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Campbell KA, Myrup T, Branson DB, Svedin L. A collaborative practice pilot between child welfare and child health care providers: Lessons in implementation and evaluation of cross-sector interventions. CHILD ABUSE & NEGLECT 2024; 149:106694. [PMID: 38359777 DOI: 10.1016/j.chiabu.2024.106694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/18/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Improved collaboration between child welfare and health care offers the possibility of improved child well-being after child welfare involvement. OBJECTIVE To pilot a collaborative practice model between CPS caseworkers and pediatric primary care providers (PCPs). PARTICIPANTS AND SETTING Infants remaining at home following child welfare involvement in 2 regions of a Western state were randomly assigned to collaborative vs. standard practice between 11/2017 and 03/2019. METHODS CPS caseworkers were trained and randomized into standard vs collaborative practice model developed to promote information sharing between caseworkers and PCPs. A mixed-methods evaluation integrated administrative and qualitative data from child welfare, caregivers, caseworkers and PCPs. Outcomes evaluated included practice implementation; caregiver, caseworker, and PCP satisfaction with collaborative practice; and preliminary descriptions of practice impact. RESULTS There were 423 eligible cases randomized to either collaborative or standard practice. Uptake of all elements of the collaborative practice by caseworkers was limited. There were no significant differences in parental satisfaction with caseworkers, parental communication with PCPs regarding social risks or CPS involvement or repeat CPS investigations within 6 months of case closure identified between practice arms. Qualitative themes regarding facilitators of and barriers to implementation were explored from both PCP and CPS caseworker perspectives. CONCLUSIONS Limited uptake challenges our ability to identify potential benefits of a collaborative practice for infant health or welfare outcomes. CPS caseworkers and pediatric PCPs report barriers to implementation as well as potential benefits for children and families with a more successful collaborative practice model.
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Affiliation(s)
- Kristine A Campbell
- Department of Pediatrics, Division of Child Protection and Family Health, University of Utah, Center for Safe and Healthy Families, 4E-200, Eccles Outpatient Building, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
| | - Tonya Myrup
- Utah Department of Health and Human Services, Division of Child and Family Services, Multi-Agency State Office Building, 195 North 1950 West, Salt Lake City, UT 84116, USA.
| | - David B Branson
- Department of Pediatrics, University of Utah, Pediatric Residency Office, Eccles Outpatient Building, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
| | - Lina Svedin
- Department of Political Science, University of Utah, Gardner Commons, Room 3350, 260 S. Central Campus Dr., Salt Lake City, UT 84112, USA.
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Rebbe R, Reddy J, Huang JS, Kuelbs CL, Putnam-Hornstein E. Counts and child protection reports of diagnosed child maltreatment before and after the COVID-19 pandemic onset. CHILD ABUSE & NEGLECT 2023; 146:106450. [PMID: 37708644 PMCID: PMC10872595 DOI: 10.1016/j.chiabu.2023.106450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic. OBJECTIVE To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19. PARTICIPANTS AND SETTING All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021. METHODS Using linked medical record and CPS administrative data, interrupted time series models tested for changes in monthly counts and percentages of CM medical encounters reported to CPS with the onset of COVID-19. Logistic regression tested for the likelihood of a CPS report being associated with a CM encounter. RESULTS CM medical encounters totaled 2528, including 793 after the onset of COVID-19. Interrupted time series models indicated with the onset of the pandemic, the counts of CM encounters increased 18 % (RR: 1.18, 95 % CI 1.03-1.34) and the percentages reported to CPS increased 10 % (RR: 1.10, 95 % CI: 1.05-1.17). CM encounters that occurred after the onset of the COVID-19 pandemic had increased odds of a CPS report (fully adjusted model: OR: 1.08; 95 % CI: 1.05-1.12). CONCLUSIONS This study found increases in monthly counts and a higher percentage of CM medical encounters with CPS reports after the pandemic onset.
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Affiliation(s)
- Rebecca Rebbe
- University of North Carolina at Chapel Hill School of Social Work, 325 Pittsboro St, Chapel Hill, NC 27599, USA.
| | - Julia Reddy
- University of North Carolina at Chapel Hill School of Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Jeannie S Huang
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA; University of California, San Diego Department of Pediatrics, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Cynthia L Kuelbs
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA; University of California, San Diego Department of Pediatrics, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - Emily Putnam-Hornstein
- University of North Carolina at Chapel Hill School of Social Work, 325 Pittsboro St, Chapel Hill, NC 27599, USA; Children's Data Network, University of Southern California, 669 W 34th St, Los Angeles, CA 90089, USA.
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Tolliver DG, He Y, Kistin CJ. Child Maltreatment. Pediatr Clin North Am 2023; 70:1143-1152. [PMID: 37865436 DOI: 10.1016/j.pcl.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Child maltreatment is associated with significant morbidity, and prevention is a public health priority. Given evidence of interpersonal and structural racism in child protective service assessment and response, equity must be prioritized for both acute interventions and preventive initiatives aimed at supporting children and their families. Clinicians who care for children are well positioned to support families, and the patient-centered medical home, in collaboration with community-based services, has unique potential as a locus for maltreatment prevention services. Clinicians can advocate for policies that support families and decrease the risk of child maltreatment.
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Affiliation(s)
- Destiny G Tolliver
- Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, 801 Albany Street, Boston, MA 02119, USA
| | - Yuan He
- Division of General Pediatrics, Children's Hospital of Philadelphia, 4865 Market Street, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Caroline J Kistin
- Division of Health Services, Policy, and Practice, Hassenfeld Child Health and Innovation Institute, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA.
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Jones MU, Banaag A, Nafea SS, Koehlmoos TP. Evaluation of Racial Disparities in Suspected Child Abuse among Insured Children with Head Injury. CHILD MALTREATMENT 2023; 28:713-722. [PMID: 36571822 DOI: 10.1177/10775595221148424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Previous studies demonstrate racial disparities in child abuse evaluations even after controlling for health insurance coverage. We conducted a cross-sectional study using the Military Health System Data Repository (MDR) of Military Health System (MHS) beneficiaries born between fiscal years 2016 and 2018 to evaluate racial disparities and other factors in the suspicion of child abuse. We observed beneficiaries for 2.5 years after birth and assessed the incidence of head injury using diagnostic codes. Among children with head injury codes, we performed a multivariable logistic regression analysis to measure the association between race and the concurrent use of the diagnostic code for suspected child abuse (SCA) or for the performance of a skeletal survey. There were 195,893 infants included and 45,269 (23.1%) underwent evaluations for head injury. Less than one percent (n = 424) concurrently had the diagnostic code for SCA or a skeletal survey performed within 2 weeks of the head injury evaluation. When controlling for other factors, race was not associated with SCA. Higher military rank was independently associated with decreased odds of SCA. Racial disparities in SCA may be mitigated in the MHS, and further evaluation is needed. Military rank could be a factor in SCA disparities and warrants further study.
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Affiliation(s)
- Milissa U Jones
- Department of Pediatrics, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Amanda Banaag
- Department of Pediatrics, Tripler Army Medical Center, Tripler Army Medical Center, HI, USA
| | - Shamim S Nafea
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
| | - Tracey Perez Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, USA
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Jamaer M, Van den Eynde J, Aertgeerts B, Toelen J. Knowledge of Child Abuse and Neglect among General Practitioners and Pediatricians in Training: A Survey. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1429. [PMID: 37761390 PMCID: PMC10528059 DOI: 10.3390/children10091429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Child abuse and neglect is a common, underreported, and worldwide problem. Health care providers play an important role in detecting and reporting this problem. This study examined the knowledge on the clinical signs and mimickers of child abuse among Belgian trainees in family medicine and pediatrics. Participants filled out an anonymous online survey of 15 fictional but realistic cases with either suspicious or non-suspicious signs of abuse or neglect in the context of primary or emergency care. The overall score on all cases, the number of correct answers per case, and the median score were calculated, and the association of the participant's demographic characteristics with their score was examined using regression analysis. A total of 70 participants completed the survey. The overall median score was 73.3% (IQR 20.0%). The suspicious cases were solved more correctly than the non-suspicious cases (median: 85.7% versus 62.5%, p < 0.001). Regression analysis could not reveal a significant association of type and level of education with the performance on the survey. Knowledge of the clinical signs of child maltreatment among pediatricians and general practitioners in training is good, but there is still room for improvement.
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Affiliation(s)
- Marjolijn Jamaer
- Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium; (M.J.); (J.V.d.E.)
| | - Jef Van den Eynde
- Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium; (M.J.); (J.V.d.E.)
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD 21205, USA
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Jaan Toelen
- Leuven Child and Health Institute, KU Leuven, 3000 Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, 3000 Leuven, Belgium
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Tsur N, Najjar AA, Katz C. "When I was a child, the doctor advised me to have sex more gently": The perceptions and experiences with the healthcare system as conveyed by adult survivors of child sexual abuse. Soc Sci Med 2023; 320:115685. [PMID: 36652755 DOI: 10.1016/j.socscimed.2023.115685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
RATIONALE Extensive findings have illuminated the implications of child sexual abuse (CSA) for mental and physical health. Attention has been dedicated to the discrepancy between the high prevalence of CSA, and the lack of adequate CSA screening and trauma-informed care within healthcare systems. OBJECTIVE This study was designed to examine this discrepancy by providing CSA survivors' perspectives. Specifically, this study aims to uncover the perceptions and experiences of female survivors of CSA concerning their encounters with the healthcare system. METHODS Written narratives were collected from 53 female survivors of CSA as part of the Israeli Independent Public Inquiry into CSA, which were analyzed guided by an inductive thematic analysis. RESULTS This study's findings portrayed a complex scenery in which female survivors of CSA are concurrently dependent on healthcare services due to the CSA-related morbidity, yet they are hesitant and have difficulty approaching healthcare services. Additionally, the findings showed that the survivors of CSA described being perceived as mentally ill and distrustful; they also were encouraged to take excessive medication by healthcare providers, which resulted in many survivors of CSA avoiding further treatment. Furthermore, the survivors of CSA conveyed several clear messages to the healthcare system, all of which called for the urgent need to implement trauma-informed care. CONCLUSIONS These findings underline the necessity of a paradigm shift in which health and illness are viewed in light of personal, interpersonal, and social contexts. Simply put, it is time for trauma-informed care to be extensively implemented in healthcare services.
