Developing the Universal Child Abuse Screening Tool (U-CAST) for Epic: A Qualitative Analysis of Expert Working Groups

Child abuse and maltreatment remain major public health concerns in the United States. Early identification is challenging, particularly for clinicians without specialized pediatric training, and disparities in detection raise concerns about bias. Universal screening integrated into electronic health records (EHRs) may improve detection and equity. To develop an evidence-based, user-friendly, and broadly applicable universal child abuse screening tool (U-CAST) for integration into the EPIC Foundation System. A qualitative study engaged nine expert working groups comprising 17 specialists in child abuse pediatrics, pediatric trauma surgery, general pediatrics, and pediatric emergency medicine. Between February and April 2022, groups met virtually to discuss screening content, clinical decision support, workflow integration, and implementation considerations. Meeting transcripts were analyzed using inductive coding and thematic analysis. Five themes emerged: (1) the importance of universal screening; (2) essential tool components; (3) appropriate clinical settings; (4) actionable follow-up protocols for positive screens; and (5) local program evaluation. Preliminary implementation data demonstrated successful integration, high screening completion rates, and encouraging performance in identifying children with suspected physical abuse. U-CAST was developed through a multi-disciplinary expert process and designed for integration into Epic workflows. Preliminary findings support its feasibility and clinical utility.