Using Advocacy to Address the Crisis of Children's Mental Health.

Children and youth in the United States are experiencing a mental health crisis that predates the COVID-19 pandemic. Child and adolescent psychiatrists have the knowledge and skillset to advocate for improving the pediatric mental health care system at the local, state, and federal levels. Child psychiatrists can use their knowledge and expertise to advocate legislatively or through regulatory advocacy to improve access to mental health care for youth. Further, including advocacy education in psychiatry and child psychiatry graduate medical education would help empower child psychiatrists to make an impact through their advocacy efforts.

Advocacy for Equitable Recess in Washington State.

Recess in schools is a critical opportunity for children to engage in important behaviors that can promote their health and well-being, and daily recess is recommended by the American Academy of Pediatrics and other national organizations. In Washington state, school recess is not equitably provided, with parents reporting a wide range from as little as 10 minutes to >45 minutes daily. State laws can help promote equitable and high-quality recess, but most states in the United States do not have recess laws. In 2023, a bill (Senate Bill 5257) mandating a minimum of 30 minutes of daily recess for all elementary students with provisions for other recess best practices (including not withholding recess as punishment and encouraging movement breaks for middle/high-schoolers) passed with bipartisan support in the Washington state Legislature and was signed into law. In this case study, we describe the process undertaken and lessons learned by the cross-sector coalition that spearheaded the advocacy efforts, which included pediatricians, parents, educators, community organizations, and youth.

Day to Day Advocacy by Pediatric Health Care Providers.

This manuscript highlights the impressive advocacy work that members of the American Academy of Pediatrics have achieved and serves to inspire pediatric health care providers of all specialties to pursue such efforts beyond the acute physical need of the child. This article represents one of the Symposia presented at the 2023 American Academy of Pediatrics Section on Surgery.

A Qualitative Study of Resident Advocacy Work.

BACKGROUND: Advocacy is a critical component of pediatric training and practice. Pediatric resident advocacy experiences include skill development and real-world projects, but little is known about how pediatric residents participate in advocacy. Without this knowledge, educators run the risk of underpreparing residents for the full scope of advocacy work. This study sought to investigate how residents participate in advocacy by characterizing their projects using an evidence-informed conceptual framework and describing the unique lessons were learned by the residents. METHODS: The authors used principles of thematic analysis to interrogate existing documents derived from pediatric residents from 2013 to 2021 at 1 institution. They purposefully sampled and deidentified project proposals and written reflections. Using a constant comparative method, they created codes. Codes, connections between codes, and findings were refined by discussion. RESULTS: Residents demonstrated 4 different types of advocacy: some residents participated in directed agency or activism and others focused on shared agency or activism. Residents reflected on different learning experiences; residents who participated in shared forms of advocacy learned skills such as "Partnering," "Evaluating," and "Planning." Residents who were involved in directed forms of advocacy shared lessons on "Leading," "Presenting," and "Intervening." Advocacy work also changed over time: in later projects (2016-2021) residents took ownership of the role of "advocate"; social and political climate was salient in reflections. CONCLUSIONS: Pediatric residents advocate through shared activism and agency and directed activism and agency. Educators should recognize, support, and supplement the experiences of residents as they participate in different types of advocacy.

Pediatric advocacy: Advancement in academic institutions.

IMPACT: Children are facing many threats to their health today that require system change at a sweeping level to have real-world impact. Pediatricians are positioned as natural leaders to advocate for these critical community and policy changes. Academic medical center (AMC) leaders recognize the importance of this advocacy and clear steps can be taken to improve the structure to support pediatricians in their advocacy careers through faculty development and promotion, including standardized scholarly measurement of the outcomes.

Team Functioning and Performance in Child Advocacy Center Multidisciplinary Teams.

The quality of teamwork in Child Advocacy Center (CAC) multidisciplinary teams is likely to affect the extent to which the CAC model improves outcomes for children and families. This study examines associations between team functioning and performance in a statewide sample of CAC teams. Multidisciplinary team members (N = 433) from 21 CACs completed measures of affective, behavioral, and cognitive team functioning. Team performance was assessed with three measures: team member ratings of overall performance, ratings of mental health screening/referral frequency, and caregiver satisfaction surveys. Linear mixed models and regression analyses tested associations between team functioning and performance. Affective team functioning (i.e., liking, trust, and respect; psychological safety) and cognitive team functioning (i.e., clear direction) were significantly associated with team members' ratings of overall performance. Behavioral team functioning (i.e., coordination) and cognitive team functioning were significantly associated with mental health screening/referral frequency. Team functioning was not associated with caregiver satisfaction with CAC services. Aspects of team functioning were associated with team members' perceptions of overall performance and mental health screening/referral frequency, but not caregiver satisfaction. Understanding associations between team functioning and performance in multidisciplinary teams can inform efforts to improve service quality in CACs and other team-based service settings.

