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Su HC, Lin YH. Analyses of Criminal Judgments about Domestic Child Abuse Cases in Taiwan. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1237. [PMID: 37508734 PMCID: PMC10378539 DOI: 10.3390/children10071237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Child abuse has negative impacts on the well-being of children and often leads to adverse consequences, such as suicide, alcohol addiction, depression, and substance abuse. To better understand domestic child abuse in Taiwan, this study analyzed 73 criminal judgments (open-access documents) in which the victims of domestic child abuse were children below the age of 12 from the "Judicial Yuan Law and Regulations Retrieving System" database. There were 73 victims and 91 perpetrators involved. The results indicated that younger children were more likely to be victims of physical abuse, and the majority of death cases were committed by biological parents and cohabiting partners. The perpetrators tended to be young males with lower education. Male cohabiting partners appeared to be a high-risk population for child abuse. Approximately 63% of perpetrators experienced poverty, and 24.7% suffered from marital discord. In the 73 cases, 61.6% of the victims died, 21.9% were mildly injured, and 16.5% were severely injured. The sentencing was related to the level of injury, with perpetrators of mild injury sentenced to less than one year while perpetrators with victim death were sentenced to a longer period of imprisonment. It is suggested that parents at higher risk require greater financial and social support and should be educated on appropriate disciplinary techniques.
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Affiliation(s)
- Hsiu-Chih Su
- Department of Early Childhood Development and Education, Chaoyang University of Technology, Taichung 41349, Taiwan
| | - Yi-Hxuan Lin
- Department of Early Childhood Development and Education, Chaoyang University of Technology, Taichung 41349, Taiwan
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Bisagno E, Cadamuro A, Serafine D, Dima BM, Anne G, Zane LO, Annija K, Dóra VS, Dorottya M, Noémi L, Monika R, Andrea G, Giovanna Laura DF, Johanna Maria Catharina B. The Development of a Screening Tool for Childcare Professionals to Detect and Refer Infant and Toddler Maltreatment and Trauma: A Tale of Four Countries. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050858. [PMID: 37238406 DOI: 10.3390/children10050858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
Child maltreatment is considered a pressing social question, compromising the present and future mental and physical health of one in four children in Europe. While children younger than three years of age are especially vulnerable, few screening instruments are available for the detection of risk in this age group. The purpose of this research was to develop a screening tool for childcare professionals working in public and private daycare settings to support them in the early identification and referral of infants and toddlers exposed to emotional and physical abuse and neglect by primary caregivers, to be used in different settings across four European countries: Belgium, Italy, Latvia, and Hungary. METHOD A stratified process was used to create the screening tool: We started by using Living lab methodology to co-create the screening tool with its final users, which was followed by testing the tool with a total of 120 childcare professionals from the four participating countries. RESULTS During the Living Lab phase, a screening tool with three layers was developed. The initial layer includes five "red flags" that signal particular concern and require immediate action. The second layer is a quick screener with twelve items focused on four areas: neglect of basic needs, delays in development, unusual behaviors, and interaction with caregivers. The third layer is an in-depth questionnaire that aids in formalizing a thorough observation of twenty-five items within the same four areas as the quick screener. After a one-day training session, 120 childcare professionals caring for children aged 0-3 from four countries assessed the screening tool and their overall training experience. Childcare professionals reported great satisfaction with the three-layered structure, which made the tool versatile, and agreed on its content, which was considered helpful in the daycare setting for the regular evaluation of the behavior of children and their primary caregivers, thus improving the early observation of change from the normal behavior of the infant or toddler. CONCLUSION The three-layered screening tool was reported as feasible, practical, and with great content validity by childcare professionals working in four European countries.
