Medicine, mental health and child welfare: "Three different worlds that need to amalgamate".

The past 50 years have witnessed a dramatic change in the morbidity and mortality of many (if not most) pediatric diseases. The primary driver for this improvement has been the billions of dollars invested in research by the National Institutes of Health and hundreds of not-for-profit advocacy groups that have raised awareness and money to support research, treatment, prevention, and advocacy for their cause. Child abuse and neglect is a glaring exception, with no significant improvement in mortality from physical abuse and neglect over the past 50 years. Furthermore, child protection in the U.S., which has been the responsibility of the state and county Child Welfare Departments, have been struggling for at least 30 years and have no data on the quality and outcomes of their services to children and families. This article discusses some of the past failures to address the issue, and suggests that for progress to be made, health, mental health, and child welfare professionals have to be able to work with each other in a way that allows child and families to be free of abuse and neglect. It builds on the recent efforts to embed mental health services and professionals in primary care practices. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

How Experiences of Child Abuse Pediatricians and Lessons Learned May Inform Health Care Providers Focused on Improving Elder Abuse Geriatrics Clinical Practice and Research.

The experience of physicians and other health care providers in child abuse pediatrics in the last six decades includes successes and failures, which can offer critical insights to inform the growing field of health care providers focusing on elder abuse clinical practice and research. We identify and describe in detail relevant lessons learned, including balancing an urgent call to action with a need for robust evidence to support clinical conclusions. We discuss solutions to research challenges, including the lack of a uniform gold standard for abuse diagnosis and how to ethically recruit subjects who may have cognitive impairment and also be crime victims. We offer recommendations on recruiting and training a specialized health care workforce. We make suggestions for health care providers about how to navigate the legal world including issues with expert testimony and also how to participate in policymaking and development of rational systems. We emphasize the importance of developing and supporting partnerships within the field, with allied fields inside and outside medicine, and internationally. We also highlight the value of connecting researchers and clinicians focused on different types of family violence.

Health and public health approach to ending child abuse and neglect.

The 30th anniversary of the United Nations Convention on the Rights of the Child provides an opportunity to reflect on whether the approaches to date in dealing with child abuse and neglect (CAN) have been successful. Initial responsibility in most countries to address CAN has been given to Child Protective Services Agencies. Recently, there have been calls for CPS to take a Public Health Approach in their practice. This paper discusses the potential positive and unintended problems that such a shift in approach might entail.

Ending Gaze Aversion Toward Child Abuse And Neglect.

For more than fifty years, not enough has been done to tackle the national problems of child abuse and neglect.

What does effectiveness mean?: A qualitative assessment of two child protection systems.

BACKGROUND: Child Protective Services (CPS) systems have not historically conducted system effectiveness research. More information is needed about the long-term outcomes of children and families served by the systems. OBJECTIVE: To investigate how workers within CPS systems in Colorado and the Netherlands measure and perceive the effectiveness of their CPS system. PARTICIPANTS AND SETTING: CPS administrators and workers in Colorado and the Netherlands from August 2015 through May 2016. At both sites, interviewees included front line employees with deep knowledge of daily mechanics and processes, as well as experts and thought leaders who possessed historical memory and perspective about their site's CPS system. METHODS: In-depth, semi-structured interviews were conducted with 77 participants. In Colorado (n = 36), 8 participants were state experts and 28 held county-level roles. In the Netherlands (n = 41), 17 participants were national experts and 24 worked at Veilig Thuis agencies. RESULTS: Participants in both sites reported that they did not know if their system had empirical evidence to support its effectiveness, and had difficulty identifying how they would measure the effectiveness of their system. CONCLUSIONS: Both systems lack the ability to collect data on the quality of their services and the longitudinal outcomes for the children and families they serve. Measures of good outcomes must be developed. Without longitudinal outcome data, CPS systems cannot assess the effectiveness of their practice. CPS systems might partner with the healthcare system, where the infrastructure and culture are already in place to look at quality and longitudinal outcomes.

Can we learn civility? Reflections on the challenge of changing culture.

Academic medicine shares the handicap of many hierarchical organizations in that it is difficult for those lower in the hierarchy to speak up when doing so requires challenging their chronologic and administrative elders. Elsewhere in this issue, Dankoski and colleagues offer specific recommendations for combating this "organizational silence," including training and mentorship for junior faculty. In this related Commentary, the authors cite their lack of success with isolated initiatives to address the problem of organizational silence in their own institution. They suggest that nothing short of a comprehensive, visible, high-priority organizational commitment to culture change is likely to be effective in facilitating respectful and candid communication up and down the academic hierarchy. Until the culture of academic medicine affirms that broad input is vital, learners and junior faculty are unlikely to feel safe in expressing concerns, providing feedback, reporting mistreatment or unprofessional behaviors, and offering suggestions for improvement.

Child maltreatment law and policy as a foundation for child advocacy.

Advocacy for children is a fundamental pediatric concern and activity. Notwithstanding achievements for children to date, pediatrics can do more in the twenty-first century to advocate for children and promote research on ways in which advocacy for children can be improved. Evidence-based advocacy should take many directions including legislation, system change in local and state agencies such as social services and health departments, financial assistance including Medicaid, evidence provided to courts at trial and on appeal through "friend of the court" participation, family guidance, public education, and the promotion of pediatric law and bioethics.

The changing face of academic health centers: a path forward for the University of Colorado Denver.

This article describes a decade of major changes at an academic health center (AHC) and university. The authors describe two major changes undertaken at the University of Colorado and its AHC during the past 10 years and the effects of these changes on the organization as a whole. First, the AHC's four health professional schools and two partner hospitals were completely relocated from a space-limited urban campus to a closed Army base. The impact of that change and the management of its potential disruption of academic programs are discussed in detail. In the middle of this total relocation, the AHC campus was consolidated with a general academic campus within the University of Colorado system, compounding the challenge. The authors describe the strategies employed to implement this major consolidation, including changing the organizational structure and selecting the new name of the university--the University of Colorado Denver.

The new University of Colorado medical school curriculum: a pediatric perspective.

The University of Colorado School of Medicine has developed an innovative 4-year undergraduate curriculum. As a strong advocate for education and curriculum reform, Dr M. Douglas Jones Jr. created an environment for pediatrics to flourish in this new curriculum. Pediatric content has increased in all years of the curriculum, and pediatric faculty have had greater opportunities to teach and seek career development in medical education. In this report, we review the process that led to curriculum reform, provide an overview of the new curriculum design, and highlight examples of the positive impact this process has had on education in pediatrics. We hope that sharing our experience, may benefit others in medical education.

Medicolegal aspects of child abuse and neglect.

Neurosurgeons that see children and care for those with traumatic injury are highly likely to see cases of child abuse and neglect. That fact makes it inevitable that they will encounter the legal system. It is hoped that this article has demystified the legal process and systems that one encounters in day-to-day practice. Avoiding the diagnosis of abuse because of lack of knowledge or phobia of the legal system is hazardous to the health and well-being of children.