Don Bross, PhD, JD
Associate Director for Pediatric Law, Policy and Ethics
The Kempe Center
Episode 27: Child Abuse Requires a Multidisciplinary Approach
Lori is joined by Don Bross, PhD, JD, Associate Director for Pediatric Law, Policy and Ethics at The Kempe Center, Children’s Hospital Colorado. Don discusses his career utilizing his expertise in law, medical sociology, and pediatrics to expand solutions for those impacted by child abuse and neglect.
- “Sexual Abuse, Another Hidden Pediatric Problem” (1977)
Read Article by C. Henry Kempe
Transcript of the Louder than Silence Podcast
Episode #27 – Child Abuse Requires Multidisciplinary Solutions
Transcribed by Adam Soisson
[Inspirational theme music plays.]
>> Lori: Thank you for joining us. In this podcast, we are real people, talking about real things. Child abuse and neglect: a topic that is all too often left in the shadows of silence, leaving survivors alone, fearful, and oftentimes without a voice. We’re having conversations to become Louder Than Silence. It is here, where we will invite you to join us and be the change needed to end child abuse and neglect.
>> Lori: This podcast is brought to you by our dear friends at The Conference Experience. The folks at The Conference Experience have really helped us out at EndCAN here for the last year and a half. They do incredible work, especially during COVID. They’ve really stepped up to the plate and helped us out so if you’re needing any audiovisual, production, or even support and help with running an event, please give The Conference Experience a call. Their number is 720 323-3273 or you can check them out at theconferenceexperience.com
>> Lori: Alright hello everybody and welcome to the Louder Than Silence podcast. My name is Lori Poland, I’m the Executive Director for the National Foundation to End Child Abuse and Neglect. Today we have my dear friend Don Bross who I just introduced Don to my daughter before we got on and I also shared with Don that he’s truly one of my favorite men. You want to talk about a man who’s a kind soul and genuine and authentic and good, Don is at the top of that list. I shared that he reminds me so much of my grandfather who I lost 7 years ago and I just really value Don a lot. So Don thank you for being here and being a guest on our podcast.
>> Don: It’s easy, glad to be here.
>> Lori: Well good. So Don if you wouldn’t mind telling our listeners what you do and what’s been your primary role in your last profession?
>> Don: It began when I was clerking for the University’s Council office for the University of Colorado Medical School. I got hired onto Henry Kempe’s staff. It was 1976 and I was told by my boss and mentor George Taku who was a very fine health lawyer that there was this pediatrician that some people found a little difficult to work with but he was looking for a lawyer and he put my name in. I said “please I need a job” and Henry Kempe and Dr. Brent Steel and Ruth Kempe and some of those other people, because I knew them and worked with them I’m going to mention them a few times because I think it helps all of us to understand how special those people were. So I went ahead at 8:00 in the morning, my only child had just been born about 6 weeks before and I would come to believe it strongly that after meeting and marrying my wife Jody the second best thing that ever happened to me was to go to work for Dr. Henry Kempe just after my son was born because then I’d say I didn’t make quite as many contributions to my son’s problems as I might have otherwise [laughs]
>> Lori: [laughs] It’s always the parents’ fault Don, it’s always the parents.
>> Don: Well Dr. Steel used to test people, not telling them that he would test them. But he always wanted to know – he could kind of tell who he could trust to be around other people was if people understood how they made contributions to other people’s problems. If you were aware of that and you could alter your behavior, then that was a good sign. Just as Dr. Kempe didn’t trust people who didn’t understand the impact they were having on a child they were caring for, Dr. Steel was very aware as a psychiatrist who worked with violence, who learned his psychiatry on the battlefields of Europe, not because of choice but because as an internist, as a primary care physician he got drafted along with half of the medical school and ended up in Europe so they didn’t have a psychiatrist and the director of that particular MASH unit came in and said – they hadn’t gone to England yet but they were on their way – “Steel, you’ve always been interested in why people do things. We lost our psychiatrist so you’re going to have to be our psychiatrist.”
