Local kids who are suspected of being victims of sexual abuse will now have access to downstate abuse specialists – without ever leaving Traverse City.
Credit the University of Michigan Health System’s Child Protection Team, which recently nabbed a $13,000 grant to launch a telemedicine program – in which patients visit with physicians via video conferencing – in a rural community.
The team chose Traverse City to launch the pioneering program, and the Traverse Bay Children’s Advocacy Center (TBCAC) and Munson Medical Center are joining forces to get it running by the end of the year.
The program will work like this: If a local child is suspected of being sexually abused, he or she will go to an undisclosed clinic in Traverse City. A nurse will be present in person to assist, but the forensic portion of the exam will be conducted via camera by Dr. Bethany Mohr, medical director of the Ann Arbor-based child protection team, or another sexual abuse specialist.
According to Mohr, this is the first time such exams will be performed via telemedicine in Michigan. “Based on my experience, these telemedicine evaluations truly replicate in-person evaluations,” she says.
Kathy Garthe, VP for regional system development and corporate communication at Munson Medical Center says, “The equipment is kind of like Skype but encrypted and very secure to ensure patient confidentiality.”
She adds that Munson has been using telemedicine in other types of examinations for years with great success. “Patients have found it’s as if the doctor is in the room with you. The doctor’s face fills the whole screen, and the doctor talks to you directly. However, patients seem to have less anxiety than if the doctor is actually there in person.”
Currently, children who are suspected of being victims of sexual abuse are seen at their local pediatrician’s office or Munson’s ER.
“Those doctors are great, and are a great resource, but there are very few pediatricians in Michigan who specialize specifically in child abuse. This new program will make sure [abused children in the area] get the best care in the state,” explains TBCAC’s Executive Director Brooke Nettz.
The telemedicine exams will be offered free of charge.
Since opening its doors less than two years ago, the TBCAC has helped more than 270 children in the Grand Traverse region – 104 last year alone.
The thought of a baby dying suddenly and unexpectedly is one that keeps parents awake at night, fearing the worst. For years, little was known about sudden infant death syndrome, or SIDS. Babies would die in their sleep, and it was presumed that little could be done to prevent those deaths.
Today in the U.S., more than 2,000 babies die of SIDS every year, according to government figures.
But the mystery surrounding SIDS is not what it once was. Many SIDS deaths are now believed to be accidents caused by unsafe sleep practices. And some are questioning whether the term SIDS remains relevant at all.
SIDS: A ‘Diagnosis Of Exclusion’
In Wayne County, Mich., 50 to 60 infants die suddenly and unexpectedly each year, most of them in Detroit.
For the past 11 years, the task of investigating those cases has fallen to Pat Tackitt, a pediatric mortality investigator for the Wayne County Medical Examiner’s Office.
When an infant dies, law enforcement will contact her. She’ll head out immediately to the family’s home, spending anywhere from one to five hours talking with the family, using a doll to help parents re-enact what happened.
She’ll hand the doll to the parents and ask them to show her where they placed the baby down, when they last saw the baby alive, and how they found him or her. She’ll also find out who and what was around.
In all, Tackitt has gone to the scene of more than 500 infant deaths — so many, she stopped counting.
In almost all of the cases, Tackitt says, she found that the baby was in an unsafe sleep environment. The baby may have been sleeping face down, may have been covered by a blanket or pillow, or may have gotten lodged between sofa cushions. In some cases, the baby was sleeping with a parent who rolled on top of the infant in the night.
Tackitt says these are all signs of accidental suffocation, not SIDS.
“There are some deaths that we cannot prevent. These are not those deaths,” she says. “The vast majority of these are preventable deaths. There’s been very, very few that we’ve seen that could not be prevented.”
SIDS is defined as the sudden death of an infant under 1 year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.
It’s often called a “diagnosis of exclusion,” meaning it’s the diagnosis that’s given when everything else has been ruled out. But, Tackitt says, often the term SIDS comes up prematurely.
