Reporting Child Abuse
REPORTING CHILD ABUSE
In 1974 Congress enacted the first Child Abuse Prevention and Treatment Act (CAPTA; Public Law 93-247) that set guidelines for the reporting, investigation, and treatment of child maltreatment. States had to meet these requirements in order to receive federal funding to assist child victims of abuse and neglect. Among its many provisions, CAPTA required the states to enact mandatory reporting laws and procedures so that child protective services (CPS) agencies can take action to protect children from further abuse. (The term "CPS" refers to the services provided by an agency authorized to act on behalf of a child when his or her parents are unable or unwilling to do so. CPS is also often used to refer to the agency itself.)
The earliest mandatory reporting laws were directed at medical professionals, particularly physicians, who were considered the most likely to see abused children. Currently each state designates mandatory reporters, including health care workers, mental health professionals, social workers, school personnel, child care providers, and law enforcement officers. Any individual, however, whether or not he or she is a mandatory reporter, may report incidents of abuse or neglect.
Some states also require maltreatment reporting from other individuals, such as firefighters, Christian Science practitioners, battered women's counselors, animal control officers, veterinarians, commercial/private film or photograph processors, and even lawyers. As of June 2003, eighteen states and Puerto Rico required all citizens to report suspected child maltreatment. (See Table 3.1.)
Some state statutes include provisions pertaining to the right of confidentiality of communications between professionals and their clients. As of June 2003, twenty-one states, the Northern Mariana Islands, and the Virgin Islands exempted from mandatory reporting the privileged communications between attorneys and clients. Twenty-five states exempted from mandatory reporting the privileged communications between clergy and penitents. Ohio and Wyoming recognize privileged communications between physicians and patients, while Oregon exempts from mandatory reporting privileged communications between mental heath professionals and patients. (See Table 3.1.)
WHO REPORTS CHILD MALTREATMENT?
In 2002 more than half (56.5%) of all reports of alleged child maltreatment came from professional sources—educators (16.1%); legal, law enforcement, and criminal justice personnel (15.7%); social services personnel (12.6%); medical personnel (7.8%); mental health personnel (2.6%); child daycare providers (1%); and foster care providers (0.7%). Friends, neighbors, parents, and other relatives comprised nearly one-fifth (19.6%) of the reporters, while alleged victims and self-identified perpetrators reported abuse in 0.9% of the cases. Another 18.6% of reports came from anonymous and other sources. (See Figure 3.1.)
All states offer immunity to individuals who report incidents of child maltreatment "in good faith," or with sincerity. Besides physical injury and neglect, most states include mental injury, sexual abuse, and the sexual exploitation of minors as cases to be reported.
FAILURE TO REPORT MALTREATMENT
Many states impose penalties, either a fine and/or imprisonment, for failure to report child maltreatment. A mandated reporter, such as a physician, may also be sued for negligence for failing to protect a child from harm. The landmark California case Landeros v. Flood et al. (17 Cal. 3d 399, 551 P.2d 389, 1976) illustrates such a case. Eleven-month-old Gita Landeros was brought by her mother to the San Jose Hospital in California for treatment of injuries. Besides a fractured lower leg, the girl had bruises on her back and abrasions on other parts of her body. She also
|Mandatory reporting statutes for child abuse and neglect, 2003|
|Professions that must report||Others who must report|
|State||Health care||Mental health||Social work||Education/child care||Law enforcement||All persons||Other||Standard for reporting||Privileged communications|
|Alabama||✓||✓||✓||✓||✓||Any other person called upon to give aid or assistance to any child||Known or suspected||Attorney/client|
|Alaska||✓||✓||✓||✓||✓||Paid employees of domestic violence and sexual assault programs and drug and alcohol treatment facilities||Have reasonable cause to suspect|
|Members of a child fatality review team or multidisciplinary child protection team|
|Commercial or private film or photograph processors|
|American Samoa||✓||✓||✓||✓||Medical examiner or coroner||Have reasonable cause to know or suspect|
|Christian Science practitioner||Have observed conditions which would reasonably result|
|Arizona||✓||✓||✓||✓||✓||Parents||Have reasonable grounds to believe||Clergy/penitent|
|§ 13-3620(A)||Anyone responsible for care or treatment of children||Attorney/client|
|Clergy/Christian Science practitioners|
|Domestic violence victim advocates|
|Arkansas||✓||✓||✓||✓||✓||Prosecutors||Have reasonable cause to suspect||Clergy/penitent|
|§ 12-12-518(b)(1)||Department of Human Services employees||Have observed conditions which would reasonably result|
|Domestic violence shelter employees and volunteers|
|Court Appointed Special Advocates|
|Clergy/Christian Science practitioners|
|California||✓||✓||✓||✓||✓||Firefighters||Have knowledge of or observe||Clergy/penitent|
|Penal Code||Animal control officers|
|§ 11166(a), (c)||Commercial film and photographic print processors||Know or reasonably suspect|
|Court Appointed Special Advocates|
|Colorado||✓||✓||✓||✓||✓||Christian Science practitioners||Have reasonable cause to know or suspect||Clergy/penitent|
|§ 19-3-304(1), (2) (2.5)|
|Firefighters||Have observed conditions which would reasonably result|
|Commercial film and photographic print processors|
|Connecticut||✓||✓||✓||✓||✓||Substance abuse counselors||Have reasonable cause to suspect or believe|
|§ 17a-103(a)||Sexual assault counselors|
|Delaware||✓||✓||✓||✓||✓||Know or in good faith suspect||Attorney/client|
|tit. 16, § 903||Clergy/penitent|
|District of Columbia||✓||✓||✓||✓||✓||Know or have reasonable cause to suspect|
|§ 4-1321.02(a), (b), (d)|
|Florida||✓||✓||✓||✓||✓||✓||Judges||Know or have reasonable cause to suspect||Attorney/client|
|§ 39.201(1)||Religious healers|
|Georgia||✓||✓||✓||✓||✓||Persons who produce visual or printed matter||Have reasonable cause to believe|
|§ 19-7-5(c)(1), (g)|
|Guam||✓||✓||✓||✓||✓||Christian Science practitioners||Have reason to suspect|
|§ 13201||Commercial film and photographic print processors||Have knowledge or observe|
|Hawaii||✓||✓||✓||✓||✓||Employees of recreational or sports activities||Have reason to believe|
|Idaho||✓||✓||✓||✓||✓||✓||Have reason to believe||Clergy/penitent|
|§ 16-1619(a), (c)||Attorney/client|
|§ 16-1620||Have observed conditions which would reasonably result|
|Illinois||✓||✓||✓||✓||✓||Homemakers, substance abuse treatment personnel||Have reasonable cause to believe||Clergy/penitent|
|325 ILCS § 5/4|
|Christian Science practitioners|
|Funeral home directors|
|Commercial film and photographic print processors|
|Indiana||✓||✓||✓||✓||✓||✓||Staff member of any public or private institution, school, facility, or agency||Have reason to believe|
|Iowa||✓||✓||✓||✓||✓||Commercial film and photographic print processors||Reasonably believe|
|§ 232.74||Employees of substance abuse programs|
|Kansas||✓||✓||✓||✓||✓||Firefighters||Have reason to suspect|
|§ 38-1522(a), (b)||Juvenile intake and assessment workers|
|Kentucky||✓||✓||✓||✓||✓||✓||Know or have reasonable cause to believe||Attorney/client|
|§ 620.030(1), (2)||Clergy/penitent|
|Louisiana||✓||✓||✓||✓||✓||Commercial film or photographic print processors||Have cause to believe||Clergy, Christian Science|
|Ch. Code art.|
|Maine||✓||✓||✓||✓||✓||Guardians ad litem and Court Appointed Special Advocates||Know or have reasonable cause to suspect||Clergy/penitent|
|tit. 22, § 4011(1)|
|tit. 22, § 4015|
|Commercial film processors|
appeared scared when anyone approached her. At the time Gita was also suffering from a fractured skull, but this was never diagnosed by the attending physician, Dr. A. J. Flood.
