Medical Management of children with suspected physical abuse

Epidemiological data indicates that physical abuse is the most common form of maltreatment in young ages. Physically abused children can be examined by health care professionals of any specialty and present evident medical findings. Physical abuse can be life-threatening and it is a fact that early intervention could act as a shield for the whole family.

Since there is a shortage of physicians specialized in the area of child abuse in Greece, ELIZA formed a multilevel partnership with the 2nd Department of Pediatrics (N.K.U.A) to address this significant deficiency.

The partnership is based on the following strategic pillars:

A.Creation of the first nationwide network of physicians dedicated to protecting children from physical abuse and training of first line health professionals

Having sought guidance and advice from experts in child abuse and neglect from the US Universities of Yale and Iowa, we developed an educational curriculum on Child Physical Abuse for a group of physicians from all the pediatric departments of all the medical schools in Greece. The educational curriculum was adapted to provide a 6-hour workshop on Child Physical Abuse. Eight workshops were conducted in seven cities of Greece with 1.220 participants, mostly physicians.

 B. Retrospective research on child physical abuse

A key element of this initiative was a retrospective study focusing on children hospitalized at the “P. & A. Kyriakou” Children’s Hospital during a 2-year period (2014 & 2015). Among 35.273 admissions, the medical records of 161 children with social problems and/or an acute serious injury were selected and analysed.

Main findings:

  • The average age of children with possible physical abuse was 7.7 years, in contrast to U.S. child abuse data, where the majority of reported cases of physical abuse are under the age of 3 years.
  • In this sample, infants were at greater risk of physical abuse, consistent with existing international literature that highlights the vulnerability of infants to physical abuse.
  • 1 in 3 cases of burns could have been prevented with improved parent/caregiver education and child supervision.

 C. Protocol for the recognition and management of suspected child physical abuse

In the context of the program, a Protocol i.e. a user-friendly standardized procedure was developed for the assessment of suspected physical abuse, which can be applied at all Greek hospitals. The Protocol could contribute in:

  • Increasing the index of suspicion and timely detection of child physical abuse among health care professionals
  • Optimizing and standardizing the laboratory workup and management of suspected physical abuse with prompt notification of child protection services
  • Empowering physicians to recognize abuse prior to irreversible physical and emotional trauma
  • Supporting and maintaining family unity, whilst avoiding institutionalization of children

The Protocol has already been adopted by 5 Hospitals in Greece, and our aim is its induction in all hospitals throughout Greece, during the next 5 years.

In the near future, the educational curriculum will be further enriched with Training Courses related to the management of cases of child sexual abuse.

The Board of Directors of ELIZA, along with its scientific team express their sincerest gratitude to the companies and organizations, which believing in the potential of this Program right from the start, actively supported it through the first year it took place.

Main Sponsor – OTE Group

Sponsor – Embassy of the United States of America, in Greece

Supporters – Aegean Airlines, Microsoft Hellas, The Fulbright Foundation in Greece

Management of children with suspected abuse

Commencing in 2017 and aware that the police force is constantly at the forefront of the fight to protect vulnerable families and children, ELIZA inaugurated the first National Training Program for Police Personnel on the management of cases of abused children, in Greece.

In 2018 – 2019, the Program was transformed into a series of seminars, covering broader areas of the country, aiming to inform and educate all ranks of the Greek Police Force, offering answers to practical problems, solutions to daily obstacles and valuable knowledge.

The Program’s Implementation

The educational material was drafted and presented by a team of experts composed of professionals, who have been involved in child protection issues for many years, and are deemed suitable to impart knowledge and advice and most of all to inspire and demonstrate how children can be saved.

Every workshop addresses the following topics:

  • Definition of child abuse and neglect/ different kinds of abuse: the cycle of violence, the psycho-social dimension of the phenomenon
  • Risk factors/ epidemiology/ medical aspect of the phenomenon
  • Legal issues of child abuse
  • Understanding why sexual abuse is so often concealed and how to establish a procedure for disclosure in the case of under aged victims
  • Practical issues concerning the management of cases of abused children
  • Basic principles of forensic interviewing for minors
  • How must I deal with a case of abuse of an underaged victim – the Prosecutor’s perspective

 The Program’s Imprint

ELIZA, in collaboration with the Central Police Force Administration, as well as with the Education & Human Resources Department and with the valuable contribution of the Public Prosecutors’ Office of the Supreme Court conducted 9 workshops during which 1.350 Police officers from 39 different prefectures of mainland Greece were trained, in the following cities:

  • Athens
  • Agrinio
  • Chalkida
  • Heraklion
  • Tripoli
  • Larissa
  • Kozani
  • Thessaloniki
  • Kavala

ELIZA would like to extend its warmest gratitude to the GEK TERNA Group and its subsidiaries TERNA, TERNA ENERGY and NEA ODOS, who believed right from the start in the program’s potential and supported it, unobtrusively, as a Major Sponsor.

