By Jennifer Andrews, DO, FAAP, Medical Director, Child Protection & Advocacy
What does it mean to be a Child Protection Pediatrician?
There are many aspects to my work, which can be broken into 4 categories:
Clinical: I see patients in a variety of settings depending on where they initially present, and the acuity of their presentation. In generally I see children in SAFE Clinic, the hospital or ED, or at Foothills Advocacy Center. The hope is as we develop a child protection program, wherever a child enters the system, if there is a concern of neglect of abuse, they will get the same type and quality of care.
Partnerships: I spend time working with our multi-disciplinary teams (MDTs). The MDT includes the Commonwealth Attorney, local law enforcement, UVA, SARA (Sexual Assault Resource Agency), Region 10, Ready Kids, CPS and other community partners depending on the locality. Each county we work with, as well as the city of Charlottesville has its own MDT which meets regularly to bring everyone together and talk about ongoing cases and ensure that everyone is on the same page
Court: I’m frequently called to court to provide testimony in cases of neglect, abuse, and sexual abuse and sexual assault.
Education: I also work on educational efforts within the community including training for DSS and law enforcement, as well as within our health system with residents and medical students. We focus on when to be concerned about abuse, when to report to DSS and/or law enforcement, and how to evaluate a child who is suspected to be a victim of abuse or neglect.
What are the first steps in establishing a new program?
One great thing about joining the team at UVA is that there was already some great infrastructure in place before I arrived. There is an amazing team of Forensic Nurse Examiners who see both adult and pediatric patients that have been victims of sexual assault or sexual abuse. They are able to collect evidence, take photographs, recommend prophylactic treatment for infections and help coordinate follow-up care.
In conjunction with the forensics team, the pediatric hospitalists have historically played a large role in the care of kids who were admitted with concerns of abuse or neglect to ensure that they got an appropriate medical evaluation, and that both social work and DSS were involved when appropriate.
Additionally, we also have a CARE Committee that meets regularly to discuss cases of suspected abuse and how we are responding to those cases. The Committee has representation from a variety of disciplines including radiology, neuroradiology, Neurosurgery, Emergency medicine, Hospitalists, PICU, Developmental pediatrics and Social Work, among others. Prior to my arrival they developed a “Non-accidental trauma protocol,” and met regularly to review cases including talking through what went well and what could be better. That was such a great thing to step into, and will certainly continue
Our hope is to take these different pieces and put them together into a unified child protection team. As we see more patients our structure will likely continue to evolve and we will be able to become more specialized in the care we provide with a whole team that is exclusively dedicated to child protection and advocacy.
What does your caseload look like?
Given the nature of my work, it varies from week-to week. I have seen 40 20-30 pediatric cases since starting here in July, covering acute and non-acute sexual abuse or assault, physical abuse, and neglect.
Why are you passionate about this work?
Before I came to UVA, I was at the University of Florida, where I did a pediatric residency followed by fellowship in child abuse. I got was fortunate to get involved with our Child Protection Team in residency and learn more about Child Abuse Pediatrics as as a subspecialty, as well as participate in quality improvement projects with their team which showed me the great need for further study and quality improvement within this field
We all go into peds because we care about kids. I think the thing that is unique about abuse is that these children often don’t have an advocate. If you think about all of the other patients we see, they typically have a parent or guardian who has their best interest at heart and is going to speak up for them. For the kids I see, their parents or guardians are often the ones harming them; they need another adult to step in and advocate on their behalf. Especially younger children who aren’t verbal, or who don’t communicate clearly yet. Our team is able to be a voice when caregivers are not filling that roll.
What would you want everyone to know?
- The question I often get is, “How do you do this work? It’s so sad.” Yes, this is sad work, but this is happening whether I know about it or not. Kids are being neglected and abused and are dying. If the case has made it to me then most likely CPS and law enforcement are getting involved and now there is whole team of advocates for these children. My hope in sharing this is to encourage others to participate in this important and meaningful work.
- A consult to me or a report to CPS does not have to be punitive. People get scared because they worry that the family will get torn apart, but this is a small minority of cases. CPS is an access point to resources. A lot of the families we see are stretched too thin and don’t have what they need. CPS can help families make sure they have access to resources and that those resources are being used appropriately. The positive side of a report is that it is helping their future. Families are often able to get the help they need to stay together safely.
How can someone learn more?
I love phone calls and questions! Please email me or use the child protection and advocacy PIC (9900).
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