Child Abuse Cases Research Articles

Detección y notificación del maltrato infantil: un estudio en docentes de educación infantil y primaria

El presente trabajo consiste en un estudio acerca de los conocimientos que poseen los profesionales del ámbito educativo en la detección, identificación y notificación de situaciones de maltrato infantil. Para ello se diseñó un cuestionario sobre detección del maltrato infantil que fue distribuido entre los profesores de Educación Infantil y Primaria de tres colegios de San Fernando (Cádiz). Los resultados indican la existencia de un desconocimiento generalizado por parte del profesorado acerca de cómo detectar, notificar y actuar ante un caso de maltrato infantil, así como la falta de conocimiento ante los protocolos de actuación sobre el maltrato infantil y de los instrumentos de notificación más usados. Asimismo, se evidencia el mantenimiento de algunas incertidumbres entre los docentes, entre las que destacan el proceso a seguir ante la sospecha de una situación de maltrato y su rol a la hora de intervenir en la forma en la que los padres educan a sus hijos. Por otro lado, un mayor número de años de experiencia docente no parece otorgar una visión más realista sobre el maltrato infantil, ni se relaciona con un mayor conocimiento de los procesos de detección y notificación del mismo. Se aboga por potenciar una mayor formación especializada del profesorado, que los dote de los conocimientos y herramientas necesarias para la detección de casos de maltrato, y su posible inclusión dentro del currículo de las carreras de magisterio.

Nonaccidental Trauma Is an Independent Risk Factor for Mortality Among Injured Infants.

The Centers for Disease Control disclosed over 600,000 cases of child abuse or neglect in 2016. Single-institution studies have shown that nonaccidental trauma (NAT) has higher complication rates than accidental trauma (AT). Nonaccidental trauma is disproportionately represented in infants. We hypothesized that NAT would increase the risk of mortality in infants. This study aims to provide a contemporary descriptive analysis for infant trauma patients and determine the association between NAT and mortality. Infants (<1 year of age) within the Pediatric Trauma Quality Improvement Program database (2014-2016) were identified. Descriptive statistics (χ2 and t test) were used to compare NAT infants to AT infants. A multivariable logistic regression was used to determine the risk of mortality associated with select variables including NAT. From 14,965 infant traumas, most presented to a level I pediatric trauma center (53.5%) with a median injury severity score of 9. The most common mechanism was falls (48.6%), followed by NAT (14.5%). Overall mortality was 2.1%. Although most NAT infants were white (60.2%), black infants were overrepresented (23.6% vs 18.3%; P < 0.0001) compared with AT infants. The incidence of mortality was higher in NAT infants (41.6% vs 13.9%; P < 0.0001), and they were more likely to have traumatic brain injury (TBI) (63.1% vs 50.6%; P < 0.001). Nonaccidental trauma [odds ratio (OR), 2.48; P < 0.001], hypotension within 24 hours (OR, 8.93; P < 0.001), injury severity score (OR, 1.12; P < 0.001), and severe abbreviated injury scale-head (OR 1.62, P = 0.014) had the highest association with mortality. This study confirms the incidence of TBI and NAT in infants. Although providers should be vigilant for NAT, suspicion of NAT should prompt close surveillance, as there is a 2-fold increased risk of mortality independent of injury or TBI.

Karakteristik anak yang mengalami child abuse dan neglect di RSUP Sanglah, Denpasar, Indonesia tahun 2015-2017

