[Survey on awareness of violence against children and the use of the guide "violence against children and young people" by paediatricians in Brandenburg].
Following the lead of other German Federal States, Brandenburg has developed a guide entitled "Violence Against Children and Young People" for use by paediatricians. This guide has two objectives: to help doctors detect violence against children at an early stage, and to improve interdisciplinary case management. In order to assess whether the guide has proved its worth in practice, the Public Health Institute of Brandenburg conducted a survey among users. In addition, paediatricians treating the victims were interviewed to obtain estimates of the incidence rate of such acts of violence against children.


METHODS
In 2002/03, the guide was provided free of charge to all paediatricians engaged in the treatment of in- and outpatients, and a structured questionnaire was used to interview a total of 285 such doctors and child and youth psychiatrists on the following topics: estimated incidence rate of acts of violence (proven and suspected cases), case management in practice (cooperation with other agencies, provision of care, support needs) as well as assessment of the guide's content and design in terms of the practical utility of the information provided. After the questionnaires had been sent out a second time, the response rate was 33.3 % (92 out of a total of 285).


RESULTS
82 (89.1 %) of the paediatricians questioned had dealt with at least one case of violence against children in 2003; only three doctors had seen no case at all. A total of 904 proven and 945 suspected cases were registered. One striking result of the survey was the great variation in the number of cases registered by individual doctors: between 0 and 179 proven cases, and between 0 and 120 suspected cases. 12 doctors (13 %) stated that they had treated proven or suspected cases in all four categories (physical abuse, physical neglect, emotional abuse, sexual abuse). Other doctors registered no proven, only suspected cases. 80 doctors (87 %) questioned said that they worked together with other agencies, but 19 (20.6 %) were dissatisfied with this cooperation. 59 (64.1 %) reported a need for case-related support, particularly from the following institutions: 1. Youth Welfare Office, 2. Child and Youth Psychiatry, 3. Public Health Office. 19 (30.4 %) doctors regarded the local provision of care as insufficient. Results of the guide's evaluation: 44 out of a total of 49 doctors (88.8 %) considered the guide's design and contents "good" or "very good". 19 doctors (38.8 %) stated that the guide had led to changes in the way they work and that they were now able to deal with the problem of violence against children more confidently.


CONCLUSIONS
Paediatricians in Brandenburg testify to cases of violence against children. The guide "Violence Against Children and Young People" offers useful information on the practical handling of such cases. The alliance "Growing up Healthy in Brandenburg" tackless the need for support by developing a catalogue of measures to be implemented. These include conducting specialised further training for paediatricians as well as cross-disciplinary furthertraining measures, and setting up regional working groups to improve basic networking in practice.
Ellsässer
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Landesgesundheitsamt Brandenburg im LASV. Gabriele.Ellsaesser@LGA.Brandenburg.de
Cartheuser
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D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006293:Health Promotion / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010372:Pediatrics / Q000193:education* / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011361:Professional Competence / Q000706:statistics & numerical data*; D011643:Publishing