The identification of early indicators of child abuse and neglect : a multi-professional modified Delphi Survey
Through the application of the Delphi technique, this study draws on the expertise of British child protection academics and practitioners from a wide range of disciplines in seeking to develop a consensus opinion on possible early indicators of child abuse and neglect. Underpinned by children's rights theory the study reflects an ideologically oriented mode of inquiry. The literature on childhood and research findings from work undertaken with adult survivors of abuse forms an important part of the background. The search for early indicators is described in the context of a secondary preventative approach to the problem of child maltreatment. The Delphi study was conducted through three rounds of data collection. Consensus was defined as 75% or more of the panel agreeing (or 75% or more disagreeing) that an item was a possible early indicator of child abuse and neglect. A total of 73 items were generated. Of these 46 reached a consensus of agreement, four reached a consensus of disagreement and the remaining 23 items failed to reach consensus. The findings from the Delphi study were then examined in the context of a retrospective case-notes review of 20 families known to have had a child protection concern. Although, it is well recognised that inter-agency working is a crucial component of child protection practice, secondary analysis of the Delphi data suggested a number of significant differences in the strength and extent of inter-agency agreement on a number of the possible early indicators. The implications of this finding are discussed in light of contemporary policy and practice. A very tentative conclusion arising from the study is that the early indicators of child abuse and neglect that achieved consensus of agreement may help in diagnosing child abuse and neglect at an earlier stage, although they are not necessarily diagnostic. Alternative explanations, differential diagnoses and information gathering are paramount, as is a willingness and ability to act on concerns. Although great caution is urged, it is suggested that the findings from the study are credible and of interest to those who are working towards more timely recognition and referral of abused and neglected children. Possible applications of the findings in practice, education and further research are suggested.