Child safeguarding service development in community pediatric setting- experience from Sri Lanka's first community pediatric clinic

Abstract

Background: Community Pediatric clinic offers child development, disability and safeguarding services. Sri Lankan national guideline on violence against children elaborates how child safeguarding lead is important in carrying out the management process when a child presents following an abuse. Method: This paper describes how the Community Pediatric service in the Gampaha district established the system to optimize the process given in the guideline. Clinical data were obtained from medical records ensuring privacy and confidentiality. Data was analyzed using SPSS software. Results: In the base hospital setting, when a child is presented following abuse, all relevant medical specialists, including community and general pediatricians, specialists in forensic medicine, and specialist psychiatrists, assess and discuss the acute plan in the clinical case conference. This is followed by multisectoral institutional case conferences, ensuring safe placement, medical, psycho-social and educational management and follow-up of the child and family. Since its' conception in 2022, 176 children have been referred to the service. The majority were females (76.7%, n=135). The mean age of presentation is 12.2 years (SD 3.77, range 2 months to 18 years and 5 months). The commonest reason to present is sexual abuse (72.2%) followed by physical abuse (14.2%). Twelve per cent (n=22) of children are abused by their parents, and 62.5% of the time, the perpetrator is either living in the home or in their neighborhood. In line with the deinstitutionalization principles, 79.6% of the children were placed in family-based care, either with their parents or a relative. Conclusion: Designated child safeguarding services in the community pediatric setting ensure multi-disciplinary and multi-sectoral management of children facing violence. Still, more females and sexual abuse are reported to the safeguarding service. Appropriate holistic management allows placing these children in family-based care.