Processes of Multiprofessional Child Protection Decision Making in Hospital Settings: Systematic Narrative Review

Abstract

The aim of this systematic narrative literature review is to explore empirical evidence as to how a multiprofessional approach to child protection decision making is implemented in hospitals settings. Child protection cases where there is a suspicious serious injury suspected sexual abuse or serious neglect are often investigated in hospital, involving a number of relevant professions. Five electronic bibliographic databases were used for the search. To be included in the review studies had to be published in a peer-reviewed journal, report on empirical research, be available full text in English, and have used an identifiable research design. The search was restricted to 10 years, from January 1, 2010, to December 31, 2019, and retrieved 6,934 studies. The review includes 26 studies undertaken in 10 countries. In all the hospital-based settings studied, child protection decision-making tasks were assigned to a designated multiprofessional team. However, there was remarkable diversity in models of team structure, regulation of workflow, structured procedures, and standardized tools through which practice was carried out. Research focused on evaluating the teams’ effectiveness in fulfilling their duties which were, first and foremost, the identification of possible child maltreatment. The analysis identifies various systemic approaches and quality improvement methods to promote effective team-based decision-making processes in hospitals. The interactional aspect of collaborative team-based practice was generally missing from the published research. This article discusses next steps for the development of practice, policy, and research to enhance useful multiprofessional child protection team working in hospitals.

Keywords

child abuse child protection decision making multiprofessional interdisciplinary hospital

There is a general agreement that effective interprofessional collaboration and cooperation is the backbone of good child protection practice. Within recent decades, the importance of organizations working with children adopting multiprofessional approach to practice had been continuously recommended by fatal or serious harm child-abuse inquiries (Brandon et al., 2009; Laming, 2003), persistently supported by scholars (Hood et al., 2016; Munro, 2011), and steadily pursued by policy makers around the world (Alfandari, 2019; Burns et al., 2017; Department of Health et al., 1999; Killick & Taylor, 2020; Taylor, 2017).

Typical multiprofessional approaches to child protection practice involve ad hoc interprofessional case conferences at specific decision-making points, such as in England, Denmark, and Israel (Alfandari, 2019; Berrick et al., 2015; Pösö et al., 2014), or unified guidelines for risk management actions, such as the family violence Multi-Agency Risk Assessment and Management Framework in Australia (Baginsky & Manthorpe, 2020). More recently, innovative examples to systemic multiprofessional working led by social services can be found in the United Kingdom, including colocation working models such as multiagency safeguarding hubs and social work units, which have some evidence base for efficacy (Baginsky & Manthorpe, 2020; Crockett et al., 2013; Forrester et al., 2013). Following such progress, this literature review was set out to examine what we know from research about how groups of professionals with a range of disciplinary knowledge make child protection decisions in real-world environments. For the purposes of this article, we define a group as a functional unit (e.g., face-to-face groups and interorganizational collaborative teams) that has an objective or mandate to make decisions or to make recommendations to some decision-making person or body (Alfandari et al., in press). The specific focus is on the processes of team working to make decisions rather than to carry out interventions or deliver services.

In approaching the scientific literature on theoretical, strategic, and operational knowledge about group decision making, we discovered a research enterprise that however lively and developing also bears some substantial limitations which hindered its applicability to this study’s context. First, the traditional or classical group decision-making research tends to analyze the phenomenon artificially along several dimensions usually studied in isolation and without a comprehensive unifying epistemological or conceptual framework (Kerr & Tindal, 2004; Levine et al., 1993; Tindale & Kameda, 2000). For example, within the field of psychology, there is often a distinction between long-term groups (e.g., teams) and short-term or ad hoc groups (i.e., small groups), between group performance and group decision making, and between shared preferences and shared information (Ilgen et al., 2005; Kerr & Tindal, 2004; Tindale & Kameda, 2000). Such approaches are often criticized for being too simplistic to capture the complex and dynamic activity carried out by groups of professionals outside the laboratory in real-world situations (Levine et al., 1993; Patel et al., 2002).

Second, considerable emphasis is given in recent research, including in sociology, economics, communication, education, medical information, military science, and social work, to the way groups process and use information (Alfandari, 2019; Patel et al., 2002; Thompson, 2013; Tindale & Kameda, 2000). One outcome of this focus on group information sharing is the rapid growth of information technologies designed to support everyday interprofessional working (Hood et al., 2017; Patel et al., 2002). However, there is limited research evidence about intragroup or interactional processes (e.g., collective norms or power dynamics) and contextual factors (e.g., the task at hand or organizational structure) that helps or hinders the ability to work effectively with others in the group (Hood et al., 2017; Kerr & Tindale, 2004). More general research suggests it is the combination of both context and processes that determines whether groups will make better or poorer performances and choices, relative to individuals working alone (Kerr & Tindale, 2004).

Hospital-Based Context

This review concentrates on hospital settings so as to give a comprehensive and holistic insight into the collaborative domains of multiprofessional child protection practice in a natural setting. Hospitals are long-standing, well-established systems in which care is provided by a range of professional teams some colocated within the same building and to varying extents working under unitary management (Patel et al., 2002; Vinokur-Kaplan, 1995). Child protection cases where there is a suspicious serious injury, suspected sexual abuse, or serious neglect are often investigated in hospital, involving a number of relevant professions, such as medicine, nursing, allied health professions, social work, and law enforcement (Moon et al., 2018; Sarkar et al., 2021; Scoglio et al., 2019; Wiseman et al., 2019). Early studies from the 1990s on social workers’ activity in hospitals, which traditionally apply physician-centered model of care (Ambrose-Miller & Ashcroft, 2016), identified confusion around roles, functions, and responsibilities; power or status differences between professions; and a tendency to safeguard professional “turf” as barriers to effective multiprofessional working (Abramson & Mizrahi, 1996; Cowles & Lefcowitz, 1995).

In relation to child protection, a hospital setting should provide a good opportunity to diagnose and plan how to address child maltreatment (CM). There is a range of professional expertise and medical resources that can be drawn on (Benbenishty et al, 2014; Teeuw et al., 2017). On the other hand, the nature of professional interaction with patients and their families—typically an episodic, stress provoking, short engagement—may generate uncertainties around the assessment and engagement process (Benbenishty et al., 2014; Chen et al., 2010; Davidson-Arad et al., 2010). In addition, hospital staff effectiveness in managing child protection cases depends on the provision of both preliminary information and follow-up feedback from community-based services (Benbenishty et al., 2011; Jedwab et al., 2015; Svärd, 2014). Thus, practice requires various layers of multiprofessional collaborative activity, both within the hospital and outside it.

Over the last 60 years, hospitals (mostly children’s hospitals or university-affiliated hospitals) around the world have adopted multiprofessional working models to strengthen decision making regarding evaluation and management of CM (Jud et al., 2010; Kistin et al., 2011; Rowe et al., 1970; Teeuw et al., 2017). Institutional multiprofessional teams, often known as child protection teams (CPTs), can be found in countries such as the Brazil, Canada, Hong Kong, Israel, New Zealand, Switzerland, Turkey, and United States (Benbenishty et al., 2014; Harr et al., 2008; Jud et al., 2010; Kelly et al., 2015; Lee et al., 2006; Ravichandiran et al., 2010; Sahin et al., 2009).

While some researchers highlight the contribution of hospitals’ CPTs in reducing duplication of effort and providing greater continuity of care, others claim the exact opposite, given that the number of practitioners involved with the child and family may increase (Balsley et al., 2019; Connolly, 2012; Harr et al., 2008). Working models that integrate practitioners into multiprofessional teams are also criticized for resulting in expertise and resources being centralized at the hands of a few specialists, rather than distributed across front line practitioners, which subsequently reduces their accessibility to patients and clients (Connolly, 2012; Hood et al., 2016, 2017). Contributing to the debate around the effectiveness of interprofessional team-based models in managing CM cases within hospitals is the variation in policy framework (e.g., legislation and regulations), structure (e.g., team’s design and professional make-up), and functions (e.g., scope of activity and responsibilities) across hospitals, jurisdictions, and countries (Jud et al., 2010; Kistin et al., 2010).

