Funded Projects

Montana Child Abuse Screening Tool implementation

Project Year

2025

City & State

Missoula, Montana

Program Name

CATCH Implementation

Topic

Child Abuse & Neglect

Program Description

Child abuse is unfortunately common in the US, with approximately 1 in 7 to 8 children experiencing abuse in the past year, and nearly 2,000 deaths in 2021 related to child abuse. There is significant data supporting the need to identify and evaluate for child abuse in the clinical environment to provide an opportunity to intervene before abuse escalates. As of 2022, Montana reported child victim rate of maltreatment to be 11.6 per 1,000 children (Child Maltreatment 2022, USDHHS 2024).  The electronic health record (EHR) can be used to standardize care, improve compliance with recommendations and, thereby, improve outcomes. EHR-embedded child abuse clinical decision support (CA-CDS) focuses on improving the quality of care as it relates to the multidisciplinary process of identification, evaluation, and/or reporting of suspected child abuse through use of the EHR. The mission of CA-CDS is to empower medical providers with clinical decision support for accurate and early identification, evaluation and reporting of child maltreatment, while actively addressing racial disproportionality. Child abuse clinical decision support can thus improve compliance with American Academy of Pediatrics (AAP) guidelines for evaluating suspected physical abuse.  Beyond CA-CDS within EHR for the medical community, we are hoping to expand the recognition of child abuse through education for our community partners, such as child welfare workers, law enforcement, and early childhood educators.   This project will begin by piloting CA-CDS implementation in the emergency department at one of two hospitals in Missoula, MT. This hospital serves patients from at least one tribal area. Three healthcare providers, specifically Emergency Department and Rrauma service registered nurses, at the pilot site will receive training and education on CA-CDS in order to support implementation and provide training at the pilot site and subsequently several additional sites, with the physician champion (estimated 20 hours). We will collect data and identify barriers to successful implementation at the pilot hospital by meeting bi-monthly with the healthcare pilot site team utilizing a PDSA model over the first 6 months of the grant period, including extrapolating EHR data, staff surveys and data analysis.  After implementation at the pilot site is complete, the pilot site team will recruit 3 additional hospitals (up to 5 if budget allows), including at least one critical access / rural hospital, throughout Montana who are interested in collaborating to implement CA-CDS at their site. We would then work with their medical staff (health care providers, nursing leadership, and hospital educators) and information technologists to determine feasibility and utility of implementation. Subsequently, we would provide education and infrastructure support, with the Child Abuse Clinical Decision Support Consortium (https://www.ca-cds.org/) to roll out the CA-CDS and improve collaboration with child welfare community agencies when these children who have likely sustained NAT are identified.  Support for our site partners would involve monthly or bimonthly meetings between the partner stakeholders and the pilot site team, initially in person but subsequently virtually if best.  And finally, we aim to provide additional education for our community partners to help them better identify children who have sustained child abuse, expanding on the existing knowledge about TEN-4 FACESp that has been shared in Montana this past year.

Project Goal

To empower healthcare providers with clinical decision support for accurate and early identification, evaluation, and reporting of child physical abuse.

Project Objective 1

At least 5 Montana hospitals are contacted for interest in project during the grant cycle.

Project Objective 2

At least 3 Montana hospitals will complete the education and roll out the project during the grant cycle.

Project Objective 3

At least 2 Montana hospital will still be implementing the screening on a majority of eligible patients at the end of the grant cycle.

AAP District

District VIII

Institutional Name

Providence St Patrick Hospital

Contact 1

Laurie Carter, MD