(bright upbeat music) - For more than 30 years, the Pediatric Resource Center in Peoria has provided medical care and social services to children impacted by abuse and neglect.

The PRC is a community service program of the University of Illinois College of Medicine at Peoria.

We're joined by Dr.

Channing Petrak who is the medical director of the PRC.

Thanks for coming in today.

- Thanks for having me.

- How unique is a program like this?

I know that it's been around for a while, and it's served a lot of counties in Central Illinois and beyond, but are there other programs like this around the state?

- There are only a few, and it is a unique program.

So you know, if you think geographically, Illinois is a very long state.

There's a few programs in Chicago, there's one in Rockford, there is our program, which takes up the majority of Central Illinois, and then there's one program at the tip of Southern Illinois.

- Okay, tell us a little bit more about how this all started, and why?

- The program started back in 1993 when Dr.

Kay Saving, who's also a hematologist oncologist, really just recognized the need for a program like this.

She was often asked about children who had bruising, and could it be abusive.

And so she saw the need for the program, and then started this specific program to address the needs of children who need a medical evaluation for abuse or neglect.

- Okay, can you kind of walk us through how, you know, if it's with the police, or DCFS that find a child, maybe they suspect of being abused, do they then call you guys and say, Hey, we need to have this child looked at?

- Yes, but most of our referrals actually come from other medical providers.

So other practitioners who will call us and say, I just am not sure, and they make the referral to us, or patients who are in the hospital.

So we get referrals from multiple sources, it could be medical providers, it could be police, it could be DCFS, and sometimes parents call us because they're concerned.

And so at that point then one of our social workers who we call case coordinators, would take that intake and would just kind of get the information, and then we do a medical triage of, how soon do we need to see the child, what do we need to do?

But a lot of our referrals are coming from multiple different sources.

- Okay, so once you get that referral, kind of tell me how the process works.

- Well there's, you know, sometimes some crisis counseling that needs to happen upfront because if a family is concerned about their child who may have been physically, sexually abused, maybe there's been some severe neglect, they're a little bit concerned or worried, and so we have to do a little crisis counseling upfront.

But then we start on the medical evaluation, and that encompasses just making sure that child is healthy and safe, and doing a thorough evaluation for that child.

And then we will connect with investigative partners, DCFS, or law enforcement, or children's advocacy centers, we work with multiple different advocacy centers to kind of explain what the medical findings mean, because none of those people are medical, and we don't expect them to understand what those big words mean.

So just an explanation of the medical findings.

And so we are working with multiple different multidisciplinary partners to make sure that the child's needs are met, and the family's needs are met as far as we make referrals to counseling if it's necessary, we make recommendations about other healthcare, making sure that the child and the family are getting what they need to move forward and to start healing.

- When the child who has gone through trauma is being evaluated, I mean that's gotta be a sticky situation in terms of, you know, even if there is just physical abuse, the emotional toll that it's taken on them has gotta be great, how do you navigate through that?

- Well, doesn't matter what child we're seeing, we move at the child's pace.

And so sometimes, you know, we can do an evaluation relatively quickly, and sometimes it just takes a long time because the kid needs a break, and that's okay.

So we move at the child's pace, we kind of let them lead the way.

But we are very thorough in looking at all of the things we need to look at medically to make sure there's no underlying medical conditions, or making sure that the child's needs are met in that moment.

And to be honest, children are children, and that's, you know, that's their primary goal is to play, and to just interact in a usually happy way.

Of course, you know, some toddlers just don't want us anywhere in the room, they don't want anybody in the room, but we really move at that child's pace and meet their needs as we go.

So we don't rush through things just because we have somewhere else to go, we take that child's lead and we move with them.

- And what age range are we looking at?

- Infancy all the way through 18, but we will go past that age if, for example, an adult has a developmental disability and really is, you know, functioning intellectually more like a child, we know that their needs are more in line with what we would do than maybe an adult provider would.

So we do go well into the twenties for some people.

- So what kind of abuse do you typically see?

I mean, we've got physical abuse, sexual abuse, emotional abuse, and then neglect, which is, you know, a whole nother story, what are you seeing in our area?

- All of it.

And sometimes there's what we would call polytrauma.

So they've had multiple forms of abuse at the same time.

And so, we really try to be comprehensive, and make sure we're covering all of those needs, and ensuring that the child is able to address all of the types of trauma that they've experienced so that we're making sure that the services they get moving forward are comprehensive enough for them.

- Now if you determine that the child may need counseling in the future for however long, is that something that your office would do, or would you refer that child to someone else?

- We refer them to someone else.

