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A
State Call To Action: Working to End Child Abuse and Neglect
in Massachusetts
Executive Summary
Section
I. ~ Incidence and Impact
Over
the ten-year period from 1987 to 1997, Massachusetts
saw a 98 percent increase in the number of children reported
for abuse or neglect - this in contrast to an increase of
54 percent nationally during the same period. Based
on Massachusetts' child population of 1.5 million in 1997
and the 100,000 children reported that year, we see that
roughly 46 of every 1,000 children was involved in a
child abuse report. Statistics released to MCC for 1999
confirm a persistent and ever worsening problem of child
abuse, even while the state's violent crime rate decreased
21 percent from 1993 to 1998.
In
Massachusetts, substantiated child neglect comprises the
largest number of cases at 68 percent. Physical abuse cases
make up 24 percent; while sexual abuse comprises 6 percent
and emotional maltreatment includes 2 percent of cases.
The
impact of abuse and neglect on children is enormous. Brain
research confirms that connections in the brain used repeatedly
during the early years of a child's life become the life-long
foundation of the brain's organization and function. By
three years old, a child's brain has reached approximately
90 percent of its full potential. To reach this optimal
stage, the brain requires good health and nutrition, as
well as a great deal of stimulation.
Early
abuse is extremely damaging to a child's developing brain.
Failure to properly nourish a child, inflicting physical
pain and injury, or simply ignoring the emotional needs
of a small child can cause trauma. Such traumatized children
often experience developmental delays across a broad spectrum,
including cognitive, language, motor, and socialization
skills.
Problems
that abused and neglected children face as they grow into
adulthood can include:
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Increased prevalence of drug or alcohol dependence
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Increased rate of status offenses - running away, truancy
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Delinquent behavior and adult criminal behavior
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Recurring health problems - physical and mental
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Growing up to repeat abusive and neglectful parenting
behaviors
Maltreated
children have greater behavioral problems and perform significantly
worse in school. Many show signs of language or cognitive
disability, exhibit learning disorders and require special
education services at some time.
Most
tragically, if the cycle of violence is not interrupted,
child abuse can be perpetuated for generations. Parents
that abuse their own children, and the perpetrators of other
forms of domestic violence, are frequently survivors of
maltreatment in their own childhoods.
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Section
II. ~ Key Causes and Links
Domestic
Violence and Child Abuse
Estimates
are that between 3.1 and 10 million children witness
acts of domestic violence each year. Research also indicates
that 30 to 60 percent of children from homes where domestic
violence is present are also victims of abuse themselves.
The
co-occurrence of domestic violence and child abuse can compound
even further the negative effects children are likely to
experience over their lifetime. Health risks for children
of parents engaged in domestic violence can begin even before
birth. Estimates are that as many as 20 percent of pregnant
women experience personal violence. The direct trauma or
stress of abuse during pregnancy can lead to low birth weight,
premature birth, and fetal distress, injury and death.
Researchers
now know that children who see or hear a parent being battered
can experience the same level of trauma as children who
themselves are beaten. In one study, 93 percent of the children
witnessing domestic violence were diagnosed with Posttraumatic
Stress Disorder (PTSD). Long-term consequences for these
exposed children can include higher rates for mental illness,
drug abuse, and criminal justice involvement as an adult.
Children exposed to domestic violence are also at greater
risk for sexual abuse outside the home. Domestic violence
constitutes the single, major precursor for child maltreatment
fatalities.
Recommendations
The State Call to Action calls for increasing the number
of Domestic Violence Specialists at DSS, expanding specialized
treatment for child victims of domestic violence, and expanding
domestic violence training for child welfare providers,
school personnel, providers of medical care for women and
children, and juvenile, family and criminal court personnel.
The Massachusetts Department of Social Services can take
pride in its leadership in coordinating training and practice
to respond to cases involving child abuse and domestic violence.
It must now work to ensure that these efforts are fully
integrated locally across the state.
Substance
Abuse and Child Abuse
The
number of Americans who during their lives have been neglected
and/or physically and sexually assaulted by substance-abusing
parents is a significant portion of our population. Many
experts believe that substance abuse and addiction are
the primary causes of the dramatic rise in child abuse and
neglect and the startling increase in the complexity of
cases since the mid-1980s. Children whose parents
abuse drugs and alcohol are almost three times likelier
to be abused and more than four times likelier to be neglected
than children of parents who are not substance abusers.
