• Kentucky Youth Advocates/Face It Movement coordinated a week of virtual TEN-4 Day webinars facilitated by experts at the Kosair for Kids Division of Pediatric Forensic Medicine at the University of Louisville and University of Kentucky Division of Pediatric Forensic Medicine.
• More than 1,000 social workers, nurses, dentists and dental hygienists, EMTs, early childhood educators, and Family Resource and Youth Service Center staff registered to attend the six regional webinars.
• Kentucky Youth Advocates/Face It Movement obtained a proclamation from the Governor of Kentucky.

• Kentucky Youth Advocates/Face It Movement and the Ann & Robert H. Lurie Children’s Hospital of Chicago partnered to expand TEN-4 Day efforts. Dr. Mary Clyde Pierce (Lurie Children’s), Kim Kaczor (Lurie Children’s) and Dr. Wee Chua (now Mass General Brigham) partnered in those expanded efforts to move the campaign beyond Kentucky.
• Proclamations were signed by Governors and local leaders in Illinois and Kentucky.

• Kentucky Youth Advocates/Face It Movement coordinated the first TEN-4 Day national info session webinar to provide advocates and stakeholders across the country with information and support towards obtaining a proclamation and organizing related events.
• Proclamations were signed by Governors and local leaders in Connecticut, Illinois, Kentucky, Massachusetts, and Michigan.

Our collective movement to recognize TEN-4 Day, increase awareness of the TEN-4-FACESp Bruising Rule, and emphasize the importance of recognizing, reporting, and preventing child abuse grew significantly in 2024. Professionals in nearly 20 states organized events, obtained proclamations, wrote for publications, engaged the media, and more in recognition of TEN-4 Day.

Connecticut:

• Children’s hospitals across the state, led by Yale, are developing a child abuse consultation process for frontline first responders.

Kentucky:

• Governor Andy Beshear, Auditor of Public Accounts, Allison Ball, and 32 other elected leaders in 22 counties and 9 cities across Kentucky proclaimed October 4th as TEN-4 Awareness Day.
• Family Enrichment Center in Bowling Green, KY hosted a proclamation signing and press conference as well as elected leaders in Richmond, KY.

South Dakota:
The Center for the Prevention of Child Maltreatment led a statewide child abuse conference that concluded on October 4th.

Michigan:

• The Office of the Child Advocate partnered with stakeholders including the Michigan Department of Health and Human Services Bureau of Emergency Preparedness, EMS, and Systems of Care to produce a TEN-4 FACESp video and toolkit. The video was shared via email to approx. 370,000 medical providers and will be played for all Michigan police academy recruits during child abuse investigation instruction.
• The Michigan State Police have agreed to include TEN-4 FACESp into their policy manual for guidance on child abuse and neglect investigations.

Montana:

• An article about the TEN-4-FACESp Bruising Rule, written by Laurie Carter, M.D., F.A.A.P., was featured in South Carolina’s Palmetto Nurse publication.
• Governor Greg Gianforte signed a proclamation in recognition of TEN-4 Day.

Wisconsin:
Governor Tony Evers signed a proclamation in recognition of TEN-4 Awareness Day.

Lectures, grand rounds, op-eds, social media, and media releases were held in:

• New Jersey at Cooper University
• The University of Tennessee Health Science Center
• Arkansas Children’s Hospital
• Massachusetts at Boston Children’s and Mass General Hospital
• University of Nevada Las Vegas

Acknowledgements of TEN-4 Day were by advocates and stakeholders in Florida, Hawaii, Maine, Indiana, New Hampshire, and New York.

The collective movement to recognize TEN-4 Day, increase awareness of the TEN-4-FACESp bruising rule, and emphasize the importance of adults knowing the signs and symptoms of child abuse and how to report it continued to expand in 2025. Professionals in 15 states and US territories created new resources, obtained proclamations, engaged the media, and more in recognition of TEN-4 Day.

