Education for Child Abuse Medical Providers

About : 2008-2009 CHAMP Program Annual Summary

When the legislature did not renew the CHAMP Program’s funding in the spring of 2008, we cut staff and consultant hours and curtailed some of our initiatives in order to extend the remaining money into the 2008-2009 fiscal year. This enabled CHAMP to provide barebones services and educational programs. CHAMP used the remaining OCFS funds and a DOH grant to accomplish the following:

  • The Mentors served as expert resources for CHAMP-trained Providers of sexual abuse evaluations and supported the National Children's Alliance (NCA) standards for medical care
  • The CHAMP Advisory Board convened five teleconferences to discuss NYS child abuse issues and strategize statewide initiatives to improve the medical response to child abuse.
  • Dr. Botash and the CHAMP Advisory Board reviewed and submitted suggestions regarding the 2008 Revised New York State Department of Health Protocol for the Acute Care of the Patient Reporting Sexual Assault and the NYSCASA white paper, Caring for Pediatric Sexual Assault/Abuse in New York State. They also responded to the OCFS request to recommend essential medical components for planning CAC Best Practices.
  • CHAMP maintained its process to recognize medical professionals who meet CHAMP criteria for child abuse experts
  • CHAMP maintained its Mentor and Faculty application process

The CHAMP Program improved the capabilities and competence of the medical services component of NYS MDTs.

  • CHAMP provided four quality assurance learning opportunities using case review sessions to address photographic documentation, lab testing, interpretation, evaluation and treatment. These CME-granting Quarterly Educational Case Reviews used the CHAMP website to support the teleconferences. A total of 93 participants were awarded CME credits: September 4 (23 participants), December 4 (26), April 2 (20) and June 4 (24).
  • October 19 to 21, 2008, Dr. Botash presented at the Northeast Regional National Children’s Alliance Basic Medical Training Academy: Pediatric Sexual and Physical Abuse.
  • On March 10 Dr. Botash presented a one-hour, CME-granting webcast NYS SANE/SAFE Basic Pediatric Skills: Anal Findings in Suspected Child Sexual Abuse. The evaluations were very positive. The intended changes participants listed in the evaluations included better documentation of anal findings, use of photographs, and documenting with drawings. Attendance for the March 10 webcast was 25 participants, with 24 receiving CME credit.
  • On June 11 Dr. Botash presented a one-hour, CME-granting webcast NYS SANE/SAFE Basic Pediatric Skills: STIs: A Bug’s Life in Perspective - HPV. The evaluations were also very positive. The intended changes participants listed in the evaluations included better documentation, more thorough history taking, improved STI testing and treatment, and expanded medical team discussion. Attendance for the June 11 webcast was 37 participants, with 30 receiving CME credit.
  • The CHAMP website posts four Practice Recommendations that were compiled by CHAMP experts During the grant year these evidence-based Practice Recommendations were downloaded a total of 3,163 times: Photographic Documentation (519 times), Testing and Treatment (790), Triage (912) and Skeletal Survey (942).
  • CHAMP also created a pocket guide as a reminder of the Photographic Documentation Practice Recommendations. These were hard laminated and mailed to 64 NYS SAFE/SANEs and 70 CHAMP Providers. The guide was also converted to PDF format and made available through the CHAMP website. Between January and June this pocket guide was downloaded 166 times.
  • CHAMP offered the Evaluating Child Sexual Abuse pre- and post-test on its website The Evaluating Child Sexual Abuse course is the first step in Provider training. The number of pretest takers, 49, exceeded the 39 of last year, which was more than the year before that: July to September (19), October to December (9), January to March (7), April to June (14). The 22 successful post-test takers continued to be mostly from the NYC area: July to September (7), October to December (4), January to March (4), April to June (7).
  • The funding cut eliminated the underwriting of mentorships. As a result, the number of CHAMP-trained Providers affiliated with NYS MDTs and CACs only increased by 1.
  • CHAMP training also extends to medical residents who are in programs taught by Mentors. Residents who complete this program can become CHAMP Providers when they are licensed to practice in NYS by submitting three of their most recent child sexual abuse cases for review by a CHAMP expert. This training combines the Evaluating Child Sexual Abuse coursework with a child abuse rotation. The 10 residents who completed their rotations this grant year reported feeling more comfortable with sexual abuse evaluation and treatment as well as diagnosing and treating STIs. This training is extremely important because no other part of their medical training addresses sexual abuse in any depth.
  • The database that tracks participation, course evaluations and CME surveys was expanded to include the Evaluating Child Sexual Abuse coursework.
  • The final revision for changing Evaluating Child Sexual Abuse from a book to an interactive, online course is in progress.

