DCS09017
Pediatric Evaluation and Diagnostic Services, Part 3
Welcome to Pediatric Evaluation and Diagnostic Services (PEDS), Part 3, developed and presented by the Indiana Child Welfare Education and Training Partnership. This training is available in different formats for State of Indiana employees and School of Social Work students. Scroll down the page for instructions on how to take this training.
State Employee Training #
State employees can take Pediatric Evaluation and Diagnostic Services (PEDS) training through the State of Indiana’s Learning Portal (also known as SuccessFactors). If you’re already logged into My Learning in SuccessFactors, you can select the PEDS Part 3 button to go directly to the training.
If you haven’t logged in, the PEDS Part 3 button will take you to a log-in screen. After you’ve logged in, select the My Learning button. From there, you can search for this training by name (using the Find Learning search box) or come back here and use the direct training link.
For a video walkthrough of how to access this training, select the help button.
School of Social Work: Student Training #
Pediatric Evaluation and Diagnostic Services, Part 3 #
Goals of this program
- Provide Expert Child Abuse Pediatric Knowledge
- Offer specialized knowledge in the medical diagnosis, assessment, and determination of possible child abuse or neglect.
- Assist in differentiating between maltreatment, accidental injuries, neglect, and various medical conditions.
- Focus on Specific Types of Injuries
- Concentrate on critical areas of injury in young children, including head injury, neck injury, burns, and fractures.
- Utilize Board-Certified Subspecialists
- Employ child abuse pediatricians who are board-certified subspecialists, ensuring a high level of expertise beyond general pediatricians or physicians.
- Address Underdiagnosis in Child Abuse Cases
- Aim to minimize the rate of missed cases in child abuse, particularly in severe conditions such as shaken baby syndrome.
- Enhance Knowledge and Skills of Medical Providers
- Improve the understanding of injury mechanisms and the likelihood of abuse or neglect among general physicians and other medical providers.
- Support medical professionals in accurately ordering and interpreting tests in suspected child abuse cases.
- Guide on Levels of Training and Specialty
- Emphasize the importance of recognizing different levels of training and specialty among medical providers interacting with child abuse cases.
- Correct Misdiagnosis and Overdiagnosis
- Address the issue of accidental injuries being overdiagnosed as abuse due to lack of complete medical history.
- Collaborative Decision-Making and Information Sharing
- Facilitate informed decision-making in child placement cases by providing comprehensive medical evaluations and expert reviews.
- Promote collaboration and information sharing among various stakeholders involved in child welfare.
- Comprehensive Approach through Various Programs
- Include a range of programs like the Pediatric Center of Hope, crisis counseling, and community education initiatives to address different aspects of child abuse and neglect.
These goals collectively highlight the PEDS program’s commitment to enhancing the detection, assessment, and management of child abuse and neglect through specialized medical expertise, education, and collaborative efforts.
Background
- Specialization in Child Abuse Pediatrics
- Child abuse pediatricians are recognized as board-certified subspecialists, similar to other pediatric subspecialties like pediatric cardiology.
- This specialization entails extensive training and expertise beyond the scope of general physicians or average pediatricians.
- Role and Expertise of Child Abuse Pediatricians
- These pediatricians possess specialized knowledge crucial for accurate diagnosis and assessment of child abuse and neglect cases.
- Their training enables them to effectively differentiate between various types of injuries and conditions, distinguishing between abuse, accidental harm, and medical issues.
- Importance of Specialized Training
- Child abuse pediatricians undergo rigorous and extended training, equipping them with capabilities well beyond the expertise of average medical practitioners in this field.
- This level of specialization is instrumental in accurately diagnosing and managing cases of suspected child abuse and neglect.
- Enhanced Medical Diagnosis and Assessment
- The program leverages the specialized training of these pediatricians to provide expert knowledge in medical diagnosis and assessment for suspected child abuse cases.
- It emphasizes the critical role of specialized medical expertise in assessing and determining cases of child abuse or neglect.
- Addressing the Challenge of Missed Diagnosis
- A key aspect of the program’s background is its focus on addressing the issue of missed diagnoses in cases like shaken baby syndrome, which are often challenging to detect.
- Such specialization aims to reduce the instances where child abuse cases go unnoticed or misdiagnosed by less specialized medical professionals.
This background information underscores the significance of specialized training and expertise in child abuse pediatrics, which forms the foundation of the PEDS program’s approach to managing and addressing cases of child abuse and neglect.
