Suspected Child Abuse Research Articles

Effect of a Universal Postpartum Nurse Home Visiting Program on Child Maltreatment and Emergency Medical Care at 5 Years of Age

The Family Connects (FC) program, a community-wide nurse home visiting program for newborns, has been shown to provide benefits for children and families through the first 2 years of life. Potential longer-term outcomes for child well-being remain unknown. To determine the effect of randomization to FC on child maltreatment investigations and emergency medical care through 5 years of age. In this randomized clinical trial, families of all 4777 resident births in Durham County, North Carolina, from July 1, 2009, to December 31, 2010, were randomly assigned to receive the FC program or treatment as usual. Impact evaluation was on an intent-to-treat basis and focused on a subsample of 549 families randomly selected from the full population and included review of hospital and Child Protective Services (CPS) administrative records. Statistical analysis was conducted from November 6, 2020, to April 25, 2021. The FC programs includes 1 to 3 nurse home visits beginning at the infant age of 3 weeks designed to identify family-specific needs, deliver education and intervention, and connect families with community resources matched to their needs. Ongoing program engagement with service professionals and an electronic resource directory facilitate effective family connections to the community. Two primary trial outcomes were CPS-recorded child maltreatment investigations and emergency medical care use based on hospital records. Of the 4777 randomized families, 2327 were allocated to the intervention, and 2440 were allocated to services as usual. Among the children in the full study population, 2380 (49.8%) were female, 2397 (50.2%) were male, and 3359 (70.3%) were from racial/ethnic minority groups; of the 531 children included in the impact evaluation follow-up, 284 (53.5%) were female, 247 (46.5%) were male, and 390 (73.4%) were from racial/ethnic minority groups. Negative binomial models indicated that families assigned to FC had 39% fewer CPS investigations for suspected child maltreatment through 5 years of age (95% CI, -0.80 to 0.06; 90% CI, -0.73 to -0.01; control = 44 total investigations per 100 children and intervention = 27 total investigations per 100 children); intervention effects did not differ across subgroups. Families assigned to FC also had 33% less total child emergency medical care use (95% CI, -0.59 to -0.14; 90% CI, -0.55 to -0.18; control = 338 visits and overnight hospital stays per 100 children and intervention = 227 visits and overnight hospital stays per 100 children). Positive effects held across birth risk, child health insurance, child sex, single-parent status, and racial/ethnic groups. Effects were larger for nonminority families compared with minority families. The findings of this randomized clinical trial suggest that, when implemented with high quality and broad reach, a brief postpartum nurse home visiting program can reduce population rates of child maltreatment and emergency medical care use in early childhood. ClinicalTrials.gov Identifier: NCT01406184.

Guideline adherence and quality assurance in radiological diagnostics in cases of suspected child abuse in Germany

