Child Abuse Pediatrics Basic Skills Webcasts

Ann S. Botash, MD, board certified child abuse pediatrician, presented three webcasts: How to Write an Effective Impact Statement on October 6, 2011; What to Do When Sexual Abuse is Suspected in a Pre-Pubertal Child on February 12, 2012; and How the Medical Provider Prepares for Testifying in a Case of Child Sexual Abuse on April 5, 2012. Attendees identified themselves as being physicians and nurse practitioners working in pediatrics, emergency medicine and family medicine; SANE/SART/SAFEs; and non-medical members of multidisciplinary teams. A total of 277 registered for these webcasts. Of those, 162 applied for CME credit. Both the webcasts and CME credits (one credit per webcast) are free. The webcasts bring research-based information to child abuse professional of NYS, draw attention to the most pertinent journal articles on the topic and provide an opportunity for attendees to ask a child abuse expert questions about the topic. Attendees evaluated Dr. Botash as an excellent educator and the content as being clear and helpful. From the responses to the surveys at the end of the webcasts, attendees were going to make significant changes in their practice, including doing more appropriate testing, working more collaboratively with other medical professionals, documenting findings more comprehensively and clearly, and working more closely with other members of their multidisciplinary team.

Quarterly Educational Case Review Webcasts

CHAMP Mentors Jamie Hoffman-Rosenfeld, MD; Ann Lenane, MD; Linda Cahill, MD; and Ann S. Botash, MD, all board certified child abuse pediatricians, presented at four webcasts: Drs. Botash and Hoffman-Rosenfeld on November 8, 2011; Dr. Lenane on December 1, 2011; Drs. Cahill and Lenane on March 8, 2012; and Drs. Lenane and Hoffman-Rosenfeld on May 10, 2012. Attendees identified themselves as being physicians and nurse practitioners working in pediatrics, emergency medicine and family medicine; SANE/SART/SAFEs; and non-medical members of multidisciplinary teams. A total of 307 registered for these webcasts. Of those, 172 applied for CME credit. Both the webcasts and CME credits (one credit per webcast) are free. The webcasts bring research-based information to child abuse professional of NYS, draw attention to the most pertinent journal articles on a topic, and provide an opportunity for attendees to get answers from an expert. In addition, other Mentors attending the webcast contribute relevant information from their own practices. Attendees evaluated the presenters as excellent and the content as being clear and helpful. From the responses to the surveys at the end of the webcasts, attendees were going to make significant changes in their practice, including applying best practices and research-based protocols to their diagnosis and management of cases, taking better histories, recognizing the need to evaluate siblings, applying the test of "Does the history and proposed mechanism of action that caused the injury really fit?" and recognizing there may be crossover of sexual abuse with physical abuse.

The Evaluating Child Sexual Abuse Course

In September Evaluating Child Sexual Abuse, which had been a self-study book with an online pre- and post-test, was launched as an online course that included a 100-question test. Dr. Botash used a grant from the Upstate Children's Miracle Network to revise the course, have it formatted for the web and apply to the American Board of Pediatrics to have the course approved for Maintenance of Certification (MOC) credit. Being online makes the course more accessible and has increased the number of physicians and SANE/SAFEs who have taken the course. Being online has also reduced the cost of becoming a CHAMP Provider because there is no fee for the course, which is the first step in becoming a Provider, and it is no longer necessary to purchase a book. The addition of the MOC credit has increased the number of pediatricians who take the course. Since its launch, 163 professionals have registered for the course; 86 have completed it by passing the test with a score of 80% or better; and 62 have applied for credit. Although the course is free, there is small charge for 12 CME credits and 20 MOC points.

After professionals register for the course, they can use it as a resource. Judging from the number of page views, people are using the course as a resource. In addition, the ECSA course has generated more traffic to the site and increased the number of people taking the other courses offered on the website.

Other CHAMP Website Resources

Dr. Botash used another grant to create the CHAMPprogram.com website feature Test Your Knowledge. It gives child abuse medical professionals an opportunity to evaluate and update their knowledge of 24 common and uncommon conditions that are suspicious for abuse. Visitors to the site read a case, answer a question that tests their knowledge and then read the answer that is based on current research. In addition, professionals can use the cases as a resource by going to a page that lists the cases by diagnosis. During the grant year there was a total of 7,434 visitors to this feature.

This grant year the CHAMP website drew 114,862 visitors, which is over 9,000 visitors a month. It addition to viewing web pages, visitors download a significant number of resources. Tracking the top 150 website downloads this grant year, were 19,309 downloads, which is over 1,600 a month. This includes a total of 3,284 Practice Recommendations relating to Triage, Test and Treatment, Skeletal Survey, and Photographic Documentation.

In addition, ChildAbuseMD.com, the website for the searchable web book Child Abuse Evaluation & Treatment for Medical Providers, had 265,459 visitors this grant year, which is over 22,000 visitors a month.

Since ChildAbuseMD was launched in mid-2005 and CHAMPprogram was launched in mid-2007, there have been nearly two million visitors to the websites.

CHAMP Mentors, Faculty and Providers

CHAMP added a faculty member, Penny Grant, MD, from the Bronx and a Mentor, Alicia Pekarsky, MD, from Syracuse. Both are board certified child abuse pediatricians. As part of their applications, they each had 5 of their cases reviewed by Mentors who were blinded to their identity. This process used the secure, Internet-based CHAMP case database.

Four Providers completed their coursework and mentorship at a CHAMP Center of Excellence. They are Vinod B. Rao, MD, Westchester County; Mary Nivens, MD, Warren/Washington Counties; Andrea Ali-Panzarella, DO, Nassau County; and Rebecca Clausen, NP, Erie County,

This grant year CHAMP added a continuing education requirement that Providers earn three continuing education credits in order to remain on an Active Provider list. These continuing education credits could be earned free of charge by attending CHAMP Child Abuse Pediatrics Basic Skills and Quarterly Educational Case Review webcasts. In addition, instead of attending a webcast, Providers could substitute one of these CHAMP courses offered through the website: Adolescent Sexual Assault: Consent Issues or Fractures and Child Abuse. Despite a series of timely reminders regarding this requirement and upcoming webcasts, only 21 of the 49 Providers met this requirement. The 28 Providers who did not met the requirement will be offered a final chance to remain on the CHAMP Network Active List by taking the online Evaluating Child Sexual Abuse course.

The large number of Providers who did not meet the requirement is disappointing. However, this is the first time since the Provider education program was established in 1998 that there has been a continuing education requirement. This requirement provided a way to determine which Providers are still evaluating child sexual abuse cases. Many of those who did not meet the requirement have moved out of state or have left the child abuse field.

Challenges and Recommendations

Challenge: There is a severe shortage of medical providers who have the training to evaluate and manage child abuse cases. A few years ago there was a flurry of professionals in the New York City area that wanted to become CHAMP Providers as part a program to improve the medical response in Emergency Departments. There has not been a similar program in the rest of the state. The rural areas of New York still have large areas that have few or no medical professionals performing child sexual abuse evaluations. CHAMP has not been able to recruit many new Providers and existing Providers have left the field, as our continuing education requirement demonstrates. Although CHAMP provides an education program, and one that is able to handle many more professionals, incentives or requirements may be needed to attract qualified medical professionals.

Recommendation: Child abuse is ten times more common than children killed or injured in car crashes and forty times more common than children with elevated blood lead levels. If the SDOH would declare child abuse a public health issue, it would draw attention to the issue and stimulate funding that could improve access to a skilled child abuse evaluation.