By Douglas J. Besharov

This article originally appeared in Children Today, March 1992.

Over the past twenty years, enormous made in protecting children from abuse and neglect. But major gaps in services remain. Recently, a consensus has developed among many child protective specialists about some basic reforms that need to be made. This report describes one way through which the broader child welfare and human services community can be helped to understand the goals of this consensus and how it can be mobilized to actively support the needed reforms.

Progress and Problems

Thanks to years of advocacy by concerned individuals across the country, there now exists a basic infrastructure of laws and agencies to protect children. All fifty states now have child abuse reporting laws. Specialized "child protective agencies" have been established to receive reports (usually via highly publicized hotlines) and then to investigate them. Health, social service, education and law enforcement agencies and individual professionals increasingly see themselves as jointly, not separately, responsible for protecting children and, wherever possible, preserving and strengthening their families. New resources have been identified, useful family support systems developed, and some simplistic solutions discarded. Statistics, definitions, and procedures are being standardized and upgraded. More concretely, the quality of treatment services has been greatly improved.

The result has been an enormous increase in reported cases.(1) In 1987, almost 2.2 million children were reported to the authorities as suspected victims of child abuse and neglect. This is more than fourteen times the estimated 150,000 children reported in 1963.

Increased reporting and specialized child protective agencies have saved many thousands of children from death and serious injury. The best estimate is that, over the past twenty years, child abuse deaths fell from over 3,000 a year (and perhaps as many as 5,000) to about 1,500 a year.

Still, in almost every community, there are serious inadequacies, breakdowns and gaps in the child protective process. Reports are increasing faster than many agencies can handle them, but detection and reporting remain haphazard and incomplete. Professionals--physicians, nurses, teachers, social workers, child care workers, and police--fail to report many of the maltreated children whom they see, including those with observable injuries severe enough to require hospitalization.

Although all statistics concerning what happens in the privacy of the home must be approached with great care, the scale of non-reporting can be appreciated with the help of the National Study of the Incidence and Severity of Child Abuse and Neglect (conducted for the federal government by Westat, Inc.). It estimated that, in 1986, selected professionals saw about 300,000 physically abused children, another 140,000 sexually abused children, and 700,000 who were neglected or otherwise maltreated.(2) According to the study, the surveyed professionals reported only about half of these children. (The study methodology did not allow Westat to estimate the number of children seen by non-professionals, let alone estimate their reporting rate.)

The professionals did not report almost 40 percent of the sexually abused children whom they saw. They did not report nearly 30 percent of fatal or serious physical abuse cases (defined as life-threatening or requiring professional treatment to prevent long-term impairment) and almost 50 percent of moderate physical abuse cases (defined by bruises, depression, emotional distress or other symptoms lasting more than 48 hours). The situation was even worse in neglect cases: about 70 percent of fatal or serious physical neglect cases were not reported and about three quarters of the moderate physical neglect cases were not reported.(3)

This means that, in 1986, at least 50,000 sexually abused children went unreported, at least 60,000 children with observable physical injuries severe enough to require hospitalization were not reported, and almost at least 184,000 children with moderate physical injuries were also not reported.

Many thousands of other children suffer serious injuries after their plight becomes known to the authorities. Studies in a number of communities indicate that 25 to 45 percent of the children who die under circumstances suggestive of child maltreatment have previously been reported to child protective agencies. 4 There is some reason to believe that, after many years of decline, child fatalities attributable to child maltreatment have begun to rise.

At the same time, the nation's child protective agencies must investigate a large number of reports that are not substantiated. Nationwide, only about 45 percent of all reports are "substantiated" (or a similar term) after investigation. This is in sharp contrast to 1975, when about 65 percent of all reports were "substantiated Each year over 500,000 families are investigated for reports that are not substantiated.

In 1988, responding to these problems, three major reports were published by leading child protective and child welfare organizations. (See Box #1.) Each document proposes substantial changes in reporting, intake and screening, investigations, and case determination practices. Despite their varied origins, remarkable agreement exists among these three documents about what needs to be done to improve services to abused children and their families. In essence, each recommends that a much greater effort be made to ensure that only appropriate cases are accepted for investigation and that suitable services are provided to families needing them. (See Box #2.)

