President's Message, June 2024
Mary Ann Rigas, MD, FAAP
Hello fellow PA AAP members!
In my 33 years in pediatric practice, I have too often found myself in a position to report a suspicion of child physical or sexual abuse or neglect. It never gets easier, and while I feel fortunate to have completed a PA AAP preceptorship in child abuse early in my career, I nevertheless worry that my patients are not getting the expert evaluation that they deserve due to our distance from child abuse pediatricians.
Each year in our Pennsylvania, approximately 150-200 children sustain fatal or near-fatal abuse at the hands of their caregivers. The PA Department of Human Services (PA DHS) Child Abuse Fatality and Near Fatality Trend Analysis Team has identified incidents where a child was not evaluated by a child abuse pediatrician during a child abuse investigation and consequently, there was inadequate assessment of safety risks. Child abuse pediatricians provide critical expertise to respond to childhood trauma and to guard against both under- and over-diagnosis of child maltreatment. A missed diagnosis of abuse puts children at risk for continued abuse and further injury, while over-diagnosis may lead to the inappropriate removal of children from their family, as well as civil or criminal court involvement for the person accused of abusing a child.
In 2023, the Pennsylvania Commission on Crime and Delinquency commissioned the PA AAP to convene an interdisciplinary Keystone State Child Abuse Medical Forum. The Forum’s Leadership Team developed a set of recommendations centered around the primary goal of reducing child morbidity and mortality from all forms of child maltreatment by ensuring children have timely access to high-quality medical evaluations.
The majority of child abuse experts in Pennsylvania are concentrated at children’s hospitals, most of which are in the southern half of the state. Many children in rural Pennsylvania lack access to child abuse pediatricians’ expertise. Some have access to local Child Advocacy Centers, which may or may not be accredited, and which primarily perform sexual abuse investigations. The remainder of rural children are evaluated by primary care pediatricians, family physicians, emergency room physicians, nurse practitioners, and physician assistants, many of whom have only the state-required two-hour child abuse training every two years.
The Keystone State Child Abuse Medical Forum produced six recommendations:
Personally, I would like to see Pennsylvania develop a hub and spoke model in which medical providers and Child Advocacy Centers across the state have direct access to consultation with regionally designated child abuse pediatricians. As we are now adept at telemedicine, consults could (at least sometimes) be performed virtually and could be provider-to-provider or provider-to-patient and family, depending on the situation.
While this may seem like a far-fetched dream, this week has brought an exciting and promising development! Rachel Berger, MD, MPH, FAAP, a member of the Child Protection Team at the Child Advocacy Center at the Children’s Hospital of Pittsburgh and director of child abuse research at the University of Pittsburgh, has been appointed Medical Director for the Office of Children, Youth, and Families (OCYF) in the Commonwealth of Pennsylvania (view the OCYF announcement here.) Dr. Berger’s primary goal is to serve as a resource on any issues related to child abuse and neglect in our child welfare system. She also hopes to be involved in decision-making and strategic planning related to improving and enhancing identification, evaluation, and reporting of suspected maltreatment in PA.
Some of Dr. Berger’s specific areas of focus in the first year will be on developing a system to provide medical expertise to Childline staff, developing and evaluating approaches to decreasing fatalities and near-fatalities from child maltreatment and finally, ensuring that child welfare providers have the medical expertise they need to make decisions about how to keep children safe. She is excited to take on this new role in our state and welcomes input from pediatric providers around the state about what you feel are the most pressing health care related issues in our child welfare system. You may email Dr. Berger at [email protected].
In the meantime, remember that our chapter houses an excellent educational opportunity in the Educating Physicians in their Community on Suspected Child Abuse and Neglect (EPIC SCAN) program. This program for mandated reporters is taught by pediatricians alongside CYS professionals and meets the requirements of Act 31 for license renewal. For more information on the SCAN program, visit their website here.
It is with sadness and much gratitude that I end this last letter to you as President of our Chapter. I have learned so much from all of you and I thank you for your support and your dedication to the children of Pennsylvania. I am thrilled to pass the baton to Kate Tigue, MD, FAAP, your next PA AAP President! Kate is in private pediatric practice in northeastern PA and brings her expertise in practice management to her new role as PA AAP President. Welcome, Kate!
I look forward to opportunities to work together in the future and hope that you have a great summer!
Sincerely,
In my 33 years in pediatric practice, I have too often found myself in a position to report a suspicion of child physical or sexual abuse or neglect. It never gets easier, and while I feel fortunate to have completed a PA AAP preceptorship in child abuse early in my career, I nevertheless worry that my patients are not getting the expert evaluation that they deserve due to our distance from child abuse pediatricians.
