Protocolized abuse screening to decrease provider bias and increase capture of potential events.

Area of Science:

• Pediatric Medicine
• Child Abuse and Neglect
• Healthcare Bias Research

Background:

• Early identification of child abuse is crucial for preventing severe outcomes.
• Provider implicit bias may contribute to disparities in child abuse reporting among minority and impoverished children.
• An institution implemented universal screening for abuse in 2016 and an objective evaluation protocol in 2019.

Purpose of the Study:

• To evaluate the impact of universal screening and an objective protocol on child abuse identification.
• To assess changes in the demographics of identified child abuse cases.
• To determine if these interventions mitigate racial and socioeconomic biases in reporting.

Main Methods:

• Retrospective chart review and forensic database analysis of patients under 18 years old (2014-2022).
• Comparison of three periods: pre-universal screening (2014-2015), post-universal screening (2016-2019), and post-protocol implementation (2020-2022).
• Statistical analysis using Chi-square tests and modified Poisson regression to compare patient characteristics and case identification rates.

Main Results:

• Universal screening significantly increased the number of identified child abuse cases.
• The demographic profile shifted, with a higher identification rate of white children, aligning with state demographics.
• The proportion of publicly insured patients decreased, contrary to the state's trend of increasing public insurance enrollment.

Conclusions:

• Objective, evidence-based protocols are effective in identifying child abuse.
• These protocols show promise in reducing racial and socioeconomic biases in child abuse reporting.
• Institutional implementation of standardized protocols can improve the accuracy and equity of child abuse detection.