Family Safety & Healing – PediaCast 333
- Dr Jennifer Tscholl, Diane Lampkins and Cathy Davis stop by the PediaCast Studio to talk about the important work at The Center For Family Safety and Healing. Hear about the Center’s Where’s The Line? Campaign and discover the important role YOU play as a bystander to family violence. Learn about child physical and sexual abuse and neglect, as well as other forms of domestic violence. Together, we can make a difference. Find out how on this week’s program!
- Family Safety And Healing
- Where’s The Line? Campaign
- Are You a Bystander?
- Child Abuse
- Sexual Abuse
- Child Neglect
- Domestic Violence
- Dr Jennifer Tscholl
Child Abuse Specialist
The Center for Family Safety and Healing
Nationwide Children’s Hospital
- Diane Lampkins
Programming and Community Outreach
The Center for Family Safety and Healing
Nationwide Children’s Hospital
- Cathy Davis
The Center for Family Safety and Healing
Nationwide Children’s Hospital
- The Center For Family Safety and Healing (FamilySafetyandHealing.org)
- TCFSH Phone: 614-722-8200
- Where’s The Line? Phone: 844-234-LINE
- Where’s The Line? Text: 87028
- TCFSH on Facebook
- @TCFSH_ on Twitter
- Franklin County (Ohio) Children Services Hotline: 614-229-7000
- National Teen Dating Violence Helpline: 866-331-9474
- Adult Protective Services (Elder Abuse): 614-525-4348
- NOMORE.org – Together we can end domestic violence & sexual assault
- Darkness To Light – Sexual Abuse Prevention
- Stewards of Children – Child Sexual Abuse Prevention Training
- Guardians Against Abuse (YMCA)
- Guardians Against Abuse (YouTube)
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It’s a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children’s Hospital, on Columbus, Ohio.
It is Episode 333 for November 18th, 2015. We’re calling this one “Family Safety and Healing”. I want to welcome everyone to the program.
So, I have another heavy show for you this week. It’s concerning a difficult but important topic. Like our show a couple of weeks ago, it’s also a sensitive topic. So if you have little ears in the car, or the room or wherever it is that you’re listening, you may want to consider another one of our episodes and coming back to this one when the little ears aren’t around anymore.
Our program today centers around family violence — physical abuse, sexual abuse, neglect, other forms of domestic violence, teen dating violence, even elder abuse. The goal here is to raise awareness and to talk about some things that are difficult to talk about, but things that we must talk about if we’re going to make a difference in the lives of kids and families.
So why are we calling the episode “Family Safety and Healing”? Well, that really is our mission with this topic, to keep family safe or help them turn where they need to turn if they don’t feel safe. Healing is important, too, especially after exposure to violence of any kind.
Here in Columbus, at Nationwide Children’s Hospital, The Center for Family Safety and Healing is at the epicenter of these efforts. Similar resources are likely available in your community for those of you outside of Central Ohio.
And, while we’ll be talking about specific programs and resources here, the point really is to get you thinking about these things and to identify resources in your local community, to be an advocate for those resources, raising awareness and maybe even to be an agent of change or get involved in the creation of services in places where shortcomings exist.
So lots to cover today. And to frame the importance of this episode, did you know that nearly one in four women will have experience physical violence by an intimate partner at some points in their lives? Nearly, one in four. I had no idea it was that high.
And it’s not just women, one in seven men had been the victim of severe physical violence by an intimate partner. More than one in four children witnessed some form of family violence during their lifetime. Five children in the US die every day due to abuse and neglect, which are totally preventable.
One third of teenagers in the US are victims of abuse by a dating partner. Elder abuses are on the rise with about 10% of the elderly facing abuse, neglect or exploitation, and 80% of these cases going unreported.
Here in Ohio, in just one state, about a quarter million people face some form of family violence. Thirty thousand children are involved in a substantiated case of child abuse and neglect. Thirty-two thousand teenage females experience physical dating violence. Sixty five thousand women are physically assaulted by their intimate partner and 105,000 seniors are abused or neglected.
Over 68,000 domestic violence calls are made to authorities each year, resulting in over 41,000 arrests every year. And that’s just in Ohio, which is not necessarily an outlier.
So this is a huge problem, one that affects every community in America in a very real and very big way, including yours. Now, in light of these numbers, you may be thinking, the problem is just too big. I’m one person, what really can I do to make a difference?
The answer is, there may be plenty you can do if you pay attention to the people and circumstances in your sphere of influence. Because as it turns out, 60% of us know someone who is the victim of domestic violence. Maybe someone you know actually comes to mind right now as you’re hearing this. Maybe you have suspicions that are real, and maybe a family or family member you know is in trouble.
Do we remain silent bystanders, or do we speak up and take a risk? We could be wrong and open ourselves up to judgment, maybe even ridicule. Or, we could be right and make a big difference or even save a life by speaking up.
So lots to consider today, and to help me cover this topic, I have some great studio guests joining me. Dr. Jennifer Tscholl is a child abuse specialist with the Center for Family Safety and Healing at Nationwide Children’s Hospital. We also have programming and community outreach expert Diane Lampkins, and forensic interviewer, Cathy Davis. That will be an interesting job to talk about.
We’ll get to the formal introductions after the break. First though, I want to remind you PediaCast is your show. So, if you do have a topic you want to have heard on the program, if you have a question for me, or you want to point me in the direction of a news story or a journal article, it’s easy to get in touch. Just head over to PediaCast.org and click on the Contact link.
We also have a voice line. You can leave a message that way, 347-404-KIDS. 347-404-K-I-D-S.
Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child’s health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.
Let’s take a quick break and we’ll be back and talk about family safety and healing right after this.
Dr. Mike Patrick: All right, we are back. Dr. Jennifer Tscholl is a child abuse specialist at The Center for Family Safety and Healing at Nationwide Children’s Hospital and an assistant professor of clinical pediatrics at the Ohio State University College of Medicine. Dr. Tscholl received her MD at the Medical College of Ohio before completing a pediatric residency at Johns Hopkins and a child abuse fellowship here in Columbus.
It’s a pleasure having Dr. Tscholl in the studio today, so let’s give her a warm PediaCast welcome. Thanks for joining us.
Dr. Jennifer Tscholl: Great to be here.