HintergrundDie bildgebende Diagnostik nimmt in der Evaluation nichtakzidentieller Verletzungsfolgen im Kindesalter eine Schlüsselrolle ein. Frakturen sind nach Hautläsionen wie Abschürfungen oder Hämatomen die zweithäufigste Folge körperlicher Kindesmisshandlung. Mit Hilfe radiologischer Kriterien können nichtakzidentielle von akzidentiellen Frakturen differenziert werden. Spezielle Frakturtypen wie die klassische metaphysäre Läsion können nur bei hoher Bildqualität differenziert werden.FragestellungIn einer prospektiven Analyse sollten Leitlinientreue und Qualitätssicherung der radiologischen Diagnostik bei Misshandlungsverdacht in Deutschland erfasst werden. Dazu wurden Quantität und diagnostische Qualität in der universitären und nichtuniversitären Versorgung sowie in Abhängigkeit einer vorhandenen kinderradiologischen Fachabteilung analysiert.Material und MethodenEs wurden 958 Röntgenuntersuchungen von 114 vermuteten Misshandlungsfällen (46 Mädchen, 68 Jungen) bewertet. Insgesamt 42 Fälle aus universitären, 42 aus maximalversorgenden und 30 aus regelversorgenden Kliniken mit einem medianen Alter von 6 Monaten (3 Wochen – 3. Lebensjahr) wurden als DICOM-Daten von 3 Kinderradiologen im Konsensverfahren hinsichtlich Leitlinientreue und verschiedener Qualitätsparameter beurteilt. Ein Begleitfragebogen sollte die theoretischen Kenntnisse mit der jeweiligen praktischen Umsetzung vergleichen.ErgebnisseJe Fall wurden im Mittel 8,4 Röntgenaufnahmen (1–22) angefertigt. In 12 von 114 beurteilten Fällen (10 %) lag ein vollständiger Skelettstatus nach S1-Leitlinie GPR vor. In 13 Fällen (10,5 %) wurde ein Babygramm durchgeführt. Abteilungen mit kinderradiologischem Schwerpunkt fertigten signifikant mehr Röntgenaufnahmen je Skelettstatus an als Einrichtungen ohne Schwerpunkt (p < 0,05). Eine signifikant höhere qualitative Umsetzung wurde in Universitätskliniken verzeichnet (p < 0,001). Eine Übereinstimmung von Fragebogenantwort und vorliegendem Bildmaterial zeigte sich unabhängig der Institutionsart nur marginal.DiskussionIn Deutschland fehlt bislang mehrheitlich ein leitliniengerechtes Vorgehen bei Misshandlungsverdacht. Es bleibt abzuwarten, ob sich dies mit der breiteren Implementierung von Kinderschutzgruppen und der 2019 verabschiedeten S3-Kinderschutzleitlinie (AWMF-Registrierungsnummer: 027-069) zukünftig ändern wird. Die Etablierung von Referenzzentren für Zweitbefundung und Empfehlungen zur Aufnahmetechnik können zusätzlich die Versorgungsqualität nachhaltig verbessern.

Race and Bias in Child Maltreatment Diagnosis and Reporting.

* Abbreviation: CPS — : child protective services Pediatricians have implicit and explicit racial biases that impact the health and well-being of children and their families.1,2 Similarly, effects of racism on diagnosis and reporting of suspected child abuse and neglect to child protective services (CPS) can have serious consequences. Although we and others are mandated to report suspected child abuse or neglect in all US states and territories, the threshold for reporting requires only “reasonable suspicion” of abuse or neglect.3 Pediatricians may also report families that they perceive need additional resources. Research on racial bias and physician reporting is limited.4 Disproportionality in reporting is widespread on the basis of race, culture, and ethnicity. Asian American and Hispanic children are underrepresented, but overrepresentation of Black children throughout the child protection system has been most widely described.5 Black children are reported at approximately twice the rate of white children, and the complex relationship of reporting with poverty and race has yet to be fully understood.4–6 Once reported, cases with Black children are more likely to be accepted for investigation, be confirmed, be brought to court, result in removal of the children from their families for longer periods of time, and take longer to be closed, possibly related to surveillance bias.5,7 Multiple points in this process are subject to bias, but the process begins with reporting.8,9 The concept of bias has been recognized and discussed within the medical community for at least half a century. Diagnostic errors due to bias can lead to errors in reporting.10 Although physicians have historically been key players in the development … Address correspondence to Vincent J. Palusci, MD, MS, FAAP, Department of Pediatrics, Grossman School of Medicine, New York University, 462 First Ave, Room GC-65, New York, NY 10016. E-mail: vincent.palusci{at}nyulangone.org

Discrepancies in Physician and Coroner Findings in Cases of Fatal Suspected Physical Child Abuse.

