Notes from the Association of Medical School Pediatric Department chairs, Inc

Child Abuse Pediatrics: A new pediatric subspecialty

Improved collaboration between child welfare and health care offers the possibility of improved child well-being after child welfare involvement.

To pilot a collaborative practice model between CPS caseworkers and pediatric primary care providers (PCPs).

Infants remaining at home following child welfare involvement in 2 regions of a Western state were randomly assigned to collaborative vs. standard practice between 11/2017 and 03/2019.

CPS caseworkers were trained and randomized into standard vs collaborative practice model developed to promote information sharing between caseworkers and PCPs. A mixed-methods evaluation integrated administrative and qualitative data from child welfare, caregivers, caseworkers and PCPs. Outcomes evaluated included practice implementation; caregiver, caseworker, and PCP satisfaction with collaborative practice; and preliminary descriptions of practice impact.

There were 423 eligible cases randomized to either collaborative or standard practice. Uptake of all elements of the collaborative practice by caseworkers was limited. There were no significant differences in parental satisfaction with caseworkers, parental communication with PCPs regarding social risks or CPS involvement or repeat CPS investigations within 6 months of case closure identified between practice arms. Qualitative themes regarding facilitators of and barriers to implementation were explored from both PCP and CPS caseworker perspectives.

Limited uptake challenges our ability to identify potential benefits of a collaborative practice for infant health or welfare outcomes. CPS caseworkers and pediatric PCPs report barriers to implementation as well as potential benefits for children and families with a more successful collaborative practice model.

Many children and families do not have access to specialized pediatric health care, including child abuse pediatricians. Medical evaluations in cases of suspected child maltreatment including physical abuse, sexual abuse, and neglect are a critical component of the multidisciplinary team response to these concerns. We review the role of child abuse pediatricians in cases of suspected child maltreatment. We discuss the advantages and disadvantages of current models of care including co-location of child abuse specialists within children's advocacy centers, hospital-based medical evaluation programs and community-based clinics. We review barriers to universal and equitable access to specialized care. We then highlight the significance of telemedicine as an important tool for improving access to care for children who would not otherwise have access.

CAPNET is a multicenter child abuse pediatrics research network developed to support research that will make the medical care of potentially abused children more effective, safe, and fair. CAPNET currently collects detailed clinical data from child physical abuse evaluations from 11 leading pediatric centers across the U.S. From its inception, the goal of CAPNET was to support multiple research studies addressing the care of children undergoing evaluations for physical abuse and to create a flexible data collection and quality assurance system to be a resource for the wider community of child maltreatment l researchers. Annually, CAPNET collects rich clinical data on over 4000 children evaluated due to concerns for physical abuse. CAPNET's data are well-suited to studies improving the standardization, equity, and accuracy of evaluations in the medical setting when child physical abuse is suspected. Here we describe CAPNET's development, content, lessons learned, and potential future directions of the network.

Data available on the economics of medical child protection teams stems from prior surveys delivered in 2008 and 2012.

The objective was to describe the current financing strategies of medical child maltreatment groups for benchmarking purposes. Additionally, we aimed to quantify often difficult to measure child abuse services that provide value to pediatric hospitals.

In 2017, a 115-item survey was distributed to 230 pediatric hospitals inquiring about child abuse services for the 2015 calendar year.

The financial topics including budget, revenue, reimbursement, expenses, research, education, and community partnership were analyzed using descriptive statistics. Previous data from similar surveys deployed in 2008 and 2012 were used when applicable to formulate trends.

One hundred and thirteen children's hospitals responded comprising a response rate of 49 %. One hundred and four hospitals provided child abuse services at some level. Sixty-two programs (26 %) responded to items about budget. Overall, average team operating budgets increased from $1.15 million in 2008 to $1.4 million in 2015. Few clinical services rendered received full reimbursement. Valuable non-clinical services were poorly reimbursed. An average of 5.45 funding sources were used to supplement remunerations.

Child maltreatment teams within pediatric hospitals provide services that are largely unfunded as they are not currently recognized by healthcare payment models. These specialists perform a variety of clinical and non-clinical responsibilities that are critical to the care of this population while relying on a variety of funding sources to support their efforts.