Building workforce capacity to detect and respond to child abuse and neglect cases: A training intervention for staff working in emergency settings in Vietnam
Introduction
The timely detection and appropriate response to cases of child abuse and neglect (CAN) presents a global challenge. Up to seven percent of paediatric injury presentations to emergency care settings are a result of CAN, making the emergency care setting an ideal environment for child abuse detection and management [1], [2], [3], [4], [5], [6], [7]. A widespread situation of under-recognition and under-reporting of abuse in emergency care settings poses a significant challenge to the accurate measurement and interpretation of this phenomenon.
The true extent of child abuse in Vietnam is still underreported, but available data suggest the problem is widespread and worse than in many other Asian and non-Asian countries. Current estimates are that between 48 and 70% of Vietnamese children will experience physical abuse in their lifetime [8], [9], [10], [11], [12], and up to one in three will witness intimate partner violence in their home [9], [11], [13], [14]. Many new initiatives have been implemented throughout Vietnam to improve early intervention for and prevention of family violence.
Emergency department doctors, nurses and healthcare staff in Vietnam are not trained in the recognition and management of child abuse presentations, the field of social work is in its infancy, and hospitals lack infrastructure to appropriately support vulnerable families. Capacity building for emergency staff has the potential to be life saving, with repeat injury and multiple presentations of abused children to emergency settings commonplace [15], [16], [17], [18], [19], [20].
This paper reports on the evaluation of a clinical training programme aimed at improving emergency staff knowledge, attitudes and reporting behaviors concerning child abuse presentations in the emergency care setting. Primary outcome measures were the ability to correctly identify abuse from case vignettes and the likelihood to report this abuse. Secondary outcome measures were attitudes towards reporting.
Section snippets
Study design and setting
A prospective cohort study using a pre- and post intervention design with longer-term follow-up was used. The pre-test was conducted with all participants in March 2014 (0 weeks). The post-test was conducted in May 2014 (6 weeks), 6 weeks after the training intervention. Longer-term follow-up was conducted in November 2014 (6 months), 6 months after the training intervention.
The study was conducted in three emergency care settings of a tertiary paediatric hospital in Vietnam. Together they treat
Characteristics of the sample
Of the 120 eligible staff, 116 gave informed consent to participate. As expected in a longitudinal study, loss to follow-up was experienced at all three time points, with data collected on 116 (100%) participants at 0 weeks, 92 (79%) participants at 6 weeks and 73 (63%) participants at 6 months. That is, there were no significant differences between group characteristics that may have accounted for differences across time. To test this, Little’s MCAR test for missing data was used, resulting in a
Discussion
Emergency staff were more likely to correctly recognise child abuse presentations following participation in the programme. This finding is very encouraging, and might lead to better identification of child victims. Effect sizes for these improvements were relatively small, however the potential to impact on children’s lives is considerable. These effects are indicative of considerable impact for minimal financial expenditure, an important consideration in a still developing country.
Lack of
Ethics statement
Ethics approval was obtained from the HREC at the study site and at the University of Sydney.
Funding
This work was supported by the UBS Optimus Foundation [Grant No. R0028_PJ].
Conflict of interest
None.
Acknowledgements
None.
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