The obstacles appear early and often during child abuse investigations.
Rarely does someone confess to a child abuse crime, especially involving small children. Instead, the explanations most often heard are that the child was simply discovered that way or was injured in a fall, usually from a bed or couch.
“Generally it’s a crime of isolation and only one person really knows what happened,” said Dr. Jayme Coffman, medical director of child abuse services at Cook Children’s Medical Center.
Often, the victims are too young to recount the incident.
“They’re not verbal and they can’t tell anyone what happened, and nobody witnessed this,” said Sgt. Seth Archer, supervisor of Arlington police’s Crimes Against Children Unit.
Because child abuse investigations involve many layers, Tarrant County employs a team approach. Law enforcement, Child Protective Services, medical professionals and the district attorney’s office work in unison to investigate child abuse.
Once a child abuse case is suspected, whether from an outcry from a child to a teacher or discovered during a police call or a visit to a hospital, the agencies go to work.
Searching for signs of abuse
The Cook Children’s Medical Center’s CARE team and the Tarrant County medical examiner’s office are charged with determining if injuries are accidental or intentional, taking into consideration the explanation given for the injury.
“We want to look at the [child’s] developmental level and then look at the biomechanics of the injury itself and see if all those mesh,” Coffman said. “If they don’t, then we have to consider abuse.”
Begun in 1994 to work sexual abuse cases, the team expanded its scope in the early 2000s, working physical abuse cases for Tarrant County as well as outside counties.
Made up of physicians, nurses and staff trained in detecting and treating child abuse and sexual abuse, the teams see patients referred from inside the hospital, CPS, and law enforcement.
Staff members get a thorough history of each child, talking to the child when possible and to caregivers. They work to make sure explanations for the injury match the type of injury and the child’s development level, and that there aren’t any other medical issues that could mimic abuse.
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“You can’t say by looking at a child what’s happened to them. It’s the history that tells you,” Coffman said.
Of suspected physical abuse cases sent to the CARE team, Coffman said that on average, abuse is believed to have occurred about 40 percent of the time.
“People think we’re always looking for abuse. We’re not,” Coffman said. “Most of the time, we don’t think it’s abuse.”
A one-stop shop for victims
If abuse is suspected, the child will likely end up at one of three Alliance For Children advocacy centers in Tarrant County — in Arlington, Fort Worth and Hurst. Once a victim arrives at Alliance, staff and others will collect evidence, do medical evaluations and forensic interviews, and provide family advocacy and trauma-focused counseling.
The county’s two largest police departments — Fort Worth and Arlington — base their Crimes Against Children Units inside the AFC centers, where CPS investigators also are stationed.
The teamwork between police and CPS ensures toes aren’t stepped on as the two agencies conduct their separate investigations. In some instances, Archer said, CPS investigators can have more luck drawing out information in an interview than a detective with a gun and a badge.
“It can be very beneficial because sometimes parents will tell CPS the wildest things that they would never tell us,” Archer said.
Victims are interviewed by specially trained AFC forensic interviewers.
Interviewers must build a rapport with each child, establishing that the child understands the difference between truths and lies before getting the child to share about the alleged abuse through open-ended questions.
“We have to be able to go to court and and defend the way we interviewed the child and not that we put words in their mouths or led them in any kind of direction,” said Kim Rocha, a former AFC spokeswoman.
In a separate room, Crimes Against Children detectives and CPS investigators often watch the interview via video monitor.
CPS investigators housed at the advocacy center specialize in working sexual abuse cases, severe physical abuse cases involving young children, and child fatality cases.
Child safety is paramount
All the involved agencies, including the Tarrant County district attorney’s office and Cook’s CARE Team, come together biweekly at the center to discuss findings and concerns with each case.
Because criminal cases take time to build and an immediate arrest is not always possible, the cooperation among agencies is critical in keeping victims safe, said Fort Worth police Sgt. Wade Walls, with the Crimes Against Children Unit.
If a child is believed to be in danger, CPS can seek an emergency removal of the child or put in place a safety plan, a written agreement in which a caregiver agrees to certain measures to keep the child safe — including sometimes placing the child with a relative.
“We want to keep the child safe, too, but our powers are limited from that aspect if we don’t have our probable cause right then and there,” Walls said. “Sometimes we’re waiting on a medical affidavit saying a doctor says this is abuse. Sometimes that may not come for a week. They can safety-plan that kid out of the home on limited facts.”
In fiscal year 2016, AFC centers in Tarrant County served 2,088 children.
Each child death is reviewed
Once a month, a group of first responders and child advocates gather to share information about the deaths of children aged 17 and under that have occurred in Tarrant County and whether they could have been prevented.
Tarrant County’s Child Fatality Review Team is one of more than 1,200 across the country.
“It sounds a little grim when I first introduce the idea of reviewing child deaths,” said coordinator Patti Shearin with Tarrant County Public Health. “... But this is a way to honor that child, to honor that family. It’s a way of saying that child was part of a community and we haven’t forgotten that child and we’re going to do everything as professionals as well as child advocates to come together to find out what happened, find out where the gaps are, so we can prevent this from happening again.”
Originally under the direction of the Tarrant County medical examiner’s office, the Public Health Department took over coordination of the team last year, with plans of tracking more robust statistics for identifying and addressing trends.
During its February meeting, those in attendance included representatives from area police departments, MedStar, CPS, the Tarrant County district attorney’s office and Cook Children’s Medical Center. They discussed a wide ranges of cases, from a 17-year-old male who committed suicide to a baby boy who died while sleeping in the same bed as his father.
We’re not finger pointers or blame-makers. What we are responsible for is was there a gap somewhere? Is there a way we can make this process better?
Patti Shearin, Tarrant County’s Child Fatality Review Team
Agencies share the part they played in each case. Team members talk about resources that may have helped, like a peer counselor program, and whether more could be done in such cases, like drug testing of a caregiver when a child dies while co-sleeping.
In the end, they vote on whether they believe the death was preventable and whether an act of omission or commission attributed to the death.
“We’re not finger pointers or blame-makers,” Shearin said. “What we are responsible for is was there a gap somewhere? Is there a way we can make this process better?”
New state review program
A relatively new Texas program was spurred by the case of a 2-year-old Austin-area boy who died from abuse despite numerous red flags from previous CPS reports.
The Multidisciplinary Enhancement Teams, located inside advocacy centers, review CPS intake reports, critiquing how each case was handled and making recommendations on whether more can be done.
“It’s another set of eyes on cases,” Rocha said. “They have the ability to go to law enforcement or go to Child Protective Services and say, ‘Hey, we read this case. Do you think you can reopen it?’”
The team now reviews cases from 17 North Texas cities.
Of the 10,658 cases reviewed in fiscal year 2016, the team recommended additional services in 3,210.