The identification and reporting of physical abuse by physicians: A review and implications for research

Warner, Jody E.; Hansen, David J.

doi:10.1016/0145-2134(94)90092-2

Cited by 70 publications

(31 citation statements)

References 32 publications

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“…8 Both practically and conceptually, significant problems arise from this lack of direction: inconsistent reporting of (possible) abuse, unequal protection of children, inequitable treatment of parents, inefficient use of child protection service resources, [9][10][11][12][13] and substantial ambiguity about the nature and meaning of the threshold in judging whether to report. 14,15 These difficulties, in turn, are compounded by (1) the multitude of individuals who qualify as mandated reporters, (2) lack of education regarding what circumstances warrant reporting, 11,16,17 (3) absence of meaningful oversight concerning actual reporting practices, [18][19][20] and (4) reporters' immunity from civil or criminal liability. 8,[21][22][23][24] Of course, multiple factors give rise to the variability in how mandated reporters understand, interpret, and apply their responsibility to report suspected child abuse, including the circumstances of individual cases, perceived efficacy of child protection services, perceptions of blame, and personal experience with abuse.…”

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confidence: 99%

“…8,[21][22][23][24] Of course, multiple factors give rise to the variability in how mandated reporters understand, interpret, and apply their responsibility to report suspected child abuse, including the circumstances of individual cases, perceived efficacy of child protection services, perceptions of blame, and personal experience with abuse. 9,10,17,20,[25][26][27][28] However, despite considerable investigation examining such causes of inconsistency, little research has examined possible confusion over what "suspicion" and "reasonable suspicion" mean. These concepts are fundamentally important, because they define the threshold for determining whether a report is warranted and hence form the basis for reporting practices.…”

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Reasonable Suspicion: A Study of Pennsylvania Pediatricians Regarding Child Abuse

Levi¹,

Brown

2005

Pediatrics

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ABSTRACT.Objective. It has long been assumed that mandated reporting statutes regarding child abuse are self-explanatory and that broad consensus exists as to the meaning and proper application of reasonable suspicion. However, no systematic investigation has examined how mandated reporters interpret and apply the concept of reasonable suspicion. The purpose of this study was to identify Pennsylvania pediatricians' understanding and interpretation of reasonable suspicion in the context of mandated reporting of suspected child abuse.Methodology. An anonymous survey was sent (Spring 2004) to all members of the Pennsylvania chapter of the American Academy of Pediatrics (n ‫؍‬ 2051). Participants were given several operational frameworks to elicit their understanding of the concept of reasonable suspicion, 2 of which are reported here. Respondents were asked to imagine that they had examined a child for an injury that may have been caused by abuse and that they had gathered as much information as they felt was possible. They then were asked to quantify (in 2 different ways) the degree of likelihood needed for suspicion of child abuse to rise to the level of reasonable suspicion.The physicians were asked to identify (using a differential-diagnosis framework) how high on a rank-order list "abuse" would have to be for it to rise to the level of reasonable suspicion (ie, first on the list, second, third, and so on, down to tenth). The second framework, estimated probability, used a visual analog scale of 0% to 100% to determine how likely suspected abuse would have to be for physicians for them to feel that they had reasonable suspicion. That is, would they need to feel that there was a 99% likelihood that abuse occurred before they felt that they had reasonable suspicion, a 1% likelihood, or something in between?In addition to standard demographic features, respondents were queried regarding their education on child abuse, education on reasonable suspicion, frequency of reporting child abuse, and (self-reported) expertise regarding child abuse. The main outcome measures were physician responses on the 2 scales for interpreting reasonable suspicion.Results. Pediatricians (n ‫؍‬ 1249) completed the survey (61% response rate). Their mean age was 43 years; 55% were female; and 78% were white. Seventy-six percent were board certified, and 65% reported being in primary care. There were no remarkable differences in responses based on age, gender, expertise with child abuse, frequency of reporting child abuse, or practice type. The responses of pediatric residents were indistinguishable from experienced physicians, and the responses of primary care pediatricians were no different from pediatric subspecialists.Wide variation was found in the thresholds that pediatricians set for what constituted reasonable suspicion. On the differential-diagnosis scale (DDS), 12% of pediatricians responded that abuse would have to rank first or second on the DDS before the possibility rose to the level of reasonable suspicion, 41% indicated a r...

