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OBJECTIVE: This study examines staffing, funding sources, reimbursement, and financing of medically-oriented child protection teams. METHOD: A 16-item questionnaire on the composition, size, and services of the team, program costs, revenue sources, reimbursement rates, and perceptions of funding stability was mailed to a sample of 118 medically-oriented child protection teams. RESULTS: After excluding 10 programs, an overall response rate of 68% was obtained. Teams varied in configuration, services, charges, and funding. Over 50% identified funding as being important, yet, demonstrated varying levels of awareness of budget and reimbursement issues. Many generally relied on patient care reimbursement from health care and government payers. Some programs seemed to be doing well financially while others were struggling. Approximately one-third of the respondents indicated that funding was unstable. CONCLUSIONS: Many programs are innovatively knitting together patch-works of funding and support to serve children and families in need. Team leaders should increase their knowledge of fiscal issues in order to be effective advocates at the institutional level for continued team support. A potential way of accomplishing this would be to utilize the existing structure of a national professional association and its national meeting to provide a forum for relatively successful programs to showcase their "ideal models" of team financing. 相似文献
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OBJECTIVE: To evaluate how well a group of recently trained pediatric chief residents could label anatomic structures on two different photographs of female prepubertal genitalia. Additionally, the study sought to explore aspects of pediatric training in sexual abuse and clinical practice issues surrounding the routine genital examination. METHOD: A 38-item questionnaire was mailed to pediatric chief residents at all of the officially listed pediatric residency-training programs in the continental US. Comparisons were made between this study and the responses to two previous surveys, which asked a more heterogeneous group of physicians to label one of the photographs used in the study. The second photograph was added because of its improved clarity of each anatomic structure when compared to the first photograph used in the previous studies. The study also asked about clinical practice issues surrounding the prepubertal genital examination. RESULTS: An overall response rate of 73% was achieved and analysis was done on 139 respondents. One-half of chief residents thought that their training during residency on sexual abuse was inadequate for practice. Sixty-four percent of chief residents correctly labeled the hymen on the photograph used in the previous studies, which was not significantly different from the 62% and 59% of physicians who correctly labeled the hymen in the previous surveys. In the second photograph, which more clearly displayed the various anatomic structures, 71% correctly labeled the hymen. CONCLUSION: Pediatric chief residents reported variable amounts of training on issues pertaining to child sexual abuse during residency, think that this time was inadequate, and, while doing slightly better than a more diverse group of previously studied physicians, did not achieve 100% accuracy in identifying basic genital structures correctly on two different photographs. 相似文献
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OBJECTIVE: Children with special health care needs are known to be at increased risk of all forms of child maltreatment when compared to children without such needs. We describe a health care team's experience providing medical evaluations for suspected child maltreatment to children with special health care needs. METHOD: Consecutive cases seen as outpatients in the Abuse Referral Clinic for Children with Disabilities were abstracted and analyzed. Mail and telephone follow-up contact was attempted after the medical evaluation to determine adherence with treatment recommendations. A subsample of cases for which complete financial information was available was reviewed to determine a reimbursement rate. RESULTS: During the study, 49 children received complete outpatient evaluations. Ages ranged from 3 to 16 years old, and 54% were males. Special needs spanned a wide range of physical, developmental/cognitive and behavioral conditions. The largest number of referrals came from child protective services (42%) followed by referrals from physicians (27%). After the team's comprehensive evaluation, 18% of the children were found to have a history or physical examination that was diagnostic for child maltreatment, 13% were thought to be at high risk, 25% were thought to be at low risk and 44% were thought to have non-abusive etiologies. The collection rate was 14% for an average reimbursement of $38 per case. Only 29 caregivers could be found at follow-up and 22 remembered the recommendations made by the team. Of the 25 cases that were referred for outpatient mental health counseling, 12 (48%) complied. CONCLUSION: Children with a wide range of special health care needs were evaluated in an outpatient special health care needs clinic that offered comprehensive medical evaluations for possible child maltreatment. Medical evaluation services for this group of children were poorly reimbursed. Mental health services were frequently recommended but often not accessed. Child maltreatment teams seeking to serve children with special health care needs will need to plan for service delivery to a potentially diverse group of children and families who may experience difficulty in carrying through on the team's treatment recommendations. 相似文献
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OBJECTIVE: The direct and indirect costs to society from child maltreatment are estimated to be quite high. The costs related to medical care are of interest to professionals serving on medically-oriented child protection teams that conduct medical evaluations of alleged abuse. This study was designed to explore a number of financially related issues on medically-oriented child protection teams specifically examining the team's staffing, funding sources, reimbursement, budgeting, perceived impact of managed health care and their perception of funding stability. METHOD: Mailed survey of medically-oriented child protection teams throughout the United States using a questionnaire that contained 28 items focused on a variety of financial issues; 14 items were drawn from a similar study done 6 years earlier, which allowed for comparison over time. RESULTS: Responses were received from 320 out of 472 organizations, yielding a response rate of 68%. Inclusion criteria were met by 153 responses and were included in the analysis; 22 of these had also responded to the earlier survey. Median total budget was $300,000 and state and local government funding was the largest revenue source (Mdn = 30%, range: 0-100%), followed by patient care generated revenue (Mdn = 20%, range: 0-100%). The mean charge for an evaluation was $283 (SD = 196.11, range: $0-$800). Forty percent of teams indicated that managed care had no impact where as 49% saw a negative impact. Comparisons between the responses to this survey and the one done 1993 demonstrated that teams were seeing about the same number of patients and showed trends towards increased budget amounts and broader inclusion of various health care and non-health care disciplines on the teams. CONCLUSIONS: No single source of funds for such teams has emerged as the uniform solution for all teams. Creative patchworks composed of various funding sources remain the typical solution to the funding needs of medically-oriented child protection teams. 相似文献
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