The Montana Child Abuse Network is a pilot project funded by RESOLVE: A Rural Health Collaborative, a strategic partnership between Providence and the University of Montana. 

Past research has shown that early signs of child abuse too often go unrecognized in the U.S. healthcare system. In Montana, a vast and largely rural state, that issue is compounded by a shortage of in-state pediatricians and a lack of child abuse pediatricians, who have received an additional three years of fellowship training after their residency. 

Those gaps pose real risks for rural children and their healthcare providers. For providers, it raises the risk of inaccurately diagnosing physical abuse. For children, that means injuries from abuse may not be recognized early enough to avoid future harm. 

A new research project supported by Providence and the University of Montana rural health collaborative, RESOLVE, aims to address those challenges.  

MT-CAN: Inspired by personal experience

Dr. Laurie Carter, a Missoula-based pediatric hospitalist, launched the Montana Child Abuse Network (MT-CAN) as a RESOLVE initiative.  

Eighteen years ago, as Carter prepared to go on maternity leave, 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 child. In the following years, she continued seeing cases where earlier intervention might have changed the outcome.

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 may not be recognized by health care providers, leaving some children in dangerous circumstances.  

“Approximately one-third of children who present with a significant injury have a history of a prior sentinel injury,” says Carter. Sentinel injuries are visible, minor, poorly explained injuries in young children that raise concern for abuse.

Improving efficiency in identifying child physical abuse 

Carter’s personal experience and passion for caring for children inspired her to establish MT-CAN. To launch the pilot and study the program, she sought funding through RESOLVE, which was launched by the partners in 2026. MT-CAN is its first funded project.

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

That challenge is exacerbated by the fact that rural providers are often isolated from large medical centers and community services. And busy physicians in smaller rural clinics often have few referral resources and fewer diagnostic tools.

The MT-CAN program responds to these challenges by providing training, resources and connections to state-based medical providers with additional training in child abuse care. The goal is to boost early recognition of potential abuse.

That’s important, because early recognition is crucial to prevention. Carter hopes MT-CAN and the resources it provides will help frontline professionals recognize sentinel injuries when they occur and prevent tragedies like the ones she saw.

Through a telehealth solution that increases access to specialized care, the program aims to decrease the barriers and improve the efficiency in identifying child physical abuse. 

Carter and other researchers from Providence and UM also will study the pilot and evaluate its potential to be reproduced in other communities across Montana.   

To learn more about RESOLVE, visit the Providence Institute for Clinical Innovation website.  

 Related news 

• KPAX MT News - No child abuse-trained pediatrician in Montana prompts Missoula doctor to take action
• Press release: Providence and University of Montana partner in transformative research initiative to advance rural health care
• UM Blog story: UM-Providence Partnership Targets Improving Healthcare for Rural Kids
• Video: Resolve, a rural health collaborative