Abstract
Background:
Despite being well-positioned to identify maltreatment in the children that they provide care for and being legally required to report suspected child maltreatment, early childhood providers (ECPs) make a limited proportion of reports to child protective services. It is critical to identify evidence-based interventions to improve the reporting practices of this group of mandated reporters allowing for the better protection of children from maltreatment.
Objective:
The goal of the present study was to determine if iLookOut, an online child abuse identification and reporting training for ECPs, results in differential gains in knowledge and attitudes towards child abuse and its reporting among ECPs, as compared to an online standard training.
Participants and Setting:
Both interventions were completed online by participants recruited from licensed child care programs in Southern Maine from October 2017 to January 2020. Eligibility criteria included being at least 18 years of age, English-speaking, and working as paid or volunteer staff at a licensed child care program taking care of children 5 years of age or younger. Of the 1152 enrolled individuals, 1094 provided complete pre- and post-intervention data.
Methods:
A randomized controlled trial comparing iLookOut with an online standard training.
Results:
ECPs who completed iLookOut significantly outperformed those who completed Standard madated reporter training in terms of both knowledge (d=1.09 vs. 0.67) and attitudes (d=0.67 vs. 0.54) relative to pre-test scores.
Conclusions:
iLookOut is a promising candidate for widespread use in meeting the need for evidence-based training on child abuse and its reporting.
Keywords: child maltreatment, abuse, neglect, randomized controlled trial, mandated reporting, early childhood professionals
Child maltreatment is a known harm. In addition to being a preventable cause of injury and death to children. Children who experience maltreatment are at increased risk for negative cognitive, language, social, and emotional functioning across the lifespan (Cicchetti & Toth, 2005). Each year in the U.S., child protective services (CPS) receive reports regarding potential maltreatment for over 7.8 million children (U.S. Department of Health & Human Services, 2020). Research from the National Child Abuse and Neglect Data System Child Files indicates that by age 18 years approximately 1 in 3 children are referred to CPS (Kim, Wildeman, Jonson-Reid, & Drake, 2017), with 1 in 8 children found to have confirmed maltreatment (Wildeman et al., 2014).
These numbers indicate that a large proportion of families come into contact with CPS and highlight the important and difficult task CPS workers must do to sift through millions of cases each year. Given that many children experiencing maltreatment (“abuse”) are never reported, and that many who are referred have not in fact experienced abuse, high-quality reports are essential for improving the efficiency and efficacy of CPS actions.
Young children are most at risk for maltreatment (U.S. Department of Health & Human Services, 2020), and nearly 7 million infants, toddlers, and preschool age children attend child care settings (Laughlin, 2013). Early childhood professionals (ECPs; e.g., preschool teachers, day care providers, child care administrators, and support staff) are not only well-positioned to identify maltreatment in the children that they provide care for, but are also mandated reporters (i.e., legally designated individuals required to report suspected child maltreatment) (Dinehart, Katz, Manfra, & Ullery, 2013; Mathews & Kenny, 2008). Yet, ECPs make up less than one percent of all reports to CPS (Services, 2020). Potential reasons for this low reporting rate include failure to recognize the abuse, confusion or disagreement about when reports should be made regarding suspected child abuse or neglect, as well as whether the risks of making reports to CPS outweigh the benefits (Alvarez, Kenny, Donohue, & Carpin, 2004). Moreover, it is widely recognized that the lack of high quality, evidence-based training contributes to such confusion and disagreement (Walsh & Jones, 2015).
To address this need for training ECPs about child abuse and its reporting, iLookOut for Child Abuse (iLookOut) was created to provide a customized online educational intervention (Levi et al., 2019). Previous work examining iLookOut’s efficacy at improving knowledge and changing attitudes regarding child abuse reporting comes from a test-retest randomized controlled trial (RCT) of 741 CCPs in the state of Pennsylvania (Mathews et al., 2017). iLookOut outperformed the control group in both improvements in knowledge and changes in attitudes about reporting. A follow-up “real-world study” (i.e., more realistic and generalizable relative to RCTs) of iLookOut in 11,065 ECPs (Yang et al., 2020), also found large effect sizes for changes in knowledge and attitudes. Thus, while iLookOut appears to be a promising intervention targeting ECPs for child abuse reporting, this intervention has yet to be rigorously compared to current mandated reporter training.
