1. Recognition, Care, and Reporting of Child Maltreatment Presented by the: Oklahoma EMSC Resource Center

2. Objectives:Objectives: Describe the size and scope of Child Maltreatment in the US. Describe the size and scope of Child Maltreatment in the US. Describe the size and scope of Child Maltreatment in Oklahoma. Describe the size and scope of Child Maltreatment in Oklahoma. Identify the types of maltreatment and patterns commonly found associated to each type. Identify the types of maltreatment and patterns commonly found associated to each type. Describe the “Roles and Responsibilities” of the EMS Provider regarding prevention, identification, treatment, and reporting of child maltreatment. Describe the “Roles and Responsibilities” of the EMS Provider regarding prevention, identification, treatment, and reporting of child maltreatment.

3. Scope of the Problem  NATIONALLY  1 million actual cases annually (50% physical abuse / 25% neglect)  Approximately 1300 deaths/year (Physical Abuse)  90% deaths occur children <5 years age  40% deaths 2° to neglect

4. Scope of the Problem  OKLAHOMA  53,548 cases Reported in 2000  14,273 cases were confirmed (23%)  48 deaths  Oklahoma and Tulsa counties have the highest rates. (population) Source: Oklahoma Department of Human Services. 2000 Report

5. Types of Maltreatment  Physical  Emotional/Psychological  Sexual  Neglect

6. Physical Abuse  DEFINITION  An inflicted act that results in a significant physical injury or the risk of such injury  Most states:  Child welfare system concerned with acts by parents or caregivers  Physical assaults by others addressed by law enforcement Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000 Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000

7. Psychological Maltreatment  DEFINITION  A repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s need. American Professional Society on Abuse of Children 1995

8. Sexual Abuse  General term referring to nonconsensual sexual acts, sexually motivated behaviors involving children, or sexual exploitation of children. Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000  State & Federal criminal statues define sexual behavior that is illegal  PEARL: STD’s are just that and should not occur in children

9. Child Neglect  DEFINITION  Omissions in care resulting in significant harm or risk of significant harm to children  Hygiene  Nutrition  Protection  Shelter  Supervision  Medical Care  Positive impact made when suspicions reported

10. Roles & Responsibilities  Prevention  Identification  Treatment  Reporting

11. PreventionPrevention  Educational Awareness  Educating all ages = Public Awareness  Educating Healthcare Providers = Awareness  Remain alert to possible abuse conditions & situations  Make proper agencies aware for assistance to be provided prior to abuse happening

12. IdentificationIdentification  Awareness & Observation  Look at the  Environment  Child & Injury  Parents  Situation  Listen to everything comprehensively  Does everything seen, heard, smelled, felt, etc make sense?

13. Identification (Continued)  Perform Assessment  Initial  A-B-C’s  Correct Problems as Discovered  History (HX)  Does Hx & mechanism of injury equate to child’s age-related developmental stage

14. Identification (Continued)  Toe to Head Exam  D = Deformity  C = Contusions  A = Abrasions  P = Punctures  B = Burns  T = Tenderness  L = Lacerations  S = Swelling

15. Identification (Continued)  Avoid Confrontation  Document Information Gathered  Obtain Hx from Everyone Present  Be non-judgmental with entire demeanor  LISTEN, LISTEN, LISTEN  Be child’s safety advocate!

16. Identification (Continued)  Skin  Pattern Marks  Burns  Ecchymoses  Bruising colors & locations  Head, Face, Eyes, Ears, Nose, Mouth, & Neck

17. Identification (Continued)  Pattern Marks  Electric Cord  Ligature Restraints  Unknown Causes

18. Identification (Continued)  Burns  Immersion  Stocking  Tobacco  Burns to Hands

19. Identification (Continued)  Ears  Mouth  Neck  Eyes  Scalp

20. Identification (Continued)  May not be abuse  Moxibustion  Cao Gao  Cupping  Mongolian Spots  Ehler’s Danlos Syndrome

21. TreatmentTreatment  Non-threatening atmosphere & care  Elicit child’s assistance  Maintain honesty with child  Treat injuries as appropriate  Observe family/child interactions

22. Treatment (Continued)  Best Care & Results with:  Sincerity  Compassion  Understanding  Honesty  SMILE

23. ReportingReporting  State Law  Any knowledge or suspicion of abuse/neglect must be reported  Documentation needed  Moral & ethical mores’

24. Reporting (Continued)  Remember the #1 goal is the safety & care of the child  Neglect is fixable with time & help  The process must be started before a positive outcome can be obtained

25. SummarySummary  Child maltreatment  No socio-economic boundaries  National problem  Includes physical, sexual, & psychological  Awareness & sincere concern essential  All responsible for prevention, identification, treatment, & reporting

26. EMSCEMSC “A Child’s Life Depends on It”

27. StaffingStaffing  Principal Investigator  John H Stuemky, MD  Director  Paul F Marmen, MEd, NREMT  Education Coordinator  James H Morehead, BS, NREMT-P

28. LocationLocation Children’s Hospital at OU Medical Center Room 1B 1303, P O Box 26901 940 NE 13 th Street Oklahoma City, OK 73190 Ph: 405-271-3307 Fax: 405-271-8709 E-mail: emsc@ouhsc.edu emsc@ouhsc.edu

29. ResponsibilitiesResponsibilities  Child safety & care  Forging interagency alliances  Education development & implementation  Research  Resource Center