Gita returned home with her mother and subsequently suffered further serious abuse at the hands of her mother and the mother's boyfriend. Three months later Gita was brought to another hospital for medical treatment, where the doctor diagnosed "battered child syndrome" and reported the abuse to the proper authorities. ("Battered child syndrome" refers to the collection of injuries sustained by a child as a result of repeated mistreatment or beatings. The term was coined in 1961 by Dr. C. Henry Kempe and his colleagues and includes not only
|Maryland||✓||✓||✓||✓||✓||✓||Have reason to believe||Attorney/client|
|Massachusetts||✓||✓||✓||✓||✓||Drug and alcoholism counselors||Have reasonable cause to believe||Clergy/penitent|
|ch. 119, § 51A|
|ch. 119, § 51B||Probation and parole officers|
|Clerks/magistrates of district courts|
|Clergy/Christian Science practitioners|
|Michigan||✓||✓||✓||✓||✓||Clergy||Have reasonable cause to suspect||Attorney/client|
|§ 722.623 (1), (8)||Clergy/penitent|
|Minnesota||✓||✓||✓||✓||✓||Know or have reason to believe||Clergy/penitent|
|§ 626.556 Subd. 3(a), 8|
|Mississippi||✓||✓||✓||✓||✓||✓||Attorneys||Have reasonable cause to suspect|
|Missouri||✓||✓||✓||✓||✓||Persons with responsibility for care of children||Have reasonable cause to suspect||Attorney/client|
|§ 568.110||Have observed conditions which would reasonably result|
|§ 210.140||Christian Science practitioners|
|Commercial film processors|
|Internet service providers|
|Montana||✓||✓||✓||✓||✓||Guardians ad litem||Know or have reasonable cause to suspect||Clergy/penitent|
|§ 41-3-201 (1)-(2), (4)||Clergy|
|Christian Science practitioners|
|Nebraska||✓||✓||✓||✓||Have reasonable cause to believe|
|§ 28-714||Have observed conditions which would reasonably result|
|Nevada||✓||✓||✓||✓||Religious healers||Know or have reason to believe||Clergy/penitent|
|§ 432B.220(3), (5)||Alcohol/drug abuse counselors||Attorney/client|
|Clergy/Christian Science practitioners|
|Youth shelter workers|
|New Hampshire||✓||✓||✓||✓||✓||✓||Christian Science practitioners||Have reason to suspect||Attorney/client|
|§ 169-C:32||Clergy||privilege denied|
|New Jersey||✓||Have reasonable cause to believe|
|New Mexico||✓||✓||✓||✓||✓||✓||Judges||Know or have reasonable suspicion||Clergy/penitent|
|New York||✓||✓||✓||✓||✓||Alcoholism/substance abuse counselors||Have reasonable cause to suspect|
|Soc. Serv. Law|
|§ 413(1)||District attorneys|
|Christian Science practitioners|
physical assault but other forms of abuse, such as malnourishment, failure to thrive, medical neglect, and sexual and emotional abuse. The term now used is child maltreatment.)
After surgery the child was placed with foster parents. The mother and boyfriend were eventually convicted of the crime of child abuse. The guardian ad litem (a court-appointed special advocate) for Gita Landeros filed a malpractice suit against Dr. Flood and the hospital, citing painful permanent physical injury to the plaintiff as a result of the defendants' negligence.
|North Carolina||✓||Any institution||Have cause to suspect||Attorney/client|
|§ 7B-310||privilege denied|
|North Dakota||✓||✓||✓||✓||✓||Clergy||Have knowledge of or reasonable cause to suspect||Clergy/penitent|
|§ 50-25.1-03||Religious healers||Attorney/client|
|§ 50-25.1-10||Addiction counselors|
|Northern Mariana Islands||✓||✓||✓||Medical examiners/coroners||Know or have reasonable cause to suspect||Attorney/client|
|§ 5313(a);||Religious healers|
|Ohio||✓||✓||✓||✓||Attorneys||Know or suspect||Attorney/client|
|§ 2151.421(A)(1), (A)(2), (G)(1)(b)||Religious healers||Physician/patient|
|Agents of humane societies|
|Oklahoma||✓||✓||✓||Commercial film and photographic print processors||Have reason to believe|
|tit. 10, § 7103(A)(1)|
|tit. 10, § 7104|
|tit. 10, § 7113|
|Oregon||✓||✓||✓||✓||✓||Attorneys||Have reasonable cause to believe||Mental health/patient|
|Court Appointed Special Advocates||Attorney/client|
|Pennsylvania||✓||✓||✓||✓||✓||Funeral directors||Have reasonable cause to suspect||Clergy/penitent|
|23 Pa.||Christian Science practitioners|
|Puerto Rico||✓||✓||✓||✓||✓||✓||Professionals or public officials||Should know or have knowledge of|
|§ 441a;||Processors of film or photographs||Suspects|
|Rhode Island||✓||✓||Have reasonable cause to know or suspect||Attorney/client|
|§ 40-11-6(a)||privilege denied|
|South Carolina||✓||✓||✓||✓||✓||Judges||Have reason to believe||Attorney/client|
|§ 20-7-510(A)||Funeral home directors and employees||Clergy/penitent|
|Christian Science practitioners|
|Substance abuse treatment staff|
|South Dakota||✓||✓||✓||✓||✓||Chemical dependency counselors||Have reasonable cause to suspect|
|§ 26-8A-15||Religious healers|
|Parole or court services officers|
|Employees of domestic abuse shelters|
|Tennessee||✓||✓||✓||✓||✓||✓||Judges||Knowledge of/reasonably know|
|§ 37-1-605(a)||Relatives||Have reasonable cause to suspect|
|Texas||✓||✓||✓||Juvenile probation or detention officers||Have cause to believe||Clergy/penitent|
|Family Code||privilege denied|
|§ 261.101(a)-(c)||Employees or clinics that provide reproductive services|
|Utah||✓||✓||Have reason to believe||Clergy/penitent|
|§ 62A-4a-412(5)||Have observed conditions which would reasonably result|
|source: 2003 Child Abuse and Neglect State Statute Series Statutes-at-a-Glance: Mandatory Reporters of Child Abuse and Neglect, U.S. Department of Health and Human Service, Administration for Children and Families, National Clearinghouse on Child Abuse and Neglect Information, June 2003, http://nccanch.acf.hhs.gov/general/legal/statutes/manda.pdf (accessed October 27, 2004)|
|Vermont||✓||✓||✓||✓||✓||Camp administrators and counselors||Have reasonable cause to believe||Clergy/penitent|
|§ 4913(a), (f)-(h)||Probation officers|
|Virgin Islands||✓||✓||✓||✓||✓||Have reasonable cause to suspect||Attorney/client|
|§ 2533(a)||Observe conditions which would reasonably result|
|Virginia||✓||✓||✓||✓||✓||Mediators||Have reason to suspect|
|§ 63.2-1509(A)||Christian Science practitioners|
|Court Appointed Special Advocates|
|Washington||✓||✓||✓||✓||✓||Any adult with whom a child resides||Have reasonable cause to believe|
|§ 26.44.030 (1), (2)|
|§ 26.44.060(3)||Responsible living skills program staff|
|West Virginia||✓||✓||✓||✓||✓||Clergy||Reasonable cause to suspect||Attorney/client|
|§ 49-6A-2||Religious healers||Clergy/penitent|
|§ 49-6A-7||Judges, family law masters or magistrates||When believe||privilege denied|
|Christian Science practitioners|
|Wisconsin||✓||✓||✓||✓||✓||Alcohol or drug abuse counselors||Have reasonable cause to suspect|
|§ 48.981(2), (2m)(c)-(e)|
|Mediators||Have reason to believe|