“We find that in many cases, families have been told from the time the ambulance drove up to the time that the clergy saw them in the emergency room … that this is going to be a SIDS death,” Tackitt says. “All that means is, ‘We don’t know.’ Why would we start out saying ‘we don’t know,’ when we haven’t even looked yet?”
Some would argue that a SIDS diagnosis offers compassion in a moment of distress, and a way to avoid blaming parents amid the tragedy.
Wayne County Chief Medical Examiner Carl Schmidt disagrees.
“I think that’s cruel,” Schmidt says. “I think actually sitting down with a parent and telling them what happened is much more humane than trying to obscure the reasons why that infant actually died. Most people really want to know what happened, so they won’t do it again.”
In Wayne County, it’s been four years since they last signed out a death as SIDS. And that’s true elsewhere, too.
The ‘Back To Sleep’ Campaign
At Children’s National Medical Center in Washington, D.C., pediatrician Rachel Moon says it’s been several years since they’ve seen what she calls a “true SIDS case” in the District.
“All the babies who died suddenly and unexpectedly have all died in unsafe sleep environments,” Moon says. “These are all cases that could have been prevented.”
Moon chairs the American Academy of Pediatrics Task Force on SIDS. In 1992, it was the academy that came out with the recommendation that babies be placed on their backs to sleep, not on their stomachs.
Baby Sleep Positions And SIDS Rates
In 1992, the American Academy of Pediatrics recommended that babies sleep on their backs to prevent accidental deaths. As the number of babies sleeping on their backs has increased, SIDS cases have decreased.
Source: CDC's National Center for Health Statistics; National Infant Sleep Position Study (funded by the National Institute of Child Health and Human Development) Credit: NPR
The “Back to Sleep” public health campaign that followed proved hugely successful. As back-sleeping rates soared, the SIDS rate dropped. By 2000, it had fallen 50 percent. But since then, progress has stalled.
About a quarter of parents in the U.S. say they don’t put their babies on their backs to sleep, and among African-Americans, it’s about half. According to statistics, African-American babies die of SIDS at a rate twice that of whites.
Moon has been researching why so many people disregard the recommendations. She’s found everything from misconceptions about the risks of choking to distrust of doctors to confusion and skepticism.
“What’s happening is, you tell people that SIDS is when a baby dies and you don’t know why. So then when you tell them they should put their baby on the back, sometimes they turn to you and say, ‘Well, wait a second, how can you tell me that putting my baby on the back is going to help prevent this thing that you don’t know what causes it?’ ”
Asked if she can imagine dropping the term “SIDS” at some point, she says, “Oh yeah, I can imagine a time when we just talk about safe sleep. And I think we’re starting to get there. I think if people know something’s preventable, and they can visualize it happening, then they’re more likely to take steps to try to prevent it.”
For now, though, Moon says, SIDS is a term people are familiar with. So she’ll continue to talk about “SIDS prevention.”
She does also believe that there are some true SIDS cases out there — cases in which babies were on their backs, alone in their cribs with nothing else in the crib. But, she says, those cases are very rare.
Can A Simpler Message Save Lives?
In Baltimore, public health officials have replaced the term “SIDS” with these ABCs: Alone. Back. Crib.
In literature distributed in hospitals and in public service announcements, there is almost no mention of SIDS, but rather the message “Sleep Safe.” They urge parents to share a room with their baby, but not a bed. They tell parents that the safest sleeping position for a baby is on his or her back, and that a baby is not more likely to choke while on the back. And they emphasize the importance of a clean and clear crib, free of blankets, pillows and toys.
From 2002 to 2010, unsafe sleep environments were identified in more than 90 percent of sleep-related infant deaths in Baltimore. The hope is that a simpler message will help save lives.
On a national level, the Centers for Disease Control and Prevention is piloting a Sudden Unexpected Infant Death case registry in several states. The goal is to create systems that allow people to more comprehensively describe the circumstances and events surrounding sudden infant deaths.
The pilot project followed a study that found great inconsistency in how SIDS deaths are reported.
