142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Practices and challenges to child abuse medical evaluations in Texas: Findings from a mixed-methods study

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 8:30 AM - 8:50 AM

Monica Faulkner, PhD , School of Social Work, The University of Texas at Austin, Austin, TX
Larra Marra, MSW , The University of Texas at Austin, Austin, TX
Purpose.  This mixed methods study explored factors influencing effective use of medical evaluations for child abuse victims brought to Children’s Advocacy Centers (CACs) in Texas. In Texas, children who go through the state’s CACs receive medical evaluations at a substantially lower rate than nationally (21% vs. 34%, respectively).

Methods.  Twelve Texas communities were sampled to participate in this study based on population size (urban, mid-size, or rural) and medical evaluation rates (high or low). Focus groups were conducted with CAC staff, law enforcement, prosecutors, CPS, and medical providers (60 focus groups, n=204). Findings from focus groups were then used to develop an online survey that was distributed to all 66 CACs in Texas (n=319). 

Results.  Regardless of population size, if the MDT had regular access to a medical provider with specialized training in child abuse, medical evaluations were used more effectively and consistently, and this was true even in remote areas where strong telemedicine programs were in place. Additional themes regarding factors that facilitate or impede effective use of medical evaluations included written protocols for medical exams, knowledge/training about child abuse and medical evaluations, child and family factors, community attitudes, and resource needs to improve provision of medical evaluations.

Conclusions and Implications.  Study findings suggest structural changes are needed to improve rates of medical exams such as revising the payment methods for sexual abuse exams through crime victim’s compensation, increasing hospital support through positive relationship building and expanding access to doctors with child abuse specialization.   

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related nursing
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Formulate an understanding the importance of medical evaluations for child abuse victims. Discuss the role of multidisciplinary teams in facilitating the use of medical evaluations for child abuse victims. Identify strategies for improving medical evaluations in communities.

Keyword(s): Child Abuse, Sexual Assault

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Presenters are qualified to present because they have personally conducted this research. Presenters have a variety of experience both in programmatic and research activities related to child abuse and neglect.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.