Medical neglect at a tertiary paediatric hospital

Medical neglect is under-researched and the extent of the problem in Australia is unknown. We conducted a review of the referrals for medical neglect to the Child Protection Unit (CPU) at a tertiary children’s hospital in Sydney over a 5 years period, from 2011 to 2016, to determine what medical conditions are being referred, the reason for the medical neglect concern and whether cases are managed in line with American Academy of Pediatrics (AAP) guideline on medical neglect.61 cases of medical neglect were identified, constituting 4.1% of all referrals to the Child Protection Unit for physical abuse and neglect. There was a wide variety of medical conditions. Most were chronic medical conditions (87%). The top two medical conditions were chronic and complex multi-system disorders (37.7%) and endocrine disorders (18%). The majority of medical neglect were related to concerns that the caregivers were unwilling to follow medical advice (45.9%) or unable to provide necessary medical care (26.2%). In line with the AAP guideline on medical neglect, all cases were managed by addressing communication difficulties (100%) and resource issues were addressed in 80% of cases. A report to statutory child protection agencies was made in 50% of cases. Directly observed therapy and medical contracts were used in 30% and 26% of cases. We conclude that children with chronic medical conditions may be at risk of medical neglect. Communication difficulties were a factor in all cases. Statutory agency intervention is often required.     

Medical neglect of a child: challenges for pediatricians in developing countries

OBJECTIVE: To conceptualize the underlying causes of the medical neglect of children in a developing country and to provide suggestions for the management of neglect by pediatricians. METHODS: A case history of a 4-year-old boy from Turkey with neglect of the required treatment for acute lymphoblastic leukemia is used to examine the causes and management of medical neglect. Results: Although epidemiological studies on child neglect are lacking, this case exemplifies how in DEVELOPING countries, reasons for neglect or non-compliance with medical recommendations and the roles and actions taken by the health care and the social service systems may differ from western populations. Common to both western and developing countries, the characteristics of the child, family, and society may be reasons for medical neglect. However, cultural fatalistic beliefs profoundly present in the developing world may also contribute to the medical neglect of a child. Identification of the neglect, a comprehensive, multidisciplinary assessment emphasizing the strengths within the family and the society, and the determination of the pediatric team to act in the best interest of the child may result in resolution of the neglect even in circumstances where resources within systems are not sufficient. CONCLUSIONS: In developing countries, increased emphasis on child neglect, its prompt recognition and management within the pediatric profession as well as at a health care and social service system levels are needed to address this prevalent and potentially fatal child health problem.     

医务社会工作教育与临终关怀

临终关怀是社会卫生保健体系的基本组成部分。我国目前实施的临终关怀主要倚重医护尤其是护理力量,缺乏医务社会工作者;而临终关怀的哲学体系来源于社会工作的基本原则,其特点决定了医务社会工作的重要性。医务社会工作教育应注重社会学知识和技能、心理学知识和死亡教育,并加强临床实践。     

An alternative to foster care for victims of child abuse/neglect: a university-based program

Two central forces dominated the conception and development of the Parents and Children Together (PACT) project: the need for provision of an in-home alternative to foster care for abuse and/or neglect families and the prevention of further abuse and/or neglect in the family. Wayne State University in Detroit is the site for Parents and Children Together (PACT) project, a contractual service of the Michigan Department of Social Services (DSS). Graduate students provide in-home services to referred families who, due to child abuse or neglect, would otherwise have their child(ren) removed from the home. This family-based work is a one-year cooperative education experience for students interested in professions in the human services. This report discusses the PACT project as a grant operated through the university, the specification of course work associated, and the attraction of students to graduate study with "hands-on" experience. All of these program attributes, as well as the resource of the project for research, make it an important effort for the university. Further, the university has an additional meaningful role with community residents. Beyond university and student opportunities, the DSS and its clients benefit by having broad-based expertise brought into homes on a weekly basis. Annual success rates of keeping children out of foster care are cited along with cost effectiveness. The university's role in levels of prevention in a highly coordinated community effort is indicated.     

Medical nonadherence in pediatric HIV: Psychosocial risks and intersection with the child protection system for medical neglect

Nonadherence to antiretroviral treatment has serious health implications for HIV-infected children, at times warranting referral to child protective services (CPS). The current study of 134 children with perinatally acquired HIV infection aimed to investigate rates of treatment adherence and CPS involvement, multilevel variables associated with nonadherence, and the manner in which these risks operated together in the prediction of adherence outcomes. Risk factors for nonadherence were grouped on the basis of confirmatory factor models, and factor score regression was carried out to determine which factors were uniquely predictive of adherence. A series of indirect effects models were then tested in order to examine how these factors operated together in the prediction of adherence. Results showed that almost half of the sample demonstrated suboptimal adherence to treatment, and in one-fifth, CPS was involved for medical neglect. Caregiver Health, Caregiver Involvement, Caregiver Acceptance, and Child Adaptation were predictive of nonadherence, and together explained 54% of the variance in treatment adherence. There were significant indirect effects of Caregiver Health on adherence that operated through Caregiver Involvement and Child Adaptation and an indirect effect of Caregiver Involvement on adherence through Child Adaptation. Findings extend current literature that has independently linked various factors predictive of medical adherence in pediatric HIV by showing separate but simultaneous associations with nonadherence and unique pathways to adherence involving multilevel risks. Healthcare and child welfare implications are discussed.     