Substance abuse causes or contributes to from 50 to 75 percent
of all child maltreatment cases reported to state authorities.
Children of substance-abusing parents are likelier to enter
foster care and stay longer in care than other children.
Child
neglect is a frequent problem among parents involved in
these addictions. The use of precious resources to pay for
drugs or alcohol often results in lack of food, heat, or
adequate clothing for these children. Lack of supervision
from addicted parents who spend extended hours or days outside
the household, can have damaging psychological consequences
for children and can place them in dangerous physical jeopardy,
as well.
Sexual
abuse among these children is not uncommon since they are
often exposed to non-related addicted adults. Even when
substance-abusing parents are in the home, their condition
may not allow for any meaningful protection. Because alcohol
leads to a lowering of inhibitions in many people, children
of alcoholics face a higher risk of sexual abuse by their
own parents. It is estimated that between 30 to 40 percent
of all reported incest cases involve an alcoholic parent.
Sadly,
many children are the victims of alcohol and drug abuse
while they are still in the womb with 500,000 babies born
each year having been exposed to illicit drugs and alcohol
during pregnancy.
Children
of substance-abusing parents are at high risk of developing
their own substance abuse problems later on. For children
growing up in these homes who are entering adolescence or
adulthood, alcohol or drugs can be a way to cope with depression,
low self-esteem and other psychological effects of their
victimization. Their early use of substances may lead to
aggressive, delinquent or anti-social behaviors that themselves
create risks for substance abuse.
In Massachusetts
over $300 million dollars were spent on child welfare services
in 1998. Nearly 76 percent of those dollars were spent
on services provided to children because of conditions "caused
or exacerbated by alcohol or drug abuse."
Recommendations
The State Call to Action proposes the development
of a comprehensive State Plan for Massachusetts aimed at
preventing alcohol and substance abuse and treating affected
parents and children. Convened by an appropriate state agency
or the legislature, and coordinated with efforts to prevent
and treat child abuse, the plan would identify strategies
to prevent the abuse of substances within the adolescent
and young adult population; ensure comprehensive treatment
of affected parents and children; and establish training
programs for workers in the social services, health care
and judicial systems.
The
high number of child abuse cases in which alcohol or substance
abuse is a major cause or contributor makes it imperative
that DSS now develop expertise to improve outcomes for children
and families affected by these addictions. Using the same
successful strategies that have made it a national leader
in the area of domestic violence, DSS should establish a
unit of Substance Abuse Specialists to provide consultation
to each local DSS Area Office and training to frontline
workers.
Homelessness
and Child Abuse
In Massachusetts
the number of homeless families increased by over 100
percent, to 10,000 families, from 1990 to 1997. With
an estimated two children per family, this means that an
estimated 20,000 children are homeless in our state.
Currently, Massachusetts ranks 24th highest in the number
of children living at risk of homelessness.
According
to the Worcester Family Research Project and The Better
Homes Fund, homeless children are hungry more than twice
as often as other children while two-thirds report they
worry they won't have enough to eat. Homeless children are
in fair or poor health twice as often as other children.
Homeless newborns have higher rates of low birth weight
and need special care after birth four times as often
as other children.
Poverty,
the rising cost of living, and lack of affordable housing
are factors that push many families into homelessness. For
others, however, histories of victimization and violence
have played a role in making them and their children vulnerable
to losing their homes. The intergenerational links among
violence, child abuse, and homelessness are startling.
When
violence from their childhood is combined with their experiences
as adults, an incredible 92 percent of homeless mothers
have been severely physically or sexually assaulted while
88 percent have been violently abused by a family member
or intimate partner. Nearly 25 percent of homeless children
have witnessed these acts of violence within their families.
Homeless
babies suffer from a significant slowing of their physical,
cognitive and emotional development from the accumulated
impact of severe environmental stresses under which they
live. Older homeless children struggle with very high
rates of mental health problems. Nearly one-third have
at least one major mental disorder that interferes with
their daily activities; nearly half have problems such as
anxiety, depression or withdrawal; and over one-third manifest
delinquent or aggressive behavior.
Sadly,
at least one-fifth of homeless children do not attend
school. For those who manage to attend, their physical
and emotional status can make academic success difficult.
Fourteen (14) percent of homeless children are diagnosed
with learning disabilities, including dyslexia or speech
and language problems. The Better Homes Fund reports that
36 percent of homeless children have repeated a grade while
14 percent were suspended from school. These effects of
their academic and emotional problems occur at double the
rate of other children.
