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Alrimawi I, Bettini E, Taylor C, Saifan AR, Al-Yateem N. Insights Into Child Abuse and Neglect in the Washington DC, Maryland, and Virginia (DMV) Area: Evidence and Opportunities. Glob Pediatr Health 2024; 11:2333794X241284029. [PMID: 39372488 PMCID: PMC11452869 DOI: 10.1177/2333794x241284029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 07/18/2024] [Accepted: 08/26/2024] [Indexed: 10/08/2024] Open
Abstract
Child abuse and neglect (CAN) significantly impact health, the economy, and society. This narrative review examines CAN in the Washington DC, Maryland, and Virginia (DMV) region, comparing it with national and international levels. The review highlights high CAN rates in the DMV, driven by factors such as socioeconomic status, parental substance abuse, and child vulnerabilities. Screening and reporting challenges, exacerbated by the COVID-19 pandemic, impede accurate data collection. This review emphasizes the need for standardized reporting mechanisms, economic investment in public health, and intersectoral collaboration. It recommends targeted support for at-risk families, specialized care for vulnerable children, and the development of predictive screening tools. Continuous research on regional and cultural factors and the pandemic's impact is crucial for future resilience. Addressing CAN requires a comprehensive approach involving prevention, early detection, intervention, and policy reform to safeguard the well-being of children.
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Affiliation(s)
| | | | - Clishia Taylor
- Global Health Access (GHA) Institute, Great Falls, VA, USA
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McGuire A, Singh M, Jackson Y. Let it go, let it go: Stop measuring child maltreatment as a binary yes/no. CHILD ABUSE & NEGLECT 2024; 155:106994. [PMID: 39154601 PMCID: PMC11383741 DOI: 10.1016/j.chiabu.2024.106994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 07/22/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
Numerous methods are used in the measurement of child maltreatment (CM) exposure. As a science, it is necessary that the field of CM research evaluate its measurement approaches periodically to ensure that the common approaches are the best approaches. A prominent method for measuring CM in research as a predictor variable is to conceptualize CM as a two-level, yes/no binary variable (e.g., 0 = No CM exposure, 1 = CM exposure). While there is no consensus on what method is the best approach for measuring CM, empirical evidence suggests that the binary measurement approach to CM has significant limitations. The current paper sought to progress the field of CM and trauma research forward by reviewing several lines of research demonstrating why the use of a binary yes/no CM measurement approach is problematic. As evidence for why a binary measurement of CM should be halted, this paper reviews research on: why the characteristics or details of CM exposure matter, risk of CM "contamination," and CM's relation with environmental or systemic factors. The ethical and clinical implications of a CM binary measurement approach are also discussed. Several recommendations for the field are provided on how researchers can improve the measurement of CM and ensure accurate and replicable studies are being published.
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Affiliation(s)
- Austen McGuire
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - M Singh
- Clinical Child Psychology Program, University of Kansas, Dole Human Development Building, 1000 Sunnyside Avenue, Lawrence, KS 66045, USA
| | - Yo Jackson
- Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA
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Reed L, Odendal L, Mercurio D, Snyder CW. Identifying injuries suggestive of child physical abuse: An innovative application of the Trauma Quality Improvement Program. J Trauma Acute Care Surg 2024; 97:272-277. [PMID: 38343003 DOI: 10.1097/ta.0000000000004274] [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: 07/26/2024]
Abstract
BACKGROUND Child physical abuse (CPA) carries high risk of morbidity and mortality. Screening for CPA may be limited by subjective risk criteria and racial and socioeconomic biases. This study derived, validated, and compared age-stratified International Classification of Diseases, 10th revision (ICD-10) diagnosis codes indicating high risk of CPA. METHODS Injured children younger than 6 years from the Trauma Quality Improvement Program (TQIP) database were included; years 2017 to 2018 were used for derivation and 2019 for validation. Confirmed CPA was defined as a report of abuse plus discharge with alternate caregiver. Patients were classified as high vs. low CPA risk by three methods: (1) abuse-specific ICD-10 codes, (2) previously validated high-risk ICD-9 codes crosswalked to equivalent ICD-10 codes, and (3) empirically-derived ICD-10 codes from TQIP. These methods were compared with respect to sensitivity, specificity, area under the receiver-operator curve (AUROC), and uniformity across race and insurance strata. RESULTS A total of 122,867 children were included (81,347 derivation cohort, 41,520 validation cohort). Age-stratified high-risk diagnoses