Donna M. PencePractice Improvement Consultant

Pence-Wilson Training & Consulting, Inc

Critical Thinking: Decision-Making in Child

Maltreatment Investigations

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Content Alert

Learning Objectives

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Key decision points in child maltreatment investigations

Styles of decision-making

Errors in Decision-making

Influence of personal and professional biases on decision-making

Benefits of MDT case staffing and supervisor consultation on decision-making

Importance of thinking about your critical thinking skills

Basic Components

of the Investigative

ProcessChild Maltreatment Investigation Components

Cross Reporting & Coordination

w/ Other Investigative

Agency

Reviewing History & Gathering

Background Information

Investigative Planning

Child

Interviewing

Adult Interviewing

Evidence Identification &

Collection: Medical/

Physical/Verbal

Critical Thinking- Evaluation of

Information & Evidence

Consultation & Decision-Making

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Community thinks we have one of these…

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Reality, we seem to be behind this

ball when it comes to child

fatalities.

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“I felt personal as well as professional responsibility

to get it right. This all contributes to anxiety.

The reality is, if you make a wrong decision lots of

people, particularly children will suffer.”

Social Worker

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“…most disasters are caused by the

result of a sequence of smaller events…”

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Critical Thinking

Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness. The Critical Thinking Community http://www.criticalthinking.org

Two Components of Critical Thinking

The habit, based on intellectual commitment, of using those skills to guide behavior.

A set of information and belief generating and processing skills

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A well cultivated critical thinker: raises vital questions and problems, formulating them clearly and precisely; gathers and assesses relevant information, using abstract ideas to interpret it effectively comes to well-reasoned conclusions and solutions, testing them against relevant criteria and standards; thinks openmindedly within alternative systems of thought, recognizing and assessing, as need be, their assumptions, implications, and practical consequences; and communicates effectively with others in figuring out solutions to complex problems.

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We want investigators to

try to reason things out on the basis of evidence

and good reasons.

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Categorical Thinking

Go down a listChoosing between various

categoriesEach question narrows the choice

Fails to grasp the importance of context

Fails to recognize that actions are mediated by circumstances that change over time and place

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Decision-Making

Complexity = increased chance of something

going wrong!

Information Gathering

Application of Rules or Criteria that is applied

Discussion Feedback

Decision/Professional Judgment Reassessment

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Steps in Decision Making

DECISIONAL BALANCE

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Wild and Wonderful Whites of West

VirginiaActivity

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Decision-Making Errors

Jumping to conclusions

Entering into power strugglewith client

Accepting parentalwithdrawal/“closure”

Sticking to the same case plan

(Reder, Duncan & Gray, 1993)

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Are we asking the right questions?

Are we correctly understanding the information?

What are the criteria we use to inform our response?

Misinterpretation or misdiagnosis of risk

Initial Report

Who, What, When Where, Why, How

Considerations in Documentation

Evaluating the source of information

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Gathering, Documenting

and Evaluation

Information

Interview Protocols

A good investigation requires an orderly, structured procedure in the gathering of sufficient information to determine if maltreatment took place and to develop a coherent investigative plan.

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Partial information is a key factor

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Jurassic Park School

of Investigation(and Decision-

Making)

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Do we take the time needed to adequately analyze, interpret, and

reflect on the information we have?

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Near Misses:

Something could have gone wrong but have been prevented

Something did go wrong but no serious harm was caused

“Near Misses”

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The prioritization of cases

Professionals not having an accurate or full picture of what is happening

Decisions made by other teams and agencies

Many near misses occurring during the referral and

investigation stages are due to:

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Preconditions - The Dirty Dozen

1. Lack of Communication

2. Complacency

3. Lack of Knowledge

4. Distraction

5. Lack of Teamwork

6. Fatigue

7. Lack of Resources

8. Pressure

9. Lack of Assertiveness

10. Stress

11. Lack of Awareness

12. Norms

• Set the person up to make the active error• Are often a combination of more than one of the

Dirty Dozen

Preconditions

To a Human Error

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Decision-Making Models

Models help us to reduce the complexity of a situation by enabling us the suppress most of it and concentrate on what is most important.

Models do not define what or how we should think; they are the result of an active thought process.

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Strategies

Investigative PlanQuestioning PlanInterviewing Plan

The Importance of “Framing” in Interviewing

“If they can get you asking the wrong questions, they don’t have to worry about

the answers.”

Thomas Pincheon

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Can I explain what I did, how I did it,

when in the process I did it, what

policies, procedures, research, best

practices support what I did (or did

not do?

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BiasThe hidden 4 letter word…

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Three Critical Concepts

Confirmatory Bias Reasonable Alternative Hypothesis Source Monitoring

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“Neuroscientists have shown

biases in thinking are built into the

very way the brain processes

information…the reasoning areas of the brain virtually shut down when confronted with

dissonant information.”

Tavris & Aronson, 2007

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“I will look at any

additional evidence

to confirm the opinion

to which I have

already come.”

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The more important the decision, the greater the need to reduce dissonance by overemphasizing the correctness of the decision.

Once we make a decision, we feel we must justify and rationalize it, even if we don’t really have strong empirical support for it.

Why we don’t accept our

decisions being questioning…

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Reasonable Alternative Hypothesis

Other explanation for statements, injuries, behaviors which should be

evaluated by the investigator during the investigative process.

