1. Infant and Pediatric Abduction & Abandonment

2. Toolkit Objectives 1.Allow for the evaluation and analysis of healthcare facility procedures to encompass the Florida Department of Law Enforcement’s Child Abduction Response Team (CART) and the National Center for Missing and Exploited Children recommendations to reduce risk and increase patient safety. 2.Develop facility-specific policies and procedures to respond to infant abandonment. 3.Discuss the utilization of the toolkit to increase organizational preparedness and response.

3. Project Purpose 1.Provide specific information to Florida’s hospitals and health systems related to infant and pediatric abduction and abandonment. 2.Florida is third in the nation, behind California and Texas respectively, in reporting the highest number of infant an pediatric abductions!

4. FHA FHA advocates proactively on behalf of hospitals at the state level on issues that will assist its members in their mission of community services and care to patients.

5. FSHSSEMP The mission of the Society is to promote the security and safety... as it relates to the healthcare environment. The Society’s mission is achieved by sponsoring continuous quality improvement opportunities and strengthening collaborative partnerships. This toolkit is the 3 rd improvement project released in 2010.

6. Project Committee Committee Chair – Jim Kendig, MS, CHSP, HEM, CHCM, LHRM - Health First, Inc. Florida Society for Healthcare Security, Safety and Emergency Management Professionals (FSHSSEMP) –Paula Bass, CHSP, CHCM - Florida Hospital Orlando –Sharon Andre, RN, MS, FACHE - Martin Memorial Health System Florida Organization of Nurse Executives –Innette Sarduy, MPH, RN, NEA-BC - James A. Haley Veteran’s Hospital –Tina Haight, RN, MSN, MBA - University Community Health –Judy Cavallaro, RN, BSN - Sarasota Memorial Healthcare System Florida Society for Healthcare Education and Training –Pamela Moore, MSN, RN-BC – Citrus Memorial Health System –Rebecca Holliman, MSN, RN-BC, Health Central

7. Project Partners Florida Department of Law Enforcement –Wayne Ivey National Center for Missing and Exploited Children –Cathy Nahirny Mead Johnson –Nancy Edwards –William Richardson –Debra Gonzalez –Mary Dishmon A Safe Haven for Newborns –Nick Silverio Niscayah –Don Knowles

8. Abduction

9. Infant and Pediatric Abduction Infant and pediatric security is an area of concern to the Joint Commission as a high-risk security area often referred to as a “security-sensitive area.” Areas designated as security sensitive areas require a specific access-control plan, initial and periodic security related training for staff members working in this area, and a critical response plan.

10. Never Events In 2006, the National Quality Forum updated their report, Serious Reportable Events In Healthcare - 2006 Update: A Consensus Report to include 28 events or what is to be considered “never-events.” “Abduction of a patient of any age” is listed as a criminal event and considered a “never event.” Source: National Quality Forum (2006). Serious Reportable Events In Healthcare - 2006 Update: A Consensus Report. Available at: http://www.qualityforum.org/Publications/2007/03/Serious_Reportable_Events_2006_full.aspxhttp://www.qualityforum.org/Publications/2007/03/Serious_Reportable_Events_2006_full.aspx

11. Never Events The Consensus Standards Maintenance Committee affirmed that these events are included in order to ensure a broad view of patient safety and the safety of the healthcare environment. The Committee also affirmed that the healthcare institution has a duty to patients, employees, and guests to ensure a safe environment and should have surveillance systems in place to do so. Source: National Quality Forum (2006). Serious Reportable Events In Healthcare - 2006 Update: A Consensus Report. Available at: http://www.qualityforum.org/Publications/2007/03/Serious_Reportable_Events_2006_full.aspxhttp://www.qualityforum.org/Publications/2007/03/Serious_Reportable_Events_2006_full.aspx

12. Abductions Abductions are not daily occurrences but abductions by non-family members of infants, birth through 6 months, from healthcare facilities is a concern to all. The good news is that of all the infants that were abducted from healthcare facilities, 95 percent were located and safely returned, usually within a few days to two weeks. There some that were never recovered! Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

