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Identifying children exposed to maltreatment: a systematic review update
Jill R McTavish1, Andrea Gonzalez2, Nancy Santesso3
1Department of Psychiatry & Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada. mctavisj@mcmaster.ca.
Insights
Identifying child maltreatment using screening tools is unreliable, leading to many false positives and missed cases. The potential harms of these strategies may outweigh any benefits for child protection.
Area of Science:
- Child Health
- Public Health
- Forensic Science
Background:
- Child maltreatment is a global issue requiring effective identification strategies.
- Existing strategies aim to identify children exposed to maltreatment to prevent further harm.
- This review systematically evaluates the accuracy of these identification strategies.
Purpose of the Study:
- To systematically review and evaluate the accuracy of strategies used for identifying child maltreatment.
- To synthesize evidence on the effectiveness and potential harms of child maltreatment identification tools.
Main Methods:
- A systematic search of seven databases was conducted for studies published between 1961 and July 2019.
- Studies estimating the accuracy of instruments for identifying neglect, physical, emotional, and sexual abuse were included.
- Data on accuracy were extracted, and evidence was narratively synthesized; false positives and negatives were calculated for relevant studies.
Main Results:
- 32 articles (31 studies) evaluated identification strategies, including three screening tools: SPUTOVAMO checklist, Escape instrument, and a child sex trafficking screening questionnaire.
- No studies assessed the impact of identification strategies on child outcomes.
- All studies exhibited serious risk of bias, indicating potential over- or under-identification of child maltreatment.
Conclusions:
- Low to very low certainty evidence suggests screening tools may lead to high numbers of false suspicions or missed cases.
- The potential harms associated with inaccurate identification may exceed the benefits of using these tools.
- Further research is needed to develop and validate accurate and reliable methods for identifying child maltreatment.
Background:
Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment.
Methods:
We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies-where the population and setting matched known prevalence estimates in an emergency department setting-we calculated false positives and negatives. We assessed risk of bias using QUADAS-2.
Results:
We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified.
Conclusions:
There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).
