Aim To determine antecedent patterns of healthcare use by children fatally or seriously harmed by maltreatment.
Methods The authors analysed recorded healthcare use for children who were the subject of a serious case review (SCR) in England in 2005–2007. The SCRs were initiated when a child under 18 years old died or was seriously harmed, maltreatment (abuse or neglect) was a factor, and there were lessons for interagency working. The authors analysed a purposive sample (N=40), similar in key demographics to all 189 SCRs in England in 2005–2007.
Results Children had extensive recorded contact with universal (N=34/40; 85%) and secondary (N=26/40; 65%) healthcare services and children's social care (N=21/40; 53%). Thirty-one children (78%) had recorded health visitor and/or school nurse contact. Fourteen children (35%) had missed appointments. Almost three-quarters (N=29) had complex family problems recorded (parental domestic violence, alcohol/drug and/or mental health problems). Data quality regarding healthcare use was poor, and the extent and type of ‘missing data’ varied by age.
Conclusions Complex paediatric and family problems and a high level of contact with services preceded serious adverse events. Universal health services are likely to be well placed for giving ongoing and family-orientated support to vulnerable families. The absence of standardised data collection and any control group limits how far the Biennial Analyses of SCRs can meet their stated objective of identifying national trends and patterns. Linking SCRs to healthcare databases would provide a control group, improve understanding of the population context and diminish demands for data from professionals delivering care.
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Funding The Department of Health contributed to the project. JW's time was funded by a joint MRC and ESRC PhD studentship. This work was partly undertaken at Great Ormond Street Hospital/University College London, Institute of Child Health which received a proportion of funding from the Department of Health's National Institute of Health Research (‘Biomedical Research Centres’ funding). The Medical Research Council provides funds for the MRC Centre of Epidemiology for Child Health. The research also took place at the Centre for Research on the Child and Family at the University of East Anglia where MB, SB and PB are located. Their time was funded by the Department of Children Schools and Families.
Competing interests None.
Ethics approval Ethics approval was provided by the University of East Anglia Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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