Journal Issue: Protecting Children from Abuse and Neglect Volume 8 Number 1 Spring 1998
Douglas J. Besharov
In the past 30 years, major progress has been made in combating child abuse. In 1963, only about 150,000 children were reported to the authorities because of suspected abuse or neglect.1 In 1995, more than 3 million children were reported,2 a 20-fold increase. As a result, many thousands of children have been saved from death and serious injury. The best estimate is that child abuse and neglect deaths fell from more than 3,000 a year (and perhaps as many as 5,000) in the late 1960s to about 1,200 a year in the mid-1990s.3
Yet many children continue to fall through the cracks. According to a federal government study, in 1986, professionals such as physicians, teachers, and child care personnel still failed to report half of the maltreated children they saw. Nearly 50,000 sexually abused children went unreported, as did about 60,000 children with observable physical injuries severe enough to require hospitalization.4
Even being reported, however, does not guarantee a child's safety. Fully 48% of the child abuse deaths in 1995 involved children previously known to the authorities.5 Tens of thousands of other children suffer serious injuries short of death while under child protective agency supervision.
No matter what is done, some child abuse tragedies cannot be prevented—because they occur behind closed doors and without warning. But in cases where an outsider, especially a child-serving professional, has an opportunity to recognize the danger the child is in, one can fairly ask: What went wrong, and can something be done about it? Fundamental reforms of both the reporting process and child protective decision making are needed.
Reforming the Reporting Process
Simply generating more and more reports of suspected child abuse and neglect is not the answer. In recent years, the problem of nonreporting has been compounded by the problem of inappropriate reporting. The emotionally charged desire to "do something" about child abuse, fanned by often sensational media coverage, has led to an understandable but counterproductive overreaction on the part of some professionals and citizens, who report many cases that do not amount to child abuse.
In 1995, about 65% of all reports were labeled "unfounded" after being investigated.6 This is in sharp contrast to 1975, when the comparable figure was about 35%.7 Although rules, procedures, and even terminology vary, in essence, an unfounded report is one that is dismissed because insufficient evidence exists upon which to proceed.
Some professionals defend the high level of unfounded reports as the necessary price for identifying endangered children. And, certainly, some amount of inappropriate reporting is to be expected. We ask hundreds of thousands of strangers to report their suspicions; we cannot ask that they be sure; and we cannot expect that they always be right.
Nevertheless, the determination that a report is unfounded can be made only after what is often a traumatic investigation and, inherently, a breach of parental and family privacy. To determine whether a particular child is in danger, child protective workers inquire into the most intimate personal and family matters. Often, it is necessary to question friends, relatives, and neighbors, as well as schoolteachers, child care personnel, doctors, clergy, and others who know the family.
For fear of missing even one abused child, workers often perform extensive investigations of vague and apparently unsupported reports. Even when a home visit prompted by an anonymous report turns up no evidence of maltreatment, workers usually conduct the same series of interviews to make sure that the child has not been abused. Besides being unfair to the children and parents involved, inappropriate reporting places an unnecessary burden on already overwhelmed child protective agencies—and threatens to undermine public support for their efforts.
Investigating so many reports that turn out to be unfounded consumes scarce agency resources, leaving child protective workers with less time to respond to children in real danger. Some reports are left uninvestigated for weeks. In other cases, workers miss key evidence and cannot adequately supervise dangerous home situations—as they rush to keep up with the new reports arriving daily on their desks. These nationwide conditions help explain why so many child abuse cases involve children previously known to the authorities.
Thus, abused and neglected children are dying, both because they are not being reported to the authorities and because the authorities are being overwhelmed by the need to investigate inappropriate reports.
What should be done? Although fear of getting involved remains a problem, few people fail to report because they do not care about endangered children. Instead, they may be unaware of the danger the child faces, or of the help that is available from child protective agencies. A study of nonreporting among teachers, for example, blamed their "lack of knowledge for detecting symptoms of child abuse and neglect."8 Similarly, few inappropriate or unfounded reports are deliberately false statements. Most involve an honest desire to protect children coupled with confusion about the conditions that should be reported—and those that should not.
