THE WESTERN
Journal of Medice Refer to: Gray DR, Leaverton DR: Physical child abuse-A review of all cases seen at Sacramento Medical Center in 1975. West J Med 129:461464, Dec 1978
Physical Child Abuse A Review of All Cases Seen at Sacramento Medical Center in 1975 DON R. GRAY, MD, Sacramento, California, and DAVID R. LEAVERTON, MD, Albany, New York
This report presents physical, sociaeconomic, demographic and follow-up information on all 18 cases of physical child abuse seen at the Sacramento Medical Center in 1975. Of the 18 abused children, 16 were initially discharged to Children's Protective Service; 13 were placed in foster homes. There were 17 alleged abusers; all were arrested; 12 came to trial; 8 were convicted. Preventive programs offer a less expensive approach and deserve the highest priority. DESPITE INCREASED public and professional awareness of the phenomenon of child abuse (and a resulting increase in numbers of cases reported),' there have been few efforts to assemble detailed quantitative documentation of trends in such specifics as type, extent and treatment cost of injuries; socioeconomic background of parents; judicial actions, and follow-up after release from hospital.2 This study was designed to provide data in these areas from the population served by the University of California, Davis/Sacramento Medical Center (UCD/SMC) in 1975. The purposes were (1 ) to enhance the validity of assessments of the current need for intervention in the Sacramento area by the Suspected Child Abuse and Neglect (SCAN) committee established at UCD/SMC in 1976 and (2) to provide a base for future research that might determine changes in local pat-terns of child abuse and degrees of success of intervention and prevention strategies. At the time this paper was submitted for publication, Dr. Gray was a senior medical student at the University of California, Davis. School of Medicine, and Dr. Leaverton was Associate Professor of Psychiatry and Pediatrics, University of California, Davis, Division of Mental Health, Sacramento. This research was partially supported by NIMH Grant No.
MH 11864 Undergraduate Training in Medical Education. Submitted April 4, 1978. Reprint requests to: David R. Leaverton, MD, Capitol District Psychiatric Center, Albany Medical College, 75 New Scotland Ave., Albany, NY 12208.
The present report is limited to physical abuse involving the individual child and family (level I abuse as defined by Gil).3 The decision to exclude institutional (level II) and societal (level III) abuse as well as nonphysical (emotional only) level I abuse is a measure not of the importance of these categories but of the greater difficulties of documentation. Physicians in private practice have been said to be reluctant to report child abuse and even more reluctant to testify about it.4 This attitude might be understandable if reporting were ultimately ineffective in terms of outcomes for the abused children. While this study could not determine the quality of life for the physically abused children reported, it does document their whereabouts in the period (up to 32 months) following hospital treatment. Children who suffered only emotional abuse and other types of neglect are not reported.
Method Physical, socioeconomic and demographic follow-up information on 18 physically abused children and 17 alleged abusers was obtained through careful review of hospital, social service and juvenile court records. Additional data regarding the outcomes for the alleged abusers in criminal THE WESTERN JOURNAL OF MEDICINE
461
PHYSICAL CHILD ABUSE ABBREVIATIONS USED IN TEXT CPS=Children's Protective Service SCAN=Suspected Child Abuse and Neglect UCD/SMC=University of California, Davis/ Sacramento Medical Center
TABLE 1.-Types of Injuries Found in 18 Abused Children*
Old traumas (on x-ray studies) 3 Old traumas (other signs) ... 11 Bruises .................. 16 Hot-water burns ...... .... 4 Cigarette burns ....... .... 2 Scratches ................ 2 Fractures ................ 2 Failure to thrive ...... 1....
after hospital admission.