CDC senior scientist Carrie Shapiro-Mendoza led that study, which looked at two years of SIDS-coded death certificates. She found that in a third of the deaths, SIDS was not explicitly reported by the certifier, raising questions about whether the certifier meant for the deaths to be counted as SIDS.
Instead of the term SIDS, the certifiers used other terms, including “sudden infant death” and “sudden unexpected death in infancy.” Some had accompanying notes pointing to unsafe sleep environments. Still, because of the way death certificates are coded, they became part of the national SIDS statistic.
Shapiro-Mendoza also found that SIDS can mean different things to different people. She points out that certifiers have varying levels of education.
“In some large metropolitan areas, for instance, you may have a medical examiner who is a board-certified pediatric pathologist,” she says. “In other smaller counties or jurisdictions, you may have an elected official, coroner, and he may have no medical background.”
The report concludes that nationally established guidelines for infant death scene investigations would help in the reporting and classification of infant deaths, and that in turn could help with identifying trends.
“If we understand the mechanisms that caused these deaths, if we can actually explain why they occurred, we can hopefully prevent these deaths,” Shapiro-Mendoza says.
Recent media articles and resources relating to child abuse and neglect. If you have items that you think would be helpful to include in this occasional post, please forward them to me at the email in my signature block.
These articles/resources were chosen because of their perceived relevance to the child welfare community. MiPSAC is not responsible for the views expressed in any of these articles and does not take a position for or against the views expressed in the articles/resources. These articles/resources are presented merely to provide a sampling of what the media is saying about child welfare.
Charlie Enright, JD, MSW
4907 Foster Rd.
Midland, MI 48642
(989) 832-9628 [email protected]
Posted August 7, 2008
Court: Michigan Court of Appeals (Unpublished) Case Name: In re Geren
Court of Appeals affirmed the trial court’s opinion. The child was in foster care for two years due to neglect, stemming in part from her mother’s inability to financially support her. The child was returned home after services. Respondent then permitted her boyfriend, a known sex offender who had been imprisoned for sexually abusing his own daughter, to move in with her. She downplayed the severity of his conduct and failed to protect her daughter from his verbal abuse and attempted sexual molestation. She also refused to leave him because she became financially dependent on him. Respondent’s reliance on Fritts for the proposition the DHS was required to prove, and the trial court was required to find, she would neglect the child for the long-term was misplaced – Fritts predated the enactment of § 19b(3), which established the current criteria for termination. Full Text Opinion
Court: Michigan Court of Appeals (Unpublished) Case Name: In re King
Concluding the “egregious nature” of the respondent-father’s conduct of entering the home where the child lived with her mother and half-siblings at night, without the mother’s consent, and sexually assaulting the child’s 11-year old half sister, suggested no child would be safe in his presence and termination was necessary to ensure the child’s safety, The court rejected respondent’s claim the trial court improperly assumed jurisdiction over the child under MCL 712A.2(b), holding the record supported the trial court’s findings his criminal act against the child’s half – sister posed a substantial risk of harm to the child’s emotional and mental well being and conferred jurisdiction under subsection (b)(1), while his depravity rendered the home unfit while his presence there was a possibility, conferring jurisdiction under subsection (b)(2). Affirmed. Full Text Opinion
SAFER, EFFECTIVE FOSTER CARE Grand Rapids Press: Friday, August 01, 2008
A recent settlement of a law suit by Children’s Rights of New York pumps an estimated $200 million into Michigan’s foster care program. Article describes major provisions of settlement. Grand Rapids Press Article
Grants for Child Abuse Prevention
WLNS.com; Channel 6 News
Posted: July 30, 2008 09:24 AM EDT
Grant approval for programs geared toward child abuse prevention have two local agencies set to receive thousands of dollars. The Michigan children’s trust fund is approving grants for Big Brothers Big Sisters of Greater Lansing and the Women’s Resource Center of Livingston County. Each will get over $17,000 or more over the next three years.
