Tara Flemington

Children presenting with injuries to hospital emergency departments should be screened and assessed for child maltreatment. While child maltreatment screening tools are reliable, their practical implementation and long-term sustainability remain challenging. This implementation study aimed to assess the clinical utility of a child maltreatment E-Checklist across two rural hospitals with mixed adult and paediatric emergency departments, and two metropolitan paediatric hospital emergency departments in New South Wales, Australia. Staff questionnaires (n = 131) and in-depth interviews (n = 15) informed the development and implementation phases. Data from 16,589 electronic medical records, 6,858 pre-intervention and 9731 post-intervention, were analysed to assess E-Checklist completion rates and child maltreatment documentation. A deductive thematic analysis of in-depth interview data highlighted the need to attend to (a) E-Checklist utility and precision, (b) professional development of key stakeholders, and (c) barriers to implementation. Pre-intervention, clinicians demonstrated high professional self-efficacy in child maltreatment reporting but had only moderate expectations of reporting outcomes. Post-implementation, E-Checklist completion and documentation of child maltreatment red flags rose from 1% compliance to as high as 62%. These rates of success varied across sites. The child maltreatment E-Checklist demonstrated strong clinical utility when applied to children under six years presenting with injuries in the emergency department. Across the four sites, child maltreatment documentation and referral processes improved significantly. A collaborative and innovative approach, incorporating real-time consultation with clinicians, proved to be a successful strategy. Additionally, responsiveness to local contexts and the presence of dedicated champions (facilitators) at each site were crucial to the initiative’s success.

The aim of this paper is to describe the development of a model of care to embed cultural safety for Aboriginal children into paediatric hospital settings. The Daalbirrwirr Gamambigu (pronounced “Dahl-beer-weer gum-um-be-goo” in the Gumbaynggirr language means ‘safe children’) model encompasses child protection responses at clinical, managerial and organisational levels of health services. A review of scholarly articles and grey literature followed by qualitative interviews with Aboriginal health professionals formed the evidence base for the model, which then underwent rounds of consultation for cultural suitability and clinical utility. Culturally appropriate communication with children and their families using clinical yarning and a culturally adapted version of ISBAR (a mnemonic for Identify, Situation, Background, Assessment and Recommendation) for interprofessional communication is recommended. The model guides the development of a critical consciousness about cultural safety in health care settings, and privileges the cultural voices of many diverse Aboriginal peoples. When adapted appropriately for local clinical and cultural contexts, it will contribute to a patient journey experience of respect, dignity and empowerment.

Cultural safety is a keystone reform concept intended to improve First Nations Peoples’ health and wellbeing. Are definitions of cultural safety, in themselves, culturally safe? A purposive search of diverse sources in Australian identified 42 definitions of cultural safety. Structuration theory informed the analytical framework and was applied through an Indigenist methodology. Ten themes emerged from this analysis, indicating that cultural risk is embedded in cultural safety definitions that diminish (meddlesome modifications and discombobulating discourse), demean (developmentally dubious and validation vacillations), and disempower (professional prose, redundant reflexivity, and scholarly shenanigans) the cultural identity (problematic provenance and ostracised ontology) of First Nations Australians. We offer four guidelines for future definitional construction processes, and methodology and taxonomy for building consensus based of definitions of cultural safety. Using this approach could reduce cultural risk and contribute to improved workforce ability to respond to the cultural strengths of First Nations Australians.

This review summarized literature about knowledge, attitudes, and beliefs of Aboriginal and Torres Strait Islander women from Australia who smoke during pregnancy, then examined the extent that existing health promotion materials and media messages aligned with evidence on smoking cessation for pregnant Aboriginal and Torres Strait Islander women. Knowledge, attitudes, and beliefs of pregnant Aboriginal women who smoke tobacco were identified in the literature. Health promotion campaigns were retrieved from a grey literature search with keywords and social and professional networks. Key themes from peer-reviewed papers were compared against the content of health promotion campaigns using the Aboriginal Social and Emotional Wellbeing Model, the Behavior Change Wheel and thematic analysis. Eleven empirical studies and 17 campaigns were included. Empirical studies highlighted women sought holistic care that incorporated nicotine replacement therapy, engaged with their family and community and the potential for education about smoking cessation to empower a woman. Health promotion campaigns had a strong focus on ‘engagement with family and community’, ‘knowledge of risks of smoking,’ ‘giving up vs cutting down’ and ‘culture in language and arts’. There were similarities and variances in the key themes in the research evidence and promotion materials. Topics highly aligned included risks from smoking and quitting related issues.