IUCPP
- Pediatric Abuse and Diagnostic Services
- Focuses primarily on physical abuse and neglect of children.
- Provides medical evaluations and expert consultations for assessing and diagnosing cases.
- Pediatric Center of Hope
- Specializes in medical evaluations for concerns of possible child sexual abuse.
- Offers crisis counseling services to support affected individuals.
- Community Education and Collaboration
- Engages in community education programs, emphasizing prevention and awareness of child abuse and neglect.
- Participates in community teams like child advocacy centers, child protection teams, and fatality review teams.
- DOCs (Doctors in Case) Program
- Focuses on child abuse screening and education across Indiana.
- Provides support and expertise to pediatricians throughout the state.
- Multidisciplinary Team Approach
- Includes board-certified child abuse pediatricians, fellows in training, social workers, nurse practitioners, and nursing staff.
- Team members assist in evaluating cases and may be the direct contacts for case consultations.
- Administrative and Educational Support
- Features an administrative secretary and an educational coordinator to facilitate program operations and educational efforts.
- Emphasis on Effective Communication
- Highlights the importance of clear communication with team members to avoid redundancy and enhance efficiency in handling cases.
- Comprehensive Child Protection Services
- Addresses the full spectrum of child abuse and neglect, including physical, sexual, and psychological aspects.
- Utilizes expert knowledge and resources to provide thorough assessments and recommendations for each case.
The IUCPP represents a comprehensive approach to child protection, integrating specialized medical expertise, education, and a collaborative, multidisciplinary framework to effectively address and manage child abuse and neglect cases.
IUCPP Team and the PEDS
IUCPP Team Composition
- Pediatricians: Includes board-certified child abuse pediatricians, offering specialized knowledge in diagnosing and assessing child abuse and neglect.
- Fellows in Training: Board-certified pediatricians undergoing specialized training to become board-certified child abuse pediatricians.
- Social Workers: Key team members who provide support in case evaluation and in handling the social aspects of child welfare cases.
- Nurse Practitioner and Nursing Staff: Engaged in case evaluation and often the first point of contact in various cases.
- Administrative Secretary and Educational Coordinator: Facilitate the smooth functioning of the program and coordinate educational efforts.
PEDS Program Structure
- Expert Child Abuse Pediatric Knowledge: Provides specialized knowledge in medical diagnosis, assessment, and determination of possible child abuse or neglect.
- Specialization in Diagnosing Specific Injuries: Focuses on head injury, neck injury, burns, and fractures in young children.
- Enhanced Medical Diagnosis and Assessment: Utilizes the specialized training of child abuse pediatricians for accurate diagnosis and management of child abuse cases.
- Addressing Underdiagnosis: Aims to reduce missed diagnoses in severe conditions like shaken baby syndrome.
- Training and Education: Improves understanding among general physicians and medical providers about child abuse and neglect, including appropriate testing and interpretation.
- Collaboration with Indiana DCS: Works in partnership with the Department of Child Services for comprehensive case assessments.
The combination of the IUCPP team and the PEDS program highlights a multi-faceted approach to child protection, integrating medical expertise, specialized training, and a collaborative framework to address the complex issues of child abuse and neglect effectively.
How we can help you
- Medical Expertise in Child Abuse Cases
- Provide specialized medical insights for accurately diagnosing and assessing child abuse and neglect.
- Help differentiate between maltreatment, accidental injuries, and medical conditions in children.
- Decision Support in Emergency and Non-Emergency Situations
- Assist in determining the urgency and type of medical care needed for a child, such as immediate emergency room visits or consultations with a child abuse pediatric expert.
- Offer guidance on the completeness of information available and what additional details might be needed for a comprehensive assessment.
- Interpretation of Medical Terms and Reports
- Facilitate understanding of medical terminologies and interpretations that may be confusing for non-medical professionals.
- Provide advice on identifying key questions to ask for clarifying the timing and nature of potential injuries.
- Clarifying Limitations of Medical Examinations
- Explain the limitations of medical examinations in determining child abuse or neglect.
- Assist in understanding the range of possibilities that might explain an injury, beyond simple categorizations of abuse or accident.
- Formal Opinion and Reporting for Legal Proceedings
- Provide formal written opinions and recommendations when required, including reports for court proceedings.
- Consulting on Mandatory Referral Cases
- Offer consultation for cases that are mandatory referrals, such as those involving head or neck injuries in young children.
