Child Abuse Management Units: How can Mental Health Services be Further Improved?

Background: Child abuse is a broad term that includes physical, sexual, and emotional (e.g., psychological, verbal) abuse. There are huge variations with regard to the level of severity and the consequences of abuse. Because child abuse is such a sensitive topic, it is a challenging task to conduct studies concerning this subject. Objective: The aim of the study was to identify areas that could be improved to offer better health care services to patients. Therefore, routine assessments, the characteristics of the cases, and the types of follow up were emphasized. Method: The Norwegian Ministry of Health and Care Services provided an exception from the principle of informed consent so that this study could be conducted. We had access to the medical records of all children between the ages of 0 and 14 years old who were referred to the regional child abuse management unit in 2006 and 2007. A descriptive, cross-sectional study was performed. Results: One hundred and six children were referred to the child abuse management unit. For the majority of these patients (80.2%), sexual abuse was the only concern. The children presented diverse psychological and somatic symptoms and problems. Psychosocial functioning was in general not properly described in the records. Four out of five of the children were referred to services for follow up after the first examination in the child abuse management unit. Only 36% of the children were referred to child protective services. Conclusion: This study revealed that psychosocial functioning is seldom documented and that psychological symptoms could be described more reliably and in more detail. A systematic approach may be helpful for health care providers, and we suggest the implementation of valid evidence-based instruments, such as the Child Behavior Checklist and the Children's Global Assessment Scale.