University of Iowa Child Protection Program

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In the following commentary, Dr. Resmiye Oral outlines the history of the University of Iowa’s Child Protection Program in preparation for the 2014 Provost’s Global Forum, “Child Protection: A Global Responsibility.” In what follows, Dr. Oral introduces a few of the key players in her extensive network of colleagues around the world who have supported her goals of education, training, and service in child protection, and who will appear at the 2014 forum.

By Resmiye Oral

The University of Iowa has a long history of leadership in the field of child protection. In the 1970s, Dr. Gerald Solomons, the then-director of the Child Abuse Clinic, spearheaded the establishment of a four-state network of child protection training and program development in Iowa, Missouri, Minnesota, and Nebraska. Under his leadership, Iowa drafted and passed its first child protection law in the 1970s – one of the earliest states doing so.

 
Dr. Resmiye Oral

After his retirement, two more leaders, Drs. Lori Fraiser and Randy Alexander, led the program. After their departure, the federal funding of child protection programs came to a halt across the country in the 1990s, and until 2001 the program went into a dormant state without a leader. Since this proved to be unacceptable at the only medical school of the state, the head of the UI Department of Pediatrics Dr. Morris saw the need to rejuvenate the program under new leadership.

I was very fortunate to be chosen to be that leader in 2001, establishing the University of Iowa Child Protection Program anew working with the good people of Iowa and the UI. I started a multifaceted saga of program development, teaching, research, and service, as well as outreach to international communities to improve the management of child abuse and neglect abroad and in the U.S. and Iowa.

Today, despite funding limitations, the University of Iowa Child Protection Program is functioning as a center of excellence in many areas:

  • It holds a regular child protection clinic to serve clients from all walks of life, referred by numerous agencies, including physicians and families.
  • It provides consultation services to all units at the UI Children's Hospital for severely abused and criminally neglected children admitted to the hospital.
  • It provides consultation services to the Department of Human Services, law enforcement, county attorney's offices, and courts in Iowa, Illinois, and Missouri by doing record review on high profile cases, holding statewide multidisciplinary case conferences on select challenging cases, and assessing some of the cases in our own clinic.

As a result of my work, I engage in several multidisciplinary teams across the state, and, as a result of all these client-based services, I testify in court 10-12 times a year to advocate for the best interests of children. Research and program development are also a solid part of the spectrum of functions of the program.

Dr. Oral stands with a few of her Turkish colleagues after a training session at Behcet Uz Children's Hospital in Izmir, Turkey, in 2011.

Since I am originally from Turkey, when I decided to stay in the U.S. in 1998 I also decided to become an academic and build bridges between Turkey and the U.S. to offer all potential resources to Turkish professionals in order to help my country of origin improve its child protection system. I had come to the U.S. only to do a one-year fellowship on child abuse and neglect. My goal was to return to Turkey and lead the first hospital-based multidisciplinary child protection team at my hospital to establish a network of similar teams across the country. However, political barriers got in the way and it became clear to me that in the short run, I wasn't going to reach that goal if I returned at the end of the year. Thus, I made a very radical decision and stayed, repeating pediatric residency to become board certified in the U.S. in order to apply for academic positions.

Dr. Frank Morris and his search committee saw what I hoped they would in me. During my hiring process, I expressed my desire to use vacation time in Turkey to start a training campaign there on child abuse and neglect including hospital-based and community-based multidisciplinary, interagency team building and national systems building. I will never forget his graciousness and generosity when he told me, "You will have two weeks of academic time every year to do that, save your vacation time to wind down".

And so I did. I worked with my dear colleagues in Turkey and together we built a large national collaboration. The number of hospital-based multidisciplinary teams has exceeded 30 teams now. In addition, we were able to reach the government and have a positive impact on the parliament to help them understand that the multidisciplinary, interagency collaborative model of the child protection center structure would revolutionize how abused children could be managed in Turkey in a humane, rehabilitative, and just manner. Thus, as a result of the work of the last five years, the child protection center model was approved as the model to be adopted by the Turkish government and expanded into a network of 29 child protection centers in 28 provinces, 12 of which have already been established. There is much more to be done in the country, but I trust the good and enlightened people and professionals of Turkey, one of whom is Betul Ulukol, a social pediatrics professor, will handle them one by one with the best interest of children in their hearts.

