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Background: Child maltreatment (CM) encompasses physical, emotional or sexual abuse, physical or emotional/psychological neglect or intimate partner (or domestic) violence and is associated with adverse cognitive, behavioural, physical and social outcomes that often continue shaping adulthood. The early and valid detection of CM is essential to initiate treatment and intervention as well as to avoid continued violence against the child. Various occupational groups, such as healthcare providers, teachers, social workers, psychotherapists and others, encounter maltreated children in their professional settings. Systematic reviews on instruments to assess suspected CM often report on retrospective measurement via caregiver's or child's self-report and are frequently limited to the health system as a setting. The purpose of this Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review is to synthesise the evidence on psychometric properties of instruments to assess suspected CM at the presentation to a broad range of different occupational groups who work with children inside and outside the healthcare system., Method: A systematic search will be performed in Scopus, PsycInfo, Medline and Web of Science with no limit on the earliest publication until January 2022. Eligibility criteria include studies that investigate psychometric properties of instruments to assess suspected CM in children and adolescents under 18 years by a professional proxy. After the independent screening of studies by two reviewers, quality assessment and data extraction will be performed using an adaptation of the COnsensus-based Standards for the selection of health Measurement INstruments Risk of Bias checklist, Strengthening the Reporting of Observational Studies in Epidemiology: Explanation and Elaboration report and Downs and Black checklist for measuring study quality. Screening, quality assessment and data extraction will be done using Covidence. The results will be presented in narrative form and, if adequate, a meta-analysis will be performed., Discussion: This review aims to give an overview of the psychometric properties of different instruments designed to screen suspected CM by professional proxies. The results will be of interest to different occupational groups who need information about methodological quality and characteristics of instruments to make decisions about the best-suited tool for a specific purpose. Furthermore, the results of this review will support the development of novel instruments and might improve the existing ones., Ethics and Dissemination: Ethics approval will not be required. The results of this systematic review will be submitted for publication in a peer-reviewed journal., Prospero Registration Number: CRD42022297997., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Child maltreatment (CM) is associated with adverse cognitive, behavioural, physical and social outcomes that often continue until adulthood. Systematic reviews on mediators and moderators of this relationship mostly investigate childhood adversities in general or only with regard to an adult population, single outcomes or single forms of maltreatment. The purpose of this review is to synthesise the evidence of variables that mediate and/or moderate the relationship between CM and diverse outcomes., Method: A systematic search will be performed in Scopus, PsychInfo, Medline and Web of Science until January 2022. Eligibility criteria include children under 18 years who have been maltreated and experienced adverse outcomes until the age of 21, moderators and/or mediators that influence the relationship between maltreatment and adverse outcomes must belong to the individual level and be amenable to change. After independent screening of studies by two reviewers, data extraction and study quality of included studies will be done using adapted checklists of similar reviews, the Strengthening the Reporting of Observational Studies in Epidemiology report, the COnsensus-based Standards for the selection of health Measurement INstruments checklist and Downs and Black Checklist. The results will be presented in narrative form and, if adequate, meta-analysis., Ethics and Dissemination: Ethics approval will not be required. The results of this systematic review will be submitted for publication in a peer-reviewed journal., Prospero Registration Number: CRD42022297982., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Limited data are available on cases presenting for triage by child abuse specialists, particularly data combining patient demographics with presenting concerns and outcomes. This study aims to provide a descriptive analysis of cases presenting to one child abuse medical subspecialty team. Data were collected for all referrals triaged by the Child Protection Program, a child abuse team located within an academic children's medical center. The program triaged a total of 928 cases and completed 345 in-person visits with a medical provider. Nearly, half of all provider visits were for evaluation of children aged 3 years and younger (51%) and for a concern of physical abuse (49%). Of these visits, 26% were determined to be consistent with an accident or medical condition. This descriptive analysis highlights the burden of child abuse cases presenting to one small hospital-based child abuse program, as well as the structural and financial challenges faced by these programs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Health and allied health professionals are uniquely positioned to collaborate in prevention, early intervention and responses to child maltreatment. Effective collaboration requires comprehensive interprofessional education (IPE), and inadequate collaboration across sectors and professions continually contributes to poor outcomes for children. Little is known about what interprofessional preparation health and allied health professionals receive before initial qualification (preservice) that equips them for interprofessional collaboration and provision of culturally safe care in child protection. This scoping review aimed to identify what is known internationally about IPE in child protection for preservice health and allied health professionals. Thirteen manuscripts reporting 12 studies met the inclusion criteria and were included in the synthesis. Key characteristics of the educational interventions are presented, including target disciplines, core content and their learning objectives and activities. Findings demonstrated primarily low-quality methodologies and educational interventions that had not been replicated beyond their initial context. Many educational interventions did not provide comprehensive content covering the spectrum of prevention, early intervention and responses for all types of child maltreatment, and/or did not clearly indicate how IPE was achieved. Key challenges to delivering comprehensive interprofessional child protection include lack of institutional support and competing priorities across disciplines who must meet requirements of separate regulatory bodies. Consequently, there is a need for further development and robust evaluation of educational interventions to explore how interprofessional collaborative skills for child protection can be developed and delivered in preservice health and allied health professional education., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Early childhood development is influential for life course capability. Children exposed to child maltreatment and at high risk of harm may be removed for their safety, but the effect on child development is uncertain., Objectives: To assess developmental vulnerability at school commencement across five developmental domains to ascertain whether removal of children with substantiated maltreatment to foster/kinship care is likely protective, or not, of developmental vulnerabilities., Methods: The study drew on linked-data for a South Australian population birth cohort (2003 to 2014) N = 74,751. For children exposed to substantiated child maltreatment meeting study criteria (N = 2011, mean age = 5.7 years, 50.7 % boys), the effect of placement in foster/kinship care (N = 666) on developmental vulnerability was explored using generalized linear models, adjusted for child and family covariates, maltreatment severity and propensity score., Results: Children placed in care had a reduced risk of developmental vulnerability on the Physical Health and Wellbeing (aRR = 0.73 [0.64, 0.84]), Language and Cognitive Skills (school based) (aRR = 0.79 [0.68, 0.92]), and Communication Skills and General Knowledge (aRR = 0.81 [0.70, 0.94]) domains, compared to children who were not removed. However, these children had increased risk of vulnerability on Social Competence (aRR = 1.14 [1.01, 1.29]) and Emotional Maturity (aRR = 1.20 [1.05, 1.37]) domains., Conclusions: These findings suggest placement in out-of-home care supported physical health and wellbeing, communication and cognitive but not social and emotional early childhood development. These results highlighting the need for professional therapeutic support for children in care and better attending to the physical development, communication and cognitive skills in maltreated children remaining at home., Competing Interests: Declaration of competing interest The other authors have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Paediatricians perform medical assessments for children in cases of suspected child maltreatment. Due to their role with statutory child protection agencies and police, paediatricians may be asked to testify in court about child protection and criminal justice matters. To the authors' knowledge, there has been no previous systematic review of the literature synthesising the evidence on the impacts on paediatricians testifying in cases of child maltreatment., Methods and Analysis: A search strategy comprising indexed and key terms will be applied to six electronic reference databases from inception to May 2023: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts and Cochrane Library. Two reviewers will independently screen titles and abstracts and full-text articles against predefined eligibility criteria to identify studies of interest. Conflicts will be independently adjudicated by a third reviewer., Ethics and Dissemination: Since the systematic review methodology aims at synthesising information from available publications, this study does not require ethical approval. An article reporting the results of the systematic review will be submitted for publication in a scientific journal, presented at relevant conferences and used in subsequent stakeholder consultations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To examine the characteristics of patients visiting the pediatric emergency department (PED) for unintentional ingestions and associations between patient race and ethnicity in referrals to Child Protective Services (CPS) for supervisory neglect., Methods: We conducted a cross-sectional analysis of children <12 years old who presented to the PED between October 2015 and December 2020 for an unintentional ingestion. Patients were identified by searching the electronic health record for diagnosis codes corresponding to unintentional ingestions. Patient demographics, ingestion type, disposition, and referrals to CPS were abstracted by manual chart review. Logistic regression models were used to evaluate associations between patient demographics and visit characteristics with referral to CPS., Results: We identified 129 PED encounters for unintentional ingestions that were included for analysis. Overall, 22 patients (17.1%) were referred to CPS for neglect. In the univariate analysis, both ingestion of an illicit drug and arrival to the PED by ambulance were associated with a higher odds of referral to CPS. In the multivariable model adjusted for parent language, ingestion type, and mode of arrival to the PED, Hispanic patients had higher odds of referral to CPS than White patients (adjusted odds ratio (aOR) = 17.2, 95% confidence intervals [1.8-162.3], P = .03). There was not a statistically significant association between Black race and referral to CPS., Conclusions: Referrals to CPS from the PED after unintentional ingestions are common and disproportionally involve Hispanic patients. More research is needed to promote equitable child maltreatment reporting for children presenting to the PED following unintentional ingestions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

