Narrowing the Digital Divide: Framework for Creating Telehealth Equity Dashboards.

Telehealth presents both the potential to improve access to care and to widen the digital divide contributing to health care disparities and obliging health care systems to standardize approaches to measure and display telehealth disparities. Based on a literature review and the operational experience of clinicians, informaticists, and researchers in the Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT)-Clinical and Translational Science Awards (CTSA) Network, we outline a strategic framework for health systems to develop and optimally use a telehealth equity dashboard through a 3-phased approach of (1) defining data sources and key equity-related metrics of interest; (2) designing a dynamic and user-friendly dashboard; and (3) deploying the dashboard to maximize engagement among clinical staff, investigators, and administrators.

Improving access to child abuse evaluations through innovation & telemedicine.

Many children and families do not have access to specialized pediatric health care, including child abuse pediatricians. Medical evaluations in cases of suspected child maltreatment including physical abuse, sexual abuse, and neglect are a critical component of the multidisciplinary team response to these concerns. We review the role of child abuse pediatricians in cases of suspected child maltreatment.

Yield of Postmortem Skeletal Surveys in Infants Presenting to Emergency Care With Sudden and Unexpected Death.

Objectives: Child abuse should be considered in cases of sudden unexpected infant death (SUID). Postmortem skeletal surveys (PM-SS) are recommended to evaluate for abusive fractures in SUID. Little is known about the yield of PM-SS among infants presenting to emergency care with SUID.

Community Resource Connection for Pediatric Caregivers With Unmet Social Needs: A Qualitative Study.

Objective: Pediatric health systems are increasingly screening caregivers for unmet social needs. However, it remains unclear how best to connect families with unmet needs to available and appropriate community resources. We aimed to explore caregivers' perceived barriers to and facilitators of community resource connection.

Using Quality Improvement and Technology to Improve Social Supports for Hospitalized Children.

Objectives: To develop and test the feasibility of a caregiver self-administered social needs screener, a Web-based searchable community resource map, and a process map for implementation of these tools as part of social needs screening and referral on a pediatric inpatient unit.

Methods: A multidisciplinary team used quality improvement methodology to develop an electronic social needs screener, resource map Web site, and electronic health record enhancements. A process map for implementation of these tools was refined through plan-do-study-act cycles before full implementation.

Nurse-Family Partnership nurses' attitudes and confidence in identifying and responding to intimate partner violence: An explanatory sequential mixed methods evaluation.

Aims: To evaluate the effect of an intimate partner violence intervention education component on nurses' attitudes in addressing intimate partner violence; complementary aims included understanding nurses' perceptions of the education and how it influenced their attitudes and confidence to address intimate partner violence in practice.

Design: An explanatory sequential mixed methods design embedded within a 15-site cluster randomized clinical trial that evaluated an intimate partner violence intervention within the Nurse-Family Partnership programme.

Methods: Data were collected between February 2011 and September 2016.

Improving Child Behaviors and Parental Stress: A Randomized Trial of Child Adult Relationship Enhancement in Primary Care.

Background: Prior single-site evaluations of Child Adult Relationship Enhancement in Primary Care (PriCARE), a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes.

Objective: To measure the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study.

Methods: Caregivers of children 2- to 6-year-old with behavior concerns recruited from 4 pediatric primary care practices were randomized 2:1 to PriCARE intervention (n = 119) or waitlist control (n = 55).

Ethical Testimony in Cases of Suspected Child Maltreatment: The Ray E. Helfer Society Guidelines.

New guidelines for ethical testimony were developed by the Ray E. Helfer Society, the largest medical professional society for physicians working in the field of child maltreatment. Building on the foundation of ethical guidelines set forth by the American Academy of Pediatrics, these new guidelines set detailed standards for testifying in cases of suspected child maltreatment and recommend that hospitals, medical practices, academic institutions, and professional societies hold their members accountable for court testimony related to child maltreatment as with other forms of medical practice and expert testimony.

Health Care Utilization for Children in Foster Care.

Objective: To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) health care utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and 3) prevalence of complex chronic conditions (CCC) and their effect on utilization.

Methods: Children ≤18 years old with a designation of FC placement and controls matched on age, race/ethnicity, gender, and zip code who had an encounter at an urban pediatric health system between 7/1/11 and 6/30/12 were identified in the EMR. Data on outpatient, ED, and inpatient encounters and charges for 7/1/12 to 6/30/13 were obtained.

Effect of Addition of an Intimate Partner Violence Intervention to a Nurse Home Visitation Program on Maternal Quality of Life: A Randomized Clinical Trial.

Importance: Intimate partner violence (IPV) is a public health problem with significant adverse consequences for women and children. Past evaluations of a nurse home visitation program for pregnant women and first-time mothers experiencing social and economic disadvantage have not consistently shown reductions in IPV.

