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Ep. 192 - LiveWell Talk On...Child Abuse Prevention (Dr. Regina Butteris & Julie Kelly-Molander)

episode 192

Ep. 192 - LiveWell Talk On...Child Abuse Prevention

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guests: Dr. Regina Butterisphysician, and Julie Kelly-Molander, manager, St. Luke's Child Protection Center

Dr. Arnold:
This is LiveWell Talk On...child abuse prevention. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's. April's national child abuse prevention month and joining me today on the podcast is Dr. Regina Butteris, as well as Julie Kelly-Molander, who are respectively the physician leadership and the administrative leadership at the child protection center out in Hiawatha. Today we'll discuss child abuse prevention, and specifically, I do want to talk about the impact the pandemic had on child abuse and then services provided by the child protection center, and much more. Dr. Butteris, Julie, welcome to the podcast.

Dr. Butteris:
Thank you.

Julie Kelly-Molander:
Good to be here.

Dr. Arnold:
I have to be honest that, you know, we joke around quite a bit on the podcast. I typically, you know, tease the guest and et cetera, and try to make light—and I even had some reservations about doing this podcast. Because it's just like, it's not something anybody wants to talk about. But that being said, it's something so important and it's something that we need to talk about, and it's something that we need to be knowledgeable in and identify and let people know that there truly are resources in the event that something occurs along these lines. So, you know, I think we need to start off by saying, what is the definition of child abuse?

Dr. Butteris:
Well, the general definition would be when a caregiver's acts or omission leads to harm to a child.

Dr. Arnold:
Okay.

Dr. Butteris:
You know, that can be physical abuse, neglect, sexual abuse, drug related, emotional abuse. There's lots of different categories, but essentially it's harm or potential harm at the hands of a caregiver.

Dr. Arnold:
And is it, like from a standpoint of the sexual abuse, is it true that it's usually a relative, I mean, or someone that the child knows?

Dr. Butteris:
Yes. Most generally, you know, it's not stranger danger that we're worried about. It's people who actually care for the child, either blood run relatives or someone who takes care of them.

Dr. Arnold:
Now, how long has the child protection center been in place? I can remember what it used to be over in the resource center, which is no longer there. And I remember the building was a furniture store, like fireplaces, right—the child protection center and we remodeled it?

Julie Kelly-Molander:
Yep.

Dr. Arnold:
Which I've always been really proud of that, that we took a building in existence and revamped it to look part of the complex out there in the medical district, or north medical district. So how long has the child protection center been in place?

Julie Kelly-Molander:
We opened in 1987. And, Dr. Arnold, you're correct. We are out in the old Rolston Creek building. We moved out here in 2008.

Dr. Arnold:
Since 2008 it's been out there?

Julie Kelly-Molander:
Yes.

Dr. Arnold:
Geez, makes me feel old in that one. Do you remember when we used Libby and Emma in a promotional video back then, do you remember that?

Julie Kelly-Molander:
Yeah, we sure did.

Dr. Arnold:
Well, April's child abuse awareness month. We have a lot of awareness months and typically kind of make fun of that on the podcast. For example, April's also fresh celery month. So, you know, I don't know what events go along with fresh celery, but what events go along with child protection—I mean, child abuse awareness?

Julie Kelly-Molander:
So you will see a lot of blue pinwheels in the community and the pinwheel is really a sign of hope. It's also a sign of a care-free, fun childhood. And so there's a committee of people who are doing a lot of activities around the hospital. They will be planting pinwheel gardens around the hospital and at some of our clinics. They'll also have pinwheel bases at many of our reception areas. And then next to the vases, they're going to have coloring sheets of pin wheels and also parenting tips for parents, so that way they can learn how to better parent their kids. We're also going to be selling t-shirts and encouraging everyone to go blue for kids on Friday, April 1st. Now those t-shirts are actually a fundraiser for CPC. If anybody's interested in purchasing the shirts, they can call the St. Luke's healthcare foundation or CPC directly.

Dr. Arnold:
Alright. And we'll cover that number at the end as well, but that's 369-790-8319. And that's the main number, Julie, to the child protection center?

Julie Kelly-Molander:
Yep. Correct.

Dr. Arnold:
You know, the pandemic—and I mention this all the time and I should get the exact dates—but for roughly six months everything was shut down, as far as basic healthcare, et cetera. What impact did that have on the incidents of child abuse? I'm sure it wasn't positive.