Alabama

• Crisis Services of North Alabama’s Forensic Nurse Examiner and their Child Advocacy Center partners, Gail Swafford from Brooks’ Place and Diane Watson from Addie’s Place, recognized TEN-4 Day and requested proclamations in multiple counties.
• Mayor Elmo Meyer and the City Council of Double Springs, AL signed the first official TEN-4 Day proclamation in the state of Alabama.

Connecticut

• Drs. Auerbach and Goodman from Yale School of Medicine and with the Emergency Medical Services for Children (EMSC) Innovation and Improvement Center produced a resource that provides emergency care professionals with key facts and recommendations for identifying and managing suspected physical abuse in children.

Florida

• Florida Emergency Medical Services for Children shared the TEN-4-FACESp bruising rule and resources on social media.

Illinois

• The College of Medicine Peoria at the University of Illinois recognized TEN-4 Day and shared information about the bruising rule.
• The Pediatric Resource Center recognized TEN-4 Day and encouraged people to learn, share, and use the information to prevent child abuse.

Kentucky

• Melissa Currie, MD, FAAP, the Kosair for Kids Professor and Endowed Chair for Pediatric Forensic Medicine at University of Louisville School of Medicine and board-certified child abuse pediatrician with Norton Children’s Pediatric Protection Specialists, in partnership with the Kosair for Kids Face It Movement created an informational video about the TEN-4-FACESp bruising rule.
• The Kosair for Kids Face It Movement created videos about keeping kids safe from abuse and neglect for community members, educators and youth serving organizations, and health professionals that includes information about the TEN-4-FACESp bruising rule.
• The Kosair for Kids Face It Movement in partnership with experts at the University of Kentucky Division of Pediatric Forensic Medicine hosted 4 virtual trainings from September 30th-October 3rd on child abuse recognition and prevention that included information about the TEN-4-FACESp bruising rule for more than 300 professionals.
• Governor Andy Beshear, Attorney General Russell Coleman, Auditor of Public Accounts Allison Ball signed proclamations.
• Partners across Kentucky obtained proclamations from elected leaders in 15 counties and 8 cities, including:
  • Family Enrichment Center in Bowling Green, KY
  • Mountain Comprehensive Care Center in Breathitt County, Estill County, Johnson County, Magoffin County, the city of Paintsville, KY, Pike County, and Wolfe County
  • Rosemary Conder in Daviess County and the city of Owensboro, KY
  • Volunteers of America in Stanford, KY

Massachusetts

• Governor Maura Healy signed a proclamation recognizing TEN-4 Day 2025.
• Wee-Jong Chua, MD, Pediatric Emergency Department Physician, and Mass General Bringham for Children recognized TEN-4 Day.

Michigan

• Governor Gretchen Whitmer signed a proclamation recognizing TEN-4 Day 2025.

• The TEN-4-FACESp bruising rule is being used outside of medicine to help investigators of child abuse recognize injuries and to give them common language when speaking with medical professionals. The Office of the Child Advocate (OCA) created a TEN-4 video with professionals that interact with children. In addition, OCA liaised with Michigan’s Department of Education and the video was disseminated to all of Michigan’s school districts, teachers and school administrators.
• The Michigan Department of Technology, Management & Budget recognized the bruising rule and shared news of the proclamation on social media.

Missouri

• Missouri Network Against Child Abuse created a graphic recognizing TEN-4 Day and the bruising rule and shared information from Lurie Children’s and the Kosair for Kids Face It Movement.