- Guidance on Non-Mandatory Cases
- Available for consultation on cases that are not mandatory but may benefit from expert medical insight.
- Understanding and Advising on Safety Plans
- Provide suggestions regarding safety, including the development of safety plans, although the final decision rests with the Department of Child Services.
- Collaborative Approach with Child Services
- Work in partnership with the Department of Child Services, respecting their expertise in case management while providing medical insights.
This assistance highlights the role of the IUCPP and PEDS program in providing medical support, expertise, and guidance in cases of child abuse and neglect, ensuring that children receive appropriate care and protection.
mandatory referral
- Specific Age and Injury Types
- Mandatory referrals are required for any allegations of suspected abuse or neglect that involve injury to a child’s head or neck, particularly if the child is under six years of age.
- Injury Locations for Young Children
- Referrals include cases involving bruising, scratches, red marks on the face or neck, injuries in the mouth, injuries to the eyes, bleeding inside the head, or skull fractures.
- Special attention is given to cases with ear bruising, as it is considered a significant injury necessitating consultation.
- Bone Fractures and Burns
- Any allegation of suspected abuse or neglect involving a bone fracture or a burn anywhere on the body of a child under three years of age is a mandatory referral.
- This is especially important for the youngest children who are non-verbal and unable to provide a history of the incident, making them more vulnerable and at a higher risk of further injury if maltreatment has occurred.
- Emphasis on Vulnerable Age Groups
- The program places a strong emphasis on the most vulnerable age groups, particularly infants and toddlers, who are at a greater risk due to their inability to communicate and higher vulnerability to serious injuries.
- These mandatory referral criteria are in place to ensure that the most vulnerable and at-risk cases of child abuse and neglect receive the specialized attention and expertise that the IUCPP and PEDS program provides.
Non-mandatory referral
- Assessment of Non-Mandatory Cases
- The IUCPP and PEDS program are open to assisting with any case of suspected child abuse or neglect, even if they do not fall under the mandatory referral criteria.
- Consultation for Additional Guidance
- Case managers or other professionals can consult with the PEDS team or their own DCS nurse consultant to determine if a referral to the PEDS program is appropriate in a particular case.
- Decision Making for Referrals
- The decision to make a non-mandatory referral is typically based on a collaborative assessment involving the family case manager, their supervisor, and potentially the DCS nurse consultant.
- Early Intervention in Assessments
- It’s advised to make the referral as soon as possible once an assessment is initiated, rather than waiting days or weeks, to ensure timely intervention and support.
- Flexibility in Handling Diverse Cases
- This approach allows flexibility to address a wide range of situations and concerns that may arise in child welfare cases, ensuring that expert medical advice is available even in less clear-cut scenarios.
The inclusion of non-mandatory referrals allows the IUCPP and PEDS program to provide a comprehensive scope of support, ensuring that all cases with potential signs of abuse or neglect can receive the necessary medical expertise and evaluation, regardless of whether they meet the stricter criteria for mandatory referrals.
When should you call us
- Emergency Situations
- Immediate contact is advised upon initiation of the assessment in emergency situations.
- Examples include cases with infants under one year of age showing signs of injuries (bruising, burns, fractures), as they are at high risk and require prompt evaluation.
- If a child who qualifies for a mandatory referral is being discharged from a medical facility, immediate contact is necessary to ensure a complete medical evaluation is conducted prior to discharge.
- For any emergency concern or issue, contact should be made right away.
- Non-Emergent Situations
- In non-emergency cases, it is still best to make the referral as soon as possible after initiating an assessment.
- The decision to make a referral, especially for non-mandatory cases, should be determined through collaborative decision-making involving the family case manager and supervisor. Consultation with the DCS nurse consultant may also be beneficial.
- Timing of the Referral
- It’s emphasized not to delay contacting the program, regardless of whether the referral is mandatory or non-mandatory.
- General Guidance
- The program encourages early contact to ensure that children receive the necessary care and assessments without undue delays.
The guidelines for contacting the IUCPP and PEDS program underscore the importance of timely communication, particularly in urgent cases, to facilitate appropriate medical evaluation and decision-making in suspected cases of child abuse or neglect.
How to contact us
- Emergency Contact Procedures
- Direct Paging: For urgent situations concerning child physical abuse or neglect, page the child abuse pediatrician on call directly. The provided number in your transcript is 317-312-2911, where you enter the complete phone number, including area code, followed by the star extension and pound sign.