>> Lori: Wow that’s a promotion
>> Don: Yeah it was unbelievable especially given what he confronted as he worked with all these people who had terrible things happen to them in the war and all the way through the tragedy of the war and saw all these things. But he came back and got formally trained. I’ll tell you about him, I think a good test of a therapist, of any background is if you feel better when you’re around them and Brent made everyone around him feel better. Henry Kempe and Brent were close friends. Henry’s career was remarkable in itself. Just to have people know a little bit, Dr. Kempe came to Colorado at the age of 33 to be the Chairman of the Department of Pediatrics which is extraordinary when you think about that early age but he was already known for his work in the eradication of smallpox, especially in India and he came to a department with only 3 other doctors. Now we have one of the top 5 children’s hospitals in the United States. The University, the medical schools and the pediatrics department weren’t even combined at that time. In fact, Dick Krugman is one of the reasons that happened. Henry tried it for 16 years but Dick helped finish that. In 1958 Dr. Kempe began to see children who had injuries and when he heard the explanation didn’t make much sense to him so he started asking questions and that is another story some day you want to tell about because I got there in ’76 and they were just beginning to deal with child sexual abuse which nobody believed could ever happen, especially not happen to the children in the preschool at the Kempe Center. It was just so unthinkable and Dr. Kempe was again ahead of his time and wrote an article- “Another Hidden Pediatric Problem: Child Sexual Abuse” which was being published in the American Academy of Pediatrics Journal and he was in New York City to receive what is called the Aldridge Award for outstanding contributions to pediatrics in the United States on a Saturday in late November in New York City and he had a massive heart attack. In fact he had to be revived over 90 times and most people never survive that kind of experience.
>> Lori: Especially back then
>> Don: It’s extraordinary. He came back and he continued to work but he ended up passing away at 61. When he had his first heart attack he’d only been in his career for 20 years and he had a cardiologist who said he had to slow down. Dr. Kempe said he had to do in 20 years what others had 40 years to do because no male had survived 60 in his family. So he had five daughters, did very well. His wife was a child psychologist, she was a marvelous person to be around because when children have been injured it’s so unthinkable. It’s very hard for the people who love them and care for them to know how to respond. Part of that is they have a real hard time with their own feelings and emotions and they feel often guilty or that they failed. I think people have a hard time knowing where to put all their feelings.
>> Lori: It’s vicarious trauma
>> Don: Well that’s right but for a long time nobody thought about that or even recognized it. I think what can happen then is the child is struggling to understand what’s happened to him or her and they get confusing messages. They don’t understand that the adults may look like they’re adults but not all of them are able, in fact an awful lot of people – nobody told us about these kinds of things, nobody prepared us for these kinds of things. So we were talking a little bit about your grandfather and one of the things that helps people become more resilient is to have something, some relationship or more hopefully than one, of people who believe in you. This is what Dr. Steel remarked about every survivor of any form of abuse that he treated as a psychiatrist which is that everyone of them recognized that everything that happened to them was not deserved and did not define them. They could go forward, they didn’t have to do this to other people and could kind of separate through all those feelings and go on. Not forgetting or rejecting their experience but finding ways to metabolize or adjust or use or acquire some resilience and you could always look at – in successful vaccination campaigns, the test of a successful campaign is to “challenge” the person who gets the vaccine. What you’re really saying is you challenge their immune system and we would like to prevent all kinds of trauma to humans, especially to children. Perhaps the best way to have that happen is to have good relationships, good care as much as possible and always have at least one or more people who believe in us. Then when we’re challenged, our immunity can rise. Not to become perfect. People can still get coronavirus but it won’t be as severe in its effect if we’ve had some preventive intervention. So these are the people I ended up working for.
>> Lori: That’s a gift right there. Like if you just stopped there.
>> Don: Well that’s it, I think it was essential. I don’t know how people do this when they don’t have that kind of support around them.
>> Lori: Well I think that our child welfare system and the turnover rate can be a good indicator of that.
>> Don: Absolutely right, I really believe that. I think that’s at the heart of our problems with that system.
>> Lori: Well right and the difference between having a supportive environment that enhances hope and possibility versus a supportive environment that’s punitive and driven by potentially the wrong things.
>> Don: They respond as if they’ve been abused too, often. But not all of them, some are very resilient and robust themselves but you and I talked briefly before we started that I had five years as an active duty Naval officer and there was plenty of exposure to difficult things then but one of the things in particular that I went through because I was on a ship that had a lot of flammables explosives on it; a tanker. I went to firefighting school and I was 22 and brand new at this thing. They would set these steel chambers on fire and we were supposed to go in with just a hose and snuff it out. It was pretty frightening. It was very loud and really hot. It was in Norfolk in August and it was very suffocating.
>> Lori: Good on the job training Don [laughs]
>> Don: Well when we started dealing with child sexual abuse in particular I thought about the idea that you couldn’t go into a flaming compartment, especially out at sea where there’s no fire department, with a ship that could blow up if you didn’t do this, without a team. The way they had it, because I was the only officer they always sent me first and you would have this hose that was trying to strike you it was so powerful. 150 lbs. of pressure coming out of this hose but there was a fellow right behind you that had what they call a gooseneck and it would drop across your shoulder. That would not be enough but it mitigated the heat enough you could stand in there. Beyond that were another pair of guys who were making sure the hoses didn’t swing wildly and run out of control. So I looked back and thought about all the emotions people start having when they start dealing with child sexual abuse and they didn’t know where to start or how to deal with it. They’d never thought about these things, nothing had prepared them for it. But you had to have this group of people who could process these things so they did not then add to the problems of the children and families they were working with.
