To increase the accuracy of doctors’ decisions to launch or forgo child abuse evaluations in their young, acutely head-injured patients, Pediatric Brain Injury Research Network (PediBIRN) investigators derived and validated a 4-variable clinical decision rule (CDR) that detects abusive head trauma (AHT) with 96% sensitivity in pediatric intensive care unit (PICU) settings. Applied at PICU admission as an AHT screening tool, the CDR categorizes young, acutely head-injured patients as high risk vs. low risk, and recommends thorough abuse evaluations for all high risk patients.
Our ‘CDR Implementation Trial’ across eight PICUs will assess the CDR’s actual impact on AHT screening accuracy. Our ‘stratified cluster randomized trial’ design will facilitate direct comparison of child abuse evaluations at four, randomly selected, control sites to four matched intervention sites, where we will deploy active, multifaceted, implementation strategies designed to promote CDR acceptability and application. Based on our strong Preliminary Studies, we predict that CDR adoption as an AHT screening tool will increase AHT detection; reduce overall abuse evaluations and their associated risks; reduce unwarranted variation in current AHT screening practices; minimize the adverse impacts of doctors’ inherent biases, uncertainty, and practice disparities; reduce AHT-associated acute health care costs in PICU settings; and save the lives of children who will be reinjured and killed if their AHT is missed or unrecognized.
The Emerging Adulthood for Maltreated and Foster Youth project (1 R21 HD091459-01) uses a statewide, longitudinal, administrative dataset that includes the entire population of CPS-involved youth and youth whose families participated in social welfare benefit programs in Wisconsin to examine how a range of maltreatment and OHC experiences are associated with social, educational, and economic outcomes in emerging adulthood, including employment and earnings, benefit receipt, educational attainment, fertility timing, incarceration, paying close attention to the type(s) of maltreatment experienced as well as OHC placement characteristics (type, length, number of placements) and type of exit from OHC (aging out, reunification or adoption). This research extends prior work in this area by using multiple identification strategies and comparison (counterfactual) groups to reduce bias in estimated associations of both maltreatment and OHC with subsequent outcomes. It has implications for informing policy and practice to better prepare CPS-involved youth to successfully transition to adulthood and, thereby, for reducing subsequent public expenditures on this population. Dr. Font is a co-investigator on this project, which is led by Dr. Lawrence Berger at the University of Wisconsin-Madison.
The System and Social Determinants of the Health of Foster Children project (1 R01 HD095946-01) will investigate the impact of specific foster care experiences on a range of health outcomes over time. In doing so, this proposal will inform efforts to improve longstanding problems of poor health among of one of the country’s most vulnerable populations. We will provide sound empirical evidence on the importance of current state and federal foster care priorities for foster children’s health. The investigative team for this project is Drs. Font (primary investigator), Noll, and Crowley (co-investigators).
This study will examine the link between prescription opioid misuse on risks of maltreatment and foster placement through creation of a statewide birth cohort of mothers enrolled in Medicaid at the time of delivery. Study aims include creating a statewide birth cohort of mother-child pairs enrolled in Medicaid at the time of delivery, and integrating the cohort with child maltreatment and foster care record systems (PA Medicaid Birth Cohort, PMBC). This cohort will be used to document maternal prenatal and postnatal prescription opioid use and misuse rates, and examine the relation to a range of maternal and child risk characteristics to misuse, as well as the effect of prescription opioid and other substance misuse on risks of child maltreatment and foster care placement.
The Ken Young Family Professor for Healthy Children, College of Health and Human Development
Director Child Maltreatment Solutions Network