|Financial and employment planners|
|Court Appointed Special Advocates|
|Wyoming||✓||Know or have reasonable cause to believe or suspect||Attorney/client|
|Have observed conditions which would reasonably result|
The trial court of Santa Clara County dismissed the Landeros complaint, and the case was appealed to the California Supreme Court. The California Supreme Court agreed that the "battered child syndrome" was a recognized medical condition that Dr. Flood should have been aware of and diagnosed. The court ruled that the doctor's failure to do so contributed to the child's continued suffering, and Dr. Flood and the hospital were liable for this. While this case applied specifically to a medical doctor, the principles reached by the court are applicable to other professionals. Most professionals are familiar with the court's decision in Landeros.
State Statutes Vary in Reporting Standards
Although all states have enacted legislation requiring, among other things, the mandatory reporting of child maltreatment by certain professionals, states vary in the standard for reporting. The standard to report child maltreatment varies from, "have reasonable cause to suspect," to "have reason to believe," to "have observed conditions which would reasonably result," to "know or suspect."
emergency nurse charged with failure to report. On August 10, 2002, two-year-old Dominic James was brought to Cox South Hospital in Springfield, Missouri. Paramedics told emergency nurse Leslie Ann Brown that the boy, who was having seizure-like symptoms, had bruises on his back and to report this to the attending physician. Told by Dominic's foster parents that the child got bruised by leaning back on a booster seat, Brown did not report the bruises to the physician. Neither did she include the presence of bruises on her medical reports. Dominic was rehospitalized a week later and died soon after.
In February 2003 the state of Missouri charged Brown with failure to report child abuse. In September 2003 Green County Judge Calvin Holden dismissed the
criminal charges, stating that the Missouri statute with the "reasonable cause to suspect" standard for reporting child abuse was unconstitutionally vague in violation of the U.S. and Missouri Constitutions. The state appealed the case in May 2004. In August 2004 the Missouri Supreme Court reversed Judge Holden's ruling, allowing the case to proceed to trial.
WHY MANDATED REPORTERS FAIL TO REPORT SUSPECTED MALTREATMENT
Gail L. Zellman and C. Christine Fair conducted a national survey to determine why mandated reporters may not report suspected maltreatment ("Preventing and Reporting Abuse," The APSAC Handbook on Child Maltreatment, 2nd ed., Thousand Oaks, CA: Sage Publications, Inc., 2002). The researchers surveyed 1,196 general and family practitioners, pediatricians, child psychiatrists, clinical psychologists, social workers, public school principals, and heads of child care centers. Nearly eight of ten (77%) survey participants had made a child maltreatment report at some time during their professional career. More than nine of ten (92%) elementary school principals reported child maltreatment at some time, followed closely by child psychiatrists (90%) and pediatricians (89%). A lesser proportion of secondary school principals (84%), social workers (70%), and clinical psychologists (63%) reported child maltreatment at some time in their career.
Nearly 40% of the mandated reporters, however, indicated that, at some time in their career, they had failed to report even though they had suspected child maltreatment. Almost 60% failed to report child maltreatment because they did not have enough evidence that the child had been maltreated. One-third of the mandated reporters thought the abuse was not serious enough to warrant reporting. An equal proportion of mandated reporters did not report suspected abuse because they felt they were in a better position to help the child (19.3%) or they did not want to end the treatment (19%) they were giving the child. Almost 16% failed to report because they did not think CPS would do a good job.
Pediatricians, typically the first professionals to come into contact with a maltreated child, may hesitate to report suspected abuse because they fear offending the parents who pay the bills and who may spread rumors about their competence, potentially damaging their practice. Some fear the time lost in reporting abuse, the possibility of being sued by an outraged parent, or having to testify in court.
Physicians in the United States and in other countries fear repercussions from reporting child abuse. In Great Britain publicity surrounding the investigations of pediatricians connected with child protection work in the mid-1990s through 2003 resulted in increasing complaints from the public. In March 2004 the Royal College of Paediatrics and Child Health (RCPCH; London, England) released a survey of the country's pediatricians regarding these complaints. Nearly 80% of the 6,072 pediatricians responded to the survey. The survey showed that one of seven (14%) RCPCH members who had participated in child abuse investigations had been the subjects of complaints. Complaints against pediatricians working in child protection rose from less than twenty in 1995 to more than one hundred in 2003. Some pediatricians received hate mail, as well as threats to themselves and their families. Nearly one-third (29%) indicated an unwillingness to take part in child protection work in the future.
Reporting Psychological Maltreatment of Children
According to the American Academy of Pediatrics (AAP), pediatricians play a major role in preventing, recognizing, and reporting psychological, or emotional, maltreatment (Steven W. Kairys, Charles F. Johnson, and the Committee on Child Abuse and Neglect, "The Psychological Maltreatment of Children—Technical Report," Pediatrics, vol. 109, no. 4, April 2002). Generally, pediatricians are the only professionals young children see before they attend school. Pediatricians are in a position to observe any abusive interaction between the child and the parent/caregiver. They should be able to identify parental characteristics, such as substance abuse and poor parenting skills, that may predispose parents to abuse their children. Pediatricians should also be able to identify at-risk children, including those who are disabled or whose parents are undergoing a hostile divorce. The consequences of psychological maltreatment may take years to surface; hence, pediatricians are encouraged to report their suspicions so that the child and the caregivers can get help right away.
