Interprofessional Collaboration in the Detection of and Early Intervention in Child Maltreatment: Employees' Experiences

Hindawi Publishing Co po a ion Nu sing Resea ch and P ac ice Volume 2013, A icle ID 186414, 10 pages h p://dx.doi.o g/10.1155/2013/186414 Resea ch A icle In e p o essional Collabo a ion in he De ec ion o and Ea ly In e en ion in Child Mal ea men : Employees’ Expe iences Jaana Inkilä,1,2 Aune Flinck,1,3 Tiina Luukkaala,4 Päi i Ås ed -Ku ki,1,5 and Eija Paa ilainen1,6 1School o Heal h Sciences (Nu sing Science), Uni e si y o Tampe e, FI-33014 Tampe e, Finland 2Hospi al Dis ic o Helsinki and Uusimaa, Hy ink¨ a¨ a Hospi al, Sai aalanka u 1, FI-05850 Hy ink¨ a¨ a, Finland 3Na ionalIns i u e o Heal handWel a e,P.O.Box30,FI-00271Helsinki,Finland 4Science Cen e , Pi kanmaa Hospi al Dis ic , School o Heal h Sciences, Uni e si y o Tampe e, FI-33014 Tampe e, Finland 5Pi kanmaa Hospi al Dis ic , P.O. Box 2000, FI-33521 Tampe e, Finland 6Sou he n Os obo hnia Hospi al Dis ic , Huh alan ie 54, FI-60220 Sein¨ ajoki, Finland Co espondence should be add essed o Jaana Inkil¨ a; [email p o ec ed] Recei ed 1 Decembe 2012; Re ised 10 Feb ua y 2013; Accep ed 11 Ma ch 2013 Academic Edi o : Ka i Gla in Copy igh © 2013 Jaana Inkil¨ a e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed. Child mal ea men is a global p oblem and a mul idimensional phenomenon occu ing in all social classes. This s udy depic s in e p o essional collabo a ion associa ed wi h he de ec ion o and ea ly in e en ion in child mal ea men aking place in he amily. The da a we e collec ed in a la ge Finnish ci y, Tampe e (207 866 ci izens). A su ey was adminis e ed o employees in day ca e, basic educa ion, social and heal h se ices, and police (𝑛 = 865). The esul s indica e ha in e p o essional collabo a ion associa ed wi h he de ec ion o and in e en ion in child mal ea men was bes accomplished by social se ice employees and police pe sonnel. Employees in day ca e, basic educa ion, heal h se ices, and police had li le knowledge o he me hods used in o he uni s. The mos suppo o collabo a ion was epo ed by employees in social se ices and day ca e. The esul s p o ide basic knowledge o in e p o essional collabo a ion associa ed wi h child mal ea men be ween he agencies in ol ed in he s udy. The esea ch e idence can also be u ilized in an in e na ional con ex when de eloping collabo a ion be ween di e en ields. 1. In oduc ion The Uni ed Na ions Con en ion on he Righ s o he Child [1] emphasizes he bes in e es s o he child and his o he igh ospecialp o ec ion.Thecon en ionisane o o secu e he child’s igh o pa en s and amily, bu on he o he hand, emphasis is laid on socie y’s obliga ion o o e he child p o ec ion and ca e i he child is being mal ea ed. Following he age de ini ion laid ou in he con en ion, he p esen s udy de ined all human beings unde he age o 18 as child en. In his s udy, child mal ea men e e s o physical and psychological abuse, sexual abuse and neglec occu ing in he amily, and li ing in he a mosphe e o domes ic iolence. Di e en o ms o mal ea men may appea ei he in isola ion o in a ious combina ions, and i is o en di icul o make a dis inc ion be ween he di e en o ms o abuse [2– 5]. Child mal ea men may a y in se e i y: i can in ol e any ac i i y o lack o ac i i y associa ed wi h a child o a child’s li e ci cums ances esul ing in a de e io a ion o he child’s li e si ua ion [2–4]. Child mal ea men is p esen in all socie ies, bu due o di e en me hods o eco ding s a is ics and di e ences in he de ec ion o he phenomenon, he e a e no eliable and compa able igu es on he incidence o child mal ea men . Na ional assessmen s and compa isons in Wes e n coun ies ha e been made, howe e [4]. In addi ion, compa ison is made di icul by he ac ha co po al punishmen o child en is no p ohibi ed by law in all coun ies. Acco ding o c oss-na ional es ima es, app oxima ely one in en o child mal ea men cases make hei way in o o icial s a is ics. 2Nu sing Resea ch and P ac ice Fo ins ance, in he Uni ed S a es e en as many as 900,000 child en annually a e es ima ed o be ic ims o abuse [5, 6]. In he Wes e n coun ies, app oxima ely 4–16 pe cen o child en a e exposed o physical abuse annually, and one in en child en a e neglec ed o exposed o psychological abuse. Fi e o en pe cen o gi ls and i e pe cen o boys ha e expe ienced childhood sexual abuse [4]. A Finnish s udy o ic imso abuse e ealed ha 12pe cen o child enunde 15 had been ic ims o mild domes ic abuse du ing 2008, while 4 pe cen had been ic ims o se ious abuse [7]. Twel e pe cen o child en had wi nessed domes ic iolence be ween pa en s [8]. In Finland, mild domes ic abuse expe ienced by child en has d opped subs an ially o e he pas 20 yea s, bu he le els o se e e domes ic abuse ha e emained almos unchanged. Ins ances o a he -daugh e inces we e epo ed by 0.2 pe cen o gi ls while s ep- a he -daugh e inces was epo ed by 2 pe cen o gi ls. Boys did no epo expe iences o inces [7]. The de ec ion o and in e en ion in child mal ea men a e always di icul and challenging asks o achie e o p o essionals wo king wi h child en. In ea lie esea ch, i has been shown ha he de ec ion o and ea ly in e en ion in child mal ea men call o in e p o essional collabo a ion [2,9] o pool he knowledge, compe encies, and esou ces o employees. In addi ion, sepa a e agencies, wo kplace cul u es and asks equi e compe ence in in e p o essional collabo a ion [10–14]. In e p o essional se ices o child en and amilies ela ed o he de ec ion o and in e en ion in child mal ea men a e o ganized wi h di e en me hods on bo h he na ional and in e na ional le el. When collabo a ion akes place ac oss p o essional and o ganiza ional bounda ies and wo k uni s, he di e en iews, asks, and esponsibili ies in e e e wi h in e p o essional wo k, e en hough hey sha e he conce n o a child’s si ua ion. In he de elopmen o spe- cial compe ence o di e en p o essions and collabo a ional skills, he cen al goals a e o inc ease knowledge and iden i y bo h common wo k p ac ices among di e en p o essions and p ac ices ha a e speci ic o each p o ession [15]. In his s udy, in e p o essional collabo a ion e e s o col- labo a ion and eamwo k be ween he employees o di e en o ganiza ions, agencies and uni s, and p o essional g oups. The pa ne s in in e p o essional collabo a ions a e all p o- essionals coming in o con ac wi h amilies o child en, wi h each p o essional g oup ha ing i s own impo an ole [2,3, 9]. The ocus is on employees who mee child en e e yday and who encoun e si ua ions whe e he e is eason o suspec and e alua e he possibili y o mal ea men [11,16]. In o de o p omo e collabo a ion, he suppo o he supe io s [17] and he wo k communi y is i al [11]. The collabo a ion is basedon heneedsandsa e yo child en[9,13]. Acco ding o a epo by Unice [18] on he well-being o Eu opean child en, mo e in o ma ion is equi ed on domes- ic iolence expe ienced by child en. Child mal ea men and in e p o essional collabo a ion ha e been in he ocus o esea ches o decades, bu a he same ime hese hemes ha e a ely been combined unde he same s udy. In mos s udies, he ocushasbeenonexamining hecollabo a ion be ween a ew p o essions and wo k uni s (e.g., [19]). In addi ion, he con en o he e ms used in s udies has a ied. The e m child mal ea men has been used o e e o iolence expe ienced by child en and you h (e.g., [16,20,21]). The e ms child abuse o iolence expe ienced by child en ha e been used as pa allel e ms o child mal ea men [2,22, 23]. Ea lie s udies ha e ocused on signs o physical abuse, easons behind iolen beha io , and indi idual e en s om he poin o iew o he ic ims o iolence and pe pe a o s o iolence. Child sexual abuse has been s udied om he poin o iew o physical indings and symp oms. I is mo e di icul o gi e e idence o emo ional abuse and neglec han o physical abuse, and he e o e i is iden i ied and s udied less. Mal ea men is an umb ella e m ha co e s bo h nega i e ac ions and neglec ed ac ions owa ds a child [3,24]. The in o ma ion ob ained is sca e ed and i does no gi e a clea holis ic pic u e o he in e p o essional collabo a ion be ween se e al ac o s ha is ela ed o de ec ing and in e ening in child mal ea men . The e o e, i is p oblema ic o u ilize esul s omea lie s udiesin hiss udy.I isimpo an o s udy he opicinab oadcon ex ,wi hala gesamplesize and simul aneously om he poin s o iew o employees in se e al di e en p o essions [16,25]. This s udy is pa o a la ge esea ch p ojec , “de ec- ion and ea men o domes ic abuse,” unde aken in he Depa men o Nu sing Science a he Uni e si y o Tampe e and unded by he Academy o Finland (no. 109830, 2006– 2008). The goal o his s udy is o p oduce in o ma ion o de eloping he p ac ices o se e al collabo a ional ac o s in he de ec ion o and in e en ion in child mal ea men . The pu pose o he s udy was o desc ibe (1) employee compe ence in in e p o essional collabo a ion, (2) how he pe spec i es o o he agencies ha e been aken in o accoun , and(3) hesuppo ecei ed o collabo a ionin hede ec ion o and ea ly in e en ion in child mal ea men wi hin he amily. 