Rich Bearup, children’s trust fund Executive Director: “The loans are voluntary, it’s prevention, these are about families that may have risk factors for child maltreatment, but they haven’t yet expressed themselves to the point where their protective services are called in. We’re trying to prevent abuse, not treat it after it takes place.”
The grants were given on a need base to the local agencies to help prevent child abuse and neglect. This is whole article.
The ABA Center on Children and the Law and the ZERO TO THREE Policy Center have published a brief: Visitation with Infants and Toddlers in Foster Care: What Judges and Attorneys Need to Know.
This brief:
explains why visitation is particularly important for very young children,
emphasizes the role of visitation in permanency planning,
highlights key elements of successful visitation plans for infants and toddlers,
suggests strategies for addressing barriers to visitation,
reviews the judge’s role in supporting parent-child visits, and
shares promising community approaches to visitation.
STATE SHUTS DOWN FLINT DAY CARE CENTER WHERE 3-YEAR-OLD BOY DIED
The Flint Journal July 30, 2008
FLINT, Michigan — The day care center where a 3-year-old boy died after a table fell on him 10 days ago has been shut down by state regulators. Flint Journal Article
SaginawSchoolsSueCity Over Halfway House. A federal judge has returned the Saginaw School District’s lawsuit against the city to Saginaw County, Judge Robert Kaczmarek’s court, where he will decide the fate of a half way house for former federal prison inmates that has stirred resident and student protests. School officials along with the Saginaw Housing Commission want to prevent the operation of a prisoner re-entry facility. The proposed construction site is within 750 feet of Arthur Eddy Academy, a K-8 grade school. Saginaw News Article
‘SEXTING’ SPURS CHARGES, CONCERNS July 27, 2008
Teens snapping nude photographs of themselves on cell phones is a disturbing new trend – known as “sexting” – in Livingston County schools and the behavior has landed four minors in juvenile court on criminal charges. Livingston Daily Press & Argus Article
An Eaton County early childhood program (Early Childhood Connections) helps children’s school readiness and to prevent child abuse. July 27, 2008; Lansing State Journal Article
Court: Michigan Court of Appeals (Unpublished) Case Name: In re Nickerson
Since the respondent-father was simply a “putative father” as discussed in MCR 3.903(A)(23) and MCR 3.921(C), he was not entitled to personal service regarding the proceedings and the court affirmed the trial court’s order terminating his parental rights. Respondent argued the trial court lacked personal jurisdiction over him because no efforts were made to personally serve him with notice of the initial pleadings or proceedings. However, as a putative father respondent was not entitled to personal service regarding the proceedings. Where a respondent does not establish himself as a “father” for purposes of MCR 3.903(A) (7), he is not entitled to the same service and notice as a non-custodial natural parent. In re Nickerson; Court’s Opinion
Here is a related article on the topic of putative fathers in child protective proceedings, published in the Michigan Bar Journal and co-authored by MiPSAC member and former MiPSAC President, Frank Vandervort: Vandervort et al. Article
POSTED July 24, 2008
Legal Options: Grandparents Raising Grandchildren
THE OAKLAND PRESS: Thursday, July 24, 2008
When a child is placed with grandparents due to the inability of the biological parents to care for them, legal arrangements may be needed to ensure grandparents have power to legally consent to their care such as medical needs and school enrollment. Oakland Press Article
The Children’s Bureau Discretionary Grants Library is now available online. The library allows users to search for, view, and print documents and information about the work and findings of projects funded by the Children’s Bureau. These projects test and evaluate innovative approaches designed to address specific challenges and improve child welfare outcomes.