The CHAMP Program improved the identification of child abuse and the evaluation and treatment of children who are suspected of being abused by providing education to pediatric primary care providers and Emergency Department medical staff and by providing information to professionals working in the area of child abuse.

  • On April 20 Dr. Botash gave a PowerPoint presentation at the statewide CPS Supervisors Meeting in Syracuse. She highlighted standards of care, team models, referrals and case follow-up, and provided information about CHAMP.
  • On April 24 Dr. Botash made a presentation at the NYS Children’s Alliance Annual Meeting in Albany: Why Children and Adolescents Suspected of Being Sexually Abused Need Medical Evaluations. The focus was on standards of medical care, skill training and quality assurance.
  • CHAMP maintained the website that is the site of Child Abuse Evaluation & Treatment for Medical Providers, a comprehensive source of child abuse information. It offers tools and resources with which to diagnose and manage child and adolescent abuse victims. From July 2008 through June 2009 the website averaged nearly 18,000 visitors a month, totaling over 215,000 visitors. Over one million visitors have been on the website since its launch.
  • CHAMP maintained its website The password-protected member side supports the CHAMP Network and the Advisory Board meetings. The public side has over 3,500 visitors a month, totaling nearly 43,000 visitors from July 2008 through June 2009.
  • CHAMP expanded the website’s Resources Section that provides information for professionals who work in the area of child abuse.
  • CHAMP maintained the two free-of-charge courses on its website: Child Abuse Reporting - The Basics and Adolescent Sexual Assault: Consent Issues
  • CHAMP maintained the Observed Structured Clinical Examination (OSCE) learning activity for pediatric, family medicine and emergency medicine residents

2009-2010 Challenges and Recommendations

  • Challenge: In 2010 NYS CACs will need to meet the NCA guidelines for quality assurance. With its 2007-2008 funding, CHAMP developed and tested an educational case review process for Mentors and Providers that meets this requirement. This cost-effective process uses a secure, Internet-based database that is accessed through the CHAMP website. It had to be discontinued because of the funding cut.

    Recommendation: The database and process are still fully functional. If OCFS and the NYS CACs and MDTs created a way for the CACs and MDTs to pay the cost of the case reviews, their medical providers would meet the NCA standard.
  • Challenge: The NYS need for medical providers to be trained in child sexual abuse evaluation has not been met. Not all CACs and MDTs have CHAMP-trained Providers.

    Recommendation: Create a way for CACs and MDTs to underwrite the cost of CHAMP mentorships ($500 per mentorship) and pay the $20 CME fee for the Evaluating Child Sexual Abuse coursework. The course will soon be offered free of charge in an online, interactive format.
  • Challenge: Children are abused in ways other than sexually and by violent assault. A narrow focus on sexual assault means that other abuse is not recognized, treated or reported. In addition, when hospitalized pediatric patients are only screened for physical abuse, sexual abuse is commonly missed.

    Recommendation: Create an assessment checklist to be used by pediatric care providers.
  • Challenge: Have a trained medical response to child sexual abuse that is available 24/7 in NYS.

    Recommendation: Hold a summit meeting for NYS providers to discuss how to work together effectively, clarify roles and NYS licensing limits, discuss quality assurance and identify needed education and training.

2008-2009 CHAMP Program Annual Summary PDF (printer friendly version)