1
|
Bouchelle Z, G. Menko S, Yazdani M, Vasan A, Scribano P, Shea JA, Kenyon CC. Parent Perspectives on Documentation and Sharing of Health-Related Social Needs Data. Hosp Pediatr 2024; 14:308-316. [PMID: 38477053 PMCID: PMC10965757 DOI: 10.1542/hpeds.2023-007478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 03/14/2024]
Abstract
OBJECTIVE Parents of pediatric patients are key stakeholders in the design and implementation of health-related social needs (HRSN) screening programs. Yet, there is little research exploring their perspectives on the documentation and sharing of HRSN data. We aimed to examine parents' preferences regarding how HRSN data are documented and shared. METHODS We conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were coded using an inductive and deductive approach to identify emergent themes. RESULTS The 20 interviewed parents were uniformly female with 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of International Classification of Diseases, 10th Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as the most appropriate recipients of HRSN data. Few parents felt comfortable with HRSN data being shared with payors. Parents desired transparency around HRSN data sharing. Many expressed concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals. CONCLUSIONS Parents expressed comfort with HRSN documentation and sharing with health care providers, but requested that providers be transparent and respect parental preferences regarding data sharing to mitigate potential harms. When implementing HRSN support programs, health systems and payors should prioritize transparency around documentation and data sharing with families.
Collapse
Affiliation(s)
- Zoe Bouchelle
- National Clinician Scholars Program
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Mishaal Yazdani
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Clinical Futures
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Philip Scribano
- Department of Pediatrics
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Judy A. Shea
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Chén C. Kenyon
- Department of Pediatrics
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab
- Clinical Futures
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Jack SM, Kimber M, Davidov D, Ford-Gilboe M, Wathen CN, McKee C, Tanaka M, Boyle M, Johnston C, Coben J, Gasbarro M, McNaughton D, O'Brien R, Olds DL, Scribano P, MacMillan HL. Nurse-Family Partnership nurses' attitudes and confidence in identifying and responding to intimate partner violence: An explanatory sequential mixed methods evaluation. J Adv Nurs 2021; 77:3894-3910. [PMID: 34288040 DOI: 10.1111/jan.14979] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the effect of an intimate partner violence intervention education component on nurses' attitudes in addressing intimate partner violence; complementary aims included understanding nurses' perceptions of the education and how it influenced their attitudes and confidence to address intimate partner violence in practice. DESIGN An explanatory sequential mixed methods design embedded within a 15-site cluster randomized clinical trial that evaluated an intimate partner violence intervention within the Nurse-Family Partnership programme. METHODS Data were collected between February 2011 and September 2016. Quantitative assessment of nurses' attitudes about addressing intimate partner violence was completed by nurses in the intervention (n = 77) and control groups (n = 101) at baseline, 12 months and at study closure using the Public Health Nurses' Responses to Women Who Are Abused Scale. Qualitative data were collected from nurses in the intervention group at two timepoints (n = 14 focus groups) and focused on their perceptions of the education component. Data were analysed using content analysis. RESULTS Nurses in the intervention group reported large improvements in their thoughts, feelings and perceived behaviours related to addressing intimate partner violence; a strong effect of the education was found from baseline to 12 months and baseline to study closure timepoints. Nurses reported that the education component was acceptable and increased their confidence to address intimate partner violence. CONCLUSION Nurses reported improved attitudes about and confidence in addressing intimate partner violence after receiving the education component. However, these findings need to be considered together with trial results showing no main effects for clients, and a low level of intervention fidelity. IMPACT These evaluation findings underscore that improvement in nurses' self-reported educational outcomes about addressing intimate partner violence cannot be assumed to result in adherence to intervention implementation or improvement in client outcomes. These are important considerations for developing nurse education on intimate partner violence.