As mandated reporters of suspected abuse, physicians must consider abuse when a child dies unexpectedly. Subsequently, a coroner or medical examiner determines the manner of death (MOD) and cause of death (COD). Accurate diagnoses and determinations are important for social safety and justice. This study described discrepancies between physicians' and coroners' findings in cases of fatal suspected physical child abuse. This study was a single-institution, retrospective review. All children 6 years or younger who died in a pediatric emergency department from October 2006 to January 2013 with a coroner report were included in this study. Coroner reports, MODs, and CODs were reviewed. Skeletal survey results were compared with coroners' findings. One hundred twenty-nine children were included. The MODs included the following: undetermined, 63 (49%); accident, 32 (25%); natural, 31 (24%); and homicide, 3 (2%). Thirty-three (26%) of the 129 patients had abuse suspected at the time of death in the emergency department; in this subset, MODs were as follows: undetermined, 16 (48%); accident, 8 (24%); natural, 6 (18%); and homicide, 3 (9%). Sudden infant death syndrome or sudden unexpected death was the most common COD in all children (68, 55%). Skeletal surveys were positive in 12 children with 29 fractures identified; 8 (28%) of the 29 fractures were corroborated on autopsy findings. Of the 12 children with positive skeletal survey findings, only 1 was ruled a homicide. We found discrepancies between coroner determination of homicide and abuse suspected by physicians, especially among children with fractures. Improved communication between agencies in cases of fatal child abuse is needed.

The use and impact of repeated questions in diagnostic child abuse assessment interviews

There is limited research regarding the use of repeated questions and the subsequent response from children in real-world forensic contexts. We analysed 71 transcripts of diagnostic assessments in which 3- to 6-year-olds were assessed for suspected abuse experiences. On average, 6% of interviewer questions were repeated, and 47% of the repeated questions were abuse-related. The majority (65%) of the repeated questions were directive, but 33% of the repeated questions contained implicit assumptions. Implicit assumption questions were more likely to be abuse-related. Interviewers repeated questions when the child failed to answer due to playing (31%), for no apparent reason (26%) or for clarification purposes (29%). Children most commonly responded to repeat questions by providing new information (64%), not responding at all (19%) or repeating information (12%). We recommend that interviewers avoid the use of suggestive and repeated questions that contain implicit assumptions in relation to assessment of suspected child abuse.

Time Doesn’t Heal All Wounds: A Call to End Mandated Reporting Laws

Mandated reporting laws are pertinent to practitioners of “helping professions,” such as social workers, doctors, nurses, and teachers. These laws dictate that a professional or student in those fields must report suspected child maltreatment to the state for investigation. The report, as well as the investigation that follows, has the potential to result in removal and separation of children from their parents or caretakers. The child welfare system of which mandated reporting is a component has a cruel history of racism and white supremacy, as well as prejudice towards those experiencing poverty, disabilities, mental health concerns, homelessness, and substance use disorders. This research examines the disproportionate harm the child welfare system has on Black and Brown individuals, particularly in New York, and how the system has used mandated reporting laws to further marginalize oppressed communities since the 1970s. This research indicates the need to comprehensively reimagine the erroneously named “child welfare system” starting with repealing mandated reporting laws in the United States.

Ehlers–Danlos syndrome: what the radiologist needs to know

Ehlers-Danlos syndrome is a real diagnosis that is erroneously used to explain multiple fractures in suspected child abuse. This paper reviews the clinical and molecular diagnostic criteria for Ehlers-Danlos syndrome. This knowledge can help prevent misdiagnosis and support clinicians when evaluating infants and young children with multiple fractures.

Siblings Are Also at Risk for Abuse.

