Ask Us Anything About… Child Abuse Prevention

April is Child Abuse Prevention Month. 394 pinwheels are planted in front of Penn State Children's Hospital—representing the 394 children that were cared for by Penn State Center for the Protection of Children in 2016 — that's more than one a day for the entire year.

Have you ever been in a situation in which you suspected child abuse and you didn't know what to do?

We discuss child abuse prevention with Dr. Lori Frasier, Director, Penn State Center for the Protection of Children.

April 20, 2017 Penn State Health News
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Transcript

Description – The video begins inside a large room with two individuals standing in front of a tan wall with the words Welcome to The Center for the Protection of Children on the wall above their heads. Standing from left to right is Scott Gilbert and Dr. Lori Frasier, Director, Penn State Center for the Protection of Children and Scott Gilbert.

Scott Gilbert – Just Ask Us Anything about — Child Abuse Prevention. I’m Scott Gilbert. You may have noticed 394 pinwheels out in front of Penn State Children’s Hospital this month. That’s because April is National Childhood Abuse Prevention Month. And each pinwheel represents one child who was helped in 2016 by the Penn State Center for the Protection of Children. The director of that center is Dr. Lori Frasier and she’s with me right now. She’s joining us for this addition of Ask us Anything About, Dr. Frasier thanks for your time.

Dr. Lori Frasier – Thank you for having me, Scott.

Scott Gilbert – Sure. Well, one of the reasons that we’re talking today is to give people advice on what to do if they suspect abuse may be happening to a child that they see, or a child that they know. What about the neighbor, or the sport’s coach, or someone who suspects something, what are some steps that that person should take?

Dr. Lori Frasier – Well, we all have a moral and ethical obligation to report child abuse when it’s happening. If you’re a professional who’s licensed, even if you’re not at your job you have a mandatory obligation to report child abuse. So if you have a reasonable suspicion that child abuse has occurred, you don’t even have to have proof, you should call ChildLine and report it. It doesn’t mean that child will automatically be yanked out of their home. It means that a professional social worker will investigate what’s happening with that child. It may be that the family is just stressed and has a lot of needs. It may be that there is very seriously something happening to that child and a major intervention needs to happen. We as normal laypeople in the public and even doctors and nurses, we don’t do that investigation. We require those professional social workers to do that. But it’s important because you cannot break the cycle of child abuse unless you report it.

Scott Gilbert – And that number for ChildLine is 1-800-932-0313. Again, that’s 1-800-932-0313. We will post that number in the comment section below this Facebook post, which is ask us anything about child abuse prevention. From Penn State Children, I’m Scott Gilbert, along with Dr. Lori Frasier. In case you’re just joining us, we invite you to add your questions to the comment field below this post and we will pose those to Dr. Frasier. Whether you’re watching this video live or even if you’re watching it on playback, we can still get some answers to those important questions for you. You know, we’re talking a bit about what to do if you suspect. Well, let’s take a step backward. What are some of the possible signs and symptoms that a child could be in trouble from a various forms of abuse?

Dr. Lori Frasier – Right, so of course everybody recognizes in many cases physical abuse. When children have injuries that might be due to physical abuse. That’s one form of abuse. Another form of abuse is sexual abuse. That’s much more covert or hidden form of abuse. We hear about that all the time recently. There is neglect where children are deprived of the necessities of life, like shelter, clothing, food, and we’ve heard about that. It’s important if you think a child is being deprived of the necessities. Child neglect is actually the most fatal form of child abuse in the United States. So neglect harms children just as much as physical or sexual abuse. There’s emotional abuse and we’ve already had someone ask us about verbal abuse, which constitutes a form of emotional abuse. Children are harmed emotionally when they’re subject to severe yelling, name calling, horrible things being said to them, that is a form of abuse that needs to be addressed. So most abuse in Pennsylvania is actually about 50 percent reported is about sexual abuse. In the United States most abuse that’s reported is neglect. So we have a very — pretty good response to sexual abuse in Pennsylvania and a high awareness, physical and abuse and neglect maybe not so much.

Scott Gilbert – That’s a comment on Facebook to one of our earlier posts about this program was from Gwen, she had asked us — or she had just basically made a statement saying that verbal abuse is indeed child abuse. And of course, Dr. Frasier I know you agree with that. My question would be when it comes to those forms of abuse for which there are no physical symptoms, it would seem that those could be tougher to spot, for example neglect and verbal abuse.