2. Me hods 2.1. Ins umen De elopmen . The de elopmen o he ins u- men d ew on he li e a u e sea ch conduc ed using he Linda, Medic, Cinahl, Medline, Psychin o, EBM e iews, and B i ish Nu sing Index da abases o e he yea s 2000–2007. The UN Con en ion on he Righ s o he Child [1]wasalso used as a basis o he de elopmen . The ins umen was i s assessed by con en expe s (𝑛= 7) who ha e de eloped collabo a ion ela ed o he de ec ion o and in e en ion in child mal ea men . The ins umen , e ised based on he expe app aisal, was hen e alua ed by expe s (𝑛=3) wi h wo p o essional quali ica ions wo k- ing in di e en agencies. P e es ing was ca ied ou wi h employees (𝑛=20) omonebasicschoolwi hin(Figu e 1). Thescaleconsis so aneigh -pageques ionnai e,whe e he domains o collabo a ion included he compe ence o he employees in in e p o essional collabo a ion, aking he pe spec i es o o he collabo a ion agencies in o accoun , and suppo o collabo a ion [2,9,16,26]. The a i ude s a emen s we e a ed on a 6-poin Like scale (1 = de ini ely disag ee, 2 = disag ee, 3 = somewha disag ee, 4 = somewha ag ee, 5 = ag ee, 6 = de ini ely ag ee). Nu sing Resea ch and P ac ice 3 Face alidi y Expe s engaged in in e p o essional wo k and ha ing dual quali ica ions P elimina y es ing Basic educa ion s a Face alidi y Expe s esponsible o de eloping he policy on in e p o essional collabo a ion Da a collec ion Agency Employees Sample Responses Rejec ed Included in he sample (%) Day ca e 662 437 (66) 26 411 Basic educa ion 715 155 (22) 8 147 Social se ices 407 209 141 (67) 3 138 Heal h se ices 396 205 116 (56) 5 111 Police 168 168 65 (35) 7 58 To al 914 (46) 49 865 𝑛=7 𝑛=3 𝑛=20 𝑛𝑛𝑛 𝑛𝑛 1299 1383 3653 1959 Figu e 1: Scale de elopmen and da a collec ion by ields (𝑛 = 865). Resea ch pe missions we e ob ained om he di ec o s o day ca e, basic educa ion se ices, and police in he ci y o Tampe e and om he Resea ch Pe mission Commi ee o heal h and social se ices. E hical app o al o he s udy was ob ained om he Pi kanmaa Hospi al Dis ic E hics Commi ee (R07019H). Tampe e is he hi d la ges ci y in Finland wi h a pop- ula ion o 207 866 in 2007. The e we e 35 629 you h and child en unde 18 yea s o age, which is 17% o he whole pop- ula ion. The e we e al oge he 20 588 amilies wi h child en in Tampe e [27]. 2.2. Da a Collec ion. The basic g oup in he s udy consis s o day ca e, basic educa ion, social se ices, heal h ca e, and police pe sonnel in he ci y o Tampe e. The da a we e col- lec ed by collec ing a s a i ied sample o 50% om uni s ha wo k wi h child en unde he age o 18. A census o police o ice s was conduc ed because o he small size o he g oup [28]. The o al sample consis ed o 1 959 employees. The line manage s o he wo k uni s dis ibu ed he su ey o ms o he pe sonnel so ha hey would ep esen a di e se g oup o employees in he wo k communi y, including all p o essions, di e en sexes, di e en ages, di e en leng hs o wo k expe ience, and bo h pe manen and empo a y wo ke s. The da a we e collec ed du ing 15.3–13.9 in 2007. The su ey o ms we e e u ned o he esea che in a closed en elope. A o al o 914 ques ionnai es we e ecei ed, gi ing a esponse a e o 46%. Fo y-nine ques ionnai es we e ejec ed 4Nu sing Resea ch and P ac ice Table 1: Compe ence in in e p o essional collabo a ion, conside a ion o he pe spec i es o o he agencies, and ecei ing suppo o collabo a ion: commonali ies and pe cen ages accoun ed o by he p incipal componen s, and he in e nal consis ency o he scale as assessed by C onbach’s alpha (𝑛 = 865). P incipal componen Commonali y Pe cen age accoun ed o % Numbe o i ems C onbach’s alpha Compe ence in in e p o essional collabo a ion 0.437–0.777 35 5 0.830 Conside a ion o pe spec i es o o he collabo a ion agencies 0.484–0.663 15 3 0.602 Recei ing suppo o collabo a ion 0.452–0.686 9 5 0.791 All i ems 0.437–0.777 59 13 0.840 because o missing da a, as o e 20% o he esponses o a se o i ems we e missing. As shown by he d opou analysis, he backg ound cha ac e is ics o hose who e u ned an incom- ple e ques ionnai e did no di e subs an ially om hose included in he s udy. The su ey achie ed he p inciple o ep esen a i eness o all uni s. Acco ding o he loss analysis, he ques ionnai e achie ed he p inciple o ep esen a i eness o all wo k uni s (Figu e 1). 2.3. S a is ical Analysis. A s a is ical analysis was pe o med using SPSS o Windows 18.0. I a ques ionnai e had less han 20% missing alues (𝑛=16), hese we e eplaced by he mean o sco es on collabo a ion a iables. A p incipal componen analysis (PCA) was conduc ed in o de o ind ou which s a emen s measu e simila p ope ies. PCA showed ha all i ems (𝑛=13)co ela ed wi h a leas one i em (𝑟 > 0.30).Thenumbe o p incipal componen s was limi ed o componen s wi h he eigen alue o o e one and wi h he a ia ion o he explana ion pa s exceeding 5%. Howe e , he la ge sample size may ha e caused he s a is ical signi icance. Ne e heless, he p inci- pal componen analysis calcula ed he Pea son co ela ion coe icien s o skewed dis ibu ions and o s a emen s wi h o dinal scales, which may weaken he analysis. I ems loading hea ily (>0.40) on a componen we e included in he scale. The numbe o he p incipal componen s was es ed wi h eeand o ced ac o ing,and he esul swe esimila .As a esul o an oblique p omax o a ion, he a iables we e loaded o only one ac o and hei con en was meaning ul. Conside ing he subjec o s udy, i is signi ican ha he s a emen s can co ela e wi h each o he . The commonali ies o indi idual i ems anged om 0.437 o 0.777, demons a ing ha he a iables measu ed he p incipal componen s ai ly