The objective of this scoping review was to map the current practice and best evidence for embedding cultural safety in child protection responses for Aboriginal families in hospitals. Electronic databases were searched systematically and the reference lists examined. Efforts to reduce the risk of bias were made including using an inductive approach. Eight research papers were included following the exclusion of 25 papers for the final analysis. Three main themes in relation to what is necessary to embed cultural safety for Aboriginal families when child protection responses are raised in hospital were found. These were (a) relationships, (b) organisational processes and (c) culture. The analysis underscores the need for development of child protection strategies that focus on cultural safety rather than cultural competence alone. This provides some direction for policy and practice development in this field, and has also highlighted the deficiencies in evidence and urgent need for further research.

Purpose: The purpose of this paper is to validate measures of professional self-efficacy for detecting and responding to child abuse and neglect presentations, and then evaluate a clinical training programme for health professionals in a tertiary-level hospital in Vietnam. Design/methodology/approach: A prospective, cohort design was used and professional self-efficacy was measured immediately prior to, and shortly after, training 116 nurses and doctors in emergency settings. Longer-term follow-up was measured six months later. Findings: Linear mixed modelling showed that there was a statistically significant improvement in efficacy expectations for both suspected and known cases of child abuse and neglect between the pre- and post-test measures at zero and six weeks. These improvements did not persist to the six-month follow-up. Research limitations/implications: The training succeeded in improving detection and clinical response to child abuse and neglect presentations but not faith in the provision of ongoing support for children and families. Practical implications: Practice change in emergency settings in Vietnam can be achieved using a sustainable theoretically driven training programme. Social implications: Building the capacity of health professionals to respond to cases of child abuse and neglect relies on the strength of the community and support services within which the hospital is located. Originality/value: Measures of self-efficacy expectations and outcome expectations for responding to child abuse and neglect presentations in emergency settings in Vietnam are now validated.

Aim: This study presents results from an intervention designed to improve identification and response to abusive head trauma in a tertiary paediatric hospital in Vietnam.Methods: One hundred and sixteen healthcare professionals (paediatric medical and nursing staff) completed a clinical training programme and participated in its evaluation. A pre–post‐test and follow‐up design was used to evaluate the outcomes. Questionnaires were used to collect data prior to training, at six weeks and at six months. Generalised linear modelling was used to examine changes in diagnostic skills and knowledge of the consequences of shaken baby syndrome (SBS) (a form of abusive head trauma), its prevention and treatment.Results: At baseline, awareness and knowledge reflected no former abusive head trauma training. Following the intervention, participants had an increased awareness of shaken baby syndrome and the potential consequences of shaking infants and had acquired techniques to inform parents how to manage the crying infant.Conclusion: The intervention was effective in raising awareness of shaken baby syndrome and its consequences amongst the participating healthcare professionals in Vietnam. Training can improve detection and prevention of abusive head trauma, and the intervention has the potential to be adapted for similar settings internationally.

Ongoing fiscal stability has enabled the National Assembly in Vietnam to turn its attention to improving the health and well-being of women and children. Training pediatric health care professionals in the recognition and response to child abuse presentations in the emergency setting has the potential to improve outcomes for the disproportionate number of vulnerable children presenting to the emergency setting with nonaccidental injuries. This study explored the training needs and expectations of the staff preparing to undertake such a clinical training program. This qualitative study is based on semistructured interviews with 16 clinicians from the emergency setting of a leading pediatric hospital in Vietnam. Interview questions focused on current practice in recognizing and responding to child abuse and neglect presentations, the level of training and experience of participants, and subjective reports of confidence in recognizing abuse. Interviews were conducted in English and Vietnamese, with check-translation of transcripts performed by an independent translator. A culture of collegiality and innovative workplace practices was revealed. Analysis revealed two overarching themes that were related to the need for evidence, forensic analysis, respecting families, and consultation. Despite participant confidence in recognizing and reporting child abuse and neglect presentations, knowledge deficits were found. This article presents a critical analysis of the context within which the first evidence-based clinical training program of its kind in Vietnam was developed and implemented in a pediatric children’s hospital. Clinicians felt a strong moral obligation to protect children from further harm, however encountered a number of barriers inhibiting this process. Findings significantly shaped the Safe Children Vietnam training program and will also contribute to the development of protocols and improvement of community support services at the study site.