Examining the power of Child-At-Risk electronic medical record (eMR) alerts to share interpersonal violence, abuse and neglect concerns: Do child protection alerts help?

Family violence Victims of family violence Child abuse Child sexual abuse Health practitioners Risk assessment Electronic health records New South Wales

This project sought to understand the impact of a Child-At-Risk electronic medical record (eMR) alert information sharing system on the practice of staff within the Northern New South Wales Local Health District (NNSW LHD) and the perceived outcomes for women and children experiencing interpersonal violence, abuse or neglect. Additionally, information was sought to determine whether other Australian jurisdictions had similar systems in place. The first known study of its kind to date, this project helped to identify effective interventions to support children and pregnant women experiencing violence, abuse and neglect through non-violence specific service delivery within regional, rural and remote areas.

Designed to identify at-risk children and pregnant women, together with their families, the Child-At-Risk eMR alert was introduced by NNSW LHD to indicate wellbeing concerns (e.g. exposure to domestic and family violence, substance abuse, unmanaged mental illness or neglect) to health clinicians. By being alerted to this information, it is expected that clinicians can then provide an enhanced level of care to the child/woman, including early intervention to prevent further harm. The Child-At-Risk eMR alert system requires that staff who report a wellbeing concern to the New South Wales (NSW) Health Child Wellbeing Unit or the NSW Child Protection Helpline also apply a Child-AtRisk alert to the eMR of the reported child/pregnant woman. Other clinicians accessing the client/patient’s eMR would then see the Child-At-Risk alert and be encouraged to take appropriate action.

Although the health impacts of violence on women in Australia are known (Webster, 2016), research has established that some women and children living in violent situations are invisible, isolated, hidden from services and face barriers preventing their access to healthcare (Wendt, Chung, Elder & Bryant, 2015). Health services, therefore, need to be able to identify victims of interpersonal violence, abuse and neglect in order to protect the human right of victims to live free from abuse; to prevent further harm; and to provide the opportunity for victims to receive treatment, heal and, in turn, maximise their quality of life. This is not always the case, as highlighted by the literature that continues to identify barriers to professionals reporting abuse and neglect (McTavish et al., 2017; Tonmyr, Li, Williams, Scott, & Jack, 2010), despite existing guidelines and legislation designed to assist paid workers, volunteers and community members to identify and report abuse (Mathews & Bross, 2014). These barriers to reporting also mean that the sector cannot test what health practitioners are doing to support at-risk patients in lieu of, or in addition to, reporting the abuse. There is very little literature available on the effectiveness of alerts in health systems for groups at risk of interpersonal violence, abuse and neglect; hence this study is the first of its kind.

The project confirmed that many staff within the NNSW LHD are identifying and responding to victims of interpersonal violence, abuse and neglect in their day-to-day work and that the Child-At-Risk alert supplements, rather than replaces, usual care approaches. An important finding of this study was that approximately one-third of the participants reported that the presence of the alert resulted in the adaptation of their practice. In addition, these adaptations to practice were made despite constraints on time and resources.

These findings show the potential of a practice change to improve responses to victims of interpersonal violence, abuse and neglect within large organisations employing thousands of staff.

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Research report, Issue 02/2018