DR. SANDY HERR EMERGENCY DEPARTMENT MEDICAL DIRECTOR, KOSAIR
CHILDRENS HOSPITAL ASSOCIATE PROFESSOR OF PEDIATRICS, UNIVERSITY OF
LOUISVILLE The Partnership to Eliminate Child Abuse: Slide 2
OBJECTIVES Review the scope of the child abuse epidemic Discuss the
utility of a collaborative approach to addressing child abuse
Describe the formation, goals, and initial efforts of the
Partnership to Eliminate Child Abuse (PECA) Explore future
directions for PECA and similar efforts Slide 3 THE LEVEL OF
CIVILIZATION ATTAINED BY ANY SOCIETY WILL BE DETERMINED BY THE
ATTENTION IT HAS PAID TO THE WELFARE OF ITS CHILDREN BILLY F.
ANDREWS, MD CHILDRENS BILL OF RIGHTS, 1968 Slide 4 A NATIONAL
TRAGEDY More than 1,000,000 substantiated cases of child abuse and
neglect/year in the U.S. Nearly 2000 documented deaths/year 80%
< 4 years of age The leading cause of injury-related death <
1 year Rate is increasing 3.1/day in 1998, > 5/day in 2010 Slide
5 Slide 6 COSTS OF CHILD ABUSE Each child abuse case in a living
victim costs approximately $200,000 Each child abuse death costs
approximately $1.3 million Annual cost of child abuse and neglect
in the U.S. estimated at $100 billion Likely an underestimate Slide
7 A STATE OF EMERGENCY Kentucky More than 84,000 reported cases
each year 30-40 known child abuse deaths/year Nearly 3
deaths/100,000 children Have ranked in the top 20 in child abuse
fatalities for the past decade Ranked first in 2007 Indiana 29 th
worst for child abuse-related deaths 20-30 child abuse deaths/year
Slide 8 A CHILDS SAFETY NET Family Community/church School/daycare
Healthcare Social workers/child welfare Judicial system The
following cases illustrate failure of one, several or all
components of this safety net. Slide 9 JJ: The infant with bruising
8 month old male with recurrent bruising since 3 months of age
Multiple visits to his PMD Referred to hematology for a possible
bleeding disorder Workup normal Referred to ENT for ear bruising
Diagnosed with traumatic bruising, referred back to PMD Ultimately
presents to ED with traumatic brain injury, multiple healing
fractures Slide 10 Slide 11 Slide 12 DS: The boyfriend factor 1
year old boy admitted for genital bruising, abdominal trauma
Diagnosed with non-accidental trauma, CPS report filed Letter from
hospital child protection team stated that child would be
re-injured or killed if returned to that environment Returned home
after 2 months in foster care Presented to an outside ED 1 month
later in full arrest, died from traumatic abdominal and brain
injuries Slide 13 Slide 14 TT: Little boy lost 3 year old boy with
a femur fracture while in moms care No history CPS notified, child
removed Due to prior domestic violence and paternal mental health
issues, physicians and CPS recommended placement with grandparents
At hearing, judge placed child with his father 1 month later, his
father shot the child and himself to death Slide 15 Slide 16 WHAT
HAVE WE DONE ABOUT IT? Child abuse wasnt even clearly
recognized/described in the medical literature before the 1960s
Animal protection laws pre- dated child protection Children viewed
as property rather than people even through the first half of this
century Slide 17 HISTORY 1870s, 8yo Mary Ellen Wilson beaten daily
by her foster family Lawyers for the ASPCA presented her case
Foster mom received 1 year sentence NY Society for the Prevention
of Cruelty to Children formed 1961: Dr. Kempe described the
Battered Child Syndrome 1967: 44 states enact mandatory reporting
for physicians Slide 18 HISTORY 1974: Child Abuse Prevention and
Treatment Act (CAPTA) passed Now all 50 states have mandatory
reporting laws for all professionals involved in the care of
children Criminal and civil liability for failure to report No
liability for good faith reporting of suspicions Educational
efforts largely focused on recognition and reporting of abuse Slide
19 HISTORY Since the 1970s, the dangers of shaking infants have
been recognized Never shake a baby campaigns have lead to
reductions in child abuse cases in some areas Education for new
parents Dangers of shaking a baby Tips for dealing with crying
infants Viewed by far more mothers than fathers Hospital-based in
most cases Slide 20 HISTORY Most pediatric centers and many
communities have resources dedicated to addressing child abuse At
KCH, we have had a Child Abuse Task Force since 2002, and a
Pediatric Forensics Division since 2007 Law enforcement agencies
specializing in child abuse investigation School and
community-based social services Interaction between hospital and
community-based resources are generally case-based and reactive
