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Minimum criteria for reporting child abuse from health care settings
J E Paradise1, J Bass, S D Forman
1Department of Pediatrics, Boston City Hospital, Boston University School of Medicine, Massachusetts, USA.
Insights
Hospital clinicians reported 88% of suspected child abuse and neglect cases, exceeding the national average. Specific criteria effectively assessed compliance with child abuse reporting laws, aiding in child protection efforts.
Area of Science:
- Medical Ethics
- Child Protection
- Healthcare Compliance
Background:
- Child abuse and neglect reporting by healthcare professionals is a critical component of child protection.
- Assessing clinician compliance with reporting laws is essential for ensuring child safety.
- Previous estimates suggest a significant underreporting of child abuse cases by hospital personnel nationwide.
Purpose of the Study:
- To evaluate the consistency of child abuse and neglect reporting by clinicians in two hospitals.
- To determine the utility of specific, operational criteria in assessing clinicians' compliance with reporting laws.
- To compare the reporting rate at the studied hospitals with national estimates.
Main Methods:
- Audited medical records of 85 children reported to child protective services (CPS) by hospital clinicians.
- Identified previously unreported suspected abuse episodes using developed criteria.
- Assessed the utility of these criteria by comparing reported child abuse cases against them.
Main Results:
- Clinicians at the studied hospitals reported 88% of documented suspected abuse episodes to CPS.
- This rate is higher than the estimated national average of 69% underreporting.
- Developed criteria identified 28 previously unreported suspected abuse episodes, demonstrating their utility in assessing compliance.
Conclusions:
- Hospital clinicians in the study demonstrated a high compliance rate with child abuse and neglect reporting laws.
- Specific, operational criteria are valuable tools for assessing hospital clinicians' adherence to reporting obligations.
- Improved assessment tools can enhance the effectiveness of child protection systems.
Abstract:
We evaluated how consistently clinicians of two hospitals reported child abuse and neglect, and the utility of specific, operational criteria for assessing hospital clinicians' compliance with the child abuse reporting laws. To evaluate clinicians' compliance, we audited the medical records of 85 children who had been reported to a child protective service (CPS) agency by clinicians at either of two hospitals and who had been seen at that hospital at least once before the index report of abuse. The time elapsed from first hospital visit to index abuse report among the 85 children averaged 4.3 years. In the children's records, we identified 28 earlier reports to the CPS agency and four episodes that met criteria we developed but that had not been reported. Thus, application of specific criteria resulted in the finding that 28 (88 percent) of 32 suspected abuse episodes were actually reported to the CPS agency (95 percent confidence interval: 76 to 99 percent). In a second phase of the study, we compared the content of 45 reported episodes of child abuse (4) index reports and four earlier reports) to the criteria in order to evaluate their utility. Thirty-five episodes (78 percent) met one of the criteria. Review of the remaining 10 episodes led to the development of one new criterion. We conclude that, although it has been estimated that hospital personnel nationwide report to CPS agencies only 69 percent of the child abuse cases they identify, clinicians at the hospitals we studied reported 88 percent of documented episodes of suspected abuse. We also conclude that specific, operational criteria can help in the assessment of hospital clinicians' compliance with their obligation to report child abuse and neglect.