Indian Health Service Child Abuse Project

Overview

      Participation in this project (designed for physicians, nurse practitioners, and physician assistants in the Indian Health Service or Tribal health programs) is a two-year commitment on the part of the participant and requires support from the administration of the employing agency for the duration of the course. Year 1 consists of an intense one-week didactic/classroom training including an image capture device/software lab for documentation of medical examinations, cultural awareness training, and a mock trial of various court case scenarios. Needed equipment is purchased for each site (image capture device such as a digital or video camera attached or not to a colposcope) and software for image transmission and is set up and tested. Travel to the didactic/classroom training is funded by the Project. The individual employing agency must supply a suitable computer in a confidential and private location, Internet access, and a 50% match for needed hardware and software.

      As each participant conducts the medical examination for child abuse victims at their respective site, it is documented as legal forensic evidence via video or digital camera. These images from each case are put into the computer and sent to the Project Director for teaching and consultation via the specialized software. If further evaluation is needed, these images are then forwarded to one of the national expert faculty. This begins the building of a statistical database, a library of cases, and a mechanism for monthly peer review (which begins in Year 2). Each participant must attend and complete successfully a one-week hands-on preceptorship with one of the expert faculty at that expert's site. This activity is funded by the employing agency.

      Year 2 consists of mastering the art of forensic documentation with the image capture device, development and implementation of site-specific policies and procedures for how a victim will enter, be treated, and exit the system, and the development of relationships locally with law enforcement, victim advocates, social services, and the Tribal court systems. The participant must attend a special one-week didactic/clinical training that focuses on interpretation of cases from a consultant's perspective, formulation of a written consult, court testimony, how to assist other sites, and must display familiarity with the current literature and research in child maltreatment. This activity is funded by the employing agency. Cases performed by participants will be sent out monthly via computer and discussed as a group via conference call as a mechanism of peer review and quality control (called Grand Rounds). A site visit will be made by the Project Director and a detailed program evaluation conducted. Upon successful completion, the participant will be awarded a Certificate of Excellence. They are encouraged to keep this current each year by attending at least one major national child abuse conference per year that has a special medical tract. Each successful participant will be encouraged to become the "expert" in their respective geographic area with the resources of the project still available to them as needed. Continuing medical educations credits are provided for all activities for both years by the Indian Health Service Clinical Support Center in Phoenix, Arizona.

      Participation in this project provides specific and significant benefits to the medical provider, the service unit/facility/agency, and the child abuse victim and family. Provider participation in the project is funded through OVC as well as needed hardware, software, resources, training, and consultation. All equipment becomes property of the service unit/agency. The ability to do these examinations at the local level allows for several things. The exam can be done immediately if needed without the wait for an appointment so forensic evidence is best preserved. It saves the service unit/facility the cost of referral for victims for medical evaluation. Consultation can be obtained on any/all cases via computer without cost to the facility or victim and can be done immediately at any time if needed. The child victim and family can stay in their home community to receive services where their religious, cultural, and family support systems are, without financial concerns for travel and care. The examination can be done by a medical provider that the victim and family are familiar with and who is culturally sensitive. Local medical care for child victims of abuse sets the framework for the development of a multidisciplinary team (that includes law enforcement, social services, victim advocates, others) to better and more efficiently process cases.

      The next upcoming two-year cycle of this project will begin in May 2005 and conducted through Primary Children's Medical Center in Utah. The curriculum contains a large cultural and mental health component and lectures are taught by some of the nation's top experts in child maltreatment. An application for this course can be obtained by calling the IHS Child Abuse Project office at (435) 725-6839.