In this study we present the first randomized controlled comparison trial of the iLookOut intervention, here using the state of Maine’s standard online mandated reporter training. We have three aims. First, we aim to examine pre- to post-intervention changes in knowledge regarding child abuse and its reporting among ECPs affiliated with child care programs assigned to the iLookOut and standard online trainings. This allows for causal inferences to be made using an active comparison group. Second, we aim to examine pre- to post-intervention changes in these groups in relation to attitudes regarding child abuse reporting. Third, we aim to explore whether characteristics of the ECP are associated with the degree of changes in knowledge and attitudes.
Methods
We present outcomes from 1094 ECPs who completed an RCT of training about child abuse and its reporting. Using a test-retest design, at baseline and also following completion of their assigned intervention, we assessed knowledge of child maltreatment, risk factors for maltreatment, and the legal requirements for reporting suspected maltreatment as well as attitudes towards reporting. Changes in scores on these two metrics (i.e., knowledge and attitudes) were compared between those assigned to the iLookOut intervention group and those assigned to the Standard intervention group. iLookOut has been described extensively in prior papers (Kapp et al., 2020; Levi et al., 2019; Mathews et al., 2017), but in brief includes a video-based storyline, game-based techniques, and interactive learning exercises, in conjunction with pre-/post-tests. ECPs learn about events that occur over 2 days in the work-life of a provider named Megan as she recounts them to Elisha, a mentor whose guidance she is seeking. At different junctures, the learner is provided resources (e.g., Facts about Abuse, Red Flags handout), posed didactic questions, and given opportunities to apply new information and practice decision-making. Such immersion into real-life scenarios helps ECPs absorb and operationalize information and develop skills to protect children from harm. The Standard intervention is Maine’s state developed mandated reporter training. In an effort to provide comparable professional development hours handouts on basic child development (i.e., language, cognitive, and social-emotional development) were added.
The study was approved by the Institutional Review Board of Penn State University and registered at the U.S. National Institutes of Health #NCT03185728 (https://clinicaltrials.gov/ct2/show/NCT03185728). At study initiation, a total of 1152 individuals were enrolled. However, 11 provided no pre or post-intervention data and an additional 47 provided only pre-intervention data. Those who were assigned but did not complete iLookOut did not differ from those who did in age, gender, race, ethnicity, marital status, education, religiosity, parental status, age of youngest child, employment type, formal training in early childhood education, previous child abuse training, previous online mandated reporter training, previous in-person training, times having reported abuse, primary job responsibility, work setting, years as a provider, or years at current workplace. For more information on the study flow, please see the CONSORT diagram (Figure 1).
Figure 1.
Study CONSORT Diagram.
Participants
Participants were ECPs from the U.S. state of Maine (population 1.344 million), whose population is predominantly Caucasian (94%), has a median per capita income ($31,253 USD) slightly below that of the U.S. ($32,621 USD) (United States Census Bureau, 2018), and has a large rural population (65%) (United States Census Bureau, 2010). Eligibility criteria included being at least 18 years of age, English-speaking, and working as paid or volunteer staff at a licensed child care program (commercial, non-commercial, home-based, or other) taking care of children 5 years of age or younger. A list of all licensed child care programs in the study catchment area was obtained from Maine’s Office of Licensing. These programs were then randomized using a stratified randomized block design (block size:3) generated by SAS software 9.4 (SAS Institute, Cary, NC) to receive either the iLookOut intervention or Maine’s existing online course on mandated reporter training. Randomization was based on the following criteria: Type (center, Head Start, home-based, preschool/nursery); number of children authorized to attend (<10, 11–25, >25); census-based rurality; RUCA (rural-urban commuting area)-based rurality (U.S. Department of Agriculture, 2020), and quality rating. Recruitment materials were sent to directors of all licensed child care programs in southern Maine. Directors of child care programs were then provided with web links enabling their staff to access iLookOut. Participants provided informed consent prior to starting the intervention, and indicated willingness to be re-contacted several months later for follow-up. A $5 gift certificate was provided following successful completion of iLookOut, which also conferred professional development credit, and satisfied state requirements for mandated reporter training. Data were collected from October 2017 to January 2020.
Measures
In addition to information assessing demographic and workplace characteristics, participants completed two measures at baseline and post-intervention. The knowledge measure (Mathews et al., 2017) comprised 25 items, each with a single correct answer (possible range of 0 to 25). Briefly, this measure assessed knowledge about child maltreatment, risk factors for maltreatment, and the legal requirements (and protections) related to reporting suspected maltreatment for ECPs to report child maltreatment. The knowledge measure was adapted from a previously validated instrument described elsewhere (Mathews et al., 2017). It was subsequently reviewed by content experts in child welfare, law, state policy, and child abuse; examined for both construct and content validity through stratified cognitive interviews in multiple states (Panlilio et al., 2020); and then field-tested with ECPs. The measure was adapted to reflect Maine law through expert review by Maine’s Office of Child and Family Services. In the current sample, the internal consistency of this measure at the first administration was 0.72.