Dr. Lori Frasier – Well, correct. Sometimes neglect is hard to spot but I think that is dependent upon the age and the needs of the child. You know, if you spot a very young child out where they might be harmed by running into traffic, or they’re not dressed appropriately for weather, that may be a very significant form of neglect. Medical neglect is not something that the lay public’s going to recognize. Nutritional neglect, if you see children who are not allowed to eat, who are deprived of food, who are deprived of appropriate shelter, those are also important things to report because they can be very serious. And often neglect part of a bigger picture too. Emotional abuse it’s hard in the state here, that includes verbal abuse and other forms of emotional abuse like — maybe you’re not physically harming a child but you’re isolating them, you’re making them feel very badly about themselves. Those forms of abuse need to be proven by a licensed physician or psychologist to show the emotional damage that has occurred to those children as a result to those actions. So those are much more difficult forms of abuse to prove, but the step towards proving it is reporting it.

Scott Gilbert – You’re watching ask us anything about child abuse prevention from Penn State Children’s Hospital. I’m Scott Gilbert, along with Dr. Lori Frasier. We welcome your questions and comments in the comment field below this Facebook post whether you’re watching this video life or on playback. And also, if you find this information useful, we encourage you to share it on hour Facebook feed. One off the most nerve-racking and perhaps uncomfortable situations might be if we’re some where in public. Say it’s in a grocery store and we see what we believe to be abuse being committed against a child by a complete stranger. We might feel helpless. We might feel like there’s nothing we can do in that situation. What should we do?

Dr. Lori Frasier – I think that it’s important to address it. If you fell like you can address it with the parent, not in a negative way but trying to assess if what is happening is because the parent is stressed out, offering to help a parent, trying to be supportive of what’s happening to a parent. It’s very hard sometimes in a store.

Scott Gilbert – Yes, because calling ChildLine on the spot, doesn’t do anything to alleviate that situation.

Dr. Lori Frasier – Correct so you might be able to intervene if it’s a situation that you feel comfortable in a supportive way that really shows that you want to help that parent. Now if you see a child who’s really in danger on the spot you need to call 9-1-1. That is most important. Children in Youth we’ll respond to ChildLine reports but they’re not a 9-1-1 response system. If you think a child is physically being harmed and you fear for that child’s safety, you can call 9-1-1 and the police will respond. On the other hand maybe it’s just not up to your standard of parenting, right? It’s maybe not abuse —

Scott Gilbert – It’s subjective right?

Dr. Lori Frasier – It’s subjective.

Scott Gilbert – Because what’s abuse to one person may not be to someone else.

Dr. Lori Frasier – Right. And perhaps it’s merely a stressed out parent or, you know, just because you’re yelling at a child isn’t automatically child abuse or emotional abuse. It needs to be much more significant that just raising your voice or maybe grabbing the child by the arm. Now hitting or striking a very young child would automatically be abuse in our state. You can’t hit a child under the age of one for example or shaking a child under the age of one. So even without any physical indicators those would automatically be child abuse.

Scott Gilbert – And that number for ChildLine again, again for a non-urgent but still pressing situation when you want to get word to authorities is 1-800-932-0313 and that number is 24-hours a day. 1-800-932-0313. If someone does call ChildLine they might then wonder how involved am I going to be in this case? Am I going to receive follow up phone calls from investigators? Might I have to go so far as to testify? What are some of — what’s some advice you can give people in that situation?

Dr. Lori Frasier – Well, every citizen is guaranteed anonymity if they report. They don’t have to give their name. What they do have to give is something that CYS can identify and find a child. So you have a guarantee of anonymity if your not in a professional capacity and even professionals can. Here at Penn State we actually provide our names and the Center for the Protection Children physicians often are very involved in the follow up and the courtroom work. Not every citizen wants to do that, that’s understandable. So you can be anonymous, you can report anonymously.

Scott Gilbert – You know, you lead the staff here of child abuse pediatricians here at the Center for the Protection of Children. Can you talk a bit about the center’s services just for folks who may not be that familiar with it?

