In the Emergency Department (ED), the 8-month-old was alert and drinking a bottle despite being covered from head to toe with lesions that turned out to be cockroach bites. The bites qualified as parental neglect, but Jill Glick, MD, and her team were concerned about injuries that might be under the baby’s skin. They ordered an X-ray, head CT and eye exam, which revealed that the baby had four rib fractures, subdural hematomas and retinal hemorrhages — a clear case of child abuse.
One of only 14 child abuse pediatricians in Illinois, Glick, medical director of Child Advocacy and Protective Services at the University of Chicago Medicine Comer Children’s Hospital, evaluates not only children who come to Comer’s ED for suspected child abuse, but also children who are treated at other hospitals throughout Chicago. Glick created and directs the Multidisciplinary Pediatric Education and Evaluation Consortium (MPEEC), which provides expert medical review of cases of suspected child abuse for children age three and younger living in Chicago — the only city in the country to mandate medical expertise in child abuse evaluations.
MPEEC brings together child welfare investigators from the Illinois Department of Children and Family Services (DCFS), law enforcement and child abuse medical experts to diagnose or rule out child maltreatment. “We have the expertise to aid in determining if a head injury in an infant was due to an accident or abusive head trauma,” says Glick. “There is no room for speculation in potential child abuse cases. Removing a child unnecessarily from a loving home or returning a child to harm’s way — either of these decisions is life-changing and traumatic.” The interagency process has set a national standard for the medical evaluation of children suspected of being abused or neglected.
In Chicago, children 36 months or younger who are reported to DCFS with head trauma, skeletal trauma or internal injuries, receive a real-time investigation by MPEEC. Glick and her team contact the treating physician, the DCFS investigator and law enforcement, guiding them on the medical evaluation of the child and the gathering of historical and scene information related to the child’s suspected abuse. After reviewing the medical records and the collected information, Glick writes a comprehensive medical opinion diagnosing or refuting the allegations of child abuse.
We have the expertise to aid in determining if a head injury in an infant was due to an accident or abusive head trauma. There is no room for speculation in potential child abuse cases.
Jill C. Glick, MD
Although the collaborative investigation is mandated only for children living in Chicago, Glick provides guidance to any medical, child welfare, law enforcement or legal professionals who call. “If a child needs to be evaluated by a child abuse pediatrician, we will facilitate that recommendation,” she says. Glick also advises medical colleagues on how to have a difficult conversation with the parent and offers support during the child welfare investigation.
MPEEC consults on more than 200 child abuse cases per year. In addition, Glick heads the medical team dedicated to child maltreatment cases that come to Comer Children’s, where hospital policy requires a child advocacy and protective service consult for any child under age two who is admitted with an injury, failure to thrive, medical child abuse or medical neglect.
MPEEC is a national landmark program. It was one of the first to recognize the need for necessary medical expertise within an interagency process. It has set a national standard for the medical evaluation of children suspected of being abused or neglected. Glick’s goal is to broaden MPEEC’s reach beyond Chicago. “I would like primary care providers throughout Illinois to be able to access child abuse medical expertise, just like any other subspecialty consult,” says Glick. “We are working toward a model where medical providers work under the direction of child abuse pediatricians to ensure all children receive an appropriate medical evaluation and automatic referral to a MPEEC team.” Currently, most infants reported for suspected child physical abuse do not receive the correct medical studies, comprehensive pediatric history and exam, according to Glick.
Glick has also helped write the Children’s Hospital Association’s national standards of care for child maltreatment and abuse. She sits on Illinois’ Children’s Justice Task Force, which is striving to improve the quality of response to child abuse across the state. She was appointed by the governor to sit on an advisory committee to the director of DCFS, and she is a member of the Cook County Child Death Review Team.