Assessment and decision-making in child maltreatment cases is difficult. Practitioners face many uncertainties and obstacles during their assessment and decision-making process. Research exhibits shortcomings in this decision-making process. The purpose of this literature review is to identify and discuss methods to overcome these shortcomings. We conducted a systematic review of the published literature on decision-making using PsychINFO and MEDLINE from 2000 through May 2014. We included reviews and quantitative research studies that investigated methods aimed at improving professional decision-making on child abuse and neglect in child welfare and child protection. Although many researchers have published articles on decision-making including ideas and theories to improve professional decision-making, empirical research on these improvements is scarce. Available studies have shown promising results. Structured decision-making has created a greater child-centred and holistic approach that takes the child's family and environment into account, which has made practitioners work more systematically and improved the analysis of complex situations. However, this approach has not improved inter-rater agreement on decisions made. Shared decision-making may improve the participation of parents and children and the quality of decisions by taking client treatment preferences into account in addition to scientific evidence and clinical experience. A number of interesting developments appear in recent research literature; however, child welfare and child protection must find additional inspiration from other areas, e.g., mental health services, because research on decision-making processes in child welfare and child protection is still rare.
Child welfare and child protection workers regularly make placement decisions in child abuse cases, but how they reach these decisions is not well understood. This study focuses on workers' rationales. The aim was to investigate the kinds of arguments provided in placement decisions and whether these arguments were predictors for the decision, in addition to the decision-makers' risk assessment, work experience and attitudes towards placement. The sample consisted of 214 professionals and 381 students from the Netherlands. The participants were presented with a vignette describing a case of alleged child abuse and were asked to determine whether the abuse was substantiated, to assess risks and to recommend an intervention. The participants' placement attitudes were assessed using a structured questionnaire. We found that the participants provided a wide range of arguments, but that core arguments - such as the suspected abuse, parenting and parent-child interaction - were often missing. Regression analyses showed that the higher the perceived danger to the child and the more positive the participants' attitudes towards placement, the more likely the participants would be to propose placing the child in care. Arguments related to the severity of the problems (i.e., suspected abuse, parenting and the child's development) as well as the parents' perceived cooperation also influenced placement decisions. The findings indicate trends in the decision-making process, in the sense that participants who decided to place the child out-of-home emphasized different arguments and had different attitudes towards out-of-home placement than those who did not. We discuss the implications of our findings.
Background The LIRIK, an instrument for the assessment of child safety and risk, is designed to improve assessments by guiding professionals through a structured evaluation of relevant signs, risk factors, and protective factors.Objective We aimed to assess the interrater agreement and the predictive validity of professionals' judgments made with the LIRIK in comparison to unstructured judgments.
MethodIn study 1, professionals made safety and risk judgments for 12 vignettes with the LIRIK (group 1, n = 36) or without an instrument (group 2, n = 43). In study 2, we compared professionals' safety and risk judgments for 370 children made with the LIRIK (group 1, n = 278) or with no instrument (group 2, n = 92), with outcomes indicating actual unsafety in files 6 months later.
ResultsIn study 1, agreement about safety and risks was poor to moderate in both groups.Differences between groups were small and inconsistent. In study 2, the predictive validity of judgments was weak to moderate in both groups. In neither group had unsafe outcomes increased consistently when unsafety or risks were assessed as higher.Conclusions Judgments made with the LIRIK were not more reliable or valid than unstructured professional judgments. These findings raise important questions about the value of risk assessment instruments and about how professional safety and risk judgments can be improved.
The aim of this chapter is to clarify how decision-making processes within the context of child welfare and child protection could be improved by decision-making theories (i.e., Decision-Making Ecology [DME] and decisional conflict model), with specific interest in methods intended to support practitioners based on these theories, in particular methods of structured decision-making and actuarial methods. Existing studies indicate that structured decision-making methods have a limited effect on the decision-making process, as well as on the reliability and validity of the judgments and choices made by professionals in cases of suspected child abuse and neglect. Actuarial methods may be more precise in making valid judgments but may ignore factors relevant to decisions concerning treatment and intervention. The DME framework reveals that other factors—in addition to rationally weighing information and arguing—influence the decision-making process and outcomes. Especially the influence of decision-maker factors seems to be ignored in structured decision-making methods. Although systematic methods and instruments do have some value, several additional options are available that take decision-maker factors more into account. This chapter discusses the potentials of critical thinking, team decision-making, systematic feedback, and shared decision-making.
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