Testimony for

The Committee on Education and the Workforce Select Education Subcommittee
United State House of Representatives

Hearing on

Child Abuse Prevention and Treatment Act

August 2, 2001

Room 2175 Rayburn House Office Building

Submitted by:

Consortium for Citizens with Disabilities
Task Force on Child Abuse and Neglect

Contact: Jill Kagan, National Respite Coalition, 703-256-9578, jbkagan@aol.com or Kim Musheno, American Association of University Affiliated Programs for Persons with Developmental Disabilities, 301-588-8252, kmusheno@aauap.org

The Consortium for Citizens with Disabilities (CCD) Task Force on Child Abuse and Neglect is pleased to submit written testimony on the reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA) to the House Select Education Subcommittee of the Committee on Education and the Workforce.

CCD is a coalition of approximately 100 national disability organizations working together to advocate for national public policy that ensures the self determination, independence, empowerment, integration and inclusion of children and adults with disabilities in all aspects of society.

In 2001, the Consortium for Citizens with Disabilities made a significant and purposeful decision to establish a Task Force on Child Abuse and Neglect and to work in tandem with the National Child Abuse Coalition for one important goal - the prevention of child abuse and neglect. Children with disabilities are particularly vulnerable to child abuse, and child abuse may result in the acquisition or development of disabilities, which may, in turn, make children even more vulnerable for further abuse.

According to an HHS report released in April 2001, substantiated cases of child abuse and neglect investigated by child protective service (CPS) agencies numbered an estimated 826,000 children nationally in 1999. States report that nearly half (44.2%) of the child victims or their families in confirmed cases of child abuse and neglect receive no treatment or any other kind of services following investigation of the report. Deaths from child maltreatment remain unacceptably high: an estimated 1,100 children died of abuse or neglect in 1999 alone. And, as noted above, near-fatal child maltreatment leaves thousands of children permanently disabled each year.

Children with disabilities are, on average, 3.4 times more likely to be maltreated. Broken down by form of maltreatment, children with disabilities are 3.88 times more likely to experience emotional abuse, 3.79 times more likely to be physically abused, 3.76 times more likely to be victims of neglect, and 3.14 times more likely to be sexually assaulted than children without disabilities.

In addition to disabilities being a contributing factor to maltreatment, maltreatment can cause disabilities. The National Center on Child Abuse and Neglect (now, Office on Child Abuse and Neglect) determined that 36.6 percent of the substantiated cases of maltreatment in a 1993 study sample caused disabilities. Near-fatal child maltreatment leaves 18,000 children permanently disabled each year (United States Department of Health and Human Services, 1995).

In addition to the unconscionable human costs, the financial costs of the child maltreatment-disabilities dynamic are staggering. Approximately 22 percent of maltreated children have learning disorders requiring special education. According to a study by Health and Human Services, the future lost productivity of severely abused children is $658 million to $1.3 billion, if their impairments limit their potential earnings by only five to ten percent.

Such alarming statistics on the child maltreatment/disabilities nexus provide a cogent argument for attending to disability concerns in CAPTA. Toward that end, CCD's priorities for the current reauthorization of CAPTA are as follows:

• Comprehensive health and developmental evaluations - Each child for whom there is an open case with Child Protective Services should be referred for a comprehensive health and developmental evaluation, if one has not already been done.
• Respite care services - Respite care should be more available, accessible, and affordable for families who are at risk of abuse and neglect, especially those families of children and/or parents with disabilities. Respite should be considered a core service of child abuse prevention programs.
• Equal protection for all children -All children should receive equal protection from abuse and neglect, including medical neglect, regardless of the health status, disabling condition, or any other characteristic of the child or child's parent(s)/caregiver(s).

