Curiosity and Critical Thinking

Jackson, Allison M.; Deye, Katherine; Halley, Tina; Hinds, Tanya S.; Rosenthal, Eric S.; Shalaby‐Rana, Eglal; Goldman, Ellen F.

doi:10.1177/0009922814549314

Cited by 17 publications

(17 citation statements)

References 25 publications

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“…Therefore, clinicians have a unique opportunity to identify suspected mistreatment and initiate intervention. [2][3][4][5][6][7][8] Influential research in child abuse [9][10][11][12][13][14] and intimate partner violence 15,16 has focused on health care utilization before identification, highlighting that many survivors had multiple previous visits for likely abuse-related issues, suggesting "missed opportunities" for identification and early intervention. Previous research has shown that older adults experiencing mistreatment have increased rates of emergency department (ED) use 2,5 and hospitalization 17 but have not further characterized this utilization or examined its association with mistreatment detection.…”

Section: Introductionmentioning

confidence: 99%

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

et al. 2023

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ImportanceElder mistreatment is common and has serious health consequences. Little is known, however, about patterns of health care utilization among older adults experiencing elder mistreatment.ObjectiveTo examine emergency department (ED) and hospital utilization of older adults experiencing elder mistreatment in the period surrounding initial mistreatment identification compared with other older adults.Design, Setting, and ParticipantsThis retrospective case-control study used Medicare insurance claims to examine older adults experiencing elder mistreatment initially identified between January 1, 2003, and December 31, 2012, and control participants matched on age, sex, race and ethnicity, and zip code. Statistical analysis was performed in April 2022.Main Outcomes and MeasuresWe used multiple measures of ED and hospital utilization patterns (eg, new and return visits, frequency, urgency, and hospitalizations) in the 12 months before and after mistreatment identification. Data were adjusted using US Centers for Medicare and Medicaid Services Hierarchical Condition Categories risk scores. Chi-squared tests and conditional logistic regression models were used for data analyses.ResultsThis study included 114 case patients and 410 control participants. Their median age was 72 years (IQR, 68-78 years), and 340 (64.9%) were women. Race and ethnicity were reported as racial or ethnic minority (114 [21.8%]), White (408 [77.9%]), or unknown (2 [0.4%]). During the 24 months surrounding identification of elder mistreatment, older adults experiencing mistreatment were more likely to have had an ED visit (77 [67.5%] vs 179 [43.7%]; adjusted odds ratio [AOR], 2.95 [95% CI, 1.78-4.91]; P &lt; .001) and a hospitalization (44 [38.6%] vs 108 [26.3%]; AOR, 1.90 [95% CI, 1.13-3.21]; P = .02) compared with other older adults. In addition, multiple ED visits, at least 1 ED visit for injury, visits to multiple EDs, high-frequency ED use, return ED visits within 7 days, ED visits for low-urgency issues, multiple hospitalizations, at least 1 hospitalization for injury, hospitalization at multiple hospitals, and hospitalization for ambulatory care sensitive conditions were substantially more likely for individuals experiencing elder mistreatment. The rate of ED and hospital utilization for older adults experiencing elder mistreatment was much higher in the 12 months after identification than before, leading to more pronounced differences between case patients and control participants in postidentification utilization. During the 12 months after identification of elder mistreatment, older adults experiencing mistreatment were particularly more likely to have had high-frequency ED use (12 [10.5%] vs 8 [2.0%]; AOR, 8.23 [95% CI, 2.56-26.49]; P &lt; .001) and to have visited the ED for low-urgency issues (12 [10.5%] vs 8 [2.0%]; AOR, 7.33 [95% CI, 2.54-21.18]; P &lt; .001).Conclusions and RelevanceIn this case-control study of health care utilization, older adults experiencing mistreatment used EDs and hospitals more frequently and with different patterns during the period surrounding mistreatment identification than other older adults. Additional research is needed to better characterize these patterns, which may be helpful in informing early identification, intervention, and prevention of elder mistreatment.

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Section: Introductionmentioning

confidence: 99%

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

et al. 2023

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“…The ability to emit curiosity was noted to be beleaguered by a multitude of factors from cultural values to avoidance, fear and tension (Anderson, 2019; Burton & Revell, 2017; Crisp & Lister, 2004; Daly, 2016; Finnbogadottir & Dykes, 2012; Helm, 2013; Jackson et al, 2015; Lines et al, 2017; Mauri et al, 2015; Platt & Turney, 2014; Rouf et al, 2011; Saltiel, 2016). Both Beswick (2004) and White (1959) proffered that not seeking further information was a purposeful choice.…”

Section: Discussionmentioning

confidence: 99%

“…Five studies specifically emphasised the importance of relationship-building with clients (Finnbogadottir & Dykes, 2012;Lazenbatt, 2010;Mauri et al, 2015;Revell & Burton, 2016;Saltiel, 2016) and how this appeared to influence the depth of information elicited. Saltiel ( 2016 Interestingly, the notion of certainty, where there appeared to be concrete clinical observations, was evident in four papers (and sometimes discussed in relation to uncertainty) (Cowley et al, 2018;Finnbogadottir & Dykes, 2012;Jackson et al, 2015;Mauri et al, 2015). Whether certainty can truly be considered a facilitator of curiosity is debatable (Revell & Burton, 2016), particularly in view of the theoretical underpinning of the concept.…”

Section: Facilitatorsmentioning

confidence: 99%

“…Organisational culture, referenced in 10 articles, was seen to have a significant impact on practitioners' ability to exercise professional curiosity (Burton & Revell, 2017;Finnbogadottir & Dykes, 2012;Helm, 2013Helm, , 2017Jackson et al, 2015;Lines et al, 2017;Lynch et al, 2019;Platt & Turney, 2014;Revell & Burton, 2016;Saltiel, 2016). Jackson et al, (2015) Themes in relation to power and authority were evident within the macro system and organisational culture, influencing practitioners' responses to concerns. This was particularly pertinent within countries where it was mandated in law to report suspicions of abuse, causing greater uncertainty and debate (Jackson et al, 2015).…”

