a special program of the National Emergency Medicine Association (NEMA)
Transcripts: 541-1 to 541-3
Week: 541.1 Guest: Carol Williams, Assoc. Commissioner, Children's Bureau, Dept. Of Health and Human Services Topic: National Study on Child Abuse, Part One of Three Producer/Host: Steve Girard
NEMA: Shameful and startling....those are the words Health and Human Services Secretary Donna Shalala used in announcing the results of a study on child abuse chronicling the seven year span between 1986 and 1993. In our next three programs, we will focus on these findings, talk about some of the potential resaons behind them, and examine some of the steps that can be taken to help the burgeoning numbers of kids who are victims of abuse. We're with Carol Williams, Associate Commissioner of the Children's Bureau of the Health and Human Services Department. Carol, give us a view of how the study was done, and the results that came back....
WILLIAMS: The National Incidence Study is an effort to get a picture of the true incidence of child abuse and neglect in this country. The study not only examines children who are reported to child protective services, but also children that come to the attention of other professionals who may not be referred to child protective agencies, or who may be screened out from child protective service agencies. One of the issues is that, we believe and this study verifies, that not every child who experiences harm, or who is endangered, gets referred to protective services and gets assisted.
NEMA: What did this snapshot show?
WILLIAMS: Let me talk about the number of children that were endangered...this study indicates that between 1986 and 1993, the number of abused and neglected children and those endangered doubled. Physical abuse doubled, sexual abuse more than doubled, emotional abuse, physical neglect and emotional neglect were more than two and a half times their 1986 level. That's startling enough, but even more startling is that the total number of children seriously injured quadrupled during this time. So, what we're really seeing is a dramatic increase in the number of children experiencing maltreatment. I think the other remarkable finding is that child protective service agencies saw about 28 percent of children who were endangered using the more selective standard, the harm standard. In 1986, when we looked at this same question, 44 percent of the children were seen and investigated by child protective service agencies. So, what we've seen is an expansion of the number of children at risk, and a decrease in the proportion of children that come to the attention of protective services. And what I think is also very interesting is that though the percentage of children served has gone down, the actual number of children served by protective service agencies has stayed the same. So you have this picture of a dramatic growth in caseload, a shrinking proportion of that group of youngsters being seen.
NEMA: We have just scratched the surface in this series on child abuse running rampant....we'll talk again with Carol Williams of the Department of Health and Human Services about the circumstances surrounding abuse in our next program. I'm Steve Girard
Week: 541.2 Guest: Carol Williams, Assoc. Commissioner, Children's Bureau, Dept. Of Health and Human Services Topic: National Study on Child Abuse, Part Two of Three Producer/Host: Steve Girard
NEMA: The U.S. Department of Health and Human Services has just announced the results of a study on child abuse over a seven year span called the National Incidence Study...aimed at determining the actual number of abused and neglected children, not just the ones whose cases are investigated by child protective services..we're talking with Carol Williams, the Associate Commissioner of the Children's Bureau in the Department of Health and Human Services. Carol, you've told us that the incidence of all kinds of abuse against children went up at least double...physical, sexual, emotional...and physical and emotional neglect went up two and a half times....all between the years 1986 and 1993.....give me some of the tendencies of the circumstances surrounding the abuse....
WILLIAMS: We did look at some of the characteristics of children who were likely to be abused and neglected, and what we found were that girls were more likely to be sexually abused than boys, boys were more likely to experience emotional neglect and serious injury than girls were. When we looked at family characteristics, we found that single parent families were at greater risk. Children in large families were at risk of being neglected, and children coming from poor families were more likely to be neglected than children coming from middle class and higher income families.
NEMA: You've mentioned that while the incidence of abuse went from 1.4 million cases in 1986 to over 2.8 million in 1993, and the number of youngsters who were seriously hurt in these cases quadrupled, the number of cases investigated remained the same...don't we have the time, or the personnel to do something?
