title: Child advocacy center multidisciplinary team decision and its association to child protective services outcomes.
abstract: Limited studies exist evaluating the multidisciplinary team (MDT) decision-making process and its outcomes. This study evaluates the MDT determination of the likelihood of child sexual abuse (CSA) and its association to the outcome of the child protective services (CPS) disposition. A retrospective cohort study of CSA patients was conducted. The MDT utilized an a priori Likert rating scale to determine the likelihood of abuse. Subjects were dichotomized into high versus low/intermediate likelihood of CSA as determined by the MDT. Clinical and demographic characteristics were compared based upon MDT and CPS decisions. Fourteen hundred twenty-two patients were identified. A high likelihood for abuse was determined in 997 cases (70%). CPS substantiated or indicated the allegation of CSA in 789 cases (79%, Kappa 0.54). Any CSA disclosure, particularly moderate risk disclosure (AOR 59.3, 95% CI 26.50-132.80) or increasing total number of CSA disclosures (AOR 1.3, 95% CI 1.11-1.57), was independently associated with a high likelihood for abuse determination. Specific clinical features associated with discordant cases in which MDT determined high likelihood for abuse and CPS did not substantiate or indicate CSA included being white or providing a low risk CSA disclosure or other non-CSA disclosure. MDT determination regarding likelihood of abuse demonstrated moderate agreement to CPS disposition outcome. CSA disclosure is predictive of the MDT determination for high likelihood of CSA. Agreement between MDT determination and CPS protection decisions appear to be driven by the type of disclosures, highlighting the importance of the forensic interview in ensuring appropriate child protection plans.
authors.affiliation: The Center for Family Safety and Healing, Nationwide Children's Hospital, 655 East Livingston Avenue, Columbus, OH 43205, USA; The Ohio State University College of Medicine, USA.
authors.forename: Farah W
authors.initials: FW
authors.lastname: Brink
authors.affiliation: The Center for Family Safety and Healing, Nationwide Children's Hospital, 655 East Livingston Avenue, Columbus, OH 43205, USA; The Ohio State University College of Medicine, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Thackeray
authors.affiliation: The Ohio State University College of Medicine, USA; The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bridge
authors.affiliation: The Center for Family Safety and Healing, Nationwide Children's Hospital, 655 East Livingston Avenue, Columbus, OH 43205, USA; The Ohio State University College of Medicine, USA.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Letson
authors.affiliation: Safe Place: Center for Child Protection and Health, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, USA.
authors.forename: Philip V
authors.initials: PV
authors.lastname: Scribano
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D002651:Child Advocacy; D000068216:Child Protective Services / Q000379:methods*; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D015146:Midwestern United States; D010348:Patient Care Team; D010808:Physical Examination / Q000379:methods; D012189:Retrospective Studies; D014342:Truth Disclosure
keywords: Child advocacy center; Child sexual abuse; Forensic child sexual abuse evaluation; Multidisciplinary team; Multidisciplinary team decision making