Methodological challenges in following up patients of a hospital child protection team: is there a recruitment bias?

Abstract

BackgroundThe aims of this study are to describe the methodological challenges in recruiting a follow-up sample of children referred to an interdisciplinary hospital child protection team (CPT) and to compare participating versus non-participating groups on several demographic variables and maltreatment characteristics.MethodsOf the 319 in- and outpatients referred to the CPT at University Children's Hospital Zurich from 2005–2006 a sample of 180 children was drawn to contact for a follow-up. The children and their parents were asked to participate in a face-to-face interview at the hospital; in 42 cases the children and parents consented to do so. Alternatively, the parents could take part in a telephone interview (n = 39). Non-participation resulted because no contact or adequate communication in German, French, or English could be established (n = 49) or because the parents or children refused to participate (n = 50).ResultsParticipants and non-participants did not differ significantly in mean child age at follow-up, gender, family status, place of residence, certainty and type of maltreatment, and type of perpetrator. However, the child's nationality had a significant impact: Percentages of foreign nationals were higher in the fully participating group (45%; n = 19) and the non-contactable group (53%; n = 26) and significantly lower in the refusal (26%; n = 10) and the telephone interview group (18%; n = 9). Although a high percentage of families had moved in the few years since the CPT intervention (32%; n = 57), the percentage of moves was not significantly higher in non-participants compared to participants.ConclusionsFurther research is needed to support these results in different national backgrounds and to test for biases in variables not included – especially socioeconomic status. This includes gathering more detailed information on non-participants, while respecting ethical boundaries. Overall, the fact that only child's nationality was unevenly distributed between participants and non-participants is encouraging.

Psychosocial problems of children whose parents visit the emergency department due to intimate partner violence, substance abuse or a suicide attempt

“…Furthermore, of all eligible families, 8% refused to be examined at the outpatient pediatric department, and another 17% was examined but refused study participation. Because reports in literature have been mixed, it is difficult to draw conclusions about the influence of refusal of treatment (Koverola et al ; Lau and Weisz ; Miller et al ) or study participation (Lynch et al ; Feehan et al ; Jud et al ) on our results. Known baseline characteristics between our participants and non‐participants were similar, except for an overrepresentation of single parent households for participants.…”

Follow‐up protocol was useful for children whose parents attended emergency departments after partner violence, substance abuse or a suicide attempt

“…Of the families who took part in the follow-up assessment, 21% reported that no mandatory or voluntary services had been involved with themselves or any of their children at any time. This might have been due to selection bias as it is possible that families with fewer problems were more inclined to participate in the study, although reports in the literature are mixed (21)(22)(23). However, after the emergency visit, the proportion of families and children not involved with or referred to mandatory or voluntary services were comparable.…”

Research in minors with a recent history of trauma—A bold venture?

“…Some families did not clearly refuse participation, but making contact was impossible, some showed little compliance as they did not show up as agreed upon or they delayed their appointments repeatedly. In their follow up, Jud, Lips and Landolt [2] made great efforts in contacting their participants, such as writing an invitation letter and attempting 5 consequent invitation calls. In the end they report a successful recruitment rate of 45% within their study sample.…”

“…As Jud et al [2] conclude, more research in the issues of recruitment is needed to assess variables which could bias the recruitment of participants, suggesting that the socioeconomic status could be of special interest. The researcher only gets into contact with the families if they agree to participate.…”