GUEST AUTHORMaking Sure thatOur Childrenare ProtectedBy Kimberly T. KrohnTHE UND RESIDENCY PROGRAM INMinot trains physicians to be familyphysicians who are well-prepared for arural setting. The program runs a familymedicine clinic, in which about 20,000patient visits a year are completed. Thepatient visits may include prenatal care,sports physicals, colonoscopy, diabetesand other chronic disease management,discussion of preventive care, treatmentof acute illness, and a number of differentissues. I am the program director of theFamily <strong>Medicine</strong> Residency Program inMinot; I practice the full scope of family20 NORTH DAKOTA MEDICINE Holiday 2010
medicine in addition to providingmentorship, instruction, supervision,and modeling for our physicians intraining. I have become involved in yetanother area of medicine by becomingmedical director of the UND <strong>North</strong>ernPlains Children’s Advocacy Center.Through this appointment, I haveagreed to participate with a multidisciplinaryteam in the evaluation ofchildren suspected of having beensexually abused.Estimates are that 150,000 childrenper year in our country are abused; 9.6percent of girls and almost 7 percent ofboys are sexually abused. Misdiagnosisof signs of abuse is common.Our local children’s advocacycenter joined the other two centers in<strong>North</strong> <strong>Dakota</strong> in 2007. The three centersare members of a national organizationcalled the National Children’s Alliance,or NCA, developed in 1987. Amongother things, the NCA providesaccreditation standards for the morethan 700 CACs in existence throughoutthe United States. Four regional trainingcenters are supported by the U.S.Department of Justice. Most CACs,however, including ours, depend a loton donations and grants to support theimportant work that they do.The UND <strong>North</strong>ern Plains CAC hasevaluated about 90 new children in2010. Seventy percent are female, 31percent less than 7 years old, 88percent less than 13 years old. Ourmultidisciplinary team has alsocontinued to process the cases startedin previous years. Several of these caseshave resulted in charges with successfulprosecutions. Our multidisciplinaryteam includes representatives of childprotection services, law enforcement,prosecutors’ offices, mental health,victim advocacy, and medical care.Since our center works with severalsurrounding counties, two Indianreservations, the FBI, and performscourtesy evaluations for otherjurisdictions, the team effort can beintricate. Our Ward County team meetsmonthly, however, to work on local cases.The first CAC was started by anAlabama prosecuting attorney in 1985.His concern was that cases be evaluatedobjectively and that the children beinterviewed and evaluated in a fashionthat would minimize additional trauma.Since then, a large body of literature andtraining programs have been developed toensure that medical personnel andforensic interviewers have the resourcesto accomplish this. The CACs must haveforensic interviewers, forensic medicalpersonnel, therapeutic interventions,victim’s advocacy, and case review andtracking. And when any of the cases goto trial, the forensic interviewers andmedical people (yes, I) have to be thereto testify.When I see a child for a forensicmedical exam, I usually start by talkingto him or her about the checkup thatwill follow. Almost all of our exams arenon-acute, meaning the assault has notoccurred in the last few days. My job isto evaluate the child for medical needsrelated or unrelated to abuse, to collectevidence, to consider alternativeexplanations to any physical findingsbeyond sexual abuse, to reassure parentsand the child, and to document findingscarefully. As a CAC, we commit to doingthat in an age-appropriate environment.Beyond individual evaluations ofchildren, I work with our team toeducate other team members about myrole, and to learn more about their rolesand the skills they bring to theevaluation. Since our CAC is the onlyone in the state embedded in aneducational program, I am able to alsoshare this area of practice with ourphysicians in training. My belief is thatin their future practices our doctors intraining, because of their exposure toour CAC, will be better equipped torecognize, refer, and treat children whohave been abused. I also work with therest of our team to keep my knowledgeand skills up to date and to engage withthe communities we serve in an effort toprevent the abuse and exploitation ofchildren. I know that through this workwe make our communities safer andmore healthful for the children in them.Kimberly T. KrohnNORTH DAKOTA MEDICINE Holiday 2010 21
Change language