- Hospital Operator: Alternatively, you can call the IU Health operator 24/7 at 317-944-5000, asking specifically for the child abuse pediatrician on call. Avoid using general terms like “pediatrician” to ensure you are directed to the right specialist.
- Non-Emergency Contact Procedures
- Office Line: For non-urgent cases, the best approach is to call the office directly. The number provided in your transcript is 317-274-7401, operational Monday through Friday from 7:30 AM to 4:00 PM.
- Voicemail Protocol: If the call is answered by voicemail, you should leave a detailed message, and the team will return your call by the end of the next business day.
- Follow-Up and Documentation
- If you’ve already spoken to one of the doctors about a case, it’s advised to follow up with the same doctor for continuity.
- Complete the online referral form for documentation, even if you’ve received answers over the phone or via email.
- Additional Contact Guidelines
- Ensure to go through the office or the on-call system for the first contact to avoid confusion and ensure proper handling of the case.
- Use the provided paging and calling systems accurately to avoid communication errors.
- Handling of Child Sexual Abuse Cases
- For emergent cases of suspected child sexual abuse, you should call 317-944-5000 and ask to speak to the Pediatric Center of Hope nurse on call.
- For non-emergent questions or appointments regarding suspected sexual abuse, contact the Pediatric Center of Hope nurse at 317-274-7377.
These detailed procedures ensure that those in need of contacting the IUCPP and PEDS program for suspected child abuse or neglect cases can do so effectively, whether the situation is urgent or requires standard consultation.
Pediatric Center of Hope
- Specialization in Child Sexual Abuse
- The Pediatric Center of Hope is dedicated to providing medical evaluation for concerns of possible child sexual abuse.
- Crisis Counseling Services
- Alongside medical evaluation, the center offers crisis counseling services, supporting children and families affected by sexual abuse.
- Emergency and Non-Emergency Contacts
- In emergent cases of suspected child sexual abuse, the center can be contacted through the IU Health operator at 317-944-5000, requesting to speak to the nurse on call.
- For non-urgent inquiries or appointments regarding suspected sexual abuse, the center’s nurse can be contacted directly at 317-274-7377.
- Assessment and Evaluation Procedures
- The Pediatric Center of Hope assesses each case to determine the appropriate timing and setting for a medical examination, considering factors like the child’s age, the type of alleged contact, symptoms, and the timing of the last incident.
- Integral Part of the Child Protection Program
- The center operates as an integral component of the broader IUCPP, specializing in a critical and sensitive aspect of child protection.
The Pediatric Center of Hope represents a specialized resource within the child protection framework, focusing on the medical and emotional needs of children suspected to have experienced sexual abuse. It operates with dedicated professionals trained to handle these sensitive cases with the necessary care and expertise.
Introduction to the Referral Form
- Introduction to the Referral Form
- The initial slides likely provide an overview of the referral form, explaining its purpose and importance in the consultation process.
- Instructions for Completing the Form
- Detailed instructions on how to fill out the form, ensuring that all necessary information is accurately provided for an effective referral.
- Mandatory vs. Non-Mandatory Referral Identification
- A section to specify whether the referral is mandatory or non-mandatory, based on the criteria outlined in the IUCPP and PEDS program guidelines.
- Case and Contact Information
- Fields for entering essential details such as the date of contact, information about the child and parents, and contact details of the referring individual and their supervisor.
- Description of the Case
- Space to provide a brief description of the case, including the nature of the injuries or concerns, the explanations given, and any specific injuries identified.
- Medical Evaluation Details
- Sections to input information about any medical evaluations already conducted, including details about completed studies or tests.
- Information on Siblings
- Questions regarding siblings of the child, to assess if they might also need medical evaluation.
- Specific Questions and Assistance Needed
- Space to articulate any specific questions the referrer has or particular areas where they need assistance from the program.
- Follow-up Information
- Instructions on how to follow up after submitting the referral, including details on who to contact and expected response times.
- Importance of Detail
- Emphasis on the importance of providing detailed and accurate information to assist the program in making a thorough assessment.
These slides serve as a guide for professionals referring cases to the IUCPP and PEDS program, ensuring that all relevant information is communicated effectively for the best possible assessment and intervention in child abuse cases.