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Affiliation(s)
- Elisa Bisagno
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Alessia Cadamuro
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Dierickx Serafine
- Expertise Centre Resilient People, University Colleges Leuven-Limburg (UCLL), 3001 Leuven, Belgium
| | - Bou Mosleh Dima
- Expertise Centre Resilient People, University Colleges Leuven-Limburg (UCLL), 3001 Leuven, Belgium
| | - Groenen Anne
- Expertise Centre Resilient People, University Colleges Leuven-Limburg (UCLL), 3001 Leuven, Belgium
| | - Linde-Ozola Zane
- Department of Anthropology, Faculty of Humanities, University of Latvia, LV-1586 Riga, Latvia
| | | | | | - Morva Dorottya
- Pressley Ridge Hungary Foundation, 1142 Budapest, Hungary
| | - László Noémi
- Pressley Ridge Hungary Foundation, 1142 Budapest, Hungary
| | - Rozsa Monika
- Pressley Ridge Hungary Foundation, 1142 Budapest, Hungary
| | - Gruber Andrea
- Pressley Ridge Hungary Foundation, 1142 Budapest, Hungary
| | | | - Blom Johanna Maria Catharina
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, 41121 Modena, Italy
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Chen CJ, Chen YW, Chang HY, Feng JY. Hospital-Based Case Management Model for Child Protection Teams in Taiwan: An Action Research Approach. J Nurs Res 2022; 30:e225. [PMID: 35675162 DOI: 10.1097/jnr.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Hospital-based child protection teams play an important role in the multidisciplinary assessment, treatment, care, and rehabilitation of abused children and their families. However, the process by which these teams are built and promoted has not been explored adequately in the literature. PURPOSE This study was developed to examine the process used to promote child protection team case management and to evaluate the related results. METHODS An action research model was adopted in this study. The participants and the investigator were members of a child protection team at a medical center in southern Taiwan. Qualitative and quantitative assessments were used to identify problems related to organizational structure, intervention procedures, and evaluation effectiveness. Thereafter, the study program was implemented, and the results were evaluated. Content analysis of the qualitative data, including transcribed interviews with external benchmark members and members of the hospital's team and text entries from the investigator's reflective journal, was conducted. Quantitative data, including monitoring indicators for team case management, were analyzed using descriptive statistics. RESULTS Three important concepts emerged related to changes in the promotion of case management by hospital child protection teams. These included formulation of a team operation model through visits to benchmark hospitals, establishment of the case management and monitoring mechanism based on team consensus, and expansion of collaboration with external agencies through the establishment of a child and adolescent protection medical regional integration center. The results of the promotion process were affected by factors that included member willingness, teamwork, hospital support, and national policy. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Use of the hospital child protection team case management model developed in this study was shown to facilitate the provision of consultation services, integrate the opinions and resources of experts from various fields, and allow the timely provision of acute care, follow-up family environment support, and social resources required by children and their family members. These measures help prevent the reoccurrence of child abuse and enable children to grow up healthily and free from violence.
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Affiliation(s)
- Chia-Jung Chen
- PhD, RN, Supervisor, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Yi-Wen Chen
- PhD, RN, Head Nurse, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Hsin-Yi Chang
- MSN, RN, Doctoral Student and Project Instructor, International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University
| | - Jui-Ying Feng
- DNS, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, and Deputy Director, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
