Va. Region Reports Unusually High Rates of Child Abuse

Dec. 18--

A mother breastfeeding her baby tests positive for cocaine use.

A toddler wanders outside in 30-degree weather wearing a 3-day-old diaper.

A child with a fungus on her face -- impetigo -- goes unchecked until it covers her head.

An 8-year-old who weighs in at 26 pounds soaking wet.

Children who show up to school and Little League practice with bruises on their legs and arms.

These are a few of the faces of child abuse in the Mountain Empire. And there are many such faces, according to those who work with abused and neglected children.

In fact, child abuse rates are worse in Southwest Virginia and Northeast Tennessee, per capita, than many other parts of both states and the nation.

Yet, one of the problems, say social workers, doctors and those who work in law enforcement, is that many people in this area believe it is a problem found elsewhere.

"Southwest Virginia as a region -- that is, Smyth County, Wythe County and west of that -- has a higher rate of child abuse per 1,000 kids," than the state average, said Kathi Roark, executive director of the Children's Advocacy Center of Bristol and Washington County, Va. "It has for some time. On average, there are around 150 new victims each year."

Virginia's average for 2010 was 3.3 abused or neglected children per 1,000 children, which makes it the fourth lowest state in the nation, according to the Council on Virginia's Future, a government agency that tracks child abuse. Alarmingly, in Southwest Virginia, the number was three times the state average.

"Per capita, there is a higher rate of kids coming into foster care than in the rest of the state," said Tommy Casteel, director of the Washington County Department of Social Services. "Proportionally, a higher rate of kids in foster care seems to indicate a higher rate of abuse and neglect."

By the numbers

The sheer number of calls and cases worked each year in this region demonstrates the abuse children suffer.

In Bristol, Va., between July 2009 and June 2010, there were 275 valid referrals to the Department of Social Services' Child Protective Services, said Karen Marion, work supervisor for the department.

In nearby Washington County, Va., social service workers took 29 valid reports involving 46 children from July to September of this year, Casteel said.

This past fiscal year alone, there were 160 new victims in Washington County, Va., and Bristol, Roark said, out of a population of about 14,000 children. Those are victims of sexual abuse or serious physical abuse, Roark said, and the number does not include other cases of neglect or less severe physical abuse.

Tennessee has its share of cases, too, although records are kept differently than in Virginia. There were 309 cases in Sullivan County in 2010, in which an allegation of abuse was made and a perpetrator indicated, according to a state report.

In total, there were more than 1,000 allegations of abuse in the county over the course of a year in 2010. Not all of those allegations were founded and investigated, but that number still sticks out in terms of the rest of the state. There were a total of 8,694 substantiated cases of child abuse in all of Tennessee in 2009, according to a state report. State numbers for 2010 were not available.

In addition, at least 12 children have died in Southwest Virginia in the past 10 years as a result of child abuse, Roark said.

Likely among them is 2-year-old Madison Snead, according to police and preliminary autopsy results. She died at her home in Abingdon on Nov. 15. Police said then that she had "bruises on [her] forehead as well as apparent scratches on her stomach." Rescue workers who responded to a 911 call about Madison reported seeing "several injuries, which appeared to be recent."

An autopsy revealed old and new injuries that indicated she was a victim of abuse, police said.

Madison's mother and her mother's boyfriend have both been charged with felony child abuse and neglect, but the case has yet to go to trial.

The fact that the advocacy centers in both Sullivan County and Bristol and Washington County, Va., were the first of their kind in their respective states and were created out of need seems to speak to the enormity of the problem in this region.

Roark said on average, the Children's Advocacy Center in Bristol sees about 150 new cases each year.

"It crosses all the cultural lines," Roark said of child abuse. "You can't say it's a product of people who live in rural areas or in urban areas. You can't say it's a product of poor areas. It's not that simple."

And, she said, there's no good answer as to why the abuse rates in this region are so high.

"It's so hard to pinpoint," she said. "In this region, there's a strong increase in family violence in general, and some of the children [are impacted by that violence]. There's a lot of child abuse in the region that's related to substance abuse."

