Barriers to identification and reporting of child abuse and neglect experienced by medical officers and nursing staff in emergency departments of the Nepean Blue Mountains Local Health District

OBJECTIVE

This structured survey sought to identify barriers to recognising and reporting potential child abuse by medical officers and nursing staff in the EDs of three Western Sydney hospitals. These include a large metropolitan teaching hospital, a small metropolitan hospital and a rural hospital.

METHODS

A mixed approach of qualitative and quantitative study methodology was used to survey potential participants. The electronic survey was distributed to participants to assess knowledge and experiences with identifying child abuse presenting to the ED over a 6-month period. A descriptive analysis of the data was performed.

RESULTS

A total of 121 responses were received from 340 potential participants, giving a participation rate of 35%. The majority of the respondents were senior medical officers (38/110, 34%) or registered nurses (35/110, 32%). The study participants perceived the lack of time as the most significant barrier to reporting child abuse (85/101, 84%). This was followed by a lack of education (35/101, 34%), resources (33/101, 32%) and support (30/101, 29%).

CONCLUSION

The combination of hospital, departmental and individual staff issues such as time limitations, lack of resources, education and support are potential barriers to reporting suspected child abuse. We recommend tailored teaching sessions, improved reporting procedures and increased support from senior staff to overcome these barriers.

Clinician Response to Child Abuse Presentations in the Vietnamese Hospital Emergency Setting

Ongoing fiscal stability has enabled the National Assembly in Vietnam to turn its attention to improving the health and well-being of women and children. Training pediatric health care professionals in the recognition and response to child abuse presentations in the emergency setting has the potential to improve outcomes for the disproportionate number of vulnerable children presenting to the emergency setting with nonaccidental injuries. This study explored the training needs and expectations of the staff preparing to undertake such a clinical training program. This qualitative study is based on semistructured interviews with 16 clinicians from the emergency setting of a leading pediatric hospital in Vietnam. Interview questions focused on current practice in recognizing and responding to child abuse and neglect presentations, the level of training and experience of participants, and subjective reports of confidence in recognizing abuse. Interviews were conducted in English and Vietnamese, with check-translation of transcripts performed by an independent translator. A culture of collegiality and innovative workplace practices was revealed. Analysis revealed two overarching themes that were related to the need for evidence, forensic analysis, respecting families, and consultation. Despite participant confidence in recognizing and reporting child abuse and neglect presentations, knowledge deficits were found. This article presents a critical analysis of the context within which the first evidence-based clinical training program of its kind in Vietnam was developed and implemented in a pediatric children's hospital. Clinicians felt a strong moral obligation to protect children from further harm, however encountered a number of barriers inhibiting this process. Findings significantly shaped the Safe Children Vietnam training program and will also contribute to the development of protocols and improvement of community support services at the study site.

Building workforce capacity to detect and respond to child abuse and neglect cases: A training intervention for staff working in emergency settings in Vietnam

BACKGROUND

Too many children are brought to hospital emergency departments on numerous occasions before they are recognised as victims of child abuse and neglect. For this reason, improving knowledge and response behaviors of emergency staff at all levels is likely to have a significant impact on better outcomes.

AIM

An Australian based training programme was the first of its kind to address this issue in a Vietnamese Emergency Department. Titled 'Safe Children Vietnam', the programme aimed to improve knowledge, attitudes and reporting behaviors concerning child abuse in the emergency setting.

METHOD

A pre-post test design was used to evaluate the impact of 'Safe Children Vietnam' on emergency staff knowledge, attitudes and intentions to report child abuse and neglect.

RESULTS

Emergency staff including doctors, nurses and healthcare staff (n=116) participated in the clinical training programme. Linear Mixed Model analyses showed that on programme completion, they were more likely to recognise serious cases of all types of abuse.

CONCLUSION

The 'Safe Children Vietnam' programme was effective at improving emergency staff knowledge of child abuse and neglect. A systems wide approach may be necessary to impact on emergency staff attitudes towards reporting cases of abuse.

Analysis of acute presentations for child protection medical assessments in a large, culturally diverse metropolitan setting

OBJECTIVE

South Western Sydney has a large culturally diverse population with many vulnerable subgroups; little is known about the health and social outcomes following acute child maltreatment assessments. We aimed to describe acute presentations of maltreatment in South Western Sydney-including examination findings of the assessment, determine health and social outcomes for children following medical assessment, to inform service development.

DESIGN

We gathered data from the acute child protection database on all children <16 years referred for physical abuse and neglect and/or sexual abuse assessment between 2013 and 2015 to one hospital service. We reviewed clinical records of the children assessed, using the reports to classify findings of the examination. We performed simple descriptive analysis on the data.

RESULTS

There were 304 children referred, 279 seen for acute assessment. Most (72%) were female, 204 (73%) referrals were for sexual abuse, 75 (27%) were for physical abuse and neglect. There were age, gender and ethnicity differentials depending on type of maltreatment presentation. Twelve per cent of sexual and 19% of physical abuse cases were found not to be abuse related. Unmet medical, developmental and behavioural concerns were identified in the majority (54%) assessed. Just under half (48%) of all children went home with families with no statutory agency support; those seen for physical abuse were more likely to be placed in care (p<0.001).

CONCLUSIONS

Children assessed for child maltreatment had a range of health and social concerns identified, needing further intervention. Comprehensive medical assessments have a critical role to play in child protection assessments.

Audit of child maltreatment medical assessments in a culturally diverse, metropolitan setting

OBJECTIVE

Child maltreatment (CM) is a major public health problem globally. While there is evidence for the value of medical examination in the assessment of CM, little is known about the quality of clinical assessments for CM. South Western Sydney (SWS) has a large metropolitan population with many vulnerable subgroups. We aimed to describe acute presentations of CM in SWS over a 3-year period-with a focus on the quality of the clinical assessments. We wanted to determine whether the cases assessed fulfilled established minimum standards for clinical assessment of CM and whether the assessments were performed in a child-friendly manner.

DESIGN

We gathered data from the acute child protection database on all children <16 years referred for assessment between 2013 and 2015. We performed simple descriptive analysis on the data. We measured the assessment, report writing and follow-up against criteria for minimum standards for CM assessments, and identified whether assessments were child-friendly from available clinical information.

RESULTS

There were 304 children referred; 279 seen for acute assessment; most (73%) were for sexual abuse, 75 (27%) were for physical abuse/neglect. Over half the assessments identified other health concerns; joint assessments performed by paediatric and forensic doctors were better at identifying these health concerns than solo assessments. Most assessments were multidisciplinary and used protocols; half were not followed up; a third were performed after-hours and a third had no carer present during assessments.

CONCLUSIONS

We identified strengths and weaknesses in current CM assessments in our service. Locally relevant standards for CM assessments are achievable in the acute setting, more challenging is addressing appropriate medical and psychosocial follow-up for these children. While we have established baseline domains for measuring a child-friendly approach to CM assessments, more should be done to ensure these vulnerable children are assessed in a timely, child-friendly manner, with appropriate follow-up.