Child maltreatment data: A summary of progress, prospects and challenges

Challenges to reliable ICD-10 coding of child maltreatment: A qualitative interview study of healthcare professionals in German and Swedish hospitals

BACKGROUND

Child maltreatment (CM) is a major public health issue. Data collection, analysis, and reporting are widely recognized as key components in developing policies and programs aimed at preventing child maltreatment. Unfortunately, CM is significantly under-coded by healthcare professionals (HCPs) in hospitals. Due to a lack of studies, causes of this under-coding are not fully understood.

OBJECTIVE

The aim was to identify and understand challenging factors leading to under-coding of CM in hospitals in Germany and Sweden.

PARTICIPANTS AND SETTING

The sample includes 28 HCPs from different professional groups involved in coding-process: pediatricians (n = 14), child psychiatrists (n = 6), pediatric surgeons (n = 4), medical coding professionals (n = 3), and child protection coordinators (n = 1). Nineteen identified as female and 9 as male; age ranged from 24 to 65.

METHODS

The transcripts of the semi-structured interviews have been coded and analyzed using the thematic analysis approach of Braun & Clarke.

RESULTS

In this study, four major themes were identified influencing child maltreatment coding practices on multiple levels. (1) The Impact of Systemic Frameworks, describing systemic factors, such as legal requirements and lack of mandatory education; (2) The Role of Organizational Culture and Structures, describing attitude of the clinic, transparency, and shortcomings in quality control; (3) Interpersonal Dynamics of Multidisciplinary Cooperation and Communication; and (4) Intrapersonal Barriers: Knowledge, Uncertainty, and Emotional Burdens.

CONCLUSION

Identified themes significantly influence HCPs coding practices. Addressing these multifaceted challenges requires comprehensive educational programs, improved organizational support, and systemic changes to counteract the under-coding of CM in hospitals.

Public concern of child maltreatment in China from 2011 to 2024 and its socioeconomic determinants: An Infodemiology analysis using Baidu Index

BACKGROUND

Child maltreatment represents a significant public health issue affecting children's well-being. In China, traditional cultural beliefs and social factors contribute to substantial underreporting and underestimation of maltreatment cases. Infodemiological approaches offer new perspectives for examining this hidden social phenomenon.

OBJECTIVES

This study aims to analyze the temporal evolution of public concern about child maltreatment in China, examine its socioeconomic determinants, and forecast future trends.

MATERIALS

I utilized the Baidu Index to obtain search volumes for child maltreatment-related keywords from 2011 to 2024, which were then integrated with provincial-level socioeconomic indicators across China.

METHODS

Structural breakpoint analysis, STL decomposition and ARIMA modeling were employed to analyze temporal patterns and generate forecasts. Standardized regression analysis was used to explore the associations between socioeconomic factors and public concern.

RESULTS

Public concern about child maltreatment exhibited four distinct phases: rapid increase (2011-2014), stable (2014-2018), slow decrease (2018-2022), and accelerated decrease (2022-present). Forecasts indicate a continuing decline next two years. Urbanization rate (β = 0.59, p < .001) and fertility rate (β = 0.36, p < .001) demonstrated significant positive associations with public concern, while sex ratio showed negative correlation (β= - 0.07, p < .001). Significant regional disparities were evident, with eastern regions maintaining consistently higher levels of concern while western regions showed a marked decline.

CONCLUSION

The findings reveal that public concern about child maltreatment in China is currently in a declining cycle, especially in western regions. The temporal and spatial pattern correlates closely with levels of social development and demographic structure. A more comprehensive public concern monitoring system needs to be established.

Research Review: Assessment of early-life adversity and trauma - cumulative risk and dimensional approaches

In this research review, we present approaches and recommendations for assessing early-life adversity and childhood trauma aligned with two leading conceptual models of adversity: cumulative risk and dimensional models. We summarize the measurement implications of each conceptual model and common approaches for assessing early-life adversity in studies utilizing each of these models. We consider other critical components in the assessment of early-life adversity and trauma, including retrospective and prospective reporting, objective and subjective measurement, and caregiver and child reporting. Finally, we briefly summarize the existing interview and questionnaire measures that are widely used to assess early-life adversity and trauma using both cumulative risk and dimensional approaches. This work suggests that there is greater heterogeneity in measures used to assess the dimensional model relative to those used to assess the cumulative risk model, which allows for more flexibility in the assessment of early-life adversity. In addition, we observed that more detailed measures were available to assess experiences of threat compared to experiences of deprivation. Measures that assess adversity experiences in terms of frequency and severity across multiple dimensions of experience within a single measure are needed to facilitate consistent and reliable assessment of early-life adversity and trauma, particularly when applying dimensional models.

