Although April marks a disconcerting annual milestone with National Child Abuse Prevention Month, we can be heartened to know that there are people like Leslie Quinn, MD, and her staff working tirelessly to protect children—and to prevent future cases of child abuse. Quinn is a child-abuse pediatrician and medical director of Banner Children’s Suspected Child Abuse and Neglect, or SCAN, program.
What unique pressures in today’s society tend to contribute to the prevalence of child abuse?
Poverty is the biggest contributor to risks of children being maltreated and to causing lifelong problems—even death. The biggest killer—70 percent—is neglect: not meeting children’s basic needs for food, shelter, clothing, love and nurturing and not getting them proper medical care.
Adults [who abuse children] are struggling because of substance abuse, incarceration, single-parent families, lack of income or their own adverse childhood experiences. They don’t have adequate role models to be good parents. It boils down to not having the skills and the resources they need to raise children in safe, stable and nurturing environments.
Give us a profile of a typical—and atypical—child abuser.
Moms have the primary caregiving responsibilities for kids. Sadly, the typical abuser or neglecter is a mom who is not meeting the child’s typical needs. The typical physical abuser is a male in the household—either the father of the baby or a [boyfriend] of the mom or some other relative at home because mom’s out working. The boyfriend is left at home, highly resentful, without any skills for taking care of a crying baby.
The atypical abuser we have seen recently—and this breaks my heart—is [military] fathers or boyfriends returning from the Middle East with anger-management or PTSD [post-traumatic stress disorder] issues who are left to care for their child while mom goes off to work. They snap and lose it and abuse their kids. This is what I didn’t see in the first 10 years of taking care of these kids. These vets really need that mental-healthcare support. We need to recognize that these kids are at risk when they are left in the care of those who have not learned to control their anger.
Is there anything notable—either hopeful or distressing—about child abuse statistics for Arizona in particular?
The statistics are both hopeful and distressing in Arizona. The 22nd annual Child Fatality Report for Arizona shows that in 2014, 4.6 per 100,000 kids died of child maltreatment, down from 5.6 in 2013—but up from 4.3 in 2012—for a five-year average of 4.5 per 100,000 kids. The actual number of children who died of child maltreatment in 2014 was 75, down from 92 in 2013—a move in the right direction, but still too high. We’re still in an upward trend.
We’re about the same nationwide in the types and amount of abuse and child-abuse fatalities. However, Arizona is up in the number of kids who are living in families where they are exposed to adverse childhood experiences: violence in the home, incarceration, food insecurity, sexual or physical abuse. Arizona ranks among the highest in the nation for kids living in a home with two or more exposures. About 33 percent of Arizona children are living in homes with two or more exposures, versus 20 percent nationwide.
Tell us about Banner’s SCAN program. How do you measure progress?
I’m the medical director and started the medical outreach part of Banner’s SCAN program [two years ago]. I was with St. Joe’s Child Protection Team, starting in 2001. Banner saw the need for a medical component to the SCAN program started in 2012—because these kids are dealing with so many medical issues—and asked me to develop that part of the program in 2013.
We want to develop our flagship program here at Cardon Children’s, but we want to be responsive to all the children Banner sees. We’re working on resource infrastructure so that when staff at any Banner emergency department sees a child who might be abused, they know how to respond with a person and a phone number to call. For a system this big, we need more front-line clinical people. We need more education and multi-disciplinary connectivity in treating child abuse, especially in the social work and case-management fields. And we also need to develop prevention strategies.
I measure progress by getting fantastic people [like those] we’ve added to help us further develop this program. Our success is going to be measured by how many kids get appropriately recognized and referred—and then protected.
What would you say to a parent with a tendency toward child abuse or to one who has observed it firsthand?
We are trying to identify some [telltale] injuries, like bruises or other minor injuries on a young child, which might have been caused by child abuse. We are obligated and want to report those kids, because the bottom line is we need kids to be raised in safe environments. A bruise is not going to hurt that child long term; the environment is going to hurt that child long term—and he or she is at high risk for suffering future severe abuse.
I don’t often deal one-on-one with parents. But given the hypothetical situation where we have a parent concerned that they might have a quick temper or may not know how to deal with a child’s oppositional behavior, we need to meet the needs of that family and determine what is causing someone to lose patience. We can offer a social work evaluation, WIC [Women, Infants, and Children] support, food or day care so [the adult] can go to work.
Sometimes parents are willing to accept the services we’re offering so they can keep their kids in the home—and sometimes they’re not willing to change the lifestyle that is endangering the child. Then DCS [Department of Child Safety] has to make the choice to protect the child.
Positive parenting is the real key. There are resources available, like Triple P [Positive Parenting Program]. Hospitals and human health organizations use it to train families, especially young ones, in positive parenting and teach them skills to deal with difficult situations with oppositional children.
Banner is also enhancing the Never Shake a Baby program, a subcommittee of Prevent Child Abuse Arizona. We’re working with them to develop a new video for parents to show them all of the things they can do when they’re frustrated that the baby is crying and they don’t know why. We’re trying to find the triggers that cause children to be either neglected or abused and go to the roots to prevent those injuries in the first place. That’s what I would tell a parent who feels they have a tendency toward abuse. We can help you—especially if you want help.
Is there one particular moment or event in your life that led you to do this kind of work?
I always knew I wanted to take care of kids. I’ve always had a soft spot in my heart for abused children. During my residency, nobody wanted to take care of abused children—especially sexually abused children—because it was a long exam with intense documentation. These kids were often stuck in the hallways because we had no advocacy centers in the ’80s, when I did my residency. They just showed up at the door.
I really liked sitting down and spending time with these children and talking to parents about resources. I could take care of vulnerable kids and specialize in an area where I knew I could make a difference. As a resident, I was called to court to testify on four cases, which was great experience for me. I was always on the Child Protection Team.