What is the system of care for abused and neglected children in children's institutions?
OBJECTIVE
The objectives of this study were to describe the number of children with suspected abuse or neglect (CAN) cared for in selected children's hospitals, to determine how they are tracked and followed, and to better describe the composition, function, and financial support of child protection teams (CPTs).


METHODS
A self-administered survey was mailed to child abuse contact leaders at institutions that were members of the National Association of Children's Hospitals and Related Institutions in 2001. Responses from rehabilitation hospitals and those that did not indicate whether a CPT was present were excluded.


RESULTS
One hundred thirty-four of 157 leaders responded. One hundred twenty-two (91%) met study criteria. Eighty-eight hospitals (72%) had a CPT-54% were pediatric facilities, 59% had >100 beds, and 89% had a pediatric residency. Compared with institutions without a CPT, institutions with a CPT were less likely to be located in the South (28% vs 70%) and more likely to have >200 beds (26% vs 1%), a medical school affiliation (92% vs 74%), and a pediatric residency (98% vs 68%). Sixty-one percent of institutions cared for <300 suspected CAN cases, and 66% had 5 or fewer CAN-associated deaths the previous year. Institutions with a CPT used more comprehensive documentation for CAN, including special CAN forms (55% vs 21%) and photographs (77% vs 53%). They also more commonly referred CAN cases to law enforcement (58% vs 35%) or a CAN clinic for follow-up (52% vs 26%). Fifty-two percent of CPTs had an annual budget of $500 000 or less. The most common primary source of financial support for CPTs was the hospital (51%), although funding was usually composed of a combination of funds from the hospital, patient fees, and state government. Functions performed by CPTs included consulting on cases of CAN (89%), functioning as a liaison with child protective services (85%), tracking cases of abuse or neglect (70%), providing quality assurance on CAN cases (63%), and filing reports with child protective services (61%). Twenty-four hour consultative coverage was provided by most CPTs (79%), for which 94% provided phone consultation and 81% provided in-person consultation when necessary.


CONCLUSIONS
The institutions surveyed cared for many children suspected of abuse and neglect. Thirty-eight percent did >300 evaluations per year. In general, institutions with CPTs provided more comprehensive documentation and follow-up of children suspected of having been abused or neglected than institutions without CPTs. Whether this is associated with better outcomes for children suspected of abuse or neglect is unknown.
Tien
Irene
I
Division of Pediatric Emergency Medicine, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts 02118, USA. irene.tien@bmc.org
Bauchner
Howard
H
Reece
Robert M
RM
D002017:Budgets; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002651:Child Advocacy / Q000706:statistics & numerical data*; D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D005378:Financial Support; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D011159:Population Surveillance; D012189:Retrospective Studies; D014481:United States