The British Society of Paediatric Dentistry's (BSPD) first policy document on dental neglect was published online in 2009. It proposed a new original definition of dental neglect, discussed the identification of dental neglect and recommended adopting a tiered response, with three stages of intervention according to level of concern. Furthermore, it detailed how the dental team should both contribute to the child protection process and implement wider measures to safeguard and promote children's welfare. Since 2009, these concepts have been widely adopted in the UK and beyond. Furthermore, there have been significant advances in both research and practice. Policy documents produced by the BSPD represent a majority view, based on the consideration of currently available evidence, and are tailored to a UK working environment. Although this updated document's recommendations remain broadly unchanged, this version reflects the professions' progress in understanding dental neglect and minor updates to terminology and, following a consultation process, has been amended to address the needs of two main audiences-dental professionals and nondental health and social care professionals-in order to enhance interdisciplinary working., (© 2023 The Authors. International Journal of Paediatric Dentistry published by BSPD, IAPD and John Wiley & Sons Ltd.)

The COVID-19 pandemic and associated public health 'stay at home' restrictions have intensified familial risk factors. Children would appear to be at increased risk of harm and abuse, yet administrative data from the early months of the pandemic showed falling cases of child maltreatment. Using weekly administrative data from Scotland, UK that span the first 17 months of the pandemic, this article found that child maltreatment activity levels fluctuated as 'stay at home' restrictions changed. During lockdown periods, the number of children subject to Inter-agency Referral Discussion fell but a higher number of children were placed on the Child Protection Register. When restrictions were eased, the number of Inter-agency Referral Discussions increased but the number of children placed on the Child Protection Register fell. To explain the fluctuations, the article asserts that the pandemic's impact on services' ability to engage directly with children and families has been critical, but the limitations of administrative data in providing an accurate measure of child maltreatment levels also need to be recognised. The article advocates that analysis of administrative data is best done in tandem with wider quantitative and qualitative sources in order to understand the impact of crisis events on children and families., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study investigated whether statewide delivery of the wraparound service model (WSM) improved child and caregiver outcomes and reduced subsequent child protective service (CPS) contact among families referred to services following a CPS report. Caregivers ( n = 247) completed baseline and 6-month interviews to document self-reported engagement in WSM and non-WSM conditions and assess changes in outcomes. Kernel-weighted difference-in-difference (K-DID) models were used to assess program effects, based on reported condition. Child behavior outcomes improved among WSM-engaged families, but differences by condition were non-significant except for internalizing behaviors. Caregiver receipt of WSM was associated with greater retention of behavioral health services, but did not produce statistically significant improvements in their wellbeing. Households in the WSM condition were more likely to be reported to CPS at 6-month follow-up, but this difference was not significant at 12 months and differences in substantiation were not statistically significant. Supplemental analyses compared alternative means of contrasting group effects, highlighting some differences based on method. The WSM produced few significant differential improvements in child or caregiver outcomes and failed to prevent future CPS involvement. Inadequate program fidelity appeared to be a factor in implementation of the WSM, which may have hampered program effectiveness under real-world conditions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: While the factors commonly associated with an increased risk of child maltreatment (CM) were found to be increased during COVID-19, reports of actual maltreatment showed varying trends. Similarly, evidence regarding the impact of COVID-19 on CM within the European Cooperation on Science and Technology and Network Collaborative (COST) Action countries remains inconsistent. This scoping review aims to explore the extent and nature of evidence pertaining to CM within the countries affiliated with the Child Abuse and Neglect in Europe Action Network (Euro-CAN), funded by the COST., Methods and Analysis: Key electronic databases were searched to identify eligible papers, reports and other material published between January 2020 and April 2023: PubMed, EMBASE, PsycINFO, Social Policy and Practice, Scopus and Web of Science. To cover the breadth of evidence, a systematic and broad search strategy was applied using a combination of keywords and controlled vocabulary for four concepts: children, maltreatment, COVID-19 and Euro-CAN countries, without restrictions on study design or language. Grey literature was searched in OpenGrey and Google Scholar. Two reviewers will independently screen full-text publications for eligibility and undertake data extraction, using a customised grid. The screening criteria and data charting will be piloted by the research team.The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews will be followed to present the results. Results will be summarised in a tabular form and narratively., Ethics and Dissemination: This review will identify and summarise publicly available data, without requiring ethical approval. The findings will be disseminated to the Euro-CAN Network and reported to the COST Association. They will also be published in a peer-reviewed journal. This protocol is registered on Open Science Framework., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Child Sexual Abuse (CSA) is widespread and pervasive in Pakistan, presenting a significant threat to a child's physical health, psychological well-being, and overall development. This study aimed to empirically substantiate the understanding of parents regarding CSA and their utilized preventive strategies. The study utilized Social Ecological Theory to gain a deeper comprehension of the phenomenon. Data was collected through in-depth semi-structured interviews with 18 parents from Islamabad capital city, using a qualitative phenomenological research approach along with thematic analysis. Results reveal that most of the parents were highly aware of the most common aspects of sexual assault and molestation, but they were unaware of the more manipulative subtle forms such as "grooming." Additionally, they had a limited understanding of the long-term consequences of sexual abuse. While many parents knew about the option of involving the police in cases of abuse, they were unaware of helpline services and the availability of psychological support. In terms of prevention, most parents employed an integrated approach involving various preventive measures, such as educating their children about appropriate and inappropriate touch. These findings underscore the importance of implementing public-focused initiatives and community-based programs to enhance parental awareness, knowledge, and capabilities in preventing CSA in Pakistan.