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Chen CJ, Chen YW, Chang HY, Feng JY. Screening Tools for Child Abuse Used by Healthcare Providers: A Systematic Review. J Nurs Res 2022; 30:e193. [PMID: 35050956 DOI: 10.1097/jnr.0000000000000475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The early detection of child abuse is essential for children at risk. Healthcare professionals working at hospitals and in the community are often the first to encounter suspected cases of child abuse. Therefore, an accurate identification of child abuse is critical for intervention. However, there is no consensus on the best method to screen for child abuse. PURPOSE This systematic review was designed to evaluate the relevant psychometric properties and critically appraise the methodological quality of child abuse screening tools used by healthcare providers with children less than 18 years old. METHODS We searched the Cochrane Library, MEDLINE, Embase, CINAHL, Education Resources Information Center, PubMed, Airiti Library, and OpenGray databases for studies on screening tools used to identify abuse in children published through October 2019 in English or Chinese. Information regarding populations, assessment methods, and accuracy parameters were extracted. Study quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and Grading of Recommendation, Assessment, Development, and Evaluation criteria. RESULTS Nine hundred thirty-nine abstracts and 23 full-text articles were reviewed for eligibility, and 15 screening tools for child abuse used by healthcare providers were identified. Screening tools often assess the presence of more than one form of abuse, but no single tool covered all forms. Of these, 10 tools screened for a single, discrete type of abuse, including nine physical abuse screening tools (three abusive head trauma tools) and one sexual abuse tool. Eighty percent (n = 12) of the screening tools had a moderate-to-high quality of evidence based on the Grading of Recommendation, Assessment, Development, and Evaluation criteria. However, none of these screening tools achieved an adequate level of evidence based on the COnsensus-based Standards for the selection of health Measurement INstruments checklist. CONCLUSIONS/IMPLICATIONS FOR PRACTICE In this systematic literature review, 15 assessment tools of child abuse used by healthcare providers were identified, of which nine screened for physical abuse. Screening tools must be valid, succinct, user-friendly, and amenable for use with children at every point of care in the healthcare system. Because of the paucity of informative and practical studies in the literature, findings related to the quality of child abuse screening tools were inconclusive. Therefore, future research should focus on the use of screening tools in the healthcare system to identify effective screening interventions that may help healthcare providers identify child abuse cases as early as possible.
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Affiliation(s)
- Chia-Jung Chen
- MSN, RN, Doctoral Student, International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, and Supervisor, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Yi-Wen Chen
- MSN, RN, Doctoral Student, International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, and Assistant Head Nurse, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Hsin-Yi Chang
- MSN, RN, Doctoral Student and Project Instructor, International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University
| | - Jui-Ying Feng
- DNS, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, and Adjunct Supervisor, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
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Chen IC, Duh MC, Jaw TS, Liu YC, Wu YH, Yin HL, Hsu JH. Experience with outreach services of a multidisciplinary team for child abuse identification. J Formos Med Assoc 2021; 121:1111-1116. [PMID: 34535376 DOI: 10.1016/j.jfma.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/PURPOSE Identifying child abuse is sometimes challenging due to its various presentations. To facilitate timely identification of critical or complex cases of physical abuse outside our child protection center, we established an outreach multidisciplinary team (OMDT) to support Kaohsiung City Government in 2014. The objective of this study was to describe our experience of OMDT services during a 6-year period and examine its role in assisting law enforcement. METHODS We retrospectively analyzed all OMDT cases from January 2014 to January 2020. Clinical characteristics and OMDT reports were reviewed. After inspection by our OMDT, cases were determined as indicating either a high risk or low risk of child abuse. Associations among clinical characteristics, radiographic findings, OMDT decisions and case outcomes including law enforcement and prosecution were examined. RESULTS Thirty-two cases (22 [68.8%] males and 10 [31.2%] females; mean age 24.2 months) received OMDT service, of whom 28 (87.5%) were admitted to the pediatric intensive care unit. The victims had an average of 2.2 types of wounds in 3.4 locations. The most common finding on radiography was subdural hemorrhage (18, 56.3%), followed by subarachnoid hemorrhage (31, 31.3%). Law enforcement was activated in 20 (64.5%) cases, and was only associated with the high-risk group as determined by the OMDT (p < 0.05) but not with any other variables. CONCLUSION Our experience indicates that an OMDT can play an important role in child protection and activating law enforcement for children with complex or critical physical abuse. We suggest that in Taiwan, OMDT services should be incorporated into child protection centers, National Health Insurance system and governmental child protection policies.
