Battle Against Child Abuse Waged at Center

“You walk in the door at 8 a.m. and the phone’s already ringing. It’s a police officer and it can be from anywhere in San Diego County. He wants a child evaluated, he’s asking for a physical exam, he’s asking for an interview.

“And you say, ‘Well, when do you need it?’ And he says, ‘We need it today.’ It doesn’t matter what the day’s like, whether we have two cases or 10 cases, we still have to fit them in.”

Geri Beattie pauses for a quick breath. A nurse, Beattie’s speaking style is energetic, precise, professional--an odd contrast to her sweat shirt and slacks.

The casual clothes serve a specific purpose, however. So do the kites painted on the walls. And the stuffed bears cluttering every spare corner of the Center for Child Protection. All are intended to alleviate the anxiety of children--children who come there for examinations that will reveal if they have been sexually abused.

Second in Country

Children’s Hospital opened the Center for Child Protection in July, 1985. It became only the second child-abuse clinic in the country-- after the Kempe Center for the Prevention of Child Abuse in Denver--to combine counseling and research to combat child abuse.

The center is a symbol of the long-simmering interests of Dr. David Chadwick, who served as chief of staff at Children’s Hospital for 17 years before leaving that position to found the center almost three years ago.

A slender, 61-year-old pediatrician with curling, iron-gray hair, Chadwick saw his first case of child abuse at Children’s Hospital in Los Angeles in 1960. Recognized as perhaps the leading local authority on the problem, Chadwick helped draft a model child-abuse reporting law adopted in all 50 states.

Over the past two decades, the number of sexual and physical abuse cases reported in San Diego County grew phenomenally, jumping from 298 in 1980 to 1,442 in 1985. Although the figures have stabilized over the past three years--there were 1,447 cases in 1987--Chadwick says there has been a disturbing increase in severe physical abuse, which he defines as “fractures and up.”

“A couple years ago we were seeing 50 or 60 (severe cases) a year. We were up around 200 in 1987,” he says. “We’ve had more deaths, too. Five or six deaths a year was about average for 1980-85. In ‘87, the number was 17.”

Tremendous Increase

Part of the tremendous increase is probably due to Children’s being designated as the county trauma center for children. But Chadwick says the jump in serious cases also results from the increased stress felt by parents and the decay of extended family relationships, factors that he says contribute not only to physical abuse, but to a general erosion of the quality of child care.

“Child abuse is just the edge of unacceptable forms of child care,” Chadwick said. “I think if you look at less serious things--latchkey kids left alone, kids in marginal child-care situations, unlicensed child care, inadequate child care--you see a big increase in that too. Child abuse is where we define it as something we just don’t tolerate.”

Although he would never justify their actions, Chadwick speaks compassionately about the kind of people who are likely to injure or neglect their children.

“We’re looking at people whose lives are pretty bad,” he says. “(Often), they were abused themselves. They’ve got to sort of reestablish their own childhoods. They’ve got to go back and learn how (to be good parents), through some positive experiences of their own.”

The center’s fight against abuse is a fierce one. Here is a glimpse of the battle:

It’s 8:30 in the center’s two-story building adjacent to Children’s Hospital, and the first of five sexual abuse exams that take place on a typical weekday is getting under way. Cases can range from the mild--an infant with a genital rash, where no evidence of abuse can be found--to the severe, like the teen-age girl who recently reported that her mother’s boyfriend had molested her since she was 2 years old.

In a fictional but typical case (the center would not discuss actual cases for legal reasons), 6-year-old Pam has been brought in after the mother of a playmate heard her saying, “My daddy touches my peepee,” and called the county child-abuse hot line.

Pam and her mother are greeted by Linda Tarke, a licensed clinical social worker, who interviews Pam in a small, cozy room equipped with toys. It looks like any child’s playroom, but care is taken to ensure that the dolls are anatomically correct, and a doll house is there to help Pam identify where an incident occurred. A one-way window allows videotaping and observation of the interview by a police officer.

Building a Rapport

First, Tarke spends 10 minutes building a rapport with Pam. Then she asks, “Do you know why you’re here?” Some children will answer directly, “Because my Daddy hurt me.” Pam, however, is vague, so Tarke tells her that many children come to talk to her because something is bothering them or scaring them. She asks Pam, “Is something happening to you that’s really worrying you or scaring you?”

Gradually, through gentle questioning and the use of the dolls, Pam tells Tarke that her father has had intercourse with her several times.

Next comes a medical examination to look for physical evidence--such as semen or genital irritation--that abuse has occurred. First, a nurse helps Pam become familiar with the exam room. This technique helps relax a child in advance of the exam, which may take as long as an hour and involves the physician not only touching but photographing the child’s genitalia.

