Cook Children’s new center focuses on child abuse

07/22/2014 6:38 PM

07/22/2014 9:33 PM

Dr. Dyann Daley recalls the vow she made while watching a tiny toddler, whose father kicked him so hard that his liver ruptured, lay bleeding to death on the operating table before her.

“I remember looking at his face. He had a little nose that reminded me of my daughter,” said Daley, a pediatric anesthesiologist for Cook Children’s Medical Center.

“When I was looking at him and knowing it was futile and he was dying, I couldn’t help but think of my own child in that same circumstance and the fear and the terror that baby suffered.

“The people he looked to for comfort offered nothing for him. It broke my heart to think that any child should have to live like that. I promised that baby, because that was all that I could do in that moment, if there was anything I could do to stand between a child and an imminent threat like that, I would do it.”

Two years later, Daley is working to fulfilling that promise as executive director of Cook Children’s new Center for the Prevention of Child Maltreatment. Through efforts such as providing education and support to families of all socioeconomic backgrounds and training doctors and first responders to recognize possible signs of abuse and neglect, the center aims to reduce Tarrant County’s alarmingly high number of known cases.

Last year, 5,689 children in Tarrant County were confirmed victims of physical or sexual abuse. Additionally, the county’s rates of child abuse and neglect and related fatalities are higher than the national rates.

“The numbers are staggering,” said Dr. Jamye Coffman, the center’s medical director. “People are surprised to know how common child abuse is in their community and what the numbers really are. We are not talking just about excessive spankings. We are talking about down to being murdered. To know that it really happens and it’s not just on TV is shocking to people.”

The center will collaborate with Tarrant County service providers, such as the Alliance for Children, as well as other child abuse prevention teams at hospitals in Texas and across the state to develop and evaluate prevention strategies and educational programs, Daley said.

One project already underway is an online training course developed by Cook to help the system’s 4,000 clinical employees detect risk factors and identify signs of drug exposure, failure to thrive, neglect and physical or sexual abuse. Those signs can range from a child being seriously underweight for his or her age to bruises on an infant who is not yet crawling, Coffman said.

“We know we are missing signs of child abuse. Then these kids are coming in with severe head trauma,” Coffman said. “No one wants to think that someone is abusing a child. Sometimes the findings can be rather subtle. If a child is coming in with these subtle findings, we want to heighten clinicians’ awareness and then interaction can happen sooner.”

Up to 50 percent of children who die from abusive head trauma had some sort of bruise that went unaddressed at a previous medical appointment, Daley said.

The center’s goal is to eventually also share the online training tool with other hospitals as well as the community, Daley said.

Specific solutions

Studying what social services are available in communities where abuse and neglect are happening will also be one of the center’s missions. Identifying areas of greatest need in the community could help area nonprofits or faith-based groups know where to broaden their efforts. Or Cook Children’s could develop its own programs to serve communities that don’t have access to needed resources, such as parenting classes, Daley said.

“The more you know about a problem and the more specific you can be about the solution, the better,” she said.

Providing education and coping techniques to new parents is one area of need.

Miriam Haro, a family interventionist for Catholic Charities, said many mothers and fathers who attend her parenting class admit to losing their temper when their children cry or misbehave.

Through the class, parents learn techniques to remain calm, such as placing a crying baby safely in a crib and walking away for a few moments or asking nearby relatives to come over to provide a break from child care. Parents can also learn how to get their child’s attention and compliance through positive reinforcement, such as temporarily taking away a favorite toy for bad behavior or ignoring a tantrum, rather than spanking or yelling.

“We get a lot of parents who come in and tell us they are completely at their wits’ end. I had a parent tell me she was so overwhelmed she wouldn’t put the kids in time out, she would lock herself in the closet,” Haro said. “She couldn’t handle it anymore.”

Crying and potty training are the top triggers for violence in the injury cases investigated by Arlington’s Crimes Against Children Unit, which has handled 87 such cases in the first half of this year. In a moment of frustration, shaking a young child can lead to permanent physical or mental disability or death, Detective Grant Gildon said.

“Potty training is such a process. Kids regress at times. They are out at a store and kids wet themselves. Little boys will go to the bathroom and miss. Parents will see this and think it’s deliberate. They will think the kids are defying them or not doing what they are told,” Gildon said. “We have parents who are trying to train their 1-year-olds. It’s really an immature and unreal expectation.”

Tarrant troubles

Tarrant County’s rate of child abuse and neglect is higher than the national rate of 9.2 victims per 1,000 children, at 10.9 per 1,000, according to a 2013 report by the Texas Department of Family and Protective Services. The county’s number of child fatalities because of abuse or neglect is also higher than the national average of 2.1 deaths per 100,000 children, at 2.7 deaths per 100,000.

“It’s epidemic,” said Julie Evans, Alliance for Children executive director. “I think its certainly worth the attention, both in time and financially, to look at how adults can create safer environments for children.”

The nonprofit alliance works with Child Protective Services, the Tarrant County district attorney’s office, Cook Children’s and police departments to coordinate investigations and provide families with services and support as their cases go through the legal system.

Those most at risk of abuse or neglect are under the age of 5, before they begin attending school where a teacher or another adult may notice a problem, Daley said.

“It’s very important we do all we can to protect these vulnerable children. They don’t have a voice and they can’t protect themselves,” Daley said. “They can be invisible before they show up with an injury. The goal is to help them before they get to that point.”

Measuring the success of prevention programs will be challenging but is a worthwhile endeavor, especially if it means fewer families damaged or destroyed by abuse, Coffman said.

“What I really hope is that we can actually tie in some prevention programs to actual reduction in maltreatment. That is what is really lacking is research,” Coffman said. “We know some of these services reduce risk factors. Does that really relate to a reduction in child abuse? We don’t have hard numbers to look at that.”

Evans said focusing on prevention would do more than save a child from emotional and physical pain.

“Children who have been abused have a higher likelihood to have challenges later in life, whether that is drug or alcohol addiction, addictive behaviors, even obsessive compulsive type behaviors,” Evans said. “You see kids more likely to have challenges in school or with the criminal justice system.

“Prevention is so much cheaper than intervention and treatment.”

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