The CAC Medical Department is excited to announce the addition of Shireen Chamberland, MD to our team! Dr. Chamberland is a Family Medicine Physician and Southern Oregon native who has been practicing medicine in the Rogue Valley for almost 20 years. Dr. Chamberland brings with her years of clinical experience caring for children and young adults, along with a sincere passion for helping vulnerable children. She is deeply invested in our community, while parenting her four children, and coaching youth swimming. Dr. Natalya Miller will be relocating out of Oregon with her family this June but plans to remain in the role of CACJC Medical Director, working virtually alongside Dr. Chamberland to provide a consistent, coordinated, evidenced-based approach to child maltreatment cases.  

In addition to expanding our Medical Team, the CACJC Pediatric Sexual Assault Nurse Examiner (PSANE) Program will be extending coverage to Asante Three Rivers Medical Center (ATRMC) in Grants Pass, OR. In partnership with the Asante Foundation, our team in Jackson County has been working closely with the physician leaders at ATRMC to make this possible. Our PSANE program, comprised of eight forensic nurses, has been responding to acute child sexual abuse cases that present to our local hospital Emergency Departments at Asante Rogue Regional Medical Center and Providence Medford Medical Center outside of CAC business hours, since 2018. The program has been critical in providing timely evaluations for sexually abused children in need of a specialized physical exam, DNA evidence collection, treatment, and testing. We have tremendous gratitude for the community partnerships that have made this program a sustainable response to a serious problem facing children in our community. 

We continue to provide comprehensive services at the CAC, including medical evaluations for all forms of child maltreatment such as physical abuse, sexual abuse, exploitation, drug endangerment, and neglect. In the past two years, the CACJC has evaluated an unprecedented number of children for the primary concern of concurrent physical neglect and drug endangerment. Most of these children are present in a complex web of unmet social, medical, and developmental-behavioral needs. In June 2021, CACJC began using hair testing, in addition to highly sensitive urine drug screens, to identify drug endangered children. Hair testing provides a range of detection of approximately 2 weeks to 3 months post-exposure. Identifying environmental drug exposure is clinically useful and allows for identification of drug endangered children and high-risk, neglectful environments in which such endangerment occurs. 

Among children referred to us, especially those under age 10, we are seeing an increase in environmental exposure to methamphetamine and marijuana. Alarmingly, we are now seeing high rates of fentanyl exposure, a highly potent synthetic opioid 50 times stronger than heroin and 100 times stronger than morphine (CDC.gov). Drug endangered children can present with acute toxicity that can result in life threatening results. On a broader scale, children with environmental drug exposure demonstrate significantly increased incidence of neurocognitive and developmental delays, physical afflictions, behavioral and emotional challenges, and disrupted attachment. 

Because safety is so important to early childhood development, caregiver substance use is a major threat to our community’s children. Research indicates that caregiver substance abuse equates to a 2.7 times increased risk of physical abuse and a 4.2 times increased risk of neglect to children. Identifying and intervening on behalf of these children is critical to support their physical and emotional safety, which promotes their healthy growth, development, and overall wellbeing. The CAC is currently at the front lines of addressing this threat in the work we do every day. 

By Natalya Miller, MD,  

Medical Director