Child Abuse and Neglect

1. Child Abuse and Neglect R. Bruce McNellie Ph.D.,LCSW,LPC,LMFT,DCSW

2. Early History • The concept of child abuse and neglect as a distinct field has relatively recent origins. Our current law has its roots in early English law developed in the 16th and 17th centuries. It was an important step forward in the rights of the individual though it did not offer the same measure of protection to all. The first protections were offered to male land owners.  These included protection from arbitrary search of one’ property, confiscation of personal belongings or land, right to refuse to house and support the military, the right to have your case heard before a panel of peers, and the right not be held indefinitely without being charged.  The concepts of individual rights reflected a strong Biblical tie. The man was the head of the house, the one in charge, and he had all rights not expressly given to the king, society, city, township, county, or state.  His right o his property was viewed as inviolate or sacred and his ‘property’ was considered to be his lands, equipment, household, as well as his wife and his children. Against this backdrop of a near sacred relationship between the man and his children, the concept of a state organization to protect children from fathers was nearly unthinkable.

3. Modern History • In the early 1850’s a man was seen brutally beating and mistreating through neglect his milk truck horse. He was arrested and brought before the authorities regarding his treatment of his work animal. The case resulted in the horse being taken from him and placed in the care of the city of New York. The reasoning was that society has a role in ensuring that work animals, which benefit all of  society, should be protected for the good of the community. From this landmark decision came the current laws regarding cruelty to all animals and marked the beginnings of the Society for the Prevention of Cruelty to Animals. • In 1873 a child, Mary Ellen, was being tied to a bed, whipped, and cut with scissors as punishment. Her plight was brought to the attention of the court through a complex process as there were no laws protecting children at that time. The court agreed with the reasoning that a child deserved the same level of  society’s protection offered to draft animals.  The child was taken away from the parents and the parents were ordered to pay for her care.

4. Principal Characters • Henry Bergh • Elbridge T. Gerry

5. The ASPCA • The first anti-cruelty laws were enacted on behalf of animals, not children, but the founding of the American Society for the Prevention of Cruelty to Animals in New York by Henry Bergh in 1866 proved fortuitous, for its applicability to human needs was recognized almost immediately. • "The children of New York are sadly in need of a champion . . ." (The New York Evening Telegram, 1866) • "It is not alone the lower animals that are subject to ill-treatment and cruelty." (The Northern Budget, Troy, N.Y., 1867) • Within four years, Bergh enlisted Elbridge Gerry as ASPCA counsel. The sensitivity imbuing these men with concern for animals also filled them with distress over the maltreatment of children.

6. Etta Wheeler • In the winter of 1873, in a New York neighborhood called "Hell's Kitchen", a rooming-house janitress told a church worker about a case of child cruelty. Dedicated and compassionate, Etta Wheeler made discrete inquiries and determined to rescue the abused child, a little girl named Mary Ellen. When others declined to intervene, Wheeler approached Henry Bergh and Bergh appealed to Gerry: • "No time is to be lost -- instruct me how to proceed."

7. Mary Ellen • In 1874, a young girl known only as "Mary Ellen", was found tied to a bed like an animal, neglected and brutally beaten by her foster parents. Her parents were dead and she had been left in the care of a foster family. • In 1874, animals were legally protected from inhumane treatment, children were not. That is until a small group of concerned citizens in New York City came together in 1875 to become the first organized child protective institution in the country—The New York Society for the Prevention of Cruelty to Children (NYSPCC). Mary Ellen

8. Mary Ellen • Gerry made clever use of an obscure section of habeas corpus to secure their legal standing. The "Mary Ellen case" was a classic child protective intervention. Within forty-eight hours of Wheeler's initial report, an investigation was conducted, a petition filed, a protective removal effected, a hearing commenced, a temporary placement arranged and a criminal prosecution in preparation.