Pediatricians Intervene in Domestic Abuse to Prevent Child Maltreatment
Researchers Richard A. Wahl, Doris J. Sisk, and Thomas M. Ball reported that an estimated ten million children in the United States are exposed to domestic violence (intimate partner violence) each year ("Clinic-Based Screening for Domestic Violence: Use of a Child Safety Questionnaire," BMC Medicine, vol. 2, May 2004). Noting the American Academy of Pediatrics' policy statement about the role of pediatricians in recognizing families experiencing child abuse, the researchers conducted the first study of its kind. The study involved mothers accompanying their children (sixteen thousand patient visits annually) to their pediatricians. Since research has shown that children of battered women are more likely to be abused, Wahl and his associates sought to screen for domestic abuse among their patients' mothers.
The authors found that active screening (having the mothers fill out a questionnaire asking their exposure to domestic violence) increased the odds of identifying families experiencing domestic violence. Prior to the screening, pediatricians identified four cases of domestic violence per one thousand children during a three-month period. Active screening identified fifteen cases per one thousand children during the subsequent three months. The study was conducted for two years, and overall the pediatricians identified nineteen cases of domestic violence per one thousand children the first year and twenty cases per one thousand children the following year. Wahl et al. noted that the numbers of children living with battered women are probably higher. Up to one-third of questionnaires were not returned.
SEXUAL ASSAULT NURSE EXAMINER
A sexual assault nurse examiner (SANE) is a registered nurse trained in forensic (using science to study evidence of a crime) examination of sexual assault victims. The SANE program emerged in the 1990s in response to the need for a more thorough collection of evidence, as well as compassionate care for the victim and better prosecution of the perpetrator. It has been recognized that, in the past, sexual assault victims have been retraumatized during forensic-evidence collection because the hospital personnel may lack training in dealing with such victims.
After the victim has received the proper medical care, the SANE gathers information about the patient and a history of the crime. The nurse evaluates the victim's mental state and performs a physical examination, collecting and preserving evidence. The nurse then documents the evidence obtained, as well as other findings. The SANE may also provide other care, including giving medication to counter sexually transmitted diseases and making referrals for other medical aid and psychological support. SANEs also testify in court as expert witnesses.
Felicia F. Romero, in "The Educator's Role in Reporting the Emotional Abuse of Children" (Journal of Instructional Psychology, vol. 27, no. 3, September 2000), pointed out that, whereas teachers attending in-service programs learn the behavioral indicators of neglect and physical and sexual abuse, they do not receive much information about emotional, or psychological, abuse. Victims of emotional abuse suffer "injuries" that are not visible, and educators may not realize that the consequences of such abuse are more severe than those from other forms of maltreatment.
A NEED FOR FAMILY VIOLENCE EDUCATION AMONG PHYSICIANS
Although child abuse is a well-documented social and public health problem in the United States, few medical schools and residency training programs include child abuse education and other family violence education in their curricula. The Committee on the Training Needs of Health Professionals to Respond to Family Violence of the Institute of Medicine examined the curricula on family violence for six groups of health professionals: physicians, physician assistants, nurses, psychologists, social workers, and dentists (Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence, Felicia Cohn, Marla E. Salmon, and John D. Stobo, eds., Washington, DC: National Academies Press, 2002).
The committee noted that as many as one out of four children and adults experience family violence during their lifetimes. Studies have shown that family violence is associated with many problems affecting health, including homelessness, alcohol and substance abuse, and delinquency. Although health professionals are usually the first people to interact with victims of family violence, their lack of education on family violence keeps them from identifying, treating, and helping their patients.
The committee found that most medical schools give instruction regarding at least one form of family violence.
|Requirements by accreditation institutions for family violence curriculum|
|Health care discipline||Accreditation institutions||Requirements related to family violence||Description|
|S = specific existing requirements.|
|NS = nonspecific requirements.|
|X = no identifiable requirements.|
|source: "Requirements by Accreditation Institutions Relating to Family Violence Curriculum," in Confronting Chronic Neglect: the Education and Training of Health Professionals on Family Violence, Felicia Cohn, Marla E. Salmon, and John D. Stobo, eds., National Academy Press, 2002|
|Medical schools||Liaison Commission on Medical Education (LCME)||S||"The curriculum should prepare students for their role in addressing the medical consequences of common societal problems, for example, providing instructions in the diagnosis, prevention, appropriate reporting and treatment of violence and abuse." Standards can be found on the LCME web site www.lcme.org.|
|Accreditation Council for Graduate Medical Education (ACGME)||X||The institutional requirements of the ACGME are very practical in nature and do not outline any single curriculum requirements including any dealing with family violence.|
|American Osteopathic Healthcare Association (AOHA)||NS||Institutions are required to include with the spectrum of "Emergency Procedures" some instruction regarding "abuse and neglect" of children. While these standards are not a requirement unto themselves, they do seem to be somewhat quantifiable.|
|Physician residencies||Residency Review Committees (RRC) of the ACGME||S||The residency review committees of the ACGME, which accredit programs rather than institutions, do have provisions for family violence in certain fields. Though the genetics area does not mention family violence, the areas of family practice and obstetrics indicate how to identify signs of family violence and the steps to take.|
|Dental schools||American Dental Association Commission on Dental Accreditation (ADA)||NS||There is no specific mention of family violence in the accreditation commission's standards. Such training is believed to fall under the purview of a provision for "ethical reasoning" and "professional responsibility."|
|Nursing schools||Commission on Collegiate Nursing Education Accreditation (CCNE)||X||CCNE guidelines are very generic and do not provide for any particular curriculum requirements. The guidelines allow schools to choose their own direction and philosophy and subsequently measures them against the standard they have chosen.|
|Nurse practitioners||National League for Nursing Accrediting Commission (NLNAC)||NS||"NLNAC does not include specific curriculum content areas within its standards and criteria. When specific curriculum content is designated it is usually from the State Boards of Nursing since NLNAC is voluntary." Standards can be accessed on the website at www.nlnac.org.|
|National Association of Pediatric Nurse Associates & Practitioners, Inc. (NAPNAP)||NS||NAPNAP recognizes that there is "substantial scientific evidence that children who are abused physically, sexually, emotionally or who are neglected, are prevented from optimal development." NAPNAP has in place a thorough position statement on child abuse/neglect.|
|Psychology programs and internship sites||Committee on Accreditation of the American Psychological Association: accredits both school and internship sites (APA)||X||There is no mention of family violence in the APA accreditation guidelines. They take a broad stance on evaluating the goals that institutions set for themselves.|
|Social work programs||Council on Social Work Education (CSWE)||NS||CSWE has no specific requirements mandating that the issue of family violence be discussed on any level. There is an expectation that a program dealing with social work must at some point address the problem. Should an institution not do this, it would probably be cited.|
|Physician assistant||Commission on Accreditation of Allied Health Education (CAAHEP) Programs||X||There is no reference to family violence made in the CAAHEP standards or guidelines. Curriculum is the responsibility of the sponsoring institution with the exception of a few general study education requirements.|
|Effective January 1, 2001, CAAHEP no longer will be the accreditor of physician assistant education programs. All current accreditations are being transferred from CAAHEP to the Accreditation Review Commission on Education of the Physician Assistant (ARC-PA) http://www.CAAHEP.org/caahep_pa.htm|
In most cases, education revolves around reporting requirements, patient interviewing skills, screening tools, health conditions related to violence, and service referrals for victims. The teaching sessions vary, ranging from a very brief discussion to several lectures or case discussions. Although about 95% of schools teach material related to child maltreatment, usually during pediatric rotation, the committee found that the curriculum is inadequate. Table 3.2 illustrates the minimal requirements for accreditation, a process that determines whether a medical school or program meets certain established standards. Accreditation is needed for eligibility to participate in federal student loan programs.
