Abstract
This paper investigates the efficacy of multidisciplinary and non-multidisciplinary approaches in child abuse management. Evidence of increased prosecution rates increased medical referrals, and increased provision of medical examinations show that a multidisciplinary approach is highly effective. Conversely, confusion, jurisdictional disputes, and weak investigations (during the detection, reporting, and management of child abuse cases) may arise if non-multidisciplinary approaches are adopted, thereby exposing children to further maltreatment. This paper positions the efforts of health workers at the axis of child abuse management because they are highly qualified in detecting and preventing child abuse. Indeed, their combined efforts with law enforcement officers provide a powerful front for managing child abuse cases. Comprehensively, this paper shows that the multidisciplinary approach is more effective in managing child abuse cases because it advances the best interests of the victims.
Key Words: Multidisciplinary, Non-multidisciplinary, Child Abuse, Prosecution rates, Health Workers, Law Enforcement, Mental health, Trauma, Medical Examination, Inter-Agency partnerships
Introduction
Child abuse manifests in different forms. However, sexual abuse, physical abuse, emotional abuse, and neglect outline the most common types of child abuse. Colleen (2007) says the incidences of child abuse in the United States have increased in the last decade. Annually, about 5% of minors become victims of child abuse (Colleen, 2007). This figure translates to about 3,000,000 cases of child abuse reported yearly (about 1,400 of these cases lead to fatalities) (The National Children’s Advocacy Center, 2006; Colleen, 2007). These statistics show that child abuse is among the leading causes of mortality in infants and children (with about half of all the children who have experienced child abuse suffering a high risk of experiencing the same maltreatment in the future). Physicians have taken a proactive approach to address this problem. Some of them have used a multidisciplinary approach in doing so, while others have adopted a non-multidisciplinary approach as well.
The National Children’s Advocacy Center (2006) says the adoption of the multidisciplinary team approach in addressing child abuse issues dates back to the early seventies. Then, few people disputed the importance of integrating the efforts of different health departments, law enforcers, therapists, and even community groups in addressing child abuse and neglect issues. A formal platform for ensuring seamless inter-agency collaboration emerged (most agencies had differing goals and perspectives). Agencies that differed from the multidisciplinary approach chose to manage the issue alone. A non-multidisciplinary approach premises on the concept of reductionism. This concept perceives child abuse as a sum of several parts (The National Children’s Advocacy Center, 2006). Through this understanding, the non-multidisciplinary approach only relies on one aspect of causality, through a preclusion of emergent phenomena (the support of non-multidisciplinary approaches in addressing child abuse mainly stem from the inadequacies of the multidisciplinary approach). This paper evaluates the effectiveness of both approaches in addressing child abuse issues. In this study, the key indicators include prosecution rates, mental health referrals, and the provision of medical examinations.
Prosecution Rates
Prosecution rates normally show the efficacy of child abuse interventions. Historically, there have been low prosecution rates of child abuse cases (American Prosecutors Research Institute, 2004). However, the adoption of a multidisciplinary approach in arresting and prosecuting offenders has led to a significant increase in the rates of prosecution. For example, a study sponsored by the National Institute of Justice and the Office of Juvenile Justice and Delinquency Prevention identified that the adoption of a multidisciplinary approach has led to high felony convictions in child abuse cases (American Prosecutors Research Institute, 2004). Consequently, there has been an increase of convictions, from about 70% in the eighties to about 95% today (Goodyear-Brown, 2011). This significant rise in prosecution rates came from the adoption of a multi-agency approach in prosecuting child abuse offenders.
The efficiency of the multidisciplinary approach in increasing the number of prosecutions stems from earlier studies that investigated the role of the classical organization theory in determining the efficiency and effectiveness of state departments in prosecuting child abuse offenders (Maguire, 2009). Max Weber was at the center of the formulation of the classical organization theory when he suggested that successful organizations adopt a closed system approach (Maguire, 2009). His ideology stemmed from the belief that organizational success came from strict compliance with bureaucratic principles and ideologies. Evidence accumulated from the last three decades shows that the closed systems approach is ineffective in realizing organizational success (Maguire, 2009; Goodyear-Brown, 2011). Instead, there has been a significant shift in philosophy from the closed systems approach to the open systems approach. If we extrapolate these findings to this study, we find that the open systems approach supports the multidisciplinary approach of managing child abuse cases. The structure contingency theory, for example, acknowledges the importance of including environmental factors in solving social issues (The National Children’s Advocacy Center, 2006). This approach informs inter-agency collaboration because, unlike the non-multidisciplinary approach, it considers environmental factors in managing child abuse cases.
