For the third year in a row, Kentucky has the highest rate of child maltreatment in the nation. Kentucky also has much higher rates of domestic violence and caregiver substance use in cases of child abuse than the national average. With more than 20,000 cases of substantiated child maltreatment, the need for expert pediatric forensic services is crucial. However, as Dr. Christina Howard, Child Abuse Pediatrician at Kentucky Children’s Hospital, explained, “Kentucky has five practicing Child Abuse Pediatricians. So that’s about 4,000 to 5,000 substantiated cases of abuse per Child Abuse Pediatrician. That is well beyond what we are capable of doing efficiently.”
What do Pediatric Forensic programs do?
Child Abuse Pediatricians and their team of forensic nurses and social workers are crucial to both the evaluation of child maltreatment cases – including severe physical abuse and near fatal neglect cases – and the ongoing work of safety and advocacy for children and their families through the use of interdisciplinary teams. Judge Libby Messer of the Fayette County Family Court elaborates:
“Recognizing physical abuse in the medical context is a unique skill which comes from years of specialized training that allows these experts and their teams to identify things that primary care physicians, pediatricians, urgent treatment centers and the like do not have the scope of information or breadth of experience to identify. An expert review of a child’s history and context for seemingly run of the mill injuries often reveals red flags for abusive behavior or risk factors which were occurring long before the traumatic event. A Judge and jury’s understanding of this may be the difference between a child being returned to a dangerous situation or not. For some children that is the difference between life and death.”
Work with the most vulnerable victims begins with the Child Abuse Pediatricians, but the work required after the child and their safe caregiver are sent home is carefully coordinated and continues for months after. The following case is just one example of the important and collaborative services the pediatric forensic programs provide at some of the worst moments of a child’s life.
This past summer, one of the worst cases of child maltreatment imaginable – a child who experienced intense torture – presented to the hospital. The social workers helped to create a sense of safety for the child and were able to elicit necessary information that guided the medical evaluation and ongoing tests that established a case for severe child abuse. The team of nurses and social workers worked closely with the Department of Community Based Services (DCBS) and law enforcement to share information necessary to hold the perpetrators accountable. The child, who was exposed to horrific abuse in the one place that should be the safest for him – his home – will likely need ongoing therapy, so the entire forensic team worked together to make referrals and coordinate ongoing care. Additionally, the team coordinated ongoing support and resources in the rural county of the family members who stepped up to provide the love, support, and safe home life this child deserves.
As a member of the Child Fatality and Near Fatality Review Team, Judge Messer sees “the profound impact their expertise can have not just on the outcome of a criminal prosecution, but on the outcome for a child’s safety.” However, with only two Pediatric Forensic Medical programs in the state, led by Dr. Melissa Currie at University of Louisville and Dr. Christina Howard at University of Kentucky, capacity limits the number of cases they can be involved in. Collectively, the programs see just over 2,000 patients annually, a comparatively small number that includes children with unsubstantiated cases of abuse. Meaning, there are children who may be at the greatest risk of harm who are not accessing these potentially lifesaving services.
How can Kentucky better support them?
The Kentucky General Assembly has proven they are champions for children, with sweeping legislation to overhaul the child welfare system, investments in evidence-based programs that can help prevent maltreatment like the HANDS home-visiting program, and supports for kinship and fictive kin caregivers. Now we are calling on legislators to continue that commitment to our most vulnerable by allocating funding in the state budget for Child Abuse Pediatricians and their teams.
Increased funding would mean expanding their teams and increasing their capacity to serve more children and families across the state. It would mean families having expert medical attention available to them in their own communities rather than needing to drive hours for care.
It would mean utilizing creative solutions to meet the needs of the most vulnerable children, like deploying forensic nurses to rural hospitals and medical facilities to provide needed care and consultation. It would mean increased opportunity to work collaboratively with social service providers and provide greater support to law enforcement.
And perhaps most importantly – when considering the huge role that secondary trauma plays in their field – it would mean that the dedicated Child Abuse Pediatricians, forensic nurses, and social workers who always show up to advocate and care for kids could have a greater capacity to care for themselves.
With your help, Kentucky’s Child Abuse Pediatricians and their teams can continue to meet the urgent needs of kids and families and support those who work daily to end the cycle of abuse in the Commonwealth. Contact your state Senator and Representative and urge them to make investments in Kentucky’s Child Abuse Pediatricians and their teams in the state budget.
Learn more about the Blueprint for Kentucky’s Children and Kosair Charities Face It Movement 2021 priority to strengthen Kentucky’s efforts to prevent child abuse and neglect and support children who’ve experienced maltreatment. Stay up-to-date on Blueprint for Kentucky’s Children priorities that are good for kids with our Kentucky General Assembly Bill Tracker.