How Should Clinicians and Health Care Organizations Promote Equity in Child Abuse and Neglect Suspicion, Evaluation, and Reporting?

Victims of child abuse and neglect come from every racial, ethnic, and socioeconomic background, yet clinical evaluation, reporting to child protective services, and responses to reports inequitably harm Black children and malign families of color. Racial bias and inequity in suspicion, reporting, and substantiation of abuse and neglect and in services offered and delivered, foster care placement, and criminal prosecution are widely documented. In response, clinicians and health care organizations should promote equity by educating clinicians about racial bias, standardizing evaluation using clinical decision support tools, and working with policy makers to support prevention services.

Social determinants of health, personalized medicine, and child maltreatment.

This review begins with a brief summary of the importance of child maltreatment as a major public health problem, given its prevalence and the substantial human and economic costs involved. The focus then shifts to consideration of personalized medicine and child maltreatment, including genetic and genomics factors, as well as the role of social determinants of health. Research on epigenetics related to child abuse and neglect is presented, followed by that pertaining to a few specific social factors, such as poverty, parental depression and substance use, and domestic (or intimate partner) violence.

Cost effectiveness of SEEK: A primary care-based child maltreatment prevention model.

Background: Funding for prevention interventions is often quite limited. Cost-related assessments are important to best allocate prevention funds.

Objectives: To determine the (1) overall cost for implementing the Safe Environment for Every Kid (SEEK) model, (2) cost of implementation per child, and (3) cost per case of maltreatment averted.

Psychosocial Factors Associated with Healthy and Unhealthy Interpregnancy Intervals.

To examine the influence of psychosocial factors, including anxiety, depression, social support, maternal substance abuse, and intimate partner violence (IPV) on interpregnancy intervals (IPIs). B'more for Healthy Babies-Upton/Druid Heights is part of a citywide initiative to improve the health of at-risk pregnant women and their children. Participants with at least one prior birth completed baseline, postpartum, and 3-month follow-up surveys with questions about pregnancy, medical, and psychosocial history.

Communities, Social Justice, and Academic Health Centers.

In November 2015, the Association of American Medical Colleges (AAMC) held its annual meeting in Baltimore, Maryland. In response both to health and health care inequities faced by residents of Baltimore and to the imminent trial of the police officers charged with Freddie Gray's death, AAMC leaders thought it crucial to address issues of health inequity, social injustice, and the role an academic health center (AHC) can play in improving the health of the community it serves. In collaboration with community-engaged researchers from Johns Hopkins University and University of Maryland, Baltimore, AAMC staff interviewed Baltimore residents, soliciting their perspectives on how medical education, clinical care, and research can and should respond to social injustice and the social determinants of health.

The effects of health care-based violence intervention programs on injury recidivism and costs: A systematic review.

Background: Youth violence affects thousands annually, with homicide being the third leading cause of death for those aged 10 to 24 years. This systematic review aims to evaluate the published evidence for the effects of health care-based violence intervention programs (VIPs), which focus on reducing recurrent presentations for injury due to youth violence ("recidivism").

Methods: Health literature databases were searched.

Examination of the Comorbidity of Mental Illness and Somatic Conditions in Hospitalized Children in the United States Using the Kids' Inpatient Database, 2009.

Objective: To examine the associations between mental and physical illness in hospitalized children.

Methods: The data for this analysis came from the 2009 Kids' Inpatient Database (KID). Any child with an International Classification of Diseases, Ninth Revision code indicative of depressive, anxiety, or bipolar disorders or a diagnosis of sickle cell disease, diabetes mellitus type 1 or 2, asthma, or attention-deficit/hyperactivity disorder (ADHD) were included.

Prevention of child maltreatment.

Pediatricians and other health care providers can play several important roles in the prevention of child maltreatment. This article aims to help pediatricians incorporate child abuse prevention into their practice. Resources for systematizing anticipatory guidance and screening for risk factors in child maltreatment are described.

The Effectiveness of Food Insecurity Screening in Pediatric Primary Care.

Background: Food insecure children are at increased risk for medical and developmental problems. Effective screening and intervention are needed.

Methods: Our purpose was to (1) evaluate the validity and stability of a single item food insecurity (FI) screen.

Transforming the healthcare response to intimate partner violence and taking best practices to scale.

Background: Intimate partner violence (IPV) is prevalent among adolescent and adult women, with significant physical, sexual, and mental health consequences. In 2011, the Institute of Medicine's Clinical Preventive Services for Women consensus report recommended universal screening for violence as a component of women's preventive services; this policy has been adopted by the Health Resources and Services Administration (HRSA). These policy developments require that effective clinic-based interventions be identified, easily implemented, and taken to scale.

The SEEK model of pediatric primary care: can child maltreatment be prevented in a low-risk population?

Objective: To examine the effectiveness of the Safe Environment for Every Kid (SEEK) model of enhanced pediatric primary care to help reduce child maltreatment in a relatively low-risk population.

