[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
STRENGTHENING PREVENTION AND TREATMENT
OF CHILD ABUSE AND NEGLECT
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON CIVIL RIGHTS AND HUMAN SERVICES
COMMITTEE ON EDUCATION
AND LABOR
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, MARCH 26, 2019
__________
Serial No. 116-12
__________
Printed for the use of the Committee on Education and Labor
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: www.govinfo.gov
or
Committee address: https://edlabor.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
36-587 PDF WASHINGTON : 2019
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COMMITTEE ON EDUCATION AND LABOR
ROBERT C. ``BOBBY'' SCOTT, Virginia, Chairman
Susan A. Davis, California Virginia Foxx, North Carolina,
Raul M. Grijalva, Arizona Ranking Member
Joe Courtney, Connecticut David P. Roe, Tennessee
Marcia L. Fudge, Ohio Glenn Thompson, Pennsylvania
Gregorio Kilili Camacho Sablan, Tim Walberg, Michigan
Northern Mariana Islands Brett Guthrie, Kentucky
Frederica S. Wilson, Florida Bradley Byrne, Alabama
Suzanne Bonamici, Oregon Glenn Grothman, Wisconsin
Mark Takano, California Elise M. Stefanik, New York
Alma S. Adams, North Carolina Rick W. Allen, Georgia
Mark DeSaulnier, California Francis Rooney, Florida
Donald Norcross, New Jersey Lloyd Smucker, Pennsylvania
Pramila Jayapal, Washington Jim Banks, Indiana
Joseph D. Morelle, New York Mark Walker, North Carolina
Susan Wild, Pennsylvania James Comer, Kentucky
Josh Harder, California Ben Cline, Virginia
Lucy McBath, Georgia Russ Fulcher, Idaho
Kim Schrier, Washington Van Taylor, Texas
Lauren Underwood, Illinois Steve Watkins, Kansas
Jahana Hayes, Connecticut Ron Wright, Texas
Donna E. Shalala, Florida Daniel Meuser, Pennsylvania
Andy Levin, Michigan* William R. Timmons, IV, South
Ilhan Omar, Minnesota Carolina
David J. Trone, Maryland Dusty Johnson, South Dakota
Haley M. Stevens, Michigan
Susie Lee, Nevada
Lori Trahan, Massachusetts
Joaquin Castro, Texas
* Vice-Chair
Veronique Pluviose, Staff Director
Brandon Renz, Minority Staff Director
------
SUBCOMMITTEE ON CIVIL RIGHTS AND HUMAN SERVICES
SUZANNE BONAMICI, OREGON, Chairwoman
Raul M. Grijalva, Arizona James Comer, Kentucky,
Marcia L. Fudge, Ohio Ranking Member
Kim Schrier, Washington Glenn ``GT'' Thompson,
Jahana Hayes, Connecticut Pennsylvania
David Trone, Maryland Elise M. Stefanik, New York
Susie Lee, Nevada Dusty Johnson, South Dakota
C O N T E N T S
----------
Page
Hearing held on March 26, 2019................................... 1
Statement of Members:
Bonamici, Hon. Suzanne, Chairwoman, Subcommittee on Civil
Rights and Human Services.................................. 1
Prepared statement of.................................... 3
Comer, Hon. James, Ranking Member, Subcommittee on Civil
Rights and Human Services.................................. 4
Prepared statement of.................................... 5
Statement of Witnesses:
Jackson, Dr. Yo, Ph.D, ABPP, Professor, Phychology Department
and Associate Diector, Child Maltreatment Solutions
Network, The Pennsylvania State University, Pennsylvania
and Research Professor, University of Kansas............... 7
Prepared statement of.................................... 10
King, Ms. Judy, MSW, Director, Family Support Programs,
Washing State Department of Children, Youth, and Families,
Olympia, WA................................................ 20
Prepared statement of.................................... 22
Thomas, Mr. Bradley, CEO, Triple P, Positive Parenting
Program, Columbia, SC...................................... 30
Prepared statement of.................................... 32
Rose, Mrs. LaCrisha, Facilitator of the West Virginia Circle
of Parents Network, Team for West Virginia Children, Miami,
WV......................................................... 40
Prepared statement of.................................... 42
Additional Submissions:
Chairwoman Bonamici:
Link: Strengthening National Data on Child Fatalities
Could Aid In Prevention................................ 64
Article: The Economic Burden of Child Maltreatment in the
United States, 2015.................................... 65
Dr. Jackson's response to question submitted for the record.. 85
Schrier, Hon. Kim, a Representative in Congress from the
State of Washington:
Prepared statement by Melmed, Mr. Matthew E., Executive
Director, Zero To Three................................ 73
Scott, Hon. Robert C. ``Bobby'', a Representative in Congress
from the State of Virginia:
Question submitted for the record........................ 84
Trone, Hon. David J., a Representative in Congress from the
State of Maryland:
Link: Within Our Reach................................... 49
STRENGTHENING PREVENTION AND TREATMENT OF CHILD ABUSE AND NEGLECT
----------
Tuesday, March 26, 2019
House of Representatives,
Subcommittee on Civil Rights and Human Services,
Committee on Education and Labor,
Washington, DC.
----------
The subcommittee met, pursuant to notice, at 2:45 p.m., in
room 2175, Rayburn House Office Building, Hon. Suzanne Bonamici
[chairwoman of the subcommittee] presiding.
Present: Representatives Bonamaci, Schrier, Hayes, Trone,
Lee, Scott, Comer, Thompson, Stefanik, Johnson, and Foxx.
Also present: Representative Langevin.
Staff present: Alli Tylease, Chief Clerk; Jacque Mosely
Chevalier, Director of Education Policy; Paula Daneri,
Education Policy Fellow; Christian Haines, General Counsel,
Education; Alison Hard, Professional Staff Member; Ariel Jona,
Staff Assistant; Stephanie Lalle, Deputy Communications
Director; Max Moore, Office Aide; Banyon Vassar, Deputy
Director of Information Technology; Cyrus Artz, Minority
Parliamentarian; Marty Boughton, Minority Press Secretary;
Courtney Butcher, Minority Coalitions and Members Services
Coordinator; Bridget Handy, Minority Legislative Assistant;
Blake Johnson, Minority Staff Assistant; Amy Raaf Jones,
Minority Director of Education and Human Resources Policy;
Hannah Matesic, Minority Director of Operations; Kelley McNabb,
Minority Communications Director; Jake Middlebrooks, Minority
Professional Staff Member; Mandy Schaumburg, Minority Chief
Counsel and Deputy Director of Education Policy; and Meredith
Schellin, Minority Deputy Press Secretary and Digital Advisor.
Chairwoman Bonamici. The subcommittee on Civil Rights and
Human Services will come to order. Welcome everyone. I note
that a quorum is present and apologize for the late start. We
were voting.
I ask unanimous consent that Mr. Langevin of Rhode Island
be permitted to participate in today's hearing with the
understanding that his questions will come only after all
members of the subcommittee on Civil Rights and Human Services
on both sides of the aisle who are present have had an
opportunity to question the witnesses.
Without objection. So ordered.
The committee is meeting today in a legislative hearing to
hear testimony on strengthening prevention and treatment of
child abuse and neglect. Pursuant to committee rule 7(c),
opening statements are limited to the chair and ranking member.
This allows us to hear from our witnesses sooner and provide
all members with adequate time to ask questions. I recognize
myself now for the purpose of making an opening statement.
We are here today to discuss our responsibility to protect
the health and safety of our Nation's children. Child abuse and
neglect, collectively, child maltreatment are quiet nationwide
tragedies that unfold every day in communities across the
country.
In 2017, state child protection services agencies received
a total of 4.1 million referrals of possible child abuse or
neglect involving 7.5 million children. All together, child
maltreatment affects as many as one in seven children. Victims
of child maltreatment typically suffer both immediate and
lasting harm. In the short-term, maltreatment can result in
significant physical injuries in addition to emotional and
psychological disruption, and the effects can last over a
lifetime.
Emotional and psychological abuse can hinder not only
social growth but also the physical growth of the brain itself.
As adults, victims of child maltreatment can suffer from
inhibited memory processing and struggle to control their
emotions and behaviors. As a result, they are 7 percent more
likely to drop out of high school and nine times more likely to
be involved with the juvenile justice system than their peers.
The trauma suffered by these children and families will stay
with them for a lifetime, and in Congress, we should always
look for ways to support trauma informed care.
In addition to the high personal costs, child maltreatment
also carries devastating societal costs. Research shows that
the long-term effects can have lifetime costs of more than
$800,000 per child all together. This is a public health crisis
that costs more than $400 billion each year.
Since the passage of the Child Abuse Prevention and
Treatment Act, or CAPTA, more than 3 decades ago we have made
progress toward reducing cases of child maltreatment. In fact,
from 1990 to 2009, rates steadily declined and then plateaued
through 2012. Despite that, we face new challenges in our
efforts to address child maltreatment. Since 2013, the rate at
which children are abused and neglected has steadily increased,
and with it, tragically, the rate of child deaths has also gone
up. In the year 2017, child deaths from maltreatment reached an
all-time high; 1,720 children lost their lives.
Evidence suggests that the opioid crisis is giving rise to
new challenges in protecting vulnerable children. In my home
state of Oregon, I have met with parents, healthcare
professionals, community leaders, veterans, and people from all
walks of life who have shared heart wrenching stories about how
the opioid crisis is taking lives and inflicting pain on
families. This crisis can be particularly devastating for
mothers and newborn children.
As our understanding of child abuse and neglect deepens, we
must update our approach accordingly. We cannot continue to
address this public health crisis by just reacting after child
maltreatment cases arise. As this committee considers
reauthorizing the Child Abuse Prevention and Treatment Act,
last updated nearly a decade ago, we must shift our focus to
preventing, preventing the maltreatment from occurring in the
first place.
We need a CAPTA reauthorization that strengthens federal
investments in community-based prevention services so families
across the country can receive help before children suffer. We
need to build networks of wraparound services that lower the
risk of child maltreatment by helping families navigate complex
health, educational, and financial hardships, and we need to
streamline communication between and among states so child
protection agencies across the country can connect the dots and
prevent cases of child maltreatment, no matter where they
occur, from slipping through the cracks.
All of us in this room recognize that Congress has a
responsibility to protect children. We must work together to
invest in services that prevent, not just treat, child abuse
and neglect. Today's hearing is an important step toward making
sure that all children grow up in a safe and healthy
environment that allows them to reach their full potential.
I want to thank all of our witnesses for being here today.
I look forward to your testimony, and I now yield to the
ranking member, Mr. Comer.
[The statement of Chairwoman Bonamici follows:]
Prepared Statement of Hon. Suzanne Bonamici, Chairwoman, Subcommittee
on Civil Rights and Human Services
We are here today to discuss our responsibility to protect the
health and safety of our Nation's children.
