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It’s Everyone’s Mission

This is my work, my blessing, not my doom
Of all who live, I am the one by whom
This work can best be done in the right way.

Henry van Dyke, The Three Best Things

There are many reasons why professionals must become involved in the detection, treatment and prevention of child abuse and neglect, not the least of which is moral responsibility.

In 1993, the National Committee to Prevent Child Abuse conducted its annual survey of state child protective agencies. An estimated 2,989,000 children were reported to child protective agencies as victims of child abuse. Fifteen percent of these were sexually abused.

Recent figures indicate as many as 1.7 million reports of child abuse annually. The point of entry for assistance for many abused children is in the hospital. They may have been brought by ambulance, parent or a police officer after a battering, neglect of their medical needs or an allegation of sexual abuse.

Since the hospital is the most frequent place where child abuse is identified, personnel must be trained to recognize abuse and neglect. Children’s Hospital in Philadelphia was one of the first hospitals to develop a training program in 1970. The hospital and medical school provide training options in child abuse at several levels:

Level one – all medical students receive two hours of training in recognizing and identifying abuse and neglect.

Senior level medical students may take a one-month elective that provides in-depth information on child abuse and neglect and community responses to it. This elective is especially important for those intererested in family practice, community-based caseworkers, police laboratory, court medical examiner work and multidisciplinary teams.

There is a year of fellowship training after residency for those who have career interest in the field. This includes pediatricians, nurses and social workers. Core curriculum child abuse training is offered to every medical, nursing and social work student.

To identify abused and neglected children, each community hospital has basic protocols. Doctors may be called to testify in family and criminal court cases. The patient charts should not reflect any preconceived notions, just the facts. Failure of a doctor to report abuse or neglect carries sanctions and could possibly be cause for a malpractice suit. Professionals should be very careful about documentation. They should not only be concerned about the findings but also about the case disposition and treatment.

If a nonoffending parent requests the child’s record, hospital personnel should review it with the parent. Requests from the accused parent is usually refused.

Sometimes staff members of a hospital do not want to get involved and so fail to chart their suspicions of abuse. The one exception to this is with seriously injured children in the intensive care unit. The staff there work hard to make sure the family fully understands the child’s pain from the injury.

Role of the Social Worker
The social worker plays a major role in establishing rapport with the family. While maintaining an empathetic attitude, the social worker assesses the families’ dynamics and needs. It calls for subtle observation as well as skillful gathering and organizing of information necessary to base decisions on.

It is the task of the social worker to maintain contact with the multidisciplinary team necessary for the families’ needs.

The immediate and long-term needs for child care, medical attention, financial requirements, counseling and treatments are all coordinated by the social worker. She also has a leading part in the postdischarge treatment plan.

Other responsibilities of the social worker:

•  educate hospital staff about the role of the Child Protective Services agency
•  serve as the focal point for data collection
•  deal with security and custody issues
•  keep the family informed
•  work with risk management professionals 
•  deal with the media, if necessary

Role of Teachers
Teachers are in the company of a lot of children most of the time. They need to be trained to recognize the indicators for sexual and emotional abuse. They should be knowledgeable about reporting abuse, about the legal issues and be familiar with school board policies regarding abuse.

Every form of mistreatment can be found among school-aged children. Physical signs of abuse and neglect are visible by the child’s appearance. Behavior clues need to be observed. Does an older child show sexual aggression toward a younger one? Educators are in an excellent position to notice behavior clues.

John was born with numerous medical problems. He had a clubfoot, cleft palate and hearing problems. He was an extremely active child and other children stimulated him. He was very aggressive at school, and frequently the teacher observed many bruises on his body. An investigation showed that his grandfather who took care of him most of the time had died. His mother was stressed and overwrought about other problems in her life, and she vented her frustration upon John.

It was lucky for John that help was brought into the family situation. Children who are being abused like John may have a change in their behavior, become more aggressive and destructive or become withdrawn.

Sometimes a parent has higher expectations for the child than the child is able to achieve. This can enrage the parent. Lighted cigarettes, because of their availability in a person’s hands, are sometimes used to strike out at the child in a fit of rage.

Despite how much the child needs help, he may not admit to being abused. In some homes, physical punishment escalates into abuse as the child grows.

While physical abuse is episodic, neglect is a chronic state. It involves inattention to the basic needs of a child such as food, clothing, shelter, medical care and supervision. A family who is neglectful will demonstrate multiple problems. On the other hand, a family with multiple problems are not always neglectful.

Rose was a thirty-two year-old whose second husband had just left her. She loved her children, but she had no energy or knowledge of how to deal with them. She was unemployed and on welfare. The irony of this was that her mother was charged with neglect when Rose was a child.

Neglect begets neglect. Neglectful parents have been reared without sufficient knowledge, judgment and the motivation to learn the skills of raising a child.

A child’s performance in school can be a clue to child abuse and neglect. If there is a change in the student’s work or a lack of attention in class, it may be a behavior clue that abuse is taking place.

A child who is physically handicapped or mentally impaired is at greater risk for child abuse and neglect than a normal child.