Collapse
Affiliation(s)
- Susan M Jack
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Melissa Kimber
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Danielle Davidov
- Department of Social and Behavioral Sciences, West Virginia University, Morgantown, WV, USA.,School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - C Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.,Faculty of Information and Media Studies, Western University, London, ON, Canada
| | - Christine McKee
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Masako Tanaka
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Michael Boyle
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Carolyn Johnston
- Nurse-Family Partnership National Service Office, Denver, CO, USA
| | - Jeffrey Coben
- School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Mariarosa Gasbarro
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - Diane McNaughton
- Department of Community Systems and Mental Health Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Ruth O'Brien
- College of Nursing, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - David L Olds
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA
| | - Philip Scribano
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Harriet L MacMillan
- Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
3
|
Miller AJ, Narang S, Scribano P, Greeley C, Berkowitz C, Leventhal JM, Frasier L, Lindberg DM. Ethical Testimony in Cases of Suspected Child Maltreatment: The Ray E. Helfer Society Guidelines. Acad Pediatr 2020; 20:742-745. [PMID: 32068125 DOI: 10.1016/j.acap.2020.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 11/26/2022]
Abstract
New guidelines for ethical testimony were developed by the Ray E. Helfer Society, the largest medical professional society for physicians working in the field of child maltreatment. Building on the foundation of ethical guidelines set forth by the American Academy of Pediatrics, these new guidelines set detailed standards for testifying in cases of suspected child maltreatment and recommend that hospitals, medical practices, academic institutions, and professional societies hold their members accountable for court testimony related to child maltreatment as with other forms of medical practice and expert testimony.
Collapse
Affiliation(s)
- Aaron J Miller
- Office of Ambulatory Care (AJ Miller), New York City Health + Hospitals, New York, NY.
| | - Sandeep Narang
- Department of Pediatrics (S Narang), Northwestern Feinberg School of Medicine, Chicago, Ill
| | - Philip Scribano
- Department of Pediatrics (P Scribano), Safe Place Center for Child Protection and Health, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Christopher Greeley
- Department of Pediatrics (C Greeley), Baylor College of Medicine, Houston, Tex
| | - Carol Berkowitz
- Department of Pediatrics (C Berkowitz), Harbor-UCLA Medical Center, Torrance, Calif
| | - John M Leventhal
- Department of Pediatrics (JM Leventhal), Yale School of Medicine, New Haven, Conn
| | - Lori Frasier
- Department of Pediatrics (L Frasier), Penn State Hershey College of Medicine, Hershey, Pa
| | - Daniel M Lindberg
- Department of Emergency Medicine (DM Lindberg), The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Aurora, Colo
| |
Collapse
|
4
|
Jack SM, Boyle M, McKee C, Ford-Gilboe M, Wathen CN, Scribano P, Davidov D, McNaughton D, O’Brien R, Johnston C, Gasbarro M, Tanaka M, Kimber M, Coben J, Olds DL, MacMillan HL. Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial. JAMA 2019; 321:1576-1585. [PMID: 31012933 PMCID: PMC6487547 DOI: 10.1001/jama.2019.3211] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Intimate partner violence (IPV) is a public health problem with significant adverse consequences for women and children. Past evaluations of a nurse home visitation program for pregnant women and first-time mothers experiencing social and economic disadvantage have not consistently shown reductions in IPV. OBJECTIVE To determine the effect on maternal quality of life of a nurse home visitation program augmented by an IPV intervention, compared with the nurse home visitation program alone. DESIGN, SETTING, AND PARTICIPANTS Cluster-based, single-blind, randomized clinical trial at 15 sites in 8 US states (May 2011-May 2015) enrolling 492 socially disadvantaged pregnant women (≥16 years) participating in a 2.5-year nurse home visitation program. INTERVENTIONS In augmented program sites (n = 229 participants across 7 sites), nurses received intensive IPV education and delivered an IPV intervention that included a clinical pathway to guide assessment and tailor care focused on safety planning, violence awareness, self-efficacy, and referral to social supports. The standard program (n = 263 participants across 8 sites) included limited questions about violence exposure and information for abused women but no standardized IPV training for nurses. MAIN OUTCOMES AND MEASURES The primary outcome was quality of life (WHOQOL-BREF; range, 0-400; higher score indicates better quality of life) obtained through interviews at baseline and every 6 months until 24 months after delivery. From 17 prespecified secondary outcomes, 7 secondary end points are reported, including scores on the Composite Abuse Scale, SPAN (Startle, Physiological Arousal, Anger, and Numbness), Prime-MD Patient Health Questionnaire, TWEAK (Tolerance/Worry About Drinking/Eye-Opener/Amnesia/C[K]ut Down on Drinking), Drug Abuse Severity Test, and the 12-Item Short-Form Health Survey (physical and mental health), version 2. RESULTS Among 492 participants enrolled (mean age, 20.4 years), 421 (86%) completed the trial. Quality of life improved from baseline to 24 months in both groups (change in WHOQOL-BREF scores from 299.5 [SD, 54.4] to 308.2 [SD, 52.6] in the augmented program group vs from 293.6 [SD, 56.4] to 316.4 [SD, 57.5] in the standard program group). Based on multilevel growth curve analysis, there was no statistically significant difference between groups (modeled score difference, -4.9 [95% CI, -16.5 to 6.7]). There were no statistically significant differences between study groups in any of the secondary participant end points. There were no adverse events recorded in either group. CONCLUSIONS AND RELEVANCE Among pregnant women experiencing social and economic disadvantage and preparing to parent for the first time, augmentation of a nurse home visitation program with a comprehensive IPV intervention, compared with the home visitation program alone, did not significantly improve quality of life at 24 months after delivery. These findings do not support the use of this intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01372098.
