Topic: Child Abuse Experts

5280 Names Kempe Professionals "Top Docs"

Kempe is home to many dedicated, passionate and thoughtful professionals who are recognized as experts in the field of child abuse and neglect prevention and treatment.

It is no surprise several of our doctors were once again included on 5280 magazine’s list of “Top Docs.”

We would like to congratulate the following docs who are a part of the Kempe team:

Dr. Andrew Sirotnak, Child Abuse Pediatrics

Dr. Antonia Chiesa, Child Abuse Pediatrics

Dr. Kathryn Wells, Child Abuse Pediatrics

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A letter from Des Runyan: 7 Steps to Prevent Child Abuse

Every year, since 1983, The US has designated April as Child Abuse Prevention Month.  This annual public awareness campaign seeks to educate the public about the problems of child abuse and neglect. Committed agencies and professionals hold public gatherings, place pinwheels and ribbons in public places, and create public service announcements to bring attention to abuse and neglect. Usually, we talking to the choir- our April gatherings are attended by the professionals we work with every day. Surveys of the public indicate that over 97% already recognize child abuse as a problem. Our calling attention to child abuse isn’t fixing it.  We need some additional substantive steps to reduce the burden of 7.2 million children reported to authorities in 2015 with 683,000 children confirmed as abused or neglected by social service agencies. The key to effective prevention is engineering the family environment to support and protect children and their parents. Here are 7 concrete steps we must take to really prevent child abuse and neglect:

  • Reduce domestic violence: Data from longitudinal studies are clear, both men and women are perpetrators and victims of intimate partner violence (ipv) and households where there is IPV are at increased risk for physical and psychological abuse perpetrated by both the perpetrators and the victims of IPV. We are moving the needle on this one, IPV has fallen over 70% in the US since 1993. Continued efforts to reduce violence between partners really benefits children.
  • Build social networks among young families: Isolation, post-partum depression, poverty, and stress are a deadly in combination. Humans are social animals. Support in terms of: group well child care, expanded community engagement and other efforts to support new families and establish connections will reduce the risk of harm.
  • Get serious about reducing prenatal exposure to substances by enhancing screening and treatment: Alcohol is a clear and established threat to the development of young children and it interferes with effective parenting. Much less research has been done with prenatal exposure to marijuana but the studies to date indicate increased risks to the fetus in terms of subsequent mental retardation. Both substances can interfere with parental caregiving. Screening and treatment done in a non-punitive manner are much more likely to help the child and sustain families.
  • Make access to home visitors such as public health nurses or SafeCare counselors routine for all new parents under 22 years of age triggered by the registrations of births: The Nurse Family Partnership and SafeCare are two home visiting programs for families with young children that have been shown to have many benefits in terms of reduced use of medical care, greater child safety, and better outcomes for mothers.  Both are well established in Colorado but only about a third of families offered these services use them. We need to link these services to newborn nurseries and doctor’s offices and make the benefits clear to the participants.
  • Advance girl’s education: The strong correlation between maternal years of education and rates of harsh punishment and shaking of their young children is clear. We need programs and policies that keep girls in school and help complete their education. Not only are children get maltreated less by more educated parents, they have advanced communication skills, finish school at higher rates, and have lower rates of other adverse childhood experiences.
  • Delay childbearing: Closely related to number 1, teens who have access to Long-acting reversible contraceptives and who delay childbearing until after age 20 are less likely to use harsh punishment, are more empathetic to their children’s needs, and have higher incomes. Their children are much more likely to prosper.
  • Establish family-friendly business practices: Kids need parental investment and care.  Paid maternal leave has been shown to significantly reduce shaken baby syndrome and the benefits of parents being able to attend school functions, teacher conferences, and child sports activities are well-known.

So, let’s make April the start of some very concrete steps that will reduce child abuse. I realize that this might put our Kempe Center out of business but won’t that be great for kids and society when we are no longer needed.

Des Runyan, MD

Executive Director, The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect

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Kempe Making a Tremendous Difference

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Thanks to the work of thousands of individuals and organizations, including Kempe, the latest reports indicate a 40% reduction in child abuse and neglect nationally over the past two decades. While there have been tremendous advances to keeping children safe, there is still much more work to do.

The information outlined in this report shows the impact our staff is making. In the past year alone, Kempe has connected with hundreds of mental and medical health professionals, child welfare professionals, scholars and other organizations in the fight to end child abuse and neglect.

In FY 2015, Kempe staff made a tremendous difference including:

  • Providing clinical care services to 2,008 children and 632 adults
  • Securing $11 million in state grants
  • Publishing 28 articles and completing 10 research papers
  • Training 5,257 child welfare professionals

We encourage you to read more about our professionals and their impact in our 2015 Kempe CARES for Children Annual Report. Because of your support, we are able to continue this crucial work. Thank you for caring for children.

John D. Faught, JD, President & CEO, The Kempe Foundation
Desmond K. Runyan, MD, DrPH, Executive Director, The Kempe Center

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Impact of Domestic Violence on Parenting

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How does being a victim of domestic violence affect parenting?

This is the question Kempe is researching as part of a systematic review of the literature, a rigorous analysis examining all previous related research in order to synthesize the results.

Leading the project is Dr. Antonia Chiesa, with Kempe and Children’s Hospital Colorado Child Protection Team, who says, “We want to find out if there are residual effects from domestic violence even after the violence stops. “Simply removing the victim from the situation may not limit the impact, ” Dr. Chiesa added.