Background: Increases in child welfare investigations involving children's exposure to intimate partner violence (IPV) in Ontario are likely the result of three factors: 1) changes to legislation, policy, and assessment instruments; 2) increased awareness of the risks of exposure to IPV for children, and 3) referrals from professionals (e.g., police)., Objectives: Using data from 6 cycles of the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) (1993, 1998, 2003, 2008, 2013, and 2018), this paper will examine the changes of the incidence rates of IPV exposure, providing important context for a type of investigation that is not well understood in Ontario., Methods: The incidence of investigations where the primary concern of the investigating worker is IPV was derived and compared across OIS cycles. Investigation were compared across cycles using incidence counts., Results: After the nearly 2-fold increase of investigations for all maltreatment types in Ontario between 1998 and 2003, IPV investigations are the only type that continue to increase. There is a growing gap between these investigations and substantiating child maltreatment. Rates of placement have not changed over time, remaining low. Rates of transfers and referrals have increased but not significantly., Conclusions: The continued growth in the rate of child welfare investigations involving exposure to IPV as well as the overwhelming endorsement of substantiated exposure to IPV, while maintaining the same proportion of transfers to ongoing child welfare services and low placement rates, is a significant concern for Ontario., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background and Objective: Simulation models are an important tool used in health care and other disciplines to support operational research and decision-making. In the child protection literature, simulation models are an under-utilized source of research evidence., Participants and Setting: In this paper, we describe the rationale for and the development of an agent-based simulation of a child protection system in the US. Using the investigation, prevention service, and placement histories of 600,000 children served in an urban child welfare system, we walk the reader through the development of a prototype known as OSPEDALE., Methods: The governing equations built into OSPEDALE probabilistically simulate the onset of investigations. Then, drawing from empirical survival distributions, the governing equations trace the probability of subsequent interactions with the system (recurrence of maltreatment, service referrals, and placement) conditional on the characteristics of children, their assessed risk level, and prior child protection system involvement., Results: As an initial test of OSPEDALE's utility, we compare empirical admission counts with counts generated from OSPEDALE. Though the verification step is admittedly simple, the comparison shows that OSPEDALE replicates the empirical count of new admissions closely enough to justify further investment in OSPEDALE., Conclusions: Management of public child protection systems is increasingly research evidence-dependent. The emphasis on research evidence as a decision-support tool has elevated evidence acquired through randomized clinical trials. Though important, the evidence from clinical trials represents only one type of research evidence. Properly specified, simulation models are another source of evidence with real-world relevance., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Child maltreatment affects a substantial number of children. However current evidence relies on either longitudinal studies, which are complex and resource-intensive, or linked data studies based on social services data, which is arguably the tip of the iceberg in terms of children who are maltreated. Reliable, linked, population-level data on children referred to services due to suspected abuse or neglect will increase our ability to examine risk factors for, and outcomes following, abuse and neglect., Objective: The objective of this project was to create a linkable population level dataset, The Edinburgh Child Protection Dataset (ECPD), comprising all children referred to the Edinburgh Child Protection Paediatric healthcare team due to a concern about their welfare between 1995 and 2015., Methods: The paper presents the process for creating the dataset. The analyses provide examples of available data from the main referrals dataset between 1995 and 2011 (where data quality was highest)., Results: 19,969 referrals were captured, relating to 11,653 children. Of the 19,969 referrals, a higher proportion were girls (54%), although boys were referred for physical abuse more often than girls (41% versus 30%). Younger children were more likely to be referred for physical abuse (35% of 0-4 year olds vs. 27% 15+): older children were more likely to be referred for sexual abuse (48% of 15+ years vs. 18% of 0-4 years). Most referrals came from social workers (46%) or police (31%)., Conclusions: The ECPD offers a unique insight into the characteristics of referrals to child protection paediatric services over a key period in the history of child protection in Scotland. It is hoped that by making these data available to researchers, and able to be easily linked with both mother and child current and future health records, evidence will be created to better support maltreated children and monitor changes over time., Competing Interests: Conflicts of interests: None declared.

Introduction: Child maltreatment (CM) is a complex global public health issue with potentially devastating effects on individuals' physical and mental health and well-being throughout the life course. A lack of uniform definitions hinders attempts to identify, measure, respond to, and prevent CM. The aim of this electronic Delphi (e-Delphi) study is to build consensus on definitions and types of CM for use in surveillance and multi-sectoral research in the 34 countries in the Euro-CAN (Multi-Sectoral Responses to Child Abuse and Neglect in Europe) project (COST Action CA19106)., Methods and Analysis: The e-Delphi study will consist of a maximum of three rounds conducted using an online data collection platform. A multi-disciplinary expert panel consisting of researchers, child protection professionals (health and social care), police, legal professionals and adult survivors of CM will be purposefully recruited. We will approach approximately 100 experts, with between 50 and 60 of these anticipated to take part. Participants will rate their agreement with a range of statements relating to operational definitions and types of CM, and free-text comments on each of the statements to give further detail about their responses and areas of uncertainty. Consensus has been defined a priori as ≥70% of the panel agreeing or disagreeing with the statement after the final round. The responses to the open-ended questions will be analysed using a 'codebook' approach to thematic analysis, and used to refine the statements between rounds where no consensus is reached., Ethics and Dissemination: Ethical approval has been granted from the Cardiff University School of Medicine ethics committee (reference number SMREC22/96). Results will be submitted for publication in a peer-reviewed journal and presented at workshops (including for the participants) and international academic conferences. The Euro-CAN network will also be used to disseminate the results, with results briefings and presentations to key public health and other relevant organisations in the field., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To explore how public health nurses in child and family health centres experience detecting and preventing child maltreatment., Design: Qualitative study., Methods: Fourteen semi-structured individual interviews with public health nurses who worked in 11 different child and family health centres were conducted. The interviews were analysed using thematic analysis., Results: Three themes were identified: (i) integrating knowledge to prevent child maltreatment as part of their everyday job, (ii) striving hard to detect child maltreatment and (iii) experiencing the assignment to be complex and demanding., Conclusion: Despite extensive experience, knowledge and following the guidelines, public health nurses in this study had difficulties finding children exposed to child maltreatment in child and family health centres. Public health nurses called for mutual multidisciplinary cooperation with other services and organizational facilitation, such as enough time and clear guidelines to effectively address this issue., Implications for Practice: This study provides knowledge about how public health nurses work with child maltreatment at the Child and Family Health Center, which can serve as valuable foundation for further research as well for collaborating services., Reporting Method: EQUATOR guidelines were followed, using the COREQ checklist., Patient or Public Contribution: No patient or public contribution., (© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Despite the recognition of emotional abuse (EA) as the most pervasive and harmful of all forms of child maltreatment, it is argued to be less understood than other forms of child maltreatment. EA is regarded as a standalone form for maltreatment and an essential factor embedded in all other forms of maltreatment of children, such as physical and sexual abuse. Thus, it is crucial for child welfare workers to understand EA, as one of their core mandates is to prevent and protect children from all forms of maltreatment., Objective: This study aims to explore how child welfare workers in Norway describe and understand EA., Participants and Setting: The study included 24 child welfare workers in 6 child welfare offices in Norway., Methods: The data were obtained from focus group interviews and analyzed using reflexive thematic analysis., Results: Overall, the findings reveal that EA was unfamiliar to the child welfare workers, and that there is a low degree of awareness on EA among the study participants. Further, EA is closely connected to whether parents provide sufficient emotional care for their children and is understood as part of the complex situation surrounding the child., Conclusions: This article concludes with the need for reflective and sensitive discussions regarding understanding and awareness of EA in child welfare work. This has the potential to lead to greater insights into how EA is understood by child welfare workers as well as to enhance child welfare workers' abilities to describe, communicate about, and document EA., Competing Interests: Declaration of competing interest None., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic., Objective: To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19., Participants and Setting: All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021., Methods: Using linked medical record and CPS administrative data, interrupted time series models tested for changes in monthly counts and percentages of CM medical encounters reported to CPS with the onset of COVID-19. Logistic regression tested for the likelihood of a CPS report being associated with a CM encounter., Results: CM medical encounters totaled 2528, including 793 after the onset of COVID-19. Interrupted time series models indicated with the onset of the pandemic, the counts of CM encounters increased 18 % (RR: 1.18, 95 % CI 1.03-1.34) and the percentages reported to CPS increased 10 % (RR: 1.10, 95 % CI: 1.05-1.17). CM encounters that occurred after the onset of the COVID-19 pandemic had increased odds of a CPS report (fully adjusted model: OR: 1.08; 95 % CI: 1.05-1.12)., Conclusions: This study found increases in monthly counts and a higher percentage of CM medical encounters with CPS reports after the pandemic onset., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To describe characteristics of suspected child abuse and neglect (CAN) cases associated with the decision of paediatric departments (PDs) in Vienna, Austria, to involve services of a regional tertiary child protection service programme (Forensische Kinder- und JugendUntersuchungsStelle, FOKUS)., Design: Retrospective cohort analysis of a regional data collection of CAN cases over the first 2 years of FOKUS's operational period (1 July 2015-30 June 2017)., Setting: All CAN cases reported to the PDs of six public hospitals in Vienna. Five of these public hospitals were secondary heath care centres and one was a tertiary healthcare centre., Results: Overall, 231 cases (59.1%) were treated without and 160 (40.9%) with additional involvement of the FOKUS service programme. The odds of a case to be treated without FOKUS involvement were higher if neglect was suspected (OR 3.233, 95% CI 2.024 to 5.279). In contrast, when sexual abuse was suspected, the odds for involvement with FOKUS were significantly higher (OR 7.577, 95% CI 4.580 to 12.879). The odds of being managed with FOKUS services nearly doubled when multiple forms of abuse were suspected (OR 1.926, 95% CI 1.136 to 3.285). The odds for additional FOKUS involvement were significantly lower for patients treated as inpatients (OR 0.239, 95% CI 0.151 to 0.373). CAN patients managed with FOKUS involvement were significantly more often reported to law enforcement (LE) (OR 3.234, 95% CI 2.078 to 5.002). Concurrently, suspected sexual abuse cases and cases reported to LE were more frequently treated in the PD of the tertiary centre than in other PDs (χ 2 p<0.001)., Conclusion: CAN case characteristics significantly influenced if PDs involved a tertiary child protection programme. Suspected sexual abuse, if more than one form of CAN was suspected and cases reported to LE required additional specialist expertise. For suspected neglect involvement of tertiary services seemed less important., Competing Interests: Competing interests: GO: Payment for expert testimony: Uppsala University Children’s Hospital; Uppsala, Sweden, bills for certain cases of expert child abuse consultation and testimony in court., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Experiences of Violence During Inpatient Child and Adolescent Psychiatric Treatment: An Explorative Study with Implications for Child Protection Abstract. Objective: Educational and medical institutions care for children and adolescents by providing supervision, schooling, education, therapy, and protection. Nevertheless, children in institutional care are exposed to potential danger through maltreatment and abuse. Method: As part of the establishment of the protection concept at the University Hospital for Child and Adolescent Psychiatry in Würzburg, a retrospective patient survey was conducted. The study population consisted of former inpatient clients from 2006 and 2007, who at the time of the catamnesis were of legal age. The survey was conducted by mail. In addition to items on their experiences of violence, the questionnaire included established scales to assess treatment satisfaction and quality of life (FBB-K, WHO-BREF). Results: Of 568 former patients, 87 (15.3 %) provided valid responses (59 female, mean age at the time of the survey: 24.5 years): 35 former patients (40.2 % of the participants) reported experiences of violence during their inpatient treatment (26 victims only, 7 experiences as victims and perpetrators, and 2 perpetrators only). Experiences as victims mainly included emotional violence (34.5 %), but also physical (5.7 %) and sexual violence (10.3 %). Conclusion: We found a significant correlation between experiences of violence, on the one hand, and retrospective treatment satisfaction and current quality of life, on the other hand. The results of the survey underline the importance of establishing protection concepts in clinics and other institutions.