Dr. Mike Patrick: We also have Diane Lampkins today. Her role with The Center for Family Safety and Healing involves programming and community outreach. She’s a literal treasure trove of information about the center and its resources. I’m excited to explore these things with her, not only to enlighten those of you in Central Ohio but also to get others thinking about your own communities as you search and seek what’s available, or as you influence and create similar opportunities in your neck of the woods.
So let’s give Diana a warm welcome. Thanks for stopping by today.
Diane Lampkins: Hi. Thank you.
Dr. Mike Patrick: And, last but certainly not the least, we have Cathy Davis. She serves as a forensic interview with the Child Assessment Center at The Center for Family Safety and Healing. This means she’s the one actually talking to the kids, obtaining a history in their words, which as you can imagine is not an easy thing to do when we’re talking about issues involving abuse and neglect. So Cathy, a warm welcome to you as well.
Thanks for joining us.
Cathy Davis: Thanks for having me.
So let’s start with you, Diane. I mentioned briefly in the introduction The Center for Family Safety and Healing. What aspect of family violence does the center really focus on?
Diane Lampkins: We actually look at all areas of violence. We are looking at child abuse and neglect, elder abuse, teen dating violence. So it’s a broad spectrum of family violence.
Dr. Mike Patrick: Now, being here, affiliated with the Children’s Hospital, I suspect that the bulk of folks that you see are kids. But The Center isn’t just limited to kids, you really take care of the whole family, right?
Diane Lampkins: That’s true. We recognize that when you’re working with children, then you have to also work with their families. So, that includes their parents or caregivers, and sometimes their caregivers are grandparents so we have adult services.
Dr. Mike Patrick: One thing I like about the center is it’s truly a multi-disciplinary tea. You really have all the different disciplines that the family is going to need. So it’s sort of a one- stop place where they can get help.
Diane Lampkins: That’s true.
Dr. Mike Patrick: What are some of the team members that we can expect to find at the center?
Diane Lampkins: You can expect to find our Columbus Police Special Victims Unit, our Franklin County Prosecutor’s Office, victim advocates. There’s Franklin County Children Services. They’re all co-located in our building, along with CHOICES, which is the local domestic violence shelter here in Columbus.
And then, within the hospital, you really utilize folks from all over lots of different disciplines. So we have physicians who see the kids that are child abuse specialists. Also, social workers, psychologists, just really whatever healthcare need, whether that’s physical or mental health we have available.
Diane Lampkins: That’s true.
Dr. Mike Patrick: Then, so the mission of the center really is to treat victims, advocate for change and also to conduct research, and then also raise awareness about these issues within the community.
Diane Lampkins: Yes.
Dr. Mike Patrick: So let’s talk about some of the specific services that The Center offers, and there’s going to be a lot more to come on this one. But the Child Assessment Center, what exactly is that?
Diane Lampkins: The Child Assessment Center is actually the heart of the center. They provide assessments for children and their families around child sexual abuse, physical abuse, exposure to violence. They may have witnessed their parent going through violence.
So that center, again, has the interviewers, our health advocate, our child abuse team experts that are providing a comprehensive one-stop exam for the family when they come to the center.
Dr. Mike Patrick: How does a child end up at The Center? Is this something that a parent brings them in or is this referred from an outside agency or both?
Diane Lampkins: It’s actually both. You can do self referrals. Sometimes, families will go to their pediatrician. Sometimes calls are coming through the main hospital Children Services and you can come in — again, self referral.
Dr. Mike Patrick: Again, then, if you have all the players involved at that one center, then really the child only has to sort of go through this one time, because you have law enforcement there, the Prosecutor’s Office or representative if that were needed. But then, they also get the health visit as well. So, that’s great.
And we’ll talk a lot more about the Child Assessment Center as we move through this. Something else that you provide is early intervention services. What are those? So kind of a word that I think parents sometimes hear but not everyone knows exactly what is early intervention.
Diane Lampkins: The early intervention is looking at… So, we have a Nurse-Family Partnership Program and Help Me Grow. And that’s working with first-time moms, providing not only education, home visiting. They look at parenting resources and making sure the babies are healthy. And the Nurse-Family Partnership, they follow these children through their second birthday. The Help Me Grow follow them through their third birthday.
So, if you can provide education upfront, you can reduce things like, child abuse, neglect, because you’re providing them that education and sub-parenting modeling.
Dr. Mike Patrick: I think that was just so fantastic to be able to… We want to prevent this stuff from happening. That’s the goal, really, if we can for all kids, and then, of course to deal with it in an honest and open way once it does happen. But with the early intervention approach, how do they get connected with that service?
Diane Lampkins: There’s a number of different ways. Sometimes the screening may come through a primary care visit, a Children Services social worker, or parent who are identified through School Services Headstart. Someone may just say, “Hey, here’s a family that I think could benefit from your services.”
Dr. Mike Patrick: I think it’s interesting because from the mom’s point of view — really, I don’t think anyone has in their head, “Oh, I’m going to abuse a child,” especially a parent — but a lot of times, it’s just a lack of education or understanding or their expectations may be different. They may think, “I’m going to have a quiet baby who’s not going to cry and keep me up for hours on end.”
So if you can educate that this is what it’s going to be like before it happens, and this is what our plan is going to be if the baby is crying all night, it’s going to safe for everybody involved, including the mental health of the parent. But if you can do that education upfront– and then also to know where’s an appropriate place to leave the baby, who are the people that you can trust — those kinds of things really, we don’t have the innate knowledge and new parents need help.
Diane Lampkins: A lot of it is even helping them understand just basic child development — what you could expect for this child and what are the behavior you might see — so that they know it’s normal and that they are not doing anything wrong. It’s just reassuring them a lot of times, “So this is what babies do when they’re ten months old. This is what they do when they’re 18 months.” So it’s helping them understand the developmental stages.
Dr. Mike Patrick: Then, you’re also involved with the foster care program. So children that are placed in foster families, how does The Center interact with those and why?
Dr. Jennifer Tscholl: Well, we have a clinic called the Foster and Connections Program and that is a medical home for children in foster care within Franklin County.
Dr. Mike Patrick: Because kids that are in foster care have some specific needs in particular with mental health kind of stuff, because it can be very traumatic for them. So, you’re not only meeting their physical needs but the mental health needs, since you deal with that specific population.
