Improving the recognition of child maltreatment in emergency departments in Europe: healthcare professionals' perceived barriers and facilitators for implementation of a comprehensive toolkit design.

Strategies to improve child maltreatment recognition in emergency departments (EDs) have been associated with increased detection. However, implementing new protocols in high-pressure environments is challenging, necessitating an understanding of healthcare professionals' perceptions. This study explored perceived barriers and facilitators for implementing a child maltreatment toolkit design in European EDs. The presented toolkit design included the Screening instrument for Child Abuse & Neglect (SCAN), training, and hospital policy. To assess barriers and facilitators for its implementation, a survey was developed using the 'Barriers and Facilitators Assessment Instrument' featuring statements on a 5-point Likert scale with additional open-ended questions. This pre-implementation survey was distributed to ED professionals through European emergency medicine societies and research networks (EUSEM, REPEM, and EuSEN) and additional contacts via snowball sampling. Descriptive statistics and thematic analyses of open-ended responses were conducted. A total of 204 respondents participated, representing 121 hospitals from 28 European countries (estimated response 36%-46%). Facilitators for implementation included the toolkit's alignment with the ED environment, covering time, financial and staff resources, ED staff motivation and the hospital policy's standardized hospital-wide implementation. Thematic analyses revealed comparable benefits, but additional disadvantages including cultural differences, risk of false positives, electronic health record (EHR) compatibility and ensuring practical over theoretical learning.

conclusionThis pre-implementation study highlights generally positive perceptions among European ED professionals regarding a structured child maltreatment toolkit design. Concurrently, important contextual and ethical considerations, including screening performance, legal frameworks, system capacity and potential unintended consequences, were identified. This underscores the need for careful contextual adaptation and prospective effectiveness-implementation evaluation before broader adoption. WHAT IS KNOWN: • European EDs generally lack strategies to improve the recognition of child maltreatment. • Successful implementation of such strategies in EDs requires an understanding of healthcare professionals' perceived barriers and facilitators. WHAT IS NEW: • This study explores perceptions of European ED professionals regarding a child maltreatment toolkit design comprising the Screening instrument for Child Abuse and Neglect (SCAN), targeted training, and hospital policy guidance. • Addressing training costs, cultural variability, and concerns about false positives is essential to support implementation and to enable wider adoption, enhancing pediatric readiness for child protection across Europe.