Research into practice

A study of serious child abuse in Wales carries a cautionary
message about the use of figures from the child protection register. Brian
Morgan reports.

Research papers recently published in social
work and medical journals have highlighted problems with the child protection
register (CPR). The value of the CPR as a front-line instrument for helping to
reduce child abuse may be viewed very differently by hospital health workers
compared to social workers.

Doctors in accident and emergency or working in
the community, who are the first to see children suspected of being abused,
need reliable, up-to-date and easily accessible information about past
concerns. The CPR is seemingly failing to provide this.

The most detailed of the recent evaluations of
the CPR was a Welsh assembly and NSPCC-funded project looking at all
discoverable cases of serious child abuse in Wales between 1996 and 1998.

The study, crucially, concludes that the best
way to prevent the severe abuse of children is to take action when abuse is at
the stage of only "minor episodes". It carries a cautionary message
about the use of CPR figures as a measure of the extent of child abuse in a
community. Wide variations in the true incidence of abuse have been uncovered
in Wales.

The Welsh Paediatric Surveillance Unit (WPSU)
gathered data from all parts of Wales for severe physical abuse of children up
to the age of 14. Abuse was specified as being equivalent to grievous bodily
harm at the criminal level. It also collated data for the incidence of physical
abuse of babies under the age of 12 months, combining data from two different
sources.

The WPSU uses a "yellow card" style
reporting system serviced by paediatricians. The inclusion of cases in WPSU
returns depends on multi-disciplinary agreement – at a strategy meeting, case
conference or Working Together part 8 review – that abuse has taken place. For
babies less than a year old, the researchers combined data from the WPSU and
the CPR using "capture-recapture analysis". This technique enables a
check to be made as to whether children are identified in just one or in both
of the data sets. In this way the team produced more accurate estimates of the
true incidence of abuse of very young children.

Some striking differences emerged in incidence
by age, sex and locality. Severe abuse was six times more frequent in babies
under a year old than in the next group up to five years of age, and 120 times
more likely than in children over five. The three categories – subdural
haemorrhage, fractures and death – account for these differences. The death
rate was 10 times higher in babies under a year old than in the group one to
five years of age. Boys were more likely to be abused than girls throughout the
whole age range – the figures being 62 and 39 respectively, a highly significant
difference, says the report.

There were too few cases identified for
meaningful differences between local authorities to emerge from the study, but
striking disparities were found between health authority areas. The three
largely urban health authorities in south Wales had significantly higher abuse
rates than the more rural health authority areas elsewhere. Bro-Taf Health
Authority, which includes Cardiff, had an abuse rate of 9.4 per 1,000 babies
less than a year old over the two year period, but Dyfed-Powys only 5.2.

The recording of names in the CPR is the result
of a "process", say the authors, and this is not a substitute for
more accurate systematic data collection, such as the WPSU. The report says the
names of one-fifth of children who had been abused were not recorded on the
CPR. A name not appearing on a CPR is no reassurance.

^l J R Sibert et al, "The
incidence of severe physical child abuse in Wales" Child Abuse and
Neglect, Volume 26, no 3, 2002

Brian Morgan is a social and health care
writer.