Keeping kids safe after a traumatic event

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11/06/2020

Center Of Hope Web

Riley leads a yearlong effort to help establish statewide guidelines for the care of pediatric sexual abuse victims.

By Maureen Gilmer, IU Health senior journalist, mgilmer1@iuhealth.org

There’s a room tucked away in a quiet hallway at Riley Hospital for Children. Handmade butterflies hang from the ceiling, and an exam table is made up to look like a little bed, complete with a comfy blanket, a colorful pillowcase, a stuffed bear and a children’s book.

It’s not a playroom but an exam room designed specifically for kids who have suffered trauma that includes sexual abuse.

Last year, forensic nurses in Riley’s Center of Hope examined 152 children suspected of being sexually abused. So far already this year, they have performed exams on 157 pediatric patients.

Riley Hospital’s Pediatric Center of Hope and Forensic Nursing Program offers compassionate care to maltreated kids. Children and adolescents who may have suffered sexual abuse, child molestation, human trafficking, physical abuse or neglect are evaluated by specially trained forensic nurses, who collaborate with physicians, emergency department staff, law enforcement and the Department of Child Services.

It’s not an easy job, but for Tanya Malone, Jamie Haddix and their colleagues, it’s a chance to save a child from more abuse. And now, thanks to Riley’s leadership, Indiana has its very first set of guidelines for pediatric sexual abuse victims who come into health facilities for care.

Malone is coordinator of the Center of Hope and Forensic Program at Riley. A nurse for 20 years, she joined Riley’s forensic team in 2012. Together with Haddix, a forensic nurse at Riley for two years, as well as other Riley team members and representatives from other hospitals in the state, DCS and child advocacy groups, they compiled the list of guidelines.

While guidelines for adult and adolescent victims have existed for some time, there were no state guidelines for pediatric victims until now, said Nettie Wilson, clinical manager for Riley’s emergency department and Center of Hope.

Calling it an “amazing accomplishment,” Wilson said, “I just wanted to recognize this work and thank those involved for their contributions and representing Riley in such a huge way for the kids in our state.”

As the largest children’s hospital in Indiana, Riley was already ahead of the curve in this area, but its forensic team knew that kids were slipping through the cracks around the state.

While there are national guidelines for medical forensic examinations, this effort at the state level is “huge,” Malone said. “There hasn’t been much guidance around what to do when a child needs an exam and a lot of times it (sexual abuse) is screened out inappropriately, affecting a child or family over the long term.”

The goal of the guidelines is to make it easier for smaller hospitals and health facilities around the state to take the proper steps to report abuse and collect evidence.

“All of us are mandatory reporters,” Haddix said. “But there have been innumerable situations where outside facilities have opted not to report. We wanted to really impress on them that we are the medical providers. We are those people who are ensuring this child’s health and safety. DCS and law enforcement are the investigators.

“Any time there’s a suspicion you always, always call DCS,” she added. “When there isn’t an investigation and it is screened out, these kiddos could be going back with these perpetrators and living this life. If anything, even if it’s not a DNA evidence exam, they deserve to have a medical exam to be told their body is healthy, to be checked for sexually transmitted infections.”

As more healthcare professionals are made aware of the guidelines, they can act to break the cycle of violence that some kids experience, Haddix said.

“Of course we want to see all the children here at Riley; we want to give them the best possible care, but we also want to share our expertise with other facilities,” she said.

Being a pediatric forensic nurse demands an extra layer of both tenderness and toughness.

“It requires a lot of self-care, but honestly I think 90 percent of nursing does,” Haddix said. “We do see and hear horrible things, but we also see prosecutions and life-changing situations, breaking that cycle and getting these kiddos the help they need. It’s the way you have to view it every day.”

She and her colleagues, who also see kids who’ve been victims of violent crime including abuse, neglect, burns, gunshots, stabbings, dog bites and suspicious motor vehicle accidents, are called to testify in some cases and collect evidence – whether that be bullets, bloody clothing or DNA.

And that takes us back to that whimsical room in the ED at Riley.

Haddix and Brenna Joyce worked together to redecorate the trauma exam room, bringing in bright colors and a touch of the outdoors in the form of birds, butterflies, flowers and a tree painted on one wall – its leaves representing kids who have come through since 2016.

“When we bring them into this room, you can see their eyes light up,” Malone said.

The Riley Cheer Guild provides stuffed bears for the children to take home. If not a bear, sometimes they will receive a backpack filled with art supplies or a book. Nurses and Cheer Guild members also donate blankets, slippers, socks, robes and other supplies for the kids.

See the guidelines approved by the state here.

Photos by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org