An E-Learning Program for Continuing Midwifery Education on Handling High-Risk Abuse Cases: A Pretest-Posttest Design.

It is essential to equip midwives and nurses working in the perinatal period with comprehensive knowledge and awareness regarding child abuse prevention. However, most midwives and nurses in Japan do not have the opportunity to learn about abuse prevention during their basic education. We aimed to develop an e-learning program to assist obstetric midwives and nurses in acquiring the knowledge needed to provide support and handle cases with a high risk of abuse, as well as to assess the program's usefulness. This study employed a single-group pre-post design; e-learning served as the intervention. Seventy-one obstetric midwives and nurses were recruited. The program's usefulness was the difference between the participants' pretest and post-test knowledge and efficacy scores. The score data were analyzed using the t-test. A paired t-test revealed that the post-test scores of knowledge and efficacy were significantly higher than those of the pretest, with a large effect size (d = 1.71). Platforms where basic knowledge on how to respond to high-risk abuse cases are lacking in nursing education; thus, this e-learning program is recommended for nurses working in the perinatal field throughout Japan. This educational opportunity for perinatal midwives and nurses will increase awareness and contribute to abuse prevention.

Professional practices in situations of child abuse: an integrative review. / As práticas profissionais realizadas em situações de maus-tratos infantis: uma revisão integrativa.

Child abuse is a problem that affects children all over the world. The present study therefore aimed to identify and analyze the main findings relating to professional practices for dealing with situations of child maltreatment in articles published in Brazil. To this end, we conducted an integrative literature review of articles published between 2017 and 2022 based on searches of the following databases: Google Scholar, SciELO Brasil, the periodicals database of the Agency for the Improvement of Higher Education Personnel (CAPES), MEDLINE, the Virtual Health Library, and Electronic Journals in Psychology (PePSIC). A total of 24 publications were selected for the review after screening the titles and abstracts. The findings reveal several challenges to ensuring the protection of children caused by shortcomings in professional training, which have a negative influence on the identification and reporting of child maltreatment. The present study reveals the lack of priority given to the issue of child maltreatment in professional training and provides important inputs to inform future research on professional practices for dealing with child violence.

A violência infantil é um problema que afeta crianças no mundo todo. O presente estudo objetiva identificar e analisar os principais resultados apresentados em artigos publicados no Brasil sobre as práticas profissionais desenvolvidas em situações de maus-tratos infantis. Para tanto, realizou-se uma revisão integrativa da literatura, com buscas nas bases de dados Google Acadêmico, no SciELO Brasil, nos Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior do Ministério da Educação (CAPES/MEC), no MEDLARS ONLINE (Medline), na Biblioteca Virtual em Saúde (BVS Saúde) e nos Periódicos Eletrônicos em Psicologia (Pepsic), abrangendo publicações de 2017 a 2022. Após a leitura dos títulos e resumos, 24 artigos foram selecionados para a análise. Os resultados apontam a dificuldade na proteção integral da criança devido à deficiência na formação do profissional, que influencia na identificação e notificação do abuso infantil. O presente estudo revela o lugar que os maus-tratos infantis ocupam na formação dos profissionais e subsidia pesquisas futuras sobre práticas profissionais para o enfrentamento da violência infantil.

Psychoanalytic Interventions with Abusive Parents: An Opportunity for Children's Mental Health.

