The Partnership to Eliminate
Child Abuse:
DR. SANDY HERR
EMERGENCY DEPARTMENT MEDICAL DIRECTOR,
KOSAIR CHILDREN’S HOSPITAL
ASSOCIATE PROFESSOR OF PEDIATRICS,
UNIVERSITY OF LOUISVILLE
OBJECTIVES
 Review the scope of the child abuse epidemic
 Discuss the utility of a collaborative approach to
addressing child abuse
 Describe the formation, goals, and initial efforts of
the Partnership to Eliminate Child Abuse (PECA)
 Explore future directions for PECA and similar
efforts
“THE LEVEL OF CIVILIZATION ATTAINED BY ANY
SOCIETY WILL BE DETERMINED BY THE
ATTENTION IT HAS PAID TO THE WELFARE OF ITS
CHILDREN”
BILLY F. ANDREWS, MD
CHILDREN’S BILL OF RIGHTS, 1968
A NATIONAL TRAGEDY
 More than 1,000,000 substantiated cases of child
abuse and neglect/year in the U.S.
 Nearly 2000 documented deaths/year
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80% < 4 years of age
The leading cause of injury-related death < 1 year
Rate is increasing

3.1/day in 1998, > 5/day in 2010
COSTS OF CHILD ABUSE
 Each child abuse case in a
living victim costs
approximately $200,000
 Each child abuse death costs
approximately $1.3 million
 Annual cost of child abuse
and neglect in the U.S.
estimated at $100 billion

Likely an underestimate
A STATE OF EMERGENCY
 Kentucky
 More than 84,000 reported cases each year
 30-40 known child abuse deaths/year
 Nearly 3 deaths/100,000 children
 Have ranked in the top 20 in child abuse fatalities for the
past decade

Ranked first in 2007
 Indiana
 29th worst for child abuse-related deaths
 20-30 child abuse deaths/year
A CHILD’S SAFETY NET
 Family
 Community/church
 School/daycare
 Healthcare
 Social workers/child welfare
 Judicial system
The following cases illustrate failure of one,
several or all components of this safety net.
JJ: The infant with bruising
 8 month old male with recurrent bruising since 3
months of age
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Multiple visits to his PMD
Referred to hematology for a possible bleeding disorder
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Referred to ENT for ear bruising
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Workup normal
Diagnosed with traumatic bruising, referred back to PMD
Ultimately presents to ED with traumatic brain injury,
multiple healing fractures
DS: The boyfriend factor
 1 ½ year old boy admitted for genital bruising,
abdominal trauma
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Diagnosed with non-accidental trauma, CPS report filed
Letter from hospital child protection team stated that child
would “be re-injured or killed if returned to that
environment”
Returned home after 2 months in foster care
Presented to an outside ED 1 month later in full arrest, died
from traumatic abdominal and brain injuries
TT: Little boy lost
 3 year old boy with a femur fracture while in
mom’s care
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No history
CPS notified, child removed
Due to prior domestic violence and paternal mental health
issues, physicians and CPS recommended placement with
grandparents
At hearing, judge placed child with his father
1 month later, his father shot the child and himself to death
WHAT HAVE WE DONE ABOUT IT?
 Child abuse wasn’t even clearly
recognized/described in the
medical literature before the
1960s
 Animal protection laws pre-
dated child protection
 Children viewed as property
rather than people even
through the first half of this
century
HISTORY
 1870s, 8yo Mary Ellen Wilson beaten daily by her
foster family
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Lawyers for the ASPCA presented her case
Foster mom received 1 year sentence
NY Society for the Prevention of Cruelty to Children formed
 1961: Dr. Kempe described the “Battered Child
Syndrome”
 1967: 44 states enact mandatory reporting for
physicians
HISTORY
 1974: Child Abuse Prevention and Treatment Act
(CAPTA) passed
 Now all 50 states have mandatory reporting laws for all
professionals involved in the care of children

Criminal and civil liability for failure to report
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No liability for “good faith” reporting of suspicions
 Educational efforts largely focused on recognition and
reporting of abuse
HISTORY
 Since the 1970’s, the dangers of shaking infants have
been recognized

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“Never shake a baby” campaigns have lead to reductions in child
abuse cases in some areas
Education for new parents
Dangers of shaking a baby
 Tips for dealing with crying infants
 Viewed by far more mothers than fathers
 Hospital-based in most cases

