PASSAGE OF THE DAY: "Yet Richard Wexler, executive director of the National Coalition for Child Protection Reform, said sometimes medical professionals make the wrong calls, and because of this families are needlessly separated. He said child advocacy centers often see the worst cases of actual child abuse and child abuse pediatricians are trained to spot abuse, which he said biases the way they do their job — in the same way that a cancer radiologist may be biased toward treating cancer with radiation, as it’s their specialty. “They see child abuse where it is. They also see child abuse where it isn’t,” Wexler said. “Their notion is, ‘Well, if we have the slightest notion we better call it child abuse.’ ” The National Coalition for Child Protection Reform and the Parents Medical Rights Group are not the only ones who say that abuse misdiagnoses are harming children and families. A 2019 investigative series by NBC News and the Houston Chronicle found instances of misdiagnoses of child abuse.
————————————————————————
STORY: "After Lehigh County Report, what you should know about the LVHN (Lehigh Valley Health Network) child advocacy centre, the CAC movement and child abuse practitioners," by Reporter Leiff Greiss, published by The Morning Call, on September 24, 2023. (Leif Greiss covers hospitals, health networks and public health in the Lehigh Valley for The Morning Call.)
GIST: "For the last 20 years, the Lehigh Valley has had a child advocacy center in one way or another, operating in plain sight but garnering little attention from those on the outside of child abuse investigations.
But now, the John Van Brakle Child Advocacy Center at Lehigh Valley Health Network’s Reilly Children’s Hospital is in the spotlight, following a critical report by Lehigh County Controller Mark Pinsley and protests by parents and the Parents Medical Rights Group, a Lehigh Valley organization that seeks more parental input in medical decisions.
The Van Brakle Center and its former director, Dr. Debra Esernio-Jenssen, who was recently replaced, are accused by some parents of misdiagnosing their children with abuse, causing traumatic investigations and family separations at the hands of Children and Youth Services, only for the investigation to be dropped later.
Pinsley’s report criticized physicians for allegedly rushing medical decisions, and while it didn’t name Van Brakle, it’s the only child advocacy center in the region, with the next closest ones in Berks and Monroe counties.
LVHN has declined to comment at length on the criticism, but defended Esernio-Jenssen and the work the center does in protecting “Lehigh County’s most vulnerable children and their families.”
Lehigh County District Attorney Jim Martin said the Lehigh Valley’s first child advocacy center was started in 2001 by the district attorney’s office.
He said the goal was to provide a multidisciplinary approach to investigating child abuse cases in a central location, which would limit how many times children would need to be interviewed. Martin said the center changed locations multiple times until LVHN offered to relocate it inside Reilly Children’s Hospital in 2014.
LVHN and its doctors do not work alone within the center. Martin said two child abuse investigators employed by his office also work out of the CAC and liaison with all suburban police departments on child abuse cases.
He added there is a forensic investigator there, as well as Allentown Police Department’s special victims unit and caseworkers from Lehigh County Children and Youth Services.
According to LVHN, there also are social workers trained in trauma therapy who can offer mental health counseling and assist with case management, and family advocates to support the family members of abused children during the process.
This collaboration at times has left the confines of the center. Past reporting from The Morning Call shows that the district attorney’s office tapped Esernio-Jenssen as an expert witness in child abuse matters.
“It’s helped hundreds if not thousands of kids over the last 20-odd years,” Martin said.
However, the Van Brakle Center is not unique; it’s based on a national model that has existed for nearly 40 years.
What are child advocacy centers?
The National Children’s Alliance is the organization in charge of accreditation and reaccreditation of child advocacy centers. Blake Warenik, spokesperson for the alliance, said CACs must be multidisciplinary, and must have approval from a community’s district attorney or state’s attorney, local law enforcement and child protective services.
But that is just one of many requirements in the accreditation process. CACs are reaccredited every five years.
According to the National Children Alliance, there are 939 accredited CACs in the U.S.; 42 are in Pennsylvania. Yet only about 100 CACs in the country are hospital-based; the majority are what Warenik referred to as community-based.
Van Brakle is one of several Pennsylvania CACs that are hospital-based; others include the Lancaster County Children’s Alliance, organized under Penn Medicine; the Children’s Advocacy Center of Centre County under Mount Nittany Health; CAC of Central Susquehanna Valley under Geisinger; and two operated by University of Pittsburgh Medical Center.
