The stakes are high when social service workers evaluate a report of potential child abuse: A wrong decision could put a kid at risk for continued harm, or lead to the inappropriate removal of a child from their family.
Despite the delicate nature of this work, Pennsylvania’s child welfare system is rife with inconsistent outcomes and practices when evaluating medical information, according to a recent report from the Pennsylvania Chapter of the American Academy of Pediatrics.
The Keystone State Child Abuse Medical Forum Strategic Plan was written after a two-day meeting in Harrisburg, in which more than 30 organizations and government agencies gathered to discuss ways to improve response to child abuse. Attendees included staff from the Pennsylvania Department of Health and the state’s Department of Human Services.
Stakeholders at the forum were concerned by a lack of standardization and medical expertise on the part of Childline staff at DHS, who triage initial reports of abuse. Frontline workers at the county level also lack the training and expertise to accurately assess medical files when conducting investigations, they found.
Pediatricians like Dr. Rachel Berger say social service agencies could draw more upon their expertise. As a physician at the Child Advocacy Center at UPMC Children’s Hospital of Pittsburgh, Berger specializes in diagnosing and treating child abuse and neglect. She likens the subjectivity in Pennsylvania’s child welfare system to Russian roulette.
“Every county should have the expertise available to them so that they [don’t] use Dr. Google, which is what a lot of agencies do,” said Berger. “’Is this fracture concerning for abuse?’ They don't know, so they go to the Internet.”
One possible solution proposed in the report is to embed a nurse within local social-service agencies. The nurse could then consult with experts like Berger to evaluate the medical records of a child who may be being abused.
Other recommendations include better training for child welfare workers so that they know when to seek a medical opinion, and more collaboration between social services and pediatricians who specialize in diagnosing child abuse. Berger often does assessments of kids to determine if they’ve been abused; she said sometimes counties are eager to collaborate, while at other times they refuse to share information with her.
“When there is no clear policies and procedures that dictate certain things, people act differently in the same situation,” said Berger.
Even with aggressive reforms, investigations of child abuse will never be totally free of subjectivity, said Cathleen Palm, founder of the Center for Children’s Justice, which participated in the forum. But she argues much could be improved with legislation, or even a directive from a state agency. Recommended changes include mandating better data collection at the county level, and bringing clarity to Pennsylvania statutes so state and local frontline workers know when to consult a medical expert.
“It’s really difficult to know what counties are doing now as it relates to any connective tissue with the health systems,” said Palm. “The state could change that in a heartbeat.”