eliably [28]. Th ee p incipal componen s based on p e ious heo e i- cal knowledge eme ged. These we e gi en names acco ding o he i em con en : compe ence in in e p o essional collab- o a ion (5 i ems), aking in o accoun he pe spec i es o o he collabo a ion agencies (3 i ems), and ecei ing suppo o collabo a ion (5 i ems). The h ee p incipal componen s accoun ed o 59% o he o al a iance (Table 1). Wi h he p incipal componen analysis, he summa ed scales we e o med in o de o examine he phenomenon holis ically. Th ee summa ed scales we e o med by adding up he i ems depic ing each p incipal componen and by di iding he sum by he numbe o i ems. This made he summa ed scales mu ually compa able, al hough he numbe o i ems a ied [28]. The in e nal consis ency o he sum a iables was exam- ined by using C onbach’s alpha alues. The alues anged om 0.602 o 0.830, and he o al alpha alue o 0.840 demons a ed ha he ins umen was in e nally consis en [28](Table 1). The dis ibu ions o esponden cha ac e is ics (gende , age, educa ion, wo k expe ience a he p esen uni , o al wo k expe ience, and employmen s a us) we e desc ibed using equencies and pe cen ages. The dis ibu ions o he h ee summa ed scales o med by using he p incipal componen analysis o c oss abula ion we e eclassi ied in o wo classes (disag ee = 1.0–3.4, ag ee = 3.5–6.0). This solu ion was sup- po ed by he ac ha he obse a ions ell in o all o he ca ego ies. In he esul s sec ion, he dis ibu ions o he i ems a e desc ibed using he pe cen ages o hose who ag eed and disag eed wi h an i em. Addi ionally, we p esen he equencies and pe cen ages o hose ag eeing wi h an i em by agencies in Table 3 because he e we e s a is ically highly signi ican associa ions be ween he agencies and he i ems. The associa ions be ween backg ound in o ma ion and he i ems we e examined by using c oss abula ion analysis, chi-squa e analysis, o Fishe ’s exac es , i he expec ed equencies we e oo small. The signi icance le el was se a <0.01due o hela gesizeo heda ase [28]. 3. Resul s 3.1. Demog aphic Cha ac e is ics o he Responden s. The ma- jo i y o he esponden s we e women. The age ange o esponden s was om 20 o 64 yea s, wi h a mean age o 43 yea s. The a e age amoun o wo k expe ience was 15 yea s ( ange 1 mon h–42 yea s) (Table 2). Fo y-eigh pe cen o he esponden s wo ked in day ca e, 17% wo ked in basic educa ion, 16% in social se ice, 13% in heal h se ice, and 7% in police depa men s (Figu e 1). 3.2. Compe ence in In e p o essional Collabo a ion. The ma- jo i y o he esponden s (93%) had he compe ence o col- labo a ewi ho he o icials.Thelowes a ingso hei com- pe ence we e gi en by heal h se ice employees (𝑃 = 0.002, 𝜙=0.140)(Table 3). Eigh y- wope cen knewwha odowhencollabo a ing wi h o he agencies o de ec child mal ea men . Howe e , Nu sing Resea ch and P ac ice 5 Table 2: Responden backg ound cha ac e is ics and job- ela ed backg ound ac o s (𝑛 = 865). Backg ound ac o s 𝑛(%) Gende Female 747 (86) Male 117 (14) Missing da a 1 (0.1) Age in yea s <30 115 (13) 30–39 217 (25) 40–49 285 (33) ≥50 243 (28) Missing da a 5 (0.6) Educa ion No oca ional quali ica ions 3 (0.3) College-le el oca ional quali ica ions 288 (33) Bachelo -le el (pos seconda y le el/poly echnic deg ee) 182 (21) Mas e -le el (unde g adua e/pos g adua e deg ee) 385 (45) Missing da a 7 (0.7) Wo k expe ience a he p esen uni in yea s ≤1147(17) 2–4 182 (21) 5–10 195 (23) 11–20 164 (19) ≥21 157 (18) Missing da a 20 (2.3) To al wo k expe ience in yea s ≤5160(19) 6–15 282 (33) 16–25 230 (27) ≥26 145 (17) Missing da a 48 (5.5) Employmen s a us Pe manen 684 (79) Con ac 173 (20) O he 6 (0.7) Missing da a 2 (0.2) Time spen wo king wi h child en Less han hal o wo k day 155 (18) Hal o mo e han hal o wo k day 700 (81) Missing da a 10 (1.2) employees in day ca e and basic educa ion e alua ed hei col- labo a i e compe ence as he weakes (𝑃 < 0.001,𝜙=0.180) (Table 3). Eigh y- ou pe cen o pe manen employees and 79% o con ac employees knew how o collabo a e wi h o he agencies (𝑃 = 0.002,𝜙= 0.113). Th ee- ou hs (74%) o he employees knew how o ac when de ec ing child mal ea men . I is no ewo hy ha one- hi d o he employees in day ca e, basic educa ion, and heal h se ices did no know wha o do when de ec ing child mal ea men (𝑃 < 0.001,𝜙=0.167)(Table 3). Young espon- den s had he leas knowledge and skills (𝑃 = 0.006,𝜙= 0.116). Se en y-se en pe cen o pe manen employees and 64% o con ac employees knew how o ac (𝑃 = 0.001,𝜙= 0.121). Six y-eigh pe cen o he esponden s we e also capable o ac ing independen ly when in e ening in child mal ea - men . The highes a ings o independen ac ion in child mal ea men cases we e gi en by social se ice employees and police o ice s (𝑃 < 0.001,𝜙=0.229)(Table 3). Employees we e be e able o ac independen ly as hey g ew olde (𝑃 = 0.004,𝜙= 0.129). Eigh y pe cen o men and 66% o women (𝑃 = 0.004,𝜙= 0.097) and se en y-one pe cen o pe manen s a and 57% o con ac s a we e capable o ac ing independen ly (𝑃 = 0.001,𝜙=0.129). Hal o he esponden s (50%) had knowledge o he p ac ices o o he s; heal h ca e employees had he leas knowledge o he p ac ices o o he s (𝑃 < 0.001,𝜙=0.171). 