Warenik said the first CAC was founded in 1985 in Madison County, Alabama, by former U.S. Rep. Robert Cramer, who was the county’s district attorney.
Blake said the motivation was to improve the way the criminal justice and social service systems worked together so that children who were abused would not be further traumatized by having to go through multiple interviews where they had to relive the abuse over and over again.
Cathleen Palm, founder and executive director of the Center for Children’s Justice, said another goal was to make sure the person interviewing children was a skilled professional who wouldn’t ask leading questions.
CACs must report data semiannually to the National Children’s Alliance. Reported data for Pennsylvania shows that in 2022 alone, nearly 16,000 children were served at CACs in the state. Of these children, 76% received forensic interviewing on-site, 37% received medical exams or treatment, and 32% either received counseling therapy on-site or were referred for counseling.
Palm said the involvement of hospitals at CACs is valuable, as there are many medical professionals who specialize in helping children who have been abused, such as child abuse pediatricians, nurses with forensic rape exam training, and mental health services.
“We want children connected to the right resources. If a child is reported as having physical injuries, sexual injuries, sexual abuse, of course, we want to involve medical experts,” Palm said. “But we want to build in safeguards so that medical expert in and of themselves is not the only party making decisions about the child.”
Palm says this not only as an advocate but as a survivor of childhood sexual assault and as a parent investigated for child abuse based on a false accusation.
Palm and her husband were investigated in 2004 based on an anonymous report to Berks County Children and Youth Services.
The social worker told her that the reporter claimed the couple had fought and during the argument, a storm door slammed on their newborn baby’s head.
She and her husband eventually were cleared, but to this day she thinks about how no medical expert ever examined her child.
“I was traumatized even as I knew there was no fight, I knew there was no injury,” Palm said. “Every day since I have believed child welfare should have had my daughter connected to someone other than a 20-something social worker, well-intentioned but way outside her scope of expertise in whether any injury, visible or internal, existed. What if our child had been legitimately caught in a domestic dispute, injured?”
‘They see child abuse where it isn’t’
Yet Richard Wexler, executive director of the National Coalition for Child Protection Reform, said sometimes medical professionals make the wrong calls, and because of this families are needlessly separated.
He said child advocacy centers often see the worst cases of actual child abuse and child abuse pediatricians are trained to spot abuse, which he said biases the way they do their job — in the same way that a cancer radiologist may be biased toward treating cancer with radiation, as it’s their specialty.
“They see child abuse where it is. They also see child abuse where it isn’t,” Wexler said.
“Their notion is, ‘Well, if we have the slightest notion we better call it child abuse.’ ”
The National Coalition for Child Protection Reform and the Parents Medical Rights Group are not the only ones who say that abuse misdiagnoses are harming children and families.
Around the same time, Philadelphia City Council created a Special Committee on Child Separations, which Wexler was a part of, after one council member was investigated for abuse by Children and Youth Services.
Data from the Pennsylvania Department of Human Services shows that in Pennsylvania, health care professionals report a significant number of child abuse cases.
Of the more than 39,000 child abuse reports that were investigated in 2022, health care employees and practitioners combined accounted for 7,804, or about 20% of all reports.
This was a slightly greater number than the 7,491 reported by employees at social service agencies and quite a bit more than the 4,587 reported by police or other law enforcement agents.
Palm said many medical professionals are not against parents or families and some pediatricians are afraid to even report real cases of abuse for fear of how it will affect the families of the children, especially if it means those parents will end up on the state’s child abuse registry.
“They want the parent to understand what you did was abuse. You can’t do this, here’s other tools,” Palm said. “So often, the people who are engaging with families, the people who are diagnosing or determining child abuse, are struggling [that] in doing so, they’re putting like a scarlet letter on the parent.”
Palm said the trauma of a child abuse investigation to children and their families, especially when children are removed into protective custody, is real. She added that no one should be considered above accountability but there are checks and balances.
“We should not be calling kids abuse victims when they are not,” Palm said. “But we’ve got to stop acting like way too many kids are being called abused and removed from their homes when that is not what the data shows — way more kids stay in the environment where they experienced abuse as kids and people need to understand that.”
