Webcast Education

• On October 7, 2010, Ann Botash, MD, board certified Child Abuse Pediatrician, presented the grant year's first one-hour, CME-granting, NYS Child Abuse Pediatrics Basic Skills webcast, What to Do When Sexual Abuse is Suspected in a Pre-pubertal Child. Handouts included a checklist for what to do when sexual abuse is suspected in a pre-pubertal child. The evaluations were very positive and included requests to continue to offer webcasts. Among the intended changes participants listed in the evaluations: take a complete history, teach primary care providers to triage suspected cases of child sexual abuse and to avoid conducting repeated examinations, use the printed guidelines for testing and follow-up, refer my colleagues to the documentation page of the website, provide my colleagues with reference materials to support SA (sexual abuse) exam protocols, and pursue CHAMP training. A comment that demonstrates the importance of providing education through webcasts was: "I thought the program was terrific – a good review and always good for those of us ‘loners’ in the rural areas to see hymen shots and compare interpretation." Registration for the October 7 webcast was 77 with 43 receiving CME credit. There have been over 610 downloads of the handouts for this session (214 downloads of the PowerPoint and 396 downloads of the Sexual Abuse Evaluations checklist).
• On December 2, 2010, Ann Botash, MD, presented the second one-hour, CME-granting NYS Child Abuse Pediatrics Basic Skills webcast, Suspecting Child Sexual Abuse When There is Severe Physical Abuse. Handouts included a checklist for what to do before calling a child abuse expert when physical abuse is suspected in a child under 2 years old. The evaluations were very positive. The intended changes participants listed in the evaluations included: will review handout information with nurses during staff meetings regarding physical/sexual abuse, be more suspicious of sexual abuse when a child presents with physical abuse, broaden my exam to include a thorough review of the genitalia when evaluating a child for physical abuse, broaden history to check for signs and symptoms of abuse if any suspicion, and start work-up/evidence collection as soon as possible. Registration for the December 2 webcast was 71 with 41 receiving CME credit. There have been over 539 downloads of the handouts for this session (157 downloads of the PowerPoint and 382 downloads of the Physical Abuse Evaluations checklist).
• On February 10, 2011, Ann Botash, MD, presented the third one-hour, CME-granting NYS Child Abuse Pediatrics Basic Skills webcast, What’s New, What’s Old in Sexual Abuse: A Literature Review. The evaluations were extremely positive. The intended changes listed in the returned evaluations included: I will be sure to use the new terminology in documentation, we will be using these articles to review and discuss at Forensic Literature Club, incorporate the useful reminder that history of abuse is the single most important finding in child sexual abuse evaluation, clearly understand how to document findings of medical exam, and use cited articles in court testimony. Registration for the February 10 webcast was 68 with 40 receiving CME credit. Through June 30, 316 copies of the session handouts have been downloaded from the CHAMP website (180 of the PowerPoint and 136 of What’s New references).
• On April 21, 2011, Dr. Botash presented the fourth one-hour, CME-granting NYS Child Abuse Pediatrics Basic Skills webcast, Fractures and Child Abuse. The evaluations were very positive. The intended changes participants listed in the evaluations included: I will utilize the What to do before you call a child abuse expert when physical abuse is suspected in a child under 2 years old tool and I will get more in depth history of injuries. Registration for the April 21 webcast was 69 with 43 receiving CME credit. Through June 30, 265 copies of the session handouts have been downloaded from the CHAMP website (185 of the PowerPoint and 80 of the Fractures References).
• Utilizing a grant to provide regional conferences, Dr. Botash used a webcast to simultaneously speak to an assembled group as well as to those who registered for this bonus webcast. On May 4, 2011, Dr. Botash presented a one-hour, CME-granting webcast Solving a Mystery of Child Sexual Abuse: The Roles of the Clinician and CPS. The evaluations were very positive. The intended changes listed in the participants’ evaluations include: will include points from this lecture in teaching medical residents and trainings, incorporate similar algorithm for emergent/urgent/important scheduling, better understanding of how to triage suspected child abuse victims, utilize top 10 reasons why children need medical evaluations when suspected of sexual abuse, and be aware of mimics of child abuse. Registrations for the May 4 webcast totaled 79 with 49 receiving CME credit. Downloads of the PowerPoint handout total 148.

Presentations for Other Child Abuse Team Members

• On March 2, Dr. Botash presented Fractured Fairy Tales at Upstate Medical University Pediatric Grand Rounds. On September 15, Dr. Botash presented What the Clinician Needs to Know about an Abused Child to the Pediatric Emergency Medicine Assembly. Dr. Botash presented Solving a Mystery of Child Sexual Abuse: The Roles of the Clinician and CPS at three regional locations: October 14 at Cortland MTD, December 8 at McMahon/Ryan Child Advocacy Site in Syracuse, and April 12 at Bassett Grand Rounds in Cooperstown.

