Clinical Education

The fellow will develop competence in recognizing and managing child abuse through clinical activities at the following settings. The two major sites in which children are seen is the Child Protection Team clinic (CPT) and Wolfson Children’s Hospital. Combined with 4 months of multi-disciplinary rotations, the fellow will have a rich experience in child abuse pediatrics.

Child Protection clinic (CPT): outpatient evaluations of children alleged to be victims of physical abuse, sexual abuse, neglect, medical neglect and/or emotional/psychological abuse. Other activities include medical chart review, multi-disciplinary staffings and two child abuse death review teams. Nearly all sexual abuse evaluations are done in this clinic, including forensic evidence collection and prophylactic treatment. Forensic interviews, specialized interviews, psychosocial interviews and psychological assessment occur on site. Individual and group therapy services are provided at this location.

Inpatient at Wolfson Children’s Hospital: inpatient evaluations of children alleged to have been physically abused, sexually abused, neglected or medically neglected with sufficient seriousness to require hospitalization. Children are often seen in the pediatric intensive care unit.

Several month-long rotations include:

Ophthalmology, radiology and neuroradiology rotations

• Inpatient atWolfson Children's Hospital: inpatient evaluations of children alleged to have been physically abused, neglected or medically neglected with sufficient seriousness to require hospitalization and who have potential eye, neuroradiologic or radiologic findings. Skeletal surveys for outpatients are also reviewed
• Inpatient at UF Health Jacksonville: evaluation of children alleged to have been severely physically abused and who are admitted through the trauma service. These children are admitted to intensive care
• Outpatient at Nemours Children's Health, Jacksonville: ophthalmology clinic; evaluation of children alleged to have been physically abused with eye findings

Community-based rotation

• Medical examiner’s office: attending pediatric autopsies of children suspected of being abused and principles of forensic pathology; primarily physical abuse
• Department of Children and Families: participating in evaluation of children alleged to have been physically abused, sexually abused, neglected or medically neglected; observation within homes and other non-medical settings; consideration of management beyond the initial evaluation phase
• Jacksonville Sheriff’s Office: participating in the evaluation of children alleged to have been physically abused or sexually abused; emphasis on the possible perpetrator and whether a crime has been committed
• State’s Attorney’s Office: participating in the evaluation of children alleged to have been physically abused, sexually abused, severely neglected and criminally psychologically maltreated; emphasis on the possible prosecution of a crime
• Guardian ad Litem: participating in the evaluation and management of children alleged to be victims of physical abuse, sexual abuse, neglect, medical neglect and/or emotional/psychological abuse and who require dependency court intervention
• Children’s Legal Services: participating in the evaluation and management of children alleged to be victims of physical abuse, sexual abuse, neglect, medical neglect and/or emotional/psychological abuse and who require dependency court intervention
• Family Support Services: participating in the management of children found to have been victims of physical abuse, sexual abuse, neglect, medical neglect and/or emotional/psychological abuse and who require voluntary or dependency court intervention and who may be in foster care

Developmental/Mental Health

• Genetics: evaluation of children with genetic conditions that might be confused with or mimic child abuse
• Neurodevelopmental pediatrics: evaluation and management of developmental problems arising from physical abuse and sometimes neglect and principles of developmental assessment
• Early Steps: evaluation and management of children with developmental problems under three years of age and principles of developmental assessment
• Child psychiatry: evaluation and management of children with mental health problems – some arising from physical abuse, sexual abuse, neglect and/or emotional/psychological abuse and principles of mental health assessment

Orthopaedic surgery, pediatric surgery, trauma surgery, neurosurgery

• Orthopedics: evaluation and management of children with bone injuries and orthopedic problems, primarily physical abuse concerns and mimics of abuse
• Pediatric surgery: evaluation, intervention and management of physical abuse
• Trauma surgery: evaluation, intervention and management of acute physical abuse
• Neurosurgery: evaluation, intervention and management of physical abuse involving the brain

Teaching Education

Fellows will develop teaching skills necessary to educate patients, families, students, and other residents through:

• Observation of faculty in working with and teaching children, families, staff, and other providers
• Being directly supervised by faculty when working with children and families as they provide teaching;
• Annual UFCOM-J Fellows as Teachers course, in which fellows in all disciplines develop skills in teaching under time constraints, evaluation and feedback, leadership, and serving as a consultant.

Fellows will teach patients, families, and others by:

• Teaching medical students and residents rotating through the CPT clinic;
• Teaching at pediatric resident didactic conferences, at least once/year;
• Observing and teaching at the annual two-day statewide child abuse course offered through the Jacksonville CPT;
• Teaching in the community (e.g., the Department of Children and Family services).

Prevention education

Fellows will develop proficiency in child abuse prevention in the following ways:

• Fellows will be members of the Florida Chapter, American Academy of Pediatrics Committee on Child Abuse, which is actively working on prevention issues.
• Fellows will participate in the two local death review teams as they consider prevention issues. They will also review the state child abuse death review team’s prevention recommendations each year.
• They will review prevention efforts by CPTs around the state and discuss application to other areas.
• Several faculty are involved in prevention activities locally (e.g. no-hit zones, safe sleep) and internationally. These activities and opportunities will be reviewed with the fellow.
• Prevention is one of the components of division retreats, in which the fellows participate.
• Fellows will be encouraged to develop their own child abuse prevention interest area and a plan to participate.
• Fellows will teach at least one resident conference on a topic in which child abuse prevention is highlighted.

Conferences

• Case Conference - Weekly patient conferences at the CPT in which the fellow participates in the discussion and presents their cases.
• Grand Rounds - Weekly departmental presentations on a variety of pediatric topics.
• Teleconference peer review - Monthly peer review between various CPT teams in Florida.
• Journal Club - Monthly review of literature in which the fellow periodically presents current research literature.
• Child fatality reviews (2 teams) - The fellow is a member of these local/regional death review teams helping to assess how child abuse deaths might better be prevented.
• Pediatric noon conference - Weekly resident conference which is open to the fellow to observe via teleconference.
• Radiology Conference - Weekly conference in which the fellow may elect to participate.