Bar Ilan University, Israel.
The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Israel.
Child Abuse Negl. 2014 Jan;38(1):11-24. doi: 10.1016/j.chiabu.2013.06.011. Epub 2013 Aug 12.
This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement.
本研究考察了医院儿童保护团队（CPT）在判断是否有合理理由怀疑儿童受到虐待以及是否向社区福利机构、儿童保护服务（CPS）和/或警方报告案件时所做的判断。这是一项前瞻性多中心研究，研究对象为 2010 年至 2011 年期间以色列六家医疗中心的 968 例连续转介至 CPT 的病例。中心是有目的地选择的，以代表以色列医疗中心在规模、地理位置和人口特征方面的异质性。设计了一份结构化问卷，以获取有关每个转介给团队的儿童的相关信息和判断。进行了二变量关联和多变量多项逻辑回归，以预测决策是否为(a)结案，(b)将案件转介给社区福利服务，或(c)向 CPS 和/或警方报告。二变量和多变量分析确定了许多与向 CPS/警方报告或向社区福利服务转介的可能性更高相关的病例特征。与决策相关的病例特征包括社会人口统计学特征（如种族和财务状况）、父母功能（如心理健康）、以前与当局和医院的接触、当前转介特征（如父母转介与儿童转介）、身体检查结果以及儿童和父母的可疑行为。大多数发现表明，CPT 的决策是基于专业文献中强有力支持的指标做出的。案件、从业人员和医疗中心之间现有的异质性对报告决策的总体可预测性产生了影响。建议关注医院和社区机构之间的协作，以支持学习和质量改进。
