Association of child abuse and neglect training with filing reports of concern to child welfare services: a cross-sectional study.

BACKGROUND: The aptitude, knowledge, and competence of dental health personnel on child abuse and neglect (CAN) is not optimal for deciding when to file a report of concern to child welfare services (CWS). OBJECTIVES: The aim of this study was, firstly, to assess the association of the public dental health personnel 's (PDHP) training on CAN received in the last three work years, i.e., in 2016 through 2018 with filing reports to the CWS in the same period and secondly to assess the association of expressed need of training on CAN with filing reports to the CWS. METHODS: This cross-sectional study uses data from an electronic survey census of PDHP from Norway (n = 1791) conducted in 2019. The Pearson chi-square test, non-parametric tests, logistic, and negative binomial regression were used for unadjusted and adjusted analysis. Data was reported with proportions, odds ratios (OR), incidence rate ratios and 95% confidence intervals (CIs). RESULTS: From 2016 to 2018, the prevalence estimate of filing reports to CWS was 50%, with a mean (standard deviation) of 1.39 (2.11) reports sent. The logistic regression analysis showed an association between filing reports of concern and CAN training in the last three years. Compared to those that had not received CAN training during the three previous years, the ORs (95% CI) for filing reports to the CWS during the same period was 2.5 (1.6-4.0) for one day CAN work training, 3.2 (2.0-5.1) for 2-4 days CAN training and 4.9 (2.6-9.4) for five or more days CAN training. Compared to workers who did not need training in reporting (routines of CAN), those who expressed the need for a little more and more training were less likely to file a report. The corresponding OR were 0.6 (0.4-0.9) and 0.6 (0.3-0.9), respectively. CONCLUSION: CAN training during the last three years is associated with filing reports of concern to CWS in the same period among PDHP in Norway. The likelihood of filing CAN reports increased with the number of days of CAN training received. Secondly, the PDHP with an expressed need for training on CAN routines were less likely to report suspicions to CWS.

COMMENTARY: Navigating the conundrum of mandatory reporting under the POCSO Act: Implications for medical professionals.

To address the under reporting of sexual offences against children, the Protection of Children from Sexual Offences (POCSO) Act, 2012, makes reporting of such offences mandatory. The duty to report such offences has been extended to healthcare professionals. The inclusion of healthcare professionals within mandatory reporting, however, strikes at the very foundation of the doctor- patient relationship based on trust and confidentiality and conflicts with the patient confidentiality safeguards of the Mental Healthcare Act, 2017. It also has unintended public health consequences, such as denial of medical termination of pregnancy due to fear of prosecution under POCSO. An urgent reassessment of these mandatory reporting norms for healthcare professionals, and a solution-based approach that harmonises societal interest in the reporting of sexual crimes with the child's right to health is essential.

[Mandatory Reporting as the Basis of Epidemiological Statistics: The Impact of the Reporting Practice and Usage of Paper Technologies on the Informative Content of Morbidity Statistics 1886-1921]. / Die Meldepflicht als Grundlage der epidemiologischen Statistik: Die Auswirkungen der Meldepraxis und der Verwendung von paper technologies auf den Informationsgehalt von Morbiditätsstatistiken 1886­1921.

This article examines the impact of the reporting practice and paper technologies like forms on reports that were later used for national morbidity statistics by studying the Swiss reporting system for infectious diseases between 1886 and 1921. Analysing the production processes of notifications shows the difficulties and solutions in the implementation of the statutory reporting process. Two disease outbreaks-a smallpox outbreak in Schaffhausen and a typhoid outbreak in the canton of Lucerne-serve as case studies. It is shown that reports are not only objective representations of diseases, but also symbolize the medico-social interactions that produce them, timed by administrative tools like reporting forms and the act of reporting. This destabilises historical statistics and illustrates the complexity of the historical source material, as these interactions and their impact on reporting must be considered. These findings are further supported by examining the Swiss reporting system during the Spanish flu of 1918 and its failure to record influenza cases.

Reporting Requirements, Confidentiality, and Legal Immunity for Physicians Who Report Medically Impaired Drivers.

