The US healthcare system and treatment of children in the US legal system

The first month of the project has drawn to a close! I can’t believe how quickly it has flown by. From starting in Austin, Texas a month ago I’ve been to Dallas, Paris, Phoenix, Philadelphia and Denver.

I’ve seen at first hand the really excellent service, care and support provided by children’s advocacy centres; I’ve seen how multi-professional teams interact together, always keeping the interests of the child at the centre of everything they do; I’ve seen how the facilities and care provided in paediatric emergency departments compare with our departments back in the UK; I’ve seen the real benefit that hospital-based social workers can provide to the care of children who might be at risk of signifiant harm; I’ve been involved in more child protection cases than I ever would have expected to see in a very bad three to six month period back in the UK; I’ve had some incredibly rich educational experiences looking critically at the research surrounding many aspects of child protection and I’ve met and collaborated with some of the most eminent physicians working in the field of child abuse anywhere in the world.

I’ve gathered a significant amount of evidence to help me form my own views on whether or not the UK should move to introduce Mandatory Reporting legislation but, before I declare my views on this, I need some time to reflect more deeply and to assimilate all of the research papers and professionals’ opinions that I have managed to obtain.

Of course, no one system is perfect and in the interests of being balanced there are two particular aspects of the US medical and legal system that I still find difficult to understand.

The first is the continual focus on costs, payment and insurance and the fact that, even in this day and age, in one of the most powerful countries in the world there are still many people living here in the US who cannot afford healthcare and do not have insurance cover to enable them to access the excellent standard of care that they deserve. Whilst the full implications of the Affordable Care Act are yet to be seen I remain concerned that right now, today there are a significant number of incredibly vulnerable adults and children who are uninsured and do not have the means to pay for the healthcare that they need.

The US government states the benefits of the Affordable Care Act as follows:




Of course, you could read the legislation yourself and make up your own mind.

The second area of significant concern to me is the treatment of children within the legal system of the USA. Although I understand that the sixth amendment to the United States Constitution gives a defendant the right to be faced by their accuser and witnesses, there has got to be a better way of proceeding than having children, sometimes as young as two or three years old, appearing in the witness box, in a Court room, when they are alleged victims of horrendous child abuse. There has got to be a way that justice can be fairly carried out and that the rights of all parties involved in a case can be protected without making them appear in such a daunting environment unless this is what they absolutely want and have made an informed decision to do. Of course, in the UK we have special protection for children in family proceedings and vulnerable witnesses.

I’m having a week’s vacation now so I don’t plan any updates until phase two of the project starts on 21 May 2014. That will have involved a very long trip half way around the world to Singapore and I’m really looking forward to seeing the similarities and differences, beginning in the Paediatric Emergency Department of their Women and Children’s Hospital.


Until then, I leave the USA with fantastic memories, lots of ideas and grateful thanks to everyone here – their enthusiasm, support and kindness has been outstanding. And as for the food I’ve been provided with… I think it is entirely possible that I might just be turning into an enchilada.


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