Child abuse and neglect, collectively child maltreatment, are
quiet, nationwide tragedies that unfold every day in communities across
the country. In 2017, State child protection services agencies received
a total of 4.1 million referrals of possible child abuse or neglect
involving 7.5 million children. Altogether, child maltreatment affects
as many as one in seven children.
Victims of child maltreatment typically suffer both immediate and
lasting harm. In the short-term, maltreatment can result in significant
physical injuries, in addition to emotional and psychological
disruption. And the effects can last over a lifetime. Emotional and
psychological abuse can hinder not only social growth but also the
physical growth of the brain, itself.
As adults, victims of child maltreatment can suffer from inhibited
memory processing and struggle to control their emotions and behaviors.
As a result, they are 7 percent more likely to drop out of high school
and nine times more likely to become involved with the juvenile justice
system than their peers. The trauma suffered by these children and
families will stay with them for a lifetime, and in Congress we should
always look for ways to support trauma-informed care.
In addition to the high personal costs, child maltreatment also
carries devastating societal costs. Research shows that the long-term
effects can have lifetime costs of more than $800,000 per child.
Altogether, this public health crisis costs more than $400 billion each
year.
Since the passage of the Child Abuse Prevention and Treatment Act,
or CAPTA, more than three decades ago, we have made progress toward
reducing cases of child maltreatment. In fact, from 1990 to 2009, rates
steadily declined, and then plateaued through 2012.
Despite that, we face new challenges in our efforts to address
child maltreatment. Since 2013, the rate at which children are abused
and neglected has steadily increased. And with it, tragically, the rate
of child deaths has also gone up. In the year 2017, child deaths from
maltreatment reached an all-time high--1,720 children lost their lives.
Evidence suggests that the opioid crisis is giving rise to new
challenges in protecting vulnerable children.
In my home State of Oregon, I have met with parents, health care
professionals, community leaders, veterans, and people from all walks
of life who have shared heart-wrenching stories about how the opioid
crisis is taking lives and inflicting pain on families. This crisis can
be particularly devastating for mothers and newborn children.
As our understanding of child abuse and neglect deepens, we must
update our approach accordingly.
We cannot continue to address this public health crisis by just
reacting after child maltreatment cases arise. As this Committee
considers reauthorizing the Child Abuse Prevention and Treatment Act--
last updated nearly a decade ago--we must shift our focus to preventing
the maltreatment from occurring in the first place.
We need a CAPTA reauthorization that strengthens Federal
investments in community-based prevention services so families across
the country can receive help before children suffer.
We need to build networks of wrap-around services that lower the
risk of child maltreatment by helping families navigate complex health,
educational, and financial hardships.
And we need to streamline communication between and among States so
child protection agencies across the country can connect the dots and
prevent cases of child maltreatment, no matter where they occur, from
slipping through the cracks.
All of us in this room recognize that Congress has a responsibility
to protect children. We must work together to invest in services that
prevent, not just treat, child abuse and neglect.
Today's hearing is an important step toward making sure that all
children grow up in a safe and healthy environment that allows them to
reach their full potential.
I want to thank all our witnesses for being with us today. I look
forward to your testimony and I now yield to the Ranking Member, Mr.
Comer.
______
Mr. Comer. Thank you, Madam Chairman, for yielding. Thank
you all for being here today. As the dad of three young
children, today's topic is a very difficult one to discuss. No
child should ever have to endure the pain of abuse or neglect
by a parent or caregiver. That is why today's hearing is so
important.
The Child Abuse Prevention and Treatment Act or CAPTA is
the key federal legislation that helps states combat child
abuse and neglect. This legislation, which was enacted in 1974,
provides states with grant funding to develop programs aimed at
prevention, assessment, investigation, prosecution, and
treatment.
The scope of this law is significant, and the number of
children that are affected by abuse and neglect each year is
staggering and absolutely heartbreaking. In 2016, Child
Protective Services received over 4 million referrals involving
7.4 million children. Teachers, law enforcement, and social
service professionals accounted for over half of all referrals.
Of those 4 million reports, 2.2 million received a direct
response from Child Protective Services. Of that number,
approximately 676,000 children were determined to be victims of
abuse or neglect.
While neglect is notoriously more challenging to confirm,
it still accounted for close to 75 percent of cases reported to
CPS. And while we know that abuse can have serious lasting
impacts on children well into the latter parts of their lives,
research shows that the effects of neglect can be just as
detrimental. In fact, some studies have shown that neglect can
have an even greater impact on a child's healthy brain
development.
As this committee works to make CAPTA more effective in our
fight against child abuse and neglect, our efforts should begin
with prevention. Prevention takes a holistic approach to
combating neglect and abuse by focusing on strengthening
communities and educating parents and caregivers on how to keep
children safe. CAPTA receives $158 million in annual
appropriations with $39.8 million designated specifically for
community-based child abuse prevention formula grants. We
support community level organizations focused on preventing
child abuse and neglect.
In addition to bolstering our prevention efforts, this
committee's work should streamline current assurances and
requirements so states can focus on serving and providing
treatment to children rather than spending more time filling
out paperwork. state agencies benefit from increased
flexibility that allows them to respond more swiftly and
effectively to reports of abuse and neglect. We must equip
states with the tools and resources needed to address
maltreatment and keep kids safe.
Children who have suffered abuse and neglect have unique
needs, and it is our duty to ensure that they receive excellent
care. I have no doubt that this subcommittee can lead this
effort and champion bipartisan initiatives that strengthen
CAPTA.
I look forward to today's discussion about how we as a
Nation can effectively and compassionately serve these
children.
I yield back.
[The statement of Mr. Comer follows:]
Prepared Statement of Hon. James Comer, Ranking Member, Subcommittee on
Civil Rights and Human Services
Thank you for yielding.
As a dad to three young kids, today's topic is a tough one to
discuss. No child should ever have to endure the pain of abuse or
neglect by a parent or caregiver, and that's why today's hearing is so
important.
The Child Abuse Prevention and Treatment Act (CAPTA) is the key
Federal legislation that helps States combat child abuse and neglect.
This legislation, which was enacted in 1974, provides States with grant
funding to develop programs aimed at prevention, assessment,
investigation, prosecution, and treatment.
The scope of this law is significant, and the number of children
that are affected by abuse and neglect each year is staggering and
absolutely heartbreaking. In 2016, child protective services (CPS)
received over 4 million referrals involving 7.4 million children.
Teachers, law enforcement, and social services professionals accounted
for over half of all referrals. Of those 4 million reports, 2.2 million
received a direct response from child protective services. Of that
number, approximately 676,000 children were determined to be victims of
abuse or neglect.
While neglect is notoriously more challenging to confirm, it still
accounted for close to 75 percent of cases reported to CPS. And while
we know that abuse can have serious lasting impacts on children well
into the later parts of their lives, research shows that the effects of
neglect can be just as detrimental.
In fact, some studies have shown that neglect can have an even
greater impact on a child's healthy brain development.
As this committee works to make CAPTA more effective in our fight
against child abuse and neglect, our efforts should begin with
prevention. Prevention takes a holistic approach to combating neglect
and abuse by focusing on strengthening communities and educating
parents and caregivers on how to keep children safe. CAPTA receives
$158 million in annual appropriations, with $39.8 million designated
specifically for Community Based Child Abuse Prevention (CB-CAP)
formula grants which support community-level organizations focused on
preventing child abuse and neglect.
In addition to bolstering our prevention efforts, this committee's
work should streamline current assurances and requirements, so States
can focus on serving and providing treatment to children, rather than
spending more time filling out paperwork. State agencies benefit from
increased flexibility that allows them to respond more swiftly and
effectively to reports of abuse and neglect. We must equip States with
the tools and resources needed to address maltreatment and keep kids
safe.
Children who have suffered abuse and neglect have unique needs, and
it is our duty to ensure they receive exemplary care. I have no doubt
that this subcommittee can lead this effort and champion bipartisan
initiatives that strengthen CAPTA. I look forward to today's discussion
about how we as a nation can effectively and compassionately serve
these children.
______
Chairwoman Bonamici. Thank you very much, Mr. Comer, for
your statement.
Without objection, all other members who wish to insert
written statements into the record may do so by submitting them
to the committee clerk electronically in Microsoft Word format
by 5 p.m. on April 8, and I will now introduce the witnesses.
Dr. Yo Jackson is a board-certified clinical child
psychologist who studies the mechanisms of resilience for youth
exposed to trauma. She is a professor at the University of
Kansas and at Penn State University where she also serves as
the Associate Director of the Child Maltreatment Solutions.
Over the last 20 years, Dr. Jackson has developed an extensive
body of research focused on the mechanisms that foster
resilience for youth exposed to trauma. Throughout her career,
she has served and continues to serve as the principal
investigator on several grants from the National Institutes of
Health.
And I am going to skip over Ms. King temporarily because we
are hoping that Dr. Schrier arrives to introduce Ms. King.
Mr. Bradley Thomas has been the CEO of Triple P America
since 2011. Triple P, Positive Parenting Program, is a system
of evidence-based education and support for parents and
caregivers of children and adolescents with a prevention focus.
Prior to being appointed as CEO, he was involved in various
capacities in working with public research organizations
interested in transferring their research into the community.
Following his work with research organizations, he accepted the
position as CEO to focus on Triple P which to date has been
provided in over 25 countries. In that capacity, he has
overseen the expansion of the program's utilization in the U.S.
from 11 to 38 states. He has a law degree and a Bachelor of
Information Technology from Queensland University of Technology
in Australia.
Mrs. LaCrisha Rose is a resident of Cabin Creek, West
Virginia where she is a loving wife and a mother of three
children. Her own personal experiences with parenting have
inspired her to be an advocate for all children and families.
Mrs. Rose is here today to talk about her experience as a
parent. Mrs. Rose is currently the facilitator of the West
Virginia Circle of Parents Network which comprises parent-led
self-help groups that allow parents and caregivers to share
ideas, celebrate successes, and address the challenges
surrounding parenting. She is a former home visitor through the
Parents as Teachers program and currently serves as a board
member to her local program. Ms. Rose is also active in her
local community through volunteering with her local elementary
school and youth sports.
And I know Dr. Schrier wanted to introduce Ms. King, but I
am going to go ahead and do that. Ms. Judy King serves as the
Director of Family Support Programs at the Washington State
Department of Children, Youth, and Families. She has 30 years
of experience in human services and family support and has
worked at the community, state, and national levels. In her
current role, she oversees work related to home visiting system
development, child abuse prevention strategy, early
intervention, therapeutic and trauma informed childcare, health
and early childhood and infant mental health. Ms. King also
serves as the Executive Director of the Prevent Child Abuse
America Washington State chapter and serves on the board of the
National Alliance for Children's Trust and Prevention Fund.
Oh. I just finished, Dr. Schrier. Welcome.
