Elsevier

International Emergency Nursing

Volume 34, September 2017, Pages 29-35
International Emergency Nursing

Building workforce capacity to detect and respond to child abuse and neglect cases: A training intervention for staff working in emergency settings in Vietnam

https://doi.org/10.1016/j.ienj.2017.03.004Get rights and content

Highlights

  • The first evaluation of child protection training for emergency staff in Vietnam.

  • Emergency staff recognition of CAN improved on completion of the programme.

  • Staff attitudes towards reporting CAN remained relatively stable.

  • Maximum impact will occur when incorporated into a system-wide approach to response.

Abstract

Background

Too many children are brought to hospital emergency departments on numerous occasions before they are recognised as victims of child abuse and neglect. For this reason, improving knowledge and response behaviors of emergency staff at all levels is likely to have a significant impact on better outcomes.

Aim

An Australian based training programme was the first of its kind to address this issue in a Vietnamese Emergency Department. Titled ‘Safe Children Vietnam’, the programme aimed to improve knowledge, attitudes and reporting behaviors concerning child abuse in the emergency setting.

Method

A pre-post test design was used to evaluate the impact of ‘Safe Children Vietnam’ on emergency staff knowledge, attitudes and intentions to report child abuse and neglect.

Results

Emergency staff including doctors, nurses and healthcare staff (n = 116) participated in the clinical training programme. Linear Mixed Model analyses showed that on programme completion, they were more likely to recognise serious cases of all types of abuse.

Conclusion

The ‘Safe Children Vietnam’ programme was effective at improving emergency staff knowledge of child abuse and neglect. A systems wide approach may be necessary to impact on emergency staff attitudes towards reporting cases of abuse.

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.

References (46)

  • S. Palazzi

    Observational study of suspected maltreatment in Italian paediatric emergency departments

    Arch Dis Child

    (2005)
  • S. Raman

    Addressing the clinical burden of child physical abuse and neglect in a large metropolitan region: improving the evidence-base

    Social Sci

    (2014)
  • A. Gwee

    Fortnightly emergency department case-file audit for timely detection of missed cases of suspicious injury

    Med J Aust

    (2014)
  • K. Sanders Jordan et al.

    Children at risk of maltreatment: identification and intervention in the emergency department

    Adv Emergency Nurs J

    (2014)
  • C. Cappa et al.

    Prevalence of and risk factors for violent disciplinary practices at home in Viet Nam

    J Interpersonal Violence

    (2014)
  • R. Michaelson

    Child abuse in Viet Nam: summary report of the concept, nature and extent of child abuse in Vietnam

    (2004)
  • Nguyen Huong Thanh et al.

    Multiple types of child maltreatment and adolescent mental health in Viet Nam

    Bull World Health Organ

    (2010)
  • Nh.u.K. Tran

    Child maltreatment in Vietnam: prevalence and cross-cultural comparisons

    J Aggression Maltreatment Trauma

    (2016)
  • Quynh Anh Tran

    Adverse childhood experiences and the health of university students in eight provinces of Vietnam

    Asia-Pacific J Public Health

    (2015)
  • Ha Thi Ninh et al.

    The proportion of violence against children from 8-11 years old by their family members at one ward of Bien Hoa city

    J Med, Ho Chi Minh City

    (2008)
  • Kim Xuan Loan, Adverse childhood experiences: prevalence and affects on mental health and risk behaviours of...
  • A. Sato et al.

    Inadequate sociomedical evaluation of possible abusive head trauma in Yokohama

    Pediatr Int

    (2016)
  • E. Thorpe

    Missed opportunities to diagnose child physical abuse

    Pediatr Emerg Care

    (2014)
  • View full text