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Affiliation(s)
- Noga Tsur
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.
| | | | - Carmit Katz
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Knowledge, attitude, and practice regarding child maltreatment amongst Iranian medical students through internship course: an 18-month longitudinal study. BMC PRIMARY CARE 2023; 24:37. [PMID: 36717772 PMCID: PMC9886537 DOI: 10.1186/s12875-023-01988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Child maltreatment has been a major worldwide problem and has remained a persistent public health challenge in all countries. Physicians have a significant role in the prevention and intervention of child maltreatment. An educated physician that can effectively identify and report child maltreatment can fill one of the most significant gaps in reducing child abuse. This study was performed to examine the knowledge, attitude, and practice regarding child maltreatment among Iranian medical students through an internship course. METHOD All the medical students (235 students) of the Iran University of Medical Sciences who passed the internship entrance exam in the 2019-2020 academic year participated in this study. The participants completed a 49-item scale questionnaire built by combining three other validated questionnaires that evaluate their attitude, knowledge, and practice skills in the first month of their internship course and then completed the same questionnaire 18 months later, at the end-point of the internship period. RESULTS One-hundred thirty nine (59.1%) participants were female, and 96 (40.9%) were male. The mean age of the subjects was 24.35 ± 0.76. Only 7 (3%) of them formerly received any education about child maltreatment. There was a significant improvement in scores of the knowledge of prevention (p-value = 0.001), the practice of prevention (p-value < 0.001) and the general subscale of the practice section (p-value < 0.001) during the internship course. However, the performance of participants decreased significantly in the subscales of the attitude towards diagnosis (p-value = 0.001) and the attitude towards reporting (p-value < 0.001) of child maltreatment. At the end of the study, the result of graduated physicians was: The total knowledge and attitude of participants were satisfactory, and the majority were at reasonable levels. Although in the practice subscale, 70.6% of the participants didn't identify, 84.7% didn't refer, and 86.4% didn't report a child abuse case in the past year. CONCLUSION The knowledge and attitude of Iranian physicians regarding child maltreatment are at a satisfactory level. Although, the practice level has deficiencies. In addition, our findings show that Iranian interns have a shallow experience regarding child maltreatment, particularly despite the higher scores in attitude and knowledge, which can be the reason for deficiencies in the practice level.
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8
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Yamaguchi A, Niimura M, Sonehara H, Sekido Y, Kishimoto M, Tachibana Y, Takehara K. The characteristics of children referred to a child protection team in Japan and factors associated with decision-making: A retrospective study using a medical database. CHILD ABUSE & NEGLECT 2022; 134:105867. [PMID: 36099685 DOI: 10.1016/j.chiabu.2022.105867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the potential efficacy of hospital-based multidisciplinary child protection team (CPTs), research analyzing Japanese CPT databases is scarce. OBJECTIVE We aimed to describe the characteristics of children and families reported to a CPT in Japan and investigate factors associated with the substantiation of maltreatment. PARTICIPANTS AND SETTING This retrospective, cross-sectional study took place in a national children's hospital in Japan and included 350 children who were reported to CPTs between April 2014 and March 2018. METHODS Univariable and multivariable logistic regression analyses were conducted using the CPT database and medical records. RESULTS Among 350 cases, 33.4 % were substantiated. Children of <6 years of age comprised 73.4 % of the cases. The majority (67.7 %) received an injury-related diagnosis and physical maltreatment was suspected in 68.3 % of cases. In the univariable analysis, older age, a primary diagnosis other than injury, reporting department, psychological maltreatment, witnessing intimate partner violence, maltreatment by relatives other than biological father or mother, developmental disability, emotional/behavioral difficulty or psychological disorder, maternal/paternal psychological difficulty, and maternal history of maltreatment were significantly associated with substantiation. When adjusted for demographic, child and familial factors, a diagnosis other than injury (AOR 2.02, 95 % CI = 1. 11-3.65) and parental psychological difficulties (AOR 2.49, 95 % CI = 1.37-4.55) were independently associated with substantiation. CONCLUSION Most cases reported to our CPT were young children with an injury-related diagnosis. Substantiation was associated with a diagnosis other than injury and parental psychological difficulties. Further prospective and comprehensive studies are needed to establish universal guidelines for databases of hospital-based CPTs.
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Affiliation(s)
- Arisa Yamaguchi
- Department of Psychosocial Medicine, National Center for Child Health and Development; Center for Child Abuse Prevention.
| | - Michi Niimura
- Department of Health Policy, National Center for Child Health and Development
| | - Harumi Sonehara
- Department of Psychosocial Medicine, National Center for Child Health and Development
| | - Yuki Sekido
- Department of Psychosocial Medicine, National Center for Child Health and Development
| | - Makiko Kishimoto
- Department of Psychosocial Medicine, National Center for Child Health and Development
| | - Yoshiyuki Tachibana
- Department of Psychosocial Medicine, National Center for Child Health and Development
| | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development
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How Stressful Is Examining Children with Symptoms of Child Abuse?-Measurement of Stress Appraisal (SAM) in German Physicians with Key Expertise in Pediatrics. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101578. [PMID: 36291514 PMCID: PMC9600667 DOI: 10.3390/children9101578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatricians frequently feel uncertain about their ability to detect early symptoms of child abuse and how to respond in suspected cases. AIM This study investigated the transactional stress model in German pediatricians who experienced imagination stories with a child protection scenario and another potentially stress-triggering scenario. METHODS A two-part survey was conducted online. Each part included a different imagination story and evaluation of the Stress Appraisal Measure (SAM), as well as questions on child protection, current problematics, and suggested remedies. In total, 96 pediatricians participated. The child abuse scenario was perceived as significantly more threatening and more stressful than a medical emergency. The pediatricians declared moderate familiarity with the Child Protection Guidelines and the Federal Child Protection Act and an average confidence in their application. The greatest perceived problems were communication difficulties with parents and youth welfare services. Suggested improvements were concrete procedural directives, more training programs, better interdisciplinary networks, and greater exchange among colleagues. CONCLUSIONS To optimize their potential in the child protection system, pediatricians need to be better supported in coping with the identified stressors in child abuse scenarios.
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Piersiak HA, Levi BH, Humphreys KL. Statutory Threshold Wording is Associated with Child Maltreatment Reporting. CHILD MALTREATMENT 2022:10775595221092961. [PMID: 35587785 DOI: 10.1177/10775595221092961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The purpose of this study was to determine whether statutory wording of child maltreatment mandated reporting legislation was associated with reporting patterns and substantiation of abuse across U.S. states and territories. Annual state averages for total referrals, referrals screened-out, referrals screened-in, referrals substantiated, and child population (all children in the U.S.; annual average = 74,457,928) were obtained from the 2010-2017 Child Maltreatment Reports. Odds ratios were calculated for: (1) two major statutory language frameworks (suspicion versus belief), (2) seven sub-categories (e.g., suspect, reasonably believe, etc.), and (3) universal mandated reporting (yes versus no). Use of suspicion (versus belief) was associated with higher rates of referrals made (OR = 1.13) and screened-in (OR = 1.13), but lower substantiation rates (OR = .92). States using universal mandated reporting (versus those who did not) had slightly lower rates of referrals (OR = .99), but higher rates of referrals screened-in (OR = 1.16) and substantiated (OR = 1.06). Differences in statutory wording are associated with variability in reports, suggesting the possibility that statutory wording is one factor involved with these differences. However, future research is needed to explore alternative contributing factors and/or explanations.
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Affiliation(s)
- Hannah A Piersiak
- Department of Psychology and Human Development, 5718Vanderbilt University, Nashville, TN, USA
| | - Benjamin H Levi
- Departments of Humanities and Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, 5718Vanderbilt University, Nashville, TN, USA
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Mudrick NR, Blackwell J, Watts C, Smith CJ, Williams A, Nielsen KA, Clark L. How do States Inform Nurses of Their Policies for Mandatory Reporting of Child Maltreatment? Policy Polit Nurs Pract 2022; 23:109-117. [PMID: 35171056 DOI: 10.1177/15271544211072843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Every state includes nurses as mandated reporters of suspected child maltreatment, and each state has its own law and policy regarding what is reportable and reporting requirements. These differences mean that generic training on child abuse and reporting needs to be augmented by practical state-specific information. In nearly every study of nurses, participants report having inadequate child abuse training. This paper presents an analysis of the information states post on their websites to educate nurses to appropriately identify and report suspected child abuse or neglect. Specifically, this study aims to answer the following questions: (1) how do mandated reporting laws that apply to nurses vary by state, (2) what information do states provide on their child protection and Board of Nursing websites about child maltreatment and mandatory reporting, and (3) what training resources do states make available on their websites to educate nurse mandatory reporters to ably fulfill their obligation? Data on state-by-state practices regarding mandated reporting of child abuse were gathered from the Rape, Abuse, & Incest National Network (RAINN) database, review of state statutes, Child Welfare Information Gateway, Board of Nursing sites, and the Nursing Licensure Compact (NLC) website. This analysis found that states provide little guidance or education about their child maltreatment laws, and few have resources targeted for nurses. Given rising membership in the NLC it is critical for nurses to have education about state specific mandated reporting requirements. States should consider adding mandatory reporting training as a requirement for licensure and for continuing education.
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Affiliation(s)
- Nancy R Mudrick
- School of Social Work, 423186Syracuse University, Syracuse, NY, USA
| | - Julia Blackwell
- School of Social Work, 423186Syracuse University, Syracuse, NY, USA
| | - Cherisse Watts
- School of Nursing, 16084University of California Los Angeles, Los Angeles, CA, USA
| | | | - Alex Williams
- School of Social Work, 423186Syracuse University, Syracuse, NY, USA
| | - Kyrian A Nielsen
- School of Social Work, 423186Syracuse University, Syracuse, NY, USA
| | - Lauren Clark
- School of Nursing, 16084University of California Los Angeles, Los Angeles, CA, USA
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12
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Laupacis M, Acai A, MacMillan HL, Vanstone M, Stewart D, Dimitropoulos G, Kimber M. A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063319. [PMID: 35329006 PMCID: PMC8949331 DOI: 10.3390/ijerph19063319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
Abstract
Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents’ understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.