Promoting Firearm Injury Prevention and Advocacy as Pediatric Surgeons: A Call to Action From the APSA/AAP Advocacy Committee.

Firearm injuries have become the leading cause of death among American children. Here we review the scope of the problem, and the pivotal role pediatric surgeons have in preventing pediatric firearm injury. Specific methods for screening and counseling are reviewed, as well as how to overcome barriers. Community and hospital resources as well as organizational efforts are discussed. Finally, a path for surgeon advocacy is outlined as is a call to action for the pediatric surgeon, as we are uniquely poised to identify pediatric patients and deliver timely interventions to reduce the impact of firearm violence. LEVEL OF EVIDENCE: Level IV.

Prevalence of internet addiction and psychological factors in adolescents during the covid-19 pandemic / Prevalência de dependência da internet e fatores psicológicos em adolescentes durante a pandemia de covid-19 / Prevalencia de la adicción a internet y factores psicológicos en adolescentes durante la pandemia de la covid-19

Addictive behaviors related to Internet are becoming more common and this tool has been essential once it enables home office, entertainment, homeschooling, and easy access to information. Despite the easiness brought by technology, the exaggerated use has affected users in different ways, including in the development of psychiatric disorders. This study aimed to assess internet addiction, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), attention, impulsivity, and stress in 48 adolescents (26 young women and 22 young men), aged from 15 to 18 years, with a mean age of 16.74 (0.61), mostly students of public schools, during COVID-19, to investigate correlations between these variables according to sex and sociodemographic aspects. To assess the factors, the Internet Addiction Test (IAT); the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) Questionnaire ; the Depression, Anxiety, and Stress scale for brazilian adolescents (EDAE-A); the Barratt Impulsiveness Scale (BIS-11); and a sociodemographic questionnaire were applied. The data collection was performed in schools located in southern Brazil. The results indicated that 12 out of 48 adolescents were considered addicted to the Internet. Moreover, Internet addiction was a predictor of depression in regression analysis (p<0.001). In addition, participants classified as more addicted to the Internet scored lower averages in general attention (p<0.035) and higher averages in behavioral symptoms of inattention and ADHD (p<0.050), stress (p<0.003), anxiety (p<0.016), and depression (p<0.015), with effect sizes ranging from moderate to high. Therefore, the intense internet use by adolescents might cause psychological consequences such as depression in adolescents. Family support and professional intervention might help in the reduction of symptoms and consequences of internet addiction as well as in its prevention.(AU)

A dependência de internet é cada vez mais comum, pois essa ferramenta tem se tornado imprescindível, uma vez que possibilita home office, entretenimento, educação domiciliar e fácil acesso às informações. No entanto, o uso exagerado da tecnologia afeta os usuários de diversas formas, inclusive no desenvolvimento de transtornos psiquiátricos. Este estudo visou avaliar a dependência de internet, depressão, ansiedade, hiperatividade, atenção, impulsividade e estresse em 48 adolescentes (26 meninas e 22 meninos) de 15 a 18 anos, com idade média de 16,74 (0,61), estudantes de escolas públicas do Sul do Brasil durante a covid-19, para investigar correlações entre as variáveis anteriores de acordo com gênero e aspectos sociodemográficos. Para avaliar, aplicou-se o Internet Addiction Test (IAT), um teste de atenção, escala SNAP IV, escala de depressão, ansiedade e estresse para adolescentes (EDAE-A), escala de impulsividade de Barratt e um questionário sociodemográfico. Os resultados indicaram que 12 adolescentes foram considerados viciados em internet, e que a dependência desta foi preditora da depressão na análise de regressão (p < 0,001). Ainda, os participantes classificados como adictos tiveram médias mais baixas em atenção geral (p < 0,035) e mais altas em sintomas comportamentais de desatenção e hiperatividade (p < 0,050), estresse (p < 0,003), ansiedade (p < 0,016) e depressão (p < 0,015), com efeitos que variaram de moderado a alto. Portanto, o uso intenso da internet por adolescentes pode ter consequências psicológicas, como a depressão. Bom apoio familiar e intervenção profissional podem ajudar na redução dos sintomas e consequências, bem como na prevenção da dependência.(AU)