Collapse
Affiliation(s)
- Susan M. Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Michael Boyle
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Christine McKee
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- Faculty of Information and Media Studies, Western University, London, Ontario, Canada
| | - Philip Scribano
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Danielle Davidov
- Department of Emergency Medicine, West Virginia University, Morgantown
- School of Public Health, West Virginia University, Morgantown
| | - Diane McNaughton
- Department of Community, Systems, and Mental Health Nursing, Rush University Medical Center, Chicago, Illinois
| | - Ruth O’Brien
- College of Nursing, University of Colorado Anschutz Medical Campus, Denver
| | - Carolyn Johnston
- Nurse-Family Partnership National Service Office, Denver, Colorado
| | - Mariarosa Gasbarro
- Department of Pediatrics, University of Colorado School of Medicine, Denver
| | - Masako Tanaka
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Kimber
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Coben
- School of Public Health, West Virginia University, Morgantown
| | - David L. Olds
- Department of Pediatrics, University of Colorado School of Medicine, Denver
| | - Harriet L. MacMillan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Stavas N, Shea J, Keddem S, Wood J, Orji W, Cullen C, Scribano P. Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination. Child Abuse Negl 2018; 85:47-57. [PMID: 30217352 PMCID: PMC7938757 DOI: 10.1016/j.chiabu.2018.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 05/30/2023]
Abstract
BACKGROUND Childhood sexual abuse is a common cause of morbidity and mortality. All victims should receive a timely comprehensive medical exam. Currently there is a critical shortage of child abuse pediatricians who can complete the comprehensive child sexual abuse examination. Telemedicine has emerged as an innovative way to provide subspecialty care to this population. Despite the growing popularity of telemedicine, no literature exists describing patient and caregiver perceptions of telemedicine for this sensitive exam. OBJECTIVE To explore caregiver and adolescent perspectives of the use of telemedicine for the child sexual abuse examination and discover factors that drive satisfaction with the technology. PARTICIPANTS AND SETTING Caregivers and adolescents who presented for a child sexual abuse medical evaluation at our county's child advocacy center. METHODS We completed semi structured interviews of 17 caregivers and 10 adolescents. Guided by the Technology Acceptance Model interviews assessed perceptions about: general feelings with the exam, prior use of technology, feelings about telemedicine, and role of the medical team. Interviews were audio-recorded, transcribed, coded and analyzed using content analysis with constant comparative coding. Recruitment ended when thematic saturation was reached. RESULTS There was an overwhelming positive response to telemedicine. Participants reported having a good experience with telemedicine regardless of severity of sexual abuse or prior experience with technology. Behaviors that helped patients and caregivers feel comfortable included a clear explanation from the medical team and professionalism demonstrated by those using the telemedicine system. CONCLUSION Telemedicine was widely accepted by adolescents and caregivers when used for the child sexual abuse examination.