Background: Child abuse and neglect is any form of physical, emotional, sexual abuse, or neglect of children. Child abuse causes various consequences that are harmful to the child and the future of the nation. The purpose of this study was to determine the characteristics of children who experience child abuse at Sanglah Hospital Denpasar.Methods: A cross sectional study design was conducted using secondary data taken from medical records of the Forensic Medicine Department, Sanglah General Hospital Denpasar from January 2015 to December 2017. Data related to age, gender, origin, types of abuse, and perpetrator’s house were analyzed as percentage using SPSS version 17 software. Ethical clearance was carried out prior study conducted. Result: From 2015 to 2017, 173 subjects were recorded as child abuse. The age group of 13-15 years and 16-18 years is the highest age group that experiences child abuse which is 28.3% and 33.5%. Subjects of female sex were 56.0%. The highest distribution of subject origin comes from Denpasar area 20.8% and the highest education level of parents is 45.0% senior high school. Subjects who experienced physical violence and threats were 93.6%, sexual violence was 50.8%, and 1.7% experienced neglect. The perpetrators of child abuse are mostly people who are known to the victim. The perpetrator's or subject's house is the place where most physical, emotional, or sexual violence occurs, which is 72.2%, 69.7%, and 89.7% respectively.Conclutions: Most cases of Child abuse occur in the age group of 13-15 years and 16-18 years. Child abuse is more common in women; most of the perpetrators are people who are recognized. Home is the most common place of physical, emotional, or sexual violence.

An example of a neglected child who constructed a special safe place both at home and at school

According to the Ministry of Justice Research and Training Unstitute Institute, White Paper On Crime 2007 (Ministry of Justice Research and Training Unstitute Institute, 2007), the number of consultations in relation to child abuse has been increasing yearly over the last decade. Of the child abuse information received at child consultation centers, 21% comes from family members or other relatives, 14% comes from neighbors and 13% comes from school teachers. (Kozu, J., 1999) However, given that in 75% of cases the abuser is the child's natural father or mother, family reporting cannot be relied upon to give a true picture of the incidence of child abuse. (Kouno, A. and Johnson, C. F., 2001) With the gradual depopulation of rural areas, it is predicted that the number of cases of abuse reported by neighbors will decrease, and that conversely the number of cases of child abuse noticed and reported by school staff, especially yogo teachers (school nurses), will increase. In basic terms, it is difficult for a single yogo teacher to keep a close eye on all the children who visit the school sick bay (yogo teacher's room). There will be situations in which the yogo teacher will need to receive assistance from specialists such as child consultation center counselors, welfare office staff or school counselors. In recent years the number of students who need medical support and/or nursing support at school has been increasing.(Hayashi, N., 2009) However, these students still study the standard curriculum. It is reported that 5 percent of students who have been labeled overly selfish, lacking in application or from problems at in fact have been suffering from pervasive development disorders. (American Psychiatric Association, 2002) The medical home care system was established in 1992, and following a review of the school attendance standards in 2002, students with special needs based on pervasive developmental disorders became able to attend mainstream classes. (Fujioka, H., 2009) The system of special needs education has shifted from focusing on a level of education according to the degree of the individual's disability to providing individual support for the variety of types of An example of a neglected child who constructed a special safe place both at home and at school Kanako Yamauchi, Tadahiro Kato and Yasuo Mukai

The Protection of Children from Sexual Offences Act (POCSO), 2012’ in Clinical Settings

Many of us feel overwhelmed while handling a child abuse case in a busy outpatient unit. Though ‘The Protection of children from sexual offences act, 2012’ is strictly in action now, it possesses a lot of imperfections which challenges its effective implementation. This article highlights the strengths of the act and at the same time reflects the ethical and legal dilemmas we usually encounter in our day to day practice.

SEXUAL ASSAULTS AND MEDICAL APPROACH

Sexual abuse can be accompanied with physical force, threatening, horrifying, drugging and / or misuse of the consents such as the unable ones to give consent because of their underage and / or mental disease. It is a major problem in all over the world as well as our country. Most of the sexual assault victims are actually also child abuse cases. This study aims to contribute to the solution of these abuses and assaults as well as to increase the awareness of the clinical examiners. We designed this study to present the data and increase the benefit for to prevent these abuses.&#x0D; 154 cases had been evaluated at our department in between the dates of October 2012 and January 2014. The ages varied as in groups such as 0-12, 12-15, 15-18 and over the age of 18. The majority of the cases (46.7%) were in the 12 – 15 age group. 25.9% were aged as 15 – 18 and 15.6% were over the age of 18. Only 11.8% were under 12 years of age. The youngest victim was seven years old while the oldest one was 27 years old. 135 cases (87.7%) were female and only 19 of the cases (12.3%) were male. 66 cases (42.8%) had been examined for second time while 88 cases (57.2%) had come to our unit for the first time. 60 cases (39%) have been abused repetitively. 94 cases (61%) defined that they have been abused for the first time. Way of the abuse is evaluated via history taken from victim and demand letter sent to us by facilities. It is claimed that 94 cases (61%) had been abused vaginally while 40 cases (26%) had been abused anally, and 20 cases (13%) had been abused both vaginally and anally.&#x0D; When we analyze the abusers’ profiles in majority of the cases (87%), the victim knows the perpetrator long before the event happens. Violent findings accompanied with sexual abuse in 14 cases (9.1%).&#x0D; The sexual assault victims should not be traumatized repeatedly by clinicians as well as the official authorities. The major point should be the victim’s higher benefit and it should always be protected.&#x0D; Key words: Sexual Abuse, Examination, Clinical Legal Medicine

