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Winqust A, Burduli E, Eddy LL, Landis T, Fraser J, Barbosa Leiker C. Associations between nurse characteristics, institutional characteristics and perceived nurse knowledge and self-efficacy of reporting suspected child abuse and neglect. J Clin Nurs 2024; 33:2662-2673. [PMID: 38366766 DOI: 10.1111/jocn.17026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 02/18/2024]
Abstract
AIM To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self-efficacy of reporting child abuse and neglect. DESIGN A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey. METHODS A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores. RESULTS Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self-efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self-efficacy of reporting child abuse and neglect. CONCLUSION This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters. IMPACT This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self-efficacy in reporting suspected child abuse and neglect. REPORTING METHODS The authors of this study have adhered to relevant EQUATOR guidelines: STROBE. PATIENT OR PUBLIC CONTRIBUTION There is no patient or public contribution as the study only looked at nurses.
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Affiliation(s)
- Anna Winqust
- College of Nursing, University of Colorado Anschutz, Aurora, Colorado, USA
| | - Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Linda L Eddy
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Tullamora Landis
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Jennifer Fraser
- Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Brink FW, Lo CB, Rust SW, Puls HT, Stanley R, Galdo B, Lindberg DM. Pilot study using machine learning to improve estimation of physical abuse prevalence. CHILD ABUSE & NEGLECT 2024; 149:106681. [PMID: 38368780 DOI: 10.1016/j.chiabu.2024.106681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/08/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes have been shown to underestimate physical abuse prevalence. Machine learning models are capable of efficiently processing a wide variety of data and may provide better estimates of abuse. OBJECTIVE To achieve proof of concept applying machine learning to identify codes associated with abuse. PARTICIPANTS AND SETTING Children <5 years, presenting to the emergency department with an injury or abuse-specific ICD-10-CM code and evaluated by the child protection team (CPT) from 2016 to 2020 at a large Midwestern children's hospital. METHODS The Pediatric Health Information System (PHIS) and the CPT administrative databases were used to identify the study sample and injury and abuse-specific ICD-10-CM codes. Subjects were divided into abused and non-abused groups based on the CPT's evaluation. A LASSO logistic regression model was constructed using ICD-10-CM codes and patient age to identify children likely to be diagnosed by the CPT as abused. Performance was evaluated using repeated cross-validation (CV) and Reciever Operator Characteristic curve. RESULTS We identified 2028 patients evaluated by the CPT with 512 diagnosed as abused. Using diagnosis codes and patient age, our model was able to accurately identify patients with confirmed PA (mean CV AUC = 0.87). Performance was still weaker for patients without existing ICD codes for abuse (mean CV AUC = 0.81). CONCLUSIONS We built a model that employs injury ICD-10-CM codes and age to improve accuracy of distinguishing abusive from non-abusive injuries. This pilot modelling endeavor is a steppingstone towards improving population-level estimates of abuse.
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Affiliation(s)
- Farah W Brink
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 West Ninth Avenue, Columbus, OH 43210, United States.
| | - Charmaine B Lo
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, United States; Abigail Wexner Research Institute, 700 Children's Drive, Columbus, OH 43205, United States
| | - Steven W Rust
- IT Research & Innovation, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Henry T Puls
- Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States
| | - Rachel Stanley
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, United States; The Ohio State University College of Medicine, 370 West Ninth Avenue, Columbus, OH 43210, United States
| | - Brendan Galdo
- IT Research & Innovation, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States
| | - Daniel M Lindberg
- The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect, 13123 East 16(th) Avenue, Aurora, CO 80045, United States; Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, 13001 East 17(th) Place, Aurora, CO 80045, United States