Welcome to all of our witnesses. We appreciate all of you
for being here today, and we look forward to your testimony.
Let me remind the witnesses that we have read your written
statements, and they will appear in full in the hearing record.
Pursuant to committee rule 7(d) and committee practice, each of
you is asked to limit your oral presentation to a 5-minute
summary of your written statement.
Let me remind the witnesses that pursuant to Title 18 of
the U.S. Code, Section 1001, it is illegal to knowingly and
willfully falsify any statement, representation, writing,
document, or material fact presented to Congress or otherwise
conceal or cover up a material fact.
Before you begin your testimony, please remember to press
the button on the microphone in front of you so it will turn
on, and the members can hear you. As you speak, the light in
front of you will turn green. After 4 minutes, the light will
turn yellow to signal that you have 1 minute remaining. When
the light turns red, your 5 minutes have expired, and we ask
that you please wrap up.
We will let the entire panel make their presentations
before we move to member questions. When answering a question,
again, please remember to turn your microphone on.
I first recognize Dr. Jackson.
STATEMENT OF YO JACKSON, PH.D, ABPP, PROFESSOR, PSYCHOLOGY
DEPARTMENT AND ASSOCIATE DIRECTOR, CHILD MALTREATMENT SOLUTIONS
NETWORK, THE PENNSYLVANIA STATE UNIVERSITY, PENNSYLVANIA &
RESEARCH PROFESSOR, UNIVERSITY OF KANSAS STATE COLLEGE, KANSAS
Ms. Jackson. Good afternoon, Madam Chair Bonamici, Ranking
Member Comer, and members of the committee. My name is Dr. Yo
Jackson, and I am a Professor of Psychology as well as the
Associate Director of the Child Maltreatment Solutions Network
at Penn State University. I am also a research professor at the
University of Kansas. And I have worked for over 20 years as a
board-certified clinical child psychologist and a researcher on
the development of resilience for kids exposed to trauma and
child maltreatment. Thank you for inviting me to speak with you
today.
Child maltreatment is a significant public health problem.
In 2017, 7.5 million children were referred to protective
services with 3.5 million children meeting at least the minimum
criteria to warrant an investigation. Of those, 674,000
children were determined to be victims of child maltreatment.
That translates to a child being significantly harmed about
every 45 seconds.
Child maltreatment includes experiences like neglect,
physical abuse, sexual abuse, with neglect being the most
common. Sadly, 1,720 children died as a result of child
maltreatment in 2017, placing the United States second only to
Mexico for the most intentional child fatalities in the
developed world.
Child maltreatment is second in terms of the most prevalent
childhood public health problems in the U.S. just after obesity
and ahead of things like attention deficit disorder, asthma,
cancer, and autism. In 2015, the average lifetime public cost
associated with child maltreatment is estimated to be over
$830,000 per victim, coming to a total of roughly $428 billion
in costs for the number of victims over the course of just 1
year, money that could have been saved if abuse and neglect
were prevented.
Maltreatment is associated with a plethora of negative and
often devastating outcomes. It is important to note that most
victims are under the age of 7, a time of great plasticity in
the developing brain and social interaction systems. Early
childhood is a sensitive period for the development of social
relationships and forming secure attachments, something that is
not possible in abusive and threatening caregiver-child
relationships.
Child maltreatment has serious negative consequences for
brain development, impacting areas critical for learning,
memory, emotion regulation, cognitive abilities,
decisionmaking, and social skills. Beyond the grave
neurological and biological effects, child maltreatment results
in a lifetime of negative health behaviors such as risky sexual
behaviors, obesity, substance use disorders, chronic pain, and
cardiovascular disease.
Maltreatment is consistently associated with higher rates
of all forms of mental health diagnoses including risk for self
harm. Youth exposed to maltreatment are five times more likely
than their peers to fail in school, to leave high school
without a degree, to become a teen parent, to be consistently
unemployed, to experience chronic physical and mental health
problems in adulthood, and are three times more likely to be
incarcerated, homeless, or live below the poverty line as
adults.
The range of emotional, behavioral, cognitive, and social
delays as a result of child maltreatment are limitations that
some may be able to adapt to but most will never overcome. If
adequate prevention programs were in place, these negative
outcomes would not occur. Moreover, the negative effects of
maltreatment are significantly increased with each
revictimization making what was a hard to treat problem much
worse and increasing the odds of long-term maladjustment.
Given that on average, a child referred for protective
services will be referred for abuse concerns three more times
before they reach the age of 18, child maltreatment is likely
underestimated in terms of its impact in the research presented
here.
The bulk of primary prevention efforts currently fall under
the definition of home visiting where professionals visit
parents in their homes and focus on the well being of children
ages 0 to 5. Several of these primary prevention programs have
been shown to reduce reports of child maltreatment. A paper in
2018 reported the cost benefit return of $4 for every dollar
spent on universal primary prevention programs.
In contrast, targeted prevention includes a host of
programs implemented within protective services to improve home
environments and protect children from another instance of
child maltreatment. A cost benefit analysis found that two of
the most widely lauded targeted programs, Safe Care, returned
over $21, and parent child interaction therapy returned over
$15 in benefit for every dollar spent on implementation.
Although child maltreatment is pervasive, it is also
preventable. Because most victims of maltreatment are young
children, prevention programs are critical to avoid the
biological and social development impacts, impairments, and
downstream effects. Child maltreatment requires a comprehensive
prevention strategy. The reauthorization of CAPTA is an
exceptional opportunity to better support the systems that
protect children from maltreatment. Through CAPTA, we seek to
better coordinate our efforts across the patchwork systems of
federal, state, and local agencies and services, to seek out
efficiencies and best practices that are supported by an
evidence base. Data driven approaches are necessary to increase
the research base and to advance knowledge on what works for
whom.
We also need to seek to find and develop innovative
coordinated solutions that facilitate the feasible and
sustainable involvement of schools, parents, adults, government
agencies, and service providers.
Coordination, data focus, innovation. These frames are
vitally important for prevention because what we know is that
our current efforts have shown little to modest impacts. What
we are doing now is not enough to stem the tide of child
maltreatment.
[The statement of Dr. Jackson follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman Bonamici. Thank you for your testimony,
Professor Jackson.
I now recognize Ms. King for your testimony.
STATEMENT OF JUDY KING, MSW, DIRECTOR, FAMILY SUPPORT PROGRAMS,
WASHINGTON STATE DEPARTMENT OF CHILDREN, YOUTH, AND FAMILIES,
OLYMPIA, WASHINGTON
Ms. King. Good afternoon, Chair Bonamici, Ranking Member
Comer, and members of the subcommittee. I appreciate the
opportunity to speak to you today about community-based child
abuse prevention or CBCAP. I serve as the Director of Family
Support Programs at Washington State's new Department of
Children, Youth, and Families, and I am the CBCAP State lead in
Washington.
Thanks to CBCAP, Washington State served 1,698 parents and
2,153 children with family support services in 12 out of 39
counties last year. We still have a long way to go in reaching
all of the children and families who could benefit from CBCAP
services and systems building efforts, but that task would be
difficult and less effective without CBCAP funding.
Brain science tells us that laying a strong foundation
early in life critically impacts healthy development. Science
also tells us that addressing trauma at the individual, family,
and community levels allows us to prevent bad things from
happening, promotes strength in children and families, and
intervene early. In our everyday work, this means we notice the
important things. We identify the tremendous stress, pressure,
and uncertainty that leaves parents feeling alone, unconnected,
and ashamed.
CBCAP is designed to create environments where families get
the support they need before harm occurs. This supports
children on a positive trajectory to reach their full potential
in school and life. This work includes parental skills
building, voluntary home visiting programs, self-help programs,
coordination and connection with mental health, and substance
use services and other family supports.
Prevention requires a highly integrated, multi-systemic
public health approach. Just as we don't wait for someone to
show signs of the flu before we encourage them to get a flu
shot, we shouldn't wait for warning signs that a family needs
support before making sure they have that support.
In 2018, Washington's newest state agency formed combining
the strengths of an early learning department and child welfare
services into one unified agency. A two-generation approach
informed by brain science leverages CBCAP funding for families
receiving TANF benefits to offer home visiting services and
parenting education. Experiencing success in education,
employment, and parenting can break the intergenerational cycle
of poverty. We offer specific programs shown to be effective
with tribal populations and are working extensively to build
pathways for new moms to get the support that they need while
experiencing perinatal mental health challenges like postpartum
depression.
These are a few examples of how my state uses its CBCAP
funding. As a chapter of Prevent Child Abuse America and member
of a National Alliance of Children's Trust Funds, I have a
front row seat to witness the extraordinary work being done by
my colleagues around the country and in each of your own
states.
The flexibility in CBCAP provides options for communities
to implement evidence-based, evidence-informed, and promising
practices. CBCAP awardees can tailor their programs to serve
the needs of their communities while evaluating programs,
measuring outcomes, meeting fidelity, and adhering to
implementation science principles to achieve the positive child
and family outcomes. states have said they need flexibility to
use federal funds to help families sooner, before serious
danger arises or harm occurs.
As far as resources, CBCAP represents the main federal
investment in primary prevention for the entire country with an
investment of $39 million over all 50 states in 2018. This
funds prevention at $0.53 per child per year resulting in a
great deal of unmet need. The current funding in Washington
State allows 10 to 12 local organizations to offer small-scale
programs with more than 90 percent of qualified applicants
turned away. DCYF, my agency, recently identified 23 small
locales with highest rates of abuse or neglect that we are not
able to serve due to funding constraints. With more funding for
prevention, we would work within each community to build
community-driven interventions using a targeted universalism
approach to increase services available in communities at known
risk. This is prevention at its best and it requires resources.
The pursuit of the goal of strengthening families is through
primary prevention, strong and responsive communities, and
collaborative efforts among public health, early learning, and
child welfare.
Every parent wants to be a good parent. They just need the
tools and supports to get them there. Families describe this
work as raising their children with opportunities to achieve
their hopes and dreams. I say it helps families live their best
lives.
I appreciate your time and attention this afternoon, and I
would be happy to answer any questions you may have. Thank you.
[The statement of Ms. King follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman Bonamici. Thank you for your testimony.
I now recognize Mr. Thomas for 5 minutes for your
testimony.
STATEMENT OF BRADLEY THOMAS, CEO, TRIPLE P, POSITIVE PARENTING
PROGRAM, COLUMBIA, SOUTH CAROLINA
Mr. Thomas. Chairwoman Bonamici, Ranking Member Comer, and
members of the subcommittee, my name is Brad Thomas, and for 8
years I have served as the CEO of Triple P America. I thank the
committee for the opportunity to share my experience with the
Positive Parenting Program which takes a primary prevention
approach to child abuse and neglect.
