Child Maltreatment, An Issue of Pediatric Clinics

Howard Dubowitz

Description

Pediatric primary care provides a unique opportunity to tackle child abuse and neglect. In the United States in particular, primary care is a well-established system, and most children have multiple visits, especially in the first few years. There is typically a very good relationship between parents and health professionals, who are respected experts on children. The interested pediatrician, thus, has a remarkable entrée into the workings of a family, its shortcomings, and its strengths. With some knowledge and skill, pediatricians can play a pivotal role, even in a few strategic minutes. We know, however, that some professionals feel very uncomfortable becoming involved in this unpleasant area and may be deterred from taking any action. Understandable as this may be, it can jeopardize a child’s health and safety. Hopefully, this issue of Pediatric Clinics of North America will help make this work a bit easier, albeit not easy. With training and support, pediatricians can equip themselves to be competent and more comfortable addressing child maltreatment. Aside from the possible forensic implications, the heart of this work is primarily about helping families take adequate or good care of their children. Indeed, helping address child abuse and neglect also helps promote children’s health, development, and safety, and it is central to the rich mandate of Pediatrics.

Sujets

• Médecine
• Médecine Générale
• Medical
• Pediatrics

Informations

• Publié par: Elsevier
• Date de parution: 22 novembre 2014
• Nombre de lectures: 0
• EAN13: 9780323326254
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

Clinics Review Articles Pediatric Clinics of North America
Child Maltreatment

Dr. Howard Dubowitz, MD, MS
Pediatrics, University of Maryland, Baltimore, MD, USA

Dr. John M. Leventhal, MD
Yale Medical School, Child Abuse Programs, Yale-New Haven Children's Hospital, New Haven, CT, USA
ISSN  0031-3955 Volume 61 • Number 5 • October 2014
Table of Contents
Cover image
Title page
CME Accreditation Page
Target Audience
Learning Objectives
Accreditation
Disclosure of Conflicts of Interest
Unapproved/Off-Label Use Disclosure
To Enroll
Method of Participation
CME Inquiries/Special Needs
Contributors
Forthcoming Issues
Foreword: Child Maltreatment and Prevention
Preface: Addressing Child Maltreatment: Helping Those on the Frontlines
The Pediatrician and Child Maltreatment
Key points
Importance of the first few years
Toxic stress
A broad view of maltreatment
Development of the field of pediatrics
Beyond the biomedical model
Protective factors
The potential of primary care
Practical pointers for practice
Summary
Prevention of Child Maltreatment
Key points
The role of pediatric health care providers in child maltreatment prevention
Screening for maltreatment risk factors and identification of families at risk
Prevention programs rooted in models of anticipatory guidance
Community-based prevention programs
Prevention of sexual abuse
Advocacy
Bringing Back the Social History
Key points
Why the social history matters
The ill effects of maltreatment can last a lifetime
Child maltreatment prevention begins with primary care
Goals of the social history
Key psychosocial risk factors that increase the risk of toxic stress and child maltreatment
Psychosocial risk factors
Summary
Appendix 1 Safe environment for every kid parent questionnaire
Engaging Families Through Motivational Interviewing
Key points
Introduction
Extent of the problem: health care provider–centered approach
Sequelae of the problem: increasing barriers to change
Preparing for MI
Effectiveness of MI
Clinical assessment
Approach
When to use MI
Summary
Sentinel Injuries
Key points
Introduction/characterize the issue/problem
Extent of the problem
Causes/contributory or risk factors
Sequelae of the problem
Clinical assessment
Approach/management
Neglect: Failure to Thrive and Obesity
Key points
Introduction
Defining age-appropriate growth
Prevalence
Etiology
Sequelae
Clinical assessment and approach
The role of neglect
Prevention
More than Words
Key points
Introduction
What is emotional maltreatment?
How emotional maltreatment affects children
The lingering effects of emotional maltreatment
Prevalence
Risk factors
Identification/intervention
Prevention
Summary
Corporal Punishment
Key points
Introduction
Extent of CP
Sequelae of spanking and hitting
Clinical assessment
Addressing corporal punishment
Summary
The Conversation
Key points
Introduction
Taking the history from parents and caregivers when abuse is suspected
The art of asking
Listen before talking
Don’t answer your own questions
Wait for an answer
Retain (benign) neutrality
Talking to children: special considerations
Three pitfalls
Understanding the medical provider’s role
Cognitive Errors
Key points
Cognitive processes: an overview
Cognitive errors and child maltreatment
Countering errors in thinking
Summary
Cultural Considerations and Child Maltreatment
Key points
Background: culture and cultural competency
Culture’s influences
Global variability
Universal principles in child maltreatment
A stepwise approach for the primary care provider
Culture and protective factors against child maltreatment
Summary
Has This Child Been Abused?
Key points
Introduction
Defining uncertainty
Approach to uncertainty in physical abuse cases
Approach to uncertainty in sexual abuse cases
The impact of uncertainty on safety
Summary
Working with Child Protective Services and Law Enforcement
Key points
Introduction
What happens when you report child abuse
Problems physicians face when child abuse is suspected
Challenges to working with community resources
Suggested approaches to working with community resources
Summary
Legal Issues in Child Maltreatment
Key points
Introduction
Mandated reporting
Expert witness testimony
Informed consent in child maltreatment
Liability
Summary
Foster Care and Healing from Complex Childhood Trauma
Key points
Introduction: Foster care and trauma
Extent of the problem: Overview of foster care
Etiology: Toxic stress and complex trauma
Sequelae of the problem: How trauma impacts the health of children in foster care
Clinical assessment: Pediatric care of the traumatized child in foster care
Approach/management: Trauma-informed care
Outcomes: Resilience and stability
Summary
Advocacy Opportunities for Pediatricians Caring for Maltreated Children
Key points
Introduction
Scope of the problem and why advocacy by pediatricians remains essential
Advocacy within a medical setting
Physical abuse
Sexual abuse
Neglect
Reporting cases of suspected child maltreatment
Working collaboratively with nonmedical professionals
Courtroom testimony
Education
Advocating for youth in foster care
Advocacy opportunities related to the development of policy and legislation
Vicarious trauma and the development of resiliency
Summary
Index
CME Accreditation Page


