A qualitative study examining stakeholder perspectives of a local child abuse program in community emergency departments

Objectives: Emergency Department (ED) providers may fail to recognize or report child abuse and/or neglect (CAN). To improve recognition and reporting, we designed the Community ED CAN Program in which teams of local clinicians (nurses, physicians, physician assistants) received training in CAN and 1) disseminated evidence-based education, 2) provided consultation, case follow-up and access to specialists, and 3) facilitated multi-disciplinary case review. The aims of this study were to understand the Program's strengths and challenges and to explore factors that influenced implementation.

Methods: We used a qualitative research design with semi-structured, one-on-one interviews to understand key stakeholders' perspectives of the Community ED CAN Program. We interviewed twenty-seven stakeholders at 3 community hospitals and 1 academic medical center. Researchers analyzed transcribed data using constant comparative method of grounded theory and developed themes.

Results: Program strengths included: 1) Comfort in seeking help from local champions, 2) access to CAN experts, 3) increased CAN education/awareness and 4) improved networks and communication. Facilitators of implementation included: 1) leadership support, 2) engaged local champions and external change agents (eg, CAN experts), 3) positive attributes of the champions and 4) implementation flexibility. Program Challenges/Barriers to implementation included: 1) variability of institutional support for the champions and 2) variability in awareness about the program.

Conclusions: A Community ED CAN Program has the potential to improve recognition and reporting of CAN. Key steps to facilitate implementation include the identification of committed local champions, strong leadership support, connections to experts, program publicity and support of the champions' time.