Introductions
Importance of Detailed Information
- Comprehensive data is crucial for accurately interpreting and understanding the context of a suspected child maltreatment case.
- Detailed information enhances the ability of the IUCPP and PEDS program to provide effective assistance and make informed decisions.
What to Provide When Contacting the Program
- Personal Introduction: Introduce yourself, including your name and professional role.
- Location Details: Mention the county or region you are contacting from.
- Contact Information: Provide your phone number for follow-up communication.
Information about the Child
- Child’s Identification: Include the child’s name, date of birth, or at least their age.
- Caregivers’ Details: Identify who the child’s caregivers are.
Nature of the Concern
- Reason for Care: Explain why the child was brought into care or medical attention.
- Source of Report: Identify who is concerned about the abuse and why.
Understanding the Context of Injury
- Injury Details: Describe the nature of the child’s injury.
- Rationale Behind Abuse Concern: Elaborate on why there is a suspicion that the injury might be a result of abuse.
Emphasis on the ‘Why’
- The program will frequently inquire about the reasons behind the suspicion of abuse, as understanding the context and background is crucial for proper assessment.
This approach underscores the program’s commitment to thorough and meticulous evaluation of child maltreatment cases, relying on detailed and comprehensive information to guide their assessments and interventions.
Child's Basic Information
Child’s Basic Information
- Age: Mention the child’s age, preferably in months if they are under three years old.
- Gender: State the child’s gender.
Involvement of DCS (Department of Child Services)
- Explain how and why the DCS became involved in the case.
Current Location and Condition of the Child
- Inform about the child’s current location (e.g., home, hospital).
- Describe the child’s current condition (e.g., stable, hospitalized).
Details of Injuries
- Detail any known injuries the child has sustained.
- Provide information on the nature and severity of these injuries.
Context and Timeline of the Incident
- Give a description of what is understood about the incident – how it happened, and when it happened.
Medical History
- Discuss any prior medical care the child has received for the current injury or other past injuries.
Injuries to Other Family Members
- Report any known injuries to other children in the family, if applicable.
Witness Information
- Indicate if there were any witnesses to the alleged accident or injury, and provide details if available.
Providing this detailed information allows the IUCPP and PEDS program to have a clearer understanding of the case, facilitating a more accurate assessment and appropriate response to the child’s situation. It underscores the program’s thorough approach in evaluating suspected cases of child maltreatment.
History -Details
This section of your transcript emphasizes the crucial role of ongoing communication and the provision of detailed, up-to-date information in child maltreatment cases. Here’s a breakdown:
Importance of Specific Details and Updates
- Need for Specificity: It’s essential to provide specific details and new information about the case as it evolves.
- Relevance of Information: Ensure that all provided information is relevant and directly pertains to the case in question.
Responding to Requests for Additional Information
- Response to Preliminary Staffing: If the IUCPP and PEDS program’s preliminary staffing suggests the need for additional information, it’s crucial to respond promptly with the requested details.
- Impact of Withholding Information: Without new or additional information, the program may not be able to modify its opinions or assessments, potentially affecting the case’s outcome.
Facilitating Comprehensive Assessments
- Enhancing Assessment Accuracy: The more information the program has, the more accurately it can assess all the possibilities in a case.
- Assistance in Decision-Making: Detailed information helps the program assist you more effectively in making determinations and plans for the child’s welfare.
Continuous Communication
- Importance of Ongoing Updates: Continuous communication and updates are vital, especially if new developments or concerns arise in the case.
The transcript segment you provided underlines the importance of a comprehensive historical assessment in evaluating suspected child maltreatment cases. Here’s a detailed breakdown:
Medical and Family History
- Child’s Regular Healthcare: Determine if the child has a family doctor or a pediatrician. Knowing who regularly sees the child medically can provide valuable insight.
- Recent Health Checks: When was the child’s last well exam or visit? This helps establish a baseline of the child’s health status before the current concern.
- Family Medical History: Inquire about any history of health or medical problems in the child or their family. Conditions like bone diseases, bleeding disorders like hemophilia, or genetic conditions can be crucial in understanding the child’s health.
Child’s Daily Behavior and Routine
- Eating, Sleeping, and Playing Patterns: How does the child normally eat, sleep, and play? Changes in these patterns can be indicative of underlying issues.
- Previous Problems or Concerns: Document any known previous problems or concerns regarding the child’s health or behavior.