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Affiliation(s)
- Megan Laupacis
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (M.L.); (H.L.M.)
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Anita Acai
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Harriet L. MacMillan
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (M.L.); (H.L.M.)
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada;
- Offord Centre for Child Studies, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Donna Stewart
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Melissa Kimber
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada;
- Offord Centre for Child Studies, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence:
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Aleissa MA, Sultana K, Saleheen HN, Aldihan DA, Al-Omar RH, Alharbi RO, Allahidan RS, Alshagary R. Attitude of pediatricians toward suspected cases of child sexual abuse (CSA) in Saudi Arabia. Int J Pediatr Adolesc Med 2021; 9:125-130. [PMID: 35663780 PMCID: PMC9152561 DOI: 10.1016/j.ijpam.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/07/2021] [Accepted: 10/24/2021] [Indexed: 11/27/2022]
Abstract
Objective To assess the attitudes of pediatricians working at the Ministry of National Guard-Health Affairs (MNGHA) to report cases of child sexual abuse (CSA) and to determine the association between the demographic, cultural characteristics, and the attitude toward reporting. Participants and Settings The participants included all pediatricians, from consultants to residents, employed at the Pediatric Department of the King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital, Riyadh. Additional inclusion criteria were females and males, Saudis and non-Saudis, and age 20–60 years. Methods A self-administered, hard copy questionnaire was distributed to 277 pediatricians, and the response rate was 58.48%. The sensitivity/specificity emphasis mean score was calculated. Categorical variables were tested against the sensitivity/specificity emphasis mean score using an ANOVA and an independent sample t-test. The reliability of the questionnaire was measured with Cronbach's alpha. Results In total, 153 completed questionnaires were analyzed. The responses were inclined toward balanced (indecisive toward reporting) and high specificity (favors the decision not to report suspected CSA). No significant difference was found in the sensitivity/specificity mean score between the different levels of professionals, experience, age, gender, and number of prior child abuse-related courses. The skepticism scale showed, for the different professional levels, that the staff physician/resident believed the 3- to 5-year-old girls and boys to be genuine. The consultants/associate consultants believed 6- to 12-year and 13- to 17-year-old girls and boys to be true most of the time. Nearly half of the participants indicated that their reporting decision was affected by the possible consequences of reporting suspected CSA for the children's families and the social perceptions of sexually abused children as adults. Conclusion The results highlight the low reporting rates of CSA cases. The findings suggest a lack of training and experience of the professionals in this area of assessing, detecting, and reporting CSA cases.
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Nihan K, Makda A, Salat H, Khursheed M, Fayyaz J, Khan UR. Assessment of knowledge, attitude, and practice of child abuse amongst health care professionals working in tertiary care hospitals of Karachi, Pakistan. J Family Med Prim Care 2021; 10:1364-1368. [PMID: 34041180 PMCID: PMC8140284 DOI: 10.4103/jfmpc.jfmpc_1691_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: UNICEF report (2004) states that a significant percentage of total child population under the age of 5 years suffered malnutrition. Child sexual abuse remains undiscussed across Pakistan. Health care professionals (HCPs) are usually the first notifiers of child abuse and are ethically obliged to manage and report it. Objective: This study was conducted to assess HCPs' response in dealing with patients of child abuse. With a better understanding, we can have a better outcome for the victims. Methods: A total of 101 participants filled out a structured questionnaire by HCPs working in three tertiary hospitals of Karachi i.e., Aga Khan University, National Institute of Child Health (NICH), and Civil Hospital. Data were entered into SPSS 19.0. Results: HCPs believed that young male relatives were thought to be most likely the offender, and that every child regardless of class is prone to get abused triggered by financial stressors and the absence of parents. Proper physical exams helped identify cases. A proper system of reporting was required in hospitals, but HCPs were reluctant to report the cases to authorities. There was a significant difference noted between public and private hospitals. Conclusion: Our findings indicate that HCPs have limited knowledge in defining various types of abuse and most were unaware of any reporting facility in hospitals. Senior HCPs as consultants have a better understanding of child abuse than nurses or interns. Mandatory reporting should be implicated so that prompt action could be taken. There could be a more successful outcome of managing a child abuse victim with proper training.
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Affiliation(s)
- Khuld Nihan
- Jinnah Sindh Medical University, Karachi, Pakistan
| | - Aamir Makda
- Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Jabeen Fayyaz
- Sick Children Hospital, University of Toronto, Canada
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Tiyyagura G, Emerson B, Gaither JR, Bechtel K, Leventhal JM, Becker H, Della Guistina K, Balga T, Mackenzie B, Shum M, Shapiro ED, Auerbach MA, McVaney C, Morrell P, Asnes AG. Child Protection Team Consultation for Injuries Potentially Due to Child Abuse in Community Emergency Departments. Acad Emerg Med 2021; 28:70-81. [PMID: 32931628 DOI: 10.1111/acem.14132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/20/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In three CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children < 12 months old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12 months. METHODS We interviewed CED providers to identify barriers and facilitators to recognizing and reporting abuse. Providers described difficulties differentiating abusive from nonabusive injuries and felt that a second opinion would help. Using a plan-do-study-act approach, beginning in April 2018, we tested, refined, and implemented interventions to increase the frequency of CPT consultation, including leadership and champion engagement, provider training, clinical pathway implementation, and an audit and feedback process. Data were collected for 15 months before and 17 months after initiation of interventions. We used a statistical process control chart to track CPT consultations about children < 1 year old with high-risk injuries, use of skeletal surveys (SSs), and reports to child protective services (CPS). RESULTS Evidence of special cause was identified beginning in June 2018, with a shift of 8 points to one side of the center line. For the subsequent 8-month period, the CPT was consulted for a mean of 47.5% of children with high-risk injuries; this was sustained for an additional 7 months. The average percentage of infants with high-risk injuries who received a SS increased from 6.7% to 18.9% and who were reported to CPS increased from 10.7% to 32.6%. CONCLUSION Targeted interventions in CEDs increased the frequency of CPT consultation, SS use, and reports to CPS for infants with high-risk injuries. Such interventions may improve recognition of physical abuse.
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Affiliation(s)
- Gunjan Tiyyagura
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Beth Emerson
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Julie R. Gaither
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Kirsten Bechtel
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - John M. Leventhal
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Heather Becker
- the Department of Emergency Medicine Bridgeport Hospital Bridgeport CTUSA
| | | | - Thomas Balga
- and the Department of Emergency Medicine Yale New Haven Hospital New Haven CT USA
| | - Bonnie Mackenzie
- and the Department of Emergency Medicine Lawrence and Memorial Hospital Norwich CTUSA
| | - May Shum
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Eugene D. Shapiro
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Marc A. Auerbach
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Caitlin McVaney
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
| | - Patricia Morrell
- and the Department of Surgery Yale New Haven Hospital New Haven CT USA
| | - Andrea G. Asnes
- From the Department of Pediatrics Yale University School of Medicine New Haven CTUSA
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Karni-Visel Y, Hershkowitz I, Hershkowitz F, Flaisher M, Schertz M. Increased risk for child maltreatment in those with developmental disability: A primary health care perspective from Israel. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 106:103763. [PMID: 32957007 DOI: 10.1016/j.ridd.2020.103763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/19/2020] [Accepted: 07/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Child Maltreatment (CM) is a worldwide phenomenon. Literature suggests that children with disabilities are at increased risk for CM. However, limited information exists regarding if such increased risk is noted in community primary care clinics. AIM To report on the incidence of CM in children with and without disabilities attending community primary care clinics. METHOD This was a cohort study of children belonging to a Health Maintenance Organization (HMO) in Israel. The study group consisted of children with disabilities and the control group consisted of children without disabilities. Formal reports to child protection services, medical and sociodemographic data were extracted from designated documentation and medical records. RESULTS The odds to be identified as suspected CM, after adjusting for sociodemographic variables, was 6.2 times higher among children with disabilities compared to children without disabilities and 5.0 times higher among children with severe vs. mild disability. CONCLUSIONS Developmental disability is a risk factor for CM, and is noted even more seriously in community primary care clinics. CM positively correlated with the severity of disability. The presented data marks higher figures than previously reported, enhancing understanding of the scope of the problem and its relation to the type of organization being examined.
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Affiliation(s)
- Yael Karni-Visel
- Child Development and Pediatric Neurology Service, Meuhedet-Northern Region, Israel; Department of Psychology, University of Cambridge, UK.
| | | | | | - Michal Flaisher
- Social Work Service, Meuhedet, Northern Region, Haifa, Israel.
| | - Mitchell Schertz
- Child Development and Pediatric Neurology Service, Meuhedet-Northern Region, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Kuruppu J, McKibbin G, Humphreys C, Hegarty K. Tipping the Scales: Factors Influencing the Decision to Report Child Maltreatment in Primary Care. TRAUMA, VIOLENCE & ABUSE 2020; 21:427-438. [PMID: 32254001 DOI: 10.1177/1524838020915581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Child maltreatment (CM) is an important public health issue linked to significant physical and mental health complications across the life span. Given the association between CM and health, general practitioners (GPs) and primary care nurses (PNs) are well-placed to identify and respond to this issue and are mandated to report suspected CM in many jurisdictions. Research has found that primary care doctors and nurses need support when responding to CM. This scoping review sought to answer the following question: What factors influence GPs and PNs decision to report CM when fulfilling their mandatory reporting duty? By exploring these factors, areas where support is needed were pinpointed. A systematic search was run across four databases: Medline (Ovid), PsycINFO, Embase, and CINAHL. Articles that reported on studies conducted in a location that had mandatory reporting legislation specific to CM and had a study population sampled from primary care were included in analysis. Thirty-three articles met the inclusion criteria. This review found that four principal factors influenced the decision to report CM: personal threshold of suspicion of abuse, relationship with the family, faith in the child protection system, and education and discussion. We conclude that improving the support and training to address these four areas may be beneficial for GPs and PNs in responding to CM.
