1. Recognition, Care, and Reporting of Child Maltreatment Presented by the: Oklahoma EMSC Resource Center

2. Objectives:Objectives: Describe the size and scope of Child Maltreatment in the US. Describe the size and scope of Child Maltreatment in the US. Describe the size and scope of Child Maltreatment in Oklahoma. Describe the size and scope of Child Maltreatment in Oklahoma. Identify the types of maltreatment and patterns commonly found associated to each type. Identify the types of maltreatment and patterns commonly found associated to each type. Describe the Roles and Responsibilities of the EMS Provider regarding prevention, identification, treatment, and reporting of child maltreatment. Describe the Roles and Responsibilities of the EMS Provider regarding prevention, identification, treatment, and reporting of child maltreatment.

3. Scope of the Problem NATIONALLY NATIONALLY 1 million actual cases annually (50% physical abuse / 25% neglect) 1 million actual cases annually (50% physical abuse / 25% neglect) Approximately 1300 deaths/year (Physical Abuse) Approximately 1300 deaths/year (Physical Abuse) 90% deaths occur children <5 years age 90% deaths occur children <5 years age 40% deaths 2° to neglect 40% deaths 2° to neglect

4. Scope of the Problem OKLAHOMA OKLAHOMA 53,548 cases Reported in 2000 53,548 cases Reported in 2000 14,273 cases were confirmed (23%) 14,273 cases were confirmed (23%) 48 deaths 48 deaths Oklahoma and Tulsa counties have the highest rates. (population) Oklahoma and Tulsa counties have the highest rates. (population) Source: Oklahoma Department of Human Services. 2000 Report

5. Types of Maltreatment Physical Physical Emotional/Psychological Emotional/Psychological Sexual Sexual Neglect Neglect

6. Physical Abuse DEFINITION DEFINITION An inflicted act that results in a significant physical injury or the risk of such injury An inflicted act that results in a significant physical injury or the risk of such injury Most states: Most states: Child welfare system concerned with acts by parents or caregivers Child welfare system concerned with acts by parents or caregivers Physical assaults by others addressed by law enforcement Physical assaults by others addressed by law enforcement Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000 Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000

7. Psychological Maltreatment DEFINITION DEFINITION A repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting anothers need. A repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting anothers need. American Professional Society on Abuse of Children 1995

8. Sexual Abuse General term referring to nonconsensual sexual acts, sexually motivated behaviors involving children, or sexual exploitation of children. General term referring to nonconsensual sexual acts, sexually motivated behaviors involving children, or sexual exploitation of children. Handbook for child protection practice, Dubowitz,Panfilis, Sage 2000 State & Federal criminal statues define sexual behavior that is illegal State & Federal criminal statues define sexual behavior that is illegal PEARL: STDs are just that and should not occur in children PEARL: STDs are just that and should not occur in children

9. Child Neglect DEFINITION DEFINITION Omissions in care resulting in significant harm or risk of significant harm to children Omissions in care resulting in significant harm or risk of significant harm to children Hygiene Hygiene Nutrition Nutrition Protection Protection Shelter Shelter Supervision Supervision Medical Care Medical Care Positive impact made when suspicions reported Positive impact made when suspicions reported

10. Roles & Responsibilities Prevention Prevention Identification Identification Treatment Treatment Reporting Reporting

11. PreventionPrevention Educational Awareness Educational Awareness Educating all ages = Public Awareness Educating all ages = Public Awareness Educating Healthcare Providers = Awareness Educating Healthcare Providers = Awareness Remain alert to possible abuse conditions & situations Remain alert to possible abuse conditions & situations Make proper agencies aware for assistance to be provided prior to abuse happening Make proper agencies aware for assistance to be provided prior to abuse happening

12. IdentificationIdentification Awareness & Observation Awareness & Observation Look at the Look at the Environment Environment Child & Injury Child & Injury Parents Parents Situation Situation Listen to everything comprehensively Listen to everything comprehensively Does everything seen, heard, smelled, felt, etc make sense? Does everything seen, heard, smelled, felt, etc make sense?

