Protecting Extremely Vulnerable Kids

When pediatrician Phil Scribano, DO, MCSE, arrived at Children’s Hospital of Philadelphia in 2011 to take the helm at Safe Place: The Center for Child Protection and Health, he was intent on expanding the center’s footprint to improve healthcare delivery and equity for the community’s most vulnerable children. It was a formidable task. Despite the importance of Safe Place’s work — caring for children who have experienced various forms of child abuse — the challenging insurance reimbursements for multidisciplinary care don’t come close to covering costs, leaving the center to depend heavily on philanthropic support.

Along with Safe Place, CHOP has programs to prevent and help children heal from other forms of violence, such as bullying. When Chedaya was in sixth grade, she was bullied and challenged to a fight over her sneakers. Scribano and his team never would have been able to achieve their goals were it not for unrestricted gifts generated through the campaign For Tomorrow’s Breakthroughs. Safe Place is a prominent leader with a longstanding history of providing foundational science and innovations in the field; training physician leaders on how to address child abuse; and providing excellent clinical care. The Safe Place team — which includes six attending physicians, three child abuse pediatrics fellows, two social workers, two mental health therapists, two occupational therapists, a nurse, and an administrative coordinator — evaluates approximately 700 children in the clinics and approximately 225 children who are hospitalized for severe physical abuse, sexual assault or neglect concerns each year.

“Unrestricted giving is the lifeblood of organizations like ours,” says Scribano. “There’s no adequate reimbursement mechanism that could support what we do. These gifts allow us to be innovative and expand our reach to help kids who have suffered abuse.”

Partnering to minimize trauma

Historically, when a child in Philadelphia reported sexual abuse, they would undergo repeated evaluations: by police, by child protective services case workers, and then by medical providers. Each time the child recounted the incident, they risked being retraumatized. Determined to change that, Scribano and his team partnered with Philadelphia’s Department of Human Services (DHS), the Philadelphia Police Department, the district attorney’s office, the Philadelphia Children’s Alliance, and St. Christopher’s Hospital for Children to create a clinic that streamlines the investigative and treatment processes for child victims to minimize trauma.

Additionally, the Fostering Health Program, an innovative care coordination model, is a partnership with DHS devoted to meeting the needs of some of the more than 5,000 Philadelphia children in the foster care system who lack access to routine healthcare.

“Working together and introducing creative solutions to improve access to care is much more effective and efficient than if our efforts are siloed from our partners,” says Scribano.

Meeting the challenges of COVID-19

The stress of the COVID-19 pandemic has created additional risks for vulnerable children. Physical distancing has substantially reduced the ability of teachers, doctors and child welfare staff to be the collective “eyes and ears” for children.

Fortunately, Safe Place was an early adopter of telemedicine. Since 2016, the program has provided tele-consultations for patients undergoing child sexual abuse evaluations. With this already in place, Safe Place was able to quickly transition more appointments and counseling services to telemedicine. And the team rapidly deployed an electronic screening project across the CHOP enterprise to help link patient families in need to community-based organizations.

“We are a small but mighty team, collaborating with our partners to improve the health and well-being of at-risk children,” says Scribano. Philanthropic support makes them even mightier. “As we bring our services to more children and their families, we can further reduce healthcare gaps for those most vulnerable in our region.”

A Determined Response During the Pandemic

At CHOP, we have been finding the right answers to previously unsolvable problems for more than 165 years. Today, we are using our incredible expertise to grow the body of medical knowledge to effectively respond to the COVID-19 crisis. By making research advances and sharing what we learn, we aim to win the fight against the coronavirus here and across the world. Three examples of what we have accomplished with the help of generous community members:

• CHOP’s Infectious Disease Diagnostics Laboratory developed a unique-to-CHOP COVID-19 test, initially performed on hospital patients and clinical staff, then extended to others through drivethrough testing stations at CHOP facilities. In early March, CHOP became the first hospital lab in the state to get the federal government’s emergency authorization to begin testing patients.
• Physicians and scientists with CHOP’s PolicyLab created a unique modeling tool to predict the spread of the disease. This tool is now used throughout the country.
• CHOP partnered with the Philadelphia Housing Authority to offer healthy meals to families already facing socioeconomic challenges.

Expanding Telehealth

Video visits became crucial to keeping families safe during the pandemic, but there are many other ways CHOP uses telehealth to create a first-rate pediatric healthcare experience. For example, using secure, interactive technology, we conduct provider-to-provider virtual sessions in which CHOP oncologists give consultations to doctors in Saudi Arabia and Greece, and CHOP urologists advise doctors in India, thereby imparting our expertise to benefit patients who otherwise would never have access to a CHOP doctor.

Free Language Interpretation

Language interpreters are vital to ensure that non-English-speaking patients and families fully understand what is happening and what actions they need to take. CHOP staff interpreters speak Arabic, Spanish, Mandarin and Cantonese. Together, these four languages encompass 80% of the demand for interpreters at the hospital. Contract interpreters are used for more than 70 other languages — and every interpreter’s services are provided free to the families, thanks to unrestricted gifts.

Research That Otherwise Wouldn’t Be Funded

Unrestricted funds pay for research conducted by trainees and early-career physician-scientists, and for early-stage projects that need to prove results before applying for larger grants. An example is the work being done by J. Gregory Dolan, MD, MS. Informed by his prior experience as a student of theology, Dr. Dolan’s research focuses on a holistic approach to the treatment journey — studying how emotion and religion tie into other factors such as resiliency and social support. This work can help providers better address these vital topics with patient families. “Such studies tend to fall more in the integrative health domain, for which there is little funding,” explains Dr. Dolan. Unrestricted funds bridge that gap.