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Mr. Mazzoli. You would prefer to leave the penalties in, even though you do have some reservations about the ease with which one who is not a medical person can identify abuse, because even medical people have some difficulty.

Dr. HEISER. With certain cases, yes.

Mr. MAZZOLI. Certain cases.

Very well. Thank you.

Congressman Stark, do you have any questions?

Mr. STARK. A couple, if I could pick up with Dr. Heiser.


I would add the observation that, if, indeed, the threat of criminal penalties were imposed, it might be an incentive for those quasi-professionals, not medical professionals, intimately involved in child care to become aware of the signs or the indications that abusive practice may be taking place

Dr. Green, Îf I could ask you to, one, in the case of the neglected child, submit some suggestions to us as to how we might better define that term; and secondly, with the question of the competent parent, which, to a layman life myself, is a term that I would have trouble defining as strictly as, I think, you might do.

I would also be interested in receiving Dr. Green's, as well as any other panel member's alternative wording for the section of the bill where the team members are listed. It was our intention in drafting this version to see that there were specific professional people mandated to serve. We do provide, however for the participation really of anyone else.

And you know, there may be other inputs there. And there is no reason, it seems to me, why, maybe, you shouldn't have a child on the team-by the same theory behind having a parent. I see no objection to that.

And again, I would ask you to suggest in writing an alternate language that we might use.


Now, one question, if I may, of the entire panel, because it will come up in other testimony. The question of clearly defining the responsibilities of authorities is, in my opinion, in any agency, whether it is the Department of Defense or HEW, a bureaucratic-like, and that it is a legislative jungle into which none of us really enjoy venturing. You all have the advantage of working with the District agencies. To the extent that you would like to suggest areas of responsibility which should be assigned to specific agencies within the city government. This means, of course, that somebody is going to be less happy. I have never yet seen an agency that likes to give authority to some other agency.

I tend to agree that there should be a clear-cut responsibility—that we should centralize the responsibility.

We have attempted, and would continue to attempt, to the extent that we work with this Bill, to see that, one, there is a clear-cut responsibility, and, as clear as we can, to define the level of cooperation and the level of independence.

Therefore to the extent that you can be specific about your druthers," as to how you would see the lines of authority, well, that would be helpful to the Committee if you would submit that to us in writing.

And I think you again for being here this morning.

Mr. MAZZOLI. Thank you very much, Mr. Stark.
Congressman Gude?

Mr. GUDE. Thank you, Mr. Chairman.

Dr. Green, I was very struck by your comments that the Director of the Child Abuse Prevention Center might need more authority than just to be able to coordinate other public and private resources.


I would gather that this matter of addressing the community's problems requires a very intense effort by the agency that is involved. It should have a certain amount of independence as far as resources from which it is able to draw.

I wonder if, we can perhaps provide in the budgetary allocation, the necessary support that the Child Abuse Prevention Center needs, and maybe it could contract out.

In other words, if the coordination which the Child Abuse Prevention Center need, isn't coming forth from some public or private agency then the Child Abuse Prevention Agency would have the fiscal means to accomplish its goals.

That is what is common in all of these problems-agencies don't have the necessary money to maintain what is necessary to carry out their mission.

Dr. GREEN. Mr. Gude, I spoke to that issue simply because of my experiences, two years as the Associate Chief of the Children's Bureau in the Office of Child Development here at HEW.

And that mission of that Bureau, of course, as you know, was, according to 1912 legislation, to identify and, after two years, to identify and to report on the welfare of all children of this nation. Well, in order to do that, that required coordinating almost 40 or 50 different programs stretched across HEW.

And without discretionary resources and no power, it becomes almost an impossible task.

An it was on that model that I saw this happening, where the agency that would have to call on Protective Services, on police, and a variety of other agencies without any clout in decision-making at the top level: I see it almost counterproductive.

Mr. GUDE. We are wasting our time unless the Director can marshal the necessary forces.

Dr. GREEN. That is correct, sir.

Mr. GUDE. In following this up, I noted that Congressman Stark spoke to the question of having a resident of the community as part of the multidisciplinary team of experts.


To that end, would it not be important to have residents of the community part-time members of the team, and those others remain as experts.

You have the resident of the community put in a difficult position of perhaps being overawed by the experts, not being a psychologist or sociologist.

Parents might tend to be run by the board of experts.

Of course, in selection, you do not know what type of members of the community you are getting. They are bound to be skewed in their biases and outlooks, one way or another.

So it would be important maybe to have serveral residents of the community to be a sounding board for the various ideas and suggestions that would come up.

Mr. STARK. Would the gentleman yield?

Mr. GUDE. Yes.

Mr. STARK. If you are suggesting that we should have-and I think that is the case that we require that professionals be residents of the District, which, I think, would be, at least that would seem to me to be perfectly in order.

This would not mean the exclusion of non-professional residentsbut it occurs to me that we have not said anything in here about professionals, which would tend to focus in on what you were saying. Mr. GUDE. I was thinking of parent-residents of the immediate neighborhood where this particular problem arose.

Parents from one side of the city, would hardly have rapport with the problems of a neighborhood on the other side of the city.

But in looking at the professional requirements, perhaps they should be residents of the District of Columbia.