The 13-item previously validated attitudes scale (Mathews et al., 2017) assessed participants’ commitment to the role of the professional in reporting, confidence in CPS to respond effectively, and concerns about consequences of reporting. Each item used a 10-point Likert-style scale (1=Strongly Disagree; 10=Strongly Agree). In the current sample, the internal consistency of this measure at the first administration was 0.80. In addition to individual item pre/post comparisons, change in total score was calculated by adding together the scores for each item, subtracting the total pre-test score from the total post-test score, and dividing by 13. Some responses were reverse scored to achieve consistency that would allow for calculating a summary total score.
Statistical analysis
The present data are drawn from a larger study still in progress. The step wedge design of this study allowed us to conduct interim analyses after the standard learning program was closed for participation. All analyses were performed using SAS and a significance level of 0.05. In order to detect potential demographic or workplace differences as a function of the intervention arm, each variable was examined relative to group assignment using Chi-square tests. Statistical significance was set at p<0.05. Variables in which differences were detected were included in analyses examining knowledge and attitudes in the iLookOut vs. Standard intervention groups.
The primary analyses examined whether changes in knowledge and attitudes differed as a function of the intervention arm. A linear effects model for the mean change in the knowledge score, attitude average, or individual attitude items was used. This model included factors for the study group as well as the pre outcome measurement, parental status, previous child abuse training, and primary job responsibility. Cohen’s d was calculated to assess the effect size. The change in the percentage correct from pre to post for the individual knowledge questions was analyzed using a generalized estimating equations (GEE) model, also adjusted for parental status, previous child abuse training, and primary job responsibility. Cohen’s h statistic was calculated to assess the effect size on the item level (see Supplemental Tables 1 and 2). We also investigated the interaction between the pre outcome measurement and the study group in relation to the change in knowledge score or attitude average with a linear effects model that compared the slopes of the regression for the pre outcome measurement with the change in the outcome between the study groups.
Exploratory analyses were then conducted to examine whether individual or workplace characteristics moderated the effect of the intervention differences. These characteristics were age, gender, race, ethnicity, marital status, education, religiosity, parental status, age of youngest child, employment type, formal training in early childhood education, previous training about child abuse, previous online mandated reporter training, previous in-person training, times having reported abuse, primary job responsibility, work setting, years as a provider, or years at current workplace, as well as baseline scores on the knowledge and attitudes scales.
Results
Randomization
Table 1 presents characteristics of those who completed the iLookOut vs. Standard intervention. By chance, those in the iLookOut arm were less likely to be parents, more likely to have had previous child abuse reporter training, and less likely to be the director of the child care program. These characteristics were therefore included as covariates in subsequent analyses.
Table 1.
Demographics by Study Arm
| Variable | Total N=1094 N (%) | Standard N=304 N (%) | iLookOut N=790 N (%) | P-value (χ2 or Mann Whitney U-test) |
|---|---|---|---|---|
|
| ||||
| Age (years) | 0.508 | |||
| 18–29 | 396 (36) | 102 (34) | 294 (37) | |
| 30–34 | 334 (31) | 95 (31) | 239 (30) | |
| More than 44 | 364 (33) | 107 (35) | 257 (33) | |
| Gender | 0.320 | |||
| Male | 51 (5) | 11 (4) | 40 (5) | |
