- Due to a lack of strong evidence, it is unclear whether child protection training is better than no training or alternative training (e.g. cultural sensitivity training) at improving professionals’ reporting of child abuse and neglect.
- Larger, well-designed studies are needed to assess the effects of training with a wider range of professional groups.
- Future research should compare face-to-face with e-learning interventions.
Why do we need to improve the reporting of child abuse and neglect?
Child abuse and neglect results in significant harm to children, families, and communities. The most serious consequence is child fatality, but other consequences include physical injuries, mental health problems, alcohol and drug misuse, and problems at school and in employment. Many professional groups, such as teachers, nurses, doctors, and the police, are required by law or organisational policy to report known or suspected cases of child abuse and neglect to statutory child protection authorities. To prepare them for reporting, various training interventions have been developed and used. These can vary in duration, format, and delivery methods. For example, they may aim to increase knowledge and awareness of the indicators of child abuse and neglect; the nature of reporting duty and procedures; and attitudes towards reporting duty. Such training is usually undertaken postqualification as a form of continuing professional development; however, little is known about whether training works, either in improving reporting of child abuse and neglect generally, for different types of professionals, or for different types of abuse.
What did we want to find out?
We wanted to find out:
- if child protection training improves professionals' reporting of child abuse and neglect;
- what components of effective training help professionals to report child abuse and neglect; and
- if the training causes any unwanted effects.
What did we do?
We searched for studies that compared:
- child protection training with no training or with a waitlist control (those placed on a waiting list to receive the training at a later date); and
- child protection training with alternative training (not related to child abuse and neglect, e.g. cultural sensitivity training).
We compared and summarised study results and rated our confidence in the evidence based on factors such as study methods and size.
What did we find?
We found 11 studies that involved 1484 people. The studies ranged in size from 30 to 765 participants. Nine studies were conducted in the USA, one in Canada, and one in the Netherlands. A number of different types of training interventions were tested in the studies. Some were face-to-face workshops, ranging in duration from a single two-hour workshop to six 90-minute seminars conducted over one month; and some were self-paced e-learning interventions. The training was developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Nine studies received external funding: five from federal government agencies, two from a university and philanthropic organisation, one from the philanthropic arm of an international technology company, and one from a non-government organisation (a training intervention developer).
It is unclear if child protection training has an effect on:
- the number of reported cases of child abuse and neglect (one study, 42 participants); or
- the number of reported cases based on hypothetical cases of child abuse and neglect (two studies, 87 participants).
Based on the available information, we were unable answer our question about whether training has an effect on the number of official cases recorded by child protection authorities, or the quality of those reports; or whether training has any unwanted effects.
Child protection training may increase professionals' knowledge of reporting duty, processes, and procedures (one study, 744 participants). However, it is unclear if this training has an effect on:
- professionals’ knowledge of core concepts in child abuse and neglect generally (two studies, 154 participants);
- professionals’ knowledge of core concepts in child sexual abuse specifically (three studies, 238 participants);
- professionals’ skill in distinguishing between reportable and non-reportable cases (one study, 25 participants); or
- professionals’ attitudes towards the duty to report (one study, 741 participants).
What are the limitations of the evidence?
We have low to very low confidence in the evidence. This is because the results were based on a small number of studies, some of which were old and which had methodological problems. For example, the people involved in the studies were aware of which treatment they were getting, and not all of the studies provided data for all our outcomes of interest. In addition, our analyses sometimes only included one professional group, limiting the applicability of our findings to other professional groups.
How up-to-date is this evidence?
The evidence is current to 4 June 2021.
The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.
Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed.
To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions.
We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list.
All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect).
We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence.
We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years.
Three studies measured the number of cases of child abuse and neglect via participants’ self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence).
Three studies measured the number of cases of child abuse and neglect via participants’ responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence).
We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training.
Four studies measured professionals’ knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence).
Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence).
Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence).
One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence).
Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence).