Evaluating Multidisciplinary Child Abuse Training: A Comprehensive Program and Questionnaire1

Tanya Beran, Ph.D.
University of Calgary

ABSTRACT: Child abuse is a complex problem that requires a comprehensive solution.  As a result, a multidisciplinary approach is often used when investigating child abuse.  Training for this approach requires evaluation to ensure that multidisciplinary teams are effective at assessing and treating cases of suspected child abuse.  In this paper I will discuss the evaluation of child abuse investigation training.  First a training program for multidisciplinary child abuse investigation is presented, followed by an evaluation approach and finally a multi-dimensional questionnaire.  Issues to consider when evaluating training are discussed including, for example, obtaining responses from trainees over time.  Also, it is recommended that evaluation tools measure knowledge, attitudes, and behaviors of trainees after the training.
 

Introduction

Today, child abuse is considered to be the most serious criminal act against children in our society (Department of Justice Canada, 2005).  Due to the complex and sensitive nature of child abuse, treatment must be comprehensive to meet the needs of children and their families.  According to Burgess (1979), "Abuse does not occur within a vacuum, but within a social matrix that consists of recurring transactions taking place between various members of the family" (p. 789).  This social matrix extends to the broader community where children affect and are affected by interactions with others at school, in their neighborhoods, and the larger society.  Thus, treatment is unlikely to be effective if it occurs within a vacuum.  As a result, multidisciplinary child protection teams began to form in the late 1950s and are now commonly used.  Indeed, failure to include a multidisciplinary approach is considered a form of malpractice (Bross, 1988).  This approach is viewed as essential in using multiple sources of information to inform assessment and treatment planning for children and families (Ford-Martin, 2001; Patterson, 2004).

Although this service approach has become normative, training for its delivery has received little attention.  Of the training programs that do exist, systematic evaluations of their ability to train professionals to work in multidisciplinary teams have been largely neglected.  For example, topics such as determining how training directly and indirectly impacts child abuse investigation, identifying barriers to developing efficient teams, and examining satisfaction with training, have yet to be addressed comprehensively.  It is the purpose of this paper to present a tool that can be used to examine the effectiveness of a multidisciplinary child abuse investigation training program.

Given that millions of children each year are referred to child protection services, it is important to consider how these cases are investigated (U.S. Department of Health and Human Services, Administration on Children, Youth, and Families, 2003).  In most states, social workers and police officers work together in a collaborative effort to identify child abuse, support families, and prosecute perpetrators (Barton, 2000).  This collaboration brings together differences in background training, knowledge and skills used to investigate child abuse.  As a result of these differences, however, problems such as conflict are likely to occur during collaboration (Smith-Cannady, 1999).
 

Multidisciplinary Training

Description

The philosophical basis of a multidisciplinary approach is to create a team that serves common goals and the interests of the victims of abuse.  This approach can also be described as a joint or team investigation, in which a mutual support network is established.  An effective multidisciplinary team has, "a shared purpose, clear goals, standards for performance ... a collaborative climate, external support and recognition, and fair and impartial leaders" (Gilbert et al., 2000, p. 225).  Training programs have been developed to assist professionals in establishing this type of approach.  Indeed Pence and Wilson (1988) state that joint training (training a group that includes a variety of professionals) is critical to developing multidisciplinary teams.  Training methods include lectures, case studies, team building, and experiential learning.  The duration of training may range from a few days to several months.  Professionals who may participate in this training include child protection workers who have the role of maintaining families, law enforcers who are responsible for gathering evidence, and prosecutors whose purpose is to seek convictions. With training, professionals are likely to be more aware of and in greater support of these differences with the end result of better meeting the diverse needs of families involved in child abuse.
 

Impact

Although it is commonly accepted that training is necessary for professionals to develop an effective multidisciplinary approach (Sullivan & Clancy, 1990), it is important to gather empirical evidence to support this claim.  Preliminary results suggest that training programs have some desired effects on trainee knowledge, attitudes, and behaviors, which are presented in this section.
 

