Management Of Child Abuse Research Articles

Repeated Episodes of Physical Child Abuse: Is the Exisiting System on Managing Child Abuse Effective in Sri Lanka?

The Sri Lanka Journal of Forensic Medicine, Science & Law (SLJFMSL) is a peer-reviewed, open-access journal published biannually in May and December each year by the Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.The mission of the SLJFMSL is to stimulate, encourage and empower researchers to publish high quality research in order to promote evidence based practice and provide a platform for researchers to share experiences and knowledge in the fields of forensic medicine, forensic sciences, medical ethics and relevant law. This journal publishes original research papers, reviews, points of view, case reports, technical notes and letters to the editor. The SLJFMSL is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.SLJFMSL was assessed by the Journal Publishing Practices and Standards framework and was placed at level four (of six) and is currently listed in SLJOL, DOAJ, IMSER, NLM Catalogue.

487 Virtual Patients: An Effective Educational Intervention to Improve Senior House Officers' Education and Training in the Management of Child Abuse?

As a junior doctor is often the only doctor to assess children presenting with an injury or illness to the A&E department, it is crucial that they are skilled in the identification of possible child abuse or neglect.Aim: To evaluate an interactive computer based Virtual Patient (VP) (using videos to simulate real life clinical scenarios) developed to teach paediatric Senior House Officers about the management of suspected child abuse.Methods: The VP was used to facilitate a child abuse case discussion for Paediatric Basic Specialist Trainees in Ireland. A questionnaire was developed to determine SHOs' perception of the value of the VP as an educational tool. Respondents were asked to rate their agreement with each statement on a 1 to 4 likert scale.Results: All participants (N=25) completed the questionnaire. 100% of participants agreed or strongly agreed that the case was enjoyable, interactive and appropriate for their level of training and a valuable use of their time. Upon completion of the case, most participants reported greater self confidence in their ability to recognize (23/25) and report (24/25) cases of suspected child abuse. All participants felt that the VP helped raise their awareness of the difficulties surrounding the diagnosis and management of child abuse and enabled them to identify deficits in their knowledge.Conclusion: There was an overwhelmingly positive response to the VP. The vast majority of participants reported improvements in their knowledge, confidence and attitude towards the management of child abuse.

The Pediatrician's Role in Child Maltreatment Prevention

It is the pediatrician’s role to promote the child’s well-being and to help parents raise healthy, well-adjusted children. Pediatricians, therefore, can play an important role in the prevention of child maltreatment. Previous clinical reports and policy statements from the American Academy of Pediatrics have focused on improving the identification and management of child maltreatment. This clinical report outlines how the pediatrician can help to strengthen families and promote safe, stable, nurturing relationships with the aim of preventing maltreatment. After describing some of the triggers and factors that place children at risk for maltreatment, the report describes how pediatricians can identify family strengths, recognize risk factors, provide helpful guidance, and refer families to programs and other resources with the goal of strengthening families, preventing child maltreatment, and enhancing child development.

Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs. Multivariate analysis was performed to examine the association between a variety of hospital characteristics, in addition to rural location, and presence of child abuse resources. Fifty-five Oregon hospitals were surveyed. A smaller proportion of rural EDs had written abuse policies (62% vs 95%, P= .006) or on-site child abuse advocates (35% vs 71%, P= .009). Thirty-two percent of rural EDs had none of the examined abuse resources (vs 0% of urban EDs, P= .01). Of hospital characteristics studied in the multivariate model, only rural location was associated with decreased availability of child abuse resources (OR 0.19 [95% CI, 0.05-0.70]). Rural EDs have fewer resources than urban EDs for the management of child abuse. Other studied hospital characteristics were not associated with availability of abuse resources. Further work is needed to identify barriers to resource utilization and to create resources that can be made accessible to all ED settings.

