A Nurse’s Passion Inspires Innovative Child Abuse Screening Program
Sheri Carson, DNP, CPNP-PC, always had an affinity for the health sciences. After helping care for her great-grandmother and volunteering as a candy striper in high school, she fell in love with nursing and embraced a career in pediatric nursing, combining her passions for health and children.
It was Sheri’s drive to help children, combined with her awareness of the national statistics on missed child abuse cases in emergency departments, that would motivate her to create a much-needed child abuse screening program. While nurses in the U.S. are trained and mandated to report child abuse, they are not mandated to screen. Her innovative framework helps healthcare workers identify the early signs of child abuse in healthcare settings, where many cases of child physical abuse often go undetected.
Now a full-time clinical instructor in the University of Arizona (UA) College of Nursing, we spoke to Sheri about developing her screening program, and how her experience has influenced the way she mentors and educates nurse leaders of tomorrow.
After I became involved with our hospital's Child Abuse Review team in 2012, I became interested in improving child abuse screening and recognition statistics to reduce the risk of continued and escalating childhood abuse. In 2016, one of our pediatric emergency department attending physicians approached me and asked me if I would be willing to develop a screening program for the pediatric emergency department. I jumped at the chance to do so, as it was the opportunity I needed to develop something I so strongly believed in.
I was able to explore national and international research that existed for educational components, screenings, and tools, but after months of searching, I couldn’t find any comprehensive screening programs out there. We have a lot of resources for preventing abuse and that’s great —but it’s really not meeting or reducing the need for a program that identifies early cases of child physical abuse. I found that there is no program that addresses everything needed to identify child abuse cases. We have standardized protocols for evaluating and treating abuse, but no systematic protocol that gets us to that moment of identifying abuse.
In the United States, 5 children die every day from child abuse and neglect. And every year, over 6.5 million referrals are made to child protection agencies.  The U.S. has no standardized screening process to identify the early signs of child abuse in emergency departments across the country, which results in many cases of child physical abuse going unnoticed. Nurses are trained and mandated by federal law to report child abuse, but they are not mandated to screen. There are cases that we are missing because we don’t recognize the subtler signs of abuse, or abuse might not fit with the symptoms we are seeing. This is what I am working to change with my program.
 Child Abuse Statistics & Facts
The comprehensive, evidence-based screening program has three main components: a ‘validated screening tool’ to determine whether injuries are consistent with abuse, an educational component that prepares healthcare workers to screen for and recognize abuse, and a systematic screening protocol that guides nurses and other healthcare providers from the moment a child arrives in the emergency department until the result of the screening. The screening tool I used as part of my program was adapted from a validated child abuse screening tool developed in the Netherlands called the “Escape Instrument”, developed by Louwers et. al in 2012.  The title of protocol I created, which was copyrighted in 2018, is called the “Emergency Department Child Abuse Screening Protocol.”
By bringing together a previously validated screening tool with the educational session and Emergency Department Child Abuse Screening Protocol I developed, I was able to create a comprehensive child abuse screening program that helps to prepare and equip nurses and healthcare professionals with the resources they need to confidently screen for and recognize cases of child physical abuse.
 Louwers, E., Korfage, I., & Affourtit, M. (2012). Effects of Systematic Screening and Detection of Child Abuse in Emergency Departments. Pediatrics,130(3). Retrieved from https://pediatrics.aappublications.org/content/130/3/457 .
Unexpected things are going happen, and some might not be easy—staffing challenges, monetary or organizational constraints— but you have to persevere. I tell my students to take a leap of faith, hope for the best, and don’t be afraid of failure. It took months for me to finalize my screening program, and now I’m being asked to give presentations on my work both locally and at national conferences. Based on the results of my project, the overarching health system for my hospital is now in the process of developing and implementing a standardized process for all their hospitals in Arizona, not just our local medical center. I was recently told that at a Texas Governor’s Emergency and Trauma Advisory Council meeting they passed mandatory pediatric screening for abuse. I’m so proud that my work is generating awareness about the need to screen and is contributing to real solutions.
Solving today’s healthcare problems takes new perspective, and nurses are best positioned to offer this perspective. But it also takes confidence. Nurses should find the people who will support them and their ideas, because that is key to making their solutions reality.
In addition to working as a full-time clinical instructor at The University of Arizona College of Nursing, Sheri Carson is also a per diem Pediatric Nurse Practitioner, Northwest Urgent Care at Orange Grove in Tucson, Arizona and is a volunteer Pediatric Nurse Practitioner for the University of Arizona College of Medicine's Tot Shots Clinics as part of the Commitment to Underserved People [CUP] program), where they provide free sports physicals and immunizations to underserved children throughout Pima county.
Sheri Carson’s work was published in the Journal of Emergency Nursing in November 2018. You can learn more and read her published article here .