title: Pediatric response to a large-scale child protection intervention.
abstract: OBJECTIVE
  In a rural area of the US state of Texas, in April 2008, the Texas Department of Family and Protective Services (DFPS) responded to evidence of widespread child abuse in an isolated religious compound by removing 463 individuals into state custody. This mass child protection intervention is the largest such action that has ever occurred in the United States. The objective of this paper is to characterize the burdens placed on the area's community resources, healthcare providers, and legal system, the limitations encountered by the forensic and public health professionals, and how these might be minimized in future large-scale child protection interventions.
  
  
  METHODS
  Drawing on publicly available information, this article describes the child abuse investigation, legal outcomes, experiences of pediatric healthcare providers directly affected by the mass removal, and the roles of regional child abuse pediatric specialists.
  
  
  RESULTS
  Because the compound's residents refused to cooperate with the investigation and the population of the compound was eight times higher than expected, law enforcement and child protection resources were insufficient to conduct standard child abuse investigations. Local medical and public health resources were also quickly overwhelmed. Consulting child abuse pediatricians were asked to recommend laboratory and radiologic studies that could assist in identifying signs of child abuse, but the lack of cooperation from patients and parents, inadequate medical histories, and limited physical examinations precluded full implementation of the recommendations.
  
  
  CONCLUSIONS
  Although most children in danger of abuse were removed from the high-risk environment for several months and some suspected abusers were found guilty in criminal trials, the overall success of the child protection intervention was reduced by the limitations imposed by insufficient resources and lack of cooperation from the compound's residents.
  
  
  CONCLUSIONS
  Recommendations for community and child abuse pediatricians who may become involved in future large child-protection interventions are presented.
authors.affiliation: Department of Pediatrics, University of Texas Health Science Center at San Antonio, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Lukefahr
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Kellogg
authors.forename: James D
authors.initials: JD
authors.lastname: Anderst
authors.forename: Amy R
authors.initials: AR
authors.lastname: Gavril
authors.forename: Karl K
authors.initials: KK
authors.lastname: Wehner
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D002662:Child Health Services / Q000458:organization & administration*; D002669:Child Welfare; D034682:Church of Jesus Christ of Latter-day Saints; D005260:Female; D006801:Humans; D035846:Law Enforcement; D008297:Male; D058028:Research Report; D012424:Rural Population; D013781:Texas