Recommendations on recognition and response to child abuse and neglect in the Indian setting

Pediatricians are usually the first point of contact of children with the health system. Studies worldwide have shown that there is insufficient knowledge about child abuse recognition and management among health workers. Presently no uniform guidelines exist in India for pediatricians regarding the appropriate response to child abuse. As part of the Child Rights and Protection Programme (CRPP) under IAP VISION 2007 of Indian Academy of Pediatrics, a Training of Trainers Workshop on Child Rights and Protection was held in Mumbai in January 2007. It was attended by participants from all over the country. The workshop recommended developing country-specific teaching and training material. A Task force of IAP CRPP was formed and it developed a module for Training of Trainers Workshops for Pediatricians. A National Consultative Meet was held in October, 2007 at New Delhi, where the program was discussed and ratified. To train pediatricians to: recognize and respond to child abuse; engage in a multidisciplinary networking mode to deal with child abuse; and, document, record and report instances of child abuse. Guidelines for recognition and management of child abuse are presented. All pediatricians should assess suspected harm with the same thoroughness and attention as they would do with a life threatening condition. Poor management after disclosure can increase psychological damage. Pediatrician should believe, support, reassure, treat and ensure rehabilitation of victims of child abuse, keeping the best interest of the child as the primary goal.

Managing Child Abuse: General Principles

1. Andrea G. Asnes, MD, MSW* 2. John M. Leventhal, MD† 1. *Associate Medical Director. 2. †Medical Director, Child Abuse Programs, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. After completing this article, readers should be able to: 1. Identify their roles as mandated reporters of child abuse. 2. Discuss the approach to evaluating cases of suspected child maltreatment. 3. Know when to become concerned about possible child maltreatment and when and how to seek help in evaluating cases. 4. Recognize the role of the pediatric practitioner in ongoing care of and advocacy on the behalf of maltreated children. Child abuse is common. In 2007, the year for which the most recent child protective services (CPS) data are available, 3.2 million reports were filed concerning approximately 5.8 million children younger than 18 years of age who were suspected victims of abuse, neglect, or sexual abuse. Also in 2007, 1,760 child deaths were attributed to abuse or neglect. Neglect constituted 59% of all cases of child maltreatment, more than all other forms of substantiated child maltreatment combined. Most maltreatment occurs in children's homes. In 2007, nearly 80% of the perpetrators of child maltreatment were parents. State laws mandate that pediatric practitioners report suspected cases of child abuse or neglect to local CPS. The process that begins when the clinician first feels concern about a child's welfare and ends when he or she makes a report to CPS is one of the most challenging and disturbing that practitioners must undertake. Because child maltreatment is common, it is likely that all pediatric clinicians will care for abused or neglected children and, therefore, will be obliged to report such children to CPS. For this reason, pediatric practitioners should know and employ a careful, systematic, and thoughtful approach to evaluating all suspected cases of child maltreatment to …

Managing Child Abuse

Managing Child Abuse

Skin manifestations of child abuse

Child abuse is a major public health problem all over the world. There are four major types of abuse: physical abuse, sexual abuse, emotional abuse and neglect. The most common manifestations of child abuse are cutaneous and their recognition; and differential diagnosis is of great importance. Clinicians, especially dermatologists, should be alert about the skin lesions of child abuse. In the diagnosis and management of child abuse, a multidisciplinary approach with ethical and legal procedures is necessary. In this manuscript, cutaneous manifestations of physical, sexual, emotional abuse and neglect are reviewed and discussed.

Child abuse: 30 years’ experience at the Bambino Gesù Children's Hospital

The management of child abuse and neglect is an area that demands great skill. Here, we give a brief presentation of the 30 years' experience in this field at the Bambino Gesù Children's Hospital, Rome, as well as a summary of certain clinical data and the intervention protocol applied. Between 1977 and 2007, a total of 1917 cases were referred to our Day Hospital (20.4% of all pathologies presenting for consultation). In order to increase the awareness of the signs and symptoms of abuse for people working with children, training courses have been introduced for school and social services workers, and a telephone counselling service has been set up to facilitate case referrals to the Day Hospital. A multidisciplinary approach was used in the assessment of abuse cases as well as for therapeutic issues. Skilled training of the entire staff is essential.

