Development of a universal child abuse screening tool (U-CAST): A qualitative analysis of medical expert perspectives

Medical providers in the U.S., Canada, and many other jurisdictions are legally obligated to report suspicions of child abuse, but clinicians often find it difficult to recognize the signs, resulting in high risk of missed or under-reporting abuse.

To improve the quality and fair application of child physical abuse screening in medical settings by developing a user-friendly Universal Child Abuse Screening Tool (U-CAST) within the electronic health record (EHR).

This qualitative study elicited medical experts' recommendations for development and implementation of a universal child abuse screening tool. To capture multiple viewpoints and refine ideas, Epic conducted a series of video-enabled, audio-recorded expert working groups (EWG) to cover tool components and design, logistics, decision support, challenges to implementation, and adequate follow-up steps.

14 experts were recruited by Epic from institutions nationwide including pediatric surgeons, child abuse pediatricians, pediatric emergency medicine physicians, nurses, social workers to serve on 9 EWG panels.

EWG discussions explored and defined essential screening tool content and generated recommendations and a descriptive list of logistical challenges to implementation. Key thematic barriers to implementation included: 1) integration of the tool into the electronic medical record system; 2) embedding the tool into current clinical workflows; 3) concerns for performance of the screening tool.

EWG achieved consensus on the need for and implementation of universal child abuse screening. Throughout the discussions, experts emphasized the importance of ensuring that positive screens have the flexibility to tailor the tool to diverse workflows and have appropriate follow-up actions.

Our user-friendly, evidence-based design supports implementation in a variety of differently-resourced settings.