Results Of the 909 admissions to the pediatric service of UCD/SMC during 1975, a total of 44 children were considered possible victims of physical abuse. In 18 cases, suspicions were confirmed by subsequent Children's Protective Service (cps) and Pediatric Social Service investigation. In the other 26 cases, these agencies found that there was insufficient evidence to justify further investigations. These children ranged in age from 2 to 102 months; 16 were less than 5 years of age. There were 11 boys and 7 girls. The racial distribution consisted of 12 Caucasians, 3 blacks, and 3 Mexican-Americans. Admissions were distributed almost equally throughout the year without seasonal clustering. The 15 households involved consisted of three married couples and 12 single parents. Twelve families were on welfare, and annual incomes of the remaining three families averaged $9,040. Table 1 shows breakdown of injuries; children often had more than one injury. Roentgenographic surveys for old skeletal traumas were done in all cases, with positive findings for three of the children. Other signs of old physical traumas were present in 11. The specific types of injuries were *
Disposition at discharge from hospital Home to abusive parent with CPS supervision 1.... Home to nonabusive parent ....... 2 ............ Receiving home (CPS) ......... ............. 15 Results of juvenile court hearing Declared dependent of court ....... ........... 15 Placed in foster home .......... .............. 13 Placed with nonabuse relative ...... 1 ........... Returned to abusive parent with court supervision 1
as
court were obtained with the cooperation of law enforcement agencies and the district attorney's office. Previous abuse information was obtained through the state Central Child Abuse File. Follow-up data were obtained 20 to 32 months
DECEMBER 1978
Number of Children
Overall status as of December 31, 1977 Remain in foster home ....................... Returned to nonabusive parent ........... Returned to abusive parent with supervision .....
*Some children had multiple injuries.
462
TABLE 2.-Disposition of 18 Children Identified as Victims of Physical Abuse
129
*
6
follows: bruises, burns, hot-water burns,
5
8 5
ciga-
rette burns, scratches (including abrasions) and fractures. Diagnosis for one child was failure to thrive secondary to neglect. Injuries of two chil-
dren
were considered potentially life-threatening: skull fracture and one third-degree burn covering 25 percent of the body surface area, for which long-term physical sequelae were scars and contractures that required multiple plastic surgery procedures. There were records of previous abuse for five of the children. There were no deaths during the follow-up period. No sexual abuse was identified in this group. Hospital costs averaged $2,079 per child, with a range from $192 to $21,150. Total hospital costs for the 18 cases amounted to $37,427. Table 2 indicates the disposition of the children after hospital treatment. As of December 31, 1977, five of the children were still in foster homes; eight had been returned to nonabusive parents; five were with abusive parents, under one
court supervision.
Of the 18 children admitted to the hospital, 16 were discharged to the custody of Children's Protective Service to await disposition hearings. One child who had been abused by the mother's boyfriend was discharged to the nonabusive mother since the boyfriend had been arrested and charged. The remaining child was discharged home to an abusive mother under supervision of cPs. This family was well known to juvenile authorities. In a review of cps records in this case, no record of this particular referral was found; however, previous child abuse was noted. This family has subsequently been lost to follow-up. Of the 16 children discharged to cps, one was
PHYSICAL CHILD ABUSE TABLE 3.-Outcome in Criminal Procedures for 17 Alleged Abusers Felony Misdemeanor Charges Charges
Number of arrests ........ Crimninal charges dropped .. Criminal charges reduced .. Trial verdict: acquittal .... Trial verdict: guilty ......