Further special thanks should be expressed to the Greek Police Headquarters and the Public Prosecutors’ Office of the Supreme Court for their solid support during all the stages of the Program’s planning and implementation.

Next Steps

ELIZA’s goal is to expand the Program so as to train police officers serving at the islands of Greece, withing the next year, thus strengthening the protection circle of vulnerable children and families all over Greece.

Management of children with suspected abuse

Since 2016, through the Nationwide Awareness Campaign against Child Abuse initiated by ELIZA, numerous child care professionals have been educated, such as physicians, nurses, teachers, police officers etc.

It was deemed necessary to reinforce the initiative, through the design and implementation of a National Program for the Training of Judges and Prosecutors.

They are the professionals who constitute a vital link in the chain of protection of children as well as vulnerable families and who are respectively in touch with all professionals involved in the prevention and management of cases of abuse.

Planning and Implementation of the Program

The planning and initial implementation of the Program in 2018 was undertaken with the valuable contribution of the Public Prosecutors’ Office of the Supreme Court.

The Program’s goal is to reinforce and improve the management process of cases, where there is suspicion of abuse and/ or neglect of infants and young children, through the provision of knowledge, practical guidance and the presentation of the best practice adopted on an international level, and adapted to Greek reality and legislation.

During 2018, under the auspices of the Public Prosecutor’s Office at the First Instance Court of Thessaloniki and the Public Prosecutors’ Office of the Supreme Court, ELIZA implemented the first two one-day seminars in Thessaloniki and Athens, on the 10th and 11th of December respectively, attended by 73 judges and prosecutors, of different ranks.

The seminars were also attended by police officers, forensic medical examiners, police psychologists, as well as social workers, reinforcing in this way the goal of promoting the multidisciplinary approach in managing any case that might bear the suspicion of child abuse.

The educational material was drafted and presented by a diverse team of expert speakers-professionals with international experience and training in the field of child protection. The main speaker at both seminars was Dr. Resmiye Oral – Professor of Pediatrics / Certified Expert at the University of Iowa Children’s Hospital, Director of the Child Protection Program at the University of Iowa Children’s Hospital and a Fulbright scholar for 2015-16 and 2018-19.

ELIZA expresses its sincerest gratitude to the Prosecutor’s Office of the Supreme Court and Mrs. Xeni Dimitriou-Vasilopoulou in particular, who from the onset trusted ELIZA’s work and believed in the program’s potential.

Further thanks should be expressed to Aegean Airlines, Air-Carrier Sponsor and the Electra Group of Hotels & Resorts, Hospitality Sponsor for their support for the implementation of the seminar in Thessaloniki.

 Next Steps

ELIZA plans, within the next two years, to extend the Judges’ and Prosecutors’ Educational Program, by implementing Seminars, which will cover broader areas in Greece.

Management of children with suspected abuse

Under the scientific guidance of the Medical Schools of Yale and Iowa Universities, ELIZA and the 2nd Department of Paediatrics of the National & Kapodistrian University of Athens (N.K.U.A.) conducted the 1rst Nationwide Nurses Training Program at the “P. & A. Kyriakou” Children’s Hospital of Athens on the management of cases of physically abused children in Greece.

Through a similar training program which was carried out for the first time during the period of 2016-2017, which received a high turnout from the scientific community, more than 1.220 health professionals that take care of children were trained, mostly physicians, pediatric residents and medical students, in 7 cities of Greece.

 The Program’s Goal

This program which began in March 2018, is addressed to nurses, as:

  • They are the first health professionals at the hospitals to come in touch with a child with suspected abuse
  • They draft the child’s first medical record and they refer children to appropriate hospital departments
  • They spend an important amount of time with the family and the child

 The program seeks to accomplish the following goals:

  • Train nurses, by providing them with valuable knowledge and expertise for the detection and management of children with suspected physical abuse.
  • Reinforce the interdisciplinary approach used for managing each case within the Hospital, through the strengthening of an effective communication between nurses and physicians, social workers etc.
  • Establishment of protocol/ guidelines for the adoption of a standardized procedure of detecting and managing cases of physically abused children.

The 1st Seminar

The 1rst Workshop was conducted under the guidance of the Nursing Services Division of the “P &A Kyriakou” Children’s Hospital in March 2018, at the “K. Papadatos” Amphitheater of the “P & A Kyriakou” Children’s Hospital of Athens, where 220 nurses attended from the Attica Region.

The Board of Directors expresses its sincerest gratitude to the Seminar’s exclusive sponsor, the global Non-Profit Organization, The Hellenic Initiative.

 Next Steps

Our ultimate goal for the period of 2019-2020, is the completion of the training program at the cities where the 12 University Pediatric Departments are located (Athens, Thessaloniki, Alexandropoulis, Ioannina, Larissa, Patras and Herakleion).