Copyright 1996 Newsday, Inc.    
                                    Newsday

               April 21, 1996, Sunday, NASSAU AND SUFFOLK EDITION

SECTION: CURRENTS; Pg. A42  

LENGTH: 1721 words  

HEADLINE: IDEAS / Ignoring the Danger Signs of Child Abuse / 'In 
the 16 montsh before Elisa''s death there were at least 10 
instances when a teacher, a doctor or a social worker saw 
injuries.'  

BYLINE: Douglas J. Besharov. Douglas J. Besharov is a resident 
scholar at the American Enterprise Institute and a visiting 
professor at the University of Maryland School of Public Affairs. 
He was the first director of the U.S. National Center on Child 
Abuse and Neglect and now serves on the New York City Child 
Fatality Review Panel. This article was prepared with the 
assistance of Jake W. Dembosky, a research assistant at the 
University of Maryland.  

BODY: 
 
SIX-YEAR-OLD Elisa Izquierdo might be alive today if her case had 
not been so tragically mishandled by New York City's Child 
Welfare Administration (CWA), now known as the Administration for 
Children's Services. But focusing on the faults of that agency 
obscures the failure of schools, hospitals and other social 
service agencies to report clear signs of Elisa's possible abuse.  

   As documented by the recently released report of the New York 
City Child Fatality Review Panel, on which I serve, Elisa "was 
known to the Brooklyn Family Court, the Department of Probation, 
a legal services agency, at least three CWA-contracted purchase-
preventive service programs, a noncontracted social services 
program, at least two drug-rehabilitation programs, one alcohol-
rehabilitation program, a preschool, a public school, a school-
based child and family therapy program, at least two psychiatric 
hospitals, several general hospitals, a private pediatrician, 
several relatives, an influential private individual and others."  

   In the 16 months before Elisa's death, there were at least 10 
instances when a teacher, a doctor or a social worker saw 
physical injuries or "bizarre" behaviors indicative of 
maltreatment that were either not reported to the state child-
abuse hotline or rejected when a call was made.  

     According to the Fatality Panel report and other published 
accounts, these signs included: "burns on the leg and foot"; "a 
bruise on the child's nose and marks around her eyes"; "head lice 
and a small patch of hair loss"; a "fever-like blister"; as well 
as repeated claims by her mother that her father, his friends, 
her teachers and various other adults had physically and sexually 
abused Elisa and "the mother's repeated references to witchcraft 
and voodoo, and her apparent belief that the child was possessed 
by the devil." Agency records also indicate that Elisa was known 
to be urinating and defecating throughout her home, spreading her 
feces on the refrigerator and drinking from the toilet. 

   Just as Elisa might have been saved by a more effectual child 
welfare agency, so might she have survived if the other agencies 
that saw her during her last two years of life had reported these 
conditions to the authorities. After all, since the early 1960s, 
child-serving professionals' failure to report has been 
punishable by law.  

   But what happened to Elisa is not unique to New York. A 
nationwide study conducted about a decade ago for the National 
Center on Child Abuse and Neglect provides evidence of how often 
professionals fail to report signs of child abuse and neglect. In 
1986, about 56 percent of the apparently abused or neglected 
children professionals saw went unreported. That is about 500,000 
children, including about 2,000 with injuries severe enough to 
require hospitalization.  

   What's going on? Although a few professionals may be callously 
indifferent to the plight of children like Elisa, most are not. 
One cannot read the records of the agencies involved in her case 
without observing that dozens of people were genuinely concerned. 
The reason we know so much about her numerous physical injuries 
and bizarre behaviors is that these professionals noticed them, 
recorded them in their files and tried to help the family. The 
problem is that too many professionals are not adept at spotting 
signs of serious physical, sexual and emotional abuse. They 
generally don't know what to report - and how to report it.  

   Widespread drug addiction among disadvantaged parents, like 
Elisa's, further complicates professionals' recognition of 
possible child abuse. Such parents may appear loving and 
concerned at one moment, only to turn violent and depraved when 
under the influence of crack and other dangerous drugs. The key 
to protecting their children is recognizing the circumstantial 
evidence of past maltreatment.  

   That didn't happen in Elisa's case. As the Fatality Panel 
noted, "There were signs of possible physical abuse and ample 
signs that both the child and her mother were in extreme 
psychological distress, that the family could no longer manage 
its problems and that intervention from an outside source was 
absolutely necessary."  

   In the past, many efforts to train professionals to do a 
better job of identifying and reporting child maltreatment have 
been made. But they have often been superficial (oneor two-hour 
training sessions are the norm) and short-lived (efforts that 
start with great fanfare tend to peter out as interest wanes).  

