The child sexual abuse case against Earl B. Bradley ignited a storm of outrage against the former pediatrician, who in August 2011 was sentenced to 14 consecutive life terms for first-degree rape and more than 160 years in jail for multiple counts of assault and sexual exploitation of a child.
The scale of the crime—which involved more than 100 patients, ranging in age from 3 months to 13—rocked the community of Lewes, where Bradley practiced, and made headlines around the world.
For the victims, the repercussions will last a lifetime. In fact, some children may have yet to exhibit the full symptoms of post-traumatic stress disorder. But those children and their families may have some trouble finding the help they need to cope with the tragedy.
Even before Bradley’s epidemic abuse was discovered, mental health care, especially for children, was scarce in Sussex and Kent counties.
Task force offers ideas to improve children's mental health care in Southern Delaware
Lt. Gov. Matt Denn discusses the Child Mental Health Study Group's findings.
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A task force established by the General Assembly in July hopes to help change that. The group, led by Lt. Gov. Matt Denn, released its findings and recommendations on Monday.
(The task force, set up prior to the suicide of three Polytech High School Students, did not look into suicide prevention services.)
The final report calls for new efforts to recruit psychiatrists, more training for those who work with children and adults suffering traumatic stress, and more funding for services to child trauma victims.
“I was not surprised at what we found in terms of the problems,” Denn said. “But I was happily surprised at the relatively straightforward and attainable things we could do to address it. We were able to reach a consensus on a pretty manageable list of recommendations that we think will put us in a better spot.”
An underserved area
The shortage of mental health care in Sussex and Kent counties is nothing new. In 2009, an analysis performed by the Center for Applied Demography and Survey Research at the University of Delaware found one psychiatrist for every 8,286 residents in Kent County. In Sussex, the population-to-psychiatrist ratio was 27,431 to 1.
The numbers were somewhat better for core mental health professionals (advanced practice nurses, mental health counselors, chemical dependency professionals, licensed clinical social workers and psychologists). In Kent County, there was one for every 2,315 residents and one for every 2,802 in Sussex.
“There’s been a need for more child mental health services in Sussex and Kent counties,” said Will, who’s been with Beebe since 1998. “The resources have never been up to par with New Castle County.”
After the Bradley case, the need for those services is even more acute, particularly since some of the victims may have yet to show symptoms.
“A 5-year-old doesn’t understand the consequences of the sexual assault,” said Cheri Will, sexual assault nurse examiner and domestic violence coordinator for the Forensic Nurse Program at Beebe Medical Center in Lewes. “As they get older, they’ll have a better understanding.” Then they must cope with the trauma all over again. Each time the children reach a new stage of growth and development, they’ll struggle anew to make sense of what happened to them, Will explained.
A growing population is also boosting the need for children’s mental health services. Enrollment in the Cape Henlopen School District, which includes Lewes, has grown by 700 students over the past 10 years.
“Over the years, more kids are being diagnosed with conditions such as ADHD, depression and the autism spectrum,” said child psychiatrist Dr. Mark Borer, who came to Dover in 1987. “There are whole variety of issues that are continuing to bring more and more kids to our attention.”
Families, teachers and physicians are also more willing to refer services, said Susan A. Cycyk, director of the Division of Prevention and Behavioral Health Services in the Dept. of Services for Children, Youth and their Families. There are fewer stigmas attached to seeking help, and both the Bradley case and the Catholic Church scandals have raised awareness about child sexual abuse.
Of the sexual abuse cases that Will and her colleagues encounter at Beebe, between 60 to 80 percent involve children under age 18. At least a third are under age 11, Will said. The statistics are in line with the national numbers.
Studying the problem, seeking solutions
Will had long been seeking more services for Sussex County. The Bradley case, she said, opened the doors for dialogue. Will spoke with Rep. Peter C. Schwartzkopf (D-Rehoboth) and Sen. George H. Bunting (D-Bethany Beach) about the help Bradley’s victims would need.
Getting help right away to the abused children was important, but dealing with post-traumatic disorder requires long-term care. “There is still a need, and people are still waiting to get into therapy,” she said.
