Screening Decisions at Child Protective Services Intake: A Systematic Review

Background and Purpose:

An estimated 1,750 children die each year from family violence due to child neglect or abuse.  Data suggests that approximately one-third of fatalities had at least one prior CPS referral.  Child fatality reviews emphasize the importance of effective screening decision processes, though little research has focused on how decisions are made.  Screening decisions present challenges for workers given the high volume of referrals, limited timescales, and often incomplete, vague, or conflicting information.  Current efforts to improve decision making largely focus on the use of technical solutions to support workers.  A more nuanced understanding of how worker decisions are made in practice may shed light on how workers might be best supported.  This systematic review begins to address this gap by examining thirty-five years of research that explores the factors associated with CPS intake workers’ decisions to investigate maltreatment reports.

 

Methods:

Study methods were guided by established systematic review guidance and consistent with PRISM-P standards.  The review focused on studies published in English between January 1980 and January 2015.  The search included six databases, eight grey literature websites, and three peer-reviewed journals, resulting in 1,147 unduplicated citations.  Eligible studies were those that examined decisions by CPS intake workers to screen in reports for investigation.  Qualitative studies, case studies, and studies using vignettes or scenarios (i.e. not actual CPS reports) were excluded. A two-stage screening process was undertaken using a specified criterion, first a title and abstract (n=130), followed by a full text review (n=22).  Studies were independently reviewed by two raters, and discrepancies resolved by a third rater.  Data extraction focused on sample and worker characteristics, methods, and findings.  The review findings report a final sample of 18 studies.  The Decision-Making Ecology (DME; Baumann, et. al., 2011) was used as an organizing framework for study findings. 

Results:

Across studies, 51-68% of reports were screened in for investigation. Statistically significant factors related to the reporter (professional status), referral (number of reports, nature of allegation, perpetrator characteristics), child, (number of child victims, demographics, characteristics), caregiver (characteristics, parental difficulties, parenting difficulties), family (number of children, prior CPS involvement, income, family difficulties, major life events), decisionmaker (worker beliefs), organization (site differences, supervision), and other external factors (maltreatment, population trends, community-CPS relationship).

Conclusions and Implications:

The results of this systematic review reveal those domains and factors that feature most prominently and consistently in screening decisions.in recent decades.  It also highlights clear gaps in knowledge about the factors in some key DME decision-making domains.  This review illustrates the complex range of factors that workers take into consideration, not all of which were directly related to incidents of maltreatment.  Implications from this review include addressing gaps to better understand the presence of environmental (organization, community, society) factors that guide screening decision, and how to minimize the risk of worker bias.  Implications also focus on strengthening decision-making processes that make best use of unbiased professional expertise and empirical knowledge of risk and protective factors for child maltreatment.