The Influence of Professional Self-Efficacy on Recognising and Responding to Child Abuse and Neglect Presentations

Purpose:

Paediatric Emergency Department (ED) clinicians assess, manage and refer injury and trauma cases using their expert skills and knowledge. Through an international collaboration between Sydney Nursing School at the University of Sydney and Children’s Hospital 2 in Ho Chi Minh City, Vietnam, we developed the Safe Children Vietnam clinical training program for clinicians working in the ED to improve recognition and response to child injury resulting from child abuse and neglect (CAN). One of the aims of the program was to improve professional self-efficacy associated with CAN recognition and reporting. This paper reports the findings of an intervention study of professional self-efficacy in the ED. There is scope for the clinical training program to be implemented in countries where child protection training and research capacity is identified as a priority.

Methods:

A pre-intervention [T1], post-intervention [T2], and 6-month follow-up [T3] design was used to test the clinical training program. Participants were 127 clinicians from frontline service departments at a tertiary paediatric hospital in Vietnam and were recruited by the project manager (TF) from the University of Sydney. Ethics approval from the University of Sydney and the Vietnamese Authority was gained prior to commencement of the study. Clinicians provided written consent to participate following a detailed explanation and written information detailing the study. Participating clinicians were free to withdraw from the study at any time without penalty. 

The Child Abuse and Neglect Response Self-Efficacy (CANRSE) measure (Lee, et al., 2012) was adapted for use in the study. CANRSE is a 44-item tool that measures professional self-efficacy associated with clinician responses to CAN presentations. CANRSE is comprised of two scales to measure both self-efficacy expectations (SE-CAN) and outcome expectations (OE-CAN). It was originally developed in English and had previously been translated for use in Taiwan with established validity and reliability. For this study, the CANRSE was translated from English to Vietnamese. Psychometric properties of the Vietnamese version were then tested using a confirmatory factor analysis and construct validity of the Vietnamese version of the tool was confirmed. 

 A suite of clinical training strategies was developed from a needs analysis conducted in Ho Chi Minh City, Vietnam in 2013 with clinicians from the ED. The needs analysis highlighted an urgent need for training and the development of protocols to assist in the recognition of and response to child maltreatment presentations; and an apparent conflict between the professional role (obligation to medically treat the child and discharge from hospital) and the ethical role (the need to protect the child from further harm, yet not having a framework to do this); and child maltreatment legislation in Vietnam.

The training program was developed and implemented in Vietnamese and English. It included the use of a workbook, lectures, workshops, role-plays, short film, and posters. Key components of the training program included specific education regarding the recognition and response to abusive head trauma presentations, and the implementation of a Child Injury Screening Tool (CIST). A train the trainer model was employed to encourage sustainability of the intervention.

Achieving high-quality translation of materials was a key priority of the project. All materials, including participant information statements, consent forms, quantitative surveys, and the CIST were fully back translated to ensure consistency of content. In addition to back-translation, feedback was sought from a variety of stakeholders regarding the suitability of the materials for use in the clinical setting to ensure cultural and procedural validity.

Results:

Clinicians initially reported low levels of personal confidence and professional self-efficacy in their capacity to recognise and respond to child maltreatment presentations at T1 (baseline). Following implementation of the training program, there was a statistically significant improvement in professional self-efficacy for the recognition and response to child maltreatment presentations, as well as knowledge of abusive head trauma at T2. The intervention had good short-term outcomes in improving professional self-efficacy. At T3 these improvements were no longer demonstrated. There was no further improvement and scores had retreated to pre-intervention levels, indicating the need for revision and updating of clinical training on a six monthly basis.

Conclusion:

Training for clinicians working in the ED can improve professional self-efficacy for recognition and response to CAN-related child injury in the short term. This is of particular relevance in transitional countries such as Vietnam, where resources must be mindfully allocated to interventions that are effective, economically viable, and have the capacity for immediate implementation throughout the country. Regular training opportunities need to be made available to ensure the sustainability of the Safe Children Vietnam program as a tool to improve clinician recognition and response to child maltreatment. Biannual training is recommended.