Transcript The Right Thing To Do

Child Abuse and Neglect
R. Bruce McNellie
Ph.D.,LCSW,LPC,LMFT,DCSW
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.
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.
Principal Characters
• Henry Bergh
• Elbridge T. Gerry
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.
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."
Mary Ellen
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).
• 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.
Mary Ellen
"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
chapter
of 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
• 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."
•
•
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.
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.
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.
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.
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.
Early Legal Issues
Legal parameters
• Common law
• Early English Law
• SPCA Legislation and its development
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
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.
• 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 .
• 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.
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
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.
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.
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.
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.
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).
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.
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 stepfathers represent over half of the perpetrators.
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.
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
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.
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
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 Child
by Solnit, Freud, and Goldstein
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
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
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.
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)
Neglect
• Lack of supervision, food, failure to thrive,
cleanliness, housing, overall care.
Emotional Abuse
• Cruelty (overt or unintentional); torture, singling
out one child for special treatment, using
relationships with pets to control child, cursing,
belittling.
Bite marks
Spiral fracture of femur on day of presentation to Emergency Department. Fracture
occurred from twisting of child’s leg.
Toddler’s fracture
of tibia.
•AP chest radiograph demonstrates
multiple fractures at varying stages
of healing.
•A new right humeral fracture and
multiple bilateral healing rib
fractures are present.
Old and new fractures
indicative of child abuse.
Newer ulnar and radial
fractures proximally and
older ulnar fracture
distally with some callus
formation
This child was beaten with a cue stick. Characteristic pattern: two parallel erythematous areas bordering a blanched area.
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.
•The child had a perforated right eardrum.
Note the bruising to the right cheek.
•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.
• 25. What if your boss ask you to lie or
mislead other staff?
• Wrist Restraint Marks
Evidence of a recent beating
of a 6-year-old boy with a
belt (linear marks) and fist
(round marks).
Shown here is the boy’s
back.
Mongoloid
spots
•Old injury to ear, caused by
a blow to the side of the face.
When the injury heals
without medical intervention,
it leaves a distortion of the
ear cartilage often called
“cauliflower” ear.
Broom
injury
•A 10-month-old boy who was taken to the emergency room by his parents because he was
irritable. They noted bruising of his abdomen and chest and abrasions to the side of his
face. He had been left in the care of an adolescent male. The injuries to his face were
done by a pick comb. Liver enzyme levels were elevated as a result of blunt trauma to the
abdomen.
Pinch
marks
•
Hairbrush
•
Cupping
•Linear bruises that result from a folk medicine practice referred
to as coining in which a coin is repeatedly rubbed against the
child’s skin causing a friction-type bruise. May be mistaken for
a linear burn
• Linear bruising from being beaten with a “switch” for disrespectful
behavior to parent. Some of the marks are raised bruise-like marks and
others have broken the skin. Beating occurred approximately 1 day
before this picture was taken.
• Horizontal linear bruise on posterior aspect of thighs after
being struck with a stick for misbehavior.
Child with massive bruising to right side of head. Blow was above ear.
Belt buckle clearly visible along with strap marks.
Mongoloid spots. Not abuse. Genetic and associated with Asian and Hispanic
races.
Hand print on left cheek.
Belt marks. Note linear nature of bruising.
Light bruising on healthy child.
Missing hair on top and back center right.
Cigarette burn leaves a clean well delineated mark, usually with minimal
infection.
Healing cigarette burns.
Clear clothes hanger mark.
Intentional burn with iron on neck and hairline.
Intentional iron burn.
Intentional iron burn.
Blow to head causes pooling of blood below eyes.
Possible impact mark. Note bruising causes by pooling.
Finger marks from slap on left cheek.
Not ‘Martha Stewart’.
Disorganized parents have difficulty in providing ordered lives for children.
Kitchen and bath are usually the most critical indicators of safety.
Presence of insects, rodents, and rotten food place children at risk.
This 5-year-old girl was beaten
by her father with a variety of
instruments, including a cord, a
belt, a paddle, a fan belt, and
tree branches (below). The
child was dead on arrival at the
hospital. Injuries (left) included
multiple abrasions and
contusions of head, face, neck,
chest, abdomen, back, and
extremities.
Healing circular
lesion of impetigo.
Could be confused
with a healing
cigarette burn, but
history of skin
infection that
responded to
antibiotics was
provided by
caregivers
These drawings were made by a 5-year-old girl who was sexually abused by her
grandfather. She was told to draw a picture of herself and her grandfather (Figure 22-5a).
She told the interviewer that her grandfather had one leg. Then she stated that she had
been abused on the couch. The interviewer drew a couch and asked the girl to show her
what happened (Figure 22-5b). When asked what the object on the floor was, she
responded that it was “grandpa’s leg.”
Indications of abuse. Partial figures rather than whole.
Phallic depiction of house.
Here the client is showing himself as the dog between a man with a
blue shirt and a huge pair of red pants and hands; there is a spider
coming up from the ground that is also threatening him.
After continued and repeated physical and sexual abuse, the client became aware of the
presence of an angel who would watch over her. This painting reflects the client’s sense of
the angel weeping about what this woman was experiencing as a child. It was done 4 years
before the client had any conscious memories of having been sexually assaulted.