Attitudes and responses of Victorian paediatric intensive care doctors to the detection and reporting of child maltreatment.

AIM: To determine the attitudes and responses of Victorian paediatric intensive care doctors to the detection and reporting of child maltreatment. METHODS: A prospective study conducted in a 30-bed paediatric intensive care unit of a university teaching hospital using data collected from a questionnaire completed by paediatric intensive care consultants and registrars. The questionnaire covered the following domains - doctors' knowledge of Victorian mandatory reporting legislation, doctors' history of reporting and doctors' current role in the detection and reporting of child maltreatment. RESULTS: The questionnaire was completed by 37 doctors. All but one doctor considered their role in the detection and reporting of all six forms of maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence and grooming to facilitate later sexual activity with a child) very important or somewhat important. Thirty-two percent of doctors did not feel adequately trained to detect child maltreatment while 51% did not feel adequately trained to report maltreatment. If a doctor wanted to make a report to Child Protection about the physical or sexual abuse of a child, only one would likely make Child Protection their first point of contact. CONCLUSIONS: Paediatric intensive care doctors show a strong intent to detect and report child maltreatment across a broad range of maltreatment types. Doctors are likely to contact one or more members of a child's care team and/or one or more relevant hospital/community services before making a report to Child Protection about the physical or sexual abuse of a child. Opportunities exist for the further education of doctors in regards to the detection and reporting of child maltreatment.

The adoption of children from out-of-home care: The understandings of key decision makers in Victoria, Australia.

Adoption is one of a range of options that can provide children in out-of-home care with permanency when they are unable to be reunified with their birth parents. This paper reports on how the adoption of children from out-of-home care is understood by professionals involved in making decisions about the permanent placement of children in out-of-home care in Victoria, Australia, where adoption is rarely used. Data were collected through a single, face-to-face semi-structured interview with 21 professionals; eight child welfare specialists, eight adoption and permanent care specialists and five judicial officers. The adoption of children from out-of-home care was primarily understood as a child-centered practice that can afford children stability and a sense of belonging. Adoption was largely viewed as a voluntary process dependent upon the consent of a child's birth parents. Adoption and permanent care specialists were the only group to refer to the dispensation of parental consent as a means of obtaining an adoption order. Most decision makers understood that contact between children and their birth parents is possible following adoption, but this was not understood by all judicial officers or all child welfare specialists. Children's connection to their cultural heritage was viewed as important to the consideration of adoption for children in out-of-home care. This research provides insight into the foundations upon which decision makers may appraise adoption, within a hierarchy of options, as a potential outcome for children in need of permanency.

The characteristics, pattern of injury and outcome of children admitted to a paediatric intensive care unit following an inflicted injury.

OBJECTIVE: To describe the characteristics, pattern of injury and outcome of children admitted to a paediatric intensive care unit (PICU) following an inflicted injury. DESIGN, SETTING AND PARTICIPANTS: A retrospective review of hospital records from a 30-bed PICU in a university teaching hospital, examining data for children admitted to the PICU after an inflicted injury from 1 January 2005 to 31 December 2013. MAIN OUTCOME MEASURES: The hospital records of 46 children with an inflicted injury were reviewed. Outcome was categorised using the Pediatric Overall Performance Category score. RESULTS: Sixty-one percent of children admitted to the PICU after an inflicted injury were aged under 12 months. Eighty-three percent of children required admission for a head injury. Radiological findings suggestive of pre-existing inflicted injury were evident in 50% of children. Follow-up information was available for 41 children; 76% were alive at follow-up while 24% had died. Among survivors, outcome was evaluated at a median of 11.3 months after admission to the PICU; 74% had a favourable outcome, despite 61% of these children having a disability. The remaining 26% of children had an unfavourable outcome and were likely to live dependent on care. CONCLUSIONS: The majority of children admitted to intensive care following an inflicted injury are aged under 12 months. Children most commonly require intensive care for management of a head injury. Many children have radiological findings suggestive of pre-existing inflicted injury. Despite high mortality, the majority of children survive. While most are likely to be independent, many children will have residual disabilities.