Completed Tasks

Educational Webcasts

There were six CHAMP webcasts this grant year:

1. October 14, 2020 — The Impact of COVID-19 on Child Health & Safety, presented by Stephanie A. Deutsch, MD
2. November 18, 2020 — Race and Bias in Child Abuse Diagnosis and Reporting, presented by Vincent J. Palusci, MD, MS, FAAP, and Ann S. Botash, MD
3. December 9, 2020 — Sexually Transmitted Infections and Child Sexual Abuse: A Case Based Discussion, presented by Lori Legano, MD, Ann Lenane, MD, and Madeline Mineo, DO
4. January 13, 2021 — Levels of Certainty for Physical Abuse: What Do Our Words Mean?, facilitated by Ann S. Botash, MD, with case presentations by Jamie Hoffman-Rosenfeld, MD, Dana Kaplan, MD, Lori Legano, MD, Alicia Pekarsky, MD, and Ingrid Walker-Descartes, MD
5. February 10, 2021 — Variability in Use of Telemedicine for Child Abuse Evaluations Since the COVID 19 Pandemic: Some Lessons Learned for Trauma-Sensitive Practice, presented by Mandy O’Hara, MD, MPH, FAAP
6. March 10, 2021 — Pediatric Approach to Childhood Trauma and Resilience, presented by Moira Szilagyi, MD, PhD, FAAP

Drs. Deutsch and Szilagyi are nationally renowned experts in child abuse pediatrics. Drs. Botash, Hoffman-Rosenfeld, Kaplan, Legano, Lenane, Palusci, Pekarsky, O’Hara and Walker-Descartes are CHAMP Mentors at Centers of Excellence and nationally recognized American Board of Pediatrics certified child abuse pediatricians. Dr. Mineo is a child abuse pediatrics fellow in her 2^nd year of training at Maimonides Medical Center. In addition, Hanna Swerdin, a 2nd-year medical student at SUNY Upstate, contributed to the data graphics for the February webcast. All webcasts bring research-based information to the child abuse professionals of NYS and provide an opportunity for attendees to get answers from an expert.

Webcast attendees identified themselves as being physicians, nurse practitioners, physician assistants and registered nurses working in pediatrics, emergency medicine and family medicine, many with SANE/SART/SAFE designation, and also social workers and non-medical members of multidisciplinary teams. There was a total of 1,290 registrants for the webcasts. Of those who registered, 529 applied for Continuing Medical Education (CME) credit. This is a 34% and 40% increase, respectively, over last year. Both the webcasts and CME credits (one credit per webcast) are free to participants.

Attendees evaluated all webcast 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:

• Recognizing the connection between COVID-19 and ACEs
• Increased understanding that the strain of COVID has a continuum of effects
• Awareness of the different types of biases and how they can relate to child abuse cases
• Encourage discussing/reflect on potential bias in multidisciplinary team meetings
• Develop a plan to confirm positive NAAT result
• There are tools to help with decision making (AHT Probability Calculator)
• Utilizing PediBIRN decision guide
• Recognition of injury and fractures that indicate need for skeletal surveys
• May present some information to upper management to see if we can extend telemedicine abilities
• Create a policy on telemedicine visits for child abuse evaluation
• Remembering THREADS for every patient
• Look into the PATTER program for our team
• Recognize importance of caregiver in promoting resilience
• I will look into screening for emotional trauma when I have a patient with behavioral issues

The Evaluating Child Sexual Abuse Course

The online course Evaluating Child Sexual Abuse (ECSA) continues to be an effective educational tool for pediatricians, emergency department physicians, physician assistants, nurse practitioners and SANEs. This grant year 159 professionals registered for the course. By June 30, 77 had passed the 100-question test. Of those who passed the test, 11 applied for and received CME credit and 2 applied for Maintenance of Certification (MOC) credit. Although the course is free, there is nominal charge for the 12 CME credits and 12 ABP MOC points.

The ECSA course was originally created to be the first step for New York State medical professionals to become CHAMP Network Members. Its use has expanded to being part of child abuse training for medical residents, fellows and self-preparation for certification examinations. Nineteen trainees from St. Joseph’s Hospital Health Center and SUNY Upstate Medical University, Syracuse, NY, including family medicine residents, pediatric residents and a pediatric emergency medicine fellow completed ECSA as a part of their rotation in child abuse with CARE clinic this year.

From the launch of the course in September 2011 through June 2021, there have been 1,676 registrants. Of those, 810 have passed the test and 332 have applied for and received CME credit.

Other CHAMP Website Resources

This grant year the CHAMPprogram.com website drew over 307,000 visitors. In addition to viewing web pages, visitors downloaded a significant number of resources. Tracking the number of downloads from the top 150 resources offered on the website, there were over 28,000 downloads. That total includes over 3,200 Practice Recommendations related to Triage, Testing and Treatment, Skeletal Survey, Photographic Documentation and Writing an Impact Statement; and over 1,700 Guidelines related to Evaluation of Physical Abuse, Evaluation of Sexual Abuse and Trauma-Informed Care. The 24 questions and answers of Test Your Knowledge were visited over 63,000 times and the individual questions and answers of What Would You Do? regarding nine child trafficking cases were visited 4,000 times.