13. The Problem Of course, this is good news unless its your infant that was abducted from your organization! Evaluating abductions (by non-family members) from 1983 through 2008, the current evidence indicates that the number of abductions range between 0 and 10 per year. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

14. Case Studies In 124 of the cases studied the infants were abducted from healthcare facilities and 99 were abductions from the home. The abduction pattern used to abduct from the home followed most of the same patterns as the abductions from healthcare facilities but with the addition of violence committed against the mother or other caregiver that was present. The abduction from healthcare facilities is the focus of this module! Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

15. Case Studies Thirty-three (33) additional infants were abducted from other places such as malls, offices, and parking lots. Interestingly, the bed size of a healthcare facility or its locale (urban or rural) does not seem to be a factor as to whether or not they will experience an abduction. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

16. Abductions from Hospitals Unfortunately, evidence suggests that there may be numerous abduction attempts at birthing facilities each year. Healthcare workers must understand the threat, be able to recognize potential abduction scenarios, and be cognizant of specific information relative to Florida. Informed workers are better suited to engage healthcare security and law enforcement for response prior to an abduction occurring.

17. The Typical Abduction The “typical” abduction from a healthcare facility involves an “unknown” abductor impersonating a nurse, healthcare employee, volunteer, or relative in order to gain access to the infant. The OB unit is usually open and inviting, where the patient’s decreased length of stay (usually 1-3 days), gives them less time to know staff members and routines.

18. The Typical Abduction The number of new and changing faces on the unit is high, thus making it an area where a “stranger” is unlikely to be noticed. With relative easy access to a mother’s room than to the newborn nursery, an abductor spends increasingly more time with mom rather than in the traditional nursery. Most abductors “con” the infant directly from the mother’s arms stressing the need to educate “mom” regarding existing safeguards in place.

19. Who is the ‘Typical’ Abductor? Female of “childbearing” age (range 12-53) and often overweight. Most likely compulsive; most often relies on manipulation, lying, and deception. Frequently indicates she has lost a baby or incapable of having one. Often married or cohabitating –Companion’s desire for a child or the abductor’s desire to provide her companion with “his” first child maybe the motivation for the abduction. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

20. Who is the ‘Typical’ Abductor? Usually lives in the community where the abduction takes place. Initially visits nursery and OB units at more than one healthcare facility prior to the abduction. Asks detained questions about procedures and the maternity floor layout; frequently uses a fire-exit stairwell for her escape; and may also try to abduct from the home setting. Frequently impersonates a nurse or other allied healthcare provider. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

21. Who is the ‘Typical’ Abductor? Usually plans the abduction, but does not necessarily target the specific infant; frequently seizes any opportunity present. Often becomes familiar with healthcare staff members, staff work routines and victim’s parents. Demonstrates the capability to provide “good” care to the baby once the abduction occurs. The race/skin color of the abductor almost always matches the infant’s or reflects the abductors significant other. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

22. Who is the ‘Typical’ Abductor? Often exhibits “nesting” behavior by “announcing her pregnancy” and purchasing items in the same way an expectant mother prepares for the birth of her baby. The positive attention she receives from family and friends “validates” her actions. Unfortunately this “nesting” activity feeds the need for the abductor to “produce” a baby at the expected time of arrival. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

23. Who Abducts from the Home Setting? Is more likely to be single while claiming to have a partner. Often targets a mother whom she may find by visiting healthcare facilities and tries to meet the target family. Often brings a weapon although the weapon may not be used. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

24. Who Abducts from the Home Setting? Often impersonates a healthcare or social-services professional when visiting the home. In over 29% of the abductions from home involved some type of violent act committed against “mom” including homicide. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

25. What Time of Day do Abductions Occur? From 1983 through 2009 there have been 127 cases where infants have been abducted from healthcare facilities by a non-family member. The following data deals with the time of day that these abductions take place. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

26. Facts LocationDay Shift Evening Shift Night Shift Mother’s Room 32196 Nursery653 Pediatrics762 On Premises561 # Cases503612 Infant Abductions Occur: 51% - on Day Shift (7-3) 37% - on Evening Shift (3-11) 12% - on Night Shift (11-7) Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

27. Infant Security Tags = Mitigation? Unfortunately not! 14 documented cases (1997 to 2009) where an infant was abducted by a non-family member from a healthcare facility and the facility had installed an infant security tagging system. Recent cases: –Timillion Trawick, Medical Center of Central Georgia (Macon, GA) 2/6/2006. The system alarmed multiple times, but the abductor was successful in leaving the unit as well as the hospital building. –Mychael Darthard-Dawodu, Covenant Lakeside Hospital (Lubbock, TX) 3/10/2007. The abductor removed the security tag before exiting the facility.