Understanding how social worker compassion fatigue and years of experience shape custodial decisions

BackgroundCompassion fatigue (i.e., a worker’s diminished ability to empathize with clients) is common among “helping workers” and can result in psychological detachment from clients as a coping mechanism. ObjectiveIn the present research, we explored the relationship between social workers’ compassion fatigue and years of job experience on hypothetical child custody case judgments. Participants and settingIn two separate studies, individuals with experience working with children in child dependency court (predominantly social workers, Study 1: N = 173, Study 2: N = 119) were recruited on Amazon’s Mechanical Turk and read a vignette depicting a mother attempting to regain custody. ResultsSupporting hypotheses, compassion fatigue significantly mediated the relationship between increased years of social worker job experience on recommendations that a neglectful mother receive custody, Indirect Effect = .06, CIs [.026, .127] (Study 1). We also found preliminary support for our hypothesized theoretically derived serial path model, in which (a) social worker compassion fatigue predicts anticipated secondary traumatic stress associated with the child neglect case, B = .54, p = .0001; (b) secondary traumatic stress predicts detachment from the neglected child, B = .27, p = .0003; (c) detachment from the child predicts job efficacy cynicism B = .65, p < .0001; and (d) job efficacy cynicism predicts decisions to allocate custody to the neglectful mother, B = .46, p = .005 (Study 2). ConclusionOur research shows that compassion fatigue among social workers may change the lens through which they perceive cases of child abuse.

Inclusion of a specific prompt within the standard clinical pro forma used in assessment of patients referred to a child and adolescent sexual assault treatment service: A suggested safety-net to facilitate detection of other children at risk of child sexual abuse

BackgroundEvaluation of an index case of child abuse necessitates risk assessment of other children who could be vulnerable to abuse from the same perpetrator/s. ObjectiveTo determine the effectiveness of the addition of a prompt to the standard clinical pro forma used for the assessment of new referrals to a child and adolescent sexual assault treatment service in terms of impact upon detection of other at risk children. Participants and SettingAll referrals to a Child and Adolescent Sexual Assault Treatment Service, Galway, West Ireland. MethodsRetrospective chart review of all children assessed between September 2016 and March 2017. Intervention initiated on September 1st, 2017. Prospective chart review of all children assessed between September 2017 and March 2018. Chart reviews established whether potential risk to siblings, and other close child contacts, of the index case had been adequately considered. ResultsComparing pre and post intervention groups, documentation of children at risk significantly increased from 70% to 96% (p = 0.0124). Cases in which a letter was sent to social services regarding other “at risk” children also significantly increased from 50% to 92% (p = 0.0005). There was a change in the percentage of “at risk” children examined or planned for examination, from 66% to 84%, however that was not statistically significant (p = 0.80). ConclusionsIntroduction of a simple prompt within the standard clinical pro forma had a significant positive impact upon clinicians’ consideration of other “at risk” children. We suggest that other services consider including a similar section in their own pro forma documents.

Child sexual abuse: The significance of the history and testifying on non-confirmatory findings.

