropriate services.

G539(P) Trainee-led quality improvement in enhancing service in community paediatrics

Context We planned to address two key areas of service provision in our secondary level hospital. Firstly, in keeping with many Community Paediatric Departments, our hospital has experienced an increase in the number and complexity of referrals. As a result many families had long waits for consultations. Secondly in our trust safeguarding work had historically represented a large proportion of the acute workload. Problem and Assessment 1. Child Development Centre (CDC) appointments Long waiting lists for medical appointments were negatively affecting patient care. The department was not compliant with the NICE guidance on the timeframe for assessment of children with possible social communication disorders. Patient satisfaction surveys had also identified this as an area of concern for families. 2. Child Protection Assessments Vulnerable children competed with acute admissions for assessments and were often seen out of hours, when Consultant medical staff were not on site. Social Care had highlighted concerns about long and unpredictable waits for assessments. Intervention Firstly, trainees in consultation with their consultant supervisors developed a flexible clinical arrangement to target service provision and meet community competencies in the CDC setting. Trainees were expected to complete six CDC clinics during their six month rotation, which were tailored to the trainee’s acute rota. Secondly, a daily child protection medical clinic was implemented and delivered by trainees under consultant supervision. Monthly safeguarding peer review meetings were initiated in line with Royal College of Paediatrics and Child Health guidance to provide support and facilitate training in this area. Strategy for change To instigate and review the response to change, the Plan-Do-Study-Act (PDSA) cycle was used. An initial multi-disciplinary team (MDT) meeting was used to formalise plans and disseminate information, with three monthly MDT feedback meetings planned. Measurement of improvement During the initial six month period, review of waiting lists has shown that trainee delivered CDC clinics have resulted in a reduction of waiting lists by 56 patients (the equivalent of 0.4 PA Consultant time). Urgent new patient appointments have fallen from 12 to 0, although routine new patient appointments have increased from 45 to 68. Feedback from the MDT is largely positive. Review of child protection referrals has shown that following the instigation of child protection medical clinics the number of assessments occurring out of hours has fallen to 19% compared to 44% previously. 81% of children are now seen at a prearranged time, without delay, compared to approximately 23% previously. Trainees report feeling more supported in carrying out safeguarding work. A repeat CDC patient satisfaction survey and a planned audit of the child protection clinics will provide further feedback on the success of these interventions, which will lead to further action (PDSA). Effects of changes Developing a flexible approach to encompass trainees’ acute commitments, has required meticulous planning. Room availability was an unexpected factor needing close consideration in the plans. Involvement of trainees has required support and supervision both from Consultants, and the wider MDT, thus requiring some changes to their previous practice. Lessons learnt Managing a change in service provision requires consideration of many different priorities. When trainees take a key role, it ensures the changes work at their level. Message for others Working within the European Working Time Directive and today’s financial constraints, a flexible approach to service provision is necessary. This initiative has highlighted that direct trainee involvement in the design of service delivery can result in significant changes that benefit patients, trusts and trainees alike. Moreover this venture has enhanced community training, as well as providing trainees with valuable experience in management of change.

SAFER: Boosting quality and efficiency of urgent child protection referrals

The Institute of Health Visiting has recently updated a tool to aid health visitors in making safeguarding referrals. Cheryll Adams explains what it is and how it is used.

G218(P) A Review and Audit of Penetrative and Forensic Child Sexual Abuse Cases

AimsTo review all penetrative child sexual abuse (CSA) cases presenting to a local unit over 12 months and audit against national guidelines for sexually transmitted infection (STI) screening and Forensic...