Statistics for the ChildAbuseMD.com website that posts the searchable webbook Child Abuse Evaluation & Treatment for Medical Providers had a total of almost 60,000 visitors.

Since ChildAbuseMD.com was launched in mid-2005 and CHAMPprogram.com was launched in mid-2007, there have been over five and a half million visitors to the websites.

CHAMP Network Members and a New Mentor

This grant year Heather Shannon, NP, became a CHAMP Network Member by successfully passing the Evaluating Child Sexual Abuse course and completing a clinical observership with Alicia Pekarsky, MD. Regina Wetterhahn, PA, renewed her network membership by completing educational sessions.

There are now 26 New York counties that have one or more CHAMP Network Members. These counties are Albany, Broome, Cayuga, Dutchess, Erie, Fulton, Herkimer, Jefferson, Kings, Madison, Nassau, Oneida, Onondaga, Orange, Otsego, Putnam, Saratoga, St. Lawrence, Schenectady, Schuyler, Sullivan, Rockland, Ulster, Warren, Washington and Westchester. The expansion of the number of counties occurred because the Westchester Institute for Human Development child abuse pediatrics program, under the leadership of CHAMP Mentor Jennifer Canter, MD, has contracted to provide sexual abuse assessments to five additional counties.

To remain on the Active Network Member roster, Members must attend at least three CHAMP educational webcasts annually. There were 27 Active Network Members at the start of the year, July 1, 2020. Of those, 24 completed the continuing educational requirements. Three members retired or left the child abuse pediatrics field. Two new providers completed an observership and coursework requirements or renewed to become Network members. As a result, there were 26 CHAMP Active Network Members as of June 30, 2021.

This grant year, Ingrid Walker-Descartes, MD, became a CHAMP Mentor. Dr. Walker-Descartes is a valuable addition to CHAMP and brings vast expertise from her roles as a child abuse pediatrician; Associate Professor of Pediatrics; Vice Chair for Education; Director, Pediatric Residency Program and Child Abuse Pediatrics Fellowship; and Director, Center for Vulnerable Children, Maimonides Children’s Hospital, Brooklyn.

Other Educational Opportunities

CHAMP education is an integral part of SUNY Upstate Medical University and the Maimonides Medical Center Child Abuse Pediatrics Fellowship programs. The educational webcasts, the ECSA online course and weekly case conferences are part of the fellowship curriculum.

The CHAMP Skeletal Survey Practice Recommendation was updated this grant year. New literature, replete with many offerings of guidelines, has greatly improved a provider’s ability to manage children when physical abuse and fractures from abuse are suspected. This work was initiated by a CAP fellow, Iram Ashraf, MD, who led a quality improvement project at SUNY Upstate Medical University and presented an educational webcast in 2020 on her findings and recommendations.

The CARE program, a CHAMP Center of Excellence in Syracuse, provided scheduled learning experiences and rotations for 17 Pediatric and Family Medicine residents, two Pediatric Emergency Medicine fellows, and three medical students. Eight other CHAMP Mentors at Centers of Excellence provide residents with an opportunity to complete the CHAMP Residency Training Program. Residents who complete this program can become CHAMP Members when they are licensed to practice in NYS by submitting three of their recent child sexual abuse cases for review by a CHAMP expert.

The journal Pediatrics has published an article written by CHAMP Mentors Vincent J. Palusci, MD, and Ann S. Botash, MD, which was based on an educational webcast they prepared for CHAMP. This article is a resource to help pediatric care professionals address personal and systemic racial bias: Palusci VJ, Botash AS. Race and Bias in Child Maltreatment Diagnosis and Reporting. Pediatrics. 2021;148(1):e2020049625.

Recommendation

Collaborative Education

Collaborations add greatly to the success of CHAMP. For the fourth year, CHAMP has collaborated with the American Professional Society on the Abuse of Children-New York (APSACNY) to present a webcast. This collaboration supports CME and expands the availability of speakers and number of attendees. In March 2021, Moira Szilagyi, MD, PhD, presented Pediatric Approach to Childhood Trauma and Resilience. She is the current AAP President and Professor of Pediatrics and Division Chief of the Developmental Behavioral Pediatrics Program and the Peter Shapiro Term Chair for Enhancing Children’s Developmental and Behavioral Health in Pediatrics, UCLA.

Collaborations also enhance the educational process. CHAMP has been involved in discussions with Prevent Child Abuse NY regarding recent NYS legislation to update mandated reporter training to include information about Adverse Childhood Events. CHAMP may provide educational offerings on this topic in the future. In addition, collaborations can improve the delivery of services. CHAMP has been involved in planning discussions with the NY OCFS and the NY Children’s Alliance regarding the creation of back-up coverage for New York’s child abuse pediatricians (CAPs) and long-term planning to provide consistent, systemic regional coverage to areas that are currently lacking CAPs.