BackgroundDespite numerous studies and publications, there is still a common expectation that a medical assessment can confirm or rule out child sexual abuse (CSA). The truth is that CSA can never be ruled out and can seldom be confirmed on clinical grounds.AimThe objective of this article was to suggest which aspects to consider when the expert medical witness in a CSA case needs to explain why CSA can seldom be confirmed and can never be ruled out. The importance of a sound medical and medico-legal history was discussed because the history was generally the only positive ‘finding’ of the assessment of children who have possibly been abused.MethodAuthoritative sources were used to support the explanation of reasons for an absence of corroborative clinical findings in CSA, as defined by the World Health Organization. The authors structured the individual sections by providing a background on which to base the testimony. They then summarised the clinical forensic significance of the information which should be offered in the courts and which should reflect on the court records, to be taken into account in the eventual decision, which will be made by the court.ResultsA guideline was provided for answering questions frequently posed to the expert witness in child abuse cases where there were no positive findings.ConclusionA structure for the explanation of reasons for a normal clinical examination when evaluating children who may have been sexually abused may reduce the discomfort of medical witnesses and improve the quality of expert medical testimony.

Barriers that inhibit reporting suspected cases of child abuse and neglect among nurses in a public hospital, Jeddah, Saudi Arabia.

Child maltreatment is considered a global problem that has serious consequences for a victim's physical and mental well-being. Nurses interact with children and their families at different levels of health care. All nurses must be able to identify children who are at risk of harm or abuse, and act accordingly. The purpose of the study was to investigate barriers that inhibit reporting suspected cases of child abuse and neglect by nurses at King Abdulaziz Medical City, Jeddah, Saudi Arabia. The study was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia. One hundred and forty-five nurses from all paediatric settings participated in the study using non-probability "convenience" sampling technique and a descriptive design was used. A structured self-report data collection method was applied to elicit data about the participants' knowledge and circumstances that prevent them from reporting child abuse. It was found that only one fifth (20.7%) of nurses had attended either a lecture or workshop on child abuse and neglect (CAN). Two fifths (40.7%) of participants had a knowledge score on CAN more than 75% while one third (33.1%) had a knowledge score ranging from 50% to 75% with a median score of knowledge of 63.10 ± 25.48. Furthermore, more than half (51%) of participants were aware of the Suspected Child Abuse and Neglect (SCAN) team in the hospital. When participants were asked about the circumstances when they would not report suspected CAN cases, "I was not certain that the child was abused" was reported by 78.6%. Other barriers that inhibit reporting of child abuse and neglect are ignorance about how to report, in addition to having previous negative experiences after reporting. The findings of the current study indicated that there exist barriers for not reporting suspected cases of child abuse and that availability of training and educational programmes are needed. Establishment of a clear and structured child protection policy to enable nurses to report abuse victims is recommended.

Perception on risk factors of child maltreatment in China: a qualitative study among health professionals

ObjectivesThe aim of this study was to explore health professionals’ perception of risk factors related to child maltreatment in China.DesignQualitative research.SettingThe study was conducted in November and December 2014 in...

An Analysis of Characteristics Affecting the Severity of Child Maltreatment Cases: A Factorial Survey Approach

An Analysis of Characteristics Affecting the Severity of Child Maltreatment Cases: A Factorial Survey Approach

Characteristics of under-reported child maltreatment cases

Characteristics of under-reported child maltreatment cases

Incidence, number and topography of Wormian bones in Greek adult dry skulls.

Wormian bones (WBs) are irregularly shaped bones formed from independent ossification centres found along cranial sutures and fontanelles. Their incidence varies among different populations and they constitute an anthropo- logical marker. Precise mechanism of formation is unknown and being under the control of genetic background and environmental factors. The aim of the current study is to investigate the incidence of WBs presence, number and topographical distribution according to gender and side in Greek adult dry skulls. All sutures and fontanelles of 166 Greek adult dry skulls were examined for the presence, topography and number of WBs. One hundred and nineteen intact and 47 horizontally craniotomised skulls were examined for WBs presence on either side of the cranium, both exocranially and intracranially. One hundred and twenty-four (74.7%) skulls had WBs. No difference was detected between the incidence of WBs, gender and age. Sutures and fon- tanelles located in neurocranium showed a higher incidence of WBs, contrariwise to orbital sutures that indicated a low incidence. WBs most commonly located in the lambdoid suture (44.6%), followed in order of frequency by the coronal suture (39.8%), asterion (21% on the left and 15.3% on the right side) and parie- tomastoid suture (15.1% on the left and 13.9% on the right side). Other sutures with WBs were the occipitomastoid, sagittal, squamosal, zygomaticosphenoid, metopic, frontonasal and frontozygomatic. Regarding the skull fontanelles, WBs were found at pterion, posterior and anterior fontanelles. The current study highlights a high incidence of WBs in a Greek population, indicating racial variation. The in depth knowledge of exact location, frequency and number of WBs is essential for clinicians intervening in the skull area, anthropologists and forensic surgeons investigating child abuse cases.

