Mayerson Center Innovates for Safety of All Children

Only a fraction of child abuse cases are ever reported. So our experts at Cincinnati Children's are finding ways to help kids in the community who will never cross our threshold.

Mayerson Center Innovates for Safety of All Children

When the Mayerson Center for Safe and Healthy Children at Cincinnati Children’s opened in late fall of 2000, it broke the mold. Founded by social worker Pat Myers, in partnership with Bob Shapiro, MD, as medical director, the center revolutionized the approach to care for children who were victims of physical/sexual abuse and neglect—first, by helping the medical community acknowledge and address the problem, which wasn’t generally talked about, and second, by providing a central location for patients and families to interact with law enforcement, medical and community personnel. The result was a comprehensive process where each child only had to tell their story once in a recorded forensic interview designed to hold up in court. Above all, it helped prevent further traumatization to the patient and solidified the partnerships among the various entities working on the child’s behalf. Fast-forward to 2021. The Mayerson Center is still breaking ground in the ways it advocates for children in the Greater Cincinnati area, only now its reach is wider. Not only are staff able to help the kids who come into the office on the fifth floor of the Sabin Education Center, the ED or the hospital itself, they can also impact kids who never have and never will set foot on our campus. This expansion in focus occurred just over 6 years ago in response to an earlier report that was published in "Pediatrics" addressing the relationship between adverse childhood experiences (ACEs) and biologic consequences in child development. Says Shapiro, who directs the Mayerson Center, “The technical report in 'Pediatrics' challenged us to implement change because of our understanding that adversity and toxic amounts of stress can really derail normal child development for many children. It affects how their brains are wired, how their immune system protects them from future disease and illness, and it changes how their genes are expressed. So, while affected children may become better at protecting themselves from threats as they grow up, that ability comes at the expense of social and emotional learning and a lot of executive functioning.” We now understand that ACEs include more than abuse and neglect. Poverty, discrimination and racism—anything that causes toxic stress, can rob children of future well-being and the ability to develop to their full potential. Says Shapiro, “This is truly a pediatric health issue. It’s not only important to recognize and stop the pain of child abuse and neglect, but for many children growing up in adverse environments, we now know it may have global negative implications on their health and well-being.”

A New Understanding

Armed with this knowledge, Shapiro and his team launched Joining Forces for Children, a diverse and inclusive network of committed partners that works to prevent and reduce the impact of childhood adversity by promoting resilient families and equitable communities. Joining Forces is divided into four channels—early childhood, school-age, healthcare and community connections. The goals of this collective impact initiative are to:

  • Inform and educate families, communities, and institutions about the effects of adverse childhood experiences.
  • Build capacity within our community and among parents to recognize and strategically improve childhood well-being by responding to childhood adversity.
  • Identify and implement best-practices and evidence-based interventions in services and supports that build resilience and reduce adversity.
  • Facilitate advocacy and policy change that addresses child well-being and reduces the effects of toxic stress.

Says Shapiro, “Over the last 6 years, we have promoted change within the community and created tools to help foster those changes, much of which involves using a trauma-informed approach.” A trauma-informed approach acknowledges the need to understand a person’s life experience and recognizes that what looks like bad behavior is often a sign or symptom of negative traumatic events. Imagine a scenario where a child is disruptive in class, and the teacher is trained to see beyond the behavior to the past trauma that triggered it. Instead of doling out punishment, the teacher de-escalates the situation so the child can rejoin the class and continue to learn.

“When we increase education and awareness about ACEs, we build a public resolve to use trauma-informed responses to help children thrive. We also establish an understanding of the public health consequences of ACEs and the potential to implement policy changes that build a more supportive community,” says Shapiro. “The number of children we identify as victims of abuse and neglect are very few, just the tip of the iceberg when compared to the general population. Most children who are abused or neglected are below the waterline, unseen. By providing trauma-informed care at a community-wide level and advocating for equity, we can address the ACEs of that invisible group, help them escape the effect of trauma and reduce trauma exposure by addressing root causes.”

April Is Child Abuse Prevention Month

If you are concerned about child abuse or neglect, call Hamilton County Jobs & Family Services 24-hour child abuse hotline at 513-241-5437 (241-KIDS).

Domestic violence is also on the rise right now. In Hamilton County, discuss concerns for domestic violence with Women Helping Women (513-381-5610) and the YWCA (513-872-9259).

National organizations for child abuse: Child Help's National Child Abuse Hotline 1-800-4-A-CHILD

For domestic violence: Domestic Violence Hotline 1-800-799-7233

Building Resilience

The Mayerson Center has actively promoted the trauma-informed approach throughout our center as well, says Kathi Makoroff, MD, medical director. “When we opened our doors in 2000, the Mayerson Center’s environment was trauma-informed for its time, with kid-sized, whimsical furniture, lots of natural light and bright colors. Cincinnati Children’s has done a lot to make the waiting rooms beautiful at all our campuses,” she explains. “But just before COVID hit, we were looking at more ways to improve.” Last year, the center introduced a facility dog named Trinity, whose role is to help support the children who come in for forensic interviews. But Trinity has also been a great comfort to the Mayerson Center staff. Says Makoroff, “Along with the trauma our patients have experienced, we are recognizing that our staff, who listen to their stories, are experiencing secondary traumatic stress, so we need to support them too.” Sarah Zawaly, a senior specialist program manager in the Mayerson Center, recently celebrated her one-year anniversary at Cincinnati Children’s. She was hired as part of Joining Forces for Children to help with prevention efforts that include using a trauma-informed approach in healthcare settings. “When we talk about trauma, we always want to talk about the other side of the coin, which is resilience,” she says. “The trauma doesn’t define us. We emphasize our resilience and how we are able to bounce back.”

Zawaly and the Core Implementation Team have set a focus for this year on three domains of the Trauma-Informed Care Framework:

  1. Physical and psychological safety, which looks at establishing safe and secure environments for patients, families, and staff to ensure re-traumatization does not occur in all levels of care
  2. Family and child/patient voice, choice and empowerment, which supports the resilience of children and non-offending parents/caregivers by providing resources for healing after a traumatic event
  3. Building a compassionate workforce, which educates staff on the latest research related to trauma-informed care and examines policies and procedures to ensure they are accessible, appropriate, and equitable.

Says Zawaly, “When we understand the historical, inter-generational, and cultural trauma experience of our patients, families, staff, and community, we can provide care for the whole individual that minimizes barriers to a healthy outcome. Using trauma-informed care is one way to help achieve health equity. By gaining a better understanding of where a family is coming from and their life experiences, we can provide them with the support needed for the best possible outcomes.” It’s a lot to take on, but the Mayerson Center staff are dedicated to the patients and families they serve. “We have the tools and the vision to address child abuse and neglect in an upstream and global manner,” says Shapiro. “We are able, not only to prevent abuse and treat those children who’ve experienced abuse and neglect, but to reach into our community to collaborate and prevent the negative outcomes of abuse and neglect. This is what makes me the most excited to get up in the morning. It’s a big vision. But we can do it because we’re Cincinnati Children’s.”

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