Non-accidental head injury in New Zealand : the outcome of referral to statutory authorities
Kelly, Patrick
Non-accidental head injury in New Zealand : the outcome of referral to statutory authorities Kelly, Patrick; MacCormick, Judith; Strange, Rebecca - 2009
Child Abuse and Neglect 33(6) June 2009 : 393-401
Objectives To describe the outcome of referral to the statutory authorities for infants under 2 years with non-accidental head injury (NAHI), and to establish whether the authorities held sufficient information to develop a risk profile for these cases. Methods Retrospective review of cases admitted to hospital in Auckland, New Zealand from 1988 to 1998. Records from the hospital admission, child protective services and Police were reviewed, up to 19 years from diagnosis. Results Of 39 infants, 33 survived to leave hospital. Documentation of risk factors was erratic, and sometimes incongruent between agencies. Inter-agency case conferences took place in 17/39 (44%). The Department of Child, Youth and Family Services (CYF) used an informal family agreement to secure safety in 15/33 survivors (45%). Family Group Conferences occurred in 17/33 (52%). Nine of 33 were placed permanently outside the home (27%), two (6%) with unrelated caregivers. Charges were laid in 18/39 cases (46%). Fifteen cases came to trial, with 14 convictions (36%). Of the survivors, 44% were later renotified to CYF. There was no obvious relationship between type of intervention and re-notification. Conclusions Ensuring the safety of an infant with NAHI, and identifying and taking appropriate action with regard to the offender, are complex tasks. In New Zealand, data collection is often incomplete and inter-agency practice and collaboration is variable. Although the rate of prosecution was relatively high by international standards, many children were later notified again for further concerns of abuse or neglect, suggesting that our interventions have been only partially successful. Practice implications This paper suggests that all infants admitted to hospital with non-accidental head injury should become part of a prospective inter-agency research study, using a standardised data collection instrument. This should include the systematic collection of all data known or suspected to be associated with risk of child abuse, and incorporate long-term prospective follow-up, regardless of child protective or legal outcomes. Without large numbers followed prospectively and according to sound methodology, it is difficult to prove which forms of intervention are better than others at reducing the risk of further abuse. [Reprinted from Child Abuse & Neglect, Vol 33, Patrick Kelly, Judith MacCormick, Rebecca Strange, Non-accidental head injury in New Zealand: The outcome of referral to statutory authorities, 393-401, 2009, with permission from Elsevier http://www.sciencedirect.com/science/journal/01452134]
can
0145-2134
New Zealand. Child, Youth and Family.
PREVENTION
CHILD ABUSE
CHILD NEGLECT
CHILD PROTECTION
CHILDREN AT RISK
FAMILY GROUP CONFERENCES
HEALTH
INFANTS
INTERVENTION
PHYSICAL ABUSE
RISK ASSESSMENT
RISK FACTORS
SHAKEN BABY SYNDROME
TRAUMATIC BRAIN INJURY
WOUNDS AND INJURIES
NEW ZEALAND
Non-accidental head injury in New Zealand : the outcome of referral to statutory authorities Kelly, Patrick; MacCormick, Judith; Strange, Rebecca - 2009
Child Abuse and Neglect 33(6) June 2009 : 393-401
Objectives To describe the outcome of referral to the statutory authorities for infants under 2 years with non-accidental head injury (NAHI), and to establish whether the authorities held sufficient information to develop a risk profile for these cases. Methods Retrospective review of cases admitted to hospital in Auckland, New Zealand from 1988 to 1998. Records from the hospital admission, child protective services and Police were reviewed, up to 19 years from diagnosis. Results Of 39 infants, 33 survived to leave hospital. Documentation of risk factors was erratic, and sometimes incongruent between agencies. Inter-agency case conferences took place in 17/39 (44%). The Department of Child, Youth and Family Services (CYF) used an informal family agreement to secure safety in 15/33 survivors (45%). Family Group Conferences occurred in 17/33 (52%). Nine of 33 were placed permanently outside the home (27%), two (6%) with unrelated caregivers. Charges were laid in 18/39 cases (46%). Fifteen cases came to trial, with 14 convictions (36%). Of the survivors, 44% were later renotified to CYF. There was no obvious relationship between type of intervention and re-notification. Conclusions Ensuring the safety of an infant with NAHI, and identifying and taking appropriate action with regard to the offender, are complex tasks. In New Zealand, data collection is often incomplete and inter-agency practice and collaboration is variable. Although the rate of prosecution was relatively high by international standards, many children were later notified again for further concerns of abuse or neglect, suggesting that our interventions have been only partially successful. Practice implications This paper suggests that all infants admitted to hospital with non-accidental head injury should become part of a prospective inter-agency research study, using a standardised data collection instrument. This should include the systematic collection of all data known or suspected to be associated with risk of child abuse, and incorporate long-term prospective follow-up, regardless of child protective or legal outcomes. Without large numbers followed prospectively and according to sound methodology, it is difficult to prove which forms of intervention are better than others at reducing the risk of further abuse. [Reprinted from Child Abuse & Neglect, Vol 33, Patrick Kelly, Judith MacCormick, Rebecca Strange, Non-accidental head injury in New Zealand: The outcome of referral to statutory authorities, 393-401, 2009, with permission from Elsevier http://www.sciencedirect.com/science/journal/01452134]
can
0145-2134
New Zealand. Child, Youth and Family.
PREVENTION
CHILD ABUSE
CHILD NEGLECT
CHILD PROTECTION
CHILDREN AT RISK
FAMILY GROUP CONFERENCES
HEALTH
INFANTS
INTERVENTION
PHYSICAL ABUSE
RISK ASSESSMENT
RISK FACTORS
SHAKEN BABY SYNDROME
TRAUMATIC BRAIN INJURY
WOUNDS AND INJURIES
NEW ZEALAND