Protocolo para actuar frente a la violencia en la infancia y adolescencia en al ámbito sanitario
This protocol has been Elaborated by the Commission against violence in children and adolescents of the Interterritorial Council of the National Health System (CoViNNA), under the coordination of the General Directorate of Public Health and Health Equity of the Ministry of Health, and in collaboration with the autonomous communities and cities and other public administrations, institutions and professionals from the different sectors involved in the prevention, early detection, protection and repair of violence and adolescence. In addition, it has been reviewed by various institutions and civil society organizations.
His aim It is none other than homogenizing the response of the health sector at the national level and systematizing the promotion of good treatment, prevention, detection and comprehensive approach to all cases and types of violence against children and adolescents from a perspective of equity, accessibility . , non-discrimination and life course.
So, it goes addressed to professionals in the healthcare field, both healthcare and non-care, and all those people with responsibility for the management and planning of healthcare policies and resources.
Boards violence exerted on children and adolescents, understood, as defined by Organic Law 8/2021, of June 4, on the comprehensive protection of children and adolescents (LOPIVI) as «any action, omission or negligent treatment that deprives minors of their rights and well-being, which threatens or interferes with their orderly physical, mental or social development, regardless of its form and means of commission, including that carried out through information and communication technologies. . . , especially digital violence.»
This protocol has been created due to the current importance of the issue, since in Spain there are official figures, from the Unified Registry of Child Abuse, which in 2021 had 21,521 notifications of suspected cases of violence in children and adolescents.
The fight against violence in childhood and adolescence is a human rights imperative and constitutes a public health issue. Violence and its consequences can be prevented or mitigated through systematic measures based on scientific evidence, among which are guaranteeing a comprehensive, multidisciplinary and quality response to child and adolescent care services, including health services.
To contribute from the health field to the prevention of violence, this protocol is aimed at reducing the prevalence of risk factors (primary prevention), through the assessment of psychosocial risk, which includes the assessment of both Adverse Experiences in Childhood (EAI) and Beneficial Experiences in Childhood (EBI), making it possible to make visible and assess the vulnerabilities and strengths of children and adolescents and their environment, as well as facilitating the early identification of situations at risk of violence (secondary prevention ). ), and the implementation of the necessary support to correct or mitigate these risk situations in a comprehensive and coordinated manner (tertiary prevention). In addition to other interventions to address risk and prevent violence.
The comprehensive approach to violence begins at the moment of its occurrence. detection or suspicion. Health services are a privileged area for this detection due to the frequent and close contact with children and adolescents and their families. But for this to be possible, health professionals must be trained in the detection of suspected indicators of each type of violence: emotional or psychological, sexual, child trafficking and exploitation, neglect…
Once a possible case has been detected, it is essential to carry out a thorough clinical and social history, as well as perform the tests necessary to carry out a diagnosis. differential diagnosis I need to rule out or confirm the suspicion. If confirmed, it will be necessary to perform a assessment both the clinical severity of the injuries and the life risk they entail, as well as the safety or risk of lack of protection of children and adolescents that will lead to the adoption of an urgent or ordinary procedure.
This document also details and explains the process of notification, including when, to whom and how it should be done. The main objective is to comply with the qualified communication duty that is established in the LOPIVI. This special duty falls on those people who, due to their position, profession, trade or activity, have the responsibility of assisting, caring for, teaching or protecting children and adolescents.
Refering to intervention and follow-up, essential recommendations are established to provide therapeutic, multidisciplinary, adapted and specialized care, in friendly spaces. This attention, regardless of the judicial process that could arise from the events, must be public, free and universal, and comply with the corresponding legislation. Action is guided by the best interests of children and adolescents, guaranteeing their right to health, life and full development, and protecting their right not to suffer any form of violence or abuse. It is also important to keep in mind that children and adolescents who commit violence also need specialized care.
The entire process of detection, assessment, care, monitoring and recovery of minors who are victims of violence must be carried out by a team made up of at least medicine, nursing and health social work (TSS) professionals, in collaboration with other professionals or specialized units, forensic, psychological and/or protection and justice specialists, when appropriate.
It is necessary to homogenize and systematize the record in the electronic medical record, ensuring confidentiality, to facilitate case follow-up and obtain data on the prevalence of cases of violence in children and adolescents, which will allow adequate monitoring and evaluation of both the public health problem in general as well as this protocol in particular.
For an adequate approach to violence, it is necessary to establish communication channels and coordination, both within health institutions, between them and with other institutions that participate in the process such as social services, for example. Therefore, it is recommended to establish procedures to ensure coordination between professionals from the competent public administrations, which result in better assistance and effective protection in situations of risk of violence and helplessness or lack of protection and avoid the re-victimization or victimization of children. . /as and adolescents who are served.
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