Research has extensively shown that most people who experience maltreatment in their childhood develop mental disorders, psychosocial adjustment problems, and, in many cases, become maltreating adults themselves. Preventing child maltreatment and treating abused children and abusive parents are, therefore, pressing public health issues. As established by the UK Children Act in 1989, child development is enhanced by remaining in the family whenever the child's safety is assured. Thus, developing prevention and intervention programs for the purpose of repairing, whenever possible, the child-parent relationship should be a social priority. This narrative review focuses on the psychoanalytic studies related to intrapsychic dynamics and therapeutic intervention for physically abusive parents. The role of the transgenerational transmission of abuse and parents' narcissistic fragility is crucial. Psychoanalytic interventions focus on helping the parent work through their past painful experiences and narcissistic vulnerability. Parent-child psychotherapy and mentalization-based treatment have been found to be prevalent, while there is scarce literature regarding intensive individual psychoanalytic treatment. Within the framework of attachment theory, brief interventions were developed; however, they did not prove effective for those parents who suffered experiences of maltreatment or severe neglect in childhood and for whom long-term parent-child psychotherapy resulted, which proved to be the most effective.

The transgenerational impact of child abuse. Health professionals' social and values / A gyermekbántalmazás transzgenerációs hatásai

Introduction: Child abuse is a worrying trend not only in our country but globally. The aim of the article is to present the adverse long-term consequences of child abuse, Adverse Childhood Experiences, which is a classified public health problem according to WHO. The attitude of primary care workers towards the prevention of abuse has a profound impact on the quality of prevention activities. Objective: To assess the knowledge and perceptions of paediatricians, midwives and paediatric nurses working in primary and specialised care about the topic child abuse. Contextualising value judgements and societal perceptions of child abuse in order to break the transgenerational effects. Method: A self-completed online survey was conducted with 49 structured, standardised questions, the data provided insights about the socio-economic status of respondents, their attitudes to the issue of child abuse, their perceptions of the seriousness of the issue and their obligation to report it under the law. Results: Based on our analysis on a sample of 195 respondents, we can conclude that health care workers perceive abuse as clearly harmful, yet it is perceived as a common phenomenon in our country. Nearly one fifth of respondents believe that society is accepting and mildly judges the phenomenon. A significant difference in the perception of abuse by educational level was found between the high and low educated respondents. We also found significant differences in signalling functioning by type of workplace location (p = 0.020) and job category (p = 0.044). Conclusion: The results highlighted that preventive action by health care workers is the key to breaking the transgenerational effects. The authors would like to draw attention to the fact that the improvement of the quality of care depends significantly on the knowledge of professionals. Continuous basic and further training and in-depth knowledge development among primary care workers are necessary.

Abuse and neglect among Ethiopian children and adolescents.

Given the dramatic situation observed in Ethiopia, the biggest humanitarian crisis in decades, children and adolescents have been the most affected. The country experiences climate change and disarrays in the political structure of the state, which increases the risk of insecurity, displacement, and protection. The outlook tends to remain in 2022 due to the expansion of the conflict and the decrease in the access of partners' humanitarian aid groups to the affected regions. The country has high rates of malnutrition, low vaccination coverage, need for educational assistance, water, and sanitation emergency, lack of services to protect against violence, and high rates of children unaccompanied by their families. During the conflict, children, often to save their lives - because they have extended families or unhealthy inter-family relationships - end up looking for work on the streets and falling into a situation of vulnerability. In this context, they become constant victims of sexual abuse and physical violence, leaving deep marks. Still, the country's folk traditions fall back on the girls, significantly in a negative way, when genital mutilation and child marriage are in considerable proportion among girls in the country. However, the humanitarian actions did not concern themselves with referring to the particular needs of adolescent girls, including the involvement of caregivers to reduce the risk of violence. In this sense, it is important to point out that the increase in discrimination, stigmatization, and xenophobia contribute negatively to local tensions and to the improvement of vulnerability and social risk of children and adolescents. Therefore, there is a need for interventions to multisectoral nutrition, due to the prevalence of thinness and stunting that are above the threshold level of public health importance, and the need for urgent humanitarian assistance care to the more than 15 million children affected by this unprecedented crisis.

Understanding and breaking the intergenerational cycle of abuse in families enrolled in routine mental health services: study protocol for a randomized controlled trial and two non-interventional trials investigating mechanisms of change within the UBICA II consortium.