3.3. Taking in o Accoun he Pe spec i es o O he Agencies in Collabo a ion. O hose who had i e yea s wo k expe ience o less, 2% did no app ecia e he compe encies o employees in o he agencies (𝑃 = 0.006,𝜙=0.124). Women (96%) we e mo e accep ing han men (90%) o he a ious pe spec i es (𝑃 = 0.001,𝜙= 0.109) o o he agen- cies, whe eas police o ice s we e he leas accep ing (𝑃= 0.002,𝜙=0.142). 3.4. Recei ing Suppo o Collabo a ion. The majo i y (81%) o he esponden s ecei ed suppo om o he agencies in child mal ea men de ec ion. Howe e , one- hi d o hose wo king in basic educa ion and heal h se ices did no ecei e suppo om o he agencies (𝑃 < 0.001,𝜙=0.162)(Table 3). Those who had a Bachelo ’s-le el deg ee ecei ed he leas suppo (𝑃 = 0.001,𝜙=0.136). The as majo i y (90%) o he esponden s ecei ed suppo om hei ownuni ode ec childmal ea men .I is no ewo hy ha 30% o police o ice s did no ecei e suppo om hei uni o de ec ing child mal ea men (𝑃 < 0.001, 𝜙=0.275)(Table 3).Theageo he esponden (𝑃 = 0.001, 𝜙= 0.137), o al wo k expe ience (𝑃 = 0.009,𝜙= 0.119), and wo k expe ience om he p esen uni (𝑃 = 0.001,𝜙=0.146) inc eased suppo . In addi ion, he mo e ime had elapsed a e g adua ion, he mo e suppo he esponden ecei ed (𝑃 = 0.003,𝜙= 0.128). Nine een pe cen o men and 8% o women did no ecei e suppo om hei uni (𝑃 < 0.001, 𝜙= 0.124). Those who spen less han hal hei wo king day(76%)wo kingwi hchild en ecei edlesssuppo han hose who spen he en i e day (94%) wo king wi h child en (𝑃 < 0.001,𝜙=0.228). Nea ly all (94%) employees ecei ed suppo om hei supe iso s o in e agency collabo a ion associa ed wi h child mal ea men . Heal h se ice employees did no ecei e suppo om he supe iso o in e agency collabo a ion 6Nu sing Resea ch and P ac ice Table 3: Employee pe cep ions o compe ence in in e p o essional collabo a ion. Pe cen ages o hose ag eeing wi h he i em. S a is ical di e ences be ween he ields we e es ed using he Pea son Chi-squa e es o Fishe ’s Exac Tes (𝑛 = 865). Day ca e Basic educa ion Social se ices Heal h se ices Police 𝑛 = 411 𝑛 = 147 𝑛 = 138 𝑛 = 111 𝑛 = 58 𝑃 alue Phi %% % %% Compe ence in in e p o essional collabo a ion 75 76 96 75 90 <0.001 I necessa y, I am capable o collabo a ing wi h o he agencies 90 95 99 89 98 0.002 0.140 I am capable o collabo a ing wi h o he agencies in child mal ea men issues 78 77 95 81 93 <0.001 0.180 Iknowwha odowhende ec ingchild mal ea men 71 69 89 68 81 <0.001 0.167 I am also capable o ac ing independen ly when in e ening in child mal ea men 62 63 88 64 86 <0.001 0.229 I am awa e o wo k pa e ns in o he uni s 47 46 69 41 50 <0.001 0.171 Conside a ion o he pe spec i es o o he collabo a ion agencies 97 99 96 99 95 0.280 I app ecia e he compe ence o o he employees in ano he ield 100 100 100 100 98 0.38410.074 I accep he di e en pe spec i es o o he agencies 97 97 93 98 86 0.002 0.142 We ha e a common app oach o collabo a ion in child mal ea men issues wi h o he agencies 88 85 87 84 85 0.721 0.049 Recei ing suppo o collabo a ion 95 90 96 80 83 <0.001 I ecei e suppo om o he agencies o child mal ea men de ec ion 86 71 84 73 81 <0.001 0.162 I ecei esuppo ommyuni o child mal ea men de ec ion 95 91 96 77 71 <0.001 0.275 My supe iso suppo s in e -agency collabo a ion ela ed o child mal ea men 96 95 97 81 95 <0.001 0.218 I am sa is ied wi h he collabo a ion in my uni 93 93 97 86 83 0.001 0.149 I ha e ime o collabo a ion wi h o he agencies 64 52 79 42 43 <0.001 0.235 1Fishe ’s Exac Tes . (𝑃 < 0.001,𝜙=0.218)(Table 3). Those wi h a Bachelo ’s-le el deg ee (89%) ecei ed he leas suppo om hei supe iso compa ed wi h hose who had a Mas e ’s-le el deg ee (96%) and hose wi h college-le el quali ica ions (96%) (𝑃 = 0.007, 𝜙= 0.127). Those who spen less han hal hei wo king day (87%) wo king wi h child en ecei ed less suppo om hei supe iso han did hose who spen he en i e day wo king (96%) (𝑃 < 0.001,𝜙=0.145). The majo i y (92%) o he esponden s we e sa is ied wi h he collabo a ion in hei own uni while he highes le els o dissa is ac ion we e epo ed by police o ice s (𝑃 = 0.001,𝜙= 0.149).Thosewhospen hal o mo e hanhal hei wo kday (94%) wo king wi h child en we e mo e likely o be sa is ied wi h he collabo a ion in hei uni han hose who spen less han hal (86%) hei ime wo king wi h child en (𝑃 = 0.001, 𝜙= 0.111). Six y pe cen o he esponden s had ime o in e agency collabo a ion. Social se ice employees had he mos ime o in e agency collabo a ion (𝑃 < 0.001,𝜙=0.235)(Table 3). Those who spen less han hal (47%) o hei wo kday wi h child en had less ime o in e agency collabo a ion han hosewhospen hal o mo e(63%)o hei wo kdaywi h child en (𝑃 < 0.001,𝜙=0.131). 