Medical residents specializing in fields in which they are most likely to interact with maltreatment victims are required to receive training in family violence. These include pediatricians, internists, obstetricians/gynecologists, geriatricians (specialists who treat the elderly), psychiatrists, and emergency-medicine doctors. The training consists of lectures and case discussions, and the training duration varies from program to program. As for continuing medical education on family violence, the committee found very little information, including lectures and programs on the Internet, for which health professionals can earn credits.
The committee also noted that not much is being done to evaluate the effects of family violence training. So far, evaluations that had been performed concerned short-term effects of the training, such as how the training had increased the health professionals' knowledge of family violence. The committee suggested that more in-depth evaluation of the training programs should measure the effects of training on health professionals' behavior and victims' health.
Primary Care Residency Program in Child Maltreatment
Suzanne P. Starling and Stephen Boos noted that, since 1962, when Dr. C. Henry Kempe wrote of the "battered child syndrome," a term that encompasses all aspects of child abuse, research on the subject has grown. Physicians' knowledge about child abuse, however, has not followed suit ("Core Content for Residency Training in Child Abuse and Neglect," Child Maltreatment, vol. 8, no. 4, November 2003). According to the authors, while there are physician specialists in child maltreatment, their numbers are limited. Therefore, primary care physicians are called upon to perform their functions, including monitoring family health, diagnosing abuse, consulting with government agencies, testifying in court, and participating in abuse prevention programs and in multidisciplinary teams that evaluate and manage child maltreatment. Drs. Starling and Boos suggested offering a core curriculum in residency programs that would enable primary care physicians (including pediatricians, family doctors, and emergency-medicine doctors) to recognize, evaluate, and manage cases of child abuse and neglect.
PSYCHOLOGISTS LACK CHILD MALTREATMENT TRAINING
The American Psychological Association (APA) believed that, because psychologists are likely to encounter cases of child maltreatment in their practice, training in this area is very important. In 2003 the APA sought to gain information on the type and amount of training psychologists receive regarding child maltreatment in APA-accredited doctoral programs (Kelly M. Champion, Kimberly Shipman, Barbara L. Bonner, Lisa Hensley, and Allison C. Howe, "Child Maltreatment Training in Doctoral Programs in Clinical, Counseling, and School Psychology: Where Do We Go from Here?" Child Maltreatment, vol. 8, no. 3, August 2003). The study examined surveys sent to training directors of doctoral programs in 1992 and 2001. The APA found that doctoral programs had remained the same within those ten years. Few doctoral programs offered specific courses on child maltreatment in 1992 and 2001, just 13% and 11%, respectively. Although 65% of programs in 1992 and 59% in 2001 covered child maltreatment in three or more courses, these courses were rarely required to complete a doctoral program. Twenty percent of programs in 1992 and 22% in 2001 offered training in child maltreatment in clinical settings; most programs, however, reported that students completed just 1% to 10% of such training. Finally, research activities in child maltreatment decreased from 60% in 1992 to 47% in 2001.
CHILD PROTECTIVE SERVICES
Partly funded by the federal government, child protective services (CPS) agencies were first established in response to the 1974 Child Abuse Prevention and Treatment Act (CAPTA; Public Law 93-247), which mandated that all states establish procedures to investigate suspected incidents of child maltreatment. Upon receipt of a report of suspected child maltreatment, CPS screens the case to determine its proper jurisdiction. For example, if it is determined that the alleged perpetrator of sexual abuse is the victim's parent or caretaker, CPS screens in the report and conducts further investigation. If the alleged perpetrator is a stranger or someone who is not the parent or caregiver of the victim, the case is screened out, or referred elsewhere, in this case, to the police because it does not fall within CPS jurisdiction as outlined under federal law.
A state's child welfare system, under which CPS functions, consists of other components designed to ensure a child's well-being and safety. These include foster care, juvenile and family courts, and other child welfare services. Other child welfare services include family reunification, granting custody to a relative, termination of parental rights, and emancipation. Cases of reported child abuse or neglect typically undergo a series of steps through the child welfare system. (See Figure 3.2.)
The juvenile or family court hears allegations of maltreatment and decides if a child has been abused and/or
neglected. The court then determines what should be done to protect the child. The child may be left in the parents' home under the supervision of the CPS agency, or the child may be placed in foster care. If the child is removed from the home and it is later determined that the child should never be returned to the parents, the court can begin proceedings to terminate parental rights so that the child can be put up for adoption. The state may also prosecute the abusive parent or caretaker when a crime has allegedly been committed.
The Adoption Assistance and Child Welfare Act of 1980 (Public Law 96-272) mandated: "In each case, reasonable efforts will be made (A) prior to the placement of a child in foster care, to prevent or eliminate the need for removal of the child from his home, and (B) to make it possible for the child to return to his home." Because the law, however, did not define the term "reasonable efforts," states and courts interpreted the term in different ways. In many cases, child welfare personnel took the "reasonable efforts" of providing family counseling, respite care, and substance abuse treatment, thus preventing the child from being removed from abusive parents.
The law was a reaction to what was seen as zealousness in the 1960s and 1970s, when children, especially African-American children, were taken from their homes because their parents were poor. At the beginning of the twentieth-first century, however, some feel that problems of drug or substance abuse can mean that returning the child to the home is likely a guarantee of further abuse. Others note that some situations exist where a parent's live-in partner, who has no emotional attachment to the child, may also present risks to the child.
family preservation does not work. Dr. Richard J. Gelles, a prominent family violence expert, once a vocal advocate of family preservation, had a change of heart after studying the case of fifteen-month-old David Edwards, who was suffocated by his mother after the child welfare system failed to come to his rescue. Although David's parents had lost custody of their first child because of abuse, and despite reports of David's abuse, CPS made "reasonable efforts" to let the parents keep the child. In The Book of David: How Preserving Families Can Cost Children's Lives (New York, NY: Basic Books, 1996), Dr. Gelles points out that CPS needs to abandon its blanket solution to child abuse in its attempt to use reasonable efforts to reunite the victims and their perpetrators.
