If people do not think about child abuse, they will not detect child abuse.
That was the primary message of Dr. Karyn Patno, a pediatrician and founder of the ChildSafe Program at Fletcher Allen Health Care in Burlington, Vermont. Dr. Patno’s recent collaboration with the St. Regis Mohawk Tribal Police on a case of suspected child abuse was the impetus for the Tribe’s first-ever Child Safe Summit, a large collective effort held this month to educate service providers and community partners on specialized resources for abuse.
The St. Regis Mohawk Tribe hosted the first one-day conference on October 10 and a second on October 21 at the Akwesasne Mohawk Casino’s new conference facility. All told, over 250 child welfare professionals representing some 50 community, Tribal, county, state and federal agencies attended the summit. In addition to local and regional service providers, the summit drew representatives from the Department of Homeland Security, U.S. Border and Customs Protection, U.S. Marshall Service and the U.S. Attorney’s Office.
“We’re here to form a web to catch all the children we can,” said Tribal Chief Beverly Cook. “To do that, we need to work together. We love our children and we’re willing to do anything for them.”
Chief Cook acknowledged the graphic nature of the summit’s presentations, including forensic photographs and x-rays of healthy anatomy and physical injuries resulting from accidents and abuse—burns, bruises, lacerations and fractures. It’s important to know what you’re looking at, said Dr. Patno.
“These images are uncomfortable to look at,” said Chief Cook. “That’s because what happens to many children is not right.”
Dr. Patno walked attendees through the methodology of the ChildSafe Program, a diagnostic clinic for any child suspected of any type of abuse. The child protection report is a summary of the evaluation performed at her clinic. It is a medical-legal document that includes reviews of behavioral and medical systems, past medical history, a family and social history, a physical exam and interviews with the child.
In her evaluation of child physical abuse for non-medical providers, Dr. Patno reviewed risk factors and injuries indicative of abuse. Attendees learned to recognize patterned bruises and burns, which imply an object came in contact with the child’s skin or that a specific hot object was inflicted. Physical signs of strangulation were also discussed.
Understanding normal infant growth and development, Dr. Patno pointed out, allows one to monitor children’s progress and to identify delay or deviance. An important rule of thumb is that “simple mechanisms result in simple injuries and complex injuries require a complex mechanism.” For example, “rolling off the couch can result in a skull fracture or broken leg. It cannot result in a subdural hemorrhage, retinal hemorrhage and rib fractures.”
Dr. Patno asks the parent to give a detailed history of how an injury occurred and then compares that mechanism not only to the developmental level of the child, but also to the severity of the injury. She says the next step is asking, “Can the proposed mechanism result in the injuries seen?”
Abusive Head Trauma (AHT) is “absolutely a complex mechanism,” she reported. AHT includes “shaken baby syndrome,” which is often coupled with impact. It accounts for 10 percent of all deaths due to abuse or neglect.
There are very specific risk factors associated with AHT for perpetrators and victims. For example, although some women commit this act, the majority of perpetrators of abusive head trauma are male (nearly 40 percent are natural fathers and about 20 percent are boyfriends of the mother).
The doctor pointed out that infant crying is the most common event prior to shaking an infant, accounting for the fact that nearly half of all AHT victims are under the age of one.
Finally, Dr. Patno shared important elements in the evaluation of child sexual abuse and what it means when an exam is deemed “normal.” She pointed out that most child exams do not result in a finding of sexual abuse, but they are important to determine mental health needs. And, it’s “incredibly helpful” to the child to be told he or she is “normal.”
The summit featured a segment on digital child exploitation, led by Special Agent Tim Losito of the Homeland Security Department. In addition to cyberbullying, which Losito says occupies most of his time, his office investigates child pornography. According to Special Agent Losito, the Northern District of New York prosecutes more child exploitation cases than anywhere else in the United States.
That shocked participants, most of whom live and work in the North Country region. For Chief Cook, it underscores the need for open communication with cross-border agencies.
“The magnitude of sexual exploitation that goes on in our area is not common knowledge to the average member of our North Country community,” she said. “Information sharing is extremely important. That our Tribal Police were instrumental in a multi-agency takedown of a sexual predator informs us that collaboration is essential.”
The seed for the Child Safe Summit was planted by Special Investigator Hawi Thomas, who deals with sex crimes for the Tribal Police Department. Having worked investigations involving agencies in several jurisdictions, Thomas wanted to improve the way cases were handled by fostering collaboration among those resources.
Thomas sought support from superiors within the Police Department, from Tribal Administration and other service providers who handle child abuse cases. The Tribe’s Onkwahwatsire Multidisciplinary Team, led by Family Advocate Jade White, supported the idea and formed an organizing committee.
“Collaboration is second nature to most women and service organizations,” said Thomas. “It's how important work gets done.” Tribal Sub-Chief Michael Conners acknowledged that work, expressing gratitude for “the strong Mohawk women whose daily dedication to this tough subject is a benefit to our community."
The Summit’s success has led organizers to try and make it an annual event.