Something for the children.... You will not be forgotten

For Every Child Who Cries At Night
 

For every child who cries at night
Alone with shame and pain and fright

For every child who wants so much
To only feel a gentle touch

For the beaten child, who cries in pain 
Whose tears run silent, like the rain

For the child used to satisfy lust 
Who never learns to love or trust

For the child taken from her home
And made to feel so all alone

For the child whose home is just a shell
Where life becomes a living hell

For the child who smiles but cannot feel
Because of scars too deep to heal

For every child who yearns for love 
I hope and pray to God above

To hear your cries and heal you pain
And give you back your life again.

Author: Nick Howington

Jane Barker Brooklyn Child Advocacy Center- the hub in Brooklyn

Safe horizons is a place where the victims of abuse can come and find treatment under one roof. the reception area is designed to make the child feel comfortable and safe with toys and movies.
Safe horizons helps children do what is extraordinarily hard: talk about the abuse they suffered. During the forensic interview, the specially trained interviewers task is to amass as much information and detail possible while making it easy for the child to talk about what happened. At the same time, a team comprised of police detectives, child protective service reps, safe horizons staff and a representative from the DA office and a medical specialist watch via closed circuit from another room. That team then plans a course of action based on the case at hand.
This multidisciplinary team approach towards helping young victims makes the process easier on that victim because they only need to be interviewed once and it allows all these specialists to consult each other and work together under one roof to provide the best possible care.

The site is a Child Advocacy Center and as such, is specialized. Whereas most medical practitioners and police officers are not experts on child abuse, this site is designed to bring together experts specialized in the field of child protection. Dr. Daniele has been involved with child abuse evaluations for more than 16 years. She is an expert at the difficult task of performing the medical examination on these victims of abuse. We spent time discussing the finding that are typical and more importantly, the fact that usually there are no findings. We talked about anatomy and how the correct terms should be used by doctors when documenting findings and reviewed picture guides in the discussion. She is very informative and in-tune to the needs of these children. She makes her patients feels safe and encourages them to express their feelings.

We also received a tour of the part of the building that houses the police. The police station is a Special Victims Unit popularized as SVU. Once again, like the medical examiners, these police are specially trained in dealing with victims, perpetrators and families of abuse. The unit is large and houses an interview room and even a jail cell.

In the same way that a multidisciplinary approach to medical treatment provides optimal care for a patient, bringing together all these specialities under one roof gives them the opportunity to consult one another and work together to provide for the families and victims of abuse.

The law in action

We were privileged to spend some some with Judge Hoffman to observe his cases. It was at this point that we saw all the individual parties in action. Usually in family court there is a lawyer for the child, a lawyer for each parent represented and sometimes a representative form the Administration for Children's Service.

With all the legal jargon accumulated in our minds over the weeks, we sat in on cases with a mixture of results- some great and some not so great. But at all times, the interest of the child remained the main focus.

The grim realities...

An unfortunate but important session was our time spent with the Pediatric Medical Examiner. Dr Monica Smiddy gave a teaching on how to proceed with a pediatric autopsy. The findings serve to give a ‘cause of death’ (scientific explanation for why the child died) and a ‘manner of death’ (an opinion formulated based on the evidence gathered). Unlike the adult autopsy, the pediatric autopsy pays very close attention to measurements (head circumference, femur length, organ weights etc) as this gives valuable information about the state of the baby while alive and tells if the child was developing normally. Although sad, the Medical Examiner’s 2 part teaching sessions are highly recommended since a lot of life is understood by examining the dead.

Health care at Foster Care

Medical care for foster children can be challenging at times and therefore we met with a specialist in that field. As a nurse on the AIDS unit for a number of years, Ms Gulick went on to do her MD and become a pediatrician at the St. Vincent’s Foster Care Agency.

We were privy to how different the history is when most of the records are not readily available and foster parents are usually unaware of the child’s medical history before coming to their home.

Nonetheless, the examination must go on and everything is done to ensure that the complete health of the child is addressed.

Dr Gulick shared with us that she initially thought this branch of pediatrics would be primarily immunization and infectious issues (as a reasonable portion of this population is HIV positive); however, she confesses that psychiatric problems have now become a bigger concern and continues to grow.

Parental Representation

Christine Zielinski is an excited young lawyer that gave us the view from the other side of the field. She represents the parents that the allegations are brought against. It is important to realize that sometimes with the great desire to protect children; the advocates may get things wrong. It is at this point that these lawyers must seek to protect the rights of the parents and prove that the guardian/ parent did not in any way abuse the child/ children in question.

Although these errors are not the norm, accidents do happen. The more usual role for the members of Child Parental Representation is to help parents as they go through whatever process is necessary to regain control of their lives and re-establish a safe home for the children.

The majority of the cases are drug-related or complaints of physical abuse. We also discussed how in a city of so many varied cultures, the difficulties encountered when discipline in one culture is not allowed according to the laws of this culture and directly violates the laws governing NYC.

