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Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years
Rick Robert van Rijn1,2, Marjo J Affourtit3, Wouter A Karst2
1Radiology, Emma Children's hospital, Academic Medical Center, Amsterdam, The Netherlands r.r.vanrijn@amc.uva.nl.
Insights
The Dutch Expertise Centre for Child Abuse (DECCA) provides essential combined paediatric and forensic expertise for child abuse assessments. Their evaluations offer valuable insights, with nearly half of cases finding no substantiated child abuse.
Area of Science:
- Forensic Medicine
- Paediatrics
- Child Protection
Background:
- Combined paediatric and forensic medical expertise is crucial for assessing physical child abuse.
- This specialized expertise was previously unavailable in Dutch healthcare facilities.
- The Dutch Expertise Centre for Child Abuse (DECCA) was established to address this gap.
Purpose of the Study:
- To present the implementation process of DECCA.
- To share cross-sectional data from DECCA's first four years of operation.
- To evaluate the added value and satisfaction with DECCA's services.
Main Methods:
- DECCA utilizes Bayes' theorem and likelihood ratios for assessments.
- A total of 761 advisory requests were analyzed from December 2014 to December 2018.
- Advisee evaluations were conducted using surveys to gauge user experience.
Main Results:
- 761 cases were included, with the most common referrals related to injuries and inconsistent clinical histories.
- Bruises and non-skull fractures were the most frequent injuries observed.
- DECCA evaluations concluded "almost certainly no or improbable child abuse" in 35.7% of cases and "child abuse likely or almost certain" in 24.3%.
Conclusions:
- DECCA demonstrates a growing demand for its specialized expertise.
- The centre is a valuable asset to Dutch child protection services, with high user satisfaction.
- DECCA's assessments found that child abuse could not be substantiated in nearly half of the evaluated cases.
Objective:
Combined paediatric and forensic medical expertise to interpret physical findings is not available in Dutch healthcare facilities. The Dutch Expertise Centre for Child Abuse (DECCA) was founded in the conviction that this combination is essential in assessing potential physical child abuse. DECCA is a collaboration between the three paediatric hospitals and the Netherlands Forensic Institute. DECCA works with Bayes' theorem and uses likelihood ratios in their conclusions.
Design:
We present the implementation process of DECCA and cross-sectional data of the first 4 years.
Participants:
Between 14 December 2014 and 31 December 2018, a total of 761 advisory requests were referred, all of which were included in this study. An advisee evaluation over the year 2015 was performed using a self-constructed survey to gain insight in the first experiences with DECCA.
Results:
761 cases were included, 381 (50.1%) boys and 361 (47.4%) girls (19 cases (2.5%) sex undisclosed). Median age was 1.5 years (range 1 day to 20 years). Paediatricians (53.1%) and child safeguarding doctors (21.9%) most frequently contacted DECCA. The two most common reasons for referral were presence of injury/skin lesions (n=592) and clinical history inconsistent with findings (n=145). The most common injuries were bruises (264) and non-skull fractures (166). Outcome of DECCA evaluation was almost certainly no or improbable child abuse in 35.7%; child abuse likely or almost certain in 24.3%, and unclear in 12%. The advisee evaluations (response rate 50%) showed that 93% experienced added value and that 100% were (very) satisfied with the advice.
Conclusion:
Data show growing interest in the expertise of DECCA through the years. DECCA seems to be a valuable addition to Dutch child protection, since advisee value the service and outcome of DECCA evaluations. In almost half of the cases, DECCA concluded that child abuse could not be substantiated.
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