In the four decades since CAPTA was first authorized, the
U.S. has built a foundation of child welfare and safety based
upon best practices, evidence, and lessons learned. Systems can
always strive to improve, and we are now in a position to build
upon that foundation. We believe that the current system is
under significant stress because it is designed primarily to
provide intervention rather than focus on the prevention of
abuse and neglect before it occurs.
Costly systems have been built to deal with the conveyor
belt of maltreatment, and therefore, avoidable abuse and
neglect of children occurs. The child welfare system is
overwhelmed, and the taxpayer is faced with the resultant cost.
There is a better way, primary prevention that targets the
broader population.
Notwithstanding the immediate and tragic impact of child
maltreatment, it can also have long-term effects on health and
well-being if not addressed. The treatment of child abuse and
neglect after it occurs is significantly more expensive than
the prevention of it. A study conducted by the Perryman Group
estimated the lifetime impact of first time child maltreatment
occurring in 2014 as costing the U.S. 5.9 trillion.
Conversely, evidenced-based models for primary prevention
catch parents well ahead of adverse experiences for children.
They normalize parents asking questions and ensure quick,
reliable, and actionable information. Oftentimes, this can be
the difference between equipping parents with the confidence to
problem solve daily stresses or allowing stressful and
challenging behaviors, left unchecked, to escalate for both
parent and child.
The challenge, however, is building systems that can scale
and achieve reductions in child maltreatment at a county or
state level. There is some essential elements that make
programs like Triple P work to achieve population level change.
One, program design. Two, evidence based. Three, use of an
existing work force. And four, cost effectiveness. Let me
explain.
The most impactful programs to achieve population level
effects are designed to make services available for delivery in
an array of settings that suit the parent's preferences and
allow parents to receive help according to their needs, not
taking a one-size-fits-all approach.
Next, it is essential that programs and services are
evidence-based. As an example, Triple P is the most researched
parenting program in the world with over 300 evaluation papers
involving more than 400 academic institutions worldwide. One
such evaluation was a landmark randomized control trial funded
by the CDC in 18 counties in South Carolina in 2005. During the
period studied, child maltreatment rates increased by 7.9
percent in the nine controlled counties and decreased by 23.5
percent in the nine counties where Triple P was implemented.
Similar patterns were found for out-of-home placements and
hospital-treated child maltreatment injuries.
Training a community's existing work force to deliver
parenting supports dramatically increases the speed at which a
program is able to scale and leverages existing trusted
relationships between parents and providers. In turn, systems
that only provide supports to the extent needed and utilize a
work force that is already in place saves money and resources.
Independent research undertaken by the Washington State
Institute for Public Policy on a range of program supports
these savings. By way of example, the research demonstrates
that for every dollar invested in the Triple P system upstream,
there is a resultant $10.05 in benefits downstream. In spite of
proven outcomes, evidence-based models that align with primary
prevention have been limited in their ability to scale due to a
lack of available funding for prevention programs.
CAPTA is the main federal legislation providing population
level primary prevention capacity building, so appropriate
funding is absolutely critical. We applaud Congress for
examining CAPTA and the prevention of child abuse and neglect
generally. As Congress looks to reauthorize CAPTA, we encourage
you to consider the following:
First, a focus on primary prevention designed to reach the
broad population or provide both monetary savings and reduce
the human toll taken on children and families exposed to abuse
and maltreatment.
Second, the designation of appropriate lead agencies for
CBCAP that have a demonstrated commitment to broad community
prevention work such as children trust chapters, prevent child
abuse chapters, and health departments may help to unfurl the
streams of funding and have a more significant impact on
communities.
Finally, ensuring funding is allocated to evidence-based
holistic primary prevention will thereby invert and shrink the
funding pyramid over time and reduce the incidence of and costs
associated with child maltreatment.
I appreciate and welcome your committee's dedication to
this important endeavor and stand ready to be of assistance in
any and all ways possible.
[The statement of Mr. Thomas follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman Bonamici. Thank you for your testimony.
And finally, Mrs. Rose, thank you so much for being here. I
recognize you for 5 minutes for your testimony.
STATEMENT OF LACRISHA ROSE, FACILITATOR OF THE WEST VIRGINIA
CIRCLE OF PARENTS NETWORK, TEAM FOR WEST VIRGINIA CHILDREN,
MIAMI WEST VIRGINIA
Mrs. Rose. Thank you. Good afternoon, Madam Chair Bonamici,
Ranking Member Comer, and members of the committee. Thank you
for the invitation to be here today.
My name is LaCrisha Rose, and I live in Cabin Creek with my
husband and three children. I am employed by TEAM for West
Virginia Children where I facilitate a program with mutual
self-help groups on the state level using the Circle of Parents
model. And today I would like to talk to you about why the
reauthorization of the Child Abuse Prevention Treatment Act is
important for families like mine.
Have you ever found yourself wondering or wishing that
someone would sit down with you and help you be a better
parent? That is exactly how I felt when my husband and I found
ourselves facing the same challenges that our parents had
before us. And just like most first-time parents, you use the
methods that were used on you as a child. But that didn't work
for us. So the more I spanked my child, the worse his behavior
became.
One day I joined a local play group at the Sharon Dawes
Elementary School through the Starting Points Family Resource
Center, right by our home. Talking with other parents made me
feel like I wasn't alone, and I really enjoyed learning about
my child's brain development. Eventually I signed up for other
programs at the Starting Point Center such as the home
visitation program with Parents as Teachers, and it was through
building a trusting relationship with my home visitor that
allowed me to reach out for help with my concerns surrounding
discipline.
My home visitor was wonderful. She provided me with tons of
positive parenting solutions such as time in versus time out,
getting down to my son's level and looking him in the eye. She
encouraged me to look at these tools like tools in a toolbox.
And some of the concepts were so simple, but yet, they never
crossed my mind. Maybe that is because the only tool I ever had
in my toolbox was a hammer, so everything looked like a nail.
A couple months later I was at a group exercise for the
Circle of Parents, and I had to play the role of a parent who
lost her child due to harsh physical punishment. And this hit
me like a ton of bricks because the only difference between
that parent's outcome and my own was prevention.
This sparked a fire inside of me and made me realize that I
needed to pay it forward, and so I started to climb the parent
leadership ladder. I became a home visitor for the Parents as
Teachers program in my local community, and then I started to
facilitate the Circle of Parents groups at a state level. Then
I was invited to become the co-chair of the Alliance National
Parent Partnership Council.
But my favorite achievement on my journey was becoming
certified to deliver the same program that saved my life, the
Strengthening Families Protective Factor Framework of bringing
the framework to life and your work. Sorry. This snowball
effect has led me here today.
Growing up, my parents worked very hard but yet struggled
to provide my brother and I with the best life that they could.
And today families continue to struggle, but local prevention
programs help families like mine succeed. Prevention matters,
and it can be used in all families, so here are my hopes.
I hope that something I have said here today helps you
recognize the importance of increasing the resources that are
available to families. Currently Congress invests about $0.53
per child annually across the Nation. We can do so much better.
It would be great if we could increase that to $0.53 per child
per month versus annually.
I hope that you hear more testimoneys in the future with
happy endings like mine due to the efforts of prevention that
you have created and supported. And I hope that 1 day my
children will be able to stand here in front of you and thank
you for listening to their mother's story and tell you about
the lives of their children and how much richer they are
because of the decisions you make in the next coming days.
Thank you for your time here today and letting me tell you
what I believe helps build strong families; yours, mine, and
all the families across the Nation.
[The statement of Ms. Rose follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Chairwoman Bonamici. Thank you very much for your
testimony. What a wonderful example of how you can break the
cycle, and we really appreciate your being here and sharing
your own personal story.
Under committee rule 8(a), we will now question witnesses
under the 5-minute rule. As chair, I will start and be followed
by the ranking member, and then we will alternate between the
parties.
Ms. King, thank you for discussing the importance of the
federal community-based child abuse prevention grants and your
agency's prevention work in Washington State, my neighbor to
the north. We know that child abuse and neglect is preventable,
and yet, as you mentioned in your testimony, the grants are
currently funded at half of the federal authorization cap.
In my home state of Oregon, the CBCAP grants are critical
to supporting key prevention activities. In the Fiscal Year
2018, we got $280,000. That is it. That is not nearly enough to
meet the needs. So can you talk about how increased federal
investment in the CBCAP grants would benefit your state's work
and the work of other states on prevention?
Ms. King. Sure. Thank you. It is an interesting experience
for us because we provide very small grants for small scale
programs with our CBCAP funding, approximately $30,000 to
$40,000 per program that is involved for a 3-year cycle. We end
up only funding three to four new programs per year with
usually asks coming in from communities for between $800,000
and a million dollars. So just the nature of communities that
are ready to be implementing services needs in their
communities have models are going to work, we see a tremendous
need.
I also discussed briefly that we have identified 23
locales. Think about neighbor--a little larger than a
neighborhood but not as large as a subcounty that really have
some of the highest risk, and what we would like to do in the
future is figure out how to embed more programs and services,
not just prevention but early learning and other types of
support services in those communities driven by the community,
and that something to do that deeper work we can't do with
current funding as well.
So I would say we have a lot of unmet needs and a lot of
communities ready to take action.
Chairwoman Bonamici. Indeed, thank you so much. I mentioned
in my opening statement, the opioid crisis, and I am very
concerned about the increase in the rate of child abuse and
neglect, and some of it, you know, we have in conjunction with
conversations about the opioid crisis.
I remember in Oregon, listening to the story of a woman who
became addicted to opioids--well, they were prescribed to her
following a C-section, and then when she ran out of her
prescription, went to the streets, lost her kids for a while.
And it was hard work to get them back. And I have seen--so we
hear tragic stories like that across the country, but I have
seen promising programs to support these families, for example,
Health Share of Oregon, a coordinated care organization in
Portland, provides integrated care for mothers with addiction
and their children, some of whom are born with withdrawal
symptoms.
And another project--program called Project Nurture that
supports families during their pregnancy for a year, and then
after the child is born, they receive substance abuse
treatment, mental health services, and parenting resources. And
the majority of mothers who have participated in the program
are now parenting successfully.
So what more can be done at the federal level to address
this increase in child abuse and neglect that is exacerbated by
the opioid crisis and support those families? I think I will
start with Professor Jackson, if you have thoughts on that?
Ms. Jackson. I think it is really important to remember
that this an issue that has multi sides to it, that child abuse
and neglect is not caused by one thing. There is not one
situation that we can point to, that will tell us every time
what is going to happen next, and so we have to be vigilant
about what the data tells us.
So I think what I would encourage you to think about is
really the multifaceted nature of the factors that contribute
ultimately to this happening and then--and part of why we have
to think about prevention in a multipronged way as well.
Chairwoman Bonamici. Thank you.
Does anybody else have thoughts on the--especially the
mothers keeping them with their kids, what is the best way to
address that?
Ms. King?
