Multi-sectoral responses to child abuse and neglect in Europe (Euro-CAN)

Logotype Euro-CanMulti-Sectoral Responses to Child Abuse and Neglect in Europe (Euro-CAN) is a COST Action network project with participants from a majority of European countries.

In Europe, millions of children experience abuse or neglect at the hands of those who should care for them. Yet, how many of these children get help, which services they receive by which agency remains largely unknown. Moreover, countries are hardly aware which maltreatment turns fatal. This constitutes a major knowledge gap that is likely due to inconsistent ways of surveying and reporting on child maltreatment services across Europe. Without this information, we cannot know how the systems work, what additional preventive efforts are required, if the interventions fit the victims’ needs or if the most vulnerable groups are properly identified.

The proposed project addresses this gap by creating a network of experts in child maltreatment and relevant stakeholders and links them in working groups, in order to promote the development of a rigorous, consistent, and comparable methodology for the collection of surveillance data on child maltreatment and maltreatment-related fatalities. Researchers, policymakers, administrators and practitioners will identify best-practice methods of surveillance and recommend efficient ways of implementing them across Europe.

Example of Euro-CAN outcomes

Book cover Participatory Research on Child Maltreatment with Children and Adult Survivors

Participatory Research on Child Maltreatment with Children and Adult Survivors

We are glad to announce that the working group 3 book Participatory Research on Child Maltreatment with Children and Adult Survivors edited by Maria Roth, Ravit Alfandari and Gemma Crous has been published.

You can download the book here

Front page of an scientific aricle

Clinical care of childhood sexual abuse: a systematic review andcritical appraisal of guidelines from European countries  

Only half of 34 surveyed European countries have national guidelines on how to provide clinical care and treatment to children who have experienced sexual abuse. This finding was revealed in a study led by researchers från Euro-Can.

Read the article in The Lancet Regional health here


Overview summary sheet

Comparative analysis of major classifications and definitions of child maltreatment

There is a lack of uniform, consensus-based definitions of child maltreatment, both within and across sectors and countries. This hinders attempts at consistent measurement of child maltreatment. Aim: to identify discrepancies and similarities contributing to consensus building.

Download the summary sheet here (PDF)


List of publications

A scoping review of participatory approaches in child maltreatment research across Europe

Participatory approaches in child maltreatment (CM) research increasingly focus on involving children, youth, and adults as co-researchers. However, little is known about their use in Europe. To review the European literature on participatory approaches in CM research. The study was undertaken by members of the Euro-CAN (COST Action 19,106) representing 35 countries in the European region. Focusing on the European research literature, we searched eight databases for studies investigating CM and using a participatory approach. The review followed scoping review guidelines and PRISMA-ScR, with thematic analysis for data synthesis.We identified 4927 potentially relevant articles, of which 307 were fully assessed for eligibility, and eight were ultimately included. The included studies addressed all types of CM; however, only two studies involved child and youth survivors of CM, while six involved children and youth from the community. Notably, no studies involving adult survivors were found. The findings indicate that children, youth, and adults can be involved in all stages of the research process, but the level of participation remains low. Eighteen different participatory methods were identified, and the ethical procedures and safeguarding of co-investigators varied significantly. Several barriers and challenges were identified, including issues related to adult gatekeeping behaviors, parental consent, confidentiality, and practical difficulties. The involvement of children, youth, and adults as co-researchers in CM research across Europe remains limited, with considerable variation in methods and procedures. These findings inform an ongoing e-Delphi study aimed at building consensus recommendations for participatory CM research.

Read the article (Child Abuse and Neglect)

Impact of COVID-19 pandemic on characteristics, extent and trends in child maltreatment in 34 Euro-CAN COST Action countries: a scoping review protocol

While the factors commonly associated with an increased risk of child maltreatment (CM) were found to be increased during COVID-19, reports of actual maltreatment showed varying trends. Similarly, evidence regarding the impact of COVID-19 on CM within the European Cooperation on Science and Technology and Network Collaborative (COST) Action countries remains inconsistent. This scoping review aims to explore the extent and nature of evidence pertaining to CM within the countries affiliated with the Child Abuse and Neglect in Europe Action Network (Euro-CAN), funded by the COST. Key electronic databases were searched to identify eligible papers, reports and other material published between January 2020 and April 2023: PubMed, EMBASE, PsycINFO, Social Policy and Practice, Scopus and Web of Science. To cover the breadth of evidence, a systematic and broad search strategy was applied using a combination of keywords and controlled vocabulary for four concepts: children, maltreatment, COVID-19 and Euro-CAN countries, without restrictions on study design or language. Grey literature was searched in OpenGrey and Google Scholar. Two reviewers will independently screen full-text publications for eligibility and undertake data extraction, using a customised grid. The screening criteria and data charting will be piloted by the research team. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews will be followed to present the results. Results will be summarised in a tabular form and narratively.

