Child abuse a serious problem especially in rural areas can lead to devastating consequences. Rural facilities often lack the resources and generally and have less experienced examiners to properly identify cases and treat victims of child abuse. In California alone, 13 rural California counties have the state’s highest rates of referrals for child abuse and neglect.
While telemedicine is experiencing growing acceptance, its effectiveness for providers in underserved rural emergency departments treating child abuse cases has not always be recognized. As a result, the UC Davis Center for Health and Technology and the Child and Adolescent Abuse Resource and Evaluation (CAARE) Center at the University of California Davis Children’s Hospital, have combined their expertise to evaluate the situation as it relates to child abuse cases.
Telemedicine can prove to be very useful to help healthcare providers from rural underserved emergency departments interact with child abuse experts at the CAARE Center to obtain assistance with taking histories, performing examinations, and interpreting complex findings in child abuse cases.
The initial telemedicine consultation involves two health care providers at the remote site consulting via video conferencing with experts in the field at the UC Davis Medical Center. Once the connection is established, the CAARE experts remotely obtain history from the patient, parent, or guardian, and/or law enforcement. Following the history, tests are done, evidence is collected, and forms are completed by CAARE experts and by the remote providers.
To begin to understand how telemedicine can be beneficial in child abuse cases, a pilot study was undertaken. Positive findings from this pilot project led to expanding the pilots to five additional intervention sites along with five comparison sites. All of the emergency department sites were located in rural underserved areas. This service is now conducted with patients, physicians, and child abuse specialists in six rural hospital emergency departments in underserved regions of northern California.
Three full time physicians and two full time nurse practitioners all experts on sexual abuse participated in the pilots and provided consultations around the clock at the CAARE Center. Equipment in use at each site includes pagers to contact experts at UC Davis 24 hours a day. In addition, videoconferencing units, digital video cameras, and DVD recorders are available. The cost of equipment located at the remote sites range from $15,000 to $25,000 depending on capital needs. Telecommunication costs range from $50 to $200 per month depending on the type of telecommunications used.
The personnel at all of the intervention sites received an overview on how telemedicine consultations operate and how the technology is used in child abuse cases. Personnel from UC Davis conduct the initial equipment training and provide ongoing technical assistance related to the use of the technology.
In addition, the program provides monthly child abuse training to healthcare providers in hospitals who might otherwise not have the time to travel the distance required to attend onsite training. Also, UC Davis hosts monthly training and/or photo review sessions on child abuse related issues that are broadcast over secure internet connections to remote sites.
Today, two of the pilot programs are self sustaining through their respective law enforcement and district attorney’s offices. HRSA”s Maternal and Child Health Research Program is also funding the rest of the pilot sites.
A study of 42 live telemedicine consultations examining sexually abused children at two of the remote sites, suggests that participation in the program has lead to positive changes in child abuse examination and the data collection methods used. In 15 out of the 42 cases, telemedicine consultations resulted in additions or changes to initial histories and data gathering. The program is collecting data to assess diagnostic accuracy and quality of care on an ongoing basis from both intervention and comparison sites.