Dr. Butteris:
No, absolutely, it was not out positive. You know, child abuse risk factors are, you know, anything that increases stressors in a home. So financial instability, unemployment, parent stressors, increase in substance use, or mental health problems. And so those of the risk factors in general for child abuse. But as you can imagine, during the pandemic all those things increased. So we definitely saw an increase in child abuse cases at the child protection center related to the pandemic, more detailed accounts from the children. Our staff here spent significantly more time with families talking about what resources we can help them with, to help with support systems or needs that they might have to decrease those stressors in the home and try to keep kids and families healthy and safe.

Dr. Arnold:
Yeah, one can imagine how that was stressful. I think it was Iceland, they closed all the liquor stores because domestic abuse was going up so rapidly during the shutdown that they shut down their liquor stores hoping to curtail it, which is kind of interesting. But what percentage of the cases do you guys—first of all, what sort of volumes do you see each month? More than one is too many, but yeah.

Dr. Butteris:
Yeah. so last year we saw 967 children. The year before that we saw 835. I think we've kind of hovered around 700/800 for a few years, but then you know, it bumped this last year.

Dr. Arnold:
And Gina, what percentage of those cases are sexual abuse and what percentage are physical or mental abuse?Or sometimes do you have both I would imagine?

Dr. Butteris:
Oh yes. Yeah, definitely combinations. So the majority are sexual abuse. I would say, you know, upwards of 90% are probably sexual abuse, but the numbers of physical abuse and neglect, emotional abuse, witness to violence, have increased over the years in the number of cases that we see. So we still see a pretty significant amount of those cases and they also utilize, you know, our services just for consultations. So we help with a lot more physical abuse cases that actually don't come to the child protection center, if that makes sense.

Dr. Arnold:
Yeah.

Dr. Butteris:
You know, DHS and law enforcement will just utilize our services to kind of run cases by us and get our thoughts. So there's even more cases that don't come here, you know, of physical abuse.

Dr. Arnold:
And I think that—you know, as a frontline physician—and you and I have discussed these cases, Dr. Butteris, it's hard to confront the family when it's just a suspicion. When you're taking care of the child and it's like, well, this is kind of peculiar, but it's not— You know, and I can imagine families get super defensive when that happens, and maybe that's probably a natural response. But, as physicians, we're mandatory reporters and that's our duty to do that. And because you're potentially preventing a morbidity and mortality by getting that child protection. Now I know—I should know this because obviously my wife's written the grants for the child protection center and we've always been supporters, a donation to the supporters—but how many counties do we serve? It's like 40, right?

Julie Kelly-Molander:
It is right about 40 counties, yes.

Dr. Arnold:
Yeah. That's what I thought, which is pretty impressive. How many child protection centers are in the state?

Julie Kelly-Molander:
There are actually six centers in the state, we were the first. There are also centers in Sioux city, Des Moines, Waterloo, Muscatine, and Davenport.

Dr. Arnold:
Okay, so kind of spread border to border. Let's talk about some of the services that you provide and resources. Dr. Butteris, you mentioned the resource for law enforcement that you serve in that capacity. But what are some other critical things that you do to prevent and curtail child abuse?

Julie Kelly-Molander:
So, you know, kind of like we've talked about, we do work with DHS and law enforcement really to help them when they are investigating allegations of child abuse. And there are three core services that we provide. We do the forensic interviews, the medical exams, and we provide advocacy to families when they are referred here by DHS and law enforcement. And we'll talk you through all three of those core services. Dr. Butteris, if you want to talk about the exams first, that would be great.

Dr. Butteris:
Sure. So that's my job is to perform the medical exam. So, you know, obviously we're looking for signs of abuse when the children are here. When you're talking about sexual abuse, the majority of the time exams are normal. So really our goal is to tell kids that they're healthy and they're normal, reassure the families that they're healthy and normal, and that's really a part of the healing process, kind of the first step for them to be able to heal and move on. The relief on from both families and kids is tremendous when they know their kids are okay. And then as you can imagine, these kids are underserved in the medical community, dental, for behavioral, mental health, all sorts of areas. And so we just want to identify anything else they need and then help. Get services in place for them, and that's where our advocate comes in as well. And Julie can talk about that.

