EDITOR - Child abuse and domestic violence since Victoria Climbié has
taken centre stage and as rightly identified by Hall1 is set to dominate
the medical and political horizon as a public health issue. Knowledge of
the roles key professionals can play in child protection, are now clearly
defined, however as health professionals do we recognise the new and
serious challenges we are facing? What is our understanding of the
complexities surrounding identifying and reporting child abuse cases, and
preventing further abuse? It was with these questions in mind that a
survey of general medical and dental practitioners and community nurses
was conducted.
In Northern Ireland (NI), more women, are killed by their husbands or
partners than anywhere else in the UK. Figures suggest that this crime is
perpetrated in at least one house in every street in NI2. For children,
exposed to domestic violence there is a 1-in-2 chance that they will be
physically abused3. This upsurge in domestic violence has coincided with
the cessation of political conflict and this provided the backdrop to the
survey. Although anonymity was assured the response rate4 was
disappointing (41%). This may indicate that child abuse was a subject not
worthy of response. For those that did respond (n=276) only 54.3% had
recognised at least one suspicious case in their professional lives (Mean
number 3.82, SE 0.52) and 74.3% of those had reported at least one case
(Mean number 2.03, SE 0.33) of child abuse. Among all participants, the
major anxiety in reporting suspicious cases was fear of misdiagnosis
(73.4%). In addition, 30.8% stated that they did not know how to report
suspicious cases. Therefore the wish for undergraduate and postgraduate
education and multi-disciplinary working to protect ‘at-risk’ children was
stated as highly desirable (78.7%). Nearly all (95.3%) of the sample
reported that it should be part of vocational training courses. Thus, we
congratulate Lord Laming for insisting on ‘A balance between theoretical
teaching and practical training [to] be guaranteed on all training
courses’ and the urgent need for a computerised database5.
However, the recommendations for policy, in our view and in agreement
with Hall1, do not go far enough. They do not acknowledge that domestic
violence and child protection are closely entwined nor do they address the
anxieties experienced by those who suspect child abuse1. Our survey has
also identified that a climate of secrecy prevailed fed not only by fears
of misdiagnosis, but isolation, stigmatisation and a lack of confidence in
the social services, i.e.: the repercussions ‘too awful to contemplate’.
The acquisition of professional knowledge, which ignores people’s fears
and anxieties, is unlikely to result in the desired improvements in child
protection. Even in the heightened atmosphere of the Victoria Climbié
case, the NI health professionals seemed “apathetic” however it may be
postulated that this reflected, first their lack of appropriate knowledge
and secondly, their fears. This sends a clear message for policy makers -
the issue of fear within professional groups must also be addressed. Staff
must be confident in asking questions and giving information rather than
advice. It is by acknowledging the culture of secrecy fuelled by anxieties
and fears1 within the professions that Lord Laming’s5 recommendations can
be implemented and the protection of children achieved.
Mary Russell, Research Associate , School of N&M, Queen’s
University, Belfast, 50 Elmwood Avenue, Belfast BT7 1NN.
Ruth Freeman, Professor of Dental Public Health, School of Dentistry,
Queen’s University, Belfast, RGH, Grosvenor Road, Belfast BT12 6BP
Anne Lazenbatt, Reader in Health Sciences, School of N&M, Queen’s
University, Belfast, 50 Elmwood Avenue, Belfast BT7 1NN.
Wagner Marcenes, Professor of Oral Epidemiology, Center for Oral
Biometrics, Barts and The London, QMUL.
References
1.Hall D. Child protection – lessons from Victoria Climbé. Br Med J
2003: 326: 293-296.
2.Dornan, C. Secrets and Lies, Northern Woman, Belfast: Greer
Publications:, 2001
3.Mooney, J. The hidden figure: domestic violence in north London—the
findings of a survey conducted on domestic violence in the north London
Borough of Islington. London: London Centre for Criminology, Middlesex
University, 1993
4.Sjostrom, D., Holst D., Lind, S.V. Validity of a questionnaire
survey: the role of non-response and incorrect answers. Acta Odontol
Scand 1999; 57: 242-246
Rapid Response:
Victoria Climbié — can we get the lessons right?
