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Pattern of hospital referrals of children at risk of maltreatment
Ella Rachamim1, Deborah Hodes, Ruth Gilbert
1Northern Health Centre, Islington PCT, London, UK.
Insights
Hospital clinicians can identify vulnerable children when parents present with issues like violence or mental health problems. A dedicated child protection advisor (CPA) and training improve detection of child maltreatment in acute care settings.
Area of Science:
- Pediatrics
- Child Protection
- Public Health
Background:
- Hospitals, particularly emergency departments (ED), are primary access points for care, especially for vulnerable populations.
- Existing research on child maltreatment detection in hospitals primarily focuses on children with injuries, overlooking cases where parents present with behavioral or mental health issues.
Purpose of the Study:
- To evaluate the impact of a dedicated child protection advisor (CPA) and staff training on the detection of suspected child maltreatment in a hospital setting.
- To assess referral patterns and identify vulnerable children when parents present with issues such as violence, drug abuse, or mental health problems.
Main Methods:
- A consecutive case series design was employed.
- Data were collected over two months following the implementation of staff training and the establishment of an on-site, full-time child protection advisor (CPA).
- Referrals for suspected child maltreatment were analyzed from various hospital departments.
Main Results:
- 44 referrals were made to the CPA within two months.
- Nearly half of the referrals originated from clinicians caring for a parent.
- Referrals came from the ED (15), maternity (14), and neonatal/pediatric wards (15); nurses made most referrals (86%).
Conclusions:
- Clinicians must recognize that vulnerable children are often identified through their parents' presentations.
- The presence of an experienced CPA and child protection training can empower clinicians to identify and address potential child vulnerability in parents with complex issues.
- This approach enhances the detection of child maltreatment in acute care settings.
Background:
Increasingly emergency departments (ED) and other acute services in the hospital provide first access care, especially out of hours and for poorer families. Studies of detection of child maltreatment in the hospital have focused on children presenting with injury, although maltreatment may be suspected when parents present to the hospital with problems related to violent behaviour, drug abuse or mental health problems.
Methods:
A consecutive case series is described of patients referred for suspected child maltreatment from one inner-city general hospital after training was given to clinical staff and 2 years after the creation of a new post comprising a full-time, experienced child protection advisor (CPA) on-site to support clinicians with concerns about child maltreatment.
Results:
There were 44 referrals to the CPA over 2 months in 2005, of whom just under half were initiated by clinicians caring for a parent. 15 referrals came from the ED (five followed a parent presenting to the ED), 14 from maternity obstetric services, and 15 from the neonatal or paediatric wards. Most families (38; 86%) were referred by nurses. One-quarter of referrals were already known to children's social care.
Conclusions:
Clinicians need to be aware that half the vulnerable children in hospital are identified through one or other parent. It is hypothesised that the availability of an experienced child protection advisor on-site, combined with child protection training, makes it possible for clinicians caring for adults with problems related to violence, drug abuse or acute mental illness, to take action to address the potential vulnerability of their children.
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