Social history: A qualitative analysis of child abuse pediatricians’ consultation notes

Abstract

Background: Child abuse pediatricians (CAPs) are often consulted for injuries when child physical abuse is suspected or when the etiology of a serious injury is unclear. CAPs carefully evaluate the reported mechanism of the child’s injury and the medical findings in the context of the child’s family and social setting to identify possible risk and protective factors for child abuse and the need for social services. It is unknown what population risk indicators along with other social cues CAPs record in the social history of the consultation notes when assessing families who are being evaluated for child physical abuse. Participants and setting: Thirty-two CAPs representing 28 US child abuse programs. Methods: Participants submitted 730 completed cases of inpatient medical consultation notes for three injury types: traumatic brain injury, long bone fracture, and skull fracture in hospitalized children 4 years of age and younger. We defined a priori 12 social cues using known population risk indicators (e.g., single mother) and identified de novo 13 negative (e.g., legal engagement) and ten positive social cues (e.g., competent parenting). Using content analysis, we systematically coded the social history for the social cues. Results: We coded 3,543 cues resulting in a median of 7 coded cues per case. One quarter of the cues were population indicators while half of the cues were negative and one quarter positive. Conclusions: CAPs choose a wide variety of information, not always related to known population risk indicators, to include in their social histories.

What Do Child Abuse and Neglect Medical Evaluation Consultation Notes Tell Researchers and Clinicians?

“…Keenan et al (2017) found that the presence of social risk factors when evaluating injuries influenced child abuse consultants' diagnosis of abuse among poor and minority children, especially in ambiguous cases. Similarly, Olson et al (2018) found that child abuse clinicians' consultation notes detail a rich social history that includes many domains of the child and families' social ecology; however, information recorded was not always related to known population risk indicators (e.g., negative impression of caregivers). In both studies the authors suggested that uniform reporting styles and tools such as checklists and peer review show promise in minimizing bias, but continued research is warranted to understand how child abuse medical providers use information on patients' social history and circumstances to understand and document their findings.…”

“…Limited research has thoroughly examined the notes documented in CAN medical clinics. One such effort examined inpatient medical notes from children younger than 5 years who had sustained one of three specific injury types that could be suspicious for physical abuse (traumatic brain injury, long bone fracture, and skull fracture; Olson et al, 2018). Through qualitative content analysis, the researchers found rich social histories contained in the 730 sets of inpatient medical consultation notes provided by 32 board-certified pediatricians from 23 child abuse programs in the United States.…”

What Do Child Abuse and Neglect Medical Evaluation Consultation Notes Tell Us?

“…Limited research has thoroughly examined the notes documented in CAN medical clinics. One such effort examined inpatient medical notes from children younger than five years who had sustained one of three specific injury types that could be suspicious for physical abuse (traumatic brain injury, long bone fracture, and skull fracture) (Olson et. al., 2018).…”

“…In the current study, we expanded Olson et al’s (2018) work by creating a coding system for abstracting and examining all aspects of comprehensive medical evaluation notes. We included children of all ages, both inpatient and outpatient records, and all types of suspected maltreatment including physical, sexual, emotional, and medical abuse, as well as neglect.…”