Child Abuse Medical Evaluations in Texas: Current Practices & Challenges.

When an allegation of child abuse is reported, it is important that children receive child abuse medical evaluations for both medical and forensic purposes.

A 2011 report by the Midwest Regional Children’s Advocacy Center stated that nationally, 34% of children referred to a non-profit Children’s Advocacy CenterTM (CAC) receive a medical evaluation. However, the Children’s Advocacy Centers TM of Texas (CACTX) has found that, in Texas, only 21% of children with alleged abuse receive medical evaluations, with even lower rates in smaller communities and rural areas. As a result, CACTX identified a need to research existing policies about and barriers to children receiving medical evaluations so that recommendations and strategies can be developed to increase the rates of evaluations in Texas.

CACTX contracted with the Child and Family Research Institute (CFRI) at The University of Texas at Austin School of Social Work to conduct this research. CFRI researchers conducted a mixed methods study in two parts. The first part of the study consisted of 60 focus group interviews of multidisciplinary team (MDT) members in twelve localities. The localities were chosen using two criteria: (1) community size (e.g. small/rural, mid-sized, and large/urban centers); and (2) rates of medical evaluations in the locality (either higher or lower than localities of similar sizes). Researchers used the focus group interviews to explore existing practices for medical evaluations in alleged child abuse cases, barriers to evaluations, and possible strategies to increase evaluation rates. The second part of this study used the initial focus group findings to develop and distribute an online survey statewide to all MDT members. Over 300 MDT members completed the survey. The research was conducted between October 2012 and June 2013.

Results suggest multiple barriers to child abuse victims receiving proper medical evaluations. Findings document the processes of obtaining medical evaluations for children, factors that impact whether a medical evaluation is completed and the functioning of MDTS. Complex issues related to children obtaining evaluations include lack of medical professionals with child maltreatment specializations; complicated reimbursement structures; factors related to a child’s outcry, the child and the child’s family; and community factors such as the proximity to specialized services. Finally, MDT functioning, collaboration and understanding between team members impacts the processes of referrals for medical evaluations.

Faulkner, M., Rivaux, S. L. & Marra, L. (2013). Child Abuse Medical Evaluations in Texas: Current Practices & Challenges. Austin, TX: Children’s Advocacy Centers of Texas.