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Affiliation(s)
- Jacqueline Kuruppu
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Gemma McKibbin
- Department of Social Work, University of Melbourne, Carlton, Victoria, Australia
| | - Cathy Humphreys
- Department of Social Work, University of Melbourne, Carlton, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Victoria, Australia
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Parents' experiences of seeking health care and encountering allegations of shaken baby syndrome: A qualitative study. PLoS One 2020; 15:e0228911. [PMID: 32078645 PMCID: PMC7032704 DOI: 10.1371/journal.pone.0228911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/27/2020] [Indexed: 12/05/2022] Open
Abstract
Objectives To explore parents’ experiences of seeking health care for their children and instead being accused by healthcare professionals of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT), being reported to Social Services, undergoing judiciary processing, and the impact of these events on family (dis)integration. Methods Design: A qualitative study based on qualitative content analysis. Participants: Twelve parents in Sweden, mothers and fathers, seeking health care for their infants, encountering allegations of SBS/AHT, losing custody of their infants, and being subjected to a judiciary process, and finally regaining custody of their children. Data collection: In-depth interviews. Results An overarching theme ‘Fighting for protection of their child after being trapped by doctors’ and four sub-themes were developed to reflect the parents’ experiences, reactions and interpretations. The first sub-theme, ‘Being accused of injuring the child’, illuminated the shock experienced when seeking care and instead being accused of being a perpetrator. The second, ‘Chaos and powerlessness’, refers to the emotions experienced when losing custody of the child and being caught in the enforcement of legislation by the authorities. The third, ´The unified fight against the doctors’ verdict´, illustrates the parents’ fight for innocence, their worry for the lost child, and their support and resistance. The fourth, ‘The wounded posttraumatic growth’, describes the emotions, grief, panic, anxiety, and challenges in reuniting the family, but also the parents’ reflections on personal growth. Unanimously, they had experienced the authorities’ inability to reconsider, and expressed a deep mistrust of paediatric care. Conclusions Being wrongly accused of child abuse and alleged SBS/AHT evoked emotions of intense stress, but parents endured because of a successful fight to regain custody of their child. However, the trauma had a long-term impact on their lives with residual posttraumatic stress symptoms and mistrust towards healthcare services and the authorities. The results provide important inferences for restoring system failures within child protection services.
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Saïas T, Kargakos S, Poissant J, Eury C. [Preventing child abuse risk factors: A study of the ease of French professionals working in early prevention]. Rech Soins Infirm 2020; 138:43-52. [PMID: 31959240 DOI: 10.3917/rsi.138.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Research on child abuse prevention has been limited for the last forty years to the experimental field. While we know how home visiting interventions can help limit situations of child abuse, we do not know how these results can be replicated in routine care situations. The objective of this study was to identify, in French public services, how prevention professionals approach child abuse risk factors with families, and with what degree of ease. The results show that, beyond a form of versatility that allows them to discuss a wide range of topics with families, prevention workers are very uncomfortable dealing with topics of family intimacy, psychopathology, or child abuse. The political implications are discussed.
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20
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Campbell KA, Wuthrich A, Norlin C. We Have All Been Working in Our Own Little Silos Forever: Exploring a Cross-Sector Response to Child Maltreatment. Acad Pediatr 2020; 20:46-54. [PMID: 31185309 PMCID: PMC6899215 DOI: 10.1016/j.acap.2019.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/11/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A child protective services (CPS) investigation for maltreatment signals risk for childhood toxic stress and poor health outcomes. Despite this, communication between child welfare and health care professionals is rare. We present a qualitative exploration of experiences with, barriers to, and hopes for cross-sector collaboration for children with suspected maltreatment. METHODS We conducted focus groups with child welfare and health care professionals participating in a cross-sector learning collaborative to improve care for children at high risk for toxic stress. Participants were asked to describe 2 phenomena: identifying and responding to childhood adversities in their professional settings and cross-sector collaboration in cases of suspected maltreatment. Analysis included an iterative process of reading, coding and comparing themes across groups. RESULTS Health care professionals shared positive experiences in screening for social risks in clinic, while child welfare professionals expressed mixed attitudes toward social risk screening during CPS investigations. Consistent with prior research, health care professionals reported limited communication with CPS caseworkers about patients but suggested that relationships with child welfare professionals might reduce these barriers. Child welfare professionals described the poor quality of information provided in referrals from medical settings. Caseworkers also recognized that improved communication could support better understanding of maltreatment concerns and sharing of outcomes of CPS investigation. CONCLUSIONS Our project extends previously published research by describing potential benefits of child welfare and child health care collaboration in cases of suspected maltreatment. Lack of effective cross-sector communication and concerns about confidentiality present significant barriers to uptake of these collaborative practices.
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Affiliation(s)
- Kristine A Campbell
- Department of Pediatrics (KA Campbell and C Norlin) and Department of Internal Medicine (A Wuthrich), University of Utah, Salt Lake City, Utah.
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21
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Wißmann H, Peters M, Müller S. Physical or psychological child abuse and neglect: Experiences, reporting behavior and positions toward mandatory reporting of pediatricians in Berlin, Germany. CHILD ABUSE & NEGLECT 2019; 98:104165. [PMID: 31627133 DOI: 10.1016/j.chiabu.2019.104165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Child abuse and neglect (CAN) are common, with a high number of undetected victims. Since 2012, the German Federal Child Protection Act grants doctors an opportunity to circumvent their duty of confidentiality if they suspect CAN may be occurring, despite the reporting of CAN not being mandatory. OBJECTIVE This study examines pediatricians' reporting behavior in cases of CAN and what their attitudes are toward mandatory reporting. PARTICIPANTS AND SETTING All 378 primary care pediatricians and pediatric psychiatrists in the German capital of Berlin were asked to complete a questionnaire anonymously. The questionnaire was sent by mail to all primary care pediatricians (N = 302) and pediatric psychiatrists (N = 76) in private practice. METHODS Patterns of reporting, response tendencies, and correlations with socio-economic factors were described and statistically examined. RESULTS The response rate was 42% (N = 157). Of the pediatricians, 28% report every suspected case to the authorities. The majority, namely 73%, has difficulties in detecting CAN, and 64% would like additional training. Furthermore, 52% are aware of legally guaranteed counseling options being available if CAN is suspected. Whereas 71% consider mandatory reporting necessary to protect children more effectively, 57% are sure it would simplify their work. CONCLUSIONS More training on diagnosing CAN should be offered to pediatricians. It is necessary to have a full and frank discussion about making reporting mandatory in cases where there is a reasonable suspicion of CAN. Doctors believe that mandatory reporting standardizes and simplifies working procedures. It may possibly reduce the number of undetected cases of CAN and would allow more children and families access to early protection and supporting measures.
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Affiliation(s)
- Henning Wißmann
- Charité ‒ Universitätsmedizin Berlin, Department for Psychiatry and Psychotherapy, CCM, Research Division of Mind and Brain, Charitéplatz 1, 10117 Berlin, Germany.
| | - Mike Peters
- Charité ‒ Universitätsmedizin Berlin, Institute of Legal Medicine and Forensic Sciences, Turmstraße 21, 10559 Berlin, Germany.
| | - Sabine Müller
- Charité ‒ Universitätsmedizin Berlin, Department for Psychiatry and Psychotherapy, CCM, Research Division of Mind and Brain, Charitéplatz 1, 10117 Berlin, Germany.
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Hospital Variation in Child Protection Reports of Substance Exposed Infants. J Pediatr 2019; 208:141-147.e2. [PMID: 30770194 PMCID: PMC6486842 DOI: 10.1016/j.jpeds.2018.12.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine whether hospital-level factors contribute to discrepancies in reporting to Child Protective Services (CPS) of infants diagnosed with prenatal substance exposure. STUDY DESIGN We used a linked dataset of birth, hospital, and CPS records using diagnostic codes (International Classification of Diseases, Ninth Revision) to identify infants diagnosed with prenatal substance exposure. Using multilevel models, we examined hospital-level and individual birth-level factors in relation to a report to CPS among those infants prenatally exposed to substances. RESULTS Of the 760 863 infants born in Washington State between 2006 and 2013, 12 308 (1.6%) were diagnosed with prenatal substance exposure. Infants born at hospitals that served larger populations of patients with Medicaid (OR, 1.25; 95% CI, 1.07-1.45) and hospitals with higher occupancy rates (OR, 1.43; 95% CI, 1.15-1.77) were more likely to be reported to CPS. Infants exposed to amphetamines (OR, 2.58; 95% CI, 2.31-2.90) and cocaine (OR, 2.33; 95% CI-1.92, 2.83) were more likely to be reported and infants exposed to cannabis (OR, 0.62; 95% CI-0.55, 0.70) were less likely to be reported to CPS than infants exposed to opioids. Infants with Native American mothers were more likely to be reported to CPS than infants with white mothers (OR, 1.47; 95% CI, 1.27-1.70). CONCLUSIONS Hospital-level and individual birth-level factors impact the likelihood of infants prenatally exposed to substances being reported to CPS, providing additional knowledge about which infants are reported to CPS. Targeted education and improved policies are necessary to ensure more standardized approaches to CPS reporting of prenatal substance exposure.
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Tiyyagura G, Schaeffer P, Gawel M, Leventhal JM, Auerbach M, Asnes AG. A Qualitative Study Examining Stakeholder Perspectives of a Local Child Abuse Program in Community Emergency Departments. Acad Pediatr 2019; 19:438-445. [PMID: 30707955 PMCID: PMC6502662 DOI: 10.1016/j.acap.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/19/2019] [Accepted: 01/27/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Emergency department (ED) providers may fail to recognize or report child abuse and/or neglect (CAN). To improve recognition and reporting, we designed the Community ED CAN Program, in which teams of local clinicians (nurses, physicians, physician assistants) received training in CAN and 1) disseminated evidence-based education; 2) provided consultation, case follow-up, and access to specialists; and 3) facilitated multidisciplinary case review. The aims of this study were to understand the Program's strengths andchallenges and to explore factors that influenced implementation. METHODS We used a qualitative research design with semistructured, one-on-one interviews to understand key stakeholders' perspectives of the Community ED CAN Program. We interviewed 27 stakeholders at 3 community hospitals and 1 academic medical center. Researchers analyzed transcribed data using constant comparative method of grounded theory and developed themes. RESULTS Program strengths included 1) comfort in seeking help from local champions, 2) access to CAN experts, 3) increased CAN education/awareness, and 4) improved networks and communication. Facilitators of implementation included: 1) leadership support, 2) engaged local champions and external change agents (eg, CAN experts), 3) positive attributes of the champions, and 4) implementation flexibility. Program challenges/barriers to implementation included 1) variability of institutional support for the champions and 2) variability in awareness about the program. CONCLUSIONS A Community ED CAN Program has the potential to improve recognition and reporting of CAN. Key steps to facilitate implementation include the identification of committed local champions, strong leadership support, connections to experts, program publicity, and support of the champions' time.
