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On May 5, 2009, Dr. Lawrence Ricci, Co-director of Spurwink's Child Abuse Program, was recognized by the Maine Children's Trust with a Statewide Advocate Award. Dr. Ricci accepted the award at the Annual Child Abuse and Neglect Prevention Recognition Awards Ceremony held in Augusta, Maine. His poignant acceptance speech follows...
I would like to thank the Maine Children’s Trust for this honor, which I accept not only on my own behalf but on behalf of all those working to prevent shaken baby syndrome in Maine. The honor must include the Maine Children’s Trust and in particular to Jan Clarkin for taking on this program with such enthusiasm and commitment. It must include all of the statewide participants in this work particularly Kelly Bowden from MMC perinatal outreach, Amy Movius from EMMC pediatric intensive care, Ellen Bridge from Maine public health nursing and Sheryl Peavey the early childhood systems manager. The hard work we have done in shaken baby prevention has been the most gratifying prevention work of my career.
The honor must include my employer Spurwink and particularly Dawn Stiles for allowing me the time and opportunity to engage in this important prevention work.
The honor must also include all of those medical professionals, child welfare professionals, and law enforcement professionals who day in and day out struggle to understand the ravages of child abuse and who at the same time minister to the children and families so affected. I particular It must include every single Maine state police CID detective I have ever worked with. They have without exception displayed the skills I most admire, objectivity, perseverance and hard work.
The last month has been a hard one for Maine babies. During the time Maine had 6 probable cases of H1N1 influenza A, one baby died, 4 sustained devastating head trauma, one 16 rib fractures, one massive pelvic injury, and one serious genitorectal trauma, all but one of these children were under 6 months of age. All were inpatients. This does not include the 50 or so outpatient less serious sexual and physical abuse cases we have seen over this same time period. You cannot know how dazed our medical community is feeling in the face of this onslaught. Last weekend alone I witnessed hardened hospital security guards and ER nurses crying after a particularly horrible injury to a 3 year old child. I ask us all to honor those nurses and security guards.
The honor must also include the overwhelming majority of child protective workers who are criticized for both too much and too little action – crazy making stuff – yet who continue to work with the unyielding belief that if they do their job correctly it will make a difference . The honor must include the many Guardians Ad Litem who recognize that their first job is see to the welfare of children. It must include the judges of Maine, the assistant attorneys general, and yes even some defense attorneys who see the larger issues at stake and who engage in their work with honorable intelligence. It must include the many local and county police departments who understand that solid police work is not a 9-5 job and that in investigation the first 24 hours are the only 24 hours.
We are at a crisis point in Maine and the nation with regard to child abuse in general and abusive head trauma in particular. In Maine we have seen a 3 fold increase in the last few years from 5 to 15 cases per year. Our rate now of 90/100,000 births is three times the reported national and international rate. Other states are seeing similar increases. Studies have shown that even that rate is 100 fold short of the rate of babies who are shaken and never receive medical care.
It is perhaps too easy to blame the economy even though the unemployment rate is the best predictor of the abuse rate. One of the most important causes I believe is the loss of services for families caused by shrinking state budgets caused by the economy. It is also perhaps too easy to say that despite these budgetary issues we will maintain the safety net for our neediest families. A safety net is no longer a safety net when it is 6 inches off the ground. It is far worse – it is the illusion of a safety net. I do not envy our state officials who have to make these hard budgetary choices.
I don’t know the solution to these problems. I didn’t several years ago when I spoke at the Blaine house about child abuse prevention and the notion of the untreatable family and I still don’t. Child protective services, law enforcement and child abuse pediatricians like myself will unfortunately continue to have a role particularly in tertiary prevention, but by its very nature tertiary prevention only starts after abuse has occurred.
I do know that over these last several years we have accumulated a wealth of research on what works and what doesn’t work in child abuse prevention. Yet having the research does us no good if we do not learn from it. Despite their attractiveness short term intensive family preservation programs are just that short term and have not demonstrated any impact on the long term abuse rate.
Primary and secondary prevention strategies otherwise known as universal and targeted have been demonstrated to work not with every family all of the time – for example, never when domestic violence is present in the home – but with sustainable success particularly with high need families and particularly when services continue through early childhood. Some of those strategies include universal shaken baby prevention as exemplified by the Period of PURPLE crying, universal home visitation with particular emphasis on targeted tiered response to those families most in need as exemplified by the triple P program, and long term, skilled, targeted family intervention as exemplified by the nurse family partnership and those programs that replicate its essential components.
The debate I must say about universal vs. targeted intervention so unfortunately distracts us from our goal. Of course intervention must be universal since as many as a third of families where abuse occurs have no obvious risk factors. Of course it must be targeted not only because most families in the end never abuse a child but because the highest risk families most benefit from the greatest level of intervention. We know who these high risk families are. Over the last 3 years in Maine 800 children were classified by CPS as high severity physical abuse. 75% of these families had prior child protective history, 54% mental health problems, 63% a history of domestic violence, and 50% alcohol and or drug abuse. We know who these high risk families are.
One might reasonably ask however about the cost of having highly trained home visitors follow a family closely for 3-5 years. I only give you this – the cost of child abuse in our society is inestimable – the long term medical care cost alone of one shaken baby is 1 million dollars.
When asked recently at a child abuse prevention group what I might say to those who are responsible for implementing prevention strategies in Maine it was this: Never forget the children as you struggle to represent your own interests whether saving a program or trying to eliminate a program, never forget the children.
Never forget that we saw 15 cases of abusive head trauma in Maine last year and are on pace to exceed that number this year.
Never forget that we saw 250 high severity physical abuse cases in Maine in 2006, 300 in 2007, and 350 in 2008.
And never forget the 2 month old with 16 rib fractures worse than any accidental crush injury, the 3 year old with massive inflicted pelvic trauma worse than any car accident, and the 4 month old with fatal head trauma worse than any fall.
The last time I spoke on child abuse prevention in Maine I closed with a quote by Doctor Henry Kempe on the untreatable family. This time I’d like to quote Holden Caulfield as written by JD Salinger:
“Anyway, I keep picturing all these little kids playing some game in this big field of rye and all. Thousands of little kids, and nobody's around - nobody big, I mean - except me. And I'm standing on the edge of some crazy cliff. What I have to do, I have to catch everybody if they start to go over the cliff - I mean if they're running and they don't look where they're going I have to come out from somewhere and catch them. That's all I do all day. I'd just be the catcher in the rye and all. I know it's crazy, but that's the only thing I'd really like to be. I know it’s crazy.”
I accept this award on behalf of all of us who believe in being crazy catchers in the rye.
Contact:
Spurwink Services
899 Riverside Street
Portland, Maine 04103
207-871-1200
1-888-889-3903
info@spurwink.org
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