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Affiliation(s)
- I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chieh Duh
- School of Post Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Twei-Shiun Jaw
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yen-Hsien Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsin-Ling Yin
- Department of Clinical Forensic Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Huang LY, Chen WJ, Yang YN, Wu CY, Wu PL, Tey SL, Yang SN, Liu HK. Maternal Age, the Disparity across Regions and Their Correlation to Sudden Infant Death Syndrome in Taiwan: A Nationwide Cohort Study. CHILDREN-BASEL 2021; 8:children8090771. [PMID: 34572203 PMCID: PMC8471108 DOI: 10.3390/children8090771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Sudden infant death syndrome (SIDS) has always been a regrettable issue for families. After sleeping in the supine position was proposed, the incidence of SIDS declined dramatically worldwide. However, SIDS still accounts for the top 10 causes of infant deaths in Taiwan. Recognizing the risk factors and attempting to minimize these cases are imperative. We obtained information on cases with SIDS from the National Health Insurance Research Database in Taiwan and interconnected it with the Taiwan Maternal and Child Health Database to acquire infant-maternal basal characteristics between 2004 and 2017. The SIDS subjects were matched 1:10 considering gestational age to normal infants. After case selection, a total of 953 SIDS cases were included. Compared with healthy infants, SIDS infants had younger parents, lower birth weight, and lower Apgar scores. After adjusting for potential confounders, infants with mothers aged <20 years had 2.81 times higher risk of SIDS. Moreover, infants in the non-eastern region had a significantly lower risk of SIDS than those in the eastern region. We concluded that infants of young mothers (especially maternal age <20 years) and infants in the eastern region of Taiwan had a higher risk of SIDS than their counterparts.
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Affiliation(s)
- Lin-Yi Huang
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan; (L.-Y.H.); (W.-J.C.); (Y.-N.Y.); (C.-Y.W.); (P.-L.W.); (S.-L.T.); (S.-N.Y.)
| | - Wan-Ju Chen
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan; (L.-Y.H.); (W.-J.C.); (Y.-N.Y.); (C.-Y.W.); (P.-L.W.); (S.-L.T.); (S.-N.Y.)
| | - Yung-Ning Yang
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan; (L.-Y.H.); (W.-J.C.); (Y.-N.Y.); (C.-Y.W.); (P.-L.W.); (S.-L.T.); (S.-N.Y.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Chien-Yi Wu
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan; (L.-Y.H.); (W.-J.C.); (Y.-N.Y.); (C.-Y.W.); (P.-L.W.); (S.-L.T.); (S.-N.Y.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Pei-Ling Wu
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan; (L.-Y.H.); (W.-J.C.); (Y.-N.Y.); (C.-Y.W.); (P.-L.W.); (S.-L.T.); (S.-N.Y.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Shu-Leei Tey
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan; (L.-Y.H.); (W.-J.C.); (Y.-N.Y.); (C.-Y.W.); (P.-L.W.); (S.-L.T.); (S.-N.Y.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - San-Nan Yang
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan; (L.-Y.H.); (W.-J.C.); (Y.-N.Y.); (C.-Y.W.); (P.-L.W.); (S.-L.T.); (S.-N.Y.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-DA Hospital, Kaohsiung 82445, Taiwan; (L.-Y.H.); (W.-J.C.); (Y.-N.Y.); (C.-Y.W.); (P.-L.W.); (S.-L.T.); (S.-N.Y.)
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
- Correspondence: ; Tel.: +886-978060068
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Chang YT, Chang HY, Chen LW, Lu TH, Tsai HJ, Chen YW, Chang YC, Feng JY. Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006-2015: a nationwide population-based study. Inj Prev 2020; 27:356-362. [PMID: 32788223 DOI: 10.1136/injuryprev-2020-043805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan. METHODS The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time. RESULTS From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1-2 (1.7/100 000 and 2.1/100 000) and 3-5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1-5 years. CONCLUSIONS This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession's sensitivity and competence for the early identification and diagnosis of PAHT is critical.
