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Injured or abused children less than one year of age: are they the same sub-population?

Pratt, Jan (2007) Injured or abused children less than one year of age: are they the same sub-population? Professional Doctorate thesis, Queensland University of Technology.

Abstract

Children less than one year of age are a vulnerable population. Injury, and child abuse and neglect (child maltreatment) are causes of morbidity and mortality in this population. The literature suggests that the family characteristics of both sub-populations are similar and they may be the same sub-population (Peterson and Brown 1994).

Large scale studies have revealed that there are multiple risk markers that are predictive of child abuse and neglect (Browne 1995, Sidebotham et al. 2001, 2002). There is mixed evidence as to whether home visiting can have an impact on preventing injury and child abuse and neglect.

This study aims to show that children who are injured and maltreated are the same sub-population. The study also examines the impact of child, family and societal risk markers on the likelihood of a child presenting for an injury or child maltreatment, and the effect of home visiting on the outcomes of injury and/or child maltreatment.

This study is a retrospective cohort study using administrative data from three administrative data systems. The data from these systems were merged as part of a work project and de-identified. The de-identified data set contained data at an individual child level and formed the study sample. There were 11,821 children in the sample who lived within the Royal Children's Hospital Health Service District. Variables included demographic data, family characteristics, service contacts which included injury and Child Advocacy Service contacts (a proxy for child maltreatment).

The main results of the study indicate there is a small cross-over of the sub-populations and these children are an extremely at-risk sub-population with a very high prevalence of risk markers. The research found that for children less than one year of age the 4.1% of the study sample presented for an injury contact and 1.1% of the study sample has a Child Advocacy Service (CAS) contact. There was 5.17% of the injury sub-population, compared to 0.93% of the non-injured population who had a CAS contact. Nineteen percent (19 %) of children who had a CAS contact also had an injury contact.

The study also found that sole parents, mothers with an intellectual disability, and mothers who live in temporary/rental housing are predictors of injury and child maltreatment. Another finding is that an injury contact is a significant predictor of child maltreatment. A child who had an injury was 9 times more likely to attend for a CAS contact than a non-injured child (AOR 9.087 significant at 95% confidence interval (CI), (4.863-17.073).

The introduction of home visiting into the model was examined and it was found that more than one home visit has the potential to reduce the likelihood of a child having child maltreatment contact if the mother is a sole parent, less than 20 years of age, abused as a child, lives in a family violence situation, has a mental health problem, is intellectual disabled or uses illicit substances. Whilst the results show a reduction, the impact clinically would be that home visiting as a single strategy will not prevent a CAS contact.

The service implications of the study revealed that, there is a high usage of Department of Emergency Medicine (DEM) of Triage Category 4 and 5 clients. This presents an opportunity to look at alterative service model for these clients. Not all CAS clients were seen by the Primary Care Program, this also presents an opportunity to develop a pathway back to preventative health care services for this vulnerable group. The practice implications are that further research is required to identify the decision making process within DEM for injury presentation to identiy the indicators that DEM staff use to make a referral to the CAS. The identification of risk by Child Health Nurses requires further research to identify if the low occurrence of family risk variables in the study sample is a result of interview skills or data recording.

The study has identified that there is a cross-over sub-population of injured and maltreated children. The research findings will provide information not previously available in the Australian context. At a service level the findings provide data to improve practice and service delivery.

Impact and interest:

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ID Code: 16555
Item Type: QUT Thesis (Professional Doctorate)
Supervisor: Fleming, MaryLou
Keywords: maltreatment, physical abuse, emotional abuse, sexual abuse, neglect
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Schools > School of Public Health & Social Work
Department: Faculty of Health
Institution: Queensland University of Technology
Copyright Owner: Copyright Jan Pratt
Deposited On: 03 Dec 2008 14:05
Last Modified: 29 Oct 2011 05:49

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