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Affiliation(s)
- Gunjan Tiyyagura
- Department of Pediatrics, Yale University School of Medicine, New Haven, Conn.
| | - Paula Schaeffer
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Marcie Gawel
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - John M. Leventhal
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Marc Auerbach
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT, USA
| | - Andrea G. Asnes
- Yale University School of Medicine, Department of Pediatrics, New Haven, CT, USA
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McCray N. Child health care coverage and reductions in child physical abuse. Heliyon 2018; 4:e00945. [PMID: 30839846 PMCID: PMC6251011 DOI: 10.1016/j.heliyon.2018.e00945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/01/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022] Open
Abstract
Children in the United States suffered almost 118,000 cases of physical abuse in 2015. One factor that might help decrease child physical abuse is health care coverage. This paper presents a justification for a link between health care coverage and reductions in child physical abuse and, though it does not assess specific causal mechanisms, examines evidence for such a connection. The paper uses panel data linear regression analysis to explore state level physical abuse and health care coverage rates. Findings indicate a statistically significant relationship between increases in child health care coverage rates, including both private coverage and Medicaid coverage, and decreases in child physical abuse.
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Hines L, Glick J, Bilka K, Lantos JD. Medical Marijuana for Minors May Be Considered Child Abuse. Pediatrics 2018; 142:peds.2017-4310. [PMID: 30213842 DOI: 10.1542/peds.2017-4310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/24/2022] Open
Abstract
The Food and Drug Administration categorizes marijuana (cannabis) as a Schedule I drug, meaning that it has no currently accepted medical use, a high potential for abuse, and no good data on safety. Other Schedule I drugs are heroin, lysergic acid diethylamide, peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("ecstasy"). The authors of some studies have shown that marijuana can reduce nausea and vomiting from chemotherapy, can improve food intake in patients with HIV, can reduce neuropathic pain, and may slow the growth of cancer cells. In many states, marijuana use is illegal. No state has approved its use for children. What, then, should doctors do if they become aware that parents are using marijuana to treat medical conditions in their children? What if the children have adverse reactions to the marijuana? In this Ethics Rounds, we present such a case and ask experts in child protection and child abuse to discuss the appropriate response.
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Affiliation(s)
- Larissa Hines
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Jill Glick
- Department of Pediatrics, The University of Chicago, Chicago, Illinois; and
| | - Kristin Bilka
- Department of Pediatrics, The University of Chicago, Chicago, Illinois; and
| | - John D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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Bachmann M, Bachmann BA. The Case for Including Adverse Childhood Experiences in Child Maltreatment Education: A Path Analysis. Perm J 2018; 22:17-122. [PMID: 29616910 DOI: 10.7812/tpp/17-122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT The lifelong, negative consequences of exposure to adverse childhood experiences (ACEs) for individuals and their families are well established. OBJECTIVE To demonstrate the importance of including ACE information in child maltreatment education curricula using path analysis. DESIGN Survey data examined the impact of child maltreatment education programs and knowledge about ACEs on medical practitioners' reporting habits and ability to detect maltreatment. A path diagram distinguished between the direct impact of education programs on outcome measures and the indirect effect that is mediated through knowledge of ACEs. MAIN OUTCOME MEASURES Medical practitioners' ability to detect child maltreatment and their number of referrals to Child Protective Services (CPS). RESULTS The optimized path diagram (χ2SB(3) = 3.9, p = 0.27; RMSEA-SB = 0.017; R2 = 0.21, where SB is Satorra-Bentler coefficient and RMSEA is root-mean-square error of approximation) revealed the mediating variable "knowledge about ACEs" as the strongest structural effect (SB-β = 0.34) on the number of CPS referrals. It was almost twice as high as the second strongest effect of formal education programs (SB-β = 0.19). For workplace training programs, the total effect when including knowledge of ACEs was almost double as strong as the direct effect alone. Even when previous child maltreatment education was controlled for, practitioners familiar with the consequences of ACEs were significantly more likely to recognize and to report abuse to CPS. CONCLUSION This study documented the importance of specialized training programs on ACEs, and the essential role ACE knowledge plays in the effectiveness of provider education programs.
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Affiliation(s)
- Michael Bachmann
- Associate Professor of Criminal Justice in the College of Liberal Arts at Texas Christian University in Fort Worth.
| | - Brittany A Bachmann
- Program Manager at The Center for Prevention of Child Maltreatment at Cook Children's Medical Center in Fort Worth, TX.
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Prevalence of nonaccidental trauma among children at American College of Surgeons-verified pediatric trauma centers. J Trauma Acute Care Surg 2017; 83:862-866. [PMID: 29068874 DOI: 10.1097/ta.0000000000001629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting. Extreme cases of child abuse, or nonaccidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians who have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma verification. It is hypothesized that ACS-verified pediatric trauma centers (vPTCs) have an increased prevalence of NAT because of this additional experience and training relative to non-ACS vPTCs. METHODS The National Trauma Data Bank, for the years 2007 to 2014, was utilized to compare the prevalence of NAT between ACS vPTCs relative to non-ACS vPTCs to produce both crude and Injury Severity Score adjusted prevalence ratio estimates. RESULTS The majority of NAT cases across all hospitals were male (58.3%). The mean age of the NAT cases was 2.3 years with a mean Injury Severity Score (ISS) of 11.1. The most common payment method was Medicaid (64.4%). The prevalence of NAT was 1.82 (1.74-1.90) times higher among ACS vPTCs and 1.81 (1.73-1.90) after adjusting for ISS. CONCLUSIONS The greater prevalence of NAT at vPTCs likely represents a more accurate measure of NAT among pediatric trauma patients, likely due to more experience and training of clinicians. LEVEL OF EVIDENCE Prognostic/Epidemiological, Level II.
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McTavish JR, Kimber M, Devries K, Colombini M, MacGregor JCD, Wathen CN, Agarwal A, MacMillan HL. Mandated reporters' experiences with reporting child maltreatment: a meta-synthesis of qualitative studies. BMJ Open 2017; 7:e013942. [PMID: 29042370 PMCID: PMC5652515 DOI: 10.1136/bmjopen-2016-013942] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To systematically search for research about the effectiveness of mandatory reporting of child maltreatment and to synthesise qualitative research that explores mandated reporters' (MRs) experiences with reporting. DESIGN As no studies assessing the effectiveness of mandatory reporting were retrieved from our systematic search, we conducted a meta-synthesis of retrieved qualitative research. Searches in Medline (Ovid), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Education Resources Information Center, Criminal Justice Abstracts and Cochrane Library yielded over 6000 citations, which were deduplicated and then screened by two independent reviewers. English-language, primary qualitative studies that investigated MRs' experiences with reporting of child maltreatment were included. Critical appraisal involved a modified checklist from the Critical Appraisal Skills Programme and qualitative meta-synthesis was used to combine results from the primary studies. SETTING All healthcare and social-service settings implicated by mandatory reporting laws were included. Included studies crossed nine high-income countries (USA, Australia, Sweden, Taiwan, Canada, Norway, Finland, Israel and Cyprus) and three middle-income countries (South Africa, Brazil and El Salvador). PARTICIPANTS The studies represent the views of 1088 MRs. OUTCOMES Factors that influence MRs' decision to report and MRs' views towards and experiences with mandatory reporting of child maltreatment. RESULTS Forty-four articles reporting 42 studies were included. Findings indicate that MRs struggle to identify and respond to less overt forms of child maltreatment. While some articles (14%) described positive experiences MRs had with the reporting process, negative experiences were reported in 73% of articles and included accounts of harm to therapeutic relationships and child death following removal from their family of origin. CONCLUSIONS The findings of this meta-synthesis suggest that there are many potentially harmful experiences associated with mandatory reporting and that research on the effectiveness of this process is urgently needed.
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Affiliation(s)
- Jill R McTavish
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Devries
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Manuela Colombini
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - C Nadine Wathen
- Faculty of Information and Media Studies, Western University, London, Ontario, Canada
| | - Arnav Agarwal
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Pelletier HL, Knox M. Incorporating Child Maltreatment Training into Medical School Curricula. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2017; 10:267-274. [PMID: 29026450 PMCID: PMC5610670 DOI: 10.1007/s40653-016-0096-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The Child Advocacy Studies Training (CAST) program has been implemented at the graduate and undergraduate levels, but has not been incorporated in medical school training. This study examines the efficacy of a modified version of the CAST program that is tailored to meet the educational needs of medical students. A total sample of 75 first year medical students (57 at 6 month follow-up) participated in the study and completed analogue vignettes depicting cases of maltreatment. It was hypothesized that, relative to the comparison group, students who completed CAST training would demonstrate better accuracy at identifying and reporting maltreatment. Results indicated that CAST students demonstrated improved accuracy at the conclusion of the CAST program and 6 months later.
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Affiliation(s)
- Heather L. Pelletier
- Department of Psychiatry, University of Toledo, Toledo, OH USA
- Department of Psychiatry, Brown University/Hasbro Children’s Hospital, Providence, RI 02903 USA
| | - Michele Knox
- Department of Psychiatry, University of Toledo, Toledo, OH USA
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Bledsoe LK, Yankeelov PA, Barbee AP, Antle BF. Understanding the Impact of Intimate Partner Violence Mandatory Reporting Law. Violence Against Women 2016. [DOI: 10.1177/1077801204264354] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intimate partner violence is a pervasive, complex problem affecting the lives and health of a large percentage of women and children. This report provides data from an evaluation designed to address questions and concerns expressed about possible unintended effects of the mandatory reporting law on victims. Case reviews were completed on 631 adult protective service cases resulting from reports of intimate partner violence. Results indicate that following a report of suspected intimate partner violence made under Kentucky mandatory reporting law, all victims who could be located received at a minimum safety planning and information about community resources. Regardless of official case status, nearly half of all cases received services.