13. Identification (Continued) Perform Assessment Perform Assessment Initial Initial A-B-Cs A-B-Cs Correct Problems as Discovered Correct Problems as Discovered History (HX) History (HX) Does Hx & mechanism of injury equate to childs age-related developmental stage Does Hx & mechanism of injury equate to childs age-related developmental stage

14. Identification (Continued) Toe to Head Exam Toe to Head Exam D = Deformity D = Deformity C = Contusions C = Contusions A = Abrasions A = Abrasions P = Punctures P = Punctures B = Burns B = Burns T = Tenderness T = Tenderness L = Lacerations L = Lacerations S = Swelling S = Swelling

15. Identification (Continued) Avoid Confrontation Avoid Confrontation Document Information Gathered Document Information Gathered Obtain Hx from Everyone Present Obtain Hx from Everyone Present Be non-judgmental with entire demeanor Be non-judgmental with entire demeanor LISTEN, LISTEN, LISTEN LISTEN, LISTEN, LISTEN Be childs safety advocate! Be childs safety advocate!

16. Identification (Continued) Skin Skin Pattern Marks Pattern Marks Burns Burns Ecchymoses Ecchymoses Bruising colors & locations Bruising colors & locations Head, Face, Eyes, Ears, Nose, Mouth, & Neck Head, Face, Eyes, Ears, Nose, Mouth, & Neck

17. Identification (Continued) Pattern Marks Pattern Marks Electric Cord Electric Cord Ligature Restraints Ligature Restraints Unknown Causes Unknown Causes

18. Identification (Continued) Burns Burns Immersion Immersion Stocking Stocking Tobacco Tobacco Burns to Hands Burns to Hands

19. Identification (Continued) Ears Ears Mouth Mouth Neck Neck Eyes Eyes Scalp Scalp

20. Identification (Continued) May not be abuse May not be abuse Moxibustion Moxibustion Cao Gao Cao Gao Cupping Cupping Mongolian Spots Mongolian Spots Ehlers Danlos Syndrome Ehlers Danlos Syndrome

21. TreatmentTreatment Non-threatening atmosphere & care Non-threatening atmosphere & care Elicit childs assistance Elicit childs assistance Maintain honesty with child Maintain honesty with child Treat injuries as appropriate Treat injuries as appropriate Observe family/child interactions Observe family/child interactions

22. Treatment (Continued) Best Care & Results with: Best Care & Results with: Sincerity Sincerity Compassion Compassion Understanding Understanding Honesty Honesty SMILE SMILE

23. ReportingReporting State Law State Law Any knowledge or suspicion of abuse/neglect must be reported Any knowledge or suspicion of abuse/neglect must be reported Documentation needed Documentation needed Moral & ethical mores Moral & ethical mores

24. Reporting (Continued) Remember the #1 goal is the safety & care of the child Remember the #1 goal is the safety & care of the child Neglect is fixable with time & help Neglect is fixable with time & help The process must be started before a positive outcome can be obtained The process must be started before a positive outcome can be obtained

25. SummarySummary Child maltreatment Child maltreatment No socio-economic boundaries No socio-economic boundaries National problem National problem Includes physical, sexual, & psychological Includes physical, sexual, & psychological Awareness & sincere concern essential Awareness & sincere concern essential All responsible for prevention, identification, treatment, & reporting All responsible for prevention, identification, treatment, & reporting

26. EMSCEMSC A Childs Life Depends on It

27. StaffingStaffing Principal Investigator Principal Investigator John H Stuemky, MD John H Stuemky, MD Director Director Paul F Marmen, MEd, NREMT Paul F Marmen, MEd, NREMT Education Coordinator Education Coordinator Stacy Morton, BS, NREMT-P Stacy Morton, BS, NREMT-P

28. LocationLocation Childrens Hospital at OU Medical Center 940 NE 13 th Street, Room 2B 2403 Oklahoma City, OK 73104 Ph: 405-271-3307 Fax: 405-271-2421 E-mail: emsc@ouhsc.edu emsc@ouhsc.edu

29. ResponsibilitiesResponsibilities Child safety & care Child safety & care Forging interagency alliances Forging interagency alliances Education development & implementation Education development & implementation Research Research Resource Center Resource Center