ALLENTOWN, Pa. — Lehigh County recently announced that, in the wake of criticism and lawsuits, its Office of Children and Youth Services would create a new "community-based" Child Advocacy Center, or CAC, in Center City Allentown.
The move will distance the center, which serves children who may have been abused, from Lehigh Valley Health Network — the subject of much of the complaints and legal actions.
But it also may operate without a specialist in assessing medical needs of suspected child abuse victims.
Previously, the region’s CAC was called the John Van Brakle Child Advocacy Center. It was “a program of Lehigh Valley Reilly Children’s Hospital,” according to its website.
Lehigh County Director of Community and Economic Development Frank Kane said that, for the most part, the operations of the CAC won’t change.
“We're just giving a different work location to already existing employees,” Kane said.
But there will be one key difference.
“We currently do not have a medical director assigned,” Kane said, “but we will be working with both area [hospital] networks to develop a stable of medical providers to meet the needs of the children we serve.”
Its former medical director, Dr. Debra Esernio-Jenssen, was replaced by Dr. Sarah Kleinle in September. Weeks before, about two dozen parents publicly said Esernio-Jenssen falsely accused them of child abuse.
Esernio-Jenssen, who soon will retire, is a child abuse pediatrician. The pediatric subspecialty trains doctors to perform examinations on children to see if there is any medical evidence of abuse.
LVHN spokesperson Jamie L Stover said via email that Kleinle left her position in February, and that the network does not currently employ any child abuse pediatricians.
The other major health network in the region, St. Luke’s University Health Network, did not respond to a request for comment. Its website does not show any child abuse pediatricians employed.
How the CAC currently works
LVHN previously declined several requests for an interview about how the John Van Brakle Child Advocacy Center functioned. LVHN representatives instead referred to the CAC Family Booklet.
Former Lehigh County Commissioner Bob Elbich gave an overview of the county’s child welfare system in October.
The county district attorney is required to convene a Multidisciplinary Investigative Team to coordinate child abuse investigations among different departments.
In Lehigh County, that team is the CAC, Elbich said.
A biannual report from the county District Attorney’s office from 2021 said the CAC had 50 members, including the district attorney’s office, the Lehigh County Office of Children and Youth, Allentown Police, the LVHN Child Protection Team, a forensic interviewer and a family advocate.
LVHN’s website says the John Van Brakle Child Advocacy Center followed the National Children’s Alliance model for responding to child abuse allegations.
According to the organization’s website, those centers centralize the response to child abuse allegations by having one place for interviews, therapy, medical exams, case management and other services.
“At the CAC, the child tells their story once to a trained interviewer who knows the right questions to ask in a way that does not not retraumatize the child,” the website reads.
“Then, a team that includes medical professionals, law enforcement, mental health, prosecution, child protective services, victim advocacy, and other professionals make decisions together about how to help the child based on the interview.”
The Parents' Medical Rights Group of the Lehigh Valley have alleged that Esernio-Jenssen had too much power in the CAC and falsely accused parents of abuse.
In a statement, the group said creating an independent CAC "is one step toward repairing this damaged process."
"The next step is an independent investigation to identify how the abuse of power was created, enabled and left for long term destruction," the statement read.
"Without this, there is no assurance that a 'new' CAC will have proper policies and personnel in place to prevent this from occurring again."
Child abuse pediatricians
Oftentimes, child abuse pediatricians such as Esernio-Jenssen work within CACs to give medical evaluations to children who are suspected to have been abused.
According to Pennsylvania law, CACs are not required to employ child abuse pediatricians — they are only required to have a “health care provider.”
But many CACs for larger areas employ them because of their specialized training.
Cases of medical child abuse require a different type of examination from child abuse pediatricians.
Formerly known as Munchausen Syndrome by Proxy, medical child abuse happens when a caregiver induces or fakes an illness in the child in their care, usually for sympathy or attention.
Alleged false accusations of the abuse have been the center of the controversy.
Mike Weber is a Texas-based detective who specializes in investigating medical child abuse. He said child abuse pediatricians are trained to review the children's medical records to see if there are any signs of deception or fabrication on the part of the parents.
