Disrupting Social Norms: Eliminating Child abuse and Neglect in our Lifetime
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In an effort to accelerate the changing of social norms with regard to how the public and professionals view child abuse and neglect in the United States, we incorporated the National Foundation to End Child Abuse and Neglect in January 2018. The mission of the Foundation is to end child abuse and neglect in our lifetime. The National Foundation to End Child Abuse and Neglect (EndCAN) is unlike any other organization that has entered into the human services field. EndCAN enters the field not as a new organization that will impede and encroach on others, or compete for scarce funds. Instead, it will focus on unifying the field, supporting it by collaborating with foundations in health and education related areas such as heart disease, cancer, suicide, obesity, and zero to three in order to improve research, prevention, education, training, and advocacy. EndCAN has two goals. First, change the public and professional’s perception of child abuse and neglect as a primarily social and legal problem to view them as the health, mental health and public health issues as well. Second, bring the currently siloed field together by financially supporting research, training, prevention and advocacy. We wish to create a larger voice and work together to end child abuse and neglect in our lifetime.
We expect that paragraph to create a reaction varying from surprise to skepticism by readers of this commentary partly because those are the very reactions we have had from the hundreds of individuals in our professional community and the public since we first started exploring the idea in July 2017. Those who are surprised “thought there was already such a foundation”. There is not. Those that are skeptical have their own reasons or roll their eyes at the seeming impossibility of the task. Such a reaction suggests to us that the current social norm is to accept child abuse and neglect as akin to the weather: it happens. That ignores the > 1700 annual deaths of children – at least five per day in the US—and the millions of children and adults who live with the pain of having experienced sexual, physical, emotional abuse and neglect that they can never talk about (because another social norm is silence and gaze aversion). The current mode for approaching abuse and neglect often leaves its victims self-treating the pain in ways that often lead to a multitude of struggles like alcoholism, substance abuse, eating disorders, and suicide among a myriad of other health issues.
The group, community or culture defines social norms as the accepted behavior of individuals in groups who adhere to unwritten rules that are expected. Given that child abuse and neglect has written rules that make it “against the law”, and there is a multi-billion-dollar system trying to protect children from abuse and neglect, it may seem odd for us to argue that the social norm in the US is to ignore the problem. It is our observation is that the American public does not want to talk about the abuse and neglect, other than when a catastrophic case makes the news. Further, people do not donate nationally to what they perceive to be “social” issues the way they support the more than 125 national foundations that raise money for research, training, prevention and treatment of every conceivable pediatric and adult disease and problems for every organ of the body and dozens of genes, (many of which are very rare)!
Thousands of wonderful, hardworking, fiscally hungry nonprofits and organizations identify, treat and prevent all forms of child abuse and neglect. These organizations work day in and day out, in their own communities trying to do their part to help the “system”. Every day, one case after another crosses their threshold while resources dwindle. The grants they obtain from local foundations are ever dependent upon “seeing outcomes” and are time limited. The field burns out, has a very high level of turn over, and works each day to do their best without the support and backing of a national presence that is not on the front lines of the fight. This is the goal for EndCAN. Since the beginning of the modern child welfare directed child protection system in the 1960s there has never been a National Foundation to support its infrastructure. This is EndCAN’s goal. We want to expand the basic, clinical and translational outcomes research on the thousands of county or state based CPS and Juvenile Court practices. We want to shed light on needed data that allows us to know what does/has/will work to create healthy, functioning, healed adults who will break the cycle of abuse and neglect and in turn end it all together.
More than 30 years ago, Ray Helfer, MD (1985), suggested it was time to create a definition of the “Medical Model”. He was accused of “medicalizing” a social problem with some child welfare organizations and others pillorying him for what they viewed as a typical arrogant physician wanting to control social workers as other non-physician professionals. Nothing came of this suggestion at the time, but in retrospect, the medical profession and the health systems in the United States began what is now nearly a two-decade long transformation that the child welfare system, law enforcement and juvenile, family and criminal court systems could learn and highly benefit from.
So given this history, is it now time to, if not “medicalize” child abuse and neglect, perhaps think of it as not just a social and/or legal problem, but also as the health, mental health and public health problem it is? A recent poll we commissioned with Research America suggests that the public is ready to accept this notion (http://www.researchamerica.org/childabusesurvey). In that survey, a majority of Americans viewed abuse and neglect as a significant health issue. It ranked lower than Drug abuse, Cancer and Obesity, but ahead of Heart Disease and Alzheimer’s as health issues that should be addressed.
Our approach as a Foundation will first be to launch a public awareness campaign to help more Americans view child abuse and neglect as a health, mental health and public health problem. We believe that historically Child Welfare and Law Enforcement and the Courts have not yet shown a readiness to acknowledge and learn from their mistakes. Part of our grant making will be to help these professions begin to do just that. We believe it can be transformative. In our view, until it happens, children and families will not be served as well as they deserve to be.