28. Infant Security Tags = Mitigation? Recent cases: –Kimorian Jones, Sentara Norfolk General Hospital, (Norfolk, VA) 7/20/2007. The abductor cut the security tag off of the infant before placing him in a diaper bag. The security system alarmed and locked down the unit preventing the abductor from leaving the floor. The abductor and the infant were located in a waiting room in the Labor & Delivery unit. –Sachit Rajkumar, Central Florida Regional Hospital, (Sanford, FL) 3/28/2008. The infant was wearing an umbilical cord security tag which did trigger the alarm for staff, however, the abductor was still able to exit the facility with the infant.

29. Infant Security Tags = Mitigation? Recent cases: –Maia Warmack, Nashville General Hospital (Nashville, TN) 12/31/2008. The infant’s security tag (ankle) was cut off by the abductor. The alarms immediately sounded, staff responded and the abductor was prevented from leaving the unit. –Julian Santa-Cruz, Santa Barbara Cottage Hospital (Santa Barbara, CA) 2/27/2009. The tagged infant was removed from the third floor maternity unit in a plastic bag. The alarm sounded, but the abductor was still able to exit the facility. Source: National Center for Missing & Exploited Children For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions; Ninth Edition 2009

30. Code Pink Florida Hospital Association recommended standardized emergency codes in 2002 for ‘Code Pink’ - infant or pediatric abduction. Recommendations were updated in 2010 adding Code Pink followed by the age. –For example, Code Pink 2 would be for a two-year old; Code Pink O would be for an infant who has not yet reached their first birthday. These measures assist staff in identifying the approximate age of the abducted child or infant.

31. What Is a CART? The Florida Department of Law Enforcement (FDLE) has worked with local law enforcement agencies to create a “Child Abduction Response Team (CART).” CART provides fast response which increases the likelihood of a safe rescue. CART provides an organized team of experts trained in the field of child abduction response. CART acts as a liaison with the NCMEC and others.

32. CART Development On Sunday, February 1, 2004 in Sarasota, FL, 11- year old Carlie Brucia was on her way home from a sleep over when she was abducted from a local car wash by Joseph Smith. Shortly after being abducted, Carlie was murdered by her abductor. As a result of this tragedy FDLE determined the need for a trained team of experts in the field of child abduction. The Team later became known as the CART.

33. How is CART Activated? CART allows local law enforcement to surge their ranks with experienced investigators that the local police department may not have access to quickly. Local law enforcement must request for the activation of CART. Cart is a multi-agency task force designed to immediately mobilize assistance and resources to law enforcement agencies when a child is missing or abducted.

34. FDLE’s CART Does your hospital have an agreement with the CART in your area? –There are 20 teams in FL Is any member of your hospital a member of CART? For more contact your local law enforcement agency

35. Abandonment

36. Infant Abandonment The Florida Safe Haven Law was enacted in 2000 in response to an increasing number of newborn infants being abandoned in austere conditions and locations. Abandonment is a criminal act. Patterns – –Young women –Desperate, fearful, and distressed –Hiding their pregnancy –Unaware of options

37. Infant Abandonment The unthinkable act of abandonment negatively impacts both mother and child. The law –The law allows new mothers who have a baby seven days or younger to take this child to a hospital or EMS/fire station without fear of reprisal. A Safe Haven for Newborns provides anonymous alternatives to abandonment through education, prevention, and community involvement.

