Assessing the Organizational Social Context (OSC) of child welfare systems: Implications for research and practice

ObjectiveThe study: (1) provides the first assessment of the a priori measurement model and psychometric properties of the Organizational Social Context (OSC) measurement system in a US nationwide probability sample of child welfare systems; (2) illustrates the use of the OSC in constructing norm-based organizational culture and climate profiles for child welfare systems; and (3) estimates the association of child welfare system-level organizational culture and climate profiles with individual caseworker-level job satisfaction and organizational commitment.MethodsThe study applies confirmatory factor analysis (CFA) and hierarchical linear models (HLM) analysis to a US nationwide sample of 1,740 caseworkers from 81 child welfare systems participating in the second National Survey of Child and Adolescent Wellbeing (NSCAW II). The participating child welfare systems were selected using a national probability procedure reflecting the number of children served by child welfare systems nationwide.ResultsThe a priori OSC measurement model is confirmed in this nationwide sample of child welfare systems. In addition, caseworker responses to the OSC scales generate acceptable to high scale reliabilities, moderate to high within-system agreement, and significant between-system differences. Caseworkers in the child welfare systems with the best organizational culture and climate profiles report higher levels of job satisfaction and organizational commitment. Organizational climates characterized by high engagement and functionality, and organizational cultures characterized by low rigidity are associated with the most positive work attitudes.ConclusionsThe OSC is the first valid and reliable measure of organizational culture and climate with US national norms for child welfare systems. The OSC provides a useful measure of Organizational Social Context for child welfare service improvement and implementation research efforts which include a focus on child welfare system culture and climate.     

Children with disabilities in the child protective services system: An analog study of investigation and case management

ObjectiveThe study used a series of vignettes to investigate how the presence of three disabilities (cerebral palsy, intellectual disabilities, emotional/behavioral disabilities) affects the processes and outcomes of child abuse investigations at two levels of child injury severity (moderate, severe).MethodSeventy-five CPS case workers completed study surveys and answered questions in response to a series of eight vignettes.ResultsThis study revealed differences in the responses of CPS case workers when the alleged victim of physical abuse had a disability. Children with disabilities were more likely than children without disabilities to be seen as having characteristics that contributed to their abuse. Most CPS workers felt at least some empathy with abusive parents; empathy was highest when the children had emotional/behavioral disabilities. Services recommended for families of children with disabilities were more likely to be child-focused. Parent-focused services, such as individual counseling and adult anger management, were more likely to be recommended for families of children without disabilities. In general, differences among disability groups and between cases involving children with and without disabilities were more pronounced when the children's injuries were less severe. Even with more severe injuries, such as a concussion or broken bones, the CPS workers still responded differently depending on the disability status of the child victims.ConclusionsRecommendations are made concerning the utilization of investigation teams that include disability specialists and the need for further disability-related training for CPS case workers.Practice implicationsThere is a strong need for training related to disability, with an emphasis on attitudes as well as knowledge and skills. The training should include examples of healthy family functioning and positive aspects of parenting a child with a disability to counteract the prevailing perception of disability as a cause of chronic stress and dysfunction; identification of broader ecological contexts in which these families live, including social response to disability and the disability-related service system and; strategies for disentangling the signs of abuse from characteristics of the disability. Interdisciplinary teams should include members from disability-related fields to share expertise and increase communication between systems.     

Interagency collaboration between child protection and mental health services: practices, attitudes and barriers

OBJECTIVE: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. METHOD: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers, 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). RESULTS: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. CONCLUSIONS: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level.     

Computer-based collaborative problem-solving assessment in Taiwan

Abstract

The current study explores students’ collaboration and problem solving (CPS) abilities using a human-to-agent (H-A) computer-based collaborative problem solving assessment. Five CPS assessment units with 76 conversation-based items were constructed using the PISA 2015 CPS framework. In the experiment, 53,855 ninth and tenth graders in Taiwan were recruited, and a multidimensional item response analysis was used to develop CPS scales and represent the students’ collaboration and problem solving performance. The results show that the developed H-A approach is feasible for measuring students’ CPS skills, and the CPS scales are also shown to be reliable. In addition, the students’ CPS performance scores are further explored and discussed under the PISA CPS framework.     

