Child Protection Service Unit
by Jean Hlady 6.4.2007
Jean Hlady, MD, FRCPC, FAAP
Director, Child Protection Service Unit
BC Children's Hospital
The Child Protection Service Unit at British Columbia's Children's Hospital provides comprehensive assessments for some of the most serious cases of child abuse and neglect in the Province. Pediatricians on the team provide 24-hour on-call service for children presenting to the Emergency Department or the Intensive Care Unit. During the daytime, referrals are accepted by our clinic Social Workers. Outpatient Clinics are held five days a week.
A child presenting to Emergency with abusive head trauma would initially be stabilized by the Emergency staff, and have some basic tests done. Once the Emergency Physician suspected abusive head trauma, he or she would typically contact the Pediatrician on-call for the Child Protection Team. That Pediatrician along with a Social Worker from the team would attend as soon as possible. The family would be interviewed and the child examined. Necessary blood tests and x-rays would be arranged. This would include a CT scan of the head and often also an MRI scan. As soon as possible, a Pediatric Ophthalmologist would attend to look for retinal hemorrhages in the eyes.
The Child Protection Physician would consult with all the sub-specialists involved (Radiology, Ophthalmology, Neurology and/or Neurosurgery) and would review all of the tests that had been done. Once it was reasonably clear that abusive head trauma was the likely diagnosis, the Ministry of Children and Family Development would be contacted (usually by the Child Protection Unit social worker). Invariably, after a report is made, the police are then notified by MCFD.
Case conferences are often held with the MCFD, the police, the physician involved and the Child Protection Unit social worker prior to the child's discharge. The family is also kept up-to-date each day on the child's condition and the results of the investigations.
At the time of discharge a detailed report is done outlining the extent of the injuries and the final conclusions. Depending on the circumstances, the child may be asked to return to the Child Protection Clinic for follow-up.
It should be noted that the Child Protection Team at Children's Hospital is only one of five teams in the Province of British Columbia. The remaining four multi-disciplinary teams are located in Surrey, Victoria, Kamloops and Prince George. These teams vary in their make-up and services. However, all four teams use an inter-disciplinary approach gathering data to provide a comprehensive history which can then guide the medical evaluation.
The diagnosis of a child with abusive head trauma is complex requiring the expertise of many different professionals. The aim of all professionals, or course, is to do all we can to ensure the best possible outcome for the child.
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