The Three Child Protective Reform Documents(5)

Child Abuse and Neglect Reporting and Investigation: Policy Guidelines For Decision Making (ABA/APWA/AEI, 1988), available from the American Bar Association, (312) 988-5555 for $ 3.

Guidelines for a Model System of Protective Services for Abused and Neglected Children and Their Families (APWA, 1988), available from the American Public Welfare Association, (202) 682-0100 for $ 10.

Standards for Service for Abused or Neglected Children and Their Families (CWLA, 1988), available from the Child Welfare League of America, (201) 225-1900 for $ 12.50.

Expanding the Consensus

Issuing a report and achieving the recommended changes, however, are two very different things, as we all know. The three reports were developed by groups largely composed of child protective and child welfare specialists. For their recommendations to be implemented, much broader understanding and support will be necessary. (Even among specialists, many of the recommendations in the three reports remain controversial.)

This report describes one way in which this consensus can be expanded and implemented. It is based on the experience of a national meeting sponsored by the American Bar Association's National Center on Children and the Law, in association with the American Enterprise Institute, the American Public Welfare Association, and the Child Welfare League of America. (The meeting was funded by the National Center on Child Abuse and Neglect.) The process has five steps. (See Box #3.)

Steps in the Process

1. Presentation and discussion of documents to involve others in the consensus,

2. Small group discussions and reporting back to the larger group to identify needs,

3. Voting to establish priorities among identified needs,

4. Structured discussion to plan strategy, and

5. Follow-up to encourage implementation.

Step 1: Involving Others: On December 15th and 16th, 1988, thirty-eight individuals from almost as many organizations met in Washington, D.C. to consider the three documents and to identify priority steps in a strategy to implement their recommendations. The participants were from a much broader array of disciplines, agencies, and advocacy groups than those who had drafted the original documents. (The participants are listed in the Appendix A.)

To open the conference, each of the three reform documents was summarized by a designated presenter. Then, the various themes and recommendations common to each of the documents were discussed by the whole group. This initial discussion provided an opportunity for participants to voice their concerns about and disagree with some of the recommendations. In this orientation process, the group as a whole worked through the most controversial issues in the documents. Although some participants would have preferred to rewrite certain recommendations in the documents (such as the need to screen reports), they were reminded that, for the purpose of the process, they had to work within the context of the documents.

There were times when it seemed as if the group would fracture in disagreement and not be able to come together again, but the participants' overriding desire to improve programs for these vulnerable children brought the discussion back to how service needs could be identified and met. The group decided that it could proceed with planning how best to seek the needed reforms even though not all participants agreed with each and every recommendation in the documents. The spirit that developed was: "Rather than getting mired down in what we disagree about, let' see what we can agree to do to improve services."

We think that this open, no-holds barred discussion was essential for the later success of the process. Indeed, it served to focus attention on the severe shortage of long-term, family oriented treatment programs--and what to do about it.

Step 2: Identifying Needs: To allow issues to be discussed in greater detail and to encourage a more informal and collaborative atmosphere, the participants were divided into small workgroups on: (1) "reporting"; (2) "intake and screening"; (3) "investigation7; and (4) "case determination" " These are, of course, somewhat overlapping categories, so that group discussions tended to cross categories. In fact, this report adds new sections on "recruitment, staffing, and training" and on "child and family services" to cover those issues that emerged across the groups. Nevertheless, the division of the entire conference into these smaller groups and the assignment of these particular topics to each group helped move the discussion forward.

Michael Weber, President of the National Association of Public Child Welfare Administrators (an affiliate of the APWA) and Director of the Hennepin County Department of Community Services, gave the charge to the conference. Each group was asked to identify up to ten priorities or actions in its specific topic area. They were also encouraged to identify the organizations that might perform these actions. (Group leaders were asked to keep the discussion on the assigned topic but to allow the group some flexibility in working things out and in identifying needs.)

Step 3: Establishing Priorities: The workgroups met for about two and a half hours, after which the full conference reconvened. Each workgroup leader presented -- and explained -- his or her group's recommendations. The recommendations were also written on flip charts and the sheets were later posted around the room. (These are summarized in Appendix B.) An unstructured discussion helped the other participants to understand their colleagues' proposals.

