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Child Abuse in Iowa
Barbara
Harre, MD
Quad
City Child and Family Resource Center, Davenport, Iowa
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In 2001, the Iowa Department of Human Services found that the number of reports of child abuse in Iowa increased by nearly 15% over 2000, reaching an all-time high of 25,696 reports. Nearly 70% of these cases were evaluated by DHS, and abuse was confirmed in 8,920 cases, affecting a total of 12,117 children. An abuse report may be determined to be:
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In 2000, 15 children died as the result of abuse by adult caregivers. Over the past several years, the deaths of abused children in Iowa have made it clear that we need a better system of protective services for children.
| Confirmed Abuse in Iowa, 2001 | ||
|---|---|---|
|
Type of abuse |
Number
of abused children
|
Percent
of all abused children
|
|
Denial of critical care [neglect] |
9,721 | 71.2% |
|
Physical injury |
2,442 | 17.9% |
|
Sexual abuse and child prostitution |
1,094 | 8.0% |
|
Presence
of |
375 | 2.7% |
|
Mental
injury
|
29 | 0.2% |
Some
children suffered more than one type of abuse.
DHS data as reported by Prevent Child Abuse - Iowa (2002)
Prevention and treatment of abuse
-
Our state has a number of parenting programs that serve as primary prevention strategies to help all families, and to prevent abuse from occurring in the first place. These programs include:
- Healthy Families-Iowa, which provides professional home visiting services to more than 800 families each year
- Success by Six, a United Way program for families and preschoolers
- Mothers of Preschoolers (MOPS), a faith-based program that focuses on parenting
-
Secondary
prevention
focuses on children and families at risk for abuse. It includes Department of
Human Services programs, foster care placements, Lutheran and Catholic Social
Services programs, play therapy, and counseling by therapists and psychologists.
Substance abuse treatment, anger management counseling, nutritional services,
financial support services, and health care services may also be tapped.
- Tertiary prevention involves programs for parents or caregivers who have abused children in their care. Its goal is to prevent the abuse from recurring. It can include imprisonment and the termination of parental rights. For abused children, it may involve costly, long-term medical and psychological care, for severe abuse can have long lasting, and even lifelong, effects on a child’s ability to function.
The
necessity of prevention
Child abuse is a symptom of a disordered relationship system that affects the entire family. Our ability to respond to this terrible problem will be limited unless we take a comprehensive look at the entire family unit and its environment.
Analyses of successful interventions with adult abusers make it starkly clear that primary and secondary prevention are essential.
Of adult abusers who receive treatment:
- One-third respond to educational and social support services
- Two-thirds
are repeat abusers. Of these:
- One-third have unhealthy coping styles that often stem from underlying personality disorders; many are substance abusers
- The other one-third have diagnosable mental and emotional disorders
Health care personnel need to recognize the factors that may forewarn a child is at risk for abuse, or that caregivers are at risk of abusing. These are outlined on insert page 2.
| Advocating
for each child
The American Academy of Pediatrics (AAP) recommends that questions about violence in the home, including child abuse, be a routine part of each well-child visit. This is an effective form of anticipatory guidance, and a key strategy in primary prevention. Topics of discussion should include:
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More than 80% of infant homicides are due to severe child abuse. American
Family |
If abuse is suspected, it is important to perform a comprehensive assessment of the child and the family (for more information on assessment, see the summer 2000 issue of this newsletter, w.medicine.uiowa. edu/uhs/ EPSDT/sum00/guide.htm). The procedures for reporting suspected child abuse are detailed on the Department of Human Resources web site, w.dhs.state.ia.us/reporting childabuse/. The initial assessment and following medico-legal evaluation for a child take time. Maine is the only state that currently provides any significant funding support for such assessments.
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What needs to happen Statewide. Often it is difficult for physicians to do such assessments well in the traditional office setting. One strategy for improving abuse services in Iowa would be to implement regional child abuse centers for medical care, such as the Regional Center for Child Protection at Blank Children’s Hospital in Des Moines and the Quad City Child and Family Resource Center in Davenport. The Iowa legislature has opened the door to the creation of such centers, but the funding hasn’t followed. Regional child abuse centers could take on the tasks of educating health care providers and consulting with front-line physicians as needed. The centers would become a communications hub for health care providers, law enforcement, social services, and the legal system. |
Centers need to be situated in the community so that they can provide a prompt response and actively participate in the critical first 24-48 hours of an investigation, when the majority of evidence is collected or lost. (For an overview of the range of services a center could coordinate, see Annotations, w.iowa-icaa.com/Annotations/2002/sep02.2.pdf, page 2.)
In the community. Finally, and very importantly, community physicians and mental health care providers need to work together to improve communications with one another. This would be mutually beneficial to these professionals and to the families they serve. Mental health support services need to be given financial support so that effective treatment can be provided.
Iowa, despite the funding woes that have plagued it for the last few years, has legislative leaders who do recognize and support efforts to improve child protective services. We can work with them to make Iowa a better place for all its children, and for their families.
Resources
Prevent Child Abuse in Iowa, www.pcaiowa.org/
Child abuse: The physician’s role in alleviating a growing problem, American Family Physician 6-15-00; www.aafp.org/afp/20000515/editorials.html
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