Approximately 9 of every 1000 children in the United States are identified as victims of maltreatment, including neglect, physical abuse, emotional abuse, or sexual abuse.1 However, many cases of maltreatment are not identified,2 which has severe consequences for affected children.3 Although it is important to evaluate any child at risk for abuse, identifying risk can be challenging. In this issue of Pediatrics, Kisely et al4 evaluated whether siblings of children with suspected abuse are themselves at increased risk. These researchers followed a large cohort of sibling pairs in Australia. They found a 60-fold increase in abuse reports for siblings of children who had themselves been reported as abused previously. The risk was even greater when the mother was <20 years of age. The type of abuse (eg, physical, sexual, neglect) was often concordant between sibling pairs.Sibling risk has previously been studied but not on the scale of this new publication. Lindberg et al5 collected data from almost 3000 children who were evaluated for physical abuse. Contacts, including siblings or others in the same environment (including day care) of physically abused children were at significantly increased risk for injury.5 This risk was even higher among twins.Armed with the knowledge of the increased risk to siblings, medical providers and child welfare professionals should advocate for evaluations of these children at high risk. In cases of physical abuse, the evaluation by Lindberg et al5 included head imaging for contacts aged <6 months or those with mental status changes, skeletal surveys for contacts aged <2 years, and physical examinations for all contacts aged <5 years. This evaluation by Lindberg’s team parallels the recommended evaluation for any child when there is concern for physical abuse, although it may be reasonable to perform head imaging on any infant at high risk for abuse, such as siblings.6,7 To conduct a thorough examination, providers should familiarize themselves with injuries that are most specific for abuse, such as facial bruises and frenular injuries.8Siblings of sexual abuse victims should also be evaluated. Although the American Academy of Pediatrics policy statement on sexual abuse does not mention siblings or contacts, the National Children’s Alliance (the accrediting body for children’s advocacy centers) recognizes that siblings and other household contacts of abuse victims are themselves at risk.9,10 Evaluations for possible sexual abuse typically involve a forensic interview (if a child is developmentally capable) and a sexual abuse evaluation performed by a provider with training in pediatric sexual abuse examinations.9,10 Children’s advocacy centers are present throughout the country to assist in these evaluations of both suspected sexual abuse victims and their siblings.10The finding that children are at increased risk for maltreatment if they live with a young mother can help inform prevention efforts. For example, some home visitation programs, such as Nurse-Family Partnership, which works with first-time mothers in poverty, can help target the risks seen with young mothers, including lack of support and lack of education, and may have some benefit to prevent physical abuse.11As pediatricians, we are advocates for children, so our evaluation for suspected child abuse or neglect should include asking about the presence of siblings or other children in that environment. Subsequently, we should follow-up to ensure that any siblings are appropriately evaluated for abuse themselves.

Risk Factors for Maltreatment in Siblings of Abused Children.

To examine the association between child maltreatment (abuse and neglect) in one sibling and that in another as well as associated risk factors. The participants were 520 sibling pairs enrolled in a population-based birth cohort study in Brisbane, Australia (N = 1040). Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. Self-reports of childhood sexual abuse were also collected at the 21-year follow-up. There were notifications in both children for 8.5% of the sibling pairs (n = 44). A notification in the first sibling was associated with a 60-fold increase in the likelihood of a notification in the second sibling (95% confidence interval: 29.3-125.1), resulting in nearly three-quarters being the subject of a report. In terms of the subtypes, neglect revealed the strongest association, followed by sexual abuse. At the 21-year follow-up, 58% of second siblings reported sexual abuse when the first sibling disclosed similar experiences. On adjusted analyses, maternal age of <20 years was the strongest and most consistent predictor of abuse, with indigenous status, maternal depression, parental relationship, and familial poverty playing a lesser role. Our results highlight the close association between child abuse in one sibling and maltreatment in a second sibling as well as possible risk factors. Greater awareness of these factors may inform interventions, particularly primary and secondary prevention.

Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study.

