Doctor explains child abuse mapping
If Dr. Dyann Daley’s groundbreaking work proves successful, in 10 years she could well be lauded throughout North Texas — and beyond — as a pioneer in the eradication of child abuse.
A pediatric anesthesiologist, Daley believes she had progressed through the first stages of a potential landmark project that identifies the city’s most vulnerable areas for child abuse. Once targeted, preventative action could be implemented to prevent abuse before it occurs, saving hundreds, and ultimately thousands, of at-risk children from long-term physical, emotional and psychological trauma — if not death.
Gauging results will take years of implementation and data collection. Indicators of success will include a gradual decrease in the high number of child abuse cases recorded in Fort Worth and Tarrant County each year, and a rapid increase in the number of cities, counties, hospitals, police departments and social service agencies that take notice, and begin their own research and implementation.
“That’s my goal, because that’s how we’re going to figure out how to prevent child abuse,” Daley said. “The more people we have doing this framework, the more geography that we can cover with this framework, the faster we’re going to figure out how to make a positive, preventative impact. So, to me, scale is important. The faster we scale, the faster we’ll be able to help some little kid who needs us.”
However, Daley will now watch her creation, The Center for Prevention of Child Maltreatment at Cook Children’s Medical Center, carry on her work from somewhere else.
Daley told the Star-Telegram that Cook Children’s “invited” her to resign in May because she refused to sign off on a plan to sell the research that is being done by the center.
“I told them ... I would not do that,” Daley said, explaining that it’s important for the information to be easily accessible to the child welfare community.
Larry Tubb, a senior vice president with Cook’s Center for Children’s Health, said they will continue to be a passionate voice for victims of child abuse and neglect.
“While Dr. Daley’s characterization of why she left Cook Children’s is not accurate, it would be inappropriate for us to debate with her in the media the actual reasons that brought our relationship to an end. Cook Children’s conducted a two-year pilot project to study the topic of child maltreatment,” Tubb said in an email. “After a long and thoughtful assessment of the project results through our Center for the Prevention of Child Maltreatment, we decided to refocus our data, research and programming around child abuse and neglect solely on our six-county primary service area. This is more in keeping with Our Promise, ‘to improve the health of every child in our region.’
“We are committed to using our resources to do this in the most efficient and effective manner possible,” Tubb said.
Daley acknowledged that she has a different vision from Cook Children’s on the direction the work should go moving forward.
“It has to be a larger scale or it will take way too long to see what works for prevention. If you do it just in Fort Worth, it could take forever to see what actually works,” Daley said.
Daley said she hopes to continue her work with a national organization that she declined to name.
‘The million-dollar question’
Daley, who joined Cook Children’s in 2006, earned the approval of the hospital’s board of directors to create the center in 2012.
Following its inception in February 2014, the center has since joined forces with TCU’s Department of Criminal Justice in utilizing risk terrain modeling, a type of predictive analytics that pinpoints high-risk areas for child abuse and neglect by analyzing six significant risk factors: poverty, domestic violence, aggravated assaults, runaways, murders and drug crimes.
Areas dealing with a high combination of risk factors have shown to be hot spots for child abuse. The risk terrain modeling used 2013’s data of confirmed child abuse cases to see if it could accurately predict 2014’s confirmed cases in Fort Worth. Daley said it predicted 98 percent of the cases.
Once these vulnerable areas are identified, the staff at The Center for Child Maltreatment can mobilize, flooding target areas with preventive resources. One example is the city’s east side in Stop Six. Donna Floyd, founder of Justin’s Place, which aids teenage mothers who lack a support system, issues baby beds provided by Cook Children’s to ensure that mothers don’t sleep with their newborns. Co-sleeping can lead to suffocation.
“Now you can figure out where are the schools, where are the churches, fire stations, police departments, community centers, any kind of location inside the geography that’s high risk where prevention resources could be deployed,” Daley said. “Then, we’ve been working on this with the state ... you can look to see, OK, all of these services that the state pays for, are they allocated to the people that need them the most? You can start to match up need with actual delivery.”