6 3 2 0 1
11 2 0 4 7
Total
17 5 2 4 8
held for two weeks, then returned to the nonabusive mother after the stepfather had been arrested and she had filed for divorce. The remaining 15 had disposition hearings in juvenile court and were declared dependents of the court. The same judge presided at all these hearings. Thirteen of these court dependents were placed in foster homes; one was placed with an aunt for a period of two months, then placed in the custody of the nonabusive father; and one was returned to an abusive mother under court supervision and with the condition that she receive counseling. Of the 13 children originally placed in foster homes, five remained with foster parents, with an average stay of 886 days (range from 734 to 940 days) as of December 31, 1977. By the end of 1977 an additional five of the 13 had been returned to the custody of nonabusive parents; the other three had been returned to the abusive parents. Two of these three abusive parents were placed under court supervision, with mandatory counseling. The other child was returned to his natural mother in Mexico (who had sold him for $1,500 to a visiting tourist), at the demand of the Mexican consulate and after lengthy court dispute. The child had come to the United States as an infant. He spoke only English and had developed a warm, nurturing relationship with his foster parents, who wanted very much to adopt him. It is doubtful that the best interest of this boy was a major consideration of the Mexican government. The eight children who were returned to their families after foster care had spent an average of 305 days (range from 90 to 624 days) in foster homes. The quality of these placements, although an extremely important variable in the prognosis, was not assessed. Seventeen alleged abusers were identified. Their average age was 23.6 years (range from 15 to 38 years), with 65 percent under age 25. The sex distribution was eight men and nine women. Educational level was obtained for 12 of the 17;
TABLE 4.-Outcomes for Eight Convicted Child Abusers
Abuser and Charge
Probation (Years)
1-Misdemeanor ... 3 2-Misdemeanor ... 3 3-Misdemeanor ... 3 4-Misdemeanor ... 3 5-Misdemeanor 5 6-Misdemeanor. 7-Misdemeanor. 8-Felony ..........
Time Served County Jail State (Days) Prison
Courtordered Psychotherapy
3
x x x
135 135 30
x x
45
x *
*By March 1978 the father who was convicted of felony child abuse had served 36 months in state prison.
the average was 10.6 years. Files of cps revealed that histories of 10 of 13 adults questioned showed that they themselves had been physically abused as children. Of the alleged abusers, 88 percent were unemployed at the time of the abusive incident. Relationships of the 17 abusers to the children were as follows: mother, seven; father, three; mother's boyfriend, three; father's girlfriend, one; stepfather, two. There was one adoptive mother who had purchased a child in Mexico for $1,500. Of the 17 abusers, 5 were married and 12 were single. All 17 alleged abusers were arrested. Outcomes of criminal procedures are given in Tables 3 and 4. Eleven were charged with misdemeanors and six with felony child abuse. Subsequently, charges were dropped in five cases and reduced in two. Twelve of those originally arrested came to trial. The one father under felony charges was convicted and was sentenced to serve time in a state prison. Seven were found guilty of misdemeanor child abuse and were sentenced to various combinations of probation, time in the county jail and psychotherapy. Four were acquitted because of insufficient evidence. Fourteen of the 17 arrests were appropriately reported to the state Central Child Abuse File by the referral agency. Five of those arrested were found to have previous records of child abuse.
Discussion This report indicates that physical child abuse is common and expensive and that outcomes are varied. Contrary to persistent rumors in the medical community, most of these children were not back in their original homes where the abuse occurred within a few months. Of the 44 children suspected to be victims of THE WESTERN JOURNAL OF MEDICINE
463
PHYSICAL CHILD ABUSE
physical abuse, medical records showed that only 18 were reported to cPs. It seems likely that more were reported but were not documented in the charts. The cross-checking of records indicated many gaps, as is illustrated by the lack of complete reporting to the state Central Child Abuse File. It is distressing that so many children had to be removed from their families for such long periods. This community (the Sacramento area) has available above-average quality and quantity of mental health professionals. Better communication and coordination among courts, agencies, and support facilities perhaps could have decreased these family disruptions. Should the priorities of these authorities become more oriented to treatment and prevention, children will be returned sooner to stabilized situations. Failure to identify a case of child abuse can result in very real tragedy. One of our primary goals at UCD/SMC iS to develop a keen awareness among housestaff of the problem and to develop a fail-safe system for referral and follow-up of these children. In the follow-up reported here, most of the children were young, and perhaps for this reason remedial treatment was not given a high priority. There remains some doubt about alleviation of the long-term emotional scars and whether the pattern of attempting to solve problems through violence can be reversed. Successful psychotherapeutic treatment of abused children and their families is now more commonly reported in the
literature.5'6 Racial distribution, income average and mental status of the persons involved in this study reflect the UCD/SMC service population. Authorities of cps state that this center is the main referral site for child abuse and thus we would suggest that
incidents of abuse in the higher-income families are not adequately reported in this area. Protec-
464
DECEMBER 1978 * 129 * 6
tion for the abused children does not seem to have been a primary concern in the cases reported here, since all suspected abusers were arrested while other child-abuse procedures, such as adequate psychosocial workup and review, were not uniformly carried out. That more cases of older children were not reported may indicate a low level of awareness in those who refer and report. Comparing this report with future data should show trends in types of abuse reported, demographic data about the abusers, the children's age and sex, permanence of injuries, expense involved and degree of previous abuse. Such comparisons can serve as an audit of the evaluations of the SCAN team. Child abuse can be prevented.7 As this community institutes programs for prevention and early intervention, future studies should reflect these changes. In view of the tremendous expense and inherent difficulty in comprehensive treatment programs, it is our opinion that prevention programs should have the highest priority.