In light of the described complexity in evaluating groups’ and teams’ effectiveness, the aim of this systematic narrative literature review was to explore empirical evidence as to what multiprofessional child protection decision making in hospital settings looks like in terms of practice processes. The approach taken in this review was influenced by our ecological perspective which takes into account the multilevel environments in which decision-making processes are embedded (Baumann et al., 2011; Nouman et al., 2020) and by Vinokur-Kaplan’s (1995) pioneering study on the effectiveness of hospital mental health teams, which highlighted the importance of attending to the organizational context and conditions when coming to study practice. Subsequently, we were aiming to capture a broad range of factors that may be proven critical to successful collaborative hospital-based practice. Our research question focused on the possible influences of case features (e.g., subtypes of CM), team design (e.g., size, professional composition), organizational environment (e.g., structured working models, training), and external factors (e.g., policy framework, regulated working networks with community-based services) on interprofessional team-based decision-making practice regarding CM in hospital settings.

Method

The systematic approach to literature reviewing taken in this study, referred to as “Systematic Narrative Review,” was primarily developed in response to the varied questions raised from everyday social work practice (Taylor et al., 2015). Principally, questions about the effectiveness of distinct interventions or services are at the heart of rigorous systematic reviews incorporating statistical meta-analysis of experimental results, such as those taken within the Cochrane Collaboration and Campbell Collaboration (Higgins et al., 2020; Kugley et al., 2017). The methodology used here has more general applicability and may also accommodate questions about views and experiences of those receiving or providing services, as well as prevalence and correlates of social problems (Alfandari & Taylor, 2021).

Systematic narrative literature review methodology is characterized by systematic and transparent processes for searching the literature to retrieve research, while retaining a more limited quality appraisal (i.e., limited to publications in peer-reviewed journals) and using a narrative synthesis (Taylor et al., 2015). This methodology has been found very useful for addressing a range of practice and service delivery questions, such as the influence of online communication and social networking on adolescent well-being (Best et al., 2014), survivors’ perspectives on intimate partner violence (IPV) perpetrator interventions (McGinn et al., 2016), resilience of child protection social workers (McFadden et al., 2015), professional decision making on elder abuse (Killick & Taylor, 2009), and decision making by health and social care professionals to protect an unborn baby (McElhinney et al., 2019).

Search Strategy

The research topic was converted into four distinct concept groups:<decision making> AND <multiprofessional> AND <child protection> AND <children and youth>. Then, search terms for each concept were combined into the initial search formula, with index terms assigned according to the facilities of the database (for the detailed search formula, see Alfandari & Taylor, 2021).

Five electronic bibliographic databases were included in the search: Scopus, Social Sciences Citation Index, Medline, Social Work Abstracts, and the Cochrane Central Register of Controlled Trials. These databases were selected based on their quality appraisal published in prior reviews, relevance to social sciences and health care research topics, and accessibility within the first author’s university library (Alfandari & Taylor, 2021). The search was restricted to a 10 year, from January 1, 2010, to December 31, 2019, and was limited to publications in the English language.

Inclusion and Exclusion Criteria

As mentioned, to provide an independent quality appraisal criterion, studies had to be published in a peer-reviewed journal. In addition, studies had to report on empirical research. We included studies that used quantitative, qualitative, or mixed methods research designs. We excluded action research or single case study methods due to challenges in determining quality based on these research designs (Taylor et al., 2015) and in accordance with the standard of this journal. Theoretical material, editorials, government papers, and policy documents were excluded.

Regarding relevance criteria, practice had to be conducted at a hospital setting. It was essential to establish sufficient conceptual clarity regarding what was meant by “multiprofessional collaboration in decision making.” Studies were excluded when decisions were not made by several professionals, or when these professionals all had the same professional background, or when the group of professionals did not include a social worker (these latter tended to be medical consultations on specific conditions). Studies where multiprofessional work was only manifested in sporadic events of consulting with one other professional were also excluded.

In order for the review to be most useful in terms of suggesting ways to improve joint decision making, we sought studies that probed links between interprofessional education or training and practice. We thus included studies on interprofessional learning into child protection that emphasized acquiring interprofessional teamwork expertise. Studies had to meet the requisites of professional variety, but we applied a more flexible boundary around the setting for the training intervention itself to also include university-based academic programs.

Data Extraction, Analysis, and Synthesis

The free citation management software program Mendeley Desktop was used to compile all 6,934 retrieved studies identified through the systematic search. The same program was also used to conduct the primary titles and abstracts screening, thus avoiding errors caused by multiple transmission and transformation of records. For the initial titles and abstracts screening, the authors developed a structured coding scheme including four labels: (a) IN for inclusion, (b) OUT for exclusion, (c) DISCUSS for uncertainties requiring team consultation, and (d) ACTION, for uncertainties requiring additional information, such as when an abstract was missing. Each study was tagged using one of the four labels along with a supplementary explanatory comment chosen from a predetermined list of possible reasons for exclusion. Next, duplications were removed and 125 full-text articles were independently assessed for eligibility by the authors. Any disagreements were discussed between authors until a consensus was reached (for a detailed account on this process, see Alfandari & Taylor, 2021). Considerable time and labor were invested in a meticulous inspection of participants’ professional background which became essential, given that the term “interdisciplinary” in health care research generally refers to different specialists within the medical occupation (Abramson & Mizrahi, 1996). Finally, the references list of articles included in the review were hand-searched by the first author and four eligible articles were added. Overall, 26 studies were included in the review. Figure 1 outlines the flow of the study selection process, using an adaptation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram (Moher et al., 2009).

Figure 1.

Flowchart outlining the study acquisition process (adaptation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram).

Key information from the 26 included studies was extracted and tabulated along the following categories: first author, year of publication, and country; setting; scope of activity; decision-making responsibility; team design; in-hospital social worker position; supportive organizational context; sample; research design; main findings; and conclusion. Overall, four major research areas were identified, with several studies making an important contribution to more than one topic. Most prevalent were studies relating to diagnosis of CM and systemic mechanisms to support team-based collaborative decision making, with only few studies contributing on interactional aspects of intergroup activity (n = 4 studies) and interprofessional education programs (n = 3 studies).

Findings

Characteristics of Included Studies

Studies from 10 different countries were encompassed in the review. Twelve studies, nearly half of all the studies included, were conducted in the United States, five in Israel, two in New Zealand, and a single study conducted in each of Canada, Germany, Hong Kong, Japan, the Netherlands, Sweden, and Switzerland. This diversity of countries emphasized the worldwide pertinence of the issue.

Fifteen studies were carried out in a single urban hospital, mostly in a children’s hospital (n = 12 studies), or a specialist pediatric department (e.g., emergency, burns) within a general hospital (n = 3 studies). Eight studies were conducted in multiple settings, ranging from two to 23 different hospitals, including children’s hospitals and a general hospital, as well as urban and rural hospitals. In addition, three studies investigating interprofessional education programs focusing on child protection decision making were conducted in universities.

Most studies (n = 15 studies) applied a broad definition of CM referring to both child abuse and neglect. Among them, one study also added Munchausen Syndrome by Proxy and another used the term “children at risk” to include also children’s exposure to parent’s drug abuse, psychological illness, or domestic violence. The other studies investigated a subtype of CM, seven studies focusing on physical abuse (e.g., fractures, head trauma, burns), three on sexual abuse, and one study on child abuse. Put together, these findings highlight the complexity of the task assigned to hospital personal necessitating comprehensive expertise in various dangerous situations and harmful behaviors imposed on children.

Strategic Approaches to Multiprofessional Collaboration

The mechanism used in all hospital settings investigated to establish multiprofessional decision-making process regarding CM cases was to bring professionals together to work in an integrated team. Yet under the overarching umbrella of multiprofessional team-based practice lay great diversity. The key characteristics of the working models used to achieve active interprofessional collaboration are summarized in Table 1.

Table 1.

Structural and Functional Characteristics of Multiprofessional Team-Based Models.

