Child Maltreatment, Volume 3 Module: Investigation, Care & Prevention

By Angelo P. Giardino, MD, Phd and James A. Monteleone, MD

Child Maltreatment Training Module seeks to provide professionals and those they train with the most comprehensive curriculum available for the diagnosis, treatment, and prevention of child maltreatment. Written by 33 leading experts in various areas of child maltreatment, this training module includes 3 workbooks that will benefit anyone who trains or teaches others how to identify, interpret, and report occurrences of child abuse, including law enforcement, medical professionals, social workers, attorneys, and teachers.



The 3 modules cover the following areas:

Physical Signs of Abuse uses color photographs and radiographs to help students learn how to distinguish abusive from nonabusive injuries.



Sexual, Emotional, & Psychological Abuse enables course participants to identify sexual abuse, delineates which children are at high risk for abuse and neglect, and addresses various psychological disorders.



Investigation, Care, & Prevention teaches the steps to take when abuse or neglect is discovered, details the agencies and procedures involved, and teaches participants strategies for preventing abuse.

• Language: English
• Publisher: GW Medical
• Release date: Mar 31, 2000
• ISBN: 9781936590940

Angelo P. Giardino, MD, Phd

Angelo Giardino, MD is a pediatrics specialist in Salt Lake City, UT and has been practicing for 27 years. He graduated from University Of Pennsylvania School Of Medicine in 1987 and specializes in pediatrics. Angelo Giardino was the medical director of Texas Children's Health Plan, a clinical associate professor of pediatrics at Baylor College of Medicine, and an attending physician for the Texas Children's Hospital's forensic pediatrics service at the Children's Assessment Center in Houston, Texas. Angelo Giardino completed his residency and fellowship training in pediatrics at the Children's Hospital of Philadelphia. Immediately after his fellowship training, Angelo Giardino became the assistant, and then the associate, medical director at Health Partners of Philadelphia, where he had primary responsibility for utilization management, intensive case management, and health care data analysis. He also shared responsibility for the plan's quality improvement program. Additionally, he began the Child Abuse and Neglect Team for Children with Special Health Care Needs, which was funded by a three-year grant from a local philanthropy. In 1998, he was appointed associate chair of clinical operations in the Department of Pediatrics at the Children's Hospital of Philadelphia (CHOP), and in June of 1999 he was asked to chair the CHOP Quality Committee. These accomplishments are only a few of his career.

Book preview

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EDITORS

ANGELO P. GIARDINO, MD, PHD

Associate Chair, Pediatrics

The Children’s Hospital of Philadelphia

Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine

Adjunct Professor of Nursing, LaSalle University, School of Nursing

Philadelphia, Pennsylvania

JAMES A. MONTELEONE, MD

Professor of Pediatrics and Gynecology

Saint Louis University School of Medicine

Director of the Division of Child Protection

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

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Publisher: Marianne and Glenn E. Whaley

Design Director: Glenn E. Whaley

Developmental Editor: Elaine Steinborn

Production Manager: G.W. Graphics

–Book Design/Page Layout: G.W. Graphics

–Print/Production Coordinator: Charles J. Seibel, III

–Cover Design: G.W. Graphics

–Production: G.W. Graphics

First Edition

Copyright © 2000 by G. W. Medical Publishing, Inc.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

Printed in the United States of America

G. W. Medical Publishing, Inc.

77 Westport Plaza Suite 366, St. Louis, Missouri 63146 U.S.A.

ph [phone] fax [phone]

www.gwmedical.com

ISBN 1-878060-35-X

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CONTRIBUTORS

Pasquale J. Accardo, MD

Professor of Pediatrics

New York Medical College

Director of Pediatrics

Westchester Institute for Human Development

Valhalla, New York

Richard C. Barry, MD

Professor of Pediatrics

Saint Louis University School of Medicine

Director of Emergency Care Services

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Karen M. Bly, RN, BSN, MA, MEd