9. "I was in a courtroom full of men with pale, stern looks. I saw a child brought in . . . at the sight of which men wept aloud. And as I looked, I knew I was where the first chapterof children's rights was written . . . For from that dingy courtroom . . . came forth The New York Society for the Prevention of Cruelty to Children with all it has meant to the world's life." Jacob Riis, reporter

10. Mary Ellen's court statement. • "My name is Mary Ellen ____. I don't know how old I am; my mother and father are both dead; I call Mrs. C____ momma; I have never had but one pair of shoes, but can't recollect when that was; I have no shoes or stockings this winter; I have never been allowed to go out . . .except in the night time, and only in the yard [to use the outdoor privy]; my bed at night is only a piece of carpet stretched on the floor underneath a window and I sleep in my little undergarment with a quilt over me; I am never allowed to play with other children; momma has been in the habit of whipping me almost everyday; she used to whip me with a twisted whip -- a rawhide; the whip always left black and blue marks on my body; I have now on my head two black and blue marks which were made by momma with the whip, and a cut on the left side of my forehead which was made by a pair of scissors in momma's hand; she struck me with the scissors and cut me; I have no recollection of ever having been kissed and I have never been kissed by momma: I have never been taken on momma's lap or caressed or petted; I never dared speak to anybody, because if I did I would get whipped; I have never had . . . any more clothing than I have on at present . . . .; I have seen stockings and other clothes in our room, but I am not allowed to put them on; whenever momma went out, I was locked up in the bedroom;. . .I don't know for what I was whipped; momma never said anything when she whipped me; I do not want to go back to live with momma because she beats me so."

11. After Mary Ellen told her story in court, her foster mother was prosecuted for assault and battery. Mary Ellen was placed into a new home in upstate New York and grew up a normal child. She became a favorite to all those who knew her. • At age 24, she married and had two daughters of her own. She also adopted a third orphaned child. Her daughters reported that Mary Ellen was always reluctant to speak of her past, but she did show them the scars of burns on her arms and the scissors scar was always noticeable on her face. It was her pride and joy to be able to provide her own daughters with a happy childhood in contrast to her own. Mary Ellen died in 1956, at the age of 92.

12. Current Legal Status • This was a significant break in the rights of fathers to their children. As a result of this case and the resulting publicity, states began passing legislation that enabled the courts to more clearly establish jurisdiction over cases involving the bond between children and their parents. By 1937 every state in America had passed legislation to this effect, that the state, or county or city acting on behalf of the state, has the unction to ensure a basic level of protection is provided for its children, generally to ensure that their health and well being is not placed in significant danger by their parents. Most of these children were placed in orphan homes run by churches or placed with relatives or community members sought out by the ‘county fathers’ for this purpose. Little public money was available initially apart from what was provided by private or religious organizations.

13. County vs. State Responsibility • During the Depression of the 1930’s there developed a greater need for public care for the children of the poor. Out of this grew the concept of local county specific boards to help root out resources for the homeless and abuse d waifs of the county. These boards assisted in placement of children with people in the community, transportation and placement in nearby orphan homes, with relatives, or community members.  They helped with development of resources to help families get food and housing if necessary. Most of their work was with the local law enforcement agency or magistrate. Again very little money was available from public funds for the purpose of helping children or families. What money was available depended on the specific county or city administrators or judges to set aside funds for medical or direct care for the children.

14. County vs. State Responsibility • Children who became “wards” of the court faced a bleak financial future, often hired out to local farmers to help pay their way, or placed in a church run institution. In 1939 in Texas, the Texas Department of Public Welfare of Office of the Aged and Disabled assumed responsibility of providing some assistance to children whose parents were disabled. Boards began to shift from working just with the counties to working with state employees as these were added across the state. The state’s responsibility, however, was principally one of providing some financial assistance on a certain number of cases and providing the county some referral assistance in getting children into appropriate settings.

