Ohio Attorney General Mike DeWine funded the Timely Recognition of Abusive Injuries (TRAIN) Collaborative with a $1 million grant from settlement funds to OCHA in 2015. The purpose of TRAIN is to prevent repeat child abuse in the most vulnerable population, infants six months and younger.
The TRAIN Collaborative analyzed what the medical community refers to as “sentinel injuries.” Sentinel injuries are minor injuries known to the medical provider that should prompt concern that the child is being abused. Unfortunately, sentinel injuries are often missed by medical providers placing the infant at risk for further abuse. The TRAIN Collaborative identified the specific injuries that should be suspect and developed a specific process – or “bundle of care” that reduces repeat instances of child abuse. If a medical provider discovers a sentinel injury, they use the prescribed “bundle,” to assist in the identification of abuse and to ensure the infant receives appropriate follow-up care. The “bundle” includes a skeletal survey of the infant, psychosocial assessment of the caregivers and pediatric consultation.
In 2016, children’s hospitals in Ohio determined that one in 10 Ohio children seen for child abuse has been seen previously with a sentinel injury and less than one in three receives the necessary physical examination and follow-up. They worked together to create and test the “bundle” within their own hospitals, and then spread the process to 19 community hospitals across the state. More information is available in the 2016 TRAIN Fact Sheet.
In June 2018, Ohio Attorney General Mike DeWine and the Ohio Children’s Hospital Association (OCHA) announced a new collaboration to further spread interventions and findings to reduce the occurrence of child abuse in infants six months and younger by enlisting pediatric practices. Eight large pediatric practices across Ohio, representing more than 30,000 patients and families and recruited through a partnership with the Ohio Chapter of the American Academy of Pediatrics, are joining children’s and community hospitals in implementing proven interventions to identify potential signs of abuse and prevent further abuse in Ohio’s youngest and most vulnerable children.