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Singh S, Knox M, Pelletier H. Exploratory factor analysis and psychometric evaluation of the Healthcare Provider Attitudes Toward Child Maltreatment Reporting Scale. CHILDRENS HEALTH CARE 2016. [DOI: 10.1080/02739615.2016.1193807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Shipra Singh
- Department of Health and Recreation Professions, College of Health Sciences, University of Toledo, Toledo, OH
| | - Michele Knox
- Department of Psychiatry, College of Medicine and Life Sciences, University of Toledo, Toledo, OH
| | - Heather Pelletier
- Department of Pediatric Psychiatry, Rhode Island Hospital, Providence, RI
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Gray J, Cadieux A, Sweeney B, Beck AR, Edgar S, Eneli I, Getzoff Testa E, Paguio K, Santos M, Ward WL. Medical neglect and pediatric obesity: Insights from tertiary care obesity treatment programs. CHILDRENS HEALTH CARE 2016. [DOI: 10.1080/02739615.2016.1163488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jane Gray
- Dell Children’s Medical Center, Texas Center for the Prevention and Treatment of Childhood Obesity, Austin, TX
- Department of Educational Psychology, The University of Texas at Austin, Austin, TX
| | - Adelle Cadieux
- Healthy Weight Center, Helen DeVos Children’s Hospital, Grand Rapids, MI
| | - Brooke Sweeney
- Weight Management Program, Children’s Mercy Kansas City, Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO
| | - Amy R. Beck
- Weight Management Program, Children’s Mercy Kansas City, Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO
| | - Susan Edgar
- Center for Healthy Weight and Nutrition, Nationwide Children’s Hospital, Columbus, OH
| | - Ihuoma Eneli
- Center for Healthy Weight and Nutrition, Nationwide Children’s Hospital, Columbus, OH
| | - Elizabeth Getzoff Testa
- Department of Psychology, Mt. Washington Pediatric Hospital/Weigh Smart Program, Baltimore, MD
| | - Kristi Paguio
- Healthy Weight Center, Helen DeVos Children’s Hospital, Grand Rapids, MI
- Spectrum Health Medical Group, Grand Rapids, MI
| | - Melissa Santos
- Connecticut Children’s Medical Center, Hartford Hospital, Hartford, CT
- The Institute of Living, University of Connecticut School of Medicine, Hartford, CT
| | - Wendy L. Ward
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
- Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, AR
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Konijnendijk AAJ, Boere-Boonekamp MM, Fleuren MAH, Haasnoot ME, Need A. What factors increase Dutch child health care professionals' adherence to a national guideline on preventing child abuse and neglect? CHILD ABUSE & NEGLECT 2016; 53:118-127. [PMID: 26687328 DOI: 10.1016/j.chiabu.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 09/11/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Abstract
Guidelines to support health care professionals in early detection of, and responses to, suspected Child Abuse and Neglect (CAN) have become increasingly widely available. Yet little is known about professionals' adherence to these guidelines or the determinants that affect their uptake. This study used a cross-sectional design to assess the adherence of Dutch Child Health Care (CHC) professionals to seven key activities described in a national guideline on preventing CAN. This study also examined the presence and strengths of determinants of guideline adherence. Online questionnaires were filled in between May and July 2013 by 164 CHC professionals. Adherence was defined as the extent to which professionals performed each of seven key activities when they suspected CAN. Thirty-three determinants were measured in relation to the guideline, the health professional, the organisational context and the socio-political context. Bivariate and multivariate regression analyses tested associations between determinants and guideline adherence. Most of the responding CHC professionals were aware of the guideline and its content (83.7%). Self-reported rates of full adherence varied between 19.5% and 42.7%. Stronger habit to use the guideline was the only determinant associated with higher adherence rates in the multivariate analysis. Understanding guideline adherence and associated determinants is essential for developing implementation strategies that can stimulate adherence. Although CHC professionals in this sample were aware of the guideline, they did not always adhere to its key recommended activities. To increase adherence, tailored interventions should primarily focus on enhancing habit strength.
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Affiliation(s)
- Annemieke A J Konijnendijk
- Institute for Innovation and Governance Studies, Departments of Public Administration, and Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Magda M Boere-Boonekamp
- Institute for Innovation and Governance Studies, Department of Health Technology and Services Research, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Margot A H Fleuren
- TNO, Department of Life Style, P.O. Box 3305, 2301 DA Leiden, The Netherlands
| | - Maria E Haasnoot
- Municipal Health Service GGD Twente, Department of Preventive Child Health Care, P.O. Box 1400, 7500 BK, Enschede, The Netherlands
| | - Ariana Need
- Institute for Innovation and Governance Studies, Department of Public Administration, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
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Regnaut O, Jeu-Steenhouwer M, Manaouil C, Gignon M. Risk factors for child abuse: levels of knowledge and difficulties in family medicine. A mixed method study. BMC Res Notes 2015; 8:620. [PMID: 26514128 PMCID: PMC4627620 DOI: 10.1186/s13104-015-1607-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/19/2015] [Indexed: 11/15/2022] Open
Abstract
Background Family physicians (FPs) have a central role in the detection and management of child abuse. According to the literature, only 2–5 % of initial reports of child abuse come from the medical profession. Methods The objective of this study was to assess levels of knowledge of risk factors for child abuse by Family Physicians (FPs) and the attention that the physicians pay to these risk factors. We conducted a mixed-method survey based on semi-structured interviews. 50 FPs practicing in the Somme County (northern France) were interviewed with closed and open questions. The FPs’ level of knowledge of risk factors for child abuse and obstacles in the detection of child abuse were assessed. Results The FPs’ level of knowledge of risk factors for child abuse was similar to that reported in the literature. However, FPs knew little about the significant role of prematurity. Likewise, the FP’s training did not seem to influence their knowledge of risk factors. Fear of an incorrect diagnosis was the main obstacle to reporting a suspected case. The FPs considered that they were often alone in dealing with a difficult situation and considered that the judicial system and the social services were not sufficiently active. Conclusions Few FPs had actually received specific training in the detection and management of child abuse but many stated their need for this type of training. FPs encounter many obstacles in the detection of child abuse, which sometimes make the FP reluctant to report a suspected or potential case. Medical education need to be improved in this field. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1607-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Océane Regnaut
- Medical School, University of PicardyJules Verne, 3 Rue des Louvels, 80000, Amiens, France. .,Forensic and Social Medicine Unit, Amiens University Medical Center, 80054, Amiens Cedex 1, France.
| | - Marie Jeu-Steenhouwer
- Medical School, University of PicardyJules Verne, 3 Rue des Louvels, 80000, Amiens, France. .,Primary Care Department, Jules Verne University of Picardy, 3 Rue des Louvels, 80000, Amiens, France.
| | - Cécile Manaouil
- Medical School, University of PicardyJules Verne, 3 Rue des Louvels, 80000, Amiens, France. .,Forensic and Social Medicine Unit, Amiens University Medical Center, 80054, Amiens Cedex 1, France.
| | - Maxime Gignon
- Medical School, University of PicardyJules Verne, 3 Rue des Louvels, 80000, Amiens, France. .,Laboratory Educations and Health Practices, EA 3412, University Paris 13, 74, Rue Marcel Cachin, 93017, Bobigny, France. .,Health Training Center (SimUSanté©), Amiens University Medical Center, 80054, Amiens Cedex 1, France.
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Ho GWK, Gross DA. Pediatric nurses' differentiations between acceptable and unacceptable parent discipline behaviors: a Q-study. J Pediatr Health Care 2015; 29:255-64. [PMID: 25620720 DOI: 10.1016/j.pedhc.2014.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/04/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nurses are mandated to report suspected cases of child maltreatment. However, it is unclear how nurses decide what constitutes child abuse or evidence for reporting. It is crucial to examine how nurses define various forms of child maltreatment, including child abuse and its differentiation from physical discipline, to enhance our services to families with young children. OBJECTIVE The present study examined pediatric nurses' views on acceptable versus unacceptable discipline behaviors to better understand parent behaviors that nurses are likely to deem reportable to child protective services. METHODS Using Q methodology, a convenience sample of 48 pediatric nurses from one urban medical center sorted 71 statements related to the behavior or outcome of punishing a child via the Internet application FlashQ. The statements were sorted on a predefined continuum ranging from "Most Unacceptable" to "Most Acceptable." By-person factor analysis was used to uncover groups of nurses with similar sorts and to generate a unique sort that represented the viewpoint of nurses in that group. RESULTS Two distinct viewpoints were uncovered. Although there was consensus on what constitutes most acceptable and most unacceptable parent behaviors, nurses varied on their endorsement of using physical force as a form of discipline, suggesting a potential for discrepant tendencies to identify and report child abuse.
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Talsma M, Bengtsson Boström K, Östberg AL. Facing suspected child abuse--what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33:21-6. [PMID: 25676563 PMCID: PMC4377737 DOI: 10.3109/02813432.2015.1001941] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the reporting of suspected child abuse among Swedish general practitioners (GPs), and to investigate factors influencing them in their decision whether or not to report to child protective services (CPS). DESIGN A cross-sectional questionnaire study. SETTING Primary health care centres in western Sweden. SUBJECTS 177 GPs and GP trainees. MAIN OUTCOME MEASURES Demographic and educational background, education on child abuse, attitudes to reporting and CPS, previous experience of reporting suspected child abuse, and need of support. RESULTS Despite mandatory reporting, 20% of all physicians had at some point suspected but not reported child abuse. Main reasons for non-reporting were uncertainty about the suspicion and use of alternative strategies; for instance, referral to other health care providers or follow-up of the family by the treating physician. Only 30% of all physicians trusted CPS's methods of investigating and acting in cases of suspected child abuse, and 44% of all physicians would have wanted access to expert consultation. There were no differences in the failure to report suspected child abuse that could be attributed to GP characteristics. However, GPs educated abroad reported less frequently to CPS than GPs educated in Sweden. CONCLUSIONS This study showed that GPs see a need for support from experts and that the communication and cooperation between GPs and CPS needs to be improved. The low frequency of reporting indicates a need for continued education of GPs and for updated guidelines including practical advice on how to manage child abuse.