And even if a child particularly doesn't think they need counseling right upfront, we strongly recommend that they at least get hooked up with somebody upfront because it's good to have that relationship started so that later when they think they do need it, that they can come back to it.

It's good to have that foundation set.

So we strongly recommend counseling for children when they've experienced trauma, and that it be focused on trauma-based counseling, because that is what's appropriate for them, so we definitely recommend it, but we refer that out to people who have expertise in trauma-focused counseling.

- When you're looking at a case, a child, are you looking at who the perpetrator may be, or is that inconsequential to you, you're just looking at the medical and the emotional things?

- We are specifically there for the medical evaluation, we are not investigators, we are not, that is not our role.

We are specifically doing a medical evaluation, and then explaining those medical findings to investigative people, but we are not in any way involved in the who of may, you know, who may have injured a child.

- Sure, do you ever have to testify in court?

- Yes.

- Okay.

- Yes, frequently.

- So you've been around for more than 30 years, prior to that, what do you think kids weren't getting in terms of medical evaluations and things like that?

- I think probably they weren't getting a thorough evaluation, and we see that even today, because our geographic area is just so large, that, if a medical provider just isn't knowledgeable about all of the evidence-based literature supporting child abuse pediatrics, that they may miss things.

And so a child may have been abused, but they're not aware of the injury they're looking at as being an abusive injury.

So then that child goes on to sustain further abuse.

And I think that that was likely happening more significantly before our program existed.

There's a lot of expertise, it is a subspecialty in pediatrics, a lot of expertise and evidence-based medicine that supports what we do.

And so in general pediatrics, or general family practice, you don't have time to keep up on all of the subspecialty literature.

It's impossible.

Nor do they have the time to do those evaluations, and so it really is better for a subspecialist to see those cases, to do the thorough evaluations, and make sure that children don't have underlying medical conditions, but also aren't being subjected to potentially further harm.

- Looking at some numbers from across the state, it looks like the types of victim neglect is a big issue, how do you define neglect?

- Neglect is basically just not providing either basic needs for a child or not, it could be not supervising them, so leaving small children home alone when that's unsafe for them.

So it is a really big category, which is why it's the biggest number when it comes to maltreatment.

It can also be medical neglect though, so, not getting a child medications that they need that could then result in a serious harm.

So for example, seizures, and you're not filling the seizure medications, that can be very dangerous to a child.

So it's a very broad category.

It's either not basic needs, or it could be medical, or it could be a supervision issue.

- When you're looking at neglect, medical neglect, sexual abuse, physical abuse, emotional abuse isn't in there, but, it seems like all of those could be emotional abuse.

- Emotional abuse by itself is difficult to prove, especially for example, in a nonverbal child, they can't tell you.

And even in an older child, that by itself is difficult to prove.

We don't have outward signs of it, we may not have findings of it, it's really what the child is telling you, we believe children.

When we see emotional abuse come into play is really when we're talking about, which is not a separate category, but torture of children.

It involves serious physical harm, as well as emotional harm at the same time.

You know, either a very serious event at once, or over time, and neglect is usually concurrent as well.

So it's multiple traumas happening at once.

- Okay, the kids that you see are, when are authorities are concerned doctors getting these kids, in terms of early stages of maybe abuse, late stages, middle stages, is there one kind of stage that you see more than another?

- It depends on where they present.

When they're coming to the hospital often, it's in a more late stage of abuse, particularly if they're really injured then, you know, that's a more late stage where they've had potentially prior injuries, and now they've had a very serious injury.

What we are trying to educate people on consistently is, that there are early injuries that may be subtle, and we want people to just pay attention to them, because we wanna intervene early.

We wanna prevent the further escalation of injuries that that child may have.

So we call those sentinel injuries, they're a bruise on an infant that shouldn't have a bruise, or you know, a mouth injury that they just shouldn't have, where the history just doesn't meet their developmental capability, and so we want people to report at that point so we can intervene, we can do an evaluation and intervene, and provide services so there's not further escalation of injury to that child.

That's the hope.

And then, we talk about, so upcoming is October 4th, and so we call that 10-4 day, because there's a good clinical decision rule that we want providers to use, and even parents to pay attention, or our grandparents, any family member.

So bruising anywhere on the torso, the ears, or the neck of a child under the age of four, 'cause that's just not where they tend to get injuries from typical play.

Anywhere on the frenulum, the little connective tissues in your mouth, injuries there, on the cheeks would be harmful if it's not over bone, on the ears, so that's the one of the other spots, angle of the jaw.

So there are certain places that we just don't expect to see bruises on children.

Bruises on infants, four months and under, anywhere, one small bruise, it doesn't matter, and then anything patterned.

Where you can look at it and go, that looks like an object.

