Date of Award

2008

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

John Leventhal

Abstract

The purpose of this study was to provide a description of the types of child abuse consultations done by experts at Yale-New Haven Children's Hospital (YNHCH) to Child Protective Services (CPS) in Connecticut, and compare the opinions of the likelihood of child maltreatment of the initial treating physician, CPS, and the child abuse expert. Eligible cases were referred by CPS for expert child abuse consultations at YNHCH between March, 1998 and June, 2005. Abstracted information included demographics, information about the type of injury, and the assessments of the case by the initial treating physician, CPS, and the child abuse expert. Of 187 cases, 49% were males; 30% were African American, 28% white, 23% Hispanic, 1% Asian, and 17% were of unknown ethnicity. The types of cases, defined by the most serious overall injury to the child varied: 46% involved fractures; 22% bruises, scars, or abrasions; 13% burns; 4% brain hemorrhages; 2% death; 1% retinal hemorrhage; and 7% other injuries; in 5% of cases no physical injury to the child was found by any of the assessors. In 57% (N=68) of the 119 cases that had opinions by all three assessors, the expert agreed with the opinion of the original physician on the case; of these 68 cases, 44 were abuse, 6 were uncertain, and 18 were accidental. In 65% (N=77) of cases the expert agreed with CPS on the case; of these cases, 50 were abuse, 2 were uncertain and 25 were accidental. The expert was more likely to determine the case to be accidental (49% of cases) compared to CPS (25% of cases), and the original physician (18% of cases). When CPS believed the case to be abuse (69 cases), the expert most often agreed it was abuse (72%), but in 22% of cases disagreed and determined the case to be accidental. Overall, the expert thought 48% of the cases were abuse. When no explanation was given by the caretaker to account for the child's injury (N= 18), the expert was very likely to find the case one of abuse (72%); in contrast, when an explanation was provided by the caretaker for a fall (N=45) or an accident by the child (N=16), the expert was less likely to find the case one of abuse (35% and 31%, respectively). Factors that increased the probability of the expert determining the case to be one of abuse included: the child had a medical or psychological problem, the child was on record with CPS for a previous concern of maltreatment, CPS removed the child from the home or provided parental services/education, and the child had 3 or more injuries. Although there was agreement in a substantial proportion of cases, in a significant number of cases the child abuse expert had opinions that differed from CPS and the treating physician. Therefore, second opinions by child abuse experts have important value in selected child abuse cases both to confirm previous assessments by the treating physician and CPS, and to change the opinion of the case.

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