DR. SANDY HERREMERGENCY DEPARTMENT MEDICAL DIRECTOR,

KOSAIR CHILDREN’S HOSPITALASSOCIATE PROFESSOR OF PEDIATRICS,

UNIVERSITY OF LOUISVILLE

The Partnership to Eliminate Child Abuse:

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

“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 CHILDREN’S BILL OF RIGHTS, 1968

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

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

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 29th worst for child abuse-related deaths 20-30 child abuse deaths/year

A CHILD’S SAFETY NET

FamilyCommunity/churchSchool/daycareHealthcareSocial workers/child welfareJudicial system

The following cases illustrate failure of one, several or all components of

this safety net.

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

DS: The boyfriend factor

1 ½ 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

TT: Little boy lost

3 year old boy with a femur fracture while in mom’s 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

WHAT HAVE WE DONE ABOUT IT?

Child abuse wasn’t 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

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

formed1961: Dr. Kempe described the “Battered

Child Syndrome”1967: 44 states enact mandatory reporting

for physicians

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

HISTORY

Since the 1970’s, 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

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

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

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'

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

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

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

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?

WHAT COLLABORATION DOESN’T LOOK LIKE

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

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 Children’s Hospitals

Riley, Peyton Manning, Kosair Children’s Hospital and Kentucky Children’s Hospitals

4 Medical Schools in Kentucky and Indiana Indiana, Pikeville, Kentucky, and Louisville

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

THE VISION

Prevention, detection, and treatment have all fallen short of our goal

Elimination should be the ultimate goalThe name evolved from this lofty goalVision statement: To completely eliminate

child abuse in the areas served by our partnership’s member organizations

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

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

INITIAL EFFORTS

Public Service AnnouncementsToolkit

Allows others to borrow/use the PECA materials for their area/target audience

Tips for eliminating child abuse Videos

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 childrenMedia saturation

Keep abuse and neglect in the forefrontSocial mediaPerpetrator perspective?

CORNELL AND KARLIE

•“ALL THAT IS NECESSARY FOR THE TRIUMPH OF EVIL IS THAT GOOD MEN DO

NOTHING”IRISH PHILOSOPHER EDMUND BURKE

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