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Affiliation(s)
| | | | - Anna-Lena Östberg
- R&D Centre, Skaraborg Primary Care, Skövde, Sweden
- Public Dental Service, Region Västra Götaland, Sweden
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Abstract
The process whereby a clinician decides that child abuse is a diagnostic possibility is often marked with doubt and fear. Abusive parents can present convincing lies, and children with suspicious injuries can have unusual accidents. Personal thresholds for reporting suspected abuse vary considerably. Clinicians may mistrust or misunderstand the roles and responsibilities of the investigators and legal professionals involved. This article aims to improve understanding of the community responses to a report of child abuse, and enable the clinician to work effectively with child protective services, law enforcement agencies, and legal professionals to ensure child safety and family integrity when appropriate.
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Diderich HM, Fekkes M, Dechesne M, Buitendijk SE, Oudesluys-Murphy AM. Detecting child abuse based on parental characteristics: does the Hague Protocol cause parents to avoid the emergency department? Int Emerg Nurs 2014; 23:203-6. [PMID: 25449550 DOI: 10.1016/j.ienj.2014.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 09/07/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The Hague Protocol is used by professionals at the adult Emergency Departments (ED) in The Netherlands to detect child abuse based on three parental characteristics: (1) domestic violence, (2) substance abuse or (3) suicide attempt or self-harm. After detection, a referral is made to the Reporting Center for Child Abuse and Neglect (RCCAN). This study investigates whether implementing this Protocol will lead parents to avoid medical care. METHOD We compared the number of patients (for whom the Protocol applied) who attended the ED prior to implementation with those attending after implementation. We conducted telephone interviews (n = 14) with parents whose children were referred to the RCCAN to investigate their experience with the procedure. RESULTS We found no decline in the number of patients, included in the Protocol, visiting the ED during the 4 year implementation period (2008-2011). Most parents (n = 10 of the 14 interviewed) were positive and stated that they would, if necessary, re-attend the ED with the same complaints in the future. CONCLUSION ED nurses and doctors referring children based on parental characteristics do not have to fear losing these families as patients.
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Affiliation(s)
- Hester M Diderich
- Emergency Department, Medical Centre Haaglanden, Lijnbaan 32, PO Box 432, 2501 CK The Hague, The Netherlands.
| | - Minne Fekkes
- Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands
| | - Mark Dechesne
- Campus The Hague, Leiden University, Lange Houtstraat 11, 2511 CV The Hague, The Netherlands
| | - Simone E Buitendijk
- Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Anne Marie Oudesluys-Murphy
- Social Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Konijnendijk AAJ, Boere-Boonekamp MM, Haasnoot-Smallegange RME, Need A. A qualitative exploration of factors that facilitate and impede adherence to child abuse prevention guidelines in Dutch preventive child health care. J Eval Clin Pract 2014; 20:417-24. [PMID: 24814668 DOI: 10.1111/jep.12155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2014] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In the Netherlands, evidence-based child abuse prevention (CAP) guidelines have been developed to support child health care professionals (CHPs) in recognizing and responding to suspected child abuse. The aim of this study was to identify factors related to characteristics of the guidelines, the user, the organization and the socio-political context that facilitate or impede adherence to the CAP guidelines. METHODS Three semi-structured focus groups including 14 CHPs working in one large Dutch child health care organization were conducted in January and February 2012. Participants were asked questions about the dissemination of the guidelines, adherence to their key recommendations and factors that impeded or facilitated desired working practices. The interviews were audiotaped and transcribed. Impeding and facilitating factors were identified and classified. An innovation framework was used to guide the research. RESULTS CHPs mentioned 24 factors that facilitated or impeded adherence to the CAP guidelines. Most of these factors were related to characteristics of the user. Familiarity with the content of the guidelines, a supportive working environment and good inter-agency cooperation were identified as facilitating factors. Impeding factors included lack of willingness of caregivers to cooperate, low self-efficacy and poor inter-agency cooperation. CONCLUSIONS The results indicate that a broad variety of factors may influence CHPs' (non-)adherence to the CAP guidelines. Efforts to improve implementation of the guidelines should focus on improving familiarity with their contents, enhancing self-efficacy, promoting intra-agency cooperation, supporting professionals in dealing with uncooperative parents and improving inter-agency cooperation. Recommendations for future research are provided.
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Affiliation(s)
- Annemieke A J Konijnendijk
- Departments of Health Technology and Services Research, Public Administration, University of Twente, Enschede, The Netherlands
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Diderich HM, Fekkes M, Verkerk PH, Pannebakker FD, Velderman MK, Sorensen PJG, Baeten P, Oudesluys-Murphy AM. A new protocol for screening adults presenting with their own medical problems at the Emergency Department to identify children at high risk for maltreatment. CHILD ABUSE & NEGLECT 2013; 37:1122-1131. [PMID: 23768937 DOI: 10.1016/j.chiabu.2013.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 04/08/2013] [Accepted: 04/16/2013] [Indexed: 06/02/2023]
Abstract
Identifying child abuse and neglect solely on the grounds of child characteristics leaves many children undetected. We developed a new approach (Hague protocol) based on characteristics of parents who attend the Emergency Department (ED) because they have the following problems: (1) intimate partner violence, (2) substance abuse, or (3) suicide attempt or other serious psychiatric problems. The goal of this protocol is to enable the Reporting Center for Child Abuse and Neglect (RCCAN) to rapidly assess family problems and offer voluntary community based support to these parents. The aim of this study is to assess whether this protocol for screening adults presenting for care in the Emergency Department can identify children at high risk for maltreatment. A before and after study was conducted at 9 EDs in 3 regions in the Netherlands (one intervention region and 2 control regions). During the period January 2006 to November 2007, prior to the introduction of the Hague protocol, from a total of 385,626 patients attending the ED in the intervention region 4 parents (1 per 100,000) were referred to the RCCAN. In the period after introduction of the protocol (December 2007 to December 2011), the number rose to 565 parents from a total of 885,301 patients attending the ED (64 per 100,000). In the control region, where the protocol was not implemented, these figures were 2 per 163,628 (1 per 100,000) and 10 per 371,616 (3 per 100,000) respectively (OR=28.0 (95 CI 4.6-170.7)). At assessment, child abuse was confirmed in 91% of referred cases. The protocol has a high positive predictive value of 91% and can substantially increase the detection rate of child abuse in an ED setting. Parental characteristics are strong predictors of child abuse. Implementing guidelines to detect child abuse based on parental characteristics of parents attending the adult section of the ED can increase the detection rate of child abuse and neglect allowing appropriate aid to be initiated for these families.
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Affiliation(s)
- Hester M Diderich
- Emergency Department, Medical Centre Haaglanden, Lijnbaan 32, PO Box 432, 2501 CK The Hague, The Netherlands
| | - Minne Fekkes
- Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands
| | - Paul H Verkerk
- Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands
| | - Fieke D Pannebakker
- Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands
| | - Mariska Klein Velderman
- Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands
| | - Peggy J G Sorensen
- Emergency Department, Medical Centre Haaglanden, Lijnbaan 32, PO Box 432, 2501 CK The Hague, The Netherlands
| | - Paul Baeten
- Advice and Reporting Centre for Child Abuse, Neherkade 3054, 2521 VX The Hague, The Netherlands
| | - Anne Marie Oudesluys-Murphy
- Social Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Pietrantonio AM, Wright E, Gibson KN, Alldred T, Jacobson D, Niec A. Mandatory reporting of child abuse and neglect: crafting a positive process for health professionals and caregivers. CHILD ABUSE & NEGLECT 2013; 37:102-9. [PMID: 23337443 DOI: 10.1016/j.chiabu.2012.12.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 12/11/2012] [Accepted: 12/13/2012] [Indexed: 05/23/2023]
Abstract
Health professionals working with children and their families are often required by law to report to governmental authorities any reasonable suspicion of child abuse and/or neglect. Extant research has pointed toward various barriers to reporting, with scant attention to positive processes to support the reporting process. This paper focuses on the context for mandatory reporting and evidence-informed practice for supporting a more structured and purposeful process of mandatory reporting. These practical strategies discusses: (1) the factors that positively influence the relationship between a child's caregivers and the mandated health professional reporter; (2) a framework and specific skills for discussing concerns about maltreatment and reporting to child protective services with the caregiver(s); and (3) the need for further training and education of health professionals.
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Affiliation(s)
- Emalee G Flaherty
- Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, Box 16, Chicago, IL 60611, USA.
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Wood JN, Feudtner C, Medina SP, Luan X, Localio R, Rubin DM. Variation in occult injury screening for children with suspected abuse in selected US children's hospitals. Pediatrics 2012; 130:853-60. [PMID: 23071208 PMCID: PMC4074645 DOI: 10.1542/peds.2012-0244] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To describe variation across selected US children's hospitals in screening for occult fractures in children <2 years old diagnosed with physical abuse and in infants <1 year old who have injuries associated with a high likelihood of physical abuse. METHODS We performed a retrospective study of children <2 years old with a diagnosis of physical abuse and infants <1 year old with non-motor vehicle crash-associated traumatic brain injuries or femur fractures admitted to 40 hospitals within the Pediatric Hospital Information System database from January 1, 1999, to December 31, 2009. We examined variation among the hospitals in the performance of screening for occult fractures as defined by receipt of skeletal survey or radionuclide bone scan. Marginal standardization implemented with logistic regression analysis was used to examine hospital variation after adjusting for patient demographic characteristics, injury severity, and year of admission. RESULTS Screening for occult fractures was performed in 83% of the 10,170 children <2 years old with a diagnosis of physical abuse, 68% of the 9942 infants who had a traumatic brain injury, and 77% of the 2975 infants who had femur fractures. After adjustment for patient characteristics, injury severity, and year of admission, hospitals varied significantly in use of screening for occult fractures in all 3 groups of children. CONCLUSIONS The observed variation in screening for occult fractures in young victims of physical abuse and infants who have injuries associated with a high likelihood of abuse underscores opportunities to improve the quality of care provided to this vulnerable population.
