CARES cares for kids who suffer abuse, neglect or trauma

If a picture is worth a thousand words, then the words in the pictures that adorn the offices of the CARES (Child Abuse Research Education and Service) Institute of RowanSOM could fill a library with stories of pain, suffering and, ultimately, recovery. Drawn by some of the children who have been patients at the CARES Institute, their messages are both horrifying and hopeful. One drawing asks, “Can it happen again?” while another reassures that “telling” about abuse is like spring cleaning – “A lot of hard work, but it feels great when it’s done!”

It’s nearly impossible to forget the messages, especially with the realization that nearly 20,000 patients have been treated at CARES since it opened its doors as the Center for Children’s Support in 1985.

On seeing the pictures, it’s hard not to speculate on the fates of those children if Dr. Martin Finkel and Dr. Esther Deblinger had chosen different career paths more than a quarter century ago. The two RowanSOM faculty members are the co-founders and co-directors of CARES, the regional diagnostic treatment center for children who have suffered abuse or neglect in New Jersey’s seven southern counties.

Today, Finkel and Deblinger lead a staff of more than 40 multi-disciplinary professionals whose focus incorporates every element of the CARES acronym. They not only help children recover from abuse, but also raise awareness and understanding of the trauma suffered by countless children around the world. And, as faculty at RowanSOM, the CARES staff has a unique opportunity to influence the next generation of physicians.

Regina Yu, is a fourth-year student who plans a career in pediatrics. Although she has assisted with research at CARES since 2011, she was impressed by the patient-physician interaction she saw there during her recent clinical rotation there.  

“How physicians talk to children is important,” Yu said. “The examination following reports of abuse can get very scary and emotional for the kids. But the way the CARES doctors talk to them is really an art that helps the kids to let their guard down and talk about what happened.”   

Kim Knapp began working with Yu on the CARES research in 2012. Now a third-year student at RowanSOM, Knapp chose CARES for a six-week elective this past summer and she echoed her student colleague’s observations on the unique clinical skills of the CARES physicians.

“Kids can tell you a whole lot and, especially in this field, that’s the most important part of their medical assessment,” she said. “Getting the kids to talk is a huge part of them being able to heal.”

“The work that the CARES staff does is just incredible on so many levels,” said Dr. Thomas Cavalieri, the RowanSOM Dean. “Their influence extends far beyond the children that they help every day here in South Jersey. The training that the CARES Institute provides and the groundbreaking research conducted there cut across geographic boundaries to help children around the world.”

Focusing on ‘R’

Given the profound nature of the services CARES provides to children and their families, and the Institute’s role in medical education, it’s easy to overlook the ‘R’ – Research – in the CARES name. But the pioneering contributions of CARES staff over the years have exponentially increased society’s understanding of the medical and mental health needs of children and families who are beset by abuse or violence. CARES staff members often provide training throughout the state and medical and mental health professionals from throughout Europe and Asia have visited the Stratford campus to learn the diagnostic and therapeutic techniques developed at CARES. 

A true pioneer in the medical care of abuse victims, Finkel is a pediatrician and the author of the first scientific paper published on the healing and interpretation of acute trauma related to child sexual abuse. His textbook on the medical evaluation of child sexual abuse is in its third U.S. printing and has been translated into Chinese and Japanese for use in those countries with pending translations into Spanish and Arabic.

CARES co-director Deblinger worked with colleagues from outside of CARES to create Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), one of the world’s most successful approaches to helping children recover from trauma. Validated by numerous scientific studies over the past decade, TF-CBT is currently in use throughout the United States and in over 90 countries worldwide.

"Although we originally developed TF-CBT to help children recover from sexual abuse, recent research has documented that it is also highly effective in addressing emotional and behavioral difficulties caused by a wide range of traumas," Deblinger said.  

Deblinger has traveled extensively to present TF-CBT training to health professionals who work with children. TF-CBT has been successful in helping children recover from traumatic stress caused by Hurricanes Katrina and Sandy and by the earthquake and tsunami that struck Japan in 2011. Through a partnership with the Medical University of South Carolina, Allegheny General Hospital and the National Child Traumatic Stress Network, introductory training in TF-CBT is also available as a free, web-based training program (www.musc.edu/tfcbt ).

“Research shows that children who experience the trauma of natural disasters, such as hurricanes or earthquakes, are at risk for developing significant psychological difficulties particularly if they have suffered prior traumatic experiences as well,” Deblinger said. "Without help, even small children may experience posttraumatic stress symptoms – withdrawal, depression, sleeplessness and unusually aggressive behavior – that can remain with them throughout their lives." 

Melissa Runyon, PhD, is the Treatment Services Director at the CARES Institute of RowanSOM and an expert on the impact of physical abuse on children and their families. Working with Deblinger, she developed Combined Parent-Child Cognitive Based Therapy (CPC-CBT), a short-term program for children and their parents (or caregivers). The program incorporates elements of cognitive based therapy to help children heal from the trauma of physical abuse and provides effective non-coercive strategies for parents who are at-risk for inflicting abuse.  

Sweden is one country that has recently embraced Runyon’s work. CPC-CBT training has been disseminated to child protection and social service workers, law enforcement, and child and family therapists across that country. There are plans for ongoing dissemination of CPC-CBT in that country as the CPC-CBT manual, published by Oxford Press, has been translated to Swedish and additional therapists are scheduled to be trained this fall. A pilot study of the impact of CPC-CBT has been accepted for publication and the Swedish Institute for Public Health has funded an additional three-year study of the program. 

Recently published research by CARES’ team members includes a study involving the use of TF-CBT among children and adolescents involved in foster care, an examination of PTSD profiles of youth who experienced abuse, and the impact of a child’s disclosure of sexual abuse on maternal caregivers.

According to Runyon, the process of gathering data to document that treatments are effective never stops at the CARES Institute of RowanSOM.

“All of the children we see are receiving evidence-based therapy,” she said. “Since 2001, we’ve conducted more than 2,000 pre- and post-treatment assessments with our clients. We found that – across the board – our therapies result in emotional and behavioral improvements for children and improvements in emotional functioning and parenting skills for parents. ”

Deblinger adds, “We continue to collect data because there is still so much more to learn both in terms of improving the effectiveness of the therapies we have developed and identifying factors that might reduce children’s risk of victimization.”

In fact, Deblinger and Finkel have conducted research that has examined parents’ and pediatricians’ knowledge base about child sexual abuse and their comfort levels in talking to children about body safety, personal space and privacy. 

“We have a long way to go” Deblinger says, “but the CARES team is dedicated to utilizing research to learn how to best help children overcome the adverse impact of child abuse, while also identifying methods to reduce children’s risk of such victimization in the first place.”