Improving the clinical assessment of acute presentations of child maltreatment using a quality and child rights framework

Background and aims: Child maltreatment (CM) is a major public health problem globally; maltreated children are more likely to be hospitalised and utilise health services. There is strong evidence-base for medical examination... [ view full abstract ]

Background and aims:
Child maltreatment (CM) is a major public health problem globally; maltreated children are more likely to be hospitalised and utilise health services. There is strong evidence-base for medical examination in the assessment of CM. South Western Sydney (SWS) has a large metropolitan population with many vulnerable sub-groups. There is little known about the health and social outcomes for children following acute CM assessments. We aimed to describe acute presentations of CM in SWS over a two year period, identify health and social outcomes for children following medical assessment and determine if the assessments fulfilled established minimum standards for clinical assessment of CM and were sensitive to child rights.

Methods
We gathered available data from the acute child protection database and hospital records, on all children <16 years referred for assessment between 2013 and 2014. We performed simple descriptive analysis on the data. We measured the assessment, report writing and follow-up against established criteria for minimum standards for acute assessments and a child rights framework.

Findings
In the time period, 187 children were seen for acute assessment. Mean age was 8.1 years, most (75%) were female; 148 (79%) referrals were for sexual abuse, the rest were for physical abuse and neglect. A minority (15%) were referred by doctors; most were referred by child protection services. Thirty-seven (20%) cases were found to be not suspicious for maltreatment; the rest had medical findings and health concerns. Most assessments were multi-disciplinary and used protocols; half were not followed-up, a third were performed after-hours. A quarter had no carer present during the assessment.

Conclusions
Comprehensive clinical assessments of CM are useful in identifying children’s other health and developmental concerns. Our audit provides valuable information on acute CM presentations in urban Sydney and identifies strengths and weaknesses in current assessment processes.