15. Fiscal Responsibility • In the early 1970’s foster parents receive $1 a  day to care for children as a partial reimbursement for the child’s care.  Most children were cared for by institutions which were not subject to licensing until the passage of the Texas Child Care Licensing Act of 1975. Initially about half of the children received  AFDC foster care, and the remainder received whatever the local board voted to pay or the county judge agreed to pay. The same was true for Medicaid. The county still had to pick up whatever costs the state did not cover with its entitlement programs.  In 1981 the state picked up responsibility for all children who were placed in the custody of TDHS.   The county was left with covering the balance, often only class rings, special medical bills, and some transportation.

16. Early Legal Issues Legal parameters • Common law • Early English Law • SPCA Legislation and its development

17. Current Legal Issues • Vernon’s annotated civil statutes 1937-1874 • Texas Family Code • Grounds for termination • Emergency removal power • Filing and trace case through court

18. Some Code Grounds • the failure or inability of the parent or guardian to adequately supervise or protect the child, or · the willful or negligent failure of the parent or guardian to adequately supervise or protect the child, or · the willful or negligent failure to provide the child with adequate food clothing, shelter, or medical treatment, or • the inability to provide regular care due to the parent’s or guardian’s mental illness, developmental disability, or substance abuse.

19. when a child is suffering, or is at substantial risk of suffering, serious emotional damage, evidenced by severe anxiety, depression, withdrawal, or untoward aggressive behavior toward self or others, as a result of the conduct of the parent or guardian, or who has no parent or guardian capable of providing appropriate care. • when a child has been sexually abused or is at substantial risk of being sexually abused by a parent, guardian, or member of the household, or the parent or guardian failed to adequately protect the child from sexual abuse when the parent knew of reasonably should have known the child was in danger of it. • when the child is under the age of five and has suffered severe physical abuse by a parent, or a person known to the parent if the parent knew or reasonably should have known the person was abusing the child. • when the child’s parent or guardian caused the death of another child through abuse or neglect. Cases in which a parent is believed to have caused the death of a child may not go to criminal court because it is too difficult to prove .

20. when a child has been left without any provision for support, or the parent has been incarcerated or institutionalized and cannot arrange for the care of the child, or the adult caregiver with whom the child has been left is unwilling or unable to provide care and support for the child and the child’s parents cannot be located, or the child, if 72 hours old or younger, was surrendered and not reclaimed within the 14-day period specified therein • when the child has been subjected to an act or acts of cruelty by the parent or guardian or a member of the household, or the parent or guardian has failed to adequately protect the child from cruelty when the parent or guardian knew or should have known the child was in danger of it. • when a child’s sibling has been abused/neglected as defined and there is a substantial risk that this child (subject of this petition) is likewise at risk.

21. Public Laws and Resources Public law 96-272 Social Security Act AFDC / TANF AFDC Foster Care Medicaid IV-B Funds In-home services Emergency Foster Care Counseling/Testing

22. In the 1970’s, a variety of federal government investigations and hearings were held regarding problems in our growing foster care system. Among these problems were: • · Children, rather than risks, were removed from abusive and neglectful families. • · The court often had little or no control of cases under its jurisdiction. • · Children sometimes “drifted” for years in foster care without being reunited with parents or being placed in a permanent home. • One result of the hearings held on foster care and dependency system was the adoption of several laws tied to federal funding. Some of these involved mandatory reporting, central record keeping, annual review of out of home care, and others related to insuring the protection of children. The most significant: • Adoption Assistance and Child Welfare Act of 1980, PL96-272, in which the states were directed to: • · Inventory all children in foster care. • · Develop an information and data system on children in care. • · Provide each child with a case plan. • Project a date of return for the child to the family, and • Provide for judicial or administrative review of cases.

23. The Juvenile Courts, according to PL 96-272, were to do case reviews, which included: · The necessity of removal and placement of abused children. · Compliance of CPS in offering services. · Compliance by parents toward reunification plans. · Procedural safeguards such as detention hearings and due process. · Control of visitation. · A limit of 18 months for reunification to occur.