Author (Year), Country	Setting	Scope of Activity	Decision-Making Responsibility	Team Design	Supportive Organizational Context
Ravichandiran (2010), Canada	One urban children hospital	Also accept referrals from outside the hospital	Confirmation of physical abuse diagnosis	SCAN team: pediatricians, psychologists, nurses, and social workers
Davidson-Arad (2010), Israel	One urban children hospital	Also accept referrals from outside the hospital	Determining reasonable basis for SCAN	Child protection team (CPT): physicians, nurses, social worker, other in-hospital professionals on consultation-only basis	– Policy framework: Ministry of Health regulations, 2003
Chen (2010), Israel	One urban children hospital	Only in-hospital referrals	Report SCAN to child protection authorities (CPO and/or police) for further investigation	CPT: pediatrician, psychiatrist, nurse, and social worker	– Policy framework: Ministry of Health regulations, 2003
Teeuw (2017), the Netherlands	One urban children hospital	– Only in-hospital referrals – Provides CAN education inside and outside the hospital – Performs research regarding CAN	– Confirmation of CAN diagnosis – Referral to support services and medical treatment – Involuntary placement outside home – Guardian appointment	Multiagency academic team for CAN (TASK): In-hospital experts: pediatrician, pediatric radiologist, gynecologist, pediatric surgeon, emergency room physician, child psychologist, nurses, and social workersOut-hospital experts: coordinator of trauma center for children and youth, head of the department of family psychiatry, confidential doctor specializing in CAN, and team leader of childcare and protection board’s crisis teamOn request:Legal expert and medical ethics expert	– Policy framework: Ministry of Health, Welfare and Sport guidelines – Consultation with professionals outside the hospital – In-hospital internet-based reporting system to TASK – Policy of ED referral by parental characteristics that may impose risk to the child (e.g., suicide attempt, substance abuse) – Regular biweekly meetings – Cases are anonymously discussed within the team until consensus is reached on the diagnosis
Higginbotham (2014), United States	One urban hospital (pediatric ED)	Only in-hospital referrals	Confirmation of physical abuse diagnosis	Child abuse detection and diagnosis team: In-hospital experts: physicians, nurses, and social workersOut-hospital experts: law enforcement officials, attorneys, CPS investigators, and other child abuse experts	– Consultation with professionals outside the hospital – A guideline algorithm for ED staff to standardize initial evaluation of suspected NAT (prereferral to child abuse detection and diagnosis team or CPS)
Jud (2010), Switzerland	One urban children hospital	Also accept referrals from outside the hospital	Confirmation of CAN diagnosis	CPT: three pediatricians, a pediatric surgeon, a child psychiatrist, a child psychologist, two pediatric nurses, and two social workers
Benbenishty (2014), Israel	Six urban hospitals (one children hospital)	Only in-hospital referrals	– Report SCAN to child protection authorities (CPO/police) for further investigation – Referral to welfare agencies for support to the family	CPT: pediatrician, psychiatrist, nurse, and social worker	– Policy framework: Ministry of Health regulations, 2003
Goyal (2013), United States	One urban children hospital	Also accept referrals from outside the hospital	– Medical treatment in response to sexual assault – Provision of mental health support resources – Referral to hospital’s child abuse clinic and primary care provider	Pediatric Sexual Assault Response Team: emergency medicine and general pediatrics, pediatric emergency medicine nurses, child life specialist, social workers, and administrative staff	– Continual feedback from pediatric child abuse specialists – Administrative support – Structured protocols for evaluation and treatment – Obtaining appropriate equipment – Staff training and education
Whaitiri (2011), New Zealand	One urban children hospital	Also accept referrals from outside the hospital	Confirmation of sexual abuse diagnosis	CPT: pediatrician, sexual health physician, nurseColocated with:police, child protection agency (Child Youth and Family), and forensic interview unit	– Colocation with police and child protection agency – A multiprofessional case conference within 24 hr with police and child protection agency – Investigation plan according to time lines
Kim (2017), United States	One urban children hospital	Only in-hospital referrals	Confirmation of physical abuse diagnosis	Child Abuse Team (CAT): physicians trained in nonaccidental trauma, social workers, pastoral care, and law enforcement	– Consultation with professionals outside the hospital – NAT initial screening guidelines (prereferral to CAT) – Clinical prediction tools for evaluating head injury
Kelly (2015), New Zealand	One urban children hospital	Only in-hospital referrals	Confirmation of physical abuse diagnosis	Te Puaruruhau: pediatricians, nurses, social workers, subspecialists, such as pediatric radiologists and neuroradiologists on consultation-only basis	– Consistent clinical approach and key personnel since 1991
Hoehn (2018), United States	One urban hospital (pediatric ED)	Only in-hospital referrals	Medical treatment in response to sexual abuse	Pediatric emergency department staff: pediatricians, physicians, nurses, pediatric sexual assault nurse, and social workers	– Care algorithm for medical evaluation and treatment of patients with reported sexual abuse
Rosado (2017), United States	Two urban children hospital	Only in-hospital referrals	Confirmation of physical abuse diagnosis	CPT: child abuse pediatricians, and child abuse social workers	– Standardized protocols for referral to CPT
Nigro (2018), United States	One urban hospital (pediatric burn center)	Also accept referrals from outside the hospital	Determining reasonable basis for SCAN	CPT: pediatrician pediatric nurses, a coordinator. Social worker on consultation-only basis in cases of children over 5 years old	– Administrative support – Investment of staff and time resources
Jedwab (2015), Israel	Six urban hospitals (one children hospital)	Only in-hospital referrals	– Determining reasonable basis for SCAN Report SCAN to child protection authorities (CPO and/or police) for further investigation	CPT: pediatrician, psychiatrist, nurse, and social worker	– Policy framework: Ministry of Health regulations, 2003
Lo (2017), Hong Kong	One urban children hospital	Also accept referrals from outside the hospital	– Confirmation of CAN – Decide on welfare plan for the child and family	A Multidisciplinary Case Conference on Protection of Child with Suspected Abuse: In-hospital experts: doctors, nurses, psychologist, medical and social workersout-hospital experts:social worker from Social Welfare Department or nongovernmental organizations, school personnel, and police	– Policy framework: Hong Kong Special Administrative Region Government, 2015 – Consultation with professionals outside the hospital – The Risk Assessment Matrix (developed by California State University in 1990) is mandatory by regulations as from 2015 – A multiprofessional case conference within 10 working days
Balsley (2019), United States	One urban children hospital	Also accept referrals from outside the hospital	Confirmation of child physical abuse	Interdisciplinary team: ED physicians, child abuse pediatricians, advanced practice providers, nurses, social workers, and subspecialists, such as radiologists and orthopedic specialist on consultation-only basis	– Performance feedback from frontline staff and families – A guideline algorithm for ED care and communication between professionals and with families – Prescribed “teaming” touchpoints for joint discussion and decision making – Scripts for engagement with families
Ross (2019), United States	One urban children hospital		– Consultation with CPT – Meeting with CPT	CPT: not specified, health care social worker on consultation-only basis	– Policy framework: Patient Protection and Affordable Care Act – Care coordination strategies
Okato (2018), Japan	23 Rural and urban hospitals (pediatric ED)	– Responsibility over domestic violence cases and elder abuse cases	– Confirmation of CAN – Decide on support to parents and families	CPT: pediatricians, nurses of emergency units and pediatric departments and medical social workersExtended members: pediatric psychiatrist and psychologistSupplemental members: psychiatrists, otorhinolaryngologists, urologists, and medical clerks	– Policy framework: Japan’s hospital-based CPT manual, 2011 – Administrative support
^{Svärd (2014)}, Sweden	Eight hospitals (children and regional hospitals)		– Determining reasonable basis for suspected child at risk – Report cases of children at risk to social services	Interprofessional team: not specified, social worker on consultation-only basis
Kistin (2010), United States	Hospitals		– Confirmation of CAN – Report CAN to state’s appropriate agenesis – Forensic interviewing – Testimony in court	CPT: Child abuse physician specialists and social worker	– Adequate resources (staff, space, and equipment) – Opportunities for CAN education
Kistin (2011), United States	Hospitals	– Provides CAN education to hospital staff – Collects data on CAN cases	– Confirmation of CAN – Report CAN to state’s appropriate agenesis – Forensic interviewing – Testimony in court – Referrals to mental health support services	CPT: pediatrician, social worker, and administrator	– Policy framework: The National Association of Children’s Hospitals and Related Institutions – Administrative support. – Self-evaluation tool for CPT members to assess performance and identify areas for improvement
Itzhaky (2014), Israel	14 Hospitals (children’s wards)		– Determining reasonable basis for SCAN – Report SCAN to child protection authorities (CPO/police) for further investigation	Child protection committee: partly specified, pediatricians, and social workers	– Training program for physicians on SCAN and the role of in-hospital social workers regarding SCAN

Note. N = 23 studies. CAN = child abuse and neglect; CPO = child protection officer; CPS = child protection services; ED = emergency department; NAT = nonaccidental trauma; SCAN = suspected child abuse and neglect.

As shown in Table 1, there are significant differences, as well as some notable similarities, between hospital-based teams regarding their multiprofessional composition, scope of activity, ways of operating, and systemic mechanisms inside and outside the institutional environment. Intergroup-level analysis shows that commonly (n = 14 studies) teams’ core permanent members were pediatricians or physicians, nurses, and social workers. Six studies were exceptional to this trend (Kim et al., 2017; Kistin et al., 2010, 2011; Nigro et al., 2018; Rosado et al., 2017; Whaitiri & Kelly, 2011), and in three, some information was missing (Itzaky & Zanbar, 2014; Ross et al., 2019; Svärd, 2014). Three studies described institutional arrangement by which in-hospital social workers participated in the team on consultation basis only (Nigro et al., 2018; Ross et al., 2019; Svärd, 2014), and in three studies, a social worker from community-based services was a regular member (Higginbotham et al., 2014; Lo et al., 2017; Whaitiri & Kelly, 2011).

