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.
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