The Art and Science of the Psychosocial Assessment: Impact on Physical Abuse Evaluations in the Emergency Department Setting

When a child presents to the emergency department with injuries concerning for abuse, a complete evaluation must look beyond the patient's physical exam to identify potential sources of harm as well as protective factors in the family's psychosocial environment. Here we discuss a structured, evidence-based assessment tool designed by our research team for use in its complete form by social workers (when available), or in its abbreviated form by licensed independent practitioners. Even amidst the controlled chaos of the acute care setting, providers can utilize trauma-informed communication strategies to effectively and efficiently elicit an unbiased narrative of relevant historical information and key psychosocial risk factors in the patient's home environment. Without understanding the contributory role of each component to the child's overall risk of abusive injury, it remains difficult to address the root cause of the problem, and the door is thus left open for ongoing harm.