BACKGROUND: Parents' mental illness (MI) and parental history of early life maltreatment (ELM) are known to be significant risk factors for poor parenting while poor parenting is a crucial mediator of the intergenerational continuity of child maltreatment. Hence, maltreatment prevention programs for families with an MI parent, which pay particular attention to experiences of ELM in the parent, are urgently needed. Parental mentalizing was previously found to mediate successful parenting. Interventions aimed at improving the parental mentalizing capacity reduced maltreatment risk in parents. The aim of the present study is to investigate the effectiveness of a mentalization-based parenting-counseling in acutely mentally ill parents currently treated at a psychiatric hospital. METHODS: Mentalization-based parenting-counseling (MB-PC) vs. enhanced standard clinical care (SCC+) will be administered in a cluster-randomized-controlled trial (RCT). Patients treated at psychiatric hospitals with children between 1.5 and 15 years will be included in the trial. MB-PC will be administered as a 12-h combined individual and group program enriched by social counseling (over a course of 5 weeks) as add-on to standard clinical care, while the control condition will be standard clinical care plus a 90-min psychoeducation workshop on positive parenting. Primary efficacy endpoint is self-reported parenting practices at follow-up. Embedded within the RCT will be two sub-studies investigating social cognition and dyadic synchrony as biobehavioral mechanisms of change. DISCUSSION: The main goal of the present study is to investigate ways to break the intergenerational continuity of maltreatment by assessing the benefits of a prevention program which aims at improving parenting in vulnerable mothers and fathers. MB-PC is a short, low-cost intervention which can be delivered by nurses and social workers and is applicable to MI patients with children with a broad range of diagnoses. If it is shown to be effective, it can be directly implemented into standard psychiatric hospital care thereby providing help to prevent child maltreatment. TRIAL REGISTRATION: German Clinical Trials Register DRKS00017398 . Registered on 5 July 2019.

Role of Pediatricians in Early Childhood Nurturing Care Related to Safety and Security.

The five components of nurturing care for early childhood development (good health, adequate nutrition, responsive parenting, early opportunities for learning, and safety and security) are essential for the attainment of the optimal developmental potential of a child, and enabling him/her to become a productive adult. Safety is a state of protection from hazards caused by natural forces or unintentional human error, whereas security comprises of protection from hazards resulting from deliberate, harmful actions or inimical behavior. Unlike the other components, safety and security have been least addressed by health programs in India. The forms of lapses in safety and security in young children include injuries, neglect and maltreatment (physical, emotional, sexual abuse), the magnitude of which is difficult to ascertain in the community. Many mishaps can be avoided by simply understanding child development, taking precautions, and environmental modification. Issues related to safety and security are usually not addressed in routine office practice. Pediatricians have multiple roles and responsibilities. They need to utilize every opportunity to discuss preventive and promotive health care with parents. Converting immunization days to holistic well child visits is an ideal strategy, in which parents can be educated about preventing avoidable injuries and informed about how to keep their children safe and secure. Pediatricians should recognize indicators of volitional injury, neglect and abuse, and be competent in their management. They need to be aware of child rights and the legal protective measures as well as their own their legal obligations. They should network with various agencies involved in child welfare and protection.

"Guboow"-child abuse or traditional medical treatment? a case report.

The examination of children suspected of being abused poses a great challenge for forensic pathologists. The risk of misjudgment is high and can have serious consequences for the child and the family. In unclear cases, an assessment should always be carried out on an interdisciplinary basis with the involvement of the relevant disciplines such as pediatrics, dermatology, or radiology. We present the case of a 2.5-year-old boy who was presented by his parents at the Pediatric Emergency Department of a Swiss University Hospital due to fever and weight loss. During the physical examination, conspicuous findings on the abdomen were present, and the responsible emergency physicians informed the child protective services. A clinical forensic examination occurred on behalf of the child protection services. The abdomen of the child showed several symmetrical scars. The initial questioning of the parents did not provide clear information about the origin of the injuries. Further professional questioning of the family by the child protective services concluded that the injuries were the result of a traditional medical treatment in Somalia, which occurred several weeks before.