Summary Cases of all physically abused children who were admitted in 1975 to UCD/SMC were reviewed. Data concerning outcome for the abused and the abusers are given, thus establishing a baseline to measure changes in incidence, treatment and prevention. REFERENCES 1. Kempe CH, Silverman FN, Steele BF: The battered child syndrome. JAMA 181:17, 1962 2. Zuckerman K, Ambuel JP, Bandman R: Child neglect and abuse. Ohio State Med 68:629-632, 1972 3. Gil DG: Violence Against Children-Physical Child Abuse in the United States. Cambridge, Mass., Harvard University Press, 1970. 4. Green FC: Child abuse and neglect. Pediatr Clin N Am 22: 329-339, 1975 5. Green AH: A psychodynamic approach to the study and treatment of child-abusing parents. J Child Psychiatry 15:414-429, 1976 6. McDermott JF: The treatment of child abuse. J Child Psychiatry 15:430.440, 1976 7. Helfer RE, Kempe CH: Child Abuse and Neglect: The Family and the Community. Cambridge, Mass., Ballinger Publishing Co, 1976
Journal of Medice Refer to: Gray DR, Leaverton DR: Physical child abuse-A review of all cases seen at Sacramento Medical Center in 1975. West J Med 129:461464, Dec 1978
Physical Child Abuse A Review of All Cases Seen at Sacramento Medical Center in 1975 DON R. GRAY, MD, Sacramento, California, and DAVID R. LEAVERTON, MD, Albany, New York
This report presents physical, sociaeconomic, demographic and follow-up information on all 18 cases of physical child abuse seen at the Sacramento Medical Center in 1975. Of the 18 abused children, 16 were initially discharged to Children's Protective Service; 13 were placed in foster homes. There were 17 alleged abusers; all were arrested; 12 came to trial; 8 were convicted. Preventive programs offer a less expensive approach and deserve the highest priority. DESPITE INCREASED public and professional awareness of the phenomenon of child abuse (and a resulting increase in numbers of cases reported),' there have been few efforts to assemble detailed quantitative documentation of trends in such specifics as type, extent and treatment cost of injuries; socioeconomic background of parents; judicial actions, and follow-up after release from hospital.2 This study was designed to provide data in these areas from the population served by the University of California, Davis/Sacramento Medical Center (UCD/SMC) in 1975. The purposes were (1 ) to enhance the validity of assessments of the current need for intervention in the Sacramento area by the Suspected Child Abuse and Neglect (SCAN) committee established at UCD/SMC in 1976 and (2) to provide a base for future research that might determine changes in local pat-terns of child abuse and degrees of success of intervention and prevention strategies. At the time this paper was submitted for publication, Dr. Gray was a senior medical student at the University of California, Davis. School of Medicine, and Dr. Leaverton was Associate Professor of Psychiatry and Pediatrics, University of California, Davis, Division of Mental Health, Sacramento. This research was partially supported by NIMH Grant No.
MH 11864 Undergraduate Training in Medical Education. Submitted April 4, 1978. Reprint requests to: David R. Leaverton, MD, Capitol District Psychiatric Center, Albany Medical College, 75 New Scotland Ave., Albany, NY 12208.