Ms. King. I would agree with Professor Jackson. I think it
is a very complex problem, and it requires a complex set of
solutions across those many partners. Your suggestion of the
work in Oregon with really embedded-in, coordinated care on the
health side, also being really supported through where dollars
flow for substance use and mental health treatment. And child
welfare and early learning, all having a response to this. What
we know is that some of our youngest children, infants in our
state--and I know many other states--are the highest percentage
of children coming into the child-welfare system with a high
degree of those children coming in due to substance use. And we
have to look at how we can work together across the system to
provide more opportunities for families.
I have had a story shared relatively recently about a
family who was receiving home visiting services, had been
using--hadn't screened in the questionnaire for using
substances, and got to the point in her comfort level with a
home visitor to say, I am afraid that my baby will be affected
when it is born, and that home visitor then was able to work
with that mom to do some planning, let go of some of the shame
and guilt and try to help her be successful.
Chairwoman Bonamici. Thank you. I don't mean to cut you
off, but I want to set a good example because I am over time. I
yield back. Thank you.
I right now recognize Representative Stefanik from New York
for her questions.
Ms. Stefanik. Thank you, Chairwoman Bonamici. I also want
to thank all of the witnesses for your very important and
compelling testimony today.
I wanted to particularly highlight your testimony, Mrs.
Rose. Thank you so much for being here. Your statement was
incredibly powerful to hear from you as a mom, and you are an
example for so many parents across this country. So thanks for
your courage today and for telling your story.
I wanted to ask the panel as a whole--and anyone can
answer--the data shows that neglect is the most prominent form
of abuse cases. Can you talk about the different ways children
are neglected that may not be obvious to viewers today or
people at this hearing. And then specifically how we can
structure programs to help prevent these cases of neglect.
So first the indicators of neglect, descriptions of
examples of neglect, and then broadly, how we prevent neglect.
Professor Jackson, I will start with you.
Ms. Jackson. Sure. So there is a couple different ways we
think about neglect. That actually covers several different
things. So it includes things like personal hygiene, physical
hygiene. It includes health, so taking your child to the doctor
when they need to go to the doctor. It also includes things
like educational neglect, which is making sure your child goes
to school. So there is a variety of different things.
Some of them are very clear from the outside. So kids who
show up to school who haven't changed clothes, for example. But
sometimes things are harder to see, right, so in terms of the
neglect in the home environment, right, sometimes those are
basic needs, kinds of things, is there enough food, right,
things that a caseworker maybe could easily spot.
But there is other types of neglect that are, I think to
your point, more challenging to see because they are not so
obvious and physical, right? So that might be more things like
emotional neglect, right, where you are not providing support--
emotional support, praises, and encouragements to your child
for the things that they do. Children need that. That is not
extra. Children need your support. They need your praise.
And so what prevention efforts do in terms of addressing
some of those harder-to-see, everyday things, is, they provide
parents with education. They provide them with support of their
own, so that they have the capacity to be able to support their
children emotionally and socially as they move forward.
Ms. Stefanik. Thank you.
Mr. Thomas, did you want to comment on how your program
invests in preventative measures when it comes to preventing
neglect?
Mr. Thomas. Sure. And I think Professor Jackson handled
that really nicely in terms of the answer. I think the
emotional neglect is certainly one that is not as obvious. And
a large part of what Triple P does is simply to get a parent to
enjoy parenting again, and to build a stronger relationship
with their child.
And there are strategies such as praise that Professor
Jackson mentioned, and getting involved in activities with the
child, to have that relationship and build that relationship
with the child.
Ms. Stefanik. One followup, and this may fall under the
educational focus that you talked about, Professor Jackson. One
of the challenges we have in the 21st century is screen time.
Can you talk about whether we have invested in parenting
classes or information on how technology specifically regarding
the regular use of screen time to keep kids occupied can
potentially lead to harm down the road?
Professor Jackson?
Ms. Jackson. So the short answer is yes. There is a whole
area of burgeoning research on what screen time is doing and
how that operates in the growing, developing brain of children,
what ages children should have screens, when they shouldn't
have screens, appreciating, too, that they have screens in
schools, right? So that is actually--there is a good side of
this, right? You see kindergartners learning faster. You see
kids who demonstrate symptoms of autism able to communicate
better, right? So there are--we talk about screen time, we are
not always talking about video games, I think which is what a
lot of times that means, when children are sort of babysat by
the screen, right?
But suffice it to say, there is a growing area of research
clearly pointing out what the negative effects can be in terms
of the reduced capacity to pay attention, reduced capacity to
be frustrated, challenges with listening and being able to
follow complex commands. But this is a growing area, because
clearly screens are everywhere. They are not, you know,
something that we see in just the home or maybe just as a toy
or an activity.
Ms. Stefanik. And just in my remaining 30 seconds, I think
it is important, when we talk about educational tools for
parents, that we provide information about screen time and
potential long-term negative impacts of too much screen time at
an early age. So thank you very much again for the testimony
and for answering my questions.
Chairwoman Bonamici. Thank you. I now recognize
Representative Trone from Maryland for 5 minutes for your
questions.
Mr. Trone. All right, good afternoon and thank you again
for your testimony, Mrs. Rose. That was really important, and--
so the numbers are very sobering, there is no question about
it. The enactment of the Protect Our Kids Act, in January 2013,
established the commission to eliminate child abuse and neglect
fatalities and called on the commission to produce a national
strategy and recommendations for eliminating fatalities across
the country.
Chairwoman Bonamici, I would like to submit the final
report, Within Our Reach, A National Strategy to Eliminate
Child Abuse and Neglect Fatalities--
Chairwoman Bonamici. Without objection.
[The information referred to follows:]LINK#2 (TRONE)
Within Our Reach: https://www.govinfo.gov/content/pkg/
CPRT-116HPRT37765/pdf/CPRT-116HPRT37765.pdf
Mr. Trone [continuing]. for your approval into the record.
Thank you.
Dr. Jackson, the commission recommended the Federal
Government create national, uniform definitions for counting
child abuse and neglect fatalities and life-threatening
injuries. In my state of Maryland, we recognize the value of
comprehensive data and have integrated steps into our system,
such as working with child fatality review teams, office of
chief medical examiners, et cetera. Can you talk and speak a
little bit about the importance of standardized data
nationally?
Ms. Jackson. So as a researcher, that is something that is
really important to me. So I think the simplest way to explain
it is that you can't further knowledge if we don't all agree on
what the definition of ``it'' is, right? And so we all have to
agree on what it is, and then we can move forward with studying
it, right, and whatever that might be.
In this case, a very, very serious topic, a critical topic,
to better understand the rates, prevalence incidence rates of
child fatalities in the country, especially those related to
child maltreatment.
So that seems almost without question to be a critically
important next step for folks, to have a universal definition.
If you don't have a universal definition, if we don't all agree
on what that is, then we can't further our knowledge. Moreover,
we can't understand why these things happen, we don't know what
leads up to them, because there is a myriad of things included
in the pool.
So it is important for us, if we actually want to create
interventions, right, or prevention interventions, that speak
to reducing those numbers, that everyone be operating out of
the same definition.
Mr. Trone. Thank you.
Last year, Congress dedicated an entire section in the
SUPPORT For Patients and Communities Act to trauma-informed
care. This section affirmed the importance of preventing opioid
addiction. In my district the other day, over 25 percent of the
babies born had opioids or alcohol in their bloodstream. Four
percent were born addicted. It is mind-boggling.
So this importance of preventing this--this report will
address a key element that often underlies substance abuse and
the harm caused by childhood trauma. This week, we are sending
a letter to the bipartisan coalition of members to the
Appropriations Committee to support funding for these
provisions. I hope we can continue to invest in tools to
identify, understand, address, and mitigate the effects of
trauma on children and families.
Ms. King, in your written testimony, you mentioned, to
prevent childhood maltreatment, you must put science into
action. Research tells us by the age of 3, 80 percent of the
brain is done developing. So laying a strong foundation early
in life is important. Could you address the importance of
addressing trauma in individual family and community levels and
how we have to have family serving systems be trauma-informed?
Ms. King. Yes, I can. I think for us, especially on the
early learning side of the spectrum, again during that critical
time of brain development--and the critical time where children
learn that their needs can be met by a caregiver--that we look
at all of the places that those children and family interact
with and make sure we have standards for what that looks like,
to both be trauma-informed and also healing-focused. We like to
look at what our settings and environments are doing to promote
healing among parents and children.
One of the key strategies that has been used and is being
implemented in a lot of states is building trauma-informed care
in childcare and early learning settings. So we have childcare
providers that understand when a child comes in and is
struggling and having a hard day, that it is not aimed at the
teacher, it is not aimed at the childcare provider. It is the
child working on trying to regulate their emotions and deal
with some things that are happening with them.
It helps us with thinking about how we can build that
capacity in our full system so that the places that those
children are during the day, they get that positive experience,
and build relationships with trusting adults.
Mr. Trone. Thank you.
Chairwoman Bonamici. Thank you.
I now recognize the ranking member of the full committee,
Dr. Foxx from North Carolina, for 5 minutes for your questions.
Ms. Foxx. Thank you, Chairwoman Bonamici. And I want to
thank our panelists for being here today.
Mr. Thomas, when you talk about saving $10 on the back end
for every $1 spent on the front end, are those real dollars?
And is it the federal, local, or state Government that is
reaping the benefit?
Mr. Thomas. Because the--the issue of child maltreatment
cuts across so many different agencies, the benefits that flow
from the investment of evidence-based programs cut across
local, state, and federal funding streams.
You also see in those benefits, some of those benefits also
go to the participants as well, and also the taxpayer. But it
is spread across all of those different systems, such as child
welfare, justice, and education, as some examples.
Ms. Foxx. Thank you. Mr. Thomas, why is it important for
state and local governments to think about where these kinds of
programs are housed within their systems?
Mr. Thomas. In the case of programs like Triple P, that are
focused on primary prevention, it is critical to have a fit
within an agency that has, as its mandate, a focus on the
broader population, and so it is important when assessing the
best fit for these programs as to what is the best agency to
actually deliver--or at least oversee the delivery of these
programs into the community, to make sure that they can scale
up effectively, and reach the broad population.
Ms. Foxx. Thank you. Pardon me. I have another question.
Mr. Thomas, I believe collaboration across stakeholders is
critical if any program is going to be successful in addressing
the issue attempting to be solved. What kind of collaboration
do you do in your program to know you understand the key
triggers of abuse?
Mr. Thomas. You are absolutely right, collaboration amongst
the various stakeholders within a state's system is--or a
county system, is critical. That if you were going to scale up
a program at a population level, you need to have all of the--
the entities involved with parents involved in that process.
And so we actually spend a lot of time, when we go into a
community, identifying what systems are in place, and making
sure that we bring those people along, to participate in the
process of bringing the program to all those various systems
and to the general population.