derived from TQIP consisted of 40 unique codes for ages 0 year to 2 years, 30 codes for ages 3 years to 4 years, and 20 codes for ages 5 years to 6 years. In the validation cohort, 890 children (2.1%) had confirmed CPA. On comparison with abuse-specific and crosswalked ICD-9 codes, TQIP-derived codes had the highest sensitivity (70% vs. 19% vs. 54%) and the highest AUROC (0.74 vs. 0.59 vs. 0.68, p < 0.0001) for confirmed abuse across all age groups. Age-based risk stratification using TQIP-derived codes demonstrated low variability by race (25% White vs. 25% Hispanic vs. 28% Black patients considered high-risk) and insurance status (23% privately insured vs. 26% uninsured). CONCLUSION High-risk CPA injury codes empirically derived from TQIP produced the best diagnostic characteristics and minimized some disparities. This approach, while requiring further validation, has the potential to improve CPA injury surveillance and decrease bias in screening protocols. LEVEL OF EVIDENCE Diagnostic Test/Criteria; Level III.
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Affiliation(s)
- Leighton Reed
- From the Department of Pediatrics (L.R.), Division of Pediatric Emergency Medicine (L.O., D.M.), Division of Pediatric Surgery (C.W.S.), Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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Håkstad K, Fegran L, Hovden E, Köpp UMS. Orofacial signs of child or adolescent maltreatment identified by dentists and dental hygienists: A scoping review. Int J Paediatr Dent 2024; 34:285-301. [PMID: 38050876 DOI: 10.1111/ipd.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/02/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Child maltreatment, the abuse or neglect of children aged 0-18 years, is a severe and underreported global problem. Compared with other body parts, the orofacial region displays more signs of child maltreatment. Dentists and dental hygienists are therefore well situated to identify orofacial signs of child maltreatment. AIM To map the current literature on orofacial signs of child maltreatment identified by dentists or dental hygienists. DESIGN A scoping review was conducted based on systematic searches of Medline (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) for primary qualitative and quantitative studies through June 6, 2022. RESULTS Twenty-nine studies were included in this scoping review. Though all child maltreatment types were identified in dental settings, physical abuse and dental neglect were most commonly identified. Reports of caries dominated the orofacial signs, followed by bruises (intra- and extraoral), poor oral hygiene, dental trauma, and lacerations (intra- and extraoral). Case reports were used most commonly to describe orofacial signs of child maltreatment. CONCLUSION Dental clinicians identify orofacial signs of all child maltreatment types intraorally. Dentists identify the same extraoral signs as do other healthcare professionals, with bruising being the most common.
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Affiliation(s)
- Katrine Håkstad
- Department of Health- and Sport Science, University of Agder, Kristiansand, Norway
- Agder County Municipality, Public Dental Service, Kristiansand, Norway
| | - Liv Fegran
- Department of Health- and Sport Science, University of Agder, Kristiansand, Norway
- Department of Peadiatrics, Sørlandet Hospital HF, Kristiansand, Norway
| | - Ewa Hovden
- The Oral Health Centre of Expertise in East of (TkØ), Kristiansand, Norway
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Bennett CV, Hollén L, Wilkins D, Emond A, Kemp A. The impact of a clinical prediction tool (BuRN-Tool) for child maltreatment on social care outcomes for children attending hospital with a burn or scald injury. Burns 2023; 49:941-950. [PMID: 35987740 DOI: 10.1016/j.burns.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/21/2022]
Abstract
Burns are common childhood injuries and 10-20% are associated with maltreatment. This prospective before/after study investigated the impact of introducing the BuRN-Tool (a child maltreatment clinical prediction tool), on actions taken by children's social care department (CSC). Before introduction (pre-intervention): we collected standardised data on cause and characteristics of burns, in four regional hospitals. A BuRN-Tool-score was calculated retrospectively pre-intervention and by the attending clinician post-intervention. CSC involvement and actions taken relative to BuRN-Tool-score were compared pre- and post-BuRN-Tool. Data were collected for 1688 children from 17 local authorities. The percentage that received a CSC action decreased post-BuRN-Tool (pre: 58.0%, 51/88; post: 37.5%, 33/88, p = 0.007). A greater percentage of cases with a BuRN-Tool-score of ≥ 3 had a CSC action, than those with a BuRN-Tool-score 3, pre-intervention (≥3 70.0%, 35/50; = 0.04) and post-intervention (≥3 50.0%, 21/42; = 0.01). Children with a BuRN-Tool-score ≥ 3 but no contact/referral recorded by CSC for the burn, and those who had a contact/referral but no action taken, were significantly more likely than those scoring 3 to have new CSC involvement within six months following the burn. The BuRN-Tool-score ≥ 3 has the potential to alert clinicians to maltreatment concerns.
