Million-dollar grant supports development of statewide program to set new standard for child-abuse investigations

August 22, 2001

The State of Illinois has awarded $1 million each year in a multi-year commitment to an interdisciplinary task force composed of physicians and other representatives from child welfare, judicial, and criminal professions, to create a model system for the investigation of child abuse.

The Multidisciplinary Pediatric Education and Evaluation Consortium (MPEEC) was created to provide a statewide network of physicians skilled in and dedicated to the detection, diagnosis and legal follow-up of abuse and to make this expertise readily available to all hospitals and child protective services throughout Illinois.

"Illinois will be the first state in the nation with a coordinated system to provide a timely, competent medical evaluation for all cases of suspected child abuse," said Illinois House Republican Leader Lee Daniels (R-Elmhurst), who worked with Jess McDonald, the Director of the Illinois Department of Children and Family Services, to secure funding for the program. "This will set the national standard for the medical evaluation of neglected or injured children."

The goal of the task force -- headquartered at the University of Chicago Children’s Hospital -- is to establish a system that can provide better medical diagnoses and immediate second opinions through the creation of centers staffed by experts in diagnosing and treating victims of abuse and a video network that lets practitioners throughout the state consult with the experts.

There is no comparable model in the United States. Two other states, Florida and Maryland, have a coordinated system for child abuse detection but both programs focus almost entirely on sexual abuse.

Initial efforts will concentrate on abusive head injury, such as shaken-baby syndrome. Whenever a child who resides in the City of Chicago is reported to the State hotline for suspicion of inflicted head injury, one of the network's child protective teams will be immediately involved in the investigation. They will review medical records; guide the primary physician through the evaluation focusing on appropriate imaging studies to confirm or rule out abuse; work closely with DCFS and police investigators to help aid their investigation culminating in a medical report that will be used to help indicate or rule out these reported cases. Once that program is in place and tested, the program will expand to include other forms of injury or neglect statewide.

Child abuse and neglect are tragically common occurrences. There were more than 900,000 U.S. victims in 1998. In 1999 the Illinois hotline received more than 100,000 reports of suspected abuse. That year, 74 Illinois children died from abuse. Yet most hospitals, which receive the most serious cases, are ill prepared to respond.

"There are less than a handful of physicians in Illinois with the skills, experience and commitment required to dedicate a significant portion of their efforts to child abuse," said Jill Glick, MD, Assistant Professor of Pediatrics at the University of Chicago and Director of the Multidisciplinary Pediatric Education and Evaluation Consortium.

Doctors are required to report suspicious cases, but after that, "the system breaks down," said Glick. "Few pediatricians are prepared to take the next step, making a definitive diagnosis or ruling out child abuse."

Most physicians assume that their legal responsibilities end once they have reported their suspicion, "but without a clear diagnosis, backed by solid medical evidence that will stand up in court," said Glick, "the child welfare system can't take the next steps."

The toll is substantial. Five children die every day in the United States from abuse or neglect, most of them under the age of two. Homicide is the third leading cause of death for children over four.

Yet efforts to detect and diagnose abuse and to bring together the medical and legal resources needed to protect these children have been hampered by the lack of medical staff assigned to the task and a coordinated statewide system.

"This project allows DCFS to obtain expert medical opinion in a timely manner so that we are better able to protect children from suffering further abuse," said DCFS Director Jess McDonald.

Part of the problem is the lack of financial support. Hospitals and physicians are not reimbursed for the added time and effort required to determine the source of an injury. Physicians are not paid for forensic work or for their time in court, which typically runs from 15 to 30 hours for a single case. Consequently, physicians "don't want to look for child abuse," said Glick.

"The MPEEC is an excellent example of what can be accomplished when a group of professionals works together on a common goal," said McDonald. "DCFS, law enforcement, pediatricians, the State's Attorney staff, a judge, and private citizens combined their expertise to create a protocol that contributes to keeping Illinois children safer."

The impetus for the program came from the mother of a 15-month-old girl who died from head trauma sustained in September 1998. Laurie Manzardo was frustrated by the lack of knowledge and communication between the medical, legal, law enforcement and social service personnel who were involved in the 14-month investigation of her daughter's death, which led to an indictment of the day-care provider. Thereafter, Manzardo organized the G.E.M. Child Protection Foundation and brought together a group of child advocates that included Glick, Daniels, and McDonald, to set up systems to protect children from abuse.

"We think we can reduce the number of child-abuse deaths by 50 percent within 15 years," said Manzardo. "This will require dedicated child-protection teams at trauma centers around the state, more forensic pediatricians, better community awareness, and more collaboration between the medical, legal and social teams involved in the process. None of that is simple. But if we save even one child," she added, "it's worth it."

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