Pediatricians as Life Care Planners to Assess Damages  in Child Abuse Cases

When a pediatrician is developing a life care plan for cases involving potential child abuse, one must consider – and potentially mitigate – the effects of prior abuse and risk of harm.   This paper, written by a board certified child abuse pediatrician and life care planner will outline damages assessments in cases involving issues of abuse.

Exposure to abuse and other adverse childhood experiences influence how the brain functions, thus increasing the risk for physical, social and behavioral health impairments later in life. [1], [2] Thus, the damages after abuse extend well beyond physical ailments and needs for rehabilitation and post-trauma mental health support.

Much of the outcomes research in this area focuses upon the “Adverse Childhood Experiences (ACE) Study” (hereinafter “ACE Study”).  This study evaluated the association between maltreatment in childhood and later-life health and well-being. It is the largest study of its kind and considered the landmark body of literature addressing future risk of harm after childhood abuse.  The study population includes more than 17,000 Health Maintenance Organization (HMO) members who underwent comprehensive physical examinations and extensive surveys providing detailed information on childhood experiences termed Adverse Childhood Experiences (ACEs) and current behaviors and health parameters. Data collected in the surveys included experience of physical abuse, sexual abuse, neglect, emotional abuse and other elements of family dysfunction. Utilizing this data, there have been more than 150 peer-reviewed scientific articles and conference presentations.[3]


Pediatrician with Child Abuse Expertise as a Life Care Planner

The goals of the ACE study included understanding potential connections between childhood adverse events and health, future illness, premature death, and quality of life so as to create early proactive preventive practices or otherwise address prevention. An individual has experienced an Adverse Childhood Experience (ACE) if he or she experienced any of the following conditions in the household prior to age 18:

  • Physical abuse[4]
  • Emotional abuse[5]
  • Contact sexual abuse[6]
  • An alcohol and/or drug abuser in the household
  • An incarcerated household member
  • Family member who is depressed, suicidal, mentally ill, institutionalized
  • Mother is treated violently[7]
  • One or no parents
  • Physical neglect[8]
  • Emotional neglect[9]


Using the survey responses, subjects are given an “ACE Score” which represents a total sum of the number of ACEs reported by study participants. Exposure to one category of ACE, qualifies as one point. When the points are added up, the total ACE Score is determined. This score represents the total amount of toxic stress during childhood. Hundreds of research studies utilizing ACE data demonstrate increased risk for medical, social and behavioral conditions correlated with ACE exposure. As the ACE score increases, there is increased risk for the following health problems, behaviors, and quality of life issues including-- but not limited to -- the list below:[10]

  • Cardiovascular disease including heart disease and stroke  
  • Asthma
  • Cancer
  • Neurological Conditions
  • Autoimmune Disease
  • Liver disease
  • Diabetes
  • Obesity
  • Health risk behaviors including smoking and high risk sexual activity.
  • Substance Abuse.
  • Cyclical Abuse (subsequent abuse of offspring)
  •  Mental Illness including eating disorders and suicide
  • Criminal Activity


 


[1] Shonkoff JP. Building a new biodevelopmental framework to guide the future of early childhood policy. Child Dev. 2010;81(1):357–367pmid:20331672
[2]  Johnson SB, Riley AW, Granger DA, Riis J. The science of early life toxic stress for pediatric practice and advocacy. Pediatrics. 2013;131(2):319–327pmid:23339224
[3] http://www.cdc.gov/violenceprevention/acestudy/pyramid.html
[4] Defined as “Sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at you or ever hit you so hard that you had marks or were injured.”
[5] Defined as “Often or very often a parent or other adult in the household swore at you, insulted you, or put you down and sometimes, often or very often acted in a way that made you think that you might be physically hurt.”
[6] Defined as “An adult or person at least 5 years older ever touched or fondled you in a sexual way, or had you touch their body in a sexual way, or attempted oral, anal, or vaginal intercourse with you or actually had oral, anal, or vaginal intercourse with you.”
[7] Defined as “Your mother or stepmother was sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her and/or sometimes often, or very often kicked, bitten, hit with a fist, or hit with something hard, or ever repeatedly hit over at least a few minutes or ever threatened or hurt by a knife or gun.”
[8] Respondents were asked whether there was enough to eat, if their parents drinking interfered with their care, if they ever wore dirty clothes, and if there was someone to take them to the doctor utilizing a Childhood Trauma Questionnaire (CTQ) short form.
[9] Respondents were asked whether their family made them feel special, loved, and if their family was a source of strength, support, and protection utilizing a Childhood Trauma Questionnaire (CTQ) short form.
[10] Felitti V,  Anda R, Nordenberg D, et al, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. The Adverse Childhood Experiences (ACE) Study, Am J Prev Med. 1998 May;14(4):245-58.

Pediatric Life Care Plans by a Certified Pediatrician