Initial Concerns and Symptom Progression
- First Signs of Concern: Identify when and what was first noticed about the child’s condition that raised concerns. Subtle signs like the child not being quite right could be significant.
- Symptom Development: Track how symptoms progressed over time, including specifics like onset, duration, and changes in symptoms like vomiting, seizures, irritability, or bruising.
Past Medical Interventions
- Previous Injuries or ER Visits: Check if the child has had any previous injuries or emergency room visits. Patterns or frequencies of such visits can be revealing.
- Healthcare Seeking Behavior: Assess whether the caregivers consistently visit the same healthcare facilities or vary them (‘hospital shopping’), which can sometimes be a red flag in maltreatment cases.
Assessment of Siblings and Household
- Siblings’ Health and Injuries: Inquire about the health and any significant injuries or fatalities among siblings or other children in the household.
Child’s Developmental Capabilities
- Developmental Milestones: Assess the child’s developmental abilities, such as their capacity to roll over, walk, climb, etc. This helps in evaluating if the child’s abilities align with the explanation provided for the injury.
Detailed questions to understand the circumstances surrounding the incident
When assessing a child’s injuries that have been attributed to an accident, it’s crucial to ask a series of detailed questions to understand the circumstances surrounding the incident. Here’s a breakdown of these key questions:
- Child’s Position Relative to the Accident
- Position Before and After: Determine the child’s position before and after the accident. This helps in understanding the dynamics of the incident.
- Witness Accounts: Even if no one directly witnessed the accident, gather information on how the child was found post-incident.
- Details of the Fall or Accident
- Height of the Fall: Assess how high the fall was, if applicable.
- Surface of Impact: Identify the type of surface the child landed on (hard, soft, uneven, etc.).
- Child’s Condition Post-Accident: Was the child awake, crying, unconscious, or showing any obvious injuries immediately after the accident?
- Response to the Injury
- Caregiver’s Reaction: Document the parent’s or caregiver’s response upon discovering the child’s injury.
- Decision-Making Timeline: How long did it take to decide to seek medical care after the injury occurred?
- Child’s Behavior After Injury: Note how the child was behaving between the time of the injury and when medical care was sought.
- Transportation to Medical Care
- Mode of Transport: How did the child get to the emergency room or healthcare facility (walked, driven, ambulance)?
- Witness Information
- Additional Witnesses: Are there any other witnesses to the incident? If so, what have they reported about what happened?
- Information Provided to Healthcare Providers
- Accounts to Medical Staff: What was told to the emergency room physician or other medical providers about the incident? This includes the initial explanation of the injury given to healthcare professionals.
- Asking these detailed questions is vital in evaluating whether the child’s injuries are consistent with the reported accident. It helps in understanding the circumstances of the injury and assessing the likelihood of the injury being accidental or a result of maltreatment.
Medical Evaluation History
- Current Condition of the Child
- Behavioral State: Assess whether the child is awake, happy, and playful, or if they are sedated, unconscious, or on a ventilator.
- Known Injuries and Medical Studies
- Identification of Injuries: Document all known injuries the child has sustained.
- Completed Medical Studies: Determine what medical evaluations, like imaging studies or blood work, have been performed to date.
- Physical Examination
- Examination for Bruising or Marks: Check if a thorough physical examination has been done to look for additional signs of injury such as bruising or marks.
- Specific Diagnostic Tests
- Head CT Scan: Find out if a head CT has been conducted for evidence of head injury or skull fracture.
- X-Rays: Ascertain if X-rays of the bones have been taken to identify fractures or other skeletal injuries.
- Blood Work: Check if any blood tests have been done to explore other medical conditions that might explain the child’s symptoms or injuries.
- Additional Evaluations
- Eye Examination: Determine if the child has had an eye exam, which can be critical in cases of head trauma.
- Photographic Documentation: Ensure that photographs of the child’s injuries have been taken, as these can be vital for medical review and legal purposes.
- Timing of Evaluations
- Progress of Medical Assessments: Understand that some evaluations might take several days to complete and that it’s helpful to know the status of these assessments during the referral process.
Providing this comprehensive medical information helps the IUCPP and PEDS program to more effectively review and interpret medical records, offer guidance, and determine if additional evaluations or interventions are necessary.
Medical Opinion
- Communication with Treating Physicians
- Direct Discussions: Emphasizes the importance of talking to the doctors who have provided care to understand the child’s condition and their perspective on the cause of injuries.
