Nurse practitioner recognized for work creating better child-abuse screening program

Sheri Carson “walks the talk” when it comes to children’s health advocacy.

Carson, a University of Arizona College of Nursing clinical instructor, was named Arizona Pediatric Nurse Practitioner of the Year last month by the Arizona chapter of the National Association of Nurse Practitioners.

Carson’s research to more accurately identify early signs of child abuse by improving the screening process in hospital emergency departments was one of the reasons Mary O’Connell, senior lecturer in the College of Nursing, says she nominated Carson for the award.

All health-care workers, teachers, social workers and law enforcement are mandated to report suspected child abuse. But suspicion and screening are not the same thing, Carson says.

Prevention methods aren’t working to stop child abuse either, she said.

“Until we can prevent it, we need to be screening and catching it early.”

Studies show that U.S. health-care providers miss 11 percent to 64 percent of cases in emergency departments. If the abuse isn’t caught early, 30 to 50 percent of those children are at risk for subsequent abuse and up to 30 percent of those children will die from abuse-related injuries.

Carson noted that the numbers are likely underestimated because not all cases are reported.

“Those statistics were the push I needed to get more involved,” she said.

To improve those statistics, Carson developed an evidence-based screening program and tested it at a local hospital.

Carson says she learned that there are three crucial ingredients to a successful screening program.

One includes the use of a “validated screening tool.” The evaluation tool she chose has proven to be 99.2 percent accurate in identifying children at high risk for abuse.

Then, health-care providers are aided by a standardized screening protocol.

“I developed it to take health-care providers from the point when the child arrives in the emergency department” and walk them through what to do at each step depending on the outcome of the screening results.

But before either of these are implemented, health-care providers must be given educational training on signs and symptoms of abuse and how to implement the screening tool and protocol she developed.

She found that her methods produced an improvement in knowledge and awareness in recognizing signs, symptoms and risk factors of abuse.

If screening results are positive, health-care providers then perform a medical examination before officially determining if the child’s injuries are abuse-related.

Carson said her program has gotten pushback at times.

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“A lot of times, the concern is by that by screening, we’ll inundate an already overwhelmed system (of child protection), but truly, I hope that people find that if you start to screen you might see an influx of reports because we’re catching the cases we would have otherwise missed.”

She said that some of the hardest abuse to identify is inflicted by someone other than a parent, so even the parents are unaware of the harm.

Moreover, she said, screening also helps the health-care system more accurately screen out the children who are not at risk.

Making change

Carson hopes that the award will bring attention to her program so it can be rolled out statewide, especially in hospitals that don’t specialize in child care.

But ultimately, she wants nationwide improvement in screening, she said.

O’Connell said that another reason she nominated Carson was because she is politically active.

Carson worked to make state politicians aware of the statistics and hopes they will push policy through to mandate screening.

She also participates in the Child Abuse Review Education Committee and contributes evidence-based advice articles to educate parents on a variety of health issues.

Carson says she has always enjoyed caring for others. As a girl she observed the care given to her grandmother, who was in a nursing home, and her grandfather, who had a prosthetic leg. She decided that was the work she would do.

In nursing school, Carson became passionate about pediatrics when she was tasked with caring for a little girl who spoke Spanish.

They taught each other a word in their native languages every day.

Despite the language barrier, “I felt like I was making such a difference in their lives,” Carson said.

“I thought I’d go into cardiology or the intensive-care unit, but ended up falling in love with the whole care of the family, not just the child.”

O’Connell said that besides Carson’s patients, her students described her as “patient, kind and encouraging.”

Carson volunteers to supervise medical students in the Tot Shots vaccination and sports physical clinic and also mentors local and rural high school students who are interested in pursuing medical careers.

“She goes so far above and beyond,” O’Connell said.