Monday, Aug. 27, 2018
Robin Foster, M.D., has barely slept. She worked a night shift in VCU Health’s pediatric emergency department, she explains as she navigates the hallways of the Children’s Pavilion at Children’s Hospital of Richmond at VCU. She excuses herself briefly to check on a family. She can’t stay with them long — she’s looking ahead to a full day of work with CHoR’s Child Protection Team, which she co-founded and leads as director.
Twenty-six years have passed since she started the team, whose sole focus is helping children who have been neglected or physically or sexually abused. As one of only three physicians in Virginia who is board certified to treat child abuse and neglect, Foster often travels the state to handle cases.
Aside from her responsibilities with the Child Protection Team, Foster teaches in the Virginia Commonwealth University School of Medicine as an associate professor in emergency medicine and pediatrics. In 2017, she stepped down as chair of the Division of Pediatric Emergency Medicine at CHoR. Without that day-to-day administrative responsibility, Foster threw herself into forming new partnerships to enhance the work of the Child Protection Team.
The team, largely composed of nurse practitioners trained to address issues of child abuse or neglect, recently began to provide mental health services as well. Licensed clinical social worker Carly Barrows is the coordinator and has spearheaded this effort.
Barrows is working toward a goal of providing therapy services for children the team treats, and to make exam rooms and treatment areas at CHoR more trauma-informed. This involves recognizing and acknowledging trauma triggers, Barrows said, and setting up the room with an eye toward soothing the patient. This could involve warmer colors, softer lighting or systems that can help distract a patient from difficult examinations.
Foster and Barrows are excited about a new grant from the Family and Children’s Trust Fund of Virginia that will help allot time for staff to screen all caregivers who accompany children into the team’s outpatient clinic at CHoR. In partnership with Project Empower, an initiative at VCU Health that provides services to people experiencing intimate partner violence, the team can identify caregivers with risk factors such as domestic violence or adverse childhood experiences they may have gone through. Then the team can connect them to resources aimed at preventing the cycle of domestic violence and intergenerational trauma. The grant also will assist staff with implementing a support group for teens aimed at preventing dating violence.
I think that parenting is the hardest job that anybody ever has.
“I think that parenting is the hardest job that anybody ever has,” Foster said. “It’s much easier for me to work a night shift in our ER on a Saturday than to raise the three children in our household. There are unique challenges, and I think that there is a huge stigma to saying, ‘I don’t know how to do this, I need help.’”
Foster said reducing that stigma is key to reducing child abuse and neglect. For example, home visits, in which a social worker checks on a family, are often seen as a punishment or sign of trouble. Foster is piloting a program to address that at CHoR in the newborn nursery in collaboration with its director, Tiffany Kimbrough, M.D., and the Virginia Department of Social Services. Every family gets a home visit seven days after the birth of a child, regardless of whether they show risk signs for child abuse or neglect. Providing support to all families, Foster said, rather than focusing only on particular demographics, is important because abuse and neglect can occur in any home. At the same time, universal education could make families who need help more comfortable receiving it.
These types of partnerships are one reason Foster is excited to work for VCU. She praises the people, resources and potential for collaboration as well as the university’s commitment to her work.
“Child abuse prevention and treatment programs don’t make any money, and so lots of institutions do not have child abuse programs,” Foster said. In contrast, she said, VCU “has been supportive and protective of our program and allowed us to continue expanding.”
Barrows said that Foster, in turn, is supportive and protective of the team. “This is not an easy job,” Barrows said. “You are seeing a lot of really, really tough things. Her attitude helps everyone around her be able to keep pushing forward to help these children.”
Foster marvels at how long she has stayed in the same place doing the same work. She encounters classmates from the School of Medicine as she travels the state or when she hosts reunions at her home. Lots of them have reinvented themselves multiples times, she said. They often ask, “Are you still doing that full time?”
“Yes,” Foster tells them.
She doesn’t rule out the possibility of burnout, though, and is keenly aware that child abuse is an ongoing problem. “I used to say when I was younger that I would like to put myself out of business in terms of the treatment side,” Foster said. “I’m not sure I’m that naive now.”
In recent years, she has been looking to ensure that the Child Protection Team remains sustainable after current team members move on. In particular, she wants to make sure the team has enough resources to do its work without relying on extreme devotion of individual members.
She talks often about the feeling of family she has at VCU Health. She praises the nurse practitioners on the team, who have worked with her for years and who take calls for cases of acute sexual assault 24 hours a day, 365 days a year. She praises the staff who invest themselves in the work.
She also maintains her commitment to her family, including her husband, Jeffrey Haynes, M.D., director of the Children’s Trauma Center at CHoR, and their three children. “I’m lucky because my three children turned out just fine and my husband is still very supportive.”
What Foster hopes for now, she said, is “to have a legacy, to leave these programs that I hope will stay in place forever and will improve the outcomes for these kids.”