Index of concern: An instrument for use in treatment of cases of physical abuse of children

In recent years attempts to improve the management of cases of child abuse have concentrated on structural procedures for achieving better coordination between agencies, at the expense of attention to less tangible factors which may impede treatment. This paper, based on a small study which analysed retrospectively cases which had resulted in the serious injury or death of a child, identifies some of these factors. The evidence suggests that the manifest level of concern for the safety of the child changes markedly in treatment, but does not correspond with the objective reality portrayed in the case material. Some underlying factors influencing this lack of congruence are: (1) formulation of the presenting problem creates a bias which becomes more pronounced through time; (2) focus on strengths and progress conceals areas of malfunctioning in the family; (3) attention to an individual masks risk to siblings; (4) concentration of attention on one adult as possible aggressor obscures contribution of others; (5) influence of any changes in family composition is not sufficiently considered. The paper discusses these findings and suggests the hypothesis that the use of a properly constructed “Index of Concern” could provide a means of counterbalancing such factors.