Facilitators and barriers to screening for child abuse in the emergency department

This qualitative study is based on semi-structured interviews with 27 professionals from seven Dutch hospitals (i.e. seven pediatricians, two surgeons, six ED nurses, six ED managers and six hospital Board members). The resulting list of facilitators/barriers was subsequently discussed with five experts in child abuse and one implementation expert. The results are ordered using the Child Abuse Framework of the Dutch Health Care Inspectorate that legally requires screening for child abuse.Lack of knowledge of child abuse, communication with parents in the case of suspected abuse, and lack of time for development of policy and cases are barriers for ED staff to screen for child abuse. For Board members, lack of means and time, and a high turnover of ED staff are impediments to improving their child abuse policy. Screening can be promoted by training ED staff to better recognize child abuse, improving communication skills, appointing an attendant specifically for child abuse, explicit support of the screening policy by management, and by national implementation of an approved protocol and validated screening instrument.ED staff are motivated to work according to the Dutch Health Care Inspectorate requirements but experiences many barriers, particularly communication with parents of children suspected of being abused. Introduction of a national child abuse protocol can improve screening on child abuse at EDs.Early detection of child abuse is a priority of the Dutch Health Care Inspectorate; in the Netherlands, each year 107,200 children are victim of some type of child abuse [1]. Child abuse is an important public health problem: besides the serious consequences for each child and their environment, the estimated costs of child abuse in the Netherlands are 965 million euros per annum [2,3].The Dutch media frequently report the inadequate detection of child abuse in hospital emergency departments (EDs). Since January 2009 all EDs are legally required to fulfil the Inspec