I was thinking that the parents of the immediate community should be part of the multidisciplinary team. It would be important to have input from them.

I do not know whether you would achieve this with just one set of parents.

Dr. GREEN. Mr. Chairman, may I respond?

Mr. MAZZOLI. Please.

Dr. GREEN. The purpose of this suggestion in my testimony was to relieve that very wide cultural gap that often exists between the children who are being cared for and the professional members of the


And I have traveled around the country enough, and seen enough child abuse teams to recognize that, in most instances, there is a very wide cultural gap between those who are delivering services and those who are serving.

And sometimes, those who are delivering services are not sensitive to the various child-rearing and culturally determined practices.

And I feel that that input is vital in arriving at a very serious decision that could possibly remove a child from the home.

I just think that that is a "non-professional" kind of input. It is a professional input; it really is, in the strictest sense of the word, that should be taken into account before we move forward into further adjudication of the child.


Mr. GUDE. What would you think of providing that the team have several sets of parents, or several parents from different families, rather than just a

Dr. GREEN. That may be—well, let me just say that that may be counterproductive to have too many members.

I think there should be that input, but having four or five members or parents, and then putting it to a vote may make the resolution of the problem extremely difficult.

Mr. MAZZOLI. Dr. Heiser?

Dr. HEISER. Yes, I agree with Mr. Gude that, for example, on community boards, it has been known that there is community representation, but people just tend to think that everyone knows more, and they do not speak up.

And it has been suggested that, in such a situation, there ought_to be more community members, so at least there is half and half maybe. But we cannot just say they shouldn't be on this team because they are not going to say anything.

They should be encouraged. There is a concept in therapy of abused children called lay therapists. They are people from the same kind of community that the abusive family is from.

They could very well be a part of this therapeutic team, and have very important input. They do know the community and the people that they are helping.

Mr. GUDE. I was not thinking of this team as a legislature who would sit and vote until they resolved it.

I appreciate the comments.

Mr. MAZZOLI. Counsel?

Mr. HOGAN. Thank you, Mr. Chairman.


Do we know the extent of the problem in the District of Columbia, Dr. Heiser?

Dr. HEISER. I believe Corporation Counsel could better answer that. But I believe there are 500 to 600 cases that they tried of abuse and neglect in 1973.

Those are the cases that they tried. It is estimated that probably three or four times that many actually occurred.

Mr. HOGAN. And Dr. Green, you were in HEW. Is there any standard incidence across the population generally that you used as some kind of a standard?

Dr. GREEN. During the consideration of Public Law 93-247, the incidence is said to be roughly 321 per million, or roughly 60,000. But that is probably an underestimate, because that only represents the population that uses public facilities.

There is no agreement among authorities really as to the true incidence of this disease.

My own feeling is that it probably is in the area of 300 to 400,000 children nationwide a year.


Mr. HOGAN. Now, I gather, from your experience at HEW, Mr. Yeldell's testimony, I gather, will indicate that approximately 3 out of every 4 dollars that could be used for a child abuse agency could be provided by the Federal Government or under the Federal legislation, matching dollar thing. Is that correct? Or is there some question

about that?

In other words, is there not some matching funds provision for a central state agency for child abuse or neglected children that gets Federal funding?

Dr. GREEN. The formula IV-A funds are identified for dependent and neglected children. The problem has been that most of those funds have not been used for this group that we are speaking about today. I am certain that Mr. Yeldell

Mr. HOGAN. The dollars that are being used, those are not being extended to the child abuse cases, setting up child abuse teams, things like that?

Dr. GREEN. The IV-B funds were used mostly for dependent children.

The present legislation allows for 15 to 20 percent of the authorized funds of 93-247 to go to states to set up such programs.

But the incredible part is that, under the current lines, for a state to be eligible for such, they should have such an excellent program that they do not or would not need the money.


Mr. HOGAN. Do you happen to know, Dr. Green, what other states have done as far as attaching a criminal penalty to reporting requirements?

Dr. HEISER. I believe, New York State has this provided, and Texas. I believe Mr. Fraser will know the answer.

Mr. STARK. If the gentleman will yield, the criminal reporting portion of our Bill is very similar to the California State code, where it has been in effect for a number of years. And it has worked very satisfactorily.

And you are right, Dr. Heiser, there are several other states with similar provisions.

Mr. HOGAN. You would have no objection to operating under a reporting system that would require, that would lay a criminal penalty on individuals, doctors, teachers, yourself?

Dr. HEISER. Not myself. I don't know whether the medical society agrees.

But you see, I have had the experience of knowing certain cases that should-when our own residents can recognize the case, other doctors have not reported it. Have seen a child a week before, have not reported it; cases that there should be no doubt at all.

And the children will get hurt more sometimes while cases that are not being reported. How do you get them to report?

Of course, education is very needed. And if this part stays in, there is going to be an obligation on someone's part to really educate doctors and the community to recognize it.

Mr. HOGAN. Can't you educate them without, you know, having the holding over them the possibility of criminal prosecution?

Dr. HEISER. Yes, you can. But it is just being human. This helps, having that held over you.

Mr. HOGAN. I would be interested to know how many prosecutions there have been in the State of California.

Dr. HEISER. I don't believe there have been any.

Mr. HOGAN. I don't believe we have had any police representative testifying.

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