The present report is limited to physical abuse involving the individual child and family (level I abuse as defined by Gil).3 The decision to exclude institutional (level II) and societal (level III) abuse as well as nonphysical (emotional only) level I abuse is a measure not of the importance of these categories but of the greater difficulties of documentation. Physicians in private practice have been said to be reluctant to report child abuse and even more reluctant to testify about it.4 This attitude might be understandable if reporting were ultimately ineffective in terms of outcomes for the abused children. While this study could not determine the quality of life for the physically abused children reported, it does document their whereabouts in the period (up to 32 months) following hospital treatment. Children who suffered only emotional abuse and other types of neglect are not reported.
Method Physical, socioeconomic and demographic follow-up information on 18 physically abused children and 17 alleged abusers was obtained through careful review of hospital, social service and juvenile court records. Additional data regarding the outcomes for the alleged abusers in criminal THE WESTERN JOURNAL OF MEDICINE
461
PHYSICAL CHILD ABUSE ABBREVIATIONS USED IN TEXT CPS=Children's Protective Service SCAN=Suspected Child Abuse and Neglect UCD/SMC=University of California, Davis/ Sacramento Medical Center
TABLE 1.-Types of Injuries Found in 18 Abused Children*
Old traumas (on x-ray studies) 3 Old traumas (other signs) ... 11 Bruises .................. 16 Hot-water burns ...... .... 4 Cigarette burns ....... .... 2 Scratches ................ 2 Fractures ................ 2 Failure to thrive ...... 1....
after hospital admission.
Results Of the 909 admissions to the pediatric service of UCD/SMC during 1975, a total of 44 children were considered possible victims of physical abuse. In 18 cases, suspicions were confirmed by subsequent Children's Protective Service (cps) and Pediatric Social Service investigation. In the other 26 cases, these agencies found that there was insufficient evidence to justify further investigations. These children ranged in age from 2 to 102 months; 16 were less than 5 years of age. There were 11 boys and 7 girls. The racial distribution consisted of 12 Caucasians, 3 blacks, and 3 Mexican-Americans. Admissions were distributed almost equally throughout the year without seasonal clustering. The 15 households involved consisted of three married couples and 12 single parents. Twelve families were on welfare, and annual incomes of the remaining three families averaged $9,040. Table 1 shows breakdown of injuries; children often had more than one injury. Roentgenographic surveys for old skeletal traumas were done in all cases, with positive findings for three of the children. Other signs of old physical traumas were present in 11. The specific types of injuries were *
Disposition at discharge from hospital Home to abusive parent with CPS supervision 1.... Home to nonabusive parent ....... 2 ............ Receiving home (CPS) ......... ............. 15 Results of juvenile court hearing Declared dependent of court ....... ........... 15 Placed in foster home .......... .............. 13 Placed with nonabuse relative ...... 1 ........... Returned to abusive parent with court supervision 1
as
court were obtained with the cooperation of law enforcement agencies and the district attorney's office. Previous abuse information was obtained through the state Central Child Abuse File. Follow-up data were obtained 20 to 32 months
DECEMBER 1978
Number of Children
Overall status as of December 31, 1977 Remain in foster home ....................... Returned to nonabusive parent ........... Returned to abusive parent with supervision .....
*Some children had multiple injuries.
462
TABLE 2.-Disposition of 18 Children Identified as Victims of Physical Abuse
129
*
6
follows: bruises, burns, hot-water burns,
5
8 5
ciga-
rette burns, scratches (including abrasions) and fractures. Diagnosis for one child was failure to thrive secondary to neglect. Injuries of two chil-
dren
were considered potentially life-threatening: skull fracture and one third-degree burn covering 25 percent of the body surface area, for which long-term physical sequelae were scars and contractures that required multiple plastic surgery procedures. There were records of previous abuse for five of the children. There were no deaths during the follow-up period. No sexual abuse was identified in this group. Hospital costs averaged $2,079 per child, with a range from $192 to $21,150. Total hospital costs for the 18 cases amounted to $37,427. Table 2 indicates the disposition of the children after hospital treatment. As of December 31, 1977, five of the children were still in foster homes; eight had been returned to nonabusive parents; five were with abusive parents, under one
court supervision.