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Affiliation(s)
- C Verity Bennett
- Division of Population Medicine, School of Medicine, Cardiff University, CF14 4YS, UK; CASCADE, School of Social Sciences, Cardiff University, CF10 3BD, UK.
| | - Linda Hollén
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, BS8 2PS, UK
| | - David Wilkins
- CASCADE, School of Social Sciences, Cardiff University, CF10 3BD, UK
| | - Alan Emond
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, BS8 2PS, UK
| | - Alison Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, CF14 4YS, UK
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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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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Di Lorenzo P, Casella C, Dei Medici S, Policino F, Capasso E, Niola M. Child Abuse: Adherence of Clinical Management to Guidelines for Diagnosis of Physical Maltreatment and Neglect in Emergency Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5145. [PMID: 36982056 PMCID: PMC10049689 DOI: 10.3390/ijerph20065145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
Child maltreatment is a phenomenon of great importance due to the significant socio-health implications related to it. Purpose of the study is assessing compliance child abuse clinical management with guidelines and suggest corrective actions to avoid false negative or false positive judgments. The data come from 34 medical records of child victims of suspected abuse hospitalized in a pediatric clinic. We examined diagnostic and medico-legal management through the analysis of pediatric, dermatological, ophthalmological (including fundus examination), and gynecological (only in some cases) consultations, brain and skeletal imaging, laboratory tests (with reference to the study of hemostasis), and medico-legal advice. Of 34 patients, the average age was 23 months, ranging from 1 month to 8 years. The judgment was positive for abuse for 20 patients and negative for 12 patients; in two cases it was not possible to express a conclusive judgment. Two children died because of the injuries sustained. We underline the need of clinical-diagnostic standardized protocols, coroner in emergency settings, short-distance follow-up, social worker support. We also suggest objectifying in a descriptive way (using a common and repeatable language) and with photographic documentation the results of all the investigations carried out, to evaluate signs of physical maltreatment and neglect.
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McTavish JR, Chandra PS, Stewart DE, Herrman H, MacMillan HL. Child Maltreatment and Intimate Partner Violence in Mental Health Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315672. [PMID: 36497747 PMCID: PMC9735990 DOI: 10.3390/ijerph192315672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/01/2023]
Abstract
Intimate partner violence (IPV) and child maltreatment (physical, emotional, sexual abuse, neglect, and children's exposure to IPV) are two of the most common types of family violence; they are associated with a broad range of health consequences. We summarize evidence addressing the need for safe and culturally-informed clinical responses to child maltreatment and IPV, focusing on mental health settings. This considers clinical features of child maltreatment and IPV; applications of rights-based and trauma- and violence-informed care; how to ask about potential experiences of violence; safe responses to disclosures; assessment and interventions that include referral networks and resources developed in partnership with multidisciplinary and community actors; and the need for policy and practice frameworks, appropriate training and continuing professional development provisions and resources for mental health providers. Principles for a common approach to recognizing and safely responding to child maltreatment and IPV are discussed, recognizing the needs in well-resourced and scarce resource settings, and for marginalized groups in any setting.