Ms Zielinski believes that different people have different issues in their lives that cause them to act in various ways. She does not believe that her clients are truly terrible people; which is the stigma attached after an allegation of child abuse, but instead people that can be helped so that they see that their behaviour impacts their children and to that end decidedly work on changing.

All aboard!!!

We're off to see the system at work in Staten Island with a glimpse of lady Liberty and Ellis Island on the way.

On Staten Island we met with the advocacy team there and discussed recent cases  at a case review. The team there consists of:

• ·         District attorney

• ·         Police

• ·         Case workers

• ·         Social workers

• ·         Medical team

Law guardian

Upon visiting the Legal Aid Society, we met with Emily Kimball who functions in the legal system as a “Law Guardian.” We learned that a law guardian is basically, a lawyer who represents the child in Family Court. They are assigned by Family Court judges and work with the child on that case and any future cases. As such, they may be involved in the child’s life for years.
For some cases, the Legal Aid Society also provides the child with a social worker in order to help address the psychological and educational issues that arise in court proceedings. We spoke a little about the society’s history and how during the 1960s, the U.S. Supreme Court ruled that children have a constitutional right to counsel at government expense.
As the legal representation of the child, the law guardian advocates for the child. Yet, we were curious about what the guardian does when the child’s wishes are incompatible with the guardian’s judgment. This therefore lead to a conversation about how the system determined that for a child under seven, the guardian may substitute the child’s judgement; yet, if the child is over seven, the role of the law guardian is to advocate that child’s wishes. The age of seven was not chosen at random and we are sure studies support it; however, in our opinion, development is by no means that discrete. This is another example of why pediatrics is so challenging: the stages of development add complexity. As such, the guardian when meeting with the child, will counsel them on what’s safe vs. not-safe and help them make thoughtful decisions.

SIDS

 SIDS presentation with Peggy Regensburg PhD.

Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant (1 month to 1 year) to which there is no found cause of death even after thorough work-up. SIDS is therefore a diagnosis of exclusion.

It has been associated with babies who are placed to sleep on their tummies and as such National Institute of Child Health and Human Development has coined the ‘Back to Sleep’ slogan which encourages guardians to place babies on their backs when putting them to sleep.

Although not a part of SIDS, the sleeping environment plays a huge role in child safety in the infancy stage. The things we may find ‘cute’ may in fact be deadly to an infant. For example, until a baby has full control of his/her head, a pillow is a suffocation hazard and is therefore not necessary in a crib. Many babies have been found lying face down on their pillows because they were unable to lift their heads.

Other ‘cute’ hazard include but is not limited to: blankets, stuffed animals/toys, crib decorations and a baby sleeping on an adult bed with an adult- these have all been the direct cause of fatalities of cases presented. 

For more information on SIDS

Also check out the services offered here

More legal stuff...

We met with Ted Baron the assistant supervising attorney in the

Brooklyn division of the New York City Children’s Services. He explained

 the differences between Criminal court and Family court with some great

 examples. 

In the criminal court, it’s the defendant vs society with the

 focus being on the defendant. Robert Blake was found “not guilty” but

was he found innocent? Definitely not. In family court the focus is

shifted to the child and what is best for them. We discussed the concept

 of preponderance (what’s more credible than not) as a concept used in

family court as opposed to the burden of proof in Criminal court.

We also discussed other Family court dilemmas, such as ‘minimal

degree of care,’ and how court terms are not always black and white.

When does the court need to interfere with family relations? What is the

 threshold? The answer is not always obvious. Since focus in family

court is the child, the goal of Family court is not to punish someone

but to make sure that the child is safe. As such, in family court, the

term Defendant isn’t used. Instead, the party is referred to as

Respondent. The focus is on the disposition - what to do with the child?

 And there are two important issues to consider: the child needs both

safety and permanency.

So what’s our role as physicians? as mandated reporters? It’s not a

responsibility to take lightly. We discussed what can happen when a

physician misses or fails to report a case of abuse. One case that took

place at Woodhull Hospital, when a Dr failed to report a case and the

patient subsequently died, made quite the impression on us. Not so much

that he had to testify in court and made himself look negligent in the

public eye, but more personally. We could not imagine the guilt that he must

feel knowing that, had he taken a few more moments to evaluate the

situation, a life could have been saved.

As physicians, we need to be vigilant and use common sense when

evaluating a patient’s injuries and interacting with their family. We

should show humility and ask for a second opinion if need be. Otherwise,

 we should always document well by being descriptive when describing

markings and quoting the children. A complete chart speaks for itself

and will often make a court appearance by the doctor unnecessary.

Finally, we shouldn’t be worried about reporting a case thinking that it

 will waste our time because court isn’t a waste of time, it serves a

purpose. Just as we can save a life in a hospital, we can also save one

in court.