Collapse
Affiliation(s)
- Natalie Stavas
- Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Judy Shea
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Shimrit Keddem
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Joanne Wood
- Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Whitney Orji
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Catherine Cullen
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Philip Scribano
- Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| |
Collapse
|
6
|
Mollen CJ, Goyal M, Lavelle J, Scribano P. Evaluation and Treatment of the Adolescent Sexual Assault Patient. Adolesc Med State Art Rev 2015; 26:647-657. [PMID: 27282016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
7
|
Hornor G, Thackeray J, Scribano P, Curran S, Benzinger E. Pediatric sexual assault nurse examiner care: trace forensic evidence, ano-genital injury, and judicial outcomes. J Forensic Nurs 2012; 8:105-111. [PMID: 22925125 DOI: 10.1111/j.1939-3938.2011.01131.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Although pediatric sexual assault nurse examiners (P-SANEs) have been providing care for over two decades there remain major gaps in the literature describing the quality of P-SANE care and legal outcomes associated with their cases. The purpose of this study was to compare quality indicators of care in a pediatric emergency department (PED) before and after the implementation of a P-SANE program described in terms of trace forensic evidence yield, identification of perpetrator DNA, and judicial outcomes in pediatric acute sexual assault. METHOD A retrospective review of medical and legal records of all patients presenting to the PED at Nationwide Children's Hospital with concerns of acute sexual abuse/assault requiring forensic evidence collection from 1/1/04 to 12/31/07 was conducted. FINDINGS Detection and documentation of ano-genital injury, evaluation and documentation of pregnancy status, and testing for N. gonorrhea and C. trachomatis was significantly improved since implementation of the P-SANE Program compared to the historical control. DISCUSSION The addition of a P-SANE to the emergency department (ED) provider team improved the quality of care to child/adolescent victims of acute sexual abuse/assault.
Collapse
Affiliation(s)
- Gail Hornor
- Nationwide Children's Hospital, Columbus, Ohio, USA.
| | | | | | | | | |
Collapse
|
8
|
Abstract
UNLABELLED Child sexual abuse (CSA) often requires psychological treatment to address the symptoms of victim trauma. Barriers to entry and completion of counseling services can compromise long-term well-being. An integrated medical and mental health evaluation and treatment model of a child advocacy center (CAC) has the potential to reduce barriers to mental health treatment. OBJECTIVE (a) to describe characteristics between CSA patients who engage versus those who do not engage in mental health treatment and (b) to identify factors associated with successful completion of mental health treatment goals. For design/setting, a retrospective cohort study was conducted of CSA patients (ages 3-16 years) referred to mental health services following a CAC assessment. Outcome variables included linkage with treatment and completion of treatment. Independent variables included demographics, abuse characteristics, and therapist characteristics. Data were abstracted from the CAC and billing databases. RESULTS Four hundred ninety subjects were evaluated. Subjects were as follows: predominately female (74%), White (60%), and more than half received Medicaid (56%). Mean age was 8.4 years. About 52% linked with mental health services and 39% of patients that successfully linked with mental health services completed therapy. Successful linkage was independently associated with referrals to other counseling services (AOR 8.4 [2.5, 27.7]). Successful completion of therapy was independently associated with caregiver participation in therapy (AOR 3.2 [1.8, 6.0]) and if the patient was referred to other counseling services (AOR 4.1 [1.9, 8.5]). There were no differences between subjects that linked and/or completed therapy and those that did not with regard to demographic characteristics or abuse severity. CONCLUSION In contrast to previous reports, efforts at our CAC seem to overcome linkage barriers in this population. However, there remain challenges in achieving successful completion of treatment goals in this population. Engaging caregivers' involvement in therapy services had a positive effect with successfully achieving treatment goals.
Collapse
|
9
|
Schifman A, Scribano P. 70 The Prevalence and Necessity of Obtaining Postmortem Skeletal Surveys in Children Under the Age of 2 Who Die in the Hospital Setting. Ann Emerg Med 2011. [DOI: 10.1016/j.annemergmed.2011.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
Abstract
INTRODUCTION Concerns have arisen among professionals working with children regarding potential emotional distress as a result of the ano-genital examination for suspected child sexual abuse. The purpose of this study was to describe and compare children's anxiety immediately preceding and immediately following the medical assessment of suspected child sexual abuse, including the ano-genital exam, and to examine demographic characteristics of those children reporting clinically significant anxiety. METHOD In this descriptive study, children between the ages of 8 to 18 years of age requiring an ano-genital examination for concerns of suspected sexual abuse presenting to the Child Assessment Center of the Center for Child and Family Advocacy at Nationwide Children's Hospital were asked to participate. The Multidimensional Anxiety Scale for Children (MASC-10) was utilized in the study. The MASC-10 was completed by the child before and after the physical exam for suspected sexual abuse. RESULTS Although most (86%) children gave history of sexual abuse during their forensic interview, the majority (83%) of children in this study did not report clinically significant anxiety before or after the child sexual abuse examination. Children reporting clinically significant anxiety were more likely to have a significant cognitive disability, give history of more invasive forms of sexual abuse, have a chronic medical diagnosis, have a prior mental health diagnosis, have an ano-genital exam requiring anal or genital cultures, and lack private/public medical insurance. DISCUSSION A brief assessment of child demographics should be solicited prior to exam. Children sharing demographic characteristics listed above may benefit from interventions to decrease anxiety regardless of provider ability to detect anxiety.
