Follow-up of suspected child maltreatment cases treated at a tertiary child protection service facility

The victim's physical and emotional safety are foremost priorities in the clinical care of suspected child maltreatment (CM). The WHO recommends follow-ups, but we lack standardized procedures. This study examined case characteristics in relation to outcomes and follow-up (FU) feasibility at the Forensic Examination Center for Children and Adolescents (FOrensische Kinder- und JugendUntersuchungsStelle, FOKUS), Austria's first tertiary healthcare service offering regular FUs of CM cases. Suspected CM cases presented to FOKUS between July 2015 and June 2017 were retrospectively analyzed regarding one-year FU outcomes. FU feasibility, timing of FU, and reasons for delay or no FU were investigated. Two groups (FU vs. no FU) were compared. In the FU group, cases discharged from FOKUS services after the initial FU visit were compared with those remaining under FOKUS care regarding child protection (federal child protection service involvement, reports to law enforcement), safety procedures (new CM incidents, new injuries/findings/observations, contact with suspected perpetrator), and therapeutic interventions. Associations between case characteristics (age, gender, FU length, suspected CM type, perpetrator) and the groups were analyzed using logistic regression models. Of 219 cases, FU was feasible in 64%. Inaccessibility of families was the main reason for no FU. Followed patients were younger and perpetrators were more often parents (OR = 2.08, 95% CI 1.10-3.99). Suspected sexual abuse cases and those with new CM incidents were less frequently discharged (OR = 0.31, 95% CI 0.10-0.85 and OR = 0.18, 95% CI 0.05-0.66).

CM case characteristics permit personalized, structured FU planning and scheduling to improve safety and continuity of care.

• The WHO recommends regular follow-up (FU) of suspected child maltreatment cases to ensure patient safety and prevent further harm, but standardized procedures are lacking. • In Austria, hospital-based child protection teams are legally required, yet systematic FUs and structured safety monitoring are rarely implemented nor legally required.

• This first CM follow-up study from Austria's tertiary child protection service (FOKUS) shows that FU was feasible in 64% of cases. • The results suggest that case characteristics influence the success of FU. Structured, individualized FU and sufficient resources are essential to enhance patient safety and long-term protection.