Child abuse physicians: coping with challenges

Child Abuse and Neglect: Awareness among Dental Students

Child abuse and neglect (CAN) have significant consequences for children's health and well-being. Dentists play an important role in identifying and reporting CAN cases. This study aimed to assess knowledge and attitudes toward CAN among dental students. A cross-sectional study was conducted among dental students, comparing second-year (preclinical) and fifth-year (clinical) students, both male and female, in the College of Dentistry at King Saud University during the first semester of the 2022/2023 academic year, using a questionnaire with 23 multiple-choice questions and an electronic link. The results revealed that most dental students (96%) were aware of CAN, with social media being the most utilized source of information (85%). However, the dental college was noticed as the least utilized source (50%). Most dental students recognize the significance of CAN in dentistry and expressed an intense interest in learning how to effectively deal with such cases. Only a small proportion, 16%, of dental students reported experiencing incidents of CAN in their clinical practice. In general, there were statistically significant differences between preclinical and clinical students, but there were no significant differences in awareness between female and male students when the source of information and role in dealing with CAN were taken into consideration. Both preclinical and clinical dental students were aware of CAN, although there were concerns about their ability to cope with it. The results emphasize the importance of comprehensive education and training programs across the dental curriculum about CAN.

Balancing the law with children's rights to participation and decision-making: Practice guidelines for mandatory reporting processes in child sexual abuse

In India, legal response to a sexual offence, namely, punishment of the perpetrator,relies nearly entirely on mandatory reporting provisions in child sexual abuse law.Mandatory reporting forms an important first step in the medico-legal processes of CSAwork, because it leads onto other legal interventions in CSA cases. However, social, stigma, perceived harassment, rampant gender stereotypes, the unwillingness of, family, disbelief of the victim, and threats by the perpetrator are a few of the many, barriers to mandatory reporting in the Indian context. One particularly insufficiently, addressed critical barrier in the global and Indian literature on CSA and law stems from the reluctance of children to allow child protection and mental health professionals to report to relevant authorities. There are few guidelines or practical strategies available,on how to engage children in mandatory reporting processes. This article uses a childcentric lens to propose the need to balance children's rights to participation and decision-making with the mandatory reporting law. It proposes a conceptual frameworkthat acknowledges the imperatives and challenges of the mandatory reporting law and its implementation, whilst also recognizing children's barriers to abuse disclosures andtheir rights to make decisions and provide consent on reporting issues. It culminates in a guideline for child mental health and protection service providers, offering step-bystep support on navigating the challenges and dilemmas of mandatory reporting through suggested scripts that engage children to enable more effective reporting ofCSA to child protection systems and relevant legal authorities.

How Stressful Is Examining Children with Symptoms of Child Abuse?-Measurement of Stress Appraisal (SAM) in German Physicians with Key Expertise in Pediatrics

BACKGROUND

Pediatricians frequently feel uncertain about their ability to detect early symptoms of child abuse and how to respond in suspected cases.

AIM

This study investigated the transactional stress model in German pediatricians who experienced imagination stories with a child protection scenario and another potentially stress-triggering scenario.

METHODS

A two-part survey was conducted online. Each part included a different imagination story and evaluation of the Stress Appraisal Measure (SAM), as well as questions on child protection, current problematics, and suggested remedies. In total, 96 pediatricians participated. The child abuse scenario was perceived as significantly more threatening and more stressful than a medical emergency. The pediatricians declared moderate familiarity with the Child Protection Guidelines and the Federal Child Protection Act and an average confidence in their application. The greatest perceived problems were communication difficulties with parents and youth welfare services. Suggested improvements were concrete procedural directives, more training programs, better interdisciplinary networks, and greater exchange among colleagues.

CONCLUSIONS

To optimize their potential in the child protection system, pediatricians need to be better supported in coping with the identified stressors in child abuse scenarios.

Pediatricians' Attitudes Toward Child Sexual Abuse in the Republic of Srpska

Child sexual abuse (CSA) affects all cultures and sociodemographic sections. As health professionals, pediatricians are often the first line of defense when it comes to CSA identification and reporting. Our previous study examined encounters, competence, beliefs, and reporting regarding CSA among pediatricians in countries of the former Yugoslavia, Serbia, and Montenegro. Following up on this work, we expanded our research to another neighboring country, the Republic of Srpska (RS). Sixty pediatricians were surveyed in 2020, comprising 30% of all practicing pediatricians in the Republic of Srpska. Compared to their colleagues from Serbia and Montenegro, RS pediatricians revealed an increased perception that children are often abused by someone they do know well, were more confident in their abilities to detect CSA, reported a higher number of CSA cases, and were more interested in further trainings on the subject of CSA. Despite this, the level of underreporting remained high (40%). To our knowledge, this is the first study to both assess and compare CSA-related attitudes in this part of the world. Key differences between RS, other two neighboring countries as well as from other countries worldwide are likely to stem from the level of pediatricians' training and education, as well as from the socio-cultural and legislation context. Although encouraging, our data indicate a need for further research in the countries of the former Yugoslavia.