Ms. Foxx. Thank you. I want to say to the panelists that
some of us were going in and out, and I apologize for that, but
we had another committee down the hall that was having votes,
and, unfortunately, we had to run down and vote and then come
back.
So I apologize for having been out of the hearing for some
time, but that was the problem. Thank you again for being here.
Chairwoman Bonamici. Thank you.
I now recognize Representative Hayes from Connecticut for 5
minutes for your questions.
Mrs. Hayes. Thank you, Madam Chair, and also thank you,
Representative Foxx, for just the explanation that the
committee--I apologize for coming in late. And I also want to
thank the witnesses for being here and for your tireless work
on this very issue of child abuse and neglect.
I spent the majority of my adult life as a teacher. In
fact, before coming to Congress, I was a classroom teacher, a
mandated reporter, so I know exactly what you are talking
about. And as some of my colleagues have expressed, I also
recognize that abuse is not always blatant, you know, for me it
was, neglect was more of a factor, you know, and understanding
and recognizing what that meant and what that looked like.
In my community, in the city of Waterbury, where I taught,
generally, that was associated with addiction, and trauma from
addiction that really reverberated out into the entire family.
In Waterbury, Connecticut, where I was a teacher, last year, we
had 85 opioid-related deaths, and in most of those families
there are children who are coming to school, and they don't
have a label that says, you know, my mom is an addict, or no
one at home is feeding me, or my dad is in prison. And so a lot
of this--it was up to the educator to have an appreciation and
understanding of what they were seeing and, you know, what
their responsibility was in that.
This is something that was very important to me because I
was one of those kids. I grew up in a home like that. And I
guess what I want to make sure--and, Ms. Jackson, my question
is for you--being that we know that poverty is a risk for many
of these young people, addiction is a risk, when we are
responding to referrals for child maltreatment, how can we
assure that we are addressing the underlying issues and not
simply separating parents from children because they are poor
or they don't have the--the background or the information they
need?
Ms. Jackson. Right. So I think that is a really important
question, because a lot of research that has been done through
the years, especially in the early years of identifying child
maltreatment, looked for correlates, right, things that seem to
be associated with abuse. What do these abused children and
these abusive families have in common? Science has evolved
tremendously since those early days, but some of the early
findings are still with us, right, in terms of trying to
clarify really what the active factors are.
So to be clear, we are much better now in our place and our
science of knowing what are the causal factors for child
maltreatment. We are very clear about those things. What we
notice about those families is that they have several things in
common with each other. They are not always identical, but they
have several things in common. There usually is a significant
difficulty in support in those families, maybe some challenges
with mental illness in the parents, maybe a tremendous amount
of stress in the family, maybe there is a tremendous amount of
conflict in the family, lots of different things that we could
point to that are active, causal factors for child
maltreatment.
Poverty is not one of them. Okay? So I get that that is
where in the beginning the thing that seemed to tie a lot of
people together. Right? But that actually isn't a factor that
is an active ingredient in risk for child maltreatment. It is
really the host of many other things that we know very well
that contribute.
So what prevention does, is, it speaks to those things, it
speaks to the things that the science tells us actually make a
difference, right? Those things that are actually important in
effecting change. The anecdotes we see a lot of still, to this
very day. But as a scientist, what I am most interested in are
the efforts that the prevention makes to tie to what we know
actually makes a difference. So prevention will tie to things
like education and conflict resolution and giving support and
resources to those families, regardless of economic background.
Mrs. Hayes. Thank you. I so appreciate you saying that.
Ms. King, my next question is for you. Based on what we are
talking about, how can we better prepare teachers and mandated
reporters to ensure that bias is not a contributing factor when
they are looking for signs and symptoms of abuse or neglect? I
have seen many young people who come from families who didn't--
not have a lot of money, you know, who lived in poverty, but
there was an abundance of love, and parents were doing the best
they could. And someone from the outside looking in at that
might not see the same thing that I saw or be able to identify
that this was a caring and supportive family.
So how do we ensure that our teachers, our mandated
reporters, the people on the receiving end of this information,
don't let their own biases get in the way?
Ms. King. Well, I think you nailed it very carefully about
the disproportionality that we see in our system, and I think
that is an ongoing struggle. It is an ongoing struggle in
education for teachers. It is an ongoing struggle in early
learning, and in reality it is an ongoing struggle in child
welfare, as well. I picked up on your comment at the beginning,
thank goodness children aren't wearing a label about what they
have going on at home, because we want our educators, the
trusted adults that work with children, to see the strength,
see their resiliency, and we want our network of the
multidisciplinary approach to child well-being to respond
looking at strengths.
That is the important piece, and I think that is where I
see a paradigm shift happening in prevention, is, we are
looking at strengths to build strong families. We have to focus
on harm when it has occurred, but if we are looking upstream,
we are looking at building strengths in families.
Mrs. Hayes. Thank you so much.
Chairwoman Bonamici. Thank you. I now recognize the Ranking
Member, Mr. Comer, from Kentucky for 5 minutes for your
questions.
Mr. Comer. Thank you.
Mr. Thomas, I appreciated your testimony about the insight,
about the principles that guide your organization. What are
some key aspects of your program that could be used by other
entities to attain the success that you have seen?
Mr. Thomas. I think the--some of the discussion previous to
this focuses on that. And it is this--you don't know where
child abuse is necessarily and you can't make assumptions. And
so one of the elements that makes Triple P successful is that
it reaches the broad population, and that way you know that you
are covering families that need the services. But also using an
existing work force enables us to scale up very quickly, and
also it leverages off that trusted relationship that is already
there, say, with a primary-care provider or a schoolteacher,
and enables that advice to be given in a trusted relationship.
Mr. Comer. This next question will be for all four members
of the panel. What is working now with CAPTA and what is not,
briefly?
Mr. Thomas, you want to start?
Mr. Thomas. Yes. I think there is--it is sometimes
difficult for agencies that have a mandate to provide services
to a specific population, to also then juggle primary
prevention which takes it outside of the narrow population that
they are serving and requires a focus on the general
population. So where we have seen it work very well is where
CBCAP moneys have flowed to children's trust, for example, in
South Carolina, where they have used CBCAP money there to
expand on some Triple P work and other things as well. And
because they have that broader population-level focus, that is
where we have seen it work exceptionally well.
Mr. Comer. Ms. King, would you like to add anything?
Ms. King. Yes, I will add. I think, I appreciate Mr.
Thomas' comments on that because I think what we have to do,
is, get out of the space where we are only thinking about
direct services to that more coordinated system, and the
systemic efforts that we really need to have to build
relationships with existing providers, existing partners that
work with families, to have that message carried out in all
kinds of ways.
We know that one message alone typically isn't enough.
Things like safe-sleep practices, that we are working really
hard on across states because we want to prevent fatalities
related to unsafe sleep. We know that message needs to be
embedded by lots of folks, many times, different ways, to be
able to ensure that we--we have children sleeping in a safe
way. So we will use that with primary care. We use it with
child-welfare staff. We use it with social network messaging
among families, sharing that information. Because those are the
ways that we--we embed it in more of a system. So moving from
individual programs to more of a system would be one of my
recommendations.
Mr. Comer. Thank you.
Professor Jackson?
Ms. Jackson. I would agree with that as well. What we
really need is this integration. I think that it is the
patchwork that we struggle with so much day to day, from one
state to the other or one agency to the other, within the same
sort of community. There is not a great deal of communication
about these things. So that is another part of the frustration
is that when there are things that work well, it is actually
very difficult to let a large proportion of folks who would be
interested know about that in a way that they can receive it.
So that is one of my recommendations as well, as we think about
integration coordination and making sure we have a vehicle, a
mechanism, that is an easy vehicle, a mechanism for
communication.
Mr. Comer. Thank you.
Ms. Rose?
Ms. Rose. So like they have said, as well as relationships,
and not only building relationship with the family, but
treating the entire family, because children grow up in
families and families grow up in communities. And so to treat
the whole family, and I mean from one generation to the next,
you know, treating that as a whole and providing that
consistent messaging that children are exposed to.
For example, my in-laws and my parents being able to sit in
on our home visits and learn the same language and the same
methods, ensures that no matter what environment my children
are in, they have the same language, they have the same
methods. And the same with our local schools and, you know, you
can just go, build, build, build, build, but--so I think the
consistent messaging and relationships as a whole, treat the
whole family.
Mr. Comer. Thank you all very much. And I yield back.
Chairwoman Bonamici. Thank you.
I now recognize Dr. Schrier from Washington for 5 minutes
with your questions.
Ms. Schrier. Thank you, Madam Chairwoman.
First, Mrs. Rose, I just want to thank you so much for
sharing your story, because you have personalized your story
for all of us. I think--I am a pediatrician, and I still found
parenting to be a challenge, and so I think we all understand
how important the job is, and how little training we get for
it. And it is the most important job of our lives, so thank
you.
Ms. King, I am sorry I was not here to introduce you. My
question is for you. As the lead CBCAP entity in Washington,
you are the primary funder of child abuse and neglect
prevention programs in our state. And in your testimony, you
talked about a coaching program for parents. You also mentioned
a two-generation approach, and I was wondering if you could
talk about this coaching program for positive discipline and
what the interaction looks like between the coach and the
parent, between the parents and the children. Then we will see
if I have time for another question.
Ms. King. Thank you. Yes, we like to use the word parent
coaching because sometimes if we use the word parent visitor or
parent educator, people view it as a top-down messaging, and
really coaching the parent has to do with the interaction
between the parent and child that someone is helping to
support. So, yes, there is pieces that have to do with
knowledge, but it is actually a lot about attitudes, skills,
and behavior.
So if you were working with a program that focuses on
infants, you would expect that coach to work a lot on
attachment issues. That serve and return, tennis term about,
you know, a child making--making some communication and a
parent being able to respond, starting that very early brain
development.
For toddlers, I would say one of the most typical things we
see with parent coaches is trying to understand what is
expected of a toddler, where they are developmentally. You
know, they just can't share right away. And working with
toddlers on, again, regulating emotions, being able to have
words for feelings, and for parents not to get triggered. So
developing that capacity in parents just to be calm and be able
to address what is going on with their child.
So the coaching really is about side-by-side work, noticing
the strengths and building on those.
Ms. Schrier. Does the coach in these interactions--I am
imagining them at a family's home, watching the interaction
between the parents--do they model it at the same time? Do they
check in afterwards and say, here is what I observed, try this
next time? All of the above?
Ms. King. Yes, I think they can. I think a lot of our
programs are really trying to focus on seeing what the parent
is already doing and helps the parent notice that. Again, with
that notion that looking at strengths, but there is lots of
side-by-side coaching because a parent, you know, wants a do-
over. They got worked up and it was hard for them to deal with
something with the child and to be able to say, that is okay,
you know, let's think about how you could try that the next
time.
So I think we get some of both, but again sort of
scaffolding, sometimes it is about how a parent's experiencing
their child, and sometimes it is actually about skills and
behaviors that a parent needs to practice, to work with a
particular age.