Importance: Physicians play an important role in assessing patients' ability to drive. There is a dearth of peer-reviewed information on policies regarding physician reporting of medically impaired drivers. Objective: To investigate state reporting requirements and the availability of confidentiality and legal immunity for physicians who report medically impaired drivers. Design, Setting, and Participants: This cross-sectional study was conducted from November 1 to 30, 2022, in 3 rounds. First, all 50 US states' Department of Motor Vehicle (DMV) websites were systematically reviewed. Second, DMV staff from each state were surveyed via telephone. Third, each state's legal codes for driver licensing were reviewed. Main Outcomes and Measures: Outcome measures included the percentage of states with mandatory and voluntary reporting policies, reporting instructions on DMV websites, anonymous reporting options, and legal immunity for reporting physicians, in addition to characteristics of states' mandatory reporting policies (ie, types of medical conditions that require reporting) and policies surrounding the confidentiality of reports. The data were analyzed using descriptive statistics. Results: One-third of state DMV websites (17 [34%]) lacked instructions regarding physician reporting. Six states had mandatory reporting requirements; 4 of these states only required reporting of conditions characterized by lapses of consciousness. Only 3 states (6%) accepted anonymous reports, and 7 states (14%) deemed physician reports of medically impaired drivers confidential without exception. Nearly one-third of states (15 [30%]) deemed reports by physicians confidential, with the exception that reported drivers could find out who reported them if they asked for a copy of the reporting form. Most states (37 [74%]) had statutes that protected physicians from liability related to reporting medically impaired drivers. Conclusions and Relevance: This cross-sectional study of state reporting requirements regarding medically impaired drivers found many differences in state policies regarding mandatory reporting and the conditions that require reporting. There was also limited availability of online reporting instructions, anonymous reporting options, and legal protections for reporting physicians.

Does a child maltreatment report source predict differences in immediate and subsequent report outcomes?

BACKGROUND: Mandated reporting policies, a core response to the identification of child maltreatment, are widely debated. Currently, there are calls to abolish or scale back these policies to include only certain professionals. These calls warrant evaluation of whether there are any differences in child welfare outcomes based on report source. OBJECTIVE: To determine if the initial report source predicts immediate and long-term risk of re-referral, substantiation, and placement. PARTICIPANTS AND SETTING: We used yearly National Child Abuse and Neglect Data System (NCANDS) hotline report and placement data. Children (0-14y) with a first ever hotline report in 2012-2014 were followed for three years. The final sample included 2,101,397 children from 32 states. METHODS: We use descriptive and bivariate statistics to show initial report outcomes by reporter source type and logistic regression models to evaluate the effect of report source on immediate and subsequent report outcomes. RESULTS: Professional sources varied in levels of substantiation and placement, with law enforcement, medical, and social service sources showing much higher rates. Reports from professional sources have higher odds of initial report substantiation and foster care entry, and slightly lower odds of later re-report than nonprofessional sources. We found no differences between professional and nonprofessional sources in subsequent foster care entry. CONCLUSIONS: Reports from professional, nonprofessional, and unclassified sources have varying levels of risk in some of their short- and long-term outcomes. To the degree that child protective services embrace a long-term preventative role, reports by nonprofessional report sources may provide opportunities for prevention.

Overcoming barriers to recognizing and reporting child abuse.

ABSTRACT: Infants and children under age 3 years have the highest risk of dying from child abuse and neglect. Clinicians treating children must recognize and report child abuse. Barriers to consistent recognition and reporting leave children in harm's way. Often, the signs of abuse in very young children are subtle, and clinicians may fail to recognize and report these signs. Clinicians also must understand the role of bias in the reporting of child abuse and ways to address abuse individually and as part of a larger system.

Iowa family physician's reporting of elder abuse: 20-year follow-up.