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Affiliation(s)
- Jill R. McTavish
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington St. North, Hamilton, ON L8L 8E7, Canada
| | - Prabha S. Chandra
- NIMHANS Hospital, Hosur Rd, near Bangalore Milk Dairy, Hombegowda Nagar, Bengaluru 560029, Karnataka, India
| | - Donna E. Stewart
- Centre for Mental Health, University Health Network, 200 Elizabeth St, 7EN229, Toronto, ON M5G 2C4, Canada
| | - Helen Herrman
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Orygen, Parkville, VIC 3052, Australia
| | - Harriet L. MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington St. North, Hamilton, ON L8L 8E7, Canada
- Department of Pediatrics, McMaster University, Health Sciences Centre 3A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
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Digital games and virtual reality applications in child abuse: A scoping review and conceptual framework. PLoS One 2022; 17:e0276985. [DOI: 10.1371/journal.pone.0276985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
Child abuse refers to any form of maltreatment, including physical abuse, sexual abuse, emotional abuse, and neglect that occurs to children under 18 years of age. Digital games and virtual reality (VR) can be used as beneficial solutions for dealing with child maltreatment concerns. This study aimed to present a conceptual framework for showing the applications of these technologies in managing child abuse. The framework is developed in two stages: (1) a scoping review to gather digital games and VR applications for child abuse issues through the search in PubMed, Ovid (APA PsycInfo), Scopus, Web of Science, ProQuest, Institute of Electrical and Electronics Engineers (IEEE), Cochrane Database of Systematic Reviews, and grey literature and (2) developing a conceptual framework based on the review results and validating it by 12 experts. The proposed conceptual framework shows that digital games and VR have been used for six main topics: (1) medical education, (2) prevention, (3) screening, (4) diagnosis, (5) treatment, and (6) forensic medicine in response to child abuse issues. Studies have more focused on child sexual abuse prevention, behavioral monitoring of sexual offenders in forensic medicine, and knowledge or performance assessment of students in medical education. Serious games (SGs), computer simulation, and immersive VR were common technologies for children, students, and forensic medicine, respectively. The experts believe the combination of immersive features of VR with SGs can further encourage user engagement. It appears that digital games and VR can play a positive role in child abuse management. Given the extensive capabilities of these technologies, further studies are needed to show all their potential applications for child abuse problems.
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Russell A, Clements K, Duschinsky R, Howarth E, Mayes T, Reisel A, Coughlan B. Domestic violence and abuse in local child safeguarding policy: How is the problem represented? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3871-e3884. [PMID: 36282145 PMCID: PMC10092451 DOI: 10.1111/hsc.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/02/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Within the United Kingdom, domestic violence and abuse (DVA) is the most commonly identified factor within child in need assessments, with rates increasing in recent years in addition to 'lockdown'-related spikes. This article examines the representation of DVA in local child safeguarding policies using Bacchi's (2009) 'What is the problem represented to be?' approach. Policies were collected from the websites of all the child safeguarding partnerships of England in July 2021. In total, we identified 59 policies. These policies are designed to guide local responses to DVA across services and thus have potential for substantial impact on practice across health and social care. Our results suggest that local DVA policy in England exists within a conceptual framework which spotlights the individual and lacks attention to their context. We argue that these policies focus on adults, neglecting attention to children within their own safeguarding policies. This is through children being peripheralized within the conceptualisation of 'victim' and the assessed adult risk being used as a proxy measure for the risk to child. Demographic discussions build an image of DVA as an issue that can affect anyone, but with little acknowledgement of the vulnerabilities facing proportions of the population and their complexities - when such vulnerabilities are discussed, they are individualised and viewed in absence of their societal causes, potentially eclipsing critical elements of a child's experience of DVA. The implications of our results are wide-ranging but suggest a need to refocus on children and their context within local DVA policy.