To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and soft-tissue injuries in suspected child abuse. In this prospective, multicentre, diagnostic accuracy study, children less than 3 years of age with suspected physical abuse were recruited. Each child underwent SS, BS and WBMRI. A blinded first review was performed in consensus by five paediatric radiologists and three nuclear medicine physicians. A second review investigated discrepancies reported between the modalities using a consensus result of all modalities as the reference standard. We calculated the sensitivity, specificity and corresponding 95% confidence interval for each imaging modality (SS, WBMRI and BS) and for the combinations [SS + WBMRI] and [SS + BS]. One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% [95% CI, 82.0-93.1] and 99.7% [95% CI, 99.5-99.8] for the SS, 69.9% [95% CI, 61.7-77.2] and 99.5% [95% CI, 99.2-99.7] for WBMRI and 54.8% [95% CI, 46.4-63.0] and 99.7% [95% CI, 99.5-99.9] for BS. Sensitivity and specificity were, respectively, 95.9% [95% CI, 91.3-98.5] and 99.2% [95% CI, 98.9-99.4] for the combination SS + WBMRI and 95.2% [95% CI, 90.4-98.1] and 99.4% [95% CI, 99.2-99.6] for the combination SS + BS, with no statistically significant difference between them. SS was the most sensitive independent imaging modality; however, the additional combination of either WBMRI or BS examinations offered an increased accuracy. • SS in suspected infant abuse was the most sensitive independent imaging modality in this study, especially for detecting metaphyseal and rib lesions, and remains essential for evaluation. • The combination of either SS + BS or SS + WBMRI provides greater accuracy in diagnosing occult and equivocal bone injuries in the difficult setting of child abuse. • WBMRI is a free-radiation technique that allows additional diagnosis of soft-tissue and visceral injuries.

A randomized control trial of a child abuse mandated reporter training: Knowledge and attitudes

BackgroundDespite being well-positioned to identify maltreatment in the children that they provide care for and being legally required to report suspected child maltreatment, early childhood professionals (ECPs) make a limited proportion of reports to child protective services. It is critical to identify evidence-based interventions to improve the reporting practices of this group of mandated reporters allowing for the better protection of children from maltreatment. ObjectiveThe goal of the present study was to determine if iLookOut, an online child abuse identification and reporting training for ECPs, results in differential gains in knowledge and attitudes towards child abuse and its reporting among ECPs, as compared to an online standard training. Participants and settingBoth interventions were completed online by participants recruited from licensed child care programs in Southern Maine from October 2017 to January 2020. Eligibility criteria included being at least 18 years of age, English-speaking, and working as paid or volunteer staff at a licensed child care program taking care of children 5 years of age or younger. Of the 1152 enrolled individuals, 1094 provided complete pre- and post-intervention data. MethodsA randomized controlled trial comparing iLookOut with an online standard training. ResultsECPs who completed iLookOut significantly outperformed those who completed Standard mandated reporter training in terms of both knowledge (d=1.09 vs. 0.67) and attitudes (d=0.67 vs. 0.54) relative to pre-test scores. ConclusionsiLookOut is a promising candidate for widespread use in meeting the need for evidence-based training on child abuse and its reporting.

Child Abuse and Neglect: Role and Obligation of Pediatric Dentist in India

Background: Child abuse is a form of behavior that involves treating someone (child, under the age of18years) with cruelty or violence resulting in actual or potential harm to the child. It has no boundariesand may occur in any geography, culture, or in any socioeconomic strata. Many studies reveal that there isinadequate knowledge and awareness regarding child abuse recognition and reporting among health workers.Method: Most of the studies reported that trauma to head and facial region occurs in approximately 50%or more of physically abused children. Therefore Pediatric Dentist has major chance of witnessing thephysical abuse in clinical practice. On the same time they are not the authority to make diagnosis of childabuse &amp; neglect, rather identify and report the suspected cases, so that a process for effective protection ofthe victimized children can be initiated. It is the responsibility of the child protection agency/commission toconfirm the crime and do the needful. Hence, the role of pediatric dentist in the identification and reportingof suspected child abuse is crucial. He is expected to practice 4R’s: Recognize, Refer (if any), Record andReportConclusion: Understanding the peculiar role of Pediatric Dentist in recognizing and reporting child abuseand neglect which ultimately contributes towards making better world for children.

Child maltreatment: knowledge, attitudes and reporting behaviour of physicians in teaching hospitals, Egypt.