Recommendations
The State Call To Action proposes funding for shelters
to hire trauma specialists who can identify women and children
with histories of violence, provide a range of support and
psycho-educational groups and when, necessary, family therapy
and counseling for children. Programs serving homeless children
should include training to sensitize workers to the issues
of domestic violence, child abuse and trauma. Hiring experienced
case managers is also critical for shelters so that comprehensive,
integrated services can be coordinated across state and
private agencies.
A range
of family support services must be made available to homeless
families including, newborn home visiting, parent aide services,
and local family resource centers that can offer parents
support and education. Creative solutions must be found
to address the transportation needs of homeless families
so that the health and educational status of their children
are not further compromised.
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Section
III. ~ Protecting Our Children
To address
systemic issues within the state's child protection network,
the Call To Action proposes numerous recommendations.
Key proposals include:
- A
multi-track system to respond differentially to cases
of child abuse and neglect depending on their degree of
seriousness and risk to the child. Low risk DSS cases,
cases "screened out" before or after investigation, and
voluntary referrals from the community would be addressed
through local Family Support collaboratives. This would
allow the state's child protection agency to focus its
resources more effectively on moderate to severe child
abuse cases.
- Quality
child and family assessments through a coordinated
system of multidisciplinary teams with clearly delineated
roles and functions to address the range of moderate to
severe child abuse and neglect cases. Moderately serious
cases would be assessed by Multidisciplinary Assessment
Teams (MDATs) operating within the Department of Social
Services. Severe cases and those requiring court involvement
would be referred to a statewide network of Children's
Advocacy Centers.
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Legislation to support a statewide system of hospital-based
Child Protection Teams (CPT) within medical teaching
institutions located regionally across the state. Each
CPT would be trained to medically evaluate and treat children
who have been abused and their families. Consultation
available on a 24-hour basis to other hospitals in the
region and to other rural medical sites would also be
included.
A diagram
of the Proposed Multi-Track & Assessment Model can be found
in Chapter 7.
- A
statewide medical training program to recruit, train
and support pediatricians, nurses and other relevant medical
providers to become child abuse and neglect specialists.
A recent MCC survey confirmed the critical shortage of
such medical experts. Despite Massachusetts' standing
as one of the country's major hospital centers, fewer
than ten recognized pediatric experts in child abuse could
be identified across the state.
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A plan to address workforce and case workload issues
within the state child protection agency. This would include:
increasing the salaries of DSS workers to reflect the
responsibility and risks of the job; establishing legislation
to adopt the Child Welfare League of America caseload
standard; tapping into federal Title IV-E/B funding to
develop graduate-level training for DSS staff; establishing
staff reimbursements to support advanced training; creating
a partnership between DSS and the Schools of Social Work
to expand the pool of MSWs and BSWs for Child Protective
Services; and developing the current DSS training program
into a full-fledged Child Protective Services Institute.
- Improvements
in the state's foster care system, including: reducing
multiple placements of children in foster homes and residential
settings; adequately funding and supporting relatives
in caring for kin children; and expanding the availability
of foster homes, particularly specialized homes able to
meet the needs of traumatized children. Other recommendations
include: identifying young adolescents likely to "age
out" of foster care without adoption and providing them
with early, permanent, and stable placements; ensuring
the successful transition to independence for older adolescents
"aging out" of foster care; and ensuring educational continuity
for foster children.
- Improvements
in the state's adoption system, including: involving
children actively in the adoption process; implementing
flexible and open adoption practices; researching alternative
permanent placement options concurrent with other efforts
to maintain children in their homes so that timely permanency
and stability can be assured; considering kinship adoptions
whenever appropriate; utilizing multidisciplinary teams
as consultants when considering the termination of parental
rights, during the adoption process and post-adoption
period; expanding Massachusetts' successful permanency
mediation program; mandating training for a broad range
of professionals involved in termination and adoption
proceedings; and providing needed post-adoption supports
and treatment for traumatized children.
- Building
accountability in the child protection system by expanding
the role of the DSS Professional Advisory Committee (PAC)
to include: the review of randomly selected cases and
a public annual report to the Commissioner with recommendations
for related policy and practice improvements; neutrality
and independence of the PAC through the election of a
non-DSS Chair and the convening of meetings within the
community; the contracting with quality assurance professionals
to apply professional methods of data gathering, to examine
aggregated data, and conduct quality assurance. In regards
to federally mandated Citizen Review Panels, the Call
To Action proposes that annual reports of the panels'
work and recommendations be published and made available
to the legislature and the public. Further, it calls for
oversight by the Executive Office of Health and Human
Services to avoid redundancies, address gaps, and ensure
uniform protocols for efficiency and quality assurance
among the PAC, the recently established Citizen Review
Boards, and the legislatively mandated Child Death Review
Teams.