Oklahoma

• Governor Kevin Stitt signed a proclamation recognizing TEN-4 Day 2025.
• Advocacy groups engaged with the media to promote TEN-4 Day, child abuse awareness and early detection.
• Child Advocacy Centers of Oklahoma recognized TEN-4 Day and shared information about the TEN-4-FACESp bruising rule and the importance of early intervention.
• Delaware County Children’s Special Advocacy Network (DCCSAN) raised awareness of the bruising rule and highlighted the state proclamation of TEN-4 Day.
• Dr. Mary Ellen Stockett, child abuse pediatrician with the Oklahoma Commission on Children and Youth, and Dr. Christine Beeson, child abuse pediatrician, sat for an interview about TEN-4 with their local media.
• Kids’ Space, Muskogee County Child Advocacy Center in partnership with the Oklahoma State Department of Health (OSDH) in partnership with Children’s Advocacy Centers of Oklahoma (CACO), Tulsa Children’s Advocacy Network (CAN) and OU Health partnered to bring attention to the bruising rule and the importance of early intervention efforts to support and strengthen families as well as honor TEN-4 Day. OU Health Physicians in Tulsa continued to share staff spotlights and information around the bruising rule throughout the month.
• Medical providers at The Care Center created videos about what TEN-4-FACESp is and how it keeps kids safe.
• Noble County Health Department and the Oklahoma State Department of Health raised awareness of the bruising rule and highlighted programs that are available at no-cost in Oklahoma to support families and parents and prevent child abuse.
• Oklahoma Children’s Hospital recognized TEN-4 Day and the importance of using the TEN-4-FACESp clinical decision rule  for early detection of child abuse.

Puerto Rico

• Brenda Mirabal, MD, a retired Child Abuse Pediatrician and Professor at the University of Puerto Rico School of Medicine, in partnership with Asociación de Centros para el Cuidado y Desarrollo de la Niñez (Association of Centers for the Care and Development of Children) and the Departamento de Salud de Puerto Rico (Department of Health of Puerto Rico) created a TEN-4-FACESp graphic to raise awareness of the bruising rule and hosted a press conference via Facebook Live announcing the proclamation for TEN-4 Awareness Day from Governor Jenniffer González Colón.

Tennessee

• Governor Bill Lee, the Tennessee General Assembly, and Nashville City Councilman Jordan Huffman signed proclamations recognizing TEN-4 Day 2025.
• Children’s Center of the Cumberlands recognized TEN-4 Day by sharing information about the bruising rule and how to report abuse.
• Erin Wade, MD, Child Abuse Pediatrician at Le Bonheur Children’s Hospital and University of Tennessee Health Science Center, in partnership with the Tennessee Commission on Children and Youth shared content throughout the month of October about the TEN-4-FACESp bruising rule and child abuse recognition and prevention.
• Le Bonheur Children’s Hospital, Memphis Child Advocacy Center, the Tennessee Commission on Children and Youth, the Nashville Police + Public Safety Alliance with the Nashville Children’s Alliance, Metro Nashville Police Department, and the Memphis City Mayor, Paul Young, each formally acknowledged TEN-4 Day.
• Metro Nashville Police Department Youth Services Division created a video to raise awareness of the TEN-4-FACESp bruising rule. All officers in the Metro Nashville Police Department received a brief training on TEN-4-FACESp and a wallet-size card about when bruising is a red flag for abuse.
• Nashville Children’s Alliance hosted a TEN-4 Community Resource Fair to raise awareness for child abuse prevention and bring families together.
• University of Tennessee Health Science Center College of Medicine-Chattanooga highlighted the first official TEN-4 Day in TN.

Texas

• Emergency Medical Services for Children (EMSC) Innovation and Improvement Center acknowledged TEN-4 Day and shared information and resources.

Utah

• The Bureau of Emergency Medical Services included the TEN-4-FACESp bruising rule in their 2025 Utah EMS Protocol Guidelines.

Vermont

• Governor Phil Scott signed a proclamation recognizing TEN-4 Day 2025.

Virginia

• Inova Children’s hosted a virtual Grand Rounds on the System-Wide Implementation of the TEN-4-FACESp Tool Using Implementation Science Frameworks.

Wisconsin

• Governor Tony Evers signed a proclamation recognizing TEN-4 Day 2025.