Read the article (BMJ Open)

The Nature and Scope of Reported Child Maltreatment in Euro-CAN Countries: Current Evidence and Future Opportunities

Most European Cooperation on Science and Technology (COST) affiliated countries aim to advance the goal of protecting children from maltreatment. However, despite the increasing numbers of population-based surveys, the development of administrative data systems has lagged. In this study, we aimed to examine the current state of development of administrative data systems in a sample of countries represented in the COST Action 19106 network, Multi-Sectoral Responses to Child Abuse and Neglect in Europe: Incidence and Trends (Euro-CAN). A structured questionnaire was distributed to researchers and professionals within Euro-CAN-affiliated countries, which captured economic, legislative, systemic, and data infrastructure characteristics. Thematic trends for 13 sampled countries were presented descriptively. The implementation of legislative measures such as banning corporal punishment varied substantially, with some countries decades apart. Almost all sampled countries mandate reports of suspected child maltreatment for all or some professionals in contact with children. In most countries, public child protection, health, or law enforcement systems are decentralized, and unsubstantiated/inconclusive incidents of suspected child maltreatment are not systematically collected at the national level. Child maltreatment data is not routinely collected in health sectors in all sampled countries. Where data is collected in different sectors, such as police and child protection agencies, different descriptions are often used. Systematic data linkage remains a seldom occurrence with only a few countries offering this capability. The call for Euro-CAN countries to develop multi-sectoral data systems to capture recorded instances of child maltreatment remains relevant.

 

Read the article (International Journal of Child Maltreatment: Research, Policy and Practice

Hospitalisations for physical abuse in infants and children less than 5 years, 2013–2021: a multinational cohort study using administrative data from five European countries

Child physical abuse (CPA) is a global public health problem associated with lifelong negative consequences, yet reliable epidemiologic data are lacking. This multinational cohort study analyses trends in CPA hospitalisations from 2013 to 2021. We used medico-administrative databases to identify children aged one month to five years hospitalised in Denmark, England, France, Ireland, and Wales. We identified CPA using a validated algorithm based on ICD-10 codes. We calculated the number, proportion, and incidence rate of children hospitalised for CPA, and the number and proportion of total hospitalisations for CPA, by year and age group (<1 and <5). We determined the proportion of CPA hospitalisations recorded using different ICD-10 codes, by country. The pooled incidence rate of infants <1 year hospitalised for CPA was stable over time (around 42/100,000 per year), ranging on average from 33 to 48/100,000 between countries. The pooled proportion of infant hospitalisations for CPA was around 0.17% (N = 750) per year (range 0.15–0.21%, N range 674–785), increasing significantly during the COVID-19 pandemic in 2020 (0.21%, N = 674). In children <5, the incidence rate (around 18/100,000 per year) and proportion of CPA hospitalisations (around 0.11% per year (N = 1600), range 0.10–0.14% (N range 1341–1657) were lower than in infants, but also increased in 2020 (0.14%, N = 1341). There were national differences in the distribution of ICD-10 codes used to record CPA and differences in year-on-year trends between countries. Comparing temporal trends in CPA hospitalisations between countries is feasible. Hospital data are one of several valuable sources for CPA surveillance.

Read the article (Tha Lancet)

 

Appraisal of published guidelines in European countries addressing the clinical care of childhood sexual abuse: protocol for a systematic review

Introduction Childhood sexual abuse (CSA) is a global public health problem with potentially severe health and mental health consequences. Healthcare professionals (HCPs) should be familiar with risk factors and potential indicators of CSA, and able to provide appropriate medical management. The WHO issued global guidelines for the clinical care of children with CSA, based on rigorous review of the evidence base. The current systematic review identifies existing CSA guidelines issued by government agencies and academic societies in the European Region and assesses their quality and clarity to illuminate strengths and identify opportunities for improvement.