Each year in our Pennsylvania, approximately 150-200 children sustain fatal or near-fatal abuse at the hands of their caregivers. The PA Department of Human Services (PA DHS) Child Abuse Fatality and Near Fatality Trend Analysis Team has identified incidents where a child was not evaluated by a child abuse pediatrician during a child abuse investigation and consequently, there was inadequate assessment of safety risks. Child abuse pediatricians provide critical expertise to respond to childhood trauma and to guard against both under- and over-diagnosis of child maltreatment. A missed diagnosis of abuse puts children at risk for continued abuse and further injury, while over-diagnosis may lead to the inappropriate removal of children from their family, as well as civil or criminal court involvement for the person accused of abusing a child.
In 2023, the Pennsylvania Commission on Crime and Delinquency commissioned the PA AAP to convene an interdisciplinary Keystone State Child Abuse Medical Forum. The Forum’s Leadership Team developed a set of recommendations centered around the primary goal of reducing child morbidity and mortality from all forms of child maltreatment by ensuring children have timely access to high-quality medical evaluations.
The majority of child abuse experts in Pennsylvania are concentrated at children’s hospitals, most of which are in the southern half of the state. Many children in rural Pennsylvania lack access to child abuse pediatricians’ expertise. Some have access to local Child Advocacy Centers, which may or may not be accredited, and which primarily perform sexual abuse investigations. The remainder of rural children are evaluated by primary care pediatricians, family physicians, emergency room physicians, nurse practitioners, and physician assistants, many of whom have only the state-required two-hour child abuse training every two years.
The Keystone State Child Abuse Medical Forum produced six recommendations:
- Ensure Pennsylvania’s children have access to equitable, timely and high-quality medical evaluations informed by standardized criteria and in consultation with specially trained health care professionals for all types of child maltreatment.
- Ensure the Pennsylvania Department of Human Services’ Office of Children, Youth and Families (OCYF) is equipped to make evidence-based child safety and protection decisions, informed by real-time consultation with specially trained health care professionals.
- Make prevention of child morbidity and mortality from maltreatment a Commonwealth priority with emphasis on children less than 3 years of age.
- Clarify the role and enhance the capabilities of Child Advocacy Centers, including the availability of expanded high quality health care services, as part of the Commonwealth’s commitment to multidisciplinary interventions with children.
- Equip mandated reporters with the knowledge and skills necessary to file high-quality reports and ensure training aims to reduce bias and disproportionality.
- Identify and address unintended consequences arising from Pennsylvania’s child abuse and neglect registry.
Personally, I would like to see Pennsylvania develop a hub and spoke model in which medical providers and Child Advocacy Centers across the state have direct access to consultation with regionally designated child abuse pediatricians. As we are now adept at telemedicine, consults could (at least sometimes) be performed virtually and could be provider-to-provider or provider-to-patient and family, depending on the situation.
While this may seem like a far-fetched dream, this week has brought an exciting and promising development! Rachel Berger, MD, MPH, FAAP, a member of the Child Protection Team at the Child Advocacy Center at the Children’s Hospital of Pittsburgh and director of child abuse research at the University of Pittsburgh, has been appointed Medical Director for the Office of Children, Youth, and Families (OCYF) in the Commonwealth of Pennsylvania (view the OCYF announcement here.) Dr. Berger’s primary goal is to serve as a resource on any issues related to child abuse and neglect in our child welfare system. She also hopes to be involved in decision-making and strategic planning related to improving and enhancing identification, evaluation, and reporting of suspected maltreatment in PA.
Some of Dr. Berger’s specific areas of focus in the first year will be on developing a system to provide medical expertise to Childline staff, developing and evaluating approaches to decreasing fatalities and near-fatalities from child maltreatment and finally, ensuring that child welfare providers have the medical expertise they need to make decisions about how to keep children safe. She is excited to take on this new role in our state and welcomes input from pediatric providers around the state about what you feel are the most pressing health care related issues in our child welfare system. You may email Dr. Berger at [email protected].
In the meantime, remember that our chapter houses an excellent educational opportunity in the Educating Physicians in their Community on Suspected Child Abuse and Neglect (EPIC SCAN) program. This program for mandated reporters is taught by pediatricians alongside CYS professionals and meets the requirements of Act 31 for license renewal. For more information on the SCAN program, visit their website here.
It is with sadness and much gratitude that I end this last letter to you as President of our Chapter. I have learned so much from all of you and I thank you for your support and your dedication to the children of Pennsylvania. I am thrilled to pass the baton to Kate Tigue, MD, FAAP, your next PA AAP President! Kate is in private pediatric practice in northeastern PA and brings her expertise in practice management to her new role as PA AAP President. Welcome, Kate!
I look forward to opportunities to work together in the future and hope that you have a great summer!
Sincerely,
Mary Ann Rigas, MD, FAAP
President, PA AAP
2022-2024
President, PA AAP
2022-2024