Lack of diagnosis and reporting of child maltreatment are important problems worldwide. This study aimed to assess the knowledge, attitude and practice of physicians in Alexandria University teaching hospitals about the diagnosis and reporting of child maltreatment cases. A descriptive cross-sectional study was conducted at three hospitals. All physicians working regularly in emergency units were invited to complete a self-administered questionnaire. Data collected included sociodemographic characteristics, knowledge of and formal training on child maltreatment, attitude to dealing with child maltreatment, and experience of child maltreatment cases and reporting behaviour. A total of 90 physicians were included in the study. Only 11% correctly identified all the signs of child maltreatment and 29% correctly answered all questions on the social indicators of maltreatment. Only 41% of the participants had a good knowledge score (≥ 75%) on child maltreatment. Longer work experience (P = 0.019) and older age (P = 0.039) were associated with better knowledge. Of 249 suspected cases of child maltreatment that the physicians reported they had experienced, only 36% were reported. Formal training on child maltreatment (P < 0.001) and older age (P = 0.006) were associated with physicians' reporting behaviour. Over half (56%) of the participants thought their workplaces did not provide them with procedures to follow if they suspected child maltreatment. Physicians' knowledge of the signs and social indicators of child maltreatment was unsatisfactory. Clinical training and education are needed to improve their ability to diagnosis and report cases of child maltreatment.

Evaluation of the abdomen in the setting of suspected child abuse.

Abusive intra-abdominal injuries are less common than other types of injuries, such as fractures and bruises, identified in victims of child physical abuse, but they can be deadly. No single abdominal injury is pathognomonic for abuse, but some types and constellations of intra-abdominal injuries are seen more frequently in abused children. Identification of intra-abdominal injuries can be important clinically or forensically. Injuries that do not significantly change clinical management can still elevate a clinician's level of concern for abuse and thereby influence subsequent decisions affecting child protection efforts. Abusive intra-abdominal injuries can be clinically occult, necessitating screening laboratory evaluations to inform decisions regarding imaging. Once detected, consideration of developmental abilities of the child, type and constellation of injuries, and the forces involved in any provided mechanism of trauma are necessary to inform assessments of plausibility of injury mechanisms and level of concern for abuse. Here we describe the clinical, laboratory and imaging evaluation of the abdomen in the setting of suspected child abuse.

Should teachers be mandated reporters?

Teachers are assigned a multitude of responsibilities they do not want, for which they are poorly suited, and that disrupt their primary roles. One such responsibility is the obligation to serve as mandatory reporters of suspected child abuse and neglect. Joan Goodman reviews the history of this duty, its current parameters, the harmful over-reporting, and its unfortunate consequences for children, teachers, and families. As an alternative to referring suspected abuse cases to authorities, schools could use logarithms for initial screening, involve personnel with more extensive training in identifying potential abuse, or consult a team of in-school personnel to evaluate cases before making referrals.

Do I Report This? Understanding Variation in the Content of State Mandatory Reporting Laws

Since accusations went public that administrators at Pennsylvania State University ignored reports of child abuse during the Jerry Sandusky trial almost a decade ago, several educational and state agencies have reinterpreted aspects of their respective laws requiring certain persons to report suspected child maltreatment (mandatory reporting laws). These reinterpretations were possible due to the ambiguity of statutory language used in the law and, subsequently, may have exposed individuals to a legal responsibility to report to which they were previously unaware. In this study, we use a thematic content analysis to examine variation across state mandatory reporting statutes from all fifty states as of 2016. Three themes emerged from this analysis: definitions for reasonableness, immediacy of danger, and inclusion of mandated reporters. Generally, we found that the vague language and variation in the content of the law, though well intentioned, may contribute to uncertainty in knowing when a report is necessary and who must report it. We conclude with considerations for future research, as well as highlight potential implications for instructors and researchers in higher education. These findings can contribute to our understanding of ambiguity in the law. Further, the sources of variability we identify in this analysis may help to anticipate potential shifts in legal risk in the wake of recent and future reinterpretations of ambiguously worded policy.

