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

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.