Those are ones we really want to intervene and make sure that that child's healthy and safe.

We wanna provide services if possible, and make sure that that child doesn't have any other injuries - In terms of what to look for, do you see a lot of malnourishment?

- We have and it kind of ebbs and flows.

You know, there was particularly a bump when there was formula shortages, because people just were desperate and you know, either maybe were diluting formula, or they just couldn't get it.

You know, that was really just a systems issue that it wasn't available for people, there was nowhere to go to get formula.

So we do tend to see bumps at certain times, sometimes it's an educational issue, there are a lot of reasons that there might be, you know, malnutrition, particularly in a small infant, but we do see that and we typically would initially attempt to educate on those cases.

- In all of your years of doing this, how have you seen the problem?

Has it gotten better, worse, stagnant?

- The numbers overall in the US have gone down for maltreatment just in general, so they've gone down a little bit, which is good.

But the number of fatalities has gone up.

So five children die each day from maltreatment.

So that number has gone up.

So what I think we're seeing is maybe more severe abuse as opposed to, you know, we're seeing more of it, we're just now seeing sometimes more severe abuse.

So either it wasn't, you know, we didn't intervene early, we didn't provide services, overall it was just missed, or it's just really severe at the time it happens.

But the fatality number has gone up over time.

- I know you don't get into the details of, who, what, when, where, why, but, anecdotally from doctors or law enforcement, are you hearing anything about why this is happening, or what some of the factors are involved in this?

- Well, we do know that from studies that have been done, looking at big public health data, in the past, for example, when there was a recession, so money makes a difference, people are more stressed, and you will see child maltreatment bump at time.

It has happened in the past, you can see the numbers go up.

So certainly as the economy worsens, we do tend to see more child maltreatment.

The pandemic was interesting, because some places in the country saw increases, others saw decreases.

So I think it really depended on, was having both parents home protective or not.

And it was variable depending on geography.

So nationally, it was kind of awash.

But again, as the economy fluctuates, and is very uncertain, you see stressors, and then we may see increase in child maltreatment rates.

- It's interesting that you say that because I think, you know, in the media when we hear about cases, and we read about details, we think all those parents are monsters, you know, they're awful people.

But I guess in some cases it could be like you said, money stressors, maybe they can't afford the food they should be giving to their infants, and their kids, and things like that.

- Right, I mean, cases are gonna be different, you know, sometimes it's just their worst day, and they just had a, you know, it was the worst day for them.

Other times, you know, when it's been happening over time, and certainly in torture cases, you know, those are certainly happening severely over time, that isn't just a worst day scenario.

So every case is gonna be a little bit different as far as the why, and I don't know that we ever really know the why it's difficult to get to, but sometimes looking at larger data sets, you can make some estimations about poverty, or you know, the economies changing or unemployment rates, you can look at those big factors as some drivers of child maltreatment.

- Have you ever seen a child twice?

- Yes, we have.

- So what's happening when that happens?

- Well, the literature supports that once you have been maltreated, that puts you at risk for further maltreatment.

- Even when authorities and doctors are involved?

- Yes.

So trauma changes the brain of a child, it just does.

So whether you are in the home when trauma has occurred, so maybe you didn't experience the trauma, maybe it was a parent or someone else in the home, or maybe it was a sibling, but trauma changes the brains of young children.

And so you then are more likely to experience trauma later in your life, and so, that's one of the reasons we really, really want counseling to occur for children, because we wanna not negate, but ameliorate those factors moving forward.

But children who've been traumatized are more likely to be victims of trauma in the future.

- And are they more likely to commit some of these acts themselves?

- Not necessarily, but there are risk factors, certainly, especially if there's been no counseling for them.

But, so even if you've had physical abuse as a young child, your risk of sexual abuse has increased in the future.

So it's not like if you were physically abused, you will be physically abused in the future and become someone who physically abuses.

It's not a linear pattern.

You are just at more risk for trauma of some sort in the future.

- Does your office do anything proactively in terms of educating the community, or trying to get ahead of this problem?

- We do.

Most of our prevention is secondary prevention, so we've seen a child, and then we're providing education at that point.

But we do talk to, basically whoever wants to hear us, about ways to prevent abuse.

So we talk about it's okay for babies to cry.

Babies do cry and that's their form of communication, and so, helping people when they get stressed about how to help families.

We also talk about, you know, ways to help families, if it's somebody you know, who just seems to need some help, there are ways to do that.

Or we talk about other resources that can be utilized.

So we do some primary prevention, safe sleep, which is really important, so we reduce the risk of suffocation in infants.

- Tell me about the Crying Plan.

- The Crying Plan.

It is on our website, which is pediatricresourcecenter.org.

