ArticleIP_3841.txt

   
   
      
         
            

            
               (posted Wednesday, Oct.
23)
            

            
               Fact
Abuse
            

            The "Hey, Wait a Minute"
column by Douglas J. Besharov and Jacob W. Dembosky ("Child Abuse: Threat or
Menace?") seriously misrepresents the methodology, findings, and
conclusions of the recently released Third National Incidence Study of Child
Abuse and Neglect (NIS-3). As the NIS-3 project director and the supervisor
responsible for implementing the NIS-3 definitions, we want to set the record
straight. We address only some of the misinformation here.

            In light of Besharov's
criticisms, it is noteworthy that he participated in the Conference of Experts
convened in late 1991 by the National Center on Child Abuse and Neglect (the
NIS-3 sponsor) specifically to refine the NIS-3 design. Together with the rest
of the conferees, Besharov recommended no changes in the NIS methodology and
definitions. Now, five years later, Besharov opines that the NIS methodology
and definitions are flawed. The NIS-3 findings may run counter to his position,
but it is important for Besharov and Dembosky, and for readers of Slate, to get
the facts straight.

            First, when Besharov and
Dembosky characterized the 1.4 million additional children who joined the ranks
of the maltreated between 1986 and 1993, they summed up the NIS-3 estimates in
inappropriate ways to draw their conclusions. In doing so, they
overstated the percent of children who were harmed only by
emotional or educational maltreatment (actually 9 percent, not the 23 percent
they indicated) and they understated the percent of new children who
were harmed by physical abuse, sexual abuse, or physical neglect (actually 37
percent, not the 22 percent they implied). Besharov and Dembosky also glossed
over how these percentages translate into numbers of children. The 37 percent
just mentioned refers to over one-half million additional children who
were harmed by physical abuse, sexual abuse, or physical neglect in 1993--over
and above the number who were harmed by these forms of mistreatment in 1986. An
estimated 1,249,000 children were harmed by these forms of maltreatment in
1993. Also, in discounting the rise in incidence found in the NIS-3, Besharov
and Dembosky contend that "fatalities arising from child abuse have held
roughly steady" between 1986 and 1993. But this is contradicted by the numbers
they themselves cite, which show that fatalities have risen by 
               20
percent during this period, from 1,014 to 1,216.

            Second, Besharov and Dembosky
misrepresented the NIS methodology for classifying the severity of injury or
harm. (We wish we could ascribe this to misunderstanding, but we clarified this
issue for them before their article's publication and they published their
misinformation anyway.) In fact, the classification of a child as seriously
injured/harmed is relatively objective in that it does not rely on a blanket
judgment by a respondent. The criteria for defining serious harm or injury are
standardized; they are applied to the described injury itself, not to the
respondent's judgment about that injury; and they have been consistent across
the three incidence studies. So the recent quadrupling of the number of
seriously injured children cannot be ascribed to some vague form of
"definitional creep."

            Third, Besharov and
Dembosky's claim that increased sensitivity accounts for the rise in the number
of seriously injured children does not make sense in the context of the
patterns of NIS findings, which do provide evidence of progressively heightened
sensitivity for more subtle maltreatment cues. Respondents' sensitivity to
moderate injuries increased between the NIS-1 in 1980 and the NIS-2 in 1986,
but did not change after that. Between the NIS-2 and the NIS-3, respondents
showed increased awareness of endangerment (i.e., maltreatment events that did
not yet cause harm). Note that the significant increases found in the NIS-3
were discontinuous across the outcome spectrum, occurring in only two
categories: serious injury/harm and endangerment, both of which essentially
quadrupled since the NIS-2 in 1986. If Besharov and Dembosky want to discount
both increments by appealing to the same process (enhanced sensitivity) then
they need to explain (1) why this process applied discontinuously in the NIS-3
and did not affect the intervening category of moderate injury or harm, and (2)
how the NIS-2 respondents managed to overlook three-fourths of the children who
had been seriously injured while at the same time evidencing greater
sensitivity in identifying moderately injured children. Seriously injured
victims of maltreatment are relatively unlikely to escape detection by the
study methodology, so the rise in incidence in this category cannot be
plausibly explained as due to heightened awareness. Considering all the
evidence, the most reasonable interpretation is that there has been a real
increase in the incidence of seriously injured children. More than one-half
million children were seriously injured by abuse or neglect in 1993.

            Fourth, Besharov and Dembosky
take issue with the documented drop of 36 percent in the rate of Child
Protective Services investigations by pointing out that the set of
uninvestigated cases includes educational neglect and emotional maltreatment.
But a careful reading of their discussion reveals that they do not address the
drop per se. Instead, their entire discussion emphasizes their "take" on the
relative inappropriateness of CPS investigations for emotional and educational
maltreatment. However, educational neglect and emotional maltreatment have
always been included in the incidence studies, and eliminating them from the
picture would not eradicate the significant drop in the overall rate of CPS
investigations from the NIS-2 to the NIS-3. In fact, the percentages of
children whose maltreatment was investigated decreased significantly in all
categories except educational neglect--from 64 percent to 45 percent
among physically abused children, from 75 percent to 44 percent among sexually
abused children, from 57 percent to 35 percent among physically neglected
children, and from 40 percent to 26 percent among children seriously injured by
any maltreatment.

