Improving the Use and Usefulness of Specialized Medical Assessments for Child Welfare Case Determination: Findings from Focus Groups of Child Welfare Investigators

Background and Aims:

Specialized child medical assessments are a critical resource for child welfare caseworkers in the investigation and assessment of suspected maltreatment. Child welfare investigators are able to refer children to assessments by a medical provider with specialized training in the assessment and detection of maltreatment. Medical findings assist investigators with case determinations and service recommendations. Although specialized medical assessments are an integral piece in the case determination process, almost no research has studied the process of referral to medical assessments and use of medical information gained from the perspective of child welfare investigators. To fill the gap in the literature the aim of this study was to qualitatively examine child welfare investigator experiences of the referral process to medical assessments and perceived usefulness medical assessments for case determination.

Methods: 

Six focus groups were completed with front line child welfare workers at the county level in North Carolina. Counties were selected for participation by geographic location, population density, and medical assessment use to ensure that the study was able to identify diverse caseworker experiences. The focus group guide was developed by child welfare caseworkers, medical providers, and public health agency officials. The focus group guide was piloted at a child welfare conference and revised on feedback. Focus groups were conducted between August and December of 2015. Focus groups were well attended with 4-12 participants at each focus group. Focus groups were audio recorded and attended by two study investigators. Recordings were transcribed and coded using ATLAS.ti by two research assistants looking for key themes within and between the focus groups.

Results:

Analysis of focus group transcripts resulted in several key findings.  Referral processes for specialized child medical assessments varies based on case characteristics. There was wide variability in the methods investigators use to determine if a case warrants a medical assessment. Investigators utilize and value multidisciplinary teams when making decisions about referrals for medical assessment and case determinations. The presentation of medical findings within the assessment reports influences the case determination. Relationships between specialized medical providers and child welfare investigators impact the case investigation timeline. These relationships also affect the way that investigators work with providers during and after medical assessments, leading to a potential impact on the quality of investigation findings.

Conclusions and Implications:

Findings highlight the importance of relationships between child welfare investigators and medical providers, as well as the importance of multidisciplinary teams. Coordination of multiple providers within and across systems was critical to case determinations. Furthermore, there were several identified barriers to service referral and restraints of usefulness of medical assessments. Social workers are charged to provide the best possible care for child welfare-involved youth. It is imperative to adopt policies that promote coordination across systems to ensure best practices when making child welfare case determinations.