4. Discussion Thepu poseo hes udywas odesc ibeemployeecompe- ence in in e p o essional collabo a ion, how he pe spec i es o o he agencies ha e been aken in o accoun , and he suppo ecei ed o collabo a ion in he de ec ion o and ea ly in e en ion in child mal ea men wi hin he amily. Nu sing Resea ch and P ac ice 7 4.1. Main Resul s. The e was a s a is ically highly signi ican associa ion be ween he esponden ’s ield and compe ence in in e p o essional collabo a ion.Thehighes le elo com- pe ence in in e p o essional collabo a ion was epo ed by social se ice employees and police o ice s. The esul con- ce ning social se ice employees was as expec ed since hey a e hekeyac o sinmal ea men issues[29]. Acco dingly, he lowes a ing o skills was gi en by employees in basic educa ion and day ca e, in o he wo ds hose who mee child en egula ly e e yday. The employee’s indi idual and posi i e a i udes and willingness o collabo a e a e ac o s ha a ec in e p o essional collabo a ion [11,12,26,30]. Acco ding o he esul s o a s udy by Rae e al. [29], he knowledge o heal h ca e se ice wo ke s ega ding leg- isla ion p ohibi ing puni i e iolence a ied signi ican ly. Djeddah e al. [2] and Paa ilainen and Flinck [3] s a e ha employees in social se ices and heal h ca e should be mo e ac i e and willing o engage in in e p o essional collabo a- ion. Pe manen employees we e mo e knowledgeable han con ac employees abou how o ac when de ec ing child mal ea men . In addi ion, pe manen employees we e mo e independen han con ac employees when in e ening in child mal ea men . The esul s may ha e been a ec ed by he s ic sec ecy clauses in Finnish heal h ca e and unce ain y abou he legal possibili ies and es ic ions on collabo a- ion [31]. Employees can also be equi ed o ake pe sonal esponsibili y and show dedica ion o collabo a ion [17,19]. Goebbels e al. [11], Ce ezo and Pons-Sal ado [16], and Rae e al. [29] emphasize ha in o ma ion on he de ec ion o and in e en ion in child mal ea men is impo an o all employees, ega dless o hei special y o le el o educa ion. This kind o compe ence in in e p o essional collabo a ion is ela ed o he e ec i eness o collabo a ion in p ac ice [12]. In his s udy, only hal o hose wo king in day ca e, basic educa ion, heal h se ices, and police we e awa e o he me hods used by o he agencies. The esul co obo a es ea lie indings in a s udy by A za e al. [10] on heal h se ices, showing ha he me hods used in child wel a e se ices we e poo ly ecognized. In his case, he e may be a isk ha in e p o essional compe ence is no u ilized su icien ly [19]. The esul s o he p esen s udy a e ele an , as Clea e and Walke [9]andG eene al.[12],andCla ke[19]ha eshown ha knowledge o he asks, esponsibili ies and me hods used by o he p o essionals educes mis us and inc eases in e p o essional ac ion. The p ac ical implemen a ion o in e p o essional collabo a ion equi es join discussion and lea ning bo h wi hin wo k communi ies and be ween he employees o collabo a ing o ganiza ions [16,32]. Acco ding o ea lie s udies, child mal ea men was no in e ened in sys ema ically and wi h de e mina ion [11], and he e o e heal h ca e wo ke s need aining, change in a i udes, and simple ools o de ec ing and in e ening in child mal ea - men [16,19,33,34]. The esul s ag ee wi h he s udy by Rae e al. [29] ega d- ing he ac ha he leng h o wo k expe ience has no e ec on knowledge o child p o ec ion legisla ion and p ac ices ega ding puni i e iolence. In a s udy by Goebbels e al. [11]andMcKenziee al.[35], howe e , inc easing wo k expe ience inc eased knowledge and p ac ical in o ma ion among heal h ca e wo ke s. The e was a s a is ically highly signi ican associa ion be ween he ield o employmen and ecei ing suppo o collabo a ion. Employees need suppo o he de ec ion o and in e en ion in child mal ea men [16,22,36]. Women employees in social se ices and day ca e and employees who spen hal o mo eo hei wo kdaywi hchild en ecei ed he mos suppo . Acco ding o Chanmugan [31], all employees need suppo om he line manage and pee suppo om he wo k communi y and on se e al occasions, i necessa y. The employees mos ly emphasized de ails ela ed o wo king co ec ly ega ding e hics and legisla ion. This esul ag ees wi h ea lie s udies in ha suppo om he supe io [17]and he wo k uni [11] had a big in luence on he collabo a ion in he de ec ion o and in e en ion in child mal ea men . The mos common sou ces o suppo we e he supe iso and heemployee’sownuni .Theamoun o imespen wo king wi h child en was also associa ed wi h he eceip o suppo om he supe iso and he wo k uni [16,20]. The esul is unde s andable, as he issues o de ec ing and in e ening in child mal ea men a e p ima ily discussed wi hin he employee’s own uni wi h amilia cowo ke s [11,19]. On he o he hand, he ole o supe iso s in he collabo a ion p ocess should be s udied mo e closely [26]. In his s udy, one- hi d o he employees