Children with Medical Complexity and Neglect: Attention Needed
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BRIEF REPORT
Children with Medical Complexity and Neglect: Attention Needed Ryan J. Coller 1 & Kelly Komatz 2
# Springer International Publishing 2017
Despite being the most common form of maltreatment (Jackson et al. 2015), neglect is poorly understood. Neglect is generally considered to be an act of omission that either results in or places a child at risk for harm. Omissions which constitute neglect can be physical, emotional, medical, educational, or supervisional acts. Legal definitions of neglect vary by jurisdiction, and inconsistencies across individual states can create scenarios where a given situation represents neglect in one state but not in another (Mennen et al. 2010). Research investigating causes and treatments of neglect are limited. Unfortunately, neglect is less understood among children with chronic medical or mental health conditions, even though these children are more likely to experience both neglect and greater suffering as a result of neglect (Hibbard et al. 2007). The purpose of this article is to review neglect among children with complex medical conditions, highlighting what is known and identifying important gaps in research, practice, and policy. Because most work with this population has centered on medical neglect, it is the primary focus of our review though we recognize that these children are at risk for neglect of any form, including physical, emotional, and educational neglect. We explore the unique influence that medical complexity introduces to the concept of neglect, highlight risk factors, and finally, describe approaches to prevention and
* Ryan J. Coller [email protected]
1
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA
2
Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL, USA
management of neglect in this population. We consider children with medical complexity (CMC) to be those fitting the definitional framework proposed by Cohen and van der Lee (Cohen et al. 2011; van der Lee et al. 2007); i.e., children with medical complexity are those that experience all of the following: severe chronic conditions, major functional limitations, substantial health service needs and high health services utilization. Children with medical complexity comprise around 1– 3% of the US pediatric population (Berry et al. 2013; Coller et al. 2015). Although significant attention has been directed to children with medical complexity in recent years (Cohen et al. 2011; Newacheck and Kim 2005; Simon et al. 2012), little work has studied the intersection between medical complexity and neglect. This topic is highly relevant since social risk - such as neglect - impacts health at least as much as biomedical risk for children with such conditions (Stein et al. 2010). Over 400,000 children are in the US foster care system (Child Welfare Information Gateway. Foster care statistics 2014. 2016), with nearly half having chronic illnesses (Mekonnen et al. 2009). Given th
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