{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T14:58:39Z","timestamp":1790521119553,"version":"4.1.0"},"reference-count":57,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,10,9]],"date-time":"2020-10-09T00:00:00Z","timestamp":1602201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR001863"],"award-info":[{"award-number":["UL1TR001863"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["kl2TR001862"],"award-info":[{"award-number":["kl2TR001862"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In three CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children\u00a0&lt;\u00a012 months old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We interviewed CED providers to identify barriers and facilitators to recognizing and reporting abuse. Providers described difficulties differentiating abusive from nonabusive injuries and felt that a second opinion would help. Using a plan\u2010do\u2010study\u2010act approach, beginning in April 2018, we tested, refined, and implemented interventions to increase the frequency of CPT consultation, including leadership and champion engagement, provider training, clinical pathway implementation, and an audit and feedback process. Data were collected for 15 months before and 17 months after initiation of interventions. We used a statistical process control chart to track CPT consultations about children\u00a0&lt;\u00a01 year old with high\u2010risk injuries, use of skeletal surveys (SSs), and reports to child protective services (CPS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Evidence of special cause was identified beginning\u00a0in June 2018, with a shift of 8 points to one side of the center line. For the subsequent 8\u2010month period, the CPT was consulted for a mean of 47.5% of children with high\u2010risk injuries; this was sustained for an additional 7\u00a0months. The average percentage of infants with high\u2010risk injuries who received a SS increased from 6.7% to 18.9% and who were reported to CPS increased from 10.7% to 32.6%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Targeted interventions in CEDs increased the frequency of CPT consultation, SS use, and reports to CPS for infants with high\u2010risk injuries. Such interventions may improve recognition of physical abuse.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14132","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T12:02:01Z","timestamp":1600948921000},"page":"70-81","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Child Protection Team Consultation for Injuries Potentially Due to Child Abuse in Community Emergency Departments"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0342-0919","authenticated-orcid":false,"given":"Gunjan","family":"Tiyyagura","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Emerson","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie R.","family":"Gaither","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Bechtel","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Leventhal","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Becker","sequence":"additional","affiliation":[{"name":"the Department of Emergency Medicine Bridgeport Hospital Bridgeport CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Della Guistina","sequence":"additional","affiliation":[{"name":"the Department of Emergency Medicine Bridgeport Hospital Bridgeport CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Balga","sequence":"additional","affiliation":[{"name":"and the Department of Emergency Medicine Yale New Haven Hospital New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Mackenzie","sequence":"additional","affiliation":[{"name":"and the Department of Emergency Medicine Lawrence and Memorial Hospital Norwich CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May","family":"Shum","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene D.","family":"Shapiro","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3796-4300","authenticated-orcid":false,"given":"Marc A.","family":"Auerbach","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"McVaney","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Morrell","sequence":"additional","affiliation":[{"name":"and the Department of Surgery Yale New Haven Hospital New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea G.","family":"Asnes","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,9]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Child Maltreatment2017.US Department of Health and Human Services Administration for Children and Families. 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