Espousing preventive measures seems logical. Yet during a blue ribbon state panel in December 2015, Madeline McClure, chief executive of TexProtects, the Texas Association for the Protection of Children, said the state spends about $60 million annually on prevention of abuse, but a staggering $1.4 billion on its aftermath.
A report released last month by the Texas Institute for Child & Family Wellbeing at the University of Texas at Austin shows that receiving services from child maltreatment prevention programs greatly prevents future child abuse cases.
The staff at The Center for Child Maltreatment is just at the early stages of determining which prevention resources will make the biggest impact, and where they can deliver the resources in high-risk areas. A significant obstacle is that areas such as Stop Six and Las Vegas Trail on the city’s west side, often lack amenities such as community centers or ample child care facilities to utilize as education centers.
“That’s the million-dollar question, right?” asked Dr. Jayme Coffman, medical director for The Center for Child Maltreatment. “That’s part of the research that’s going on as well as to look at, OK, once we find these areas that we have a higher risk of abuse, then what are the services that aren’t being provided versus those that are? And then let’s look at which of the services that we do provide that make a difference.
“So this isn’t going to be a short-term answer. We’re in it for the long haul.”
‘This one baby in particular’
Just reading the list of common injuries to babies and toddlers at the hands of their abusers is grotesquely unnerving.
Skull fractures. Retinal hemorrhaging. Torn neck ligaments. Snapped ribs. Lacerated livers.
Daley, 40, bore witness to this stark reality up close as these battered little bodies, one after another, day after day, were rushed into the Cook Children’s operating room. Daley, fresh from returning from maternity leave after having her second child in 2012, could not reconcile the heartbreaking beatings she was seeing.
“There was this one baby in particular that died in the operating room, which usually we can keep almost anybody alive to get to the ICU,” Daley said. “But this child’s injuries were just too awful and he bled to death.
“And so it was during that case that I made a promise to that baby that I would try to help little children like him. And the thing that pushed me over into that space was I was just imagining it was his family that was doing this to him. I know, just from having children of my own, that he was looking for comfort from the man who was beating him to death.”
Daley acted on her promise and formulated a plan that was initially rejected by the hospital’s board of directors. After brainstorming sessions with her husband, Daley introduced a more comprehensive plan to the board, and it was approved on the spot.
“That’s when,” she said, “the work started in earnest.”
There’s plenty of work to be done. Fort Worth and Tarrant County annually record some of the highest rates of child abuse and infant mortality in the state.
According to Cook Children’s, from 2010 through 2016, the hospital recorded between 1,387 and 1,520 visits each year for child abuse. The hospital tracks visits and not patients because some patients make multiple visits.
‘Change the world’
While child abuse occurs across all demographics, it is often the result of crises: ill-equipped teenage mothers, drug and alcohol abuse, economic hardship or violence in the home and neighborhood.
Abuse can also stem from neglect: An unattended baby wandering into an apartment pool, co-sleeping causing accidental suffocation, lack of child care choices that force working mothers to rely on baby-sitting from an ill-equipped relative or boyfriend.
Many agencies in Fort Worth have worked for decades to fight these crises. Daley’s work is producing a co-mingling agencies to consolidate their efforts.
“Identifying the area of need is the first step, and making sure agencies and organizations work together to provide these needed resources is the second step,” said Brenda O’Quin of One Safe Place, an agency devoted to preventing crime and violence in Tarrant County's neighborhoods, schools and homes. “Dr. Daley has been successful, in addition to her data, in bringing organizations together to focus their services in areas identified by the risk terrain model as areas of need.”
Added Floyd of Justin’s Place: “I know that Dr. Daley’s geo-mapping is going to do nothing but change this world. When you can pinpoint where it’s happening, what excuse do we have not to get in there and do the hard work to make these kids’ lives safer and more full of the fun and opportunities the rest of the world has.”
Jeff Caplan: 817-390-7705, @Jeff_Caplan