>> Lori: The systemic impact, yeah
>> Don: So here we have social services today that – it’s an observation that is unfair for some agencies but not many at least in my experience, I’ll say that. There are some that do this very well. There’s a tendency to take your youngest, greenest workers and hand them a portfolio and say ‘go take care of the Smith family’ and right away I think that’s not good. We actually had a little research that says you should not do it that way. You should have mentors and you should be taken to be with the family and somebody demonstrates how you listen and what you’re able to do and not do. Again going back to the military analog, I always thought that the very best leaders were the ones up in front. If we look at doctors, even when they teach medicine they’re seeing patients and they’re seeing them in all kinds of circumstances and I think we’d like to see our very best people helping not only see who needs the most help first, frontlines kind of questions – MASH units, triage. How do we figure out who to start with now because we’re not going to have all the people we need with all the families we have to help. But also recognizing a situation that’s developing that’s really urgent and crucial and we have to be paying special attention to the child in question and to the workers involved because it’s going to be a tough case. I just feel like we kind of stick them out there, the way it would be like if I was in the Army and I sent some young Private out to the frontlines and said ‘go attack that pillbox’ or you had a young firefighter and you told them to go into the first room and snuff out that fire
>> Lori: We’ll supervise from here.
>> Don: Exactly. Exactly right. You lead from the front. We’ve never- and the reason behind it – I think it’s unstated, unrecognized because it’s too discouraging, is that the smart people can’t wait to move up in the hierarchy and get further and further away from the action. There are some very special, good, caring people who hang in there and become wonderful frontline workers and what makes them unusual is they stay there. Bu the way I think it too often works is they don’t abandon them; they don’t incentivize or reward your best clinicians. In fact the whole field of social work has tended to move, in child protection services, away from clinical work and they become managers. That was an unpaid political announcement, I don’t want to make any more.
>> Lori: [laughs] Sure fair enough, well I won’t ask you to. I do want to clarify one thing though Don, your training is as a JD. You’ve got a legal background and so what was your role? I know you “retired” technically because Don and I were just talking about he, among others has done a very poor job of what retirement looks like because he retired in 2017 and just today is talking about vacating his office. You know I think it really speaks to who you are as a person but it also goes to show that when you love what you do, you don’t stop doing it. So I’d love for our listeners to understand what was your role in this field from a legal perspective?
>> Don: Well I think as I look back I’ve always tried to figure out, I tried to be useful and I tried to find problems that were really challenging and important that I’d try to address. I should say that I was a very difficult person to get a full education. I was raised by a single mom from a dust bowl kind of background. Before I went to law school, after the Navy I ended up working on a doctorate in medical sociology in Madison, WI during the anti-war period so I did work on injury for my Masters and for my doctorate, Henry Kempe knew this when he hired me, and I think it’s part of the reason I was hired. I was working on a study of every doctor in Denver except pathologists and psychiatrists who might see and diagnose a sexually transmissible infection. Working with CDC, we had to question our private physicians. We did a study, it took three years and this is after I started working for Dr. Kempe. We found a way to find out exactly what was being reported versus how much was being seen. We also found a way to calibrate systems that already existed. I think it turned out to be hugely important that I had that exposure when I was hired because when people didn’t want to believe that such a thing as child sexual abuse could occur, I was working with VD investigators and people across the country that knew this. I’ll just tell you a quick story because it shows that there was both a legal and a medical sociology background that helped me be useful. So I had a really good friend by the name of John Potter down in Colorado Springs. He and I worked together when legal issues came up and I was with the Health Department. He called me once to say they had a case they didn’t quite understand. There were three clusters of children under the age of five with gonorrhea. I thought that was outrageous. He said ‘No Don you don’t get it. We’re around a lot of people that don’t think about children versus any other object they would have sex with but what shocks us is that males, knowing they were positive for gonorrhea, would go ahead and then have sex.” What he meant was that males are symptomatic, they usually have a drip from their penis and therefore we knew this. Why would they do this? If you do find out could you call me back. So John calls me back about 2 months later and said “we know all the pimps in our city. We’ve retested all of them. Most males, about 90% are pre-symptomatic. Only 10% of males are symptomatic but we’ve found in our population that 90% of the men have it and it was asymptomatic.
