ICAN HOSPITAL NETWORK
MICHAEL DURFEE MD
PAST
PRESENT
FUTURE
We measure three populations
1) Birth services for female resident of LA County 344/day
2) Injured LA County child under age 3 in Emergency Department 95/day
3) Injured LA County Child under age 3 inpatient (may be PICU or Burn unit) 4/day
Average 400+ children 0-3 / day to be screened for abuse/neglect
We know little about them. This project will make them known
Society has denied child abuse for centuries
Radiologist noted multiple fractures
but did not focus on child abuses
Child abuse was not indexed in
medical literature until 1965
Child Abuse may be ancient
But, our response is a new denial
Today we look for magic answers
As if we know what to do.
Ambrose Tardieu
Described Fatal Abuse 1860
102 years later
Henry Kempe
Described Fatal Abuse 1962
• PAST - 1960 to date
• 1960s State Laws began to address Child Abuse
• 1977 – ICAN and DCFS Hotline both began
• 1978 ICAN Child Fatality Review - first team and first case
• 1980s ICAN National Center on Child Fatality Review all states 2001,
• 1981 First ICAN Hospital Network caused an increase in reports
• 1990s Child Fatality Review spread – Canada and Australia
• 2004 child traumatic grief (Survive fatal family violence)
• 2016 Hospital Network Activation – LA County
Why add hospitals and what happens when you do.
• Necessary, for very young: newborn, infants, toddlers Health
professionals know the very young and injuries. The network needs
agencies and hospitals to share information and case management.
• The first ICAN hospital network, 1981 to 1990, •
•
•
•
1,000% increase in reports from hospitals,
Most cases were newborn, infants young toddlers
then teen/preteen mothers. Will this one do the same?
The Dependency Court called about increasing in cases
• Why molested toddlers?
• Why skinny babies?
• Why newborn?
• The system was stopped for legal concern and data destroyed
• New laws address the need to share data to protect children
ICAN Hospital Network Plans to move Statewide in 2017 with the
data system and local hospital leadership from 9 regions.
Hospitals supply major
Health resources for little
cost if you connect
them to child protection
and let them serve
children and families.
63 Hospitals
63 hospitals with 7
from other counties
serve LA County
residents
90% of Emergency
Department visits for
injured under age 3
97% of births
99% of inpatient
injured under age 3
inpatient includes
PICU
BURN
THE ICAN HOSPITAL NETWORK
This document includes 63 hospitals
that serve LA County residents.
Others were separated with low
numbers to keep the list workable
With time this will expand with
clinics, home visitors, Urgent Care
EMT and Paramedic
We will support SCAN teams to
develop minimal standards We are
asking DCFS to have their staff visit at
least one SCAN meeting as part of
their cross training.
Adding hospitals to the network adds resources
(SCAN teams, Burn Units, PICU, Birth Services)
10 Counties (population 21 million) will form a working
network with Child Fatality Review and hospitals. (only
California and Texas have more people)
We began connecting
Child Fatality Review, teams
with multicounty cases
PRESENT - LA County Structure
• Other Death Review –
• Suicide review and undetermined review
• Child Traumatic Grief Conference
• March 2017 Program models “ Experts”
• Data base model for homicide review
• Needs software to manage its content
• New software
Future
• Mix CFR, DVFR, and other death review as Fatal Family Violence
• Standard data that helps monitor us (e.g. LA Model)
• Resolve Protect Records vs Protect Children
• Uncensored
• Automated data base of reports for each hospital
• data for Child Abuse Prevention
SOFTWARE…