Dr. Jennifer Tscholl: They absolutely are a special population. They have a heightened well child care schedule, and they just require a little bit more care, a little bit more time, and there are a lot of issues related to past neglect, whatever occurred to them prior to being placed in the foster care system. Often, that’s more important than the basic medical needs we think of when we think of classic well child care.
Dr. Mike Patrick: Yeah, absolutely. Now, there’s a lot of listeners out there who are not in Central Ohio. We have listeners all across the country and in other countries as well. So how can folks who are listening to this find similar resources in their home community? Where’s the good place to start looking for that if someone has a concern. They think a child needs to be evaluated for abuse.
Diane Lampkins: I would say primary care physicians, your children’s hospitals, local health departments, they all have good resources. There are national hotlines out there that can be utilized.
Dr. Mike Patrick: Yeah, so I would suspect that primary care doctors come across this before and will know what resources are available in their local area. So that’s a great place to start. But if you don’t, you had mentioned most big children’s hospital are going to have a child abuse program. That may come with a variety of name. So if just call the main hospital number and say, “What is your child abuse program called? How do I get connected with it?” There should be no shame in going that route, right?
Dr. Jennifer Tscholl: Exactly, and I do think primary care providers are probably the best resource for families, because depending on what their needs are, their concerns are, they might get referred to a different resource.
Dr. Mike Patrick: And if it’s an urgent concern, then you just contact local law enforcement, they’re also going to know what resources are available. It may not be something that you can wait until an office is open if you have very genuine real concern.
Dr. Jennifer Tscholl: Exactly.
Dr. Mike Patrick: Now, another term that I think people hear about is something called a mandated reporter. What is a mandated reporter? Any of you can answer this. What do they report and who do they report to? What is that all about?
Dr. Jennifer Tscholl: So every state has their own legal mandates that dictate who is a mandated reporter. And a mandated reporter would be somebody who is mandated by law to report to Children Services and/or law enforcement, any concerns about child abuse, sexual abuse, physical abuse, neglect. Embedded in all of these laws are some protections from liability. So as long as the mandated reporter is making that report in good faith and not in a way to be punitive in nature, they’re protected from any sort of liability. There doesn’t have to be total proof that abuse exist. There just has to be the suspicion that there is some sort of maltreatment that’s occurring.
While I say that you’re protected from liability by reporting as mandated reporter, the opposite is not true. So if you suspect something and you don’t report, subsequent to that, something happened, you can be held viable for which you didn’t report but had suspected previously.
And, included in the list of mandated reporters — it’s a long list — but included in that would be most health care personnel, including physicians, nurse practitioners, nurses, social workers, counselors, teachers, policemen, firemen. There’s tons and tons of people on the list of general mandated reporters.
Dr. Mike Patrick: I would add to that pastors and those who are in religious organizations, especially they have a lot of people coming to them in kind of a counseling kind of capacity where, “I’m going to talk to my pastor about something.” So, I think it’s important that they realize that they’re mandated reporters as well.
Dr. Jennifer Tscholl: This is true.
Dr. Mike Patrick: Tell us a little bit about the Where’s The Line Campaign. The reason that I brought up mandated reporters is I think a lot of people have this sense of, “Well, I might have suspicion, but I’m not a mandated reporter. I’m not a professional that takes care of kids and families in one way or another. And so, it’s not my responsibility to do that.”
I think the Where’s The Line Campaign is trying to kind of bridge that gap and educate. So tell us a little bit about the campaign.
Diane Lampkins: So, the campaign is awesomely launched last year. It’s really trying to educate Central Ohio how to intervene safely. And if you’re not willing to intervene, thinking of ways that if you have questions you can call the line. There’s a person who will answer that phone line to share information on what you can do. But for situations even scenarios that if you were in a grocery store, and you were to witness something, it will kind of encourage you to take a stance. What’s your responsibility as a person witnessing it and why people don’t?
So they talk to you about how you can stand up, take a stand, and intervene. Whether it’s a distraction, we don’t certainly want people to put themselves in harm’s way. But there’s ways to talk about how you can intervene and help distract maybe, even in the situation if there’s some violence that’s going on in our community.
Dr. Mike Patrick: There was some research that showed that bystanders are three times more likely to intervene after exposure to an action campaign. I mean, when you go out into the community and kind of spread the word about this, there’s some real data that would suggest that people do listen, pay attention and respond a little bit differently in those situations. So I think it’s great that you do sort of take this campaign out into the community. Who are some of the folks that you present it to?
Diane Lampkins: We talk about it to anyone we can get in before. So first responders.
Dr. Mike Patrick: Anyone who’ll listen, right?
Diane Lampkins: Yeah. We’re talking first responders, residents, doctors, social service organizations. We have place in the malls. So there’s like wallscapes that talk about the campaign in Easton Town Center and Polaris, where the people can visibly see it. And then, they’re wondering, “What is this line?”
We have a number that you can call. It is a warm line, so there is someone who mans the line to answer the questions. We also have, you can text that line and ask information. The number is 844-324-LINE. Again, there’s a resource person who answers to take questions and provide information around what to do if you’re in a situation.
Dr. Mike Patrick: We’ll have that number and other ways that you can connect with that program in the Show Notes for this episode, 333, over at PediaCast.org in the Show Notes.
When you’re talking about Where’s The Line, sometimes it gets a little bit grey and cloudy, doesn’t it?
Diane Lampkins: It does.
Dr. Mike Patrick: So where do you draw the line between what’s reasonable discipline and when does it become abuse? Or, when is it love or when are you stalking the other person? When are you giving a child independence or when are you neglecting that child? When are you giving gifts, or are you trying to control?
So, sometimes, folks that witness these things and kind of have a second thought, like “Is this right? I’m not quite sure it is,” then, this program kind of can act as a sounding board can it? I mean, someone can call in and just say “Hey, this is what I’m seeing. Is this something I should be concerned about? Or, is this something that could be expected?”
Diane Lampkins: Yeah, it’s really one of those educational pieces that you can ask any questions. There’s no wrong question. We want you to call in with perhaps something you’ve seen even like I said out publicly. They may have been a dispute between a couple, and you didn’t want how to handle it and wanted to know what could you do. Call that line, and we can talk about how to — role-play even — how to get through that or resources you can use.