So the Crying Plan is basically a way to write down and have it in writing, what to do when your baby cries.

And it talks about why babies cry, lots of reasons they cry, but kind of the, what I'm gonna do ahead of time?

Here are the people I'm gonna call, right?

It's also for you to give to someone who watches your baby, so, my baby likes whatever, when they cry, every baby's a little different.

So what are you gonna do when your baby's crying?

It's okay to step away when your baby cries, so it gives you some ideas about what you can do if your baby's crying, put them down, and take a few minutes for yourself.

'Cause a crying baby can be very frustrating when you really can't figure out what they're crying for.

And if you feel like you should be able to stop it, and you can't, people can get very frustrated.

Crying is never personal.

Babies are just crying to communicate.

So it also has some tips on there about choosing a caregiver for your baby.

So you know, you don't want the person who says your baby's spoiled if you pick them up, or, you should, your baby cries too much, or if they're gonna harm your baby if they're angry at you.

So there's a lot of good information on it about crying babies, 'cause that is a big trigger for some people to harm infants.

They just have a very low tolerance for crying.

- Yeah, and I'm sure there's some parents out there who maybe weren't ready to be parents, or maybe didn't have a good upbringing themselves, and they're just not equipped to handle things like that.

- Right, like I said, some people can tolerate it, and other people just have a very low threshold for it, and get very frustrated quickly with crying.

- Tell us about some of your affiliations here in town, who you work with, and tell us where your office is on Knoxville.

- Sure, we are at 1800 North Knoxville, so it's in an OSF building, so we are affiliated with the Children's Hospital of Illinois.

We also are affiliated with Carl Methodist, or I should say Carl Health, but Carl Methodist.

So we go to both hospitals to do consults on patients.

And then we also work with children's advocacy centers, so we work with the Peoria County Children's Advocacy Center, but we also work with surrounding counties, multiple in our entire region.

And then we also work with the Center for Prevention of Abuse, because we see children at the emergency department who have had acute sexual assault, so we work with them, and their advocates.

We work with really any agency that works with children.

- Sure, and just to clarify, for people who are watching, if they suspect maybe someone in their life is being abused, who do they go to first?

- The first call really should be the DCFS hotline.

That should be the first call.

Because it really starts the ball rolling of making sure that there's safe plan for a child if they're being harmed, that is the first rule.

DCFS is the agency in charge of safety for children.

- Okay.

And I guess, if they think a child is in immediate danger, they should probably- - Call 911, I mean that's a police call, yes.

'Cause DCFS is not going to arrive immediately, but then you would call the police in that case.

And people are very hesitant to call DCFS, I will say that they also provide a lot of services.

So if what you're calling about doesn't necessarily rise to the level of taking an investigation, they have a whole another arm of just providing services for people that a lot of people really are in need of.

And so there's no harm in calling them, because it may be very helpful to families.

- That's good to know, 'cause DCFS seems to get mostly negative coverage.

- They do.

- And sometimes for good reason, but they are there for a purpose, and like you said, they can do a lot of different things for folks.

How are you guys funded?

- Our funding is some federal money that comes through, so we have grants and contracts.

And then we also have fundraiser.

So we have to raise funds to stay in business.

And so we have a couple of events throughout the year that people come to, and help us raise some funds.

One of them is coming up, it's October 16th at a venue Shiksa, like, I couldn't remember where it was.

And so it's always a good time, we love people to come and join us.

We have good music, good food, some fun stuff to bid on.

But it definitely helps us stay in business because we never have enough money throughout the year from our grants and contracts to actually pay all the bills.

- Sure.

Anything else you'd like folks to know about what you guys do over there?

- I think, you know, we take a lot of phone calls where people just are not sure about something, or they just need some information, and we provide educational resources frequently.

So parents who are maybe concerned about sexual behaviors of their child, or that their child may have been sexually abused, but they just need someone to talk to, or they just need someone to talk to them about the possibility of abuse, and we're more than happy to do that, we send out resources all the time.

- I was gonna say, do you do a lot of community outreach in terms of talking to groups, and things like that?

- Yes.

So yeah, if somebody's involved with a group, and they want us to come and talk, we'd be happy to do that.

But also on an individual basis, we do provide, we have a lot of books that are geared toward children to help people talk to the children about sexual safety, body safety, bodily autonomy, things like that.

- Okay, very good.

Well, we appreciate all the hard work that you all have been doing for more than 30 years now, and glad you're a part of the community.

- Thank you.

- Dr.

Channing Petrak, Medical Director of the PRC.

And we are gonna have more on this topic on our website.

You can check out this interview, and share it with your friends and family, just go to wtvp.org.

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Thanks for watching, have a good night.

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