Ongoing child welfare services: Understanding the relationship of worker and organizational characteristics to service provision

Ongoing child welfare services are put in place after completion of the initial maltreatment investigation when there is a perceived need to mitigate the risk of future harm. The knowledge of how clinical, worker, and organizational characteristics interact with this decision to provide ongoing child welfare services is not well integrated in the research literature. Using secondary data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2008, this study’s primary objective is to understand the relationship of clinical, worker, and organizational characteristics to the decision to transfer a case to ongoing child welfare services and their relative contribution to the transfer decision in Canada. Findings indicate that several clinical level variables are associated with families receiving ongoing services. Additionally, organizational factors, such as type of services offered by the organization and the number of employee support programs available to workers, significantly predicted the decision to transfer a case to ongoing services. While no worker factors, such as education, amount of training, experience, or caseload, were associated with ongoing service receipt, the intraclass correlation coefficient of the final three-level parsimonious model indicated substantial clustering at the worker level. Results indicate that Canadian child welfare workers make decisions differently based on factors not available in the current study and that what would be deemed as important worker characteristics do not necessarily predict this outcome. Findings and implications for future research are discussed.     

Interagency collaboration: Strengthening substance abuse resources in child welfare

Supporting child welfare (CW) workers’ ability to accurately assess substance abuse needs and link families to appropriate services is critical given the high prevalence of parental substance use disorders (SUD) among CW-involved cases. Several barriers hinder this process, including CW workers’ lack of expertise for identifying SUD needs and scarcity of treatment resources. Drawing from theories and emergent literature on interagency collaboration, this study examined the role of collaboration in increasing the availability of resources for identifying and treating SUDs in CW agencies. Using data from the second cohort of families from the National Survey of Child and Adolescent Well-Being, study findings highlight a lack of SUD resources available to CW workers. On the other hand, the availability of SUD resources was increased when CW agencies had a memorandum of understanding, co-location of staff, and more intense collaboration with drug and alcohol service (DAS) providers. These results provide evidence to support efforts to improve collaboration between CW and DAS providers and showcase specific collaboration strategies to implement in order to improve service delivery.     

What does effectiveness mean?: A qualitative assessment of two child protection systems

BackgroundChild Protective Services (CPS) systems have not historically conducted system effectiveness research. More information is needed about the long-term outcomes of children and families served by the systems.ObjectiveTo investigate how workers within CPS systems in Colorado and the Netherlands measure and perceive the effectiveness of their CPS system.Participants and settingCPS administrators and workers in Colorado and the Netherlands from August 2015 through May 2016. At both sites, interviewees included front line employees with deep knowledge of daily mechanics and processes, as well as experts and thought leaders who possessed historical memory and perspective about their site’s CPS system.MethodsIn-depth, semi-structured interviews were conducted with 77 participants. In Colorado (n = 36), 8 participants were state experts and 28 held county-level roles. In the Netherlands (n = 41), 17 participants were national experts and 24 worked at Veilig Thuis agencies.ResultsParticipants in both sites reported that they did not know if their system had empirical evidence to support its effectiveness, and had difficulty identifying how they would measure the effectiveness of their system.ConclusionsBoth systems lack the ability to collect data on the quality of their services and the longitudinal outcomes for the children and families they serve. Measures of good outcomes must be developed. Without longitudinal outcome data, CPS systems cannot assess the effectiveness of their practice. CPS systems might partner with the healthcare system, where the infrastructure and culture are already in place to look at quality and longitudinal outcomes.     

Helping Teachers Support Pupils with Mental Health Problems Through Inter-professional Collaboration: A Qualitative Study of Teachers and School Principals

ABSTRACT

A qualitative study conducted in four lower secondary schools in Norway explored teachers’ and school principals’ experiences of collaboration with a variety of extended services (ES). Particular attention was directed to the ways (if any) they perceived collaboration to be relevant to helping teachers support pupils with mental health problems through their everyday social and pedagogic practices. Findings of the study indicated that teachers valued initiatives that could help develop mutual understandings of teachers’ and ES professionals’ roles and responsibilities. Initiatives to build inter-professional relationships were perceived as laying the foundation for more productive collaboration. However, to be able to provide coherent, sustained support in the classroom, teachers needed guidance from ES professionals. This required a shift in collaborative processes away from a focus on individualized pupil support towards helping teachers support pupils through their classroom-based social and pedagogical practices. Implications for policy and practice are discussed.     

