Completed Tasks

Educational Case Review Webcasts

There were six webcasts this grant year: on October 11, November 8, and December 6, 2012; and January 17, February 14, and April 18, 2013. CHAMP Mentors who presented cases included Drs. Ann Botash, Linda Cahill, Jamie Hoffman-Rosenfeld, Lori Legano, Ann Lenane, and Alicia Pekarsky, all American Board of Pediatrics certified child abuse pediatricians. In addition, Mentor Nancy Mitchell, NP, and Provider Danita Curtis, NP, each presented a case. 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, Mentors attending the webcast contribute relevant information from their own practices.

Webcast 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 509 professionals registered for the webcasts. Of those, 332 applied for Continuing Medical Education (CME) credit. Both the webcasts and CME credits (one credit per webcast) are free. 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 planned to make significant changes in their practice, including:

• I will be especially cognizant of the risk of internal injuries in young children with bruising inconsistent with their developmental age.
• Make sure there is no underlying medical condition that may cause skin changes that can be misinterpreted as bruising, hematomas, bite marks, burns, or scratches.
• Test all siblings [for STDs] if one has a positive test.
• Double check method used by lab for sensitivity and specificity.
• Be aware of inflicted vs accidental burn patterns.
• Get all information from all parties and examine the injury to determine if the story and the injury relate.
• Consider evaluation for sexual abuse when child presents with physical abuse.
• Any fracture in an infant is concerning and needs to be evaluated for abuse. Also need to check for retinal hemorrhages.
• Encourage photo documentation at scene of trauma to better judge height of alleged fall, type of floor, etc. May help elucidate inconsistencies in history.
• Remember that signs of abusive head trauma are often subtle and missed, so be alert for sentinel injuries such as facial bruising in an infant.
• Refer more patients to mental health at time of medical exam.
• Recognize that there may be a relationship between social, cognitive, and emotional problems, high risk behavior and health care utilization, and may be associated with adverse childhood experiences. This requires compassion, careful consideration, assessment.

The Evaluating Child Sexual Abuse Course

The online course Evaluating Child Sexual Abuse continues to be an effective educational tool for pediatricians, emergency department physicians, physician’s assistants, nurse practitioners and SANEs. This grant year 154 professionals registered for the course. By June 30, 79 had passed the 100-question test that is part of the course. Of those, 42 applied for CME credit and 41 applied for American Board of Pediatrics Maintenance of Certification (MOC) credit. Although the course is free, there is small charge for the 12 CME credits and 20 MOC points. From the launch of the course in September 2011 through June 2013, 317 professionals had registered for the course and 165 had passed the test, with 104 applying for credit.

Dorothy Shuldman, an Upstate MPH student who did her Capstone Policy Project with CHAMP, emailed surveys to over 250 ECSA registrants. She received only 32 responses; 21 respondents had completed the course and 11 had not. (We consider a registrant a non-completer if that person doesn't take or pass the 100-question test.) Although the response was not large enough to draw definitive conclusions, we learned that 71% of those who completed the course, and 36% of those that did not, reported changes they made in their practice. In addition, 71% of the completers and 72% of the non-completers continue use the course as a resource. Ninety percent of the non-completers and all the completers have recommended the course to others.

Other CHAMP Website Resources

This grant year the CHAMPprogram.com website drew over 122,000 visitors. That is 7,500 more visitors than last year. It addition to viewing web pages, visitors download a significant number of resources. Tracking the top 150 website downloads each month, there were over 25,000 downloads, an increase of 6,000 downloads over last year. That total includes 3,500 Practice Recommendations relating to Triage, Testing and Treatment, Skeletal Survey, and Photographic Documentation. This is a slight increase over last year.

In addition, the ChildAbuseMD.com website that posts the searchable webbook, Child Abuse Evaluation & Treatment for Medical Providers, had over 282,600 visitors this grant year. This is an increase of more than 17,000 visitors over the number of visitors last grant year.

Since ChildAbuseMD.com was launched in mid-2005 and CHAMPprogram.com was launched in mid-2007, there have been over 2,400,000 visitors to the websites.

CHAMP Providers

This grant year six medical professionals became Providers by successfully passing the Evaluating Child Sexual Abuse course and a completing a mentorship at a CHAMP Center of Excellence. Their names were added to the roster of Active CHAMP Providers. They are John Juriga, MD, Chemung County; Angela Silvernail, NP, Otsego County; Janice Bach, MD, Madison County; Andrea Ali-Panzarella, DO, Nassau County; Andrea Kulp, NP, Ontario County; and Joseph Wetterhahn, MD, Jefferson County. The Mentors who provided the mentorships were Ann Lenane, MD, at the REACH program in Rochester; Jamie Hoffman-Rosenfeld, MD, at Queens Child Advocacy Center and Ann Botash, MD, Alicia Pekarsky, MD, and Nancy Mitchell, NP, at the CARE program in Syracuse.

In addition, Linda Cahill, MD, at the J.E. and Z.B. Butler Child Advocacy Center of the Children’s Hospital at Montefiore had seven residents complete the CHAMP Residency Training Program. Residents who complete this program can become CHAMP Providers when they are licensed to practice in NYS by submitting three of their recent child sexual abuse cases for review by a CHAMP expert

Last 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 educational webcasts. At the beginning of this grant year there were 30 Active CHAMP Providers who needed to meet the requirement. The Active Providers who did not complete the continuing education webcast requirement were given the opportunity to meet the requirement by passing the online ECSA course. On June 30, 2013, there were 29 Active CHAMP Providers.

Recommendation

With the American Board of Pediatrics child abuse pediatrics certification, there is now a national standard for child abuse medical experts. This standard has illuminated the fact that there is a drastic shortage of child abuse experts in New York State. To best serve children who may be victims of child abuse there needs to be a system of care that includes primary pediatric and emergency physicians who can identify the possibility of abuse and refer these children to expert care and services provided by child advocacy centers. To achieve this, medical providers need easily accessed and cost-effective education regarding appropriate diagnosis, management and referral of suspected child abuse cases. It will also require the other professions who provide services to children suspected of being abused to understand and support the need for skilled medical evaluation of these children.

It would be a major positive step toward this goal if The New York State Department of Health and the Office of Children and Family Services jointly encouraged pediatric providers and emergency medicine physicians to get education in the triage and management of suspected child abuse and created incentives for CACs to employ or create an affiliation with a child abuse pediatrician.