 

Methods and analysis This 10-database systematic review will be conducted according to the Centre for Reviews and Dissemination guidelines and will be reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Guidance for HCPs regarding CSA, written by a national governmental agency or academic society of HCPs within 34 COST Action 19106 Network Countries (CANC) and published in peer-reviewed or grey literature between January 2012 and November 2022, is eligible for inclusion. Two independent researchers will search the international literature, screen, review and extract data. Included guidelines will be assessed for completeness and clarity, compared with the WHO 2017/2019 guidelines on CSA, and evaluated for consistency between the CANC guidelines. The Appraisal of Guidelines for Research and Evaluation II tool and Grading of Recommendations Assessment, Development and Evaluation methodology will be used to evaluate CANC guidelines. Descriptive statistics will summarise content similarities and differences between the WHO guidelines and national guidelines; data will be summarised using counts, frequencies, proportions and per cent agreement between country-specific guidelines and the WHO 2017/2019 guidelines.

Read the article (BMJ Open)

 

Clinical care of childhood sexual abuse: a systematic review and critical appraisal of guidelines from European countries

The clinical management of Child sexual abuse (CSA) demands specialised skills from healthcare professionals due to its sensitivity, legal implications, and serious physical health and mental health effects. Standardised, comprehensive clinical practice guidelines (CPGs) may be pivotal. In this systematic review, we examined existing CSA national CPGs (NCPGs) from European countries to assess their quality and reporting. We systematically searched six international databases and multiple grey literature sources, reporting by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligible guidelines were CSA guidance from national health agencies or societies in 34 COST Action 19106 Network Countries (CANC), published between January 2012 and November 2022. Two independent researchers searched, screened, reviewed, and extracted data. NCPGs were compared for completeness with reference WHO 2017 and 2019 guidelines. We used the Appraisal of Guidelines for Research and Evaluation (AGREE II) to appraise quality and reporting. PROSPERO: CRD42022320747. Of 2919 records identified by database searches, none met inclusion criteria. Of 4714 records identified by other methods, 24 NCPGs from 17 (50%) of CANC countries were included. In 17 (50%) of eligible countries, no NCPGs were found. Content varied significantly within and between countries. NCPGs lacked many components in state-of-the art clinical practice compared to WHO reference standards, particularly in safety and risk assessment, interactions with caregivers, and mental health interventions. Appraisal by AGREE II revealed shortcomings in NCPG development, regarding scientific rigour, stakeholder involvement, implementation and evaluation. A notable number of European countries lack an NCPG; existing NCPGs often fall short. The healthcare response to CSA in Europe requires a coordinated approach to develop and implement high-quality CPGs. We advocate for a multidisciplinary team to develop a pan-European CSA guideline to ensure quality care for survivors.

Read the aricle (The Lancet)

 

Current issues and challenges in the definition and operationalization of child maltreatment: A scoping review

Studies show considerable variability in the definitions and operationalization of child maltreatment (CM), which limits research, policy formation, surveillance, and cross-country and cross-sector comparisons.

To review the recent literature (2011–2021) to understand current issues and challenges in defining CM, to assist in the planning, testing and implementing of CM conceptualizations.

We searched eight international databases. Articles were included if the substantive content was related to issues, challenges, and debates in defining CM, and the article was an original study, review, commentary, report, or guideline. The review followed methodological guidance for the conduct of scoping reviews and was reported in accordance with the PRISMA-ScR checklist. Four experts in CM conducted a thematic analysis to summarize findings. Methodological rigor of the included studies was not formally assessed.

We identified 7372 potentially relevant articles; 55 full-text studies were assessed for eligibility, 25 satisfied the inclusion criteria. We identified three themes: 1) strategies to define CM, including the integration of child and victim perspectives; 2) difficulties in defining specific CM types; and 3) real-world implications for research, prevention and policy.

Despite longstanding concerns, challenges regarding the definitions of CM persist. A small minority of studies have tested and implemented CM definitions and operationalizations in practice. The findings will inform international multi-sectoral processes to develop uniform definitions of CM, for example by highlighting the need to acknowledge challenges in defining some CM types and emphasizing the importance of considering the perspectives of children and CM survivors.

Read the article (Child Abuse and Neglect)

Defining child maltreatment for research and surveillance: an international,multi-sectoral, Delphi consensus study in 34 countries in Europe and surrounding regions

Child maltreatment is a complex public health issue that has consequences across the life-course. Studies to quantify child maltreatment and identify interventions and services are constrained by a lack of uniform definitions. We conducted a European Delphi study to reach consensus on types and characteristics of child maltreatment for use in surveillance and research. Statements were developed following a scoping review and identification of key concepts by an international expert team (n = 19). A multidisciplinary expert panel (n = 70) from 34 countries completed three rounds of an online survey. We defined consensus as ≥70% agreement or disagreement with each statement after the final round. Consensus was reached on 26/31 statements (participant retention rate 94%). From the statements, we propose a unified definition of child maltreatment to improve measurement and surveillance in Europe. Concerted efforts are now required to test and refine the definition further prior to real-world operationalisation.

