Tuesday, February 11, 2014 - 3:00pm to Tuesday, February 11, 2014 - 4:30pm ET
Target Audience:
This activity has been designed to meet the educational needs of nurses, physicians, and other health and legal professionals involved in the treatment and care of victims of sexual assault and domestic violence.
Statement of Need/Program Overview:
There is a paucity of information regarding child torture as a form of child abuse in the literature. The research conducted has documented system wide failures that prevented earlier recognition and intervention of the child victims.
The presentation will provide information to better recognize the red flags suggesting child torture as a form of child abuse in order to allow for earlier intervention with the child.
Educational Objectives:
After completing this activity, the participant should be better able to:
- Discuss the rationale for a diagnosis of child torture as a form of child abuse
- Summarize proposed inclusion criteria for the medical diagnosis of child torture
- Evaluate system-wide failures and address red-flags which can allow for earlier intervention of tortured children.
- Identify and address needs of the child victims
Presenter(s):
Dr. Barbara Knox
This presentation describes clinical findings and case characteristics of children who are victims of severe and multiple forms of abuse; and proposes clinical criteria that indicate child abuse by torture. Medical records, investigation records, and transcripts of testimony regarding a non-consecutive case series of 28 children with evidence of physical abuse, neglect and psychological abuse such as terrorizing and isolation were reviewed for types of injuries, duration of maltreatment, medical and physical neglect, social and family history, and history of prior Child Protective Services (CPS) involvement. The median age was 7.5 years (9 months to 14.3 years). Thirty-six percent died. Duration of abuse ranged from 3 ½ months to 8 years (median 3 years). Ninety-three percent of children were beaten and exhibited cutaneous injury; 21% had fractures. There were 25 victims of isolation (89%), including 61% who were physically restrained and 89% who were restricted from food or water. All of the children were victims of psychological abuse; 75% were terrorized through threats of harm or death to themselves or loved ones and 54% were degraded and/or rejected by caregivers. Nearly all children were medically neglected. Half had history of prior referrals to CPS. The children in this case series were physically abused, isolated, deprived of basic necessities, terrorized, and neglected. We define child torture as a longitudinal experience characterized by at least two physical assaults or one extended assault, two or more forms of psychological abuse and neglect resulting in prolonged suffering, permanent disfigurement or dysfunction, or death.
Dr. Barbara Knox is the Medical Director of the University of Wisconsin Child Protection Program at the American Family Children’s Hospital in Madison, Wisconsin. Dr. Knox completed her residency at the Mayo Clinic in Rochester, Minnesota. She then completed a fellowship in Child Abuse Pediatrics at Cincinnati Children’s Hospital Medical Center before joining the faculty in the Department of Pediatrics at the University of Wisconsin, where she is currently an Associate Professor. Dr. Knox is board certified in General Pediatrics and Child Abuse Pediatrics. Dr. Knox is Chair of the Wisconsin Chapter of the American Academy of Pediatric Section on Child Abuse and Neglect and is a member of the Ray E. Helfer Society of Child Abuse Physicians. She is the Chair of the Wisconsin Child Abuse and Neglect Prevention Board that administers the Wisconsin Children’s Trust Fund. She is also a team member serving on the Department of Justice’s Statewide Child Fatality review team that advises state agencies and the Legislature on law, policy and practice modification in an on-going effort to reduce preventable childhood deaths. She co-directs a statewide Medical Peer Review project with Dr. Lynn Sheets from Children’s Hospital of Wisconsin. Areas of research interest for Dr. Knox include child torture as a form of child abuse and physician performance improvement education for rural physicians regarding the recognition, diagnosis and treatment of child abuse. Dr. Knox has published on many topics, including burns of abuse, abusive head trauma, and is currently an editor for three textbooks relating to child maltreatment. She also reviews current child abuse medical research journal articles for The Quarterly Update. As part of her practice she cares for children who have been or are suspected of being victims of physical abuse sexual abuse and neglect. She also provides medical review of child abuse cases for social service agencies, law enforcement and lawyers.
Physician Accreditation Statement:
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine and International Association of Forensic Nurses. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Physician Credit Designation:
The Postgraduate Institute for Medicine designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nursing and Other Continuing Education Accreditation Statement:
The International Association of Forensic Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. JBS International, Inc. is an approved provider through NAADAC, the Association for Addiction Professionals (Provider Number 000208).
Nursing and Other Continuing Education Credit Designation:
The International Association of Forensic Nurses designates this live activity for 1.5 Nursing CE Credits. JBS International, Inc. designates this live activity for 1.5 Continuing Education Unit (CEU) Credits.
Disclosure of Conflicts of Interest:
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
| Name of Faculty or Presenter | Reported Financial Relationship |
|---|---|
| Dr. Barbara Knox | Nothing to disclose |
The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity: The following PIM planners and managers, Laura Excell, ND, NP, MS, MA, LPC, NCC, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CCMEP, and Jan Schultz, RN, MSN, CCMEP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. The following International Assoication of Forensic Nurses planners and managers, Kim Day, RN, FNE A/P, SANE-A, SANE-P, Jenifer Markowitz, ND, RN, WHNP-BC, SANE-A, Jennifer Pierce-Weeks, RN, SANE-A, SANE-P and Sarah Tucker, BA, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months
Media:
Live webinar
Disclosure of Unlabeled Use:
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer:
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
CNE CEU Evaluation:
How to Obtain your CNE or CEU Certificate
IAFN and JBS will use their standard activity evaluation for CNE and CEU.
To access the activity evaluation and receive your CNE or CEU certificate, click the green 'CNE/CEU Evaluation' button below.
CME Evaluation:
How to Obtain Credit
Physician Request for Credit:
How to Obtain your CME Certificate
PIM supports Green CME by offering your Request for Credit online. If you wish to receive acknowledgment for completing this activity, please follow the steps below:
- Go to CME University at: www.cmeuniversity.com and register or login
- Once logged in, click on “Find Post-test/Evaluation by Course” at the top of the page
- Type in “9773” in the box, and hit enter
- Click on the activity title
- Complete the online evaluation and obtain your CME certificate to download and/or print for your files.
Upon completion of the online Evaluation form, you will have immediate access to a certificate of attendance to print or save for your files. You can save your certificate by selecting the “Save” option on the print screen.
If you have any questions regarding the CE certification for this activity, please contact Postgraduate Institute for Medicine at: [email protected] or (303) 799-1930.
This presentation describes clinical findings and case characteristics of children who are victims of severe and multiple forms of abuse; and proposes clinical criteria that indicate child abuse by torture.