   Better education about reporting responsibilities would be the 
single most effective method of encouraging more complete and 
more accurate reporting. Education programs should sensitize all 
child-serving professionals to the occurrence of child abuse and 
neglect - especially within the context of chronic parental drug 
addiction. The programs should be comprehensive, rigorous and 
ongoing. (There is, after all, substantial turnover in most of 
the agencies that serve children.)  

   Moreover, the training should cover the emotional and 
behavioral problems that are signs of possible maltreatment - 
whose significance was either missed or ignored by so many 
professionals who encountered Elisa. As the panel noted, "In 
addition to recognizing physical signs of maltreatment, mandated 
reporters must be trained to recognize children's emotional 
reactions to abuse and neglect, including behavior that is 
abnormal, extreme and is not age-appropriate." Put simply, 
Elisa's behaviors were red flags signaling the need for societal 
intervention.  

   Such training will have to be planned with great care. It will 
not do, for example, to tell people simply to report their "gut 
feelings." That does not give investigators enough to go on, as 
we saw in Elisa's case. The more details a report contains about 
possible abuse, the more likely a child-abuse investigator will 
be able to confirm the situation.  

   Vague advice also increases the likelihood of inappropriate 
reports, a problem that is now depleting scarce agency resources. 
In 1993, more thanthree-quarters of the reports made to the state 
child-abuse hotline were closed after an initial investigation 
determined that they were "unfounded."  

   At least one of the reports about Elisa was deemed unfounded. 
An unfounded report does not necessarily mean that the child was 
not actually abused or neglected. Sometimes, the worker makes a 
mistake. More often, evidence of child maltreatment is hard to 
obtain and may not be uncovered when agencies lack the time and 
resources to complete a thorough investigation or when inaccurate 
information is given to the investigator.  

   But the current high rate of unfounded reporting goes far 
beyond anything reasonably needed by the child welfare agencies. 
Besides being unfair to parents, it endangers children who are 
really abused. It imposes an unnecessary burden on an agency 
already hard-pressed to investigate all the cases reported 
appropriately, because each report must be carefully investigated 
- homes must be visited; parents questioned, friends, relatives 
and neighbors interviewed, agency records checked and so forth. 
But all this takes time. When workers feel the press of new cases 
coming in every day, they inevitably cut corners and make 
mistakes.  

   How serious a problem is inappropriate reporting? Between 1989 
and 1993, as the number of reports received by the city's child 
welfare agency increased by more than 30 percent (from 40,217 to 
52,472), the percentage of substantiated reports fell by about 47 
percent (from 45 percent to 24 percent). In fact, the number of 
substantiated cases - some families were reported more than once 
- actually fell by about 41 percent, from 14,026 to 8,326. Thus, 
12,255 additional families were investigated during that time, 
although 5,700 fewer families received child-protective help.  

   As a result, children in real danger - like Elisa - get lost 
in the day-to-day pressures of large caseloads. For example, as 
of June, 1995, CWA had 712 investigative workers, but only 190 
workers providing court-ordered preventive or home-monitoring 
services. Reducing inappropriate reporting by only 20 percent 
would have allowed the agency to almost double the number of 
caseworkers assigned to court cases.  

   Like nonreporting, inappropriate reporting is generally 
neither deliberate nor malicious. Many unfounded reports involve 
situations in which a well-intentioned person overreacts to a 
vague and often misleading possibility that the child may be 
maltreated. Others involve instances of poor child care that, 
though of legitimate concern, simply do not amount to child abuse 
or neglect. 

   The statewide child-abuse hotline could also do more to help. 
Right now, the hotline staff itself decides whether to reject 
reports from callers without reviewing the family's history of 
child abuse and neglect. That is a mistake.  

   For example, on Oct. 14, 1994, about a year before Elisa's 
death, the school she was attending called the hotline in Albany 
to report "conflicting information about an injured hand." The 
call was rejected, presumably because the school could not 
connect the injury to the mother's conduct. But this decision was 
made by a worker who did not have access to Elisa's record and 
the many previous, confirmed reports of maltreatment over the 
preceding five years.  

   If the hotline had known of this prior record, as the panel 
noted, "it would have been more likely to accept" the school's 
report. The computers at the Albany hotline should be upgraded so 
that records of past reports can be used - while the caller is on 
the line - to help decide whether to accept or reject a report of 
child abuse.  

   One hospital was so concerned about burns on Elisa's leg and 
foot that it asked its child-protection committee whether a 
report should be made. The committee eventually decided against 
calling the hotline, but again, if the committee had known of 
Elisa's maltreatment, it almost certainly would have done so. The 
panel called for the implementation of a long-standing state law 
that authorizes the hotline to provide such information to 
physicians.  

   The glare of publicity surrounding little Elisa's death may 
push agency officials to adopt these and other long-overdue 
reforms. That's a high price for her to pay, but wouldn't it be 
worse if she died in vain?