Valoración forense integral del maltrato infantil intrafamiliar / Child abuse due to domestic violence: Integral forensic assessment

El abordaje del maltrato infantil intrafamiliar (MII) es uno de los más complejos en medicina forense. Los objetivos periciales son la evaluación del daño físico-psíquico y de los indicadores de MII, el análisis de credibilidad del testimonio y el estudio de la dinámica familiar. En este artículo se revisa la sistemática de abordaje del MII (fuentes de documentación, evaluación psíquica, recogida del relato y uso de pruebas psicológicas); se propone un modelo de exploración psíquico basado en bloques, se formulan pautas para la determinación del nexo causal entre hechos denunciados y daño detectado, y para el análisis de la credibilidad con el fin de concluir sobre la coherencia del relato. También se describen los principales indicadores de MII. Las conclusiones del informe forense se deben basar en evidencias sólidas ya que una peritación deficiente podría producir daños irreparables en víctimas menores y sus familias

The approach to child abuse due to domestic violence is one of the most complex in forensic medicine. The objectives are the evaluation of the physical-psychological damage and of the indicators of child abuse, the analysis of credibility of the testimony and the study of the family dynamics. In this article, the systematic approach to child abuse is reviewed: sources of documentation, psychological evaluation, story gathering and use of psychological tests. A model of psychological exploration based on blocks is proposed, guidelines for the determination of the causal relationship between allegation of ill-treatment and damage detected are formulated, and recommendations for the analysis of credibility in order to conclude on the coherence of the story are suggested. The main indicators of child abuse are also described. The conclusions of the forensic report must be based on solid evidence, since poor evaluation could cause irreparable damage to children and their families

[Minor Victims of Violent Acts in the Context of the Victim Reparation Law]. / Minderjährige Opfer von Gewalttaten im Verfahren des Opferentschädigungsgesetzes.

Objective: A descriptive analysis of victim compensation applications for children and adolescents as well as sociodemographic and trauma-specific information concerning victims and perpetrators. Method: We did analysis of 100 victim-compensation application files based on a self-developed category system. Results: The files included solely interpersonal trauma, 59 % of which are type II trauma. The most frequent form is sexual violence. The perpetrators stem mostly from children's homes or peripherals. 79 % of the victims received a diagnosis of a mental disorder, most often posttraumatic stress disorder. Conclusions: Sexually abused children and adolescents make up the majority of the target population in OEG-related trauma outpatient units. Such outpatient units should therefore offer a specific expertise in treating sexually abused children and adolescents.

The Child Witness in the Courtroom.

Beginning in the 1980s, children have increasingly served as witnesses in the criminal, civil, and family courts; currently, >100 000 children appear in court each year. This statement updates the 1992 American Academy of Pediatrics (AAP) policy statement "The Child as a Witness" and the subsequent 1999 "The Child in Court: A Subject Review." It also builds on existing AAP policy on adverse life events affecting children and resources developed to understand and address childhood trauma. The purpose of this policy statement is to provide background information on some of the legal issues involving children testifying in court, including the accuracy and psychological impact of child testimony; to provide suggestions for how pediatricians can support patients who will testify in court; and to make recommendations for policy improvements to minimize the adverse psychological consequences for child witnesses. These recommendations are, for the most part, based on studies on the psychological and physiologic consequences of children witnessing and experiencing violence, as well as appearing in court, that have emerged since the previous AAP publications on the subject. The goal is to reduce the secondary traumatization of and long-term consequences for children providing testimony about violence they have experienced or witnessed. This statement primarily addresses children appearing in court as victims of physical or sexual abuse or as witnesses of violent acts; most of the scientific literature addresses these specific situations. It may apply, in certain situations, to children required to provide testimony in custody disputes, child welfare proceedings, or immigration court. It does not address children appearing in court as offenders or as part of juvenile justice proceedings.

[The protection of children exposed to intimate partner violence]. / La protection des enfants victimes de violences dans le couple.

