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The Honolulu Advertiser

Posted on: Saturday, May 7, 2005

Program that helps pinpoint child abuse may be extended

By Mike Gordon
Advertiser Staff Writer

Lawmakers have approved $450,000 to boost a three-year-old private program that allows specially trained doctors to perform medical evaluations of suspected child-abuse victims.

The Child At-Risk Evaluation Program, which is run by Kapiolani Medical Center for Women and Children, greatly improved the quality of medical information available to child-welfare authorities, said Lillian Koller, director of the state Department of Human Services. The CARE program gives social workers, guardians and Family Court judges a clear picture of what happened and the risk of future abuse, she said.

But the program needs the state money to survive. Funding for the program has come from private foundations and will run out in July. If approved by the governor, the state money would keep the program going for another year.

"These guys are experts in child safety and neglect," Koller said. "They know the difference between the type of injury that is accidental and the type that is abuse. We need to improve our child-welfare services with their expertise."

Koller wants to give the program director, Dr. Victoria Schneider, a copy of every intake report received by the state's child-welfare authorities. Schneider will decide which are the most serious cases and they will go to the CARE doctors.

The program offers the only source of medical expertise for child-abuse cases on O'ahu, but with only three doctors and a nurse, can only handle about 700 cases a year, far fewer than the nearly 2,500 cases that are confirmed on O'ahu each year.

Schneider said the examinations give authorities a documented history of abuse that can stand up in court during custody hearings or criminal cases.

"We know that at least 10 percent of kids who are coming into foster care have marks of abuse on their bodies, evidence of old injuries in the way of scarring or fresh bruises, bite marks or burns — things that a trained eye can see that often get overlooked by an untrained eye," Schneider said.

Most of the cases the program handles come from social workers. The exams can take up to an hour and a half with lengthy, detailed reports written for case workers, Schneider said.

The information is good for foster parents, too, because abused children have a greater array of health problems. The CARE program can spot a problem and recommend special treatment, said Sarah Casken, executive director of the Hawai'i Foster Parent Association.

"When they come into the system, to have this comprehensive exam and referrals made up front to the specialist, we are meeting their needs rather than exacerbating or ignoring them," Casken said. "CARE is a community acknowledgment that these kids' needs have to be met."

Case workers like the program because it offers a calm alternative to the way many cases are still handled, said social worker Jalen-Ann Mastin.

Social workers bringing children into the foster-care system are usually under a 72-hour deadline to make a case for a Family Court judge, Mastin said. That includes the medical exam, which has to be done within 24 hours. For years, that frequently meant a trip to the nearest emergency room and the cursory examination, she said.

"Most of the time, they just check their hair for 'ukus, check their ears, eyes, nose, OK, you're done, have a nice day," Mastin said.

If a child has a regular doctor, that doctor can perform the exam. But often, those doctors have not seen the child in months or do not want to get involved, she said.

"I'm not knocking regular doctors but they don't have the expertise to know what to look for," Mastin said. "Some doctors don't even have patients take off their shirts. In some physicians' perspective, it is not supposed to be a full exam. It is an 'uku check."

Reach Mike Gordon at mgordon@honoluluadvertiser.com or 525-8012.