Dr. Mike Patrick: And it’s anonymous, correct? If you want to say who you are and be aided and reporting, that can happen. But at the same time, you don’t have to say who you are. They’re not going to trace phone numbers, or send anyone out to the house of people who called, right?
Diane Lampkins: That’s true.
Dr. Mike Patrick: Then, the other question I have is — I don’t want to inundate you with phone calls, but let’s say someone in another community — so it’s not really our local resources here, but let’s say they’re a couple of hundred miles away but they don’t know who else to call, and they witnessed something — they can still call you and talk about it, right?
Diane Lampkins: Certainly.
Dr. Mike Patrick: And you can help them problem solve in terms of where to call and contact and all that.
Again, that phone number is 844… I would suspect that’s a toll-free number, 844?
Diane Lampkins: Yes, it is.
Dr. Mike Patrick: 844-234-LINE. They can also text 870-28 and you can even go to your website which is FamilySafetyAndHealing.org, and send an instant message that way. So there’s a lot of different ways to get in touch with this program if you have a concern about something that you’re seeing.
And this is not just kids, right? So if there’s any family violence that you’re concerned about, even if the victim’s an adult, you can call this program, too.
Diane Lampkins: Yes, that’s true. Elder abuse, anything that your concerned about, have a suspicion on. I always say err on the side of caution and make the call.
Dr. Mike Patrick: Yeah, absolutely. I also like that your website… So, I went to FamilySafetyAndHealing.org and I immediately got a pop-up window that said “Hey, people can track that you’re coming to our website. So if you don’t feel safe , get off of this computer and go to a computer where someone’s not going to be checking your history.” I mean, you thought of everything. That’s really something that I think you… I wouldn’t have thought to do that, but I can see the importance of it.
Diane Lampkins: Certainly, when you’re thinking about victims who are in potentially dangerous situations, you want to make sure that they are safe, and that they understand that we consider their safety a priority. So yeah, it’s really important to let them know that.
Dr. Mike Patrick: So as we talk about bystanders, anyone can chime in here, what are some examples of a bystander? Who are bystanders?
Dr. Jennifer Tscholl: I think that’s something that we see not infrequently, kind of people who saw the precursor behaviors leading up to something that ultimately was what we could consider kind of clear family violence, whether it be child abuse or domestic violence or whatever.
You hear a lot of people who will say, “You know, it just didn’t feel right. We were at this party, and I just didn’t like the way he was disciplining her.” And then, that child comes in and has clearly abusive injuries a couple of months later. Everyone in hindsight is really feeling terribly guilty and wishing that they had done something but not knowing what they could have done.
So this line is something for those people who just feel a little bit uneasy and little uncomfortable, and they may not be something that’s reportable to Children Services or the law enforcement at that time, but maybe if you empower them to intervene and to say something. You know, see something, say something.
Dr. Mike Patrick: Yeah, because if Children Services comes along and start questioning, then that may change behaviors down the road as well. And, not everyone is going to have meaningful contact with the mandatory reporter. So, they may not ever have a mandatory reporter that witnesses these things. You may be the only one who’s witnessing it, and has the concern and that’s why it’s so important.
Dr. Jennifer Tscholl: Right.
Dr. Mike Patrick: If we think about 60% of the population know someone who is the victim of domestic violence, there’s probably a lot of concern out there that does go unreported that then leads to hard down the road. That’s what we’re trying to prevent.
Cathy Davis: I think what happens a lot of times is we might see something or hear something and our gut is alerted that something’s not right with this situation. But I think what we tend to do is rationalize things. We might tell ourselves, “It’s none of my business. I don’t want to insert myself in their situation, and I’m sure they can work it out on their own.”
I think a lot these things occur to us in hindsight. Which is why again, like you mentioned earlier, you can all this line at any time to learn “What can I do now after the fact, after I thought about this?”
Dr. Mike Patrick: There really is a mental process that you have to go through when you first notice that there’s a concern until the action happens. So, you really do have to notice. You have to be kind of aware of your surroundings. You don’t want to be a Debbie Downer but you do have to kind of have that lens as if there is so much abuse that goes on out there that relates to families, that certainly, there is something or someone that you touch their lives that probably have this going on.
So I guess, first, it’s just awareness and noticing that that thing’s going on. And then, I guess you have to develop a sense of personal responsibility concerning that matter, don’t you?
Diane Lampkins: Yes you do. You have to look at what is my responsibility? Would I want someone to help me? Thinking about how can you intervene safely or distraction, whatever you can do creatively to make a difference in that situation. You want to think about that.
Dr. Mike Patrick: What about bullying and child violence? Is that something that you guys at the center deal with as well?
Diane Lampkins: In our behavioral health programs, we’ll get kids that had been referred for that counseling. And certainly, some of our educators go into the schools and talk to them. There’s a peer education program that they provide and they talk about teen abuse, dating violence, but they also talk about bullying and looking at how to provide social skills. Basically, what is being a friend mean? How do you be nice? How do you socially fit in? So a lot of it is having those discussion with those children about that.
Dr. Mike Patrick: I would suspect that then once you kind of do get invested in a little bit, and you think, “Oh yeah, I do have a responsibility here to help this person or this family out,” I guess the next step then is to say “Do I have the skills to do it?” But what we’re saying is you don’t really need any skills. You just need to talk to someone about it.
Diane Lampkins: Yes.
Dr. Mike Patrick: And then, you have to decide to help.
Cathy Davis: Exactly.
Dr. Mike Patrick: To actually do it.
What kind of barriers are in place to prevent that process from happening? So, if you are a bystander, what are some of the barriers that may prevent you from getting involved?
Diane Lampkins: I think sometimes it’s fear of retaliation. Again, like Cathy said, “Do I get involved in this people’s business?” There is this process in your mind, kind of ticker taping like, should I do something now or what do I do?
So, safety is always a concern. Sometimes, you have to think it through. Sometimes, you might need to step away. If it’s really dangerous, call 911. But you have to think about how to intervene, keep them safe or keeping yourself safe.
Dr. Mike Patrick: Yeah, you really do have to kind of put yourself out there, and then you worry, am I putting my own family in danger? So that does become very difficult, doesn’t it? We talk about it like, “Oh, yeah, this is an easy thing to do, “but it really isn’t.
