Translating Child Abuse Research Into Action

Abstract

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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