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10/28/16news article

Dayton Children’s Hospital adds local partners to statewide collaborative to prevent repeat child abuse

The fight to control a disturbing trend of increasing deadly child abuse takes the next step this month, by adding new partners to a statewide initiative. With expanded outreach, education and support, Ohio children’s hospitals and the Ohio Attorney General hope to keep children safer and families healthier.

Since the spring of 2015, Dayton Children’s and five other Ohio pediatric hospitals teamed up in the TRAIN (Timely Recognition of Abusive Injuries) Collaborative. Funded by Ohio Attorney General Mike DeWine and supported by the Ohio Children’s Hospital Association (OCHA), the goal of the TRAIN Collaborative 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, medical director of the department of child advocacy and principal investigator for the TRAIN Collaborative at Dayton Children’s. “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.”

The TRAIN Collaborative 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 plan to implement 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 begins this month with the addition of 18 hospitals to the collaborative; locally that includes 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 now, these three hospitals will add their emergency room data to the pool and implement the bundle of care elements to ensure highest level of care for infants with injuries.

The four-year plan also includes a phase three that will involve community physicians and general practice pediatricians in the TRAIN Collaborative in the future. With education, outreach and providing 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,” said Jonathan Thackeray, M.D., director of the TRAIN Collaborative. “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.”

More information about TRAIN is available at