Collapse
Affiliation(s)
- Gail Hornor
- Nationwide Children's Hospital, Center for Child and Family Advocacy, Columbus, Ohio, USA.
| | | | | | | |
Collapse
|
11
|
Abstract
Retropharyngeal abscess is an unusual infection in teenagers, and it is rarely associated with blunt trauma. We present the case of 17-year-old male who developed signs and symptoms of retropharyngeal abscess soon after being struck by a car. The case illustrates that retropharyngeal abscess should be considered, even in an adolescent, if the patient has fever, neck stiffness, and sore throat with symptoms out of proportion to the oropharyngeal findings.
Collapse
Affiliation(s)
- S M Selbst
- The Division of Emergency Medicine, The Children's Hospital of Philadelphia, and The University of Pennsylvania School of Medicine, USA
| | | | | | | | | |
Collapse
|
12
|
Abstract
OBJECTIVE Children who live in violent households are at risk for emotional and physical injury. Although recent research has addressed the emotional impact of witnessing family violence, no study has addressed the inadvertent physical injuries that result to children who witness family violence. The objective of this study was to describe the causes, types, and patterns of pediatric injuries resulting from family violence. METHODS We reviewed the medical records of 139 children who presented to the emergency department with injuries resulting from domestic violence for demographic information, mechanism of injury, type, location, and severity of injury, treatment, and disposition. RESULTS Children who were injured during domestic violence ranged in age from 2 weeks to 17 years. Although the mean age of the children identified was 5 years, 48% of the children were younger than 2 years. Although the most common dyad involved in the fight was the mother and father (57% of cases), extended family members and nonrelated adults were involved in almost one third of the cases. The most common mechanism of injury was a direct hit (36%). Of the injured children who were younger than 2 years, 59% were injured while being held by parents. Thirty-nine percent of the children were injured during attempts to intervene in fights. The majority of injuries were to the head (25%), face (19%), and eyes (18%). Young children sustained more head and facial injuries than older children, who had disproportionately more extremity trauma. Medical intervention was indicated in 43% of patients, of which 9% required hospital admission and 2% required surgical or intensive care intervention. Of the 91% of children discharged from the emergency department, 73% returned home, and 27% went to alternative homes. CONCLUSIONS Children sustain a wide range of physical injuries from family violence. Because the majority of injuries are minor, specific inquiry into the causes of all pediatric injuries may help further identify children living among family violence.
Collapse
Affiliation(s)
- C W Christian
- Institute of General Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA
| | | | | | | |
Collapse
|
13
|
Ozkaynak MF, Scribano P, Gomperts E, Izadi P, Millin R, Isaacs H, Ettinger LJ. Comparative evaluation of the bone marrow by the volumetric method, particle smears, and biopsies in pediatric disorders. Am J Hematol 1988; 29:144-7. [PMID: 3189309 DOI: 10.1002/ajh.2830290305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Bone marrow cellularity estimated by biopsy was compared to the cellularity of the aspirate particle smear and the volumetric method in two groups of children. In the first group, 101 consecutive bone marrow biopsies and aspirates were evaluated from patients with various diagnoses. In the second group, 20 patients with acute nonlymphoblastic leukemia were studied with 80 biopsies and aspirates at diagnosis and following chemotherapy. A wide discrepancy was noted between bone marrow cellularity confirmed by biopsy vs. the particle smear or the volumetric method in both groups. Neither the volumetric nor the particle method provides a good correlation of bone marrow cellularity. We also compared the volumetric method with that of the biopsy to evaluate the efficacy of the former method in detecting bone marrow infiltration by solid tumors. The volumetric method is an accurate modality of identifying solid tumor infiltration in the bone marrow.
Collapse
Affiliation(s)
- M F Ozkaynak
- Division of Hematology-Oncology, Children's Hospital, Los Angeles, CA 90027
| | | | | | | | | | | | | |
Collapse
|