Objectives: To assess the validity of an International Classification of Diseases (ICD) code based definition of non-fatal head trauma caused by child abuse (abusive head trauma) for population surveillance in New Zealand., Design: A retrospective cohort study of hospital inpatient records., Setting: A tertiary children's hospital in Auckland, New Zealand., Participants: 1731 children less than 5 years of age who were discharged after a non-fatal head trauma event over a 10-year period from 1 January 2010 to 31 December 2019., Outcome Measures: The outcome of assessment by the hospital's multidisciplinary child protection team (CPT) was compared with the outcome of ICD, Tenth Revision (ICD-10) discharge coding for non-fatal abusive head trauma (AHT). The ICD-10 code definition of AHT was derived from an ICD, Ninth Revision, Clinical Modification definition developed by the Centers for Disease Control, Atlanta, Georgia, which requires both a clinical diagnosis code and a cause-of-injury code., Results: There were 1755 head trauma events with 117 determined as AHT by the CPT. The ICD-10 code definition had a sensitivity of 66.7% (95% CI 57.4 to 75.1) and specificity of 99.8% (95% CI 99.5 to 100). There were only three false positives but 39 false negatives, with 18 of the false negatives coded with X59 (exposure to unspecified factor)., Conclusions: The ICD-10 code broad definition of AHT is a reasonable epidemiological tool for passive surveillance of AHT in New Zealand but it underestimates the incidence. Its performance could be improved by clear documentation of child protection conclusions in clinical notes, clarifying coding practice and removing the exclusion criteria from the definition., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Violence, abuse and neglect constitute major threats to children's health and wellbeing globally. However, until recently, relatively little systematic attention has been paid to the role of faith communities in shaping the protective environment for children. This paper describes the development of a measure to capture child-protective disposition amongst faith communities through field studies with faith leaders and their spouses in Senegal, Uganda and Guatemala. Identifying common factors related to child care and protection practices, orientation to child rights and approaches to discipline, the measure potentially serves to both inform and evaluate interventions seeking to engage with the beliefs and behaviours of faith communities to support children's health and wellbeing., (© 2022. The Author(s).)

Background: Child protective services (CPS), or their equivalent, have statutory power to remove children from birth parents in instances of child abuse, neglect, or concerns around parenting capacity via public family care proceedings. Parents who have children subject to proceedings, 'birth parents', often have complex health and social care needs., Objective: We aimed to review what is known about the health needs of birth parents and the interventions implemented to support these health needs., Methods: We searched PubMed, Scopus, and grey literature using a systematic strategy of key concepts "health", "care proceedings", and "parents". We included all publications in English that reported parental health in the context of care proceedings from the 1st of January 2000 to the 1st of March 2021., Results: Included studies (n = 61) reported on maternal health (57 %) or the health of both parents (40 %), with only one study reporting on fathers alone. We conceptually categorised parental health need (n = 41) into i) mental health, ii) physical health, iii) substance misuse, iv) developmental disorders, and v) reproductive health. Health inequities and poor access to services were described across all categories, with longstanding issues often pre-dating proceedings or the child's birth. All interventions supporting parental health (n = 20) were targeted at mothers, with some supporting fathers (n = 8), formally or informally. We grouped similar interventions into three types: alternative family courts, wrap-around services, and specialist advocacy/peer support., Conclusions: Parents who have children subject to care proceedings have complex health needs that pre-date CPS concerns. The studies included in our review strongly suggest that health issues are exacerbated by child removal, triggering deteriorations in mental health, poor antenatal health for subsequent pregnancies, and avoidable mortality. Findings highlight the need for targeted and timely intervention for parents to improve whole-family outcomes. There are models that have been designed, implemented, and tested using relationship-based, trauma-informed, multidisciplinary, family-focused, and long-term approaches., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Burns are common childhood injuries and 10-20% are associated with maltreatment. This prospective before/after study investigated the impact of introducing the BuRN-Tool (a child maltreatment clinical prediction tool), on actions taken by children's social care department (CSC). Before introduction (pre-intervention): we collected standardised data on cause and characteristics of burns, in four regional hospitals. A BuRN-Tool-score was calculated retrospectively pre-intervention and by the attending clinician post-intervention. CSC involvement and actions taken relative to BuRN-Tool-score were compared pre- and post-BuRN-Tool. Data were collected for 1688 children from 17 local authorities. The percentage that received a CSC action decreased post-BuRN-Tool (pre: 58.0%, 51/88; post: 37.5%, 33/88, p = 0.007). A greater percentage of cases with a BuRN-Tool-score of ≥ 3 had a CSC action, than those with a BuRN-Tool-score 3, pre-intervention (≥3 70.0%, 35/50; = 0.04) and post-intervention (≥3 50.0%, 21/42; = 0.01). Children with a BuRN-Tool-score ≥ 3 but no contact/referral recorded by CSC for the burn, and those who had a contact/referral but no action taken, were significantly more likely than those scoring 3 to have new CSC involvement within six months following the burn. The BuRN-Tool-score ≥ 3 has the potential to alert clinicians to maltreatment concerns., Competing Interests: Declarations of interest None., (Copyright © 2022 Elsevier Ltd and ISBI. All rights reserved.)