Cathy Davis: I think a lot of times too, people will second guess themselves, and say, “Well, you know, maybe that’s not how I would treat somebody but perhaps I’m making a bigger deal out of this than it really is.”
Dr. Jennifer Tscholl: And I think the barriers are different based on every circumstance, so if you’re witnessing, as Diane was saying, something in a grocery store. Like, “That mom looks like she’s about to lose it on those kids.” You feel a little bit different in that situation than if it’s a family member where maybe your barrier in that case is, “If I say something, I might never see this kid again. She might never bring him over to my house again.” Whereas, in a grocery store, it’s little bit of “Is that really my business? I don’t really know their situation,” and kind of relinquishing responsibility from that perspective and trying not to be nosy.
Dr. Mike Patrick: Right.
Diane, you had mentioned when you’re teaching people about that, one effective thing that you can do is distraction.
Diane Lampkins: Yes.
Dr. Mike Patrick: What does that mean?
Diane Lampkins: So, like Jen was talking about, maybe a mom overwhelmed in a grocery store and there’s multiple children. She’s trying to get through checkout. They’re taking candy and causing her more stress. You might just talk to the children, mention to mom, “Oh, I have grandchildren, I’ve been through this before. Let me just distract her. Let me talk to your kids.”
Just offering help, so that way they don’t feel like you’re talking down to them about being harsh to their children. You’re really just distracting the kids and the parents. So they can get through the line. It’s a win-win situation.
Dr. Mike Patrick: Yeah, because once you are perceived as judgmental or confrontational, then it’s not likely that you’re going to really change behaviors, right?
Diane Lampkins: Exactly.
Dr. Mike Patrick: So again, when bystanders do decide to act, at least here in Central Ohio, we have all those ways that we had mentioned. Again, we’ll have those in the Show Notes over at PediaCast.org for Episode 333, the phone number, text numbers, all that.
So if someone does call in, who is it that they’re talking to?
Diane Lampkins: There’s a resource line positioned. So that person is there to provide resources, answer questions. Sometimes they’ll even go within our building because we have all those partners. If there’s additional information they need, they’ll go get it from them and provide that information to the caller.
Dr. Mike Patrick: So they’re not talking to someone who’s law enforcement. They’re not talking to someone from Children Services. It really is just a person trained to help.
Diane Lampkins: Yes.
Dr. Mike Patrick: Great. All right, let’s kind of shift gears here a little bit. I had mentioned that Cathy Davis is a forensic interviewer with the Child Assessment Center. So, Cathy, you have a tough job. Tell us a little bit about what you do.
Cathy Davis: Sure. Well, my job really is to talk to kids when there’s concern for some type of abuse. Or if there’s been some disclosure that’s already been made of either physical or sexual abuse. As a forensic interviewer, we try to gather as much information from the kids as we possibly can in a very open, neutral sort of way.
Dr. Mike Patrick: In The Center, it’s unfortunate, but you really are kind of heavy on seeing sexual kids with sexual abuse. Is that right?
Cathy Davis: Yeah.
Dr. Mike Patrick: What kind of behaviors do you think should alert parents to the possibility that this may be going on?
Cathy Davis: Well, I think it really depends on the age of the child. Typically, if the kids are younger, parents will notice, I guess, some regression possibly. So, for instance, a child that was maybe once potty-trained might start to wet themselves.
You might notice more tearfulness from these kids than as normal. Difficulty separating from caregivers, and then sometimes, you can notice just an increase in temper tantrums and fits. If you’re talking about a school-age child, I think you’ll probably notice sort of a sudden change in personality perhaps. So a kid that’s typically calm and laid back might suddenly become very emotional or oppositional. Or, a child that’s generally very active and social with friends might suddenly kind of want to stick to themselves and stay at home.
In as far as adolescents go, I think you would be more prone to notice these kids as being a little bit more secretive, maybe not wanting to share with you as much as they normally would. You might notice changes in sleeping or eating habits. Sometimes kids will start to self-harm or use drugs and alcohol.
But, and same as, I really want to caution parents that those responses are pretty typical responses to a lot of different stressors that kids encounter. And, it’s not uncommon to see these changes in our kids from time to time.
Dr. Mike Patrick: But sexual abuse should be one of the things, but one of many that could result in that.
Cathy Davis: Absolutely.
Dr. Mike Patrick: Couple of episodes back, we talked about the importance of talking about sex openly with kids from a very early age and answering their questions and calling body parts by their real names, so everybody knows exactly what they’re talking about and to identify private parts as private.
Do you think it’s important to have that open line of communication with kids from an early age?
Cathy Davis: Absolutely. And what I tell parents that it’s not The Talk. It’s lots of little conversations over the years that are done in a developmentally appropriate way based on how old the child is.
Dr. Mike Patrick: So let’s say a parent does have a concern. They’re not really getting anywhere in terms of figuring out what the cause it. But they are seeing these changes in their child. What should they do?
Cathy Davis: Well, I think it’s OK to talk to your kids. If you have a concern, I wouldn’t say to question them directly about what that concern is, but just check and ask them if something has happened that they’re not OK with, or something that’s happened that made them feel uncomfortable.
Most importantly, parents need to educate their kids like we just talked about and create an environment where the kids are going to feel safe coming to them should something ever happen. Where they know that I can talk to mom and dad. They’re not going to fly off the handle, and I know that they’ll help to take care of me and keep me safe.
Dr. Mike Patrick: Once a kid is seen in The Center, and you are talking to them, what can they expect during that interview? What goes on?
Cathy Davis: Well, like Diane mentioned, we try to streamline the process as much as possible for families by working with a multi-disciplinary team. So, when families come in to our center, our hope is that any professional from any agency that might be involved with the case would be available to them at that same appointment.
But typically what happens is, families will come in and they’ll meet with a counselor and social worker and have the process explained to them a bit further. At that point, their child will be interviewed. And as the interviewed is taking place, the parent or the caregiver will meet with another counselor or social worker. The role of that professional is really to provide support, answer questions that the parents might have and mainly to provide any possible referrals for the child in terms of things like counseling.
Dr. Mike Patrick: Now, if it is a family that the parent is not able to get a kid to talk about these things, how are you able to establish trust and get kids to talk to you about very private matters?
