The question is however, whether the low detection rate of the checklist—even if it consists of only two questions—justifies implementation. A history that is inconsistent with the patient's injuries is the hallmark of physical abuse. Persons doing evaluation must be professionals with special skills and experience in child and adolescent sexual abuse, and evaluations ideally should be performed under the direction of an experienced child and adolescent psychiatrist or psychologist. The page also provides information on protective factors and includes a resource section for more information on child maltreatment. Journal of Family Violence, 6 4 , 351-363. A complete skeletal survey is indicated in children younger than two years when physical abuse is suspected.
Psychologists, social workers, and other professionals involved in child abuse investigations and evaluations will agree that this checklist provides an excellent survey of child abuse symptomatology. Unfortunately, these evaluators often use inadequate diagnostic techniques and fail to evaluate the child within the context of the family. California has barred the admissibility of evidence obtained through use of anatomically correct dolls until such a time that the procedure has been accepted as reliable in the scientific community in which it was developed. Preconceived ideas regarding racial, cultural or economic norms as well as the strong feelings elicited when children may have been intentionally injured are confounding factors complicating the evaluation of suspected child abuse. Before we discuss implementation, some limitations need to be discussed.
Journal of Clinical Psychology, 45, 450-454. Assessment of Family Violence: A Handbook for Researchers and Practioners. In addition to providing the diagnosis and treatment, the physician plays a new role when providing care for victims of physical abuse. Click to find all the appropriate forms. The dating of bruises by color is advocated by medical textbooks and older literature on child abuse. Preferably, the examination should be performed by a pediatrician or family physician known to the child or by a pediatric gynecologist. We also thank Primair Huisartsenposten and Veilig Thuis for their cooperation and contribution.
S A degree, certificate, or license to practice in a health care profession or occupation, including but not limited to the following: medicine, neurology, nursing, occupational therapy and other allied health care professions, physician's assistants, psychiatry, social work; plus appropriate training and experience in the ethical administration, scoring, and interpretation of clinical behavioral assessment instruments. The likelihood of having accidental bruises is a function of a child's behavior and developmental ability. Journal of American Medical Association, 273 6 , 477-482. The shape or pattern of injury may also suggest inflicted trauma. Testing alone does not diagnose sexual abuse either in the victim or offender.
Radiologic Evaluation The skeletal system may be injured in situations of child abuse or as a result of everyday activities. Journal of Research in Adolescence, 7, 457-478. With consistent use of the steps, a sound decision on whether to report to child protection services can be reached. Below is a sampling of these references: 1. What is the teacher turnover? Statistical analyses Characteristics of the children were described using median and percentages. A carefully written report should document the basis for these determinations.
Child and Family Behavior Therapy, 11, 39-58. Assessing traumatic experiences in children. Adolescents may also occasionally make false allegations out of vindictiveness or to cover their own sexuality. The parent s and child should be informed as clinically indicated, and to the extent that the child protective services investigation begins, it often becomes difficult to obtain a history from the accused parent, who may become defensive. Such evaluations require special training which many physicians in the community have not yet obtained.
In addition to the traditional roles of diagnosis and treatment, the physician also has the responsibilities of evidence collection, alerting the child protective services agency and protecting the child. Bruises in infants and toddlers. The use of the checklist does foresee in recognizing some victims of abuse. If a child is already being evaluated by a mental health professional, the physician doing the physical exam should be sensitive to the child and minimize questions about the abuse so as to avoid contaminating the child's data and duplication of interviews. The law requires reporting all cases of suspected, but not necessarily proven, abuse. They should be comfortable with testifying in court and prepared and willing to do so.
These evaluations differ from the usual psychiatric evaluation, because the examiner is being asked to determine whether certain events occurred, and determine at least one individual's credibility. It is essential that the clinician maintain emotional neutrality, approach the case with an open mind, adapt a non-judgmental stance and seek out the unique particulars of each case. Secondary, to determine whether reducing the length of the checklist compromises diagnostic value. Further research on the value and accuracy of guidelines for specific injuries in these care settings is necessary. When the medical evaluation is inconsistent with the history provided by the child's caregiver, physical abuse should be seriously considered. Gathering a history on the child or adolescent from parents or caregivers is an important part of the evaluation and should include: developmental history, cognitive assessment, history of prior abuse or other traumas, relevant medical history, behavioral changes, history of the parent's abuse as a child, and the family's attitudes towards sex and modesty.