Martin & Besharov (1991) were among the first researchers to use the above theories in the assessment of child abuse cases. In their study, Martin & Besharov (1991) said, “neither number of officers in the department, nor the organizational location of specialists, had an effect on arrest rates, and that fewer cases are closed by the arrest in agencies with specialized sexual abuse squads than in other agencies” (p. 7). Their views proved to be useful in understanding how organizational structures in the police department allowed for the adoption of a multidisciplinary approach in managing child abuse cases (the views of the researchers however relied on qualitative impressions of the respondents) (Martin & Besharov, 1991). The researchers also found out that most police departments were highly insensitive to the plight of patients and their families, whenever they managed child abuse cases (Martin & Besharov, 1991). This led to increased trauma to the victims, thereby reducing the rates of prosecution. Institutional failures have forced many police departments to be open about seeking the support of other agencies (inter-agency approach). In detail, the inter-agency approach involved the realization of joint efforts by different agencies in addressing child abuse. The San Diego Police department is one agency that has greatly benefitted from the adoption of the multiagency approach in prosecuting child abuse offenders. Colleen (2007) says, “San Diego’s multiagency approach involves coordination among child protective services (CPS), the police, the medical community, and the prosecutor’s office” (p. 119).
Evidence shows that the non-multidisciplinary approach for addressing child abuse cases has often resulted in poor management of such cases. For example, in the seventies and eighties, child protection services (CPS) assumed the sole responsibility of protecting children from abuse (Maguire, 2009). They often undertook their activities with little or no assistance from the police. In fact, CPS only required the police to stand guard, only when the children were withdrawn from their families and transferred into protective homes (sometimes, child protective services would not even seek the services of medical practitioners in ascertaining the degree of abuse) (Maguire, 2009). This non-multidisciplinary approach led to many problems that failed to protect children from further abuse. Maguire (2009) says, “The lack of communication, coordination, and cooperation between community helping agencies resulted in frustration, duplication of effort, jurisdictional disputes, weak investigations, and tragedies” (p. 157). Through the problems realized from adopting a non-multidisciplinary approach, child protection services acknowledged the need to share the responsibility of protecting children from child abuse by collaborating with other agencies. This way, they started to appreciate the importance of the multidisciplinary approach, as opposed to the non-multidisciplinary approach, in managing child abuse.
Mental Health Referrals
Mental health referrals outline among the most important processes and outcomes for children who have experienced child abuse. Multidisciplinary approaches for addressing child abuse issues have largely helped to increase the number of mental health referrals. Mainly, increased agreements between juvenile justice systems and mental health systems have helped to realize this outcome (Franklin & Harris, 2006). Sometimes, courts help to increase the number of referrals by ordering abused children to attend counseling sessions and receive guidelines on how to conduct visitations and reunification plans.
A study conducted by the Office of the Family and Children’s Ombudsman (OFCO), in 2008, affirms the positive progress made by adopting a multidisciplinary approach in health referrals (Washington State Institute for Public Policy, 2009). The study established that between 2006 and 2008, an effort to integrate the activities of different agencies increased the rate of mental health referrals to about 96,000 (Washington State Institute for Public Policy, 2009). Nine categories outlined the most active agents in this study. They included “corrections personnel, DSHS employees, medical professionals, law enforcement personnel, mental health professionals, foster care providers, social service professionals, educators, and child care providers” (Washington State Institute for Public Policy, 2009, p. 1).
Maguire (2009) commented on these findings by saying that the high rates of referrals witnessed through the adoption of the multidisciplinary approach also stemmed from the legal requirement for state agents to report incidences of child abuse. The state also required the agents to refer abused children to mental health facilities (or counseling programs) whenever they detected a victim underwent some type of trauma (ideally, all children who have undergone trauma from child abuse and neglect should go for counseling). Maguire (2009) also cited inputs from third parties (who are not required to participate in the rehabilitation of abused children) as contributors to higher referral rates for the multidisciplinary approach. These third parties included the inputs of friends, neighbors, and strangers who know the victims. Comprehensively, the referrals made by the contributors not only aimed to rehabilitate the abused children, through mental health therapy but also helped to recommend the prosecution of known sex offenders. In fact, the Washington State Institute for Public Policy (2009) explains that about 47% of the referrals made by the agents were for mental treatment, while about 60% of the referrals aimed to support law enforcement activities. The latter group of referrals often led to further investigations into child abuse cases (and occasionally, the removal of children from their homes into foster care).
Most of the mental health referrals outlined above are subject to other factors that affect the measures for addressing the child abuse. For example, when the resolution of child abuse cases existed outside the realms of the official child protection law, alternative solutions always seemed attractive (Franklin & Harris, 2006). For example, Ludwig (1981) says that if people could refer a solution to a community service provider, they often chose this option. Public health services, counseling, and other family services therefore provided an alternative for rehabilitating abused children outside the realms of child protection services.
