3 research outputs found
Systematic screening for child abuse at emergency departments
Child abuse is a serious problem and has serious consequences for the victim, his or her environment
and for society itself. It has been estimated that one in every 30 Dutch children is exposed
to child abuse.1 While preventable morbidity and mortality of infectious diseases in childhood
is enormously reduced over the past decades, unfortunately this has not been the case for the
staggering statistics surrounding child abuse.2 Child abuse includes all forms of physical and
emotional maltreatment, sexual abuse and neglect that result in actual or potential harm to the
child’s health, development or dignity.3 Child abuse was already addressed as a public health
problem in the 19th century by a French forensic expert, Ambroise Tardieu (Born in Paris on
March 10, 1818). He was the fi rst physician to acknowledge the appearance of children being
mistreated at the hands of their parents, and described the classical features of almost all forms
of child abuse and neglect. A century later, in 1962, American physicians wrote a landmark article
about child abuse being a pediatric and public health problem, called “The battered childsyndrome”.
This was the starting point for further recognition and awareness of child abuse.
The increasing awareness of child abuse by health care professionals since 1962 is refl ected
in the enormous increase in articles published in the MEDLINE database. In 1963, 12 articles
were categorized under the newly added keyword “child abuse” versus 914 in 2011.7 In 1970 the
Dutch Association Against Child Abuse was founded
Screening for child abuse at emergency departments: a systematic review
Introduction: Child abuse is a serious problem worldwide and can be difficult to detect. Although children who experience the consequences of abuse will probably be treated at an emergency department, detection rates of child abuse at emergency departments remain low. OBJECTIVE: To identify effective interventions applied at emergency departments that significantly increase the detection rate of confirmed cases of child abuse. DESIGN: This review was carried out according to the Cochrane Handbook. Two reviewers individually searched Pubmed, The Cochrane Library, EMBASE, Web of Science, and CINAHL for papers that met the inclusion criteria. RESULTS: Fifteen papers describing interventions were selected and reviewed; four of these were finally included and assessed for quality. In these studies the intervention consisted of a checklist of indicators of risk for child abuse. After implementation, the rate of detected cases of suspected child abuse increased by 180% (weighted mean in 3 studies). The number of confirmed cases of child abuse, reported in two out of four studies, showed no significant increase. CONCLUSIONS: Interventions at emergency departments to increase the detection rate of cases of confirmed child abuse are scarce in the literature. Past study numbers and methodology have been inadequate to show conclusive evidence on effectiveness
Facilitators and barriers to screening for child abuse in the emergency department
Background: To identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts.Methods: This qualitative study is based on semi-structured interviews with 27 professionals from seven Dutch hospitals (i.e. seven pediatricians, two surgeons, six ED nurses, six ED managers and six hospital Board members). The resulting list of facilitators/barriers was subsequently discussed with five experts in child abuse and one implementation expert. The results are ordered using the Child Abuse Framework of the Dutch Health Care Inspectorate that legally requires screening for child abuse.Results: Lack of knowledge of child abuse, communication with parents in the case of suspected abuse, and lack of time for development of policy and cases are barriers for ED staff to screen for child abuse. For Board members, lack of means and time, and a high turnover of ED staff are impediments to improving their child abuse policy. Screening can be promoted by training ED staff to better recognize child abuse, improving communication skills, appointing an attendant specifically for child abuse, explicit support of the screening policy by management, and by national implementation of an approved protocol and validated screening instrument.Conclusions: ED staff are motivated to work according to the Dutch Health Care Inspectorate requirements but experiences many barriers, particularly communication with parents of children suspected of being abused. Introduction of a national child abuse protocol can improve screening on child abuse at EDs