Kinderschutz im Rettungsdienst: Erkennen, Bewerten, Handeln

[The Frequency of Cases of Child Abuse - Results of a Survey of Brandenburg Child and Adolescent Psychotherapists]

BACKGROUND

 Within the field of (medical) child protection, child and adolescent psychotherapists are an important occupational group. However, that fact has mostly been overlooked in scientific discourse. The objectives of this study were to determine the prevalence and the approach to dealing with cases of (suspected) child abuse in psychotherapeutic practice.

METHODS

All KJP who are admitted in the federal state of Brandenburg were asked to answer a questionnaire about the frequency of child abuse, divided by form of abuse and age. Furthermore, the number of reports to an authority/ agency, reasons for not reporting a (potential) case as well as necessary prerequisites for reliable recognition, evaluation and initiation of medico-legal, medical and psychotherapeutic interventions were recorded.

RESULTS

In 2016, 74.4% and in 2017, 87% of child and adolescent psychotherapists registered at least one case of (suspected) child abuse. For both years, emotional negligence and emotional abuse were the most common types of abuse. The age group 6-13 was most affected by child abuse. In 2016, 34.4% and in 2017, 35% of child and adolescent psychotherapists who saw at least one case of (suspected) child abuse reported those to an agency. The most common reason (47.6%) for not reporting cases of (suspected) child abuse was the child's wish to not share any content discussed in therapy. 83.7% stated that clear criteria to reliably diagnose emotional negligence and emotional abuse are missing. Continuing education on medical/ psychotherapeutic and medico-legal aspects (53.3%), better cooperation between involved professions (43.4%) and inclusion of the overall topic in psychotherapist training and education (26.7%) were mentioned as the most important requirements for effective child protection.

CONCLUSIONS

Cases of (suspected) child abuse are highly relevant in ambulant psychotherapeutic practice. Due to their close relationship with the patient, child and adolescent psychotherapists can identify emotional negligence and emotional abuse especially well. Their contribution to the care of children affected by abuse requires continuing education offers specific to their profession, the development of clear measures regarding the cooperation with Child Protective Services (county-level) as well as binding definitions and criteria for the different types of abuse.

[Improving child protection in healthcare: peer counseling, education, and research using the example of abusive head trauma]

Too often, diagnosis of maltreatment is missed by healthcare professionals - thus denying children in danger from necessary protection. Insufficient knowledge and insecurities towards professional confidentiality and how to approach child protection services may be the reasons for the failure to protect children effectively.In this article, we present how a comprehensive concept by the competence center of child protection in medicine of the state of Baden-Wurttemberg consisting of peer counseling, peer education, and research can add to the prevention of maltreatment. One component is peer counseling through a telephone helpline that is accessible 24/7, the medical child protection hotline. The requests to the helpline are analyzed and add to the generation of tailored content for the education of doctors, psychotherapists, nurses, and other healthcare professionals. As an example, we present the online course "Child protection in medicine - a basic course for all health professionals" (so far available only in German). One common issue when the child protection hotline is called for counseling is abusive head trauma. Research shows that sometimes a diagnosis of abusive head trauma might be missed. This condition is most prevalent in children under the age of 2 and represents one of the most severe forms of physical abuse with high mortality.Inquiries to the medical child protection hotline are constantly increasing, but making the service known nationwide to all healthcare professionals still poses a challenge. The online course is widely used and being constantly improved. The comprehensive concept of peer counseling, education, and research is an important contribution to the improvement of the prevention of child maltreatment.