“For instance, having a medical test that says your child does not have Crohn's disease, then you go to another doctor who knows nothing about that medical test…and say, ‘My child was diagnosed with that.’ You're looking for those intentional lies,” Weber said.
“The question is, will they devote the massive amount of hours to do that? And who's going to pay them to do that?"Mike Weber, a Texas-based detective who specializes in investigating medical child abuse
Weber said health care professionals who are not child abuse pediatricians can do record reviews for medical child abuse cases, but the records often are complex and thousands of pages long.
“The question is, will they devote the massive amount of hours to do that?" Weber said. "And who's going to pay them to do that? Do they have the expertise to know what they're looking for?”
Weber said child abuse pediatricians often are critical to investigating not only medical child abuse, but also abusive head trauma and severe physical abuse.
Howard Dubowitz, director of the Center for Families at the University of Maryland School of Medicine in Baltimore and a board-certified child abuse pediatrician, said it is “optimal” for a child abuse pediatrician to work in CACs.
“It fosters the team sharing information, working together,” Dubowitz said.
But he said some counties have very few cases.
“And so, logistically, it doesn't justify a pediatrician sitting there all the time,” Dubowitz said.
Dubowtiz suggested that CACs at least form relationships with child abuse pediatricians so they could evaluate some tougher cases.
A profession under fire
In many of the publicized cases of parents saying they were falsely accused of child abuse, the field of child abuse pediatrics has come under fire — including in Lehigh County.
Members of the Parents’ Medical Rights Group said Esernio-Jenssen had too much power in the CAC and accused parents of abuse without enough evidence.
Other child abuse pediatricians across the country have received the same complaint.
Dr. Eli Newburger, who helped found the Child Protection Program at Boston Children's Hospital, has been among critics of the field.
Newburger said previously that he thinks the field of child abuse pediatrics has been flawed since its conception.
“I pointed out then, and still believe now, that the new specialty would be better characterized as forensic."Dr. Eli Newburger, who helped found the Child Protection Program at Boston Children's Hospital
He was at the meeting convened by the American Academy of Pediatrics in the late 1990s to discuss whether to create the subspecialty.
“I objected to those efforts because of my concern that if pediatricians were identified as specialized in this field, they would be appointed… as the people who would be called in to say, ‘Thumbs up or thumbs down, is this child abuse?’” Newburger said then.
“I pointed out then, and still believe now, that the new specialty would be better characterized as forensic, in which the physician's role as an expert would be to guide and inform decision-makers in the field that dealt with criminal and civil allegations.”
Dubowitz said child abuse pediatricians do not make the final determination of whether a child is abused.
The American Academy of Pediatrics recently published a paper about how there are not enough child abuse pediatricians in the country, and cited the national criticism as a cause.
“Because of [HIPAA], [child abuse pediatricians] cannot explain their evaluations or diagnoses to noncustodial families or the media; therefore, inaccurate or incomplete information may be presented in the news and on social media,” the article reads.
“Even the awareness of this negative, likely threatening, exposure is a stressor for those in the field, because there is currently no organized way to respond.”
There are about 350 child abuse pediatricians in the country, according to the paper.
Because of problems with retention and recruitment, the field is expected to grow at a lower rate than any other pediatric subspecialties in the next 20 years.
“It's a tough, unpleasant area,” Dubowitz said. “Even though some of us see it's important, it's still somewhat peripheral in the medical field.
"And it's not the same as cardiology or dermatology, that have been well-established for a long time.
“And there are the challenges of working with the legal system of families who may get particularly disgruntled and the possibility of lawsuits.”
LVHN and Esernio-Jenssen are currently facing three lawsuits related to the false accusations of child abuse. Two were filed last month, and a third was filed last week. It includes seven more families.
The 13 claims in the latest lawsuit mirror that of the other suits, including negligent and intentional infliction of emotional distress, interference with parental rights, false report of child abuse, defamation, and assault and battery.
EDITOR'S NOTE: Lehigh Valley Health Network is a financial supporter of Lehigh Valley Public Media and a founding supporter of LehighValleyNews.com. LVHN has no influence on our editorial or business operations.