24. In 1983, PL 96-272 was amended to include the following: · No federal dollars were to be awarded to states who did not make “reasonable efforts” to provide services to families in the dependency system. · The case plan must be related to the reasons for the child’s removal. · Placement was to be in the “least restricted” and “most family like” setting in the “closest proximity to the parent’s home.” · The court must make specific findings at hearings. As more and more children spent years in foster care, child welfare professionals and others became increasingly concerned that many of the parents would ultimately not be able to get their children back and that these children needed a permanent home in which they could form lasting emotional attachments.

25. In 1997 the federal Adoption and Safe Families Act (PL 105-89) concurrent services planning” for legal permanence for all dependent children in out-of-home placement where reunification services are being provided. “Concurrent planning” means that it is not only OK, but expected, that CPS both provide reunification services and search for a more permanent placement if reunification is ultimately not successful. Ultimately, changing and sometimes conflicting values related to the rights of parents, the rights of children to not be abused and/or neglected, and the rights of children to have a stable permanent home have been codified into a variety of laws, rules, regulations, policies and practices related to dependent children. These include: · Federal Statutes · State Statutes · Decisional Law · State and Local Rules · Regulations · Practices and Policies Ultimately these laws, regulations, policies, and practices have left child welfare services with a general philosophy and specific duties in serving abused and or neglected children. Key points in this general philosophy follow.

26. Philosophy of Child Welfare Services · Parents have a fundamental right to parent. · Children have a fundamental right to be safe and stable. · The child welfare services system should intervene in family’s life only when necessary. · Voluntary and/or preventative services should be provided whenever possible. · Intervention by the CWS system should be in the least intrusive manner possible. · Parents and extended family members should be involved in the dependency process. · The placement of children, if needed, should be in the least restrictive level of care necessary and most family like setting. · Social workers should provide reunification and permanency planning services concurrently. · Consistent with the law, time spent in care should be viewed through the eyes of a child. · Sibling relationships are important to children. They should be kept together or in contact with each other (even after adoption).

27. Social Worker’s Responsibilities At a minimum social workers are responsible for: · Initial investigations. · Risk and reunification prognosis assessments. · Sibling contact and visitation. · Case planning, including concurrent services planning. · Petition filing, report writing and testifying. · Provision of reunification and alternative permanency planning services. · Counseling, guiding, referring, helping. · Ongoing investigation and supervision. · Ongoing risk and reunification prognosis assessments. · Ongoing involvement in court processes. · Upholding Indian Child Welfare Act laws.  Not only are social workers in dependency cases expected to fulfill all of the above responsibilities, but they are expected to do so in an ethical manner. Ethical social work involves complying with the law, regulations, policies and good social work practices. One ethical issue for social workers is related to supervision and consultation. It is vital that workers have ongoing review and consultation on their cases with their supervisor. Also, social workers must be able to identify ethical issues as they arise in their cases and behave according to the NASW Code of Ethics.

28. Prevalence • Generally 1% of the child population is abused at anyone time. This has increased some but is still a good rule of thumb in looking at the needs of a community. Children under 2 are at the most risk of abuse/death. • About 66% of abuse is by mothers. About 66% of child deaths is at the hands of fathers. Sexual abuse is about 40% of all referrals and step-fathers represent over half of the perpetrators.

29. Sexual Abuse of Girls • Masters and Johnson’s study in the late 1970’s reported an incidence rate of 4 of 10 women being sexual abuse victims by the age of 18, 80% by close family members or people known to the family or the victim. Subsequent studies support this same finding.

30. Sexual Abuse of Boys • Later studies confirm this and add approximately 1 of three boys as victims of sexual abuse by the time they reach 18. Not as much is known about males due to problems with reporting and cultural bias against receiving information regarding the abuse of males. About 1 of 10 perpetrators of boys are female

31. Percentages • Today about 40% of all reports investigated are sexual in nature up from about 30% in the 70’s and 80’s.  30% physical abuse and 25% neglect with about 5 % emotional abuse. It is rare that there is not some overlapping in the type of reports.  Causes or predictors also overlap. • In Texas there are about 100,000 reports received each year with about 35 to 40% confirmed. This figure is similar to national statistics for incidence. There is a confirmation rate of about 10.7 per thousand children.  In 2000 there were over 15,000 children in the legal responsibility of the state with about 9000 in foster care.  This number has sharply increased.