Safeguarding children part 2: reporting and acting on abuse

This second of two articles, highlighting child abuse, focusing on the practical aspects of the recognition and the management of child abuse. The article outlines some of the obstacles, looking at alerting features and also some of the clinical presentations to alert health professionals to potential child abuse. The article also set out an action plan – to assist practitioners in managing this difficult aspect of clinical care. This second article also refers to looking after yourself and the role of some of the other agencies involved in child protection, including the role of child protection conferences.

Strategies in the management of child maltreatment: should reporting be mandatory or voluntary?

Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.

Child Abuse Training and Knowledge: A National Survey of Emergency Medicine, Family Medicine, and Pediatric Residents and Program Directors

The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. Surveys were administered to program directors and third-year residents at 67 residency programs. The resident survey included a 24-item quiz to assess knowledge regarding the medical management of physical and sexual child abuse. Sites were solicited from members of a network of child abuse physicians practicing at institutions with residency programs. Analyzable surveys were received from 53 program directors and 462 residents. Compared with emergency medicine and family medicine programs, pediatric programs were significantly larger and more likely to have a medical provider specializing in child abuse pediatrics, have faculty primarily responsible for child abuse training, use a written curriculum for child abuse training, and offer an elective rotation in child abuse. Exposure to child abuse training and abused patients was highest for pediatric residents and lowest for family medicine residents. Comfort with managing child abuse cases was lowest among family medicine residents. On the knowledge quiz, pediatric residents significantly outperformed emergency medicine and family medicine residents. Residents with high knowledge scores were significantly more likely to come from larger programs and programs that had a center, provider, or interdisciplinary team that specialized in child abuse pediatrics; had a physician on faculty responsible for child abuse training; used a written curriculum for child abuse training; and had a required rotation in child abuse pediatrics. By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must establish the importance of this topic in the pediatric education of residents of all specialties.

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

Objectives The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002–2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. Methods A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. Results Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly ( R 2 = 91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. Conclusions A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. Practice implications Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Primary care pediatricians’ experience, comfort and competence in the evaluation and management of child maltreatment: Do we need child abuse experts?

Objective We assessed the self-reported experience, comfort and competence of primary care pediatricians in evaluating and managing child maltreatment (CM), in rendering opinions regarding the likelihood of CM, and in providing court testimony. We examined pediatricians’ need for expert consultation when evaluating possible maltreatment. Methods A questionnaire was mailed to 520 randomly selected AAP members. Pediatricians were asked how frequently they evaluated and reported children for suspected maltreatment, and whether child abuse pediatricians were available to and used by them. Pediatricians were asked to rate their knowledge, comfort and competence in the management of CM. Demographic information was also gathered. Pediatricians’ experience with CM, their comfort, self-reported competence, and need for expert assistance is described. Logistic regression was used to assess factors that predicted pediatricians’ sense of competence while controlling for covariates found to be significant in bivariate analyses. Results One hundred forty-seven questionnaires were eligible for analysis. The majority of respondents had little experience evaluating and reporting suspected CM, and was interested in having expert consultation. While pediatricians often felt competent in conducting medical exams for suspected maltreatment, they felt less competent in rendering a definitive opinion, and did not generally feel competent to testify in court. Sense of competence was particularly low for sexual abuse. Increased practice experience and more courses in CM led to increased sense of competence in some areas. Conclusions Pediatricians acknowledged many limitations to providing care to maltreated children, and expressed interest in subspecialist input. Practice implications These findings add additional support to the American Board of Pediatrics’ decision to create a Child Abuse Pediatrics subspecialty. The findings also indicate a need to ensure funding for fellowship training programs in this field.