in basic educa- ionandheal hse ices el ha heydidno ecei esuppo om o he agencies o de ec ing child mal ea men . The esul is wo ying because he possibili y o consul a ion ac oss o ganiza ional bounda ies has been ega ded as an impo an o m o suppo when de ec ing mal ea men [9, 16,31]. Fo example, in he s udy by Cla ke [19], social se ices we e an impo an collabo a ion pa ne o he school nu se. In addi ion, he suppo ecei ed depended on legisla- ion, ope a ing p ac ices, go e nmen suppo , and socie al decisions [16,25]. Fo example, he paedia ics commi ee on child abuse and neglec o he Ame ican Academy [22] ecommends app o ing laws p ohibi ing he use o puni i e iolence. Some s a es now place an ac o child abuse on he cen al egis y only when he abuse is conside ed “se ious.” Financial conside a ions and he legi ima e ea o being o e whelmed by he numbe o abuse child en has led some child p o ec i e se ices sys ems o cons uc a iage sys em whe eby a child has o be in ela i ely imminen dange o se iously abused be o e he e will be a esponse. The esul s o his s udy show ha social se ice employ- ees had he mos ime o in e agency collabo a ion. Simila esul s we e ob ained by Ødeg˚ a d [30] in a s udy o child en’s men al heal h ca e whe e employees used nea ly hal hei wo king day on collabo a ion. I is clea ha he de elopmen o good collabo a ion calls o ime and discussions [12,14,25, 26,37]. In his s udy, especially sepa a e agencies and ields o employmen eme ged as hind ances o collabo a ion. The lack o sha ed models o hough and he small amoun o collabo a ion may ha e a ec ed he iews o he esponden s. In addi ion, di e en wo k asks and p o essional insecu i y in collabo a ion ela ed o de ec ing and in e ening in child mal ea men may ha e had an e ec on he esul s, especially 8Nu sing Resea ch and P ac ice in he esponses o employees in day ca e, basic educa ion and heal h ca e. Acco ding o he esul s o a s udy by Bun ing e al. [37], in addi ion o join in e p o essional aining, open and common discussion and sha ing o expe iences ega ding in e p o essional collabo a ion, as well as in o - ma ion on he job desc ip ions o collabo a ing pa ne s, is needed o inc ease join ac i i ies and e iciency. In di icul si ua ions eelings and esponsibili y can be sha ed wi h o he s. Th ough in e p o essional aining and collabo a ion, employees would ge suppo o de ec ing and in e ening in child mal ea men . A minimum, he aining should include he de ec ion o signs o abuse, and when how, and whe e shouldabusebe epo ed[16,20]. I would be use ul o o e aining on di e en occasions as basic, con inued, and complemen a y aining [37]. 4.2. Reliabili y o he S udy. Con en alidi y was s eng h- ened in a s epwise manne by expe assessmen s and p elimi- na y es ing. The alpha alues o he summa ed scales anged om 0.602 o 0.830. Alpha alues o ≥0.70 can be conside ed ela i ely good o a new ins umen . The summa ed scale “Taking in o accoun he pe spec i es o o he agencies” con ained only h ee i ems, which may ha e con ibu ed o he low alpha alue [28]. Wi hin a la ge sample, e en small di e ences be ween g oups o associa ions be ween a iables can be s a is ically signi ican as de e mined by he chi-squa e analysis. Based on an assessmen , a ma ked con en - ela ed associa ion is called signi ican [28]. In his s udy, he e was a signi ican associa ion be ween he agencies and he i ems. Ex e nal alidi y was assessed on he basis o he sample, esponse a e, and ep esen a i eness o he da a [28]. To inc ease he eliabili y o he s udy, he da a we e collec ed by d awing a s a i ied sample o 50% om each uni because he esponse a ewases ima ed o a y.The esponse a e (46%) may ha e been educed by he employees’ pe cep ion o child mal ea men de ec ion as no being he co e ask o hei wo k, al hough he child wel a e ac [38]s ipula es ha child mal ea men de ec ion is he esponsibili y o all employees. The commen s gi en in he ques ionnai es men ioned he di icul y o he esea ch opic as he eason o missingda a.Thescaledidno include he esponse op ions “canno say” o “does no conce n me,” which may ha e con ibu ed o he ac ha some esponden s e u ned a blank o pa ially comple ed ques ionnai e. Because o he missing da a, al oge he 49 ques ionnai es we e ejec ed. The numbe o esponden s was la ge wi h ega d o he a ge popula ion.Thesamplesizeshouldbe10pe cen o he su ey popula ion o allow gene aliza ion o esul s [39]. The esponden s (𝑛 = 856) ep esen 24% o all employees. The su ey achie ed he p inciple o ep esen a i eness o he agencies as he ollowing pe cen ages show: day ca e 24%, basic educa ion 11%, social se ices 34%, heal h se ices 28%, andpolice34%.The esul so hes udy ep esen hes udy sample. This s udy does no gi e an explana ion o he low esponse a es om basic educa ion and heal h ca e se ices, bu i does aise se e al u he ques ions and p esen a opic o u he esea ch. The esponse a e