Quality Assurance

• CHAMP provided four quality assurance learning opportunities using case review sessions as the basis for detailed discussion regarding differentiating between normal and abnormal child abuse examination findings, identifying the key factors for quality documentation of child abuse cases and identifying appropriate testing and treatment when child abuse is suspected. Out of 263 registrations, a total of 144 participants were awarded CME credits: September 21 (32 participants); November 2 (19); January 13 (52); and March 10 (41). The presenters each created a handout regarding the health concern or diagnosis of the case they presented. We have tracked the downloads of these handouts. Through June 30, 379 handouts from the September 21 session have been downloaded; 367 handouts from the November 2 session; 353 handouts from the January 13 session; and 117 handouts from the March 10 session. This demonstrates that health professionals are eager to learn about the issues they confront when diagnosing and treating suspected abuse. Like with the handouts for the Basic Skills webcasts, the handouts for the Quarterly Reviews become resources for professionals who were not able to attend the webcast.

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

• The number of Evaluating Child Sexual Abuse (ECSA) course pretest takers was 24: July to September (5), October to December (9), January to March (6), April to June (4). The 24 post-test takers continued to be mostly from the NYC area. The number of CHAMP mentorships has dwindled, partly due to funding problems that included a lack of money for mentorship stipends. There were six CHAMP Providers trained this grant year. They are from the following counties: Schenectady, Westchester, Chautauqua, Rockland and Orange.
• 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 ECSA coursework with a child abuse rotation. The 15 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. One resident commented, "This was a very educational elective and is absolutely necessary for anyone practicing medicine, not just pediatrics."

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 website, CHAMPprogram.com, provides convenient, time-efficient and cost-effective professional education and networking. It also supports the visual component of the CHAMP Advisory Board meetings, Quarterly Educational Case Reviews and webcasts; enables online registration for coursework and webcasts; and posts and archives handouts and reference materials. Each month there are over 2,000 downloads of the information posted on the website. Visitors to the website totaled 108,560 for the grant year.
• The other website created by Dr. Botash, ChildAbuseMD.com, provides a comprehensive source of child abuse information with tools and resources with which to diagnose and manage child and adolescent abuse victims. It is a resource for medical providers who do not have a background or expertise in child abuse pediatrics and are striving to develop best practice standards for their patient care setting. Website visitors totaled 217,329 for this grant year.

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

• The CHAMP website provides four research-based, expert-reviewed Practice Recommendations and a pocket guide for photographic documentation. Downloads of these documents for the grant year totaled 3,187 (Photographic Documentation, 528; Photographic Documentation pocket guide, 372; Testing & Treatment, 691; Skeletal Survey, 887; Triage, 709).
• This grant year Dr. Botash and Child Abuse Referral and Evaluation (CARE) Program at Golisano Children's Hospital developed best practices procedural checklists for physical and sexual abuse to help pediatric medical providers and Emergency Department staffs provide appropriate care when child abuse is suspected. They were first introduced in the Basic Skills webcasts presented by Dr. Botash in October and December 2010. These evaluation checklists are also available from the Resources for Professionals area of CHAMP website. Through June 30, there have been 382 downloads of What to do before you call a child abuse expert when physical abuse is suspected in a child under 2 years old and 396 downloads of What to do when sexual abuse is suspected in a prepubertal child.

Challenges and Recommendations

• Challenge: CHAMP training to become a Provider is done through a CME-granting educational process. Many, but not all, of the Providers attend the CHAMP Basic Skills and Quarterly Review webcasts. To better assure that Providers continue to learn and update their knowledge, there needs to be requirement that Providers obtain continuing education on a yearly basis and CHAMP needs to provide educational opportunities that are easy-to-access and free of charge for the Provider.
  
  Recommendation: CHAMP can use some of the resources of its website to create a system of required continuing education opportunities using the webcasts and online coursework as the platform for providing the education. It can also explore ways to increase access to child abuse experts by creating activities that foster less-formal sharing of information and concerns between the Providers and CHAMP Mentors.
• Challenge: General pediatric care providers and Emergency Department staff do not necessarily know how to best diagnose and manage suspected child abuse. The Internet provides a cost-effective way to reach a great number of people and make educational materials available 24/7. CHAMP could help address this need by increasing its profile as a source of child abuse education.
  
  Recommendation: Making the Evaluating Child Sexual Abuse course Internet based and applying to have the course designated as a Maintenance of Certification activity by the American Board of Pediatrics is the first step in enhancing the appeal of coursework for these pediatric medical professionals. CHAMP secured funding to put the Evaluating Child Sexual Abuse course online. It has also secured a grant to apply to the American Board of Pediatrics to have the course accepted as a Maintenance of Certification educational opportunity. Once the ECSA is fully functional as an online course, CHAMP can seek additional funding to make the other short courses already on the website as well as yet-to-be-developed courses designated as MOC activities in addition to applying for continuing medical education (CME) credit.