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Ralph Hicks, MD, discusses a case with learners

Child Abuse Pediatrics Fellowship

The Child Abuse Pediatrics Fellowship at Indiana University and Riley Hospital for Children in Indianapolis, Indiana is a 3-year ACGME accredited program. Our fellowship program offers extensive clinical subspecialty training in child abuse pediatrics at Indiana’s only Level I Pediatric Trauma Center. Our 4 full-time and 1 part-time faculty physicians are all board-certified child abuse pediatricians. Our section also includes pediatric nurse practitioners (PNPs), social workers, registered nurses, and data entry/research staff. Fellows have opportunities to work closely with a wide variety of other medical and surgical subspecialists and community partners.

The IU Child Protection Program (CPP) was founded in 1985 and provides consultation services to children, families and professionals involved with child maltreatment. The CPP mission is to improve care, evaluation and coordination of services to children who are suspected victims of child abuse or neglect. Collaboration with professionals from other disciplines that work in this field and work with multidisciplinary teams is an important component of the CPP work. We offer:

  • Comprehensive medical evaluations for children about whom abuse or neglect is suspected;
  • Comprehensive medical evaluations for children recently entering the foster care system;
  • Professional consultation for health care providers, child protective services (CPS), law enforcement officers or other professionals;
  • Expert testimony in legal settings;
  • Professional education;
  • Parent education;
  • Prevention efforts; and
  • Leadership in identifying and solving community issues dealing with child abuse.

Apply for Fellowship

Physicians interested in applying for a Pediatrics Fellowship program at IU School of Medicine should submit an application through the Electronic Residency Application Service (ERAS). Required materials are listed at the bottom of this page.

ERAS

Video

Find out about all the Child Protection fellowship program has to offer

Program Leadership

Fellowship Director
18688-Hicks, Ralph

Ralph A. Hicks, MD

Professor of Clinical Pediatrics

Read Bio

Program Coordinator
Pediatric Nephrology fellowship coordinator

Lyn Terrell

lynterre@iu.edu

Our Services

  • Child Abuse Consultation Service
    The Child Abuse Consultation Service provides comprehensive medical evaluations for children alleged to have been abused or neglected. For the year ending June 30, 2019 a total of 6,110 children were referred to our program for concern about any type of child maltreatment. Included in these were a total of 542 patient examinations performed at Riley Hospital for Children (222 sexual abuse exams, 320 physical abuse/other). Requests for consultation come from health care providers, CPS, law enforcement, attorneys and other professionals.
  • PEDS Program
    PEDS Program (Pediatric Evaluation and Diagnostic Services): Since 2008, in collaboration with the Indiana Department of Child Services (which houses CPS), CPP physicians have provided formal consultation for agency case managers. The goal of the PEDS Program is to provide expert knowledge from child abuse pediatricians in order to assist case managers in understanding medical aspects of their cases, including differentiating abusive injuries, accidental injuries and medical conditions.
  • Pediatric Center of Hope
    The Pediatric Center of Hope (child sexual abuse clinic) provides comprehensive medical evaluation for children alleged to have been sexually abused. Children are referred primarily by CPS, law enforcement, and health care providers. Patients are seen for both scheduled and acute examinations (the latter often involving forensic evidence collection).
  • Foster Care Bridge Clinic
    Foster Care Bridge Clinic (FCBC) is the newest CPP program and opened in May 2019. The FCBC addresses the limited health care access and unmet health needs (medical, dental, mental health, developmental, and psychosocial) of children recently placed in foster care until a permanent medical home is identified. Children seen in FCBC receive a multidisciplinary trauma-informed (1) comprehensive medical evaluation; (2) developmental screening, social-emotional screening, and behavioral surveillance; and (3) social determinants/safety assessment.
  • Liaison Child Abuse Forum
    The Liaison Child Abuse Forum is a community coordination effort founded and directed by the Child Protection Program. This forum brings together Marion County CPS, law enforcement, prosecutor, and public school system representatives on a monthly basis to solve community problems in the identification, evaluation and handling of child abuse cases.
  • Marion County Child Fatality Review Team
    The Marion County Child Fatality Review Team was developed in 1994 under the leadership of the CPP. This multidisciplinary/multiagency team meets monthly and reviews child fatalities in Marion County to assess the (1) epidemiology of child deaths not due to natural causes, and (2) potential to better understand child deaths and possibly their prevention.
  • Educational Efforts
    The team has regular multi-disciplinary case review and educational sessions. They include a weekly review of hospital-based consultations, a monthly radiology and neuroradiology child abuse case review conference, and a monthly review of acute sexual assault examinations. Team members are regularly asked to provide trainings for professionals in various disciplines locally and statewide. Several secondary level pediatricians around the state have joined with us to assist with the medical evaluations of children reported to CPS, and they are invited to participate virtually in our weekly case reviews.

Current fellows

Child protection fellow Ann Freshour

Ann E. Freshour, DO

PGY 4

Undergraduate School: University of Southern Indiana
Medical School: University of Pikeville-Kentucky College of Osteopathic Medicine
Residency: Michigan State University
Hobbies: Outside of work, I enjoy spending time with my husband and our pets (one dog and one cat).  We like to spend time outside (gardening, hiking, fishing), cooking, and watching football games.
Research/QI Interests: One of my main interests in the field of child abuse pediatrics includes looking at the impact of different types of abuse on a child’s developmental trajectory, including the behavioral and psychiatric sequelae of abuse.   