Ending violence against children: What can global agencies do in partnership?

Globally, the range, scale and burden of all forms of violence against children (VAC) have visibly increased. Yet VAC as a physical, mental, public and social health concern is only recently gaining the prominence it deserves. Addressing VAC is critical. Violence experienced early in life can result in short, medium, long-lasting, and/or even inter-generational negative health outcomes. Ample evidence shows that VAC is widespread and the most common forms are usually perpetrated by people with whom children interact every day in their homes, schools and communities. We report on an innovative collaboration between global agencies, led by the International Society for Social Pediatrics and Child Health (ISSOP), the International Society for Prevention of Child Abuse and Neglect (ISPCAN), and the International Pediatric Association (IPA), who were galvanized to respond to VAC using a child-rights and public health lens. This collaboration led to a position statement on VAC with an implementation plan. The strength of the position statement was the explicit incorporation of a rights-based expansive understanding of VAC, with a description of typologies of violence pertinent to children globally, including child labor, children in armed conflict, trafficking of children and gender-based violence; and the identification of strategies both in preventing violence from occurring and ameliorating the effects in its aftermath. We report on the challenges and successes of our collaborative action at regional and supra-national levels, including opportunistic action.

Child's Play or Sexual Abuse? Reviewing the Efficacy of the Justice Framework in Dealing with Child on Child Sexual Abuse in the United Kingdom.

This literature review appraises how the justice system of the United Kingdom deals with child on child sexual abuse allegations. It is crucial to consider the impact of minor sexual abuse within the community. Sensationalized reporting of sex crimes demonizes offenders and unintentionally hides some perpetrators by not representing children can cause harm. Cases where children demonstrate sexual agency are confusing and uncomfortable to appropriate blame. A freedom of information request to the Metropolitan Police uncovered 5,500 minor sex abuse allegations in England and Wales between 2011 and 2014, including, 4,000 physical assaults and 600 rape allegations. Officials caution these figures only represent a small proportion of known sexual abuse cases but the full extent of the problem is yet to be seen. Children are being exposed to explicit imagery far beyond their developmental age causing a blurring of the lines between normal sexual curiosity, harmful behavior, sexual deviance, and abuse. Evidence suggests societal failings and technological advances have created vulnerabilities from which new and dangerous sexual norms have evolved. Therefore, this paper reviews the justice, welfare, and restorative justice frameworks to explore the efficacy of the justice system in dealing with child on child sexual abuse in the UK.

Nurses' perceptions of systems and hierarchies shaping their responses to child abuse and neglect.

Nurses have an important role in preventing and responding to child abuse and neglect. This paper reports on nurses' perceptions of how organisational systems and hierarchies shaped their capacity to respond to child abuse and neglect. This is one of four key themes identified through an inductive analysis of data from a broader qualitative study that explored nurses' perceptions and experiences of keeping children safe. The study was guided by social constructionist theory, and data were collected through in-depth interviews with nurses working with children in Australia (n = 21). Key findings showed that nurses experienced many challenges to responding to child abuse, including difficulties sharing information, fear of making mistakes and inflexible systems of care. This was underpinned by an organisational 'rule-centred' culture of following policies at the expense of maintaining an explicit focus on children's needs. These findings demonstrate first the importance of creative and flexible thinking from individual professionals, so policies are enacted with a clear child focus. Second, they highlight the need for leadership to enact organisational and systemic cultural change that maintains a genuinely child-centred approach.

Two-generational trauma-informed assessment improves documentation and service referral frequency in a child protection program.