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Affiliation(s)
- Joanne N. Wood
- Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Departments of Pediatrics, and
| | - Chris Feudtner
- Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Departments of Pediatrics, and
| | - Sheyla P. Medina
- Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Xianqun Luan
- Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Russell Localio
- Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David M. Rubin
- Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and,Departments of Pediatrics, and
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Flaherty EG, Schwartz K, Jones RD, Sege RD. Child abuse physicians: coping with challenges. Eval Health Prof 2012; 36:163-73. [PMID: 22960291 DOI: 10.1177/0163278712459196] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores how child abuse physicians (CAPs) experience the unique challenges of the emerging field of child abuse pediatrics. Practicing CAPs completed a written survey about known challenges in their field. Fifty-six CAPs completed the written survey and reported experiencing many negative consequences including: threats to their personal safety (52%), formal complaints to supervisors (50%) and licensing bodies (13%), negative stories in the media (23%), and malpractice suits (16%). A purposeful sample of CAPs participated in telephone interviews about these challenges. The 19 physicians who were interviewed described the challenges, while they spontaneously expressed satisfaction with their career and described some strategies for coping with the stresses of child abuse pediatrics. The findings highlight the stressors and challenges that may affect the ability to maintain an adequate CAP workforce. Better understanding of the challenges should help prepare physicians to practice this subspecialty.
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Wood JN, Pecker LH, Russo ME, Henretig F, Christian CW. Evaluation and referral for child maltreatment in pediatric poisoning victims. CHILD ABUSE & NEGLECT 2012; 36:362-9. [PMID: 22571909 DOI: 10.1016/j.chiabu.2012.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/16/2012] [Accepted: 01/23/2012] [Indexed: 05/14/2023]
Abstract
OBJECTIVE Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS. METHODS Retrospective study of poisoning victims<6 years old seen at an urban children's hospital from 2006 to 2008. Logistic regression was performed to evaluate the associations between the outcomes (evaluation for maltreatment by hospital team and/or referral to CPS) and predictor variables (demographics and circumstances, type and severity of poisoning). RESULTS Among 928 poisonings, 41% were from household products, 20% from over-the-counter drugs, 7% from prescription narcotics/sedatives, 29% from other prescription drugs, and ≤ 1% each from ethanol, illicit drugs, or other substances. Most children were asymptomatic (69%) or stable (28%); 3% were critically ill. Only 13% were evaluated by the hospital team and 4% were referred to CPS. Demographic characteristics were not associated with referral to CPS. Higher clinical severity was associated with increased referral (p<0.001). Compared to poisonings with over-the-counter drugs, referrals were more likely for poisonings with ethanol and prescription narcotics/sedatives, but not other prescription drugs or household products (p<0.001). All illicit drug poisonings and 44% of ethanol poisonings were referred. The majority of referrals to CPS were for concerns for illicit drugs, poor supervision or multiple forms of maltreatment; 6% were secondary to concerns for intentional poisoning. CONCLUSIONS Evaluations and referrals to CPS for maltreatment are uncommon in young poisoning victims. Referrals occurred consistently for illicit drugs but not ethanol. Although referrals were more likely for higher severity poisonings, it is unclear if the severity of poisoning is associated with the level of supervisory neglect or a marker of ongoing risk to the child. These findings suggest the need to identify risk factors for ongoing harm and the development of clinical guidelines used to determine which poisoning victims should be referred to Child Protective Services.
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Affiliation(s)
- Joanne N Wood
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Chiang WL, Huang YT, Feng JY, Lu TH. Incidence of hospitalization due to child maltreatment in Taiwan, 1996-2007: a nationwide population-based study. CHILD ABUSE & NEGLECT 2012; 36:135-141. [PMID: 22405478 DOI: 10.1016/j.chiabu.2011.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 08/30/2011] [Accepted: 09/09/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Little is known regarding the epidemiology of child maltreatment in Asian countries. This study aimed to examine the incidence of hospitalization coded as due to child maltreatment in Taiwan. METHODS We used inpatient claims data of the National Health Insurance for the years 1996 through 2007 for estimation. Hospitalization of children aged 0-12 years with an ICD-9-CM code 995.5 "maltreatment syndrome" or E960-E969 "assault" in the main or secondary discharge diagnosis in claims data was defined as hospitalization due to child maltreatment. Poisson regression was used to examine the trends. RESULTS A total of 1,726 children with 1,780 hospitalizations due to child maltreatment were identified during 1996-2007. The averaged annual incidence over 1996-2007 was 13.2/100,000 for infants, 3.5/100,000 for children aged 1-3 years, 2.1/100,000 for children aged 4-6 years and 3.3/100,000 for children aged 7-12 years. The incidence increased most among the infant group, from 4.8/100,000 in 1996-1997 to 25.4/100,000 in 2006-2007, a greater than 5-fold increase. The magnitude of the increase in incidence decreased with age, and no change in incidence was noted among children aged 7-12 years. The drastic increase in incidence in infants since 2003 corresponds with the introduction of use of ICD-9-CM code 995.55 "shaken infant syndrome" in Taiwan since 2003. Head injury was the main type of injury in all age groups. CONCLUSIONS The incidence of hospitalization coded as due to child maltreatment in Taiwan differed by age group. Infants had the highest and the largest increase in incidence during the past decade. The increase might be due to improvement in awareness, competence and willingness to diagnose child maltreatment of medical staff in hospitals during the past decade after the revision of Child Welfare Law in 1993 and the new ICD-9-CM code for "shaken infant syndrome" being used since 2003. PRACTICE IMPLICATIONS Physicians and nursing staff should be aware of and provide the detailed and specific information needed for proper discharge diagnosis coding, from which valid estimation of the incidence of hospitalization due to child maltreatment can be made. Administrative data should include both the N-code and E-code for each case of child maltreatment hospitalization to provide more complete information.
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Affiliation(s)
- Wan-Lin Chiang
- NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, No. 1 Dah Hsueh Road, Tainan, Taiwan
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Wider LC. Identifying and responding to child abuse in the home. HOME HEALTHCARE NURSE 2012; 30:75-81. [PMID: 22306752 DOI: 10.1097/nhh.0b013e318242c41c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Given the sheer numbers of abused children, home health clinicians will likely encounter youngsters who are living in volatile and neglectful homes. This article details information that is designed to assist clinicians to identify and respond to child abuse and neglect.
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Affiliation(s)
- Lottchen Crane Wider
- School of Health Professions, Maryville University, St. Louis, Missouri 63141, USA.
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Somji Z, Plint A, McGahern C, Al-Saleh A, Boutis K. Diagnostic coding of abuse related fractures at two children's emergency departments. CHILD ABUSE & NEGLECT 2011; 35:905-914. [PMID: 22104188 DOI: 10.1016/j.chiabu.2011.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 04/28/2011] [Accepted: 05/03/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Pediatric fractures suspicious for abuse are often evaluated in emergency departments (ED), although corresponding diagnostic coding for possible abuse may be lacking. Thus, the primary objective of this study was to determine the proportion of fracture cases investigated in the ED for abuse that had corresponding International Classification of Diseases (ICD) codes documenting abuse suspicion. Additional objectives were to determine the proportion of these fractures with admission ICD abuse coding, and physician text diagnoses recording abuse suspicion in the ED and/or admission notes. Factors possibly associated with abuse-related ED ICD codes were also examined. METHODS Children less than three years of age that presented primarily with a fracture to two large academic children's hospitals from 1997 to 2007 and were evaluated for suspicion of abuse by child protective services were included in this retrospective review. The main outcome measure was the proportion of the fracture cases that had abuse suspicion reflected in ED discharge ICD codes. RESULTS Of the 216 eligible patients, only 23 (11.5%) patients had ED ICD codes that included the possibility of abuse. Forty-nine (22.7%) had the possibility for abuse documented by physicians as an ED discharge diagnosis. In addition, 53/149 (35.6%) of all admitted patients and 34/55 (61.8%) of confirmed abuse cases included abuse-related admission ICD coding. Female gender was found to be a factor associated with ED ICD abuse codes. CONCLUSION Current standards of ICD coding result in a significant underestimate of the prevalence of children assessed in the ED and hospital wards for possible and confirmed abusive fracture(s).
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Affiliation(s)
- Zeeshanefatema Somji
- Department of Pediatrics, Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Sege R, Flaherty E, Jones R, Price LL, Harris D, Slora E, Abney D, Wasserman R. To report or not to report: examination of the initial primary care management of suspicious childhood injuries. Acad Pediatr 2011; 11:460-6. [PMID: 21996468 DOI: 10.1016/j.acap.2011.08.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examined the validity of primary health care providers' (PHCPs) assessment of suspicion that an injury was caused by child abuse and their decision to report suspected child abuse to child protective services (CPS). METHODS By using a subsample of injuries drawn from the 15,003 childhood injuries evaluated in the Child Abuse Recognition and Evaluation Study, PHCPs completed telephone interviews concerning a stratified sample (no suspicion of abuse; suspicious but not reported; and suspicious of abuse and reported) of 111 injury visits. Two techniques were used to validate the PHCPs' initial decision: expert review and provider retrospective self-assessment. Five child abuse experts reviewed clinical vignettes created by using data prospectively collected by PHCPs about the patient encounter. The PHCPs' opinions 6 weeks and 6 months after the injury-related visits were elicited and analyzed. RESULTS PHCPs and experts agreed about the suspicion of abuse in 81% of the cases of physical injury. PHCPs did not report 21% of injuries that experts would have reported. Compared with expert reviewers, PHCPs had a 68% sensitivity and 96% specificity in reporting child abuse. A PHCP's decision to report suspected child abuse to CPS did not reduce the frequency of primary care follow-up in the 6 months after the index visit. PCHPs received information from their state CPS in 70% of the reported cases. CONCLUSIONS Child abuse experts and PHCPs are in general agreement concerning the assessment of suspected child physical abuse, although experts would have reported suspected abuse to CPS more frequently than the PHCPs. Future training should focus on clear guidance for better recognition of injuries that are suspicious for child abuse and state laws that mandate reporting.
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Affiliation(s)
- Robert Sege
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts 02118, USA.
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