Protecting the Innocent

February 15, 2017

No child deserves abuse. Lurie Children's is a leader in addressing child maltreatment. From expanding clinical services to conducting game-changing research, our Division of Protective Services is improving the health and safety of the estimated one in four children in the United States who experience abuse in their lifetimes.

Physical abuse is no accident, but many times it can look like one. To the untrained eye, the subtleties of maltreatment injuries—from bruises to broken bones—often go unrecognized. Lacking the specific knowledge or resources, medical and social work professionals are challenged to make the right call. Their decisions can mean the difference between returning a child to a harmful environment or removing a child from a loving home.

Child abuse pediatrics remains a young and emerging medical field. Only 352 board-certified child abuse pediatricians exist in the nation. About a dozen practice in Illinois and Lurie Children's has four of them, including Sandeep Narang, MD, JD, who became the new Division Head of Child Abuse Pediatrics in July 2015. With more than three million child abuse reports filed annually in the United States, the caseload is overwhelming for a relatively small pool of physician experts. At Lurie Children's, child abuse pediatricians assess more than 1,200 children suspected of being abused annually.

"With large volumes of work and low numbers of people in the specialty, innovating new methods for diagnostic decision-making is sorely needed," says Dr. Narang. "Through the Stanley Manne Children's Research Institute at Lurie Children's, we have the capacity to become a global research leader—to advance not only our clinical, educational and advocacy efforts, but those of others as well."

Improving diagnostic accuracy

Harnessing the power of technology serves as the basis for several child abuse pediatric studies currently underway. Dr. Narang is engaged in the development of an innovative web-based tool that aims to reduce error in child maltreatment assessments, with the potential to significantly change the way these investigations are conducted. 

Other innovative research on diagnostic tools includes a bruising app currently in development by Mary Clyde Pierce, MD, Senior Director of Research for the Division of Child Abuse Pediatrics. Called the Humagram, it awaits funding to be fully developed and would offer a quick evidence-based screening tool for clinicians, social workers and police officers to determine the most likely cause of suspicious bruises.

"Child abuse cases are emotionally charged for everyone involved—families, child welfare workers and medical professionals as well," says Dr. Narang. "Studies have confirmed a high prevalence of subconscious bias in diagnostic decision-making in child maltreatment assessments. What if we could minimize personal human bias by using diagnostic tools and apps built with evidence-based literature and outcomes data as the brains of the system? Such tools could revolutionize initial serious harms investigations in every statewide child protection system in the country."

Innovative research

Imagine a day when a simple cheek swab could reveal not only whether a child had experienced abuse in his or her lifetime, but the long-term health risk of that abuse. Adverse Childhood Experience, or ACE, research has confirmed that abuse during childhood can affect victims well into adulthood. Beyond causing emotional issues, maltreatment sets off biological triggers that put individuals at risk for chronic illnesses, such as heart disease or diabetes. Studies have confirmed that individuals with a significant number of ACEs often have shorter lifespans.

In the exciting area of epigenetics, Dr. Pierce is beginning to explore the possible impact of child abuse and psychosocial factors on epigenetic changes to our DNA. While better understanding the biology of maltreatment could offer powerful predictive tools for health outcomes in the future, it may provide even stronger support for child abuse prevention and advocacy today.

Reforming child abuse education

A key concern identified by Dr. Narang is that clinicians, attorneys and social workers frequently evaluate child abuse issues only from their own perspectives. He is attempting to break down these silos by creating a multidisciplinary child maltreatment seminar involving schools of law, social work and medicine in the Chicago area. To assist, Dr. Narang has recently hired a former Wisconsin assistant district attorney with years of experience in juvenile and criminal child abuse, Henry Plum, JD, as the Lurie Children's Child Abuse Division’s first legal educator.

Social workers are essential members of the Child Abuse Pediatrics program, completing the psychosocial assessment that the medical and protective services teams rely on, as well as facilitating communication between the medical team and community agencies. While child maltreatment is seen across the spectrum of social work practice, many social workers graduate from master's programs with little direct training or experience of best practices in working with this population. To address this gap, the Protective Services Team at Lurie Children's offers a two-year postgraduate social work fellowship, the Christine Speiser Post Graduate Social Work Fellowship in Child Protection. The first of its kind in the United States, the fellowship educates and trains social work professionals interested in child maltreatment.

By taking a multi-faceted approach, Lurie Children’s plays a critical role in protecting children from abuse—close to home and around the world—through the Child Abuse Pediatrics program.

"Children's hospitals must roll out the red carpet for these young victims and stand up for their welfare," says Dr. Pierce. "With high-quality thinkers in the field, we have the ability to use our resources to help the vulnerable."

The Division of Protective Services is supported by Anthony E. and Christine Speiser, the program’s lead donors.

This article originally appeared in the Winter 2017 issue of Heroes magazine.