WI-IAFN Meeting
WI-IAFN MeetingHSHS St. Vincent’s GB3.28.19, 9:30-3:30Note Taker: Ambir DornMinutesAgenda item:Child Sexual AbuseChildren’s Hospital of Wisconsin, Child Advocacy CenterPresenter:Jennifer Yates Discussion: Effective protection of children requires a multidisciplinary response (CPS, Medical, Law, Advocacy…)Offer both medical exams and forensic interviews at the CACWhy don’t we give prophylactic STI treatment in pre-pubital children?Because + findings of STI in children is significant evidence of abuseAvoid unnecessary Abx exposureAscending infection risk is low in pre-pubital children, unlike adults/adolescentsUse quotes of what children sayLimit direct questions about the abuse, but it is ok to ask about physical symptomsBe detailed in your reports to CPS, if insufficient information is provided it may be screened outDual reporting to L.E and CPS is best practiceTips for making kids comfortableHave mom hold in lap for as much of the exam as possibleLeave the ears for lastProvide distraction (bubbles, gloves, books…)Explain what you are doing when appropriateSwab the vulva first (no mucosal tissue involved)Once you start involving the mucosal tissue and if evidence is found they can charge “penetration”Remember most pediatric disclosures are delayed! Differences between “Peer Review” and “Consult”Suggested positions: supine frog leg, forward and downward traction w/ separation (carefully!), prone knee chestPosterior fourchette in children is easily irritated in children due to poor hygiene, learning to toilet… not typically indicative of child abuseNo scientific value in measuring the diameter of the vaginal openingUpdated 2018 “Interpretation of Medical Findings in Suspected Child Sexual Abuse” Joyce Adams as a professional resource“SMR” sexual maturity rating has replaced the Tanner ScaleReviewed examples of mimics for trauma/sexual contacts (adhesions, clefts, anal fissures {constipation}, lichen sclerosus, urethral prolapse, group A strep…)Infections found in peds need to confirm that they weren’t spread from childbirth in order to consider it indicative of child abuseIncreasing frequency of parents “selling” their kids for drugs (sex in exchange for drugs)Agenda item:Hair Follicle/DECEau Claire CtyPresenter:Amy RegginDiscussion:DEC = drug endangered childrenIdentity of mandated reports is confidential, but someone could infer from the information provided that it was a medical provider vs a teacherNeglect can be hard to identify and proveIdentifying DEC – reports of several people coming in and out of the house, using the “street” names for drugs, reporting trouble waking mom and dad, drawing drug images, overtired (chaos in the home)Early involvement of CPS can help events from progressing or working (protective capacity process)Physical abuse is often the most obvious form of abuse, but difficult to prosecute (have to prove intent)Person w/ firsthand knowledge should make the call (RN, MD, not office assistant)Avoid asking leading questions, but open-ended questions can be usefulDon’t cut children off while they’re disclosing information When calling and reporting within your professional role provide your work address not your home addressResponse time of CPS varies based on assessment of danger/likelihood of events occurring againMDTs – multidisciplinary teams – format varies from county to countyHuman services, law enforcement, medical, DAs, victim witnesses, support agencies…Collaborating helps to decrease the trauma of a child (repeat separate interviews are avoided)Hair Follicle TestingJust a few counties left that need to develop DEC in WILarge benefit for areas with high meth issues, testing goes back 90 daysHair can trap drug and ETOH biomarkers through multiple routes (blood, sweat, sebum, environmental exposure)Children should not test positive for exposure, this is indicative of exposure to drugsConsent or search warrant is needed for collection of hair follicle Repeat testing can help establish exposure timelines Some public health depts can do environmental testing of the residenceAgenda item:DOJ Discussion/Suspect ExamsPresenter:Jamie and groupDiscussion:WI-IAFN sent a letter requesting protection for RNs collecting evidence from non-consenting suspects from civil/criminal chargesMandated Reporting injuries: must report any injury where the “skin is broken”, we have been under the impression that it was only injuries caused by a gun or knife were used to cause the injury, but they are now saying that it is ANY broken skin injury no matter the causeWe must report this, and patient’s do NOT have to cooperate with law enforcementWI-IAFN will draft a response to this letter Other InformationSpecial notes:Networking event to follow meeting. ................
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