Rationale

Comprehensive Health and Developmental Evaluations: Chernoff et al. (1994) determined that over 90% of the foster care children in their study had an abnormality in at least one body system. While identification and treatment of the medical, developmental, and mental health problems of children have been shown to decrease the amount of time a child spends in out of home placements and increase the likelihood that he or she will experience stable living situations (Horwitz, Owens, and Simms, July 2000), numerous systemic and direct service barriers prevent many children in the child welfare system from receiving adequate health care (GAO, 1995). It is time for CAPTA to address this issue when a child is first referred to CPS for an investigation.

Respite: Research has demonstrated that respite is a successful, effective and cost-saving child abuse and neglect prevention strategy. One of the first comprehensive, comparative respite care studies of families with a disabled member found significant beneficial outcomes. This is especially noteworthy, given that children with disabilities are at much greater risk of abuse or neglect. The National Respite Coalition has summarized the effectiveness data for respite care in preventing child abuse and neglect, in enhancing family stability and lowering stress, and in reducing out-of- home placements. (See NRC testimony for the record).

However, respite is in short supply and the demand is great. During an average week, nearly 1,500 families representing 3,425 children are turned away from respite and crisis care programs because resources to meet the need are absent. In a 1998 survey of respite programs nationwide, half had families waiting for respite care at the time of the survey (ARCH National Resource Center on Respite and Crisis Care, 1999).

Recommendations

CCD believes that these priorities are essential in the prevention and treatment of all children, not just children with disabilities. In support of these legislative priorities, CCD is requesting the inclusion of the legislative language in CAPTA being put forth by the National Child Abuse Coalition and lend our particular support to the following:

• Make Prevention a National Priority. Preventing abuse and neglect of children from happening in the first place should be a national priority. Billions of dollars are spent on protecting and serving children once they are in the CPS and foster care system, while only minimal investments are made in up-front prevention. Redirecting CAPTA will keep children safe and avert the long-term consequences and more costly out-of-home placements that result from serious abuse.
• Comprehensive Health and Developmental Evaluations: CAPTA will include discretionary funding for developing model programs in the provision of comprehensive health and developmental screenings. A required element of CPS intake protocol for selected pilot sites would be a determination of the child's health care coverage and an appropriate referral based on that determination.
• Respite Services Should be Preserved as One of Core Community-Based Child Abuse and Neglect Prevention Strategies: CAPTA should be the basic source of funding for proven effective community-based prevention programs, including the identified core programs of respite care, home visiting, parent mutual support, parent education, and family resource services.
• Strengthen Role of Families of Children with Disabilities, Parents with Disabilities. Recognizing that children with disabilities are at increased risk of abuse and neglect and that abuse is a significant cause of disabilities, CCD strongly supports all existing and NCAC proposed language in CAPTA Title II, which requires the involvement of families of children with disabilities, parents with disabilities, and agencies and organizations who work with families of children with disabilities to be an integral component of every aspect of program implementation and evaluation.
• Increased Funding is Critical for Prevention. Funding should be authorized at $500 million for Title II, which represents a modest commitment to support prevention of child abuse and neglect through CAPTA. It is also the amount necessary to begin to bring promising practices to scale and to keep local programs from having to turn families away from effective prevention services they are seeking voluntarily. CCD also supports an increase in Title I's authorization level to $500 million and to $100 million for research and demonstration.
• Enhance Accountability. CCD also supports the National Child Abuse Coalition's proposal to increase program and state accountability through improved reporting requirements to demonstrate effective and efficient use of funds under and in accordance with the Act.

In addition to requesting Chairman Hoekstra and his colleagues on the Select Education Subcommittee to include the above outlined language in CAPTA, CCD also requests that Chairman Hoekstra and the other distinguished Subcommittee members encourage their colleagues on the House Appropriations Committee to increase funding for CAPTA to their full authorization levels for FY 02.

Finally, CCD recommends that all children receive equal protection from abuse and neglect, including medical neglect. CCD's proposal is for CAPTA to include report language that precludes states from discriminatory practices in the provision of child abuse and neglect prevention and treatment services based on the health status, disability status, race, income, native language, ethnicity, religion, insurance coverage, gender, or any other characteristic of the child or the child's parent(s)/caregiver(s).

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