By and large, the key function of the teams, or the main decisions to be made, involved assessment whether the child’s condition resulted from CM (two studies were exceptions and focused on decisions subsequent to reported sexual abuse; Goyal et al., 2013; Hoehn et al., 2018). Yet, a more nuanced analysis of the studies revealed important variations in responsibilities, some narrow and some wide. A main function was often to determine whether there was a reasonable basis for Suspected Child Abuse or Neglect (SCAN) and report the case to state’s protective authorities for further inquiry, such as in Israel (e.g., Chen et al., 2010) and Sweden (Svärd, 2014). On the other hand, there were teams that conducted robust investigation, including forensic interviewing, with the aim of confirming (or not) a CM diagnosis, such as in New Zealand (Kelly et al., 2015; Whaitiri & Kelly, 2011). Some teams initiated voluntary referrals to health care and support services, for example, in Israel (Benbenishty et al., 2014) and the United States (Kistin et al., 2011). Teams in the Netherlands (Teeuw et al., 2017), Japan (Okato et al., 2018), and Hong Kong (Lo et al., 2017) had a leading role in deciding on welfare and support plans for children and their families. Thus, while for some teams’ recognition of possible SCAN was the end of the process, for others it was only the beginning. Other responsibilities prescribed for some hospital-based teams included duties of CM education and research such as in the United States (Kistin et al., 2011) and the Netherlands (Teeuw et al., 2017), participation in legal proceedings, as in the United States (Kistin et al., 2010, 2011), and management of a wide-range of familial problems, including domestic violence and elder abuse in the case of Japan (Okato et al., 2018). In some settings, teams accepted referrals of SCAN from external professionals and the public in general, while in other settings, referrals could only be made by hospital staff.

Diagnosis of CM by Multiprofessional Teams

Table 2 summarize the main findings from 14 studies in relation to multiprofessional teams’ key function of identifying CM cases.

Table 2.

Summary of Key Findings on Multiprofessional Teams’ Performance in Child Maltreatment Evaluation.

Author (Year), Country	Sample	Research Design	Main Findings
Ravichandiran (2010), Canada	258 Cases of children <3 years referred to SCAN team between 1993 and 2007	Retrospective case analysis	– Referrals to SCAN team: – One fifth of children with abuse-related fractures were missed during initial medical visit. That is, although risk factors for abuse (e.g., parental report of mechanism did not explain the injury) and social concerns (e.g., young single parent, domestic violence, substance abuse problem, prior contact with CPS) – Reasons for missed cases involved among others incorrect interpretation of the radiograph findings and incomplete imaging series – Cases with particular risk to be missed involve boys, extremity shaft fracture, and when the child is presented to a general ED or primary care setting
Davidson-Arad (2010), Israel	414 Cases of children referred to CPT between1991 and 2006	Retrospective case analysis based on a structured form	Referrals CPT:Professionals in the community and hospital have difficulty in identifying neglectCPT diagnosis: – Children diagnosed as SCAN differ from accident victims in certain psychosocial features and in the impressions they and their parents left on staff – Children diagnosed for neglect were more likely to have early developmental problems and belong to families that live in poverty and receive state’s benefits and social services, in comparison to children diagnosed for abuse – Professionals tended to link mothers to neglect and fathers to abuse – Children’s and mainly parents’ behavior were the key factors in rising SCAN
Chen (2010), Israel	990 Cases of children <9 years referred to the hospital between1991 and 2006	Retrospective case analysis based on structured form	Referrals CPT: – Mostly children<3 years with trauma or illness, suspected for physical neglect while parents were the source of danger – Suspicions were based on parental or child behavior and medical indicators CPT reporting to protective authorities: – 57.2% of the cases were reported to the authorities (mostly to CPO) due to SCAN – A higher proportion of girls than boys were reported – About half of the cases reported involved physical neglect, 21.5% physical abuse and 7.6% sexual abuse
Teeuw (2017), the Netherlands	642 cases of children<18 years referred to TASK team between 2010 and 2012	Retrospective case analysis	Referrals to TASK:Between 1.2% of children visiting or admitted to the hospital were referred to TASK, mostly due to physical abuse, followed by neglect and emotional abuseTASK diagnosis: – CAN Conformation rate was 55.5% of the cases referred to TASK – Witnessing IVP, physical neglect and emotional abuse were the most common type of confirmed cases – Parents and parental reports had a high substantiation rate – Interventions were offered in 98.3% of the confirmed cases
Higginbotham (2014), United States	332 Infants <1 year presented to the hospital with skeletal fracture (not caused by a motor vehicular crash) over 3 years	Pre–post a guideline algorithm for initial screening of suspected NAT within ED retrospective cohort study design	Referrals to child abuse detection and diagnosis team or to CPS:After implementation of screening algorithm: – Decrease in referrals to child abuse team – Minority children were as likely to receive skeletal survey as white children – Insurance status was no longer a factor in decision to screen for child abuse with a skeletal survey – Insurance status was still a factor in decision to refer the case to CPS or child abuse clinical team – More of children’s injuries were evaluated as being accidental in nature rather than intentional or lacking evidence
Jud (2010), Switzerland	1,484 Cases of children referred to CPT between 2003 and 2006	Retrospective case analysis	Referrals CPT:Majority concerned sexual abuse (most external referrals) following by physical abuse (most internal referrals)CPT diagnosis: – Physical abuse had higher substantiation rate than sexual abuse – Girls are at significantly higher risk of sexual abuse – Younger children are at significantly higher risk of neglect and older children for sexual abuse – Lower socioeconomic status children are at higher risk of physical abuse than sexual abuse – Nationality (Swiss or of foreign nationality) had no impact on CM type when controlling for socioeconomic status
Benbenishty (2014), Israel	968 Cases of children referred to CPT between 2010 and 2011	Prospective case analysis using structured questionnaire	CPT reporting to protective authorities: – SCAN cases were more likely to be reported to CPS or the police when the child was an Arab, had developmental problems and/or nonorganic failure to thrive, was not living with parents, parents were not married, parents had addiction problem or mental health difficulty, family had severe economic difficulties, there were past referrals to the hospital, previous engagement with protective services, the referral was made by the child or community-based professional, and suspicious behavior of child and parent was observed by staff – SCAN cases were less likely to be reported to CPS or the police when medical examinations showed supporting physical findings (e.g., fractures, burns)
Whaitiri (2011), New Zealand	10 Cases of prepubertal children diagnosed at the hospital with genital gonorrhoea between 2002 and 2008	Retrospective case analysis	CPT diagnosis: – Through investigations 153 people on the contact list were immediately screened for potential sources of infection – In all cases with reliable evidence for a mode of transmission, it was sexual – Overall, sexual transmission was established in four cases and regarded as possible in eight cases – In nine cases, child protection agency concluded the child was in need of care and protection on the basis of probable sexual abuse or other factors such as family violence
Kim (2017), United States	563 Cases of infants <1 year screened for NAT according to hospital guideline between 2008 and 2015	Retrospective case analysis	Referral to child abuse team: – Screening rate: only 70% of the cases eligible by guidelines received a skeletal survey – There were no differences in screening based on race or insurance status Child abuse team diagnosis: – 25.6% of children <1 year with unwitnessed head injury were victims of NAT – Patients of lower social economic status (indicated by insurance type) had higher rates of NAT, but race was not a factor – Children with more severe injuries had higher rate of NAT
Kelly (2015), New Zealand	345 Cases of children <15 years referred to CPT between 1991 and 2010	Retrospective case analysis	Referral to CPT: – Were mostly of children <2 years, boys, from more deprived families, and Polynesians CPT diagnosis: – Overall, 60% of the cases were diagnosed as AHT – Children diagnosed with AHT were younger than accidental cases – The likelihood for a diagnosis of AHT was higher for Maori ethnicity – Injuries patterns varied between age groups (under 2 years and over 2 years)
Rosado (2017), United States	97 Infants <18 months with humerus fractures presented at the hospital between 2007 and 2012	Retrospective case analysis	Referral to CPT: – Only 45% of the children required by protocol were referred to CPT – Black children were more likely to be referred to CPT CPT diagnosis: – Of the children referred to CPT, 55% were diagnosed for abuse – Younger children were more likely to be diagnosed as abused than older children – The majority of abused cases had no explanation provided for the injury or changing explanations – The existence of other injuries was a factor in diagnosis
Nigro (2018), United States	434 Cases children <5 years with pediatric burn referred to CPT and social workers between 2010 and 2014	Retrospective case analysis	CPT diagnosis: – Overall, 1.7% of the cases were identified as SCAN – SCAN cases included children who were younger, suffered from more severe injuries and stayed longer in the hospital compared to the total population – No readmission for repeated nonaccidental burn was reported
Jedwab (2015), Israel	358 Cases reported by CPT to CPO during 2010	Mixed-methods design including questionnaire completion by CPT members and structured interviews with CPO	CPT diagnosis: – Maltreatment was substantiated in 53.3% of the cases referred by CPTs to CPOs, of which emotional neglect was the most common type of CM followed by physical neglect, emotional and physical abuse, and sexual abuse CPT reporting to CPO: – Almost a quarter of the cases (22.5%) referred by CTPs did not reach the CPOs
Lo (2017), Hong Kong	265 Cases of children hospitalized for suspected child abuse between 2012 and 2014	Retrospective case analysis, including medical records, multidisciplinary Case Conference’s (MDCC) investigation reports and meeting minutes	A MDCC on Protection of Child with Suspected Abuse diagnosis: – CM was established in 46% of the cases referred to MDCC, among them physical abuse was most common followed by sexual abuse, neglect, and multiple abuse – Parents, especially mothers, were the most prevalent abuser – Certain parental characteristics were identified as risk factors for CM, including low mood, marital conflicts, low education or economic status, poor social support, and parenting stress – Factors associated with CM included: severity and/ or frequency of abuse, location of injuries, and strength of family support system

