Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg Research article Child protective services utilization of child abuse pediatricians: A mixed methods study Rebecca Girardet a, ⁎ , Kelly Bolton a , Syed Hashmi a , Emily Sedlock b , Rachna Khatri b , Nina Lahoti a,1 , James Lukefahr c a Department of Pediatrics, The McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1425, Houston, TX, 77035, USA b Department of Internal Medicine, The McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 1425, Houston, TX, 77035, USA c Department of Pediatrics, School of Medicine, The University of Texas Health Science Center at San Antonio, 315 N. San Saba #201, San Antonio, TX, 78207, USA ARTICLE INFO Keywords: Utilization of child abuse pediatricians Child protection worker Mixed methods ABSTRACT Several children’s hospitals and medical schools across Texas have child abuse pediatricians (CAPs) who work closely with child protection workers to help ensure accurate assessments of the likelihood of maltreatment in cases of suspected abuse and neglect. Since the state does not mandate which cases should be referred to a CAP center, we were interested in studying factors that may influence workers’ decisions to consult a CAP. We used a mixed methods study design consisting of a focus group followed by a survey. The focus group identified multiple factors that impact workers’ decision-making, including several that involve medical providers. Responses from 436 completed surveys were compared to employees’ number of years of employment and to the state region in which they worked. Focus group findings and survey responses revealed frustration among many workers when dealing with medical providers, and moderate levels of confidence in workers’ abilities to make accurate determinations in cases involving medical in- formation. Workers were more likely to refer cases involving serious physical injury than other types of cases. Among workers who reported prior interactions with a CAP, experiences and attitudes regarding CAPs were typically positive. The survey also revealed significant variability in referral practices by state region. Our results suggest that standard guidelines regarding CAP referrals may help workers who deal with cases involving medical information. Future research and quality improvement efforts to improve transfers of information and to better understand the qualities that CPS workers appreciate in CAP teams should improve CAP-CPS coordination. 1. Introduction The Texas Department of Family and Protective Services (DFPS) handles a heavy burden of child protection cases each year, with 166,753 completed cases in FY 2016, representing 2.3% of the child population (Texas Department, 2016). The Texas legislature designated funds for a statewide network of child abuse pediatricians (CAPs) in 2006, and a separate grant program in 2010; together https://doi.org/10.1016/j.chiabu.2017.11.019 Received 13 July 2017; Received in revised form 10 November 2017; Accepted 28 November 2017 ⁎ Corresponding author at: Department of Pediatrics, The McGovern Medical School at The University of Texas Health Science Center at Houston,6410 Fannin Street, Suite 1425, Houston, Texas, 77035, USA. 1 Present address: Rice University, 440 Allen Center-MS1, Houston, Texas 77005, USA. E-mail addresses: rebecca.g.girardet@uth.tmc.edu (R. Girardet), kelly.bolton@uth.tmc.edu (K. Bolton), syed.s.hashmi.1@uth.tmc.edu (S. Hashmi), Emily.w.sedlock@uth.tmc.edu (E. Sedlock), Rachna.p.khatri@uth.tmc.edu (R. Khatri), ninalahoti@gmail.com (N. Lahoti), lukefahr@uthscsa.edu (J. Lukefahr). Child Abuse & Neglect 76 (2018) 381–387 0145-2134/ © 2017 Elsevier Ltd. All rights reserved. T