Department of Pediatrics, Yale University School of Medicine, New Haven, Conn.
Department of Pediatrics, Yale University School of Medicine, New Haven, Conn.
Acad Pediatr. 2019 May-Jun;19(4):438-445. doi: 10.1016/j.acap.2019.01.006. Epub 2019 Jan 29.
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 multidisciplinary case review. The aims of this study were to understand the Program's strengths andchallenges and to explore factors that influenced implementation.
We used a qualitative research design with semistructured, one-on-one interviews to understand key stakeholders' perspectives of the Community ED CAN Program. We interviewed 27 stakeholders at 3 community hospitals and 1 academic medical center. Researchers analyzed transcribed data using constant comparative method of grounded theory and developed themes.
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.
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.
急诊（ED）医护人员可能无法识别或报告儿童虐待和/或忽视（CAN）。为了提高识别和报告能力，我们设计了社区 ED CAN 项目，该项目由当地临床医生（护士、医生、医生助理）团队组成，接受过 CAN 培训，（1）传播循证教育；（2）提供咨询、病例随访和专家访问；（3）促进多学科病例审查。本研究旨在了解该计划的优势和挑战，并探讨影响实施的因素。
我们采用定性研究设计，通过半结构化的一对一访谈，了解关键利益相关者对社区 ED CAN 计划的看法。我们采访了 3 家社区医院和 1 家学术医疗中心的 27 名利益相关者。研究人员使用扎根理论的恒定性比较方法分析转录数据，并开发主题。
计划的优势包括：（1）方便向当地拥护者寻求帮助；（2）可以获得 CAN 专家；（3）增加了 CAN 教育/意识；（4）改善了网络和沟通。实施的促进因素包括：（1）领导力支持；（2）参与当地拥护者和外部变革推动者（如 CAN 专家）；（3）拥护者的积极属性；（4）实施的灵活性。实施的挑战/障碍包括：（1）机构对拥护者的支持程度存在差异；（2）对该计划的认识程度存在差异。
社区 ED CAN 项目有可能提高 CAN 的识别和报告能力。促进实施的关键步骤包括确定有承诺的当地拥护者、强有力的领导支持、与专家的联系、项目宣传以及拥护者时间的支持。