A qualitative data analysis: family victim advocates in child advocacy centers

ABSTRACTFamily victim advocates in child advocacy centers provide a valuable resource to children and parents involved in child abuse investigations. This work requires that family victim advocates be knowledgeable in such areas as child development, crisis intervention, community resources, family relationships, child welfare and criminal justice systems. Because family victim advocates provide essential services to parents and caregivers, the role requires ongoing training and education to remain current on the ever-changing complexities of working with not only the children and families but also the criminal and child protection systems responsible for investigating these cases. The current study reports the findings from a nationwide survey of family victim advocates employed in child advocacy centers related to their motivation for doing the work as well as their perceptions of their training and potential training needs. A group of doctoral students comprised the research team and worked collaboratively under the supervision of university faculty to conduct the qualitative data analysis. The findings describe the characteristics and motivations of family victim advocates working in child advocacy centers and emphasize the need for more advanced trainings that focus on skill-building and strengths-based practices utilized to support children and parents in child abuse cases.

Associations of Child Maltreatment and Intimate Partner Violence With Elder Abuse in a US Chinese Population

People who have experienced abuse as a child or violence with an intimate partner might have higher odds of being abused again, but this has been insufficiently investigated regarding elder abuse. More conclusive evidence might be critical to assessment and prevention strategies. To examine the associations of child maltreatment and intimate partner violence with elder abuse. Cross-sectional data of 3157 community-dwelling US Chinese older adults (60 years or older) in Chicago, Illinois, were collected during 2011 through 2013. Cases of child maltreatment and intimate partner violence. Cases of elder abuse. Of the 3157 US Chinese older adults included in the study, 1328 (42.1%) were men, and the mean (SD) age was 72.8 (8.3) years. The prevalence of elder abuse, child maltreatment, and intimate partner violence in the cohort was 15.2%, 11.4%, and 6.5%, respectively. After adjusting for sociodemographic variables, health status, quality of life, and health change, individuals reporting child maltreatment had increased odds of intimate partner violence (13.4% vs 5.6%; adjusted odds ratio [aOR], 2.57; 95% CI, 1.78-3.71) and elder abuse (25.2% vs 13.8%; aOR, 2.08; 95% CI, 1.57-2.75) than those not reporting child maltreatment. Individuals reporting intimate partner violence had increased odds of elder abuse than those not reporting intimate partner violence (48.8% vs 12.9%; aOR, 5.53; 95% CI, 4.01-7.64). Prior abuse across major lifespan stages is associated with higher odds of elder abuse. Health care professionals should be more aware of the possibility of abuse when there is a known history of violence in a patient and consider the cumulative effect of violence among those exposed to elder abuse.

PENANGANAN KEKERASAN TERHADAP ANAK BERBASIS MASYARAKAT DI INDONESIA

Kasus kekerasan anak merupakan isu internasional dengan kasus yang mulai meningkat. Hal ini juga terjadi di Indonesia, namun keadaan anak masih termarginalkan. Metode penelitian ini menggunakan literature review, artikel dikumpulkan menggunakan mesin pencari seperti Science direct dan EBSCO. Kriteria artikel yang digunakan adalah yang diterbitkan tahun 2014-2018. Penelitian ini untuk mengumpulkan dan menganalisa artikel yang berhubungan dengan penanganan kekerasan terhadap anak berbasis masyarakat. Berdasarkan hasil bahwa situasi kekerasan terhadap anak menjadi isu dibalik masih tingginya angka kematian dan kesakitan anak. Kondisi ini diperberat dengan faktor lain yang berasal dari dalam keluarga dan faktor eksternal di luar lingkungan keluarga. Penanganan terhadap korban kekerasan terhadap anak di Indonesia telah dilakukan, baik yang dilakukan oleh berbagai institusi baik itu institusi pemerintah maupun lembaga swadaya masyarakat. Namun koordinasi lintas sektor ini yang masih menjadi permasalahan. Kesimpulanya adalah penanganan terhadap anak korban dan pelaku kekerasan yang komprehensif melalui pengananan yang menyeluruh dan melibatkan berbagai pihak yang kompeten.

