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HAPPY HILLS HOSPITAL, Baltimore, Md., August 12, 1974.
Ms. REBECCA MOORE,
DEAR MS. MOORE: Thank you very much for copies of House Resolution No. 15779 and No. 15918 pertaining to child abuse legislation for the District of Columbia. You have asked me for my comments on these bills and I will take your request at face value and give you my comments for what they are worth. My major reference will be to H.R. 15779 (Mr. Stark's Bill). Overall, I think that this is an excellent piece of legislation and well thought out, however, I do have some bones to pick. I cannot argue with the correctness of the Bill's definition of child abuse and neglect, but I am somewhat disturbed that there is no reference made to the problem of emotional abuse. As a physician, I recognize that this is a very difficult area to define, however, we are coming to the realization that emotional abuse constitutes perhaps an even greater problem than the more evident one of physical abuse. I would like to see some thought given to the inclusion of emotional abuse (with an attempt at definition) in a Bill such as this.
On page 4, lines 15 through 19, wherein the constitution of the team is described, I am disappointed to note the absence of Public Health Nurse and community involvement in the form of a "community aide" such as those used in the Denver programs and by our own team here in Baltimore. I am cognizant of the fact that "each multidisciplinary team may include additional persons" and I take this to mean that such persons might include the above-mentioned categories, but I am not certain as to why they should "not be employees of the Center" (line 19) since they would be a valuable integral part of any team. I could, at this point, clarify for you at great length the roles of these individuals, but that may not be appropriate in this letter. I will say, at least, that I am not sure which member of your team, as described in the Bill, will be going into the home and befriending these lonely, isolated families and helping them with their health and home care problems and such items as budgeting, cooking, cleaning, etc. These are imperative needs which must be met to alleviate the stresses within these families and they are not roles traditionally fulfilled by a social worker.
On page 5, line 5, a reference is made to the responsibility of the pediatric team member. I feel that it is inappropriate to specify and limit the pediatrician's responsibility to provide only for the physical condition of the child. As a pediatrician, it is my role to assess overall the physical and emotional problems of the child and his family and this does not constitute an invasion of the area of the psychiatric or psychological team member-it is simply the ordinary role of the pediatrician. I do not like Section (3) on page 5 since I think that it fixes (or at least attempts to fix) roles of team members in an inappropriate and unduly limiting fashion.
I do not understand the rationale behind lines 21 through 24 on page 5 since I cannot see a major conflict of interest in this particular situation. Who, better than the attorney employed by the Center to represent either the parents or the children in any legal proceeding (although I strongly feel that it is often the case that one attorney should not represent both interests)?
I am concerned with the large number of people given access to the confidential register described on page 6, particularly with the vague statement in lines 24 and 25, i.e., persons employed by the Center. I suppose that my concern is engendered by my very strong feeling about confidentiality and I would like there to be a more stringent limitation here.
I would like to express my extreme concern with the method of reporting in Section 202 of this Bill and reiterated in Mr. Fraser's Bill involving direct reports to "specially designated and trained nonuniformed members of the Metropolitan Police Force". We have generally found the police to be the least satisfactory agency to handle the initial stages of a child abuse investigation. I say
this, recognizing that the Bill provides for a "specially trained unit" (who would do the training anyway?), and I would suggest to you that this role would be much better filled by a member of a social work agency. Traditionally, this is the role of the Protective Service worker which by virtue of his background is far better equipped to handle this very touchy and difficult investigation with equanimity. There is no area in these Bills with which I disagree with more violently then this particular item. Further, I cannot find any precise statement of the interval of time required from the time of investigation to the time of filing this report. Is this an oversight on Mr. Stark's part or mine?
There is a typographical error in line 13 of page 11, i.e., transit should read transmit.
As a third year law student, I would like to argue against the preservation of the lawyer-client privileges in these matters. The courts are attempting to discard the traditional privileges in revising and materializing the rules of evidence and I see no reason for preservation of the lawyer-client privilege alone. I say this recognizing that some of the authors of this bill are probably attorneys. It is the role of the court to find the facts, and preservation of this archaic privilege does not expedite this role.