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Affiliation(s)
- Yi-Ting Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Yi Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yi-Wen Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chun Chang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Ying Feng
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan .,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chou IJ, Kong SS, Chung TT, See LC, Kuo CF, Lin JJ, Wang HS, Lin KL, Hung PC. Evaluation of the effect of the child protection act on serious child physical abuse in Taiwan. CHILD ABUSE & NEGLECT 2019; 95:104066. [PMID: 31284024 DOI: 10.1016/j.chiabu.2019.104066] [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: 01/02/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Few studies have examined the effects of the Child Protection Act on child maltreatment in Taiwan. OBJECTIVE This study estimated the secular trends in the incidence rate of physical abuse of children requiring hospitalization between 1996 and 2013, and the subsequent in-hospital death proportion before and after implementation of the Act in 2003. PARTICIPANTS AND SETTING The cases were children younger than 12 years old who were hospitalized due to child abuse, shaken-baby syndrome, neglect, or homicide between 1996 and 2013. A comparison group consisted of children requiring hospitalization for other reasons. We used the National Health Insurance database to identify patients. METHODS The Joinpoint Regression Program was used to estimate temporal trends in the standardized incidence rates. RESULTS Between 1996 and 2013, 2050 children required hospitalization for physical abuse. Before 2005, the annual percent change increased by 9.40 [95% confidence interval (CI), 4.98-14.00] per year, and after 2005 the annual percent change was -4.80 (95% CI, -9.53-0.17) per year. Among the 2050 physically abused children requiring hospitalization, 83 (4%) died in hospital. The in-hospital death proportion was 2.62% before 2003 and 4.90% after 2003, and the ratio of these two proportions was 1.43 (95% CI, 0.80-2.58). CONCLUSIONS The trend in the incidence of hospitalization of children due to physical-abuse-related injuries started to decline 2 years after implementation of the Child Protection Act. However, the proportion of children who died in hospital as a result of physical abuse requiring hospitalization did not change.
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Affiliation(s)
- I-Jun Chou
- Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taiwan
| | - Shu-Sing Kong
- Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taiwan
| | - Ting-Ting Chung
- Big Data Research Office, Chang Gung Memorial Hospital, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine and Biostatistics Core Laboratory, Molecular Medicine Research Centre, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK; Big Data Research Office, Chang Gung Memorial Hospital, Taiwan
| | - Jainn-Jim Lin
- Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taiwan
| | - Huei-Shyong Wang
- Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taiwan
| | - Kuang-Lin Lin
- Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taiwan
| | - Po-Cheng Hung
- Division of Paediatric Neurology, Chang Gung Memorial Hospital, Taiwan.
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Paek SH, Kwak YH, Noh H, Jung JH. A survey on the perception and attitude change of first-line healthcare providers after child abuse education in South Korea: A pilot study. Medicine (Baltimore) 2019; 98:e14085. [PMID: 30633217 PMCID: PMC6336610 DOI: 10.1097/md.0000000000014085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We had designed an educational program for early reporting of suspected child abuse for healthcare providers in South Korea. The purpose of study was to evaluate the effectiveness of education program for health care providers as pilot study. The educational program consisted of two 2-hour-long didactic lectures and was held at 15 hospitals between July and December 2016. We conducted a survey study with physicians, nurses, emergency medical technicians, and other hospital staff. Participants completed survey questionnaires before and after the lecture and 3 months later. The questionnaire contained 3 sections: practical knowledge regarding child abuse, confidence in reporting, and willingness to report. A 10-point Likert scale was used to evaluate the responses. A total of 1103 participants working in 15 different hospitals attended the educational program. In all, 663 participants (75.5%) completed the survey with nurses at 61.7% and physicians at 22%. 26.4% had previously received education about child abuse and reporting methods, and 227 (34.2%) had experience with reporting (direct and indirect) child abuse. The score about knowledge improved from 5.28 points before to 8.03 after the educational program, and was 7.1 after 3 months (P < .001), using a 10-point Likert scale. The confidence increased from 4.76 before the program to 7.59 after it, and was 6.6 after 3 months (P < .001). The willingness to report increased from 7.46 before the program to 8.68 after it, and was 8.14 after 3 months (P < .001). Participants' satisfaction with the education program was 8.3 points immediately after education and 7.6 points after 3 months. The recommendation index of curriculum was 8.4 points before program and 8.1 points after 3 months. The educational program on the assessment of child abuse and reporting methods increased healthcare professionals' knowledge and confidence and improved their willingness to report suspected child abuse in a low-perception environment.
