History of Maltreatment and Psychiatric Impairment in Children in Outpatient Psychiatric Treatment

There is increasing evidence that childhood victimization and attachment disruptions impact a child’s development. In this study, children and adolescents from an outpatient psychiatric clinic were assessed, measuring history of trauma, history of out-of-home placement, initial diagnoses, and CBCL internalizing and externalizing problem scores. Multiple regression analyses showed that both violent abuse trauma (physical/sexual abuse) and victim trauma (physical abuse/sexual abuse/witnessing domestic violence/witnessing community violence) are prevalent among patients with externalizing severity problems; concluding that diagnosis alone may not account for a history of victimization, but externalizing problem severity does. Overall, the study is consistent with past literature that it is important to acknowledge a child’s history of maltreatment and out-of-home placement when understanding their psychiatric development and diagnosis.

C4I Roadmap March 2005

Patients expect to be safe from harm inside the walls of a hospital. Increasing reports of medical errors and adverse events have brought these concerns to public attention. Although we have celebrated many scientific advances over the past several decades, many patients do not benefit because the healthcare infrastructure is inadequate to deliver care to all. Studies confirm opportunities to improve in areas such as inpatient vaccination for flu and outpatient screening for breast, cervical or colon cancer. (Institute of Medicine, (IOM), 2000, 2001, 2004). This document outlines the steps needed to further increase our focus on patient safety in John Dempsey Hospital through the development of a multi-disciplinary Collaborative Center for Clinical Care Improvement (CCCCI). The dimensions of safety and outcomes are briefly discussed to provide some perspective on the scope of these challenges (Strongwater, 2003).