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Snyder CW, Barry TM, Ciesla DJ, Thatch K, Danielson PD, Chandler NM, Pracht EE. Risk of Injury-Related Readmission Varies by Initial Presenting-Hospital Type Among Children at High Risk for Physical Abuse. Pediatr Emerg Care 2024; 40:119-123. [PMID: 37308173 DOI: 10.1097/pec.0000000000002996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Children experiencing physical abuse may initially present to hospitals with underappreciated minor injuries, only to experience more severe injuries in the future. The objectives of this study were to 1) describe young children presenting with high-risk diagnoses for physical abuse, 2) characterize the hospitals to which they initially presented, and 3) evaluate associations of initial presenting-hospital type with subsequent admission for injury. METHODS Patients aged younger than 6 years from the 2009-2014 Florida Agency for Healthcare Administration database with high-risk diagnoses (codes previously associated with >70% risk of child physical abuse) were included. Patients were categorized by the hospital type to which they initially presented: community hospital, adult/combined trauma center, or pediatric trauma center. Primary outcome was subsequent injury-related hospital admission within 1 year. Association of initial presenting-hospital type with outcome was evaluated with multivariable logistic regression, adjusting for demographics, socioeconomic status, preexisting comorbidities, and injury severity. RESULTS A total of 8626 high-risk children met inclusion criteria. Sixty-eight percent of high-risk children initially presented to community hospitals. At 1 year, 3% of high-risk children had experienced subsequent injury-related admission. On multivariable analysis, initial presentation to a community hospital was associated with higher risk of subsequent injury-related admission (odds ratio, 4.03 vs level 1/pediatric trauma center; 95% confidence interval, 1.83-8.86). Initial presentation to a level 2 adult or combined adult/pediatric trauma center was also associated with higher risk for subsequent injury-related admission (odds ratio, 3.19; 95% confidence interval, 1.40-7.27). CONCLUSIONS Most children at high risk for physical abuse initially present to community hospitals, not dedicated trauma centers. Children initially evaluated in high-level pediatric trauma centers had lower risk of subsequent injury-related admission. This unexplained variability suggests stronger collaboration is needed between community hospitals and regional pediatric trauma centers at the time of initial presentation to recognize and protect vulnerable children.
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Affiliation(s)
- Christopher W Snyder
- From the Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Tara M Barry
- Division of Trauma and Acute Care Surgery, University of South Florida, Tampa, FL
| | - David J Ciesla
- Division of Trauma and Acute Care Surgery, University of South Florida, Tampa, FL
| | - Keith Thatch
- From the Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Paul D Danielson
- From the Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Nicole M Chandler
- From the Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Etienne E Pracht
- College of Public Health, University of South Florida, Tampa, FL
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Winquist A, Leiker CB, Landis T, Fraser J, Eddy LL, Burduli E. Development and psychometric evaluation of the reporting suspected child abuse and neglect (RSCAN) scale for United States registered nurses. J Pediatr Nurs 2023; 73:e319-e326. [PMID: 37863784 DOI: 10.1016/j.pedn.2023.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE In the United States (US), nurses have a mandated duty to report child abuse and neglect (CAN). Despite comprising the highest proportion of the US healthcare workforce, limited research has explored the institutional barriers they face in reporting suspected CAN. Furthermore, there is no existing valid and reliable measure of reporting relevant to US. The purpose of this research is to develop and psychometrically evaluate a scale to measure nurse knowledge and self-efficacy as CAN mandated reporters. DESIGN AND METHODS The Reporting Suspected Child Abuse and Neglect (RSCAN) tool was developed from two existing international tools to examine institutional barriers and facilitators to US nurses' professional knowledge and reporting of CAN. A convenience sample of one hundred and sixty-six US nurses primarily from the Pacific Northwest responded to an online survey. An exploratory factor analysis (EFA) and Cronbach's α were used to examine validity and internal consistency, respectively, of an initial 16-item scale. RESULTS A two-factor model consisting of eight items indicated good model fit (CFI = 0.986, RMSEA = 0.049, and SRMR = 0.028) and was internally consistent (Cronbach's α = 0.822). CONCLUSION RSCAN is the first US instrument to reliably measure nurses' professional knowledge and self-efficacy of reporting suspected CAN. PRACTICE IMPLICATIONS Future research can build upon these findings to recognize and support nurses in their mandated role to report CAN.
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Affiliation(s)
- Anna Winquist
- University of Colorado Anschutz, College of Nursing, Aurora, CO 80045, USA.
| | - Celestina Barbosa Leiker
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
| | - Tullamora Landis
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
| | - Jennifer Fraser
- University of Sydney, Medicine and Health, Sydney, NSW 2006, Australia.
| | - Linda L Eddy
- Washington State University, College of Nursing, 14204 NE Salmon Creek Ave, Vancouver, WA 98686, USA.