With this understanding, a relatively clear agenda for reform emerges:
- Clarify child abuse reporting laws. Existing laws are often vague and overbroad. They should be rewritten to provide real guidance about what conditions should, and should not, be reported. This can be accomplished without making a radical departure from present laws or practices. The key is to describe reportable conditions in terms of specific parental behaviors or conditions that are tied to severe and demonstrable harms (or potential harms) to children.9
- Provide continuing public education and professional training about child abuse reporting. Better—and more accurate—reporting depends on informed laypersons as well as professionals who are mandated to report suspicions of child abuse. Training and educational programs must be ongoing, and should emphasize the conditions that do not justify a report, as well as those that do. Unfortunately, far too many training programs are of short duration, haphazard in their focus, and handicapped by the absence of comprehensive resource materials.
- Screen reports. No matter how well professionals are trained and no matter how extensive public education efforts are, there will always be a tendency for persons to report cases that should not be investigated. Therefore, all states should have formal policies and procedures for determining whether to accept a call for investigation, including explicit guidance about the kinds of cases that should not be assigned for investigation. (When reports concern a family problem more appropriately handled by another social service agency, a proper referral should be made.)
- Modify liability laws. Current laws provide immunity for anyone who makes a report in good faith, but they give no protection to those who, in a good-faith exercise of professional judgment, decide that a child has not been abused or neglected and, hence, should not be reported. This combination of immunities and penalties encourages the over-reporting of questionable situations.
- Give feedback to persons who report. If persons who report are not told what happened, they may conclude that the agency's response was ineffective or even harmful to the child, and the next time they suspect that a child is maltreated, they may decide not to report. In addition, reporters need information about whether their suspicions were valid to interpret subsequent events as they monitor the child's condition, and to improve the quality and accuracy of their future reports.
- Adopt an agency policy on reporting. Appropriate reporting of suspected child maltreatment requires a sophisticated knowledge of many legal, administrative, and diagnostic matters. To prepare their staffs to respond properly, an increasing number of public and private agencies (such as schools and child care agencies) are adopting formal agency policies about reporting. The primary purpose of these agency protocols is to inform staff members of their obligation to report and of the procedures to be followed. Such formal policies are also an implicit commitment by agency administrators to support front-line staff members who decide to report. Moreover, the process of drafting a written document can clarify previously ambiguous or ill-conceived agency policies.
To call for more careful reporting of child abuse is not to be coldly indifferent to the plight of endangered children. Rather, it is to be realistic about the operations and capabilities of child protective systems.
Reforming Child Protective Decision Making
Child protective decision making also suffers because of unrealistic expectations. Although no two cases are exactly alike, one pattern repeats itself with disturbing frequency: The agency knew that a particular mother was dreadfully inadequate—often from multiple reports made month after month, and sometimes year after year—yet did not remove the children from the danger. Or, the deceased child had been placed in foster care, but was later returned to the mother. (Yes, it is mostly the child-rearing ability of the mothers that is at issue. In these chronic cases, even when a man is the actual killer, he is rarely a longtime presence in the home.)
The conventional wisdom blames most of these deaths on inadequate funding and on poorly trained and overworked caseworkers. On the basis of my experience, however, I do not think that more money will help matters very much. Decision-making problems plague agencies even when they have low per-worker caseloads. Even though most agencies can certainly use more (and better) staff and treatment resources, the real culprit is wishful thinking about parents and the efficacy of treatment.
Each year, about 250,000 children are placed into protective foster care, according to the American Public Welfare Association. Although many children are returned in a matter of days, many others languish in foster care. The most up-to-date data are from 1990, when about 40% of the 400,000 children in foster care had been away from home for at least two years. About half of these children had been in at least two foster homes, and a quarter of them in three or more foster homes. Fewer than 5% of these hundreds of thousands of children, however, are freed for adoption each year. Too many children are returned home, where they are frequently abused again and once more placed in foster care.
If abused children are to have a fair chance in life, seven basic reforms are needed. I will put these recommendations within the context of drug-addicted parents because the drug crisis is changing the face of the child welfare caseload and stretching agencies to the breaking point. Although we are now 10 years into the crack epidemic, most states have yet to develop laws and programs that accurately reflect how crack devastates parental functioning—and that recognize our limited ability to cure addiction.
- Recognize that parental drug addiction is widespread and will continue to endanger children. Although the number of new drug addicts seems to have declined in recent years, hundreds of thousands of parents remain addicted. On their own, most true drug addicts simply cannot adequately care for their children. Without societal intervention, their children are condemned to lives of severe deprivation and, often, violent assault. In 1994, for example, drug addiction was present in almost three-quarters of New York City's child abuse fatalities.
