Collaborations between Police and CPS to Increase Accessibility of Medical Examinations in Cases of Alleged Child Abuse

Background and Purpose: About 9.2 children per 1,000 are victims of maltreatment in the U.S. In cases of alleged child maltreatment, a timely medical examination may help gather evidence and identify unknown medical needs. Previous studies have found significant differences between diagnoses of child abuse when children are examined by experts in child abuse versus non-experts. The use of multidisciplinary teams (MDTs) has been found to be effective in better identifying children who have experienced maltreatment and in assessing their overall needs. In addition, MDTs with effective collaboration have been found to reduce re-victimization rate. Yet, little is known about how the presence of an MDT and participation of different stakeholders may increase the accessibility of medical examinations for children involved in alleged maltreatment cases. The objective of this study was to examine if MDTs that include law enforcement (LE) personnel and CPS practitioner collaboration were more likely to report accessibility of medical examinations than those MDTs who do not have this collaboration.

Methods: Data came from an online survey conducted by the Child Advocacy Centers (CAC) of Texas in partnership with the Texas Institute for Child and Family Wellbeing. A convenience sample of 333 MDT members from 66 CAC across Texas was obtained for this analysis. Measures included access to medical examinations, MDT characteristics (LE and CPS collaboration and equal decision-making responsibility), and type of community (rural, mid-size and urban).

Results: The majority of MDTs (87%) had collaboration from LE and CPS. Communities were split between urban (42%), mid-size (40.8%), and rural (17.2%). Notably, in urban communities, 67.2% of respondents reported that children who needed medical examinations could access them, compared to only 45.5% in rural areas. Moreover, 61.7% of respondents in MDTs with LE and CPS collaboration reported accessibility, compared to only 29.3% of respondents in MDTs without this collaboration. MDTs located in urban communities had 3.3 higher odds (95% CI= 1.7, 6.3) and those in mid-size communities had 2.1 higher odds (95% CI=1.1, 4.1) of accessibility to medical examinations than those in rural communities. MDTs that had equality in the decision-making process had 3.2 higher odds (95% CI=1.6, 6.4) of reporting accessibility to medical examinations than those that reported inequality in the decision-making process.

Conclusion and Implications:  These results suggest that most MDTs in Texas have existing collaboration between LE and CPS. These MDTs may have slightly higher odds of access to medical examinations, but these odds diminish when other factors are controlled for. Community type and equality in decision-making process were the two variables most strongly associated with access to medical examinations, suggesting that rural-urban inequities and horizontal decision-making may be more important to focus on than participation from specific personnel in MDTs. The findings from this study offer empirical evidence on the importance of team dynamics and collaboration for MDTs addressing child maltreatment in their communities. Therefore, it is not enough for MDT members such as LE and CPS to collaborate, but equal power in the decision-making process and addressing rural-urban inequities are necessary.