Improving Protocols for Assessing and Reporting Non-recent Child Abuse: A Quality Improvement Project

Background: Mandated reporters, including mental health clinicians, are legally required to report suspected child abuse, including non-recent abuse if a current minor could be at risk. Despite this requirement, underreporting child abuse is prevalent due to factors such as insufficient knowledge, fear of repercussions, and unclear guidelines. Local Problem: An urban outpatient mental health clinic primarily staffed by students and novice clinicians lacked formal training and protocols for assessing and reporting non-recent child abuse. This absence of clear guidelines left clinicians ill-equipped to respond sensitively and knowledgeably to disclosures of non-recent abuse. A structured approach was needed to address this gap. Methods: This quality improvement (QI) project utilized the Johns Hopkins Evidence-Based Practice (JHEBP) Model and the Plan-Do-Study-Act (PDSA) cycle. The intervention involved developing and implementing a non-recent abuse reporting tool at the clinic. Interventions: Current child abuse reporting laws in Utah were sourced from The Rape, Abuse & Incest National Network (RAINN) website and combined with findings from a comprehensive literature review. Input from the clinic co-director, project sponsor, and content expert was incorporated into the tool's design. The intervention was conducted in four phases: (1) preimplementation survey to assess baseline knowledge, confidence, and satisfaction; (2) creation of the reporting tool; (3) introduction of the tool; and (4) post-implementation survey to evaluate outcomes. Tool usability was monitored bi-weekly, and feedback was collected throughout the implementation period. Results: The project included 10 participants comprising students and clinicians. Pre-survey results from nine respondents indicated low confidence levels in assessing and reporting non-recent child abuse and an average knowledge score of 79%. Following tool implementation and training, post-survey results from seven participants revealed improved confidence levels, with all respondents reporting moderate to high confidence. The average knowledge score increased to 87%, reflecting an 8% improvement. All participants found the tool easy to use, feasible, and satisfactory. Additionally, 85% expressed intent to use the tool for future disclosures of nonrecent abuse, suggesting its potential for sustained impact on clinical practice. Conclusion: The implementation of an evidence-based reporting tool significantly enhanced clinicians' confidence and competence in addressing disclosures of non-recent child abuse. This project underscores the importance of clear protocols and targeted training in equipping clinicians to navigate complex reporting requirements effectively, ultimately contributing to improved protection for at-risk minors.