Cathy Davis: Well, sometimes kids won’t talk to us about the concern, but we do our best to make the children feel as comfortable as possible. So usually, the interview start out just by talking about regular everyday things. We’ll talk about what they like to do for fun. We’ll talk about school, family, those sorts of things.
And then, it’s also really important to provide reassurance to the kids, that they’re not in trouble with us, and that this is a safe place for them to talk.
Dr. Mike Patrick: How do you know if the kid is telling the truth? Especially, if there’s an abuser, that’s the first thing that they’re going to say, is that the kid’s lying about it. At the end of the day, do you see there many kids lying about this kind of thing?
Cathy Davis: Well, first of all, it’s really not our job whether or not a child is telling the truth, but we generally don’t have any reason not to believe what a kid says to us. There is a lot of research out there to suggest that false disclosures are generally very low. But again, it’s just our job to talk to the kids and gather information and then document whatever is said or report them.
Dr. Mike Patrick: So this then really kind of falls into more law enforcement in terms of trying to decide if there’s proof of what they’re saying or whether it’s true or not. So you talked about law enforcement and the Prosecutor’s Office being involved in the clinic. What does that look like actually at The Center? Are they there during the interview or only in specific cases? What is their role during the interview process?
Cathy Davis: Like I said earlier, if law enforcement is involved with the case, we always try to invite the detective that has been assigned to the case to observe the interview as it’s talking place. The purpose for that though really is hopefully minimize the number of times that a child has to be questioned regarding whatever the allegation is. And so, by allowing the detective to watch the case, hopefully, they won’t have too many follow-up questions for the child pertaining to the investigation itself.
Dr. Mike Patrick: Are the interviews recorded?
Cathy Davis: Yes, they are.
Dr. Mike Patrick: Video and audio both?
Cathy Davis: A-hmm.
Dr. Mike Patrick: So they would have that also to review if they needed to.
Cathy Davis: Sometimes, law enforcement can’t make it to The Center for that assessment, and in those cases, we will make sure that they got copy of the recording itself.
Dr. Mike Patrick: And then, it’s up to the Prosecutor’s Office if any charges are going to be made based on the evidence of the interview and the physical, but also of whatever else the law enforcement is able to find. It’s all in the Prosecutor’s hands at that point, right?
Cathy Davis: Yeah, it’s really up to law enforcement to send whatever information they have gathered or collected to the Prosecutor’s Office, and then the Prosecutor decides what if any charges can be brought.
Dr. Mike Patrick: Now, where does CS or child protective agencies, how do they get involved in this whole process? So if someone is seen in your clinic, does that mean automatically the Children Services are going to be involved? Or, is that if we just find enough evidence, then we contact them? How does that all work?
Cathy Davis: So most of the time, Children Services is involved.
Dr. Mike Patrick: They may be the ones that made the referral, right?
Cathy Davis: Yeah, actually, I would say the majority of the families that we see, we actually get those referrals from Children Services. If, for any reason, that agency is not involved yet, and let’s say the call comes in from the parent, or law enforcement, then our in-take staff will alert Children Services of the concern.
Dr. Mike Patrick: I think it’s important to parents that Children Services isn’t necessarily your enemy. I mean, they’re really there to help you, to help you, parent, to provide resources to connect you with what you need. Now, obviously, they’re going to protect the child if they’re in a dangerous situation, but their primary goal is to keep a family intact.
So I think just in my own job of having worked in the emergency department, there’s always kind of some fear when you mention Children Services, but really they’re there to help.
Cathy Davis: Absolutely.
Dr. Jennifer Tscholl: That’s definitely a common misunderstanding. A lot of people think that when Children Services is called, their initial question is, “Are you going to take my child away from me?” That actually happens very rarely, that children get placed in out-of-home placement. It only is to keep the family dignified.
Dr. Mike Patrick: And a parent who has that concern, already, they’re showing that they have a bond with their child that they love and they want the best for him.
Cathy Davis: Yes.
Dr. Mike Patrick: Dr. Tscholl, let’s talk a little bit about the physical examinations. So, as difficult as the interview is, I think a physical examination, especially in terms of sexual abuse can be a very sensitive thing too. How do you go about evaluating kids for that.
Dr. Jennifer Tscholl: Well, we do the physical exam on every child after the interview has already taken place. The interview really gives us a sense of what type of testing we might want to do and what kind of findings we may possibly expect.
And then, we really just go about it the same way any doctor would go about any exam. So they don’t come in and just get a focus exam. We do really a full, very complete history and physical with every child that we see.
So, we go through the standard process that any doctor would in the doctor’s office. We establish rapport with the child. We tell them upfront what we’re going to do, “I’m just going to ask you a bunch of questions. I’m going to ask you about your body. And then, I’m going to look you over from head to toe, and that will include looking at your private parts.” And we try to use the same terminology that they use when they refer to their private parts so as to not… If the parents haven’t introduced proper anatomic terms to them…
Dr. Mike Patrick: Yeah, in language they can understand.
Dr. Jennifer Tscholl: We don’t want to be the ones to do that. And so, we talk to them. We don’t necessarily go through the history again, because we’ve just gotten a lot of information from our forensic interview process. And then, we just ask them if anything’s bothering them that might lead us to do any additional testing.
We look them over from head to toe, a very thorough cutaneous exam, because even if we’re evaluating someone for sexual abuse, sometimes there’s overlaps and different types of abuse that happen within the same household.
Then, we use a colposcope to do anal-genital portion of the exam. Part of us doing this exam is also trying to normalize it for the child, so we’re really trying to say, “We do this with every child.” Then, we provide a little bit of education along with that, “I can only do this because I’m a physician and because,” whatever support person the child has with him, “because this person is saying it’s OK.” And if anyone else ever try to do this, what would you do and who could you tell?
And take that as an opportunity to educate them that, “It is OK because I’m a medical professional. I’m doing this to make sure your whole body is healthy. But no one else should be asking to look at your body in this way.”
Dr. Mike Patrick: You mentioned a colposcope. What is that?
JD: So our a colposcope is for lack of a better description, it’s like a microscope to look at that part of the body. We use it to see things very up close and also to have a really good light source to be able to see those things. We have a camera attached to our colposcope so we’re able to photo document our findings. Which, although families are often very nervous about this when they come in, I would say, majority of the time, that’s one of their biggest apprehension. It’s what is going to happen in the medical portion of this? What kind of exam is my kid going to get, or they’ll say, “We’re not going to do that.”