- Role of the IUCPP and PEDS Program
- Facilitating Understanding: The program can act as a mediator or interpreter between the treating physicians and caseworkers, helping to clarify medical information and terminology.
- Providing Support: The program is willing to communicate with treating physicians on behalf of caseworkers to address questions, concerns, and additional needs.
- Bridging Communication Gaps
- Bilingual in Medical and Case Language: The IUCPP and PEDS staff are adept at understanding both the medical aspects (from physicians) and the child welfare concerns (from caseworkers), enabling them to bridge communication gaps.
- Obtaining Medical Opinions
- Understanding Physicians’ Assessments: It’s important for caseworkers to get the medical opinion from the providers who are directly involved in evaluating the child.
- Real-Time Consultation
- Timely Consultations: Consultations with the IUCPP and PEDS program can be conducted in real-time, even while the child is still in the emergency room, to ensure a comprehensive evaluation.
- Preventing Premature Discharge: This approach can prevent premature discharge from the ER and ensure all necessary evaluations are completed.
This process underscores the importance of cohesive collaboration and thorough communication in child welfare cases, ensuring that all parties have a clear understanding of the child’s medical situation and the implications for their care and protection.
PEDs consultation may involve
- Modes of Consultation
- Phone Calls and Emails: Consultations can be conducted through phone calls or emails, providing flexibility in communication.
- In-Person Evaluations: Direct medical evaluations of the child are possible, either at the hospital or in a pediatric clinic.
- Formal Medical Record Review: A thorough review of the child’s medical records, X-rays, and CT scans can be undertaken for a comprehensive assessment.
- Importance of Photographic Evidence
- Photos in Assessments: Sending photos of the child’s injuries is strongly encouraged as it helps in assessing the severity of bruises or injuries.
- Impact on Opinions and Recommendations: The program may refrain from providing opinions or recommendations without visual evidence of injuries.
- Documentation and Tracking
- Tracking Form: Information discussed over the phone is documented in a tracking form, which is uploaded into a system by the central office for record-keeping.
- Court Suitability: This form is not suitable for court use but serves as an internal document reflecting the consultation’s content.
- Formal Reporting for Court
- Formal Letter and Written Opinion: A formal letter and written opinion can be provided for court, summarizing all gathered information and evidence.
- Timing of Requests: Requests for formal reports should be made at the beginning of the assessment, not just before court dates.
- Direct Medical Evaluation
- Child’s Examination by Child Abuse Doctors: If necessary, the child may be examined directly by child abuse pediatricians, particularly if the child is at Riley Hospital or referred to the pediatric clinic.
- Formal Documentation for Court
- Medical Record as Legal Document: The Child Protection Program consultation included in the medical record can be used as formal documentation for court proceedings.
- Continuous Updates and Communication
- Updating Medical Records: Medical record notes might be extended as more results and information become available.
- Contact for Queries: For further questions, contacting the PEDS physician directly or consulting with DCS nurse consultants is advised.
- This approach emphasizes the comprehensive and adaptable nature of the PEDS program’s consultation process, ensuring thorough assessment and proper documentation for each child’s case.
What PEDS will Need
- Collaboration with Family Case Manager
- The program will have a detailed discussion with the family case manager to determine the appropriate level of care and consultation required.
- Requirement for Detailed Medical Records
- For a thorough assessment, all relevant medical records and reports are needed.
- It’s essential to obtain the actual images from radiographic studies like head CTs, X-rays, or MRIs, not just the written reports of these studies.
- Need for Photographic Evidence
- Photographs of the child’s visible injuries and any relevant photos of the scene are crucial to help interpret what might have happened.
- Gathering Additional Information
- Information or statements provided about the child’s condition and what occurred are necessary for a complete assessment.
- Evaluating the Case
- Upon reviewing all information, the program may provide conclusions such as whether the situation is likely abuse, an accident, a result of an underlying medical problem, neglect, or medical child abuse.
- In some cases, a combination of these potential diagnoses might be considered.
- Indeterminate Cases
- Some cases may be classified as ‘undetermined,’ meaning that there is insufficient information to clearly distinguish between abuse, neglect, and an accidental condition.
- Being undetermined does not imply that there are no concerns; it may indicate that the available information is not adequate for a definitive conclusion.
- Role of Medical Impressions in Assessments
- The medical impression is based on the available information and is a critical component of the overall assessment by the Department of Child Services (DCS).