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Affiliation(s)
- So Hyun Paek
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University College of Medicine
| | - Hyun Noh
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University Bucheon Hospital
| | - Jin Hee Jung
- Department of Emergency Medicine, SMG-SNU Boramae Medical Center, Republic of Korea
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Lee EP, Hsia SH, Huang JL, Lin JJ, Chan OW, Lin CY, Lin KL, Chang YC, Chou IJ, Lo FS, Lee J, Hsin YC, Chan PC, Hu MH, Chiu CH, Wu HP. Epidemiology and clinical analysis of critical patients with child maltreatment admitted to the intensive care units. Medicine (Baltimore) 2017; 96:e7107. [PMID: 28591056 PMCID: PMC5466234 DOI: 10.1097/md.0000000000007107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Children with abuse who are admitted to the intensive care unit (ICU) may have high mortality and morbidity and commonly require critical care immediately. It is important to understand the epidemiology and clinical characteristics of these critical cases of child maltreatment.We retrospectively evaluated the data for 355 children with maltreatments admitted to the ICU between 2001 and 2015. Clinical factors were analyzed and compared between the abuse and the neglect groups, including age, gender, season of admission, identifying settings, injury severity score (ISS), etiologies, length of stay (LOS) in the ICU, clinical outcomes, and mortality. In addition, neurologic assessments were conducted with the Pediatric Cerebral Performance Category (PCPC) scale.The most common type of child maltreatments was neglect (n = 259), followed by physical abuse (n = 96). The mean age of the abuse group was less than that of the neglect group (P < .05). Infants accounted for the majority of the abuse group, and the most common etiology of abuse was injury of the central nervous system (CNS). In the neglect group, most were of the preschool age and the most common etiologies of abuse were injury of the CNS and musculoskeletal system (P < .001). The mortality rate in the ICU was 9.86%. The ISS was significantly associated with mortality in both the 2 groups (both P < .05), whereas the LOS in the ICU and injuries of the CNS, musculoskeletal system, and respiratory system were all associated with mortality in the neglect group (all P < .05). The PCPC scale showed poor prognosis in the abuse group as compared to the neglect group (P < .01).In the ICU, children in the abuse group had younger age, higher ISS, and worse neurologic outcome than those in the neglect group. The ISS was a predictor for mortality in the abuse and neglect groups but the LOS in the ICUs, injuries of the CNS, musculoskeletal system, and respiratory system were indicators for mortality in the neglect group. Most importantly, identifying the epidemiological information may provide further strategies to reduce the harm, lower the medical costs, and improve clinical care quality and outcomes in children with abuse.
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Affiliation(s)
- En-Pei Lee
- Division of Pediatric Critical Care Medicine
- College of Medicine, Chang Gung University
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine
- College of Medicine, Chang Gung University
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Jing-Long Huang
- College of Medicine, Chang Gung University
- Division of Pediatric Allery, Asthma, and Rheumatology1
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine
- College of Medicine, Chang Gung University
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Oi-Wa Chan
- Division of Pediatric Critical Care Medicine
- College of Medicine, Chang Gung University
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Chia-Ying Lin
- Division of Pediatric Critical Care Medicine
- College of Medicine, Chang Gung University
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Yu-Ching Chang
- Division of Pediatric General Medicine
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - I-Jun Chou
- College of Medicine, Chang Gung University
- Division of Pediatric Neurology
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Fu-Song Lo
- Division of Pediatric Endocrinology
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Jung Lee
- College of Medicine, Chang Gung University
- Division of Pediatric General Medicine
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Yi-Chen Hsin
- College of Medicine, Chang Gung University
- Division of Pediatric General Medicine
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Pei-Chun Chan
- College of Medicine, Chang Gung University
- Division of Pediatric General Medicine
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Mei-Hua Hu
- College of Medicine, Chang Gung University
- Division of Pediatric General Medicine
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- College of Medicine, Chang Gung University
- Division of Pediatric Infectious Diseases
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
| | - Han-Ping Wu
- College of Medicine, Chang Gung University
- Division of Pediatric General Medicine
- Study Group for Prevention and Protection Against Child Abuse and Neglect, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan
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