- freely available
Soc. Sci. 2014, 3(4), 771-784; https://doi.org/10.3390/socsci3040771
|Facility 1||Total paediatric ED attendance||Injury presentations n (%) **||Injury admissions n (%) **||ED Injury with CM concerns n (%) **||Clinician estimate of PAN||Audit of Paediatric ED presentations|
|A||12,989||3012 (23)||202 (2)||125 (1)||8–12/ month||Yes|
|B||11,477||2538 (22)||389 (3)||118 (1)||30/year to 30/month||No|
|C||8112||1926 (24)||117 (1)||65 (1)||24–52/year||No|
|D||7850||1892 (24)||109 (1)||56 (1)||10–50/year||No|
|E||7431||993 (13)||51 (1)||19 (0)||60–70/year||Yes|
|F||6957||1521(22)||85 (1)||37 (1)||12–50/year||No|
|G||4141||1528 (37)||1 *||27 (1)||6–24/year||Yes|
|H||4052||1373 (34)||77 (2)||32 (1)||4–12/year||No|
|I||1691||790 (47)||12 (1)||18 (1)||Minimal||Yes|
|Facility 1||Medical||Nursing||Social work|
|A||1 Paediatric, 1 ED||1 ED, 1 Paediatric||1 Paediatric|
|B||1 Paediatric, 1 ED||1 ED, 1 Paediatric||1 Paediatric|
|C||1 Paediatric, 1 ED||1 Paediatric||1 Paediatric, 1 ED|
|D||1 ED||1 ED, 1 Paediatric||1 ED|
|E||1 Paediatric||1 ED||1 Paediatric|
|F||2 Paediatric||1 Paediatric||1 paediatric|
|G||1 ED||1 ED||1 ED|
|H||1 Paediatric||1 ED, 1 Paediatric||1 Paediatric|
|I||1 ED||1 ED||1 ED|
3.1. What is the Clinical Burden of Child Physical Abuse/Neglect in This Region?
3.2. How are Child Physical Abuse/Neglect Assessments Conducted?
|Facility 1||In Hours||Social Worker Involved|
|A||Paediatric Registrar 2 supported by paediatrician||Rarely|
|B||Paediatric Registrar + paediatric SW * + Community paediatrician||Always|
|C||Paediatric Registrar or junior doctor ± Paediatrician support||Rarely|
|D||ED Doctor + Paediatric Registrar with ED Consultant Support ± SW ± RN **||Rarely|
|E||Paediatric registrar or junior doctor||Always|
|F||Paediatric registrar supported by paediatrician||Sometimes|
|H||ED doctors or Paediatric junior or Paediatrician||Rarely|
|I||ED registrar + RN ** + SW * supported by ED Consultant||Rarely|
|Facility 1||Medical Report||Follow-up (proportion)||Who follows up||CP Policy used|
|A||Yes||Yes (75%)||Orthopaedic, Ambulatory Paediatrics, Paediatrician||No (Doctors)|
|B||Yes||Yes (100%)||Paediatrician, or child at risk clinic||Yes, not used clinically|
|C||No||Yes (100%)||Paediatrician, ED clinic||Yes, not used clinically|
|D||No||Yes (don’t know)||Paediatrician, CPU, CS||No|
|E||No||No||CS||Yes and helpful clinically|
|F||No||Yes (>50%)||Local paediatricians, CS||Aware, not used clinically|
|G||No||Yes (if transferred)||All transferred to hospital A||Not aware|
|H||No||Yes (most)||Paediatrician or GP||Aware of policy not used clinically|
|I||No||Yes (75%)||Hospital elsewhere||Aware, not used|
3.3. What Child Protection Training Does Your Staff Get?
3.4. What is Working Well?
- Team approach: Multidisciplinary teams with social worker involvement often had staff with a “passion” for child advocacy. Particular local teams with good working cultures were identified and commended on their collaborative working relationship.
- Availability of protocol and policy: Clinicians, who knew about the existing child protection policy, were able to find it and use it when required. Being able to locate the policy online was particularly useful.
- Positive working relationship between health and statutory services: Some teams had established relationships with their local CS, this facilitated ease of reporting CM concerns and improved referral pathways between CS and hospitals.
- Good communication channels: These were reported in certain facilities or teams and included internal and external pathways. Teams with a culture of consultation with senior staff were acknowledged. For child protection managers, being able to consult a paediatrician and having a key contact person at each site to facilitate the referral process was a major bonus.
3.5. What are the Gaps in Systems Currently?
- Inadequate awareness, recognition and follow-up of CM among frontline clinicians: Social workers were more likely to point out that there was inadequate awareness and recognition of CM in the acute setting. While responses for whether some form of follow-up was provided varied (Table 3), most hospitals had inadequate psychosocial staff, i.e., social workers to provide appropriate follow-up for children identified as at risk.
- Children with CM concerns not prioritised in EDs: This was a frustration not just for child protection caseworkers but also for social workers. Caseworkers felt that children should not have to wait for a medical assessment, given their traumatic experiences.
- Poor communication between hospitals and CS: Busy clinicians, particularly doctors and nurses, pointed to poor information provided to clinicians by caseworkers, lack of feedback, and case coordination provided by CS.
- Workforce issues: Lack of trained and qualified staff was a significant issue, particularly social workers in some hospitals and medical staff with paediatric experience. Workforce constraints contributed to the lack of multi-disciplinary assessments carried out. Limited after-hours availability of access to social work, radiology and paediatric expertise was a concern in the smaller district hospitals.
- Marked variability in quality: This was highlighted not just by child protection managers but also by clinicians. There were variations across hospital sites of quality of PAN assessments, timeliness and quality of medical reports.
- All paediatric injuries/poisoning presenting to ED are triaged using Paediatric Injury Sticker or equivalent 1
- All children presenting with suspected significant PA/N or referred by CS, are assessed by a paediatric trained doctor, social worker, ± nurse as appropriate
- All clinical assessments to follow PA/N clinical protocol 2
- Assessments to be discussed with most senior Consultant
- If child protection report is to be generated, it needs to be counter-signed by Consultant
- Child Protection Medical Report to follow standard format 3
- Clinical photography if needed to be organised via the hospital audio-visual service
- PA/N protocol and report to be filed in the medical record
- Clearly defined pathway in existence between child protection services and frontline health services in the region for children presenting with PA/N
- Paediatric and psychosocial follow-up to be available to all children identified with abuse and neglect, across the region
- All frontline clinical staff (i.e., doctors, nurses and social workers) working in ED and Paediatric Departments have completed core child protection training
- Clinically oriented child protection training to be scheduled annually in continuing education programs in all ED and Paediatric Departments across the region
- Notes: 1 The existing paediatric injury/poisoning risk assessment sticker has been incorporated into an online risk assessment tool in ED; 2 The Suspected Child Abuse and Neglect (SCAN) clinical protocol is available on the intranet across the region; 3 A template for the Child Protection Medical Report is available on the intranet across the region; ED: Emergency Department; PA/N: physical abuse and/or neglect; CS: Community Services, the State child protection service.
physical abuse and/or neglect
Conflicts of Interest
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