Knowledge

Several researchers have reported that trainees gain knowledge from multidisciplinary training programs (Bannon, Carter, Pace, & Thome, 2001; Elmer et al., 1978; Harris, Saunders, & Zasorin-Connors., 1978).  This knowledge includes a better understanding of the nature of abuse and intervention strategies.  For example, Elmer et al. (1978) found that trainees report a better understanding of family interactions, and Abramson and Mizrahi (1996) indicated improvement in understanding client needs.  In the area of intervention, trainees develop a greater understanding of various intervention skills (Abramson & Mizrahi, 1996), and become clearer about their own roles and responsibilities (Bannon et al., 2001).  They also are able to clarify the roles and responsibilities of other professionals (Harris et al., 1978).  Bannon et al. (2001) reported an improvement in understanding legal procedures in child abuse cases and a greater awareness of possible conflicts and their solutions when working from a multidisciplinary approach (Bannon et al., 2001).
 

Attitudes

In addition to improving knowledge, multidisciplinary training programs may change trainees' attitudes about their clients, themselves, and other professionals.  Harris et al. (1978) found that trainees reported greater sensitivity to families who encounter difficulties within the child protection system.  Bannon et al. (2001) indicated that trainees reported higher levels of confidence in managing their cases, and Lacey (1998) found that trainees reported a more positive attitude toward teamwork.  As it has been suggested that work in the area of child abuse is emotionally taxing on professionals (Krell, Richardson, LaManna, & Kairys, 1983), it is also possible that multidisciplinary training will lower perceptions of work stress and burnout if they gain a more positive work attitude.
 

Behaviors

Researchers have also found evidence of some behavioral changes that occur as a result of multidisciplinary training.  Although no behavioral outcomes have yet been demonstrated in interventions with clients, some changes have been shown in interactions with other professionals.  Harris et al. (1978) examined whether training would result in placing greater responsibility on the families and focusing on the client rather than on the problems; however, no significant changes were found.  Regarding interactions with other professionals, Harris et al. (1978) found that trainees became more willing to share their roles with other professionals.  Also, Lacey (1998) reported increases in productivity whereby time was better managed and people worked more closely together.  Although an improved awareness of other professions and interventions skills has been reported (Abramson & Mizrahi, 1996; Harris et al., 1978), Sullivan and Clancy (1990) found that the number of referrals did not increase after training and that the number of interviewing techniques increased but only moderately.

Effective communication skills with other professionals are regarded as critical to collaboration (Abramson & Mizrahi, 1996).  Communication skills include negotiating, compromising, asserting, persuading and defending.  Although Harris et al. (1978) examined communication and problem-solving skills with other professionals, no significant improvements were shown.  There to be no other studies that have examined the impact of training on these aspects of communication.

Additional work indicators that may be improved as a result of training include eliminating duplication, obtaining more proper and expedient collection of physical evidence (and also collateral data from other agencies), reducing secondary trauma associated with the investigation, and increasing the number of pleas and reducing the need for child testimony (Pence & Wilson, 1994).  These changes would result in more integrated and coordinated care for families.
 

Barriers

Although numerous benefits can potentially be gained from multidisciplinary training, many barriers may exist (Heck, 1999).  They may include either strategic (agency interactions) or operational (worker interactions) (Fowler, Hannigan, & Northway, 2000).  Agency barriers may include different philosophies, organizational structures, funding limitations, conditions of service, training, and values of organizations in which professionals work (Patterson, 2004).  It has even been suggested that these differences may be resistant to training (Davey & Hill, 1995).

Worker barriers may include work-style differences, communication problems, sexism, racism, age differences, sexual involvements with team members, conflicts over power/status, and mistrust and lack of respect (Reder & Duncan, 2003).  Also, researchers have reported that conflict is likely to occur during multidisciplinary meetings (Abramson & Mizrahi, 1996; Davis, 2001; Milligan, Gilroy, Katz, Rodan &
Subramanian, 1999).  Explanations for these difficulties such as feelings of superiority
and power struggles, loss of autonomy, differences in authority and initial training, and need for recognition have been suggested (Lardner, 1992).  Some professionals,
moreover, may see little value in a multidisciplinary approach (Abramson & Mizrahi, 1996).

Rodgers (1994) proposed that multidisciplinary training might reduce these barriers.  Indeed, Pence and Wilson (1994) stated that joint training could improve understanding of and respect for differences that can lower these barriers.  These barriers must be considered in the development of multidisciplinary training programs, and an example of one is described next.
 

A Training Program

When asked about their training needs, practitioners in the area of child abuse report wanting better interviewing and rapport-building techniques with parents and children, referral guidelines, preparation of conference reports, identification of abuse, counseling skills, legal information, understanding of ethical issues, role clarification, and understanding of symptoms (Bannon et al., 2001).

