By Shadi Houshyar, Vice President, Child Welfare Policy for First Focus
Stories about abused and neglected children who, for one reason or another, were time and again failed by the adults and systems entrusted to care for and protect them are common. Every day, we hear stories of children who had one too many unsubstantiated reports of abuse, only to end up in foster care, in the emergency room, or worse. Looking at the case files of these children, red flags or early warning signs might seem obvious. Why then do we so often miss these signs?
The sad reality is that early warning signs are not easy to see and often overlooked. Children interact with adults every day – in schools, at the pediatrician’s office, in afterschool programs, in churches and synagogues. Yet it’s easy for kids to go unnoticed, for adults to miss signs of trouble, and for systems to fail to communicate with one another even when abuse is suspected. Knowing this, it’s important to look for opportunities to collaborate across systems, and improve how, where and when we identify children who are abused or neglected or at risk for maltreatment.
We need to identify effective prevention strategies in settings including health care. The field of child abuse pediatrics offers an opportunity to do just that. Child abuse pediatricians are trained to diagnose and treat children who are suspected victims of abuse, typically working in multidisciplinary teams alongside child welfare, law enforcement, and courts.
The Safe Environment for Every Kid (SEEK) model demonstrates the importance of child abuse pediatricians in efforts to identify risk for and prevent child abuse. The SEEK model is designed to enhance pediatric primary care and better address major risk factors for abuse. This model includes (1) training residents to address targeted risk factors, (2) a brief Parent Screening Questionnaire (PSQ), and (3) a resident-social worker team to address concerns. An evaluation of the program has found a significant reduction in child protective service reports (CPS), with 31% fewer CPS reports among intervention-group families compared with controls.
A recent Chicago Tribute story highlights an innovative program now underway at several Chicago hospitals, designed to improve the identification and treatment of child abuse victims. The story describes child abuse pediatric teams of medical professionals in hospitals working – together with child protective service investigators – to appropriately assess physical abuse and develop treatment plans.
These teams work together to identify cases of abuse at the time of injury and to share information with one another. At the Ann and Robert H. Lurie Hospital in Chicago, a multidisciplinary team is in place to evaluate and provide appropriate intervention services to children who may have been abused. The team includes pediatricians, radiologists, social workers, developmental and behavioral psychologists, as well as child protective service workers, all working together to provide comprehensive care to children at risk for abuse or neglect. And similar efforts are underway in other parts of the country. In Florida, the Child Protection Team (CPT) program is a medically directed, multidisciplinary program that works with local law enforcement and the Department of Children and Family Services in cases of child abuse and neglect, in order to inform investigation activities.
As the Tribune story highlights, in several prior death cases, children had suffered earlier injuries but child protective services had not taken protective custody of the child because of uncertain medical opinion about the injuries in the cases. In these cases, an evaluation from a trained child abuse pediatrician – and involvement in developing an appropriate treatment plan – could make a difference.
Child protective service agencies are also looking at creating medical units within their agencies led by child abuse pediatricians with the goal of improving evaluations in ongoing investigations, reviewing and strengthening policies and collaboration with pediatricians and others in the medical community, providing evidence in cases where deadly abuse may have occurred and ultimately reducing fatalities.
There are challenges to taking these types of programs to scale. First, they are relatively new and costly, with limited evaluation data. Second, child abuse pediatrics is a young specialty. Bringing more attention to the field of pediatric forensics, offering more opportunities and incentives for practitioners to take up the specialty, and investing in models that bring child abuse pediatric teams into practice across the country can help make the case for taking these efforts to scale in the future.