Note. N = 14 studies. AHT = abusive head trauma; CAN = child abuse and neglect; CPO = child protection officer; CPS = child protection services; ED = emergency department; NAT = nonaccidental trauma; SCAN = suspected child abuse and neglect.

As shown in Table 2, studies encompass several decision-making points along the CM diagnosis process, including initial referral to multiprofessional teams for assessment (n = 8 studies), teams’ evaluation of possible or confirmed CM (n = 10 studies), and mandatory reporting suspected CM to state’s protective authorities (n = 3 studies). In several hospitals, structured artifacts, such as tools protocols and technologies, were designed to support primary screening and referrals to the team (n = 4 studies; Higginbotham et al., 2014; Kim et al., 2017; Rosado et al., 2017; Teeuw et al., 2017) or the team’s subsequent diagnosis (n = 2 studies; Kim et al., 2017; Lo et al., 2017).

Examining the clinical characteristics of cases evaluated (with different levels of confidence) as the outcome of CM reveals notable consistency with the literature on CM identification in health care environments (Nouman & Alfandari, 2020). Team members recognized clinical and familial features which were frequently regarded as signs of emerging vulnerability about the child’s condition, these included features of the child (e.g., young age and early developmental problems), family (e.g., prior engagement with child protection service [CPS], marital status and conflicts, and financial hardship), and injury (e.g., severity and repetition of injury; Benbenishty et al., 2014; Jud et al., 2010; Kelly et al., 2015; Kim et al., 2017; Lo et al., 2017; Ravichandiran et al., 2010; Rosado et al., 2017).

Nonetheless, there are also concerns about assessment of probable CM being influenced by personal perceptions including subjective interpretations of observed parental behavior (Chen et al., 2010; Davidson-Arad et al., 2010; Kim et al., 2017) and social group biases that link minority groups and lower socioeconomic status with CM (Benbenishty et al., 2014; Higginbotham et al., 2014; Jud et al., 2010). The latter pattern was frequently found in individual professional’s isolated judgments in health care settings (Enosh et al., 2020).

Findings also suggest decision making by hospital personnel who referred cases to the team, as well as by team members, was possibly affected by errors. These diagnostic errors lead to overreferral of cases in which the child’s condition was not the outcome of CM (false positive error; Benbenishty et al., 2014; Higginbotham et al., 2014; Itzaky & Zanbar, 2014; Jedwab et al., 2015) or underreferral of cases of possible CM (false negative error; Kim et al., 2017; Nigro et al., 2018; Rosado et al., 2017; Teeuw et al., 2017).

Team Members’ Perspective on Collaborative Practice

Another way in which the collaborative function and performance of teams can be evaluated is to seek professionals’ own reflection about their teamwork experience. Applying Hackman’s (1990) classical model of group effectiveness, one could ask factors such as team members’ enthusiasm to work together again and by their sense of growth and well-being through the experience of teamwork (Kistin et al., 2010; Vinokur-Kaplan, 1995). However, only about a quarter (n = 6 studies) of the studies in this review actually approached professionals and collected information directly from them. The methodologies used in these studies explored professionals’ working-together experience, including data gathering using a questionnaire, Delphi approach, a task-tracing instrument, and rapid improvement events (Balsley et al., 2019; Kistin et al., 2010; Okato et al., 2018; Ross et al., 2019) as well as two studies that used semistructured interviews (Itzaky & Zanbar, 2014; Svärd, 2014). These studies emphasized the importance of professionals’ feedback on their everyday practice and its crucial contribution to meeting key goals such as:

identifying weak links in the workflow: For example, indicate on communication gaps in the habitual way the work is carried out (Balsley et al., 2019);

uncovering insufficient expertise: -For example, competence and skills around particular patient populations, such as pregnant women (Okato et al., 2018) or patients with reported sexual abuse (Hoehn et al., 2018);

direct improvement efforts to meet workforce needs: For example, when professionals voiced the importance of encouraging active interprofessional collaboration and team collegiality, as well as investment of hospital’s resource (Kistin et al., 2010); and

detecting unexpected and unwanted outcomes of reforms: -Such as limited investment of time by in-hospital social workers in CPTs CM activities (Ross et al., 2019) following the introduction of a care coordination strategy leading, escalation in power struggles and friction between social workers and physicians following an increase in physicians’ confidence dealing with SCAN following training (Itzaky & Zanbar, 2014), and the impact of institutionalized norms of action (e.g., juridical, therapeutic, or medical) on the role or position (i.e., active, passive, or reflective) social workers took in CPTs (Svärd, 2014).

Discussion

In the wake of the growing emphasis by researchers, practitioners, and policy makers on the role of multiprofessional collaborative decision-making practices in promoting children’s welfare and safety (Alfandari, 2019; Baginsky & Manthorpe, 2020; Hood et al., 2016; Munro, 2011), we applied a systematic narrative review methodology to investigate how this approach is implemented within hospitals. The analysis of the 26 studies included in this review revealed that in all hospital-based settings studied, CM decision-making tasks were assigned to a designated multiprofessional team. Yet, we also found a remarkable diversity in teams’ models, regulation of workflow, structure of procedures, and use of standardized tools through which practice was carried out. This required caution in synthesizing concluding arguments and integrated implications based on the empirical evidence.

The effectiveness of hospital-based multiprofessional teams was regularly predicated on fulfillment of their duty to identify possible CM. Overall, findings suggest that multiprofessional teams were effective in detecting CM, with some subtypes of CM being more successfully than others (Davidson-Arad et al., 2010; Jud et al., 2010; Lo et al., 2017), that is, in comparison to alternative methods of diagnosis such as utilization of The International Classification of Diseases (ICD) codes or judgments made by an individual professional which would have missed actual CM cases (false negative error; Chen et al., 2010; Lo et al., 2017; Nigro et al., 2018; Ravichandiran et al., 2010).

Our analysis identified numerous systemic approaches and quality improvement methods taken by policy makers and hospitals to promote effective team-based decision-making process. These efforts to increase teams’ effectiveness can be clustered around the key measures listed below.

Policy framework: Embedding teams’ function within governmental or national regulations, such as in Israel, Hong Kong, and Japan (Chen et al., 2010; Davidson-Arad et al., 2010; Lo et al., 2017; Okato et al., 2018).

Enabling working conditions: Provision of appropriate resources such as staffing, medical equipment, administrative support, and protection of time (Goyal et al., 2013; Kistin et al., 2010).

Standardized decision-making aids: Utilization of structured tools and protocols such as a guideline algorithm for initial screening of SCAN (Higginbotham et al., 2014; Rosado et al., 2017), risk assessment matrix (Lo et al., 2017), or clinical prediction tools (Kim et al., 2017).