A scoping review of participatory approaches in child maltreatment research across Europe

BACKGROUND

Participatory approaches in child maltreatment (CM) research increasingly focus on involving children, youth, and adults as co-researchers. However, little is known about their use in Europe.

OBJECTIVE

To review the European literature on participatory approaches in CM research.

METHODS

The study was undertaken by members of the Euro-CAN (COST Action 19,106) representing 35 countries in the European region. Focusing on the European research literature, we searched eight databases for studies investigating CM and using a participatory approach. The review followed scoping review guidelines and PRISMA-ScR, with thematic analysis for data synthesis.

RESULTS

We identified 4927 potentially relevant articles, of which 307 were fully assessed for eligibility, and eight were ultimately included. The included studies addressed all types of CM; however, only two studies involved child and youth survivors of CM, while six involved children and youth from the community. Notably, no studies involving adult survivors were found. The findings indicate that children, youth, and adults can be involved in all stages of the research process, but the level of participation remains low. Eighteen different participatory methods were identified, and the ethical procedures and safeguarding of co-investigators varied significantly. Several barriers and challenges were identified, including issues related to adult gatekeeping behaviors, parental consent, confidentiality, and practical difficulties.

CONCLUSIONS

The involvement of children, youth, and adults as co-researchers in CM research across Europe remains limited, with considerable variation in methods and procedures. These findings inform an ongoing e-Delphi study aimed at building consensus recommendations for participatory CM research.

Defining child maltreatment for research and surveillance: an international, multi-sectoral, Delphi consensus study in 34 countries in Europe and surrounding regions

Child maltreatment is a complex public health issue that has consequences across the life-course. Studies to quantify child maltreatment and identify interventions and services are constrained by a lack of uniform definitions. We conducted a European Delphi study to reach consensus on types and characteristics of child maltreatment for use in surveillance and research. Statements were developed following a scoping review and identification of key concepts by an international expert team (n = 19). A multidisciplinary expert panel (n = 70) from 34 countries completed three rounds of an online survey. We defined consensus as ≥70% agreement or disagreement with each statement after the final round. Consensus was reached on 26/31 statements (participant retention rate 94%). From the statements, we propose a unified definition of child maltreatment to improve measurement and surveillance in Europe. Concerted efforts are now required to test and refine the definition further prior to real-world operationalisation.

Child welfare worker perspectives on documentation and case recording practices in Canada: A mixed-methods study protocol

In health care and child welfare, clinical records and case notes serve multiple functions. When records are aggregated and processed to create administrative data, they can be analyzed and used to inform policy development and decision-making. To be useful, such data should be complete, accurate, and recorded in a standardized way. However, sources of bias and error can impact the quality of administrative data. During the development of national child welfare data in Canada, child welfare sector partners expressed concerns about the accuracy and completeness of data about children and families. This protocol describes a study that seeks to answer two questions: 1) What individual and institutional factors influence how client data is recorded by child welfare workers in Canada? 2) What data quality issues are created through documentation and case recording practices that may impact the use of clinical case management system data for public health statistics? In this protocol, we describe an exploratory mixed methods study that involves an online survey, interviews with a purposive sample of child welfare workers, and a document review of case recording guidelines. To be eligible for the study, participants must have worked at a child welfare agency or department with clinical documentation responsibilities as a part of their job. We will use descriptive statistics to analyze the survey data and thematic analysis to analyze the qualitative data. This study will help uncover strengths, limitations, and possible sources of bias created through case recording and documentation practices in child welfare. Study results will be shared through presentations to interest holders and will inform the further development of national child welfare data in Canada.

