The Development of a Screening Tool for Childcare Professionals to Detect and Refer Infant and Toddler Maltreatment and Trauma: A Tale of Four Countries

Abstract

Child maltreatment is considered a pressing social question, compromising the present and future mental and physical health of one in four children in Europe. While children younger than three years of age are especially vulnerable, few screening instruments are available for the detection of risk in this age group. The purpose of this research was to develop a screening tool for childcare professionals working in public and private daycare settings to support them in the early identification and referral of infants and toddlers exposed to emotional and physical abuse and neglect by primary caregivers, to be used in different settings across four European countries: Belgium, Italy, Latvia, and Hungary.

Method: A stratified process was used to create the screening tool: We started by using Living lab methodology to co-create the screening tool with its final users, which was followed by testing the tool with a total of 120 childcare professionals from the four participating countries.

Results: During the Living Lab phase, a screening tool with three layers was developed. The initial layer includes five "red flags" that signal particular concern and require immediate action. The second layer is a quick screener with twelve items focused on four areas: neglect of basic needs, delays in development, unusual behaviors, and interaction with caregivers. The third layer is an in-depth questionnaire that aids in formalizing a thorough observation of twenty-five items within the same four areas as the quick screener. After a one-day training session, 120 childcare professionals caring for children aged 0-3 from four countries assessed the screening tool and their overall training experience. Childcare professionals reported great satisfaction with the three-layered structure, which made the tool versatile, and agreed on its content, which was considered helpful in the daycare setting for the regular evaluation of the behavior of children and their primary caregivers, thus improving the early observation of change from the normal behavior of the infant or toddler.

Conclusion: The three-layered screening tool was reported as feasible, practical, and with great content validity by childcare professionals working in four European countries.

Keywords: 0–3 age group; child abuse; childcare professionals; maltreatment detection; three-layered screening tool.

Figure 1

Clinical presentation of ACEs in children aged 0–3. Note. Adapted from the National Health Service Education for Scotland [19]. Image by Emese Iványi.

Figure 2

Procedure and development of the ECLIPS screening tool. Phases 1 and 2 have been explained elsewhere [20]. Phases 3 and 4, respectively, represent the co-creation phase and the training and assessment phase.

Figure 3

Mean score on knowledge from T0 to T2 in the four countries.

Figure 4

Mean score on attitude from T0 to T2 in the four countries.

Figure 5

Mean score on screening from T1 to T2 in the four countries.

Figure 6

Mean score on training from T1 to T2 in the four countries.