Children of colour and child protection medical assessments: Improving cultural competency in clinical practice

Objectives Black and ethnic minority populations are known to be over-represented in child maltreatment (CM) statistics in western countries. In Australia, indigenous children are over-represented in CM notifications, but... [ view full abstract ]

Objectives
Black and ethnic minority populations are known to be over-represented in child maltreatment (CM) statistics in western countries. In Australia, indigenous children are over-represented in CM notifications, but little is known about other culturally diverse population groups. Our aims were to describe children from culturally diverse backgrounds presenting for CM medical assessments in South Western Sydney (SWS), a large multicultural urban population. We wanted to determine how culturally competent the assessments were to provide guidelines for culturally competent CM assessments.
Methods
We identified all children <16 years presenting to a community-based clinical service for CM in SWS, between 2013 and 2015. Demographic and clinical data were collected. Simple descriptive analysis was performed; ethnic groups were compared to the epidemiological profile of SWS. Clinical assessments were checked against culturally competent healthcare standards.
Results
Over the three years, 279 children were seen for an acute CM assessment, mean age was 8.1 years; majority (72%) were female, most (73%) presentations were for sexual abuse. A quarter (28%) were Anglo-Australian, 13% were Aboriginal, 13% were middle-eastern, 11% were Pacific Islander (PI) and 8% were Asian background. Aboriginal and PI children were significantly over-represented, Asian children under-represented compared to SWS population. PI and Asian children were significantly more likely to present with physical abuse. Over a quarter of the assessments (28%) where conducted with no accompanying carer; three-quarters (73%) of these were children of colour. Interpreters were not present for 40% of assessments that needed them.
Conclusions
Risk and resilience factors differ between the various ethnic groups in SWS. Children of colour need to be identified and supported using a culturally respectful, child rights promoting framework. We identified strengths and weaknesses in current clinical assessment models, and formulated guidelines for a culturally competent child protection clinical service.