12 Access to paediatric maltreatment services through a northern community hospital

Abstract

Abstract Background Few studies have evaluated how paediatric maltreatment services based in community hospitals can provide access to care for populations who live far away from tertiary centres. The Violence Intervention Prevention Program (VIPP) and the Paediatric Abuse and Referral Evaluation (PARE) clinic based in a northern community hospital in Canada offer assessment for sexual and physical maltreatment. Objectives The aim of the study was to describe demographic and clinical characteristics of patients accessing VIPP and PARE services and to characterize the length of time required to access care. Design/Methods We conducted a retrospective chart review of patients, under 16 years of age, who attended PARE clinic for initial consultation between 2017-2019. Analyses were descriptive. This work was approved by the research ethics board at our hospital. There are no funding disclosures. Results Of 164 patients, 62.2% were female; 37.8% male. The mean age was 6.6 years, ranging from 1 month to 15.9 years. 54.3% of referrals were for suspected physical maltreatment, 44.4% for suspected sexual maltreatment and 1.2% for both. 87.5% of patients listed home addresses within the hospital’s city limits. The maximum distance travelled from home to access care was 171 km. 87.2% of patients presented through the emergency department; a minority presented through direct referral to outpatient services (11.5%) or through inpatient (1.2%). When called from the emergency department, on-call VIPP nurses responded within a mean of 32 minutes for initial assessment. These patients received a maltreatment assessment by a paediatrician through the PARE clinic a mean of 14.3 days later. If patients did not present through the emergency department, the mean wait time for a maltreatment assessment by a paediatrician was 16 days. 13.4% (22/164) required referral to other medical or multidisciplinary services. General paediatrics (11/22) was the most frequent referral, followed by community speech programs (5/22). A minority (3.0%) of cases required consultation with external maltreatment teams, where two cases were peer-reviewed with a tertiary care team, one with a paediatric maltreatment physician at another community hospital and two cases were reviewed with a paediatric tertiary care radiologist. Conclusion Our results suggest that community-based paediatric maltreatment services provide care for our regional northern population. There is timely on-call access to allied-health providers through the emergency department. All patients were able to be assessed locally and none were required to travel to a tertiary care hospital. Further study is needed to assess how our data compares to other community maltreatment programs.