| | - Ekaterina Burduli
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
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Brink FW, Lo CB, Shi J, Stanley R, Lindberg DM. Diagnosis codes dramatically underestimate the burden of abuse. CHILD ABUSE & NEGLECT 2023; 135:105986. [PMID: 36516562 DOI: 10.1016/j.chiabu.2022.105986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND International Classification of Diseases (ICD) billing codes are not well-suited to estimate physical abuse prevalence among hospitalized patients and may be even less accurate in emergency departments (EDs). The Centers for Disease Control and Prevention (CDC) has recently published a child abuse and neglect syndromic surveillance definition to more accurately examine national abuse trends among ED visits. OBJECTIVE To retrospectively apply the CDC syndromic definition to a population of physically abused children and determine its sensitivity for abuse in an ED and at hospital discharge. PARTICIPANTS AND SETTING All physically abused children <5 years seen in the ED and evaluated by the child protection team from 2016 to 2020 at a large Midwestern children's hospital. METHODS Retrospective cross-sectional study utilizing the hospital's child protection team administrative database, the Pediatric Health Information System and the electronic health record to identify the study sample, chief complaint, and abuse-specific codes assigned in the ED and at hospital discharge. Abuse-specific codes were defined as all ICD-10-CM and Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) codes included in the CDC syndromic definition, which was applied to the sample and its sensitivity determined. RESULTS Among the 550 abused patients identified, most were male (58.4 %), white (65.1 %), <2 years old (80.4 %), and had public insurance (81.6 %). When applying the CDC syndromic definition, only 11.6 % were identified as abused in the ED and 65.3 % were identified at hospital discharge. CONCLUSIONS The CDC syndrome surveillance definition lacks sensitivity in identifying abuse in the ED or at hospital discharge.
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Affiliation(s)
- Farah W Brink
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States of America.
| | - Charmaine B Lo
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Drive, Columbus, OH 43215, United States of America
| | - Junxin Shi
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Drive, Columbus, OH 43215, United States of America
| | - Rachel Stanley
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, United States of America; The Ohio State University College of Medicine, 370 W 9th Ave, Columbus, OH 43210, United States of America; The Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Drive, Columbus, OH 43215, United States of America
| | - Daniel M Lindberg
- Children's Hospital Colorado, Anschutz Medical Campus, 13123 East 16th Avenue, Aurora, CO 80045, United States of America; University of Colorado Denver, Anschutz Medical Campus, 1380 Lawrence Street 80204, Denver, CO 80204, United States of America
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He Y, Leventhal JM, Gaither JR, Jones EA, Kistin CJ. Trends from 2005 to 2018 in child maltreatment outcomes with caregivers' substance use. CHILD ABUSE & NEGLECT 2022; 131:105781. [PMID: 35820322 DOI: 10.1016/j.chiabu.2022.105781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/22/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Caregivers' substance use is associated with child maltreatment. OBJECTIVE Examine trends from 2005 to 2018 in percentages of three outcomes with caregivers' drug or alcohol use: child protective services (CPS) referrals, substantiated maltreatment reports, and foster care placements. PARTICIPANTS AND SETTING 22 U.S. states that contributed child-level maltreatment outcomes and caregivers' substance use data to the National Child Abuse and Neglect Data System from 2005 to 2018. METHODS Joinpoint regression was used to examine the average annual percent change (AAPC) in outcomes with caregivers' drug or alcohol use and to identify temporal changes. RESULTS From 2005 to 2018, CPS referrals with caregivers' drug use increased (AAPC 2.33, p < .001), while referrals with alcohol use remained unchanged (AAPC -0.11, p = .92) (trend difference p = .04). Substantiated reports with caregivers' drug and alcohol use increased (AAPC drug use 3.63, p < .001, AAPC alcohol use 1.28, p = .03), with a greater increase observed with drug use (difference p = .03). Foster care placements with caregivers' drug use increased (AAPC 2.54, p < .001), while placements with alcohol use did not change (AAPC -1.22, p = .29), (difference p = .005). Within the study period, changes in trends with caregivers' drug use included increased substantiated reports from 2010 to 2018 (p < .001) and increased foster care placements from 2009 to 2018 (p < .001). With caregivers' alcohol use, CPS referrals and foster care placements decreased from 2007 to 2018 (all p < .001). CONCLUSIONS Trends differed for outcomes with caregivers' drug versus alcohol use. Findings can inform policies to improve care for families affected by substance use.
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Affiliation(s)
- Yuan He
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, 801 Albany Street, Boston, MA 02119, United States of America.
| | - John M Leventhal
- Department of Pediatrics, Yale School of Medicine, 20 York Street, New Haven, CT 06510, United States of America
| | - Julie R Gaither
- Department of Pediatrics, Yale School of Medicine, 20 York Street, New Haven, CT 06510, United States of America
| | - Eric A Jones
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), 85 East Newton Street, Boston, MA 02118, United States of America
| | - Caroline J Kistin
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, 801 Albany Street, Boston, MA 02119, United States of America
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