Why Child Protection?
I have been drawn to this field since I was first exposed to it during medical school when I volunteered at a Child Advocacy Center.  I was able to witness the great need for medical providers who are trained to care for children who have undergone abuse.  During residency, I was able to provide firsthand care for numerous patients who had been abused, and I was able to observe it’s lasting effect on a child’s life.  In those moments, I knew I wanted to devote my career to being a lifelong advocate to those children in need.  Specializing in this field will not only give me the diagnostic skills necessary to investigate traumatic injuries, but will also allow me to provide education and awareness regarding child abuse to the community to hopefully prevent reoccurrences.

Why IU/Riley?
Growing up in Southern Indiana, I had always heard of Riley Hospital for Children and knew of its prestigious reputation.  After making my decision to pursue fellowship in child protection, I knew I wanted to return to my home state and serve this population.  During my third year of residency, I did an “away rotation” where I spent a month with the Child Protection Team here at Riley.  After the first week, I knew this is where I wanted to be.  Everyone was so nice and welcoming.  It will be an honor to learn from this medical team’s experience.

Read Bio

Facilities and Resources

Riley Hospital for Children is the only comprehensive children’s hospital and Level I Pediatric Trauma Center in the state of Indiana. All pediatric subspecialties are represented at Riley Hospital, which also includes a pediatric burn unit. The emergency department includes a sexual assault examination room with dedicated photo-videography equipment. The high clinical volume allows for exposure to a wide variety of conditions (including accidental injuries, inflicted injuries and mimics).

Fellows have multiple opportunities for exposure to the medical-legal system, including providing testimony in cases for which they provided medical care at juvenile and criminal courts. In addition, fellows may provide medical-legal consultation along with a faculty member to attorneys seeking an expert opinion in cases involving alleged child maltreatment. Our faculty physicians receive on average approximately 75 subpoenas each year, with testimony required in approximately 20% of those cases. As an example, our most recent fellow testified a total of 22 times over the 3 years of training.

Fellows will participate in weekly teleconferences with other programs nationally as part of the Project Echo Child Abuse Pediatrics Fellowship Curriculum, sponsored and organized by Children’s Healthcare of Atlanta.

Research opportunities include a wide variety of clinical and pediatric health services research in a university setting with an already existing infrastructure. The IU Department of Pediatrics ranks in the top 10 in NIH research funding. Our Children's Health Services Research division is one of the largest and most productive of its kind. The clinical volume in our program also allows fellows to have ample clinical research opportunities. IU CPP faculty physicians have co-authored multiple articles published in the peer reviewed medical literature. Fellows and faculty have also presented research abstracts at national meetings.

Curriculum

The following is a guide to the curriculum organized by months, which provides an approximate amount of time for each of the respective experiences.  The notes which follow the outline provide further explanation.

Year 1
Child Protection Team Consult Service 6 months
Elective 1 month
Community Rotation 1 month
Research 3 months
Vacation 1 month
Year 2
Child Protection Team Consult Service 5 months
Elective 1 month
Community Roation 1 month
Research 4 months
Vacation 1 month
Year 3
Child Protection Team Consult Service 4 months
Elective 1 month
Community Rotation 1 month
Research 5 months
Vacation 1 month

The following activities are ongoing throughout a fellow's training:

  • Clinic, one half day per week;
  • Home call, one weeknight per week with one weekend per month;
  • Weekly CPP case review meetings;
  • Monthly hospital child advocacy meetings;
  • Monthly county child fatality review team meetings; and
  • Responding to subpoenas and court appearances

Due to the volume of clinical consults and requests for case reviews from outside agencies, fellows typically do not spend more than 1-2 consecutive weeks at a time on the consult service.  Elective and specialty clinic experiences are then scheduled during non-consult service weeks. Therefore, the schedule does not conform exactly to the classic month-long rotations.

Community rotations include experiences at the county child advocacy center (which houses CPS and the Indianapolis Metropolitan Police Department’s Child Abuse unit), forensic interview training, the county prosecutor’s office, juvenile and criminal courts, the local domestic violence shelter, and the county coroner’s office.

Research months include required core graduate courses which cover clinical research methods, clinical trials, and biostatistics.  This time also allows for fellows to develop and complete the scholarly activity/research requirement of the American Board of Pediatrics. Fellows with the interest and commitment may combine their core course work with additional courses to allow for the completion of a master’s degree (examples in our program include clinical research and ethics).

 

Necessary for Application

Prerequisites for acceptance into the IU Child Abuse Pediatrics Fellowship Program are graduation from an accredited U.S. medical school (or for International Medical Graduates a valid unexpired ECFMG certificate) and successful completion of a 3 year accredited U.S. residency in general pediatrics. Applicants will be considered who are U.S. citizens, have permanent residence status (green card holder), or a J-1 visa. Applications should be submitted through the Electronic Residency Application Service (ERAS). In addition to the MyERAS application, we require three letters of recommendation (one of which must be from the applicant’s residency program director), personal statement, curriculum vitae, USMLE transcript (or COMLEX transcript for DO applicants), and ECFMG Status Report (International Medical Graduates only). Our program participates in the National Resident Matching Program (NRMP) and therefore complies with the NRMP policies and rules.

Contact Us

For more information:

Lyn Terrell, C-TAGME
Program Coordinator
317-274-2516
lynterre@iu.edu

Ralph A. Hicks, MD
Program Director
317-274-2617
raahicks@iu.edu