1. The Partnership to Eliminate Child Abuse:
Dr. Sandy Herr
EMERGENCY DEPARTMENT Medical Director,
Kosair Children’s Hospital
Associate Professor of Pediatrics,
University of Louisville

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

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
Children’s Bill of Rights, 1968

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

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

7. A STATE OF EMERGENCY Kentucky Indiana
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

8. A CHILD’S 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.

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

12. 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

14. 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

16. 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

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

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

19. 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

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

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

22. Child abuse often linked to unrelated, live-in lovers
2 charged in separate Jennings Co. child abuse cases
Father tortures infant and leaves her with brain damage
Child in Broomfield abuse case died of 'Oxycodone toxicity'
Severely tortured toddlers mom and her boyfriend arrested
Baby reportedly punched repeatedly in the stomach and face will likely die

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

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

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

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?

27. WHAT COLLABORATION DOESN’T LOOK LIKE

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

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 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

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

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 partnership’s member organizations

32. THE APPROACH Engage the media Public awareness campaign
PSAs
Op-ed columns
Expert availability for interviews
Public awareness campaign
Videos
Website:
Education for schools, community organizations, etc.
Achieve a constant presence in the public consciousness

33. INITIAL EFFORTS Family champions Op-ed columns
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

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

35. THE FUTURE Educational campaigns Media saturation Social media
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?

36. CORNELL AND KARLIE

37. “All that is necessary for the triumph of evil is that good men do nothing”
Irish philosopher Edmund Burke

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