Palm said in cases of potential child abuse, teams will usually meet to look at the objective information and determine if the available data meets the threshold for reasonable cause to suspect abuse.
Usually the report to Children and Youth Services is filed online by a social worker that is part of the team, not doctors.
In certain cases, hospitals can immediately take children they believe are in imminent danger into temporary protective custody, but the hospital needs to contact Children and Youth Services, which will then determine if there is enough evidence to pursue a court order to retain custody of the child.
But Wexler said these checks are weak and the balances are not weighted in favor of parents.
He added evidence for the state to take custody of a child in these cases is only a preponderance of the evidence, the lowest standard of legal evidence, much lower than the beyond a reasonable doubt standard used in criminal trials.
Pennsylvania data for 2022 shows 4,926, or 12.6%, of reports resulted in the child being moved “from the setting where the alleged or actual abuse occurred.”
Of all the reports of child abuse investigated, 4,992, or 12.7%, were determined to be substantiated and 86.5% were unfounded, meaning “the alleged abuse did not meet the definition or criteria for abuse.”
Yet there are some children missed. Palm said in Pennsylvania, 150-200 children die from abuse every year. Most of the time, these children slip through the cracks even after reports of abuse are made.
“You talk to anybody who works in this system — a teacher who’s called ChildLine, a child care provider or doctor — there’s a general frustration. You tell us to call, you tell us to report, you tell us to be on the lookout for children and then we call and guess what? You don’t do anything in response,” she said.
Wexler said these children are missed because of the safeguards that are supposed to protect them.
“All the false reports in trivial cases so overload the system, they’re less likely to find the children in real danger in the first place,” he said.
He said one step toward both protecting children and families is abolishing mandated reporting, which was one of the conclusions Philadelphia’s Special Committee on Child Separations came to in a report issued last year.
Wexler said to guard against misdiagnosis of child abuse in the medical setting, more physicians with other specialties need to be brought in when a child abuse diagnosis is on the table.
Families should also be able to get a second opinion at no extra cost to determine if their child is experiencing abuse or if there are alternative causes.
Wexler said the ideas behind the creation of CACs are noble and good. He added child advocacy centers should not just involve prosecutors but also family defense attorneys to keep things objective.
Palm said the system is failing both children who are abused and parents, but to call the motives and abilities of child abuse pediatricians and mandated reporters into question will result in children who need it not receiving medical care and not having their abuses investigated.
“Any of us who do this work know children are best in their families, but their families have to be healthy and strong and strengthened and supported,” Palm said. “We shouldn’t turn a blind eye to abuse. That doesn’t mean we should say the parent is bad, but if the child’s abused we should call it what it is.”
The entire story can be read at:
SEE BREAKDOWN OF SOME OF THE ON-GOING INTERNATIONAL CASES (OUTSIDE OF THE CONTINENTAL USA) THAT I AM FOLLOWING ON THIS BLOG, AT THE LINK BELOW: HL
https://www.blogger.com/blog/post/edit/120008354894645705/47049136857587929
FINAL WORD: (Applicable to all of our wrongful conviction cases): "Whenever there is a wrongful conviction, it exposes errors in our criminal legal system, and we hope that this case — and lessons from it — can prevent future injustices.
Lawyer Radha Natarajan;
Executive Director: New England Innocence Project;
—————————————————————————————————
FINAL, FINAL WORD: "Since its inception, the Innocence Project has pushed the criminal legal system to confront and correct the laws and policies that cause and contribute to wrongful convictions. They never shied away from the hard cases — the ones involving eyewitness identifications, confessions, and bite marks. Instead, in the course of presenting scientific evidence of innocence, they've exposed the unreliability of evidence that was, for centuries, deemed untouchable." So true!
Christina Swarns: Executive Director: The Innocence Project;
------------------------------------------------------------------
YET ANOTHER FINAL WORD:
David Hammond, one of Broadwater’s attorneys who sought his exoneration, told the Syracuse Post-Standard, “Sprinkle some junk science onto a faulty identification, and it’s the perfect recipe for a wrongful conviction.”
https://deadline.com/2021/11/alice-sebold-lucky-rape-conviction-overturned-anthony-broadwater-1234880143/
————————————————————
