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Paediatric approaches to child maltreatment are subject to wide organisational variations across Europe.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Pediatrisk Inflammationsforskning)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. (Socialmedicin/CHAP)
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2017 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 7, p. 1110-1117Article in journal (Refereed) Published
Abstract [en]

AIM: Little is known about the organisation of child maltreatment practice in Europe. We therefore explored medical child protection systems and training across Europe.

METHODS: An online survey was completed by physicians working in child maltreatment, identified through professional organisations in 28 member countries of the European Union, Iceland, Norway and Switzerland in 2012-2013. Respondents were questioned regarding management of suspected child maltreatment, mandatory reporting, professional training, patient referral and physician roles in multidisciplinary investigations. Responses underwent a narrative synthesis and descriptive enumerations.

RESULTS: The survey was completed by 88 individuals, unevenly distributed in 22 of 31 countries. Physicians were mandated to report child maltreatment in 16 of 22 countries. All of 88 responding physicians described multidisciplinary involvement in the clinical and forensic management of suspected child maltreatment. Practitioners involved in physical examinations included general physicians, paediatricians, forensic medical examiners, gynaecologists and paediatric surgeons. Paediatricians were required to undergo child protection training according to 30 of 86 respondents in 14 of 22 countries.

CONCLUSION: This survey demonstrates that there were wide variations in the organisation of child maltreatment paediatrics in Europe. The differing legislative frameworks and models of care are pertinent to consider when comparing epidemiology of maltreatment reported from across European countries.

Place, publisher, year, edition, pages
2017. Vol. 106, no 7, p. 1110-1117
Keyword [en]
Child death review, Child health services, Child maltreatment, Mandatory reporting
National Category
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-317114DOI: 10.1111/apa.13779ISI: 000405216700024PubMedID: 28176364OAI: oai:DiVA.org:uu-317114DiVA, id: diva2:1080509
Available from: 2017-03-10 Created: 2017-03-10 Last updated: 2018-04-17Bibliographically approved
In thesis
1. Health sector and community response to child maltreatment in Sweden and in a European context
Open this publication in new window or tab >>Health sector and community response to child maltreatment in Sweden and in a European context
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Child maltreatment is a public health problem of global magnitude. This thesis examined different aspects of the multi-sector response to child maltreatment in Sweden and in Europe.

Aims To explore how child physical abuse (CPA) is disclosed and how adolescents perceive adult support when they report physical abuse. To examine how police-reported cases of suspected CPA were associated with criminal investigation procedures and prosecutions. To assess how physicians who care for maltreated children across Europe are organised to recognise and respond to child abuse and neglect. To investigate time trends in rates of childhood deaths in Sweden recorded as due to external, ill-defined and unknown causes, from 2000 to 2014.

Methods We analysed data from a school-based national survey of adolescents, police records of reported suspected CPA in a metropolitan area, a purposeful survey of European child abuse physicians and individual-level data from the Swedish cause of death register. We used quantitative methods to calculate prevalence, descriptive statistics, odds ratios, logistic regression and trends in mortality rates. Qualitative methods included content analysis and narrative synthesis.

Results Only a minority of reported CPA was brought to the attention of professionals and the most prominent barrier to disclosure was lack of trust in adults or authorities. The police-reported cases of suspected CPA were characterised by high severity, but only a small proportion of the 158 alleged child victims were physically examined and only half were forensically interviewed. All 88 responding physicians in 22 European countries described multidisciplinary involvement in the management of suspected child maltreatment, but wide variations in the organisational approaches were revealed. A sustained decline in childhood deaths from external causes during a 15-year period was observed. A sizeable number of infant deaths were recorded each year as ill-defined or with incomplete documentation from clinicians.

Conclusions The results presented in this thesis suggest that the multi-sector response in Sweden and in Europe is insufficiently organised, with no clear mandate for the health sector to robustly combat child maltreatment, and that this may undermine the ability of society to adequately protect children.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 101
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1465
Keyword
Child physical abuse, Cause of death, Child death review, Disclosure, Police report, Child mortality, Register data, Multidisciplinary team
National Category
Medical and Health Sciences Clinical Medicine
Research subject
Pediatrics; Pediatrics
Identifiers
urn:nbn:se:uu:diva-347796 (URN)978-91-513-0342-0 (ISBN)
Public defence
2018-06-07, Gunnelsalen Auditorium, Psychiatry House, Sjukhusvägen 10, Uppsala, 13:15 (English)
Opponent
Supervisors
Funder
The Swedish Crime Victim Compensation and Support Authority
Available from: 2018-05-16 Created: 2018-04-17 Last updated: 2018-05-16

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Otterman, GabrielSarkadi, AnnaJanson, Staffan

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