Child Maltreatment

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RCGP Multisite Audit:
Recording concerns about child maltreatment in primary care databases

maltreatment_logos-9768611

[The online feedback form can be found here.]

[A PDF version of all three Stages can be found here.]

[We just released the “
Background information to RCGP Multisite Safeguarding Audit – Recommendations for recording concerns in primary care about child maltreatment” presentation in PDF format, which you can download here.]

[The Frequently Asked Questions (FAQ) section at the bottom of this page is also downloadable as a PDF here.]

[The development of this approach to recording of child maltreatment has been published.

Woodman J, Allister J, Rafi I, de Lusignan S, Belsey J, Petersen I, et al. Simple approaches to improve recording of concerns about child maltreatment in primary care records: developing a quality improvement intervention. Br J Gen Pract 2012;62(600):e478-e86(9).

Some supplementary material about the frequency of codes used can be found here ]

Alternatively, a PDF version of All Three Levels can be downloaded here.

A three stage approach to coding Child Maltreatment:

We recommend that child maltreatment is coded in clinical records, currently there is marked under-recording which means that high risk cases can’t readily be identified. 

Child maltreatment refers to any acts of commission or omission by parent or other caregiver that results in harm, potential for harm, or threat of harm to a child, even if harm is not intended. 

The key messages are: 

  1. This recommended approach for recording maltreatment concerns was generated from a systematic analysis of current practice and builds on evidence that use of data entry forms and/or standardised coding in primary care settings can improve recording. 
  2. Improved recording allows the GP to rapidly identify any previous maltreatment concerns during a consultation. 
  3. At a practice level, searches for children with maltreatment concerns can be used to ensure rate review in team meetings or early intervention (e.g. targeted health visiting and parent training). 
  4. We recommend that GPs flag whenever maltreatment is considered using the code ‘child is cause for concern’ (Read version 2 term: 13If Read 3: XaMzr) and a data entry form (template) for key elements of the case. 

Three stages of coding recommended:

Stage 1:          Red flag when maltreatment is considered. Health care professionals should flag whenever maltreatment is considered using the term:

‘Child is cause for concern’

Read version 2 term:            13If
Read 3:                                   XaMzr

Stage 2:          Basic consistent coding: Use the following six codes where relevant:

maltreatment_level2-1298070

This short table is also downloadable as a .pdf here.

Stage 3: Consensus coding of Child Maltreatment – incorporate our full list of consensus codes into a template/data entry form 

This coding list provides an aide-memoire to assist you in recording concerns you might have around child maltreatment.

We suggest the following list of codes for capturing more specific details:

maltratment_codes-7142285

We would welcome any suggestions for its improvement.

A summary of the above Stage 3 codes and recommendations can be downloaded by clicking here (PDF).

Suggested additional codes:

We welcome feedback and currently the following have been suggested for inclusion into our code list (Only Read Version 2 codes are shown):

suggested_additional-4482302

When to code the end of an episode

Feedback, and further suggestions are always welcome.

SNOMED CT Codes:

We also would like to introduce the SNOMED CT Codes.

codes_ctonly-7370911

This short table is also downloadable as a .pdf here.

 0 0 1 577 3294 Thoughtified Ltd 27 7 3864 14.0 Normal 0 false false false EN-GB JA X-NONE

Frequently Asked questions (FAQ):

This short summary of FAQ’s are aimed at the individual healthcare professional who is involved in looking after children in primary care. It will also be of use to data entry administrative staff in primary care who would like further information about this work.

Why is there a need to measure concerns about child maltreatment in primary care?

This will help to identify children at risk of maltreatment who need early intervention but do not meet the criteria for receiving children’s social care. The process, we hope, will help to improve local coordination of care and matches the aims of the 2009 National Institute for Health and Clinical Excellence (NICE) guidance on when to suspect child maltreatment.

Why do you need my help with this work?

We would like to use a standardised approach to coding using the identified codes that based on a three stage approach to coding Child Maltreatment:

So, if I have a concern about a child and would like to record this, what could I do?

The laminated sheets we can provide to your practice highlight the stages of coding:

  • Stage 1: the main area of consensus was to ‘red flag’ children with considered maltreatment (as defined by NICE) using one single code, ‘Cause for Concern’.
  • Stage 2 is what the consensus came up with as most important to code after the minimum red flag.
  • Stage 3 is the longer list of recommended codes.

What is the minimum Red Flag code we should be using for stage 1 coding?

Health care professionals should flag whenever maltreatment is considered using the term:

‘Child is cause for concern’ which would be coded as either Read version 2 term: 13If or Read 3:XaMzr 

What if I want to use a code that is not in this list of provided codes?

This is not a problem. We envisage that through an iterative process stage 2 and stage 3 code lists will be revised through a regular process of review where we can discuss all the suggested codes particularly for stage 3.

Are the templates and feedback form available online?

All the materials mentioned above are downloadable through the following web link: https://clininf.eu/maltreatment 

So what are the key messages?

  1. This recommended approach for recording maltreatment concerns was generated from a systematic analysis of current practice and builds on evidence that use of data entry forms and/or standardised coding in primary care settings can improve recording. 
  2. Improved recording allows the GP to rapidly identify any previous maltreatment concerns during a consultation. 
  3. At a practice level, searches for children with maltreatment concerns can be used to ensure rate review in team meetings or early intervention (e.g. targeted health visiting and parent training). 
  4. We recommend that GPs flag whenever maltreatment is considered using the code ‘child is cause for concern’ (Read version 2 term: 13If Read 3: XaMzr) and an optional data entry form (template) for key elements of the case.

Who should I contact if I need any other information?

In the first instance please contact your GP lead who has been invaluable in setting this work up. Core steering group members will also be happy to receive any feedback you have. Please do contact them.

RCGP:

Dr Imran Rafi:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Dr Janice Allister:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it  

Institute for Child Health: 

Professor Ruth Gilbert:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Jenny Woodman:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

University of Surrey:

Professor Simon de Lusignan:  This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Thank you for your participation