Webcast Education

• On October 22, 2009, Ann Botash, MD, presented a one-hour, CME-granting NYS SANE/SAFE Basic Pediatric Skills webcast, STIs: A Bug’s Life in Perspective — Herpes. The evaluations were very positive. The intended changes participants listed in the evaluations included: know how to manage a case of herpes and when to report; culture lesions and improve documentation of lesions; make sure to obtain HSV culture of any genital lesion for definitive diagnosis; do not send serological testing on children for HSV unless there is a really, really good reason to do so; and use greater caution when interpreting serology results in peds. There have been over 300 downloads of the handouts for this session.
• On December 10, 2009, Jamie Hoffman-Rosenfeld, MD, presented a one-hour, CME-granting NYS SANE/SAFE Basic Pediatric Skills webcast, Assessing Bruises in Children. The evaluations were also very positive. The intended changes participants listed in the evaluations included: evaluate body areas typically injured during abuse, even if no complaints are presented; take off all clothing when examining a child; I will be better able to document cases of bruising; will be able to order imaging studies more appropriately; more comfortable in assessing bruising and its physiology related to different types of injury.
• On March 4, 2010, Dr. Alicia Pekarsky, board certified Child Abuse Pediatrician, presented a one-hour, CME-granting NYS SANE/SAFE Basic Pediatric Skills webcast, The Myths and Mimics of Child Abuse. The evaluations were extremely positive. The intended changes participants listed in the evaluations included: remember to consider cultural practices when suspicious of abuse; document normal and abnormal physical assessment; never attempt to date a bruise; and seek more child abuse courses. Participation for the March 4 webcast resulted in 32 CME credit awards. Through June 30, 259 copies of the session handout have been downloaded from the CHAMP website.
• On June 9, 2010, Dr. Botash, board certified Child Abuse Pediatrician, presented a one-hour, CME-granting NYS SANE/SAFE Basic Pediatric Skills webcast, Ethical Challenges in Responding to Child Abuse. The evaluations were again very positive. The intended changes participants listed in the evaluations included: careful review of ethical dilemmas that one may confront as they communicate with minor children, parents, CPS and police; careful consideration and documentation of types of consent; and documentation of mature minor status. Registration for the June 9 webcast was 53 with 19 CME credit awards. Through June 30, 69 copies of the session handout have been downloaded from the CHAMP website.

Presentations for Other Child Abuse Team Members

• On April 15 Dr. Botash presented Responding to Child Abuse and Neglect: The Role of the Nurse at Upstate Medical University Nursing Grand Rounds. Forty-one participants received continuing education credit for attendance.

Quality Assurance

• CHAMP provided four quality assurance learning opportunities using case review sessions with detailed discussion regarding photographic documentation, lab testing, interpretation, evaluation and treatment. These CME-granting CHAMP Quarterly Educational Case Reviews use the CHAMPprogram.com website to support the teleconferences. A total of 126 participants were awarded CME credits: October 1 (24 participants), December 3 (31), February 11 (35), and April 29 (36). Beginning with the December 3 session, presenters created a handout regarding the health issue or diagnosis of the case they presented. We began tracking the downloads of these handouts on April 1. Through June 30, 258 handouts from the December 3 session have been downloaded; 169 handouts from the February 11 session; and 136 handouts from the April 29 session. This demonstrates that health professionals are eager to learn about the issues they confront when diagnosing and treating suspected abuse.

Evaluating Child Sexual Abuse (ECSA) Coursework and Training for Medical Residents

• The number of Evaluating Child Sexual Abuse (ECSA) course pretest takers was 37: July to September (10), October to December (8), January to March (8), April to June (12). The 45 post-test takers continued to be mostly from the NYC area: July to September (15), October to December (11), January to March (10), April to June (9). The number of CHAMP mentorships has dwindled, partly due to funding problems that included a lack of money for mentorship stipends. Six new CHAMP Providers are from the following counties: Albany, Broome, Schenectady, New York, Saratoga and Columbia.
• CHAMP training was extended 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 ECSA coursework with a child abuse rotation. The 11 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 education is extremely important because no other part of their medical training addresses sexual abuse in any depth.

Ongoing Organization Work

• The CHAMP Program Manager responded to statewide inquiries by mail, email and telephone and supported applicants for CHAMP training and education, including awarding CME credit, working with SUNY Upstate IT to produce the Quarterly Educational Case Reviews and webcasts and facilitating electronic communication among the Mentors using GoToMeeting.

The CHAMP Mentors improved the capabilities and competence of the medical services of NYS MDTs by writing Practice Recommendations.

• This grant year CHAMP focused on improving photographic documentation of child abuse cases in order to improve the consistency and quality of the medical response to suspected child abuse and to facilitate accurate interpretation by experts. The CHAMP Practice Recommendations for Photographic Documentation were posted on the CHAMPprogram.com website and referenced during CHAMP webcasts as a resource. The number of downloads from July to December 2009 was 289. The number of downloads from January to June was 252, for a total of 541 downloads for the grant year.
• CHAMP also created a "pocket guide" as a reminder of the Photographic Documentation Practice Recommendations. The guide is available in PDF format through the CHAMP website. Between July and December this pocket guide was downloaded 189 times. Between January and June 30, 182 copies were downloaded, for a total of 371 for the grant year.
• CHAMP’s three other research-based, expert-reviewed Practice Recommendations (Testing and Treatment, Triage and Skeletal Survey) are also available on the CHAMP website. During the grant year these three Practice Recommendations were downloaded a total of 2,285 times: Testing and Treatment (765), Triage (664), Skeletal Survey (856).

Challenges and Recommendations

• 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: When caring for suspected child sexual abuse, there is need for a standardized system of response and quality assurance through peer review.
  
  Recommendation: Continue building CHAMP’s ability to provide statewide education, training and quality assurance. The CHAMP educational case review system for the purpose of quality assurance has been developed, tested and finalized. It only lacks funding to implement it.
• Challenge: The nearly 70,000 visitors to CHAMPprogram.com and over 235,000 visitors to ChildAbuseMD.com this grant year demonstrate the effectiveness of online educational resources. The challenge is to expand these resources to better fill the educational needs of medical professionals and improve the acceptance of the medical professionals as part of multidisciplinary teams.
  
  Recommendation: Hold a summit meeting for NYS providers to discuss how to better work within multidisciplinary teams and to identify education, training and quality assurance needs as well as ways to fund them.
• Challenge: There need to be guidelines and standards for the provision of child sexual abuse medical services with regard to billing, laboratory use, office structure, staffing and other health care business issues for the outpatient setting. Although CHAMP trains medical providers, it doesn’t have the resources to consult with child advocacy centers (CACs) and multidisciplinary teams that want to add a medical provider and need guidance regarding establishing medical services.
  
  Recommendation: With the establishment of guidelines and DOH support, CHAMP could consult with CACs and multidisciplinary teams to help them establish their medical services.