may ha e been a ec ed by he di e en backg ounds o wo kplace cul u es and adi ionsin he espec i elineso ac i i ies,aswellas he p o essional ole and he connec ion o he esponden s’ co e wo k asks o child mal ea men . In he s udies o Ma ijcke and B owne [23] and Sa egua ding Child en [13], he employees did no ha e he eadiness, skills, and means o in e ene in child mal ea men . Collabo a ion ela ed o he de ec ion o and in e en ion in child mal ea men usually begins when an employee becomes conce ned and suspec s mal ea men o when a amily membe epo s i [11]. Basic educa ion and heal h ca e se ices a e cen al e e yday en i onmen s in a child’s li e whe e i is possible o iden i y mal ea men [3,11,16]. The commen s led us o assume ha employees in di e en ields o employmen conside ed he esea ch opic impo an . A numbe o ques ionnai es included a commen ha he esponden does no ha e expe ience o de ec ing o in e ening in child mal ea men , so hei esponses we e basedonanassump iono how heywouldac .Thisde- c eases he eliabili y o he s udy, as esponden s may ha e esponded in a socially desi able way [28]. In gene al, he esponden s e alua ed hemsel es as compe en , bu di e - ences eme ged be ween di e en agencies. The esponden s we e c i ical o how hey would ac , and he e o e he use o sel -e alua ion is no a majo p oblem. 5. Conclusions We can conclude ha he employees a ed in e p o essional collabo a ion ai ly posi i ely. The esul co obo a es he esul s o p e ious na ional and in e na ional s udies in ha he de ec ion o and in e en ion in child mal ea men equi e employees o ha e compe encies in in e p o ession- al collabo a ion ha anscend o ganiza ional bounda ies. These esul s poin o he need o de elop in e p o essional collabo a i e compe encies o de ec ing child mal ea men especially among employees in day ca e, basic educa ion, and heal h se ices, because hese a e he p o essionals ha wo k wi h child en on a egula basis. Mo e a en ion needs o be paid o hands-on collabo a- ion. These esul s call o inc eased collabo a ion be ween di e en agencies, o example, by using mu ual isi s o ge o know and be e unde s and he wo k o o he s and o make con ac s easie . Th ough egula mee ings he com- mon goal and aim can be c ys allized o employees a end- ing o he same amilies bu wo king in di e en agen- cies/o ganiza ions. This could inc ease he dedica ion o he employees and inc ease hei app ecia ion o and knowledge o he wo k o he o he agencies. 5.1. Implica ions o P ac ice. The esul s can be u ilized in de eloping and implemen ing sha ed aining o di e en p o essions. I is possible o de elop p ac ical collabo a ion h ough in e p o essional aining. The aining should ocus on amilia izing he employees wi h he job desc ip ions o employees in o he agencies/o ganiza ions and on discussing wha in e p o essional collabo a ion means o each indi id- ual employee and o di e en p o essions. The aining should Nu sing Resea ch and P ac ice 9 discuss wha he pe quisi es o in e p o essional collabo a- ion a e and how i could be p omo ed. A challenge o u u e esea ch is deepening he knowl- edge on he opic by in e iewing he employees, especially ela ed o di e ences be ween he di e en lines o ac i i ies andlow esponse a es.I wouldalsobeimpo an ogain knowledge o he expe iences o child en and amilies. Using di e en esea ch app oaches and da a collec ed om di e - en agencies, i is possible o ge a mo e e sa ile pic u e o he de ec ion o and in e en ion in child mal ea men han by using only one esea ch me hod. Fu he de elopmen o collabo a ion will bene i child en and hei amilies, as mal- ea men will be de ec ed a an ea ly s age. Disclosu e The esea ch da a o he pape has been analyzed wi h he SPSS S a is ics so wa e. The Uni e si y o Tampe e has been paid by he esea che o using hei license o he p og am. The au ho s ha e no o he connec ion o he SPSS so wa e. Acknowledgmen s The au ho s acknowledge he suppo o he esea ch p ojec “Ea ly in e en ion model de elopmen and e alua ion in iden i ying and dealing wi h amily iolence” (no. 109830, 2006–2008) unded by he Academy o Finland, Compe i i e Resea ch Funding o he Nu ses’ Educa ion Founda ion, and Compe i i e Resea ch Funding o he Finnish Conco dia Fund. The esea ch p ojec ecei ed inancial suppo om he Compe i i e Resea ch Funding o he Pi kanmaa Hospi al Dis ic , Tampe e Uni e si y Hospi al. Re e ences [1] The UN Con en ion on he Righ s o he Child, 1989. [2] C. Djeddah, P. Facchin, C. Ranza o, and C. Rome , “Child abuse: cu en p oblems and key public heal h challenges,” Social Science and Medicine, ol.51,no.6,pp.905–915,2000. [3] E. Paa ilainen and A. Flinck, “Iden i ica ion o and in e en ion in child mal ea men . A clinical p ac ice guideline,” Nu sing Resea ch Founda ion, 2008, h p://www.ho us. i/sys em/ iles/ Child mal ea men iden i ica ion ENG.pd . 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