Not simple

Child abuse is a complicated issue.

Anything from refusing to get a child medical attention or failing to change a baby's dirty diaper for several days to physical abuse or sexual exploitation can be classified as a form of child abuse, and all have been seen in this region, Roark said.

"I think a big problem is the community is rather naïve in thinking it's not in our backyard," said Connie Steere, executive director of Court Appointed Special Advocates for Children, an agency that investigates a child's side of the story in an abuse situation and reports the findings to court.

Steere said the largest percentage of abused children fall into the category of neglect -- nearly 80 percent. Those children are often overlooked, however, because it's the more violent or graphic abuse that gets attention.

"If neglect can be looked at, that child needs to be out of that home," she said. "We often wait until it gets to sexual or physical abuse -- we're missing that population, which is the biggest population in the first place."

Most of the victims of child abuse are under the age of 6, Roark and Steere said. Most, two-thirds, are girls.

And, the national figures related to sexual abuse are astounding, Roark said.

"One in four girls and one in six boys will experience sexual abuse before they are 18 years old," she said.

That includes any type of sexual exploitation from unwanted touching to prostitution, she added.

Bristol, Tenn., Police Detective Justin Branson said typically between 100 and 175 sexual and physical abuse cases are opened each year at his city's Police Department.

"We probably have more sex abuse cases reported to us," than other kinds of abuse, he said, adding that the department gets referrals from the Department of Children's Services. "I think child sexual abuse gets reported more than it used to."

In Virginia, there is a list of mandated reporters, including teachers, doctors, law enforcement officers and social workers. In Tennessee, anyone who sees abuse is supposed to report it.

Reporting

But one problem, Branson said, is that although sexual abuse is the most-often reported type of abuse, many cases of all forms of abuse go unreported each year.

Authorities believe as few as one in 10 instances of child abuse or neglect is reported.

"People don't want to report it," Branson said. "It's a very life-altering thing, and a lot of people suppress that. It's not uncommon for me to get a case that's five years old. And it's hard to prove, and traumatic -- it alters [the victim's] life in a negative way, forever."

He said it's often hard for people to understand what's going through a child's mind when he or she is suffering abuse.

"People need to understand the drastic effect it really has on a [child], and how hard it is for them to talk about it," he said. "It's normally family members, close friends, stepmoms and stepdads -- people who have access to kids in a trusted role. [Parents] have to be really careful who [they] let [their] children be around."

Roark said one child that she worked with could not bring herself to say what had happened to her -- she had to write it on a white board.

"Often children will not talk about it," she said. "People aren't readily going to say, 'I've been abused.'"

She said part of that is the stigma attached to the abuse -- the child might feel he or she is betraying the family, or that they somehow asked for the abuse. In addition, she said, children are often threatened with harm to themselves or their siblings if they tell.

Gena Frye, executive director of the Children's Advocacy Center of Sullivan County, said one reason abuse may go unreported is because people want to deal with it themselves, within their family.

"I think sometimes we feel it can't happen to us, and it can, and a lot of cases go unreported," she said. "If it's the breadwinner [the abuser], they might think, we can just not respond to this because we need somewhere to live."

Sometimes, abuse might not get reported, Branson said, because children, particularly teenagers, are sometimes "groomed" -- that is, their abuser might molest them and then pay them off with a trip to the mall or some money. Eventually, the child becomes resigned to the abuse, gives in, and does not report it.

Branson said the evidence of the difficulty of reporting child abuse is obvious in people years later.

"You talk to people who are suspects in cases and they'll tell you that 15 years ago they were abused," he said. "This is a position where a lot of times, you're the only one who can help the kid. Is it going to take back what happened? No. But you have to stay motivated and help them."

Front line

Among those on the front line of treating victims of child abuse are emergency room doctors.

Travis Watson, an emergency room physician at Bristol Regional Medical Center, said doctors see all aspects of child abuse, from physical to emotional.

"The physical abuse is the easiest to pick up on," he said. "You look for things that don't fit: injury patterns, broken bones that show up during an X-ray."