Communication facilitators: Implementation of artifacts to enhance easy and useful communication with the team and among team members. For example, internet-based internal reporting system of SCAN cases to the team (Teeuw et al., 2017), structured communication tools, and standard scripts (Balsley et al., 2019).

Availability of external consultation: Opportunities and networks for consulting with professionals in the community, including child welfare and protection services. For example, arrangements like colocation of the team, police, and child protection agency in one center just beside the hospital (Whaitiri & Kelly, 2011) and carrying out case conferences within the hospital (Lo et al., 2017).

Prescribed meeting touchpoints: Regulations and schedules for joint meeting for discussion and decision making, for example, timely case conferences (Lo et al., 2017; Whaitiri & Kelly, 2011) and fixed scheduled biweekly meetings (Teeuw et al., 2017).

Low referral threshold: In-hospital policy that encourages referral to the teams. For example, referral of all parents presented to the hospital’s emergency department (ED) with potentially risky characteristics (e.g., suicide attempt or substance abuse; Teeuw et al., 2017) or all children under 5 years with burns (Nigro et al., 2018).

In-hospital training on multiprofessional working: Training programs for staff, for example, physicians (Itzhaky & Zanbar, 2014) or ED personal (Goyal et al., 2013) around CM and related local working procedures.

Regular performance review: Measures taken to review and evaluate the quality of teams’ performance. For example, implementation of self-evaluation tool (Kistin et al., 2011), continuously review of all cases by a pediatric child abuse specialist (Goyal et al., 2013), and collecting feedback from patients’ families (Balsley et al., 2019).

Limitations

The search methodology to identify studies was rigorous but was necessarily limited in terms of the number of databases that it was feasible to use. Restricting the review to papers published in peer-reviewed journals had the merit of having the objectivity of a standard beyond the knowledge base of the review team and which draws on the expertise of journal reviewers who had been selected for their particular knowledge in relation to the topic of this article. It is acknowledged that this may leave the review open to some publication bias. However, there is little in the way of financial incentives that might bias against the publication of negative results on this topic area, so we do regard this as a major limitation.

The majority of studies investigated the teams’ competence in identifying CM by utilizing a retrospective record analysis design (two studies were exceptions; Benbenishty et al., 2014; Jedwab et al., 2015). This methodology bears some inherent limitations which hinder the ability of making robust inferences about teams’ diagnostic capacity. Mainly, retrospective studies depended exclusively on the quality of case file documentation, which was found to be unstandardized and deficient in many settings (Chen et al., 2010; Goyal et al., 2013; Jedwab et al., 2015; Jud et al., 2010; Ravichandiran et al., 2010; Rosado et al., 2017). In addition, retrospective studies may have relatively limited capacity in recognizing possible gaps between what the workforce is expected to do according to regulations and what is actually done in practice. Such protocol-practice gaps were reported in two studies in relation to compulsory tasks prior to team involvement. In one study, 30% of eligible children did not received a skeletal survey (Kim et al., 2017), and in another, 55% of eligible children were not referred to the team (Rosado et al., 2017) as required by hospital guidelines. These findings suggest that examining cases assessed by teams may only reveal part of the picture, and it may be that the guidelines do not sufficiently encompass the diversity of forms of abuse: physical, sexual, emotional, and neglect. Yet, even more importantly, retrospective studies lacked follow-up information that could provide external verification of team assessment, such as legal conviction of CM, provision of services to families, or other multisector administrative data (Benbenishty et al., 2014; Davidson-Arad et al., 2010; Goyal et al., 2013; Kim et al., 2017; Kistin et al., 2011; Ravichandiran et al., 2010; Teeuw et al., 2017). In addition, only one study used readmission data, which may be more easily assessable, as a mean to verify team evaluations (Nigro et al., 2018).

The second limitation that we would like to highlight is that research on interactional or interpersonal aspect of collaborative team-based practice was limited in the published literature. In general, studies did not go beyond the investigation of organizational and procedural arrangements to enhance teams’ effective function, illustrating the “rational-technical” approach to enhance child protection decision making (Alfandari, 2017; Hood, 2015). Only a small number of studies addressed issues such as the importance of acceptance of professional boundaries, mutual trust and respects, and collegial atmosphere (Itzhaky & Zanbar, 2014; Kistin et al., 2010; Svärd, 2014). It remains unclear how can these qualities be achieved.

Hospital-based CPTs are in effect encounters between professionals whose judgments are rooted within different knowledge systems (Svärd, 2014) and working cultures; it may be inevitable that they clash. For example, physicians with a medical, patient-centered approach were found to be more inclined to report SCAN to CPS in comparison to social workers which hold a more holistic and therapeutic perspective (Itzhaky & Zanbar, 2014; Svärd, 2014). With each profession striving to protect its area of jurisdiction (Svärd, 2014) and to contribute its unique skills, how can such conflicts be bridged? One simple solution, reported in two studies, is professionals taking initiatives to report SCAN cases without having the other team members directly involved (Itzhaky & Zanbar, 2014; Svärd, 2014).

What Have We Learned (and Didn’t Learn) From Research?

In this final section, we extend our discussion, considering the studies included in this review in terms of broad implications for practice, policy, and research. Key points to consider in terms of practice, policy, and research to enhance useful multiprofessional team working around CM in hospitals are summarized in Table 3.

Table 3.

Implications for Practice, Policy, and Research to Enhance Useful Multiprofessional Team Working Around Child Maltreatment (CM) in Hospitals.

Key Points to Consider in Terms of Practice, Policy, and Research
Loosely designed working guidelines	Use of loosely designed central or national guidelines allow adaptations across varied hospital-based settings. There may be no one-solution-fits-all in relations to hospital-based multiprofessional teams. For example, hospitals with birth facilities may consider including also antenatal specialists, such as midwives, neonatologists, and obstetricians within the team (^{Okato et al., 2018}). Research could provide a fuller and comprehensive account of the environmental context to clarify the applicability of more general guidance. Studies in this field are still lacking in this regard, as was clearly demonstrated by missing data about the professional composition of teams
Appropriate organizational support	Providing teams with the appropriate organizational support to meet the scope of activity and specific duties assigned to them. The research provided considerable richness of evidence as to various systemic organizational strategies that can benefit the performance of teams. The emphasis is on the fit between institutional resources and practice demands. For example, lower thresholds for referral may increase teams’ workload and thus require additional support (Nigro et al., 2018; Teeuw et al., 2017). We suggest that future research investigates the interconnection between hospitals’ contextual factors and how they influence teams functioning
Inclusive multiprofessional approach	Adopting an inclusive multiprofessional approach in relation to wide aspects of the teams’ work, including organization, management, and planning practice developments (Balsley et al., 2019; Okato et a., 2018). For example, several studies described how quality improvement measure were built on shared discussions among staff across professions (Balsley et al., 2019; Hoehn et al., 2018; Kistin et al., 2010). Multiprofessional perspective can also be highly beneficial in research as demonstrated by studies carried out Israel in which authors were professionals from both health and social work professions (Benbenishty et al., 2014; Chen et al., 2010; Davidson-Arad et al., 2010; Jedwab et al., 2015)
Regular monitoring and reviewing of practice	Establish standardized mechanism for regular monitoring and reviewing practice, including feedback from all key shareholders involved. Studies highlighted performance of teams should be evaluated both internally by its members and externally by those who use the teams’ services (Balsley et al., 2019; Benbenishty et al., 2014; Kistin et al., 2010, 2011). Only one study approached patients’ families for their feedback which proved very valuable (Balsley et al., 2019). As detailed above, research is lacking in terms of providing firsthand evidence on professionals’ experience of teamwork
Multiprofessional collaboration skills and qualifications	Strengthening practice culture so as to encourage multiprofessional collaboration requires the acknowledgment of teamwork as a stand-alone skill, acquired thought education, training, and experience (Hood et al., 2016; Sonney et al., 2018; Straub et al., 2017; Wilcox et al., 2017). Studies on interprofessional education (IPE) programs around CM recognition and reporting emphasis the importance of shared learning of health and social care students early in their qualification process (Sonney et al., 2018; Straub et al., 2017; Wilcox et al., 2017). IPE programs using authentic case-based learning (e.g., case video vignettes and simulation scenarios) in small interprofessional teams, fostered teamwork and rapport among students and increased positive attitudes and confidence about working within interprofessional health care team (Sonney et al., 2018; Straub et al., 2017; Wilcox et al., 2017)

As shown in Table 3, studies’ recommendations to enhance useful multiprofessional team working around CM in hospitals involve adopting an inclusive multiprofessional approach when coming to study and improve practice, utilizing loosely designed working guidelines that can be adjusted across settings, providing teams with the appropriate organizational support including qualification around multiprofessional collaboration skills, and regularly monitor and review practice.

