Montana telehealth plan aims to speed child abuse consultations

Missoula pediatric hospitalist Dr. Laurie Carter confirmed Montana had never had a board-certified child abuse pediatrician. She explained the subspecialty required three additional years of fellowship training and prepared doctors to assess whether an injury might be abuse, an accident or tied to a medical condition.

Carter said her work to build the Montana Child Abuse Network, or MT CAN, grew out of cases that stayed with her.

“There was an infant that I cared for who presented with what we call respiratory failure, or not breathing on his own. And in the end, he had suffered abusive head trauma. And then he ended up passing away,” Carter said. “And in my mind, I was wondering, gosh, was there a sentinel injury that wasn't recognized that could have avoided having that significant, you know, life-ending type of injury?”

Carter explained that sentinel injuries were smaller warning signs such as bruising on an infant who was not yet mobile. She also said about one-third of children who arrived with a severe injury had a history of an earlier sentinel injury.

The latest federal data identified 2,079 Montana children as victims of abuse or neglect in 2024. That worked out to a rate of 8.9 per thousand children, which was higher than the national rate of 7.2.

Brenda George, executive director of the Children’s Alliance of Montana, said the broader response also involved law enforcement, Child Protective Services and children’s advocacy centers.

“Rural providers can get trained, but they may see fewer cases, so they may not feel as confident in, you know, making findings,” George said. “And so, really the key for our medical providers is having access to experts in the field.”

George said Montana had nine accredited children’s advocacy centers and 32 locations where children could receive forensic interviews. She added that medical providers could already seek peer review or consult with out-of-state experts including specialists in Denver, Salt Lake City and Seattle.

MT CAN was designed to create a more direct in-state path. Under the plan, five Montana health care providers with additional training would consult with frontline providers through a secure audio-visual connection. Cases that were more complex could still be elevated to board-certified specialists at the University of Utah.

“Our goal is to reduce the barriers and increase the efficiency of that frontline professional, whether it's CPS or whether it's a local health care provider who's seeing the child, to be able to have that question answered to them about whether this injury is concerning for physical abuse,” Carter said.

Supporters do not present MT CAN as a replacement for a board-certified child abuse pediatrician in Montana. Instead, they hope it gives providers a faster way to reach trained guidance before a small warning sign can turn into a more serious injury.