Dr. Gelles found that those parents who seriously abuse their children are incapable of changing their behaviors. On August 2, 2001, testifying before the U.S. House of Representatives during the reauthorization hearing on CAPTA, Dr. Gelles reported:
A major failing in child abuse and neglect assessments is the crude way behavioral change is conceptualized and measured. Behavioral change is thought to be a two-step process—one simply changes from one form of behavior to another…. As yet, there is no empirical evidence to support the effectiveness of child welfare services in general or the newer, more innovative intensive family preservation services. The lack of empirical support for the effectiveness of intensive family preservation services was the finding of the National Academy of Sciences panel on Assessing Family Violence Prevention and Treatment Programs and the United States Department of Health and Human Services national evaluation of family preservation programs.
family preservation works. The National Coalition for Child Protection Reform (NCCPR), a nonprofit organization of experts on child abuse and foster care who are committed to the reform of the child welfare system, believes that many allegedly maltreated children are unnecessarily removed from their homes. NCCPR recognizes that, while there are cases in which the only way to save a child is to remove him or her from an abusive home, in many cases providing support services to the family in crisis, while letting the child remain at home, helps ensure child safety.
The NCCPR believes that, with the proper assistance, a family in crisis can change its behavior (What is "Family Preservation?" Issue Paper 10, Alexandria, VA, undated). According to the NCCPR, family preservation encompasses intervention procedures based on the Homebuilders program first implemented in 1974 in Tacoma, Washington. Homebuilders services are designed for families with children at risk of an imminent placement in foster care. It starts with an intensive initial intervention lasting four to six weeks in the family's home with provision of counseling and concrete services (for example, buying food, paying rent, providing clothing). The Homebuilders worker is on call twenty-four hours a day during that period, and the amount of counseling he or she gives the family has been compared to a year's worth of conventional counseling. After the period of intensive intervention, aftercare is afforded the family as needed.
CPS SYSTEM UNDER SIEGE
The Child Welfare Workforce
Child welfare caseworkers perform multiple tasks in the course of their job. Among other things, they investigate reports of child maltreatment, coordinate various services (mental health, substance abuse, etc.) to help keep families together, find foster care placements for children if needed, make regular visits to children and families, arrange placement of children in permanent homes when they cannot be safely returned to their parents or caretakers, and document all details pertaining to the case. Caseworker supervisors monitor and support their caseworkers, sometimes taking on some of the cases when there is a staff shortage or heavy caseload. In 2003 the U.S. General Accounting Office (GAO), the investigative arm of Congress, examined the child welfare workforce and how challenges in recruiting and retaining caseworkers affect the children under their care (Child Welfare: Health and Human Services Could Play a Greater Role in Helping Child Welfare Agencies Recruit and Retain Staff, Washington, DC, March 2003). Among other things, GAO examined exit interview documents of caseworkers who had left their jobs from seventeen states, forty counties, and nineteen private child welfare agencies. GAO also interviewed child welfare officials and experts and conducted on-site visits to agencies in four states—California, Illinois, Kentucky, and Texas.
GAO found that CPS agencies continued to have difficulty attracting and retaining experienced caseworkers.
The low pay not only made it difficult to attract qualified workers but also contributed to CPS employees leaving for better-paying jobs. Since the federal government has not set any national hiring policies, employees have college degrees that may not necessarily be related to social work. Workers that the GAO interviewed in different states also mentioned risk to personal safety, increased paperwork, lack of supervisory support, and insufficient time to attend training as reasons that affected their job performance and decision to leave.
In the four states GAO visited, caseworkers spent from 50% to 80% of their time doing paperwork. Staff shortage due to workers quitting their jobs resulted in excessive caseloads. Figure 3.3 shows the GAO's findings for worker caseloads as compared to recommended standards. The Child Welfare League of America (CWLA), a private child welfare organization, recommends a case-load of twelve to fifteen cases per caseworker, while the Council on Accreditation for Children and Family Services (COA), which evaluates organizations against best-practice standards, recommends no more than eighteen cases per worker. GAO found that, in reality, individual caseworkers handled anywhere from ten to 110 cases, with the average being twenty-four to thirty-one cases.
slipping through the cracks. Some CPS workadoptive mother's decisioners at times fail to monitor the children they are supposed to protect. In Florida the Department of Children and Families could not account for the disappearance of a five-year-old foster child, Rilya Wilson, who had been missing for more than a year before the agency noticed her absence in April 2002. At around that time the agency had reportedly lost track of more than 530 children. Rilya's disappearance was only discovered after her caseworker was fired and the new caseworker could not locate the child. The former caseworker had falsely reported that Rilya was fine, although she had not visited the child at her foster home for months. As of November 2004 the Department of Children and Families still could not account for Rilya's disappearance. Authorities, however, discovered that her foster mother continued to receive welfare payments for the girl in her absence. Witnesses had also testified the foster mother and her roommate abused the child prior to her disappearance. The women faced charges of aggravated child abuse, and her foster mother was convicted of fraud and sentenced to three years in jail.
New Jersey's child welfare system had also come to national attention because of its failure to protect adopted and foster children. In October 2003 four brothers of the Jackson family in Collingswood, New Jersey, ages nine, ten, fourteen, and nineteen, were removed from their adoptive parents' home and the couple were arrested. Investigations later revealed the brothers were systematically starved over many years. They weighed no more than forty-five pounds and stood less than four feet tall. The children reportedly subsisted on peanut butter, pancake batter, and wallboard. Authorities admitted two of the boys had fetal alcohol syndrome and two had eating disorders, the reasons the adoptive parents gave to neighbors for the brothers' emaciated appearance. The brothers, however, had put on weight and height since living with other foster families.
Investigations also revealed that Division of Youth and Family Services (DYFS) workers visited the adoptive parents' home thirty-eight times in the past to check on three other foster children but never asked about the brothers. In 1995, when DYFS was notified by the oldest boy's school that he seemed malnourished, DYFS did not require a medical examination and even agreed to the adoptive mother's decision to homeschool the brothers. DYFS policies
|Estimated numbers and percentage of children aged 17 or younger living with one or more parents with past year substance abuse or dependence, 2001|
|Ages of children (years)||Estimated numbers (in thousands)||Percentage||Standard error|
|Notes: Children include biological, step, adoptive, or foster. Children aged 17 or younger who were not living with one or more parents for most of the quarter of the NHSDA interview are excluded from the present analysis. According to the 2000 Current Population Survey, this amounts to approximately 3 million or 4 percent of children aged 17 or younger.|
|source: "Table 2. Estimated Numbers (in Thousands) and Percentage of Children Aged 17 or Younger Living with One or More Parents with Past Year Substance Abuse or Dependence: 2001," in The NHSDA Report: Children Living with Substance-Abusing or Substance-Dependent Parents, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, June 2, 2003, http://www.oas.samhsa.gov/2k3/children/children.pdf (accessed October 27, 2004)|
|Younger than 3||1,078||9.8||0.81|
|3 to 5||1,115||9.8||1.10|
|6 to 11||1,816||7.5||1.28|
|12 to 17||2,100||9.2||0.81|
required an annual medical evaluation and interview of each household member, but these never took place. In May 2004 the adoptive parents were indicted on twenty-eight counts of aggravated assault and child endangerment.
