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 Stacy Morton, BS, NREMT-PStacy Morton, BS, NREMT-P

LocationLocationLocationLocation

Children’s Hospital at OU Medical CenterChildren’s Hospital at OU Medical Center

940 NE 13940 NE 13thth Street, Room 2B 2403 Street, Room 2B 2403

Oklahoma City, OK 73104Oklahoma City, OK 73104

Ph: 405-271-3307Ph: 405-271-3307

Fax: 405-271-2421Fax: 405-271-2421

E-mail: E-mail: emsc@ouhsc.edu

ResponsibilitiesResponsibilitiesResponsibilitiesResponsibilities

Child safety & careChild safety & care

Forging interagency alliancesForging interagency alliances

Education development & implementationEducation development & implementation

ResearchResearch

Resource CenterResource Center