Child protection and welfare concerns in an adult emergency department

Emergency clinicians may be the first professionals to identify child protection and welfare (CPW) concerns. Under Children First legislation, mandated persons are legally required to report such concerns to Tusla Child and Family Agency (CFA). This study aimed to enhance emergency clinician knowledge and confidence in identifying and reporting CPW concerns.

A retrospective review of Emergency Department (ED) referrals to Medical Social Work (MSW) from January 2023 to October 2024 was undertaken. A series of interventions were implemented, including targeted educational sessions. Anonymised questionnaires assessing knowledge of mandated reporting responsibilities was administered at baseline (March 2025), post-education (May 2025), and at a later follow-up (November 2025).

Between January 2023 and October 2024, 106,793 ED attendances occurred with 840 referrals to medical social work. CPW concerns accounted for 161 (19.2%) referrals. Number of clinicians having a registered Tusla portal account increased from 4 (20%) at baseline to 14 (77.8%) post-implementation (p < 0.05). Awareness of how to report concerns through the Tusla online portal increased from 7 emergency clinician respondents (35%) to 18 (100%) respondents (p < 0.05) post intervention.

This phased quality improvement project improved emergency clinicians' knowledge of their legal responsibilities as mandated persons and enhanced familiarity with CPW reporting processes and procedures.