WILLIAMS: I think it's difficult for us to tell exactly what's happening from the nature of this study, because it doesn't pull out those things that contribute to it. Generally, in order for a child to be seen, someone has to make a report, it might be a teacher, it might be a health care official, it might be a neighbor. Once a report is made, then the child protective service agency takes the information and makes a determination about whether a child needs to be seen and how quickly a child needs to be seen and they follow through on the investigation. One of the things that may be contributing to this kind of flat level of investigations, even though the number of children have increased, and again, this is speculative, because the study doesn't even speak to it...is the fact that we know that the child welfare system's capacity may have been maxed out, and what happens in those circumstances, either formally or informally, the system will shift to taking the most severe cases when they're at maximum capacity. The other thing is that not all of these children were in fact reported to agencies. When we did this study, we cross-checked the cases to determine which ones were referred to protective services and which ones were not. And a substantial proportion of the cases were never referred.
NEMA: We'll take a look at some of the steps needed to stem the rise in child abuse in the United States...with Carol Williams, of the Department of Health and Human Services...in the last of our trio of pieces on this important issue. Hope you'll join us. I'm Steve Girard.
Week: 541.3 Guest: Carol Williams, Assoc. Commissioner, Children's Bureau, Dept. Of Health and Human Services Topic: National Study on Child Abuse, Part Three of Three Producer/Host: Steve Girard
NEMA: Child abuse incidence is up...staggeringly up. The National Incidence Study, which looked at abuse from 1987 to 1993, showed 2.8 million cases of abuse or neglect in 93...more than double the 1986 study...and all categories were at least double...physical, sexual, emotional...and neglect cases went up two and a half times. And startlingly, the study found the number of cases investigated in 93 by child protective service agencies were the same as 1986, despite the doubling of the cases. We're talking with the Associate Commissioner of the Children's Bureau in the Department of Health and Human Services, Carol Williams.....after looking at and interpreting the numbers in the study...what things can we do as government and community...or what things are already in the works to improve the system?
WILLIAMS: I think one of the criticisms of our system...well, two criticisms: one is that we haven't done enough to prevent abuse and neglect, and to work with families before circumstances get acute. And I think that is, in fact, true, because only in the child protection service system, are the most urgent cases being seen. So that one of the issues we need to deal with is the issue of prevention and early intervention. I think a second issue that the child welfare community and the protective service community is examining is, are there ways of working, by working with community based organizations, to get more good services at the community level without people really having to find themselves in dire circumstances to get help'?
NEMA: Those kinds of programs could only help prevent serious problems for these children down the line...whether it's the continuation of poverty or lack of education, or of neglect, violence or even crime...
WILLIAMS: Exactly, for example...a program of home visiting that focuses on child development and helping parents manage, and reducing their anxiety in helping them understand how children develop..and what they need. There have been some really excellent results in terms of those kind of programs when compared to no intervention. Really reducing the incidence of abuse and neglect.
NEMA: Is it just a matter of staff numbers...more workers needed to handle the increasing incidence of abuse?
WILLIAMS: I think it's not just agency personnel...it's very clear that we need a broad base of community partnership in order to assure the safety of kids. And I think that means the protective child service agency, but it also means schools, and faith communities, and physicians being involved in a kind of family education and development...not just catching parents when they're wrong, but supporting parents in their development and how they learn to handle their children.
NEMA: At the Heart of the Matter, we write about illnesses and conditions of the human body, and the valiant efforts to treat each other and rid ourselves of these maladies. I know child abuse doesn't fall into this category... but it is an illness of society that must be treated just as valiantly, because these are our children, and the future exists only with them. We can increase personnel, come up with new programs, but the answer to this, like many other societal problems, has to come from within. It used to be that the values that made us great came from our homes, our families, regardless of the economic situation we faced. That strength must return for us to stem the rising tide of abuse, which victimizes the most innocent of us...and puts our future at risk. I'm Steve Girard.