For over 25 years, Dr. John M. Leventhal has been fighting a battle to protect the lives of hundreds of children who come through one of the child abuse programs at Yale.
He has won many struggles along the way, but to win the war, he says, the program needs to be armed with more state and federal support, as well as support from individuals and foundations.
"Finding ways to protect children who can't defend themselves is part of what wakes me up in the morning and motivates me to continue this tough, but important work," says Leventhal, professor of pediatrics at Yale School of Medicine and director of the Child Abuse Programs at Yale-New Haven Children's Hospital.
The Yale Daily Bulletin recently spoke with Leventhal about a job that he admits can be challenging at times but, he says, can also be personally fulfilling and life changing.
What role do you play in addressing and preventing child abuse?
I've been in charge of the Child Abuse Program since 1982. My colleagues, including Dr. Andrea G. Asnes, and I also run a prevention program that is about 15 years old. The child abuse programs are a collaborative effort of the Department of Pediatrics at the School of Medicine, the Department of Social Work and Yale-New Haven Children's Hospital. They include the DART (Detection, Assessment, Referral and Treatment) team, the Child Sexual Abuse Clinic and the Bridging Program.
I evaluate children when there's a concern about child maltreatment — physical abuse, sexual abuse or neglect — at Yale-New Haven Children's Hospital. We also provide prevention programs in families' homes. I work with my colleagues to examine each case and make appropriate referrals for treatment and child abuse prevention.
When a child arrives at the hospital with a burn, a broken bone or other injury, how can you tell if it's an accident or child abuse?
If a physician is concerned about suspected physical abuse or neglect, they are obligated to report the case to the Department of Children and Families (DCF). We meet with the family, examine the child, and review medical records, and meet with DCF and the police if they're involved. We try to sort out whether this is an accident, birth injury or medical problem. We try to balance all these issues to figure out what happened to the child so we can ensure the child's safety.
Kids who are over age 4 or 5 can provide reasonable histories. We will interview those children, but sometimes they are reluctant to talk about the injury that brought them to the hospital, especially if it is a family member who has hurt them. We have a weekly child abuse meeting that includes social workers, nurses, emergency doctors and DCF colleagues to discuss these cases to ensure that our decisions are the right ones.
What clinical services do you provide when child sexual abuse is suspected?
We provide forensic interviews of the children, which are observed by the police and child protective services; forensic medical exams are used to look for signs of sexual abuse. A child life specialist helps the child through the interview and accompanies him or her through the medical exam. It is important for children and families to be linked with services in the community, so our family advocate helps families connect with therapy. Also, many families will have immediate access to the treatment provided through the Bridging Program, a short-term trauma-focused treatment provided in collaboration with the Child Study Center.
How Does the Family Advocacy Center try to help prevent child abuse?
The Family Advocacy Center, which opened in January 2010 has two major programs: the Child Sexual Abuse Clinic and the Child Abuse Prevention Program, which includes our parenting support programs. On average, we see about 400 children from the New Haven area each year.
The advocacy center staff offers home visiting services to all at-risk, first-time mothers who are screened for eligibility on the postpartum floor of YNHH, including teen mothers, single mothers, mothers who have cognitive limitations and those who might be dealing with domestic violence. For example, we saw a 15-year-old mother the other day. Eligible mothers can participate in one of the seven home visiting programs in New Haven. These programs, including the one we run, can provide services to over 400 families per week. Each of these programs helps the mothers by promoting healthy parenting, nutrition, safety and discipline.
With early recognition, we can prevent serious injuries to the child, such as brain injuries, which can lead to long-term cognitive issues. The idea is to help families before there's serious trouble. If these mothers choose to participate in one of the programs, they receive support from the birth of their child up until age 5. Our goal is not just to prevent abuse and neglect in those home visits, but also to help families become more effective as parents, promoting development and nurturing their children.
My colleague, Dr. Asnes and I know that it is critical to detect neglect and injuries early on so that we can prevent the problem from getting out of control. Neglect of children is the most common kind of problem that DCF sees. If we can prevent this kind of maltreatment, then we can make major strides in ensuring children's safety and their health and well-being.
Have these programs been effective at preventing abuse?
We know that our child abuse prevention program has had successes. Research has shown that the rates of abuse and neglect in the families who participate in the home visiting programs throughout the state are very low — 2% to 3% per year, which is much lower than the rates for similar families who do not get services.
Your job is not always a happy one. What motivates you to keep going after seeing an injured child?
While this can be tough work, it's work that I think pays huge dividends. By identifying a child who has been abused, I can help stop the abuse, ensure the child's safety, and help the family. I feel down occasionally, but I also have great colleagues. The opportunity to discuss cases with them to make sure our decisions are the right ones is very important. Their support allows me to continue to do this work.
What can help win the battle against child abuse?
Prevention is where the future is. What we'd like to see is double the funding for our prevention programs. Unfortunately the state does not always understand the issue of prevention. We hope to convince the new governor that this is critical work. Each case of serious physical abuse probably costs DCF about $20,000; then the cost of short-term hospitalization can run $30,000 to $50,000, and related long-term care can add up to hundreds of thousands of dollars. Prevention can be a real cost-saver and make a huge difference for families and society.