Child Abuse: Psychosocial and Religious Intervention Strategies in Zimbabwe

The article examines psychosocial and religious intervention strategies used to prevent and manage child abuse in Zimbabwe. Psychosocial interventions used include primary, secondary and tertiary interventions. Religious interventions include primary and tertiary intervention. It appears that the intervention strategies are used mostly by professionals who offer psychosocial support than by religious organizations.

Child abuse as a complex and wicked problem: Reflecting on policy developments in the United Kingdom in working with children and families with multiple problems

In spite of significant public concern, professional efforts and financial expenditure, there has been a perceived lack of progress in reducing the incidence of child abuse, and in improving the outcomes for children in both the short and longer term. In this article the authors reflect on recent policy developments in the United Kingdom relating to children and families experiencing multiple adversities, and argue that the current conceptualisation of child abuse is flawed. In adopting a rational technical approach to the management of child abuse, there is a tendency to focus on shorter term outcomes for the child, such as immediate safety, that primarily reflect the outputs of the child protection system. However, by viewing child abuse as a wicked problem, that is complex and less amenable to being solved, then child welfare professionals can be supported to focus on achieving longer term outcomes for children that are more likely to meet their needs. The authors argue for an earlier identification of and intervention with children who are experiencing multiple adversity, such as those living with parents misusing substances and exposed to intimate partner violence.

Child protection procedures in emergency departments

Background:Emergency departments (EDs) may be the first point at which children who have been subject to abuse or neglect come into contact with professionals who are able to act for...

Violence against children: the UN report

> Understand that one person can do something about violence but many people can stop violence. > > No violence against children is justifiable; all violence against children is preventable....

A National Assessment of Knowledge, Attitudes, and Confidence of Prehospital Providers in the Assessment and Management of Child Maltreatment

The goal was to assess the knowledge and confidence in recognition, management, documentation, and reporting of child maltreatment among a representative sample of emergency medical services personnel in the United States. A questionnaire was developed and pilot-tested, with the input of experts in emergency medical services and child maltreatment, to assess knowledge, attitudes, confidence, and training needs regarding assessment and treatment of child maltreatment. The questionnaire was distributed nationally to a random sample of prehospital providers by using a previously validated sampling plan. Of 2863 surveys sent to prehospital providers, 1237 (43%) were returned. Most prehospital providers reported receiving < or = 1 hour of continuing medical education regarding child maltreatment. Most (78%) asked for additional educational opportunities, with only 3% stating that they required no additional training. Participants lacked knowledge regarding the developmental abilities of children, management of families in which child maltreatment is suspected, key elements of the history that should be noted, and the degree of suspicion necessary for reporting. Prehospital providers expressed confidence in their abilities to recognize and to manage cases of child abuse and neglect; however, significant deficiencies were reported in several critical knowledge areas, including identification of child maltreatment, interviewing techniques, and appropriate documentation.

Child Abuse Training, Comfort, and Knowledge Among Emergency Medicine, Family Medicine, and Pediatric Residents

Purpose: To assess the training, comfort, and knowledge related to the medical management of child abuse among emergency medicine, family medicine, and pediatric residents.Method: In 2004, a 25-item survey was distributed to 274 pediatric, emergency medicine, and family medicine residents at two medical schools in Norfolk, Virginia and Dallas, Texas. Analyses focused on identifying differences in training, comfort, and knowledge by specialty and site, and identifying factors associated with greater knowledge and comfort.Results: Pediatric residents reported receiving the most hours of instruction in child abuse during residency. Training experiences of family medicine residents differed significantly by site. Clinical and overall knowledge and comfort with handling exams correlated strongly with the number of abuse patients seen during residency. On both clinical and overall knowledge, family medicine residents performed significantly worse than pediatric and emergency medicine residents. Knowledge of genital anatomy and comfort with sexual abuse exams was poor among all specialties.Conclusion: The results support the need for improvements in and a more systematic approach to residency training in child abuse.