The purpose of this project was to assess changes over 20 years, between family physicians perceived magnitude of elder mistreatment, physician knowledge of state laws, barriers to reporting suspected cases, and what is done in practice. Questionnaires were mailed to 1,080 physician members of the Iowa Academy of Family Physicians. Thirty-six percent of physicians returned the questionnaire. These respondents had a mean age of 51 years, were licensed for 19 years, and 51% were male. Twenty-nine percent of physicians ask their patients direct questions about elder abuse in 2022 compared to 14% in 2002. Identifying an elder abuse case was associated with asking direct questions about abuse and the belief that prompt action would be taken. Knowledge of elder abuse legislation was associated with reporting of all abuse cases, along with thinking there were clear definitions of abuse and that reporting benefits patients.

Ophthalmologists' Attitudes, Knowledge, and Willingness to Report Child Abuse.

The aim of the present study was to explore ophthalmologists' attitudes, knowledge, and willingness to report child abuse. One-hundred-and-seven ophthalmologists employed in various hospitals in Israel completed an online questionnaire. Less than half the ophthalmologists (44.9%) reported that they had treated children whom they identified or suspected as being victims of child abuse, while only 43.9% of these reported child abuse. Despite generally positive attitudes towards reporting of child abuse among the ophthalmologists, their average level of knowledge was low. Ophthalmologists who had received training on child abuse and residents displayed a higher level of knowledge. In addition, female ophthalmologists tended to agree more that ophthalmologists are obligated to screen for and report child abuse. Moreover, female ophthalmologists expressed higher willingness to report child abuse. The present study reveals that underreporting of child abuse, and more precisely the discrepancy between identification and reporting, is present among ophthalmologists. It seems that lack of knowledge regarding identification and reporting of child abuse is the main barrier to reporting, especially among medical specialists. These findings underscore the importance of training programs on child abuse, both during formal education in medical school, and post-qualification, for all ophthalmologists, irrespective of seniority.

Global Approaches to Primary, Secondary, and Tertiary Elder Abuse Prevention: A Scoping Review.

Public health professionals use a three-pronged approach to address broad-reaching issues of societal concern: primary prevention, secondary prevention, and tertiary prevention. Applying this framework to the study of elder abuse, the purpose of this review is to describe the status of elder abuse prevention research on a global scale. Elder abuse prevention articles published between 2015 and 2021 were identified through electronic bibliographic searches (PubMed, Medline, CINAHL, APA PsycINFO, and AgeLine). After removing articles based on inclusion and exclusion criteria, articles were sorted into the three main prevention types and further divided into subcategories for a more in-depth review. Most of the studies identified were conducted in North America (n = 42). Of the 72 articles identified, 13 articles focused on primary prevention (agism, education, and intervention), 35 articles focused on secondary prevention (developing and evaluating screening tools, identifying and reporting abuse, and barriers to detecting and reporting abuse), and 21 focused on tertiary prevention (professional response to cases of abuse, intervention methods, and impact of policy). Collectively, findings bring greater understanding of elder abuse as a public health problem and identify ways of addressing the complexities of elder abuse. Several gaps were identified in the elder abuse prevention literature including the need for global research that includes older adults as stakeholders, evidence-based education and intervention programs, and cultural sensitive and valid tools to identify elder abuse.

Health Professionals: Identifying and Reporting Child Physical Abuse-a Scoping Review.

Health professionals play a significant role in identifying and reporting child physical abuse (CPA). However, several studies have pointed out non-reporting behavior among these professionals, evidencing difficulties identifying and reporting suspected cases. This review aimed to explore the frequency and possible barriers in identifying and reporting CPA by health professionals worldwide and to identify associated factors. This scoping review was conducted in the Pubmed, Web Of Science, Scopus, and SciELO databases between July 2019 and December 2020. Analytical and qualitative observational epidemiological studies were selected and published in English, Portuguese, and Spanish, with data on the identification and/or reporting of CPA by health professionals. Twenty studies fulfilled the criteria of this review. The studies were conducted with dentists, nurses, pediatricians, and general practitioners. The frequency of identification of CPA ranged from 50% to 89%, while the frequency of reporting ranged from 8% to 47%. This review revealed that health professionals had a low frequency of reporting of CPA, especially for dentists. In addition, several associated factors and barriers in the identification and reporting of CPA were identified in the studies. These were discussed in five main themes: training and continuing education in CPA, impact on professional practice, experiences and perceptions about child protection services, the threshold for suspicion of the professional, and the professional category.

