An Evidence-Based Educational Intervention to Improve the Recognition and Photo Documentation of Child Abuse Injuries in a Rural Health Facility

Background: Child abuse is an unfortunate reality for millions of children across the United States every year. The consequences of abuse result in long term emotional problems, including aggressive behavior, depression, anxiety, and thoughts of suicide; physical consequences include risk of asthma, hypertension, cardiovascular disease, and obesity. Lack of education has been cited as one of the reasons that many clinicians fail to report suspected child abuse. This quality improvement intervention evaluated the impact of child maltreatment education on the knowledge of clinical facility staff, as well as their comfort in reporting suspected child abuse. This intervention was set in a rural, 99-bed acute-care healthcare facility in Sweetwater County Wyoming, and included participants from many departments, including administration, nursing, dietary, education, and quality improvement. Methods: The Ace Star Model of Knowledge Transformation was used in the development of this educational intervention. Discovery research was conducted, and an evidence summary occurred prior to the translation to guidelines; translation to guidelines included the development of a pre education assessment, which was conducted approximately two weeks prior to the education sessions. Practice integration occurred with the presentation of five, one-hour education sessions, which were conducted at the facility over a two-day period. Process, outcome, and evaluation occurred with the administration of a post education assessment, which took place approximately four to eight weeks following the education sessions and analysis of data. Intervention: A simple pre education assessment was conducted to evaluate participant comfort with recognizing child physical abuse, familiarity with state reporting hotlines, and mandates requiring the reporting of suspected abuse. Participant barriers to reporting suspected abuse were ascertained to evaluate possible reasons that abuse is under-reported in healthcare facilities. Finally, 11 questions were developed to assess participant knowledge of the general topic of child physical abuse. Education about abuse was presented to facility staff, and the assessment was re-administered four weeks after to determine the effectiveness of the child maltreatment education. Results: Following the intervention, there was a statistically significant improvement in participants' comfort in their ability to recognize child physical abuse (p = 0.02). Many participants were aware of the mandate to report suspected abuse, and most were unfamiliar with the reporting hotline; the education intervention resulted in a statistically significant increase in the familiarity with the reporting hotline (p = 0.18). The barriers mentioned in the pre-education assessment were significantly reduced following participation in the educational session, with many of the participants stating that they now had no barriers to reporting. Overall participant knowledge related to child maltreatment injuries (p = 0.0034) also showed a statistically significant increase. Conclusions: Based on feedback from participants, the information presented in this educational intervention was relevant to all who attended and was useful in improving their ability to recognize possible abusive injuries. The results showed improvements in most areas assessed, and the project lead believes that there is the potential for greater success with implementation of this educational intervention at additional sites, including those where the rates of child maltreatment may be higher