- Improvements
in court responses to abused and neglected children,
including: developing protocols for information sharing
among the several Courts involved with children's cases;
ensuring reporting of child abuse by the Courts; making
available multidisciplinary child protection team consultations
to the Court; providing court-friendly practices for child
victim witnesses; mandating judicial training in child
protection; creating accountability within the state's
Guardian Ad Litem (GAL) program; and providing legislative
review of the Supreme Judicial Court's ruling in the cases
of Jeremy and Issac.
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Section
IV. ~ Healing Our Children
To succeed
in ending child maltreatment, child protective services,
the legislature and the public-at-large must ensure that
abused, neglected and traumatized children receive the appropriate
treatment and supports they need to heal. Recommendations
proposed by the State Call To Action include:
- Treatment
services for abused/neglected and traumatized children
that are responsive to their special needs for quality
and flexibility. Specifics include: establishing an unprecedented
state-level commitment that entitles every child victim
of abuse, neglect or trauma in Massachusetts the full
complement of therapeutic and other services needed to
recover as fully as possible from the effects of their
maltreatment; establishing a separate category for trauma-recovering
children outside the current managed care capitation system
so that limitations in the type, duration and frequency
of clinical services can be waived for this special population.
Other
related treatment proposals call for: expanding the range
of interventions for these children and providing adequate
reimbursement for related evaluations and case coordination
activities; piloting effective treatment and interventions
based on new research findings on brain development and
childhood trauma; establishing a Board of Education-sponsored
scholarship and payback program for graduates in social
service and mental health to address staff shortages in
these fields; and the pooling of "blended" funding among
state agencies to optimize services for children and to
encourage inter-Departmental coordination and collaboration.
- Schools
as safe havens and healing places for abused, neglected
and traumatized children. Proposals include: training
educators to identify the symptoms of traumatized children
as a crucial starting point in developing a comprehensive
school-wide approach to helping these children learn;
creating clinical support systems for teachers to help
them develop classroom strategies for addressing the needs
of traumatized children; reevaluating school policies
on confidentiality, curricula, and discipline in light
of the needs of traumatized children; adapting the school
curriculum to include interactive teaching styles and
non-academic approaches that can foster development of
self-confidence and mastery in traumatized children; and
the development of protocols for early identification
and services before children are at risk for discipline
or school failure.
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Section
V. ~ Preventing The Hurt
The
State Call To Action proposes the building of a strong
infrastructure of family supports across the state that
would work to address family needs early on so that state
intervention would be avoided or reduced. It calls for:
- Expansion
of the DSS-administered "Community Connections" family
support collaboratives statewide and building its
capacity to serve a broad range of voluntary referrals.
Federal dollars have been the only source of support for
these programs since 1993 and are only secure until 2002.
Massachusetts must work now to ensure a smooth transition
to state funding and expansion of this vital family support
structure across the state.
- Establishment
of local Family Support Teams to address low-risk
child abuse cases within DSS, cases screened out by DSS
before or after investigations, and voluntary referrals
from the community. These Teams of local professionals
and family advocates would coordinate family conferencing
as a tool to assist families in assessing their own needs
and the best ways to address them.
- Collaboration
among state and private family support and service providers,
coordinated through a specific state mandate backed with
sufficient resources and quality assurance. One proposal
put forth to accomplish this has been the creation of
a Governor's Cabinet on Families and Children. The Cabinet
would coordinate planning and services of the various
state agencies involved with children and families, coordinate
state efforts at the local level, and address identified
gaps in service coverage. The Cabinet would endorse and
actively promote the principles of family support, and
would coordinate training in family support practices
among state and private service providers.
- Funding
for universal, newborn home visiting for all new parents
seeking this support. Massachusetts can be proud of its
success in making available newborn home visitation support
to all parents 20 and under. The state must now move to
benchmark when and how it will phase in universal home
visitation for all new parents, irrespective of parental
age.
- Expansion
of family support services that have documented their
effectiveness in preventing child abuse and neglect and
in reducing the stresses associated with child maltreatment.