Read the article (The Lancet)

 

Hospitalization for physical child abuse: Associated medical factors and medical history since birth

Background

Physical abuse often begins at a very young age and sometimes results in serious or fatal injuries. It is crucial to diagnose physical abuse as early as possible to protect this vulnerable population.

Objective

To study the factors associated with the first hospitalization for physical abuse from birth to the infant's first birthday in France.

Participants and setting

We included all singleton children born in a hospital setting in France between 2009 and 2013, who were identified from the French national information system database (SNDS).

Methods

To study factors associated with the first hospitalization for physical abuse during the first year after birth, we used the Fine and Gray regression model. Factors included in the multivariate model were the infant's sex, prematurity, neonatal conditions, the number of hospitalizations (at least two), medical consultations and complementary universal health insurance (proxy for family precariousness and socio-economic vulnerability).

Results

Over the 2009–2013 period, among 3,432,921 newborn singletons, 903 (0.026 %) were hospitalized for physical abuse in the year following birth. Among the factors associated with physical abuse, such as prematurity (aHR = 2.2[1.8–2.7]), male sex (aHR = 1.3[1.2–1.5]), or having had at least two hospitalizations (aHR = 1.7[1.4–2.1]), we found that complementary universal health insurance coverage was the factor most associated (aHR = 4.1[3.5–4.7]) with being hospitalized for physical abuse.

Conclusion

These findings could help introduce preventative measures for infant protection in certain groups, such as parents of infants born prematurely, especially if they are in a precarious situation. This study also suggests that particular attention should be paid to infants who have been hospitalized at least two times in the first year of life, whatever the reason.

Read the article (Child Abuse & Neglect)

Physical abuse of young children during the COVID-19 pandemic: Alarming increase in the relative frequency of hospitalizations during the lockdown period

Background

In France, the COVID-19 pandemic led to a general lockdown from mid-March to mid-May 2020, forcing families to remain confined. We hypothesized that children may have been victims of more physical abuse during the lockdown, involving an increase in the relative frequency of hospitalization.

Methods

Using the national administrative database on all admissions to public and private hospitals (PMSI), we selected all children aged 0–5 years hospitalized and identified physically abused children based on ICD-10 codes. We included 844,227 children hospitalized in March–April 2017–2020, of whom 476 (0.056%) were admitted for physical abuse. Relative frequency of hospitalization for physical abuse observed in March to April 2020 were compared with those from the same months in the three previous years (2017–2019).

Findings

Even if absolute number of children exposed to physical abuse did not fluctuate significantly, we found a significant increase in the relative frequency of young children hospitalized for physical abuse from 2017 (0.053%) to 2020 (0.073%). Compared with the 2017–2019 period, and considering the observed decrease in the number of overall hospital admissions during the first lockdown, the number of children exposed to physical violence was 40% superior to what would be expected.

Interpretation

The sharp increase in the relative frequency of hospitalizations for physical abuse in children aged 0–5 years in France is alarming. As only the most severe cases were brought to the hospital for treatment during the lockdown, our figures probably only represent the tip of the iceberg of a general increase of violence against young children.

Read the article (Child Abuse & Neglect)

 

Child maltreatment and Covid-19: A crisis within a crisis

The fight against the SARS-CoV-2 pandemic was carried out through strong restrictive measures, including general population lockdown, which allowed the convergence of risk factors for child abuse. During this period, the French national hotline for children in danger recorded a 56% increase in calls. Calls followed by an alert to departmental child protection services increased by 30%. Through an algorithm created by our team, we showed a 50% increase in the relative frequency of hospitalizations for physical abuse in children aged 0-5 years during the lockdown. This has fueled thinking about subsequent health measures to protect the youngest children. Our goal is now to use this algorithm for epidemiological purposes as a barometer of abuse or in daily practice to help the diagnosis of physical abuse in young children.

Read the article

Improving opportunities for data linkage within Children Looked After administrative records in Wales

Background

Domestic violence and abuse (DVA) has a detrimental impact on the health and well-being of children and families but is commonly underreported, with an estimated prevalence of 5.5% in England and Wales in 2020. DVA is more common in groups considered vulnerable, including those involved in public law family court proceedings; however, there is a lack of evidence regarding risk factors for DVA among those involved in the family justice system.

