No great discovery has to be made-no invention of some new device, no solving of an age-old mathematical riddle-to stop the killing, abuse and neglect of children. The answers are already known.
They reflect decades of research by social scientists, but they can be reduced to common sense.
Children would be saved if all new parents received the support and guidance of a healthy extended family. Instead, many single parents go it alone.
Children would be saved if families did not have to struggle with hunger, poor housing or drug addiction. Instead, many languish in hopelessness.
Children would be saved if neighborhoods were safe havens that encouraged family life. Instead, many are terrifying battlefields.
In short, healthy families living in healthy neighborhoods would raise healthy children.
So the question is not what would reduce child abuse. The question is whether the nation wants to take on the task.More to the point, would any large-scale government effort to prop up families do any good? Or would it disintegrate into another expensive failure, not unlike the nation’s welfare system, which also began with noble intentions?
These are the questions that frame the debate over curbing child abuse in this country.
If the nation shifts from damage control to prevention in its child welfare system, the expense will be steep.
No one has accurately calculated the cost, but the National Committee to Prevent Child Abuse, which runs one of the nation’s leading prevention programs, Healthy Families America, believes the cost could run into the billions.
In Illinois, where the Department of Children and Family Services spends about $1 billion annually, large-scale prevention programs certainly would cost millions-perhaps hundreds of millions. Voices for Illinois Children estimates that there are 10,000 new at-risk families each year in this state that need help.
At least early on, the costs would be on top of what DCFS already spends. It is an essential front-end investment, advocates say, to stem the flood of children into DCFS-and reduce costs in the long run.
At a time when the nation is struggling with how to pay for universal health care and other needs, the prospect of mounting another social welfare initiative is destined to meet resistance.
In part, this is because of uncertainty that prevention-probably in the form of home visiting and family resource centers-will deliver the hoped-for results.
But there also are philosophical roadblocks.
On one side, there are those who argue that child abuse prevention strategies don’t go far enough, that they just treat the symptoms. The real, long-term answer, they say, is to rebuild communities and create jobs.
Short of that, instead of spending millions on teaching parents to change diapers or keep house, the nation would better spend its money on birth control, adoption and abortion-measures that will keep children from being born into risky conditions in the first place.
On the other side, critics say such programs simply send one more message that people aren’t responsible for their own actions, that government will bail them out.
Supporters of family intervention, however, say that in the absence of dramatic progress on other social fronts, a multitude of children will be born into precarious households. They must be helped when they are first born, not first abused.
The mechanical aspects of transforming prevention efforts from models into a full-fledged child welfare system are less formidable than the economic and philosophical ones. A network of social service agencies already exists to administer them, some of which are engaged in home visiting programs targeting other ills such as drug abuse and teen pregnancy.
Officials anticipate that any nationwide program probably would be funded by state health departments and other sources, including the federal government, then contract with private non-profit agencies to deliver the services.
In discussing how the nation could revamp its approach to children’s issues, some experts suggest even more ambitious strategies:
They would redesign the entire child welfare system so that one bureaucracy doesn’t have the conflicting tasks of both supporting and punishing families. One idea is to delegate the investigation of abuse claims to police, freeing agencies such as DCFS to work on prevention and support programs.
The key is making the idea of prevention acceptable in America. In other societies, notably Western Europe, the notion of government as a benevolent force of social good has a long tradition. But Americans value their independence fiercely, especially on family matters, and have a general skepticism of government. And the deep poverty and racial divisions in America make government action vastly more complicated than in the relatively homogenous European societies.
Yet among a growing coalition of policymakers, interest in child abuse prevention even spans the chasm between liberal Democrats and conservative Republicans.
“You’ve got to provide hope for people who are apparently hopeless, and you have to provide incentives, and these programs can do a lot,” said Rep. Henry Hyde (R-Ill.), whose conservative politics would typecast him as against these kinds of sweeping government projects.
“It would seem to me to be very useful to have as many home visits as practicable, because there is nothing sadder or produces more anger than finding rooms full of children who are hungry or neglected,” Hyde said.
Still, even families receiving help can easily fall into the old destructive patterns.
That’s the nagging fear of people like Kathy Graver, who supervises a home visiting program in Davenport, Iowa, and knows the profound obstacles even the best social services theories face in trying to help families with deep-seated problems.
Recently, for instance, she said, a couple who had been showing real improvement in taking care of their toddler are falling back into dangerous old ways. The father is believed to be taking drugs again; and the mother is so apathetic she does not clean the apartment, even the excrement left by the family dog.
Another young mother, urged to get a high school equivalency degree, has passed the test and enrolled in a college nursing program. Yet she continues to submit to regular beatings by her boyfriend, and no one can persuade her to leave him.
