Telling their stories: primary care practitioners’ experience evaluating and reporting injuries caused by child abuse

Flaherty, Emalee G.; Jones, R.; Sege, Robert

doi:10.1016/j.chiabu.2004.03.013

Cited by 86 publications

(76 citation statements)

References 5 publications

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“…Suspicion of child maltreatment is comparatively rare in most settings. 6 CPS procedures and staff change frequently. An enormous amount of ongoing training would be required, and its benefit would be limited.…”

Section: Trainingmentioning

confidence: 99%

Understanding Roles and Improving Reporting and Response Relationships Across Professional Boundaries

Goad

2008

Pediatrics

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Child abuse is underreported. The author, a child protective service professional with extensive field and management experience, provides his perspective on some of the barriers that inhibit an effective response to reporting and collaboration between the professionals evaluating and investigating possible child abuse. Then presented are his ideas for improving the collaboration, including recommendations for changes in training, child protective service procedures, child protective service staffing, confidentiality requirements, and the adoption of a Child Advocacy Center (CAC) model. Pediatrics 2008;122:S6–S9

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Section: Trainingmentioning

confidence: 99%

Understanding Roles and Improving Reporting and Response Relationships Across Professional Boundaries

Goad

2008

Pediatrics

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“…8 In addition, health care providers often complained that they had not received feedback from CPS about the results and disposition of their investigation. 4,9 The providers indicated that the lack of CPS feedback might make them less likely to report suspected abuse in the future. 9 Mandated reporters from all professions have described how inadequate law enforcement investigations, ill-prepared prosecution efforts, and inappropriate legal decisions leave children exposed and vulnerable to further maltreatment.…”

Section: Understanding Roles and Improving Reporting And Response Relmentioning

confidence: 99%

“…Previously, clinicians had expressed distrust about the effectiveness of CPS intervention. 4,5,9 In general, clinicians perceive that CPS fails to protect significant numbers of children from further abuse, and they lack confidence that CPS activation will improve patient outcomes. Because the clinicians also reported that they frequently do not receive feedback from CPS, 4,9 they may assume that CPS has not intervened simply because they have received no feedback.…”

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confidence: 99%

Translating Child Abuse Research Into Action

2008

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The Child Abuse Recognition Experience Study revealed that primary care clinicians did not always follow the legal mandate to report suspected child abuse to child protective services. National child abuse experts representing different disciplines met in a 2-day conference in January 2007 to discuss and develop new strategies that would address the barriers to reporting suspected child abuse and improve the protection of children. This article describes the rationale, structure, and goals of the conference. Pediatrics 2008;122:S1-S5 B ETWEEN 1963 AND 1967, all 50 states passed laws mandating that suspected child abuse be reported. 1 Although significant strides have been made in the identification and protection of children since that time, child abuse continues to affect the lives of many children and families. The mortality and morbidity rates seem unchanged. Each year ϳ1500 children die as a result of maltreatment, and many more suffer serious, permanent physical and emotional trauma. Sometimes the diagnosis of child abuse is delayed because child abuse is not recognized. Jenny et al 2 found that approximately one third of children with abusive head trauma had been seen by a physician before their diagnosis because of symptoms caused by their head trauma, and the opportunity to intervene and prevent further abuse had been missed. These children had been evaluated by a physician for signs and symptoms related to their abuse an average of 2.8 times (range: 2-9) and an average of 7 days (range: 0 -189 days) before the diagnosis of maltreatment was made.Sometimes physicians recognize that a child may have been abused and do not report the suspected abuse to child protective services (CPS). In a number of retrospective studies that researched physician response to suspected abuse, physicians have said that they do not report all suspected abuse. [3][4][5][6] Physicians in these studies provided a variety of reasons for not reporting. Lack of certainty that the child had been abused and a previous negative experience with reporting were the 2 most common reasons for not reporting.The Child Abuse Recognition Experience Study (CARES) demonstrated the extent to which clinicians do not report suspected abuse. 7 CARES was a national study conducted through the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) Network and the National Medical Association Pediatric Research Network (NMAPedsNet). The study prospectively examined primary care clinician decision-making around 15 003 childhood injuries they cared for in the office. The participants indicated their level of suspicion that an injury was caused by child abuse on a 5-point Likert scale and whether they reported the child to CPS.CARES participants reported only 24% of injuries that they indicated were possibly caused by abuse. 7 They seemed to need to consider that the child's injury was likely or very likely to have been caused by abuse before reporting to their state's CPS. Even when they were quite suspicious of abuse, c...

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“…That this sentiment is shared by pediatricians is supported by the Child Abuse Recognition Experience Study research. 27,28 Although it is acknowledged that child welfare systems across the country face great challenges in meeting their mandate, most physicians are unaware of the successes that are made by child protective services every day. Physician participation in the interdisciplinary process of child protection would underscore the difficulty of the work and lead to improved decision-making by child protection workers and law enforcement personnel.…”

Section: Future Stepsmentioning

confidence: 99%

Professional Education in Child Abuse and Neglect

Christian

2008

Pediatrics

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Physicians have reported feeling that they were not adequately trained to identify and report child abuse. This article reviews the current state of medical education and residency training and the needs of physicians in practice and proposes changes and additions that can be made to improve the ability and confidence of physicians who are faced with the responsibility of keeping children safe. Pediatrics 2008;122:S13-S17 A MONG OUR MANY responsibilities, physicians are sentinels for child maltreatment. Federal and state laws mandate us to report suspected cases of abuse and neglect for investigation, and our ethical mandate is to use our skills to promote the health, safety, and well-being of our patients. Yet, despite our best intentions, the data suggest that many physicians are unable to fulfill the mandate to protect children from abuse and neglect. 1,2 Physician inability to identify abused children and resistance to reporting suspected abuse is explained by many considerations, as noted in the Child Abuse Recognition Experience Study (CARES). 1,2 One of the more important contributors to physicians' discomfort with the management of child and family violence is their lack of education and training about the problem. In all specialties in medicine, clinical competence is based in both knowledge and experience. If the aim of medical education is to improve practice, rather than simply knowledge, appropriate education must ensure that physicians are capable of identifying child abuse, addressing the concern with families, reporting suspicions to the proper authorities, assisting investigators with interpretation of medical information, managing medical consequences of both physical and psychological trauma, advocating for their patients, and working with families affected by child maltreatment. It is a lot to learn, and the evidence published to date suggests that we have not done our job sufficiently. 1,2 MEDICAL STUDENT EDUCATION Accreditation of US medical schools is obtained through the Liaison Committee on Medical Education (LCME). Accreditation by the LCME is required for medical schools to receive federal grants for education, and the majority of state licensing boards require US medical schools to be accredited by the LCME. The LCME publishes accreditation standards that address the structure of medical education for all students. Clinical education is required for all organ systems and must include ambulatory experience. In the most recent revision of the accreditation standards, the LCME states, "The curriculum must prepare students for their role in addressing the medical consequences of common societal problems, for example, providing instruction in the diagnosis, prevention, appropriate reporting, and treatment of violence and abuse." 3 Although the standards for medical education explicitly include a requirement for education in social issues such as child abuse, the responsibility for curriculum development rests with medical school faculty and is not specifically dictated by accrediti...

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Telling their stories: primary care practitioners’ experience evaluating and reporting injuries caused by child abuse

Cited by 86 publications

References 5 publications

Understanding Roles and Improving Reporting and Response Relationships Across Professional Boundaries

Understanding Roles and Improving Reporting and Response Relationships Across Professional Boundaries

Translating Child Abuse Research Into Action

Professional Education in Child Abuse and Neglect

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