Factors Impacting Effective Use of Medical Evaluations in Child Abuse Cases: Findings From a Multi-Site Study
This qualitative study explored both contributing and impeding factors influencing effective use of medical evaluations for child abuse victims brought to Children’s Advocacy Centers (CACs) in Texas. Medical evaluations are considered a best practice in the response to abuse, critical to the safety of children and to evidence collection. However, research has shown that, in Texas, children who go through the state’s CACs receive medical evaluations at a substantially lower rate than nationally (21% vs. 34%, respectively), with even lower rates in mid-size and rural areas.
Twelve Texas communities were theoretically sampled to participate in this study based on population size (urban, mid-size, or rural) and medical evaluation rates (high or low). Within communities, focus groups were conducted with each multi-disciplinary team (MDT) professional group (CAC staff, law enforcement, prosecutors, CPS, and medical). This resulted in a total of 60 focus groups and a sample of 204 participants. Focus groups consisted of a 1 – 1.5 hour semi-structured, audio-taped interview. Data analysis consisted of identifying and clustering themes through holistic and line-by-line reading of transcripts, as well as examining how thematic patterns differed by community characteristics. Dedoose software was used to code themes and retrieve quotes to substantiate and describe the findings. Coder consistency was enhanced through training/mentoring, reliability testing, and a coding verification process. Potential bias was further reduced by including external audits, having research and practitioner colleagues “shadow” the analysis, peer debriefing, and member checking results with CAC staff who were not focus group participants.
Primary themes identified in the data suggest multiple factors impact the use of medical evaluations. Variations in MDT structure and community size (rural vs. urban) influenced the use of medical evaluations. For instance, regardless of population size, if the MDT had regular access to a medical provider with specialized training in child abuse, medical evaluations were used more effectively and consistently, and this was true even in remote areas where strong telemedicine programs were in place. MDT protocols also influenced use of medical evaluations in that MDTs had more effective use of evaluations when all members had clear protocols designating when a child should receive an exam and sufficient cross-training about the multiple purposes of an exam. Additional themes regarding factors that facilitate or impede effective use of medical evaluations included MDT member knowledge/training about child abuse and medical evaluations, child and family factors, community attitudes, and resource needs to improve provision of medical evaluations.
Conclusions and Implications
This study explored community and organizational factors influencing the use of medical evaluations of alleged child abuse in Texas. Study findings suggest specific organizational, policy, and training steps to improve effective use of medical evaluations. The study highlighted a need to develop community-specific approaches for both MDT collaboration development and medical evaluation protocols. The study also highlights the need for a broader, quantitative study of Texas MDTs to see if the patterns identified in this study can be generalized.