Universal mandatory reporting policies show null effects in a statewide college sample.

OBJECTIVE: It is widely assumed that universal mandatory reporting policies (MRPs) for sexual misconduct are important for campus safety, but there is little evidence to support these assumptions. HYPOTHESES: Given the exploratory nature of this research, no formal hypotheses were tested. We did not expect universal MRPs to be significantly associated with increased reporting or postreporting outcomes. METHOD: Data on MRPs and sexual misconduct reporting in annual security reports and to Title IX coordinators at institutions of higher education in New York (N = 188) were used to examine the prevalence of universal MRPs as well as the relationship between MRPs and reporting and postreporting outcomes. RESULTS: Descriptives showed that 44% of institutions of higher education have a universal MRP. Multivariate linear regression models indicated that universal MRPs were not significantly related to reporting in annual security reports; reports to Title IX coordinators, campus police, campus safety or security officers; or rates of referrals to additional services, no-contact orders, access to the judicial conduct process for sexual misconduct, or findings of student responsibility for sexual misconduct. CONCLUSIONS: Our findings raise concerns about the widespread implementation of MRPs and highlight the need for future research on their impact on student-survivor reporting and access to remedies and resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A History of Child Abuse Pediatrics: Training, Research, and Clinical Diagnosis.

This article provides an historical review of child maltreatment, focusing on the three most common subtypes: physical abuse, sexual abuse, and neglect. The evolution of recognizing, evaluating, and accurately diagnosing child maltreatment is described. Over time, the establishment of multidisciplinary teams, mandatory reporting, and Child Abuse Pediatrics as a subspecialty of pediatrics has improved the training, research, and clinical diagnosis for all forms of child maltreatment. These advancements have set clinical standards to ensure accurate diagnosis, prevent the misdiagnosis of child abuse and neglect, and continually improve the systems meant to protect children. The expansion of knowledge of child maltreatment continues with attention on early detection of children at risk of developing lifelong physical, psychological, and behavioral consequences from trauma associated with all forms of child maltreatment.

Development and psychometric evaluation of the reporting suspected child abuse and neglect (RSCAN) scale for United States registered nurses.

PURPOSE: In the United States (US), nurses have a mandated duty to report child abuse and neglect (CAN). Despite comprising the highest proportion of the US healthcare workforce, limited research has explored the institutional barriers they face in reporting suspected CAN. Furthermore, there is no existing valid and reliable measure of reporting relevant to US. The purpose of this research is to develop and psychometrically evaluate a scale to measure nurse knowledge and self-efficacy as CAN mandated reporters. DESIGN AND METHODS: The Reporting Suspected Child Abuse and Neglect (RSCAN) tool was developed from two existing international tools to examine institutional barriers and facilitators to US nurses' professional knowledge and reporting of CAN. A convenience sample of one hundred and sixty-six US nurses primarily from the Pacific Northwest responded to an online survey. An exploratory factor analysis (EFA) and Cronbach's α were used to examine validity and internal consistency, respectively, of an initial 16-item scale. RESULTS: A two-factor model consisting of eight items indicated good model fit (CFI = 0.986, RMSEA = 0.049, and SRMR = 0.028) and was internally consistent (Cronbach's α = 0.822). CONCLUSION: RSCAN is the first US instrument to reliably measure nurses' professional knowledge and self-efficacy of reporting suspected CAN. PRACTICE IMPLICATIONS: Future research can build upon these findings to recognize and support nurses in their mandated role to report CAN.

Counts and child protection reports of diagnosed child maltreatment before and after the COVID-19 pandemic onset.

