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Child Maltreatment Screening and Anticipatory Guidance: A Description of Pediatric Nurse Practitioner Practice
Insights
Pediatric nurse practitioners (PNPs) often do not routinely screen for child maltreatment or provide anticipatory guidance. This gap in practice is particularly evident in identifying sexual abuse and related psychosocial risk factors in children.
Area of Science:
- Pediatrics
- Child Health
- Public Health
Background:
- Child maltreatment has severe, long-term consequences for affected children.
- Prompt identification of child maltreatment is critical for intervention and prevention.
- Pediatric nurse practitioners (PNPs) play a vital role in child welfare.
Purpose of the Study:
- To describe the practice behaviors of PNPs regarding child maltreatment screening.
- To assess PNP practices in providing anticipatory guidance for child maltreatment and its psychosocial risk factors.
Main Methods:
- A Risk Assessment Survey was developed by 12 expert PNPs.
- The survey was distributed to over 8500 members of the National Association of Pediatric Nurse Practitioners (NAPNAP).
- A total of 243 PNPs responded, yielding a 3% response rate.
Main Results:
- 51% of PNPs rarely or never inquire about domestic violence.
- 30% of PNPs rarely or never ask about discipline practices.
- 50% of PNPs perform ano-genital exams during well-child visits.
Conclusions:
- A significant proportion of PNPs do not routinely screen for child maltreatment.
- Gaps in screening practices are particularly notable for sexual abuse and associated psychosocial risks.
- Enhanced training and standardized protocols may be necessary to improve PNP practices in child maltreatment identification.
Introduction:
Given the number of children affected by child maltreatment and the dire consequences that can develop, prompt identification of child maltreatment is crucial. The purpose of this study was to describe pediatric nurse practitioner (PNP) practice behaviors related to screening and providing anticipatory guidance for child maltreatment and its psychosocial risk factors.
Method:
The Risk Assessment Survey was developed for this study by 12 PNPs, all of whom were members of NAPNAP's Child Maltreatment Special Interest Group to ensure face validity; all 12 PNPs were content experts in child maltreatment. The content of the survey was derived from key characteristics from the evidence on child maltreatment. The survey was emailed to the more than 8500 NAPNAP members.
Results:
Two hundred forty-three PNPs responded to the survey, which represents a response rate of 3%. Approximately half of the participants (n = 121; 51%) stated that they never/rarely ask parents questions about domestic violence, more than one-fourth (n = 71; 30%) reported that they never/rarely ask parents questions about discipline, and half of the responding PNPs (n = 120; 50%) reported that they perform an ano-genital exam at well visits.
Discussion:
This study demonstrates that a significant number of PNPs do not routinely screen for child maltreatment and psychosocial risk factors. This is especially true in regards to sexual abuse screening and anticipatory guidance.
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