Apparent life-threatening events in neonates and infants of the first year of life

There are presented data on the apparent life-threatening event (ALTE) that may develop as a sudden, frightening episode with the cessation of breathing (apnea), skin discoloration (cyanosis, pallor, redness), violation of muscle tone: lowering (more often) or rigidity, with the presence of cough or breathlessness in the first year infant. ALTE incidence ranges from 0.46 to 10 per 1000 live births. Common causes of ALTE are established to be gastroesophageal reflux disease, viral infections of the lower respiratory tract, convulsions, whooping cough, sepsis and/or meningitis, arrhythmias or congenital malformations of the heart and respiratory hypoxic-ischemic brain damage, cases of child abuse. There are described history characteristics and features of the examination of ALTE survivors. Most of the ALTE babies are indicated to require hospitalization for cardiorespiratory monitoring within 24 hours after the event. A child older than 30 days suffered from first ALTE clearly associated with feeding, can be observed and examined on an outpatient basis. There is notes particular importance of the new medical and organizational technologies for the improvement of newborn health care, which will significantly promote the prevention of these conditions.

Child abuse and dentistry: a study of knowledge, perspective and attitude among the dentists of west Bengal

Aims A cross sectional study was undertaken to assess the level of knowledge, experience and attitude regarding child abuse and neglect among dentists of West Bengal. Material and Methods Data was collected from an anonymous, self-report questionnaire from 160 dentists of West Bengal. Data was interpreted in SPSS software. Descriptive statistics was generated and Chi square test was used to compare between groups. Results Results of this present study suggest a lack of proper awareness and thorough knowledge among the dentists of West Bengal. This is preventing them from recognizing suspected cases of child abuse and neglect. Lack of knowledge about legal procedures against child abuse poses a barrier to report diagnosed cases effectively. Summary and Conclusion Further improvement in child abuse education is needed to enhance the dental professionals’ ability to identify child abuse and neglect cases and rise above this serious child healthcare issue. Key Words-child abuse, awareness of dentists, child maltreatment

Interdisciplinary collaboration needed in obtaining high-quality medical information in child abuse investigations.

Despite reporting legislation, healthcare providers (HCPs) do not always report and collaborate in cases of suspected child abuse. Recognizing this leaves children at risk, the Wisconsin Child Abuse Network (WI CAN) sought to understand barriers to mandated reporting and collaboration with child abuse investigators. The purpose of the study was to investigate barriers for professionals in providing and obtaining high-quality medical information in child abuse investigations. Participants included five discipline-specific focus groups: HCPs, child protective services (CPS), law enforcement, lawyers, and judges. All professionals had been directly involved in Wisconsin child abuse cases. This qualitative study consisted of discipline-specific focus groups, directed by open-ended interview questions. Data analysis was completed through the narrative inquiry methodology. Barriers to providing and obtaining high-quality medical information in child abuse investigations were both discipline-specific and universal amongst all groups. Discipline-specific barriers included: HCPs' discomfort with uncertainty; CPS' perception of disrespect and mistrust by HCPs; law enforcement's concerns with HCPs' overstepping professional boundaries; lawyers' concern of HCPs' discomfort with court proceedings; and judges' perception of a lack of understanding between all disciplines. Universal barriers included: value of high-quality medical information in child abuse investigations, burden of time and money; unequal resources between counties; a need for protocols, and a need for interdisciplinary collaboration. Findings from this study suggest several ways to address identified barriers. Possible interventions include equalizing resources between urban and rural counties (specifically financial resources and access to child abuse experts); protocolizing reporting and investigations; and, increasing interprofessional education.