During the COVID-19 lockdown, social isolation from school closures and home visitation restrictions compounded known risk factors for child maltreatment. The aim of our study was to determine the incidence and types of child protection concern (CPC) among inpatients during the COVID-19 lockdown compared to the matched timeframe in 2019. We retrospectively reviewed the CPC assessments performed at Children's Health Ireland at Crumlin and Tallaght from March 13 to August 31, 2020, and the same period in 2019. Eighty-six versus 163 inpatients were assessed for CPC in 2020 versus 2019. Higher proportions of physical abuse concerns (52.3% versus 11% (p < 0.001)) and emotional abuse concerns (7.0% versus 1.2% (p = 0.015)) were observed in 2020. Case complexity, defined as involving two or more types of CPC, increased with 48.8% in 2020 versus 13.5% in 2019 (p < 0.001). In conclusion, there were fewer assessments for CPC during the 2020 lockdown. However, the complexity of the CPC cases was significantly increased in 2020., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Child abuse and neglect (CAN) is a global phenomenon that takes many forms, with child neglect being the most common. CAN comprises serious incidents with medicolegal implications for the caregivers. The recognition of CAN is still in its early stages in Middle Eastern cultures, including in Oman, where parental authority over children is traditionally sacrosanct. This case series presents nine serious incidents from a regional hospital in Oman from 2020-2021 that appear to fulfil the definition of child neglect. All cases were diagnosed by the Suspected Child Abuse and Neglect (SCAN) team. This article provides evidence that child neglect exists in Oman and has resulted in the death of some children while causing significant physical, psychological and social sequelae in others. It also addresses risk factors and provides recommendations for management. Furthermore, the experience of the SCAN team and limitations of the current Child Protection Services in Oman are highlighted., (© Copyright 2023, Sultan Qaboos University Medical Journal, All Rights Reserved.)

Background: As part of an effort to rigorously apply behavioral science to child protection efforts, a behavior change model called Nurturing Care Groups (NCGs) was tested for effectiveness in changing child abuse and corporal punishment behaviors., Objective: The primary research question was to what degree NCGs could change child protection knowledge, attitudes, and practices among caregivers in a low-cost program with broad reach, which could feasibly be scaled., Participants and Setting: The NCG project was implemented in two distinct ecological zones in Ghana, reaching 73,959 caregivers of children under 5 across 41 communities; while 20 communities were control sites with no NCG intervention., Methods: Stratified random sampling was used to select intervention area respondents. Cluster sampling was utilized in control areas, using the Probability Proportional to Size method. Standard measures were used to assess changes in practices of violence and abuse, stress experience and management, parenting techniques, and the household environment. Difference-in-difference linear regression was used to compare intervention and control results., Results: Intervention areas demonstrated statistically-significant and substantial changes in reported knowledge, attitudes and behaviors related to physical abuse and corporal punishment. Knowledge of negative impacts of stress on parenting, as well as stress reduction techniques increased in intervention areas, as did positive discipline and parenting practices., Conclusions: The NCG model demonstrated important promising results for changing child protection behaviors in this descriptive study. Statistically-significant decreases in reported physical and psychological punishment and corresponding increases in reported positive discipline indicate that this may be an effective and low-cost intervention for child protection behavior change., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Research highlights that mothers are often blamed for their child's exposure to domestic abuse and they are given a leave ultimatum. This article furthers discussion, guided by the question "how do (UK) mothers with violent partners experience social work interventions?" Nineteen mothers located around England and Wales were interviewed. Data were analyzed using deductive thematic analysis. The findings resonate with research from a decade earlier showing mothers felt blamed and were responsibilized for the violence they experienced and given the leave ultimatum by social workers. This article calls for a change in social work practice for mothers experiencing domestic abuse.

Background: Local multi-agency case reviews are regularly held in England when children have suffered significant harm from abuse or neglect, including from child sexual abuse (CSA). Most CSA takes place within families, is common but under-reported and can cause long-term harm., Objective: The aim was to analyse English child protection reviews relating to intrafamilial CSA to identify improvements for professional practice., Participants and Setting: Local Child Safeguarding Practice Reviews (LCSPRs) and Serious Case Reviews (SCRs) relating to serious incidents of intrafamilial CSA occurring between 01 April 2017 and 31 March 2020., Methods: LCSPRs and SCRs were obtained from the National Case Review Repository and thematically analysed., Results: There were 243 reviews, of which 25 featured intrafamilial CSA. The main themes related to perpetrators, vulnerable families, and professional practice. Half of perpetrators were known by services to have previously abused children, but issues with professional practice enabled them to continue. Most children did not disclose CSA verbally showing challenging or sexualised behaviour; but professionals lacked knowledge and confidence on how to intervene without verbal disclosure, which limited safeguarding actions. Non-engagement by families with services was common, with some non-abusing parents complicit in abuse and deception. Significant neglect occurred in half the families, which diverted professional attention away from CSA., Conclusion: CSA is deliberate abuse of children involving considerable deception by perpetrators in contrast to some other types of child abuse. This difference in abuser behaviour makes child protection more difficult, particularly when professionals do not recognise and respond to children's non-verbal disclosures., Competing Interests: Declaration of competing interest Dr. Garstang, Professor Dickens and Professor Taylor were all funded by the Department for Education for their analysis of Local Child Safeguarding Practice Reviews and Serious Case Reviews. The funder requested an analysis of intrafamilial CSA in Serious Case Reviews, but had no role in the design, analysis, reporting or decision to publish this paper. Ms. Menka has no declarations of interest to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The aim of this systematic narrative literature review is to explore empirical evidence as to how a multiprofessional approach to child protection decision making is implemented in hospitals settings. Child protection cases where there is a suspicious serious injury suspected sexual abuse or serious neglect are often investigated in hospital, involving a number of relevant professions. Five electronic bibliographic databases were used for the search. To be included in the review studies had to be published in a peer-reviewed journal, report on empirical research, be available full text in English, and have used an identifiable research design. The search was restricted to 10 years, from January 1, 2010, to December 31, 2019, and retrieved 6,934 studies. The review includes 26 studies undertaken in 10 countries. In all the hospital-based settings studied, child protection decision-making tasks were assigned to a designated multiprofessional team. However, there was remarkable diversity in models of team structure, regulation of workflow, structured procedures, and standardized tools through which practice was carried out. Research focused on evaluating the teams' effectiveness in fulfilling their duties which were, first and foremost, the identification of possible child maltreatment. The analysis identifies various systemic approaches and quality improvement methods to promote effective team-based decision-making processes in hospitals. The interactional aspect of collaborative team-based practice was generally missing from the published research. This article discusses next steps for the development of practice, policy, and research to enhance useful multiprofessional child protection team working in hospitals.

Background: Little is known about the patterns of child maltreatment change over time and vary according to gender and child protective services (CPS) experience in Taiwan., Objective: To examine the latent status and the trajectories of child maltreatment and to identify effects that gender and CPS have on these statuses and trajectories in Taiwan., Participants and Setting: A national proportionately stratified sample of 6233 4th-grade students were recruited from 314 elementary schools in Taiwan, and followed up at 6th and 8th graders. A total of 1908 students completed valid data at all three time points was analyzed., Methods: Latent class analysis and latent transition analysis were used to identify the number of latent variables and the patterns of child maltreatment. Multiple-group model was used to test with gender difference., Results: Four latent maltreatment statuses were identified: high all maltreatment, high psychological maltreatment, high neglect, and no/low maltreatment. A reduction in maltreatment severity occurred over time was found. The percentage of students in the "high all maltreatment" and "high neglect" groups decreased whereas those in the "high psychological maltreatment" and "no/low maltreatment" groups increased. Differences in the transition probabilities of latent maltreatment status by gender was revealed. The percentage of CPS recipients in the "high all maltreatment" decreased over time., Conclusions: This study highlighted the dynamic nature of child maltreatment and described the timing, continuity, and change that characterizes children's exposure to maltreatment in Taiwan. Policies and interventions geared toward early detection, mitigation, and prevention of child maltreatment are needed., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The goal of this study, the first of its kind in Canada, was to estimate the child lifetime prevalence of child protection involvement in Quebec. Using administrative and population data spanning 17 years, we performed a survival analysis of initial incidents of child protection reports, confirmed reports, confirmation of a child's security or development being compromised, and placement outside the home for one day or more. We found that before reaching the age of 18 years, over 18% of children were reported to child protection at least once, one in every ten children (10.1%) in the province had a report that led to the finding of their security or development being compromised, and over 5% were placed outside the home. We found that neglect was a primary concern in close to half (47.6%) of cases. By using a full population dataset, we obtained a more accurate prevalence estimate than studies using synthetic cohort life tables. These findings only captured initial incidents of involvement with child protection, meaning this study does not show the extent of recurrent involvement for some children. The findings reflect prior results showing that neglect is common in initial child protection involvement but less pervasive than has been shown in incidence studies, suggesting that recurrent child protection involvement is more driven by neglect than initial incidents are.

