Introduction and Purpose

The International Society for the Prevention of Child Abuse and Neglect (ISPCAN) has developed the Child Maltreatment Medical Curriculum materials to support its mission of creating sustainable child abuse and neglect systems of prevention, protection, and treatment throughout the world.

This curriculum, edited by Aaron J. Miller, MD, MPA, and Marilyn Kaufhold, MD, has been developed for medical professionals and students in medical fields. Through 28 hours of didactics and case discussions, the curriculum provides an in-depth introduction to skills that medical professionals need in order to provide diagnosis, medical treatment, and advocacy for children who have been abused and neglected.

Professionals from social services, law enforcement, and the courts are also welcome and encouraged to participate in this curriculum.  The scope of the curriculum is medical in nature, so it will not teach these professionals the full range of information and skills they need in their specific roles, but it will provide a valuable knowledge base of medical and psychosocial issues so they can have a better understanding of how best to help children.

Goals of the Curriculum

ISPCAN endeavors with this Curriculum to:

  • Improve the identification and medical treatment of children who have been abused and neglected
  • Increase communication, information exchange, and networking among multidisciplinary professionals in local private and public agencies and organizations
  • Build and strengthen multi-disciplinary teams
  • Strengthen and expand existing services through more qualified professionals
  • Increase training of facilitators and number of trainers trained and engaged

Overview of Resources

Below you will find brief descriptions of and links to Accompanying Documents and the 10 Learning Modules that make up the Medical Curriculum.

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Accompanying Documents

Facilitator Manual

This manual outlines the learning objectives for each module as well as information on how to prepare the curriculum for a specific country; how to use the modules (e.g., speaker’s notes, modifying the modules, and training of trainers); and how to assess efficacy.

Participant Manual

This manual outlines for participants the goals of the curriculum, the modules, and the learning objectives for each module.

Baseline Survey of Child Maltreatment Response and Societal Norms

This survey is designed for physicians who are developing capacity-building activities to enhance the community’s response to child maltreatment. The questions and issues raised in this survey are detailed, sensitive, and designed to tailor trainings and meetings to the community’s specific needs.

Course Review

This questionnaire provides a means for participants to give feedback on the course.

Learning Modules

1) Child Maltreatment Overview

Module 1: Child Maltreatment Overview

This presentation gives participants an overview of child maltreatment, including various ethical frameworks for addressing child maltreatment, a description of the various forms of child maltreatment within the context of the United Nations and the Convention on the Rights of the Child, and a discussion of how adverse childhood experiences affect long-term medical, emotional, and social problems for the individual and for society.

2) Social and Developmental Impact

Module 2A: Child Maltreatment Interrelationships

Participants will be able to: discuss the importance and challenges in obtaining accurate research data; explain the advantages of viewing child victimization in a social ecology model; and describe child/family characteristics associated with various categories of child abuse.

Module 2B: Effects of Abuse and Neglect on Brain Development

Participants will be able to: define the term developmental traumatology; summarize evidence that shows the effect of early life stress on the biologic stress response system in maltreated children; compare and contrast brain development in healthy versus maltreated children; and list circumstances capable of attenuating or accentuating the effects of maltreatment.

3) Taking a Medical History

Module 3A: Taking a Medical History from Caregivers

This presentation outlines how to effectively conduct a medical history interview with caregivers, including general considerations, preparing for an interview, taking a history (past and present medical, family, and social histories), and concluding an interview.

Module 3B: Taking a Medical History from Children

Participants learn how to effectively interview children in order to take a medical history, including how to discuss important logistical issues and incorporate evidence-based practices when asking children about maltreatment.

4) Physical Abuse

Module 4A: Physical Abuse: Evaluation, Diagnosis, Management, & Documentation

The learning objectives of this module are to: recognize historical and physical findings of child abuse; structure an appropriate evaluation; make rational diagnoses; initiate management of abuse; strengthen medical documentation; recognize how Social Services and Law Enforcement can be helpful partners in diagnosing/identifying abuse or neglect; and discuss concerns with and explain next steps to parents.

Module 4B: Effective Discipline

Objectives: Define corporal punishment (physical discipline); from global studies, summarize information about incidence and attitudes regarding corporal punishment; contrast characteristics of effective discipline from the practice of physical discipline; and structure a culturally sensitive dialogue between a health care provider and a parent to discuss discipline.

Module 4C: A Multidisciplinary Approach to Child Abuse and Neglect

This comprehensive module includes 14 presentations which give an overview of child abuse and neglect, types of injuries, how to conduct interviews, and working in child protection teams.

