Darwiche Sabrina, Terrell Lindsay, Skinner Asheley C, Narayan Aditee P
pediatric resident, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California
assistant professor, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
N C Med J. 2019 Nov-Dec;80(6):325-331. doi: 10.18043/ncm.80.6.325.
Children may be placed in either kinship or foster care, forms of out-of-home placement (OHP), if maltreatment is suspected. The American Academy of Pediatrics has identified them as children with special health needs requiring elevated care. While North Carolina has increased support for foster care, it is unclear whether similar support exists for kinship care. Child abuse medical providers (CAMPs) were interviewed regarding their understanding and assessment of the state of the kinship care system in North Carolina, and how it can be improved. CAMPs were individually interviewed using a semi-structured, open-ended question guide to assess their perspectives on kinship versus foster care in North Carolina. Data were coded, and the analysis was conducted in an inductive manner, allowing themes and then recommendations to emerge from interviews. The following three themes were identified: 1) providers have a foundational understanding of the kinship care system, marked by knowledge gaps; 2) children in kinship care and foster care have equivalent, elevated health needs, but children in kinship care do not receive the same level of care; 3) individual and structural changes have to be made to the interprofessional teams working within the OHP system. The study sample was small, including eight CAMPs who had relatively homogenous demographic characteristics. CAMPs typically see the worst cases of maltreatment, which may bias responses. Additionally, the majority of children in kinship care are unknown to CAMPs and may not be fully represented in responses. CAMPs' responses were summarized into a set of recommendations targeting four different components of the OHP team: the general interprofessional team, policymakers and state leaders, medical providers, and social workers.
如果怀疑存在虐待行为，儿童可能会被安置在亲属照料或寄养机构中，这是两种家庭外安置形式。美国儿科学会已将他们认定为有特殊健康需求、需要更高护理水平的儿童。虽然北卡罗来纳州增加了对寄养照料的支持，但亲属照料是否有类似支持尚不清楚。就他们对北卡罗来纳州亲属照料系统状况的理解和评估以及如何改进该系统，对虐待儿童医疗服务提供者（CAMPs）进行了访谈。使用半结构化、开放式问题指南对CAMPs进行单独访谈，以评估他们对北卡罗来纳州亲属照料与寄养照料的看法。对数据进行编码，并以归纳方式进行分析，以便从访谈中得出主题，进而提出建议。确定了以下三个主题：1）提供者对亲属照料系统有基本的了解，但存在知识差距；2）亲属照料和寄养照料中的儿童有同等的、更高的健康需求，但亲属照料中的儿童没有得到同等水平的护理；（3）必须对家庭外安置系统内的跨专业团队进行个体和结构上的改变。研究样本较小，包括八名人口统计学特征相对同质的CAMPs。CAMPs通常看到的是最严重的虐待案例，这可能会使回答产生偏差。此外，亲属照料中的大多数儿童CAMPs并不认识，他们的回答可能无法充分代表这些儿童的情况。CAMPs的回答被总结为一套针对家庭外安置团队四个不同组成部分的建议：一般跨专业团队、政策制定者和州领导人、医疗服务提供者以及社会工作者。
