rather than the more appropriate policy formulation, program planning, and technical assistance to the various child abuse teams in health facilities in this community. It would seem more appropriate to me for such an agency to serve the advocacy function of addressing the collective needs of abused and neglected children and their families.

8. Continuity of Care

The critical need for continuity of parental care for the abused child, particularly in the case of a child over seven years of age, as noted in Title III Section 301 of this bill, is not well served.

Although recognition is properly given to the differing critical ageddependent time intervals that may seriously impair the bonding process between a child and his psychological parent, the very fact that it is possible for a child of seven years to be legally kept in a temporary foster care status, with all of its disadvantages, for over two years, is far too long. It would seem that for the welfare of this child, this interval could be markedly shortened.

9. Performance Evaluation

I can find nothing in this bill that mandates ongoing review and evaluation of the reporting procedures to be developed and implemented by the Director of this agency.

I would feel that such ongoing monitoring is essential.

Although the above comments do not exhaust my concerns, I am hopeful that when the guidelines for this legislation are developed they may be made available for public comment and debate.

Thank you Mr. Chairman and Members of the Subcommittee for giving me this opportunity. I will be happy to cooperate in any further way possible.

However you want to read your testimony, who will go first, I will let you settle that yourselves.

Dr. HEISER. Mr. Mazzoli, and other members of the Committee, we are very happy to be here to be able to testify. Barbara Steele of our Social Work Department will explain the system as it is now in D.C., once the child has been identified as an abused child.

Mr. MAZZOLI. Thank you.

STATEMENTS OF DR. ANNETTE HEISER, COORDINATOR, CHILD ABUSE TEAM, CHILDREN'S HOSPITAL; ACCOMPANIED BY BARBARA STEELE, DEPARTMENT OF SOCIAL WORK, AND DR. FREDERICK C. GREEN, CHILDREN'S HOSPITAL

MS. STEELE. If you have your copy of our testimony before you, if I could direct you to Figure 1 on page 6.

PRESENT SYSTEM

We have attempted to diagram the flow of an abused child in the system as it exists in the District of Columbia right now.

The child is presented to Children's Hospital, brought there by a police officer, a protective service worker, or a school teacher, but most often by a parent.

There is a medical determination that the child is probably an abused child. The child is admitted to the hospital, referred to the Department of Social Work, and the child's name entered in our trauma index.

At that point, we are required to make a referral to the Youth Division of the Metropolitan Police Department for them to begin an investigation.

The Youth Division then proceeds with their investigation, consults with Corporation Counsel and/or the U.S. Attorney.

If sufficient evidence is found, they then proceed to place a hold order on the hospital chart, ordering the hospital to keep the child for up to 5 days.

And within 24 hours, the case is presented to the Juvenile Branch of the D.C. Superior Court for preliminary hearing.

At that point, Corporation Counsel is assigned, a probation officer or a court social worker, as they are sometimes called, is assigned to interview the family.

The parents are assigned attorneys, and the child is assigned an attorney.

At that point, the Judge can make the determination that the child should be placed in the temporary custody of the Social Rehabilitation Administration, otherwise referred to as SRA, or he can rule at that point that the child can be returned home when medically ready. If he rules that the child be retained in temporary custody, a trial date is set, probably within about a month, and the child is then placed into foster care or institutional care by the Social Rehabilitation Administration.

While trial is pending, a Court probation officer does a home study for use at the time of the trial, making recommendation to the Court about the disposition and the safety of that child.

Then at the time of the trial, the Judge will make a ruling as to the child, whether the child has been neglected or not, and then decide whether the child sould be retained in extended custody of SRA, or whether the child should be returned home.

If the child is retained in custody, he is committed to the custody of SRA for up to two years, with a review date probably set in court. The child then becomes the responsibility of the Social Rehabilitation Administration for care and services.

Directing you to the right side of the chart, where the flow indicates the ways in which the child can be returned home.

If, after the initial investigation of the Youth Division officer; there is not sufficient evidence to take the case to Court, the hospital is notified that the child can be returned home as soon as medically ready.

At that point, the Department of Social Work, after it has also interviewed the family and made at least a cursory evaluation, will refer the case to the Protective Services Branch of the D.C. Department of Human Resources, the Social Rehabilitation Administration. Again, if the child is returned home after the preliminary hearing or after the trial, the child is also referred for protective services.

So after both processes, we come down to the child being under the responsibility of the Social Rehabilitation Administration, and the flow through another system starts again.

Dr. HEISER. I would like to speak to some of the problems as we see them in the District of Columbia.

CHILD ABUSE PROBLEM

The Children's Hospital National Medical Center of Washington, D.C. is gratified that the Committee on the District of Columbia is considering a Bill which deals with the complicated and serious problem of child abuse within the District of Columbia.

We are confronted with this problem daily at Children's Hospital where we reported approximately 125 cases of suspected or actual child abuse in 1973.

This year, in 1974, we have reported 76 cases.

Of the ones in 1973, there were four deaths. It is the seventh most common medical diagnosis that we admit to the hospital.

These children and families are in need of many services which require the cooperation and coordination of multidisciplines within and without the hospital.

RESPONSIBILITY

Presently, primary responsibility for the care and protection of these abused children rests with the hospital physicians, social workers and nurses, child life workers, and with numerous official agencies outside the hospital.

The latter comprise an extended community team.

These agencies are: the Youth Division of the Metropolitan Police Department to whom we report cases, the other agencies that you see on the chart, including the Courts, the Protective Services, and Nursing Services.

