Feb 1 2013
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Clinical Scholar Discusses Work to Curb and Treat Child Abuse

Andrea Gottsegen Asnes, MD, MSW, is an assistant professor of pediatrics at the Yale School of Medicine and a Robert Wood Johnson Foundation (RWJF) Clinical Scholars program alumnus (2001-2003).

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Human Capital Blog: What kind of work do you do in the area of child abuse pediatrics?

Andrea Gottsegen Asnes: I am a child abuse pediatrician.  Nearly eight years ago, I joined former Robert Wood Johnson Foundation (RWJF) Clinical Scholar and fellow child abuse pediatrician John Leventhal, MD, as a member of the faculty of the Yale School of Medicine. In 2009, we both became board certified in the new pediatric sub-board of child abuse pediatrics. At Yale, I am the associate director of the Yale Child Abuse and the Yale Child Abuse Prevention programs.

Most often, I am asked to evaluate suspected cases of child abuse by other medical colleagues, by my state’s child protective services agency, or by local police departments. I am frequently asked to testify in court as a medical expert in cases of suspected child maltreatment. I also participate in several multidisciplinary, community-based teams that are designed to improve both criminal prosecutions of those who abuse children as well as the care that abused children receive. 

I have a particular interest in optimizing recognition of subtle signs of physical abuse by frontline pediatric providers, and I teach on this subject regularly. I also have a special interest in linking abused children and their non-offending caregivers to mental health treatment. In 2006, I started the Bridging Program, which provides immediate, evidence-based mental health care to sexually abused children and their non-offending family members. My hope for the future is to devote increasingly more time to work in child abuse treatment and prevention.

HCB: Why did you decide to focus on this area?

Gottsegen Asnes: I chose to spend some of my time doing child abuse work early in my career and then made it my primary focus. Initially, I was driven by a general wish to do some good: to help vulnerable children and to answer an unmet need where I was working at the time. Once I was involved in the work, I was sustained by the enjoyment I took, and still take, in working with many people outside the hospital setting. 

On a given work day I am as likely to engage with child protective services workers, attorneys, police detectives and victims’ advocates as I am with other medical professionals. The systems in which I work are messy and less predictable than the hospital and I do my best to navigate them effectively. As I have gotten older, I also have come to a desire to help struggling parents do a better job with their children. This came as a surprise to me; when I was younger, I thought mostly about my wish to care for children and less about how I could help parents to do the caring.

HCB: How did you get your start in child abuse pediatrics?

Gottsegen Asnes: I was a social worker before I became a physician, and I have always had an interest in working with and advocating for vulnerable people as well as a special interest in children. When I was working as a pediatric hospitalist at the Cleveland Clinic, I was offered the chance to medically direct the child protection team there.

Soon after, when my husband and I were jointly recruited to Yale, I researched the pediatric faculty and found John Leventhal. When I asked to meet with him during my recruitment trip (for a hospitalist position that I did not take), I didn’t quite realize I was having iced tea with a leader in the field of child abuse pediatrics. Luckily, something pushed me to ask him to mentor me. I became his first partner at Yale, and he taught me to do the work I do now. I wish I could say I had a fully articulated vision for a career when I made that choice, but I know that I didn’t. I had an interest and a desire to do meaningful and useful work. I was incredibly lucky to find myself in the hands of such a capable mentor who made me the physician I now am.

HCB: How did the RWJF Clinical Scholars program affect your work in this field and your career trajectory?

Gottsegen Asnes: My time as an RWJF Clinical Scholar taught me an uncountable number of skills, but the two I recognize most often are how to think about and understand social determinants of health and how to address (often with skepticism) numbers. My training in social determinants of health as a Clinical Scholar underscores not only the way I work but also the way I see the world. I learned an illness model as a pediatric resident. As a Clinical Scholar, I learned to look at society, at communities, and at culture as predictors of health and wellness. This is exactly the kind of ecological model that informs my thinking about both the roots of child abuse and the ways in which we can prevent child abuse.

As for numbers, I didn't recognize it at the time, but the opportunity I had to learn about epidemiology as a Clinical Scholar prepared me for my current work in important ways. The ability to count cases of child abuse, and to recognize the inherent flaws in any counting system, are crucial to our ability to evaluate the success of our treatment and prevention programs.

HCB: Can you describe your work in health policy?

Gottsegen Asnes: Over the last several months I have had the opportunity to work in collaboration with physician leaders and our state’s child protective services agency, the Department of Children and Families, on an effort to improve recognition of abuse in Emergency Department settings. This work gave me the unexpected and very pleasant chance to reunite and work with former RWJF Clinical Scholar Brendan Campbell, MD, MPH (University of Michigan 2000-2002), who is now a pediatric trauma surgeon in Connecticut. Together, Brendan and I and others are developing reproducible tools to assist frontline providers in identifying signs of abuse when they see them.

HCB: In the wake of the Newtown shootings, what are your thoughts about what needs to be done to curb gun violence in Connecticut and in the United States?

Gottsegen Asnes: As a pediatrician and a former Clinical Scholar I can answer this question in the most evidenced-based way, and I quote the American Academy of Pediatrics’ Council on Injury, Violence and Poison Prevention Executive Committee as I do so: “The most effective measure to prevent suicide, homicide, and unintentional firearm-related injuries to children and adolescents is the absence of guns from homes and communities.”

To this end, I support immediate renewal of the ban on assault weapons, careful efforts to restrict loophole sales of guns without background checks (such as those sales that occur at gun shows and online), and the strengthening of background checks. I have seen highly successful buy-back programs for guns here in Connecticut and hope these will both continue and spread. At the very least, families must be repeatedly and strongly counseled about the need to keep guns in locked storage away from children and separate from ammunition.

RWJF Clinical Scholars have played a critical role in the development of the medical subspecialty of child abuse pediatrics. Read more about their important work here. Read a blog post on child abuse prevention by Brendan Campbell.

Tags: Clinical Scholars, Health Care Workforce, Violence Prevention, Violence and Trauma, Voices from the Field