Of the 18 children admitted to the hospital, 16 were discharged to the custody of Children's Protective Service to await disposition hearings. One child who had been abused by the mother's boyfriend was discharged to the nonabusive mother since the boyfriend had been arrested and charged. The remaining child was discharged home to an abusive mother under supervision of cPs. This family was well known to juvenile authorities. In a review of cps records in this case, no record of this particular referral was found; however, previous child abuse was noted. This family has subsequently been lost to follow-up. Of the 16 children discharged to cps, one was
PHYSICAL CHILD ABUSE TABLE 3.-Outcome in Criminal Procedures for 17 Alleged Abusers Felony Misdemeanor Charges Charges
Number of arrests ........ Crimninal charges dropped .. Criminal charges reduced .. Trial verdict: acquittal .... Trial verdict: guilty ......
6 3 2 0 1
11 2 0 4 7
Total
17 5 2 4 8
held for two weeks, then returned to the nonabusive mother after the stepfather had been arrested and she had filed for divorce. The remaining 15 had disposition hearings in juvenile court and were declared dependents of the court. The same judge presided at all these hearings. Thirteen of these court dependents were placed in foster homes; one was placed with an aunt for a period of two months, then placed in the custody of the nonabusive father; and one was returned to an abusive mother under court supervision and with the condition that she receive counseling. Of the 13 children originally placed in foster homes, five remained with foster parents, with an average stay of 886 days (range from 734 to 940 days) as of December 31, 1977. By the end of 1977 an additional five of the 13 had been returned to the custody of nonabusive parents; the other three had been returned to the abusive parents. Two of these three abusive parents were placed under court supervision, with mandatory counseling. The other child was returned to his natural mother in Mexico (who had sold him for $1,500 to a visiting tourist), at the demand of the Mexican consulate and after lengthy court dispute. The child had come to the United States as an infant. He spoke only English and had developed a warm, nurturing relationship with his foster parents, who wanted very much to adopt him. It is doubtful that the best interest of this boy was a major consideration of the Mexican government. The eight children who were returned to their families after foster care had spent an average of 305 days (range from 90 to 624 days) in foster homes. The quality of these placements, although an extremely important variable in the prognosis, was not assessed. Seventeen alleged abusers were identified. Their average age was 23.6 years (range from 15 to 38 years), with 65 percent under age 25. The sex distribution was eight men and nine women. Educational level was obtained for 12 of the 17;
TABLE 4.-Outcomes for Eight Convicted Child Abusers
Abuser and Charge
Probation (Years)
1-Misdemeanor ... 3 2-Misdemeanor ... 3 3-Misdemeanor ... 3 4-Misdemeanor ... 3 5-Misdemeanor 5 6-Misdemeanor. 7-Misdemeanor. 8-Felony ..........
Time Served County Jail State (Days) Prison
Courtordered Psychotherapy
3
x x x
135 135 30
x x
45
x *
*By March 1978 the father who was convicted of felony child abuse had served 36 months in state prison.
the average was 10.6 years. Files of cps revealed that histories of 10 of 13 adults questioned showed that they themselves had been physically abused as children. Of the alleged abusers, 88 percent were unemployed at the time of the abusive incident. Relationships of the 17 abusers to the children were as follows: mother, seven; father, three; mother's boyfriend, three; father's girlfriend, one; stepfather, two. There was one adoptive mother who had purchased a child in Mexico for $1,500. Of the 17 abusers, 5 were married and 12 were single. All 17 alleged abusers were arrested. Outcomes of criminal procedures are given in Tables 3 and 4. Eleven were charged with misdemeanors and six with felony child abuse. Subsequently, charges were dropped in five cases and reduced in two. Twelve of those originally arrested came to trial. The one father under felony charges was convicted and was sentenced to serve time in a state prison. Seven were found guilty of misdemeanor child abuse and were sentenced to various combinations of probation, time in the county jail and psychotherapy. Four were acquitted because of insufficient evidence. Fourteen of the 17 arrests were appropriately reported to the state Central Child Abuse File by the referral agency. Five of those arrested were found to have previous records of child abuse.