1. Introduction to Child Protection

2. Facts and Risk Factors for Child Abuse and Neglect

3. Domestic Violence and Children

4. Diagnostic Approach to Child Abuse and Neglect

5. Abusive Head Trauma

6. Skin: Key to Diagnosis

7. Fractures and Physical Abuse

8. Burns/Visceral Injuries

9. How to Interview Families

10. Interviewing Children

11. Visual Documentation

12. Hospital-based Child Protection Teams Part 1

13. Hospital-based Child Protection Teams Part 2

14. Forensic Report and Letter-Writing in Child Physical Abuse

5) Sexual Abuse

This module includes the following seven aspects.

Module 5A: Sexual Victimization Overview

Module 5B: Developmental Anogenital Anatomy

Module 5C: Exam Techniques

Module 5D: Prepubertal Findings

Module 5E: Adolescent Findings

Module 5F: STD in the Context of Sexual Abuse

Module 5G: Evidence Collection in Abuse Sexual Abuse

Sexual Abuse – Spanish

Translated by Drs. Marilyn Kaufhold and Lorena Vivanco of the Chadwick Center for Families and Children and Rady Children’s Hospital, San Diego, California

Programa de Entrenamiento en  Peritaje  Sexológico Forense en el Marco de un Sistema de Garantías de Derechos

Módulo 1: Anatomía del desarrollo anogenital

Módulo 2: Hallazgos y tipos de lesiones del examen forense en adolescentes

Módulo 3: Victimización sexual de Niños y Adolecentes: Vision general

Módulo 4: Recolección de los antecedentes en casos de maltrato infantil: Conversando con los cuidadores/adultos acompañantes

Módulo 5: Técnicas de examen forense en niños pre-puberales y adolescentes

Módulo 6: Recolección de pruebas en casos de abuso sexual agudo

Módulo 7: Consideraciones para la obtención de información médico forenses sobre delitos sexuales en niños pre-puberales

Módulo 8: Hallazgos genitales en los exámenes agudos y no agudos de los niños prepúberes

Módulo 9: Efectos del abuso y la negligencia sobre el desarrollo del cerebro

Módulo 10: Infecciones de transmisión sexual en el contexto del abuso sexual

Módulo 11: Identificación y evaluación del maltrato infantil mediante un equipo multidisciplinario

6) Psychological Maltreatment

Module 6: Psychological Maltreatment

Participants will review developing knowledge and consensus about psychological maltreatment/emotional abuse and learn how to recognize the impact of psychological maltreatment by itself and as a component of all physical abuse, sexual abuse, and neglect as well as how to incorporate questions about psychological maltreatment when asking children about maltreatment.

7) Neglect

Module 7A: Neglect

This module describes the importance of defining and identifying neglect, discusses the categories of neglect with age-specific examples of each, explains the role of poverty, and highlights the increased risk for children with disabilities.

Module 7B: Failure to Thrive

Participants in this module will review use of growth charts and how to identify failure to thrive (FTT), become familiar with the three broad categories of causes and how FTT can result from abuse and neglect, and learn strategies for managing FTT.

Module 7C: Safety at School

Objectives: Learn how to identify logistical issues with schools that increase children’s susceptibility to abuse and neglect, recognize the impact of bullying as a form of child maltreatment, and discuss teacher-student dynamics that increase susceptibility to sexual abuse, physical abuse, and psychological maltreatment.

8) Human Trafficking

Module 8A: Human Trafficking

Objectives: Define human trafficking, describe the causes and mechanisms of human trafficking, list various approaches to combat human trafficking, explain the health consequences of human trafficking., and identify tools for medical providers to use for victim identification and assessment.

Module 8B: Child Sex Trafficking and Forced Labor

Objectives: Be familiar with factors placing children at risk for human trafficking; understand adverse health effects of labor and sex trafficking; recognize possible indicators; and learn techniques for a trauma-informed approach to patient care.

9) MDT Identification and Evaluation

Module 9A: Multidisciplinary Identification and Evaluation

Objectives: Explain the different roles and responsibilities of medical and other health professionals, social services, law enforcement, education/schools, NGOs and other agencies; discuss the medical, psychosocial, and safety benefits of interagency coordination; list common barriers to interagency coordination and consider effective steps to create lasting improvements in coordination; and recognize the signs and symptoms of compassion fatigue/secondary trauma.

Module 9B: Child Fatality Review

Objectives: Explain the components and processes of effective child fatality review teams; compare the relative benefits of active case review versus retrospective case review; and consider how child fatality review might be implemented in the host country given the level of resources and interagency coordination.

10) Testifying in Court

Module 10: Testifying in Court

Objectives: List important legal elements of medical documentation in child abuse; explain the steps in working with attorneys to prepare for court; and describe how to testify in court.