Child Abuse and Neglect Awareness among Medical Students

Physical, emotional, and sexual abuse and various forms of neglect of children have been encountered more frequently by healthcare providers, particularly physicians. However, mismanagement of child abuse and neglect (CAN) due to a lack of awareness of it can lead to substantial and serious consequences. This study primarily aimed to evaluate the awareness of CAN among medical students and compare it between preclinical and clinical males and females in Imam Abdulrahman Bin Faisal University in Dammam, Saudi Arabia. A cross-sectional study using a self-reported-based questionnaire was carried out to study child abuse and neglect awareness and compare preclinical and clinical male versus female medical students during the first semester in 2021/2022. The majority of the participants were aware of CAN (90.6%), agreed that CAN exists locally (96.6%), believed that CAN is important in the medical field (96.3%), and expressed the important role of physicians in participating in the management of CAN (84.3%). Some students did not know about the legislation of CAN in Saudi Arabia (15%). The results show a lack of exposure to real CAN cases (80.3%) and the need for more formal education (70.3%). In general, the students were comparable, but there were significant differences showing more awareness in female students compared to males and, similarly, more awareness in clinical-year students. Both clinical and preclinical medical students were aware of CAN, with some concerns regarding their competency in dealing with CAN. CAN should be given more weight in the medical school curriculum.

"Invisible" children: A multiple case study on the experiences and protection of hospital-stranded children

BACKGROUND

Hospital-stranded children are defined as children who are left by parents in medical settings for over six months. These children, who legally are not classified as orphans, are excluded from existing permanent placement policies in China. Yet, little is known about this vulnerable population of children.

OBJECTIVE

This study explores the experiences of hospital-stranded children and the causes for their plight, and examines the strengths and weaknesses of existing child protection practices in medical settings.

METHODS

Using a multiple-case design, 20 hospital-stranded children from three children's hospitals in a first-tier Chinese city were included in this study. Sixteen hospital personnel participated in semi-structured interviews. Interview findings, case records, and field observations were analyzed using a thematic analysis approach. Current child protection practices were analyzed through a child protection system model.

RESULTS

The children in this study were well cared for by the hospitals, but their rights to provision, participation, and protection were violated due to the lack of a national child protection system. Three key weaknesses of child protection practices were identified: underreporting of suspected cases, delayed action after reporting, and inadequate follow-up services. The ineffectiveness of the national child welfare system and the family-oriented cultural values in China also created barriers to the protection of hospital-stranded children.

CONCLUSIONS

The findings suggest an urgent need for a national child protection system. Professional child protection training for healthcare workers and collaboration among departments within and outside hospitals are also necessary to offer a systematic protective network for hospital-stranded children.

Reasonable suspicion in reporting child maltreatment: a survey among German healthcare professionals

BACKGROUND

With regular contacts to the general child population, healthcare professionals could play an important role in the detection of child maltreatment. However, a majority of child maltreatment cases go unnoticed by the healthcare system. Child protection legislations usually offer terms like "reasonable suspicion" to corner a threshold that warrants reporting to child protection services (CPS) is defined as. The indistinct legal terminology leads to marked differences in the interpretation of this threshold. Therefore, we aimed to systematically assess the understanding of reasonable suspicion and subsequent handling of cases in the German context.

METHODS

A cross-sectional online survey was conducted among 2485 physicians and psychotherapists working with children and adolescents. Field access was gained by German professional associations. Via case vignettes, predictors of thresholds for reporting were assessed.

RESULTS

The probability of a report to CPS increased positively with the degree of suspicion for maltreatment. However, even if participants were certain that child maltreatment occurred, 20% did not chose to report to CPS. Training in child protection lowered the professionals' threshold for reasonable suspicion; experience with child protection cases and good knowledge of the legal framework increased the likelihood to report an alleged situation of child maltreatment to CPS.

CONCLUSION

Our data show that a significant proportion of health care professionals are uncertain about estimating reasonable suspicion and on how to proceed when there are strong indications for child maltreatment Therefore, data point towards the relevance of training in child protection among healthcare professionals in order to improve detection and adequate handling of cases of child maltreatment.

GPs' suspicion of child abuse: how does it arise and what is the follow-up?

Background: Child abuse is widespread, occurs in all cultures and communities, remains undiscovered in 90% of cases and has serious long-term effects. Physicians generally underidentify and underreport child abuse. To understand this low reporting rate and how the suspicion of child abuse arises, we examined GPs' experiences.Research questions: How does the suspicion of child abuse arise in GPs' diagnostic reasoning? How do they act upon their suspicion and which barriers do they encounter in their management?Methods: Twenty-six GPs participated in four focus groups. We used purposive sampling to include GPs with different levels of experience. We performed a thematic content analysis.Results: Suspicion of child abuse arose from common triggers and a gut feeling that 'something is wrong here'. GPs acted upon their suspicion by gathering more data, through history taking and physical examination. They often found it difficult to decide whether a child was abused, because parents, despite good intentions, may simply lack parenting skills and have different values. Clear signs of sexual abuse and physical violence were institutionally reported by GPs, whereas in less clear-cut cases they followed them up and built a supporting network of professionals around the family.Conclusions: A low child abuse reporting rate by GPs to CACRC does not mean a low detection rate. In trying to improve a child's situation, GPs make use of patients' trust in their doctor by involving other professionals. Awareness of the role of gut feelings in developing a suspicion may increase early detection and preventive actions.Key pointsPhysicians generally underidentify and underreport child abuse.Suspicion of child abuse arose from common triggers and a gut feeling that 'something is wrong here'.GPs acted upon their suspicion by gathering more data, through history taking and physical examination.GPs found it difficult to decide whether a child was abused, because parents, despite good intentions, may lack parenting skills.