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Reasonable Suspicion: A Study of Pennsylvania Pediatricians Regarding Child Abuse

Levi¹,

Brown

2005

Pediatrics

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“…O tipo e a intensidade da gravidade são fatores importantes para a notificação do caso. 4,10 No entanto, não havia diferença significativa nos tipos (dados não apresentados) de maus-tratos identificados entre os pediatras que notificaram e àqueles que não notificaram, supondo-se, portanto, que a incidência de casos graves foi semelhante nos dois grupos. Fora isso, questões culturais, tais como crença religiosa e outras, as quais poderiam estar influenciando atitudes profissionais, não foram avaliadas.…”

Section: Discussionunclassified

“…3,4 Dentre os vários fatores que interferem na não notificação de maus-tratos infantis, pelo médico, citamse: o tipo e o grau de gravidade dos maus-tratos, o conhecimento insuficiente sobre os procedimentos de notificação, a deficiência de estruturas de atendimento, influências culturais, experiências prévias, desconfiança nos serviços de proteção à criança, medo de serem processados e envolvimento emocional com a família da criança vítima. [5][6] Nesses estudos notou-se que o pediatra teria uma propensão a subavaliar a gravidade dos maus-tratos quando comparado com outros trabalhadores da saúde, notificando-os com menor freqüência.…”

Section: Introductionunclassified

Barreiras, para a notificação pelo pediatra, de maus-tratos infantis

Pires

Goldani

Vieira

et al. 2005

Rev. Bras. Saude Mater. Infant.

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Objectives: to determine factors interfering with the reporting of child abuse by pediatricians to children protection services.Methods: cross sectional observation study. A random sample of pediatricians from Porto Alegre was selected among the 990 registered in the local pediatrician's society. Social and demographic variables, professional background, knowledge concerning child abuse were obtained through the application of anonymous questionnaires. Descriptive and multivariate analyses were utilized to determine factors associated to the failure in reporting.Results: ninety seven pediatricians were selected and 92 agreed to participate of the study. Of these, 80 (86.9%) identified some case of child abuse, and 63 (78.7%) reported at least one case. The majority of pediatricians admitted fear of legal involvement, demonstrated adequate knowledge of the issue and low confidence in child protection entities. Insufficient knowledge (OR = 3.94), working exclusively in the private sector (OR = 6.33) were the factors associated to the failure in reporting. Following adjustments, insufficient knowledge was significantly associated to result OR = 5.06 (95%CI = 1.45 -17.59).Conclusions: a high rate of identification and reporting of child abuse through pediatricians was determined. Continuous education programs, improvement of protection services, professional support to the private sector could increase child abuse identification and reporting.Key words Child abuse, Domestic violence, Mandatory reporting ResumoObjetivos: determinar os fatores que interferem na notificação de maus-tratos infantis, pelos pediatras, aos serviços de proteção à criança.Métodos: estudo observacional transversal. Uma amostra aleatória de pediatras de Porto Alegre foi selecionada entre 990 inscritos na sociedade de pediatria local. Variáveis sócio-demográficas, formação profissional, conhecimento diante de casos de maustratos infantis foram obtidos através de questionário anônimo. Análises descritiva e multivariada foram utilizadas para determinar os fatores associados a não notificação.Resultados: foram incluídos 97 pediatras dos quais 92 concordaram em participar do estudo. Oitenta identificaram casos de maus-tratos, e destes 63 notificaram ao menos um caso. A maioria revelou medo de envolver-se legalmente, apresentou nível suficiente de conhecimento e baixo grau de confiança nos órgãos de proteção à criança. Conhecimento insuficiente (OR = 3,94), trabalhar exclusivamente no setor privado (OR = 6,33) foram fatores associados a não notificação. Após ajustes, o conhecimento insuficiente foi significativamente associado com o resultado OR = 5,06 (IC95% = 1,45 -17,59).Conclusões: verificou-se uma alta taxa de identificação e notificação, pelo pediatra, de maus-tratos infantis. Programas de educação continuada, melhoria dos serviços de proteção, suporte técnico profissional para o setor privado podem aumentar a taxa de identificação e notificação de maus-tratos.Palavras-chave Maus-tratos infantis, Violência doméstica, Notificação de abu...

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“…There are no indicators relating to the severity or pattern of injury: for example, slap 'No indicators relating to the severity or pattern of injury' marks on the face; cigarette burns; the presence of a fracture or head injury in a non-ambulant child; rib fractures, or spiral or metaphyseal fractures, all of which have a high specificity for abuse Speight, 1997;Kornberg, 1992, pp. 151-162;Warner and Hansen, 1994;Worlock et al, 1986;Tzioumi and Oates, 1998).…”

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confidence: 98%

Red skies, risk factors and early indicators

Sidebotham¹

2003

Child Abuse Review

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The identification and reporting of physical abuse by physicians: A review and implications for research

Cited by 70 publications

References 32 publications

Reasonable Suspicion: A Study of Pennsylvania Pediatricians Regarding Child Abuse

Reasonable Suspicion: A Study of Pennsylvania Pediatricians Regarding Child Abuse

Barreiras, para a notificação pelo pediatra, de maus-tratos infantis

Red skies, risk factors and early indicators

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