Delaware House Joint Resolution 7, which formed the task force, in part stemmed from those conversations.
The task force recommended using funds from the Delaware Health Care Commission to recruit two private psychiatrists to Sussex County. “If people are asking for help, you want to be able to provide it—and you want it to be skilled help so people will persist and get the treatment that they need,” Cycyk said.
Officials also want to provide that treatment in the patients’ own backyards. “We want to identify their concerns and serve them within their communities,” said Rita Landgraf, secretary of the Department of Health and Social Services.
Recruiting psychiatrists to rural Sussex, however, is no easy task. Nationwide, there’s a shortage of psychiatrists. Training, including degrees and residencies, does not come cheap, and insurance reimbursement for mental health services is often limited. Those with an interest in medicine may opt for a more lucrative track.
What’s more, psychiatrists often begin practicing where they did their residency, noted Jim Lafferty, executive director of the Mental Health Association of Delaware. Some medical school students may do residencies in Delaware through Christiana Care Health Systems’ partnership with Jefferson Medical College in Philadelphia. But these young doctors may see Philly and not Southern Delaware as the place they want to start their new practice. “We need to establish a ‘tourism’ bureau for doctors,” he said.
Landgraf agreed that the state must be more aggressive in recruitment. Student loan repayment is one recruitment tool that doctors may find attractive. In the past federal funds were available for recruitment but only if the state could match funds. Under the approval conditions of the Highmark-Blue Cross Blue Shield of Delaware merger, the state now has funds to use.
While proximity to the beach might serve as bait, the need for psychiatrists is particularly high in western Sussex County. The task force’s wish list includes psychiatrists who are willing to work in that section of the county, who speak Spanish and who are willing to work nights and weekends so parents need not take off from work.
The psychiatrists ideally would serve in supervisory roles, overseeing core mental health professionals. Borer refers to himself a “collaborative psychiatrist” and has found success with the model. While maintaining his own practice in Dover, he works with other groups in the public and private sector.
Involving family members is part of the collaboration. Because pediatricians and family doctors are often too harried to collect all the data that the consulting psychiatrist needs, family members frequently fill out the forms. “Most people do a decent job of that,” Borer says. “The primary care doctor takes a look, writes down his or her concerns and adds some clinical information.”
Telemedicine, through which health care providers consult with experts via technology, is another way to access professional psychiatric services, Denn said. The problem, Cycyk added, is that Medicaid currently doesn’t cover telemedicine.
In the wake of Bradley’s arrest, the state had provided Sussex County with a temporary mental health case management service. “When those referrals calmed down, the manager was redeployed,” Cycyk said. But post-traumatic stress disorder causes recurrent problems, and mental health services in the county are scarce, so the task force recommended a central case-management service in Sussex, who could consult with front-line professionals, such as primary care physicians. The task force also recommended stable funding for the Children’s Advocacy Center, which receives what Denn calls a “patchwork of state and federal funds.”
The task force felt that the state did a good job with children suffering from post-traumatic stress disorder. However, providers need additional training to spot problem in children who’ve yet to display full-on symptoms. The University of Pennsylvania offers Child and Family Traumatic Stress Intervention training, which the task force anticipated would cost $14,000.
Will speaks highly of a program called Stewards of Children. Created by the organization Darkness to Light, the program is often presented to day care centers, after-school programs, and youth organizations.
“Many programs hold the kids responsible with topics such as ‘Stranger Danger,’” Will said. “Stewards of Children holds the adult responsible.” The goal of any training is to catch symptoms as early as possible, Denn said.
Denn and Will, who both attended all the task force meetings, were pleased at the outcome. “I was afraid the ball would have a hard time moving forward,” Will said. “It ended up being like a bowling alley, hitting all these topics. I was amazed.”
The task force included representatives from the Department of Services for Children, Youth and their Families, the Department of Health and Social Services, the attorney general’s office, the Disabilities Council, school officials from the counties, the Children’s Advocacy Center, victim service workers, the Psychiatric Society of Delaware, and members of the general public and General Assembly.
“We needed to have all the players sit at the table,” Will said. “I am pleased how driven they were to attack this issue.”