- Assume that parental crack addiction cannot be cured. Although there has been some success in treating heroin addiction and alcoholism, even the best treatment programs report that, in most cases, they can break patterns of crack usage only temporarily—because of the addictive qualities of the drug and the social factors that encourage addiction. That is why drug-treatment professionals consider crack addiction to be "a chronic, relapsing syndrome." So should child welfare professionals.
- Provide intensive—and prolonged—child protective supervision. Many children of addicts remain at home in their parents' custody. Child protective agencies provide only short-term services to these families, on the assumption that a referral to a drug-treatment program will cure the parents' addiction. Since drug addiction (even if treated) is usually a long-term affliction, this short-term orientation is a grave mistake. Case planning should be based on the understanding that the family will likely require many years of supervisory home visits to monitor whether the child is being abused again, and to provide counseling to the parents.
- Formalize "kinship care" programs. Members of the extended family play a key role in caring for the children of addicts. In August 1995, for example, about 40% of New York City's 42,000 foster children lived in these kinship placements. But too many of these children are placed with relatives who are burdened with many of the same problems as the parents and, thus, cannot provide an adequate home environment. Although it would be a mistake to apply all the formalities of nonfamilial foster care to these relative placements, a set of minimum standards for licensing, monitoring, and supporting these placements should be developed. In addition, in many states, foster care payments to kin are much higher than welfare payments the mother might receive, creating an incentive to leave children in these temporary situations. This disparity in levels of support should be erased.
- Increase adoptions, especially of abandoned infants. Child welfare agencies do a poor job of identifying the children who should be freed for adoption (because of a general reluctance to terminate parental rights, administrative and decision-making breakdowns, and, to a lesser extent, current statutory provisions). Laws and procedures should be reformed to encourage adoption when the parents' demonstrable inability to care for a child is coupled with an unwillingness to accept a reasonable offer of treatment. Since termination should be pursued only when there is a reasonable likelihood of adoption, the focus should be on younger children, especially abandoned infants.
- Create alternate living arrangements that are stable and nurturing. Children who are not appropriate candidates for adoption (because they are older or have behavioral problems) and who cannot be placed with relatives are likely to spend many years in substitute care. These children are in desperate need of the consistency and support that only long-term residential environments can provide. Among the possibilities are explicitly designated family foster care homes, group homes, and residential care facilities (yes, what we used to call orphanages).
- Make family planning a child welfare service. Most drug-addicted women would be better off if they had greater control over their own fertility. Child welfare agencies often take away the children of drug-addicted mothers one by one—at birth or shortly thereafter. Although some of these mothers want to have more children, many do not. Their lifestyles (and the men in their lives), however, limit their ability to use contraceptives effectively. Family planning should be automatically offered to addicted mothers, not to coerce abstention or contraceptive use, but, rather, to help motivate female addicts to gain control over their own lives.
Two sets of reforms are proposed here—steps to encourage more careful reporting and reduce intrusive investigations of unfounded allegations, and steps to provide a more realistic response to the devastating effects of drug addiction on child rearing. These reforms will not guarantee that there won't be any more child abuse deaths. Without these reforms, however, no amount of finger-pointing or additional funding will solve the child welfare system's problems.
- Besharov, D.J. Recognizing child abuse: A guide for the concerned. New York: Free Press, 1990, pp. 7–19.
- National Committee to Prevent Child Abuse. Current trends in child abuse reporting and fatalities: The results of the 1995 fifty-state survey. Chicago: NCPCA, April 1996, p. 3.
- See note no. 2, National Committee to Prevent Child Abuse, p. 12.
- Sedlak, A. The supplementary analyses of data on the national incidence of child abuse and neglect. Rockville, MD: Westat, May 1989, p. 2-2, Table 2-1.
- See note no. 2, National Committee to Prevent Child Abuse, p. 12
- See note no. 2, National Committee to Prevent Child Abuse, p. 6.
- American Humane Association. National analysis of official child neglect and abuse reporting, 1976. Denver, CO: AHA, 1978, p. 11.
- Levin, P. Teachers' perceptions, attitudes, and reporting of child abuse/neglect. Child Welfare January/February 1983) 62,1:14–19.
- See note no. 1, Besharov, pp. 28–36.