Discussion This report indicates that physical child abuse is common and expensive and that outcomes are varied. Contrary to persistent rumors in the medical community, most of these children were not back in their original homes where the abuse occurred within a few months. Of the 44 children suspected to be victims of THE WESTERN JOURNAL OF MEDICINE
463
PHYSICAL CHILD ABUSE
physical abuse, medical records showed that only 18 were reported to cPs. It seems likely that more were reported but were not documented in the charts. The cross-checking of records indicated many gaps, as is illustrated by the lack of complete reporting to the state Central Child Abuse File. It is distressing that so many children had to be removed from their families for such long periods. This community (the Sacramento area) has available above-average quality and quantity of mental health professionals. Better communication and coordination among courts, agencies, and support facilities perhaps could have decreased these family disruptions. Should the priorities of these authorities become more oriented to treatment and prevention, children will be returned sooner to stabilized situations. Failure to identify a case of child abuse can result in very real tragedy. One of our primary goals at UCD/SMC iS to develop a keen awareness among housestaff of the problem and to develop a fail-safe system for referral and follow-up of these children. In the follow-up reported here, most of the children were young, and perhaps for this reason remedial treatment was not given a high priority. There remains some doubt about alleviation of the long-term emotional scars and whether the pattern of attempting to solve problems through violence can be reversed. Successful psychotherapeutic treatment of abused children and their families is now more commonly reported in the
literature.5'6 Racial distribution, income average and mental status of the persons involved in this study reflect the UCD/SMC service population. Authorities of cps state that this center is the main referral site for child abuse and thus we would suggest that
incidents of abuse in the higher-income families are not adequately reported in this area. Protec-
464
DECEMBER 1978 * 129 * 6
tion for the abused children does not seem to have been a primary concern in the cases reported here, since all suspected abusers were arrested while other child-abuse procedures, such as adequate psychosocial workup and review, were not uniformly carried out. That more cases of older children were not reported may indicate a low level of awareness in those who refer and report. Comparing this report with future data should show trends in types of abuse reported, demographic data about the abusers, the children's age and sex, permanence of injuries, expense involved and degree of previous abuse. Such comparisons can serve as an audit of the evaluations of the SCAN team. Child abuse can be prevented.7 As this community institutes programs for prevention and early intervention, future studies should reflect these changes. In view of the tremendous expense and inherent difficulty in comprehensive treatment programs, it is our opinion that prevention programs should have the highest priority.
Summary Cases of all physically abused children who were admitted in 1975 to UCD/SMC were reviewed. Data concerning outcome for the abused and the abusers are given, thus establishing a baseline to measure changes in incidence, treatment and prevention. REFERENCES 1. Kempe CH, Silverman FN, Steele BF: The battered child syndrome. JAMA 181:17, 1962 2. Zuckerman K, Ambuel JP, Bandman R: Child neglect and abuse. Ohio State Med 68:629-632, 1972 3. Gil DG: Violence Against Children-Physical Child Abuse in the United States. Cambridge, Mass., Harvard University Press, 1970. 4. Green FC: Child abuse and neglect. Pediatr Clin N Am 22: 329-339, 1975 5. Green AH: A psychodynamic approach to the study and treatment of child-abusing parents. J Child Psychiatry 15:414-429, 1976 6. McDermott JF: The treatment of child abuse. J Child Psychiatry 15:430.440, 1976 7. Helfer RE, Kempe CH: Child Abuse and Neglect: The Family and the Community. Cambridge, Mass., Ballinger Publishing Co, 1976