38. Prevention Develop security standards to better protect infants (and pediatric patients) that are reasonable, appropriate, and defensible. These include: –Comprehensive programs including policies and procedures; –Education at all levels; and, –Coordination of physical and electronic security features adapted to your situation and location. –Drills and Exercises

39. Post Test

40. 1.Non-Family infant abduction are of “epidemic proportions in the United States? True or False

41. Post Test 1.Non-Family infant abduction are of “epidemic proportions in the United States? True or False

42. Post Test 2.A comprehensive program should be established to prevent abductions from healthcare facilities and from the home? True or False

43. Post Test 2.A comprehensive program should be established to prevent abductions from healthcare facilities and from the home? True or False

44. Post Test 3.The comprehensive program should address: A.Policy, procedures, and processes B.Education focusing on staff, parents, and security C.Coordination of various elements of physical and electronic security specific to our location D.All the above

45. Post Test 3.The comprehensive program should address: A.Policy, procedures, and processes B.Education focusing on staff, parents, and security C.Coordination of various elements of physical and electronic security specific to our location D.All the above

46. Post Test 4.Providing a DNA sample is one example of: A.Proactive program to assist in locating an abducted infant B.An expensive program that is no longer needed C.Does not support abductions

47. Post Test 4.Providing a DNA sample is one example of: A.Proactive program to assist in locating an abducted infant B.An expensive program that is no longer needed C.Does not support abductions

48. Post Test 5.FDLE’s Child Abduction Team (CART) is available to assist in the investigation of any abduction? True or False

49. Post Test 5.FDLE’s Child Abduction Team (CART) is available to assist in the investigation of any abduction? True or False

50. Post Test 6.The first step in developing a proactive program to address abductions from a healthcare facility and from the home is to read and understand the most recent guidelines published by the National Center for Missing & Exploited Children? True or False

51. Post Test 6.The first step in developing a proactive program to address abductions from a healthcare facility and from the home is to read and understand the most recent guidelines published by the National Center for Missing & Exploited Children? True or False

52. Post Test 7.One security feature to assist a new mom in identifying appropriate individual's who may be caring for her is a “clearly different” badge? True or False

53. Post Test 7.One security feature to assist a new mom in identifying appropriate individual's who may be caring for her is a “clearly different” badge? True or False

54. Additional Information More information is available at: –NCMEC Guidelines http://www.missingkids.com/missingkids/servlet/ResourceServ let?LanguageCountry=en_US&PageId=468http://www.missingkids.com/missingkids/servlet/ResourceServ let?LanguageCountry=en_US&PageId=468 –NCMEC general information www.missingkids.com –Safeguard Their Tomorrows CE presentation http://www.pediatricnutritionce.org/activities.aspx –Mead Johnson Healthcare Professional Resource Center http://www.mjn.com/professional

55. Additional Information More information is available at: –A Safe Haven for Newborns http://www.asafehavenfornewborns.com –Florida Department of Law Enforcment http://www.fdle.state.fl.us/Content/home.aspx Missing and Endangered Persons information –http://www.fdle.state.fl.us/MCICSearch/http://www.fdle.state.fl.us/MCICSearch/ CART Brochure –http://www.fdle.state.fl.us/Content/getdoc/573308f2-8ec5-42e5- a832-e36ed75c4688/CART_Brochure_Jan08.aspxhttp://www.fdle.state.fl.us/Content/getdoc/573308f2-8ec5-42e5- a832-e36ed75c4688/CART_Brochure_Jan08.aspx

56. References National Center for Missing & Exploited Children. For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abductions. Ninth Edition. 2009. Available at:http://www.missingkids.com/missingkids/servlet/Resour ceServlet?LanguageCountry=en_US&PageId=468http://www.missingkids.com/missingkids/servlet/Resour ceServlet?LanguageCountry=en_US&PageId=468 National Quality Forum (2006). Serious Reportable Events In Healthcare - 2006 Update: A Consensus Report. Available at: http://www.qualityforum.org/Publications/2007/03/Serious _Reportable_Events_2006_full.aspx http://www.qualityforum.org/Publications/2007/03/Serious _Reportable_Events_2006_full.aspx

58. Questions and Answers If you have questions that were not answered, please e-mail John@fha.orgJohn@fha.org Thank you for your participation!