In Section 206 on page 12 in lines 16 through 19, I believe that the category of osteopath should be included since you have seen fit to include that of chiropractor, either under medical and professional category or at least under the category "certain persons involved in child care." I would personally include physical therapists, occupational therapists and speech therapists on any list that I was composing.
On page 16, I am somewhat at a loss to understand the reason for allowing two years of delay between hearings for children over age 7. Should we delay in making final decisions for these children simply because they are older? Is it any less necessary for them to find stability? I think that this is patently wrong and I would suggest a length of one year between hearings for all ages over 1.
Concerning Mr. Fraser's Bill (H.R. 15918) I have some specific concerns. On page 13, Section 205, I am worried about the procedure described for obtaining photographs. No mention is made of consent and I wonder whether without consent, this may not raise a question of constitutionality, particularly in the area of invasion of privacy.
Section 206 on page 14 seems to me to be fine theoretically, however, I would wonder whether this really has any legal teeth since it seems to me that it would be very difficult to prove willful failure to file an abuse report.
I hope that some of my comments will be of use to you and I would be glad to further consult with anyone attempting to redraft similar Bills in the future. Yours sincerely,
ROBERT CHABON, M.D., President/Medical Director, Happy Hills Hospital, Assistant Professor of Pediatrics, Johns Hopkins Hospital, Assistant Professor of Pediatrics University of Maryland Hospital.
THE WASHINGTON TEACHERS' UNION, Washington, D.C., August 14, 1974. HOUSE DISTRICT OF COLUMBIA SUBCOMMITTEE ON LABOR, SOCIAL SERVICES AND THE INTERNATIONAL COMMUNITY,
U.S. House of Representatives.
GENTLEMEN: I am William H. Simons, President of The Washington Teachers' Union, Local #6, American Federation of Teachers, AFL-CIO. Accompanying me this morning is Barry M. Spiegel, Legislative Representative for the Union. I am appreciative of the opportunity of testifying on H.R. 15779, as I feel that this is a very important and needed piece of legislation. It relates to a problem that has been very much neglected. Child abuse is one of the most heinous crimes, one that is not limited to any particular economic, social or intellectual level, race or religion. It is one that usually leaves the victim, scarred for life physically, mentally or both and in some cases dead. It is one that affects the most innocent of us, the child and in most cases the infant child.
While this bill addresses itself to the many different problem areas involved in dealing with child abuse, think one of the key provisions is that of requiring a person who has knowledge of this crime to report it.
Probably one of the most serious problems in criminal law enforcement and prevention today is the willfull failure of people to assist, i.e.; to file a complaint or testify, in a criminal case. In other words, deliberately avoiding involvement. Even those persons who are connected with child care, apparently, are involved only to the extent of their own immediate responsibilities. As I see it, this bill would require one to look and act beyond one's own sphere of interest, i.e., the physician would not only have to deal with healing the abused child, but also with the prevention of a reoccurrence and the prosecution of the perpetrators, by reporting the case.
It is estimated that as many as two million youngsters are the victims of child abuse in the United States each year. That 500 to 1,000 children each year are beaten to death. However, no one really knows how many, since most child abuse goes unreported. Thus, most abused and neglected children go unprotected, and the parents are given the opportunity to continue their vicious actions.
Obviously, we cannot require everyone to report incidences of child abuse, but at least we can require of those persons most closely connected with children to do so. However, at the sametime, there must be definitive guidelines laid down for each of these groups as to the standards under which they would be required to guide themselves.
In the case of teachers, especially those who meet with different groups of students during a school day, the standard under which they would operate should certainly be less than that of, say a doctor. Since a teacher is exposed to more children than any other "child caring group," it is going to be more difficult for a teacher to discern that a child was subjected to some abuse; other than the normal knocks the average school child suffers. In addition, the large number of students a teacher sees also would exclude close scrutiny of every child, except in the most blatant and severe cases.