Parenting Interventions to Prevent and Reduce Physical Punishment: A Scoping Review

Physical punishment is the most common form of violence against children worldwide and is associated with an increased risk of long-term adverse outcomes. Interventions targeting parents/caregivers are frequently implemented to prevent and reduce the use of physical punishment. This scoping review aimed to map the existing literature on evidence-informed parenting interventions targeting physical punishment. A scoping review following the World Health Organization (WHO) Review Guide, the Joanna Briggs Institute (JBI) 2020 Guide for scoping reviews, was conducted to address the objective of this review. An academic health sciences librarian systematically searched electronic databases (EBSCO, MEDLINE, EMBASE, SCOPUS) for peer-reviewed journal articles. Two reviewers independently screened titles and abstracts, followed by a full-text review according to inclusion and exclusion criteria following the Participants, Concept, and Context framework. Eighty-one studies were included for full-text eligibility. The results suggest that most interventions examined were conducted in North America, targeted mothers and fathers, and were delivered in person. The results from this scoping review describe the state of evidence-informed parenting interventions to prevent and reduce physical punishment. This review found opportunities for future research to implement effective parenting interventions on a larger societal scale and use mixed methods approaches to evaluate parenting interventions.

Hasn't Child Abuse Been Overlooked? An Evaluation of Abused Children Who Visited the Emergency Department with Sentinel Injuries

OBJECTIVE

Effective child abuse intervention requires understanding its prevalence. While obtaining a comprehensive national estimate of child abuse cases is challenging, sentinel injuries-minor yet unusual injuries like bruises or wounds in pre-cruising-age children-can provide an indicative measure. Using the National Emergency Department Information System (NEDIS) data, this study aimed to gauge the prevalence of sentinel injuries using diagnostic codes in children under 12 months who visited emergency centers in South Korea and to evaluate the extent of child abuse screening in these cases.

METHODS

This cross-sectional study used diagnostic codes indicative of sentinel injuries previously defined using the Delphi method. This study, using NEDIS data, included children under 12 months who visited emergency centers nationwide from 2014 to 2021 for reasons of injury. Children injured in car accidents were excluded. Independent variables included patient demographics, the injury mechanism, intentionality, the route of arrival, the emergency center level, the triage level, and specialist consultation. Dependent variables were the presence of a sentinel injury code, and whether diagnostic tests for child abuse were conducted.

RESULTS

Based on NEDIS and national statistical data, the frequency from 2014 to 2021 averaged 2501 per 100,000 of the population. Of the 186,065 patients studied, 63,131 (33.9%) had a diagnostic code corresponding to a sentinel injury. The proportion of patients undergoing diagnostic tests for suspected child abuse was 36.9% for those with sentinel injuries and 43.8% for those with other codes. The percentage of children with sentinel injuries receiving diagnostic tests increased annually, from 32.4% in 2014 to 54.4% in 2021. By institution, the rates were 36.4% for regional emergency centers, 38.4% for local emergency centers, and 20.0% for local emergency institutions.

CONCLUSIONS

A significant proportion of children presenting to emergency departments had sentinel injury codes. However, the rate of diagnostic tests conducted for suspected child abuse in these cases remains suboptimal. Although there has been an upward trend in testing rates in recent years, there is a pressing need for increased attention to and enhancement in screening for child abuse among children with sentinel injury codes.

Socioeconomic differences in children's victimization to maternal and paternal violence: a register-based study

AIMS

To explore the potential of administrative data in assessment of the association between parental socioeconomic position (SEP) and children's violent victimization by biological parents.

METHODS

A longitudinal register-linkage study based on child-mother and child-father data, including all children born in Finland between 1991 and 2017. The data included 1,535,428 children, 796,335 biological mothers, and 775,966 fathers. We used logistic regression with person-years as observations and cluster-robust standard errors to predict children's violent victimization in 2009-2018 and assessed effect modification by child's age and gender.