Methods: A total of 18 pediatric practices were assigned to intervention or control groups, and 1119 mothers of children ages 0 to 5 years were recruited to help evaluate SEEK by completing assessments initially and after 6 and 12 months. Children's medical records and Child Protective Services data were reviewed.

Epidemiology of abusive abdominal trauma hospitalizations in United States children.

Objectives: (1) To estimate the incidence of abusive abdominal trauma (AAT) hospitalizations among US children age 0-9 years. (2) To identify demographic characteristics of children at highest risk for AAT.

Design: Secondary data analysis of a cross-sectional, national hospitalization database.

Outcomes for children hospitalized with abusive versus noninflicted abdominal trauma.

Background: Abusive abdominal trauma (AAT) is the second leading cause of child abuse mortality. Previous outcome studies have been limited to data from trauma centers.

Objectives: The goals of this study were (1) to examine mortality, length of hospitalization, and hospital charges among a national sample of children hospitalized for AAT; and (2) to compare these outcomes with children with noninflicted abdominal trauma.

The safe environment for every kid model: impact on pediatric primary care professionals.

Objective: To examine whether the Safe Environment for Every Kid (SEEK) model of enhanced primary care would improve the attitudes, knowledge, comfort, competence, and behavior of child health care professionals (HPs) regarding addressing major risk factors for child maltreatment (CM).

Methods: In a cluster randomized controlled trial, 18 private practices were assigned to intervention (SEEK) or control groups. SEEK HPs received training on CM risk factors (eg, maternal depression).

Screening for occult abdominal trauma in children with suspected physical abuse.

Objectives: The goals were (1) to determine the prevalence of occult abdominal trauma (OAT) in a sample of children with suspected physical abuse, (2) to assess the frequency of OAT screening, and (3) to assess factors associated with screening.

Methods: Charts of children evaluated for abusive injury were identified through a search of hospital discharge codes. Identified charts were reviewed to determine whether OAT screening occurred.

Primary care pediatricians' experience, comfort and competence in the evaluation and management of child maltreatment: do we need child abuse experts?

Objective: We assessed the self-reported experience, comfort and competence of primary care pediatricians in evaluating and managing child maltreatment (CM), in rendering opinions regarding the likelihood of CM, and in providing court testimony. We examined pediatricians' need for expert consultation when evaluating possible maltreatment.

Methods: A questionnaire was mailed to 520 randomly selected AAP members.

Update on child abuse prevention.

Purpose Of Review: Child abuse remains a significant problem in the United States with 2.9 million reports and 825 000 indicated cases in 2005. This report will highlight recent efforts toward child abuse prevention, focusing on home visiting programs, abusive head trauma primary prevention, parent training programs, sexual abuse prevention, and the effectiveness of laws banning corporal punishment.

Screening for parental substance abuse in pediatric primary care.

Objective: Parental alcohol and drug abuse may have significant deleterious effects on children. Although screening in the pediatric office is recommended, few screening measures have been evaluated for use in this setting. We sought to validate a 2-question screening tool for parental substance abuse.

What factors affect the identification and reporting of child abuse-related fractures?

Child abuse is a serious problem in the United States. Because orthopaedic surgeons are responsible for identifying and reporting suspicious fractures to child protective services, we asked two primary questions: (1) How skilled are orthopaedists in distinguishing abuse-related from noninflicted fractures and making appropriate child protective services reports?; and (2) Are decisions influenced by orthopaedist training or by the race or socioeconomic status of injured children? We developed and mailed a questionnaire containing 10 case vignettes to 974 US orthopaedists. Respondents assessed the likelihood of abuse and need to report to child protective services.

Disparities in the circumstances of asthma deaths in Maryland.

The reasons for significant disparities in asthma mortality are unclear. Maryland vital statistics and medical examiner data were used to examine timing, location, and circumstances of asthma deaths. We found that unexplained deaths increased substantially over the past 10 years and that young, male, and black asthmatics were more likely to die before hospital admission.

Child sexual abuse evaluations: adherence to recommendations.

Sixty-eight parents of children with alleged child sexual abuse (CSA) were surveyed 4 months after visiting an interdisciplinary CSA evaluation clinic in order to examine the extent to which recommendations were recalled and implemented. Of those parents for whom specific recommendations were provided, 9% recalled recommendations for medical follow-up, 79% recalled recommendations for child therapy, and 43% recalled recommendations for parental therapy. Families were more likely to receive and adhere to recommendations when there were behavioral problems and a strong indication of CSA.

Racial differences in the evaluation of pediatric fractures for physical abuse.

Context: Child maltreatment is a significant problem within US society, and minority children have higher rates of substantiated maltreatment than do white children. However, it is unclear whether minority children are abused more frequently than whites or whether their cases are more likely to be reported.

Objectives: To determine whether there are racial differences in the evaluation and Child Protective Services (CPS) reporting of young children hospitalized for fractures.