BACKGROUND: Two-generational trauma-informed assessment (TIA) helps providers conduct holistic family well-being assessment (FWbA). This tool makes it possible to use families' trauma history in the case-finding process. OBJECTIVE: This study compares the documentation and frequency of adverse childhood experiences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC). PARTICIPANTS AND SETTING: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013. METHODS: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers. RESULTS: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,p <  0.0001) and caretakers (60.7 % vs 7.3 % p <  0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % p <  0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, p =  0.110). Both children and caretakers were referred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, p <  0.0001). CONCLUSIONS: In families evaluated for child abuse and neglect, conducting TIA in addition to conventional psychosocial evaluation increased documentation regarding trauma history, which led to increased referral rates.

Development and pretest of key visual imagery in a campaign for the prevention of child maltreatment.

INTRODUCTION: This article discusses the development and pretesting of key visual imagery in a promotional campaign developed in Quebec, Canada. This campaign is the media-based component of a broader prevention strategy involving the use of the Triple P program (Sanders, 1999). OBJECTIVES: The purpose was to pretest with parents the preliminary version of a poster that uses the campaign's key visual imagery prior to final production. METHOD: In total, 26 parents from the regions of Quebec City and Montreal participated in four focus groups. RESULTS: Two general themes emerged from the focus groups: (i) emotions and reactions arising from the key visual imagery; and (ii) comprehension of the message being conveyed. CONCLUSION: Based on this information, recommendations were made to the marketing agency, which then modified the campaign's key visual imagery and proposed a final layout.

Lighthouse Parenting Programme: Description and pilot evaluation of mentalization-based treatment to address child maltreatment.

This article introduces an innovative mentalization-based treatment (MBT) parenting intervention for families where children are at risk of maltreatment. The Lighthouse MBT Parenting Programme aims to prevent child maltreatment by promoting sensitive caregiving in parents. The programme is designed to enhance parents' capacity for curiosity about their child's inner world, to help parents 'see' (understand) their children clearly, to make sense of misunderstandings in their relationship with their child and to help parents inhibit harmful responses in those moments of misunderstanding and to repair the relationship when harmed. The programme is an adaptation of MBT for borderline and antisocial personality disorders, with a particular focus on attachment and child development. Its strength is in engaging hard to reach parents, who typically do not benefit from parenting programmes. The findings of the pilot evaluation suggest that the programme may be effective in improving parenting confidence and sensitivity and that parents valued the programme and the changes it had helped them to bring about.

Modelo de la dinámica del proceso de promoción de salud frente al maltrato infantil / Model of the dynamics of the process of health promotion against child abuse

Introducción: el maltrato al niño como expresión de violencia intrafamiliar requiere para su abordaje de la promoción de salud y de su relación con los determinantes sociales.Objetivo: valorar la pertinencia científico-metodológica del modelo de la dinámica del proceso de promoción de salud frente al maltrato infantil en la familia. Método: se aplicaron los métodos: analítico-sintético, histórico-lógico y holístico-dialéctico. La consulta a 19 expertos se utilizó para la valoración de la pertinencia científico-metodológica del modelo teórico construido. El coeficiente α de Cronbach permitió cuantificar la confiabilidad de la consistencia interna del instrumento y el de Kendall, el grado de concordancia de los expertos.Resultados: se reveló un sistema de relaciones dialécticas que transitó desde las configuraciones hasta el eje sistematizador de la dinámica. Las dimensiones: cultural y habilitadora contextualizada, emergieron desde las configuraciones identificadas. Lo cual condicionó sus eslabones y posibilitó revelar la regularidad esencial. La sistematización de la asertividad de las relaciones con el niño en la familia, constituyó el eje sistematizador. La consistencia interna fue adecuada (α = 0,971) y la concordancia de los expertos, altamente significativa (W de Kendall = 0,714, c2 = 102,794, p = 0.000). Conclusiones: se constató la pertinencia científico-metodológica del modelo construido desde una concepción integradora de la promoción de salud y las determinantes teniendo en cuenta la interacción familia - comunidad - sociedad, que permitió integrar la dimensión cultural, expresión de lo universal de la cultura sobre la protección de los derechos y lo particular de la práctica del maltrato infantil(AU)