Footnotes

Acknowledgments

The authors gratefully acknowledge Amy Lauren Shapira of the reference department at the Younes and Soraya Nazarian Library at the University of Haifa, for her advice and assistance with formulating the database search strategies.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Ravit Alfandari

References

Abramson

J. S.

Mizrahi

(1996). When social workers and physicians collaborate: Positive and negative interdisciplinary experiences. Social Work, 41(3), 270–281.

Alfandari

(2017). Systemic barriers to effective utilisation of decision-making tools in child protection practice. Child Abuse & Neglect, 67, 207–215.

Alfandari

(2019). Multi-professional work in child protection decision-making: An Israeli case study. Children and Youth Services Review, 98, 51–57.

Alfandari

Taylor

J. B.

(2021). Systematic bibliographic database searching for literature reviews: Case study on child protection decision making. British Journal of Social Work. https://doi.org/10.1093/bjsw/bcab013

Alfandari

Taylor

J. B.

Enosh

Killick

McCafferty

Przeperski

Rölver

Whittaker

(in press). Group decision-making theories for child and family social work. The British Journal of Social Work.

Ambrose-Miller

Ashcroft

(2016). Challenges faced by social workers as members of interprofessional collaborative health care teams. Health & Social Work, 41(2), 101–109.

Baginsky

Manthorpe

(2020). Keeping children and young people safe during a pandemic: Testing the robustness of multi-agency child protection and safeguarding arrangements for schools. King’s College London.

*Balsley

Pierce

M. C.

Katsogridakis

Y. L.

Rosado

Mathey

Hickey

Kelleher

(2019). Multidisciplinary quality improvement approach to standardize care and communication for suspected child abuse arriving to the ED. Clinical Pediatric Emergency Medicine, 20(3), 100715.

Baumann

Dalgleish

Fluke

J. D.

Kern

(2011). The decision-making ecology. American Humane Association.

10.

Benbenishty

Davidson-Arad

Chen

Glasser

Tzur

Lerner-Geva

(2011). The decision of hospital-based child protection teams to report to community child protective services. British Journal of Social Work, 41(7), 1232–1250.

11.

*Benbenishty

Jedwab

Chen

Glasser

Slutzky

Siegal

Lavi-Sahar

Lerner-Geva

(2014). Predicting the decisions of hospital-based child protection teams to report to child protective services, police and community welfare services. Child Abuse & Neglect, 38(1), 11–24.

12.

Berrick

J. D.

Peckover

Pösö

Skivenes

(2015). The formalized framework for decision making in child protection care orders: A cross-country analysis. Journal of European Social Policy, 25(4), 366–378.

13.

Best

Manktelow

Taylor

B. J.

(2014). Online communication, social networking and adolescent wellbeing: A systematic narrative review. Children and Youth Services Review, 41(6), 27–36.

14.

Brandon

Bailey

Belderson

Gardner

Sidebotham

Dodsworth

Warren

Black

(2009). Understanding serious case reviews and their impact: A biennial analysis of serious case reviews 2005–2007. Research Report no. DCSF–RB129. Department for Education and Skills.

15.

Burns

Pösö

Skivenes

(2017). Child welfare removals by the state: A cross-country analysis of decision-making systems. Oxford University Press.

16.

*Chen

Glasser

Benbenishty

Davidson-Arad

Tzur

Lerner-Geva

(2010). The contribution of a hospital child protection team in determining suspected child abuse and neglect: Analysis of referrals of children aged 0–9. Children and Youth Services Review, 32(12), 1664–1669.

17.

Connolly

(2012). Everyone’s business: Developing an integrated model of care to respond to child abuse in a pediatric hospital setting. Social Work in Health Care, 51(1), 36–52.

18.

Cowles

L. A.

Lefcowitz

M. J.

(1995). Interdisciplinary expectations of the medical social worker in the hospital setting: Part 2. Health and Social Work, 20(4), 279.

19.

Crockett

Gilchrist

Davies

Henshall

Hoggart

Chandler

Simms

Webb

(2013). Assessing the early impact of Multi Agency Safeguarding Hubs (MASH) in London. University of Greenwich.

20.

*Davidson-Arad

Benbenishty

Chen

Glasser

Zur

Lerner-Geva

(2010). Distinguishing neglect from abuse and accident: Analysis of the case files of a hospital child protection team in Israel. Health & Social Care in the Community, 18(6), 614–623.

21.

Department of Health, Home Office and Department for Education and Employment. (1999). Working together to safeguard children: A guide to interagency working to safeguard and promote the welfare of children. The Stationery Office.

22.

Enosh

Alfandari

Nouman

Dolev

Dascal-Weichhendler

(2020). Assessing, consulting, reporting heuristics in professional decision-making regarding suspected child maltreatment in community healthcare services. Child Maltreatment. https://doi.org/10.1177/1077559520937351

23.

Forrester

Westlake

McCann

Thurnham

Shefer

Glynn

Killian

(2013). Reclaiming Social Work? An evaluation of systemic units as an approach to delivering children’s services: Summary report of a comparative study of practice and the factors shaping it in three local authorities. University of Bedfordshire.

24.

*Goyal

M. K.

Mollen

C. J.

Hayes

K. L.

Molnar

Christian

C. W.

Scribano

P. V.

Lavelle

(2013). Enhancing the emergency department approach to pediatric sexual assault care: Implementation of a pediatric sexual assault response team program. Pediatric Emergency Care, 29(9), 969–973.

25.

Hackman

J. R.

(1990). Groups that work (and those that don’t): Creating conditions for effective teamwork. Jossey-Bass.

26.

Harr

Fairchild

Souza

(2008). International models of hospital interdisciplinary teams for the identification, assessment, and treatment of child abuse. Social Work in Health Care, 46(4), 1–16.

27.

*Higginbotham

Lawson

K. A.

Gettig

Roth

Hopper

Higginbotham

George

T. M.

Maxson

Edwards

Garcia

N. M

. (2014). Utility of a child abuse screening guideline in an urban pediatric emergency department. Journal of Trauma and Acute Care Surgery, 76(3), 871–877.

28.

Higgins

J. P. T.

Lasserson

Chandler

Tovey

Thomas

Flemyng

Churchill

. (2020). Methodological expectations of Cochrane intervention reviews. Cochrane Community.

29.

*Hoehn

E. F.

Overmann

K. M.

Fananapazir

Simonton

Makoroff

K. L.

Bennett

B. L.

Duma

E. M.

Kurowski

E. M.

(2018). Improving emergency department care for pediatric victims of sexual abuse. Pediatrics, 142(6), e20181811.

30.

Hood

. (2015). A socio-technical critique of tiered services: Implications for interprofessional care. Journal of Interprofessional Care, 29(1), 8–12.

31.

Hood

Gillespie

Davies

. (2016). A conceptual review of interprofessional expertise in child safeguarding. Journal of Interprofessional Care, 30(4), 493–498.

32.

Hood

Price

Sartori

Maisey

Johnson

Clark

. (2017). Collaborating across the threshold: The development of interprofessional expertise in child safeguarding. Journal of Interprofessional Care, 31(6), 705–713.

33.

Ilgen

D. R.

Hollenbeck

J. R.

Johnson

Jundt

. (2005). Teams in organizations: From input-process-output models to IMOI models. Annual Review of Psychology, 56, 517–543.

34.

*Itzhaky

Zanbar

(2014). In the front line: The impact of specialist training for hospital physicians in children at risk on their collaboration with social workers. Social Work in Health Care, 53(7), 617–639.

35.

*Jedwab

Benbenishty

Chen

Glasser

Siegal

Lerner-Geva

(2015). Child protection decisions to substantiate hospital child protection teams’ reports of suspected maltreatment. Child Abuse & Neglect 40, 132–141.

36.

*Jud

Lips

Landolt

M. A.

(2010). Characteristics associated with maltreatment types in children referred to a hospital protection team. European Journal of Pediatrics, 169(2), 173–180.

37.

*Kelly

John

Vincent

A. L.

Reed

(2015). Abusive head trauma and accidental head injury: A 20-year comparative study of referrals to a hospital child protection team. Archives of Disease in Childhood, 100(12), 1123–1130.

38.

Kerr

N. L.

Tindale

R. S.

(2004). Group performance and decision making. Annual Review of Psychology, 55, 623–656.

39.

Killick

Taylor

B. J.

(2009). Professional decision making on elder abuse: Systematic narrative review. Journal of Elder Abuse and Neglect, 21, 211–238.

