Implementing scientific evidence to improve the quality of Child Protection

Abstract

In contrast to other areas of medical practice, there was a lack of a clear, concise and accessible synthesis of scientific literature to aid the recognition and investigation of suspected child abuse, and no national training program or evidence based guidelines for clinicians. The project's aim was to identify the current scientific evidence for the recognition and investigation of suspected child abuse and neglect and to disseminate and introduce this into clinical practice.Since 2003 a comprehensive program of Systematic Reviews of all aspects of physical abuse, emotional abuse, and neglect of children, has been developed. Based on NHS Centre for Reviews and Dissemination standards, methodology was devised and reviewers trained. Dissemination was via peer reviewed publications, a series of leaflets highlighting key points in a Question and Answer format, and a website.To date, 21 systematic reviews have been completed, generating 28 peer reviewed publications, and six leaflets around each theme (eg fractures, bruising). More than 250,000 have been distributed to date. Our website generates more than 10,000 hits monthly. It hosts primary reviews that are updated annually, links to all included studies, publications, and detailed methodology. The reviews have directly informed five national clinical guidelines, and the first evidence based training in Child Maltreatment.Child abuse is every health practitioner's responsibility, and it is vital that the decisions made are evidence based, as it is expected in all other fields of medicine. Although challenging, this project demonstrates that it is possible to conduct high quality systematic reviews in this field. For the first time a clear concise synthesis of up to date scientific evidence is available to all practitioners in a range of accessible formats. This has underpinned high quality national guidance and training programs. It ensures all professionals have the appropriate knowledge base in this difficult and challenging field.

Documentation of paediatric head injuries in a mixed metropolitan emergency department

“…The challenges associated with the understanding of child injuries and a lack of standardised protocols may be associated with less adequate documentation of suspected NAI 17,18 . In a child younger than 3 years of age, retinal haemorrhage, apnoea and seizures are associated with abusive head trauma 19–22 . With the exception of seizures, we did not review the documentation of these features, as they were not part of local guidelines.…”

Recognition of risk and prevention in safeguarding of children and young people: a mapping review and component analysis of interventions aimed at health and social care professionals

“…The format of the training varied but courses lasting one or a few days were most common. One exception was the paper by Cowley et al reporting on an initiative to raise awareness of child protection by conducting rigorous systematic reviews and making the results available in accessible formats102 . Components of the training initiatives are discussed in more detail below (see 'Component analysis').…”