Thirty thousand children. That's how many are investigated by the Maryland Department of Social Services every year in suspected cases of abuse or neglect. About enough to fill Baltimore's old Memorial Stadium. Yet only when children die in the custody of DSS does the public become aware of the plight of those tens of thousands of kids. Unfortunately, the most common reaction is to assign blame without fully understanding this basic fact: Our society does not have a system designed to protect children. The current system does not focus on prevention; it merely reacts to try to prevent repeated abuse and punish abusers.
Child abuse and neglect often go undetected at all levels of this "system." Friends and family, police officers and doctors - all can ignore, miss or misinterpret the signs of abuse. The only time a professional has a chance of getting into a home to assess a family is after the abuse has been reported. Then, is it the job of an often underpaid, undertrained, overworked caseworker to evaluate the situation. If DSS moves to protect an abused child - and about 80 percent of investigations do not lead to a removal - a judge might not understand the complex medical and psychological issues, and the child may be returned to an abusive situation.
Each step of the way, nothing ensures that only properly trained people are making decisions that affect children's futures - even their lives. We need to create a comprehensive child-protection program. What would this look like?
* Families and communities would be involved in their children's and neighbor's lives. They would be aware of the substance abuse, domestic violence, mental health and anger issues in the child's family and seek to intervene with professional and community resources, or even just a helping hand. A comprehensive public service campaign can be the starting point for educating the public about the risk factors for child abuse, the signs of child abuse, and what to do if abuse is suspected.
* Parents would receive resources and education about child rearing. In order to be a successful parent, you need to have knowledge of appropriate developmental expectations, an ability to control anger and frustration, and tools to teach children how to behave without violence. These skills are not being taught in our classrooms and are not available to parents in a coordinated or sufficient fashion.
* New parents would receive support via a home visitor, which studies have shown may prevent child abuse and delay subsequent pregnancies. Unfortunately, in Maryland these programs are reaching a small fraction of new families. For example, of the 10,000 births each year in Baltimore County, there is the capacity for home nurses or paraprofessionals to reach only a few hundred families.
* Professionals involved with abused and neglected children - including police, DSS, state's attorneys and health workers - would communicate regularly, and share information as needed. Multidisciplinary teams have been organized in the past, but they often fizzle because of lack of time or commitment from the agencies. It will take a firm commitment from the leadership of public agencies to make participation in such teams part of the job description of these professionals. Also, more of Maryland's private hospitals can commit to developing hospital-based child-protection teams.
* The medical community would have a public health infrastructure to evaluate abused children. Fortunately, pediatricians from the Maryland Chapter of the American Academy of Pediatrics have started the Maryland Child Abuse Provider Network (CHAMP) to train physicians across the state to recognize abused children. This initiative has linked doctors in Child Advocacy Centers from 12 counties across the state and trained physicians in three rural counties so far.
* DSS would have trained workers with adequate staffing. Hiring freezes over the years have overextended the resources of many local departments. Secretary Brenda Donald wants to divert some physical abuse and neglect cases away from the current investigative process and into a broader evaluation of family needs. This is a worthy goal, but the first priority must be improving DSS funding and staffing. DSS also needs more community resources such as drug treatment programs, accessible quality child care, and parent support programs.
* Judges would be trained to understand child abuse and its effects. Too many times children have been returned to parents only to suffer more abuse.
* The state would create a comprehensive child abuse prevention plan. Many states have put forward the resources to develop such plans. The Maryland State Council on Child Abuse and Neglect has proposed launching an effort to complete a plan for this state. It should be supported and funded by the O'Malley administration.
Changing the system will be neither easy nor cheap. The cost of not doing anything, however, is enormous. Preventing one serious case of abusive head trauma would save hundreds of thousands of dollars in health care costs alone. Breaking the cycle of abuse for one family could save hundreds of thousands of dollars in jail costs by stopping the victim from becoming an abuser.
Besides, can anyone set a price on preventing the deaths of more innocent children?
Scott Krugman is chairman of the Department of Pediatrics at Franklin Square Hospital Center also chairs the state chapter of the American Academy of Pediatrics Child Maltreatment Committee. His e-mail is firstname.lastname@example.org.