Background

In 2020, Children’s of Alabama (COA) and the UAB Dept. of Pediatrics began working to establish a statewide medical network to ensure that victims of child abuse receive immediate and professional care, to be called the Alabama Child Abuse Medical System (ALCAMS). ALCAMS is a joint effort between COA/UAB and the Alabama Network of Child Advocacy Centers (ANCAC).

Child maltreatment is a prevalent public health problem in Alabama. In 2018 reports were made to the Alabama Department of Human Resources (DHR) involving 42,379 children¹. After investigation, 12,506 children were determined to be victims. This amounted to 4% of Alabama’s children involved in investigations and 1% determined to be victims that year. The health consequences for abused children are substantial, including short term risks such as physical injuries, STIs, pregnancy, mental health problems, and death (43 in Alabama in 2018). The financial cost to society is substantial, estimated at $2.3 billion annually in Alabama alone². The primary roles for the medical profession in the investigation are: determining the overall health of the child; identifying medical problems including injuries, illnesses, or mental health problems; initiating treatment; and preventing any additional harm. The latter is accomplished through communication with the investigative agencies with a goal of protecting the child.

The ability of the medical provider (MP) to assist in the investigation of child maltreatment is dependent on the training and experience of the examiner. To be effective, the MP needs to be trained in the examination and care of children with specific training in child abuse pediatrics. There is considerable variability of exposure to child abuse in training programs across the US. Even if the MP has been adequately trained, maintaining those skills through experience and ongoing education is difficult for many MPs in the typical healthcare setting. In recognition of this need, some states have developed medical networks in order to increase the quality & quantity of resources available to perform evaluations of abused children, including four in the Southeast (Florida, Mississippi, North Carolina, and South Carolina). Funding for the program may potentially be secured through the Alabama Department of Economic and Community Affairs (ADECA) Victims Assistance Grant Program. The immediate goals of the system are to:

• Recruit & train an adequate number of MPs across the state in the recognition & management of child maltreatment.
• Increase the quality of the medical evaluations by standardizing the approach to the assessment based on current recommendations.
• Maintain a central database of the assessment results for ongoing reporting and quality improvement.
• Provide support to the MPs by providing training in child abuse pediatrics and ongoing peer review for cases seen.
• Provide ongoing communication with the members of the investigative team (DHR, law enforcement) regarding indications for when to obtain a medical assessment.
• Collaborate with involved agencies to remove barriers and improve delivery of medical services to child maltreatment victims.

The Central Office for ALCAMS is in conjunction with the offices of the Child Abuse Pediatrics Division, UAB Department of Pediatrics in Birmingham, Alabama. The CAP Division Director serves as the Medical Director. ALCAMS worked with the Alabama Network of Child Advocacy Centers (ANCAC) and the Alabama DHR to develop an appropriate referral process for children in need of a medical evaluation. As of July of 2020, there are 34 Child Advocacy Centers in Alabama that are servicing all 67 Alabama Counties.

References

1. US Department of Health and Human Services, Children’s Bureau. Child Maltreatment 2018. Washington, DC: US Government Printing Office; 2020. (available at http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment )
2. Boschung M, Kendrick A, Addy S, Bell G, Ijaz A, Riiman V. The cost of child maltreatment to the Alabama economy in 2013. From the Department of Child Abuse and Neglect Prevention, The Children’s Trust Fund. Available at https://ctf.alabama.gov/wp-content/uploads/2018/05/Cost-of-Child-Maltreatment_Alabama-2013.pdf