Bidirectional Relations between Parenting Practices and Child Externalizing Behaviors in Formerly Homeless Families: A Random-Intercept Cross-Lagged Panel Analysis

SYNOPSIS

Objective . This study examined the bidirectional relations between effective parenting practices and externalizing problems in children in homeless families. Design . The sample comprised 223 children (M = 8.12 years) in 137 families living in temporary supportive housing, who participated in the Early Risers conduct problems prevention program lasting 2 years. Video-recorded observations of parent-child interactions were collected and rated by trained observers to assess effective parenting practices. Child externalizing problems were reported by their school teachers. Both variables were assessed at baseline prior to intervention and at 1- and 2-year post-baseline. Results . Child externalizing problems at baseline were negatively associated with effective parenting from baseline to year 1 as well as from year 1 to year 2. Observed effective parenting practices at year 1 were negatively associated with child externalizing problems from year 1 to year 2. Conclusions . These findings underscore the presence of bidirectional influence processes between parents and children in high-risk families. Implications for intervention programs for high-risk families are discussed.     

Interdisciplinary collaboration needed in obtaining high-quality medical information in child abuse investigations

BackgroundDespite reporting legislation, healthcare providers (HCPs) do not always report and collaborate in cases of suspected child abuse. Recognizing this leaves children at risk, the Wisconsin Child Abuse Network (WI CAN) sought to understand barriers to mandated reporting and collaboration with child abuse investigators.ObjectiveThe purpose of the study was to investigate barriers for professionals in providing and obtaining high-quality medical information in child abuse investigations.Participants and settingParticipants included five discipline-specific focus groups: HCPs, child protective services (CPS), law enforcement, lawyers, and judges. All professionals had been directly involved in Wisconsin child abuse cases.MethodsThis qualitative study consisted of discipline-specific focus groups, directed by open-ended interview questions. Data analysis was completed through the narrative inquiry methodology.ResultsBarriers to providing and obtaining high-quality medical information in child abuse investigations were both discipline-specific and universal amongst all groups. Discipline-specific barriers included: HCPs’ discomfort with uncertainty; CPS’ perception of disrespect and mistrust by HCPs; law enforcement’s concerns with HCPs’ overstepping professional boundaries; lawyers’ concern of HCPs’ discomfort with court proceedings; and judges’ perception of a lack of understanding between all disciplines. Universal barriers included: value of high-quality medical information in child abuse investigations, burden of time and money; unequal resources between counties; a need for protocols, and a need for interdisciplinary collaboration.ConclusionFindings from this study suggest several ways to address identified barriers. Possible interventions include equalizing resources between urban and rural counties (specifically financial resources and access to child abuse experts); protocolizing reporting and investigations; and, increasing interprofessional education.     

The overrepresentation of First Nations children and families involved with child welfare: Findings from the Ontario incidence study of reported child abuse and neglect 2013

BackgroundWhile there are national studies on the overrepresentation of First Nations children in the Canadian child protection system, there is a dearth of provincial/territorial studies.ObjectiveThe objectives are to: 1) estimate the rate of overrepresentation of First Nations children and youth involved in child welfare investigations in the Ontario child welfare system and, 2) determine which factors drive the overrepresentation of First Nations children in child welfare at the investigation stage compared to White children.Participants and SettingChild welfare workers completed a three-page data collection form at the conclusion of a child protection investigation.MethodsA secondary analysis of the Ontario Incidence Study 2013 was conducted. Incidence rates were calculated and bivariate analyses were conducted, comparing investigations involving First Nations children to investigations involving White children.ResultsFirst Nations children represent 2.5% of the child population; however, they represent 7.4% of child maltreatment related investigations in Ontario. The rate of investigations for First Nations children was approximately three times higher than the rate for White children. Overrepresentation was most pronounced for investigations of neglect and exposure to intimate partner violence. Rates of substantiation, ongoing child welfare services, child welfare court, and placement in care were higher for the First Nations child population.ConclusionsThe findings provide a foundation for further research and analyses examining the compounding of disparities across the investigation process. Research is needed to disentangle factors that influence decision-making in the child welfare system and how these vary based on a child’s race.     