EDITOR - Child abuse and domestic violence since Victoria Climbié has
taken centre stage and as rightly identified by Hall1 is set to dominate
the medical and political horizon as a public health issue. Knowledge of
the roles key professionals can play in child protection, are now clearly
defined, however as health professionals do we recognise the new and
serious challenges we are facing? What is our understanding of the
complexities surrounding identifying and reporting child abuse cases, and
preventing further abuse? It was with these questions in mind that a
survey of general medical and dental practitioners and community nurses
was conducted.
In Northern Ireland (NI), more women, are killed by their husbands or
partners than anywhere else in the UK. Figures suggest that this crime is
perpetrated in at least one house in every street in NI2. For children,
exposed to domestic violence there is a 1-in-2 chance that they will be
physically abused3. This upsurge in domestic violence has coincided with
the cessation of political conflict and this provided the backdrop to the
survey. Although anonymity was assured the response rate4 was
disappointing (41%). This may indicate that child abuse was a subject not
worthy of response. For those that did respond (n=276) only 54.3% had
recognised at least one suspicious case in their professional lives (Mean
number 3.82, SE 0.52) and 74.3% of those had reported at least one case
(Mean number 2.03, SE 0.33) of child abuse. Among all participants, the
major anxiety in reporting suspicious cases was fear of misdiagnosis
(73.4%). In addition, 30.8% stated that they did not know how to report
suspicious cases. Therefore the wish for undergraduate and postgraduate
education and multi-disciplinary working to protect ‘at-risk’ children was
stated as highly desirable (78.7%). Nearly all (95.3%) of the sample
reported that it should be part of vocational training courses. Thus, we
congratulate Lord Laming for insisting on ‘A balance between theoretical
teaching and practical training [to] be guaranteed on all training
courses’ and the urgent need for a computerised database5.
However, the recommendations for policy, in our view and in agreement
with Hall1, do not go far enough. They do not acknowledge that domestic
violence and child protection are closely entwined nor do they address the
anxieties experienced by those who suspect child abuse1. Our survey has
also identified that a climate of secrecy prevailed fed not only by fears
of misdiagnosis, but isolation, stigmatisation and a lack of confidence in
the social services, i.e.: the repercussions ‘too awful to contemplate’.
The acquisition of professional knowledge, which ignores people’s fears
and anxieties, is unlikely to result in the desired improvements in child
protection. Even in the heightened atmosphere of the Victoria Climbié
case, the NI health professionals seemed “apathetic” however it may be
postulated that this reflected, first their lack of appropriate knowledge
and secondly, their fears. This sends a clear message for policy makers -
the issue of fear within professional groups must also be addressed. Staff
must be confident in asking questions and giving information rather than
advice. It is by acknowledging the culture of secrecy fuelled by anxieties
and fears1 within the professions that Lord Laming’s5 recommendations can
be implemented and the protection of children achieved.
Mary Russell, Research Associate , School of N&M, Queen’s
University, Belfast, 50 Elmwood Avenue, Belfast BT7 1NN.
Ruth Freeman, Professor of Dental Public Health, School of Dentistry,
Queen’s University, Belfast, RGH, Grosvenor Road, Belfast BT12 6BP
Anne Lazenbatt, Reader in Health Sciences, School of N&M, Queen’s
University, Belfast, 50 Elmwood Avenue, Belfast BT7 1NN.
Wagner Marcenes, Professor of Oral Epidemiology, Center for Oral
Biometrics, Barts and The London, QMUL.
References
1.Hall D. Child protection – lessons from Victoria Climbé. Br Med J
2003: 326: 293-296.
2.Dornan, C. Secrets and Lies, Northern Woman, Belfast: Greer
Publications:, 2001
3.Mooney, J. The hidden figure: domestic violence in north London—the
findings of a survey conducted on domestic violence in the north London
Borough of Islington. London: London Centre for Criminology, Middlesex
University, 1993
4.Sjostrom, D., Holst D., Lind, S.V. Validity of a questionnaire
survey: the role of non-response and incorrect answers. Acta Odontol
Scand 1999; 57: 242-246
5.Lord Laming. Inquiry into the death of Victoria Climbié. London:
Stationery Office, 2003. www.victoria-climbie-inquiry.org.uk
Competing interests:
None declared
Competing interests: No competing interests