Of course, reporting cases is only one part of the problem. What is also needed, is treatment for the parent who neglects or abuses a child, coupled with a way to insure future adequate preventive measures that will help eliminate the pyschological and social environmental factors that foster child abuse.
I feel that the creation of a child abuse center is a step in the right direction. That once it is established, and becomes effective within the scope of the bills requirements, its responsibilities can then be extended to programs of prevention and rehabilitation.
WILLIAM H. SIMONS, President, Washington Teachers' Union, Local #6, AFT.
THE TRAVELERS AID SOCIETY OF WASHINGTON, D.C., INC., Washington, D.C., August 28, 1974. Hon. ROMANO L. MAZZOLI, Chairman, Subcommittee on Labor, Social Services and the International Community, U.S. House of Representatives, Committee on the District of Columbia, Washington, D.C.
DEAR CONGRESSMAN MAZZOLI: At first reading of the correspondence between Miss Hiatt, our Executive Director, and you I felt that H.R. 15779 adequately covered our concerns for the emotionally abused child. Your broad definition of neglect included emotional abuse which we have observed to be equally or, at times, more permanently disabling to normal development than physical abuse. On more detailed analysis we find one provision of the bill which we hope can be modified.
On page 3, lines 7 through 11 of H.R. 15779 the referrals to the proposed center are restricted "to the courts or other governmental agencies, or who voluntarily request treatment or counseling".
I am wondering if at line 8 page number 3 a clause might be inserted following "governmental agencies" to read "established voluntary agencies such as Travelers Aid of D.C.".
The transiency of our clients poses many problems and our inability to make direct referrals without parental consent would leave us helpless to use the proposed center; because the parent who is emotionally abusive or neglectful will rarely voluntarily request treatment, nor willingly relinquish the child for
evaluation and for treatment. If the police accept us as official referrents they might more readily be willing to take such a child to the center at our request and on our evaluation. Since emotional abuse is far more subtle to perceive than physical abuse, psychological and psychiatric evaluation is imperative in situations where the child is not physically battered. At present the police are required to make this preliminary evaluation prior to taking a child to protective setting and the police are not trained to assess emotional abuse. I know little about law and whether private agencies can be included as legal referrents, but I know from our experience with the police that they touch only the obvious abuses.
A case in point of the subtle abuse that can be so damaging is that of a young mother recently seen in our agency. She was 20 years old and had traveled constantly since the birth of her 21⁄2 year old son, taking him with her. She had applied for and received welfare in several cities using her first check in each instance to go to another city. The longest period she had been settled since her son's birth was a 3-month stay in a midwestern city where Travelers Aid had attempted, unsuccessfully, to get her involved in counseling to work at the destructive results of her uprootedness on both herself and her child. When she came to D.C. she appealed to us for support until she could get on welfare here. She acknowledged that she did not intend to stay here. Her short interest span and unusual apathetic manner made us wonder if she was "high" on drugs of some kind. She denied it and we had no hard evidence to prove it.
Our real concern was for help for her little son. He was pale, extremely immatiated, listless and withdrawn. He did not know how to play, showed no normal interest in exploring our office. He presented the symptoms of extreme autism. His mother was not concerned and would not consider referral of any kind. We had learned from past experience that if we called the Youth Division of the D.C. police or 24-hour protective service they would look over the child for signs of physical abuse and would refuse to take him for protection and exploration of the damage. Thus, in this case we did not go through the motions of calling and having the police refuse to take him. Yet one shudders to speculate on the degree of damage already suffered by this little boy and the future consequences of the gross neglect that already makes him act as an automaton. This mother's protection is travel. There are no neighbors or relatives to force her into treatment and Travelers Aid lacks the authority to forcibly intervene. She bas broken contact with us probably to move to another city.
In summary, a child who is being neglected or abused in the District of Columbia should have the right to protection here whether he is a local resident or is transient in the city. Very often Travelers Aid is the only agency the transient approaches and cannot intervene in their interest.