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Affiliation(s)
| | | | - Robbie Duschinsky
- Department of Public Health and Primary Care, Primary Care Unit, University of CambridgeCambridgeUK
| | - Emma Howarth
- School of Psychology, University of East LondonLondonUK
| | - Tammy Mayes
- Lived experience, parent advocate & activist of numerous charitiesGuildfordUK
| | | | - Barry Coughlan
- Department of Public Health and Primary Care, Primary Care Unit, University of CambridgeCambridgeUK
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Rantanen H, Nieminen I, Kaunonen M, Jouet E, Zabłocka-Żytka L, Viganò G, Crocamo C, Schecke H, Zlatkute G, Paavilainen E. Family Needs Checklist: Development of a Mobile Application for Parents with Children to Assess the Risk for Child Maltreatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169810. [PMID: 36011439 PMCID: PMC9408053 DOI: 10.3390/ijerph19169810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 05/12/2023]
Abstract
Child maltreatment (CM) has been enormously studied. However, a preventive practice still requires comprehensive and effective instruments to assess the risks for CM in a family context. The aim of this study is to describe the development process of an evidence-based CM risk assessment instrument (Family Needs Checklist, FNC) for primary prevention online utilization. This article reports the development process of the checklist and its mobile application, consisting of a systematic literature review, identification of known risk factors using the content analysis method, and generation of the checklist, including a multidisciplinary group in the design and feedback. As a result, a comprehensive and compact checklist was developed to be used by parents or caregivers as a self-referral instrument with an option to be used with professionals as a basis for joint conversations. The FNC consists of parental, family-, and child-related risk factors. Based on the international evidence, the online application consists of knowledge about different CM types, information about risk factors and protective factors as well as recommendations and guidance to support services. The FNC is based on robust evidence on known risk factors causing CM in families. It can be used for primary prevention utilization in the general population.
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Affiliation(s)
- Heidi Rantanen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- Pirkanmaa Hospital District, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Correspondence: (H.R.); (E.P.)
| | - Irja Nieminen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- School of Health Sciences, Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland
| | - Marja Kaunonen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- Pirkanmaa Hospital District, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
| | - Emmanuelle Jouet
- Mental Health and Social Sciences Research Laboratory, Groupement Hospitalier Universitaire, Psychiatrie & Neurosciences (GHU-PARIS), 258 Rue Marcaret, Bât N, 2ème étage, 75018 Paris, France
| | - Lidia Zabłocka-Żytka
- Institute of Psychology, The Maria Grzegorzewska University, Szczęśliwicka 40, 02-353 Warszawa, Poland
| | - Giovanni Viganò
- Synergia s.r.l., Via Molino delle Armi 19, 20123 Milan, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Biocca, Via Cadore 48, 20900 Monza, Italy
| | - Henrike Schecke
- Department of Addictive Behaviour and Addictive Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Virchocstrasse 174, 45147 Essen, Germany
| | - Giedre Zlatkute
- School of Medicine, University of St Andrews, N Haugh, St Andrews KY16 9TF, UK
| | - Eija Paavilainen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- Etelä-Pohjanmaa Hospital District, 60220 Seinäjoki, Finland
- Correspondence: (H.R.); (E.P.)
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Stilwell L, Golonka M, Ankoma-Sey K, Yancy M, Kaplan S, Terrell L, Gifford EJ. Electronic Health Record Tools to Identify Child Maltreatment: Scoping Literature Review and Key Informant Interviews. Acad Pediatr 2022; 22:718-728. [PMID: 35131505 PMCID: PMC9262814 DOI: 10.1016/j.acap.2022.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 01/06/2022] [Accepted: 01/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To prevent missed cases and standardize care, health systems are beginning to implement EHR-based screens (EHR-CA-S) and clinical decision supports systems (EHR-CA-CDSS) for the identification and management of child maltreatment. This study aimed to 1) document the existing research evidence on the performance of EHR-CA-S and EHR-CA-CDSS and 2) examine clinical perspectives regarding the use of such tools and factors that affect uptake. METHODS We searched MEDLINE, Embase, EBSCO, Scopus, and CINAHL databases for English language articles published prior to November 2021 that describe and/or evaluated an EHR-CA-S and/or EHR-CA-CDSS involving 0 to 18-year olds. We performed semistructured interviews with 20 individuals who have experience in identifying, evaluating, and/or treating child maltreatment and/or conducting research on these topics. RESULTS Our search identified 574 articles; 16 met inclusion criteria. Studies examined screening, alerts and triggers, and quality improvement. None evaluated long-term clinical outcomes. Sensitivity ranged from 0.14 to 1.00, specificity from 0.865 to 1.00, positive predictive value from 0.03 to 1.00 and negative predictive value from 0.55 to 1.00. A variety of EHR-CA-S and/or EHR-CA-CDSS have been implemented at institutions in our sample. Interviewees cited missed cases, policy requirements, and the lack of standardization of care as impetuses for adopting these tools, yet expressed concerns regarding insufficient evidence, bias, and time-intensiveness of implementation. CONCLUSIONS Interviewees and the literature agree that current evidence does not support adoption of a particular CA-S or CA-CDSS. Further refinement and research on EHR-CA-S and EHR-CA-CDSS is necessary for these tools to be feasibly implemented and sustained, reliable for clinical practice, and not cause any unintentional harms.