Perceived Skill and Willingness to Address Child Sexual Abuse: Assessing Serbian and Montenegrin Pediatricians

Most research on pediatricians' reporting of child sexual abuse (CSA) is based in western countries. Only recently have studies focused on low-income countries. We are the first to survey pediatricians in Serbia and Montenegro on their encounters, competence and beliefs regarding CSA. Pediatricians in Serbia (n = 358) were recruited during a professional conference; pediatricians in Montenegro (n = 121) were sent an online survey. Demographic information was not obtained. Frequencies and percentages were calculated. A quarter of pediatricians in both countries felt competent detecting medical evidence of CSA. Twenty-seven percent in Serbia and 7% in Montenegro felt adequately trained to assess and diagnose CSA. Forty percent believed that CSA occurs predominately in poor, unstable or disorganized families. Twenty-nine percent in Montenegro and 15% in Serbia believed that complete strangers perpetrate CSA. Both Serbian (23%) and Montenegrin (30%) pediatricians were uncomfortable asking questions about possible abuse. One third of pediatricians in both countries were interested in further training. CSA is underreported at a concerning rate in Serbia and Montenegro, yet only a third of pediatricians in both countries were interested in further training. Future studies should focus on barriers to reporting in these regions, to increase awareness and competencies related to CSA.

Reporting of violence against children and adolescents in a protective institution in southern Brazil

OBJECTIVE

This study aimed to analyze the reports of violence against children and adolescents in the period between January 2009 and May 2014 in a municipality protection institution of Rio Grande, RS.

METHODS

This is a descriptive and documentary study with a quantitative approach that analyzed 800 medical records of Specialized Reference Center for Social Assistance (CREAS), from the development of a research instrument containing the study variables.

RESULTS

The results show that 44.5% of the notifications sent to the protection of organs were carried out by family members and evidence of physical signs was the reason that triggered them (34%). The dismissing by abandonment of families is very present in the institution (36.9%), which possibly supports the maintenance of the cycle of violence.

CONCLUSION

The results of this study show that although there were improvements regarding the notification by the family, the number of notifications made by the health and education sectors are still reduced, thereby increasing the need for more effective and articulated actions in these sectors.

Trauma informed care in medicine: current knowledge and future research directions

Traumatic events (including sexual abuse, domestic violence, elder abuse, and combat trauma) are associated with long-term physical and psychological effects. These events may influence patients' health care experiences and engagement in preventative care. Although the term trauma-informed care (TIC) is widely used, it is not well understood how to apply this concept in daily health care practice. On the basis of a synthesis of a review of the literature, the TIC pyramid is a conceptual and operational framework that can help physicians translate TIC principles into interactions with patients. Implications for clinical practice and future research are discussed in this article.

Advocacy opportunities for pediatricians caring for maltreated children

Pediatricians are advocates for children. It is one of the central elements of the job description. In the course of their work, pediatricians have many opportunities to advocate for abused and neglected children. The most effective form of advocacy that most pediatricians will engage in with regard to child abuse and neglect is by being highly skilled doctors who provide excellent clinical care to children and families, knowing how to recognize child abuse and what to do when they encounter it, and being familiar with the resources of their communities.

A Framework to Examine the Role of Epigenetics in Health Disparities among Native Americans

Background. Native Americans disproportionately experience adverse childhood experiences (ACEs) as well as health disparities, including high rates of posttraumatic stress, depression, and substance abuse. Many ACEs have been linked to methylation changes in genes that regulate the stress response, suggesting that these molecular changes may underlie the risk for psychiatric disorders related to ACEs. Methods. We reviewed published studies to provide evidence that ACE-related methylation changes contribute to health disparities in Native Americans. This framework may be adapted to understand how ACEs may result in health disparities in other racial/ethnic groups. Findings. Here we provide evidence that links ACEs to methylation differences in genes that regulate the stress response. Psychiatric disorders are also associated with methylation differences in endocrine, immune, and neurotransmitter genes that serve to regulate the stress response and are linked to psychiatric symptoms and medical morbidity. We provide evidence linking ACEs to these epigenetic modifications, suggesting that ACEs contribute to the vulnerability for developing psychiatric disorders in Native Americans. Conclusion. Additional studies are needed to better understand how ACEs contribute to health and well-being. These studies may inform future interventions to address these serious risks and promote the health and well-being of Native Americans.