Subjective Factors Constitute to Play a Role in Assessment of Child Maltreatment By Healthcare Professionals' in Community-Based Services

Background: This study examines healthcare professionals' judgments in detecting cases of child abuse and neglect when working in community services. Insufficient empirical attention has been directed at this group of professionals although their position at a crucial juncture in the process of identification of child maltreatment incidences, and the provision of early help. Unlike other conditions, child abuse and neglect present particular diagnostic challenges for the healthcare profession. For example, the definition of maltreatment is variable and unclear, and there is no single line of explanation that accounts for evident harm or visible signs. Research suggest that healthcare-professionals' judgment about the probability that the individual child was maltreated, is biased by ethnic and class stereotypes. Research shows that healthcare professionals tend to attribute more abuse and neglect to children of ethnic/racial minorities, and from lower socio-economic background. It is thus hypothesized that such child-maltreatment assessments are influenced not only by the objective risk to the child, but also by other factors such as (1) the child’s ethnic background, (2) the child's socio-economical background, and by (3) the child’s gender.

Methods:  The study used an experimental design within a cross-sectional survey framework. A series of vignettes were constructed, describing a child at risk. Three factors were randomly manipulated: child’s ethnic background (Jewish/Arab), child's socio-economical background (Middle-Class/Low-Class), and child’s gender (Male/Female). Professionals were asked to assess risk to the child, and their reporting intention for the case. The sample was a purposive convenience sample, intended to maximize variation, consisting of 517 healthcare-professionals working in community-based HMO clinics, in Israel. Each professional was asked to respond to five randomly selected vignettes (from a pull of nine vignettes). Responses included the perceived risk to the child. Each questionnaire also asked of the workers’ socio-demographic background, professional training, and specific professional role. Linear and logistic regression-analyses were carried at the vignette level, controlling statistically for within worker clustering using robust standard-errors within a Generalized Estimating Equations (GEE) model.

Results: As hypothesized, child’s gender, ethnic, and socio-economic background, have all turned to have significant effects on subjective risk-assessment and reporting intentions. Being a girl, Arab, and belonging to low socio-economic class increased the likelihood that child's condition will be identified as the result of abuse and neglect, and of reporting the child for further investigation.

Conclusions and Implications: This study reinforces prior findings in regard to effects of healthcare professionals' personal attitudes and believes on their ability to identify child maltreatment correctly. The results are discussed in terms of their implications on service delivery, including the perceived danger of intervening in the lives of innocent families and investing scares resources at the wrong place. Recommendations are made in relation to professionals' education and training.