We are quite dependent upon them for decisions regarding the future care and protection of the children admitted to the hospital for child abuse.

With so many people involved, coordination and education are key concerns of our team as advocates for the family.

Our efforts have included meetings with members of the Youth Division, who now have a specialized force of officers who investigate the abuse and neglect cases with much expertise.

These officers often attend the child abuse team meetings when their case is discussed at the hospital.

The office of Corporation Counsel has developed a very sophisticated staff regarding child abuse. Three lawyers have been assigned to the cases and have had very successful dispositions.

This is, in part, attributed to excellent communication with our team, and the Youth Division, and the other personnel involved.

The Corporation Counsel has been instrumental in increasing the awareness of other hospitals in the area regarding child abuse.

For a while, most of the cases of child abuse reported were from our hospital only.

As a result, we have acted as consultants for several hospitals who are forming child abuse teams.

We have written letters and attended meetings urging that Protective Services be maintained as a unit, although present plans call for decentralization and generalization of social workers within the Department of Human Resources.

NEEDS

We see a need for more specialized social workers who are experts in dealing with the abusive families, and who can make frequent home visits and obtain needed services.

We become very frustrated because the help the families need is not available in the form of adequate mental health facilities, parent groups, crisis day care, job opportunities, better housing, et cetera in the District of Columbia.

For the children who are removed from their homes, there are inadequate numbers of specialized foster homes for them.

The following is an outline of some of the problems from our perspective that need to be dealt with in order to provide the best dispositions for families and the children.

There is a lack of extensive community and medical education on the identification and dynamics of child abuse.

There are inadequate therapeutic facilities for treatment of families. There are inadequate residential treatment facilities for children. There are inadequate numbers of special foster families for children with emotional problems associated with child abuse.

As a result of the latter, that is, inadequate numbers of foster homes. children in the custody of SRA stay in an acute care hospital, such as Children's, for prolonged periods of time, awaiting the proper placement. We see this as very detrimental to the child.

When children return to their homes, Protective Services is the most important agency for continued contact and help to these abusing families.

Fifty percent of the children suspected of being abused returned home in 1972.

Twenty-five percent return to the hospital more seriously abused when no rehabilitation is available to that family We have found this to be very true. If there are no helps given to the family, those children are going to be abused again.

Children have returned to the hospital more seriously abused after having been in temporary placement and then returned to their own families, again because nothing was done in that interim period when they were out of the home to help whatever what was going on.

When an abused child is removed from the home through Court procedures, too often, their sibling later becomes abused.

And in the written testimony that we have submitted, there are case examples of this.

Many abusing families seek medical attention at several different facilities. There is no system of obtaining histories of past suspicious injuries within the city.

ALTERNATIVE SOLUTIONS

Some alternative solutions might be, would be :

Various modalities of therapy suited to an individual family's needs; for example, parents anonymous, lay therapists, individual and group psychotherapy.

Preventive programs that might include crisis day care facilities, parenting classes in the schools.

Residential psychiatric treatment facilities for children.

Foster homes specially reserved for abused children with ongoing support and counseling to these foster parents.

Interim placement facilities for children awaiting trial, and disposition hearings that would provide treatment and a homey atmosphere.

Retention of Protective Services as a specialized unit. possibly to have these social workers involved with the family from the beginning to the end of the legal and treatment process.

Provision for siblings of abused children to be examined and safety assured

A confidential central registry for the Metropolitan area, a coordinating agency within the city which would be held accountable for services to these families.

In the light of the needs previously discussed in this paper, we are happy about most of the concepts in the Bills which do speak to these problem areas.

AMENDMENTS PROPOSED

Parts of the Bills need clarification and expansion, and we will recommend some additions and deletions.

These following comments are, more or less, mine and Barbara Steele's opinions. Our team is a multidisciplinary, and not all of us agree on everything, which is good.

The sections referred to below will correspond to those in H.R. 15779, and comparison made of H.R. 15918, when needed.

Section 101 (a) of H.R. 15779. A center for the prevention of child abuse is badly needed in the District of Columbia. However, we do not think it should be an independent agency, but should be a separate division under the Department of Human Resources, with a Director appointed by the Commissioner.

For this legislation, the Director must be held accountable for help given the abused child and his family, so that this center does not exist. in name only.

In addition to the "District of Columbia Court system, the Metropolitan Police Force, hospitals," we hope that a Protective Service unit in the Department of Human Resources will be maintained, from which social workers with expertise in this field could work for the center, being assigned to families as soon as possible, and remain assigned until the legal and therapeutic processes are finished.

Contracting already existing community resources for services is excellent, so that these families can be helped in their immediate neighborhoods as much as possible.

Section 101 (d) (2). This section needs clarification as to roles.

It seems necessary that the multidisciplinary teams in a center take on several different functions.

There could be an executive team which would act as a consultant to other teams in the community. That is, every hospital which treats children should have a multidisciplinary team.

These community teams are the ones who identify abused children and make some initial evaluation of the family. They would then refer the family to the executive team of the center, who would assign the family, depending on their needs, to the therapeutic team within the

center.

The therapeutic team would either provide or seek out the psychiatric counseling, the continued medical care, and safe home environment referred to in Section 101 (d) (3).

Whenever the term "investigate" is used, referring to one of the functions of the center, it seems more accurate to say evaluate. We believe the investigatory function should be with the Youth Division of the Police Department.