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Source Monitoring Determining how the

information being provided was acquired by the person sharing it. Did they experience it, see it, hear it? Were they told about it, saw something suspicious and have drawn conclusion based on that?

Source Confusion Confusing an event that

happened and the details . Other people provided details, time delay, telling and retelling, embellishing.

Source Monitoring

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Investigator and Organizational Issues

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Optimism BiasNegativity Bias

Previous History BiasPrejudices/ Stereotype

Biases of Memory

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The Rockman

“You see what you want to see and you hear what you want to hear.”

“The Point”, 1972

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Belief Systems Can…

• Skew Perceptionso “See what we want to see and hear what we want to hear.”

• Influence Clinical Judgment o Confirmatory bias Professional Personal

• Subvert Accurate Documentationo “Good facts” and “Bad facts”

• Affect Decision-Makingo Viability, Credibility, Logic, Optimism-Pessimism, Attribution of Responsibility, Weight to Evidence and

Expert Opinion (Munro, 1999)

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The Challenge of Challenging

Beliefs

(Munro, 1999)

Confirmatory Bias Trap

Case Theory

Question Design/

Evidence Collection

Interpretation of Evidence/ Answers to Questions

Quality Consultatio

n?

Confirm

Theory

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Case Planning

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“GOOD FACTS”

Those pieces of information or evidence which support my working hypothesis

“BAD FACTS”

Those pieces of information or evidence which do not support my working hypothesis or directly refute it.

Lawyers way of looking at

“facts”

Identify Reasonable Case Theories

Trauma/ Culturally-

Informed Case Planning

Question Design/ Evidence Collection

to Explore All Reasonable

Theories

Interpretation of Evidence/ Answers to

Questions

Validate Most Reasonable Theory

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Theory disproved

Theory disproved

New Theory developed

Determine Action/s

MDTConsultation w/

Supervisor, peers, MDT,

experts

Theorydiscarded

OUR MIND PROCESSES…

SATISFICING•Selection of the first identified alternative that appears good enough.

AVAILABILITY

•Ease by which previous examples come to mind. Recent & vivid events easy to recall.

FRAMING• The

presentation of information influences its interpretation. Implies information is understood within a context.

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Minimum Sufficient Level of Information

Experience

Knowledge & Experience

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MDT Case Staffing

Supervisory Consultation

Peer Consultation

“Expert” Consultation

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Truth Evaluation

Denial or Admission

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Decision many of us make frequently as we are confronted with our behaviors or beliefs.

What is it we’re being asked about?What has been our past experience/s?Who is doing the questioning?Can I convince you you’re wrong?How guilty am I feeling?

They’re telling me the truth. I know because…

Its sounds plausible It fits my experience They wouldn’t lie about something like

this Their body language didn’t indicate

deception Their story has been consistent I’ve worked with them before and I

know them

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Secondary Traumatic Stress (STS) and Decision-making

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Sources of Secondary Trauma

in Child Welfare

The death of a child or adult on the worker’s caseload

Investigating a vicious abuse or neglect report

Frequent/chronic exposure to emotional and detailed accounts by children of traumatic events

Photographic images of horrific injury or scenes of a recent serious injury or death

Helping support grieving family members following a child abuse death, including siblings of a deceased child

Concerns about the continued funding and adequacy of resources for their agency

Concerns about being publicly scapegoated for a tragic outcome when they did not have the means or authority to intervene effectively

Source: Osofsky, J. D., Putnam, F. W., & Lederman, C. (2008). How to maintain emotional health when working with trauma. Juvenile and Family Court Journal, 59(4), 91-102

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Fear

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Safety and Trauma

Have problems controllin

g their reactions

to perceived threats

Be hyperaw

are of potential threats

Have difficulty trusting

others to protect them

Have valid fears

about their own safety or

the safety of loved

ones

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Looking at the totality of the information and evidence gathered during the investigation, can you determine:

Was this child abused or neglected?

Who was responsible?

What evidence is there to support our decision?

Substantiation –Validation

Evaluation Of Evidence

Ignorance of Significance Don’t know what is relevant

Don’t collect or document in timely manner Too much stuff, so little relevance

Ignoring Context Misinterpretation of evidence

Verification / Confirmatory Bias “You see what you want to see and hear what you

want to hear.” The Point, 1971 “Jurassic Park” School Of Investigation

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Families who “withdraw” and avoid professional attention, intervention and surveillance.

Dale, 2005

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Multiple Incidents Progression/ Transitional

Behaviors Richness of Details/

Idiosyncratic Details Sexual Knowledge Secrecy Experiential Perspective/

Sensory Details Internal Logic, Consistency,

Feasibility Pressure/ Coercion/

Enticement Family Dynamics/ Outside

Influences

Analyzing the Child’s Statement:

CSA

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•A critical attitude to all evidence is needed•Always check information and remember “facts” can be inaccurate

•Investigators often rely on people’s testimony rather than written records for information•Always check statements against existing records

•When focusing on biological caretaker pay attention to their new relationships •This includes both men & women. How much time are they with the child?

•Avoid “start again syndrome”•When a family is transient and the caseworker approaches the case as new or simply fails to find the prior history

•Past history, written records, abstract theory and research findings tend to be under-used compared with the current, often emotionally charged, factual information gained in interviews

Munro, 1999

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“Good decisions do not guarantee good outcomes.”Munro, 2010

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Children need our Skills, Knowledge, CooperationAnd Caring to help them

grow

Let’s do it right!