But just to dispel any myths, we don’t do the same type of exam that an adult women would expect to have if she went to her gynecologist. We are doing just an external exam. There are no speculums involved. If a child is a teenager, like an adolescent, who’s already going through puberty, there might be a cue tip to touch kind of the outside tissues, but still, it is exceedingly rare that there’s any need to do any more type of exam.
And, if it’s a young child, especially those exams would have to be something done under anesthesia. It would be a really big deal if we thought like we had to do a more thorough exam.
Dr. Mike Patrick: So, really, the priority too is to make sure the child’s comfortable, that they understand what’s going on. And if it’s a kid that’s been to a pediatrician, they probably had a similar exam. Just, it might take you a little longer but otherwise, you’re going to be doing the same sort of things that they have done except documenting with photos.
Dr. Jennifer Tscholl: Exactly. And I would say most of the time, even when people are really apprehensive about it including kids, when it’s done, they’re a little bit surprised. “Oh, that was it.” I think it’s a lot less invasive than people would expect it to be.
Dr. Mike Patrick: Now, there are also limitations to the physical exam, particularly in cases of sexual abuse. Tell us about that.
Dr. Jennifer Tscholl: So, with sexual abuse especially, our mantra is that it’s normal to be normal. And so, there’s a lot of evidence and anecdotal experience that dictates that even in kids who have been sexually abused, even in kids with testing or pregnancy or sexually transmitted infections that really are diagnostic of sexual contact, that they still have normal physical exams. That there is no, well, there is no virgin test.
And so, this is something that’s really hard for parents to come in. And especially in maybe in forensic interview, it’s still not entirely clear what may or may not have happened. Or, in a very young child who may not be able to say what happened. It’s really hard for parents to hear, “Everything is normal and everything looks good. And that’s reassuring. Nothing’s causing your child pain. Nothing needs to be followed up. Nobody could ever tell if anything abnormal ever happened.” But it’s also uncomfortable for families to not have a definite answer. Because I can’t say that just because the exam is normal, that means that nothing happened.
And, there’s a lot of different reasons for that. A couple of reasons are, one, even if something did happen, it may not have caused an injury. There’s a lot of different things that can be considered abusive that don’t necessarily cause a traumatic injury to the genitalia.
Another is that, if there was an injury, the nature of that area of the body is that it’s really resilient, and it heals very quickly. And so, if you’re not seeing something in an acute setting, that injury may have healed in a way that we can’t tell that there’s ever an injury there.
The last thing is that, especially in really young kids, the idea of what is inside, what is outside of where necessarily anything happened is really a hard concept for them. All they know is, “Something touched me and it was uncomfortable.”
Dr. Mike Patrick: It was a bad touch.
Dr. Jennifer Tscholl: It was bad. It shouldn’t have happened. But I can’t say definitively that there was or wasn’t what families like to ask about is penetration. And, I can’t say definitively whether or not that happened. That’s a really hard concept until you get into kind of an older age group.
Dr. Mike Patrick: And with sexual abuse, I know one of the situations that we come across frequently in the emergency department is a child who is with the non-custodial parent — let’s say for a weekend — and they come back. The parent doesn’t have any specific concern, but they just want to make sure that the child hasn’t been physically abused. Really, there’s no way that you can look at the kid — unless there’s evidence that they were — but if it’s a normal exam, you can’t say one way or the other.
Dr. Jennifer Tscholl: Exactly, if it’s a normal exam.
Dr. Mike Patrick: That’s frustrating, I’m sure, for parents.
Dr. Jennifer Tscholl: Right. If it’s a normal exam, which most of the time it is, then you can’t really reassure them that nothing happened. Conversely, if you do have a finding, although it’s rare, usually that’s diagnostic of something.
Dr. Mike Patrick: Like so many things in medicine, that’s where the whole picture becomes important. The history, why does mom have a concern? And if there is a concern, maybe Children Services should be involved so that they can just go out and check and make sure that nothing is happening. So, really, it’s the whole big picture, which is why this whole multi-disciplinary approach is so important.
Dr. Jennifer Tscholl: Yeah, that’s why it’s incredibly necessary because a lot of the times, the allegations are based off of mistrust and things that have happened previously and not necessarily involving the child, but maybe within a relationship when it comes to custodial parents and things like that.
Dr. Mike Patrick: So a lot of times, when it’s a concern of sexual abuse, the referrals coming either from Child Protective Services because the parent had said something, or there’s been a mandated reporter who maybe had said something.
With a physical abuse, I would think that you’re a little bit more likely to have that finding, like a physician would see something, like, “This is a concern for physical abuse.” We do have a lot of pediatric providers in the audience for this show. What kind of things should they be in the lookout that would alert them to possible, physical abuse in kids?
Dr. Jennifer Tscholl: So when I’m thinking about physical abuse and addressing it with other medical providers, I like to focus, especially on the really young kids, because those are the kids that are especially at risk and just can’t tell you what happened. So, everyone can breathe the sigh of relief once kids are, in general, like three and older, and they can say roughly what happened to them and how they got something, if you see some sort of mark or an injury of sorts.
But in that really young age group, the younger, the more at risk that they are. We like to focus on things that kids are developmentally incapable of kind of self-inflicting, things that from a clinical management perspective are not very serious injuries, things that will be self-limited and not require medical intervention, but they can be a real marker of violence towards a child.
On that list of things is bruising in any non-ambulatory child. And that’s really any bruise, anywhere that’s unexplained on a child who’s not cruising because there’s just no reason for those children to have bruises. And that’s a really hard concept for people, to see a bruise, which in an older child is everywhere. It’s the most common injury ever.
Dr. Mike Patrick: Yeah, especially in the front of the lower legs, right?
Dr. Jennifer Tscholl: Exactly. And so, it’s so hard to then take this one kind of sub-population and think of that as being a really serious that should be a marker of some sort of trauma has happened to that child. And, if there’s no explanation for it, you have to work that up a little bit further.
So that would be one thing that I would point out to medical providers. Another would be oral injuries. Again, in that same age group, so before kids are mobile and really face-planting, if you have a torn frenulum, and you can have a torn labial frenula and that’s like the little piece of tissue that connects like your gums to your lips. And there’s also the same little piece of tissue that connects the bottom of your tongue to the base of your mouth. And if you see any of those are torn…
Dr. Mike Patrick: In a non-ambulatory kid.
