Healthcare use by children fatally or seriously harmed by child maltreatment: analysis of a national case series 2005-2007.
OBJECTIVE
To determine antecedent patterns of healthcare use by children fatally or seriously harmed by maltreatment.


METHODS
The authors analysed recorded healthcare use for children who were the subject of a serious case review (SCR) in England in 2005-2007. The SCRs were initiated when a child under 18 years old died or was seriously harmed, maltreatment (abuse or neglect) was a factor, and there were lessons for interagency working. The authors analysed a purposive sample (N=40), similar in key demographics to all 189 SCRs in England in 2005-2007.


RESULTS
Children had extensive recorded contact with universal (N=34/40; 85%) and secondary (N=26/40; 65%) healthcare services and children's social care (N=21/40; 53%). Thirty-one children (78%) had recorded health visitor and/or school nurse contact. Fourteen children (35%) had missed appointments. Almost three-quarters (N=29) had complex family problems recorded (parental domestic violence, alcohol/drug and/or mental health problems). Data quality regarding healthcare use was poor, and the extent and type of 'missing data' varied by age.


CONCLUSIONS
Complex paediatric and family problems and a high level of contact with services preceded serious adverse events. Universal health services are likely to be well placed for giving ongoing and family-orientated support to vulnerable families. The absence of standardised data collection and any control group limits how far the Biennial Analyses of SCRs can meet their stated objective of identifying national trends and patterns. Linking SCRs to healthcare databases would provide a control group, improve understanding of the population context and diminish demands for data from professionals delivering care.
MRC Centre of Epidemiology for Child Health, UCL-Institute of Child Health, London, UK. j.woodman@ich.ucl.ac.uk
Jenny
J
Woodman
Marian
M
Brandon
Sue
S
Bailey
Pippa
P
Belderson
Peter
P
Sidebotham
Ruth
R
Gilbert
D000293:Adolescent; D001071:Appointments and Schedules; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data / Q000628:therapy*; D002662:Child Health Services / Q000706:statistics & numerical data*; D016241:Child of Impaired Parents / Q000706:statistics & numerical data; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004739:England / Q000453:epidemiology; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012947:Social Work / Q000706:statistics & numerical data