ATrain Education

 

Continuing Education for Health Professionals

IA: Child Abuse, A Guide for Mandatory Reporters

Module 1

Legal Response to Child Abuse

Child abuse is not a new phenomenon. The abuse and neglect of children has been documented for more than two thousand years. However, attempts to prevent child abuse are relatively new.

The first documented legal response to child abuse in the United States occurred in 1874. The New York Society for the Prevention of Cruelty to Animals pleaded in court to have an 8-year-old child removed from her abusive and neglectful environment. Since there were no child abuse laws, the society argued that the child was, in fact, an animal, and should be provided the same protection as other animals. During the last few decades of the nineteenth century, societies to protect children from cruelty were formed in many states.

The next movement to protect children came as the result of several pediatricians publishing articles about children suffering multiple fractures and brain injuries at the hands of their caretakers. In 1961, C. Henry Kempe, a physician who was then president of the American Academy of Pediatrics, held a conference on the “battered child syndrome,” in which he outlined a “duty” to the child to prevent “repetition of trauma.” The Battered Child Syndrome Conference resulted in many states passing laws to protect children from physical abuse.

Child abuse is now recognized as a problem of epidemic proportions. Child abuse has serious consequences that may remain as indelible pain throughout the victim’s lifetime. The violence and negligence of parents and caretakers serve as a model for children as they grow up. The child victims of today, without protection and treatment, may become the child abusers of tomorrow.

As with any social issue, child abuse is a problem for the entire community. Achieving the goals of protective services requires the coordination of many resources. Each professional group and agency involved with a family assumes responsibility for specific elements of the child protective service process.

National Response

Nationally, the 2015 Child Maltreatment Report, published by the U.S. Department of Health and Human Services Children’s (USDHHS) Bureau, indicates that an estimated 4 million referrals alleging child abuse and neglect involving approximately 7.2 million children were made to state child protective service agencies that year, a 15.5% increase since 2011. Approximately 58% of referrals were accepted for investigation or assessment (ie, screened in) (USDHHS, 2015).

Approximately 21.4% of the investigations and assessments confirmed child abuse. There were an estimated 683,000 victims of child abuse nationwide. The rate of victimization was 9.2 per 1,000 children. The highest victimization rates were for the birth to age 1 group (24.2 per 1,000 children). Boys accounted for 48.6% of victims and girls 50.9% (USDHHS, 2015).

National studies continue to indicate that only about one-third of maltreated children are reported to child protection agencies. Significant numbers of victims remain unidentified and thus without protection and treatment.

In 1985 the U.S. Surgeon General declared family violence to be a national epidemic. At that time, an estimated 3.3 million children were exposed to violence by a family member against a mother or female caretaker. The U.S. Advisory Board on Child Abuse and Neglect found domestic violence to be the single major precursor to child abuse and neglect fatalities in the United States.

 

Did You Know. . .

Child abuse is 15 times more likely to occur in homes where adult domestic violence is present.

 

According to the Effective Intervention in Domestic Violence and Child Maltreatment Cases: Guidelines for Policy and Practice, published by the National Council of Juvenile and Family Court Judges in 1999, “Domestic violence perpetrators do not victimize only adults.” Known as The Greenbook, this publication fostered demonstration sites and is still in use today. Recent reviews of more than two decades of studies have revealed that in families where women are abused many of their children are also maltreated (IDJ, 2016, 1999).

According to the Iowa Attorney General’s Office, Crime Victim Assistance Division, from January 1995 through April 2016, 279 Iowans were killed in domestic abuse homicides. During that period:

  • 190 women were killed by their spouse, former spouse, boyfriend, or intimate partner
  • 35 men were killed by their partners
  • 54 bystanders were killed
  • 28 children were killed in domestic abuse murders
  • 200 minor children survived the murder of their mother or father
  • 84 children were present at the scene of the murder (IDJ, 2016)

Although many adults believe they have protected their child from exposure to domestic violence, 80% to 90% of children in those homes can give detailed descriptions of the violence experienced in their families (Doyne et al., 1999). The U.S. Advisory Board on Child Abuse suggests that domestic violence may be the single major precursor to child fatalities in this country.