Introduction: Child abuse as an expression of intrafamily violence requires for its approaching of the promotion of health and its relationship with social determinants.Objective: to assess the scientific-methodological relevance of the model of the dynamics of the health promotion process against child abuse in the family.Method : the methods were applied: analytical-synthetic, historical-logical and holistic-dialectical. The consultation of 19 experts was used to assess the scientific-methodological relevance of the theoretical model built. Cronbach's α coefficient allowed to quantify the reliability of the internal consistency of the instrument and Kendall's, the degree of agreement of the experts.Results: a system of dialectical relations was revealed that went from the configurations to the systematizing axis of the dynamics. The dimensions: cultural and enabling contextualized, emerged from the identified configurations. Which conditioned its links and made it possible to reveal the essential regularity. The systematization of the assertiveness of the relations with the child in the family constituted the systematizing axis of the dynamics. The internal consistency was adequate (α = 0.971) and the agreement of the experts, highly significant (Kendall W = 0.714, c2 = 102.794, p = 0.000).Conclusions: the scientific-methodological relevance of the model constructed from an integrating conception of the determinants of health was confirmed taking into account the family-community-society interaction, which allowed to integrate the cultural dimension, expression of the universal of the culture on the protection of rights and the particular of the practice of child abuse(AU)

[Midwives and Nurses in Early Childhood Intervention: The Benefit of Additional Qualification]. / Gesundheitsfachkräfte in den Frühen Hilfen: Wie nützlich ist die Zusatzqualifikation? Eine quantitative Studie.

Midwives and Nurses in Early Childhood Intervention: The Benefit of Additional Qualification Abstract. BACKGROUND: Early childhood interventions are locally and regionally organized support services for families from pregnancy until the end of the third year of life. The interventions promote diverse measures to enhance parental skills in order to improve developmental and living circumstances. Midwives and nurses with additional qualification support burdened families in early childhood intervention. METHOD: Within a retrospective survey (standardized interviews, CAPI) mothers' (N = 298) perspective of the benefit of the home visiting support is assessed. Data from two groups were compared: (1) mothers in the care of a midwife or nurse with additional qualification (GruppeGFK + Quali) and (2) mothers cared for by a midwife or nurse without additional qualification (GruppeGFK). RESULTS: (1) Families with weighted levels of psychosocial burdens reported an enhanced need for help. (2) Midwives and nurses with additional qualification support more frequently families with high levels of psychosocial burdens. (3) Mothers with care of midwives and nurses with additional qualification reported this support as more useful in relation to every day demands than mothers with regular care after birth (questionnaire for evaluation of the received support: GruppeGFK + Quali: mean = 2.57; GruppeGFK : mean = 1.97; t (121) = 2.799, p = .003). CONCLUSION: The study complements results of national and international studies showing that families with high levels of psychosocial burdens accept home visiting support. Furthermore, this support seems to be useful. An increase of the offer and the additional qualification is recommended for improving the developmental and living conditions of families with psychosocial burdens.

Protocolo de atención en salud integral de niñas y niños en situación de maltrato infantil / Comprehensive health care protocol for girls and boys in situations of child abuse

