Educating early childhood care and education providers to improve knowledge and attitudes about reporting child maltreatment: A randomized controlled trial

Ben Mathews, Chengwu Yang, Erik B Lehman, Claudia Mincemoyer, Nicole Verdiglione, Benjamin H Levi, Ben Mathews, Chengwu Yang, Erik B Lehman, Claudia Mincemoyer, Nicole Verdiglione, Benjamin H Levi

Abstract

Early childhood care and education providers (CCPs) work with over 7 million young children. These children are vulnerable to physical, sexual and emotional abuse, and neglect. However, CCPs make less than 1% of all reports of suspected child abuse and neglect that are made to child protective services. CCPs are therefore an untapped resource in the public health response to child maltreatment. However, their knowledge and attitudes about duties to report child maltreatment are poorly understood. Moreover, no rigorous research has tested whether their knowledge and attitudes about reporting child maltreatment can be improved. These gaps in knowledge are important because knowledge of the duty and positive attitudes towards it produce more effective reporting, and little evidence exists about how to enhance cognitive and affective attributes. Using the CONSORT approach, we report a single-blind test-retest randomized controlled trial evaluating iLook Out for Child Abuse, a customized online educational intervention for CCPs to increase knowledge and attitudes towards the reporting duty. 762 participants were randomized with results analyzed for 741 participants (372 in the intervention group; 369 in the control). Knowledge of the reporting duty increased in the intervention group from 13.54 to 16.19 out of 21 (2.65 increase, 95% CI: (2.37, 2.93); large effect size 0.95, p < 0.001); the control group remained stable, moving from 13.54 to 13.59 (0.05 increase, 95% CI: (-0.12, 0.22); negligible effect size 0.03, p = 0.684). Attitudes were enhanced on all 13 items for the intervention group, remaining stable in the control, with significant differences between groups on all items (p < 0.05). Gains were largely sustained at four month follow-up. Findings support education for CCPs and other professions. Future research should also explore effects of education on reporting behavior.

Trial registration: US National Institutes of Health NCT02225301.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Participant flow diagram.
Fig 1. Participant flow diagram.

