Recurrent concerns for child abuse: Repeated consultations by a subspecialty child abuse team

Jennifer Martindale, Alice Swenson, Jamye Coffman, Alice W. Newton, Daniel M. Lindberg, Deb Bretl, Nancy Harper, Katherine Deye, Antoinette L. Laskey, Tara Harris, Yolanda Duralde, Marcella Donaruma-Kwoh, Daryl Steiner, Ken Feldman, Kimberly Schwartz, Robert A. Shapiro, Mary Greiner, Ivone Kim, Kent Hymel, Suzanne HaneyAlicia Pekarsky, Andrea Asnes, Paul McPherson, Neha Mehta, Gwendolyn Gladstone

Research output: Contribution to journalArticlepeer-review

Abstract

Physically abused children may be repeatedly reported to child protection services and undergo multiple medical evaluations. Less is known about recurrent evaluations by hospital-based child abuse teams for possible abuse. The objectives of this study were to determine the frequency of repeated consultations by child abuse teams and to describe this cohort in terms of injury pattern, perceived likelihood of abuse, disposition plan, and factors related to repeat consultation. This was a prospectively planned, secondary analysis of data from the Examining Siblings to Recognize Abuse (ExSTRA) research network. Subjects included children younger than 10 years of age who were referred to child abuse subspecialty teams at one of 20 U.S. academic centers. Repeat consultations occurred in 101 (3.5%; 95% CI 2.9-4.2%) of 2890 subjects. The incidence of death was 4% (95% CI 1-9%) in subjects with repeated consults and 3% (95% CI 2-3%) in subjects with single consults. Perceived likelihood of abuse from initial to repeat visit remained low in 33% of subjects, remained high in 24.2% of subjects, went from low to high in 16.5%, and high to low in 26.4% of subjects. Themes identified among the subset of patients suspected of repeated abuse include return to the same environment, failure to comply with a safety plan, and abuse in foster care. Repeated consultation by child abuse specialists occurs for a minority of children. This group of children may be at higher risk of subsequent abuse and may represent an opportunity for quality improvement.

Original languageEnglish (US)
Pages (from-to)1259-1266
Number of pages8
JournalChild Abuse and Neglect
Volume38
Issue number7
DOIs
StatePublished - Jul 2014

Keywords

  • Abuse
  • Child protection
  • Foster care
  • Maltreatment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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