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Workforce safety is a precondition of patient safety, and safety from both physical and psychological harm in the workplace is the foundation for an environment in which joy and meaning can exist. Achieving joy and meaning in the workplace allows health care workers to continuously improve the care they provide. This requires an environment in which disrespectful and harmful behaviors are not tolerated or ignored. Health care leaders have an obligation to create workplace cultures that are characterized by respect, transparency, accountability, learning, and quality care. Evidence suggests, however, that health care settings are rife with disrespectful behavior, poor teamwork, and unsafe working conditions. Solutions for addressing workplace safety problems include defining core values, tasking leaders to act as role models, and committing to becoming a high-reliability organization.

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Children with disabilities experience elevated rates of maltreatment but little is known about the interaction of children with autism spectrum disorder (ASD) with child protection systems. A population-based dataset of 24,306 children born in 2008 in Tennessee, which included 387 children with ASD identified through the Autism and Developmental Disabilities Monitoring network, was linked with state child protection records. Rates of maltreatment referrals, screening for further action, and substantiated maltreatment were examined for children with versus without ASD. Significantly more children with ASD (17.3%) than without (7.4%) were referred to the Child Abuse Hotline. Children with ASD were less likely than children without ASD to have referrals screened in for further action (62% vs. 91.6%, respectively), but substantiated maltreatment rates were similar across groups (3.9% vs. 3.4%, respectively). Girls versus boys with ASD were more likely to have substantiated maltreatment (13.6% vs. 1.9%, respectively). The high percentage of children with ASD referred for allegations of maltreatment, the differential pattern of screening referrals in for further action, and the high levels of substantiated maltreatment of girls with ASD highlights the need for enhanced training and knowledge of the complex issues faced by children with ASD, their families, and state welfare agencies. Keywords autism spectrum disorder; maltreatment; child protective services; child abuse Population-based studies and national data reporting entities clearly indicate that children with disabilities experience elevated rates of maltreatment and encounters with child protection systems (Horner-Johnson & Drum, 2006; Maclean et al., 2017; Spencer et al.,