title: Barriers and Facilitators to Detecting Child Abuse and Neglect in General Emergency Departments.
abstract: OBJECTIVE
  Child abuse and neglect is common in the United States, and victims often present to emergency departments (EDs) for care. Most US children who seek care in EDs are treated in general EDs without specialized pediatric services. We aim to explore general ED providers' experiences with screening and reporting of child abuse and neglect to identify barriers and facilitators to detection of child abuse and neglect in the ED setting.
  
  
  METHODS
  We conducted 29 semistructured interviews with medical providers at 3 general EDs, exploring experiences with child abuse and neglect. Consistent with grounded theory, researchers coded transcripts and then collectively refined codes and identified themes. Data collection and analysis continued until theoretical saturation was achieved.
  
  
  RESULTS
  Barriers to recognizing child abuse and neglect included providers' desire to believe the caregiver, failure to recognize that a child's presentation could be due to child abuse and neglect, challenges innate to working in an ED such as lack of ongoing contact with a family and provider biases. Barriers to reporting child abuse and neglect included factors associated with the reporting process, lack of follow-up of reported cases, and negative consequences of reporting such as testifying in court. Reported facilitators included real-time case discussion with peers or supervisors and the belief that it was better for the patient to report in the setting of suspicion. Finally, providers requested case-based education and child abuse and neglect consultation for unclear cases.
  
  
  CONCLUSIONS
  Our interviews identified several approaches to improving detection of child abuse and neglect by general ED providers. These included providing education through case review, improving follow-up by Child Protective Services agencies, and increasing real-time assistance with patient care decisions.
authors.affiliation: Yale University School of Medicine, Department of Pediatrics, New Haven, CT. Electronic address: gunjan.kamdar@yale.edu.
authors.forename: Gunjan
authors.initials: G
authors.lastname: Tiyyagura
authors.affiliation: Yale University School of Medicine, Department of Pediatrics, New Haven, CT.
authors.forename: Marcie
authors.initials: M
authors.lastname: Gawel
authors.affiliation: Yale University School of Medicine, Department of Pediatrics, New Haven, CT.
authors.forename: Jeannette R
authors.initials: JR
authors.lastname: Koziel
authors.affiliation: Yale University School of Medicine, Department of Pediatrics, New Haven, CT.
authors.forename: Andrea
authors.initials: A
authors.lastname: Asnes
authors.affiliation: Yale University School of Medicine, Department of Pediatrics, New Haven, CT.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bechtel
mesh_terms: D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D003237:Connecticut; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D014481:United States