Programs, including the self-help Parents Helping Parents,
the Family Nurturing Program, and parent aides must be
expanded where they currently exist and their availability
extended statewide.
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Expansion of Shaken Baby Syndrome (SBS) prevention efforts.
Massachusetts should replicate efforts that have succeeded
in reducing SBS-related infant death and disability. Initiatives
aimed at educating new parents within birthing hospitals,
and special outreach to young men - the most frequent
perpetrators of SBS - should be implemented. All state
agencies involved with parents and children should incorporate
SBS prevention education into their training and direct
service programs.
- Development
of a comprehensive, coordinated, statewide strategy to
effectively reduce sexual assaults against children
and to address the critical lack of effective evaluation
and treatment resources for both child victims and for
child, youth, and adult offenders. Public education efforts
involving the media should be an integral part of the
strategy. Such coordinated efforts in Vermont have reduced
confirmed cases by over 50 percent over a decade. Massachusetts
should set a similar goal and work to achieve it.
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Section
VI. ~ Taking Action
Research
suggests that without intervention and supports many abused
and neglected children can become society's most disabled,
dysfunctional and dependent individuals. Increasingly, child
maltreatment appears to be the common denominator underlying
our most serious social problems - from delinquency
and runaway behavior in adolescents to the violence and
sexual crimes of adults. For example, over 50 percent
of juvenile offenders served by the Department of Youth
Services have previously been abused or neglected children
and under the care of DSS. A 1998 Boston University
study concludes that children who are abused and neglected
are 1.8 times more likely to be arrested as juveniles,
and 1.5 times more likely to be arrested as adults,
than children who have not been exposed to abuse or neglect.
The
human and social costs of abuse translate into enormous
fiscal costs for society. Estimated expenses for dealing
with the aftermath of violence against children range from
a conservative $30 billion dollars annually, according to
researcher van der Kolk, to $56 billion dollars estimated
by the National Institute of Justice in 1996. After abuse
and neglect have occurred, we pay for emergency medical
care, investigation, foster placement of child victims,
emergency shelters, therapeutic, rehabilitative and special
education services, and emergency shelters. In the long
term, the costs of juvenile detention, adult institutionalization,
and incarceration are added to the bill.
The
high costs of adult medical care related to the long-term
consequences of child abuse and neglect can now also be
included. A new study conducted by the U.S. Centers for
Disease Control and Prevention and other leading research
groups confirms: the extent of exposure to physical,
emotional, sexual abuse, and household dysfunction in childhood
has a significant graded relationship to multiple risk factors
for the leading causes of deaths in adults - including,
ischemic heart disease, cancer, chronic lung disease and
liver disease.
In working
to reduce these staggering human and fiscal tolls, an unprecedented
commitment must be made to ensure effective treatment
services for abused/neglected children and their families
as soon as they are identified. It must be matched
with a parallel commitment to strengthen state systems
charged with the care and protection of these children and
to expand family support and prevention services significantly,
to keep families from failing and children from being damaged
in the first place.
These
efforts must not be viewed as separate and competing. They
are inextricably bound to each other and are fundamentally
tied to our success in ending the tragic abuse and neglect
of our children's minds, bodies and spirits.
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Next
Steps
With
publication of the State Call To Action, the Summit
Initiative moves to its next phase. During 2001 and beyond,
MCC and its Summit colleagues will work to engage an even
larger constituency to support implementation of the proposed
agenda. Targets of our dissemination, education, and mobilization
efforts will include: community leaders, legislators, government
officials, faith-based groups, business representatives,
and the public, including citizen members of MCC's Campaign
For Children, and adults who have been affected by abuse
and neglect.
In the
months ahead, MCC will convene new Summit Work Groups to
document the costs to implement proposed recommendations,
target appropriate revenue streams, and develop strategies
to create new sources of funding. We will work with legislative
leaders and our colleagues to draft child protection and
family support legislation. In collaboration with our prevention
partners, we will work to develop a statewide strategy to
reduce child sexual abuse and to ensure quality care for
its victims.
During
the period leading up to the 2002 Massachusetts State elections,
MCC will educate candidates about the Call To Action
and work to secure their endorsement of its recommendations.
Through candidate briefings, published results of candidate
questionnaires and public opinion polling, we will provide
citizens with information so they themselves can decide
when choosing their elected officials, "Who's for kids,
and who's just kidding?"
Working
in collaboration with our Summit partners, MCC will continue
providing leadership for the broad-based effort to end the
abuse and neglect of Massachusetts' children.
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