RESULTS

For the SEP indicators, lower maternal education (adjusted odds ratio (OR) 2.90, secondary education OR 1.99) and lower paternal education (OR 2.24, secondary education OR 1.59) were risk factors for violent victimization. Parental social assistance receipt (OR 2.4) and non-employment (OR 1.8-1.9) increased the risk of victimization to maternal and paternal violence. Income was associated with victimization in a gradient-like manner, with ORs ranging from 1.14 to 1.98 among mothers and from 1.29 to 2.56 among fathers. Children with low parental SEP were at the highest risk of parental violence, particularly paternal violence, at ages 3-8 years.

CONCLUSIONS

All indicators of low SEP increased the risk of children experiencing both maternal and paternal physical violence, especially at ages 3-8 years. Longitudinal register data-because of large samples, no nonresponse or self-report bias, and the possibility to analyze violence committed by mother and father and age-groups separately-have great potential for comprehensive research on the risk factors of parental violence that are difficult to reliably assess with other types of data.

Is Physical Intimate Partner Violence a Risk Factor for Physical Child Maltreatment in a Nationally Representative Sample of Finnish School Children?

Previous studies have found a high co-occurrence between intimate partner violence and child maltreatment. However, little is known about the nuanced association between physical intimate partner violence (pIPV) and physical child maltreatment (pCM) in countries where corporal punishment is prohibited by law. Furthermore, there is a lack of information on the co-occurrence from children's perspectives and nationally representative surveys. The main objective of this study was to examine the connection between pIPV and pCM in a nationally representative sample of 12 to 13 and 15- to 16-year-old Finnish children (N = 6,825) after controlling for other known risk factors. The χ2 test and the logistic regression model were used. Around 47.3% of the children who had been exposed to pIPV had also experienced pCM during the past year, whereas 6.7% of those who had not been exposed to pIPV reported pCM. Children exposed to pIPV were almost three times more likely to experience pCM than children who were not exposed to pIPV. The connection remained statistically significant after controlling for other risk factors. Prevention and early identification of pIPV might reduce pCM in families. Targeted prevention efforts and interventions aimed at physical family violence are necessary to reduce its occurrence and mitigate the impact of abuse on children and families.

Insights Into Child Abuse and Neglect in the Washington DC, Maryland, and Virginia (DMV) Area: Evidence and Opportunities

Child abuse and neglect (CAN) significantly impact health, the economy, and society. This narrative review examines CAN in the Washington DC, Maryland, and Virginia (DMV) region, comparing it with national and international levels. The review highlights high CAN rates in the DMV, driven by factors such as socioeconomic status, parental substance abuse, and child vulnerabilities. Screening and reporting challenges, exacerbated by the COVID-19 pandemic, impede accurate data collection. This review emphasizes the need for standardized reporting mechanisms, economic investment in public health, and intersectoral collaboration. It recommends targeted support for at-risk families, specialized care for vulnerable children, and the development of predictive screening tools. Continuous research on regional and cultural factors and the pandemic's impact is crucial for future resilience. Addressing CAN requires a comprehensive approach involving prevention, early detection, intervention, and policy reform to safeguard the well-being of children.

The burden of prenatal and early life maternal substance use among children at risk of maltreatment: A systematic review

ISSUES

Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high-income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results.

KEY FINDINGS

Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out-of-home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records.

IMPLICATIONS

Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care.

CONCLUSIONS

Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment.

The Utility of Administrative Data in Understanding the COVID-19 Pandemic's Impact on Child Maltreatment: Learning From the Scotland Experience

The COVID-19 pandemic and associated public health 'stay at home' restrictions have intensified familial risk factors. Children would appear to be at increased risk of harm and abuse, yet administrative data from the early months of the pandemic showed falling cases of child maltreatment. Using weekly administrative data from Scotland, UK that span the first 17 months of the pandemic, this article found that child maltreatment activity levels fluctuated as 'stay at home' restrictions changed. During lockdown periods, the number of children subject to Inter-agency Referral Discussion fell but a higher number of children were placed on the Child Protection Register. When restrictions were eased, the number of Inter-agency Referral Discussions increased but the number of children placed on the Child Protection Register fell. To explain the fluctuations, the article asserts that the pandemic's impact on services' ability to engage directly with children and families has been critical, but the limitations of administrative data in providing an accurate measure of child maltreatment levels also need to be recognised. The article advocates that analysis of administrative data is best done in tandem with wider quantitative and qualitative sources in order to understand the impact of crisis events on children and families.

