John Leventhal, MD: A Career Spent Preventing Child Abuse

[February 2008] John M. Leventhal, MD, spends his time on the kinds of cases every physician dreads. As a child abuse specialist, Leventhal consults at Yale-New Haven Children’s Hospital when there is a suspicion of physical abuse, neglect or sexual abuse involving children.

“There are injuries that make people very worried about physical abuse,” Leventhal explained. These include any serious injury to a child less than a year old, or head trauma such as a fractured skull or subdural hemorrhage, for which there is not a plausible explanation. Leventhal meets with the family, examines the child, reviews X-rays, checks lab data, meets with the physicians, and if necessary, reports the case to the Department of Children and Families (DCF).

Not surprisingly, Leventhal’s work requires delicacy and compassion, and he has assembled a team to handle the medical, psychological and social issues faced by his patients. Specially trained social workers conduct forensic interviews to obtain information regarding sexual abuse allegations; the interviews take place in a room with a one-way mirror, so that representatives from the police department and the DCF can observe. Specialists trained in child development help prepare children for their interviews and medical exam, sometimes accompanying them into the exam room to help distract them, especially when sexual abuse is suspected. A family advocate is also available to link the family to the appropriate mental health services in the community. “It’s a team approach,” said Leventhal, who arrived at Yale as an intern in 1973, took over direction of DART, Detection, Assessment, Referral and Treatment, one of the first hospital-based child abuse programs in the country, in 1982, and established a sexual abuse clinic in the mid-1980s. Leventhal’s team now includes about 20 staff members, including those who work in prevention programs he’s helped to develop during the last 10 years. Prevention efforts include parenting groups, weekly home visits with socially high-risk first-time mothers, and a phone system in which volunteers check in with first-time mothers to see if they need help or advice.

The worst cases Leventhal sees involve serious injuries to children under 3 years, who don’t have the language skills to explain what happened to them. These cases are very painful for doctors and staff as well, he said. But the rewards when his team is able to make a difference are gratifying. “The best-case scenario is that the abuse is recognized early and stopped,” he said. “Then the parents can get help, and the abuser can get an intensive intervention so that the family can be reunified.”

- Originally published in the February 2008 issue of Yale Practice.