As the undisputed leader in the field of home visits, and one of the few researchers to conduct long-term evaluations, David Olds, of the University of Colorado, might logically lead the fight to promote child abuse prevention.
But he’s not comfortable doing that. He is currently conducting long-range studies of home visits in Denver and Memphis that he hopes will provide the answers needed to justify major programs.
“I’m optimistic, but I also think that one needs to be very careful about assuming that simply because you have someone go into the home to try to help that it will make a difference,” he said.
Even so, Olds says the severity of the problem demands action now.
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In Washington last year, Congress passed major child abuse prevention legislation for the first time in 10 years, authorizing $1 billion over five years to encourage new approaches to prevention.
One major supporter is Atty. Gen. Janet Reno, who with other Justice Department officials, travels the country pitching what used to seem like a far-fetched idea for reducing crime: protecting children from abuse. Otherwise, studies show, they become much more likely to commit violent crime.
In Illinois, in this year’s court-ordered progress report on reform, DCFS devotes a chapter to child abuse prevention, a subject the report previously ignored.
In Chicago, this year and next, pilot home visiting projects are beginning in eight poor neighborhoods. And Illinois just passed legislation to plan for these programs statewide, though no money has been appropriated.
“I think the recognition has grown across America that you have to turn to intervention, because nothing else is really going to fix it,” said Olivia Golden, commissioner of the Administration on Children, Youth and Families in the Department of Health and Human Services.
Charles Murray, a research fellow at the American Enterprise Institute and author of the book, “Losing Ground,” has argued for 10 years that unless people are motivated to become productive adults and better parents, any blanket effort by government to prevent child abuse will fail. He believes many families living at risk of committing child abuse won’t be eager to seek help.
“If you go back and look at children who have died, you aren’t going to find very many parents who are motivated to do better,” he said. “A few will maintain lip service to it, but what you’ll find are a lot of women and boyfriends who have been responsible for one hell of a lot of this violence.
“They are on drugs. There is borderline retardation. These are people living lives of chaos. The track record of trying to intervene with those people is very bad.”
Murray, along with other figures in this debate, argues that the only true way to attack child abuse is by having children “born to two mature adults committed to being parents.
“Until we come to grips with the fact that we don’t know very much about how to intervene from the outside,” Murray said, “we are going to kid ourselves about solutions.”
The issue of how to assure that more children are born to married couples is another formidable issue. Murray takes the dramatic stance that the system has to stop subsidizing fractured families through welfare and other benefits, while “sending the strongest signal possible” that having children out of wedlock is wrong.
Harold Richman, director of the Chapin Hall Center for Children at the University of Chicago, believes that focusing merely on preventing problems shortchanges children’s welfare.
A caring mother, he argues, isn’t one whose sole boast is that she doesn’t beat her children. And a caring society isn’t one that settles for a goal that children aren’t abused.
“What we ought to be after here are individuals who are able to make a positive contribution to their own lives, their families and society,” he said. “That’s not preventing something. That’s promoting something. It’s saying that the test of how we intervene as a government has to be: Have we helped produce young people who are contributing members of society?”
In a 60-page report published by Chapin Hall this year, Richman and three colleagues say that all children and their parents need what is everyday fare in many middle-class neighborhoods: play groups, day care, sports teams, art and music, parks, museums, libraries.
Their vision veers into utopia, where even football coaches would be sensitive to mental health issues. Although Richman concedes he can sound too much like Norman Vincent Peale, it’s not because his view is wrong. It’s because society falls so far short of the goal for so many children and families.
Chapin Hall started studying the child welfare system at the request of DCFS after the agency settled a 1991 lawsuit by agreeing to reform its management practices.
The first idea offered by Chapin Hall was that DCFS completely revamp, eliminating most of its burdensome caseload by concentrating only on the most serious allegations of abuse and neglect.
The rest of its cases, in which there was no immediate risk of harm to the children, should be removed from the child welfare system and its stigma. They would be treated by the kinds of wide-ranging, community-based systems of support that Chapin Hall espouses.
Leroy Pelton, a professor at Salem State University in Massachusetts, calls for a similarly complete overhaul of the child welfare system, although he takes the opposite approach: Instead of retaining only its most difficult cases, the agency should hand over the investigation and prosecution of serious abuse and neglect to law enforcement. The agency would retain the job of promoting healthy families.
The likelihood of either concept taking hold in the near future seems remote at best, and even Richman acknowledges that he prefers to talk in terms of promoting a philosophy that can be debated, instead of hoping to get some kind of legislation passed.