40.

Killick

Taylor

B. J.

(2020). Assessment, risk and decision making in social work: An introduction. SAGE.

41.

*Kim

P. T.

McCagg

Dundon

Ziesler

Moody

Falcone

R. A.

Jr (2017). Consistent screening of admitted infants with head injuries reveals high rate of nonaccidental trauma. Journal of Pediatric Surgery, 52(11), 1827–1830.

42.

*Kistin

C. J.

Tien

Bauchner

Parker

Leventhal

J. M.

(2010). Factors that influence the effectiveness of child protection teams. Pediatrics, 126(1), 94–100.

43.

*Kistin

C. J.

Tien

Leventhal

J. M.

Bauchner

(2011). A novel self-evaluation tool to assess the team function of a child protection team. Academic Pediatrics, 11(6), 451–459.

44.

Kugley

Wade

Thomas

Mahood

Jørgensen

A. M. K.

Hammerstrøm

Sathe

(2017). Searching for studies: A guide to information retrieval for Campbell systematic reviews. The Campbell Collaboration.

45.

Laming

(2003). The Victoria Climbié inquiry. HM Stationery Office.

46.

Lee

A. C.

C. H.

K. T.

(2006). The impact of a management protocol on the outcomes of child abuse in hospitalized children in Hong Kong. Child Abuse & Neglect, 30(8), 909–917.

47.

Levine

J. M.

Resnick

L. B.

Higgins

E. T

. (1993). Social foundations of cognition. Annual Review of Psychology, 44(1), 585–612.

48.

*Lo

W. C.

Fung

G. P.

Cheung

P. C.

(2017). Factors associated with multidisciplinary case conference outcomes in children admitted to a regional hospital in Hong Kong with suspected child abuse: A retrospective case series with internal comparison. Hong Kong Medical Journal, 23(5), 454–461.

49.

McElhinney

Taylor

B. J.

Sinclair

. (2019). Decision making by health and social care professionals to protect an unborn baby: Systematic narrative review. Child Care in Practice. https://doi.org/10.1080/13575279.2019.1612733

50.

McFadden

Campbell

Taylor

B. J.

(2015). Resilience and burnout in child protection social work: Individual and organizational themes from a systematic literature review. British Journal of Social Work, 45(5), 1546–1563.

51.

McGinn

A. H.

Taylor

B. J.

McColgan

Lagdon

. (2016). Survivor perspectives on IPV perpetrator interventions: Systematic narrative review. Trauma, Violence & Abuse, 17(3), 239–255.

52.

Moher

Liberati

Tetzlaff

Altman

D. G

., & Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097.

53.

Moon

D. J.

Damman

J. L.

Romero

(2018). The effects of primary care-based parenting interventions on parenting and child behavioural outcomes: A systematic review. Trauma, Violence and Abuse, 21(4), 706–724.

54.

Munro

(2011). The Munro review of child protection: A child-centred system. HM Stationery Office.

55.

*Nigro

L. C.

Feldman

M. J.

Foster

R. L.

Pozez

A. L.

(2018). A model to improve detection of nonaccidental pediatric burns. AMA Journal of Ethics, 20(6), 552–559.

56.

Nouman

Alfandari

. (2020). Identifying children suspected for maltreatment: The assessment process taken by healthcare professionals working in community healthcare services. Children and Youth Services Review, 113, 104964. https://doi.org/10.1016/j.childyouth.2020.104964

57.

Nouman

Alfandari

Enosh

Dolev

Daskal-Weichhendler

(2020). Mandatory reporting between legal requirements and personal interpretations: Community healthcare professionals’ reporting of child maltreatment. Child Abuse & Neglect, 101, 104–261.

58.

*Okato

Hashimoto

Tanaka

Tachibana

Machizawa

Okayama

Endo

Senda

Saito

Iyo

(2018). Hospital-based child protection teams that care for parents who abuse or neglect their children recognize the need for multidisciplinary collaborative practice involving perinatal care and mental health professionals: A questionnaire survey conducted in Japan. Journal of Multidisciplinary Healthcare, 11, 121–129.

59.

Patel

V. L.

Kaufman

D. R.

Arocha

J. F.

(2002). Emerging paradigms of cognition in medical decision making. Journal of Biomedical Informatics, 35, 52–75.

60.

Pösö

Skivenes

Hestbæk

(2014). Child protection systems within the Danish, Finnish and Norwegian welfare states—Time for a child centric approach? European Journal of Social Work, 17(4), 475–490.

61.

*Ravichandiran

Schuh

Bejuk

Al-Harthy

Shouldice

Boutis

. (2010). Delayed identification of pediatric abuse-related fractures. Pediatrics, 125(1), 60–66.

62.

*Rosado

Ryznar

Flaherty

E. G.

(2017). Understanding humerus fractures in young children: Abuse or not abuse? Child Abuse & Neglect, 73, 1–7.

63.

*Ross

Arnold

Gormley

Locke

Shanske

Tardiff

. (2019). Care coordination in pediatric health care settings: The critical role of social work. Social Work in Health Care, 58(1), 1–13.

64.

Rowe

D. S.

Leonard

M. F.

Seashore

M. R.

Lewiston

N. J.

Anderson

F. P

. (1970). A hospital program for the detection and registration of abused and neglected children. New England Journal of Medicine, 282(17), 950–952.

65.

Sahin

Çepik-Kuruoglu

Demirel

Akar

Duyan-Çamurdan

Iseri

Demiroğullari

Pasli

Beyazova

Oral

(2009). Six-year experience of a hospital-based child protection team in Turkey. The Turkish Journal of Pediatrics, 51(4), 336.

66.

Sarkar

Ozanne-Smith

Bassed

(2021). Systematic review of the patterns of orofacial injuries in physically-abused children and adolescents. Trauma, Violence and Abuse, 22(1), 136–146.

67.

Scoglio

A. J.

Kraus

S. W.

Saczynski

Jooma

Molnar

B. E.

(2019). Systematic review of risk and protective factors for revictimization after child sexual abuse. Trauma, Violence and Abuse, 22(1), 41–53. https://doi.org/10.1177/1524838018823274

68.

*Sonney

Willgerodt

Lindhorst

Brock

(2018). Elizabeth: Typical or troubled teen? A training case for health professionals to recognize and report child maltreatment. MedEdPORTAL, 14(10712), 1–8.

69.

*Straub

Krüger

Bode

(2017). Interprofessional education in pediatrics—Child protection and family services as a teaching example. Annals of Anatomy, 213, 62–68.

70.

*Svärd

(2014). Hospital social workers’ assessment processes for children at risk: Positions in and contributions to inter-professional teams. European Journal of Social Work, 17(4), 508–522.

71.

Taylor

B. J.

(2017). Decision making, assessment and risk in social work (3rd ed.). SAGE.

72.

Taylor

B. J.

Killick

McGlade

(2015). Understanding and using research in social work. SAGE.

73.

*Teeuw

A. H.

Sieswerda-Hoogendoorn

Aaftink

Burgers

I. A.

Vrolijk-Bosschaart

T. F.

Brilleslijper-Kater

S. N.

Heymans

H. S.

van Rijn

R. R.

(2017). Assessments carried out by a child abuse and neglect team in an Amsterdam teaching hospital led to interventions in most of the reported cases. Acta Paediatrica, 106(7), 1118–1127.

74.

Thompson

(2013). Multi-agency information practices in children’s services: The metaphorical “jigsaw” and professionals’ quest for a “full” picture. Child & Family Social Work, 18, 189–197.

75.

Tindale

R. S.

Kameda

(2000). “Social sharedness” as a unifying theme for information processing in groups. Group Process & Intergroup Relations, 3, 123–140.

76.

Vinokur-Kaplan

(1995). Treatment teams that work (and those that don’t): An application of Hackman’s group effectiveness model to interdisciplinary teams in psychiatric hospitals. The Journal of Applied Behavioral Science, 31(3), 303–327.

77.

*Whaitiri

Kelly

(2011). Genital gonorrhoea in children: Determining the source and mode of infection. Archives of Disease in Childhood, 96(3), 247–251.

78.

*Wilcox

Miller-Cribbs

Kientz

Carlson

DeShea

(2017). Impact of simulation on student attitudes about interprofessional collaboration. Clinical Simulation in Nursing, 13(8), 390–397.

79.

Wiseman

Hamilton-Giachritsis

Hiller

R. M.

(2019). The relevance of cognitive behavioural models of post-traumatic stress following child maltreatment: A systematic review. Trauma, Violence and Abuse, 22(1), 191–206.