The Middletown Press (Middletown, CT)
Helping to heal the abused child 50-year-old programs assist 450 young people a year
NEW HAVEN — Beth’s twins, a boy and a girl, were sexually assaulted when they were 6 years old by a 14-year-old boy at a summer camp. More than a year later, they’re not the innocent children they once were, but they’re coping much better while undergoing therapy at the Clifford Beers Clinic.
Beth now runs a nonprofit called Be a Child’s Voice, in West Haven, to raise awareness about juvenile sexual abuse and to advocate for a juvenile sexual offender registry.
While the last two years have been difficult, the family has progressed as far as it has because of the 50-year-old Yale Child Abuse Programs, which help the vulnerable victims of child abuse and their families get the appropriate medical, legal and psychological services they need to begin healing.
Beth said of the program’s effect on her children, “It’s like a tree. We started there, they slowly bridged them in, and through their counseling got them into the counseling that they needed.”
The programs began in 1967 as DART, which stands for Detection, Assessment, Reporting and Treatment, in which four doctors and an advance practice registered nurse,
all board-certified in child abuse pediatrics, are called to Yale New Haven Hospital “at any time when there’s an injury that is a concern of abuse,” said Paula Schaeffer, coordinator of the Child Abuse Programs, which are run jointly by the Yale School of Medicine and Yale New Haven Children’s Hospital.
DART is now staffed by Dr. John Leventhal, director of the Yale Child Abuse Programs, Dr. Andrea Asnes, associate director, Dr. Lisa Pavlovic and Beth Moller, who is both a nurse practitioner and physician assistant.
Now, the programs have expanded. They include the Yale Child Sex Abuse Clinic , an outpatient office at the Yale Family Advocacy Center at 1 Long Wharf, where forensic interviews are conducted in an atmosphere meant to make the child and family comfortable.
Finally, there’s the Nurturing Families Home Visiting Program, part of a statewide program. Seven home visitors “go into the home and screen for risk and identify which families are appropriate” to be enrolled in the support program, Schaeffer said. Those services may be provided until a child’s fifth birthday
DART paved the way
In 1967, DART was launched as one of the first hospital-based programs set up to identify abused children. Leventhal said he believes child abuse has not gotten worse in the years since he joined the program in 1982, but “the identification has gotten better. The treatment services have grown. The coordination … has made a huge difference in terms of the evaluation of these children and families and their treatment.”
Child abuse pediatrics is a relatively new subspecialty, Leventhal said, with about 400 pediatricians certified nationally. In June, Leventhal completed a two-year term as president of the Ray E. Helfer Society , a national organization of doctors specializing in child abuse.
The DART team examines about 450 children a year, and not all are determined to have been abused, but the team meets weekly to discuss those who are identified as victims of child abuse. Many are children too young to communicate what’s happened to them, Schaeffer said.
“Taking care of and evaluating an infant who has been abused in the hospital and helping to sort out what happened is not just a medical problem but requires involvement with DCF, sometimes the police, the family’s pediatrician to help sort out what happened to the child,” Leventhal said.
“At the medical end, we can figure out the child’s injuries, but understanding how they happened required a much larger team than just the medical providers.”
Included in that team are several pediatric departments in the hospital, as well as the Department of Social Work and the hospital’s Women’s Center. In addition to the state Department of Children and Families, the DART staff communicates with sexual assault crisis services and mental health providers.
“It’s critical to work as a team so that the diagnosis is the correct one,” Leventhal said. “If a child with an abusive injury is sent home with the diagnosis of an accidental injury, there’s a risk that that child might return with a more serious injury or even of dying.
“On the other hand, mislabeling a child who has an accidental injury as abuse has consequences as well, because we do not want a child being removed from his or her home because of an accident that was mislabeled as an abusive injury,” he said.
Leventhal said “about 65 percent of the time after our assessment we believe the child has not been abused and the injuries have an accidental cause, sometimes neglect and, rarely, underlying medical problems.”
It’s appropriate that the hospital calls in the DART team so often, Schaeffer said. “I think it speaks to the hospital’s mission to not miss abuse and accessing the experts on the questionable injuries to help sort out whether it’s abuse or an accident,” she said.
The program also works closely with the Yale Child Study Center, Yale New Haven Hospital’s Trauma Center and the Clifford Beers Clinic.