Nurse/Counselor

Child Protection Unit

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

John R. Brewer, MD

Associate Clinical Professor of Pediatrics

Saint Louis University School of Medicine

Medical Director of Grace Hill Neighborhood Health Clinics

St. Louis, Missouri

Mary E. S. Case, MD

Associate Professor of Pathology

Saint Louis University Health Sciences Center

Chief Medical Examiner

St. Louis, St. Charles, Jefferson and

Franklin Counties, Missouri

Kevin Coulter, MD

Associate Clinical Professor

Department of Pediatrics

University of California, San Francisco

Medical Director

Center for Child Protection

San Francisco General Hospital

San Francisco, California

Oscar A. Cruz, MD

Associate Professor of Ophthalmology

Saint Louis University School of Medicine

Director of Pediatric Ophthalmology

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Bradley V. Davitt, MD

Assistant Professor of Ophthalmology

Cardinal Glennon Children’s Hospital

Saint Louis University School of Medicine

St. Louis, Missouri

Cassandra K. Dolgin, BA, JD

Member of the Missouri Bar

Assistant Attorney General

Office of the Missouri Attorney General

Jefferson City, Missouri

Richard P. Easter*

Chief Investigator

State Technical Assistance Team (STAT)

State of Missouri

Timothy J. Fete, MD

Associate Professor of Pediatrics

St. Louis University School of Medicine

Director of the Division of General Academic Pediatrics

Cardinal Glennon Hospital

St. Louis, Missouri

Allan D. Friedman, MD, MPH

Associate Professor, Department of Pediatrics

Case-Western Reserve University

Director, Department of Pediatrics

St. Joseph Mercy Hospital–Oakland

Pontiac, Michigan

Senior Medical Staff

Henry Ford Health System

Detroit, Michigan

Angelo P. Giardino, MD, PhD

Associate Chair, Pediatrics

The Children’s Hospital of Philadelphia

Assistant Professor of Pediatrics

University of Pennsylvania School of Medicine

Adjunct Professor of Nursing

LaSalle University, School of Nursing

Philadelphia, Pennsylvania

Sheilah Glaze, MSW, LCSW

Medical Social Worker

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Jesse A. Goldner, MA, JD

Professor of Law

Director of the Center for Health Law Studies

Saint Louis University School of Law

Professor of Pediatrics

Professor of Law in Psychiatry

Saint Louis University School of Medicine

St. Louis, Missouri

Michael Graham, MD

Professor of Pathology

Co-director, Division of Forensic & Environmental Pathology

Saint Louis University School of Medicine

Chief Medical Examiner

City of St. Louis, Missouri

Deputy Medical Examiner

St. Louis and Jefferson Counties, Missouri

E. Richard Graviss, MD

Professor of Pediatrics and Radiology

Saint Louis University School of Medicine

Director, Diagnostic Imaging

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Stuart L. Kaplan, MD

Professor of Psychiatry

Saint Louis University School of Medicine

Director, Division of Child and Adolescent Psychiatry

Chief, Child Psychiatry

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Donna M. (Prenger) Kolilis, BS, Business Administration

Director of Administration

Missouri Public Service Commission

Past Administrator

State Technical Assistance Team (STAT) and

Child Fatality Review Program

Missouri Department of Social Services

Gus H. Kolilis, BS, Education

Chief, Missouri Capital Police

Missouri Police Chiefs Association

International Police Chiefs Association

Past Director

State Technical Assistance Team (STAT) and

Child Fatality Review Program

Missouri Department of Social Services

Gregory D. Launius, MD

Instructor, Department of Radiology

Saint Louis University School of Medicine

St. Louis, Missouri

Atchawee Luisiri, MD

Associate Professor of Radiology

Saint Louis University School of Medicine

St. Louis, Missouri

Sandra H. Manske, RN, MA, JD

Member of the Missouri Bar

St. Louis, Missouri

James A. Monteleone, MD

Professor of Pediatrics and Gynecology

Saint Louis University School of Medicine

Director of the Division of Child Protection

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Lynn Douglas Mouden, DDS, MPH, FICD, FACD

