Within the US alone, nearly 700,000 children are victims of abuse and neglect each year. Children’s advocacy centers provide critical interventions and case management, yet they reach less than half of these child victims—an estimated 311,000 in 2014. Today, with shelter-in-place orders enacted across the country amid the COVID-19 pandemic, psychologists worry that instances of domestic violence may even heighten.
With enormous caseloads and even more abused children beyond their reach, these protective centers are stretched thin when it comes to resources. Every minute of time spent with inefficient administrative processes is precious time lost that could otherwise be allocated to more individual time with children in need.
When the Audrey Hepburn Children’s House (AHCH)—a division of the pediatrics department of the Joseph M. Sanzari Children’s Hospital at Hackensack Meridian University Medical Center—opened its doors in 2002, its mission was clear: collaborate with child protection agencies to coordinate the investigation, diagnosis, and treatment of young child abuse survivors. AHCH is a designated Regional Diagnostic and Treatment Center and processes more than 4,500 patient visits each year.
Managing a multidisciplinary treatment team and coordinating services and data-sharing with external agencies requires modern tools, and by 2019, the original Children’s House Information Management System (CHIMS) was simply no longer up to those tasks.
That’s where four senior design students and their advisor Vikki Hazelwood, professor in the the Department of Biomedical Engineering at Stevens Institute of Technology, came in. The team of biomedical engineering (BME) and software engineering (SSE) students—Kyle Gensheimer (SSE), Kiran Joseph (BME), Mariam Leiton (BME), and Nneka Udeagbala (SSE)—worked with Hazelwood and the staff of AHCH to begin building a customized, secure case management system.
A modern tech stack
One of the most pressing issues was that CHIMS could not support the updates required for data security. That’s a big deal for any organization, and it’s especially critical for AHCH since the facility handles sensitive medical and legal information for minor patients. The outdated CHIMS was also inefficient and not very user-friendly. In specialized medical settings like AHCH, those issues take up valuable time that clinicians and healthcare providers could spend on patient care.
The Stevens students worked with AHCH staff to identify their needs and then built a website wireframe for validation by the client. The new case management system is designed to meet the facility’s needs long-term. “This new technology stack has a lot of documentation behind it, so future teams that work on this project [can] easily add on to it and modify it as well as maintain security,” explained Gensheimer.
That flexibility is crucial for this project because, due to safeguards for patient privacy, the students needed to build the case management system without viewing the old CHIMS setup or AHCH data themselves. “One of the main challenges that we had coming into the project was that we wouldn't actually have access to the hospital's database,” said Udeagbala. “So we needed to focus on setting up the web application in as much detail as possible so that when a [future] team is able to access the database, it's pretty easy for them to connect the database to the website and know what they need to do.”
“They gave us a manual, but the manual was [only] helpful to a certain extent,” added Leiton. “So, for the whole first semester, we didn't have any pictures of the system, and the only time we'd seen the system was when we visited the Children's House—but that was once in the span of two hours.”
Meeting the task together
Those challenges pushed the students to hone their communication skills and lean on the strengths of each team member. “We had a lot of discussion [with AHCH] in the beginning, and it helped us get a great start,” noted Joseph. “I really enjoyed communicating with our client and seeing how hard it is to actually understand a project and what needs to be done—and transferring those requirements into actual software. I learned so much from Kyle and Nneka…and I've already been applying [that] knowledge to other projects.”
The students enjoyed the opportunity to provide a technical upgrade to AHCH and ease the burden on the facility’s staff. “They get so happy to see that we're making something for them that actually looks nice and is something they can use,” said Leiton. “Seeing our work affect them already—even though they're not even using our system yet—is really satisfying.”
“I definitely think working on something that has such a significant impact was really beneficial for me,” added Udeagbala. “[All] the projects have different significance and different impacts, but this one was something that I can emotionally connect to.”
Toward the future
The students’ outcomes—gaining confidence in working with clinician clients and communicating effectively in multidisciplinary teams—are all part of Hazelwood’s formula for her senior design students. “When I step into a project like this with these kids, I have an idea of who I'm working with, and I have an idea of what needs to be done, but it’s a free-for-all for all of us,” Hazelwood explained. “And I love that experience because they actually see just how capable they are. It's really the first time they are applying their engineering to a practical problem.”
The team is headed in different directions after graduation and will carry the lessons they learned with them. “While I learned a lot of practical programming knowledge from web development, the single most valuable thing I got out of this [project] was getting such a real-world experience of creating software for a client and being able to effectively communicate with a client,” said Gensheimer, who will pursue an accelerated master’s degree in computer science at Stevens next year.
Udeagbala will also continue an academic path, beginning a Ph.D. program in Informatics at the University of California Irvine. Leiton is seeking employment, while Joseph plans to pursue a startup project.
As the students wrap up their work on the case management system, which will likely continue with another group of seniors next year, the students wanted to express their gratitude to Drs. Hazelwood, Biller, and Diah; and all AHCH staff, including Nurse Coordinator Suzanne McGunness, and Nurse Manager Christa Orr. “They were all extremely helpful and open to offering their insight on the system,” said Joseph. “We want to make sure they are all acknowledged since they all contributed to the progress of the project.”
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