Intimate partner violence is one of the most serious forms of abuse inflicted on children. It poses a challenge for professional practices. The protection of the child cannot be separated from that of the parent suffering the abuse, and their safety cannot be assured without an adapted arrangement of the conditions of parental authority.

Correlates of joint child protection and police child sexual abuse investigations: results from the Canadian Incidence Study of Reported Child Abuse and Neglect-2008.

INTRODUCTION: Our study examines the frequency of joint investigations by child protection workers and the police in sexual abuse investigations compared to other maltreatment types and the association of child-, caregiver-, maltreatment- and investigation-related characteristics in joint investigations, focussing specifically on investigations involving sexual abuse. METHODS: We analyzed data from the Canadian Incidence Study of Reported Child Abuse and Neglect-2008 using logistic regression. RESULTS: The data suggest that sexual abuse (55%), and then physical abuse, neglect and emotional maltreatment, are most often co-investigated. Substantiation of maltreatment, severity of maltreatment, placement in out-of-home care, child welfare court involvement and referral of a family member to specialized services was more likely when the police were involved in an investigation. CONCLUSION: This study adds to the limited information on correlates of joint child protection agency and police investigations. Further research is needed to determine the effectiveness of these joint investigations.

TITRE: Corrélats des enquêtes conjointes des services de protection de l'enfance et des services de police sur les abus sexuels d'enfants : résultats de l'Étude canadienne sur l'incidence des signalements de cas de violence et de négligence envers les enfants 2008. INTRODUCTION: Dans cette étude, nous examinons la fréquence des enquêtes conjointes menées par les services de protection de l'enfance et les services de police dans les cas d'abus sexuels en comparaison des autres types de maltraitance. Nous examinons également les associations, dans les enquêtes conjointes, entre les caractéristiques relatives à l'enfant, celles relatives au pourvoyeur de soins de l'enfant, celles relatives aux mauvais traitements eux-mêmes et celles relatives à l'enquête, en nous intéressant plus particulièrement aux enquêtes sur les abus sexuels. MÉTHODOLOGIE: Nous avons analysé par régression logistique les données de l'Étude canadienne sur l'incidence des signalements de cas de violence et de négligence envers les enfants 2008. RÉSULTATS: D'après les données, les enquêtes conjointes portent en premier lieu sur les abus sexuels (55 %), puis sur la violence physique, la négligence et la violence psychologique. La corroboration des mauvais traitements, les mauvais traitements graves, le placement, l'intervention des tribunaux de la jeunesse et l'orientation d'un membre de la famille vers des services spécialisés sont plus fréquents quand les services de police participent à l'enquête. CONCLUSION: Cette étude vient bonifier l'information limitée dont on dispose sur les corrélats des enquêtes conjointes menées par les agences de protection de l'enfance et les services de police. D'autres recherches devront être effectuées pour déterminer l'efficacité de ces enquêtes conjointes.

Alagille syndrome case report: implications for forensic pathology and anthropology.

This case report offers a multidisciplinary interpretation of the violent death of a 4-year-old girl suffering from Alagille syndrome who died after a low-height fall that resulted in temporal bone fracture and a large epidural hematoma. The article evidences the macroscopical and microscopical characteristics of the syndrome, focusing especially on the skeletal findings that emerged during autopsy. In the case report, distinction is made between a possible accidental or non-accidental nature of the injuries and the characteristics of the injury have been interpreted in the light of the existing data on Alagille syndrome. In conclusion, the death was documented as accidental since abnormalities in the skeletal system evidenced during autopsy have predisposed the death of the child albeit through a very mild head trauma. The case report evidences the importance of studying features of skull macro- and microstructure in patients with Alagille syndrome, which have been, until now, underreported in literature and which might contribute to fracture vulnerability in these patients. Although rare, Alagille syndrome is a condition that should be known to forensic medicine practitioners and whose features and peculiarities must be taken into consideration in pediatric autopsy and suspected child abuse cases.