Objective

This study examines risk factors for DVA within a cohort of mothers involved in public law family court proceedings in Wales and a matched general population comparison group.

Methods

We linked family justice data from the Children and Family Court Advisory and Support Service (Cafcass Cymru [Wales]) to demographic and electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank. We constructed 2 study cohorts: mothers involved in public law family court proceedings (2011-2019) and a general population group of mothers not involved in public law family court proceedings, matched on key demographics (age and deprivation). We used published clinical codes to identify mothers with exposure to DVA documented in their primary care records and who therefore reported DVA to their general practitioner. Multiple logistic regression analyses were used to examine risk factors for primary care–recorded DVA.

Results

Mothers involved in public law family court proceedings were 8 times more likely to have had exposure to DVA documented in their primary care records than the general population group (adjusted odds ratio [AOR] 8.0, 95% CI 6.6-9.7). Within the cohort of mothers involved in public law family court proceedings, risk factors for DVA with the greatest effect sizes included living in sparsely populated areas (AOR 3.9, 95% CI 2.8-5.5), assault-related emergency department attendances (AOR 2.2, 95% CI 1.5-3.1), and mental health conditions (AOR 1.7, 95% CI 1.3-2.2). An 8-fold increased risk of DVA emphasizes increased vulnerabilities for individuals involved in public law family court proceedings.

Conclusions

Previously reported DVA risk factors do not necessarily apply to this group of women. The additional risk factors identified in this study could be considered for inclusion in national guidelines. The evidence that living in sparsely populated areas and assault-related emergency department attendances are associated with increased risk of DVA could be used to inform policy and practice interventions targeting prevention as well as tailored support services for those with exposure to DVA. However, further work should also explore other sources of DVA, such as that recorded in secondary health care, family, and criminal justice records, to understand the true scale of the problem.

Read the article (Int. Journal of Population Data Science)

Risk Factors Associated With Primary Care–Reported Domestic Violence for Women Involved in Family Law Care Proceedings: Data Linkage Observational Study

Background

Child maltreatment is a complex public health issue that has consequences across the life-course. Studies to measure child maltreatment and identify interventions and services are constrained by a lack of uniform definitions across sectors and countries. We conducted a Delphi study to reach consensus on types and characteristics of child maltreatment for use in surveillance and research in Europe.

Methods

Statements were developed following a scoping review and identification of key concepts by an international expert team (n = 19). A multidisciplinary expert panel (n = 70) from 34 countries participated in three rounds of online data collection. We defined consensus as ≥ 70% agreement or disagreement with each statement after the final round.

Results

Consensus was reached on 26/31 statements, with a participant retention rate of 94%. The definition states that child maltreatment is a subtype of violence against children. The perpetrator can be an adult or minor, but must be in a position of power over the child. To define an act or omission as child maltreatment, it must cause harm or have the potential to cause harm, regardless of intention, severity, chronicity, or the traditional/cultural beliefs of the perpetrator. In addition, the broad umbrella term encompassing emotional, behavioural or cognitive maltreatment should be “psychological”, and psychological maltreatment should be split into sub-types of psychological abuse and psychological neglect. “Neglect” is a broad type of child maltreatment within which there are subtypes that can all be characterised as “failure to provide” or “failure to supervise”.

Conclusions

This is the first study to demonstrate consensus on the types and key characteristics of child maltreatment across multiple sectors and countries, providing a unified definition of child maltreatment to improve consistency of measurement and surveillance in Europe. This abstract is submitted on behalf of Working Group 1 COST Action 19106.

 

Key messages

• A standardised definition is essential for monitoring child maltreatment.

• We propose a consensus-based definition that can be used to improve child maltreatment measurement in research and surveillance.

Read the article (Journal of Medical Internet Research)

Defining child maltreatment for research and surveillance: a Delphi study in 34 countries

Background

Child maltreatment is a complex public health issue that has consequences across the life-course. Studies to measure child maltreatment and identify interventions and services are constrained by a lack of uniform definitions across sectors and countries. We conducted a Delphi study to reach consensus on types and characteristics of child maltreatment for use in surveillance and research in Europe.

Methods

Statements were developed following a scoping review and identification of key concepts by an international expert team (n = 19). A multidisciplinary expert panel (n = 70) from 34 countries participated in three rounds of online data collection. We defined consensus as ≥ 70% agreement or disagreement with each statement after the final round.

