Child abuse and neglect risk assessment: Quality improvement in a primary care setting

Objectives: Practicing Safety (PS) is an AAP toolkit to help practices address child abuse and neglect (CAN) risk by increasing screening and providing resources. The objectives, in an urban practice serving low-income children, were to 1) standardize CAN risk assessment and developmental screening and 2) improve resource provision.

Methods: A quality improvement (QI) initiative to standardize CAN risk assessment, using materials adapted from PS (aPS) was conducted through the use of "SmartTools" in an electronic health record (EHR). The Edinburgh Postnatal Depression Scale and Parents Evaluation of Developmental Status were used to assess maternal depression and child development, respectively. Charts were reviewed in waves: pre-, immediate post-, and early post-implementation (waves 1-3), monthly for six months (waves 4-9), then quarterly for 12 months (waves 10-13) to assess screening and resource provision for six domains: infant crying, maternal depression, development, discipline, temper tantrums, and toilet training.

Results: A total of 581 charts were reviewed (waves 1-3: 92, 95, 94, respectively; waves 4-13: 30 each). Screening for infant crying, maternal depression, development, and discipline rose from 0% pre- to over 50% post-implementation. Screening for temper tantrums and toilet training rose from 6% to 72% and 36% to 82%, respectively. For all measures, resource provision improved over time, and all improvements were maintained for 1.5 years post-implementation.

Conclusions: Incorporating aPS into an EHR is a practical and effective approach to improving CAN risk assessment and resource provision. This QI initiative is an example of a practice-wide improvement that resulted in clinical practice change.