April/May 2000 - Volume 3 - Issue 3
When Edward Zigler, PhD, was head of the U.S. Health and Human Services' Children's Bureau in 1973, he argued that efforts to control child abuse and neglect were doomed to fail if they didn't focus on prevention.
Now, 26 years later, after seeing the number of reported child abuse cases jump from 750,000 to 3 million, Zigler wishes he'd been wrong.
While he and other experts continue to believe resources should focus on proactive, supportive prevention efforts--as opposed to reactive, punitive measures--the only such solutions at work so far are piecemeal research projects and scattered programs funded through state and private funds.
"We need to redirect resources to programs that provide support to families and educate parents because most abuse is caused by stress and lack of support," says Zigler, Sterling professor of psychology at Yale University's Child Study Center in the School of Medicine.
But with nearly $14 billion spent annually to deal with child abuse, less than 10 percent of that is spent on prevention, says Anne Cohn Donnelly, former executive director for the National Committee to Prevent Child Abuse in Chicago.
Efforts that focus solely on abuse and neglect that has already occurred will never result in any meaningful reduction in the number of child abuse cases, says Cohn Donnelly, now a professor in nonprofit management at Northwestern University.
Insurance won't cover it. Yet experts say it's difficult to build political support for funding prevention efforts, even though prevention is less expensive than treatment.
"We don't get insurance dollars to prevent things, we get money when there is a clear-cut problem," says David Wolfe, PhD, professor of psychology and psychiatry at the University of Western Ontario in London, Ontario.
On average, he says, it costs $33,000 to hospitalize an abused child compared with $3,000 to provide an at-risk family with a home visitor to teach them parenting skills for one year. However, one reason there is no comprehensive, federally funded program to prevent child abuse, some experts say, is that they don't know how to create a national program that would be effective in all situations.
"We know that providing a more supportive environment for newborns and their parents is effective but we are still figuring out how to do it," says Deborah Daro, a research fellow at the Chapin Hall Center for Children at the University of Chicago.
For now, the problem is loosely covered by programs such as the Healthy Families America initiative, sponsored by the private National Committee to Prevent Child Abuse, Ronald McDonald House Charities and the Freddie Mac Corporation--a shareholder-owned corporation that helps families obtain financing to buy or rent homes.
Forty states and the District of Columbia participate in this program. It provides training and other resources to encourage local departments of health, and education, hospitals, private corporations and private citizens, to work together to develop a system of intensive home visitation services and other supports for new parents, says Daro.
Individual states and other private foundations provide additional program funding. Most states, for instance, provide for a trained home visitor who works with the families facing the greatest challenges during pregnancy and the first two to three years of the child's life. Some also include support groups for parents. But each state's handling of the program is different, depending on local resources and political priorities. And while comprehensive programs that help families obtain housing support and adult education are the most effective, says Cohn Donnelly, not all Healthy Families sites can provide them.
Also, prevention programs like Healthy Families America reach only a fraction of the estimated 1 million families with young babies that are vulnerable to child abuse, says living near them. Then folks can identify where there is a need, he says, and provide the necessary support, such as helping with babysitting.
For example, Beaufort, S.C., has reorganized the child-care services provided through Medicaid to create the Well-Baby Plus program, which helps link parents of newborns to other parents as well as local resources and services.
Through it, says Melton, families of same-age infants periodically bring their children to the Child Development Center at Beaufort Elementary School for a 90-minute program that includes an infant check up, support groups for parents and help in obtaining additional health and social services.
While the pediatrician is examining the baby, the parents can meet with a counselor to discuss parenting skills or educational needs such as literacy programs. Families also are linked with home visitors who provide in-home reinforcement of the education and counseling given in the group visits.
"For child protection to work, it has to happen in everyday life," Melton says. Child protection is definitely part of everyday life in Aiken, S.C. There, the Moms and Cops program expands the role of the community police officer to include child protection and family support. It does this by training the officers to ask questions, spot moments when a child might be in danger and then provide help to the family. The officers ride around on bicycles and go to local churches and schools to become part of the community.
These officers focus on community services rather than traditional law enforcement, says Melton. "They are in the neighborhood and on the street," he says, "and everyone knows they are there to help."
David Nieves, an Aiken police officer, says if he sees a pregnant woman in the neighborhood, he'll ask her when she last saw a doctor. If she hasn't seen a doctor recently, he will refer her to the state health department for care. And, if she doesn't show up for her appointment, he'll encourage her to set up another one.
As part of the program, Nieves also gives away free cribs and other supplies to mothers of newborns. But, Nieves says, to receive the supplies the mother must provide her name and address, which he then passes on to a local program that teaches parenting skills.
"The community police officers make it their business to be helpful and when they see a need, they help engineer support," says Melton. "It's done in the context of their everyday job."
However, programs like Mom and Cops and Well-Baby Plus are the exception rather than the rule. Many prevention programs are simply pilot research projects and are not available throughout the country, says Maureen Black, PhD, immediate past president of the Society of Pediatric Psychology and a professor of pediatrics at the University of Maryland.
"They are wonderful first steps," she says, "but the next step is to figure out how to implement them beyond some federally funded research project."
To help pay for prevention efforts, APA's Public Policy Office is working with the National Child Abuse Coalition on a legislative initiative that would allow states, schools and local agencies to use federal monies to fund prevention programs.
The coalition has identified several federal education, juvenile crime and child-care programs that Congress is likely to approve this year and is working to have prevention efforts--including home visitors and other support programs could fund, says Daniel Dodgen, PhD.
"What we're talking about is a very gradual and incremental approach to prevention," says Dodgen, senior legislative and federal affairs officer in APA's Public Policy Office. "We're not saying every one of these programs must fund prevention, we're just trying to get child abuse prevention added to the allowable list of potential services they can offer."
Wolfe of Ontario agrees. "Changing the system will take political will and more voices, like psychologists, saying we tried to treat this and we had some success but prevention is a lot less expensive," he says.
Source: http://apa.org/monitor/apr99/abuse.html (Volume 30 , Number 4 April 1999)
April/ May 2000 - Volume 3 Issue 3 - Articles