Corporal punishment remains the most common form of violence against children in Canada. Along with being legally permitted, it is made socially acceptable through cultural and social norms often disguised as discipline. Paraphrases of Judeo-Christian sacred texts such as "spare the rod; spoil the child" have been widely used to justify corporal punishment, and to create norms around the idea that it is a god-given responsibility of parents to inflict corporal punishment on their children "for their own good." Corporal punishment is then not only an acceptable part of raising children but can be a godly duty. Though Canada is a secular country, this social norm provides a moral hegemony under which violence becomes the status quo and has proven very difficult to change. In this commentary, we outline the ways that Christian religion has contributed to social norms around corporal punishment. We then argue that religious leaders have an opportunity-and moral responsibility-to contribute to change. We conclude with insights from social norms theory and offer evidence-based recommendations for ways forward that could help shift attitudes around corporal punishment in order to decrease its prevalence and harm. While each of these issues has been written about extensively in isolation, this commentary offers an analysis of these matters together under one umbrella. By making this relationship between Christianity and the social norms that propagate corporal punishment more visible, we draw attention to the role leaders in Christian churches could play in disrupting the social acceptance of violence against our youngest Canadian citizens. We provide a practical and evidence-based framework, rationale, and appeal to Canadian faith leaders to use their influence to add momentum to a critical health, rights-and religion-issue in Canada.

Background: Child abuse and neglect are significant social and health issues in New Zealand. As the government provides free oral care to children and adolescents, oral health practitioners are positioned to respond to child protection concerns. However, research on the knowledge and attitudes of oral health practitioners is limited. This study aimed to understand the knowledge and attitudes of New Zealand dental and oral health therapists in detecting and reporting child abuse and neglect., Methods: In this descriptive exploratory cross-sectional study, we invited registered New Zealand dental and oral health therapists treating children and adolescents to the anonymous online survey., Results: Among the 92 dental and oral health therapists, 72% agreed that they could recognise the signs and symptoms of child abuse and neglect. Yet, only 48% agreed they were familiar with the reporting process. During their professional careers, 62% had at least 1 suspected case; and only 21% had ever reported their concerns. Fear of false reporting (70%) was the most significant barrier., Conclusions: Participants understood child abuse and neglect as significant social issues; however, the knowledge and attitudes to respond were limited. Efforts to enhance the knowledge and attitudes will be necessary to promote child safety and wellbeing., (© 2022. The Author(s).)

