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      Mandated reporters’ experiences with reporting child maltreatment: a meta-synthesis of qualitative studies

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          Abstract

          Objective

          To systematically search for research about the effectiveness of mandatory reporting of child maltreatment and to synthesise qualitative research that explores mandated reporters’ (MRs) experiences with reporting.

          Design

          As no studies assessing the effectiveness of mandatory reporting were retrieved from our systematic search, we conducted a meta-synthesis of retrieved qualitative research. Searches in Medline (Ovid), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Education Resources Information Center, Criminal Justice Abstracts and Cochrane Library yielded over 6000 citations, which were deduplicated and then screened by two independent reviewers. English-language, primary qualitative studies that investigated MRs’ experiences with reporting of child maltreatment were included. Critical appraisal involved a modified checklist from the Critical Appraisal Skills Programme and qualitative meta-synthesis was used to combine results from the primary studies.

          Setting

          All healthcare and social-service settings implicated by mandatory reporting laws were included. Included studies crossed nine high-income countries (USA, Australia, Sweden, Taiwan, Canada, Norway, Finland, Israel and Cyprus) and three middle-income countries (South Africa, Brazil and El Salvador). Participants: The studies represent the views of 1088 MRs.

          Outcomes

          Factors that influence MRs’ decision to report and MRs’ views towards and experiences with mandatory reporting of child maltreatment.

          Results

          Forty-four articles reporting 42 studies were included. Findings indicate that MRs struggle to identify and respond to less overt forms of child maltreatment. While some articles (14%) described positive experiences MRs had with the reporting process, negative experiences were reported in 73% of articles and included accounts of harm to therapeutic relationships and child death following removal from their family of origin.

          Conclusions

          The findings of this meta-synthesis suggest that there are many potentially harmful experiences associated with mandatory reporting and that research on the effectiveness of this process is urgently needed.

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          Most cited references104

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          Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis.

          To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood. A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I(2) test. Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse.The combined ORs for anxiety were 2.52 (95 % CI:2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18)for physical abuse. High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.
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            Synthesising qualitative and quantitative evidence: a review of possible methods.

            The limitations of traditional forms of systematic review in making optimal use of all forms of evidence are increasingly evident, especially for policy-makers and practitioners. There is an urgent need for robust ways of incorporating qualitative evidence into systematic reviews. In this paper we provide a brief overview and critique of a selection of strategies for synthesising qualitative and quantitative evidence, ranging from techniques that are largely qualitative and interpretive through to techniques that are largely quantitative and integrative. A range of methods is available for synthesising diverse forms of evidence. These include narrative summary, thematic analysis, grounded theory, meta-ethnography, meta-study, realist synthesis, Miles and Huberman's data analysis techniques, content analysis, case survey, qualitative comparative analysis and Bayesian meta-analysis. Methods vary in their strengths and weaknesses, ability to deal with qualitative and quantitative forms of evidence, and type of question for which they are most suitable. We identify a number of procedural, conceptual and theoretical issues that need to be addressed in moving forward with this area, and emphasise the need for existing techniques to be evaluated and modified, rather than inventing new approaches.
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              Cultural-geographical differences in the occurrence of child physical abuse? A meta-analysis of global prevalence.

              Our comprehensive meta-analysis combined prevalence figures of child physical abuse reported in 111 studies, including 168 independent samples with a total of 9,698,801 participants. The overall estimated prevalence was 3/1000 for studies using informants and 226/1000 for studies using self-report measures of child physical abuse, with no apparent gender differences. Methodological factors partly explained the vast variation of self-reported prevalence rates in individual studies. The highest prevalence rates were found for studies using a broad definition of child physical abuse, studies measuring physical abuse over the longest period of 0-18 years, studies using college samples, studies in which adults served as respondents, and studies using more questions on physical abuse. Cultural-geographical factors did not seem to affect prevalence rates of physical abuse, which may be partly due to procedural factors. More crosscultural research on physical abuse is badly needed, especially in Africa and South America. We conclude that child physical abuse is a widespread, global phenomenon affecting the lives of millions of children all over the world, which is in sharp contrast with the United Nation's Convention on the Rights of the Child.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                16 October 2017
                : 7
                : 10
                : e013942
                Affiliations
                [1 ]departmentDepartment of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton, Ontario, Canada
                [2 ]departmentDepartment of Global Health and Development , London School of Hygiene and Tropical Medicine , London, UK
                [3 ]departmentFaculty of Public Health and Policy , London School of Hygiene and Tropical Medicine , London, UK
                [4 ]departmentFaculty of Information and Media Studies , Western University , London, Ontario, Canada
                [5 ]departmentFaculty of Medicine , University of Toronto , Toronto, Ontario, Canada
                [6 ]departmentDepartment of Pediatrics , McMaster University , Hamilton, Ontario, Canada
                Author notes
                [Correspondence to ] Dr Jill R McTavish; mctavisj@ 123456mcmaster.ca , jillrmctavish@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-5009-9622
                http://orcid.org/0000-0001-8935-2181
                http://orcid.org/0000-0002-0931-7851
                Article
                bmjopen-2016-013942
                10.1136/bmjopen-2016-013942
                5652515
                29042370
                f5f89487-9aa9-4764-9d61-51ebcaf665bf
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 22 August 2016
                : 27 April 2017
                : 03 July 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000226, Ontario Ministry of Health and Long-Term Care;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000029, Institute of Gender and Health;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000034, Institute of Neurosciences, Mental Health and Addiction;
                Categories
                Paediatrics
                Research
                1506
                1719
                Custom metadata
                unlocked

                Medicine
                child protection,medical law
                Medicine
                child protection, medical law

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