La adicción a Internet es cada vez más habitual, puesto que esta herramienta es esencial para el trabajo remoto, el entretenimiento, la educación domiciliar y el fácil acceso a la información. Sin embargo, su uso exagerado afecta a la vida de las personas de diferentes maneras, incluso en el desarrollo de trastornos psiquiátricos. El objetivo de este estudio fue evaluar la adicción a Internet, depresión, ansiedad, hiperactividad, atención, impulsividad y estrés en 48 adolescentes (26 muchachas y 22 muchachos), de entre 15 y 18 años, con una edad promedio de 16,74 (0,61), en su mayoría estudiantes de escuelas públicas del Sur de Brasil, durante la pandemia de la COVID-19, para investigar las correlaciones entre las variables mencionadas según género y aspectos sociodemográficos. Para evaluar los factores, se aplicaron el Test de Adicción a Internet (TAI), un test de atención, la escala SNAP IV, la Escala de Depresión, Ansiedad y Estrés para adolescentes (EDAE-A), la escala de impulsividad de Barratt y un cuestionario sociodemográfico. Los resultados indicaron que 12 adolescentes fueron considerados adictos a Internet, además, la adicción a Internet fue un predictor de la depresión en el análisis de regresión (p<0,001). Igualmente, los participantes clasificados como más adictos a Internet tuvieron promedios más bajos en atención general (p<0,035), y más altos en síntomas conductuales de falta de atención e hiperactividad (p<0,050), estrés (p<0,003), ansiedad (p<0,016) y depresión (p<0,015), con efectos que varían de moderado a alto. Por lo tanto, el uso intenso podría producir consecuencias psicológicas como la depresión en los adolescentes. Tener un buen apoyo familiar e intervención profesional puede ayudar a reducir los síntomas y las consecuencias de la adicción a Internet, así como prevenirla.(AU)

Reflexividad ética de un traspié: niñez y adolescencia migrantes no acompañadas / Ethical Reflexivity of a Stumble: Unaccompanied Migrant Children and Adolescents

(analítico) El objetivo de este artículo es sistematizar un proceso de reflexividad ética surgido en un proyecto de investigación (Fondecyt) cuyo fin era conocer la situación de la niñez y la adolescencia migrantes no acompañadas en Chile. El proyecto fue aprobado con reparos éticos que hacían difícil poner en práctica métodos participativos. Este «traspié» dio paso a la reflexividad. Mediante una metodología de panel de expertos, creamos un comité de ética autoconvocado (profesionales en derecho y psicología especialistas en infancia) que capacitó al equipo y elaboró recomendaciones y protocolos. En los resultados exponemos algunos dilemas éticos (en torno al consentimiento informado, los derechos de autoría y un balance entre riesgos y beneficios) identificados en las distintas instancias evaluativas, así como los aprendizajes derivados de ello; finalizamos con futuras líneas de investigación.

(analytical) The objective of this article is to systematize a process of ethical reflexivity that emerged in a research project (Fondecyt) whose purpose was to know the situation of unaccompanied migrant children and adolescents in Chile. The project was approved with ethical qualms that made it challenging to implement participatory methods. This «stumble» gave way to reflexivity. Through a Panel of Experts methodology, we created a self-convened ethics committee (professionals in Law and Psychology specializing in childhood) that prepared entry and exit reports with recommendations and protocols and trained the team. In the results, we expose some ethical dilemmas -around informed consent, copyright, and a balance between risks and benefits- identified in the different evaluation instances and the learning derived from it. We end with future lines of research.

