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Children's Health

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Primary care providers report most but not all cases of suspected child abuse

Doctors and nurse practitioners often treat children whom they suspect have been abused, and they report most, but not all cases, of suspected abuse to child protective services (CPS). Uncertainty about the abuse diagnosis, past negative experience with CPS, and a perception that past reporting of abuse did not benefit the child were reasons given by providers for not reporting all cases, according to a recent study supported by the Agency for Healthcare Research and Quality (HS09811).

Providers who had some formal education in child abuse after residency were 10 times more likely than other providers to report all suspected abuse. Efforts must be made to ensure that all primary care providers receive continuing medical education about child abuse, concludes Emalee Gottbrath Flaherty, M.D., of Children's Memorial Hospital and Northwestern University Medical School.

Dr. Flaherty and her colleagues surveyed 85 primary care providers in a regional practice-based network to collect information about the demographic characteristics of each provider and practice, their overall experience with child abuse, and their experience during the previous year in identifying and reporting suspected child abuse, as well as past experience with CPS. In the prior year, over half of the providers (56 percent) said they had treated a child they suspected was abused; 8 percent did not report children with suspected abuse (5 percent of all suspected cases). A majority of providers (63 percent) believed that children they had reported previously had not benefited from CPS intervention, and 49 percent said their experience with CPS made them less willing to report future cases of suspected abuse.

The most common negative consequences of reporting suspected child abuse among practitioners reporting abuse in the last year included losing other patients in the practice who had heard about the report and spending a lot of time on the phone or in court related to the case. Only one-third of providers said they had been informed by CPS of the progress and disposition of the reported case. Provider education about child abuse and a formalized process for CPS feedback to reporting providers could increase the probability that providers will report suspected abuse, conclude the authors.

For more details, see "Health care providers' experience reporting child abuse in the primary care setting," by Dr. Flaherty, Robert Sege, M.D., Ph.D., Helen J. Binns, M.D., M.P.H., and others, in the May 2000 Archives of Pediatric and Adolescent Medicine 154, pp. 489-493.

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