In 1999, the Institute of Medicine of the National Academy of Sciences issued a report entitled: To Err is Human: Building a Safer Health System (Kohn, Corrigan, & Donaldson, 2000). The impact of this work, which spawned a movement, changed the social norms of physicians, nurses and hospitals throughout the United States. For years, physicians were perceived as being professionals who could do no wrong. They rarely made mistakes, and when they did, they met in private and discussed them in a privileged environment. They did not acknowledge mistakes to their patients, or to the media, lest a malpractice suit follow. The report acknowledged publicly that 100,000 patients died in our hospitals because of mistakes by physicians, nurses, pharmacists and others. It laid out the path to create a safer health care environment. Less than two decades later, hospital deaths have dropped by 17% to 83,000 this past year. The new normal is to acknowledge mistakes, get feedback from patients on their experiences, analyze how they occurred and implement the changes necessary. Further, it is now practice in many institutions that when mistakes are made, the patient gets an immediate apology and is offered appropriate compensation.
Until very recently, few child protective services systems in the US know what the short or long-term outcomes are for the children and families they have served. Recent reports from Tennessee (Vogus, Cull, Hengelbrok, Modell, & Epstein, 2016; Cull, Rzepnicki, O’Day, & Epstein, 2013) have called for child welfare agencies to emulate the efforts that have been huge cultural changes in embedding principles of safety science in the airlines and in health care. We have not personally ever seen child welfare agencies acknowledge mistakes or errors that lead to further abuse and harm to their clients. The “norm” is to stay silent and invoke confidentiality. This approach leads to child welfare policy made in reaction to a scandal rather than policy based on data. This leaves front-line workers in a terrible predicament. It is a goal of The National Foundation to End Child Abuse and Neglect to incent agencies to go through the same type of transformation that hospital systems went through. Such a change would help create an environment intended to support not only the clients, children and families served, but to support and guide the providers serving them.
This leads us to another intended focus: addressing shame. There is no denying that on every layer, from every angle, and in every case of abuse and neglect, shame is the underlying mode of approach. Victims of abuse and neglect often feel that they have done something wrong. If they do not report the people who are supposed to protect and guide them, they are bad and in turn shamed. This shame does not end after the abuse is gone. This shame seeps through in children’s behaviors, relationships, schoolwork, ideals, fears, joys, values and morals. Shame leads to a need to self-protect, and that need takes one into a state of primitive response: Fight or Flight. Experiences lived through this viewpoint often generate health problems, and specifically to responses that are based on a need to survive. When people respond in this fashion, they often make poor choices; say things, and experience life in survival mode that can be self-destructive: all from shame.
This same sense of shame creates a need to hide, guard, blame, and “pay back”, which often can be the underlying intent behind why abusers are made and not born. Nearly all abusers were once babies who were pure. We think not one of them sat in kindergarten raised their hands and never announced to the room, nor thought the concept of “when I grow up- I will neglect my children, I will beat them, sexually abuse them, yell at them and cause them harm.” No 5 year old has this in mind. Abusers grow up repeating what they know, feeling shame from all vantage points and are treated with shame. Lastly we have the bystander, the parents who never knew, the neighbor who wondered, the witness who didn’t know how to intervene, the friend who feared being hurt, the sibling who couldn’t stop it, those who were around the abuse who feel an insurmountable weight of shame because they didn’t know how to help, what to do or say and they carry this shame on and on, for years and years leading to defensiveness, depression, anxiety, remorse, anger, and so on. EndCAN will address shame through our PSA and advocacy work, by talking about child abuse and neglect and ultimately by changing the conversation about child abuse and neglect as being seen solely as a social problem to also being seen as a health, public health and mental health problem. The ending of shame will be an underlying intention for every area of our work.
As we all know, child abuse and neglect hurts everyone in direct and indirect ways. The damage seems to be so long lasting, yet we have no data to show how millions have grown up, in spite of experiencing abuse and neglect, to live healthy, functioning lives, while others go on to cause harm or suffer forever. This is information we must begin to understand. EndCAN intends to achieve this, with the support of foundation partners and the thousands of existing agencies, health organizations and millions of people who can stand together, raise a hand and join us in saying, “it is now the time to end child abuse and neglect.”
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
The opinions expressed in this commentary are those of the authors. This article does not contain any studies with human participants or animals performed by any of the authors. Funding for the foundation comes from the Robert Wood Johnson Foundation, Casey Family Programs and individual donors.
- Cull, M., Rzepnicki, T. L., O’Day, K., & Epstein, R. A. (2013). Applying principles from safety science to improve child protection. Child Welfare, 92(2), 179–195.Google Scholar
- Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: Building a safer health care system. Institute of Medicine (U.S.) Committee on Quality of Healthcare in America. Washington, D.C.: National Academy Press.Google Scholar