A voice for the voiceless: programs at Yale aim to stop child abuse

Until relatively recently, the physical abuse of children and spouses was commonplace—largely tolerated (if discouraged) as a misfortunate byproduct of life. Although child abuse still exists, structures like the Child Abuse Programs at Yale New Haven Children’s Hospital and Yale Medical School have done extensive work to ameliorate the problem.

“When I headed the program over 35 years ago, it was just a doctor and a social worker in Yale New Haven Hospital,” said John Leventhal, M.D., HS ’76, FW ’78. “The program has since expanded greatly. We have a staff of thirteen professionals, and a DART team that holds weekly case conference meetings at the Children’s Hospital, and we work closely with professionals in the community to identify maltreatment of children.”

According to Leventhal, the program has also expanded to three affiliated hospitals in Connecticut—Bridgeport, Lawrence and Memorial, and Saint Raphael Campus. Clinicians at these hospitals meet regularly to discuss the management of cases where there is concern for abuse and neglect.

The DART team (Detection, Assessment, Referral and Treatment) is a group of clinicians with special expertise in child abuse that evaluates injured children to determine whether the injuries are from child abuse or the result of accident. Leventhal said that about a third of the cases flagged for further evaluation are due to abuse, but the remainder are either accidental or birth injuries or in certain rare cases, undiagnosed medical conditions.

Leventhal described a typical case of abuse. A three-month-old infant had a bruised ear noted during a routine examination, but the physician had believed that the injury was self-inflicted—the mother’s story. A month later, the infant was seen in the Children’s Hospital’s ED with marked lethargy, bilateral subdural hemorrhages, several bruises on the face, and two healing rib fractures.

“It turned out that the child was, in fact, being abused,” said Leventhal, “and we were able to facilitate interventions in that child’s life to protect the infant from further harm.” We also are working to help primary care clinician recognize that minor, unexplained bruises in premobile children can be the first sign of abuse and identifying the correct cause of these injuries can prevent more serious abuse and even save the child’s life.

Amplifying the availability of diagnosis, treatment, and support have been top priorities for Leventhal’s team. And as their capabilities have expanded, the Child Abuse Programs have been part of nationwide changes within the medical community.

“The American Board of Pediatrics has a sub-specialty in ‘child abuse pediatrics’ now,” said Leventhal. “There are 350 board-certified child abuse pediatricians across the country.”

Since their humble beginnings, the Child Abuse Programs have grown substantially. Currently, they field over 125 in-patient consultations, and over 400 evaluations for suspected sexual abuse per year. The program at Yale has numerous full-time staff, but its greatest impact is achieved through robust collaboration with professionals throughout the community including Child Protective Services, law enforcement, primary care and emergency department clinicians and mental health providers.

“The key point,” Leventhal continued, “is that determination of abuse or non-abuse depends on having a collaborative system and a procedure by which professionals can evaluate and diagnose injuries. For decades, now, the Child Abuse Programs have been providing that capability to the community.”