Health Professionals: Identifying and Reporting Child Physical Abuse-a Scoping Review

Health professionals play a significant role in identifying and reporting child physical abuse (CPA). However, several studies have pointed out non-reporting behavior among these professionals, evidencing difficulties identifying and reporting suspected cases. This review aimed to explore the frequency and possible barriers in identifying and reporting CPA by health professionals worldwide and to identify associated factors. This scoping review was conducted in the Pubmed, Web Of Science, Scopus, and SciELO databases between July 2019 and December 2020. Analytical and qualitative observational epidemiological studies were selected and published in English, Portuguese, and Spanish, with data on the identification and/or reporting of CPA by health professionals. Twenty studies fulfilled the criteria of this review. The studies were conducted with dentists, nurses, pediatricians, and general practitioners. The frequency of identification of CPA ranged from 50% to 89%, while the frequency of reporting ranged from 8% to 47%. This review revealed that health professionals had a low frequency of reporting of CPA, especially for dentists. In addition, several associated factors and barriers in the identification and reporting of CPA were identified in the studies. These were discussed in five main themes: training and continuing education in CPA, impact on professional practice, experiences and perceptions about child protection services, the threshold for suspicion of the professional, and the professional category.

Focusing the APA Ethics Code to Include Development: Applications to Abuse

Extant ethics codes in psychological work generally are not sufficiently developmentally oriented. Here, we examine the American Psychological Association ethics code for its developmental sensitivity, find it lacking in this regard, and make recommendations. Our approach was to place children and youth at the forefront in forming developmentally-targeted principles, meta-principles, values, and rights. To further this aim, we consulted the one ethics code in the field that is developmentally-attuned, the ethics code of the American Academy of Child and Adolescent Psychiatry. We used a revised set of ethical principles for psychological work and developed a set of meta-principles. The five APA ethics code principles are: (a) beneficence and nonmaleficence; (b) fidelity and responsibility; (c) integrity; (d) justice; and (e) respect for people's rights and dignity. The set of ethical principles taken from Young (Revising the American Psychological Association ethics code, Springer International Publishing, 2017) includes: (a) life preservation, (b) caring beneficence/nonmaleficence, (c) relational integrity, (d) respect for the dignity and rights of persons and peoples, and (e) promoting and acting from justice in society. The major meta-principles proposed here include: (a) functioning from responsibility, (b) promoting personhood, and (c) promoting participation. In addition, we added meta-principles for working from appropriate (d) theory and (e) meta-theory (Neo-Maslovian and a combined relationism-empiricism, respectively). Secondary meta-principles in the text refer to (a) systems, (b) the person as unique, (c) the vulnerabilities of people, (d) autonomy, and (e) morality.

Asking youth and adults about child maltreatment: a review of government surveys

OBJECTIVES

In this review we: (1) identify and describe nationally representative surveys with child maltreatment (CM) questions conducted by governments in low-income, middle-income and high-income countries and (2) describe procedures implemented to address respondents' safety and minimise potential distress.

DESIGN

We conducted a systematic search across eight databases from 1 January 2000 to 5 July 2021 to identify original studies with information about relevant surveys. Additional information about surveys was obtained through survey methods studies, survey reports, survey websites or by identifying full questionnaires (when available).

RESULTS

Forty-six studies representing 139 surveys (98 youth and 41 adult) conducted by governments from 105 countries were identified. Surveys implemented a variety of procedures to maximise the safety and/or reduce distress for respondents including providing the option to withdraw from the survey and/or securing confidentiality and privacy for the respondent. In many surveys, further steps were taken such as providing information for support services, providing sensitivity training to survey administrators when interviews were conducted, among others. A minority of surveys took additional steps to empirically assess potential distress experienced by respondents.

CONCLUSIONS

Assessing risk and protective factors and developing effective interventions and policies are essential to reduce the burden of violence against children. While asking about experiences of CM requires careful consideration, procedures to maximise the safety and minimise potential distress to respondents have been successfully implemented globally, although practices differ across surveys. Further analysis is required to assist governments to implement the best possible safety protocols to protect respondents in future surveys.