Ms. Schrier. Have you seen even maybe within a family, a
difference in outcomes, kindergarten readiness, later success
in life, between say the first or second child where the parent
didn't have this kind of coaching and then subsequent children
where they did have this kind of coaching and what that meant
for a family long-term?
Ms. King. I probably can't speak to research on that. I do
know what we hear from families where they say, wow, if I only
had known this with the first child--because they may not have
found that trusted partner or that appropriate service when
they had their first child, and the second child comes around,
and there is this notion of, wow, it would have been a lot
easier if only I had known.
I don't actually know if we have any research or data that
is showing different outcomes by--
Ms. Schrier. I have another question that you might have an
easier answer to. You said you have only been able to serve 12
out of 39 counties. And I was wondering if you had more
resources, can you tell me where--where you would put them,
either which counties or which sorts of programs expanding to
different areas?
Ms. King. Well, it is interesting. We are sort of in a
unique place. I think there is a commitment to evidence-based
models, and there is also really a commitment to working in
communities with changing demographics, and building evidence
for things that have been shown to be effective in a community.
So we have 23 we have identified in this analysis, and we would
really like to begin that work, planning with those communities
with the solutions that they want to best meet the needs of
their families. Not us choosing the model or approach, but
really having the community look at what is available to match
for their needs.
Ms. Schrier. Thank you very much.
Chairwoman Bonamici. Thank you. I now recognize
Representative Johnson from South Dakota for 5 minutes for your
questions.
Mr. Johnson. Thank you very much, Madam Chair.
Mr. Thomas, for almost a decade I was on the board of
directors at Abbott House, which is a home for abused and
neglected girls in my hometown of Mitchell. And I have seen the
cost in human terms, as well as dollars and cents, in dealing--
in providing a therapeutic-based approach. And so I was
connected very deeply with your conversation about the
importance of prevention as opposed to just treatment.
And I thought the outcomes, the data from your program, was
really impressive, some of the things you mentioned. You
mentioned that it was widespread deployment. I mean, give me
some sense of how widespread?
Mr. Thomas. You mean in terms of--throughout the U.S.?
Mr. Johnson. Yes.
Mr. Thomas. Yes. So we have trained in over 38 states in
the U.S., and one of the states that I like to highlight in
terms of really scaling up within the state is North Carolina,
where there is, at the moment, services being delivered in--
between 40 and 50 counties with plans to scale up to the full
100 counties within the next year or two. And so programs like
Triple P are built and designed to scale.
Mr. Johnson. You mentioned in your testimony having some--
you know, a flexible and tailored approach. I would think that
would make it more difficult to scale up. That's Not the case?
Mr. Thomas. No. It is--the planning of it is the critical
part. And so when you go into a community, you need to work out
where the--because there are a variety of approaches from
light-touch intervention through to more intensive services.
You need to identify where the parents are that are likely to
need to receive those services, and then you engage with those
groups and train those people.
So we have invested heavily in implementation science to
understand how best to roll out an evidence-based program. The
trial data always shows that a program works. The next
challenge you have got then, is, how do you then take that and
make that work within a community. And that is where the field
of implementation science has taught valuable lessons in terms
of how to scale up.
Mr. Johnson. And you talked about using existing labor,
existing professionals, which I agree, seems like it would make
it much easier to scale up. When I talk to these people out in
the real world, they all, without an exception, describe how
full their jobs already are, how complete the demands of their
profession are. I mean, how do you clear space for those people
to deploy yet another intervention?
Mr. Thomas. Often it is a case of--it is not adding on to
what they do. It is a case of--particularly, I will use the
example of a pediatrician. They will quite often get asked
questions that are not health-related. They will get asked
questions that are behavioral-related or developmental-related.
And so a lot of the time they struggle to know how to actually
answer that question in an evidence-based manner. And so it is
not adding to the job, but it is giving them the tools to do
their job in a better way.
Mr. Johnson. And I don't know a lot about your curriculum
or your approach, although what you described in your written
testimony and verbally made a ton of sense to me. I mean,
having parents engaged and, you know, playing with and
experiencing things with their children, when I do that as a
father, I feel far more connected with my children. I think I
would assume that is a message that needs to be reinforced on a
regular basis with parents so that is really sticks. You know,
is that demanding too much of someone like a pediatrician?
Mr. Thomas. No. Because when you roll out a program like
Triple P, the idea is to have multiple touch points within a
community--I think that was mentioned before--that the more the
message is heard, the more the messages are reinforced. So if
you embed a program like Triple P within a community, you will
be getting similar messaging from a teacher, from a
pediatrician, or a place of worship. And so when the parent is
consistently exposed to that--part of what we also do is a
communications strategy, and that is a large part of the
program where there are messages either on the internet or
radio, TV, posters, flyers, that really destigmatize the need
for parenting supports, and normalize that process for asking
for assistance, and also is another touch point for providing
assistance.
Mr. Johnson. So the data suggests that what you are
describing works well. Is there anything within CAPTA or other
federal regulations or programs that makes it more difficult
for your program to scale up and help more people?
Mr. Thomas. No. I think the evidence we have seen is that--
that the CBCAP moneys that are flowing to the agencies that
have rolled out Triple P, it has worked well in that regard.
Mr. Johnson. Thank you very much.
Thank you, Madam Chair.
Chairwoman Bonamici. Thank you. And I now recognize the
chairman of the full committee, Representative Scott from
Virginia, for 5 minutes for your questions.
Mr. Scott. Thank you, Madam Chair.
Mr. Thomas, you were asked about real numbers on
prevention, and one of the problems with prevention generally
is that the person funding the prevention program isn't going
to be the one reaping the benefits. If the city could fund a
nice summer program, intensive enrichment program in a
community, the benefits are going to be reduced incarceration
and social services, to some other agencies down the way. That
is just the way it is.
But if a case goes bad and it costs a million dollars, it
seems to me that somewhere along the lines, we should have
figured out how to prevent it if we could.
You talked about the community--primary community
prevention generally as opposed to trying to target the
prevention to a small group. Can you--you just said a little
bit about it. Can you say why it is important to be community-
wide and not try to target it?
Mr. Thomas. Sure. First, it is thought that there is more--
it is likely there is 40 times more abuse occurring than is
actually reported. And so even if you tried a targeted
approach, you don't know where that abuse is occurring. And so
a broader approach is critical for that reason. But also, even
what you would consider typically well-resourced parents are
also susceptible to abuse. And there can be triggers within any
household that can lead to that abuse and neglect.
And so the other issue with targeting specific populations,
you start to stigmatize those families and the program as well,
when you target families in that fashion, when you are having a
primary prevention focus. And so the idea is to make it widely
available in order to really address child maltreatment rates.
Mr. Scott. Thank you.
And, Dr. Jackson, I guess one question people would have
is, does prevention actually work? Are you familiar with the
Nurse-Family Partnership program?
Ms. Jackson. Yes, I am.
Mr. Scott. Has that been studied, and can you say a word
about the results of those studies?
Ms. Jackson. Sure. The Nurse-Family program is probably one
of the oldest programs, one of the first ideas, was to have a
pair of professionals or have nurses or have other types of
professionals come in the house, come meet with the family and
help you in the house, really starting prenatally in lots of
cases, right, so with pregnant, what might be considered high-
risk families, and to prepare that family for the arrival of
the child and then to work with them after they left.
It has the most evidence perhaps because it has been around
the longest. It has also been evaluated tremendously, but we
find that that is considered to be an evidence-based program at
the highest level of rigor that we have a metric for evidence.
Mr. Scott. And what is it? Does it reduce child abuse?
Ms. Jackson. Well, it reduces child abuse reports. The
evidence also speaks to fewer hospitalizations. Bearing in
mind, too, that child abuse is several different kinds of
things. Primarily what we find--
Mr. Scott. Does it reduce prison? Long-term, does it reduce
prisons?
Ms. Jackson. Well, I think that--that is a hard connection
to make, for anything, long-term, at reducing time in prison.
What we find more immediately is fewer juvenile-justice
problems, right, fewer conflicts in the homes.
Mr. Scott. Currently each state uses its own child abuse
and neglect registry to collect information, which means that
if somebody has a problem in Oregon and moves to Virginia,
Virginia may not know. Would creating a mechanism that allows
states to share data of their child abuse and neglect
registries help other states avoid problems? Ms. Jackson?
Ms. Jackson. So--so this is a vital next step, that states
be able to speak to each other. It may surprise some members of
the committee to understand that actually every state has its
own system and that they don't necessarily speak to each other.
And they don't--not only do they not speak to each other, they
often are adversarial, in terms of sharing information.
Where we see positive indication of this, there are some,
if you will, rather informal agreements, between states. They
are almost always states, though, that are close to each other,
on the map. And around cities that sit around a state line,
right, where it makes sense to share in Kansas City between
Kansas and Missouri, and more informally, right, because you
have a very fluid place like that.
But it is absolutely critical, perhaps most importantly,
because what we know is that being victimized, especially
having a substantiated case of child maltreatment puts you at
tremendous, exponential risk for another incidence of child
maltreatment, right? So it doesn't go away because you move,
right? The change of scenery doesn't do anything for your risk
factors. In fact, it probably increases them because you are
now in a place with fewer resources, fewer people you know,
fewer programs that you are involved with. And it doesn't allow
that new state to know what worked for you before, what
services did you get before, what made a difference, what
didn't work, right? So without sharing that information we set
ourselves backward in terms of helping children in the country.
Mr. Scott. And a quick followup on the Nurse-Family
Partnerships, do you have a cost-benefit ratio?
Ms. Jackson. I believe I provided one in my written
testimony.
Mr. Scott. Okay. Thank you.
Chairwoman Bonamici. Thank you.
I now Representative Thompson from Pennsylvania for 5
minutes for your questions.
Mr. Thompson. Chairwoman, thank you so much. Thanks for
this hearing, and thank you to all members of the panel here
for your testimony, your experiences you bring.
Dr. Jackson, as on behalf of all my Penn State alumni,
welcome to Happy Valley. We are sure glad to have you there.
Welcome to the Penn State family. In your written testimony,
you state that despite public health approaches--and certainly
the emphasis that we have all had to child maltreatment
prevention--that national rates have not fluctuated
substantially over the past 15 years.
You also mentioned that the most recent report shows that
the number of children investigated for child maltreatment has
actually increased by 10 percent over the past 5 years, and
that the number of proven child-maltreatment cases has
increased by almost 3 percent.
Just--I wanted to drill down a little bit and get your
impressions of why that is. Are we just more aware of these
issues than we were in years past, or we really didn't have a
good benchmark in the past--an accurate benchmark in the past?
Or is it reflected with some of your most immediate
conversations of, you know, we are not all reporting the same
way? What are your thoughts on that, why that is occurring?