Background: Research on child maltreatment and protection in the Arab Gulf Cooperation Council countries-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE)-is limited but growing, as is child protection as a sector., Objectives: We aimed to identify themes and gaps in existing research on child maltreatment and protection, identify opportunities for building capacity in research and practice., Participants and Setting: N/A., Methods: We conducted a scoping review of empirical studies published in peer-reviewed journals in English and Arabic and reported methods and findings according to the PRISMA-ScR reporting protocol. Articles were coded by country, topic of research, and type of abuse studied, if any., Results: Our database search returned 6109 articles and 160 articles were included in our review. Themes included (1) prevalence, incidence, and characteristics of maltreatment, (2) outcomes associated with maltreatment, (3) attitudes, awareness, and reporting, (4) accidental injury and death potentially associated with neglect, (5) policy and practice. Eighty-seven articles studied Saudi Arabia, while 28 studied the UAE, 21 Kuwait, 13 Qatar, 12 Oman, and 11 Bahrain. Physical abuse was studied in 77 articles, followed by sexual abuse in 54 articles and emotional abuse in 54., Conclusion: Although the medical community produces an encouraging volume of child maltreatment research, gaps remain. Intervention research is lacking, and further inquiry into family dynamics, culture, and spirituality could inform the development of effective interventions. Cross-sectoral collaboration among education, social work, law enforcement, and healthcare is also needed to safeguard children's rights in the GCC., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objectives: To compare the characteristics of subdural haematoma (SDH) in children under the age of 2 years, between inflicted, otherwise known as abusive head trauma (AHT), and non-inflicted aetiologies., Methods: This was a retrospective cohort study of 37 cases of SDH in children under the age of 2 years presenting to the ED at an Australian tertiary children's hospital between January 2009 and December 2012 and been assessed by the Child Protection Unit. SDH aetiology was classified into AHT and non-inflicted groups, based on child protection interagency outcome. These groups were compared to determine clinical associations with AHT., Results: Of the 37 infants with SDH, 20 cases were deemed due to AHT, whereas 17 cases were determined to be non-inflicted SDH (15 cases due to accidental trauma and two cases due to congenital benign enlargement of the subarachnoid space). SDH due to AHT was associated with antenatal maternal drug use, previous Department of Child Safety involvement, delayed presentation, history of seizures, floppiness or altered level of consciousness; extracranial findings of fractures, bruising or retinal haemorrhages; radiological findings of >5 mm depth, bilateral, inter-hemispheric blood, posterior fossa blood and diffusion restriction; and outcomes of death or permanent disability. Non-inflicted SDH was associated with witnessed injury, falls and scalp haematoma on imaging., Conclusions: Infant SDH due to AHT accounts for high mortality and morbidity. Early identification of these patients in the ED with referral to specialised units that investigate for potential child abuse is essential., (© 2022 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Background: Child maltreatment leads to substantial adverse health outcomes, but little is known about acute health care utilization patterns after children are evaluated for a concern of maltreatment at a child abuse and neglect medical evaluation clinic., Objective: To quantify the association of having a child maltreatment evaluation with subsequent acute health care utilization among children from birth to age three., Participants and Setting: Children who received a maltreatment evaluation (N = 367) at a child abuse and neglect subspecialty clinic in an academic health system in the United States and the general pediatric population (N = 21,231)., Methods: We conducted a retrospective cohort study that compared acute health care utilization over 18 months between the two samples using data from electronic health records. Outcomes were time to first emergency department (ED) visit or inpatient hospitalization, maltreatment-related ED use or inpatient hospitalization, and ED use or inpatient hospitalization for ambulatory care sensitive conditions (ACSCs). Multilevel survival analyses were performed., Results: Children who received a maltreatment evaluation had an increased hazard for a subsequent ED visit or inpatient hospitalization (hazard ratio [HR]: 1.3, 95 % confidence interval [CI]: 1.1, 1.5) and a maltreatment-related visit (HR: 4.4, 95 % CI: 2.3, 8.2) relative to the general pediatric population. A maltreatment evaluation was not associated with a higher hazard of health care use for ACSCs (HR: 1.0, 95 % CI: 0.7, 1.3)., Conclusion: This work can inform targeted anticipatory guidance to aid high-risk families in preventing future harm or minimizing complications from previous maltreatment., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: The prevention of child abuse and neglect is an urgent matter given the serious effects persisting into adulthood, and the increased risk of the offspring of abused children being abusive themselves. Intervening as early as possible may prevent abuse that can begin in infancy. Although several systematic reviews have investigated the effects of interventions on populations who are at increased risk for perpetrating child abuse and neglect, few studies have focused on women or interventions that start during perinatal periods. This study aims to describe a systematic review to examine the effects of interventions to prevent child abuse and neglect that begin during pregnancy and immediately after childbirth (less than 1 year). The study will involve performing a systematic review and meta-analysis based on the latest research articles and a broader literature search., Methods and Analysis: The protocol was prepared using the 2015 statement of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search will be performed using the MEDLINE, PsycINFO, Embase and Cochrane Central Register of Controlled Trials databases from inception onward. Randomised controlled trials of interventions that begin during pregnancy or the first year postpartum, designed to prevent child abuse and neglect in families who are at increased risk for these issues, will be included. Data collection, quality assessment and statistical syntheses will be conducted by following the methods in the protocol that are predefined. Any index of child maltreatment will be included as a primary outcome. A meta-analysis and sub-group analyses will be considered based on the characteristics of interventions., Ethics and Dissemination: This study does not require ethical approval. The findings will be presented at conferences and will be submitted to a peer-reviewed journal., Prospero Registration Number: CRD42021266462., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The UN Convention on the Rights of the Child prohibits all forms of violence against children. Sweden was early in introducing a ban on disciplinary violence; however, difficulties have been noted in identifying children in need of protection and providing help for children exposed to violence., Objectives: The purpose of this study was to explore the social services' police reporting and children's access to protection and support in cases of physical and sexual child abuse., Methods: The sample consisted of 291 child welfare reports from three Swedish municipalities. Data were collected from child welfare reports, investigations, and child social records and analyzed using quantitative content analysis., Results: A majority of the cases, including cases with a high indication for police reporting, were not reported to the police by the social services. Although the child in 60.1 % of cases provided information about violence, 70.7 % of all child welfare investigations were completed without support measures, and only 8.2 % led to protection or support linked to violence. Children's participation was limited, suggesting inadequate conditions for children's access to protection and support., Conclusions: Children's right to protection against violence requires the recognition of children as active participants with access to safe participation. Failure to report suspected crimes against children risks minimizing acts of violence or making violence invisible. Difficulties in handling conflicts of interest between children and parents risk neither protection nor support being provided for the child., Competing Interests: Declaration of competing interest None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Domestic violence and abuse (DVA) is an everyday aspect of many children and young people's lives, both in the home and in their own relationships. Studies estimate that up to one million children and young people experience some form of DVA each year in the UK. Although the majority of families experiencing DVA have more than one child, most research to date has focused on individual children within these families. This study aims to explore the views of practitioners, parent/carers and young people on sibling responses in the context and aftermath of DVA. Our protocol has followed SPIRIT guidelines., Methods and Analysis: We propose a multimethod study consisting of semistructured interviews, the completion of Sibling Relationship Questionnaires, photovoice interviews and illustrative case studies to explore sibling experiences in the context and aftermath of DVA. A purposive sample of front-line practitioner participants will be recruited and interviewed first. We will ask them to introduce us to parent/carer and young people participants using a snowball approach (n=70). Qualitative data will be analysed through reflexive thematic analysis, theoretically underpinned by critical realism, to explore patterns in participants' views and experiences of siblings in the context and aftermath of DVA. Quantitative data collected from the Sibling Relationship Questionnaire's four domains (warmth/closeness, power/status, conflict and rivalry) will be analysed. Data triangulation of the quantitative and qualitative data within this study will occur at the results interpretation stage., Ethics and Dissemination: Ethical approval has been obtained from the University of Birmingham Research Ethic Committee (ERN&#95;21-0795). Findings will be published in open access peer-reviewed journals and presented at relevant conferences and events. Child-facing infographics and front-line practitioner guides will also be produced., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Almost all countries have developed measures to ensure that children do not suffer from violence in their families. However, the legal framework, definitions of maltreatment, and institutional structures differ. Whereas in other areas of social policy comparative research is very common, child protection research falls behind., Research Questions: The article examines the differences between cases referred to local child and youth welfare authorities due to concerns about abuse or neglect in Germany, England and the Netherlands, comparing the characteristics of the child, the family, the person reporting the suspected maltreatment, and the type of maltreatment., Method: 1207 case files on children investigated due to suspected child maltreatment from the Netherlands, England, and Germany were analyzed using a standardized coding scheme., Results: The family backgrounds of the children reported differed substantially, with more lone parents in England and more children living in two households in the Netherlands. The persons and institutions reporting their concerns to the local child and youth welfare authorities also differed, with more reports from children and family members in Germany and more from health services in England. In England, physical abuse, sexual abuse, and sexual exploitation were more frequently the reason for referral than in the Netherlands and Germany., Discussion: Differences between countries can partially be explained based on differences in policies and relations of other systems to the child protection system., (Copyright © 2022. Published by Elsevier Ltd.)

Objectives: To examine the associations of childhood maltreatment (CM) with hypertension, and the mediating effects of hypertension risk factors on the associations in South African women, using baseline data of the Rape Impact Cohort Evaluation longitudinal study., Design: Cross-sectional SETTING AND PARTICIPANTS: Self-reported data on CM exposure and its severity in 18-40-year-old women living in KwaZulu-Natal province were assessed. Logistic regression models, adjusted for traditional hypertension risk factors, rape exposure, HIV-infection, other traumatic exposures, depression scores and acute stress reactions (ASR) scores were used to examine the CM-hypertension associations., Results: Among 1797 women, 220 (12.2%) had hypertension; CM prevalence was higher in women with hypertension than without hypertension overall (70.9% vs 57.2%) and for each abuse type: sexual abuse (20.9% vs 12.4%), physical abuse (51.8% vs 41.5%), emotional abuse (40% vs 27.6%) and parental neglect (35% vs 25.7%). Exposures to 1-2 types and 3-4 types of CM were 46.4% and 24.5%, respectively, in women with hypertension, and lower in women without (42.9% and 14.3%, respectively). Exposures to any CM (adjusted OR: 1.62; 95% CI: 1.19 to 2.25), sexual abuse (1.64; 95% CI: 1.12 to 2.37), emotional abuse (1.57; 95% CI: 1.16 to 2.13), physical abuse (1.43; 95% CI: 1.07 to 1.92) and parental neglect (1.37; 95% CI: 1.00 to 1.86) were associated with hypertension. Exposures to an increasing number of abuse types and cumulative severity of CM overall (1.13; 95% CI: 1.05 to 1.21) and for each CM type were associated with increased odds of hypertension. Alcohol use, other trauma experienced, depression and ASR partially mediated these associations., Conclusion: CM was associated with hypertension; the effects were greater with multiple abuse types and severe abuse, and were partially mediated by alcohol use, depression, ASR and other traumatic exposures. While CM must be prevented, effective mental health interventions to curb the uptake of unhealthy behaviours and the development of hypertension in women exposed to CM are key., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: The current evidence for child maltreatment (CM) and domestic violence and abuse (DVA) interventions is limited by the diversity of outcomes evaluated and the variety of measures used. The result is studies that are difficult to compare and lack focus on outcomes reflecting service user or provider priorities., Objective: To develop core outcome sets (COSs) for evaluations of child and family-focused interventions for: (1) CM and (2) DVA., Design: We conducted a two-stage consensus process. Stage 1: a long list of candidate outcomes across CM and DVA was developed through rapid systematic reviews of intervention studies, qualitative and grey literature; stakeholder workshops; survivor interviews. Stage 2: three-panel, three-round e-Delphi surveys for CM and DVA with consensus meetings to agree with the final COSs., Participants: 287 stakeholders participated in at least one stage of the process (ie, either CM or DVA COS development): workshops (n=76), two e-Delphi surveys (n=170) and consensus meetings (n=43). Stakeholders included CM and DVA survivors, practitioners, commissioners, policymakers and researchers., Results: Stage 1 identified 335 outcomes categorised into 9 areas and 39 domains. Following stage 2, the final five outcomes included in the CM-COS were: child emotional health and well-being; child's trusted relationships; feelings of safety; child abuse and neglect; service harms. The final five outcomes in the DVA-COS were: child emotional health and well-being; caregiver emotional health and well-being; family relationships; freedom to go about daily life; feelings of safety., Conclusions: We developed two COSs for CM and DVA with two common outcomes (child emotional health and well-being; feelings of safety). The COSs reflect shared priorities among service users, providers and researchers. Use of these COSs across trials and service evaluations for children and families affected by CM and DVA will make outcome selection more consistent and help harmonise research and practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Child abuse is a major health problem that can lead to physical and psychological issues. Its diagnosis can be difficult and sensitive. Physicians are submitted by law to inform the parents when they report to child welfare services or judicial authorities, unless otherwise in the minor's interest. This exercise is destabilizing for both patients and physicians. The physician must be trained to detect and announce a possible diagnosis of child abuse. To facilitate and increase those reports, we have developed guidelines for the physicians to help the exercise of announcement. These guidelines were based on pre-existing recommendations about how to announce bad news. We have also planned to put into practice these guidelines with a communication skills training program based on standardized patients. We propose the acronym PROTECT; P for plural: never stay alone in such situations, R for remaining a caregiver and not becoming an investigator or judge, O for obligation to protect minors, T for time, to take enough time to inform the parents and the child but in a limited time frame, E for explaining to the parents what preoccupy the professionals; C for centring ourselves on the child, his or her symptoms, needs and pain; T for total care of the child that should integrate physical, psychological, and social child health, through a global and interdisciplinary approach in collaboration with child welfare services, and should involve also the child in the process. This tool will be applied by simulation in child welfare training with standardized patients. The evaluation of this tool and its application would need further study., (Copyright © 2022. Published by Elsevier Masson SAS.)