We see school age children who have never been to school. We see children used as pawns by their parents to force agencies and churches to assist them as they travel from place to place. Fortunately we do not see a large volume of gross abuse cases but when we do there is urgency for treatment.
I thank you for inviting our comments in behalf of emotionally abused and neglected children and hope that the unique needs of our transient clientele can be covered in H.R. 15779.
(Mrs.) RUTH E. SPURLOCK, ACSW.
MS. KAREN FLEISCHER.
Director of Program Service.
CHILDREN'S HOSPITAL, NATIONAL MEDICAL CENTER,
Subcommittee Staff Consultant, District of Columbia Subcommittee on Labor, Social Services and the International Community, House Office Annex, Washington, D.C.
DEAR MS. FLEISCHER: This is to acknowledge the receipt of the request from the Honorable Romano L. Mazzoli, Chairman of the Subcommittee on Labor, Social Services and the International Community received by me on August 30, 1974 to submit to you supplemental information to my testimony before the Subcommittee on Wednesday, August 14, 1974.
At that time I was asked by members of the Subcommittee to elaborate further on the questions of 1. The organizational position of the Center for the Prevention of Child Abuse within the hierarchy of the District of Columbia government and, 2. The role of the community residents in the case management of the abused child.
1. The Organizational Position of the Center for the Prevention of Child Abuse in the District of Columbia Government.
I do not agree that this should be a component of the Department of Human Resources. Availability of vital service components for case and class management within that Department notwithstanding, I have heard no compelling argument to make me change my position that such a Center should not be located directly in and responsible to the Mayor of the District of Columbia. By the sheer number of issues that must be addressed by the Department of Human Resources, by necessity the problem of child abuse and neglect would not demand the top priority that it deserves.
The only circumstances under which I could see a Center for the Prevention of Child Abuse subsumed under any organizational component, would be the creation of a governmental unit again located at the highest level of the Executive Branch of the District of Columbia government whose primary and top priority would be addressing the needs and welfare of the children of the District. Such a unit could be identified as a Child Protection Agency, a District Office of Child Development or a District of Columbia Children's Bureau modeled after the Office of Child Development in the Department of Health, Education, and Welfare but being a potent force for children rather than the relatively impotency that characterizes the present O.C.D. and Children's Bureau in the Department of Health, Eduction and Welfare.
I do agree with Mr. Yeldell's call for less fragmentation and more coordination of services, since this has been a problem within the child, health and welfare field for many years. However, I do feel that this coordination should take place under the aegis of an agency whose top priority would be children and their families. Such an agency should of course have very strong linkages with the Department of Human Resources and the Directors of such agencies should be at a peer level. Such an agency should also have the resources and the influence to assure that the legitimate needs of children will be met.
Therefore, I recommend that the Center for the Prevention of Child Abuse be an autonomous organizational entity directly responsible to the Mayor of the District of Columbia with strong linkages assured to the Department of Human Resources and the assurance of adequate influence and resources to accomplish its mission. Hopefully, in the future such a Center would become part of a major high level governmental agency whose primary mission would be addressing the total needs of our children and youth.
2. The Role of Non-professional Community Residents in the Management of Cases of Child Abuse.
At every point in a decisionmaking process that may eventually result in the dissolution of a parent-child relationship, there would seem to be a critical need for input into that process that was sensitive to and knowledgeable of the varying culturally related childrearing practices. I am certain that the majority of child abuse teams in this country do not have this kind of input because of the ethnic and cultural differences between the professionals delivering the services and those being served.
We have accepted the concept of the guardian ad litem in the adjudication process but I am suggesting that a similar guardian ad litem make input in the pre-adjudication process, at the point in time when the child may be first removed from the home.
Of course this step would not be necessary if there were adequate numbers of minority group professionals to meet this growing need.
I believe that this covers the two major points I was asked to respond to during the hearings. I will be more than happy to be of further assistance if I am needed.
Very truly yours,
FREDERICK C. GREEN, M.D.,