(analítico) O objetivo deste artigo é sistematizar um processo de reflexão ética que surgiu em um projeto de pesquisa (Fondecyt) cujo objetivo era conhecer a situação de crianças e adolescentes migrantes desacompanhados no Chile. O projeto foi aprovado com observações éticas que dificultaram a implementação de métodos participativos. Essa dificuldade inesperada impulsionou a reflexividade. Por meio da metodologia de Painel de Especialistas, foi criado um comitê de ética autoconvocado (com profissionais de Direito e Psicologia especializados na infância) que treinou a equipe e desenvolveu recomendações e protocolos. Nos resultados se expõem alguns dilemas éticos -em torno do consentimento informado, direitos autorais e o equilíbrio entre riscos e benefícios- identificados nas diferentes instâncias de avaliação, bem como as aprendizagens delas derivadas; sendo finalizado com futuras linhas de pesquisa.

A Pediatric Resident Advocacy in Complex Care Curriculum.

Introduction: Children and youth with special health care needs (CYSHCN) are a special, vulnerable population. Children with medical complexity (CMC) represent a smaller, medically fragile sliver (6%) of the US child population. Several professional pediatric entities direct (or require) pediatric educators to instruct residents in advocacy for all children, explicitly including CYSHCN/CMC populations. While many existing curricula address pediatric advocacy education, a gap remains in curricula specifically designed to aid learners in advocacy of CYSHCN/CMC. Methods: Using Kolb's experiential learning cycle as a framework, we designed and delivered a comprehensive outpatient complex care curriculum, including several didactic video lectures (total: 60:04 minutes, median: 6:25 minutes) and experiential site visits devoted to advocacy topics for CMC, as one portion of a 4-week elective complex care rotation. Residents completed pre- and posttests of knowledge and pre- and postsurveys to self-assess attitudes, comfort, and behavior; viewed didactic video lectures; and engaged in experiential site visits. Reflective statements captured attitudes regarding advocacy for CMC. Results: Between July 2016 and June 2020, 47 trainees completed the rotation; data were available for 30 trainees. Residents demonstrated a statistically significant improvement in knowledge (p < .001), as well as improved attitudes, diversity sensitivity, and comfort in advocating for CMC postrotation. Qualitative comments showed overwhelmingly positive learner reaction. Discussion: This curriculum, which can be offered as a stand-alone resource or a supplement to a comprehensive complex care curriculum, incorporates didactic and experiential teaching methods and addresses a significant competency in advocacy education.

Lineamientos técnicos para la implementación de unidades de puertas abiertas en la atención de neonatos y población pediátrica / Technical guidelines for the implementation of open-door units in neonatal and paediatric care

Para salvaguardar la vida de cada niña y niño es imprescindible la participación de madres, padres, familiares y cuidadores en las unidades de atención neonatal y pediátricas, enfatizando el enfoque de derecho que facilita la transmisión de conocimientos, fomentando una cultura de corresponsabilidad entre el personal de salud y los / as usuarios /as, además promoviendo el empoderamiento de los familiares y cuidadores en el cuidado de niñas o niños durante el periodo de internación. Razón por la cual se han elaborado los presentes lineamientos, que promueven la transformación de las unidades de atención neonatales y pediátricas, a un modelo de puertas abiertas, con calidad, y con calidez, dando un mayor protagonismo y participación activa de las personas que son parte importante de la vida y desarrollo de la niña o niño, asegurando un enfoque práctico que facilite su implementación como parte de los derechos de la niñez, promoviendo la vinculación y participación activa de madres, padres, familiares y cuidadores las 24 horas del día en conjunto con el equipo de salud.

In order to safeguard the lives of each child, the participation of mothers, fathers, relatives and caregivers in neonatal and paediatric care units is essential, emphasizing the legal approach that facilitates the transmission of knowledge, fostering a culture of co-responsibility between health personnel and users//s, and promoting the empowerment of family members and caregivers in the care of children during the period of hospitalization.This is why these guidelines, which promote the transformation of neonatal and pediatric care units, have been developed into an open-door model with quality and warmth, giving greater prominence and active participation to persons who are an important part of the life and development of the child, ensuring a practical approach that facilitates its implementation as part of the rights of the child, promoting the involvement and active participation of mothers, fathers, relatives and caregivers 24 hours a day in conjunction with the health team.

Impressions of child advocacy center leaders: How problematic sexual behavior in children and adolescents is perceived by community professionals.