>> Lori: Wow
>> Don: Exactly, wow. In other words, I ended up able to look at things from the legal perspective but also from the querying, scientific perspective. Are we missing something? What don’t we understand? It was helpful when people doubted there were children being abused, this was the kind of information that showed us. HIV came along just a few years after that so I was always working both sides of railroad track. I was working on public health, medical health side as kind of thinking about research and I was going to court for children and being house council on the other side. So now what I still do is I sit on the children’s hospital institutional review board, reviewing research involving children. Right now they’re only calling me about once or twice a month but I’ve done that for about 35 years I think and I always sat on the child protection team. Right now I know I’ve got a successor coming in so she’ll be doing that. I’m doing some teaching, a lot of writing, some research and often trying to learn from the cases of children that are being brought through and the cases I had to go to court for. The kind of cases that would be referred to us because of their complexity. What were the important legal as well as other research issues. There are legal issues that we have to figure out right now. What legislative fixes or what case law or what positions could we take. It was like having a set of tools and toolkit and I tried to bring each one to bear when it was necessary. One of my first assignments from Dr. Kempe was to help draft a law to free children for adoption if they’d had severe abuse and the parents weren’t responding to the intervention. That’s a great example where it was helpful to be trained in law but also to be trained in social psychology and medical sociology which were my other backgrounds because I had learned to hear these different perspectives and find ways to translate. So now I’ve really done the job of explaining I think the complicated answer of what I did. Maybe you could think, I kind of think I was a translator that also had to use the languages I was translating myself in certain individual situations.
>> Lori: Sure, for the rest of us that don’t maybe understand
>> Don: I think we can all understand. What are important things I always talk about in research committee but also when I’m teaching residents about relationships between medical providers and their patients is useful all over. We think we’re understood but we should always people what they understood that I said. Translate it back. That matters not just with foreign languages, with people coming from different countries but because a lot of us, about 90% of us get no scientific training that really counts so we get these terms thrown at us. A lot of problems, as you and I are speaking we have this epidemic and a lot of people don’t want to take the vaccine. A lot of people don’t think it’s real but if you go in as a patient and the doctor asks how do you know, you have to have the patience to say here’s how we know this. Do you understand? Can you tell me what you understand? Because otherwise they’re going to still not understand. I don’t know if this is true for therapists or not but I think for some it would be true as well but what do you think we’re talking about?
>> Lori: It’s funny as you said that earlier – tell me what you understand – I use that as a mother on a regular basis. What did you just hear me say? [laughs]
>> Don: Very nice. That’s lovely
>> Lori: Then they translate it in their own words and it’s like ‘oh that’s not at all what I said. Let me try that again.’ So it’s important to hear how people are hearing us.
>> Don: You know what you and I are talking about right now brings back another memory of Dr. Steel. He once had a mother who had adopted five children and came from a very strict background in terms of faith and experience. She got identified for the other children being severely beaten and that’s why Dr. Steel was seeing her. The long story short is he treated her for years as she needed and it turned out that the older children did continue to struggle but the third child did a little better and the last two did very well. One time he got a call from this mother who said she just wanted to talk to him again because this was years in the past. He was delighted to hear from her and asked her how she was doing and that’s how he got this information. Then he asked her why she kept crediting him, saying how wonderful it was what he’d done. So he asked her what she was doing for her children because you’re saying they’re doing very well. She says she was listening to them the way you used to listen to me.
>> Lori: That’s beautiful. Well I think we’re going to wrap it up on that note. That is so beautiful Don. Thank you so much from the bottom of my heart for being here.
>> Don: Thank you Lori for what you’re doing
>> Lori: Ladies and gentlemen, I’m Lori Poland and I am the Executive Director at the National Foundation to End Child Abuse and Neglect. Today you have joined me in having the pleasure of listening to Don Bross who is truly such a good person. Don thank you for all of your years of service, both in the Navy as well as to children and families all over the place. You certainly were impactful in my case and with my family and I know that you have done a lot of wonderful things for thousands of other people so thank you for who you are and what you’ve done in this world, Don. Thanks everybody for listening today. Come back again and join us for our next podcast. Have a wonderful day.
>>Lori: I want to thank each of you again for joining us today and listening in. If you or someone you know is being abused, please call 1-800-4-A-CHILD. To learn more about EndCAN, visit www.endcan.org or find us on all social media platforms. Join us in being Louder than Silence and being a part of the change. Please leave a comment, like our podcast, or share with your friends. The more the word spreads, the more of a collective impact we can have. If you have a question or you know someone who would want to be a guest on our podcast, please contact firstname.lastname@example.org. Thanks again, and have a great day.