Child abuse and maltreatment remain major public health concerns in the United States. Early identification is challenging, particularly for clinicians without specialized pediatric training, and disparities in detection raise concerns about bias. Universal screening integrated into electronic health records (EHRs) may improve detection and equity. To develop an evidence-based, user-friendly, and broadly applicable universal child abuse screening tool (U-CAST) for integration into the EPIC Foundation System. A qualitative study engaged nine expert working groups comprising 17 specialists in child abuse pediatrics, pediatric trauma surgery, general pediatrics, and pediatric emergency medicine. Between February and April 2022, groups met virtually to discuss screening content, clinical decision support, workflow integration, and implementation considerations. Meeting transcripts were analyzed using inductive coding and thematic analysis. Five themes emerged: (1) the importance of universal screening; (2) essential tool components; (3) appropriate clinical settings; (4) actionable follow-up protocols for positive screens; and (5) local program evaluation. Preliminary implementation data demonstrated successful integration, high screening completion rates, and encouraging performance in identifying children with suspected physical abuse. U-CAST was developed through a multi-disciplinary expert process and designed for integration into Epic workflows. Preliminary findings support its feasibility and clinical utility.
This study examined how caregivers and child welfare professionals reported service needs over 25 years, focusing on housing, legal, mental health, and substance use supports. Using three cohorts of the National Survey of Child and Adolescent Well-Being (1999–2024; N = 6,102), we estimated longitudinal multilevel logistic regression models to assess trends in reported service needs and associations with child, caregiver, and child welfare professional characteristics. Reported housing and legal needs declined modestly, while reported mental health and substance use needs increased. Caregivers consistently reported fewer needs than professionals, and service need trajectories differed between caregivers and child welfare professionals. Racial/ethnic differences persisted, with Black and Hispanic caregivers more likely to report housing needs and less likely to report behavioral health needs relative to White caregivers. Findings highlight evolving perceptions of caregiver service needs and underscore the importance of multi-informant, equity-focused assessment practices within child welfare systems.
When a parent is accused of child sexual abuse (CSA), parent conflict raises concerns about allegation credibility. However, little is known about how attorneys question children about parent conflict. We examined 21,863 question-answer pairs from 53 testimonies of 6- to 17-year-olds ( M = 13.46) in cases involving accused parents (49.1% stepfathers, 42.1% biological fathers, 8.8% other). We identified parent conflict topics and analyzed differences by attorney, child age, question type, and child elaboration. Parent conflict arose in nearly all cases but served different purposes: defense attorneys used it to suggest allegations resulted from conflict, whereas prosecutors used it to contextualize delayed disclosure. Attorneys questioned younger children more often about coaching. Closed-ended questions and unelaborative responses predominated, although children elaborated more when describing general parent conflict than other conflict topics. Findings highlight parent conflict as a versatile rhetorical tool and the need for developmentally sensitive questioning.
Intrafamilial child torture is an extreme and distinct form of child maltreatment associated with high rates of child fatality. It is vastly under-researched and poorly understood, contributing to cases being overlooked or mishandled leaving child victims at high risk of serious harm. A broad conceptual definition that incorporates criteria to serve as red flags could greatly improve identification of potential cases and ensure that they are referred for more thorough assessment. This study was designed to assess level of professional agreement with such a proposed broad conceptual definition of ICT, derived from agreed-upon criteria found in the professional literature. Two hundred and fifty-three members of the Association of Professionals Solving the Abuse of Children were surveyed. Almost 90% endorsed the proposed conceptual definition and demonstrated high levels of recognition of key ICT red flags. Respondents also confirmed that ICT cases require a different level of professional intervention than typical child maltreatment cases.
