Medical-Forensic Child Neglect: Improving Assessment of the Unsafe Home Environment

Abstract

Purpose: The purpose of this DNP project was to improve the knowledge, confidence levels, and ability of child neglect investigators at the Southern Arizona Children’s Advocacy Center (SACAC) to recognize health and safety risks within an unsafe home environment and to standardize assessment of unsafe home environments by using an evidence-based Medical-Forensic Child Neglect Assessment (MFCNA) checklist. Background: Child neglect is the most common form of child maltreatment. Each year, child neglect affects over 3.5 million children. Consequences of neglect and maltreatment can be lifelong. The effects and high prevalence rates of neglect throughout the United States (US) necessitate a more comprehensive, coordinated response to improving children’s outcomes, particularly when found living in unsafe environments. Interventions aimed at improving recognition and documentation of neglect in an unsafe home environment can positively impact children. Child neglect investigators have a crucial role in recognizing child neglect in the home; however, they lack a consistent system to guide and document their findings. Methods: A single site pretest, posttest, and follow-up survey design guided this project. A multidisciplinary team of law enforcement investigators, healthcare providers, social workers, attorneys, administrators, and advocates engaged in a 75-minute evidence-based synchronous webinar training to improve their knowledge of health and safety risks and confidence levels in recognizing risk by using a child neglect assessment checklist. Results: Of the 66 webinar attendees, a total of 16 participants completed pretest surveys, 12 returned the posttest, and nine participants completed the 6-week follow up survey. There was a statistically significant (p< 0.05) increase in knowledge of health and safety risks on the posttests and in safety risks on the follow-up surveys. Confidence levels improved; however, not statistically significant. Most of the participants (83%) found the checklist useful, and all said the checklist changed their practice. Conclusions: The educational training effectively improved multidisciplinary child neglect team members’ knowledge of health and safety risks. An assessment checklist can standardize the approach and increase recognition of child neglect risks in an unsafe home environment. Future child neglect training is feasible and beneficial to the multidisciplinary team.