Recognition, Care, and Recognition, Care, and Reporting of Child Reporting of Child
MaltreatmentMaltreatment
Recognition, Care, and Recognition, Care, and Reporting of Child Reporting of Child
MaltreatmentMaltreatment
Presented by the:Presented by the:
Oklahoma EMSC Resource CenterOklahoma EMSC Resource Center
Objectives:Objectives:Objectives:Objectives:• Describe the size and scope of Child Describe the size and scope of Child
Maltreatment in the US.Maltreatment in the US.
• Describe the size and scope of Child Describe the size and scope of Child Maltreatment in Oklahoma.Maltreatment in Oklahoma.
• Identify the types of maltreatment and patterns Identify the types of maltreatment and patterns commonly found associated to each type.commonly found associated to each type.
• Describe the “Roles and Responsibilities” of the Describe the “Roles and Responsibilities” of the EMS Provider regarding prevention, EMS Provider regarding prevention, identification, treatment, and reporting of child identification, treatment, and reporting of child maltreatment.maltreatment.
Scope of the ProblemScope of the ProblemScope of the ProblemScope of the Problem
NATIONALLYNATIONALLY
1 million actual cases annually 1 million actual cases annually ((50% physical 50% physical abuse / 25% neglectabuse / 25% neglect))
Approximately 1300 deaths/year Approximately 1300 deaths/year ((Physical AbusePhysical Abuse))
90% deaths occur children 90% deaths occur children <<5 years age5 years age
40% deaths 240% deaths 2° to neglect° to neglect
Scope of the ProblemScope of the ProblemScope of the ProblemScope of the Problem
OKLAHOMAOKLAHOMA
53,548 cases Reported in 200053,548 cases Reported in 2000
14,273 cases were confirmed 14,273 cases were confirmed ((23%23%))
48 deaths48 deaths
Oklahoma and Tulsa counties have the Oklahoma and Tulsa counties have the highest rates. highest rates. ((populationpopulation))
Source: Oklahoma Source: Oklahoma Department of Human Department of Human Services. 2000 ReportServices. 2000 Report
Types of MaltreatmentTypes of MaltreatmentTypes of MaltreatmentTypes of Maltreatment
PhysicalPhysical
Emotional/PsychologicalEmotional/Psychological
SexualSexual
NeglectNeglect
Physical AbusePhysical AbusePhysical AbusePhysical Abuse
DEFINITIONDEFINITION
An inflicted act that results in a significant An inflicted act that results in a significant physical injury or the risk of such injuryphysical injury or the risk of such injury
Most states:Most states:
Child welfare system concerned with acts by Child welfare system concerned with acts by parents or caregiversparents or caregivers
Physical assaults by others addressed by law Physical assaults by others addressed by law enforcementenforcement Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000
Psychological MaltreatmentPsychological MaltreatmentPsychological MaltreatmentPsychological Maltreatment
DEFINITIONDEFINITION A repeated pattern of caregiver behavior or A repeated pattern of caregiver behavior or
extreme incident(s) that convey to children extreme incident(s) that convey to children that they are worthless, flawed, unloved, that they are worthless, flawed, unloved, unwanted, endangered, or only of value in unwanted, endangered, or only of value in meeting another’s need.meeting another’s need.
American Professional Society on Abuse of Children 1995American Professional Society on Abuse of Children 1995
Sexual AbuseSexual AbuseSexual AbuseSexual Abuse
General term referring to nonconsensual General term referring to nonconsensual sexual acts, sexually motivated behaviors sexual acts, sexually motivated behaviors involving children, or sexual exploitation of involving children, or sexual exploitation of children.children.
Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000
State & Federal criminal statues define State & Federal criminal statues define sexual behavior that is illegalsexual behavior that is illegal
PEARLPEARL: STD’s are just that and should not : STD’s are just that and should not occur in childrenoccur in children
Child NeglectChild NeglectChild NeglectChild Neglect
DEFINITIONDEFINITION Omissions in care resulting in significant Omissions in care resulting in significant
harm or risk of significant harm to childrenharm or risk of significant harm to children HygieneHygiene NutritionNutrition ProtectionProtection ShelterShelter SupervisionSupervision Medical CareMedical Care
Positive impact made when suspicions Positive impact made when suspicions reportedreported
Roles & ResponsibilitiesRoles & ResponsibilitiesRoles & ResponsibilitiesRoles & Responsibilities
PreventionPrevention
IdentificationIdentification
TreatmentTreatment
ReportingReporting
PreventionPreventionPreventionPrevention
Educational AwarenessEducational Awareness
Educating all ages = Public AwarenessEducating all ages = Public Awareness
Educating Healthcare Providers = AwarenessEducating Healthcare Providers = Awareness
Remain alert to possible abuse conditions & Remain alert to possible abuse conditions & situationssituations
Make proper agencies aware for assistance Make proper agencies aware for assistance to be provided prior to abuse happeningto be provided prior to abuse happening
IdentificationIdentificationIdentificationIdentification
Awareness & ObservationAwareness & Observation Look at theLook at the
EnvironmentEnvironment Child & InjuryChild & Injury ParentsParents SituationSituation
Listen to everything comprehensivelyListen to everything comprehensively
Does everything seen, heard, smelled, felt, Does everything seen, heard, smelled, felt, etc make senseetc make sense??
