Child Maltreatment: Overview and Prevention Considerations
Child Maltreatment: Overview and Prevention Considerations
Given that CM is a significant public health problem with serious negative developmental consequences, it is important that CM and its prevention be understood by all of those who interact with families. Nurses, employed in a wide range of settings and engaged in a variety of roles (e.g., primary care, hospitals, schools, academic research institutions, patient and health advocacy, community agencies), are in a unique position to prevent CM and/or identify victims. For example, nurses who work in maternity, neonatal intensive care (NICU), and other pediatric units are in the position of teaching and observing primary caregivers as they care for their infant or child. Maternity nurses often conduct interventions to prevent abusive head trauma and promote safe sleep, and NICU nurses are responsible for ensuring the parent is capable of providing competent care before the infant is discharged home. Nurses working in the Emergency Department (ED) who see older infants and children admitted for treatment of injuries, ingestions, and acute or chronic conditions are in a key position to assess for suspected maltreatment or identify the potential for maltreatment. In school settings, nurses may assist teachers and other school staff and in providing universal prevention programs for child sexual abuse. School nurses are in a position to first assess students who display signs and symptoms of potential maltreatment. Vigilance by nurses is especially important given that the signs and symptoms of maltreatment can be confused with other health problems.
Nurses in each of these settings are also subject to mandatory reporting laws. All 50 states have laws that require certain professionals to report suspected CM via child protective services, law enforcement agencies, or a "hotline" telephone number. This often includes nurses, in addition to other professionals such as physicians, psychologists, teachers, and law enforcement personnel. Generally, mandatory reporting statutes require that a report is made when there is "reasonable cause" to believe that a child has been maltreated or exposed to conditions that could result in maltreatment (although it is important to note that statutes do vary from state to state). Child protective service agencies are responsible for making decisions about whether an investigation will take place, but it is often the reports made, such as those made by nurses, that set this process in motion. It is important to note that the requirement to report overrides professional confidentiality requirements. In fact, failing to report can lead to criminal penalties or civil liabilities, as well as professional ethical and malpractice complaints. All states provide criminal and civil immunity from liabilities when reports are made in good faith and without malicious intent.
Despite these mandatory reporting statutes, numerous studies indicate that many instances of abuse do not get reported by professionals (Gilbert et al., 2009). Research suggests that a variety of factors can influence reporting, including the perceived severity of the situation; a lack of awareness of the appropriate processes for reporting; fear of misinterpreting cultural practices; or concerns about making the situation worse or disrupting a therapeutic relationship (Gilbert et al., 2009; Greipp, 1997). It is important to always make a report to the appropriate authority when required and to not assume that one has already been made. Multiple reports from different sources may mean that child protective services is more likely to investigate or substantiate a referral (Child Welfare Information Gateway, 2003; Fluke, Shusterman, Hollinshead, & Yuan, 2005). In addition, referrals from professionals are more likely to be substantiated than referrals from family, neighbors, and other community members (Child Welfare Information Gateway, 2003).
A CPS report that is substantiated may prevent more serious and even life-threatening CM from occurring in the future. A CPS report that is unsubstantiated may also prevent CM because of the support and additional services that may be provided to families as a result. For example, most states (72.5%) refer both substantiated and unsubstantiated cases to community agencies for services (USDHHS, 2003).
Considerations for Nurses
Given that CM is a significant public health problem with serious negative developmental consequences, it is important that CM and its prevention be understood by all of those who interact with families. Nurses, employed in a wide range of settings and engaged in a variety of roles (e.g., primary care, hospitals, schools, academic research institutions, patient and health advocacy, community agencies), are in a unique position to prevent CM and/or identify victims. For example, nurses who work in maternity, neonatal intensive care (NICU), and other pediatric units are in the position of teaching and observing primary caregivers as they care for their infant or child. Maternity nurses often conduct interventions to prevent abusive head trauma and promote safe sleep, and NICU nurses are responsible for ensuring the parent is capable of providing competent care before the infant is discharged home. Nurses working in the Emergency Department (ED) who see older infants and children admitted for treatment of injuries, ingestions, and acute or chronic conditions are in a key position to assess for suspected maltreatment or identify the potential for maltreatment. In school settings, nurses may assist teachers and other school staff and in providing universal prevention programs for child sexual abuse. School nurses are in a position to first assess students who display signs and symptoms of potential maltreatment. Vigilance by nurses is especially important given that the signs and symptoms of maltreatment can be confused with other health problems.
Nurses in each of these settings are also subject to mandatory reporting laws. All 50 states have laws that require certain professionals to report suspected CM via child protective services, law enforcement agencies, or a "hotline" telephone number. This often includes nurses, in addition to other professionals such as physicians, psychologists, teachers, and law enforcement personnel. Generally, mandatory reporting statutes require that a report is made when there is "reasonable cause" to believe that a child has been maltreated or exposed to conditions that could result in maltreatment (although it is important to note that statutes do vary from state to state). Child protective service agencies are responsible for making decisions about whether an investigation will take place, but it is often the reports made, such as those made by nurses, that set this process in motion. It is important to note that the requirement to report overrides professional confidentiality requirements. In fact, failing to report can lead to criminal penalties or civil liabilities, as well as professional ethical and malpractice complaints. All states provide criminal and civil immunity from liabilities when reports are made in good faith and without malicious intent.
Despite these mandatory reporting statutes, numerous studies indicate that many instances of abuse do not get reported by professionals (Gilbert et al., 2009). Research suggests that a variety of factors can influence reporting, including the perceived severity of the situation; a lack of awareness of the appropriate processes for reporting; fear of misinterpreting cultural practices; or concerns about making the situation worse or disrupting a therapeutic relationship (Gilbert et al., 2009; Greipp, 1997). It is important to always make a report to the appropriate authority when required and to not assume that one has already been made. Multiple reports from different sources may mean that child protective services is more likely to investigate or substantiate a referral (Child Welfare Information Gateway, 2003; Fluke, Shusterman, Hollinshead, & Yuan, 2005). In addition, referrals from professionals are more likely to be substantiated than referrals from family, neighbors, and other community members (Child Welfare Information Gateway, 2003).
A CPS report that is substantiated may prevent more serious and even life-threatening CM from occurring in the future. A CPS report that is unsubstantiated may also prevent CM because of the support and additional services that may be provided to families as a result. For example, most states (72.5%) refer both substantiated and unsubstantiated cases to community agencies for services (USDHHS, 2003).
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