How the Ohio Attorney General’s Office Is Helping Hospitals Screen for Child Abuse

Together with the Ohio Children’s Hospital Association, the Ohio Attorney General’s Office is taking steps to reduce child abuse in infants 6 months and younger.

With support from a $1 million grant from the Ohio Attorney General’s Office, a coalition of Ohio’s six major children’s hospitals studied how to help prevent repeated child abuse in this most vulnerable population. The group of child advocates and pediatricians formed the Timely Recognition of Abusive Injuries (TRAIN) collaborative and released a set of findings and recommendations last year.

Ohio Attorney General Mike DeWine

The TRAIN Collaborative began by analyzing what medical professionals call “sentinel injuries,” or minor injuries that could be potential warning signs of abuse. Sentinel injuries can include bruises; fractures; head or abdominal injuries; burns; and oral or genital injuries.

Sentinel injuries are particularly troublesome in infants younger than 6 months of age because they lack mobility and can’t do much to injure themselves. Those facts should raise questions about whether an infant was in an accident or was being abused.

To ensure that sentinel injuries aren’t overlooked by medical providers, the TRAIN Collaborative developed a recommended physical exam for infants under 6 months of age, as well as a recommended protocol—called the “bundle of care”—to follow when a medical provider discovers a sentinel injury. The bundle of care helps identify abuse and ensures the infant receives appropriate follow-up care.

TRAIN Collaborative researchers found that one in 10 victims of child abuse in Ohio have been seen before with a sentinel injury. Fewer than one in three of those babies with sentinel injuries receive the necessary physical examination and follow-up. We’re confident that giving all medical providers the tools and information created by the TRAIN Collaborative will significantly reduce child abuse.

As a result of the work of the TRAIN Collaborative, doctors and nurses at 19 hospitals across Ohio be trained to screen for signs of child abuse in infants six months of age or younger.

Sentinel injuries in infants should trigger a physical examination that checks for current or healing bone fractures, a family assessment and a referral to the appropriate child protective services. The TRAIN Collaborative aims to make the screening process more routine and comfortable for healthcare providers whose training in child abuse may not be extensive.

Our findings align with the work and recommendations of the federal Commission to Eliminate Child Abuse and Neglect Fatalities, which released its report last March. In their report, they call for states to “improve current child protective services (CPS) practice and intersection with other systems through a two-year multidisciplinary action to protect and learn from children most at risk of maltreatment fatalities.” They identified children under the age of 3 and those with a prior CPS report as among those most vulnerable to maltreatment and fatality.

It’s our responsibility to protect children who are too young to understand their injuries or even to speak for themselves. By establishing evaluation techniques that identify early signs of child abuse, we hope to prevent more serious abuse in the future. The work we’re doing with some of Ohio’s largest children’s hospitals and other community hospitals, and the resulting changes to diagnostic practice, are part of an improved effort to care for Ohio’s next generation.

Mike DeWine is serving his second term as Ohio’s Attorney General.

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