In January 2003 Newark, New Jersey, police found two boys, ages four and seven, locked in a basement and the dead body of another seven-year-old, twin brother Faheem Williams, stuffed in a plastic container. The boys' mother had left the children with a cousin before leaving to serve a prison sentence. It was discovered that a DYFS caseworker and a supervisor assigned to the family had closed the file on the boys a year earlier without ever checking on them.
The Problem of Substance Abuse
CPS workers are faced with the growing problem of substance abuse among families involved with the child welfare system. According to the National Household Survey on Drug Abuse, with information from the U.S. Bureau of the Census, in 2001 nearly seventy million children younger than eighteen lived with at least one parent. About 6.1 million children seventeen or younger (comprising 8.7% percent of all children in the nation) lived with one or more parents with past-year substance abuse or dependence. About one-fifth (19.6%) were five years old or younger. (See Table 3.3.) Among these children, about 4.5 million lived with an alcoholic parent, an estimated 953,000 lived with a parent with an illicit drug problem, and approximately 657,000 lived with parents who abused both alcohol and illicit drugs. (See Figure 3.4.) Fathers (7.8%) were more likely than mothers (4%)
to report having had a past-year substance abuse or dependence (National Household Survey on Drug Abuse (NHSDA) Report: Children Living with Substance Abusing or Substance-Dependent Parents, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Science, Rockville, MD, June 2003). (See Figure 3.5.)
According to the U.S. Department of Health and Human Services, about one-third to two-thirds of substantiated child maltreatment reports (those having sufficient evidence to support the allegation of maltreatment) involve substance abuse. Younger children, especially infants, are more likely to be victimized by substanceabusing parents, and the maltreatment is more likely to consist of neglect than abuse. Many children experience neglect when a parent is under the influence of alcohol or
is out of the home looking for drugs. Even when the parent is at home, he or she may be psychologically unavailable to the children.
substance abuse among pregnant women. Illicit drug use among pregnant women continues to be a national problem. Each year the National Survey on Drug Use and Health (NSDUH), formerly known as the National Household Survey on Drug Abuse, asked female respondents ages fifteen to forty-four about their pregnancy status and illicit drug use the month prior to the survey. In 2002, 3% of pregnant women, compared to 9% of non-pregnant women, reported using illicit drugs during the past month (The NSDUH Report: Pregnancy and Substance Use, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, MD, 2004). Nearly 7% of pregnant women fifteen to twenty-five years old reported illicit drug use the previous month, compared to just 0.5% of pregnant women ages twenty-six to forty-four. Among pregnant women, more African-Americans (6.2%) than whites (3.6%) and Hispanics (1.7%) reported using illicit drugs the previous month. (See Figure 3.6.)
children at illicit drug labs. The rapid growth of methamphetamine use in the United States has resulted in the establishment of clandestine methamphetamine laboratories (meth labs) in many places. Traditionally, large-scale operations, particularly in California and Mexico, have produced large quantities of drugs, which are then distributed
throughout various areas in the country. With more demand for methamphetamines, many small-scale businesses have started operating. Since methamphetamines can be produced almost anywhere, using readily available ingredients, nearly anyone can set up a temporary laboratory, make a batch of drugs, then dismantle the apparatus. Authorities have found makeshift laboratories in places inhabited or visited by children, including houses, apartments, mobile homes, motel rooms, and storage lockers.
As more children are found living in or visiting home-based meth labs, child protection personnel have to deal with those children who have been exposed not only to potentially abusive people associated with the production of methamphetamines, but also to such dangers as fire and explosions. Hazardous living conditions include unsafe electrical equipment, chemical ingredients, syringes, and the presence of firearms and pornography (Karen Swetlow, OVC Bulletin: Children at Clandestine Methamphetamine Labs: Helping Meth's Youngest Victims, U.S. Department of Justice, Office of Justice Programs, Office for Victims of Crime, Washington, DC, June 2003). Police have found meth homes with defective plumbing, rodent and insect infestation, and without heating or cooling. The author added that children living in meth labs are likely to be victims of severe neglect and physical and sexual abuse. A report by the El Paso Intelligence Center, a collaborative effort of more than fifteen federal and state agencies that track drug movement and immigration, showed that thousands of children were living in or visiting meth labs that were seized by law enforcement nationwide from 2000 to 2002. In 2002 more than one thousand children, or about half of the children present during lab-related incidents, were taken into protective custody. (See Table 3.4.)
CPS and Domestic Violence
When CPS workers get involved with children who have witnessed domestic violence, their main concern is the interests of the children. Critics have charged that CPS further penalizes battered women by taking away their children when their partners have abused the children. Stephanie Walton, who tracks domestic violence for the National Conference of State Legislatures, observed that experts on domestic violence and child welfare like Jeffrey L. Edleson have noted that "fragmented treatment systems" stand in the way of solving the problems of domestic violence and co-occurring child maltreatment ("When Violence Hits Home," State Legislatures, vol. 29, issue 6, June 2003). Walton added that child welfare workers and domestic violence agencies work against each other, with the former blaming the mother for exposing the child to her partner's violence and the latter protecting the mother from prosecution for failure to protect her child.
According to Thomas D. Morton, president and chief executive officer of Child Welfare Institute, child welfare agencies need to hold the batterers accountable for their actions (Failure to Protect? Child Welfare Institute, Duluth, GA, February 2002). Morton noted that some CPS caseworkers may equate a mother's victimization to her inability to protect her child, consequently removing the child from the home. CPS and/or state legislatures should clarify certain CPS practices, including what course of action to take when a nonrelated caregiver in a household is the child abuser. The author asked whether or not CPS should pursue family preservation (keeping the family together) if the abuser is not legally related to the child. He also raised such questions as to whether CPS may require the biological parent to end a relationship with the nonbiological caretaker as a requirement for keeping the child in the family.
Holding States Accountable
In 2004 the U.S. Department of Health and Human Services released the fourth in a series of annual reports on states' performances in meeting the needs of at-risk children who have entered the child welfare system. The Child Welfare Outcomes 2001: Annual Report (Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau, Washington, DC) was required by the 1997 Adoption and Safe Families Act (ASFA; Public Law 105-89).
