ABSTRACT
Presented at the Pediatric Academic Societies annual meeting, May 2004
See
No Evil: Education and Experience in Child Abuse
E Flaherty1, LL Price2, R Wasserman3,4, M Trowbridge2, K OConnor5 and R Sege2. 1Pediatrics, Children�s Memorial Hospital/NWU, Chicago, IL; 2Ped Adol Hlth Res Ctr, Floating Hospital for Children/Tufts-NEMC, Boston, MA; 3Pediatrics, U of VT, Burlington, VT; 4Pediatric Research in Office Settings (PROS), Department of Practice and Research; American Academy of Pediatrics, Elk Grove Village, IL and 5Division of Health Policy Research, American Academy of Pediatrics, Elk Grove, IL.
Background: Pediatricians in practice face difficult decisions when assessing whether a particular injury may have resulted from child abuse; few reports exist concerning actual pediatric experience.
Objective: Describe practicing pediatricians experience and confidence identifying and managing child abuse.
Design/Methods: AAP Periodic Survey was mailed in 2003 to a random sample of 1603 U.S members; 851(53%) responded. Data from the 668 pediatricians providing direct patient care were analyzed. Survey items included demographic information; career experience with child abuse; previous years experience identifying and reporting suspected child abuse; and Likert scale items measuring attitudes and experiences surrounding child abuse management. Child abuse CME in the past 5 years and a pediatricians self-confidence score were used to evaluate factors affecting physician reporting and identifying child abuse.
Results: About half (46%) of the respondents had seen 1 child with an injury caused by physical abuse in the past year; 91% reported having seen at least one child abuse injury in their careers. The 58 pediatricians who said they had never seen a child with suspicious injuries were less likely to have received any education about child abuse (p=.006) and less confident in their ability to manage child abuse (p=.009) than their colleagues who had seen an abused child. Most (63%) believed their report to child protective services resulted in protecting the child from further harm. The 451 physicians who received some education about abuse expressed more confidence in their ability to identify and manage child abuse (p=<.0001) than the 127 pediatricians who had not received education. Fifteen physicians did not report all suspicious injuries to child protective services. The most common reasons given for not reporting were uncertainty as to the injury being caused by abuse and the perception that they could work with the family to solve problems without outside intervention.
Conclusions: Most practicing pediatricians have experience caring for abused children and believe CPS reports benefit children. Those physicians who report they have never seen a child abuse case have lower self-confidence in the diagnosis of child abuse, and are less likely to have taken relevant CME programs. Improved education may result in better recognition of child abuse.