Julie Kelly-Molander:
So as far as the forensic interviews, we have specially trained interviewers who talk with the children. And it's really the goal of the forensic interview, just to gather information about the abuse allegation. The interviewers are highly trained and highly skilled. They gather the information in a way that is developmentally and culturally sensitive. The interviews are non-leading, they're fact finding, and they're legally sound. When we do the interviews, they're actually recorded and DHS and law enforcement are observing the interview while it's going on from another room. So that's kind of the interview process. And like we said, we also have a family advocate here. Our family advocate, Heather, just does amazing work with the families as well. And like Dr. Butteris said, you know, it's really her job to follow up with these families. We want to make sure that they're getting what they need. So, you know, Heather's the person who provides crisis intervention and education. She maintains contact with them after they've been seen here for as long as they want. She makes sure that they're getting the counseling and the resources that they need in the community.

Dr. Arnold:
You know, Dr. Butteris, back to you. What are the signs and symptoms of child abuse? And we know the obvious, you know, the signs of physical violence, i.e. black eyes, bruising, et. cetera. But what are some subtle ones, that as clinicians and also as the general public and listeners, that they should know that's not quite how things should be. What are some subtle findings?

Dr. Butteris:
Well, and you're exactly right, a lot of times it is very subtle. And to be honest, there might not be any signs. So we have to be aware that, you know, just because a kid is a straight A student and star athlete, it doesn't mean they could not be experiencing abuse. But when you're talking about subtle findings, some of the behavioral changes—something's just different. So they used to get good grades and now their grades are dropping. Or they used to want to go do things with their friends and now they don't want to do anything, they're withdrawn. Anything that's just a difference. Littler kids, it might be out of control behaviors, tantruming, all of a sudden, you know, this sweet little kid is just angry or frustrated all the time. Regression can happen. So a lot of times people think, you know, if a starts bed wetting, they might automatically jump to, oh, this could be sexual abuse. Well, that's not the most common reason, but certainly regression in development would be another thing. So the main thing is: is this something different from the child's normal self? And I think one area we kind of miss out in this is these kids will have these behavior changes and everyone is like, I don't know what's happening. Why is this child so different? And they'll get diagnosed with, you know, maybe ADHD or ODD. And really, it might not even be abuse per se, but I think there's the traumas. And, you know, we really learned about all the ACEs and the trauma experiences and how they affect kids. And I think sometimes that's where we might miss those cases. So we might be thinking trauma, but we might not necessarily be thinking abuse and especially kids that come from, you know, your normal families, it still happens. And so I think we have to just make sure we don't disregard those situations because abuse can occur any in any home.

Dr. Arnold:
Yeah. I think those—how do I say this? The perfect family is seldom perfect, you know?

Dr. Butteris:
Exactly.

Dr. Arnold:
I mean, if you know a family and they don't have some dysfunction, something's probably up, right. You know what I mean?

Dr. Butteris:
Yeah.

Dr. Arnold:
Dysfunction's normal. Or at least I keep telling myself that. Now, if somebody suspects child abuse, what should they do?

Julie Kelly-Molander:
Well, they should definitely report the abuse as soon as they suspect it. And I think people need to remember that it's everybody's job. So if you suspect abuse, call DHS right away. They have a hotline that's open 24/7. The number is 1-800-362-2178. When you call the hotline, just be prepared because you're going to need to give them information about the child, about your concerns, and even the whereabouts of the child. So you do need to be prepared to provide the information when you make that call. The other place that you can call is law enforcement. You know, by all means, if you're concerned about child abuse, call your local law enforcement agency. And certainly if a child is in imminent danger, make sure you call 911.

Dr. Arnold:
Okay. Good advice. Well, you know, we often ask guests on the program why did they get into this particular specialty. And so, you know, let's start with you Julie, how did you—after attending the Harvard of the Metro, Kennedy High School and matriculating from there—how did you end up at the child protection center?

Julie Kelly-Molander:
You know, that's a great question. So when I graduated from college, you know, I didn't know exactly what I wanted to do. I knew I wanted to work with kids. I knew I wanted to make a difference, but I didn't know exactly what that looked like. And interestingly, a family friend told my mom about this job opening at CPC. So I applied, got hired. And again, I had no idea what a child protection center was, but I got here and, you know, the amazing work that we do just really resonated with me. And deep down, I just knew this is where I was meant to be. So I've been here for a long time. I am so happy to be here. You know, and I just am so grateful for the opportunity that we have to make a difference with the families that we serve. And I often say that I truly believe the work that we do and our staff members, we are often the beginning of the healing for these kids and these families.