BACKGROUND: Consistent with the goals of National Children's Alliance, Children's Advocacy Centers (CACs) are optimal for addressing needs related to problematic sexual behavior (PSB) of youth due to their multidisciplinary approach and emphasis on community-level evidence-based interventions (Kelley et al., 2019). To promote child well-being and safety, decisions of the CAC's multidisciplinary team must be based on an accurate understanding of youth with PSB, child sexual development, and best-practice responses. However, misperceptions about youth who have engaged in PSB appear to broadly persist (Hackett, Masson, et al., 2013), leading to obstacles for CACs in addressing PSB. OBJECTIVE: To better understand and address the training and service needs of CACs across the country, the goal of this study was to assess CAC community professionals' (e.g., MDT members) perceptions of children and adolescents with PSB, as reported by CAC leaders. PARTICIPANTS AND SETTING: Participants were 351 CACs from 47 US states, a representative sample based on regional and community distributions. METHOD: A designated point-of-contact (e.g., the Director) for each CAC completed an online survey reflecting on their CAC's professional community's perceptions of youth with PSB. RESULTS: Findings suggested that a number of misperceptions about youth with PSB, particularly adolescents, are commonly reported for CAC professional communities. Prevalent misperceptions surrounded the etiology of PSB, treatment-related needs, and differences between youth with PSB and adults. CONCLUSIONS: Results can be used to inform policy, practice, training, and resource utilization to address youth with PSB in CACs, with specific recommendations provided to enhance an evidence-based approach.

Lactancia materna exclusiva y trabajo. Su importancia en la medicina del trabajo / Exclusive breastfeeding and work. Its importance in occupational health

En todos los ámbitos laborales, sin excepción, es imprescindible la vigencia ineludible del derecho irrestricto de toda madre a ejercer, practicar, su lactancia con su bebé. Y las razones médicas debieran formar parte de campañas incesantes para que este derecho de las mamás esté absolutamente naturalizado en todos los niveles y en cada rincón del país. La lactancia materna protege al bebé de enfermedades infecciosas y le da la nutrición ideal para una vida más sana. Es fundamental desde el primer día de vida extrauterina hasta los 6 meses con exclusividad y luego continúa con suplementos vitamínicos y nutrientes apropiados. En todo lugar de trabajo deben existir lactarios como una estrategia de Salud Pública y en Medicina del Trabajo. (AU)

In all areas of work, without exception, the unavoidable validity of the unrestricted right of every mother to exercise, practice, breastfeeding with her baby is essential. And the medical reasons should be part of incessant campaigns so that this right of mothers is absolutely naturalized at all levels and in every corner of the country. Breastfeeding protects the baby from infectious diseases and gives it the ideal nutrition for a healthier life. It is essential from the first day of extrauterine life until 6 months exclusively and then continues with appropriate vitamin and nutrient supplements. In every workplace there must be lactation rooms as a strategy of Public Health and Occupational Medicine. (AU)

Percepciones y sentimientos de niños argentinos pospandemia por COVID-19 / Perceptions and feelings of Argentine children post pandemic COVID-19

La mortalidad y formas graves atribuibles al COVID-19 en población pediátrica han sido bajas en comparación con los adultos. No obstante, los niños, niñas y adolescentes (NNA) constituyen un universo especialmente afectado por la pandemia, en cuanto a restricción y limitación de sus derechos. La Subcomisión de Derechos de la Niñez y Adolescencia y el Comité de Pediatría Social de la Sociedad Argentina de Pediatría entendieron trascendente recolectar sus voces para relevar el impacto que la transición de la situación de pandemia por COVID-19 a la actual "nueva normalidad" ha producido en los sentimientos, emociones y deseos de los NNA en Argentina. Realizamos un estudio cualitativo, descriptivo, basado en encuesta anónima, entre NNA argentinos de 6 a 18 años residentes en Argentina. El análisis incluyó 1537 entrevistas efectivas. Los resultados permitieron sugerir recomendaciones para desarrollar estrategias de afrontamiento, contención y acompañamiento de los NNA en la pospandemia.

The frequency of the severity of the different expressions of SARS-COV-2 disease, and its mortality in the pediatric population have been low unlike in the adult population. However, children and adolescents have been very affected by this virus, through the restriction and limitations of their rights. The Subcommittee on the Rights of the Childhood and Adolescence and the Committee of Social Pediatrics of the Sociedad Argentina de Pediatría understood that it was very important to gather their voices to weigh the impact of the transition from COVID pandemic to this "new normalcy" and the effects on argentine children and adolescents' rights, emotions and desires, especially those related to accessibility to education and health. We carried on a qualitative descriptive narrative transversal phenomenological research, through an open anonymous survey, among children and adolescents between 6 and 18 years old, living in Argentina; 1537 surveys were collected. The research findings allowed elaborate recommendations to develop strategies to face, protect and accompany the children and adolescents during the post-pandemic.