In an effort to fulfill these training needs, the "Investigating Child Sexual Abuse: A Training Curriculum for Police Officers and Child Welfare Workers" was developed by the Canadian Society for the Investigation of Child Abuse.  This 13-week, one full day/week series of workshops aims to increase both professional knowledge and skills regarding issues such as the definition of child sexual abuse, mandates of law
enforcement and child welfare, child development and memory in children, interviews with children, and retractions and allegations that pertain to the practice of child abuse investigation.  Child welfare workers and police officers participate in activities that include mock interviews, role plays, videos, discussion groups, case studies, a court tour, and lectures.  In these activities, barriers to multidisciplinary investigation such as work style and communication differences among professions, attitudes and behaviors toward women and minority groups, and various forms of conflict are critically discussed.

Although some studies have examined how collaboration positively impacts child abuse investigation, very few have examined how collaboration training positively impacts collaboration and child abuse investigation (Patterson, 2004).  The purpose of this paper is to provide a questionnaire that can be used by researchers when evaluating the effectiveness of multidisciplinary child abuse investigation training programs.  This questionnaire was developed to measure a) knowledge about child abuse investigation issues that participants gain from the multidisciplinary training, b) trainees' attitudes about their clients, themselves, and other professionals who may have been impacted by the training, and c) improvements in the form of behavioral outcomes in child abuse investigation (e.g., responsibility, referrals, communication, etc.).
 

Measure

The evaluation questionnaire measures the degree of impact the training program has on participants' knowledge, attitudes and behaviors (see appendix A).  This questionnaire was developed based on items used in previous research that evaluate training programs or that were identified as important to include in training programs.  Also, professionals who work in the field of child abuse reviewed the items developed for this questionnaire and modifications were made until agreement was reached. These two approaches provide good content validity for the questionnaire.  It consists of 44 items on a 5-point response scale ranging from 'no impact' to 'great impact', and it requires approximately 20 minutes to complete.

It is recommended that this questionnaire be administered at more than one time after the training is completed.  For example, it may be useful to determine trainees' perceptions of the program immediately following the training and then again several months after having an opportunity to implement the new information to determine how useful it is.  It is important to ensure confidentiality for participants, and it is recommended that research assistants who do not provide the training administer the questionnaires to maximize accuracy of responses.
 

Analyses

Responses should be aggregated and available for reporting to the participants.  Responses can also be compared between the times the questionnaire is administered.  For example, it would be possible to determine the impact of the training just after the program in comparison to a few months later.  In addition, analyses between male and female respondents as well as among professionals can be conducted if the group sizes are large enough.  These results may be particularly useful for the trainers to modify the training to best meet trainees' needs.
 

Implications of the Results

Many researchers have argued that child abuse is a multidisciplinary problem that requires a multidisciplinary approach.  It is unreasonable to expect that any one profession, nor indeed person, can obtain all the information that is relevant to treatment (Perlman & Whitworth, 1988).  In recognition of their importance, many U.S. states have developed functioning multidisciplinary teams (Kaminer, Crowe, & Buddge-Giltner, 1988).  As a result of community actions and legislative mandates this approach has become established. It is also our responsibility to evaluate its use.
 

References

Abramson, J. S., & Mizrahi, T. (1996). When social workers and physicians collaborate: Positive and negative interdisciplinary experiences. Social Work, 41(30, 270-281.

Bannon, M. J., Carter, Y. H., Pace, M., & Thorne, W. (2001). Meeting the training needs of GP registrars in child abuse and neglect. Child Abuse Review, 10, 254-261.

Barton, R. (2000). Police officers and the interface with social work. In M. Davies & R. Barton (Eds.), The Blackwell Encyclopedia of Social Work (Hardcover - Out of Print - Limited Availability)(Paperback) (pp. 257). Oxford, UK: Blackwell.

Bross, D. C. (1988). Liability of agencies, child protection teams, and individuals. In D.
C. Bross, R. D. Krugman, M. R. Lenherr, D. A., Rosenberg, & B. D. Schmitt (Eds.), The New Child Protection Team Handbook (Library Binding). (pp. 356-369). NY: Garland Publishing.

Burgess, R. L. (1979). Project Interact: A study of patterns of interaction in abusive, neglectful, and control families. Child Abuse & Neglect, 3, 781-791.

Davey, R. I., & Hill, J. (1995). A study of the variability of training and beliefs among professionals who interview children to investigate suspected sexual abuse. Child Abuse & Neglect, 19(8),933-942.

