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:

• Increased prevalence of drug or alcohol dependence
• Increased rate of status offenses - running away, truancy
• Delinquent behavior and adult criminal behavior
• Recurring health problems - physical and mental
• 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.

 

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.

 

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.

• 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.


• 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.

 

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.

 

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.
  
  
• 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.

 

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.

 

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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