Each participant was then asked to select the ten most important recommendations. Each participant was given ten round stickers and told to put one or more next to the recommendations that he or she deemed most important. Box 4 lists the identified needs and the priority votes they received.

Step 4: Planning Strategy: The next step was to determine how best to pursue the priorities that had been established. Participants were asked to suggest how their particular organization, either alone or in cooperation with others, could help. Mike Weber led the discussion, working down from the recommendation that received the most votes. Appendix C lists the specific strategies or implementation plans that were proposed.

Step 5: Encouraging Implementation: We did not have funds for a second meeting, so that follow-up was limited. There was a general feeling that this hampered efforts to work together toward common goals and that more formal monitoring of the plans described at the meeting would have encouraged implementation.

Lessons Learned

We believe that the conference successfully helped to identify important objectives for reform in a way that engaged and invested the participants in the outcome. We believe that our experience can serve as a model for similar efforts at the local, state, and regional level, but we did learn some practical lessons about the process that should be shared with those contemplating a similar conference.

Choose the workgroup leaders carefully and make sure that they understand their crucial role in the process. Group leaders need to be both firm and flexible--firm enough to keep the group on its task and flexible enough to recognize when the group needs to work through an unexpected issue. Ours were, and that made all the difference.

Carefully review the workgroup recommendations before they are presented to the group as a whole, combining those that are essentially the same. We had a number of overlapping recommendations, and there was a clear tendency for participants to split their votes among similar priorities. For example, if the risk assessment recommendations had been combined, as they quite properly could have, the resulting recommendation would have scored among the highest.

Select participants with an eye for the ultimate purpose of the process--to get agencies and organizations to commit themselves to specific efforts and projects. Thus, (1) they should come from organizations whose efforts could be relevant to improving child protective and child welfare services, and (2) although it is not necessary that they have authority to commit their agency, at the meeting, to a specific project or activity, they should have a reasonable voice in setting their organization's priorities.

During the session on planning strategy, be alert to the possibility that some priority areas--even though they receive a large number of votes--will not have action items suggested for them. It was only after the meeting that we realized that there were no implementation ideas for two priority areas.

Finally, keep your expectations for the process reasonable. Realize that many of your pet ideas will not be recommended and be prepared for many action items to go unimplemented. If even one in ten comes to pass, the process will have been worthwhile.

Douglas J. Besharov is a Resident Scholar at the American Enterprise Institute for Public Policy Research in Washington, D.C. He was the first director of the National Center on Child Abuse and Neglect, Administration for Children, Youth and Families.

Footnotes

(1) Much of the following material concerning reported cases is derived from Child Abuse and Neglect Reporting and Investigation: Policy Guidelines For Decision Making (ABA/APWA/AEI, 1988), reprinted in D. Besharov, Protecting Children From Abuse and Neglect (Charles C. Thomas, 1988), Chap. 13. (2) A. Sedlak, Study of National Incidence and Prevalence of Child Abuse and Neglect (Westat, Inc., Bethesda, Md., December 1987). (3) Supplementary Analyses of Data on the National Incidence of Child Abuse and Neglect, supra n. 4, at pp. 3-19. (4) J. Alfaro, "What Can We Learn from Child Abuse Fatalities: A Synthesis of Nine Studies" found in: D. Besharov, Protecting Children From Abuse and Neglect (Charles C. Thomas, 1988), Chap. 9. (5) The views expressed in the documents do not necessarily represent the views or policy of the National Center on Child Abuse and Neglect, the Administration for Children, Youth and Families, or the Administration for Children and Families, U.S. Department of Health and Human Services. (6) Prepared by Beverly Jones. The absence of a notation for a particular element does not denote disagreement but, rather, the fact that that element was not addressed by the document. (7) Some of the recommendations have been edited for clarity and brevity. The recommendations do not necessarily represent the views or policy of the National Center on Child Abuse and Neglect, the Administration on Children, Youth and Families, or the Administration for Children and Families, U.S. Department of Health and Human Services.