Dr. Lori Frasier – Sure so we have a variety of services here. We are a group of medical and mental health professionals who work directly with children. From the medical side of things we provide the care of children who are abused who come to Penn State Hershey or who are found in the community and children and youth may call us and ask us to evaluate children’s injuries, which we may find may be due to abuse or may not be due to abuse. We have those medical skills as pediatricians. The other thing that we do is we have a clinic for children in out of home placement at our TLC Clinic, Transforming the Lives of Children Clinic in Harrisburg. If children are removed for some reason whether they’re placed in foster care, kinship care, we have a medical home for those children, pediatrician who provides care. We also have a mental health program that provides the follow up and mental health services for children who are abused and who are traumatized by something, abuse or neglect or other violence in the community. They might suffer from post-traumatic stress disorder. We have mental health programs for those children at the TLC Clinic in Harrisburg. We also provide resources for parents who might be engaged in harsh parenting through fairly intensive parenting interventions that require really hands on teaching of parents on how to more positively parent. And we have a program for children who might be exhibiting sexual behavioral problems and to help them understand what’s appropriate and what’s not. So we are — and we’re increasing our services all the time to different modalities to treat different kinds of children who might be abused or neglected or traumatized.

Scott Gilbert – Dr. Lori Frasier is head of the Center for the Protection of Children here at Penn state. She’s joining us today for Ask Us Anything About — Child Abuse Prevention. I’m Scott Gilbert. We welcome your questions in the comment field of this Facebook post. Like I said before whether you’re watching this video live or if you’re watching if after the fact, we’ll track down an answer for you. I would really like to ask you a bit about a grant that Penn State recently received from the National Institutes of Health. One of your colleagues, Dr. Kent Hymel is integrally involved with this and it involves a clinical trial that tests a tool that doctor’s can use. Can you tell us about that tool and how it plays into these cases?

Dr. Lori Frasier – Certainly. It’s about a series of questions that a physician can address when they see a child in the Pediatric Intensive Care Unit. So it’s not meant for just normal clinical use. It’s specifically designed when children come into the Intensive Care Units across the United States, what types of questions do the physicians need to address to either proceed with a full workup for child abuse, or realize the child is at low risk? Understanding that we have limited medical resources, we don’t want to proceed with a full medical workup for child abuse when it’s not indicated, when that child has a completely explainable problem, versus we don’t want to miss children who are abused that may go on to be more abused if they’re sent home. So it’s really what’s called the clinical decision rule to help doctors sort through the complex medical questions and his project is really about implementation. It partners with two other studies that he’s done to develop the clinical prediction rule, the clinical decision rule, and to move forward with spreading it out through the different pediatric intensive care units in the United States.

Scott Gilbert – As pare of a larger $7.7 million NIH grant that Penn State has received, you can find more information on that grant and the project of Dr. Hymel’s at PennStateHealthNews.org. There’s a story we posted just earlier this week about that. Dr. Lori Frasier, I need to ask you — you’re job seems like it would be very difficult to do what you do. What inspires you to keep coming back each and every day to help children and do what you do?

Dr. Lori Frasier – Well, we see them get better. We see them protected. We make the right decisions, we hope. And many times we’re the team that says the children are not abused. We find another explanation. So our expertise allows us to make accurate diagnosis and then we have other programs where children can be followed up, they can receive mental health services, parents can receive services. I enjoy education, which is why I’m part of Penn State Hershey College of Medicine. I teach medical students. I teach residents. I work in the community to educate law enforcement as well as children in youth in the medical aspects of child abuse. It’s a wonderful job to have that allows you to be part of the community that you live in, in more ways that I think other forms of medicine do.

Scott Gilbert – Very important work, Dr. Lori Frasier. Thank you for your time.

Dr. Lori Frasier – Thank you very much Scott.

Scott Gilbert – All right, Dr. Lori Frasier is a child abuse pediatrician and director of the Penn State’s Center for the Protection of Children. She joined us for this addition of “Ask Us Anything About”. We welcome your questions, your comments, add them to the comment field even if you’re watching this video on playback, we’ll be happy to respond and get you some answers. And also of course feel free to share this interview if you felt that the information was worthwhile. I did, I hope you did too and I appreciate you watching this addition of Ask Us Anything About — Child Abuse Prevention from Penn State Health.

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