Provision of Medical Examination
This section of the report acknowledges the role of medical examinations in child abuse cases. Goodyear-Brown (2011) says medical exams are very important in treating abused children, especially when they experience physical or sexual abuse. Medical evidence in child abuse cases often provides satisfactory and powerful evidence to convict child abuse offenders. Since child abuse victims may not provide a clear narration of their ordeal, medical examinations often provide a holistic picture of what may have happened. When prosecuting offenders, medical examination results provide protection for prosecutors when the defense intends to discredit cases, based on the absence of medical results (American Prosecutors Research Institute, 2004). For example, in sexual abuse cases, the presence of semen, sexually transmitted diseases (STD), and tissue damage may make it difficult for defense teams to discredit a prosecutor’s case.
The usefulness of medical examinations in addressing child abuse depends from the efficiency and expediency of the exams. In many child abuse cases, medical examinations are inconclusive because of procedural issues, or the lack of timely reporting of child abuse cases (Goodyear-Brown, 2011). Poor or inconclusive medical results often come from the adoption of non-multidisciplinary approaches of addressing child abuse. Notably, non-multidisciplinary approaches lead to the loss of medical evidence, or the failure to prosecute offenders. For example, if law enforcement officers do not understand the importance of a timely medical exam in child abuse cases, a victim’s wound or injuries may heal, thereby leading to the loss of evidence to corroborate the claim. Part of the problem lies in officer training. Kinnear (2007) says that a survey of about 200 police academies in the US showed that many officers did not have the skills or knowledge to manage child abuse cases. Most of the officers interviewed said they only had a general understanding of how to manage child abuse cases. This challenge may undermine the efficiency of the multidisciplinary approach. Interestingly, the American Prosecutors Research Institute (2004) says the high rate of inconclusive medical exams in non-multidisciplinary approaches of managing child abuse does not mean there will be fewer prosecutions. In fact, the American Prosecutors Research Institute (2004) says that in one jurisdiction in the US, the high number of inconclusive medical results has not affected the rate of prosecution for child abuse cases.
The greatest challenge for achieving conclusive results of medical examination is the fragility of medical evidence. Seminal fluid, bleeding, and bruises (just to mention a few) are common medical evidences that may not last for long. However, a multidisciplinary approach to addressing child abuse issues often leads to better identification and recording of these medical evidences. For example, a timely collaboration of law enforcement officers and physicians may lead to the timely identification of medical evidence that could be useful in prosecution. A multidisciplinary approach of addressing child abuse cases also creates fewer traumas for victims because children are often scared to narrate their ordeals.
The American Prosecutors Research Institute (2004) says many child advocacy centers use the multidisciplinary approach for examining children by allowing a holistic medical evaluation of the children at once. The comprehensive exam eliminates the possibility of the victims experiencing multiple encounters of evaluation (possibly at different sites). By conducting comprehensive medical exams, physicians may come up with comprehensive results of the medical examination because they can easily check for every medical possibility that may arise from the abuse. Comprehensively, the adoption of the multidisciplinary approach helps to expedite medical examinations, thereby improving their roles in providing medical evidence for prosecution.
Conclusion
After weighing the findings of this paper, the importance of adopting a multidisciplinary approach in addressing child abuse surfaces as the most effective approach to protecting children from such maltreatments. This paper acknowledges the effectiveness of an inter-agency approach by health workers, law enforcers, judicial officers, community workers and other agencies in preventing and prosecuting child abuse cases. The role of health workers especially surfaces in this paper as the most important piece of managing child abuse because such cases normally take a medical twist (physical injuries, mental health trauma, and sexual abuse). It is therefore unsurprising for Beth & Crisp (2006) to say that health workers are among the most qualified people to detect child abuse or identify children who have a high risk of experiencing the same. However, to maintain their relevance, health workers need to appreciate the importance of inter-agency training when preparing new and existing health workers to manage child abuse cases. Notably, the importance of increased collaboration between community health workers and physicians is valuable here because their increased collaboration prepares them to manage child abuse better.
Through a comprehensive analysis of child abuse and its antecedents, this paper show that the efficiency of the multidisciplinary approach spills over to all the three issues covered in this paper – prosecution rates, provision of medical examination, and mental health referrals. For instance, this paper shows that the adoption of a multidisciplinary approach leads to increased medical evaluations by healthcare workers (increased medical evaluations increase the body of evidence needed for successful prosecution). This outcome easily depicts the success that could occur from the increased collaboration between physicians and law enforcement officers. Comparatively, the non-multidisciplinary approach proves to be an ineffective model for combating child abuse cases because it precludes effective coordination and communication (which are important in protecting children from child abuse). Evidence of the classic organization theory also affirms this fact because it outlines that it is untenable for organizations to operate as closed systems. This is particularly true for law enforcement agencies because they need help from other agencies (like healthcare institutions) to prosecute child offenders. The open systems approach (multidisciplinary approach) is therefore more effective in protecting children from child abuse because it emphasizes the role of the environment in addressing child abuse. Future research should however identify which inter-agency partnerships provide the best combination for managing child abuse.
References
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