Judgments and Decision Making Processes of Child Protective Teams (CPTs) within Medical Centers and Community Child Protective Services (CPS) In Cases of Alleged Child Abuse and Neglect

Purpose: Hospital-based Child Protection Teams (CPT) are charged with the important task of assessing cases of suspected child maltreatment and deciding whether to report the case to community Child Protective Services (CPS). The decision whether to refer to CPS carries significant consequences for children and families and should be explicated and opened to professional and public scrutiny. Today CPTs do not get feedback from CPS and cannot assess the validity of their decisions. Hammond's Social Judgment Theory and the ‘Lens model' are employed to describe the decision-making process of CPTs and the validity of their decision to report maltreatment suspicion, based on CPS feedback. The aims of the study were to: Identify which case characteristics are associated with referrals to CPS and assess the validity of hospital CPT decision-making process in referrals to community CPS. Methods: The study covered 731 consecutive cases in five hospitals that were assessed by CPT for alleged child abuse and neglect during 16 months period. More than half of the children were males (52%), and age at admission ranged from the first month in life to 18 years old, mean 8.4 (SD=6.2), median 4.0. The great majority of children were Jewish (69.6%), and most of them born in Israel (89.5%). A large majority of the families (68.5%) were dual parent families, and most of the children (84.2%) lived in their parents' home. Structured questionnaires were developed to capture all case information, including demographics, parental background, child development history, observations of child and parent behaviors and interactions, medical assessments and CPT judgments and decisions. Phone interviews were conducted with CPS staff handling all those cases referred by CPT. Bi-variate measures of association were computed between case characteristics and the referral decision. Multivariate hierarchical logistic regressions were used to estimate the overall model Results: About 54% of cases investigated in hospitals were reported to CPS. The decision to report to CPS was predicted well (75.2% accurate predictions) by case information. Early development difficulties, physical signs (broken bones, burns), assessments of child behavior and parents reactions to the child and to staff were strong predictors of the decision to refer to CPS. According to CPS, almost all referrals (99%) were justified. However, CPS follow-up investigations indicated that in 24.2% maltreatment was not substantiated. Conclusions and Implications: The model predicting referral to CPS is congruent with available knowledge and suggests good practice. This is the first time in Israel CPS's provide feedback to hospital CPT's. This feedback is most instrumental in improving the decision-making processes of CPTs in order to optimize their efforts and minimize the number of unwarranted reports to CPS. The fact that a quarter of referred cases were not substantiated indicates the need for closer communication to enhance more learning, training and CPT-CPS cooperation to improve hospital-based assessments. Implementation of standardized assessment guidelines for CPTs and modifications in current practice based on CPS feedback will contribute to the important assessments and screening carried out in hospitals.