|Children found at methamphetamine labs in the United States, 2000–02|
|Number of children|
|Year||Number of meth lab-related incidents||Present||Residing in seized meth labs1||Affected2||Exposed to toxic chemicals3||Taken into protective custody||Injured or killed|
|1Children included in this group were not necessarily present at the time of seizure.|
|2Includes children who were residing at the labs but not necessarily present at the time of seizure and children who were visiting the site; data for 2000 and 2001 may not show all children affected.|
|3Includes children who were residing at the labs but not necessarily present at the time of seizure.|
|source: "Children Found at Methamphetamine Labs in the United States," in Children at Clandestine Methamphetamine Labs: Helping Meth's Youngest Victims," U.S. Department of Justice, Office of Justice Programs, Office for Victims of Crimes, June 2003 (accessed October 27, 2004)|
|2002||15,353||2,077||2,023||3,167||1,373||1,026||26 injured, 2 killed|
|2000||8,971||1,803||216||1,803||345||353||12 injured, 3 killed|
ASFA gives states flexibility in interpreting the "reasonable efforts" required to reunify children with their birth families. When victims cannot safely return home, states can start proceedings to terminate parental rights for children who have been in foster care for fifteen of the previous twenty-two months. Children can then be placed in permanent homes. The Child Welfare Outcomes 2001: Annual Report showed that in fiscal year 2001 (October 1, 2000, to September 30, 2001) an estimated 290,000 children entered foster care. About 263,000 exited foster care. Fifty-seven percent were reunited with their parents or primary caretakers, 10% went to live with relatives, 18% were adopted, and 7% were emancipated (recognized by the court as an adult). Three percent were transferred to another CPS agency, and another 3% were put under guardianship. Two percent of foster children had run away. Another 528 children had died. (See Table 3.5.) As of September 30, 2002, an estimated 532,000 children remained in foster care.
Although CPS agencies have had many problems and are often unable to perform as effectively as they should, many thousands of maltreated children have been identified, many lives have been saved, and many more have been taken out of dangerous environments. It is impossible to tally the number of child abuse cases that might have ended in death; these children have been saved by changes in the laws, by awareness and reporting, and by the efforts of the professionals who intervened on their behalf.
CPS'S PERCEPTION OF RACIAL DISPARITY IN THE CHILD WELFARE SYSTEM
In 2003 the Children's Bureau released the first study of its kind to explore the attitudes and perceptions of CPS personnel regarding the over-representation of minority children, particularly African-American children, in the child welfare system (Susan Chibnall, Nicole M. Dutch,
|Outcomes for children exiting foster care, fiscal year 2001|
|Note: Deaths are attributable to a variety of causes including medical conditions, accidents, and homicide.|
|source: "What Were the Outcomes for the Children Exiting Foster Care during Fiscal Year 2001?" in Child Welfare Outcomes 2001: Annual Report, U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, Children's Bureau, 2004, http://www.acf.hhs.gov/programs/cb/publications/cwo01/cwo01.pdf (accessed October 27, 2004)|
|Reunification with parent(s) or primary caretaker(s)||57%||148,606|
|Living with other relative(s)||10%||26,084|
|Transfer to another agency||3%||7,918|
|Death of child||0%||528|
Brenda Jones-Harden, Annie Brown, Ruby Gourdine, Jacqueline Smith, Anniglo Boone, and Shelita Snyder, Children of Color in the Child Welfare System: Perspectives from the Child Welfare Community, U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau, Washington, DC). According to the authors, while African-American children make up 15% of all children in the United States, they represent 25% of substantiated maltreatment victims. In addition, these children account for 45% of all children in foster care.
Researchers conducted the study in nine child welfare agencies across the country. They interviewed agency administrators, supervisors, and caseworkers. The child welfare personnel gave a variety of reasons why minority children are over-represented in the child welfare system, including:
- Poverty and poverty-related issues—Child welfare personnel thought that African-American families are more likely to be poor than other ethnic/racial groups. This makes them more vulnerable to social problems such as child maltreatment, domestic violence, and substance abuse. Moreover, these families typically live in areas lacking resources where they can go for assistance.
- Visibility—Poor families are more likely to use public services, such as public health care, making them more visible to mandated reporters when they are experiencing problems, including child abuse and neglect.
- Over-reporting—Many study participants proposed that, since poor families are more visible to mandated reporters such as doctors and nurses, they are more likely to be reported to CPS.
- Worker bias—When investigating particular families, some caseworkers may not understand the cultural norms and practices of minorities; this may influence their decisions at different stages of child welfare services, including child maltreatment reporting, investigation, substantiation, and the child's removal from home and placement in foster care.
- Media bias—According to child welfare personnel, the media frenzy that occurs after each high-profile child abuse case influences their decision to substantiate certain cases and remove children from their homes. Caseworkers in two sites (both located in areas that are mainly African-American) revealed that they felt "frightened and insecure" each time they came under media attention, which they thought has become quite frequent. One worker stated,
[Workers] tend to feel safer placing children in care … because they've gotten pressure about leaving children in homes and something happens to them so they feel safer bringing a child into care. When in doubt, take them out. A lot of times, in African-American communities, they're going to take them out.
Perspectives on the Impact of Federal Policies on Children in the Child Welfare System
Some child welfare personnel who were interviewed for the study Children of Color in the Child Welfare System: Perspectives from the Child Welfare Community believed that the Multi-ethnic Placement Act (MEPA) of 1994 (Public Law 103-382), which allows the placement of African-American children in nonminority homes, does not serve children's best interests. They were concerned that transracial placements might be harmful to minority children's self-esteem and ethnic/racial identity.
On the other hand, child welfare personnel said MEPA has given them the alternative of placing some children with extended families. One supervisor quoted by the study commented, "The other thing that [MEPA] has done … is that it has broadened the role that family [are] able to play. For instance, we never used to recommend relative adoptions. It was seen as being very problematic and creating all kinds of difficult dynamics within the family system. And, now, that's a preferred plan, to have a relative that wants to adopt."
Study participants were also asked about their perspectives on the Adoption and Safe Families Act (ASFA) of 1997 (Public Law 105-89). Among its provisions, AFSA has accelerated the permanent placement of children waiting in foster care. ASFA allows the termination of parental rights in situations where family reunification is considered not possible. ASFA gives states incentive payments to find adoptive families for foster children within a certain time frame.
Participants reported concerns that families experiencing other issues, such as substance abuse and mental health problems, may take longer to resolve their problems. CPS workers admitted they feared that, under ASFA requirements, they might have to terminate parental rights before parents have had the time to sort out their problems. To aggravate the situation, these goals are hard to accomplish when they lack the financial resources to provide social services and treatments.
states should use asfa to their advantage. Richard Wexler, executive director of the National Coalition for Child Protection Reform (Alexandria, VA), noted, "In passing ASFA, Congress failed to learn the lessons some states have begun to learn after experiencing foster care panics—huge, sudden increases in placements that follow intensive media coverage of the death of a child who was known to the [child welfare] system" ("Take the Child and Run: Tales from the Age of ASFA," New England Law Review, vol. 36, no. 1, Fall 2001). Wexler described how, in the aftermath of foster care panics, child abuse deaths tend to increase. Caseworkers, fearing the scrutiny of politicians and the media and overwhelmed with more cases, may remove children from homes that could have been made safe with the right services, while leaving others in dangerous homes.
Wexler observed that while ASFA encourages states to terminate parental rights within a restricted time period and provides monetary incentives for adoptions, nothing in the law prevents states from providing parents with housing or child care. States do not have to use the "take the child and run" approach. Instead, states can provide rent subsidies so that parents would not lose their children because of lack of decent housing. Moreover, states can provide daycare so that single working parents who leave children unsupervised in order to earn a living would not lose those children because they have been found neglectful.