P3.057: Who Provides Care? A National Survey of Medical Providers in Child Maltreatment

Background: An estimated 1 in 4 children will experience child maltreatment (CM) in their lifetime. Providing care for children who have experienced maltreatment requires specific training to provide appropriate care. The < 400 child abuse pediatricians (CAPs) in the U.S. who have completed a CM fellowship, cannot care for all maltreated children. Care is also provided by non-CAP pediatricians, nurse practitioners (NPs), physicians' assistants (PA), and sexual abuse/assault nurse examiners (SANEs). A literature review identified no current data on the number of non-CAP providers in CM.

Methods: To understand the role of non-CAP providers in the CM field, child abuse clinicians from three Baltimore institutions developed and administered an electronic survey via Qualtrics to CM providers across the US. Over three months (January to March 2025), participation was solicited through multiple professional listservs, including the Helfer Society, Advanced Practice Providers working in maltreatment, and the NAPNAP Child Maltreatment and Neglect Special Interest Group. Participation was also solicited in-person at the International Conference on Child and Family Maltreatment in San Diego. Recipients were encouraged to disseminate the survey.

Results: A total of 106 responses were received, including 8 duplicates, representing 34 states and the District of Columbia. After removing duplicates, respondents from 98 programs identified 596 team members, including 164 CAPs, 54 non-CAP pediatricians, 181 NPs, 9 PAs, 18 non-CAP/non-pediatrician physicians, and 251 SANEs. Nearly 40% (n=37) of respondents represented high volume programs, which see > 600 children annually. Among high-volume programs, all had at least one CAP. Conversely, none of the programs seeing < 100 cases annually employ a CAP, suggesting smaller programs are less likely to have access to the most highly trained experts.

While most programs reported participating in continuous quality improvement (CQI), the methods vary. Internal peer review is most common (71%, n=70), followed by external review (21%, n=21). However, 6% (n=6) of programs reported no CQI system. Among the 29.5% (n=29) of programs led by non-CAP providers, 31% (n=9) conduct internal peer review, 62% (n=18) utilize external review, and two reported no CQI system.

Conclusion: CAP training provides a nationally recognized certification of expertise requiring three years of fellowship after pediatric residency. There is currently no national training curriculum providing accreditation for general pediatricians not completing fellowship or NPs; therefore, their extent of their training is variable. Participation in CQI, particularly for those with more limited training enables more accurate diagnoses and provides an opportunity for feedback and learning. While most survey respondents participate in CQI, those who do not, and particularly those led by individuals with more limited training, may put their patients at risk for misdiagnosis. The medical CM field would benefit from a non-CAP standardized training curriculum as well as universal participation in CQI.