337 - Advancing Child Abuse Prevention: The Impact of TEN-4 Day and the TEN-4-FACESp Tool

Publication Number: 337.3799

Bishoy N. Ibrahim, MassGeneral Hospital for Children, Natick, MA, United States; Wee-Jhong Chua, Harvard Medical School, Boston, MA, United States; Shannon Moody, Kentucky Youth Advocates, Louisville, KY, United States; Debbie Abreu MSW, Kentucky Youth Advocates, Louisville, KY, United States; Mara Powell, Kentucky Youth Advocates, Louisville, KY, United States; Kim Kaczor, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; MARY Clyde Pierce, Ann & Robert H. Lurie Children's Hospital of Chicago, EVANSTON, IL, United States

Background: Child abuse is a prominent public health issue with 1,990 pediatric deaths from abuse or neglect in 2022. Children under 1 accounted for nearly 50% of those fatalities.1 TEN-4-FACESp is a clinical screening tool for bruising that is more commonly due to non-accidental trauma.2 Since 2019, “TEN-4” Day has been held in states and communities on October 4th to bring attention to the TEN-4-FACESp and emphasize the importance of recognizing, reporting, and preventing child abuse.

Objective: We aim to describe the expansion and impact of “TEN-4 Day."

Design/Methods: After establishing a coalition of child advocates in 2023, we surveyed our partners in October 2024 to gauge the engagement and impact of TEN-4 Day. The coalition included community organizations, physicians, Emergency Medical Service providers, and government child advocacy leaders. The survey included multiple-choice and free text responses. Respondents were not compensated. National webinars were held in April and September 2024 to encourage engagement and provide resources and expertise. The survey explored various observances including lectures, institution specific emails, media press releases, Grand Rounds, workshops, and the number of proclamations submitted and awarded. The survey was conducted using Google Forms and was available for 1 week.

Results: In 2024, 12 states and the District of Columbia held activities to acknowledge TEN-4 Day (Figure 1). The educational trainings and conferences brought together social workers, dentists, dental hygienists, community healthcare workers, educators, paramedics, nurses, law enforcement, Department of Child Services, clinicians, emergency departments, and hospitals. Proclamations were obtained from 6 governors, 11 mayors, 21 county judges, and an Auditor of Public Accounts. The proclamations promoted TEN-4 Day via news releases, hospital-wide emails, Grand Rounds, and trainings.

Conclusion(s): “TEN-4 Day” creates an opportunity and the TEN-4-FACESp provides a platform to encourage engagement around child abuse prevention and collaboration between stake holders. Proclamations from city and state elected officials help promote advocacy and education, and signal to their constituency that child abuse prevention is a priority of their government.
1.U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2024). Child Maltreatment 2022.
2. Pierce, M. C. et al. Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics. JAMA Netw. Open 4, e215832 (2021).

Table 1: Examples of state led TEN-4 Day initiative


Figure 1. States acknowledging TEN-4 Day (SD, NV, NJ, IL, CT, MI, AR, KY, MA, MT, TN, WI) + District of Columbia and States that obtained a gubernatorial proclamation (AR, KY, MA, MT, TN, WI)