Dr. Jennifer Tscholl: In a non-ambulatory kid, again.
Dr. Mike Patrick: Or if there’s no good story for how that happened.
Dr. Jennifer Tscholl: Exactly. So things that don’t have history. And then, as kids start getting a little bit older, you just have to think of every injury in the context of their developmental capability.
Dr. Mike Patrick: So bruises on the legs and the forehead are going to be common. But if you see bruises on the abdomen that are equally spaced like fingers would be spaced apart, then that raises concern.
Dr. Jennifer Tscholl: Or a child who’s still in diapers and has buttock bruising. That’s a really protected area of the body, or really any genital bruising at all is going to be really concerning.
Dr. Mike Patrick: Now, if you have a concern in those younger kids and I do want to go here, because there had been some studies recently that showed that maybe not as many doctors who see young kids are doing the things that we feel that they ought to be doing the evidence would suggest that you should do.
So let’s say less than two or three years old who come in with this kind of unexplained bruising, what kind of workup would you recommend?
Dr. Jennifer Tscholl: My stance is if you don’t have the education, if you don’t kind of just have the knowledge to know to do it, then it’s hard to plead the case for someone to do it. But, if you have that concern, my recommendation would be to refer that child probably to a children’s hospital who’s capable of doing the workup. Any child less than two years should get a skeletal survey, which is a series of about 24 to 26 images of the entire skeleton.
Hospitals that don’t focus on children aren’t necessarily familiar with all those images. Nor do they have a radiologist who can interpret correctly all of the bony findings on young growing bones, because kids are not just little adults.
Dr. Mike Patrick: And we cover this on a previous PediaCast but there was a study that showed that it was a very low number of kids that are seen outside of pediatric emergency departments that actually get that done.
Dr. Jennifer Tscholl: Yes, and there are studies that even in pediatric hospitals, that doesn’t get done as often as it ought to. And then, again, depending on the age and depending on the injuries, there may be recommendations to get head CTs. There’s going to be a recommendation to get labs to look for occult abdominal trauma. So it’s just really hard to tell if kids have any kind of injury in their belly.
And so, there’s some labs that you can draw that can kind of heighten your concern for that and so doing some tests to see if the liver enzymes are elevated, or the pancreatic enzymes are elevated. And if they are, then you get an abdominal CT as well.
Dr. Mike Patrick: And I think parents would say, “Well, maybe he just bruises easily.” And so, you probably want to check some blood work that sees if they bleed easily or not.
Dr. Jennifer Tscholl: If that is the chief complain, I would say that it is totally appropriate that you should be working a child up for any kind of bleeding disorder, just starting with the CBC and some coags. But I would caution any provider or parent that a bleeding disorder is far less likely than child abuse, just statistically speaking.
Dr. Mike Patrick: Absolutely.
Dr. Jennifer Tscholl: And so, if you’re going to be thinking, “Maybe this is a bleeding disorder,” and doing those labs, you should be doing the workup for child abuse at the exact same time.
Dr. Mike Patrick: I’m going to open this question out to everyone. It’s a little bit of a difficult question, I think. And I don’t suspect that you’re going to have the — there’s probably not the right answer –but I suspect that there’s a lot of parents who have concerns about physical or sexual abuse. Or, agencies that have that concern, and they come and there’s just isn’t enough evidence to do anything. And so, the kid goes back to the home where they might still be around the person that someone’s concerned about. What advice do you have for parents who find themselves in that situation?
Cathy Davis: My recommendation, like I said earlier, is always listen to your gut. If you feel like something is off, then I would encourage parents to do what they can reasonably do to keep their kids safe. So if it’s possible to keep your child away from the person that concerns you, I would recommend that. But a lot of times, it’s not possible.
So then, trying to increase supervision when your child is around somebody that worries you would be the next step. But again, sometimes, that’s not always the case either. At that point, that’s when you really need to just rely on that education that you’ve provided to your kids to where if, heaven forbid, something were to happen to them, that they know that they come and tell you about it.
Dr. Mike Patrick: And if there’s future concerns, don’t say, “Well, I already reported it and then nothing came of it.” If you still have concern, you still keep reporting.
Cathy Davis: Yeah, absolutely.
Dr. Mike Patrick: All right, well, I really appreciate all three of you taking time to stop by the studio and talk to us about these things. They’re difficult but they’re certainly important. But thanks very much.
Cathy Davis: Thank you.
Diane Lampkins: Thank you.
Dr. Jennifer Tscholl: Thanks for having us.
Dr. Mike Patrick: Again, we’ll put links to all the things that we have talked about in the Show Notes for this episode. And not only the contact information, the phone numbers and the text number and the website, but The Center for Family Safety and Healing is also on Facebook, on Twitter. We’ll put links to those social media channels that you guys have as well.
There’s also a website called NoMore.org. Families can get a lot of information and education from that site as well. Their motto is “Together, we can end domestic violence and sexual assault.” So I’d encourage folks to check out NoMore.org.
We also have a phone number for Adult Protective Services. If you’re concerned about elder abuse which is a common thing, there’s a phone number if you’re in Central Ohio that you can call to talk about someone about your concern there.
We also have the phone number for the National Teen Dating Violence Helpline. And, for those in Central Ohio, Franklin County Children Services hotline, we’ll put their phone number.
So we have tons of resources for folks, again, if you head to PediaCast.org and look for the Show Notes for this episode, 333.
So, once again, thanks to Dr. Jennifer Tscholl, Diane Lampkins, and Cathy Davis. I appreciate all of you stopping by.
Let’s take another quick break and I will wrap up the show right after this.
Dr. Mike Patrick: All right, I also want to thank all of you for taking time out of your day to make PediaCast a part of it. We really do appreciate it. PediaCast is a production of Nationwide Children’s Hospital. Don’t forget, you can find PediaCast in all sorts of places. We’re in iTunes and most podcasting apps for iPhone and Android, including the Apple Podcast App, Downcast, iCatcher, Podbay, Stitcher and TuneIn.
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Thanks again for stopping by, and until next time, this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.
Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening. We’ll see you next time on PediaCast.