Associate Chief, Bureau of Dental Health

Missouri Department of Health

Jefferson City, Missouri

Wayne I. Munkel, MSW, LCSW

Supervisor of Social Services

Cardinal Glennon Children’s Hospital

Lecturer, School of Social Work

University of Missouri–St. Louis

St. Louis, Missouri

Peggy S. Pearl, EdD

Professor, Department of Consumer and Family Studies

Southwest Missouri State University

Springfield, Missouri

Colette M. Rickert, LPCC, ATR-BC

American Art Therapy Association

American Counseling Association

Anthony J. Scalzo, MD, FAAP, ACMT

Professor of Pediatrics

Division of Emergency Medicine

Medical Toxicologist and Director, Division of Toxicology

Saint Louis University School of Medicine

Medical Director, Missouri Regional Poison Center at

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Michael J. Silberstein, MD

Professor of Radiology and Pediatrics

Saint Louis University School of Medicine

St. Louis, Missouri

Patricia M. Sullivan, PhD

Professor, Department of Otolaryngology and

Human Communication

Creighton University School of Medicine

Director, Center for Abused Children with Disabilities

Boys Town National Research Hospital

Omaha, Nebraska

Thomas R. Weber, MD

Professor of Surgery

Saint Louis University School of Medicine

Director of Pediatric Surgery

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Thomas F. Weeston, MD

Resident of Child Psychiatry

Saint Louis University School of Medicine

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

Barbara Y. Whitman, PhD

Associate Professor of Pediatrics

Saint Louis University School of Medicine

Director, Family Services and Family Studies

Knights of Columbus Developmental Center

Cardinal Glennon Children’s Hospital

St. Louis, Missouri

ADDITIONAL ILLUSTRATIONS BY

Evaline Alessandrini, MD

Attending Physician, Emergency Medicine

The Children’s Hospital of Philadelphia

Assistant Professor of Pediatrics

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

Louis M. Bell, MD

Division Chief, General Pediatrics

Medical Director, Infection Control

The Children’s Hospital of Philadelphia

Assistant Professor of Pediatrics

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

John M. Flynn, MD

Pediatric Orthopedic Surgeon

The Children’s Hospital of Philadelphia

Assistant Professor of Orthopedics

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

Marc H. Gorelick, MD

Research Director in Emergency Medicine

A.I. duPont Hospital for Children

Wilmington, Delaware

Mark L. Helpin, DMD

Director, Dentistry

The Children’s Hospital of Philadelphia

Chair and Associate Professor of Pediatric Dentistry

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

Mark Joffe, MD

Director, Section of Community Pediatric Emergency Medicine

The Children’s Hospital of Philadelphia

Associate Professor of Pediatrics

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

Susan N. Kamerling, MSN, RN, CCRN

Clinical Nurse Specialist, Trauma Program

The Children’s Hospital of Philadelphia

Philadelphia, Pennsylvania

Jane Lavelle, MD

Associate Director, Emergency Medicine

The Children’s Hospital of Philadelphia

Associate Professor of Pediatrics

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

Monica Artiles Liebman, MSN, RN

Clinical Nurse Specialist, Trauma Program

The Children’s Hospital of Philadelphia

Philadelphia, Pennsylvania

John M. Loiselle, MD

Assistant Director of Emergency Medicine

A. I. duPont Hospital for Children

Wilmington, Delaware

Frances M. Nadel, MD

Attending Physician, Emergency Medicine

The Children’s Hospital of Philadelphia

Assistant Professor

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

Richard Scarfone, MD

Attending Physician, Emergency Medicine

The Children’s Hospital of Philadelphia

Assistant Professor of Pediatrics

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

Kathy N. Shaw, MD

Chief, Division of Emergency Medicine

Emergency Department

Associate Professor

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

Perry W. Stafford, MD

Director, Pediatric Trauma and Surgical Critical Care

Pediatric General and Thoracic Surgery

The Children’s Hospital of Philadelphia

Associate Professor of Pediatric Surgery

University of Pennsylvania, School of Medicine

Philadelphia, Pennsylvania

*Deceased

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FOREWORD

I am pleased to introduce these Modules and Workbooks, which were written to accompany the second edition of Child Maltreatment: A Clinical Guide and Reference edited by James A. Monteleone, MD. This presentation is designed to prepare professionals dealing with child abuse situations to cope with their daily challenges confidently and competently, with an enhanced awareness of how what they do fits into the overall scheme of care.

This set of Modules and Workbooks reflects both the authors’ and the publisher’s commitment to educating everyone involved about the problem of child maltreatment. Through this education, it is hoped that a generation of physicians, nurses, teachers, social workers, law enforcement personnel, and other child care workers will be able to improve the standards of care and make their services more widely available in preventive efforts.

One of the strengths of this presentation is the hands-on aspect, in which participants are challenged to go beyond an intellectual assent to what the book says and apply their knowledge in practical situations. To give the instructor a broad base of knowledge in presenting these practical exercises, each chapter has been reviewed by those with real experience in dealing with these issues. These individuals come from medicine, nursing, social work, law enforcement, the judicial system, and psychology. This spectrum exemplifies the teamwork approach advocated in Child Maltreatment: A Clinical Guide and Reference. It is hoped that an understanding of the various roles of professionals dealing with child abuse will lead to improved communication about, and handling of, these important cases.