He said most cases in the ER are new injuries -- sometimes parents bring the child in and sometimes the child comes in an ambulance.

"When we suspect child abuse, we're required to report it, to make sure the nurse in charge knows. A social worker is assigned to the case, and a report made to the Department of Children's Services."

He said seeing a bruised and broken child is difficult.

"Emotionally, it's difficult, particularly if the nurses or physicians have children of the same age," he said. "There's lot of anger and rage among the staff -- how could someone do this?"

One of the most challenging cases, he said, came when he was working at a different hospital.

"A small child came in, and wasn't acting right, and ended up having multiple skull fractures," he said. "But almost all the cases we see are survivable injury patterns."

And he expects, somewhat bitterly, for those cases to pick up this time of year. With the holidays comes stress and often there is increased exposure between an abuser and a child, he explained.

Marion said there are more calls to the DCS during the school year in general.

"When in school, a child might feel safer talking to people, and people with access to the child might notice something" that tips them off to abuse, she said.

The influence of substance abuse

Often, child abuse is not the only ongoing problem in a home where abuse occurs: in many instances, substance abuse is also a problem.

"We see a lot of drug-exposed infants," Frye said. "OxyContin and meth shows up [in the fetus] or the child has withdrawals. And those people [the mothers] can be charged."

Steere said more than 90 percent of the cases CASA deals with in this region involve substance abuse.

"It's a big part of why children are neglected," she said. "Having an addiction to drugs doesn't mean your child will be abused or neglected, but the likelihood is there, because your judgment is impaired. Everything is connected -- food, shelter and clothing are not what [people addicted to drugs] buy first."

She said the problem can affect children throughout their lives. For instance, a child who grew up in a home where substance abuse was commonplace might have been taken from that home and bounced around from foster home to foster home. That affects their education -- "you can never get all the credits you need," Steere said.

Then that child is "not likely to develop good relationships with people that are good for them," she said. "Selling drugs is extremely profitable. It's supply and demand. It's learned behavior, either the usage or the selling."

Another contributor in this region is the prevalence of meth labs, Marion said.

"In the past year, and the past six months, the number of meth labs in the city" has increased, she said. "Any time the police investigate a meth lab with children involved, we get called. That seems to be on the rise for us."

What can be done?

Although those who work with child abuse victims admit it's difficult to understand and treat, many seem hopeful that with proper education, adults can help protect the children in their communities.

"I think we just lack education on how to protect kids," Frye said. "For every adult, studies have shown that they could protect 10 children. When you figure the numbers, you could train a few people and protect a lot of children."

The advocacy centers in both Washington County, Va., and Sullivan County have several educational resources available for adults and will participate in a new initiative next year. Stewards of Children, presented by nonprofit group Darkness to Light, will provide training for community adults, discuss types of abuse and provide first-hand testimonies from adults who were abused as children.

"Every adult comes to a recognition that it is their moral and ethical obligation to report," Roark said. "As a human being, if I felt like a child was being hurt, it's my obligation to report. Children have to rely on grownups -- children should not have to be responsible for their own safety."

One way people can get involved is through CASA, Steere said.

"CASA is the eyes and ears for the child," she said.

Volunteers are assigned to a case that is going through the court system, and act as the child's advocate throughout the proceedings. They investigate the home life, school performance and anything else that might make the child's case in court stronger. Judges take CASA's suggestions seriously, Steere said.

"We're constantly training new volunteers," she said. "The need is great. It's the opportunity to truly make a lifelong difference."

It's here

Above all, people who work with child abuse victims want members of the community to understand that it is a universal problem and one that is found here.

"I think one thing that's misunderstood is the prevalence of it," Roark said. "A lot of things that came out after [the] Penn State [scandal] were, 'How could that happen in an athletic world?' Hello, it happens all the time. Just because it's not in the headlines, people think it's not as bad as it is."

But it is bad, Branson said. And it's horrific in its negative effect on a person's life.

"It's not like somebody stole your mailbox," Branson said. "This is one human committing a crime against another human."

arobinson@bristolnews.com

(276) 645-2531

Copyright 2011 - Bristol Herald Courier, Va.