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Affiliation(s)
- Laura Stilwell
- Duke University School of Medicine (L Stilwell, S Kaplan), Durham, NC; Sanford School of Public Policy (L Stilwell, E Gifford), Durham, NC
| | - Megan Golonka
- Center for Child and Family Policy (M Golonka, E Gifford), Durham, NC; Department of Psychology and Neuroscience (M Golonka), Center for the Study of Adolescent Risk and Resilience, Duke University, Durham, NC.
| | | | | | - Samantha Kaplan
- Duke University School of Medicine (L Stilwell, S Kaplan), Durham, NC
| | | | - Elizabeth J Gifford
- Sanford School of Public Policy (L Stilwell, E Gifford), Durham, NC; Center for Child and Family Policy (M Golonka, E Gifford), Durham, NC; Duke Department of Pediatrics (L Terrell), Durham, NC
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Shanahan ME, Austin AE, Berkoff MC. Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect. CHILD MALTREATMENT 2022; 27:218-224. [PMID: 34319172 PMCID: PMC9003754 DOI: 10.1177/10775595211031651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Prior research has identified common injuries among children who experience child maltreatment; however, most of this work has focused on inpatient settings and has excluded many cases of neglect. This study examines the prevalence of injuries that occur prior to a diagnosis of child maltreatment, as well as the proportion of children with well-child visits prior to the injury and child maltreatment diagnosis. Based on a secondary analysis of Medicaid data from four states, we found that among infants with 12 months of continuous enrollment (N = 4817), 30.6% of those diagnosed with maltreatment were previously diagnosed with an injury. Among infants diagnosed with child maltreatment, 88.4% had at least one well-child visit prior to the maltreatment diagnosis. Among children with a maltreatment diagnosis and a prior injury, 84% had at least one well-child visit preceding the injury. These results indicate that most children had at least one well-child visit prior to being diagnosed with child maltreatment or an injury, indicating opportunities for prevention.
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Affiliation(s)
- Meghan E. Shanahan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
- Meghan Shanahan, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 421 Pittsboro Street, CB# 7445, Chapel Hill, NC 27599-7445, USA.
| | - Anna E. Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Molly C. Berkoff
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Makis A, Masina V, Spiteri EA, Aggeli I, Vartholomatos G, Chaliasos N, Pergantou H. A refugee child with multiple patterned ecchymoses: a diagnostic dilemma between nonaccidental injury and primary hemostatic defect. Blood Coagul Fibrinolysis 2021; 32:603-606. [PMID: 33973895 DOI: 10.1097/mbc.0000000000001047] [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: 11/26/2022]
Abstract
A 4-year-old girl from Syria presented to the hospital with multiple bruises on her body. Bruises were observed in protected areas in a shape of fingerprints and objects, while no other bruises occurred during hospitalization. The parents also reported a history of bleeding diathesis from infancy. Both the initial laboratory evaluation and the secondary tests done for possible thrombocytopenia and coagulation factors deficiencies were normal. Thus, the nonaccidental injury protocol of the Hospital was activated, and the possibility of abuse was not quite evident. Investigation for platelet disorders followed. Platelet aggregation test and flow cytometry were indicative of Glanzmann's thrombasthenia. It is of great importance in these cases, that the doctor eliminates any possibility of physical abuse and examines the patient for common and rare primary hemostatic defects, although both can co-exist.