On behalf of the editors and authors, I wish you success in conveying these important truths to those in your classes, whether this takes place in an in-service setting or as part of the formal education leading to a degree program. It is our hope that the practical application of this information will have a positive impact on child abuse training programs as well as on the practice of child abuse management and prevention.

Howard Dubowitz, MD, MS

Professor of Pediatrics

University of Maryland       

School of Medicine               

Baltimore, Maryland

PREFACE

The reception of Child Maltreatment: A Clinical Guide and Reference and Child Maltreatment: A Comprehensive Photographic Reference Identifying Potential Child Abuse has been gratifying for those of us dealing with child abuse issues. The principles and information offered in this two-volume set have proved vital to many practitioners. To ease the process of conveying the message of these volumes to medical students, nurses, therapists, social services personnel, mental health personnel, law enforcement personnel, and other concerned professionals, we have developed the Instructor’s Manuals and accompanying Student Guides for three modular presentations. It is hoped that the exercises and lesson plans offered here will help instructors of degree as well as in-service programs develop meaningful and pertinent instructional interactions on child abuse topics.

The Instructor’s Manual for each module is designed to clearly identify the goals for each chapter’s presentation and walk the instructor through the process of presenting material and helping participants apply the information learned. To achieve this, we have a brief summary of the content for each topic, followed by exercises that involve the participants, whether it be in a discussion, a role-playing situation, a slide presentation with questions and answers, or an actual clinical experience. Throughout, we have incorporated the principles of effective adult education. Each exercise should be appropriate for a 1-hour class period. With an average of five exercises in each of the 23 chapters, this three-module set represents approximately 100 hours of instructional time.

Each chapter has been formatted to stand on its own, although the option of reviewing previous lessons is included in the lesson outline. This recognizes that some programs may focus on specific areas, such as law enforcement or medical involvement, with less emphasis on other areas. However, using the entire three-module presentation will give participants a global view of the process of dealing with child maltreatment, from prevention to detection and intervention. We recommend using the entire presentation to achieve the most effective participant training.

I want to thank the many contributors who allowed their materials and slides to be used in this project. Their support was essential in developing this manual. I also want to recognize the motivation supplied by the publisher, G. W. Medical Publishing, Inc., who saw the potential to help instructors prepare quality lessons and put the raw materials together in this user-friendly format. Finally, I want to dedicate this publication to the ongoing efforts of the many instructors who strive to prepare their students and in-service trainees for the realities of child maltreatment that face healthcare, law enforcement, and social services professionals every day. My hope is that our society will learn to value its youngest and most vulnerable citizens as our future, and that child maltreatment will be viewed as the destructive force it truly is.

Angelo P. Giardino, MD, PhD

November 5, 1999

VOLUME THREE MODULE TABLE OF CONTENTS

INTRODUCTION

Objectives

Checklist for Instructors/Trainers

Participant Registration

Instructor Evaluation Form

Participant Evaluation Form

Evaluation Form Program for Instructors/Trainers

INSTRUCTOR’S MANUAL

CHAPTER 17: THE ROLE OF LAW ENFORCEMENT IN THE INVESTIGATION OF CHILD MALTREATMENT

Objectives

Lesson Outline

The Lesson

Review and Introduction

Law Enforcement and the Child Victim

Worksheet 17-1

Answer Key for Worksheet 17-1

Interview Guidelines

Preliminary Investigative Checklist

Worksheet 17-2

Serious Crime/Event Scene Procedures

Appendix

Excerpt from pages 421-422 of Clinical Guide, 2nd Edition

Excerpt from pages 422-423 of Clinical Guide, 2nd Edition

Excerpt from pages 423-426 of Clinical Guide, 2nd Edition

Excerpt from pages 431-432 of Clinical Guide, 2nd Edition

CHAPTER 18: THE REVIEW PROCESS AND CHILD FATALITY REVIEW TEAMS

Objectives

Lesson Outline

The Lesson

Review and Introduction

The Death Review Process

Child Abuse Studies

Worksheet 18-1

Role of the Child Fatality Review Team

What is Being Learned from Child Fatality Review Teams

Appendix

Excerpt from pages 436-438 of Clinical Guide, 2nd Edition

Excerpt from pages 513-515 of Clinical Guide, 2nd Edition

CHAPTER 19: THE ROLE OF THE MEDICAL EXAMINER IN FATAL CHILD ABUSE

Objectives

Lesson Outline

The Lesson

Review and Introduction

Medical Examiner’s Definitions

Worksheet 19-1

Answer Key for Worksheet 19-1

Medicolegal Evaluation of Death

Data Interpretation

Lethal Injuries and Neglect

Conditions That Are Not Abuse

Appendix

Excerpt from pages 534-536 of Clinical Guide, 2nd Edition

CHAPTER 20: LEGAL ISSUES

Objectives

Lesson Outline

The Lesson

Review and Introduction

Reporting Statutes and Child Protective Services (CPS)