More immediately, Chapin Hall’s ideas of community involvement are getting a tryout through the Chicago Community Trust. Over nine years the foundation will spend up to $30 million in nine Chicago-area neighborhoods on small ventures from Little Leagues to tutoring.
Cleo Terry, DCFS executive deputy director, said that it took the current crisis of an overclogged system with 500 to 600 new foster child cases a month and some highly publicized failures for DCFS to even include a prevention chapter in its annual progress report.
The chapter is only 12 pages out of 317 and consists mostly of plans to make plans for the several million dollars it will receive from the new federal legislation.
Terry said she hopes one focus of any effort is drug abuse, an issue in three-fourths of the cases DCFS handles and a problem so entrenched that she doubts it can be overcome with even the most promising child abuse prevention efforts.
“If mom is on the street all the time because she is looking for cocaine, I’m not sure home visiting is going to impact that,” Terry said.
Even the agency’s new director, Jess McDonald, agrees that the answers to the broad, intertwined problems of families that come to the attention of DCFS are confoundingly elusive.
“I wish I could put a plan out on the street to say that all this is going to go away,” he said. Absent that, about the only idea he comes up with is to extend mandatory school requirements. By extension, that could cut back on the number of ill-prepared, poorly educated teenagers who become potentially abusive parents.
“No one gets out of school until they’re 18 or they graduate. We stick with them,” he said. “If I could change one thing, that would be it.”
In Hawaii, the state’s model home visiting program caught fire with legislators who were exasperated by soaring budgets for social services in their state. A decade ago, home visiting advocates lobbied long and hard to convince lawmakers that home visitors could save the state money on special education, crime and social services.
Mamoru Yamasaki, an influential Democrat who chaired the state senate’s Ways and Means Committee for a dozen years, said he quickly bought their argument, but it took some wheeling and dealing to get the votes to line up.
“They showed me numbers about how many children were being abused,” he said. “I thought this was a terrible thing.”
Despite such signs of agreement, many people in key positions of policy are discouraged by an American public that doesn’t seem in the mood for long-term prevention efforts on any serious problem.
In Illinois, Sen. Paul Simon, searching for the reasons for those feelings, said: “We are more segregated on the basis of economics than at any point in our nation’s history. The poor are no longer our neighbors. So the more distant the problem is, the less concerned we are with it. We’re concerned only when it reaches crisis proportions.”
In a symbolic gesture, the U.S. House of Representatives last year did away with its Select Committee on Children, Youth and Families.
“The politically popular thing to do is not to prevent but to punish,” said U.S. Rep. Patricia Schroeder, a longtime backer of family issues who sees little commitment at the federal, state or local levels for new initiatives. “We’re tinkering around the edges, not much else.”
The U.S. Advisory Board on Child Abuse and Neglect has been calling child abuse a “national emergency” for more than five years. Every year, the panel releases at least one report on combating abuse and neglect. The panel has been particularly urgent about a nationwide commitment to home visits. It has been thoroughly frustrated.
“Never have so many reports been ignored by so many,” said Richard Krugman, dean of the University of Colorado School of Medicine and former chairman of the panel. “They say: Gee, that’s terrific. And then they do nothing.”
Krugman said there won’t be progress until the nation’s middle-class understands how society will benefit from ideas like universal home visits, and then starts putting pressure on elected officials.
“I happen to believe that even low-risk parents have high-risk days,” he said. “There isn’t any parent who couldn’t use the help.”
Jerome Stermer, president of Voices for Illinois Children, said elected officials are slowly starting to question why the state has to wait for families to fall apart before dealing with their problems. And whether there is a better way to spend taxpayers’ money.
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“When we go around the state, I can’t tell you how positively people react to suggestions that we must prevent (abuse), and not just respond to it,” Stermer said.
One of the spate of home visit projects getting under way in Illinois is run by Child Abuse Prevention Services (CAPS). Uncertainty about its future is typical.
CAPS, a non-profit oganization in Chicago, is working with the National Committee to Prevent Child Abuse and planning a program that will identify mothers at risk who give birth at the University of Chicago Hospitals, then offer home visits.
When the program is running at full strength, four full-time home visitors will see dozens of families a year. The first year, two visitors will take on 30 or 40 clients.
The full program will cost about $250,000 annually, but CAPS only has about $25,000 so far. The organization hopes to cobble together funding from private donors, corporate foundations and the government, including a check-off box on income tax forms and new federal money.
Although the momentum is undeniable, Claire Dunham believes that the nation is years away from making a national commitment to prevention.
“Part of it is we haven’t made the jump in the funding arena,” she said. “At the policy level, money still flows toward problems. I see the battle coming on because everybody continues to say there is not enough money.
“I don’t agree with that. There is enough money. We just have to make some hard choices about how we spend it.”