The4th meeting of the Subcommittee on Families and Children of the Interim Joint Committee on Health and Welfare was held on Wednesday, November 13, 2002, at 10:00 AM, in Room 111 of the Capitol Annex. Representative Tom Burch, Chair, called the meeting to order, and the secretary called the roll.
LRC Staff: DeeAnn Mansfield, Murray Wood, and Cindy Smith.
The first item on the agenda was a presentation on adoption trends and Adoption and Safe Families Act (ASFA) requirements by April Vandeventer, Director, Division of Protection and Permanency, Cabinet for Families and Children, and Charla Pratt, Manager, Adoption Services Branch, Cabinet for Families and Children. Ms. Vandeventer reported that adoptions have increased from 222 in 1998 to 564 in 2002. She said most adoptions from the Cabinet for Families and Children are foster care adoptions.
Representative Burch asked if foster parents that adopt continue to provide foster care. Ms. Vandeventer said some foster parents continue to foster children, and some do not. It varies from family to family.
Next, Ms. Vandeventer discussed termination of parental rights (TPR) data. From July 1, 2000 through June 30, 2001 there were 299 TPR’s; from July 1, 2001 through June 30, 2002, there were 316 TPR’s. In response to a question from Representative Jenkins, she reported that for 2000-2002, Kentucky reported a 9 percent disruption rate for adoptions. For 2002, Kentucky reported a 7 percent disruption rate for special needs adoptions. Next, she discussed Kentucky’s Incentive Bonus Dollars, which are federal funds to states that improve their number of adoptions. She said for the federal fiscal year 1999, Kentucky received $235,765 in incentive bonus dollars because they had a 53 percent increase in adoptions. For federal fiscal year 2002, Cabinet data indicates that 564 children were adopted from public foster care, and Kentucky received $796,000 in bonus dollars. She said that Kentucky uses the incentive bonus dollars for the following: (1) advancing adoption technology; (2) resource family training; (3) staff adoption training; (4) recruitment programs; (5) marketing of foster care adoption program; (6) training programs for the legal professionals; and (7) employing additional legal professionals.
Next, she talked about the Kinship Care Program. She said the Kinship Care Program was established to facilitate permanency for children who otherwise would be placed in foster care by placing them with relatives. As of August, 2002, approximately 4,984 children were in the Kinship Care Program.
The last item on the agenda was a presentation on “Shaken Baby Syndrome”, by Betty Spivack, M.D., Forensic Pediatrician, and Co-Director of Clinical Forensic Program at the University of Louisville Department of Pathology, Rashmi Adi-Brown, Program Director, Prevent Child Abuse Kentucky, Peggy Arvin, R.N., Cabinet for Families and Children, and Marcia Burklow, Department for Public Health.
Ms. Arvin began by saying that shaken baby syndrome (SBS) is an abusive head injury. SBS is the severe intentional application of violent shaking in one or more episodes resulting in intra-cranial injuries to a baby’s brain. The shaking episodes cause an acceleration-deceleration injury. A baby’s head is large compared to its body, and its weak neck muscles allow the head to move around with little support. SBS is similar to whiplash in adults, but cause more injury to the brain because of the baby’s physical make-up. Two short videos were shown to the members, one which demonstrated shaken baby syndrome, and one was a news brief on SBS.
Representative Burch asked if this is something that is found across all income levels. Dr. Spivack said it is not something only identified with the poor, but there seems to be an association with parental alcohol and drug abuse, and the cases are higher in the most vulnerable communities where poverty increases parental stress, but child abuse fatalities also occur with upper class citizens.
Next, Rashmi Adi-Brown spoke about Prevent Child Abuse Kentucky. She said SBS is just one of the preventions programs that her agency deals with, but in the last few years strong steps have been taken to address awareness and education across the state regarding SBS. A prevention effort in 1998, piloted in four hospitals across the state, provided an opportunity for parents of newborns and other interested family members to view a seven minute video entitled “Crying, What Can I Do?” In 2001, they entered into a partnership with the NFL Players Association. They received a grant and nine of the NFL players agreed to have their picture taken with 11 babies to make a poster targeted at men, who are primarily the perpetrators of shaking. They also joined with the Cabinet for Families and Children in two initiatives, one was a brochure and poster which is currently being distributed, and the other was four trainings that were done across the state regarding shaken baby syndrome. She said they would like to see this type of training regarding shaken baby syndrome mandated as education for parents throughout the course of the pregnancy.
Next, Dr. Betty Spivack addressed issues regarding SBS, and she recommended that information about SBS be provided to all parents, grandparents and care-givers. Dr. Mark Diaz, a pediatric neurosurgeon started a program in New York where volunteers went into postpartum wards in the hospital and spoke to both mothers and fathers and had them sign an affidavit that they were aware that shaking is dangerous to the infant and that they would not shake their babies. He found over a 60 percent decrease in SBS in the following two years. Currently, this program is being conducted in North Carolina, Utah, and New York.
Dr. Spivack said there needs to be more help in teaching pediatricians, family practitioners, and nurse practitioners to identify children with the milder form of abusive head trauma and shaken baby syndrome. About one-third of all children with abusive head trauma are misdiagnosed initially.
Dr. Spivack also spoke about the clinical forensic program in Louisville. They are a resource for evaluation and documentation of physical abuse. Half of the children they see are from Jefferson County. They also have contracted to provide services around the state. She said Centers of Excellence need to be set up around the state modeled after the regional child advocacy centers which are making progress in evaluating allegations of sexual abuse. Currently, Dr. Spivack is the only full-time forensic pediatrician in Kentucky.
Next, Marcia Burklow from the Department for Public Health spoke about child fatality review and injury prevention for children. The legislation that initiated the overall state child fatality review system was passed in 1996. They rely on data from the Cabinet for Families and Children for abuse and neglect statistics for their annual report. She reviews all the vital statistics information regarding death certificates statewide. They also review coroner reports. According to 2001 data, she reported that there were seven child deaths due to abusive head trauma. She said that they sub-contract with the Kentucky Injury Prevention Center through the University of Kentucky, and there is an attempt from their staff to educate medical students and practitioners on ways to help diagnose abusive situations.
The meeting was adjourned at 12:02 p.m.