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Affiliation(s)
- Alexandros Makis
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Vasiliki Masina
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Evangelia-Anna Spiteri
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Ioanna Aggeli
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | | | - Nikolaos Chaliasos
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Helen Pergantou
- Haemophilia Centre- Haemostasis and Thrombosis Unit, 'Aghia Sophia' Children's Hospital, Athens, Greece
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Sánchez-Luque B, Martínez-Angulo P, Cantón-Habas V, Ventura-Puertos PE. Care and Rearing of Institutionalized Girls in Arequipa, Peru: An Ethnographic Approach. J Transcult Nurs 2021; 33:190-198. [PMID: 34784813 DOI: 10.1177/10436596211057898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Institutional care for children is a global phenomenon. Despite its advantages, common threats have been described. In Peru, more than 70% of institutionalized children/adolescents have living parents who cannot take care of them. The study aims to understand the care/rearing of institutionalized girls in Arequipa, Peru. METHODOLOGY Ethnographic design, with a sample integrated by 27 institutionalized girls. Data collected based on participant observation and semi-structured interviews. The analysis followed the Method of Constant Comparisons. RESULTS Five main themes were found: (a) The little house (foster home) is better than my house; (b) They take care of me-even when I am sick-; (c) But . . .; (d) What I have lived is what I am; (e) Happiness fits in this little house. DISCUSSION An ethnography of care/rearing practices could be helpful for a better understanding of the dimensions of the life of institutionalized girls living in developing countries.
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Affiliation(s)
- Berta Sánchez-Luque
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Córdoba, Spain
| | - Pablo Martínez-Angulo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Córdoba, Spain
| | - Vanesa Cantón-Habas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Córdoba, Spain
| | - Pedro E Ventura-Puertos
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS), Córdoba, Spain
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Gonzalez A, Afifi TO, Tonmyr L. Completing the picture: a proposed framework for child maltreatment surveillance and research in Canada. Health Promot Chronic Dis Prev Can 2021; 41:392-397. [PMID: 34569775 PMCID: PMC8639173 DOI: 10.24095/hpcdp.41.11.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Tracie O Afifi
- Departments of Community Health Sciences and Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lil Tonmyr
- Public Health Agency of Canada, Ottawa, Ontario, Canada
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Child abuse and neglect in a pediatric emergency department: epidemiology and outcome. Arch Pediatr 2021; 28:504-508. [PMID: 34400056 DOI: 10.1016/j.arcped.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/23/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Managing child abuse and neglect in pediatric emergency departments (PEDs) is difficult because of the complexity of screening and the prolonged care process. This study's main objective was to measure the child protection activity in a PED. METHODS A retrospective, single-center study was conducted in the PED of the Lille University Hospital from 16 September∫2017 to 11 February 2019. All patients who required a social evaluation by the PED staff were included. Children admitted at first to the PED but for whom social management was exclusively performed by other units were not included. The whole population was analyzed first and then by type of abuse. The primary endpoint was the rate of patients who needed social management in the PED. The length of stay in the PED, the number of reports for investigation by child protective services, and reports to a judge were secondary assessment criteria. RESULTS The study involved 245 patients (median age, 5 years; interquartile range [IQR], 2-13; boys, 49%), accounting for 0.6% of the PED visits. The main reasons for visiting the PED were somatic complaints (31%), sexual assault (23%), and behavioral disorders (20%). The median length of care in the PED was 5 h (IQR, 3-13). Thirty-three percent of the patients were monitored in the short-stay unit of the PED; 78% returned home. The main social measures taken were reports to child protective services (34%) and reports to a judge (24%); 51% of the patients required further actions by the PED physician after discharge. CONCLUSION Management of child abuse in the PED is important and time-consuming. A hospital team specialized in child protection is essential for the initial care and monitoring of child victims.