References

    1. United States Department of Health and Human Services. Child maltreatment 2013. Washington, D.C.: Administration for Children and Families; 2015. Available from
    1. Finkelhor D, Turner HA, Shattuck A, Hamby SL. Prevalence of childhood exposure to violence, crime, and abuse: Results from the national survey of children’s exposure to violence. JAMA Pediatr. 2015;169(8): 746–54. doi:
    1. Sedlak AJ, Mettenburg J, Basena M, Petta I, McPherson K, Greene A et al. Fourth national incidence study of child abuse and neglect (NIS–4): Report to congress, executive summary. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families; 2010. Available from
    1. Gilbert R, Widom C, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373(9657): 68–87. doi:
    1. Finkelhor D, Ormrod R, Turner H. Polyvictimization: A neglected component in child victimization. Child Abuse Negl. 2007;31(1): 7–26. doi:
    1. Widom C, Czaja S, Bentley T, Johnson M. A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow-up. Am J Public Health. 2012;102: 1135–44 doi:
    1. Norman R, Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Med. 2012;9(11): e1001349 doi:
    1. Danese A, McEwen BS. Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav. 2012;106(1): 29–39. doi:
    1. Flaherty E, Thompson R, Dubowitz H, Harvey E, English D, Proctor L, Runyan D. Adverse childhood experiences and child health in early adolescence. JAMA Pediatr. 2013;167(7): 622–9. doi:
    1. Fang X, Brown D, Florence C, Mercy J. The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse Negl. 2012;36(2): 156–65. doi:
    1. Mathews B, Kenny M. Mandatory reporting legislation in the United States, Canada and Australia: A cross-jurisdictional review of key features, differences and issues. Child Maltreat. 2008;13(1): 50–63. doi:
    1. United States Department of Health and Human Services. Child maltreatment 2009. Washington, D.C.: Administration for Children and Families; 2010. Available from
    1. Laughlin L. Who’s minding the kids? Child care arrangements. Washington, D.C.: U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau; 2013.
    1. Kohl P, Jonson-Reid M, Drake B. Time to leave substantiation behind: Findings from a national probability study. Child Maltreat. 2009;14(1): 17–26. doi:
    1. Starling SP, Boos S. Core content for residency training in child abuse and neglect. Child Maltreat. 2003;8(4): 242–7. doi:
    1. Starling SP, Heisler KW, Paulson JF, Youmans E. Child abuse training and knowledge: A national survey of emergency medicine, family medicine, and pediatric residents and program directors. Pediatrics. 2009;123(4): e595–e602. doi:
    1. Ajzen I, Fishbein M. The influence of attitudes on behaviour In: Albarracin D, Johnson B, Zanna M (Eds), The handbook of attitudes (pp. 173–221). Mahwah: Lawrence Erlbaum Associates Publishers; 2005.
    1. Fraser J, Mathews B, Walsh K, Chen L, Dunne M. Factors influencing child abuse and neglect recognition and reporting by nurses: A multivariate analysis. Int J Nurs Stud. 2010;47(2): 146–53. doi:
    1. Hawkins R, McCallum C. Effects of mandatory notification training on the tendency to report hypothetical cases of child abuse and neglect. Child Abuse Rev. 2001;10(5): 301–22.
    1. Mathews B. Teacher education to meet the challenges of child sexual abuse. Australian Journal of Teacher Education. 2011;36(11): 13–32.
    1. Crenshaw WB, Crenshaw LM, Lichtenberg JW. When educators confront child abuse: An analysis of the decision to report. Child Abuse Negl. 1995;19(9): 1095–113.
    1. Kenny MC. Teachers' attitudes toward and knowledge of child maltreatment. Child Abuse Negl. 2004;28(12): 1311–19. doi:
    1. Walsh K, Rassafiani M, Mathews B, Farrell A, Butler D. Exploratory factor analysis and psychometric evaluation of the Teachers Reporting Attitude Scale for Child Sexual Abuse. J Child Sex Abus. 2012;21(5): 489–506 doi:
    1. Christian CW. Professional education in child abuse and neglect. Pediatrics. 2008;122(Supplement): S13–S17. doi:
    1. Feng JY, Levine M. Factors associated with nurses' intention to report child abuse: A national study of Taiwanese nurses. Child Abuse Negl. 2005;29(7): 783–95. doi:
    1. Jones R, Flaherty EG, Binns HJ, Price L, Slora E, Abney D, et al. Clinicians’ description of factors influencing their reporting of suspected child abuse: Report of the child abuse reporting experience study research group. Pediatr. 2008;122(2): 259–66.
    1. Alvarez KM, Kenny MC, Donohue B, Carpin KM. Why are professionals failing to initiate mandated reports of child maltreatment, and are there any empirically based training programs to assist professionals in the reporting process? Aggress Violent Behav. 2004;9(5): 563–78.
    1. McGrath P, Cappelli M, Wiseman D, Khalil N, Allan B. Teacher awareness program on child abuse: A randomized controlled trial. Child Abuse Negl. 1987;11(1): 125–32.
    1. Palusci V, McHugh M. Interdisciplinary training in the evaluation of child sexual abuse. Child Abuse Negl. 1995;19(9): 1031–8.
    1. Paranal R, Thomas KW, Derrick C. Utilizing Online Training for Child Sexual Abuse Prevention: Benefits and Limitations, J Child Sex Abus. 2012;21(5): 507–20. doi:
    1. Kenny MC. Web-based training in child maltreatment for future mandated reporters. Child Abuse Negl. 2007;31(6): 671–8. doi:
    1. Smeekens A, Broekhuijsen-van Henten D, Sittig J, Russell M, ten Cate O, Turner N, et al. Successful e-learning programme on the detection of child abuse in emergency departments: A randomised controlled trial. Arch Dis Child. 2011;96(4): 330–4. doi:
    1. Rheingold A, Zajac K, Chapman J, Patton M., de Arellano M., Saunders B., et al. Child sexual abuse prevention training for childcare professionals: An independent multi-site randomized controlled trial of stewards of children. Prev Sci. 2015;16(3): 374–85. doi:
    1. Carter Y, Bannon M, Limbert C, Docherty A, Barlow J. Improving child protection: A systematic review of training and procedural interventions. Arch Dis Child. 2006;91(9): 740–3. doi:
    1. Barber-Madden R. Training day care program personnel in handling child abuse cases: Intervention and prevention outcomes. Child Abuse Negl. 1983;7(1): 25–32.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. BMJ. 2010. March 23;340: c869 doi:
    1. Schulz K, Altman D, Moher D, for the CONSORT Group. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Lancet. 2010;375(9721): 1136.
    1. United States Census Bureau. 2009–2013 American community survey 5-year estimates. Available from
    1. Freeh LJ, Sporkin S, Sullivan ER. Report of the special investigative counsel regarding the actions of the Pennsylvania State University related to the child sexual abuse committed by Gerald A. Sandusky. 2012. Available from
    1. Cerezo A, Pons-Salvador G. Improving child maltreatment detection systems: A large scale case study involving health, social services and school professionals. Child Abuse Negl. 2004;28(11): 1153–69. doi:
    1. Socolar R, Raines B, Chen-Mok M, Runyan D, Paterno S. Intervention to improve physician documentation and knowledge of child sexual abuse: A randomised controlled trial. Pediatrics, 1998;101(5): 817–24.
    1. LeTourneau EJ, Nietert PJ, Rheingold AA. Initial assessment of stewards of children program effects on child sexual abuse reporting rates in selected South Carolina counties. Child Maltreat. 2016;21(1): 74–9. doi:
    1. Mathews B, Walsh K, Coe S, Vagenas D, Kenny MC. (2015). Child protection training for professionals to improve reporting of child abuse and neglect. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD011775.
    1. Knowles MS, Holton EF, Swanson RA. The adult learner (8th ed.). New York: Routledge; 2015.
    1. Hein G, Morishima Y, Leiberg S, Sui S, Fehr E. The brain’s functional network architecture reveals human motives. Science. 2016;351(6277); 1074–8. doi:
    1. Singer T, Seymour B, O’Doherty J, Stephan K, Dolan R, Frith C. Empathic neural responses are modulated by the perceived fairness of others. Nature. 2006;439(7075): 466–9. doi:
    1. Eisbach SS, Driessnack M. Am I sure I want to go down this road? Hesitations in the reporting of child maltreatment by nurses. J Spec Pediatr Nurs. 2010;15(4): 317–23. doi:
    1. Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr. 2005;5(2): 96–101. doi:
    1. Rheingold A, Zajac K, Patton M. Feasibility and acceptability of a child sexual abuse prevention program for childcare professionals: Comparison of a web-based and in-person training. J Child Sex Abus. 2012;21(4): 422–36. doi:
    1. Dimitrov D, Rumrill P. Pretest-post-test designs and measurements of change. Work. 2003;20(2): 159–65.
    1. Solomon RL. An extension of control group design. Psychol Bull. 1949;46(2): 137–50.
    1. Shih T, Fan X. Comparing response rates from web and mail surveys: A meta-analysis. Field Methods, 2008;20(3): 249–71.

Source: PubMed

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