This project, now in its second year, is the first systematic review conducted at Kempe. Kempe experts from cross disciplines have been involved including a social worker, mental health professionals, pediatricians and doctors. Kempe also engaged leading systematic review expert Dr. Sabine Maguire at the University of Cardiff in Wales to assist with the project.

The process involves sifting through multiple databases to find studies and articles related to this topic and conducting an initial review of every relevant abstract – the team found more than 4000.

After the initial review, the Kempe team scanned 400 full studies to determine if the information was specific to this topic – they found over 100 potential studies.

Next, the research team conducted a critical review of each study to ensure that studies met narrowly defined inclusion criteria. These criteria are developed in order to assess quality of the research and ensure that the study answers the specific question.

“This has been a huge undertaking with many people on our staff spending time outside regular work hours to complete the study,” Chiesa said. “As we examine the research, we are noticing a differences in parenting discipline and research design methods – all of which must be accounted for in our evaluation.” Results are not final as the review is not complete. Preliminarily, it appears that domestic violence victimization may impact parenting. The results of the review will explore how this occurs and the strength of current evidence.

Kempe is in the process of documenting the findings and expects to publish the results of the review in 2016.

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Advancing the Work to Identify Abdominal Injuries and Abusive Head Trauma in Child Abuse Victims

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Abdominal and head injuries are significant indicators of child abuse, but often go undetected by emergency room doctors. In fact, an estimated 30% of children with abusive head injuries are sent away without a diagnosis.1 Even more, of all child abuse cases, an estimated 3% of child abuse victims have injuries to the liver.2

These startling statistics have prompted Kempe to take action to educate and share knowledge and tools with doctors to help them better identify abdominal injuries and abusive head trauma when a child first visits an emergency room or doctor’s office. By empowering doctors with this knowledge, we can keep children from suffering recurring abuse.

Abdominal Injuries

Liver lacerations and other injuries to abdominal organs are often a clear indicator a child has been abused. Unfortunately, doctors often miss these hidden signs of abuse because the injuries are not visible to the naked eye.

Dan Lindberg, Associate Professor of Emergency Medicine and Pediatrics at The Kempe Center and University of Colorado Anschutz Medical Center shared significant findings related to abusive abdominal injuries in Clinical Pediatric Emergency Medicine. His research shows that while abdominal injuries are generally uncommon in children, many abused children often suffer from abdominal injuries. And, frequently doctors miss screening for abdominal injuries.

Since publishing this research, Dr. Lindberg has been working to share these findings with pediatricians and emergency room doctors across the country. One tool doctors can use to identify an abdominal injury is a blood test. This blood test can immediately alert doctors to the possibility of an abdominal injury – and raise concern for missed abuse.

This simple blood test could make the world of difference in keeping children safe and prevent them from suffering recurring abuse.

Abusive Head Trauma

Abusive head trauma is the leading cause of death among abused kids, killing one in five children who have this type of injury. Of those who survive, 8 in ten are left with permanent injuries.3,4

Dr. Lindberg and the team at Kempe are also making significant strides helping doctors identify children who have suffered abusive head trauma.

Because child abuse is hard to assess, doctors sometimes mistake abusive head trauma for the flu or illness, as the child’s only symptom is vomiting. Small signs like these often deter doctors from running more extensive tests like CAT scans or MRIs, even when there are other reasons to think about abuse.

Since 30% of kids with abusive head injuries are sent away without a proper diagnosis, Kempe is working to address this need. One of the identification tools Kempe is currently researching is FAST MRI. The FAST MRI has the ability to scan a child’s head in 3-5 minutes versus the 20-30 minutes a traditional MRI takes. Additionally, children would not be exposed to radiation through the use of a FAST MRI.

Kempe believes the FAST MRI can reduce the number of children who are sent away without a proper diagnosis being made. Once a proper diagnosis is made, children can receive proper treatment and begin to heal. It can save lives.

The Colorado Clinical Translational Sciences Initiative and The Colorado TBI Trust Fund recently provided funding that will enable Kempe to find a solution to address this gap in diagnosis.

Kempe is also partnering with Kohl’s Cares and Children’s Hospital Colorado on a public awareness campaign to prevent shaken baby syndrome, a form of abusive head trauma, called the Kohl’s Shaken Baby Syndrome Prevention Campaign.

If you would like to support Kempe’s efforts in encouraging doctors to run blood tests to screen for liver lacerations or support our research to identify young victims with abusive head trauma through FAST MRIs, please consider making a donation to support our research and outreach.

Together, we are making a difference for children in Colorado and across the globe.

  1. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA : the journal of the American Medical Association. Feb 17 1999;281(7):621-626.
  2. Lindberg DM, Shapiro RA, Blood EA, Steiner RD, Berger RP, for the ExSTRA investigators. Utility of Hepatic Transaminases in Children With Concern for Abuse. Pediatrics. Jan 14 2013.
  3. Barlow KM, Thomson E, Johnson D, Minns RA. Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy. Pediatrics. Aug 2005;116(2):e174-185.
  4. Makoroff KL, Putnam FW. Outcomes of infants and children with inflicted traumatic brain injury. Dev Med Child Neurol. Jul 2003;45(7):497-502.

 

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