Dr. Arnold:
So what—before we get to Dr. Butteris, and both of you can answer this question—what do you and your staff do to prevent from becoming cynical and giving up on humanity? I mean, I know that's hyperbole, of course. But, how do you recharge your battery to say that there is still good in the world I'm going to make sure it is there.

Julie Kelly-Molander:
You know, we talk about that all the time because of what we see and abuse is everywhere. And like Dr. Butteris said, it's in every single family—type of family. And so we do, we have to be supportive of one another and we laugh a lot here, not at the families, but we have a lot of fun with each other. We celebrate everything under the sun. So we try and make the work environment a really fun place. And we try our best to really encourage our staff to leave work at work. You know, and I think for the most part, we're all really good at that. Of course, there are some cases that you just automatically take home with you, but I think one of the biggest things is being able to leave work at work.

Dr. Arnold:
Good advice. Good advice, not only for child protection, but just in general life advice. Dr. Butteris, when I came to town, you were a family practice doctor in Mount Vernon. Well respected, still respected. So how did you end up at the child protection center?

Dr. Butteris:
Well, I like to say when people ask how I chose this, I say, well, it chose me rather than me making that decision. So when I was a resident here in Cedar Rapids and we had our residency program, we spent three weeks at the child protection center. And I think like most people, when I came to the child protection center, I had no idea what a child protection center was. And I was so impressed by the interviewers, number one, which by the way back then Julie was an interviewer, and Dr. Opderbeck. It's almost like I couldn't even find words like how it made me feel. And I didn't express that to anyone, but I guess I've never asked, but I have the sense that maybe they kind of knew that it just touched me. And so when I was in practice, I'd been in practice for four years, Dr. Opderbeck called me and she said, I'm looking for someone to work part-time at the child protection center. And I said, sure, I'll do that. And so I took two half days a month from practice and I came and she trained me and was my mentor. And I did that for four years. And then when she was ready to retire it was just the transition that happened. I loved it here and I decided to leave practice and to come here.

Dr. Arnold:
What year did you go full-time there, when Opderbeck retired in there?

Dr. Butteris:
Yeah. So is was actually July, 2008. So we moved here about a month after I started full-time. And then Dr. Opderbeck retired in January of '09.

Dr. Arnold:
What are her and Dr. Mcmenamin doing these days?

Dr. Butteris:
Living life and traveling the world.

Dr. Arnold:
Yeah. I mean, they travel before they retired, you know.

Dr. Butteris:
Yes, for sure.

Dr. Arnold:
That was their thing.

Dr. Butteris:
Yeah. They have, you know, five kids all over and they visit them and have grandkids.

Dr. Arnold:
What a great couple, you know. I mean, they're just wonderful people.

Dr. Butteris:
Yeah. I actually spent time with Dr. Mcmenamin when I was a resident too, before I met Dr. Opderbeck and I loved him. I loved Dr. Mcmenamin. And then I met her and I was like, oh my gosh, this is an amazing family.

Dr. Arnold:
He was one of those older doctors that just made everything so simple, you know? Oh they have an infection, give them penicillin. Oh they are dehydrated, give them saline. Oh just give him five milligrams of Coumadin. And like 99.9% of time, he was right on the money, you know? And you're just like, how's he making things so simple?

Dr. Butteris:
Yeah.

Dr. Arnold:
But he was a good surgeon and we certainly miss him. A wonderful guy to talk to. Well, Dr. Butteris and Julie, thank you for joining me here on the podcast. Certainly, you have a job that I wish didn't exist, but I'm glad that you're there because it is a problem that needs resources and you guys do a phenomenal job. And as often said, you do God's work. There's been great information. Again, this is Dr. Regina Butteris and Julie Kelly-Molander with St. Luke's child protection center. For information about child abuse prevention and other services provided by the child protection center call 319-369-7908.

Thank you for listening to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on Apple Podcast, Spotify, Pandora, or wherever you get your podcasts. Until next time, be well.