Pediatric Child Abuse and Neglect Service

Summer 2014

An Overview Duke Children’s Hospital & Health Center, located in Durham, N.C., is ranked among the best children’s hospitals in the Southeast and United States. Child Abuse Pediatricians are responsible for the diagnosis and treatment of children and adolescents who are suspected victims of any form of child maltreatment. This includes physical abuse, sexual abuse, factitious illness (medical child abuse), neglect and psychological/emotional abuse. Child Abuse Pediatricians participate in multidisciplinary collaborative work within the medical, child welfare, law enforcement, and judicial arenas as well as with a variety of community efforts. Child Abuse Pediatricians are often called to provide expert testimony in the court systems. This field offers the opportunity for involvement and leadership roles in community, regional and national advocacy, and in prevention efforts and public policy. Fellowship training includes medical evaluations of children with manifestations of acute and chronic child maltreatment. The trainee develops expertise in determining non-accidental trauma and other forms of maltreatment by developing excellent diagnostic expertise and knowledge of various disorders which may mimic child maltreatment. Training includes mandatory reporting laws, legal proceedings, child abuse and family violence prevention, teaching opportunities, and clinical research. Our team has protected time to develop and disseminate innovative research, program, and policy efforts to improve the care of children. There is a compelling need for improved care for maltreated children. The number of referrals to Child Protective Services has been increasing since 2007. About 723,000 children were maltreated in the US in 2011 and 22,940 were maltreated in NC, not including repeated episodes of maltreatment per child. In 2011, 1,570 children died from abuse and neglect nationally. In Durham County, 43% of children are in poverty, compared to 31% in 2000. North Carolina has the 5th highest unemployment rate in the United States. Social services funding has been reduced, resulting in families losing housing, safe child care, and increasing stressors. These factors are related to higher maltreatment rates for children. In Durham County alone, 174 children per year are in need for medical evaluations for physical abuse. Local child fatality reviewers have identified cases where Child Abuse medical evaluations may have prevented deaths in infants and children in our community. Child Abuse Pediatricians can help address these significant needs. However, there is concern that not enough Child Abuse Pediatricians are available, particularly in North Carolina. Thirty-three percent of Child Abuse Pediatricians are over 55 years in age, while only16% are less than 40 years in age. Only 9-11 new Child Abuse Pediatricians join the work force per year. In addition to workforce attrition through retirement, there are unique stressors and challenges to Child Abuse Pediatricians due to the nature of the job that may accelerate attrition.

The Child Abuse and Neglect team at Duke Children’s Hospital & Health Center is committed to meeting these needs by addressing the following goals: 1. Improve access and consistency of care for children who may be maltreated In our catchment area, there is an identified need to improve access to medical care for children in foster care and out of home placements. Many of these children have had little to no medical care, have multiple chronic health problems, have unmet mental health needs, and have unmet educational needs. Our team collaborates with the community in providing prompt, comprehensive care that successfully links children to needed services, thereby improving health outcomes. This is done through a new comprehensive Foster Care Clinic. Patient populations include the regional Duke catchment area including Durham, Granville, Vance, Person, Wake, Harnett, Orange counties, and referrals from other NC counties and Virginia. 2. Provide high quality, objective child maltreatment assessments and meet workforce concerns Children referred for maltreatment require thoughtful, objective medical evaluations that are patient and family centered. Children can be misdiagnosed by inexperienced providers, resulting in missed cases of abuse or inaccurate identification of abuse. Our team is trained in accurate assessment, and we provide maximized trainings to other providers and learners. Our staff will develop community-based educational series, as well as educational modules for medical providers throughout the state. We will also address the workforce concerns – we plan to recruit fellows who will remain in NC to care for our communities. 3. Connect children and their families with appropriate support Child Abuse medical evaluations are often the first step for maltreated children and their families. If diagnosed with maltreatment, the Child Abuse team connects children with high quality, evidence-based mental health services. These services help children and their families heal and move forward with their lives. Many times, evidence-based therapies are delayed until a comprehensive medical evaluation has been performed. Our team is dedicated to providing prompt care and referrals, while assisting the family navigate complex care systems. 4. Reduce societal and personal health care costs related to maltreatment According to the CDC, children who survive neglect, physical abuse, psychological abuse or sexual abuse cost the country an estimated $210,012 during their lifetimes. One year’s worth of child abuse cases costs $124 billion. An abuse-related death costs the country an estimated $1.27 million. We aim to reduce this burden through prevention efforts. Our staff will develop processes to improve community follow-through and tracking. This effort includes prevention of recurrent abuse through improved information-sharing, collaboration with community agencies. We also focus on primary prevention efforts through improved screening protocols in primary care clinics and outreach.

H o w y o u c an h e l p Duke Children’s Hospital & Health Center are reaching out to families and our community to partner with us by supporting the Child Abuse & Neglect program. We hope you will consider a philanthropic investment in this program.

Thank you so much taking the time to review these documents and for all that you have done in partnership with Duke Children’s and Duke Medicine. If you require any further information, please contact Josh Hewitt, associate director of development, at (919) 385-3134 or [email protected]. Your tax-deductible contribution to this initiative will provide the necessary resources to hire and retain pediatricians that will specialize in Child Abuse Pediatrics.