Child Abuse Pediatrics: Research, Policy and Practice

Abstract

THE 5 ARTICLES in this issue of Academic Pediatrics are illustrative of excellent research being conducted in the recently recognized subspecialty of child abuse pediatrics. There are clear implications for future research, practice, and policy in this field. Three ofthepapersinvolveensuringthatmedicalassessments of possible maltreatment be as accurate as possible. Physicians often offer critical information for child protective services (CPS) to decide whether to substantiate suspected maltreatment. The ramifications of these decisions can be far reaching. Substantiation may lead to children being removed from their homes. An alleged perpetrator may be arrested, tried, and imprisoned. Alternatively, erroneously not identifying maltreatment may allow ongoing abuse and neglect. It is naturally important that these decisions be made as carefully and accurately as possible. Even a relatively low error rate should not be accepted. In other serious circumstances in medicine, a high standard of diagnostic accuracy is demanded. Child protection teams (CPTs) play an important role in consulting with hospital staff regarding the likelihood of maltreatment. Their work is complex, comprising multiple disciplines and often including representatives from community agencies as well as sensitive relationships with hospital staff, family members, and outside professionals. Their consultation involves the high stakes mentioned previously. It is imperative that CPTs conduct their work in a highly professional, optimal manner. Many CPT chairs and members, however, likely have limited training in understanding and fostering team processes. The article by Kistin et al 1 describes a valuable tool for CPTs to assess and improve their functioning. The tool covers several core areas of team functioning; however, others could be added to more comprehensively capture a CPT’s functioning. For example, what is the team’s process for arriving at a consensus? The tool focuses mostly on a CPT’s internal working, but relationships with hospital staff and outside agencies are also important.