Background: Child maltreatment (abuse and neglect) is a global public health problem. Healthcare professionals must contribute to safeguarding and promoting the welfare of children at risk., Aim: To determine whether paediatric dentists' rates of child protection training, experience and practice have changed and to identify factors currently associated with maltreatment recognition and referral., Design: A pre-piloted anonymous questionnaire was mailed to the UK-based British Society of Paediatric Dentistry members in 2005 (n = 789) and 2016 (n = 575). Analysis was conducted for practising dentists., Results: Response rates were 66.3% in 2005 and 62.4% in 2016. Increases were observed in respondents' postgraduate child protection training (87.2% vs. 99.7%), multi-agency training (27.9% vs. 49.2%), ever suspected (67.9% vs. 82.3%) and ever referred child maltreatment (30.7% vs. 61.0%). The proportion who had suspected maltreatment but never referred a child reduced from 37.2% to 21.3%. Having referred more than five times in the preceding five years rose from 0.4% to 14.6% of respondents, yet those seeing children with neglected dentitions daily or more frequently remained unchanged., Conclusion: This repeated cross-sectional survey demonstrates a substantial improvement in UK paediatric dentists' training and practice, but a gap remains between suspecting and referring maltreatment concerns such that some children remain at risk., (© 2021 BSPD, IAPD and John Wiley & Sons Ltd.)

Background: Caregivers' substance use is associated with child maltreatment., Objective: Examine trends from 2005 to 2018 in percentages of three outcomes with caregivers' drug or alcohol use: child protective services (CPS) referrals, substantiated maltreatment reports, and foster care placements., Participants and Setting: 22 U.S. states that contributed child-level maltreatment outcomes and caregivers' substance use data to the National Child Abuse and Neglect Data System from 2005 to 2018., Methods: Joinpoint regression was used to examine the average annual percent change (AAPC) in outcomes with caregivers' drug or alcohol use and to identify temporal changes., Results: From 2005 to 2018, CPS referrals with caregivers' drug use increased (AAPC 2.33, p < .001), while referrals with alcohol use remained unchanged (AAPC -0.11, p = .92) (trend difference p = .04). Substantiated reports with caregivers' drug and alcohol use increased (AAPC drug use 3.63, p < .001, AAPC alcohol use 1.28, p = .03), with a greater increase observed with drug use (difference p = .03). Foster care placements with caregivers' drug use increased (AAPC 2.54, p < .001), while placements with alcohol use did not change (AAPC -1.22, p = .29), (difference p = .005). Within the study period, changes in trends with caregivers' drug use included increased substantiated reports from 2010 to 2018 (p < .001) and increased foster care placements from 2009 to 2018 (p < .001). With caregivers' alcohol use, CPS referrals and foster care placements decreased from 2007 to 2018 (all p < .001)., Conclusions: Trends differed for outcomes with caregivers' drug versus alcohol use. Findings can inform policies to improve care for families affected by substance use., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: When a child welfare service agency receives a report of concern, there is an initial screening to decide whether an investigation needs to be initiated. In addition to the decision maker, case factors, external factors, and organizational factors have an impact on decision making in Child Welfare Services (CWS). Few recent studies have considered the impact of case factors on the initial screening., Objective: This study examined case factors that have an impact on the decision to investigate in the Norwegian CWS., Participants and Setting: Participants included randomly drawn samples of case files from 16 agencies (N = 1365)., Methods: The study was designed as a cross-sectional case file study. Researchers coded the data on site at the agencies. To examine the association between a decision to investigate and case specific variables, multilevel logistic regression (generalized linear mixed model) analysis was conducted to account for case clustering effects within agencies., Results: The rate of investigation was 82.3 %. Concerns of physical and sexual abuse (OR = 2.61***), parents' health and stressful events (OR = 2.20***), domestic violence or witnessing violence (OR = 2.52***), and concerns related to finances, housing, and employment (OR = 3.25**) lowered the threshold for investigation. Prior referrals were found to raise the threshold for investigation (OR = 0.88). (**p < .01, ***p < .001)., Conclusion: Although large differences between agencies exist in decision-making processes in the Norwegian CWS, there are common case factors affecting the initial screening of referrals., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: This study aimed to understand the main factors influencing the decision of adolescent girls to run away from home in Tigray, northern Ethiopia, and to explore the social and cultural construction of female adolescent runaways in this region., Method: In-depth qualitative interviews with seven runaway adolescent girls and six women married at an early age (11-16 years old) were conducted in Wukro and Mekelle in Tigray to investigate why the girls escaped from home and how communities responded to these decisions., Results: Findings suggest that the immediate trigger that led all the young participants to run away was to escape an arranged marriage, except in one 'romantic' elopement case. Individual and structural factors, such as child maltreatment and educational aspirations, and new family law respectively, also contributed to the decision to escape., Conclusion: Adolescent runaways seem to be ignored or normalized within the community in Tigray and, in particular, by its public institutions. This may explain why there are limited services for runaway girls, such as shelters and other forms of support. This lack of social protection structures has left these girls unprotected and exposed to a range of risks, such as early and unwanted pregnancies, labor exploitation, dropping out of school, and transactional sex. To date, this phenomenon of adolescent runaways has remained an invisible issue in Tigray as runaway girls are counted under general migration figures. Further research is needed to explore how this phenomenon is categorized at policy level in order to address runaway girls' needs as defined by them., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In 2020, the number of reported cases of child maltreatment in Germany has never been higher and most of them showed signs of neglect. Most of the time, dental neglect (DN) appears together with a general form of neglect, and includes, apart from caries, many other negative short- and long-term effects for the affected child. In this study, the prevalence of DN in Germany and the way dental practices are currently addressing the topic are examined. Moreover, this study explored whether the experiences of German dentists with DN are related to their work experience, their gender or further education about DN. The data was collected using an anonymous questionnaire. The hypotheses were tested using unpaired t -tests based on differences in mean values. The three most common reasons for a suspected case of child maltreatment were the interaction of children with parents, or a legal guardian, insufficient oral or general hygiene, and grave caries. Even though most of the participating dentists agree that it is the task of the dentist to report suspected cases of child maltreatment, only few of them have done so in the past themselves. Not only insecurity about recognition and whom to contact in the suspected case, but also concern about unfounded suspicion were the most common reasons not to report a suspected case of DN. The detection and communication of suspected cases should be encouraged in order to protect affected children.