Robin Foster of Children's Hospital of Richmond at VCU (Photo by Jay Paul)
Robin Foster keeps a small crystal figure on her desk at Children’s Hospital of Richmond at VCU, a gift from a retired nurse practitioner she worked alongside for 20 years. Etched in its glass is a quote from anthropologist and social activist Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”
The quote is a favorite, says Foster, and one on which she has often reflected during her 20-plus years practicing pediatric emergency medicine at VCU. Until last September, Foster served as division chief of that department. She also directs the hospital’s Child Protection Team, which provides diagnosis, treatment and support for children who have been abused or neglected. She is one of the few physicians in the state who are certified in child abuse and neglect by the American Board of Pediatrics.
Cases where there may be a larger issue underneath a simple diagnosis are a common occurrence in the pediatric ER, according to Foster. (“All day, every day” is how she puts it.) Administering to those underlying problems is a critical part of what she considers good medicine.
“I always try to treat everyone I take care of like they’re my family members,” she says. “So [I think], ‘If this were my family member that came in with this problem, what would I try to do to fix it for them?’ I can’t just give them the diaper cream and ignore the fact that their lives are falling apart.”
Emily Horne, a nurse practitioner who has worked with Foster for the past five years, says it’s not unusual to walk into a room where Foster is seeing a patient and find her sitting on the foot of the bed or propped on the edge of a trash can. “She’s the classic teacher,” Horne says. “She spends extra time [with patients and their families] to make sure they understand why and where she’s coming from with her treatment plan … she’s always teaching and sharing her knowledge.”
In 2016, Foster was awarded a Salute to Service Award by the Medical Society of Virginia in recognition of her dedication to the uninsured and underserved.
Horne worked with Foster in the general ER before joining her Child Protection Team in May 2017. The team also includes nurse practitioner Shamika Byars and Carly Barrows-Compton, a licensed clinical social worker specializing in trauma-informed pediatrics. The team provides evaluation and treatment for children who are alleged victims of abuse and neglect — conducting interviews and physical examinations, working with law enforcement and social services, and providing ongoing care, including counseling, as needed.
“Child abuse is definitely a cycle. Many of our families were raised in chronically abusive and neglectful environments.” —Robin Foster, Child Protection Team director
Officially, the team serves the greater Richmond area, but Foster says they really have about 40 jurisdictions in the state that they cover. “We still don’t have any other programs to the southwest of us at all,” she explains.
The team was formed at MCV in 1992, the product of a grant from the Virginia Department of Social Services (DSS). At the time, the Children’s Hospital of the King’s Daughters in Norfolk was the only Virginia hospital with an in-house program to evaluate and treat cases of child abuse.
Foster, a medical resident at the time, says she often found herself going to law enforcement and social services to learn more about the issue when her own training wasn’t enough. “Sort of the nature of my personality was, ‘There’s this huge gap, there is this huge need,’ ” she says. When two of her mentors, Dr. Joseph Zanga and Dr. Miriam Baron, responded to a request from DSS for a plan to address the issue, Foster jumped at the chance to be part of the team.
“I didn’t ever think [child abuse and neglect] was going to be an area of sub-specialty for me,” she says. “[But] working in the pediatrics ER, I became overwhelmed by the volume of cases that came to our emergency department that had some element of abuse or neglect.”
There were more than 9,500 cases of proven child abuse or neglect in Virginia in the fiscal year running from July 2016 through June 2017. That works out to more than one case every hour. But those numbers are only based on cases that make it to Virginia’s Child Protective Services — the actual numbers are likely higher.
Foster’s team treats around 1,000 cases a year, almost all of which come through referrals from other doctors, social services, or law enforcement. “I don’t think people understand the magnitude of the problem,” Foster says. “I didn’t understand the magnitude of the problem until I worked here.”
Foster notes that abuse and neglect are often intergenerational. “Child abuse is definitely a cycle,” she says. “Many of our families were raised in chronically abusive and neglectful environments.”
Child Protection Team members discuss a case. From left, Carly Barrows-Compton, Robin Foster, Emily Horne, Shamika Byars (Photo by Jay Paul)
Foster’s team has put together a proposal with VCU’s Project Empower, which provides advocacy and support to victims of intimate partner violence, to screen caretakers for issues such as domestic violence and sexual assault. Caretakers who screen positive, Foster says, will receive a consultation from Project Empower and be offered ongoing mental health treatment.
“That intergenerational issue needs to be disrupted,” says Foster. “To do that, not only do we need to provide mental health services to the child victim, but to the caretaker so that entire family heals together in parallel.”
“Robin is always the one at the table saying, ‘What else can we do?’ ” explains Jeanine Harper, executive director of Greater Richmond Stop Child Abuse Now (SCAN). The two have worked together for more than 20 years on child abuse prevention initiatives, including the founding of SCAN’s Child Advocacy Center in 2004.
“When you’re talking about a child who’s been sexually abused or a child who has been injured due to physical abuse or neglect — it kind of doesn’t get much harder than that,” Harper says. “Robin lives in the deep end of that work.”
Foster didn’t always see herself in medicine. “Originally I thought I wanted to be a lawyer,” she says. She began her undergraduate studies as a government major at the College of William & Mary and spent the summer between her freshman and sophomore years at a corporate law firm, an experience that led to the conclusion that law “probably wasn’t me.” That fall, she went back to school and switched her major to chemistry.
She has worked the bulk of her medical career at VCU: She came to the university (then the Medical College of Virginia) in 1985 as a medical student and stayed on for her residency. In addition to her clinical role at Children’s Hospital, she is also an associate professor of pediatric emergency medicine at the university.
For someone originally interested in law, emergency medicine offers some parallels, including thinking on your feet and real-world problem solving.
“You never know what’s going to walk in the door,” Foster says of the ER. “Somebody may come in, and they’re not really there because of the child’s diaper rash but because of some complex social issue that’s going on in their life.”
“I always say I feel like I’m half social worker, half physician,” she adds.
Since stepping down as the division chief of pediatric emergency medicine at VCU last year, Foster has had more time to focus on building structures she hopes will grow her work into the future. “I want to be able to leave something that’s sustainable and will serve the community long after I’m gone,” she says.
The question that almost seems too obvious to ask: With so much to do and so much at stake, does the work ever get discouraging? “I feel sometimes at the end of a week like I’ve run a marathon,” Foster says. “But the work is so inspirational that I think it gives you extra energy.”
“In my 20-plus years with the child abuse team, I’ve seen children who have been chronically abused and neglected in their environments for years,” she continues. “And once those children are provided a protected environment, I’ve seen them knock everyone’s socks off in terms of what they’ve been able to accomplish. … To be able to have the privilege of being the person who helped advocate for those children and tried to get them into an environment where that can happen is the best job in the world.”
