Client evaluation of a consultation team on crimes against children.

OBJECTIVE: Cases of child abuse filed in court as crimes against children represent a small percentage of the total numbers of children maltreated. However, studying crimes of maltreatment against children is important for individual victims and their families, and for theory and policy in order to assure that these cases are managed as well as possible. Forensic consultation teams can perform several functions related to child abuse crimes: provide multidisciplinary expertise in the evaluation of maltreatment cases, offer a method for allocating resources between cases managed by the criminal justice and child protection systems, and provide important research and teaching opportunities. This study reviews the role played by multidisciplinary team consultations based on the perception of client professionals whose agencies pay for an outside consulting forensic team. METHOD: Professionals referring to a forensic team for consultative assistance were asked to evaluate the service during telephone interviews, responding to both structured and unstructured questions. RESULTS: Responding professionals (N= 18) stated that the team increased their confidence that the approach being taken to a case was correct (94%), that missing expertise was provided (100%), that progress was made in cases that might otherwise not have been made (55%), and that ambiguity was reduced (in 83% of referred cases). Using the team sometimes caused delays. Some delays were unacceptable administrative delays while others were considered necessary to assure completeness of the evaluation. CONCLUSION: The use of the team did not result in resolution of all of the cases referred, but referral to the team consistently provided closure for referring professionals. In one-third of the cases studied, if it had not been for the START consultation the cases would not have proceeded to an appropriate criminal or civil resolution.

Legal issues affecting dentistry's role in preventing child abuse and neglect.

Dentists can best help protect children from maltreatment through an understanding of the child protective services process. All dentists are covered under state statutes as mandated reporters of suspected child abuse and neglect. Reporting statutes vary considerably from state to state. All dentists must understand the intricacies of applicable state laws to help identify suspected child maltreatment while protecting themselves from liability.

What have we learned about treating child physical abuse? A literature review of the last decade.

A literature review of articles on treatment of physically abused children and treatment of physically abused parents was undertaken. Only articles that had more than five subjects in the sample, at least 15% of the children in the sample having been physically abused and either pretest, posttest; comparison group; or randomization between different treatments used in the design were selected. Twelve papers meeting these criteria for abusive parents and 13 for treatment of abused children were found. Treatment duration ranged from 4 weeks to 12 months for parents and 4 weeks to 24 months for children. A wide range of treatments were used, the most popular for children being therapeutic daycare, with emphasis on improving developmental skills. While most programs showed some improvement with treatment, many had no, or very short, follow-up to see if improvement was sustained. More emphasis needs to be placed on rigorous evaluation and longer-term follow-up of children in physical abuse treatment programs.

The pediatrician's documentation of child maltreatment.

Pediatricians are increasingly involved in the assessment of suspected child maltreatment. These assessments are a crucial component of the overall evaluation of the patient and provide the basis for interventions to protect the child. An accurate documentation of the pediatrician's assessment is important to convey the information to professionals in the public agencies involved, including the legal system. However, there may be uncertainty among pediatricians concerning what should be documented in the medical record in cases of child maltreatment. The objectives of this article are to provide a detailed but generic description of the information that should be gathered during the evaluation of children who show signs of any form of child abuse and neglect and to provide clear guidelines for the proper written documentation of child maltreatment.

The child protective service worker: a profile of needs, attitudes, and utilization of professional resources.

County child protection units throughout the United States were surveyed to (1) profile the attributes of child protection workers, (2) determine their prevailing attitudes and needs, and (3) assess their access to and utilization of professional literature and consultation resources. Responses were received from 301 child protection workers employed in 33 different states. Respondents were generally depressed about their working conditions, the burden of huge caseloads, and unrealistic expectations of them. Job dissatisfaction was especially prevalent among workers who had been in the field for longer periods of time. Many workers had developed attitudes of resignation to their inability to help clients and had a tendency to avoid client contact. Workers reported doing very little professional reading due to the service requirements of their large caseloads and inaccessibility to journals and other meaningful literature pertinent to the field of child abuse and neglect. The availability of consultation in major specialty areas related to the performance of their child protective duties was frequently inadequate to meet their needs. Participation in formal training prior to first case involvement promoted professional reading and worker confidence in the quality of service provided. Worker job satisfaction and self-perceived professional skills were enhanced by membership in professional associations or societies and membership in or use of multidisciplinary teams. These results suggest the need to further develop national and regional resource centers in support of the practice of child protective service (CPS) workers.

Medical care neglect.

Discussed in sequence in this article are: the information which must pass from doctors to patients in the United States before a medical procedure is legally authorized, the necessity for comparable information to be provided to a judge who is being asked to order medical treatment for a child over objections by parents, the factors likely to influence a judge to order treatment over parental objections, and a process for deciding when the threshold for court intervention has been reached. While the general right of parents to be informed sufficiently and then to give consent for medical procedures, or to refuse to give consent, on behalf of their children is not in question, judges to override parental refusals to agree to care which is lifesaving or prevents severe impairment. An analysis of American law reveals that the factors likely to support court orders for treatment are: sufficient data has been provided for full, informed consent; a very severe prognosis exists if treatment is not provided, for example, death, retardation, paralysis, or blindness; delay is not a reasonable alternative; the medical procedure is not experimental and is likely to succeed; there are few contraindications; the quality of the child's life, given a successful intervention, will be at least of average "quality"; a child who is older consents to the procedure; and there is no strongly conflicting medical opinion. After a thorough discussion of medical factors with parents, court intervention should be considered if it is thought by those involved that no minimally reasonable parent would refuse to consent to treatment under the circumstances.

Reporting of gonorrhea by private physicians: a behavioral study.

Physicians in the Denver Metropolitan Area were randomly assigned to study groups and exposed to an intervention designed to test current hypotheses concerning the reasons for underreporting of gonorrhea (lack of saliency in the request, patient interference, violation of the physician-patient relationship, insufficient rewards and excessive administrative cost to the reporter). A periodic telephone contact, initiated by the Health Department and requiring only contact between clerical personnel, more than doubled the number of reported cases. The effect was most striking for those who had not previously reported, and for doctors who practiced alone. An estimate of 42 per cent was obtained for the proportion of cases reported, substantially higher than that produced by retrospective surveys based on recall. The impact of undernotification on total morbidity will vary with the preexisting mix of public and private reporting. The telephone reporting system appears to be an inexpensive and effective program tool for determining that impact locally.

Gonorrhea in street prostitutes: epidemiologic and legal implications.

Sociodemographic characteristics of a group of street prostitutes in Colorado Springs, Colorado, were determined through retrospective chart review and compared with those of a group of nonprostitute women seen at a venereal disease clinic. Initially, the risk that prostitutes would contract gonorrhea was substantially higher than the risk for other women (31% vs. 21%) but the risks for both groups decreased over the two-year period during which control measures were applied. These measures included use of legal orders, based on the constitutional requirement of "least restrictive alternative." Prostitutes in this setting may well constitute a "core group" of transmitters.