| Female | 1041 (95) | 291 (96) | 750 (95) | |
| Non-White Race | 0.220 | |||
| Yes | 51 (5) | 18 (6) | 33 (4) | |
| No | 1043 (95) | 286 (94) | 757 (96) | |
| Hispanic/Latino | 0.373 | |||
| Yes | 14 (1) | 2 (1) | 12 (1) | |
| No | 1080 (99) | 302 (99) | 778 (99) | |
| Marital Status | 0.513 | |||
| Single | 397 (36) | 105 (35) | 292 (37) | |
| Married/Cohabitating | 609 (56) | 179 (59) | 430 (54) | |
| Separated/Divorced | 76 (7) | 17 (6) | 59 (7) | |
| Widowed | 12 (1) | 3 (1) | 9 (1) | |
| Education | 0.229 | |||
| High School or Less | 441 (40) | 125 (41) | 316 (40) | |
| CDA credential | 44 (4) | 16 (5) | 28 (4) | |
| Associate’s Degree | 224 (21) | 70 (23) | 154 (19) | |
| Bachelor’s Degree | 294 (27) | 70 (23) | 224 (28) | |
| Graduate Degree | 91 (8) | 23 (8) | 68 (7) | |
| Religiosity | 0.866 | |||
| Extremely Unreligious | 34 (3) | 10 (3) | 24 (3) | |
| Unreligious | 217 (20) | 57 (19) | 160 (20) | |
| Somewhat Unreligious | 49 (4) | 15 (5) | 34 (4) | |
| Neutral | 303 (28) | 84 (28) | 219 (28) | |
| Somewhat Religious | 240 (22) | 73 (24) | 167 (21) | |
| Religious | 220 (20) | 59 (19) | 161 (20) | |
| Extremely Religious | 31 (3) | 6 (2) | 25 (3) | |
| Parent/Guardian | 0.008 | |||
| Yes | 669 (61) | 205 (67) | 464 (59) | |
| No | 425 (39) | 99 (33) | 326 (41) | |
| Age of Youngest Child | 0.179 | |||
| 5 years or Younger | 189 (28) | 67 (33) | 122 (26) | |
| 6–17 Years Old | 265 (40) | 80 (39) | 185 (40) | |
| Older than 18 Years | 215 (32) | 58 (28) | 157 (34) | |
| Employment | 0.226 | |||
| Volunteer | 22 (2) | 4 (1) | 18 (2) | |
| Paid Full-Time | 849 (78) | 231 (76) | 618 (78) | |
| Paid Part-Time | 208 (19) | 63 (21) | 145 (18) | |
| Paid Seasonal | 6 (1) | 1 (1) | 5 (1) | |
| Paid Substitute | 9 (1) | 5 (2) | 4 (1) | |
| Formal Training in Child Development | 0.596 | |||
| Yes | 436 (40) | 125 (41) | 311 (39) | |
| No | 658 (60) | 179 (59) | 479 (61) | |
| Any previous mandated reporter training | 0.034 | |||
| Yes | 528 (48) | 131 (43) | 397 (50) | |
| No | 566 (52) | 173 (57) | 393 (50) | |
| Previous Maine OCFS online mandated reporter training | 0.054 | |||
| Yes | 328 (58) | 74 (51) | 254 (60) | |
| No | 239 (42) | 71 (49) | 168 (40) | |
| In-person OCFS training | 0.425 | |||
| Yes | 186 (34) | 43 (31) | 143 (35) | |
| No | 362 (66) | 95 (69) | 267 (65) | |
| Times Reported Abuse (by primary job responsibility) | 0.64 (1.47) | 1.21 (4.78) | 0.782 | |
| Director/Owner | 206 (19) | 70 (23) | 136 (17) | 0.027 |
| Assistant Director | 42 (4) | 14 (5) | 28 (4) | |
| Teacher | 483 (44) | 136 (45) | 347 (44) | |
| Teacher’s Aid | 250 (23) | 64 (21) | 186 (24) | |
| Support | 113 (10) | 20 (7) | 93 (12) | |
| Work Setting | 0.190 | |||
| Rural | 68 (6) | 24 (8) | 44 (6) | |
| Suburban | 960 (88) | 258 (85) | 702 (89) | |
| Urban | 66 (6) | 22 (7) | 44 (6) | |
| Years as ECP Less | 0.549 | |||
| Than 1 | 140 (13) | 35 (12) | 105 (13) | |
| 1–2 | 131 (12) | 34 (11) | 97 (12) | |
| 3–5 | 219 (20) | 55 (18) | 164 (21) | |
| 6–10 | 176 (16) | 58 (19) | 118 (15) | |
| 11–15 | 132 (12) | 38 (13) | 94 (12) | |
| More Than 15 | 296 (27) | 84 (28) | 212 (27) | |
| Years at Current Workplace | 0.620 | |||
| Less Than 1 | 316 (29) | 77 (25) | 239 (30) | |
| 1–2 | 194 (8) | 59 (19) | 135 (17) | |
| 3–5 | 201 (20) | 60 (20) | 141 (18) | |
| 6–10 | 46 (13) | 38 (13) | 108 (14) | |
| 11–15 | 92 (8) | 27 (9) | 65 (8) | |
| More Than 15 | 145 (13) | 43 (14) | 102 (13) | |
Intervention Effects
Aim 1. Pre- to post-assessment of knowledge improved in both the Standard arm (baseline mean: 18.6, 95% CI [18.3, 18.9] to post-test: 20.2, 95% CI [19.9, 20.5]; p<.001; Cohen’s d=0.67) and the iLookOut arm (baseline mean: 18.2, 95% CI [18.0, 18.4] to post-test: 21.4, 95% CI [21.2, 21.6]; p<.001; d=1.09). However, significantly greater gains were made in the iLookOut arm (p<.001; see Figure 2). Item-level data for these changes in can be found in Supplemental Table 1. Of particular note is the markedly greater improvement with iLookOut with regard knowledge about bruising, including differentiating bruises from birthmarks (Supplemental Table 1).
