Protecting our Most Vulnerable Children from Maltreatment

More children in the US die every year from child maltreatment than die from COVID, RSV and influenza combined. Many of the children who die or nearly die from abuse had been previously evaluated by physician(s) who did not recognize and/or properly evaluate the abuse.

Identifying abuse in its milder forms (e.g., abusive bruising or an abusive fracture) and intervening at that time can reduce the likelihood of more severe forms of abuse such as abusive head trauma (e.g., shaken baby syndrome) which are far more devastating and expensive. Most children with injuries which are suspicious for abuse are evaluated by adult-trained providers, most of whom have little, if any, specific training in child abuse. More than 1/3 of children ultimately diagnosed with abusive head trauma – the most devasting form of abuse – have previously been evaluated for more minor injuries which, in hindsight, were the result of abuse but were not recognized as such.

In January 2018, we started the PA Child Abuse Initiative to assist in the identification, evaluation and reporting of abuse. Funded from the PA Medicaid Managed Care Organizations (PAMCO), this program has continued to grow. As part of the initiative, a team of child abuse experts reviews the medical record of every child who triggers a child abuse clinical decision support system which is embedded in the electronic health record in 19 community UPMC emergency departments which are located as far east as Clinton and Lycoming Counties, as far west as Allegheny County and as far north as Erie County. 

When there are deficiencies in evaluation or assessments, our team works with primary care physicians and emergency departments to obtain additional necessary testing, and/or provide expertise for Child Protective Services Approximately 600 children annually trigger the child abuse alert system; more than 3000 visits have been reviewed. The Child Abuse Initiative has directly intervened in ~300 cases since 2018; the outcomes in these children were directly impacted by our ability to provide child abuse-related expertise including recommendations for additional medical testing, evaluation by a child abuse pediatrician, completion of a chart review to assist child protective services in protecting the child identified by the Initiative and their siblings, and/or court testimony. We have unequivocally saved the lives of children as part of this program and have been able to protect children from unnecessary removal from their caretakers. In some cases, the treating physician did not recognize that injuries were the result of abuse, but in an almost equal number, physician believed that injuries were abusive, when they were accidental or related to an underlying medical condition.

 Sustainability and expansion of this program throughout PA is essential to protect our most vulnerable children.