The library includes a list of grant projects and contains grant documents from 1995 to the present. Users can search for information by keyword, State or territory, region, fiscal year, or document type. Visit the Discretionary Grants Library at: http://basis.caliber.com/cbgrants/ws/library/docs/cb_grants/GrantHome
For more information, please contact Child Welfare Information Gateway at 1.800.394.3366 or [email protected]
DETROIT NEWS, July 24, 2008 — A Detroit Medical Center attorney on Wednesday threatened to move a proposed pediatric project out of Detroit if the City Council waits until September to discuss the matter again. Detroit News Article 24July08
DETROIT FREE PRESS, July 24, 2008– – A federal judge has scheduled a hearing for preliminary approval of a court settlement that would mean sweeping changes in Michigan’s child welfare system. Terms of the settlement call for a drastic decrease in workers’ caseloads, an increased push to find permanent homes for Michigan’s 6,000 legal orphans and the hiring of an outside monitor to oversee the changes. The changes would cost about $50 million more a year for the next four years, the state Human Services Department has estimated. This is entire article.
Case Name: Hakam v. Hakam Court: Michigan Court of Appeals (Unpublished) / In a Domestic Relations Case The Court of Appeals Decision
Holding the trial court correctly determined MCL 600.2163a applies to custody matters and properly quashed the defendant-mother’s subpoena for the release of the parties’ children’s videotaped statements taken during a CPS investigation. The court affirmed the trial court’s order granting the plaintiff-father’s motion for sole legal and physical custody of the children. The prosecutor filed a motion to quash the subpoena, arguing release of the statements was prohibited by MCL 600.2163a because this case was neither a criminal case nor a child protective proceeding. The court concluded the statutory language was unambiguous – videotaped statements taken in prosecutions and CPS proceedings can only be released by the custodian to a law enforcement agency, an agency authorized to prosecute the criminal case to which the statement relates, or an entity that is part of the county protocols established under § 8 of the Child Protection Law. Link to the Michigan Statute Prohibiting Disclosure
Lincoln Park: Tanveer Ali; The Detroit News; July 22, 2008
A Lincoln Park man who was accused of murdering and sexually assaulting his 8-day-old daughter is seeking $5 million in damages against two officers after the charges were dismissed. DETROIT NEWS ARTICLE
Detroit Free Press Lansing Bureau July 22, 2008;Michigan’s oversight of child care providers was so ridden with deficiencies that Michigan’s DHS licensed hundreds of convicted sex offenders, child abusers and criminals, according to an audit released today by the state auditor general. DETROIT FREE PRESS ARTICLE
Posted July 19, 2008
2009 Call for Abstracts
APSAC is now accepting submissions for its 17th Annual Colloquium, June 17-20, 2009 at the Omni Hotel in Atlanta, Georgia. The submission process is online at www.apsac.org. You do not need to be an APSAC member and you do not need to login to submit your program abstract. When you are ready to submit, please be sure that you have all of the necessary information handy: leader and co-presenter contact information, vitae (limited to 4,000 characters), session title, description and abstract, learning objectives, etc. To access the online submission process, click here. The form is also available through a link on the home page. Or you can click on this link to download a copy of the form.