Performing High Quality Reports Of Suspected Child Maltreatment By Using An Innovative Toolkit

Performing High Quality Reports Of Suspected Child Maltreatment By Using An Innovative Toolkit

Medical child protection during the coronavirus lockdown

HintergrundEs gibt Anhaltspunkte dafür, dass die Gefahr von Kindesmisshandlung, sexuellem Kindesmissbrauch und Vernachlässigung während der strengen Kontaktbeschränkungen im pandemiebedingten Lockdown zugenommen hat, während der Wegfall der gewohnten Mechanismen zur sozialen Kontrolle mutmaßlich zu einer Zunahme des Dunkelfelds geführt hat.Ziel der ArbeitAnhand der Kinderschutzfallzahlen und -qualitäten deutscher Kinderkliniken und Kinderschutzambulanzen sollen Aussagen über Häufigkeit und Schwere vermuteter Kindeswohlgefährdung während des pandemiebedingten Lockdowns getroffen werden.MethodenIm Mai 2020 erfolgte eine Onlinebefragung mit Items a) zur Beschreibung der Institution, b) zur nach Alter, Gewaltform und Schweregrad differenzierten Anzahl von Kinderschutzfällen in März/April 2019 und 2020 sowie c) zu Besonderheiten und Ideen für den Kinderschutz während der Pandemie.ErgebnisseIn einer Vollerhebung wurden 343 Kinderkliniken und medizinische Kinderschutzambulanzen zur Onlinebefragung eingeladen; die Teilnahmequote lag bei 46 %. Es gaben 81 Einrichtungen Gesamtfallzahlen für März/April 2019 und März/April 2020 an. Bei den Ambulanzen konnte ein Rückgang von 454 auf 387 Fälle (−15 %) verzeichnet werden, bei den Kinderschutzgruppen von 307 auf 246 (−20 %). Hinsichtlich der Altersgruppen und der Formen der Gefährdung fanden sich keine signifikanten Unterschiede.SchlussfolgerungDie Untersuchung beschreibt einen Rückgang der absoluten Fallzahlen im medizinischen Kinderschutz während des Lockdowns im März und im April 2020. Dieses Ergebnis stützt die Vermutung, dass das Dunkelfeld gefährdeter Kinder weiter gestiegen sein könnte. Weitere Datenerhebungen nach dem Lockdown werden die längerfristigen Auswirkungen besser bewerten können.

Decision-Making and Relationship Competence When Reporting Suspected Physical Abuse and Child Neglect: An Objective Structured Clinical Evaluation.

Mandatory reporting of suspected child abuse and neglect highlights the challenges between the ethical and legal obligations of social workers and the need to maintain the therapeutic relationship with the client. The ability to bridge this tension is paramount to ensure continued psychosocial treatment and the well-being of children. This paper discusses a study to determine the decision-making factors of social work students and practitioners when facing a suspicion of child abuse and neglect, how they justify their decision to report or not report to child protection services, and the current and future relationship repair strategies used with simulated clients during an objective structured clinical evaluation (OSCE). Nineteen BSW, MSW, and experienced practitioners (N = 19) underwent an OSCE with one of two child maltreatment vignettes, physical abuse or neglect. Fisher’s exact test was used to examine participants’ historical and current reporting behaviors. Independent samples T-tests, Cohen’s D, and qualitative content analysis was used to examine participants’ decision making and relationship repair strategies when faced with suspected child abuse and neglect. Results showed that six participants discussed the duty to report during the OSCE while 13 participants did not. Participants’ who discussed and did not discuss the duty to report during the OSCE articulated clear reasons for their decision and identified relationship repair strategies in working with the client. A sub-group of participants who identified the child maltreatment but did not discuss the duty to report, provided more tentative and complex reasons for their inaction and next steps in working with the client. All participants demonstrated a degree of competence and critical reflection in the OSCE, with integration for future learning. These findings are discussed and implications for future practice are offered.

Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence. To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic. This cross-sectional study used data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC. Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex. From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P < .001), and opioid ODs (n = 5502 vs 4168, P < .001); counts were significantly lower for IPV ED visits (n = 442 vs 484, P < .001) and SCAN ED visits (n = 884 vs 1038, P < .001). Median rates during the same period were significantly higher in 2020 compared with 2019 for all outcomes except IPV. These findings suggest that ED care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.