Child abuse cuts across all socioeconomic lines. It does not matter what neighborhood a family lives in or how much money is in a bank account. In Columbia, and in every part of this country, child abuse is an unfortunate reality.
In the 12 counties encompassed by the Midlands, a total of 3,081 intakes were accepted for investigation this past year by the South Carolina Department of Social Services. That number reflects the reports taken regarding some type of child abuse among children under 18 years of age. Many cases are not reported.
Of those reported cases, 1,706 were founded investigations, meaning at least one child was found in each case to be a victim of abuse or neglect. This past year, the total number of abused children was 2,877.
Even though child sexual abuse receives the most press due to the heinous nature of the crime, the number of sexual abuse cases is significantly lower than physical abuse or neglect cases. Most recently, physical abuse cases have been front and center in the media. Reported have been cases of physical abuse so extreme that the children died: a 15-month-old this past May, a 4-year-old this past July and a 7-week-old this past August. All three children died due to extreme physical trauma to their bodies.
Neglect, as well, is prevalent. Neglect is defined as not providing a child with basic needs such as food, medical care, shelter and clothing. Neglect accounted for about 58 percent of all founded cases.
An Uphill Battle
According to the area’s leading child abuse authority, Olga C. Rosa, MD, who has a litany of titles to her credit, child abuse may garner headlines now and then, but consistent coverage in the media, and support from politicians, corporations and organizations, is most often focused on less widespread (albeit important) ills affecting children, such as autism, sickle cell anemia and cancer. Dr. Rosa, associate professor of pediatrics at USC and director of the Division of Forensic Pediatrics and the S.C. Children’s Advocacy Medical Response System, says child abuse impacts, for example, six times more children in the state than type 1 diabetes.
Dr. Rosa, a native of Puerto Rico, is one of a handful of pediatricians in the United States to become board certified in child abuse pediatrics. The subspecialty was approved by the American Board of Pediatrics in 2006. Dr. Rosa attended Brown University School of Medicine in Rhode Island for two years to add the subspecialty to her resume. Dr. Warren Derrick, then-chair of the Department of Pediatrics at USC, hired her in October 2004 to help bring clarity to an existing but fragmented system of dealing with child abuse in the Midlands.
“This area needed a cohesive way to respond to child abuse,” she says. In the past few years, many people have collaborated to grease the wheels of this complicated endeavor. “It’s multi-faceted, but we’ve come a long way.”
Within a few years, Dr. Rosa developed a statewide medical response network and established the S.C. Children’s Advocacy Medical Response System, which joined with the South Carolina Children’s Hospital Collaborative to address the shortage and training of clinicians specializing in the medical assessment of child abuse and neglect. The goals have been not only training, but also establishing clinical practice guidelines and assessment tools, as well as meeting for discussion and input forums. One of the physicians in this network, Dr. Susan Luberoff, medical director of the Assessment and Resource Center, worked with Dr. Rosa to provide 795 medical evaluations in the Midlands region this past year.
Dr. Rosa says it has been hard to know where to refer children for medical evaluations. Today, there is a more effective centralized system. The nightmare reality, however, is that for every story of child abuse that is reported and investigated, there are many more children that no one hears about.
As is telling in the three fatal cases recently reported by local news outlets, Dr. Rosa says, “We don’t get a second chance to help these children. If we cannot give a medical evaluation, DSS and law enforcement may have a harder job protecting the child. Without an informed medical decision, authorities may return the child to the family.”
Often, if a child is returned to an abusive home, he or she is likely to become abused again, perhaps fatally. Also, if abuse occurs with one child, it is highly probable that other children in the home will be victims of abuse as well. One of the recently reported cases, where the 7-week-old infant died, is one such instance. In mid-2012, Dr. Rosa assessed a 4-month-old brought into Palmetto Health Children’s Hospital because of blood on the brain, and extensive fractures were later found. DSS and law enforcement were called in to investigate which led to a court case. The 4-month-old was then taken out of the home. In the meantime, the mother had another child who, at 7 weeks old, died after a violent beating.
Dr. Rosa points out that it is always easy to blame DSS, but explains that this state agency — as well as law enforcement — can only do so much. There are laws, protocol and procedures to be followed when the state is investigating child abuse. Due, sometimes, to understaffing and low funding, children sometimes fall through the cracks of the same legal system put in place to protect them. And although social workers and law enforcement officers may have a gut feeling that something terrible may have happened, it can be difficult to obtain objective evidence.
“There is always tweaking that can be done — more checks and balances to put into place, more uniformity in the investigative process,” Dr. Rosa says. “We have to keep in mind that every case is idiosyncratic and needs to be looked at with keen eyes.”
Reaching the Top?
Dr. Rosa and others know that child abuse will — sadly — always be prevalent. However, the more people become aware of children in abusive situations and the more professionals become trained to handle abusive circumstances, the more children will benefit and be saved. Still, training additional people to become dedicated in the area of child abuse requires money, which often has to be accumulated in the form of grants and donations, explains Dr. Rosa. Physicians will often avoid a child abuse subspecialty because there are few monetary rewards.
In addition, Dr. Rosa says that involvement in child abuse is a highly emotional and often disturbing route for advocates, social workers, law enforcement officers and medical professionals alike, yet a sense of achieving a greater good sometimes serves to override emotions. For her part, Dr. Rosa says she has especially been affected by some cases. The case of the 7-week-old’s death was tragic in that she had already assessed the child’s sibling the year before. Although Dr. Rosa has no children of her own, realizing a loss due to child abuse is personally grievous.
“Thankfully, I have an awesome network of friends and family. I have a sister in Puerto Rico who runs a special needs education program and who is on the front lines of dealing with some of this, so she understands what I go through.” Dr. Rosa also finds escape in theater, art and music.
And when a child is saved and placed in a healthy home, or when the family members are rehabilitated so the child is safe in their own home, this is a reward, says Dr. Rosa. She has assessed some abused children who appeared as if they would not survive, yet, she sees them or hears of them months or years later and they are thriving. “When I know this, it is a really good day.”