The contribution of a hospital child protection team in determining suspected child abuse and neglect: Analysis of referrals of children aged 0–9

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Abstract

Background

Hospital professionals have a unique opportunity to identify victims of child abuse and neglect (CAN). The hospital multi-disciplinary Child Protection Team (CPT) offers a means for optimizing procedures, maximizing caution and enhancing decision-making.

Objective

The current study describes cases of children aged 0–9 years referred to the CPT, to identify the contribution of the CPT to the assessment process in determining reasonable suspicion of child abuse or neglect.

Methods

The files of all 990 cases of children aged 0–9 referred to the CPT from 1991 thru 2006 were abstracted.

Results

Nearly equal rates of boys and girls were referred to the CPT, and the average age was 2.4 years (SD 2.6), with over two-thirds aged 0–2. Half of the cases arrived at the hospital due to accident or trauma, and nearly one-third due to illness. Eighty-five neonates were referred due to parental risk factors identified at birth. The most common reasons prompting referral to the CPT were medical indication and parent behavior, with parents most often the suspected source of danger. Over half of the cases (566) were reported to authorities. Nearly half of those reported were cases of suspected physical neglect, 21.5% were suspected of physical abuse, and 7.6% of sexual abuse. There were significant differences in the patterns of reporting and types of suspicion both for the various age groups (p < 0.001) and the genders (p < 0.001), as well as by age-gender groups (shown in the first figure).

Conclusions

The current findings illuminate the various factors and steps involved in the hospital CPT's assessment of preliminary suspicions of CAN raised by front-line clinicians. It is recommended that standardized criteria be developed based on current state-of-knowledge.

Introduction

In Israel, as elsewhere, the issue of child abuse and neglect (CAN) has attracted increased attention, evident in the 120% rise from 1995 to 2006 in the number of cases treated by Child Protection Services (CPS) (National Council for the Child [NCC], 2007, Wallace et al., 2007). Hospital professionals have a unique opportunity to identify victims of CAN (Kang & Poertner, 2006, Mckinney et al., 2004). However, child maltreatment poses diagnostic and therapeutic challenges, since a truthful history may not be provided and typically no single finding or diagnostic test definitively confirms or rules out the possibility of CAN (Flaherty et al., 2004, Wallace et al., 2007).

The hospital multi-disciplinary Child Protection Team (CPT) offers a means for optimizing procedures, maximizing caution, enhancing decision-making and educating team members regarding CAN (Drury-Hudson, 1999, Lindberg et al., 2008, Wallace et al., 2007). The efficacy of this approach has led to broad implementation of such teams in the USA, Europe and Israel (Chen et al., 2008, Drury-Hudson, 1999, Wallace et al., 2007). According to Israeli Ministry of Health 1991 guidelines, the Edmond & Lily Safra Children’s Hospital CPT, comprising a social worker, nurse, pediatrician and psychiatrist, was established to conduct preliminary investigations of suspected child abuse and neglect (SCAN) by addressing physical, behavioral and psychosocial parameters. This assessment is based on the immediately available information, and according to its findings the CPT determines whether there is reasonable basis for suspicion. If so, the Child Protection Officer (CPO) and/or police are notified for further investigation; if not, the case is ‘closed’. Since its establishment, over 1600 children have been referred to Safra's CPT, and approximately two-thirds of these were reported to authorities.

The purpose of the current study is to describe the cases of children aged 0–9 years referred to Safra's CPT, to identify the contribution of the CPT to the assessment process in determining reasonable suspicion of child abuse or neglect, and ultimately for improving hospital assessment procedures in cases of SCAN.

Section snippets

Subjects

The Study Group included all 990 cases of children aged 0–9 years, referred to Safra Children's Hospital CPT from 1991 thru 2006.

Procedure

The files of all Study Group cases were abstracted to a pre-constructed form including: socio-demographic factors, aspects of the hospitalization and referral to the CPT, and CPT decision. Reliability of data was checked by having a random sample of 10% of the files abstracted by two reviewers; only variables with an ≥ 80% rate of agreement are presented. Data entry was

Discussion

This study describes characteristics of suspected child abuse and neglect (SCAN) cases and characteristics of hospital procedures regarding 990 referrals of children from birth to 9 years of age, at Safra Children's Hospital's CPT, from 1991 through 2006. There was a preponderance of referrals to the CPT of children under 3 years was found, of which nearly 40% were under one year of age. This confirms the important role that medical personnel play in detecting infants and young children at risk.

Conclusion

The current findings illuminate the various factors and steps involved in the hospital CPT's assessment of preliminary suspicions of CAN raised by front-line clinicians. Through multi-faceted assessment, the CPT either substantiates suspicions or rules them out, and by so-doing raises the confidence level regarding cases ultimately reported to the authorities. This is essential for preventing erroneous reports, which could unjustifiably expose children and families to the scrutiny and

Conflict of interest

There is no conflict of interest among any of the authors with any aspect of this research.

Acknowledgements

The authors wish to express their appreciation to Ms. Valentina Boyko for her valuable contribution to the statistical analysis, and to Ms. Esther Pollak for her administrative assistance.

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