Results

Consensus was reached on 26/31 statements, with a participant retention rate of 94%. The definition states that child maltreatment is a subtype of violence against children. The perpetrator can be an adult or minor, but must be in a position of power over the child. To define an act or omission as child maltreatment, it must cause harm or have the potential to cause harm, regardless of intention, severity, chronicity, or the traditional/cultural beliefs of the perpetrator. In addition, the broad umbrella term encompassing emotional, behavioural or cognitive maltreatment should be “psychological”, and psychological maltreatment should be split into sub-types of psychological abuse and psychological neglect. “Neglect” is a broad type of child maltreatment within which there are subtypes that can all be characterised as “failure to provide” or “failure to supervise”.

Conclusions

This is the first study to demonstrate consensus on the types and key characteristics of child maltreatment across multiple sectors and countries, providing a unified definition of child maltreatment to improve consistency of measurement and surveillance in Europe. This abstract is submitted on behalf of Working Group 1 COST Action 19106.

Read the article (European Journal of Public Health)

Why social work needs to embrace data linkage research

Purpose

Linked data can provide unique insights into both the need for social care services and the outcomes of intervention. Crucially, these insights will be based on much more representative coverage of the population of people receiving social care than is achieved by surveys and they are not subject to the reporting bias that can arise in relation to stigmatised services.

Design/methodology/approach

The opportunities are expanding for linking together routine administrative data from different public services, e.g. health care, social care, education and criminal justice. These linked data can be used for research in trusted research environments which are very secure and where no researcher can identify individuals. Work is rapidly developing using children’s social care data.

Findings

Much of the data linkage research using children’s social care data is being conducted by data scientists and medical researchers without knowledge of the sector, and very few social care or social work specialists who have that knowledge are involved in these studies.

Originality/value

This viewpoint piece argues the need for social care and social work research to embrace data linkage. What is needed is an integration of methods expertise in linked data and substantive knowledge of children’s social care work. The arguments are illustrated with reference to some recent research in Wales.

Read the article (Journal of Children's Services)

Health service use of infants involved in family justice care and supervision proceedings in Wales: a data linkage study

Introduction

When a child has suffered, or is at risk of suffering, significant harm from parents or caregivers, the local authority may issue Section 31 (s.31) Care and Supervision proceedings under the Children Act (1989).


Objectives
We compared the healthcare use of infants less than one year old subject to s.31 proceedings in Wales (n = 1,332),to that of a comparison group of infants not subject to s.31 proceedings (n = 204,417), between January 2011 and February 2020.

Methods
Population-based e-cohort study utilising data held in the Secure Anonymised Information Linkage (SAIL) Databank. Infants in s.31 proceedings were identified using the Children and Family Court Advisory and Support Service dataset. This was linked to demographic and healthcare datasets, to identify General Practice (GP) visits, emergency department (ED) attendances, and hospital admissions (emergency and elective); before the study end date or the child's first birthday for the comparison group, orbefore the s.31 application date.Regression analysis calculated event rate ratios [RR] and incidence rate ratios [IRR] for healthcare events, adjusting for widerdeterminants of health (e.g. perinatal factors, maternal mental health, deprivation), and investigated reasons for healthcare use.

Results
Infants in s.31 proceedings had ahigher number and incidence of healthcare events compared with the comparison group, across all healthcare settings. Differences were greatest for emergency hospital admissions (IRR = 4.03, 95% confidence interval [CI] = 3.53 - 4.59; RR = 4.60, CI = 3.90 - 5.41). "Injury and poisoning" was the main reason for emergency admissions amongst infants in s.31 proceedings. For ED presentations, emergency hospital admissions, and GP visits, there were proportionally more events for these infants across all top ten reasons for healthcare.

Read the article (Int. Journal of Population Data Science)

Eight-Year Period Prevalence of Physical Abuse in Hospitalised Infants and Corresponding In-hospital Mortality in France

Child abuse is a global public health issue; however, there is a severe lack of reliable epidemiological data. This study estimates the period prevalence of child physical abuse requiring hospitalisation and the corresponding in-hospital mortality, using the French medico-administrative database. We included all children less than one year old who were hospitalised from 2007 to 2014. Three groups were defined: group one – physically abused children; group two – possible physically abused children; and group three – all other hospitalised children. Estimation of the national eight-year period prevalence of physical abuse among hospitalised children was equivalent to the number of children included in group one or groups one and two divided by the number of children aged less than one year in France from 2007 to 2014. Infants hospitalised for physical abuse represent between 0.04 per cent (group 1) and 0.10 per cent (groups 1 and 2) of all children less than one year old in France, which corresponds to 0.28 per cent (group 1) and 0.74 per cent (groups 1 and 2) of all hospitalised children (less than one year old). Hospital mortality at first admission ranged from 2.93 per cent (group 1) to 2.36 per cent (groups 1 and 2). To our knowledge, this is the first study to provide an estimation of the period prevalence of child physical abuse requiring hospitalisation in France and the corresponding in-hospital mortality. More effective prevention strategies are needed to help health professionals identify and protect at-risk children. © 2019 John Wiley & Sons, Ltd.

