Research by Topic

Emergency care for children is provided predominantly in community emergency departments, where abusive injuries frequently go unrecognized. There are substantial differences between pediatric and community EDs in the access to subspecialty expertise, quality of pediatric care, and outcomes of pediatric patients. Following qualitative interviews with providers, quality improvement studies, and implementation of a clinical guideline, our targeted interventions have increased compliance with national guidelines for abuse evaluations and mitigated differences between pediatric and community EDs in the evaluation of high-risk injuries.

Our team has conducted various interventions to improve the care of infants presenting with abuse-associated injuries using a clinical guideline. Our child abuse guideline links ED providers with child abuse experts and has improved provider decision-making, decreased bias, and standardized care between pediatric and community EDs. We have developed natural language processing technology to identify high-risk injuries in the electronic medical record and are in the process of implementing electronic clinical decision support to sustain and augment the positive impact of the guideline across multiple EDs in the Yale-New Haven Health System.

Our Community Advisory Board consists of members from local IPV organizations, the Department of Children and Families, the Yale child abuse team, Yale emergency medicine department, New Haven police department, Yale Child Study Center, and community representatives. Board members ensure a trauma-focused environment for abused caregivers and children exposed to IPV. One project that arose from this collaboration was the idea to link a child’s medical evaluation with an opportunity to connect the child’s caregiver to a community-based IPV advocate. The board’s next project is to implement the evidence-based CUES (Confidentiality, Universal Education & Empowerment, Support) intervention in the Yale-New Haven Health adult and pediatric EDs.

As part of the New Haven Family Violence Community Advisory Board, the FRESH Collaborative recently collaborated on the development of an integrated care program at the South-Central Child Advocacy Center for families living with IPV. Since July 2020, the program has provided medical evaluations for young children exposed to IPV and real-time linkage with an IPV advocate for caregivers. Addressing the child’s safety while optimizing the safety and advocacy of a caregiver may ultimately decrease the child’s exposure to physical harm and reduce the occurrence of IPV. We are examining the acceptability and feasibility of this model and planning a clinical trial to compare the effectiveness of the family-centered care model with usual care.

Children are witnesses to 50% of IPV episodes in the US and are often evaluated after exposure to IPV. Abusers may access the electronic health records (EHRs) of victims and their children and learn of the IPV disclosure, leading to potential threats to safety. Implementation of the 21st Century Cures Act, a federal law mandating that healthcare providers give patients immediate access to electronic clinical notes, has amplified concerns of worsening safety for victims of IPV and their children. We recently completed a study demonstrating that discussions about EHR safety are infrequent when adults and children present after IPV and notes are infrequently unshared even when safety concerns are present. We are evaluating and developing interventions to improve documentation practices for IPV-related care in emergency departments.

We aim to understand the impact of racism on Asian Americans in healthcare. Currently, we seek to understand the impact of anti-Asian racism on Asian American medical students.

We aim to decrease restraint use, both physical and chemical, in the behavioral health population in the pediatric emergency department. More specifically, we have found that people of color are disproportionately more restrained compared to their white counterparts, so our team is aiming to reduce the disparities of restraint use as well as bring awareness to this issue.