# Intrahospital and Territorial Management of Violence Against Children in the Verbano-Cusio-Ossola Area, Northern Italy

## TL;DR

This study examines how child abuse is managed in hospitals and community services in a region of Italy, revealing gaps in detection and the need for better coordination.

## Contribution

The paper introduces a retrospective analysis combining hospital and territorial data to identify systemic gaps in diagnosing and reporting child maltreatment.

## Key findings

- Hospital records showed a diagnostic gap, with only one child abuse case explicitly recorded out of 1,586 pediatric ED admissions.
- Territorial data revealed 161 minors identified with high activation rates but 8.13% had a history of missed reports.
- 72% of caregivers had adverse childhood experiences and 27% had psychiatric comorbidities, indicating transgenerational risk factors.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Under-reported crisis: Child maltreatment is a major global public health issue that is often overlooked.Multidimensional violence: It encompasses physical, sexual and psychological abuse, as well as neglect and exposure to domestic violence.

Under-reported crisis: Child maltreatment is a major global public health issue that is often overlooked.

Multidimensional violence: It encompasses physical, sexual and psychological abuse, as well as neglect and exposure to domestic violence.

Public health significance—Why is this work of significance to public health?
Diagnostic gap: There is a critical disconnect between hospital settings and territorial networks, with many cases of abuse being missed in emergency departments.Transgenerational risk: Caregivers often have a history of adverse childhood experiences (72%) or psychiatric comorbidities (27%), perpetuating a cycle of violence.

Diagnostic gap: There is a critical disconnect between hospital settings and territorial networks, with many cases of abuse being missed in emergency departments.

Transgenerational risk: Caregivers often have a history of adverse childhood experiences (72%) or psychiatric comorbidities (27%), perpetuating a cycle of violence.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Standardized protocols: Implementing specific diagnostic codes and universal guidelines in hospitals is vital for accurate identification.Specialized training: Healthcare providers require targeted education to recognize “indicators of suspicion” and coordinate with multidisciplinary teams.

Standardized protocols: Implementing specific diagnostic codes and universal guidelines in hospitals is vital for accurate identification.

Specialized training: Healthcare providers require targeted education to recognize “indicators of suspicion” and coordinate with multidisciplinary teams.

Violence against minors remains a significant, often under-reported public health crisis. This study evaluated the incidence and clinical management of child abuse within the Verbano-Cusio-Ossola area (Northwest Italy) from January 2017 to August 2023. A retrospective descriptive analysis was conducted using two primary data streams: (1) Territorial data: records from the multidisciplinary “Maltrattamento, Trascuratezza, Abuso” (“Maltreatment, Neglect, Abuse”) team. (2) Hospital data: Pediatric Emergency Department admissions in Verbania and Domodossola, screened via diagnostic filters and ICD-related codes. At the territorial level, 161 minors were identified. While the territorial network demonstrated high activation rates (96.25%) and legal reporting (92.55%), a history of missed reports was noted in 8.13% of cases. Parental risk factors were prevalent: 72% of caregivers reported adverse childhood experiences and 27% presented with psychiatric comorbidities. In contrast, hospital data revealed a diagnostic gap. Out of 1,586 pediatric ED admissions, only one case was explicitly recorded as child abuse. Furthermore, none of the discharges utilized specific maltreatment diagnostic codes, despite several patients presenting with recurrent “accidental” traumas. These findings highlight a disconnect between community services and acute clinical settings. Enhancing intrahospital surveillance and implementing specialized training for healthcare providers are essential to bridge this diagnostic gap and ensure a coordinated, multidisciplinary response to child maltreatment.