Evaluation of child maltreatment in the emergency department setting: an overview for behavioral health providers

Trauma Craniano Violento (TCV): Relação entre Conhecimento de Pais, Potencial de Abuso Infantil e Status Socioeconômico Familiar

Resumo Descreve a relação entre conhecimento sobre Trauma Craniano Violento (TCV), status socioeconômico e potencial de maus-tratos infantis. Dezenove pais e 61 mães responderam aos instrumentos Escala de Atitudes Frente ao Choro do Bebê, Inventário de Potencial de Abuso Infantil e Questionário Socioeconômico. A correlação de Spearman demonstrou resultados significativos entre escolaridade e renda com crenças sobre cuidados com o bebê (r = 0,32, p = 0,004; r = 0,22, p = 0,05, respectivamente), poder aquisitivo e escolaridade com conhecimentos sobre choro infantil (r = -0,40, p<0,001; r = -0,22, p = 0,05, respectivamente), número de filhos com estratégias para lidar com choro (r = -0,29, p = 0,01) e rigidez com consequências de sacudir o bebê e crenças sobre cuidados com o bebê (r = -0,29, p = 0,008; r = -0,359, p = 0,001, respectivamente). Considera importante direcionar intervenções às necessidades de cada população e trabalhar a flexibilidade parental para reduzir o TCV.

Sentinel surveillance of child maltreatment cases presenting to Canadian emergency departments

Background

The Canadian Hospitals Injury Reporting Prevention Program (CHIRPP) is a sentinel surveillance program that collects and analyzes data on injuries and poisonings of people presenting to emergency departments (EDs) at 11 pediatric and eight general hospitals (currently) across Canada. To date, CHIRPP is an understudied source of child maltreatment (CM) surveillance data. This study: (1) describes CM cases identified in the CHIRPP database between1997/98 to 2010/11; (2) assesses the level of CM case capture over the 14-year period and; (3) uses content analysis to identify additional information captured in text fields.

Methods

We reviewed cases of children under 16 whose injuries were reported as resulting from CM from 1997/98 to 2010/11. A time trend analysis of cases to assess capture was conducted and content analysis was applied to develop a codebook to assess information from text fields in CHIRPP. The frequency of types of CM and other variables identified from text fields were calculated. Finally, the frequency of types of CM were presented by age and gender.

Results

A total of 2200 CM cases were identified. There was a significant decrease in the capture of CM cases between 1999 and 2005. Physical abuse was the most prevalent type (57%), followed by sexual assault (31%), unspecified maltreatment (7%), injury as the result of exposure to family violence (3%) and neglect (2%). Text fields provided additional information including perpetrator characteristics, the use of drugs and/or alcohol during the injury event, information regarding the involvement of non-health care professionals, whether maltreatment occurred during a visitation period with a parent and, whether the child was removed from their home.

Conclusions

The findings from this initial study indicate that CHIRPP could be a complimentary source of CM data. As an injury surveillance system, physical abuse and sexual assault were better captured than other types of CM. Text field data provided unique information on a number of additional details surrounding the injury event, including risk factors.

Evaluation and Management of Psychiatric Emergencies in Children

Mental illness among children and adolescents is an increasing burden, projected to become one of the world's leading disabilities in near future. A dearth of specialized services and personnel to provide optimal care affects the disease burden, prevalence, health care services, and health care costs. The increasing demand weighs down on generalized systems of care such as emergency department (ED) services, in which the lack of specific training, personnel, and specialized protocols tends to prolong length of stay, recidivism, and suboptimal care. This article reviews outcomes and trends of overburdened ED systems in the context of pediatric mental health care management, guidelines of care, and strategies to manage common pediatric mental health emergencies and expand services within the ED. [Pediatr Ann. 2018;47(8):e328-e333.].

The credibility of testimony from minors allegedly victims of abuse within the Italian legislative framework

The authors aim to analyze the key aspects related to the testimony of children who might have been victims of sexual harassment and abuse. The issue of medico-legal psychiatric assessment of minors who claim to have been sexually abused is extremely contentious and widely-debated, not only due to the growing spread of such claims, but also on account of the technical challenges it raises. For these reasons, national as well as European lawmakers have intervened by enacting new legislation, and scientific communities have established new sets of guidelines aimed at improving the overall conditions under which a child is called to testify as well as the process through which depositions are collected and evaluated, so as to ensure that any assessment of the reliability of the testimony is scientifically grounded. The authors also highlight the importance of regulatory measures meant to minimize the risk that the questioning of a child might negatively affect his or her emotional balance by limiting and lessening stressful conditions and anxiety, which may traumatize and irretrievably scar the child. Moreover, they stress the importance of dealing with the social issue of child abuse by strengthening a preventive set of measures.