The Strengthening Families Initiative and Child Care Quality Improvement: How Strengthening Families Influenced Change in Child Care Programs in One State

Research Findings: This study investigated how the Strengthening Families through Early Care and Education initiative in Illinois (SFI) influenced change in 4 child care programs. Findings indicate that SFI influenced quality improvements through 4 primary pathways: (a) Learning Networks, (b) the quality of training, (c) the engagement of program directors, and (e) the organizational climate at programs. SFI's multilevel model of implementation was key to its effectiveness. Two barriers to improving family partnership practices were identified: lack of cultural competence and a negative organizational climate. Practice or Policy: First, quality improvement and professional development efforts are likely to be more effective in promoting real change when they target multiple levels of the context in and around child care programs. SFI's multilevel implementation approach is a model. Second, quality improvement efforts in the area of family engagement may be more effective when specific attention is given to strategies for creating a supportive organizational climate and collegial relationships among staff. Relationships within programs set the tone for relationships with families. Third, cultural competence requires increased attention to efforts to improve the quality of family partnership practices. A focus on organizational cultural competence may provide the workplace environment necessary to support culturally competent practice among program staff.     

Repeated reports for child maltreatment among intimate partner violence victims: Findings from the National Survey of Child and Adolescent Well-Being

ObjectivesTo determine the prevalence of intimate partner violence (defined as any physical violence during the last 12 months or previously) among mothers who maltreat their children, and to examine whether mothers’ experiences of intimate partner violence (IPV) are associated with repeated reports (rereports) of children to Child Protective Services (CPS) during the following 18 months.MethodsData for the analyses were from the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children investigated for child maltreatment. The sample of 5,501 children (ages 0–14) was randomly selected from the families who entered the US child welfare system between October 1999 and December 2000. The analysis sample was restricted to 1,236 families in which caregivers were: (1) the alleged perpetrators of the child maltreatment at baseline (independently of substantiation status) and (2) the biological mothers (n = 1,212 or 98.6%), adoptive mothers (n = 17 or 1%), or stepmothers (n = 7 or 0.3%) of children not placed in out-of-home care.ResultsChildren of mothers physically abused by an intimate partner during the last 12 months or previously at the intake interview (44%) were twice as likely as children of mothers who had not experienced such violence to be rereported to CPS (29% vs. 14%, Odds Ratio = 2.0, 95% Confidence Interval = 1.1–3.4). Rereports occurred almost twice as quickly for children of mothers who experienced IPV compared to children of mothers who had not experienced IPV (Hazard Ratio = 1.9, 95% Confidence Interval = 1.1–3.0).ConclusionsThe higher risk and speedier rereports of child maltreatment associated with intimate partner violence highlights the need for universal assessment and provision of services for IPV among families that are investigated by CPS.     

Can coders abstract child maltreatment variables from child welfare administrative data and case narratives for public health surveillance in Canada?

BackgroundPublic health surveillance is essential to inform programs that aim to eradicate child maltreatment (CM) and to provide services to children and families. However, collection of CM data imposes a burden on child welfare workers (CWWs). This study assesses the feasibility of hiring coders to abstract the required information from administrative records and case narratives.MethodsBased on a convenience sample of child welfare data from Manitoba, Canada, two coders abstracted information on 181 alleged CM cases. The coders completed a short web-based questionnaire for each case to identify which of five types of CM had been investigated, level of substantiation for each type, and risk of future CM. The CWWs responsible for each case completed the same questionnaire. Percentages of the occurrence of CM by the three sources were compared. The validity of the coders’ classifications was assessed by calculating sensitivity, specificity, and positive and negative predictive values, against the CWWs’ classifications as the “gold standard.” Cohen’s kappa was also calculated.ResultsThe coders’ classifications of physical abuse, sexual abuse and neglect generally matched those of CWWs; for exposure to intimate partner violence, agreement was weak for one coder. Coding of emotional maltreatment and risk investigations could not be evaluated.ConclusionResults were promising. Abstraction was not time-consuming. Differences between coders and CWWs can be largely explained by the administrative data system, child welfare practice, and legislation. Further investigation is required to determine if additional training could improve coders’ classifications of CM.     

The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth

ObjectiveFor child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse—teen dating violence link.MethodsA random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales.ResultsOver 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63–67%) and nearly half of males (44–49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings.ConclusionsThese results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others.Practice implicationsThe present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatolgy among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths’ conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for long-term, unique impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare.     