Read the article (Child Abuse Review)

Challenges of estimating costs of child welfare risk in different care settings and an approximation of costs in health care

Objective
This article aims at presenting gaps and challenges of cost analyses on child maltreatment in the German child welfare and the German health sector. For the latter, challenges are illustrated by a cost analysis using health insurance data.

Material and methods
The analyses are based on the caseload of statutory health insurance data from 2010 to 2021 with ICD-10-codes T74.x, Y05, Y06.x, Y07.X, Z61, Z61.2, Z61.4, Z61.5, Z61.6, Z61.7 (ICD-10-GM) – codes in the context of child maltreatment incidents.

Results
The one-year prevalence for child maltreatment increases between 2010 and 2021 to culminate in an estimated total of 30038 incidents in the German population in 2021. Calculated costs approximate 11 Mio Euro in 2021. For inpatients, no or a maximum of one incident of child maltreatment per year is documented.

Conclusions
Population surveys report double-digit percentages for victimization by child maltreatment. Consequently, the costs of child maltreatment in the German health care sector are significantly underestimated due to lack of documentation – not only for inpatients. In child welfare, valid data for cost analyses are lacking completely.

Clinical relevance There is a need to improve or even create structures for data collection on costs of child maltreatment in Germany. Trainings on the importance of documenting child maltreatment data in the health sector is recommended.

Read the article (Nervenheilkunde)

The effects of COVID-19 on the development of reported incidents of child maltreatment over time: A systematic literature review

Background

During the COVID-19 pandemic, the life of families all over the world changed unprecedentedly, risks and vulnerabilities for child maltreatment might have altered. While several studies and reviews look at altered reports to child protective services and other organizations in the child protection system, particularly during the first lockdown in spring 2020, there is a gap in research on trends of reported child maltreatment incidents over time.

Objective

To bridge the gap on mid- to long-term developments and trends of changes over time, we aimed at summarizing findings on monthly breakdowns of CM reports over time during the pandemic.

Methods

In systematic searches of academic literature databases, we have identified 11 articles that adhere to the inclusion criteria of monthly breakdown data from child protective services during the COVID-19 pandemic with a pre-pandemic comparison period. Three additional grey literature reports haven been identified. Both studies and reports had to be published in either English, Arabic, French, German, Portuguese, or Spanish.

Results

Notably, overall, the level of reported incidents has decreased compared to the years before the COVID-19 pandemic. Overall, no clear and reliable picture emerges in developments by different types of reporters. If the number of reports decreases overall, consequently, the overall number or responses to reports does. Some studies, however, report an altered proportion of responses that increased.

Conclusion

There is still a lot to be investigated and understood when it comes to the impact of the COVID-19 pandemic on CM. Policy-makers are called to not only invest into more research on the topic, but, first and foremost, to anticipate a potentially surging need in improved responses to a vulnerable group.

Read the article (Child Abuse & Neglect)

Do socio-structural factors influence the incidence and reporting of child neglect? An analysis of multi-sectoral national data from Switzerland

Although there is evidence that documented child neglect is strongly related to the family’s environments, environment factors are largely unexplored. This study seeks to fill this gap by examining the relationship between the socio-structures in which a family is living and the number of documented cases of neglect. We used a subsample of Optimus Study 3 data, the first multi-sectoral survey of child maltreatment in Switzerland. Included in this study were 222 organizations and 4,735 cases. The number of reported cases of child neglect varied greatly between regions, up to 6-fold from the canton with the highest number to the canton with the lowest number. Multilevel analysis revealed associations between child neglect reporting rates and cantonal vacant housing rates, social welfare rates, and single-parent household rates. At the organizational level, the sector in which an incident was referred or reported had an impact on the documented incidents of child neglect.