Role of Day-Care Professionals
As the number of children in day-care facilities increases, it is important to choose a center that is licensed by the state.

Licensed day-care providers are professionals who receive specific training in areas such as first aid, nutrition and child development. Professional associations sponsor various educational seminars to better prepare the staff to provide superior care for the child.

A licensed day care provider is required to:

•  complete twelve hours of pediatric cardiopulmonary resuscitation and pediatric first aid.
•  three hours of infectious disease control.
•  be trained in child injury prevention and emergency preparedness.
•  have general liability insurance.
•  have verification that each child in their care has proof of current immunizations.
•  provide evidence of on-site inspections of smoke alarms, fire extinguishers and fire-evacuation plans.

To obtain a license, the day-care center owner has to attend an orientation class, and submit to a fingerprint and criminal background check along with all adults in the home where care will take place. All adults must also have proof of tuberculosis tests.

The home is inspected for potential safety and health problems. Parents should insist on placing the care of their child in a licensed day-care center. Be aware that there are unlicensed ones in the area.

Teachers, day-care personnel, mental health professionals and medical professionals are all valuable resources in the prevention of child abuse and neglect. These professionals, because of prevention training programs, have increased their knowledge, skills and attitudes toward victims and their families. Other professionals, such as police officers and clergyman, benefit greatly from these preventive training programs.

No single profession can handle the huge problem of child abuse and neglect. It has to be a united effort. Targeting these individuals who have an ongoing contact with children is advantageous because with knowledge of prevention, they can identify problems and react appropriately.

Role of the General Public
Ultimately, child abuse and neglect is every citizen’s responsibility. Denial, dislike, anger, guilt and nervous fascination are frequently social responses to knowledge of child abuse and neglect.

Some people even blame the victim for the abuse and deny the seriousness of the charges. “That’s their problem, it’s not my kid” is the response. Ignore it and it will go away. Public awareness and education is the way to combat this horror.

Television is a powerful means of educating the public. One of the first television programs to deal with the issue of incest was “Something About Amelia.”

Recently there was a thought-provoking fictional movie on television titled, “While Justice Sleeps.” It was the story of a woman recently widowed who discovers that her eight year-old daughter has been assaulted by a trusted family friend. The story deals with the denial of the people in the town, even in the face of proof that he has abused many children. It portrays the fear of a child and a family to accuse the person of this deed. It almost drives the child to suicide rather than to testify in court. It becomes a double tragedy when the mother becomes so overwrought that she kills the perpetrator in the courthouse. 

The story shows how the passions of people can destroy their lives. The mother was so devastated over the death of her husband that she neglected the feelings of her daughter. That gave the male friend the opportunity to take advantage of the child. He showered her with the attention that she craved.

The media is an effective educator. This movie was nonfiction but it dealt effectively with the tragedy of child abuse and how it devastates the lives of many people. There was a true story of a mother who killed the molestor of her son in a courthouse a couple of years ago. Although most people sympathized with her anger, she was sentenced to prison for taking a life.
There have been recent prosecutions of some educators for failing to report obvious cases of child abuse.

Most of the time, the family warns the child about strangers, but neglects to look closer to home. The general public needs to be educated about the high risk factors and explore what can be done to protect their children.

A disturbing factor in America is the increase in adolescent pregnancies. This has resulted in a large population of very young mothers who are not prepared for the demands of parenting. For a parent whose own needs are not met, the home is a dangerous place for the child.

Parenting skills training is becoming a mandatory program in many of our high schools. Child development classes should also be taught. Some cases of abuse and neglect occur because the parents have a lack of knowledge of a child’s developmental needs. The students who are trained to understand what children do at specific ages are better able to cope with parenthood.

It is a traumatic experience for a family to be reported. I heard of three cases, where abuse was not the problem.

One small boy had a mosquito bite on his face and it got infected. He was running in the house and hit his eye on the edge of a desk. The eye injury needed to be stitched. They took him to the emergency unit and were soon confronted by the police about possible abuse. The infected mosquito bite on the face looked like a burn from a cigarette. It was finally explained, neither parent smoked, and the face was examined closer. This happened many years ago, but it is still a vivid experience in the parents memory.

The general public needs to press for more preventive training programs. It will take the efforts of all concerned people to stamp out child abuse and neglect.

There is a moral responsibility to become involved in the detection, treatment and prevention of child abuse and neglect.

As many as 1.7 million children are abused annually.

Child abuse and neglect is everyone’s concern.

Professionals need training and knowledge in how to recognize child abuse and neglect.

The social worker plays a major role in establishing rapport with the family in distress. She gathers and organize information about the family to determine the best source of treatment to help them.

Teachers are major observers of a great deal of school-aged children. They are frequently the first ones to report child abuse and neglect.

When looking for a day-care center for a child, a person should only seek a licensed one. Caretakers these are trained in nutrition, child development, first aid and CPR.

It is a very serious matter for a family to be reported to the Child Protective Services. All the facts should be obtained in a responsible fashion.