The exam itself is conducted “very slowly, very methodically,” Beattie said. “You have to go slow with kids, because you really don’t want it to be frightening, you really don’t want them to be traumatized by this.” Like Beattie, the doctor dresses casually--no white lab coats.

To further ease the tension, children are given the choice of being examined by a male or female physician. A full 100% of the girls choose a female physician, as do many of the younger boys.

After the physical exam, both Tarke and the physician meet with the police officer and Pam’s mother to discuss their initial findings and recommend follow-up care. In this case, Tarke suggests that Pam come in for weekly therapy.

At the same time Pam is being examined, Dr. Chadwick is at the hospital seeing two children admitted over the weekend with signs of possible physical abuse. The first youngster is a 5-year-old girl who has a serious head injury. She has had surgery and is now in intensive care.

He evaluates the child’s appearance, the records of the surgeon and other physicians in the case, X-rays and the history provided by the child’s parents. He also asks a female physician to conduct a genital exam to see if the child has been sexually abused.

Chadwick next sees an infant who was brought in with mild diarrhea, and is suffering “water intoxication.” The condition involves the presence of too much water in the system and usually results from improper feeding, indicating neglect. At this point, he has no information about the family, so it’s difficult to assess whether the child is at risk.

That is not unusual. Abuse cases are delicate and tricky matters, and because terminating parental custody is no minor affair, physicians and law enforcement authorities must balance the potential threat to a child’s safety with the rights of the family.

Occasionally, officials at the center and similar institutions come under fire for allegedly being overzealous in their pursuit of prosecutions of parents suspected of abuse. In 1985, for example, an Oceanside mother alleged that a careless autopsy performed at Children’s prompted the filing of criminal charges against her in connection with the death of her son.

The mother, Carole Phinney, was acquitted and later sued the county, challenging the coroner’s practice of allowing doctors from Children’s to perform autopsies on victims of suspected child abuse. The judge in the criminal case said Phinney deserved an “abject apology” for her ordeal, which he blamed on “people not exercising their discretion” appropriately.

Mothers and children are now arriving for one of the center’s weekly support group meetings. The lobby is filled with active, happy-looking toddlers headed for the center’s child-care room, where volunteers will look after them while their mothers are in the three-hour meeting.

There are about 10 mothers in the support group this morning. Joining them are parent aides--volunteers who are generally women who have raised children of their own. These aides essentially take the role of a loving grandmother to families where there has been abuse or neglect. Typically, they focus on the mother, who is often raising her children alone.

On this day, one of the parent aides, Sharon Howlett, arrives with a graduate of the support group--Kathleen (Lucky) Luckavage. Luckavage sought help four years ago, when her children’s father was hospitalized for acute alcoholism and she felt she couldn’t cope with her daughters on her own.

Since then, Luckavage, now 33, has kicked a drug habit she developed at age 12, landed a good job as a resident apartment manager and learned to have fun with her daughters.

“I think I started believing in myself, because Sharon believed in me,” Luckavage said. “And I wanted my kids to believe in me.”

More women--both mothers and parent aides--have been drifting in, getting Styrofoam cups of coffee and greeting each other. Now Diana Gordon, the center’s assistant director, gets the meeting started.

Gordon enlisted in the battle to end child abuse in 1967, when she worked with child-abuse pioneer Dr. C. Henry Kempe in Denver. She began coordinating parent aides through Children’s Hospital when she moved to San Diego 12 years ago. Gordon is skilled at helping the mothers express their feelings, which, like any mother’s, combine a lot of love for their children with utter frustration at being unable to handle them.

Today, Linda, a single mother attempting to get off drugs, talks about her desperate need to have time away from her two children.

“I don’t know how to be a mother,” Linda sobs. Gordon quietly lets the sobs come out. Adams puts an arm around Linda and another mother gets her a box of tissues.

Gordon comes down hard, however, when she senses a mother may be putting her child at risk.

“Those kids will be taken away from you,” she says firmly to Mary, who has just said she sometimes spanks her two children with a belt.

“Sometimes they need it,” says Mary.

“No they don’t,” Gordon responds. “It doesn’t help them, it doesn’t teach them anything.”

Mary looks as if she’s not sure she agrees, and Gordon persists: “I want you to put that belt away. Lock it up someplace.”

Gordon believes the center’s programs have significantly helped participating families--and she has the statistics to prove it. She reviewed records for 92 families--representing 154 children--seen at the center in 1985 and 1986, and said that prior to their involvement with the center, 71% of abuse reports filed against them were substantiated. During and after their involvement, substantiated reports went down to 26%.