O2001: A Medical Child Welfare Team and Managing Medical Child Abuse

Background: Medical Child Abuse (MCA) is a diagnosis in which caregivers exaggerate, fabricate, or induce symptoms in a child resulting in unnecessary and potentially dangerous medical procedures. The medical system is manipulated into taking part in the child’s physical and/or psychological maltreatment. Medical Child Abuse results in tremendous harm to the child and takes a toll on involved providers. Following a particularly grueling case of MCA, our institution created a task force with the goal of identifying MCA concerns earlier and empowering physicians to adhere to standards of care, thereby preventing children from receiving unnecessary invasive interventions.

Methods: A multi-disciplinary task force was assembled to include physicians (hospitalists, child abuse, palliative care), nurse practitioners (GI, Bioethics), social workers, and legal counsel, with hospital executive team sponsorship. The team was tasked with reviewing possible MCA cases monthly, identifying concerning cases early, and providing education and medical decision-making support to providers. Due to its initial success, this task force was incorporated into the hospital’s Quality Improvement Committee as a sub-committee titled the Medical Child Welfare Committee (MCWC).

Part of MCWC’s success is attributed to an electronic medical record tool that assists with patient tracking. Data includes number of subspecialties involved in the patient’s care, number of clinical encounters in the past year, frequency of parental MyChart access, care management risk score, and whether a formal Child Abuse Report has been filed. There is also a free-text section for ongoing clinical and social updates.

A survey to assess provider self-reported ability in recognizing and managing MCA as well as assessing the benefit of MCWC was administered 3 years following the initiation of MCWC. The survey was sent to providers in medical specialties with high risk for encountering MCA.

Results: To date, MCWC has reviewed 39 cases. 15 children have had formal Child Abuse consultations, 7 have been removed from their caregiver’s custody, 15 have had active county welfare involvement, 6 have been successfully de-escalated without county intervention and 11 are actively being followed.

Providers with high risk for encountering MCA at our institution were surveyed (n = 116). Respondents spanned clinicians across 10 medical specialties. 88% reported they would benefit from more education and assistance around recognition and management of MCA. Of those who had interacted with MCWC, two-thirds reported that their ability to recognize MCA improved; 71% reported that their ability to manage MCA improved. 95% of respondents felt their consultation/s with MCWC were beneficial to very beneficial to their patients, with similar numbers reporting benefit to providers personally.

Conclusion: This unique team has increased provider comfort and skill in identifying and managing potential MCA cases. It has improved multi-disciplinary care and helped facilitate rehabilitation for patients with complex and challenging MCA.