Specialty in sexual abuse
Sexual abuse inflicts a multitude of harms to the victim, which last long after, often into adulthood, said Asnes.
“With child sexual abuse what we worry about most is the downstream consequences of the trauma to the children and their families and so the mental health care in particular is crucial in our efforts to prevent those consequences,” Asnes said.
Sexual abuse suffered in childhood can lead to suicidal tendencies, substance abuse problems, relationship problems and early sexual activity, Asnes said. “Not only do they have a higher risk of sexual abuse run in their own families … they also are at risk for problem sexual behaviors in themselves, including that they would abuse others.”
At the Child Sexual Abuse Clinic, also at 1 Long Wharf, suspected victims are made comfortable by child-life specialists, who “prepare the child for the evaluation, give them a tour, show them what’s going to happen, including the interview room, show them the cameras that are going to capture what they say … show them the medical room where they’re going to have a checkup and our equipment that we use so that they’re fully prepared for what’s going to happen next,” Asnes said.
“Oftentimes when a report comes in to DCF or police they will ask us to perform this forensic evaluation,” she said. “We have a lot of orchestrating to do” to arrange a meeting including those agencies and the family.
The interview is conducted by a specially trained social worker who is “able to interview children in a
nonleading and developmentally appropriate manner,” accompanied by a doctor or nurse practitioner, Asnes said. The child’s caregivers also are interviewed.
“The forensic interviewers also ask kids if they have concerns about their bodies,” Asnes said. “It’s the nature of sexual abuse that kids are involved in something that they don’t understand and they often can be fully confused and they can have worries about their bodies that we can address in clinic.”
Sometimes misinformation can be corrected, such as a worry that pregnancy can result from being touched through a girl’s clothes. Some victims worry “that they’ll be recognized as damaged goods,” Asnes said. “As medical providers we play a role in giving children an opportunity to share their concerns about their bodies, address them and often reassure them.”
The clinic offers a shortterm mental health treatment called the Bridging Program and, once the team meets to determine the best course of treatment, referrals are made to the Yale Child Study Center’s Childhood Violent Trauma Clinic, DCF and other agencies, from the Valley to Middletown to Old Saybrook.
While the clinic’s staff sees babies and toddlers, most children are between 3 and 18 years old, with the average age 8 or 9, Leventhal said. About threefourths of the victims are girls, he said.
“Our families meet with police, DCF, a hospital social worker, a medical provider and a victim’s advocate, all during this one appointment, and one of my roles is to help make that happen for those families,” Schaeffer said. “The value of this program is really giving back to the community and providing a space for our families to deal with a difficult experience with the most support that we can provide them.”
Services brought home
The Nurturing Families Home Visiting Program is one of more than 50 statewide funded by the state Office of Early Childhood. It aims to support families to prevent abuse from occurring.
“All the programs aim to screen mostly first-time births, but also second-time births, to identify socially high-risk families, such as teen mothers, single parents, families with housing problems, parents with mental health problems and then to offer those high-risk families the opportunity to participate in the Home Visiting program,” Leventhal said. In addition to being visited at home, families are seen in the Yale New Haven Women’s Center and on the hospital’s postpartum floors.
“About one-third of families who are offered the services agree to participate and their home visiting begins either prenatally or postpartum and can continue until the child’s fifth birthday,” he said.
The average stay is about 1½ years, “but each year we have a special graduation for families who stay the full five years and each year, six to eight families celebrate with us that accomplishment,” Leventhal said. About 100 families a year participate in the program, he said.
The home visitor offers guidance about getting a job, earning a high school diploma and connecting with substance abuse or domestic violence prevention programs.
“Of the seriously abused children that we see with bruises, broken bones or head injuries, about 70 percent of these children have been injured by men, either fathers, stepfathers or mothers’ boyfriends,” Leventhal said. “So you can imagine how important it is to help and to educate young fathers.”
For Beth and her twins, it’s been a difficult time since the children were abused. “It’s been over a year and they still need extensive therapy. … I don’t know if my children will ever be the same,” she said. My kids were very shy, very quiet, happy little kids.” Now, her daughter is “mean, she’s very bitter, she’s not the same.”
But she praised Leventhal and his staff for their treatment not only of the children but of her husband and herself.
For more information on the Yale Child Abuse Programs, call 203-688-2468.