Dr. Oral poses with her Portuguese colleagues Dr. Teresa Magalhães and Dr. Agostinho Santos after a training session at the 19th World Child Abuse Conference in Istanbul, Turkey, in 2012.

As a result of this work, the first child protection center in Ankara, Turkey, was accepted as an honorary member of the National Children's Alliance in the U.S., which funds and oversees more than 700 similar centers in the U.S. thanks to the vision of its director Teresa Huizar. Also featured at our March 2014 conference will be Drs. Ken McCann and Regina Butteris, the medical directors of two child protection centers in Iowa, Karen Evans, the director of the Johnson County Department of Human Services, and Christine Corken, assistant county attorney of Dubuque County in Iowa, who will discuss how this system is working in Iowa.

During one of my teaching activities at an international conference in Turkey, I met a team of bright, open-minded Portuguese forensic medicine physicians led by my now-very good friend Professor Teresa Magalhães. I will never forget how she pointed to me and said, "We want you in Portugal!" benevolently. And I went. We have been working together for the last five years around multiple educational venues and engaging in cross-training activities.

One day I received an e-mail from the American Academy of Pediatrics Global Health section asking me if I would be interested in working with Dr. Naeem Zafar, a pediatrician from Pakistan, who was applying for a grant to do training on child abuse and neglect in his country. Of course I would. He and I worked together and his application was so moving that he was awarded the necessary funding to train nurses in his country to increase recognition of child abuse and neglect.

While visiting Crete, Greece, where my ancestors came from, I taught a full-day conference with Dr. George Nikolaidis, an adult psychiatrist on how to organize resources in Crete to establish a multidisciplinary response to child sexual abuse. We knew each other from the International Society for the Prevention of Child Abuse and Neglect, and this encounter strengthened our connection. When he became the proud PI (principal investigator) of a European Union funded research project to study the epidemiology of child abuse and neglect and adverse childhood experiences in nine Balkan countries, including Turkey, the Turkish Team led by Dr. Zeynep Sofuoglu, a physician, invited me to be the ethical and scientific consultant for the part of the project to be carried out in Turkey. And I did.

Dr. Oral presents information on multidisciplinary response to child sexual abuse at a training session in Rethymnon, Crete-Greece, in 2012.

I knew it was a sound project. The team would be using the I-CAST questionnaires, which were created by a team of international trainers led by one of my extraordinary colleagues, Dr. Desmond Runyan from the U.S. You will hear from him the history of the development of I-CAST questionnaires that now allow studying adverse childhood experiences and child abuse and neglect epidemiology at a global scale. I was also intrigued by adverse childhood experiences since I had listened to Dr. Felitti in Amsterdam, Netherlands, at a child abuse conference. As a result of that fortunate encounter, you will also hear from Dr. Felitti, who will tell us what will happen to the health (physical and emotional) of abused children of today as adults if we don't interfere in a very effective way.

Finally, at our conference we will also hear from my dear colleague Dr. Waldron, who will tell us about the American Academy of Pediatrics' position on adverse childhood experiences; from Dr. Verlig, who will tell us about what the Iowa steering committee on adverse childhood experiences has been doing since its inception; and from Dr. Gudmunson, who will tell us what data from Iowa on adverse childhood experiences tell us about Iowa population, which we will be able to compare with data from the nation and nine Balkan countries, including Turkey.

This is the story of my decade-long work and ever increasing connections both domestically and internationally. It fills my heart with pleasure to be able to host these phenomenal individuals after working with them for over a decade in some cases, with trust, mutual appreciation, learning, and sharing of resources.

The Provost’s Global Forum will be held in March 2014. More information

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