Section: Organisational and Macro Level Influencesmentioning

confidence: 99%

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Health and social care practitioners' experiences of exercising professional curiosity in child protection practice: An integrative review

Muirden¹,

Appleton

2022

Health Social Care Comm

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This integrative review aims to evaluate the experiences of health and social care practitioners with regard to how they exercise professional curiosity in child protection practice. Professional curiosity gained significant currency following the Munro Review of Child Protection (2010) in England, as a means of seeking clarity on what is happening within a family. However, a recurrent finding from child safeguarding practice reviews is that practitioners continue to struggle to exercise curiosity. This is evident within both the United Kingdom and international literature, although descriptors for the concept may differ. This study attempted to identify facilitators and barriers to applying professional curiosity to provide a greater understanding of this theoretical concept. Title and abstract review of 1428 articles identified from databases and 11 from other sources resulted in 52 papers for full-text review. The quality of each article was appraised using the Critical Appraisal Skills Programme tool for qualitative studies, the Mixed Methods Appraisal Tool (MMAT) for quantitative/mixed method studies and the Joanna Briggs framework for theoretical/opinion papers. Key findings were recorded in the Summary Table of Literature Reviewed. Data extracts were thematically analysed. Twenty-four papers predominantly from the UK, but also from Australia, Italy, Sweden and USA formed the data set. Overarching themes that emerged from the thematic analysis included: noticing dissonance, emitting curiosity, constructing meaning, facilitators, individual professional challenges, organisational and macro-level influences and conceptual development. This review demonstrated that professional curiosity is multifaceted and involves a whole system approach, from empowered, knowledgeable and competent frontline practitioners to creative, innovative and empathic organisations, that value staff contributions and place the child's best interests at the forefront of service development. Recommendations are made for practice and further research.

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“…The magnitude of the importance of soft tissue injuries in terms of specificity is highlighted by the work of McMahon et al [13], who reported more than 3 million cases of child abuse in a single year that included cutaneous symptoms, making it the most recognizable symptom of abuse. Jackson et al [14] highlight the contribution to delay in abuse diagnoses via clinical inattention to soft tissue findings. Accordingly, soft tissue bruising, for example, the result capillary failure via blunt trauma [15][16][17], in any of the locations indicated by the Frequency or Specificity (Tables 2 and 3) should also be considered a significant finding.…”

Section: Discussionmentioning

confidence: 99%

The Symptoms of Child Physical Abuse by Frequency and Specificity

Lee¹,

Noh²,

Barber³

et al. 2017

Forensic Biomechanics

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IntroductionFor children in the United States between the ages of one and four, the three leading causes of death in 2014 in descending order were unintentional injuries, congenital anomalies, and homicide. Similarly, homicide was the number two causes of death for children less than one year old [1]. Clearly, child abuse is perennially a leading cause of morbidity and mortality in young children and infants [2], with more than four children dying in the United States every day as a consequence [3]. Aside from physical trauma, child abuse also results in significant psychological and sociological impacts [4], as well as personal and civic costs [5]. The authors estimated the lifetime cost per victim of nonfatal child maltreatment was $210,012 (2010 dollars), with a total lifetime economic burden resulting from all new cases of fatal and nonfatal child maltreatment at approximately $124 billion. Clearly, child abuse is a significant social dilemma, and it is manifested in different forms, including neglect, sexual, emotional, and physical, and yet its clinical recognition is relatively recent. Caffey's study garnered a great deal of attention in the medical community because of its revolutionary effort to recognize how patterns of injury, medical history, and parent behavior are indicative of child abuse. In doing so, he was the first to question the sanctity of the parent-child relationship. He was also the first to identify an abuse constellation: long bone fracture and subdural hematoma. A constellation arises when two or more symptoms of abuse are manifested in a potential victim and whose collective suspicion index rises above the sum of the individual symptoms. In this way, Caffey presciently defined the landscape for all future abuse studies. Despite Caffey's findings, the prevalence of child abuse was not widely acknowledged by the general population until Kempe et al. [6] published their research on the battered-child syndrome, inciting the first national movement towards addressing child abuse. This movement culminated in the passage of the 1974 Child Abuse Prevention and Treatment Act. Despite these advances, it was estimated that 1,580 children in the United States died from physical abuse in 2014 [3], and failure to recognize child maltreatment results in chronic exposure to high-risk environments where re-injury or death may occur, with AbstractThe modern medical history of child physical abuse dates back to 1946 with the publication by John Caffey, Multiple Fractures in the Long Bones of Infants Suffering from Chronic Subdural Hematoma. This now-classic paper was the first modern clinical recognition of child physical abuse and laid the cornerstone for all future clinical diagnoses, as well as prevention and prosecution legislation at state and federal levels. Today, the primary literature is replete with descriptions and analyses of the symptoms of child abuse, but the typical focus is on individual symptoms, their frequencies, and how to diagnose them. Despite the obvious clinical and legal adva...

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Curiosity and Critical Thinking

Abstract: Having a greater index of suspicion for abuse may mitigate missed opportunities. With variability of medical training in child abuse, the factors we identified can be used as learning objectives for continuing medical education.

Cited by 17 publications

References 25 publications

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

Emergency Department and Hospital Utilization Among Older Adults Before and After Identification of Elder Mistreatment

Health and social care practitioners' experiences of exercising professional curiosity in child protection practice: An integrative review

The Symptoms of Child Physical Abuse by Frequency and Specificity

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