Program Objective
The goal of the Pediatric Clinics of North America is to keep practicing physicians and residents up to date with current clinical practice in pediatrics by providing timely articles reviewing the state-of-the-art in patient care.

Target Audience
All practicing pediatricians, physicians and healthcare professionals who provide patient care to pediatric patients.

Learning Objectives
Upon completion of this activity, participants will be able to:

1.  Discuss child abuse prevention.
2.  Recognize advocacy opportunities for pediatricians caring for maltreated children.
3.  Review what to expect when working with child protective services and law enforcement.

Accreditation
The Elsevier Office of Continuing Medical Education (EOCME) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The EOCME designates this enduring material for a maximum of 15 AMA PRA Category 1 Credit (s ) ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other health care professionals requesting continuing education credit for this enduring material will be issued a certificate of participation.

Disclosure of Conflicts of Interest
The EOCME assesses conflict of interest with its instructors, faculty, planners, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by EOCME for fair balance, scientific objectivity, and patient care recommendations. EOCME is committed to providing its learners with CME activities that promote improvements or quality in healthcare and not a specific proprietary business or a commercial interest.
The planning committee, staff, authors and editors listed below have identified no financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interest related to the content of this CME activity:
Carol Berkowitz, MD; Andrew M. Campbell, BS; James E. Crawford-Jakubiak, MD, FAAP; Howard Dubowitz, MD; Heather C. Forkey, MD; Nancy S. Harper, MD, FAAP; Roberta Hibbard, MD; Kerry Holland; Brynne Hunter; Kim Kaczor, MS; Nancy D. Kellogg, MD; Gauri Kolhatkar, MD, MPH, FAAP; Indu Kumari; Wendy G. Lane, MD, MPH; Antoinette L. Laskey, MD, MPH; Sandy Lavery; John Mischel Leventhal, MD; Jill McNair; John D. Melville, MD; Rebecca Moles, MD; Lindsay Parnell; Hillary W. Petska, MD; Mary Clyde Pierce, MD; Lynn K. Sheets, MD; Bonita F. Stanton, MD; John Stirling, MD; Moira Szylagi, MD, PhD; Richard Thompson, PhD; Adrienne A. Williams, PhD; Katherine S. Wright, MA; Adam J. Zolotor, MD, DrPH MD, DrPH.
The planning committee, staff, authors and editors listed below have identified financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interest related to the content of this CME activity:
Andrea Asnes, MD, MSW is a paid consultant and child welfare expert to law enforcement, child welfare defense and patient attorneys.
Sandeep K. Narang, MD is a consultant/advisor in child maltreatment cases.

Unapproved/Off-Label Use Disclosure
The EOCME requires CME faculty to disclose to the participants:

1.  When products or procedures being discussed are off-label, unlabelled, experimental, and/or investigational (not US Food and Drug Administration (FDA) approved); and
2.  Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinions. Faculty may discuss information about pharmaceutical agents that is outside of FDA-approved labelling. This information is intended solely for CME and is not intended to promote off-label use of these medications. If you have any questions, contact the medical affairs department of the manufacturer for the most recent prescribing information.

To Enroll
To enroll in the Pediatric Clinics of North America Continuing Medical Education program, call customer service at 1-800-654-2452 or sign up online at http://www.theclinics.com/home/cme . The CME program is available to subscribers for an additional annual fee of USD 290.

Method of Participation
In order to claim credit, particip