Davis, J. R. (2001). Interdisciplinary Courses and Team Teaching (Hardcover)(Paperback). Washington, D. C.: Oryx Press.

Department of Justice Canada. (2005). Child abuse: A fact sheet. Retrieved on May 8, 2005, from http://canada.justice.gc.ca/en/ps/fm/childafs.html

Elmer, E., Bennett, H. G., Harway, N., Meyerson, E. T., Sankey, C. G., & Weithom, L. (1978). Child abuse training: A community-based interdisciplinary program. Community Mental Health Journal, 14(3), 179-189.

Ford-Martin, P. (2001). Interdisciplinary treatment. Gale Encyclopedia of Psychology: Interdisciplinary Treatment (2nd ed.) (E-Book (download)). Gale Group and LookSmart.

Fowler, P., Hannigan, B., & Northway, R. (2000). Community nurses and social workers learning together: A report of an interprofessional education initiative in South Wales. Health and Social Care in the Community, 8(3), 186-191.

Gilbert, J. H. Y., Camp, R. D., Cole, C. D., Bruce, C. Fielding, D. W., & Stanton, S. J. (2000). Preparing students for interprofessional teamwork in health care. Journal of Interprofessional Care, 14(3), 223-235.

Harris, J. L., Saunders, D. N., & Zasorin-Connors, J. (1978). A training program for interprofessional health care teams. Health and Social Work, 3(2), 35-53.

Heck, W. P. (1999). Basic investigative protocol for child sexual abuse. FBI Law Enforcement Bulletin, 68, 19-25.

Kaminer, B. B., Crowe, A. H., & Budde-Giltner, L. (1988). The prevalence and characteristics of multidisciplinary teams for child abuse and neglect: A national survey. In D. C. Bross, R. D. Krugman, M. R. Lenherr, D. A., Rosenberg, & B. D. Schmitt (Eds.), The New Child Protection Team Handbook (Library Binding) (pp. 548-567.). NY: Garland Publishing.

Krell, Richardson, LaManna, & Kairys, 1983).

Lacey, P. (1998). Interdisciplinary training for staff working with people with profound and multiple learning disabilities. Journal of Interprofessional Care, 12(1),43-52.

Lardner, R. (1992). Factors affecting police/social work inter-agency co-operation in a child protection unit. Police Journal, 65, 213-228.

Milligan, R. A., Gilroy, J., Katz, K. S., Rodan, M. F., & Subramanian, K. N. S. (1999). Developing a shared language: Interdisciplinary communication among diverse health care professionals. Holistic Nursing Practice, 13(2),47-53.

Patterson, G. T. (2004). Evaluating the effects of child abuse training on the attitudes, knowledge, and skills of police recruits. Research on Social Work Practice, 14(4), 273-280.

Pence, D., & Wilson, C. (1988). CPS and law enforcement: The uneasy alliance. APSAC Advisor, 3,2-6.

Pence, D., & Wilson, C. (1994). Team Investigation of Child Sexual Abuse: The Uneasy Alliance (Hardcover - Out of Print - Limited Availability)(Paperback). London: Sage.

Perlman, M., & Whitworth, J. M. (1988). Group process and interprofessional communication: The human aspects of teamwork. In D. C. Bross, R. D. Krugman, M. R. Lenherr, D. A., Rosenberg, & B. D. Schmitt (Eds.), The New Child Protection Team Handbook (Library Binding) (pp. 299-320). NY: Garland Publishing.

Reder, P., & Duncan, S. (2003). Understanding communication in child protection networks. Child Abuse Review, 12, 82-100.

Rodgers, J. (1994). Collaboration among health professionals. Nursing Standard, 9(6), 25-26.

Sullivan, R., & Clancy, T. (1990). An experimental evaluation of interdisciplinary training in intervention with sexually abused adolescents. Health and Social Work, 15(3),207-214.

U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. (2003). Child maltreatment 2001: Reports from the States to the National Child Abuse and Neglect Data System. Washington, DC: U.S. Government Printing Office.


The Questionnaire

1 This project was supported by the Canadian Society for the Investigation of Child Abuse.

[Back to Volume 15]  [Index of Authors]

 
Copyright 1989-2014 by the Institute for Psychological Therapies.
This website last revised on April 15, 2014.
Found a non-working link?  Please notify the Webmaster.