Varying by samples selected and types of data gathered, the majority of these studies have found that a substantial proportion, ranging from 30% to 60%, of battered mothers’ children also are maltreated. Children who are abused physically or sexually or who witness violence tend to exhibit more developmental, cognitive, emotional, and social behavior problems—including depression and increased aggression—than other children (Edelson, 2011; FWV, 2013).

Iowa Response

Iowa’s child abuse reporting, assessment, and rehabilitation law, Iowa Code (IC) sections 232.67–232.75, was initially enacted in 1978 and has been amended numerous times since. Changes to the law can be made in any legislative session and have occurred in six of the last eight legislatures. An important change made in 2016 was the expansion of the definition of child abuse to include child sex trafficking and a modification of the sexual abuse code to include acts or omissions not only by a caretaker but also by “a person who resides in a home with the child” (Coreless, 2016; IC section 232.68(2)(a)(3) & (11); INAHT, 2016, 2016a).

The intent of the law is to identify children who are victims of abuse. The law also provides for a professional assessment to determine if abuse has occurred. Accompanying the assessment are protective services designed to protect, treat, and prevent further maltreatment.

The purpose of the Iowa law is to “provide the greatest possible protection to victims or potential victims of abuse through encouraging the increased reporting of suspected cases of abuse, ensuring the thorough and prompt assessment of these reports, and providing rehabilitative services, where appropriate and whenever possible, to abused children and their families, which will stabilize the home environment so that the family can remain intact without further danger to the child” (IC 232.67).

According to Iowa statute (IC 232.70), the Department of Human Services (DHS) has the responsibility to receive and assess reports of suspected child abuse and neglect.

In calendar year 2015, DHS accepted 24,298 reports for assessment. Family assessments were completed for 7,469 and child abuse assessments for the remaining 16,829. After completing the child abuse assessments, DHS found 10,787 (64%) to be unconfirmed, 1,231 (7.3%) confirmed, and 4,811 (28.6%) founded. These data reflect only the number of reports or assessments. Looking at unique children, the total reports covered 29,695 unique children, with the confirmed reports covering 1,408 and founded 6,890.

In 2014 the total number of reports accepted for assessment was 23,562 covering 28,332 unique children, and in 2013 26,129 reports covered 30,801 unique children (DHS, 2015).

 

Source: DHS, 2015.

Iowa Confirmed Child Abuse in Calendar Years 2013–2015

 

Percentage of total confirmed or founded abuse

Types of abuse

2013

2014

2015

Denial of critical care

78

.4%

70

.0%

72

.0%

Physical abuse

9

.0%

12

.4%

11

.4%

Presence of illegal drugs in child’s system

6

.4%

8

.5%

9

.4%

Sexual abuse

3

.9%

6

.6%

4

.8%

Allows access by registered sex offender

1

.0%

1

.1%

1

.3%

Exposure to manufacturing of meth

0

.9%

1

.1%

0

.6%

Mental injury

0

.2%

0

.2%

0

.2%

Other

0

.0%

0

.0%

0

.0%

 

DHS works closely with physicians, nurses, educators, mental health practitioners, law enforcement agencies, and the judiciary. These parties are involved in the identification, reporting, assessment, and treatment of cases of child maltreatment. Ultimately, children can be kept safer from abuse and neglect through increased community ownership, responsibility, and involvement. One entity alone (whether legislators, DHS, physicians, educators, or local law enforcement) cannot eliminate child abuse. The safety of children depends upon how well communities support families, organize basic systems, and make inclusive decisions about available resources.

Partnerships that involve parents, neighbors, and grassroots community groups, in addition to public agencies and non-profit organizations, create community ownership, responsibility, and involvement. The vision of partnerships has evolved with the realization that one size does not fit all. Through partnerships, citizens define a community’s needs, and services can be tailored to the particular needs and strengths of individual communities.

The child abuse reporting law is only one type of Iowa statute designed to deal with child abuse. Juvenile justice laws authorize the court to provide protection for children through supervision in their own homes or in substitute care. Criminal laws are separate from the child abuse reporting and juvenile justice laws. Criminal laws provide for prosecution of alleged perpetrators in cases where a criminal act has been committed.

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