论严重不负责任

“严重不负责任”不仅能视为犯罪构成中的客观要件,而且也能理解为是过失心理的主观要件;构成医疗事故罪的本质,就主观方面而言,是严重不负责任的态度,即对职责所采取的不认真的心理态度。就客观方面而言,是指行为人对就诊人进行的救治、护理和身体健康检查中,严重违反职责的行为。     

Cognitive processes associated with child neglect

OBJECTIVE: To compare neglectful and non-neglectful mothers on information processing tasks related to child emotions, behaviors, the caregiving relationship, and recall of child-related information. METHOD: A natural group design was used. Neglectful mothers (N=34) were chosen from active, chronic caseloads; non-neglectful comparison mothers (N=33) were obtained from community agencies serving families. Participants were administered the IFEEL Picture task to assess maternal perceptions of infant emotions, eight vignettes of young children's behavior to assess attributions for child behavior across different scenarios, and a passage recall task to assess information processing problems. A measure of depression was used as a covariate to control for this variable. RESULTS: Neglectful mothers were significantly less likely to recognize infants' feelings of interest, more likely to see sadness and shame, more inaccurate at labeling infants' emotions, and had a more limited emotion vocabulary. They also made more internal and stable attributions for children's behaviors in situations where it was not clear whether a child was at risk of harm, and had poor recall of information. Depressive symptoms had little effect on these findings with the exception of information recall. CONCLUSIONS: Neglectful mothers show significant problems in information processing concerning their child's emotions and behaviors, which may affect their childrearing behavior. Cognitive-behavioral interventions to improve parents' abilities to recognize their child's emotions and to address maladaptive attributions may be of value.     

Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice

OBJECTIVE: There were two aims to this study: first to examine whether emotional abuse and neglect are significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women presenting to a primary care practice, and second to examine the strength of these relationships after controlling for the effects of other types of childhood abuse and trauma. METHOD: Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis, 1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla, 1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression analyses were conducted to examine unique contributions of emotional abuse and neglect variables on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma exposure. RESULTS: A history of emotional abuse and neglect was associated with increased anxiety, depression, posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual abuse and lifetime trauma were also significant predictors of physical and psychological symptoms. Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure. CONCLUSIONS: Long-standing behavioral consequences may arise as a result of childhood emotional abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further trauma exposure.     

Navajo child abuse and neglect study: A comparison group examination of abuse and neglect of navajo children

The presence of vastly different cultural influences on child rearing and family life in Native Americans than are found in the general population offers an opportunity to examine the issue of child abuse and neglect in a different cultural context. A study was conducted to obtain baseline data and to isolate types and circumstances associated with maltreatment of Navajo children under 9 years of age. Records from tribal and state courts, the Bureau of Indian Affairs (BIA), state social services and a sample of ambulatory pediatric cases were reviewed to elicit abuse or neglect status data for calendar year 1975. Data on 365 abuse or neglect cases were compared with 867 nonabused or nonneglected children (comparison group). A double blind case numbering system was employed to ensure confidentiality of data obtained. Abuse cases were dichotomized according to litigation status (e.g., adjudicated versus documented by clinical findings). Neglect cases were categorized by perceived parental control over circumstances leading to the neglect (e.g., voluntary versus involuntary neglect). Reliability sub-studies were conducted by study staff and Navajo volunteers to assess the degree of agreement in the classification of study case status. Tribal census data for 1975 provided baseline information from which the incidence of abuse or neglect involving Navajo children was established. Extrapolated study data suggests up to 8.6% of the reservation resident Navajo children under age 9 to have been abused or neglected. Various sociode-mographic characteristics differentiating the abusive and neglectful families from those of the nonabused or nonneglected children in the comparison group are reported.     

Child neglect: developmental issues and outcomes

OBJECTIVE: This article highlights the manner in which child neglect, the most common form of maltreatment, affects children's development. METHOD: The review is organized according to three developmental periods (i.e., infancy/preschool, school-aged and younger adolescents, and older adolescents and adults) and major developmental processes (cognitive, social-emotional, and behavioral). Although the focus is on specific and unique effects of various forms of child neglect, particular attention is paid to studies that allow comparisons of neglect and abuse that clarify their similarities and differences. RESULTS: Past as well as very recent findings converge on the conclusion that child neglect can have severe, deleterious short- and long-term effects on children's cognitive, socio-emotional, and behavioral development. Consistent with attachment and related theories, neglect occurring early in life is particularly detrimental to subsequent development. Moreover, neglect is associated with effects that are, in many areas, unique from physical abuse, especially throughout childhood and early adolescence. Relative to physically abused children, neglected children have more severe cognitive and academic deficits, social withdrawal and limited peer interactions, and internalizing (as opposed to externalizing) problems. CONCLUSIONS: The current review offers further support for the long-standing conclusion that child neglect poses a significant challenge to children's development and well-being. Limitations with regard to the state of the knowledge are discussed and directions for future research are outlined.     

Patterns of reported child abuse and neglect

Confirmed reports of abuse and neglect logged in a large state registry file from 1977 to 1984 are analyzed. Boys tend to sustain more frequent and more serious injuries. Victims of male perpetrators tend to sustain more serious injuries. A modest same-sex perpetrator/victim pattern is revealed for physical abuse; males are more likely to physically abuse boys while females are more likely to physically abuse girls. Among younger victims (aged 12 and younger) boys outnumber girls in all reporting categories except sexual abuse. Among adolescent victims, female victims greatly outnumber male victims in all reporting categories. Similarities between adolescent physical abuse and spouse abuse are noted; males are are the predominant perpetrators and females the predominant victims. As expected, victim age emerged as a strong predictor of severity of physical abuse injury. Several other factors including social isolation, mental health problems, lower income, and unemployment of the father are identified as modest predictors of severity.