Lineamientos Técnicos para la Implementación del Modelo de Atención Primera Infancia / Technical Guidelines for the Implementation of the Early Childhood Care Model

El presente documento contiene los Lineamientos Técnicos para la Implementación del Modelo de Atención Integral a la Primera Infancia, los cuales deberán ser aplicados por todos los sectores y actores involucrados con la atención de niñas y niños, con el objetivo de asegurar la pertinencia y calidad de las intervenciones desde una visión multidimensional del desarrollo y la responsabilidad compartida de todos los sectores y actores en la provisión de cuidados, estimulación, educación, salud y nutrición, así como en el cumplimiento de sus derechos en entornos protectores que incluyen a las familias y a los actores del territorio nacional

The present document contains the Technical Guidelines for the Implementation of the Model of Comprehensive Care for Early Childhood, which should be applied by all sectors and actors involved in the care of children, with the aim of ensuring the relevance and quality of interventions from a multidimensional vision of development and the shared responsibility of all sectors and actors in the provision of care, stimulation, education, health and nutrition, and the fulfilment of their rights in protective environments that include families and national actors

Climate Change Imperils Pediatric Health: Child Advocacy Through Fossil Fuel Divestment.

Climate change poses an existential threat to children's health. Divestment of ownership stakes in fossil fuel companies is one tool available to pediatricians to address climate change. Pediatricians are trusted messengers regarding children's health and therefore bear a unique responsibility to advocate for climate and health policies that affect children. Among the impacts of climate change on pediatric patients are allergic rhinitis and asthma; heat-related illnesses; premature birth; injuries from severe storms and fires; vector-borne diseases; and mental illnesses. Children are disproportionately affected as well by climate-related displacement of populations, drought, water shortages, and famine. The human-generated burning of fossil fuels emits greenhouse gases (GHG) such as carbon dioxide, which trap heat in the atmosphere and cause global warming. The US healthcare industry is responsible for 8.5% of the nation's entire greenhouse gases and toxic air pollutants. In this perspectives piece we review the principle of divestment as a strategy for improving childhood health. Healthcare professionals can help combat climate change by embracing divestment in their personal investment portfolios and by their universities, healthcare systems, and professional organizations. We encourage this collaborative organizational effort to reduce greenhouse gas emissions.

Independent non-legal advocacy in the child protection context: A descriptive review of the literature.

OBJECTIVE: To review the current literature on the use and value of independent non-legal advocacy for parents in the context of child protection. METHOD: A descriptive literature review was undertaken to identify, review, synthesize and unify the available literature on independent non-legal advocacy for parents in a child protection context. A systematic search resulted in 45 publications published between 2008 and 2021 being included in the review. Each publication was then thematically analyzed. OUTCOME: The role and context of different forms of independent non-legal advocacy are described. This is followed by an overview of the three overarching themes identified through thematic analysis - human rights, improving parenting and child protection practice and economic benefits. CONCLUSIONS: The topic of independent non-legal advocacy in child protection settings is an important, under-researched topic. The increasing number of positive outcomes noted in small scale program evaluations suggests the role of independent non-legal advocate may hold significant benefits for families, service systems and governments. Implications for service delivery include enhanced social justice and human rights for parents and children.

Increasing Access to Medical Forensic Care for the Pediatric Patient.

ABSTRACT: Child sexual abuse is a major public health problem. About one in every four girls and one in every 13 boys in the United States experience sexual abuse. In order to best serve these patients and families, the forensic nurse examiner team from a large urban Level 1 trauma center partnered with the local child advocacy center to provide ready access to educated, competent pediatric examiners who provide developmentally appropriate medical forensic care in a child-friendly environment. Consistent with national best practice standards, this occurs as part of a coordinated, colocated, highly functional multidisciplinary team. These services are provided free of charge and regardless of timeline from abuse. This partnership removes several key barriers to this care, including difficulty coordinating with multiple organizations, cost, lack of knowledge regarding available resources, and decreased ability to provide medical forensic care to nonacute patients.