Section develops Royal College training program in child maltreatment

Cases of child maltreatment are often complex, requiring collaboration among paediatricians and other physicians, mental health professionals, child welfare workers and legal professionals.

In addition to doing a traditional medical assessment and considering a child’s mental health and developmental needs, a paediatrician might need to collect forensic evidence, report the situation to child services, provide expert opinion about the medical findings and even testify in court.

“[It’s important for paediatricians to] understand those different systems…what rules apply and how to communicate effectively,” said Dr. Michelle Shouldice, paediatrician at the Hospital for Sick Children and President of the CPS Child and Youth Maltreatment Section.

The expanding knowledge base relevant to child maltreatment, and the need to understand this complex interaction of systems and professionals, helped drive the Section’s successful application to the Royal College of Physicians and Surgeons to consider child maltreatment paediatrics as a defined field of practice with a route to training and certification. Child maltreatment paediatrics is now an Area of Focused Competence, with diploma certification available to paediatricians in 2014. It is expected that fellowship training programs may begin to apply for accreditation in the 2014/15 academic year.

“The purpose is to provide ready access to expert consultation for health professionals, improve medical care for children who have been maltreated, to enhance recognition of the mental health needs of [these] children…and ultimately to improve their health outcomes,” said Dr. Shouldice.

Research such as the Adverse Childhood Experiences (ACE) study increasingly shows that children and youth who have been maltreated are more at risk for adverse short- and long-term health outcomes, she said.

In the short-term, these may include sleep disturbances, anxiety and behavioural issues, as well as physical injury and, in severe cases, death. Long-term problems can include anxiety and depression, cardiovascular disease or chronic lung disease. As the amount of stress in childhood increases, so do the risks of these adverse health consequences in later life.

Yet until now, there has been no organized field of study or practice for maltreatment in Canada. In its absence, many Canadian paediatricians have independently developed focused practices in child maltreatment, and are now recognized as experts, both in medicine and in the legal system. While this new route to certification is an important step forward, it does not reduce the essential role that all health care providers who work with children and families must play in child maltreatment recognition and intervention, said Dr. Shouldice. Consultant paediatricians who certify in this field of practice are there to support, assist, educate and generate new knowledge, not to replace the important role of others involved in maltreatment cases.

“It’s challenging to work in child maltreatment. The issues are quite emotionally difficult, and the stakes associated with medical opinions used within the child protection and legal systems are high,” said Dr. Shouldice. “The hope is that identification, recognition and appropriate intervention will be enhanced by having access to paediatricians with this defined area of knowledge and practice. If there’s a clear training path, than physicians can choose this as a route of practice, rather than come to it by chance.”

Paediatricians can become certified either by completing a formal fellowship training program, or by applying for practice eligibility certification if they have experience working in child maltreatment.

For more information, contact info@cps.ca or join the Section on Child and Youth Maltreatment for regular updates.

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