32. Characteristics of the abusive family: • Young and of child bearing age between 22 and 34 • Mainly women (60%) • Severe Abusers are male (60%) • Isolated socially and literally • Poor impulse control • Financial Worries • History of child abuse in personal background • Inaccurate view of child • Child has some behavior or perceptual problems • Troubled marriage/either dysfunctional in roles or sexual incompatibility’ Poor or troubled work history • Associated with a sudden increase in stress or perceived stress • Poor role definition; who does what • Structure of home or lifestyle abnormal: too strict, too lax, lack of clarity in place in family for all members • Religious oriented but isolated • Fundamentalist in orientation-dogma • Inflexible in approach to life an to others, boundaries closed

33. Additional Readings Weeping in the Playtime of Others by Kenneth Wooten Before the Best Interest of the Child; Beyond the Best Interest of the Child; In the Best Interest of the Childby Solnit, Freud, and Goldstein

34. Children Removed from Parents Why remove children, what does it take, how bad is ‘enough’? Issues related to termination. Termination process Adoption process and length of time. Foster care program PRIDE Separation and placement trauma Guilt/helplessness/powerlessness Ideology of foster care Adoption/foster care Selection process

35. Ongoing services • In-home services Counseling, testing Joint plan of service development • Safety related issues, RISK Assessment Impulse control, finances, discipline, marriage, past history of child care and discipline, criminal behavior, perception of the child. • Training program: Hiring of staff, selection and posting process, requirements, BSW, MSW, internships

36. Physical Abuse • Bruises, burns, pinches, twisting, breaks, falls, pushes, hits, abdominal injuries, soft tissue damage, head injuries, shaking, coat hangers, brushes, cords, belts, walls, cigarette burns, torture Vs  off-hand injuries.

37. Sexual Abuse • Intercourse, fondling, exposure, inappropriate words or literature, pornography, molesting; • Immediate and long range impact. • Interview process, video taping/physical and sexual abuse, cover law • Sex offenses: Two types of typical sex abuses, fixated and regressed (Roland Summit and Nicholas Groth, Sexual Abuse of Children and Adolescents)

38. Neglect • Lack of supervision, food, failure to thrive, cleanliness, housing, overall care.

39. Emotional Abuse • Cruelty (overt or unintentional); torture, singling out one child for special treatment, using relationships with pets to control child, cursing, belittling.

40. Bite marks

41. Spiral fracture of femur on day of presentation to Emergency Department. Fracture occurred from twisting of child’s leg.

42. Toddler’s fracture of tibia.

43. AP chest radiograph demonstrates multiple fractures at varying stages of healing. • A new right humeral fracture and multiple bilateral healing rib fractures are present.

44. Old and new fractures indicative of child abuse. Newer ulnar and radial fractures proximally and older ulnar fracture distally with some callus formation

45. This child was beaten with a cue stick. Characteristic pattern: two parallel erythematous areas bordering a blanched area.

46. This 2-year-old boy’s parents noted “blood coming out of his ear, after he had fallen out of his high chair.” Abuse was suspected and reported. The child also had circumferential markings to his arm where he was restrained. • The child had a perforated right eardrum. Note the bruising to the right cheek.

47. The child had a perforated right eardrum. Note the bruising to the right cheek.

48. 23. A parent informs you that his/her 10 yr old child is terminally ill, but does not wish to tell the child of his condition. The child is wheel chair bound, but is not obviously ill. • The child also had circumferential markings to his arm where he was restrained.

49. 25. What if your boss ask you to lie or mislead other staff?