Slide 21 RESPONSE TO TRAGEDY: REACTIVE When a death or severe case
of abuse occurs Family responses complex and often conflicted
Denial Anger Grief Community shock and anger Media attention with
shocking headlines and lead stories Within hours to days the case
is forgotten by all but those directly involved Slide 22 Child
abuse often linked to unrelated, live-in lovers Severely tortured
toddlers mom and her boyfriend arrested Father tortures infant and
leaves her with brain damage Baby reportedly punched repeatedly in
the stomach and face will likely die 2 charged in separate Jennings
Co. child abuse cases Child in Broomfield abuse case died of
'Oxycodone toxicity' Slide 23 A NEW APPROACH IS NEEDED: PROACTIVE
Despite multiple efforts in all areas, abuse and abuse- related
deaths have not decreased Improved detection, reporting are often
too late High risk groups not identified/targeted for education
Newborn education directed at new parents fails to address
unrelated caregivers Abuse and neglect have not consistently been
in the public consciousness Little collaboration/cooperation across
groups Slide 24 HOUSE BILL 285 KY Legislation mandating education
on pediatric abusive head trauma New parents Child care providers
EMTs and paramedics RNs ARNPs Law enforcement officers Foster
parents Physician assistants Social workers Slide 25 A NEW APPROACH
Collaboration: the act of working together in order to achieve
shared goals Can a collaborative effort link key players across all
realms? Common goals Varied backgrounds, skill sets and resources
Different levels of access to families and children at risk Slide
26 WHAT DOES COLLABORATION LOOK LIKE? Who are the key players? How
do we get the players to the table? What are the common goals on
which to focus? How do we begin working toward those goals? Slide
27 WHAT COLLABORATION DOESNT LOOK LIKE Slide 28 CHILD ABUSE
COLLABORATIVES Successful efforts have occurred in other
communities Most include healthcare providers, community leaders,
social workers Few include judicial, law enforcement, and media
representatives Most are limited to one hospital or system or a
small geographical area Slide 29 THE PARTNERSHIP A group of people
working together for a common purpose Key players Physician
leaders, hospital and community-based Child abuse/forensics,
private practice, ED 4 Childrens Hospitals Riley, Peyton Manning,
Kosair Childrens Hospital and Kentucky Childrens Hospitals 4
Medical Schools in Kentucky and Indiana Indiana, Pikeville,
Kentucky, and Louisville Slide 30 THE PARTNERSHIP Broad partners
More than 200 groups, organizations, and individuals Social workers
Child advocacy Media/PR representatives Community leaders School
leaders Judicial and law enforcement organizations Legislators
Judges Lawyers Business leaders Slide 31 THE VISION Prevention,
detection, and treatment have all fallen short of our goal
Elimination should be the ultimate goal The name evolved from this
lofty goal Vision statement: To completely eliminate child abuse in
the areas served by our partnerships member organizations Slide 32
THE APPROACH Engage the media PSAs Op-ed columns Expert
availability for interviews Public awareness campaign Videos
Website: www.pecakyin.org Education for schools, community
organizations, etc. Achieve a constant presence in the public
consciousness Slide 33 INITIAL EFFORTS Family champions Families of
victims sharing their stories Op-ed columns The child abuse problem
in Kentucky and Indiana Warning signs of abuse Unrelated
caregivers/boyfriends Crying New parents need extra support Expert
media spokespersons identified Slide 34 INITIAL EFFORTS Public
Service Announcements Toolkit Allows others to borrow/use the PECA
materials for their area/target audience Tips for eliminating child
abuse Videos Slide 35 THE FUTURE Educational campaigns School-based
education Other high risk groups Expanded educational efforts for
expecting/new parents Expanded mandatory education for physicians,
others involved in the care of children Media saturation Keep abuse
and neglect in the forefront Social media Perpetrator perspective?
Slide 36 CORNELL AND KARLIE Slide 37 ALL THAT IS NECESSARY FOR THE
TRIUMPH OF EVIL IS THAT GOOD MEN DO NOTHING IRISH PHILOSOPHER
EDMUND BURKE Slide 38 SUMMARY The Partnership to Eliminate Child
Abuse is a collaborative effort Linking diverse organizations and
individuals across Indiana and Kentucky Common goal of completely
eliminating child abuse Multifaceted approach using media,
physician champions, families Educational and awareness campaigns
Seeking to establish and maintain child abuse in the public
consciousness
