The experience of professionals working in childprotection and fabricated and induced illness (FII) : a thematic synthesis of qualitative evidence and a qualitative empirical study

Abstract

Protecting children from harm is a multi-faceted endeavour. Professionals who work in child protection are frequently exposed to high stake, complex, and emotionally demanding situations, which can have significant psychological implications. Vicarious trauma (VT) and secondary traumatic stress (STS) refer to cognitive, emotional and behavioural changes resulting from the indirect exposure to traumatic events. Research has increasingly started to acknowledge and explore this construct amongst the helping professions, but a qualitative review focusing on the experiences of child protection professionals specifically was warranted. Additionally, one specific situation that child protection professionals may be exposed to is the involvement in a case of Fabricated and Induced Illness (FII), which refers to a child being harmed due to parental behaviour and action. The current approach to FII in the UK has been argued to be unsatisfactory in terms of its definition, identification and approach, and there is a limited understanding of professional perspectives. Further curious investigation is needed to understand this experience for professionals. A systematic search of qualitative evidence was completed to thematically synthesise and critically appraise the existing literature on the experiences of VT and STS for child protection workers. It was hoped that the identification of knowledge gaps could enhance understanding and guide future research and practice. Thematic synthesis helped to develop six interconnected themes from 13 identified studies. Findings suggest that VT/STS significantly impact the psychological well-being of child protection professionals, and the experience is much the same as direct trauma survivors. Most significantly, a vicarious trauma-informed awareness is needed at every iii level, in order to prevent psychological harm. Further cross-cultural research and research specific to this population are needed to inform specific interventions. Professional experiences of FII specifically were explored qualitatively, to develop insights into the use of guidance, behaviours associated with FII, and clinical decision-making. Online semi-structured interviews were held with nine professionals who have been involved in an FII case. Six themes and 12 subthemes were developed using Reflexive Thematic Analysis. Findings revealed facilitators and barriers to clinical decision-making at an individual, team and systemic level, as well as the trauma that professionals and families experience from involvement in these cases. Professionals reflected on their learning and ways forward. It was concluded that current guidance lacks ecological and construct validity, and further understanding of the psychological basis of FII is needed in order for a trauma-informed approach and system-wide understanding to occur. Findings from both the literature review and empirical project highlight the considerable psychological burden on child protection professionals as an issue which demands urgent attention. Both illustrate the combined perspective that iatrogenic harm can and does occur at all levels, and this is in part due to a system that lacks understanding of concepts such as VT, STS and FII. Ultimately, the results highlight the need for a system-wide, trauma-informed approach to practice and policy in the child protection field.