Read the article (Children and Youth Services Review)

Webinar: Defining child Maltreatment for research and surveillance

Training schools

Information about the 1st Training School

The first Euro-CAN Training School for early-career researchers took place from August 16–18, 2021, in Lucerne, Switzerland. Organized under the Euro-CAN COST Action 19106 initiative, the event gathered researchers and professionals across Europe to develop skills in planning and preparing epidemiological studies on agency responses to child maltreatment.

Over the course of 2.5 days, participants took part in interactive modules, practical sessions, and trainee-led discussions designed to foster collaboration, methodological rigor, and ethical awareness in child maltreatment research. The training combined theoretical input with real-world challenges in research practice, and encouraged participants to refine their own project ideas through peer feedback and expert guidance.

Key highlights included:

  • Sessions on developing research questions and designing multi-sectoral studies using administrative and agency data.
  • Hands-on learning on questionnaire development, sector-specific responses (health, welfare, justice), and cross-national data collection challenges.
  • Ethical considerations in conducting sensitive research, including cultural sensitivity, participatory approaches, and data protection.
  • “Snack Discussions” — informal, trainee-led sessions where participants shared challenges from their own research for group discussion and problem-solving.

The Lucerne training school laid the foundation for strengthening interdisciplinary and international research on child maltreatment and helped build a network of emerging scholars committed to advancing knowledge and practice in this crucial field.


Information about the 2nd Training School

The second Euro-CAN Training School for early-career researchers, was held from September 9-11, 2024, in Warsaw, Poland. This event, organized under the Euro-CAN COST Action 19106 initiative, brought together early-career researchers, professionals, and academics from across Europe to focus on analyzing and promoting the need for data on agency responses to child maltreatment.

Over 3 days, participants engaged in interactive sessions, hands-on workshops, and insightful discussions with experts, gaining knowledge on accessing administrative data, developing guidelines, research methodology, and advancing skills in research-policy transfer. The event provided a unique opportunity for participants to exchange ideas and collaborate on research aimed at improving child protection services across Europe.

Key highlights included:

  •  In-depth discussions on the need for consensus in defining child maltreatment for research and surveillance purposes, as well as the challenges of developing clinical guidelines.
  •  Accessing administrative datasets on child maltreatment for research and overcoming barriers.
  • Discussions on the impact of COVID-19 on child protection and child maltreatment in Europe.
  • Insights into participatory research and practical advice on disseminating findings to policymakers and publishing studies.

This event not only strengthened the capacity of early-career researchers but also emphasized the critical need for collaboration between researchers and policymakers to improve outcomes in child protection.


Euro Can objectives

A pair of friends Photo credit Flashpop

  • Establish the bases for ultimately mapping and evaluating agency responses to child maltreatment across European countries and across different health and social protection systems.
  • Create an open, interdisciplinary network for practitioners, researchers, survivors, administrators and policymakers.
  • Compile knowledge on national data collection efforts and document changes in national and pan-European legislation and policy related to CMS.
  • Support policymakers and researchers in improving comparability of data collection between (disciplinary) sectors of the child protection system and across countries.
  • Focus on the main capacity-building goal of advocating for and implementing an evidence base for national policies to combat child maltreatment.

Organisation

Action leadership positions

Action Chair

Prof Andreas Jud, Germany

Action Vice Chair

Dr Gabriel Otterman, Sweden

WG 1- Definition and operationalisation of child maltreatment

Prof Leonor Bettencourt Rodrigues, Portugal
Dr Ulugbek Nurmatov, United Kingdom

WG2 - Promoting secondary analyses

Prof Catherine Quantin, France
Dr Laura Cowley, United Kingdom

WG 3- Promoting participatory approaches to child maltreatment surveillance

Prof Maria Roth, Romania
Dr Enila Cenko, Albania

WG 4 - Dissemination and multiplication

Ms Joanna Wlodarczyk, Poland

WG 5 - Covid 19

Dr Eva Mora-Theuer, Austria
Dr Chryssa Grylli, Austria


Grant Holder Scientific Representative

Dr Georgios Nikolaidis, Greece


Science Communication Manager

Prof Laura Korhonen, Sweden


STSM Coordinator

Dr Miroslav Rajter, Croatia


ITC Conference Grants Manager

Mr Athanasios Ntinapogias, Greece

Funding

Logotype EU Cost ActionCOST (European Cooperation in Science and Technology) is a funding organisation for research and innovation networks.

Our Actions help connect research initiatives across Europe and beyond and enable researchers and innovators to grow their ideas in any science and technology field by sharing them with their peers. COST Actions are bottom-up networks with a duration of four years that boost research, innovation and careers.


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