South Carolina Children's Advocacy Medical Response System

Issue

Funding for the statewide child abuse medical response program should be preserved in fiscal year 2010. Despite numerous budget reductions, the program has continued to provide forensic medical services to children, although at a reduced level.

Information

South Carolina child abuse statistics:

• Incidence Data
  
  
  1. 21,000 reports each year in SC of suspected child abuse or neglect to SC DSS {SC Department of Social Services} and law enforcement.
  2. 1 out of 3 reports made to SC DSS is indicated for abuse or neglect
  3. Most indicated reports of abuse involve two children
  4. 1 out of 89 children is a victim of child abuse or neglect


• Indicated Abuse by Maltreatment Type:
  
  

  Maltreatment Type	Percent of Total
  Neglect & Medical Neglect	68%
  Threat of Harm	18%
  Physical Abuse	10%
  Sexual abuse	3 %
  All other types	1%

  
  
  
• Prevalence of Child abuse as a chronic childhood condition:
  
  
  1. 6 times more common than Type I diabetes in children
  2. 9 times more common than cancer in children
  3. Asthma is the only chronic childhood illness more prevalent than child abuse

Child Abuse Pediatrics - New Pediatric Subspecialty

The American Board of Pediatrics recognized Child Abuse Pediatrics as a new pediatric subspecialty in 2006. Pediatricians must complete a three-year fellowship in addition to passing the specialty board examination.

Child Abuse Medical Evaluations - Time, Costs, & Reimbursement

A typical office visit with a physician generally lasts 15 - 30 minutes. For more complicated patients, the physician may spend another 15-30 minutes for medical case coordination after the patient has left. Unlike typical medical evaluations, child abuse medical evaluations require significantly more medical provider time - on average, 7.5 - 10 hours per patient. For the one-third of cases that end up in court, the child abuse medical provider needs an additional 8 hours dedicated to his or her patient. Medical provider costs range from $750 to $3,300, depending upon the indication of abuse, the severity of injuries, and any court related time. Before SCCAMRS {see next section}, reimbursement for medical provider services was limited to a $105 reimbursement from SOVA {SC State Office of Victims Assistance} or reimbursement from an insurer such as Medicaid. {See table below.}

Child abuse medical providers are rarely reimbursed for their court-related time. Instead, attorneys generally issue a subpoena and the medical provider must provide expert medical testimony without compensation for his or her time.

Medical Provider Service & Time	Outpatient Evaluation Abuse Indicated	Outpatient Evaluation No Abuse Found	Inpatient Evauation Abuse Indicated	Inpatient Evaluation No Abuse Found
TIME
Face to face medical evaluation	2 hours	2 hours	4-6 hours	4-6 hours
Medical case coordination	5.5 hours	3.5 hours	5.5 hours	3.5 hours
Court prep, deposition, testimony	8 hours	n/a	8 hours	n/a
TOTAL TIME	15.5 hours	5.5 hours	17.5 - 19.5 hours	7 - 9.5 hours
COSTS
Cost - without court	$1,200	$750	$1,800	$1,100
Court related	$1,500		$1,500
TOTAL COST	$1,200 - $2,700	$750	$1,800 - $3,300	$1,100
REIMBURSEMENT
SOVA Provider	$105	$105
Medicaid	$141 or $116	$141 or $116

South Carolina Children's Advocacy Medical Response System (SCCAMRS)

History:

In 2003, the South Carolina Children's Hospital Collaborative and the South Carolina Network of Children's Advocacy Centers came together to address the following issues:

1. The shortage of clinicians specializing in the medical assessment of child abuse and neglect
2. The training of these clinicians
3. The variance in the quality and delivery of these services

In December 2003, a grant was awarded by The Duke Endowment to establish a statewide medical response program. This program, known as the South Carolina Children's Advocacy Medical Response System {SCCAMRS}, is administered by the University of South Carolina Department of Pediatrics. At the time of its inception, only 21% of the need for pediatric forensic medical evaluations was being met in South Carolina.

Accomplishments:

SCCAMRS has accomplished the following:

• Currently meeting 34% of the need for forensic medical evaluations in South Carolina - a 13% decrease from 2007
• Increased the number of trained medical providers from 11 to 18 by 2007. Currently there are 17 providers.
• Increased the number of pediatric forensic medical evaluations from 1,900 in 2003 to 4,404 by the end of 2007. As a result of budget reductions, however, the number of pediatric forensic medical evaluations is projected to be 20% lower in 2009.
• Developed & implemented statewide guidelines for the diagnosis and medical management of child abuse and neglect
• Developed & implemented referral guidelines for law enforcement and social services
• Implemented a statewide quality assurance program that includes a provider "roundtable" and peer review
• Updated & implemented SC SLED child maltreatment protocol and clinical assessment tool
• Developed & implemented qualification standards for primary care providers
• Developed & implemented child abuse curriculum for pediatric residents
• Developed statewide database to track incidence and services

Child Abuse Talking Points (pdf)

Legislative Action Center

Contact Information & Links

SCCAMRS:	Dr. Olga Rosa, Medical Director South Carolina Children's Advocacy Medical Response System Nine Richland Medical Park, Suite 260 Columbia SC 29203 Tel: (803) 434-3822 Email: Olga.Rosa@uscmed.sc.edu
SCCHC:	Ms. Maggie Michael, Executive Director South Carolina Children's Hospital Collaborative 310 Broad Street, Suite 10 Charleston SC 29401 Tel: (843) 534-0033 Email: michaelm@musc.edu

Links

South Carolina Children's Advocacy Medical Response System
SC Network of Children's Advocacy Centers
SC Department of Social Services
SC Coalition Against Domestic Violence & Sexual Assault (SCCADVASA)
SC Office of Victims Assistance (SOVA)
SC Victims Assistance Network (SC VAN)
USC Children's Law Center
Prevent Child Abuse South Carolina