There is a lot that can be trying about working on child abuse cases.
At The Lighthouse for Kids, a child abuse evaluation center in Astoria, Dr. Roy Little has evaluated almost 500 cases. The stories can be heartbreaking, and their resolutions sometimes disappointing.
But then there are the drawings. For years, Little has accumulated sketches and notes from the children he has helped. One child wrote that a “big hole in my heart got filled up.” Another, which still hangs on the wall, simply says, “Thank you.”
“You can take on a lot of headache when you get those,” he said.
After 17 years, Little will retire as the evaluation center’s primary medical examiner this year.
Originally from California, Little moved to the North Coast after receiving a call from another local physician, Dr. Tom Duncan, near the end of his eight-year tour in the Air Force. In 1990, he established his own private practice in Astoria.
In 2002, the Lighthouse approached Little and asked him to join as a medical examiner in addition to his practice.
“I’ve always liked working with children,” he said. “It’s fun to watch them grow up, (and) it’s satisfying to help families out.”
Little conducts medical evaluations to look for evidence of neglect and abuse. Other specialists also do interviews with the children, which are recorded and can be used in court.
“The reason we do things ... is to try and create as much legally admissible information about what happened to the child without the child having to be exposed to the courtroom adversarial environment,” he said.
Now, with retirement six months away, Little is hoping to find his replacement. For the past two years, he has attempted to recruit a successor so he could train them on the job, but so far has had little luck.
“There just seems to be less of an interest,” he said.
There could be many reasons, Little said. Clatsop County’s population is too small to support a full-time, independent child abuse evaluation center, so the work Little and others do at the Lighthouse is on an on-call basis, and often on top of other jobs.
It’s not an uncommon model for rural communities. Places like the county jail, where Little also works, nursing homes and other entities all require ad-hoc doctors to perform on-call functions.
Traditionally, many of these roles have been filled by doctors in private practice, Little said. While the North Coast is seeing more doctors likely than ever before, fewer and fewer are going into private practice due to growing economic pressures.
Little also believes part of the issue could be a change in culture within the medical community. The demands of medical practice are greater, meaning fewer feel they can carve out time for another job.
Medical practice is also seen more as an 9-to-5 job, he said, with more doctors moving from opportunity to opportunity rather than settling down and committing to one community for years.
“(In private practice), your livelihood relies on people trusting you by knowing you,” he said. “There’s an economic imperative to build your practice up, and you build your practice up by being in the community.”
“Small-town life is built on everybody pitching in and helping everybody,” Little continued. “As a small-town doctor, you come in with a certain mindset.”
If his position at the Lighthouse can’t be filled, Little said, the medical piece would have to be outsourced to a regional center in Portland.
But sometimes, when a family is in economic and emotional turmoil, the difference between a 15-mile drive and a 100-mile drive can be the difference between whether a child abuse case is fully pursued.
“It’s hard enough to take time off work,” he said. “We want to make this as barrier-free as possible when it’s needed.”
He hopes someone will step forward.
“We’re not going to stop child abuse by having the Lighthouse,” Little said. “But if we can find out what has happened to kids or what’s not happened to kids, we can better help the families, and maybe make a difference in the outcome of that child’s life.”