Paediatric approaches to child maltreatment are subject to wide organisational variations across Europe

Otterman, Gabriel; Jalsenius, Marie; Maguire, Sabine; Sarkadi, Anna; Janson, Staffan

doi:10.1111/apa.13779

Cited by 14 publications

(17 citation statements)

References 17 publications

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“…This could reflect the wide variations in the organisation of child maltreatment paediatrics in Europe as described by Otterman et al . (). The authors stress the importance of considering the differing legislative frameworks and models of care across Europe when comparing epidemiology in child maltreatment.…”

Section: Discussionmentioning

confidence: 97%

“…Otterman et al . () suggest that only a small minority of represented countries in Europe have established systematic requirements for the education of physicians on child maltreatment. Others have shown the positive impact of subject‐specific training (Herbst et al ., ) and specialisation (Furth et al ., ) on clinical decision‐making and subsequent management.…”

Section: Discussionmentioning

confidence: 99%

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Variability in Child Protection Medical Evaluations of Suspected Physical Abuse in Four European Countries: A Vignette Study

et al. 2018

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When suspicions of physical abuse arise, children are referred for a child protection medical evaluation, which occurs in a variety of health settings by a variety of clinicians. This comparative vignette survey was performed among a cross‐section of medical professionals engaged in child protection in Sweden, Ireland, the UK and the Netherlands between April and July 2016. Three vignettes describing different probabilities of physical abuse were included. Components of child protection medical evaluations across the four countries were analysed. A total of 236 physicians responded (113 UK, 49 the Netherlands, 39 Sweden, 35 Ireland). Of these, 62 per cent were female (there were more females in the UK, Sweden and the Netherlands). More variation in practice than similarities was found. Similarities: experience level, confidence level and management approach (vignettes 1 and 3). Cross‐country differences: decision to investigate, adherence to national guidelines, experience versus specialism and subsequent management post‐assessment. These findings suggest the need for further exploration of practice between countries including specific and regular training, availability of support for non‐specialists and use of national and international clinical guidelines to promote best practice and reduce variation. More consideration of the human and financial cost to the healthcare system of unnecessary investigations and the length of hospital admission may be warranted. Key Practitioner Messages There is a lack of uniformity in the clinical management of physical abuse between these four European countries. Specific and regular training included in professional development plans and discussed at appraisal will promote clinician confidence in assessments. Expert support should be easily available to non‐specialists undertaking these assessments. National and local clinical guidelines are important tools in promoting best practice and reducing variation across and within countries.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Variability in Child Protection Medical Evaluations of Suspected Physical Abuse in Four European Countries: A Vignette Study

et al. 2018

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“…Teamwork in child abuse diagnostics in itself is not a novel development. In many countries, the hospitals have some form of a hospital-based multidisciplinary team, and these have proven their value over time 9–12. Besides these hospital-based teams, many countries, as well as The Netherlands, have initiated regional or citywide rape and sexual abuse counselling centres, where in many cases specially trained sexual assault nurse examiners and/or child abuse paediatricians work 13–15.…”

Section: Discussionmentioning

confidence: 99%

Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years

et al. 2019

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ObjectiveCombined paediatric and forensic medical expertise to interpret physical findings is not available in Dutch healthcare facilities. The Dutch Expertise Centre for Child Abuse (DECCA) was founded in the conviction that this combination is essential in assessing potential physical child abuse. DECCA is a collaboration between the three paediatric hospitals and the Netherlands Forensic Institute. DECCA works with Bayes’ theorem and uses likelihood ratios in their conclusions.DesignWe present the implementation process of DECCA and cross-sectional data of the first 4 years.ParticipantsBetween 14 December 2014 and 31 December 2018, a total of 761 advisory requests were referred, all of which were included in this study. An advisee evaluation over the year 2015 was performed using a self-constructed survey to gain insight in the first experiences with DECCA.Results761 cases were included, 381 (50.1%) boys and 361 (47.4%) girls (19 cases (2.5%) sex undisclosed). Median age was 1.5 years (range 1 day to 20 years). Paediatricians (53.1%) and child safeguarding doctors (21.9%) most frequently contacted DECCA. The two most common reasons for referral were presence of injury/skin lesions (n=592) and clinical history inconsistent with findings (n=145). The most common injuries were bruises (264) and non-skull fractures (166). Outcome of DECCA evaluation was almost certainly no or improbable child abuse in 35.7%; child abuse likely or almost certain in 24.3%, and unclear in 12%. The advisee evaluations (response rate 50%) showed that 93% experienced added value and that 100% were (very) satisfied with the advice.ConclusionData show growing interest in the expertise of DECCA through the years. DECCA seems to be a valuable addition to Dutch child protection, since advisee value the service and outcome of DECCA evaluations. In almost half of the cases, DECCA concluded that child abuse could not be substantiated.

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“…A survey completed by physicians working with maltreated children in 22 European countries showed that there were wide variations in how the units dealing with this trauma were organised . The authors, Otterman et al., suggest that European children would probably benefit from a more unified organisational framework that includes standardised training for physicians.…”

Section: Paediatric Approaches To Child Maltreatment Vary Across Europementioning

confidence: 99%

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Acta Paediatrica

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Paediatric approaches to child maltreatment are subject to wide organisational variations across Europe

Cited by 14 publications

References 17 publications

Variability in Child Protection Medical Evaluations of Suspected Physical Abuse in Four European Countries: A Vignette Study

Variability in Child Protection Medical Evaluations of Suspected Physical Abuse in Four European Countries: A Vignette Study

Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years

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