BACKGROUND: Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic. OBJECTIVE: To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19. PARTICIPANTS AND SETTING: All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021. METHODS: Using linked medical record and CPS administrative data, interrupted time series models tested for changes in monthly counts and percentages of CM medical encounters reported to CPS with the onset of COVID-19. Logistic regression tested for the likelihood of a CPS report being associated with a CM encounter. RESULTS: CM medical encounters totaled 2528, including 793 after the onset of COVID-19. Interrupted time series models indicated with the onset of the pandemic, the counts of CM encounters increased 18 % (RR: 1.18, 95 % CI 1.03-1.34) and the percentages reported to CPS increased 10 % (RR: 1.10, 95 % CI: 1.05-1.17). CM encounters that occurred after the onset of the COVID-19 pandemic had increased odds of a CPS report (fully adjusted model: OR: 1.08; 95 % CI: 1.05-1.12). CONCLUSIONS: This study found increases in monthly counts and a higher percentage of CM medical encounters with CPS reports after the pandemic onset.

Argument-based Ethics and Mandatory Reporting Laws for Trafficked Persons.

Human trafficking, which includes sex and labor trafficking, is a pressing issue that needs to be more adequately addressed. Health care professionals have a unique opportunity to assist people who are experiencing human trafficking. However, no consensus exists concerning the involvement of law enforcement through mandatory reporting of trafficked adults. This column uses argument-based ethics to analyze existing literature on ethical justification for mandatory reporting laws. It also recommends areas of growth for health care professionals and ethicists concerned about the use of mandatory reporting for human trafficking.

Nurses' and physicians' reported difficulties and enablers to recognising and reporting child abuse in Swiss paediatric emergency and paediatric surgery departments - an observational study.

BACKGROUND: Under-detection and under-reporting of child abuse remains a considerable challenge in paediatric care, with a high number of cases missed each year in Switzerland and abroad. Published data regarding the obstacles and facilitators of detecting and reporting child maltreatment among paediatric nursing and medical staff in the paediatric emergency department (PED) are scarce. Despite the existence of international guidelines, the measures taken to counteract the incomplete detection of harm done to children in paediatric care are insufficient. AIM: We sought to examine up-to-date obstacles and enablers for detecting and reporting child abuse among nursing and medical staff in PED and paediatric surgery departments in Switzerland. METHODS: We surveyed 421 nurses and physicians working in PEDs and on paediatric surgical wards in six large Swiss paediatric hospitals using an online questionnaire between February 1, 2017, and August 31, 2017. RESULTS: The survey was returned by 261/421 (62.0%) respondents (complete n = 200, 76.6%; incomplete n = 61, 23.3%) with a preponderance of nurses (n = 150/261; 57.5%), 106/261 (40.6%) physicians, and 1/261 (0.4%) psychologists (n = 4/261; 1.5% missing profession). The stated obstacles to reporting child abuse were uncertainty about the diagnosis (n = 58/80; 72.5%), feeling unaccountable for notification (n = 28/80; 35%), uncertainty of whether reporting has any consequences (n = 5/80; 6.25%), lack of time (n = 4/80; 5%), forgetting to report (n = 2/80; 2.5%), and parental protection (n = 2/80; 2.5%) (unspecific answer, n = 4/80; 5%, multiple answers were possible, therefore items don not sum up to 100%). Even though most (n = 249/261 95.4%) respondents had previously been confronted with child abuse at/outside work, only 185/245 (75.5%) reported cases; significantly fewer nursing (n = 100/143, 69.9%) than medical staff (n = 83/99, 83.8%) (p = 0.013). Furthermore, significantly more nursing (n = 27/33; 81.8%) than medical staff (n = 6/33; 18.2%) (p = 0.005) reported a discrepancy between the number of suspected and reported cases (total 33/245 (13.5%). An overwhelming amount of participants were strongly interested in mandatory child abuse training (n= 226/242, 93.4%) and in the availability of standardised patient questionnaires and documentation forms (n = 185/243, 76.1%). CONCLUSION: In line with previous studies, insufficient knowledge about and lack of confidence in detecting the signs and symptoms of child abuse were the principal obstacles to reporting maltreatment. To finally address this unacceptable gap in child abuse detection, we recommend the implementation of mandatory child protection education in all countries where no such education has been implemented in addition to the introduction of cognitive aid tools and validated screening tools to increase child abuse detection rates and ultimately prevent further harm to children.