An Op ED by Ismael AhmedDirector, Michigan Department of Human Services, Lansing. Gov. Jennifer M. Granholm directed me to hammer out and negotiate the successful agreement with the New York-based Children’s Rights organization in the best of interest of the state. This agreement puts children first. It reflects the shared goals of improved safety for children, stronger supports for those who care for them, and more promising outcomes for their future. http://www.freep.com/apps/pbcs.dll/article?AID=/20080718/OPINION02/807180337
The Flint Journal, Wednesday July 16th
The mother of the late Rose Kelley, the 5-year-old Flint girl who died from liver failure and neglect in her lice-infested home in 2006, is getting out of prison after serving just past her minimum sentence. http://www.mlive.com/flintjournal/index.ssf/2008/07/post_13.html
Michigan Court of Appeals (In an unpublished opinion) reversed termination of parental rights of a mother with 4 children who, the court said, substantially complied with parenting plan. Decision extensively quotes evidence and argument from the trial court. Case Name: In re Ross: Full Text Opinion
The court reversed the trial court’s order terminating the respondent-mother’s parental rights pursuant to §§ 19b(3)(c)(i), (g), and (j), concluding the record showed she substantially complied with her court-ordered treatment plan, had full-time employment for more than two years, “maintained a stable and appropriate” apartment, attended over 300 drug screens with only 2 isolated positive screens in 2006, and had twice completed substance abuse treatment, “demonstrating no imminent relapse or other ongoing substance abuse problem.” No evidence supported a finding at the time of the termination hearing, she “remained habituated to drugs, used drugs regularly, or resorted to drug use in stressful situations.” She had no documented alcohol or marijuana use during 2006 and 2007, establishing her understanding of the need to refrain from using illegal substances. There was no clear and convincing evidence dependency or domestic violence issues existed for respondent at the time of the termination hearing. Even accepting the caseworker’s interpretations of two or three of respondent’s 2007 supervised visits and the validity of her other concerns, the court held her testimony plainly did not rise to the level of clear and convincing evidence respondent lacked parenting skills, particularly considering “the overwhelming testimony by experts and others to the contrary that respondent consistently and over long periods of time demonstrated love for the children, parenting insight, the willingness to engage in a multitude of parenting-related services, and the capacity to learn from these services.” The court noted respondent became pregnant for the first time at age 13 and had 4 children when she turned 21. Before DHS intervention, she struggled with drugs, suffered emotional abuse by the children’s father, and lacked parenting abilities. However, the record “clearly and convincingly demonstrated” she substantially benefited from the services she was provided, “and with the guidance of therapists and other professionals, developed maturity, remarkable insight, and a willingness to accept responsibility for her previous shortcomings.” Reversed and remanded to the trial court.
Posted July 12, 2008
Couple Charged in Sexual Assault of Girl in Their Home
Detroit News – Jul 03
CLARKSTON — A convicted sex offender and his wife were charged Thursday in 52-2 District Court in the alleged sexual assault of a 16-year-old girl who told investigators she was paid to test and rate sexual devices for the man. Victim was brought into home by one of her school teachers, the alleged assailant’s wife.
Michigan Set to Reform Foster Care
Detroit News – Jul 03 10:14 PM
A settlement reached Thursday with an advocacy group that sued the state is expected to add hundreds of workers and help reform Michigan’s child welfare system.
Iron Mountain Daily News (July 2nd): “A Vulcan man sentenced to prison for criminal sexual conduct against two victims under the age of 13 years, in 2006 has been granted the right to a new trial by the Michigan Court of Appeals.” The Court of Appeals said that the trial court should have allowed the defendant to introduce evidence of the male complainant’s prior sexual conduct for the express purpose of showing bias and ulterior motive for making the charge. An exception to the rape shield law?! Full story
Macomb Daily (July 3rd): “No jail for sex with student: Judge [says] teacher has already suffered plenty.” Full story
CME/CESpontaneous Bruising in a 2-Month-Old A 2-month-old female with vomiting, bloody diarrhea, and decreased oral intake visits the ED. While there, bruising develops. Two days later, she returns with persistent vomiting. What’s going on? Turns out to likely be child abuse. May require establishing a free Medscape account. From Medscape; July 1st.
Lansing State Journal, July 1st: “A program that helps youths in the juvenile court system earn high school diplomas has a new home, allowing it to double in size this fall.” | Full story
OCALA — A jury took just under an hour Wednesday to find an Ocklawaha man guilty of capital sex battery and lewd and lascivious molestation of a child under age 12.
David Lamont, 61, faces a mandatory life sentence for the sex battery count and up to 30 years in prison for the molestation count.
Florida law requires a life sentence without the possibility of parole in sex battery cases where the offender is older than age 18 and the victim is younger than 12. Circuit Judge Willard Pope set a sentencing date of July 7.
This story was chosen because DrMohr [Associate Medical Director, Child Protection Team Pediatric] had worked on this case when she was the Medical Director at UF.
MiPSAC is not responsible for the views expressed in any of these articles, nor does it take a position for or against the positions expressed in the articles. They are presented merely to provide a sampling of what the media is saying about child welfare.