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Reid C, McKenzie JE, Brennan SE, Bennetts SK, Clark Y, Mensah F, Hokke S, Ralph N, Brown SJ, Gee G, Nicholson JM, Chamberlain C. Interventions during pregnancy or up to two years after birth for parents who are experiencing complex trauma or have experienced maltreatment in their childhood (or both) to improve parenting capacity or socio-emotional well-being. Hippokratia 2021. [DOI: 10.1002/14651858.cd014874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Reid
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Shannon K Bennetts
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Murdoch Children's Research Institute; Parkville Australia
| | - Yvonne Clark
- South Australian Health and Medical Research Institute; Adelaide Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
| | - Stacey Hokke
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Naomi Ralph
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Central Queensland University; Townsville Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
- South Australian Health and Medical Research Council; Adelaide Australia
| | - Graham Gee
- Murdoch Children's Research Institute; Parkville Australia
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Australia
| | - Jan M Nicholson
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Catherine Chamberlain
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity; Murdoch University; Perth Australia
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Hollen L, Bennett V, Nuttall D, Emond AM, Kemp A. Evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with children's burns. BMJ Paediatr Open 2021; 5:e000796. [PMID: 33644416 PMCID: PMC7883870 DOI: 10.1136/bmjpo-2020-000796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An estimated 10%-24% of children attending emergency departments with a burn are maltreated. OBJECTIVE To test whether a clinical prediction tool (Burns Risk assessment for Neglect or abuse Tool; BuRN-Tool) improved the recognition of maltreatment and increased the referral of high-risk children to safeguarding services for assessment. METHODS A prospective study of children presenting with burns to four UK hospitals (2015-2018), each centre providing a minimum of 200 cases before and after the introduction of the BuRN-Tool. The proportions of children referred to safeguarding services were compared preintervention and postintervention, and the relationship between referral and the recommended cut-off for concern (BuRN-Tool score (BT-score) ≥3) was explored. RESULTS The sample was 2443 children (median age 2 years). Nurses and junior doctors mainly completed the BuRN-Tool, and a BT-score was available for 90.8% of cases. After intervention, 28.4% (334/1174) had a BT-score ≥3 and were nearly five times more likely to be discussed with a senior clinician than those with a BT-score <3 (65.3% vs 13.4%, p<0.001). There was no overall difference in the proportion of safeguarding referrals preintervention and postintervention. After intervention, the proportion of referrals for safeguarding concerns was greater when the BT-score was ≥3 (p=0.05) but not for scores <3 (p=0.60). A BT-score of 3 as a cut-off for referral had a sensitivity of 72.1, a specificity of 82.7 and a positive likelihood ratio of 4.2. CONCLUSIONS A BT-score ≥3 encouraged discussion of cases of concern with senior colleagues and increased the referral of <5 year-olds with safeguarding concerns to children's social care.
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Affiliation(s)
- Linda Hollen
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Verity Bennett
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Dianne Nuttall
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Alan M Emond
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Kemp
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Kimber M, Gonzalez A, MacMillan HL. Recognizing and Responding to Child Maltreatment: Strategies to Apply When Delivering Family-Based Treatment for Eating Disorders. Front Psychiatry 2020; 11:678. [PMID: 32754071 PMCID: PMC7366365 DOI: 10.3389/fpsyt.2020.00678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/29/2020] [Indexed: 11/29/2022] Open
Abstract
Child maltreatment encompasses a constellation of adverse parental behaviors that include physical, sexual, or emotional abuse, physical or emotional neglect, as well as exposure to violence between parents. A growing body of literature indicates that exposure to child maltreatment is a significant risk factor for the development and maintenance of eating disorders (EDs) and that practitioners experience challenges related to recognizing and responding to various forms of child maltreatment in their practice. Parent-child interactions signifying possible child maltreatment can be subtle; furthermore, the emotional and behavioral symptoms associated with an ED can overlap with those linked with child maltreatment, making it difficult for practitioners to distinguish whether children's symptoms are attributable to underlying psychopathology versus exposure to child maltreatment. This challenge can be further complicated in the context of delivering family-based treatment (FBT); FBT reaffirms that there is no single cause of EDs and asserts the leadership role of parents in their child's recovery process-both of which may lead practitioners to inadvertently miss indicators of child maltreatment. In this article, we provide an overview of the evidence linking child maltreatment to EDs among children and adolescents, as well as evidence-informed strategies for practitioners to safely recognize and respond to suspected child maltreatment when delivering FBT to children and adolescents in their practice.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Harriet L. MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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