HISTORY
 Most pediatric centers and many communities have
resources dedicated to addressing child abuse
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At KCH, we have had a Child Abuse Task Force since 2002,
and a Pediatric Forensics Division since 2007
Law enforcement agencies specializing in child abuse
investigation
School and community-based social services
Interaction between hospital and community-based resources
are generally case-based and reactive
RESPONSE TO TRAGEDY: “REACTIVE”
 When a death or severe case of abuse occurs
 Family responses complex and often conflicted
Denial
 Anger
 Grief
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Community shock and anger
Media attention with shocking headlines and lead stories
Within hours to days the case is forgotten by all but those
directly involved
Child abuse often linked to unrelated,
live-in lovers
2 charged in separate Jennings Co.
child abuse cases
Father tortures infant and leaves her
with brain damage
Child in Broomfield abuse case died of
'Oxycodone toxicity'
Severely tortured toddlers mom and her
boyfriend arrested
Baby reportedly punched repeatedly in
the stomach and face will likely die
A NEW APPROACH IS NEEDED: “PROACTIVE”
 Despite multiple efforts in all areas, abuse and abuse-
related deaths have not decreased
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Improved detection, reporting are often too late
High risk groups not identified/targeted for education
Newborn education directed at new parents fails to address
unrelated caregivers
Abuse and neglect have not consistently been in the public
consciousness
Little collaboration/cooperation across groups
HOUSE BILL 285
 KY Legislation mandating education on pediatric
abusive head trauma
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New parents
Child care providers
EMTs and paramedics
RNs
ARNPs
Law enforcement officers
Foster parents
Physician assistants
Social workers
A NEW APPROACH
 Collaboration: “the act of working together in order
to achieve shared goals”
 Can a collaborative effort link key players across all
realms?
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Common goals
Varied backgrounds, skill sets and resources
Different levels of access to families and children at risk
WHAT DOES COLLABORATION LOOK LIKE?
 Who are the key players?
 How do we get the players to the table?
 What are the common goals on which to
focus?
 How do we begin working toward those
goals?
WHAT COLLABORATION DOESN’T LOOK LIKE
CHILD ABUSE COLLABORATIVES
 Successful efforts have occurred in other
communities
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Most include healthcare providers, community leaders,
social workers
Few include judicial, law enforcement, and media
representatives
Most are limited to one hospital or system or a small
geographical area
THE PARTNERSHIP
 “A group of people working together for a common
purpose”
 Key players

Physician leaders, hospital and community-based
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4 Children’s Hospitals
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Child abuse/forensics, private practice, ED
Riley, Peyton Manning, Kosair Children’s Hospital and Kentucky
Children’s Hospitals
4 Medical Schools in Kentucky and Indiana

Indiana, Pikeville, Kentucky, and Louisville
THE PARTNERSHIP
 Broad partners
 More than 200 groups, organizations, and
individuals
Social workers
 Child advocacy
 Media/PR representatives
 Community leaders
 School leaders
 Judicial and law enforcement
organizations

Legislators
 Judges
 Lawyers
 Business leaders

THE VISION
 Prevention, detection, and treatment have all fallen
short of our goal
 Elimination should be the ultimate goal
 The name evolved from this lofty goal
 Vision statement: To completely eliminate child
abuse in the areas served by our partnership’s
member organizations
THE APPROACH
 Engage the media
 PSAs
 Op-ed columns
 Expert availability for interviews
 Public awareness campaign
 Videos
 Website: www.pecakyin.org
 Education for schools, community organizations, etc.
 Achieve a constant presence in the public
consciousness
INITIAL EFFORTS
 Family champions
 Families of victims sharing their stories
 Op-ed columns
 The child abuse problem in Kentucky and Indiana
 Warning signs of abuse
 Unrelated caregivers/boyfriends
 Crying
 New parents need extra support
 Expert media spokespersons identified
INITIAL EFFORTS
 Public Service Announcements
 Toolkit
 Allows others to borrow/use the PECA materials for their
area/target audience
 Tips for eliminating child abuse
 Videos
THE FUTURE
 Educational campaigns
 School-based education
 Other high risk groups
 Expanded educational efforts for expecting/new parents
 Expanded mandatory education for physicians, others involved
in the care of children
 Media saturation
 Keep abuse and neglect in the forefront
 Social media
 Perpetrator perspective?
CORNELL AND KARLIE
•“ A L L T H A T I S N E C E S S A R Y F O R T H E
TRIUMPH OF EVIL IS THAT GOOD MEN DO
NOTHING”
IRISH PHILOSOPHER
EDMUND BURKE
SUMMARY
•The Partnership to Eliminate Child Abuse is a
collaborative effort
–Linking
diverse organizations and individuals across Indiana
and Kentucky
–Common goal of completely eliminating child abuse
–Multifaceted approach using media, physician champions,
families
–Educational and awareness campaigns
–Seeking to establish and maintain child abuse in the public
consciousness