Ms. Jackson. Right. So why do rates stay the same, or why
do they change? It is a really great question, because it
speaks to, I think, ultimately a question we want to ask about,
is what we are doing making a difference, and can that be
reflected in the prevalence and incidence rates that we see
reported.
So we do know a couple of things. One, the public is much
more informed about child maltreatment than it ever was before,
to be sure. There is many, many ways we are getting more
information. Public service information within our school
systems, right, so we get more information about the types of
child abuse, the types of child maltreatment, so we are aware
of those things.
To my knowledge, though, the number of things like the
mandated reporters haven't increased, like, so we don't have
more people reporting, but we do have more people who are
aware, and I know particularly in the state of Pennsylvania,
where lights--when lights get shone on a situation, where they
are concerned about a particular incidence of child abuse--Penn
State, of course, experienced this several years ago--it tends
to increase the knowledge base in that particular state. So we
see rates of reporting in child maltreatment in the state of
Pennsylvania skyrocket, particularly. So there is some sense
that that is based on education, based on information that you
have given them some encouragement to share that.
But also to be clear, the risk factors for abusing your
children, whether those are neglect, physical abuse, or sexual
abuse, have also increased. The amount of stress that families
are feeling, the amount of conflict that is present in the
home, the amount of mental illness that parents are reporting,
the amount of addiction that is present in this country are
also contributing to those rates. And so as a clinical child
psychologist those are usually the things that I am paying
attention to, are those sort of active factors that speak to
risk in the family, even if reports are also increasing.
Mr. Thompson. Thank you.
Mrs. Rose, thank you for your testimony. Excellent
testimony. You know, and obviously life can be challenging.
There is no doubt about it. Adversity is kind of a part of life
from time to time. It comes in different degrees and shapes.
Have you ever--That said, with the experiences that you have
had, how can families and parents build resilience to be able
to deal with that? What are some of the--I love your lessons
learned--they were excellent--that you shared in your oral
testimony, written testimony, you know--you know, but what else
can we do, what can parents do or a family do to build that
resiliency?
Ms. Rose. Thank you for your question. So, I think back--in
my written testimony, it is there--to a time when I lost a
daughter, and it was a really hard time for us. And so
everything I had essentially been equipped with, with the tools
in my toolbox, were just kind of out the window. And really the
connection and all the work that had been laid up to that
point, with my children and spending time and building
relationships with the family, gave me that reason to move
forward.
And so when you ask about building resilience and how we
can make families do that, is just through simple, everyday
actions. Pointing out family's strengths. So instead of
pointing out, we are so sorry this happened to you, that is
being empathetic and that is helpful, but this may have
happened to you, but here is, you know, not a silver lining,
but here is what you are strong at as a parent. Here is the
reason why you need to move forward. Here are some things you
can build upon. So not dismissing the fact of things that they
may need to work on, but really building on the strengths of
things that they are good at and highlighting that.
Mr. Thompson. All right very good. Thank you.
Thank you, Madam Chair.
Chairwoman Bonamici. Thank you.
And I now recognize the Representative Langevin from Rhode
Island for 5 minutes for your questions.
Mr. Langevin. Thank you, Madam Chair and Ranking Member
Comer. I want to thank you for holding this important hearing
and for allowing me to sit in and question today.
And I want to thank our panel of witnesses and thank you
all for the work that you are doing to promote child welfare.
Clearly, we all have a lot that we can do, and we rely on
experts, of course, like yourselves, who are on the front lines
doing everything you can to make sure that we are protecting
our children.
I am proud to co-chair the Foster Youth Caucus with
Congresswoman Karen Bass from--and several other co-chairs. And
I came to these issues years ago. When I was growing up, my
parents had welcomed many foster children into our home, and
today it is a priority of mine. It has really helped me to be a
better policymaker on these issues, to ensure that every child
has a safe and loving home.
So I would like to touch on a specific issue that I became
aware of several years ago, sadly, as a result of a Reuters
report. It is a frightening phenomenon known as unregulated,
child-custody transfers, or UCT, also known colloquially as
rehoming. And it is a practice of basically transferring
custody of a child, usually an adopted child, to a stranger
outside the safeguards of the child welfare system, resulting
basically from a failed adoption.
And I first learned about this about 5 years ago from a
Reuters published report on parents who were advertising, if
you can believe that, the children on online forums, often
because they couldn't handle their child's behavioral issues
resulting from past trauma.
Without a system of support, these parents turned to
strangers, people who hadn't been--who hadn't undergone
background checks, home studies, or supervision. Some children
from the report ended up in homes where they were subjected to
physical, sexual, or emotional abuse, not to mention the
additional trauma, instability of a new placement.
Addressing UCT, of course, requires a multi-pronged
approach, including increasing support services for families so
that they never reach the crisis point where they feel they
need to give up their child. Again, the result of a failed
adoption.
Just as important, however, is the need for uniform
national standards to identify and--for identifying and
responding to reports of UCT. So instinctively, we know that
UCT is a form of abuse and neglect, and yet on the federal
level, in the vast majority of states, the law doesn't clearly
treat it as such, creating confusion for child protective
services when they try to investigate cases, and sometimes
leaving them uninvestigated entirely.
So I would like to start, if I could, Dr. Jackson, with
you. Based on your experience, can multiple home placements
cause trauma for the children, and do you agree that
unregulated custody transfers, which often place children in
unsafe environments are a form of child maltreatment?
Ms. Jackson. Thank you for the question. So the first part
of your question is about multiple placements causing harm. So
my answer to that question is, it depends on the placement. So
if you are moving someone from a dangerous placement or a risky
placement or unsupportive placement to some other place that is
supportive, then it is a good idea. And if that environment no
longer meets the needs of the child, finding a place that does
is a good idea.
Now, that said, children need stability in their lives.
They need that kind of basic foundation to be able to
understand routine. So we wouldn't encourage it by any means,
but I wouldn't give a blanket statement to suggest that
multiple placements are necessarily problematic. It is all
about the quality. You know, this is true when it comes to
alternative care in general. The idea of it is not bad. It is
the implementation that can be problematic. It is the kind of
home you get placed in, it is the supported environment that
you are in now that makes a difference. And if that new place
is not a better place, it doesn't meet your needs, then you
will continue to have difficulty.
To answer your second question, unfortunately, I am not
familiar with this phenomena that you are describing, this--if
I understand it correctly, this having adopted kids and saying
this is not working out, and then on your own as a family,
finding another place and bypassing child protective services.
Unfortunately, I am not familiar with that.
Mr. Langevin. Okay. Probably my time is about to expire,
and I will put this one for the record. But in your testimony
you mentioned the importance of coordinating efforts across the
patchwork system of federal, state, and local agencies to
prevent child maltreatment. How important is it to have clarity
about what constitutes child abuse and neglect to this
coordination, to preventing and responding to child
maltreatment?
So I know my time is expired, so I will yield back, and if
you would answer that question for the record--
Chairwoman Bonamici. Thank you, Mr. Langevin. I see no
other Members to ask questions, so I want to remind my
colleagues that pursuant to committee practice, materials for
submission for the hearing record must be submitted to the
committee clerk within 14 days following the last day of the
hearing, preferably in Microsoft Word format.
The materials submitted must address the subject matter of
the hearing. Only a Member of the committee or an invited
witness may submit materials for inclusion in the hearing
record. Documents are limited to 50 pages each. Documents
longer than 50 pages will be incorporated into the record via
an internet link that you must provide to the committee clerk
within the required timeframe, but please recognize that years
from now the link may no longer work.
And now without objection I would like to enter into the
record a report from the U.S. Government Accountability Office
which recommended that the Secretary of Health and Human
Services strengthen the data quality of child abuse and neglect
fatalities and current practices leading to incomplete counts.
And a scholarly article written by researchers at the
Centers for Disease Control, showing that the total lifetime
cost of substantiated cases of child abuse and neglect is
$830,928 per child, which bears a total annual cost of $428
billion to our country.
[The information referred to follows:]
Strengthening National Data on Child Fatalities Could Aid
In Prevention: https://www.govinfo.gov/content/pkg/CPRT-
116HPRT37764/pdf/CPRT-116HPRT37764.pdf
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Chairwoman Bonamici. Again, I want to thank the witnesses
for their participation today. What we have heard is very
valuable. Members of the committee may have some additional
questions for you, and we ask that you please respond to those
questions in writing. The hearing record will be held open for
14 days, in order to receive those responses.
And I remind my colleagues that pursuant to committee
practice, witness questions for the hearing record must be
submitted to the majority committee's staff or committee clerk
within 7 days, and the questions submitted must address the
subject matter of the hearing.
And I now recognize the distinguished ranking member for
his closing statement.
Mr. Comer. Thank you, Madam Chair, and our witnesses gave
excellent testimony today on the importance of CAPTA. We know
this is a critical law that helps states, local governments,
and organizations save lives. We also heard that there are some
improvements that can be made to improve the system and help
the grantees better help families and children, changes like
looking at prevention programs, focusing on ensuring local
programs can serve people in a way that works for them, and
collaborating with stakeholders to improve services.
I look forward to working with my colleagues on these
improvements, and thank you all very much for your time.
Madam Chair, I yield back.
Chairwoman Bonamici. Thank you, and I now recognize myself
for the purpose of making a closing statement.
Thank you again to all of the witnesses for being with us.
We appreciate your expertise and experiences.
Today's hearing was an important step toward strengthening
our approach to child abuse and neglect. Although we have made
progress in reducing some rates of child maltreatment, we
cannot allow ourselves to become complacent, and we cannot
allow the disturbing rise in child abuse and neglect cases to
go unaddressed. This is not only a public health crisis but a
threat to the future of our country.
Accordingly, Congress has the moral obligation to expand
and improve the Child Abuse Prevention and Treatment Act for
the new challenges facing our children, families, and
communities. And we can all agree, regardless of party
affiliation, that our current system needs improvement, to make
sure that children are protected from immediate and long-term
consequences of abuse and neglect.
And as our witnesses also reminded us today, any proposal
to reauthorize CAPTA, the Child Abuse Prevention and Treatment
Act, must recognize the importance of holistic solutions that
prevent families and children from suffering, instead of
waiting to treat children after they have been hurt.
We need to make sure that state agencies can work quickly
and collaboratively with a broad range of protection and
support services for all children, no matter where they are.
Everyone here knows what is on the line. We are committed
to taking bipartisan steps toward a Child Abuse Prevention and
Treatment Act that our children desperately need and deserve.
And I look forward to working with my colleagues on both sides
of the aisle to make sure that all children have a safe and
healthy environment that allows them to reach their full
potential. The lives and future of so many of our children and
families are at stake.
With there being no further business, without objection,
the committee stands adjourned.
[Additional submission by Ms. Schrier follows:]
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[Questions submitted for the record and their responses
follow:]
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[Whereupon, at 4:23 p.m., the subcommittee was adjourned.]
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