- However, it’s one of several factors considered in the broader DCS assessment.
This process highlights the importance of a thorough and collaborative approach in evaluating suspected child abuse or neglect cases, ensuring all possible angles are considered before reaching a conclusion.
what we can tell you
The transcript outlines the process for assisting in cases of suspected child abuse or neglect, emphasizing the need for comprehensive information and collaboration. Here’s a detailed breakdown:
- Collaboration with Family Case Manager
- The program will have a detailed discussion with the family case manager to determine the appropriate level of care and consultation required.
- Requirement for Detailed Medical Records
- For a thorough assessment, all relevant medical records and reports are needed.
- It’s essential to obtain the actual images from radiographic studies like head CTs, X-rays, or MRIs, not just the written reports of these studies.
- Need for Photographic Evidence
- Photographs of the child’s visible injuries and any relevant photos of the scene are crucial to help interpret what might have happened.
- Gathering Additional Information
- Information or statements provided about the child’s condition and what occurred are necessary for a complete assessment.
- Evaluating the Case
- Upon reviewing all information, the program may provide conclusions such as whether the situation is likely abuse, an accident, a result of an underlying medical problem, neglect, or medical child abuse.
- In some cases, a combination of these potential diagnoses might be considered.
- Indeterminate Cases
- Some cases may be classified as ‘undetermined,’ meaning that there is insufficient information to clearly distinguish between abuse, neglect, and an accidental condition.
- Being undetermined does not imply that there are no concerns; it may indicate that the available information is not adequate for a definitive conclusion.
- Role of Medical Impressions in Assessments
- The medical impression is based on the available information and is a critical component of the overall assessment by the Department of Child Services (DCS).
- However, it’s one of several factors considered in the broader DCS assessment.
This process highlights the importance of a thorough and collaborative approach in evaluating suspected child abuse or neglect cases, ensuring all possible angles are considered before reaching a conclusion.
Policy 4-16
- Comprehensive Assessments
- The Indiana Department of Child Services (DCS) conducts thorough assessments to determine the health and well-being of children involved in suspected abuse or neglect cases.
- Medical Examinations
- Medical examinations are obtained for the alleged child victim to assess their physical health status.
- Psychological Evaluations
- Psychological tests and evaluations are conducted to understand the mental and emotional state of the child.
- Drug Screens and Substance Abuse Evaluations
- If relevant, drug screens and substance abuse evaluations are performed. This is particularly important in cases where substance abuse is suspected in the household.
- Inclusive Assessment of Household Children
- DCS policy extends these evaluations not only to the alleged victim but also to any other children living in the home of the alleged victim.
- This inclusive approach ensures that any potential harm or risk to other children in the same environment is also assessed.
- Objective of the Policy
- The primary goal of this policy is to ensure a comprehensive understanding of the health, safety, and well-being of all children potentially affected in situations of alleged abuse or neglect.
- This policy underscores DCS’s commitment to a thorough and holistic approach in assessing the welfare of children in potentially harmful situations, ensuring that all aspects of their health – physical, mental, and emotional – are adequately evaluated.
Collaboration
The transcript emphasizes the critical importance of collaboration among various professionals in assessing cases of suspected child abuse or neglect. Here’s an outline of the key points:
- Collaboration as the Key to Success
- Effective assessment and intervention in child abuse or neglect cases require a collaborative approach.
- Multidisciplinary Approach
- Child abuse and neglect are multidisciplinary issues that necessitate the expertise of professionals from diverse fields.
- Involvement of Various Professionals
- The PEATS program involves collaboration between DCS nurse consultants, family case managers, and other community providers.
- Each professional brings unique expertise and perspective, contributing to a more comprehensive understanding of each case.
- Common Goal
- All parties involved work together with the common goal of ensuring the health, safety, and well-being of children and families.
- Importance of Comprehensive Information
- Acquiring the best possible information is crucial for making well-informed decisions in the interest of the children and families served.
- Focus on Children and Families’ Welfare
- The paramount concern is the welfare of the children and families involved, guiding all efforts and decisions.
- This approach highlights the significance of a cohesive, team-oriented strategy in handling child welfare cases, ensuring that decisions are informed, holistic, and in the best interests of the children and families involved.
Thank You
Thank you for completing the Pediatric Evaluation and Diagnostic Services (PEDS), Part 3, developed and presented by the Indiana Child Welfare Education and Training Partnership.