Figure 2.
Change in knowledge scores as a function of intervention arm.
Aim 2. Pre- to post-assessment of attitudes about child maltreatment and its reporting again showed changes in both those in the Standard arm (baseline mean: 8.7, 95% CI [8.6, 8.8] to post-test: 9.1, 95% CI [9.0, 9.2]; p<.001; Cohen’s d=0.54) and the iLookOut arm (baseline mean: 8.6, 95% CI [8.5, 8.7] to post-test: 9.2, 95% CI [9.1, 9.3]; p<.001; d=0.66), but again to a greater extent in the iLookOut arm (p<.001; see Figure 3). Item-level data for these changes in attitude can be found in Supplemental Table 2.
Figure 3.
Change in attitude scores as a function of intervention arm.
Exploratory Analyses of Intervention Moderators
Aim 3. We examined whether any participant or workplace characteristics were associated with differential changes in scores for either knowledge or attitudes as a function of the intervention arm. The only specific difference found was that individuals with lower knowledge scores at baseline made much greater gains in knowledge when assigned to the iLookOut group relative to the Standard intervention (F(1, 1090)=7.42, p<.05).
This same effect was found for attitude scores, insofar as individuals with lower baseline attitude scores assigned to the iLookOut group showed significantly greater changes in attitudes relative to those assigned to the Standard intervention (F(1, 1090)=337.55, p<.0001). No demographic characteristics were associated with differential gains in knowledge or attitudes.
Discussion
The present randomized controlled trial demonstrates that early childhood professionals who completed iLookOut outperformed those who completed Standard mandated reporter training in terms of both knowledge (d=1.09 vs. 0.67) and attitudes (d=0.67 vs. 0.54). Exploratory analyses examining potential moderators of the effectiveness of iLookOut relative to the Standard intervention indicated that lower baseline knowledge and lower scores on the attitudes measure predicted greater the gains at post-test. For both knowledge and attitudes, these gains were significantly greater with the iLookOut intervention.
While the present findings are consistent with prior data on the iLookOut intervention, they fill an important gap in knowledge. The initial evaluation of iLookOut’s effectiveness by Mathews et al. (2017), which involved a test-retest design, and the subsequent real world study by Yang et al. (2020) both found that iLookOut significantly (p<0.001) improved knowledge (d=0.95 and d=0.96, respectively) and changed attitudes (d=0.98 and d=0.80, respectively) from pre- to post-training. In neither of these studies, however, was iLookOut compared to standard training (i.e., active comparison training). Such a comparison is valuable because it helps demonstrate that an interactive online training that uses best practices for adult learning and a nuanced approach to decision-making markedly outperforms standard training approaches. This is important because we need more effective ways to prepare mandated reporters to protect children from maltreatment (Humphreys, 2020). Such individuals need to know what to report and when, as well as when not to report; and they also need resources to help them feel (and be) prepared to make reports that provide the information that CPS needs to protect at-risk children. Given the potential for disproportionate referrals made to CPS for people of color, the ability to imbue knowledge (as iLookOut does) about what is a concerning bruise versus birthmark may be particularly helpful.
The advantage in improved knowledge from participation in iLookOut may be attributable to more active learning processes by ECPs relative to standard training. Specifically, components of the iLookOut training modules, such as the interactive scenarios, relevance to practice, first-person perspective video storylines, knowledge prompts, and downloadable resources, have been designed to foster more learner engagement. Within primary, secondary, and post-secondary education, learner engagement is defined as the “active, goal-directed, flexible, constructive, persistent, focused interactions with the social and physical environments” (p. 149) (Furrer & Skinner, 2003). According to Fredricks et al. (2004), engagement is multifaceted and includes cognitive (i.e., thoughtfulness and willingness to exert the effort necessary to comprehend complex ideas and master difficult skill), behavioral (i.e., drawing from the idea of participation), and affective dimensions (i.e., positive and negative reactions to learning environments that influence willingness to do the work). From this perspective, iLookOut’s customizable online learning experience (which is not present in standard training) may allow the learner to deepen their understanding and appreciation of mandated reporter responsibilities.
