Child Abuse Pediatrics Chooses You

Jan 25, 2013, 9:00 AM, Posted by

Brendan T. Campbell, MD, MPH, is an assistant professor of surgery and pediatrics at the University of Connecticut School of Medicine and an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2000-2002).

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

Brendan Campbell: I am a pediatric general and thoracic surgeon and the medical director of the pediatric trauma program at Connecticut Children’s Medical Center in Hartford. Connecticut Children’s is a Level I pediatric trauma center, which means we see patients with relatively minor and severe multisystem injuries. Caring for abused children is one of the most important services we provide. When children with non-accidental trauma are initially identified, they are admitted to the pediatric surgical service to rule out life-threatening injuries. During their admission we work closely and collaboratively with the suspected child abuse and neglect team (SCAN) to make sure children with inflicted injuries are identified, have their injuries treated, and are kept out of harm’s way.

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

Campbell: It can be challenging to get a pediatric surgeon interested in child abuse because caring for vulnerable children who are intentionally harmed is not easy, and most of these kids don’t have life-threatening injuries that require an operation. What draws me to the care of injured children is that they are the patients who need me the most.  If we don’t identify the risks they are up against at home, no one else will. They need someone to advocate for them.

The other thing that draws me to child abuse pediatrics is that there is an enormous need to develop better ways to screen for and to prevent abuse.  Over the last 30 years we’ve made enormous strides in lowering the number of children injured in car crashes by enacting seat belt laws, toughening drunk-driving laws, and improving graduated driver licensing systems. Child abuse in the United States, however, remains a significant public health problem that needs more effective screening initiatives and prevention programs.

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

Campbell: If you decide to be a pediatric general surgeon, you don’t choose to become involved with child abuse pediatrics; child abuse pediatrics chooses you. Most pediatric surgeons in clinical practice are based at tertiary children’s hospitals, which is where most children with suspected non-accidental trauma end up for evaluation and treatment. My time as an RWJF Clinical Scholar was instrumental in preparing and motivating me to want to improve processes of care around non-accidental trauma because there is much more than the clinical issues that is important. Societal, cultural and socioeconomic issues related to health care delivery are critically important to both preventing and improving the processes of care around child abuse.

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

Campbell: The two years I spent as a Robert Wood Johnson Clinical Scholar at the University of Michigan were easily the most intellectually stimulating and satisfying of my nine years of post-graduate medical education. In addition to the curriculum offered through the Clinical Scholars program, I was also able to complete a master’s degree in public health and devote part of my time to clinical work as an extracorporeal life-support fellow working with Robert Bartlett, a pioneering surgeon who developed a membrane oxygenator to help children with cardiac and respiratory failure. The most important thing that happened while I was a Clinical Scholar was that my perspective on the delivery of surgical care shifted from the individual patient to the delivery of surgical care at the population level.

The other extraordinary opportunity I had as a Clinical Scholar was to cultivate my interest in health policy. One of my most memorable experiences happened at the end of April 2002, when I traveled to Chicago to participate in the Health Economics Symposium sponsored by the RWJF Clinical Scholars program at the University of Chicago. The program title was “Universal Health Coverage: Who Cares and Why?” The afternoon session at the symposium was titled “Distributive Versus Contributive Justice: Whose Responsibility is Health?” There was one participant in that session who really impressed me with his command of the subject matter and his passion. That person was Illinois State Senator Barack Obama. 

HCB: Can you describe your work in health policy?

Campbell: My work and interest in health policy, which started when I was in Ann Arbor, has grown significantly. Shortly after arriving in Connecticut I had the opportunity to serve on the Governor’s Task Force on Teen Driving that ultimately created the recommendations to strengthen Connecticut’s graduated driver licensing system, which Gov. Jodi Rell signed into law. 

Most recently, I was appointed by the Connecticut State Trauma Committee to identify ways to improve screening for child abuse in the emergency department setting. I also collaborated with Harford’s other two adult trauma centers to hold a gun buy-back program for the last four years, which has successfully removed nearly 500 unwanted guns from circulation and has educated people about the importance of safe firearm storage. 

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?

Campbell: I am the parent of two elementary school age children, a pediatric surgeon, and a gun owner. We must do something to lower the risk of firearm injury in this country. Former RWJF Clinical Scholar  Arthur Kellermann, MD, MPH, FACEP, demonstrated that access to guns dramatically increases the risk of death and injury and made physicians and the public health community aware of the inherent risks of firearm ownership. The Connecticut Children’s Trauma Program and Injury Prevention Center has developed a public policy statement in response to the shooting at Sandy Hook Elementary School that recommends four common sense firearm policy reforms:

1.      Federal regulation of gun purchases that would include mandatory waiting periods, closure of gun show/internet sales loopholes, mental health restrictions for gun purchases, and more comprehensive background checks.

2.      Renew the federal assault weapons ban that expired a decade ago and close the loopholes in Connecticut’s assault weapons ban.

3.      Ban high-capacity magazines.

4.      Allow federal public health agencies to study firearm violence and make recommendations on evidence-based ways to prevent firearm violence.

While we may not be able to prevent every gun injury in the United States, I believe that sensible restrictions on ownership of the most dangerous firearms (i.e., assault weapons and handguns) should be something most Americans are willing to accept to make our children and communities safer.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.