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5/21/18news article

Call for local pediatricians to join collaborative to stop abuse

training to begin in June to recognize first, early signs of abuse

A statewide quality improvement collaborative called TRAIN (Timely Recognition of Abuse Injuries Network) is now recruiting primary care physicians in Ohio for the third phase of the project.  The goal is to recognize earlier the minor injuries that should raise suspicion for abuse, often called ‘sentinel injuries,’ and intervene to prevent more serious injuries from abuse later. 

Jonathan Thackeray, MD, medical director of Dayton Children’s Center for Community Health and Advocacy, is also director of TRAIN.  “These injuries are normally minor – an isolated bruise or a small lesion – so they may not be recognized as abuse.  Since the launch of the TRAIN collaborative, the frequency with which children are identified as having a sentinel injuries has quadrupled.  By training our pediatric practices in what we have learned in this collaborative, we are hopeful that we can get families help much earlier and stop the alarming growth of abuse we are seeing.”

Participating providers will receive: 

  • Education on identification and importance of sentinel injuries 
  • Training and support in implementing evidence-based recommendations for evaluation of infants with injury 
  • Strategies to work collaboratively with caregivers whose children have injury 
  • 25 Points of ABP MOC Part IV credit and opportunities to earn ABP Part II MOC credit for qualifying physicians
  • Guidance and quality improvement coaching from the Ohio AAP
  • Opportunities for networking and presentation with other physicians

The informational flyer is available for download here.

TRAIN began in spring 2015 with Dayton Children’s and five other Ohio pediatric hospitals. Funded by Ohio Attorney General Mike DeWine and supported by the Ohio Children’s Hospital Association (OCHA), the goal is to prevent repeat child abuse in the most vulnerable population, infants 6 months and younger. 

TRAIN researchers started a baseline collection of data regarding injuries seen across the six Ohio pediatric hospitals. These findings backed up previous research that children 6 months and younger are often seen for minor injuries that should prompt concern for abuse, before a later incident of significant or even fatal abuse might occur. If those injuries, also called “sentinel injuries,” are addressed, future and escalating incidents of abuse may be prevented. 

“As a group of child abuse physicians, we were all concerned about the number of missed opportunities to intervene,” says Lori Vavul-Roediger, MD, who was the principal investigator for the TRAIN Collaborative at Dayton Children’s from 2015 to 2017.  “These are key moments to ensure children are safe and their families have the social supports needed to be healthy. We hope to make lasting, positive differences for the children of our state by improving identification and practice parameters.”

TRAIN created several tools to facilitate this process. The group developed a comprehensive list of more than 50 different sentinel injuries, including bruising, fractures, head injuries, abdominal injuries, burns, genital injuries and oral injuries. They also implemented a protocol, or bundle of care, that includes three key care elements for medical providers to use when confronted with a possible sentinel injury. The first is physical exam standards to help medical providers detect sentinel injuries, including detailed examination of the face, mouth, ears, neck, torso, genitals and buttocks. Then the provider would consider additional testing and psychosocial assessment with a social work consultation.

Phase two began in 2016 with the addition of 18 hospitals to the collaborative; locally that included Atrium Medical Center, Springfield Regional and Upper Valley Medical Center. Dayton Children’s works closely with these facilities on pediatric-specific care, with liaisons and outreach currently in place. By joining the TRAIN Collaborative, these three hospitals added their emergency room data to the pool and implemented the bundle of care elements to ensure the highest level of care for infants with injuries.

Phase three of the four-year plan beings this June with the addition of community physicians and general practice pediatricians to the TRAIN Collaborative. With education, outreach and the necessary tools, the medical community will be better prepared to identify child abuse earlier and provide resources to help families grow stronger and healthier.

“We are grateful to Attorney General DeWine for making this program possible,” says Dr. Thackeray. “We believe we are not only going to prevent further injuries to infants across the state, but also save lives here in Ohio, and eventually, across the country.”

To learn more or register for the TRAIN Collaborative, visit

Jonathan Thackeray, MD, FAAP

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