Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter July 10, 2013

Educating medical students about adolescent maltreatment

  • Michele Knox EMAIL logo , Heather Pelletier and Victor Vieth


The purpose of the current study was to examine the effects of training first year medical students using a Child Advocacy Studies Training (CAST) elective course. The 9-month course was taught by a multidisciplinary group of professionals and addressed prevention, identification, reporting, and responding to all forms of child and adolescent maltreatment. It was hypothesized that, relative to students in a comparison group, students who completed the elective course would report being significantly more prepared to identify signs of maltreatment, to report a case of suspected maltreatment, and to recommend or secure needed services for a maltreated child or adolescent, more likely to report suspected maltreatment, even if they did not know for sure it happened, and demonstrate improved knowledge in the areas of maltreatment identification and reporting. Results supported all five of the study’s hypotheses and indicate that the CAST program may be an effective method of better preparing future physicians to address child and adolescent maltreatment.

Corresponding author: Michele Knox, Associate Professor, Department of Psychiatry, University of Toledo, College of Medicine, 3130 Glendale Avenue, Toledo, OH 43614, USA

Appendix A

An 18-year-old female with developmental disabilities (severe mental retardation) attends her annual physical exam. During the appointment, the girl’s mother talks about how stressed she has been as she struggles to work three jobs in order to make ends meet while trying to tend to the constant special needs of her teenager. She also mentions that finding someone to stay with the girl while she goes to work has been problematic. Mother mentions that the girl often stays home alone while she is at work.

  • Is this child being maltreated (Please circle one)  Yes  No

  • Would you report this case to Children’s Services (circle one)?   Yes  No

Appendix B

A 15-year-old girl comes in for a physical to get medical clearance to play soccer for her high school. During the visit, the teenager asks the physician for advice about a situation that happened at her friend’s house the last two weekends. She explains that her friend’s step-father has been watching pornography and does not allow the girls to leave the room. The teenager says that she feels uncomfortable because her friend’s step-father touches his private parts while watching the pornography.

  • Is this child being maltreated (Please circle one)   Yes  No

  • Would you report this case to Children’s Services (circle one)?   Yes  No

Appendix C

A 20-year-old male with transverse myelitis is seen for a regular check-up. The young man relies on a wheelchair for mobility and has to depend on his father’s girlfriend when he wishes to leave the home. His father reports that his son recently admitted to showing his penis to his father’s girlfriend on several occasions. Per father’s report, the young man told his father he did not want to show his penis, but he only does it because his father’s girlfriend refuses to take him to the store if he does not follow her sexual requests.

  • Is this child being maltreated (Please circle one)   Yes  No

  • Would you report this case to Children’s Services (circle one)?   Yes  No

Appendix D

The mother of a 12-year-old girl and 10-year-old boy reports that her ex-husband has been threatening to lock her children in the dark basement for the weekend with no food if they continue to refuse to eat dinner while at his house every other weekend. While mother is explaining her concerns, the girl interjects and says, “He really will do it, too – he did it to Kris before!” Mother reports that Kris is her children’s half-sibling.

  • Is this child being maltreated (Please circle one)   Yes  No

  • Would you report this case to Children’s Services (circle one)?   Yes  No


1. National Center for Child Death Review. Policy and practice. Washington, DC: National Center for Child Death Review. Available at: Accessed July 20, 2011.Search in Google Scholar

2. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child maltreatment 2010. Washington, DC: U.S. Department of Health and Human Services, 2012. Available at: Accessed June 25, 2012.Search in Google Scholar

3. Ireland TO, Smith CA, Thornberry TP. Developmental issues in the impact of child maltreatment on later delinquency and drug use. Criminology 2002;40:359–99.10.1111/j.1745-9125.2002.tb00960.xSearch in Google Scholar

4. Mersky JP, Topitzes J, Reynolds AJ. Unsafe at any age: linking childhood and adolescent maltreatment to delinquency and crime. J Res Crime Delinq 2012;49:295–318.10.1177/0022427811415284Search in Google Scholar

5. Smith CA, Ireland TO, Thornberry TP. Adolescent maltreatment and its impact on young adult antisocial behavior. Child Abuse Negl 2005;29:1099–119.10.1016/j.chiabu.2005.02.011Search in Google Scholar

6. Thornberry TP, Ireland TO, Smith CA. The importance of timing: the varying impact of childhood and adolescent maltreatment on multiple problem outcomes. Dev Psychopathol 2001;13: 957–79.10.1017/S0954579401004114Search in Google Scholar

