UM-Providence Partnership Targets Improving Healthcare for Rural Kids

By Naomi DeMarinis, UM News Service

MISSOULA – Missoula pediatrician Laurie Carter is piloting a program with University of Montana researchers as part of RESOLVE, a new strategic healthcare partnership between UM and Providence Health.

The new program, the Montana Child Abuse Network (MT CAN), uses a telehealth model to help rural health providers and child welfare professionals care for children who may have experienced abuse and neglect, said Dr. Carter, who is a pediatric hospitalist.

“Montana is one of four states in the U.S. that doesn’t have a child abuse pediatrician,” she said, “and rural communities are especially under-resourced.”

Rural providers are often isolated from large medical centers and community services. The program provides training, resources and connections to state-based medical providers with additional training in child abuse care. MT CAN is RESOLVE’s first funded project.

Eighteen years ago, Carter was about to go on maternity leave when an infant arrived by helicopter in respiratory failure, intubated and with no visible signs of injury. Before moving him to the pediatric intensive care unit, she walked him to the emergency department for a CT scan and saw multiple subdural hematomas --  a signature of traumatic head injury from abuse. The baby was transferred to another hospital and later died.

“If you've seen one child who sustained significant abuse,” Carter said, “it’s going to stick in your mind forever.”

Caring for her own newborn, Carter couldn’t stop thinking about that boy, and over the years that followed, she continued seeing cases where earlier intervention might have changed the outcome.

“Approximately one-third of children who present with a significant injury have a history of a prior sentinel injury,” Carter said.

Sentinel injuries are seemingly minor and include bruises or subtle fractures in non-mobile infants. Early recognition is crucial to prevention. Busy physicians in small clinics often have few referral resources and fewer diagnostic tools, so a bruise on an infant’s cheek may not raise a red flag. She hopes MT CAN and the resources it provides will help physicians recognize sentinel injuries when they occur and prevent tragedies like the ones she saw.

There are an estimated 2,500 to 2,700 victims of child abuse and neglect in Montana each year, according to a 2022 Child Welfare League of America analysis of state-level data. But with no specialists in pediatric child abuse, many of these cases are missed early on, leaving some children in dangerous circumstances.

Carter said child abuse and neglect follow a person across their lifespan, potentially contributing to poor health and economic outcomes throughout adulthood.

Sara Cox, a former pediatric nurse and the clinical research coordinator for RESOLVE, worked with Carter at Community Medical Center in Missoula, and Cox has seen some of the same type of cases that inspired the project.

“When Laurie came forward with this idea, I was very excited,” Cox said. “RESOLVE is the conduit between the University of Montana and Providence Health and all the incredible academic researchers and centers that we have on campus.”

She helped connect Carter with DART, the Developmental Adversity, Resilience and Transformation Lab at the University.

DART is the result of years of research on adverse childhood experiences, or ACEs. Dr. Jim Caringi, a former social worker and now a professor in UM’s School of Public and Community Health, leads the lab. He imagines a world where future generations experience less developmental adversity – such as physical abuse and neglect – and enjoy better, healthier lives.

“If an individual has just one ACE, they’re more likely to have almost every other health problem you could ever think of,” Caringi said. “This project gives us the opportunity to stop the abuse as it’s happening.”

Working together, Carter and Caringi are implementing and evaluating the RESOLVE program to determine if it’s feasible and adoptable by other providers, with hopes it will lay the foundation for future funding and serve as a model for other states. The pilot phase is underway in western Montana, with plans to expand it into a statewide project.

“If we can recognize those sentinel injuries early,” Carter said, “and get children and their families the resources they need, we can prevent the worst outcomes.”

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Contact: Dr. Laurie Carter, pediatric hospitalist, Providence St. Patrick’s Hospital, 406-327-4237, laurie.carter@yahoo.com; Dr. Jim Caringi, UM Professor of Public and Community Health, 406-243-5548, james.caringi@umontana.edu.