Implementation of a Toolkit for Families After Pediatric Sexual Assault: A Quality Improvement Project

Background: An estimated one in four to eight girls and one in ten to twelve boys are the victims of sexual assault or abuse before reaching adulthood. During an encounter for pediatric sexual assault, patients and caregivers are given extensive information about recovery, coping, and follow up care. Most of this information is given verbally, even though this has been shown to be less effective than written information. Even under ideal circumstances, studies suggest that patients will immediately forget 40-80% of the medical information they receive verbally. Recent trauma further impairs the ability to process, learn, and remember new information. Methods: Clinic staff and patient family members were given a pre-survey to determine the usefulness of current discharge education and how it could be improved. Based on pre-survey results and staff input, an evidence-based toolkit was developed for families whose children have experienced sexual assault and implemented in the emergency department at Primary Children's Hospital. The toolkit included education about follow-up care, sexually transmitted infection testing and treatment, mental health resources, and information about the involvement of other agencies such as the Department of Child and Family Services and law enforcement. Clinic staff and patient family members who received the new discharge toolkit were given a post-survey to assess knowledge, satisfaction, usability, and feasibility. Results: Eleven staff members and 18 patient family members participated in the pre-survey, and ten staff members and ten patient family members participated in the post-survey. Mann- Whitney U testing indicated a statistically significant increase in parental understanding, satisfaction, and empowerment, as well as staff satisfaction and belief that the toolkit was helpful for parents. Usability and feasibility remained the same pre and post-intervention with no significant difference. Conclusions: This project provides improved education and access to resources for families of children who experience sexual assault or abuse and encourages better follow-up care. Providing comprehensive written discharge education has the potential to demonstrate long-term implications such as lower rates of Human Papilloma Virus and decreased health impacts of Adverse Childhood Experiences.