7. Ibanez ES, Borrego J, Pemberton JR, Terao S. Cultural factors in decision-making about child physical abuse: identifying reporter characteristics influencing reporting tendencies. Child Abuse Negl 2006;30:1365–79.10.1016/j.chiabu.2006.06.007Search in Google Scholar

8. Warner-Rogers JE, Hansen DJ, Spieth LE. The influence of case professional variables on identification and reporting of physical abuse: a study with medical students. Child Abuse Negl 1996;20:851–66.10.1016/0145-2134(96)00073-7Search in Google Scholar

9. Flaherty EG, Sege RD, Price LL, Christoffel KK, Norton DP, et al. Pediatrician characteristics associated with child abuse identification and reporting: results from a National Survey of Pediatricians. Child Maltreat 2006;11:361–9.10.1177/1077559506292287Search in Google Scholar PubMed

10. Flaherty EG, Sege RD, Griffith J, Price LL, Wasserman R, et al. From suspicion of physical child abuse to reporting: primary care clinician decision-making. Pediatrics 2008;122:611–9.10.1542/peds.2007-2311Search in Google Scholar PubMed

11. Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians’ reporting of suspected child maltreatment. Ambul Pediatr 2005;5:96–101.10.1367/A04-094R.1Search in Google Scholar PubMed

12. Reece RM, Jenny C. Medical training in child maltreatment. Am J Prevent Med 2005;29:266–71.10.1016/j.amepre.2005.08.028Search in Google Scholar PubMed

13. Flaherty EG, Sege RD, Mattson CL, Binns HJ; for the Pediatric Research Group. Assessment of suspicion of abuse in the primary care setting. Ambul Pediatr 2002;2:120–6.10.1367/1539-4409(2002)002<0120:AOSOAI>2.0.CO;2Search in Google Scholar

14. Ward MGK, Bennett S, Plint AC, King WJ, Jabbour M, et al. Child protection: a neglected area of pediatric residency training. Child Abuse Negl 2004;28:1113–22.10.1016/j.chiabu.2004.05.002Search in Google Scholar

15. Liaison Committee on Medical Education. Functions and structure of a medical school: standards of accreditation of medical education programs leading to the MD degree. Liaison Committee on Medical Education, 2012. Available at: Accessed June 25, 2012.Search in Google Scholar

16. Council on Medical Student Education in Pediatrics. Available at: Accessed August 6, 2012.Search in Google Scholar

17. Council on Medical Student Education in Pediatrics. Available at: Accessed August 6, 2012.Search in Google Scholar

18. Kenny M. Compliance with mandated child abuse reporting: comparing physicians and teachers. J Offend Rehab 2002; 34:9–23.10.1300/J076v34n01_02Search in Google Scholar

19. Alpert EJ, Sege RD, Bradshaw YS. Interpersonal violence and the education of physicians. Acad Med 1997;72:41–50.Search in Google Scholar

20. Hill JR. Teaching about family violence: a proposed model curriculum. Teach Learn Med 2005;17:169–78.10.1207/s15328015tlm1702_12Search in Google Scholar

21. Carter YH, Bannon MJ, Limbert C, Docherty A, Barlow J. Improving child protection: a systematic review of training and procedural interventions. Arch Dis Child 2006;91: 740–3.10.1136/adc.2005.092007Search in Google Scholar

22. Christian CW. Professional education in child abuse and neglect. Pediatrics 2008;122:13–7.10.1542/peds.2008-0715fSearch in Google Scholar

23. Alvarez KM, Donohue B, Carpenter A, Romero V, Allen DN, et al. Development and preliminary evaluation of a training method to assist professionals in reporting suspected child maltreatment. Child Maltreat 2010;15:211–8.10.1177/1077559510365535Search in Google Scholar

24. Knox M, Pelletier HL, Vieth V. Effects of medical student training in child advocacy and child abuse prevention and intervention. Psychol Trauma Theor Res Pract Policy 2013; in Google Scholar

25. Dubowitz H, Black M. Teaching medical residents about child maltreatment. J Dev Behav Pediatr 1991;12:305–7.10.1097/00004703-199110000-00004Search in Google Scholar

26. Vieth V. Unto the third generation: a call to end child abuse in the United States within 120 years. Hamline J Public Law Policy 2006;1:26–8.Search in Google Scholar

27. Reiniger A, Robinson E, McHugh M. Mandated training of professionals: A means for improving reporting of suspected child abuse. Child Abuse Negl 1995;19:63–9.10.1016/0145-2134(94)00105-4Search in Google Scholar

Received: 2012-7-17
Accepted: 2012-8-18
Published Online: 2013-07-10
Published in Print: 2013-09-01

©2013 by Walter de Gruyter Berlin Boston

Downloaded on 4.6.2023 from
Scroll to top button