Objective: To determine the effect on maternal quality of life of a nurse home visitation program augmented by an IPV intervention, compared with the nurse home visitation program alone.

Three-dimensional printed models of the rib cage in children with non-accidental injury as an effective visual-aid tool.

Three-dimensional (3-D) printing is gaining terrain in medical education, presurgical evaluation and recently as forensic evidence in court. Physicians, including radiologists, often provide expert testimony in court cases involving children with rib fractures and other injuries concerning for child physical abuse. Effectively communicating the complexities of fractures and other skeletal findings to nonmedical personnel using standard radiology studies can be challenging, especially during medical courtroom testimony.

Quality Improvement Initiative to Improve Abuse Screening Among Infants With Extremity Fractures.

Objectives: The aim of this study was to evaluate the effectiveness of clinical pathway implementation and quality improvement (QI) interventions to increase the percentage of infants with extremity fractures undergoing evaluation for suspected physical abuse, including skeletal survey (SS), and consultation with social work, and/or Child Protection Team.

Methods: Charts were retrospectively reviewed to establish percentage of infants less than 12 months old with extremity fractures undergoing an SS and consultation during the prepathway (January 1, 2012 to December 31, 2013) and postpathway (January 1, 2014 to June 30, 2015) periods. Using an Ishikawa framework, key process drivers were identified and additional QI interventions (clinical decision support and provider education) were developed and implemented.

Perceptions of caregivers and adolescents of the use of telemedicine for the child sexual abuse examination.

Background: Childhood sexual abuse is a common cause of morbidity and mortality. All victims should receive a timely comprehensive medical exam. Currently there is a critical shortage of child abuse pediatricians who can complete the comprehensive child sexual abuse examination.

The Impact of Child Sexual Abuse Discovery on Caregivers and Families: A Qualitative Study.

In this qualitative study with nonoffending caregivers of suspected child sexual abuse victims, we aimed to explore the perceived impact of sexual abuse discovery on caregivers and their families, and caregivers' attitudes about mental health services for themselves. We conducted semistructured, in-person interviews with 22 nonoffending caregivers of suspected sexual abuse victims <13 years old seen at a child advocacy center in Philadelphia. Interviews were audio-recorded, transcribed, coded, and analyzed using modified grounded theory.

Laboratory Screening for Children Entering Foster Care.

Objectives: To determine the prevalence of medical illness detected by laboratory screening in children entering foster care in a single, urban county.

Methods: All children entering foster care in a single county in Ohio were seen at a consultation foster care clinic and had laboratory screening, including testing for infectious diseases such as HIV, hepatitis B, hepatitis C, syphilis, and tuberculosis as well as for hemoglobin and lead levels.

Results: Over a 3-year period (2012-2015), laboratory screening was performed on 1977 subjects entering foster care in a consultative foster care clinic.

Pediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity.

Objective: The purpose of this study was to understand pediatric emergency department (ED) and primary care (PC) health care provider attitudes and beliefs regarding the intersection between childhood adversities and health care.

Methods: We conducted in-depth, semistructured interviews in 2 settings (ED and PC) within an urban health care system. Purposive sampling was used to balance the sample among 3 health care provider roles.

Improving HIV post-exposure prophylaxis rates after pediatric acute sexual assault.

The purpose of our study was to increase the rate of children with appropriate HIV-PEP regimens among those diagnosed with sexual assault in The Children's Hospital of Philadelphia Emergency Department (ED). The outcome measure was the percent of patients receiving correct HIV-PEP. We retrospectively reviewed 97 charts over 31 months to define the baseline rate of children receiving appropriate HIV-PEP regimens (pre QI-implementation period: 2/2012-8/2014).

A child abuse research network: Now what?

As foundational work in preparation for a sustainable, multi-center network devoted to child abuse medical research, we recently used a combination of survey and modified Delphi methodologies to determine research priorities for future multi-center studies. Avoiding missed diagnoses, and improving selected/indicated prevention were the topics rated most highly in terms of research priority. Several constructive commentaries in this issue identify the key challenges which must be overcome to ensure a successful network.

Research priorities for a multi-center child abuse pediatrics network - CAPNET.

Although child maltreatment medical research has benefited from several multi-center studies, the new specialty of child abuse pediatrics has not had a sustainable network capable of pursuing multiple, prospective, clinically-oriented studies. The Child Abuse Pediatrics Network (CAPNET) is a new multi-center research network dedicated to child maltreatment medical research. In order to establish a relevant, practical research agenda, we conducted a modified Delphi process to determine the topic areas with highest priority for such a network.

Prior opportunities to identify abuse in children with abusive head trauma.

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included.