Barriers to reporting child abuse encountered by emergency department physicians in Nova Scotia

BACKGROUND: Sentinel injuries identified but not reported have been found in almost 30% of children that present with life-threatening injuries secondary to abuse. Child abuse often goes unrecognized in the emergency... [ view full abstract ]

BACKGROUND: Sentinel injuries identified but not reported have been found in almost 30% of children that present with life-threatening injuries secondary to abuse. Child abuse often goes unrecognized in the emergency department. Previous studies of pediatricians identified perceived barriers to reporting suspected child abuse including diagnostic uncertainty, insufficient feedback from child protection services, insufficient time for patient assessment, fear of lawsuits, and prioritizing medical treatment. To the best of our knowledge, there are no published Canadian studies on barriers to reporting child abuse perceived by non-Pediatric physicians working in mixed, non-tertiary emergency departments. We hypothesize similar barriers identified in the literature may be discussed by our study participants, but the study allows for identification of unique issues perceived by this physician population.
OBJECTIVE: To identify and describe perceived barriers to reporting child abuse by emergency and family physicians working in regional and community emergency departments in Nova Scotia.
METHOD: This qualitative study is based on grounded theory. Participants will be recruited from emergency departments with a range of patient volumes and resources. Focus groups of 3 to 10 physicians in regional emergency departments will be conducted in 4 of 8 health districts in Nova Scotia, Canada. One-on-one interviews with 1 to 2 physicians in community emergency departments will be conducted in the remaining 4 districts. Focus group and interview discussions will be transcribed and analyzed using thematic content analysis.
RESULTS: Data collection will occur between April and October 2016. Preliminary results will be available by August 2016. Results will be presented as themes derived from transcripts with examples of narrative text.
CONCLUSIONS: The results of this study will inform future work developing policy and education interventions in emergency departments to improve reporting of child abuse. Future nation-wide studies of the issue could further disseminate and build on Nova Scotia data.