A partir de la premisa, que el maltrato infantil se está convirtiendo en un problema cada vez más serio a nivel nacional, situación que es avalada por la Organización Panamericana de la Salud (OPS) que considera que la violencia y sus diferentes manifestaciones son un problema que afectan a la salud y al desarrollo social y económico de amplios sectores de la población. Este protocolo considera que es importante que los proveedores de salud desarrollen habilidades y competencias que ayuden a detectar los casos de niños maltratados, así como conocer las mejores estrategias de intervención. El objetivo de este protocolo es proponer una herramienta que proporcione los elementos básicos a proveedores y proveedoras de salud para brindar atención de calidad en salud integral y realizar la notificación oportuna de los casos de maltrato infantil. Para ello han seleccionado un modelo basado en el triage del AIEPI (Atención Integral a las Enfermedades Prevalentes de la Infancia). Es una estrategia elaborada por la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (Unicef) presentada en 1996 como principal método para mejorar la salud en la niñez. La metodología del modelo se lleva a cabo por medio de tres componentes. El primero está dirigido a mejorar el desempeño del personal de salud para la prevención de enfermedades en la niñez y su tratamiento. El segundo se dirige a mejorar la organización y funcionamiento de los servicios de salud para que brinden atención de calidad apropiada; y el tercer componente está dirigido a mejorar las prácticas familiares y comunitarias de cuidado y atención de la niñez. Contiene un marco teórico, marco legal, así como una serie de anexos dirigidos a apoyar tanto el diagnóstico, como el seguimiento dado a las víctimas.

Interagency collaboration and receipt of substance abuse treatment services for child welfare-involved caregivers.

Caregivers dealing with problematic substance use pose persistent challenges for families involved with the child welfare (CW) system. Research has indicated that receipt of substance use disorder (SUD) services help improve family outcomes. However, there are many challenging stages of intervention in the SUD treatment process, including detection, assessment, referral, entry, and completion. Considerable work is needed to illuminate factors that strengthen the delivery of SUD-related services at various points in the treatment services continuum. Although a growing body of work has focused on individual-level correlates, few studies have examined organizational factors that potentially affect the delivery of SUD-related services. This study sought to further understanding of the relationship between CW organizational factors (interagency collaboration and organizational resources) and delivery of SUD-related services in a nationally representative sample of CW-involved caregivers. In this study sample, engagement in collaboration through a memorandum of understanding (MOU) and co-location supported caregiver receipt of a referral to SUD services. Caregivers were more likely to receive a formal assessment for SUD problems when their CW agencies reported the availability of a standardized SUD assessment tool. Also, having arrangements with SUD agencies so that CW-involved families had priority status to enter treatment was pertinent to caregiver receipt of SUD treatment services. These results provide evidence that engagement in collaboration activities and greater organizational resources can increase an organization's capacity to deliver services to clients.

Factors associated with multidisciplinary case conference outcomes in children admitted to a regional hospital in Hong Kong with suspected child abuse: a retrospective case series with internal comparison.

INTRODUCTION: In all cases of suspected child abuse, accurate risk assessment is vital to guide further management. This study examined the relationship between risk factors in a risk assessment matrix and child abuse case conference outcomes. METHODS: Records of all children hospitalised at United Christian Hospital in Hong Kong for suspected child abuse from January 2012 to December 2014 were reviewed. Outcomes of the hospital abuse work-up as concluded in the Multi-Disciplinary Case Conference were categorised as 'established', 'high risk', or 'not established'. All cases of 'established' and 'high risk' were included in the positive case conference outcome group and all cases of 'not established' formed the comparison group. On the other hand, using the Risk Assessment Matrix developed by the California State University, Fresno in 1990, each case was allotted a matrix score of low, intermediate, or high risk in each of 15 matrix domains, and an aggregate matrix score was derived. The effect of individual matrix domain on case conference outcome was analysed. Receiver operating characteristic curve analysis was used to examine the relationship between case conference outcome and aggregate matrix score. RESULTS: In this study, 265 children suspected of being abused were included, with 198 in the positive case conference outcome group and 67 in the comparison group. Three matrix domains (severity and frequency of abuse, location of injuries, and strength of family support systems) were significantly associated with case conference outcome. An aggregate cut-off score of 23 yielded a sensitivity of 91.4% and specificity of 38.2% in relation to outcome of abuse categorisation. CONCLUSIONS: Risk assessment should be performed when handling suspected child abuse cases. A high aggregate score should arouse suspicion in all disciplines managing child abuse cases.