As the designated Regional Pediatric Centre in the Fraser Health region, Surrey Memorial Hospital offers specialized and unique care to babies, children and youth from Burnaby to Hope. The Leader provides an inside look at how B.C.’s second-largest hospital has grown and adapted to treat its youngest and most vulnerable patients.
A three-month-old boy is brought to the doctor for a routine check-up. The doctor notices a bruise on his forehead the parent says is from his older sister tossing a toy at him. Less than a month later, the baby is in emergency with a bleeding mouth. It’s a minor injury the mom explains happened when he bumped his head with hers. But in just weeks, he’s brought to the hospital again, this time, barely conscious. There is severe bruising on his head and arms, and X-rays show an earlier rib fracture.
A 13-year-old girl keeps coming to school overtired and unable to concentrate. She seems sad and when her teacher asks, the girl says she’s been living at a relative’s house and it’s “different” there. When questioned further, she eventually confides her uncle has been touching her in bed at night and forcing her to do things she doesn’t think are right.
Another child is often seen by neighbours playing in the yard by himself when he should be at school. His clothes are getting dirtier by the day and he appears to be getting thinner. When police knock on the door, they discover a home stacked with garbage. Mom and dad are high and there’s no food in the fridge.
These scenarios serve as examples of children being abused and neglected. And unfortunately, the stories aren’t entirely unfamiliar to the HEAL (Health Evaluation Assessment and Liaison) team at Surrey Memorial Hospital.
In existence since 1995, it is the Fraser Health region’s only Suspected Child Abuse and Neglect (SCAN)-designated team, identifying the health needs of mistreated children. There are just four other such teams in B.C.
The Surrey HEAL clinic, housed across the street from the hospital, welcomes young people from newborns to 18-year-olds.
It is non-acute, meaning it doesn’t treat children and youth needing immediate medical attention. Instead, it sees patients who have been referred – often from the Ministry of Children and Families, doctors and nurses, or police – for physical and/or psychological care.
Prior to their arrival, a child’s records are examined to see if any patterns can be established.
“For example,” explains nurse Nancy Bell (above left), “if the main concern is neglect, I look for different things than, say, if it was sexual abuse.”
Besides registered nurses, the team includes physicians, psychologists, social workers and child life specialists.
But once a young person walks through the clinic doors, they’re the ones in charge.
“It’s really important to our team that this be an invitin
g, warm place for them,” says Christene Buchanan (below left), HEAL clinic coordinator. “This is a crisis moment for them – often their world has been turned upside down. They still have their own worries, wondering what happens next.”
As such, everything proceeds only at the pace the child wants.
For the younger patients, a typical visit begins with a certified child life worker who invites them (and caregiver if desired) to play and have some fun in a private, kid-friendly room. They may colour or do a puzzle. It’s a casual process meant to make the children feel safe and comfortable in an unfamiliar place.
“We find when we have that one-on-one time, we make them understand they’re the boss,” says child life specialist Kimberly Wartak.
But while the children play and interact, the child care worker is observing carefully. Is there aggression? Can they distinguish colours? Do they understand consequences? Are they able to match items? Interspersed are plenty of positive messages about why they’re at the clinic.
All the while, nurses and social workers wander in and out, getting to know the child, sometimes joining in on the play and documenting observations.
“I often say it’s like a well-choreographed dance – we know when to come in…” says Wartak.
The appointment, which lasts between an hour and an hour-and-a-half, also includes a physical exam, but again, only at the young patient’s pace. There’s a doll on the exam table they’re welcome to do their own check-up on and they can touch and try out whatever medical equipment they want.
When it’s the child’s turn, the exam is non-intimidating and entirely on their terms, with each step explained before anything is done. If the child isn’t comfortable with something, they’re free to say so and their wishes are honoured.
Social workers at the HEAL clinic work mainly with parents and caregivers, helping them cope with the often difficult situation. The abuser may well have been a relative or friend, so they have that to deal with on top of helping the child.
Recommendations for the child’s care needs – such as follow-up medical appointments or appropriate community resources or counselling – are shared with guardians. The goal is to help both the child and parent succeed.
“Sometimes, they just need a little help with that,” Bell says.
The centre sees kids and youth three days a week for consultations. The team saw 197 children last year, most for medical concerns related to abuse, but some requiring psychological care. Sexual abuse continues to be the most common reason for visits, followed by physical abuse and neglect.
The cases can be troubling, but the HEAL team knows its child-focused approach is effective. They see it regularly when a patient who was ambivalent coming through the door doesn’t want to leave at the end of the appointment.
“Something right happens here that they feel that comfort,” Bell says.
ON WEDNESDAY: SURREY'S FORENSIC NURSING SERVICE
Other stories in this series:
• Surrey's kids-only ER sees 100+ children per day