Introduction: The accurate identification and appropriate investigation of child maltreatment is a key priority for promoting the optimal health and development of children. Healthcare providers are often well-positioned professionals to report suspected child abuse and neglect, and, therefore, interact regularly with child welfare workers. Little research has examined the relationship between these two groups of professionals.Methods: We interviewed healthcare providers and child welfare workers in order to examine the referral and child welfare investigation processes to understand strengths and identify areas of improvement for future collaboration. Thirteen child welfare workers from child welfare agencies and eight healthcare providers from a pediatric tertiary care hospital in Ontario, Canada were interviewed to meet the study’s objectives.Results: Healthcare providers spoke about positive experiences making reports, factors impacting reporting decisions, areas for improvement (e.g., difficulties communicating, lack of collaboration, and disruption of therapeutic alliance), training, and professional roles. For interviews with child welfare workers, identified themes included healthcare professionals’ perceived expertise and understanding the role of child welfare. Both groups brought up the need for increased collaboration as well as systemic barriers and legacies of harm.Discussion: Our core finding was a reported lack of communication between the groups of professionals. Other identified barriers in collaboration included a lack of understanding of each other’s roles, hesitation for healthcare providers making reports, as well as legacies of harm and systemic inequities in both institutions. Future research should build on this examination by including the voices of healthcare providers and child welfare workers to identify sustainable solutions for increased collaboration.

Background There is a dearth of literature surrounding mandated reporters to child welfare services in the Canadian context. This paper examines 20 years of reporting patterns from hospitals, which represent 5% of all referrals to child welfare services in Ontario. Methods The Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) is a representative study that has taken place every 5 years since 1993. The OIS is a multistage cluster sample design, intended to produce an estimate of reported child abuse and neglect in the year the study takes place. Results There have been significant changes in referral patterns over time. Hospital referrals in 2013 are more likely to involve a concern of neglect, risk of maltreatment or exposure to intimate partner violence. In 1993, children were more likely to be referred from a hospital for a concern of physical abuse. Between 1993 and 1998, there was a significant drop in the number of sexual abuse investigations referred from a hospital. Hospitals have low rates of substantiation across all of the OIS cycles. Conclusion This is the first study to examine hospital-based referral patterns in Canada. The relatively low percentage of hospital referrals across the cycles of the OIS is consistent with the extant literature. The findings warrant further discussion and research. This study is foundational for future research that can assist in identifying and developing responses across sectors that meet the complex needs of vulnerable families and that ultimately promote children’s safety and well-being.

For the past 20 years, the Ontario child welfare sector has made significant legislative and policy changes. Changes to legislation and policy can impact the public and sector’s response to child maltreatment and inform identified trends. Using an investigative taxonomy of urgent protection and chronic need this paper examines the shift in the nature of investigated maltreatment over time. Data from five cycles of the Ontario Incidence Studies of Reported Child Abuse and Neglect (1993, 1998, 2003, 2008 and 2013) were used. Provincial incidence rates were calculated by dividing the weighted estimates by the child population 15 years of age and under and then multiplying by 1000 in order to produce an annual incidence rate per 1000 children. Investigations were divided into urgent (severe physical harm, sexual abuse, neglect and physical abuse of children under 4) and chronic (risk only, exposure to intimate partner violence, emotional maltreatment, neglect and physical abuse of children four or over). Tests of statistical significance were calculated to assess changes in subtypes between cycles. Between 1993 and 2013, the rate of child maltreatment related investigations completed in Ontario has increased from 20.48 per 1000 children to 53.27 per 1000 children. Overall there has been a decline in the incidence of urgent investigations from 9.31 per 1000 child maltreatment investigations in 1993 to 5.94 per 1000 maltreatment investigations in 2013. There has been a fourfold increase in the incidence of chronic investigations from 11.18 per 1000 child maltreatment investigations in 1993 to 47.33 per 1000 maltreatment investigations in 2013. The nature of child protection work using the urgent-chronic taxonomy shows a dramatic shift in the types of concerns identified without a corresponding shift in the way families are assessed for need. The provision of a forensic investigation to all families does not distinguish between urgent safety concerns and needs that may require prolonged engagement. Effective service provision requires more precision in our response to these diverse concerns.

This study examines whether increased interaction and observation of young children by school professionals leads to an increase in school-based reports to child welfare authorities and in the identification of child maltreatment victims. Comparing provincial-level data collected before and after full-day kindergarten implementation in Ontario, a doubling in rates of school-referred investigations involving 4- and 5-year-old children was found. There was no significant difference in the rates of maltreatment substantiation, service referrals made or transfers to ongoing services, but the rate of child functioning concerns noted in these investigations tripled. The findings suggest there are differences in how the school and child welfare systems define and respond to suspected child maltreatment. Implications for practice, policy and research are explored.

Victims of intimate partner violence (IPV) and their children may be at an increased risk for negative health outcomes and may present to healthcare settings. The objective of the current study is to examine the profile of medical-referred child welfare investigations of exposure to IPV in Ontario, Canada. Data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 were used. We compared medical-referred investigations with all other investigations of exposure to IPV. Descriptive and bivariate analyses as well as a logistic regression predicting transfers to ongoing services were conducted. Six percent of investigations of exposure to IPV conducted in Ontario in 2018 were referred by a medical source. Compared to other investigations of exposure to IPV, these investigations were more likely to involve younger children (p = 0.005), caregivers with mental health issues (p < 0.001) and few social supports (p = 0.004), and households noted to be overcrowded (p = 0.001). After controlling for clinical case characteristics, investigations of exposure to IPV referred by healthcare sources were 3.452 times as likely to be kept open for ongoing child welfare services compared to those referred by other sources (95% CI [2.024, 5.886]; p < 0.001). Children and their families who are identified in healthcare settings for concerns of exposure to IPV tend to receive extended child welfare intervention compared to those identified elsewhere. There is a clear difference in service provision in healthcare-originating investigations of exposure to IPV versus investigations originating from other sources. Further research into the services provided to victims of IPV and their children is needed.