Worksheet 20-1

Answer Key for Worksheet 20-1

The Litigation of Child Abuse and Neglect Cases

Worksheet 20-2

Procedural and Evidentiary Rules

Worksheet 20-3

Answer Key for Worksheet 20-3

Appendix

Excerpt from page 564 of Clinical Guide, 2nd Edition

Excerpt from pages 562-574 of Clinical Guide, 2nd Edition

Excerpts from pages 574-579 of Clinical Guide, 2nd Edition

Excerpt from pages 579-589 of Clinical Guide, 2nd Edition

Excerpt from pages 590-598 of Clinical Guide, 2nd Edition

CHAPTER 21: TESTIFYING

Objectives

Lesson Outline

The Lesson

Review and Introduction

Preparation for Court Appearance

Worksheet 21-1

Elements of Giving Testimony

Ploys Used in Questioning and How to Respond

Documentation

Appendix

Excerpt from pages 604-605 of Clinical Guide, 2nd Edition

Excerpt from pages 606-609 of Clinical Guide, 2nd Edition

CHAPTER 22: ART THERAPY

Objectives

Lesson Outline

The Lesson

Review and Introduction

Using Art Therapy in Abuse Cases

Aspects Chart

Stages of Child Development and Art

Symbolic Indicators of Potential Abuse

Appendix

Excerpt from page 250 of Clinical Guide, 2nd Edition

Excerpt from pages 252-253 of Clinical Guide, 2nd Edition

Excerpt from page 255 of Clinical Guide, 2nd Edition

CHAPTER 23: PREVENTION

Objectives

Lesson Outline

The Lesson

Review and Introduction

Role of Government, the Judicial System, and the Private Sector in Prevention

Programs and Services Needed by Families

Worksheet 23-1

Answer Key for Worksheet 23-1

Programs to Prevent Neglect and Sexual Abuse

Appendix

Excerpt from pages 612-614 of Clinical Guide, 2nd Edition

Excerpt from pages 615-616 of Clinical Guide, 2nd Edition

REFERENCES

ORDERING

Reordering Forms for Workbooks

Related G.W. Medical Publications

VISUALS

INTRODUCTION

Child Maltreatment: Instructional Modules training package is designed to provide the educator/instructor with the materials needed to impart the content of the text, Child Maltreatment: A Clinical Guide and Reference to participants in the learning process. However, we have attempted to structure the Instructor’s Manual sections to enable instructors to present the necessary content without the need to refer to the text, so that its use, while recommended, is optional. Although cross-references to the text are supplied, all of the material required from the textbook has been excerpted in an appendix to the relevant Instructor’s Manual chapter. Tables, figures, and references mentioned in the excerpts and essential to instruction are incorporated into the chapters. Instructors seeking the additional information found in the tables, figures and references may consult the parent text. Our goal is to make the information concerning the important topic of child maltreatment as widely available as possible. Therefore we offer this as either an added resource to work along with the clinical textbook or as a stand-alone instructional tool to help in teaching about child maltreatment.

This presentation is divided into three modules and accompanying slide sets. These modules address the various aspects of child maltreatment, from its identification to its different forms to its causes. Then we offer information regarding treatment possibilities, linking management techniques with those agencies most likely to deal with these treatment aspects. Finally, wherever possible, we offer a discussion of prevention strategies, encouraging participants in this course to become active participants in helping child maltreatment become a rare rather than a pervasive event.

Volume I: Physical Signs of Abuse covers the aspects of abuse that relate to actual physical maltreatment. Chapter 1 defines what abuse is, helping participants see what an abused child looks like and bringing to light the discrepancies in a caregiver’s history that point to abuse. We also offer information on how to differentiate maltreatment from conditions that mimic abuse. In Chapter 2 we outline the radiologic evidence that leads to a suspicion or support of abuse. We also explore the various imaging modalities and their strengths and weaknesses in exposing abusive injuries. Chapters 3 through 6 look at injuries that affect specific structures or systems, including the oral cavity, the thoracoabdominal region, the eyes, and the head. In each of these chapters we offer specific signs that