Identification Identification ((ContinuedContinued))Identification Identification ((ContinuedContinued))
Perform AssessmentPerform Assessment InitialInitial
A-B-C’sA-B-C’s Correct Problems as DiscoveredCorrect Problems as Discovered
History History (HX)(HX) Does Hx & mechanism of injury equate to child’s Does Hx & mechanism of injury equate to child’s
age-related developmental stageage-related developmental stage
Identification Identification ((ContinuedContinued))Identification Identification ((ContinuedContinued))
Toe to Head ExamToe to Head Exam DD = Deformity = Deformity CC = Contusions = Contusions AA = Abrasions = Abrasions PP = Punctures = Punctures BB = Burns = Burns TT = Tenderness = Tenderness LL = Lacerations = Lacerations SS = Swelling = Swelling
Identification Identification ((ContinuedContinued))Identification Identification ((ContinuedContinued))
Avoid ConfrontationAvoid Confrontation
Document Information GatheredDocument Information Gathered
Obtain Hx from Everyone PresentObtain Hx from Everyone Present
Be non-judgmental with entire demeanorBe non-judgmental with entire demeanor
LISTEN, LISTEN, LISTENLISTEN, LISTEN, LISTEN
Be child’s safety advocate!Be child’s safety advocate!
Identification Identification ((ContinuedContinued))Identification Identification ((ContinuedContinued))
SkinSkin Pattern MarksPattern Marks BurnsBurns
EcchymosesEcchymoses Bruising colors & locationsBruising colors & locations
Head, Face, Eyes, Ears, Nose, Mouth, & Head, Face, Eyes, Ears, Nose, Mouth, & NeckNeck
Identification Identification ((ContinuedContinued))Identification Identification ((ContinuedContinued))
Pattern MarksPattern Marks
Electric CordElectric Cord
Ligature RestraintsLigature Restraints
Unknown CausesUnknown Causes
Identification Identification ((ContinuedContinued))Identification Identification ((ContinuedContinued))
BurnsBurns
ImmersionImmersion
StockingStocking
TobaccoTobacco
Burns to HandsBurns to Hands
Identification Identification ((ContinuedContinued))Identification Identification ((ContinuedContinued))
EarsEars
MouthMouth
NeckNeck
EyesEyes
ScalpScalp
Identification Identification ((ContinuedContinued))Identification Identification ((ContinuedContinued))
May not be abuseMay not be abuse MoxibustionMoxibustion
Cao GaoCao Gao
CuppingCupping
Mongolian SpotsMongolian Spots
Ehler’s Danlos SyndromeEhler’s Danlos Syndrome
TreatmentTreatmentTreatmentTreatment
Non-threatening atmosphere & careNon-threatening atmosphere & care
Elicit child’s assistanceElicit child’s assistance
Maintain honesty with childMaintain honesty with child
Treat injuries as appropriateTreat injuries as appropriate
Observe family/child interactionsObserve family/child interactions
Treatment Treatment ((ContinuedContinued))Treatment Treatment ((ContinuedContinued))
Best Care & Results with:Best Care & Results with:
SinceritySincerity
CompassionCompassion
UnderstandingUnderstanding
HonestyHonesty
SMILESMILE
ReportingReportingReportingReporting
State LawState Law
Any knowledge or suspicion of abuse/neglect Any knowledge or suspicion of abuse/neglect must be reportedmust be reported
Documentation neededDocumentation needed
Moral & ethical mores’Moral & ethical mores’
Reporting Reporting ((ContinuedContinued))Reporting Reporting ((ContinuedContinued))
Remember the #1 goal is the safety & care Remember the #1 goal is the safety & care of the childof the child
Neglect is fixable with time & helpNeglect is fixable with time & help
The process must be started before a The process must be started before a positive outcome can be obtainedpositive outcome can be obtained
SummarySummarySummarySummary
Child maltreatmentChild maltreatment
No socio-economic boundariesNo socio-economic boundaries
National problemNational problem
Includes physical, sexual, & psychologicalIncludes physical, sexual, & psychological
Awareness & sincere concern essentialAwareness & sincere concern essential
All responsible for prevention, identification, All responsible for prevention, identification, treatment, & reportingtreatment, & reporting
EMSCEMSCEMSCEMSC
““A Child’s Life Depends on It”A Child’s Life Depends on It”
StaffingStaffingStaffingStaffing
Principal InvestigatorPrincipal Investigator John H Stuemky, MDJohn H Stuemky, MD
DirectorDirector Paul F Marmen, MEd, NREMTPaul F Marmen, MEd, NREMT
Education CoordinatorEducation Coordinator James H Morehead, BS, NREMT-PJames H Morehead, BS, NREMT-P
LocationLocationLocationLocation
Children’s Hospital at OU Medical CenterChildren’s Hospital at OU Medical Center
Room 1B 1303, P O Box 26901Room 1B 1303, P O Box 26901
940 NE 13940 NE 13thth Street Street
Oklahoma City, OK 73190Oklahoma City, OK 73190
Ph: 405-271-3307Ph: 405-271-3307
Fax: 405-271-8709Fax: 405-271-8709
E-mail: E-mail: [email protected]@ouhsc.edu
ResponsibilitiesResponsibilitiesResponsibilitiesResponsibilities
Child safety & careChild safety & care
Forging interagency alliancesForging interagency alliances
Education development & implementationEducation development & implementation
ResearchResearch
Resource CenterResource Center