Several potential moderators of the differences in increased knowledge or attitude scores between the interventions were examined. Only baseline scores were found to moderate intervention differences in improvements, and this effect was found for both knowledge and attitudes. Specifically, individuals with lower baseline knowledge and attitude scores made greater gains in knowledge and attitudes, respectively, when assigned to iLookOut. This cannot be attributed to regression to the mean (Marsden & Torgerson, 2012) given that any differences between pre- and post-test from such a phenomenon would be cancelled out to due to the RCT design (Tucker-Drob, 2011). Lower baseline scores indicate the greatest potential to improve over the course of any intervention. Moreover, ECPs with the lowest scores at baseline for knowledge and attitudes are likely the individuals for whom additional training is most important. Thus, it is particularly promising that iLookOut is especially effective in improving both knowledge and attitudes among those most in need.
While there are several strengths to this study, including the large sample size and rigorous RCT design, several limitations should be noted. The randomization procedure did not result in groups that were of identical size and some participant demographic and workplace characteristics differed between arms. That said, these variables were not found to impact the key findings for either knowledge or attitudes. In addition, while changes in knowledge and attitudes are considered to be important precursors to behavior change (Ajzen & Fishbein, 2005), the present data are not correlated with ECPs’ actual reporting behavior. Preliminary data from this ongoing study do suggest that iLookOut positively influences ECPs’ reporting, but to date such outcomes cannot be stated with certainty. Lastly, it is unclear how much the effects of the iLookOut training diminish over time. The earlier trial by Mathews and colleagues (2017) showed that 52% of the gains in knowledge from iLookOut were sustained 4–5 months postintervention; and a similar trend was seen with regard to attitudes. A rigorous evaluation of how to sustain improvement in knowledge and attitudes from iLookOut has been proposed, and is currently under consideration for funding.
In conclusion, this study demonstrates that, compared to standard online training, iLookOut results in significant gains in knowledge and changes in attitude with regard to child abuse and its reporting. Those who care for young children and are designated as mandated reporters need evidence-based training to help them protect children from maltreatment. iLookOut is a promising candidate for widespread use in meeting these training needs. Future research will examine iLookOut’s impact on subsequent behavior, and if effective may be important to adapt to other states as well as for use with other mandated reporters (e.g., pediatricians, law enforcement, social workers).
Supplementary Material
Article Summary
Early childhood professionals who completed iLookOut significantly outperformed those who completed Standard online mandated reporter training in changes in knowledge and attitudes.
What’s Known on This Subject
Despite being well-positioned to identify and legally required to report suspected child maltreatment, early childhood providers make a limited proportion of reports. High quality, evidence-based trainings are needed to improve the child abuse reporting practices of ECPs.
What This Study Adds
In the first randomized controlled comparison trial of iLookOut, greater knowledge and attitudes improvements were made in the iLookOut versus Standard arm. iLookOut is a promising candidate for meeting the need for evidence-based training on child abuse and its reporting.
Highlights.
Knowledge and attitudes regarding child abuse and its reporting are modifiable
iLookOut outperformed a Standard online intervention in improving knowledge
iLookOut outperformed a Standard online intervention in improving attitudes
Acknowledgements:
All phases of this study were supported by the National Institute of Child Health and Human Development [R01HD088448] (PI: Levi). Dr. Humphreys received funding for her time from the Jacobs Foundation Early Career Research Fellowship [2017-1261-05].
Funding/Support: All phases of this study were supported by the National Institute of Child Health and Development, R01HD088448 (PI: Levi). Dr. Humphreys received funding for her time from the Jacobs Foundation Early Career Research Fellowship, 2017-1261-05.
Abbreviations:
- ECP
early childhood provider
- CI
confidence interva
- CPS
child protective services
- GEE
generalized estimating equations
- RCT
randomized controlled trial
- RUCA
rural-urban commuting area
Footnotes
Conflict of Interest Disclosures: The authors have no conflicts of interest to disclose.
Clinical Trial Registration:ClinicalTrials.gov; Identifier: NCT03185728; https://clinicaltrials.gov/ct2/show/NCT03185728. Data Sharing Statement: Deidentified individual participant data will not be made available.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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