Factors associated with racial differences in child welfare investigative decision-making in Ontario,Canada

Despite the substantial body of literature on racial disparities in child welfare involvement in the Unites States, there is relatively little research on such differences for Canadian children and families. This study begins to address this gap by examining decision-making among workers investigating Black and White families investigated for child protection concerns in Ontario, Canada. Using provincially representative data, the study assessed whether Black children were more likely than White children to be investigated by child welfare, if there was disparate decision-making by race throughout the investigation, and how the characteristics of Black and White children contribute to the decision to transfer to ongoing services. The results indicate that Black children were more likely to be investigated than White children, but there was little evidence to suggest that workers in Ontario child welfare agencies made the decision to substantiate, transfer to ongoing services, or place the child in out-of-home care based on race alone. Black and White children differed significantly with respect to child characteristics, characteristics of the investigation, caregiver risk factors, and socioeconomic circumstances. When adjusting for these characteristics, Black families had 33% greater odds (OR = 1.33; 95% CI: 1.26, 1.40; p = <0.001) of being transferred to ongoing services compared to White families. Among Black families, the assessed quality of the parent-child relationship and severe economic hardship were the most significant and substantial contributors to the decision to provide child welfare services. Implications for practice, policy, and research are discussed.     

Coordination between child welfare agencies and mental health service providers,children's service use,and outcomes

ObjectiveInterorganizational relationships (IORs) between child welfare agencies and mental health service providers may facilitate mental health treatment access for vulnerable children. This study investigates whether IORs are associated with greater use of mental health services and improvement in mental health status for children served by the child welfare system.MethodsThis was a longitudinal analysis of data from a 36-month period in the National Survey of Child and Adolescent Well-Being (NSCAW). The sample consisted of 1,613 children within 75 child welfare agencies who were 2 years or older and had mental health problems at baseline. IOR intensity was measured as the number of coordination approaches between each child welfare agency and mental health service providers. Separate weighted multilevel logistic regression models tested associations between IORs and service use and outcomes, respectively.ResultsAgency-level factors accounted for 9% of the variance in the probability of service use and 12% of mental health improvement. Greater intensity of IORs was associated with higher likelihood of both service use and mental health improvement.ConclusionsHaving greater numbers of ties with mental health providers may help child welfare agencies improve children's mental health service access and outcomes.Practice implicationsPolicymakers should develop policies and initiatives to encourage a combination of different types of organizational ties between child welfare and mental health systems. For instance, information sharing at the agency level in addition to coordination at the case level may improve the coordination necessary to serve these vulnerable children.     

Is the diagnosis of physical abuse changed when Child Protective Services consults a Child Abuse Pediatrics subspecialty group as a second opinion?

ObjectivesTo characterize the changes regarding the diagnosis of physical abuse provided to Child Protective Services (CPS) when CPS asks a Child Abuse Pediatrics (CAP) specialty group for a second opinion and works in concert with that CAP group.MethodsSubjects were reported to CPS for suspected physical abuse and were first evaluated by a physician without specialized training in Child Abuse Pediatrics (non-CAP physician). Subjects were then referred to the area's only Child Abuse Pediatrics (CAP physician) group, located in a large metropolitan pediatrics center in the United States, for further evaluation. The diagnoses regarding abuse provided by CAP physicians working in concert with CPS were compared to those provided to CPS by other physicians.ResultsTwo hundred consecutive patients were included in the study. In 85 (42.5%) cases, non-CAP physicians did not provide a diagnosis regarding abuse, despite initiating the abuse report to CPS or being asked by CPS to evaluate the child for physical abuse. Of the remaining 115 cases, the diagnosis regarding abuse differed between non-CAP physicians and CAP physicians working in concert with CPS in 49 cases (42.6%; κ = .14; 95% CI, ?.02, .29). In 40 of the 49 cases (81.6%), CAP assessments indicated less concern for abuse when compared to non-CAP assessments. Differences in diagnosis were three times more likely in children from a nonurban location (OR 3.24; 95% CI, 1.01, 11.36).ConclusionsIn many cases of possible child physical abuse, non-CAP providers do not provide CPS with a diagnosis regarding abuse despite initiating the abuse investigation or being consulted by CPS for an abuse evaluation. CPS consultation with a CAP specialty group as a second opinion, along with continued information exchange and team collaboration, frequently results in a different diagnosis regarding abuse. Non-CAP providers may not have time, resources, or expertise to provide CPS with appropriate abuse evaluations in all cases.Practice implicationsThough non-CAP providers may appropriately evaluate many cases of physical abuse, the diagnosis regarding abuse provided to CPS may be changed in some cases when CAP physicians are consulted and actively collaborate with CPS investigators. Availability of Child Abuse Pediatrics subspecialty services to investigators is warranted.