The Safety of Minors on College and University Campuses: A Social Justice Challenge

1. The Safety of Minors on College and University Campuses: A Social Justice Challenge Bethany Mohr, MD, FAAP Clinical Assistant Professor Medical Director, Child Protection Team Department of Pediatrics and Communicable Diseases University of Michigan Health System

2. The University of Michigan Child Protection Team • Bethany Mohr, MD and Lisa Markman, MD • Provide expert medical opinions regarding: • Physical Abuse, Sexual Abuse, Neglect • Medical Child Abuse • Martha Kerr, LMSW, Clinical Coordinator (Abuse Prevention Initiative) • Child Abuse • Domestic Violence (Intimate Partner Violence) • Vulnerable Adult Abuse • Donna Schaefer, LMSW, CPT SW • All members of the CPT work closely with DHS/LE/Judicial System and have the means to readily communicate regarding specific children and cases.

3. Maltreatment Types US Department of Health and Human Services , Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2012). Child Maltreatment 2011.

4. Former U-M resident physician Stephen Jenson • Jenson, 36, who was fired from the hospital in late December 2011, is charged with four counts of possessing child sexually abusive material. • Records show university officials waited six months before filing a report with university police after another resident physician told them she found child porn on a thumb drive that was left in a computer at the Pediatric Emergency Department. She reported that she saw a photo of a “nude adult lying” on a young child whose arms "were bound" and appeared to be tied to a bed frame. • They found child porn on a thumb drive in his work bag, on a laptop computer in his living room and on a hard drive in his bedroom.

5. State suspends Ann Arbor pediatrician Howard Weinblatt's medical license • Weinblatt pled no contestto one count of surveilling an unclothed person in January 2012 and was sentenced to 5 years of probation and a $2,000 fine. Weinblatt was also required to move from his home and to register as a sex offender. • Weinblatt was accused of watching a 12-year-old girl (a family friend and one of his patients) change clothes in her bedroom. At his sentencing, he expressed remorse for the pain and suffering the case had caused to the victim, her family and his family. His Burns Park home was situated just 11 feet from the girl’s home. • During their investigation, Ann Arbor police found images of suspected child porn on computers they seized from Weinblatt's home Nov. 22, the police report says. Some of those images the federal government considers "child exploitation material," the report says.

6. Protecting Children from Abuse by Health Care Providers • SEXUAL ABUSE • Occurs when a child is engaged in sexual activities that the child cannot comprehend, for which the child is developmentally unprepared and cannot give consent, and/or that violate the law or social taboos of society. • Dominant or more powerful person (“control and authority”) coercing a child or adolescent to engage in sexual activities for that dominant person’s own sexual stimulation or gratification of other people.” • Someone the child: • Knows and trusts; position of authority  Health Care Provider

7. Sexual Abuse • Sexual activities • Rape to physically less intrusive acts done to or by the child: • Oral-genital • Digital-genital • Anal contact • “Non contact abuse” • Exhibitionism, voyeurism, pornography

8. DEFINITIONS • Pedophilia • Over at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a prepubescent child or children • Hebephilia/ephebophilia • Sexual focus on postpubertal minor girls/boys • Paraphilias • Persistent, deviant patterns of primary sexual attraction • Exhibitionism • Fetishism • Frotteurism • Pedophila • Masochism • Sadism • Transvestitiism • Voyeurism

9. PEDOPHILIC MOLESTERS • Often choose vocations/activities that provide access • Select vulnerable victims and groom them • Prolonged periods • Assess response to gradually more intrusive sexual activities • Assess ability to remain silent • Groom parents and community

10. HEALTH CARE PROVIDERS • Frequency of sexual abuse of pediatric patients? • Incidence of pedophilia among pediatricians? • Frequent, potentially private, contact with children • History-taking and verbal interaction • Physical Examination • Annual assessment of anogenital region; and with complaints • Gloves • Draping/gowning • Chaperones • Joint decision • Provider directed

11. INDICATORS PARENTS SHOULD BE INFORMED THAT: • Favors, gifts, unusual social contact • Exam indications, frequencies, techniques unusual • Parents/chaperones excluded from exams • Chaperoned exams can be requested • Any concerns about sexually inappropriate exams or provider actions should be reported to the institution’s administration • They have the right to report directly to CPS

12. UMHS HEALTH CARE PROVIDERS • Should be trained to recognize and abide by appropriate provider-patient boundaries • Policies • Medical institutions: • Should screen staff members for a history of child abuse issues • Establish policies and procedures to receive and investigate concerns about patient abuse • Each person has a responsibility to ensure the safety of children in health care setting and follow appropriate legal and ethical reporting and investigation procedures Pediatrics 2011; 128:407-426

13. UMHS HEALTH CARE PROVIDERS • Training • Appropriate professional boundaries • Professional interactions during sexually sensitive/explicit discussions/examinations • When and how to use chaperones • Screening • Past employment • Criminal and child abuse registry checks • Assessment • Review which queries peers, parents, nursing staff and supervisors

14. UMHS POLICIES NEEDED • Maintaining a Professional Relationship with Patients/Families • Patient Chaperones • Allegations of Abuse or Neglect by a UMHS Staff Member • Staff Allegation Protocol for Staff

15. REASONABLE CAUSE TO SUSPECT ABUSE/NEGLECT OF A CHILD BY A MEDICAL PROVIDER

16. The University of Michigan Child Protection Team24/7734-763-0215 855-264-9763