            Finally, contrary to what
Besharov and Dembosky convey, the NIS-3 report does not "blithely call for
more" reporting. Nor did we "claim recklessly that too few cases are
investigated." Instead, we concluded that the NIS-3 findings "emphasize the
need for better targeting, whether by reporters in referring children to CPS,
by CPS screening practices in connection with reports, or by both."

            
               --Andrea
J. Sedlak, Ph.D.
            

            
               associate
director of the Human Services Research Area at Westat Inc.
            

            
               --Diane
D. Broadhurst, M.L.A.
            

            
               senior researcher at
Westat Inc.
            

            
               Douglas
J. Besharov Replies:
            

            It is difficult to respond
to Sedlak and Broadhurst's letter. First, I have great respect for their past
work, and appreciate the constraints they faced in this project--as government
contractors in an underfunded study. Second, words like "misrepresented" and
"misinformation" are, in the world of policy analysis, fighting words. Third,
their study is complicated, and numbers can be thrown back and forth until the
eyes of the average reader glaze over. Most important, my complaint is not so
much with the study as with the interpretation of its findings--and especially
with the spin given to it by political appointees in the Department of Health
and Human Services.

            Hence, I will deal with the
personal attacks in their letter and then go on to my larger policy--and
ethical--concerns about their response.

            In their letter, Sedlak and
Broadhurst correctly point out that I participated in a 1991 Conference of
Experts that discussed the study's methodology. In fact, as director of the
National Center on Child Abuse and Neglect in the mid-1970s, I helped design
the study in the first place--long before either Sedlak or Broadhurst were
involved. So, I know well the strengths--and weaknesses--of the study's
approach to the difficult task of counting illegal behaviors toward children
that largely occur behind closed doors.

            They claim that, after the
1991 meeting, I "recommended no changes in the [incidence study's] methodology
and definitions." But they conveniently leave out two important facts. First,
at that meeting, I pointed out that the methodological changes that were
planned for the study all would have the effect of raising the count of
abused and neglected children . In fact, Sedlak and her colleagues described
(in a report to HHS) how they planned to "fine-tune" the study to "ensure that
categories of key participants who were most likely to encounter suspected
maltreatment cases in the [1986 incidence study] are given higher probability
of being included in the [new study]." In other words, they proposed to change
the study's methodology so that more reports would be made to Westat. Second, I
did urge that the study's conclusions be modified--six months before it was
released to the public. On Dec. 7, 1995, Secretary Shalala issued a press
release stating that "the number of abused and neglected children rose sharply
from 1.4 million in 1986 to 2.9 million in 1993." I tried to get a copy of the
report, but was informed that no one outside the government would be given a
copy until it was complete. In other words, Shalala issued her press release
based on an uncompleted report.

            Like others, I tried to get
more information about the study from Westat, but was rebuffed. In fact, Sedlak
sent me a memorandum stating that "the continued contacts from your office on
the matter give the appearance of efforts to place me and my staff in a
compromising position in relation to our client, NCCAN. Please ensure that your
staff refrain from further contacts of this nature."

            Concerned, I wrote to
Secretary Shalala in March, stating: "The Westat findings may be extremely
significant, but there is reason to doubt that they reflect an actual increase
in abuse and neglect." I went on to explain what the problems seemed to be, and
to offer my assistance in interpreting the study's results.

            In a bureaucratic
nonresponse, a political appointee replied by enclosing a defense of the study
prepared by Sedlak and stating, "I believe that the enclosed memo concerning
the study adequately addresses your concerns."

            I mention this history,
rather than dueling with Sedlak and Broadhurst's statistics, because I think
that it exemplifies their selective presentation of information.

            The last time Sedlak
conducted an incidence study, it had to be revised and reissued almost three
years later because technical problems in the analysis inflated the estimated
number of abused and neglected children by 11 percent.

            This time around, the
problem seems to be more severe. The plain fact is that no attempt was made to
conduct the kind of second-level analysis that would have explored whether the
increases were real. (The data that they cite in their letter to contradict us,
by the way, were not presented in the original report and, in any event, are
too incomplete for these purposes.) I realize that one reason this essential
work was not performed was that the government was unwilling to pay for it. But
that is no excuse for announcing that "child abuse and neglect nearly doubled"
without also cautioning the reader about the study's limitations. I hope that,
before three years pass, a revised report that does so will be issued.

            Moreover, I doubt that the
people at HHS seriously believe that child abuse doubled in seven years. If it
had, America would be in the midst of a child-abuse crisis. Decisive and
perhaps radical action would be required, not the puny list of previously
planned and budgeted activities that Shalala described in her press release: A
demonstration program in Illinois, $23 million in prevention grants, $2.5
million to maternal and child-health programs, past initiatives to fund family
preservation programs and to oppose child-welfare block grants, and an
"unprecedented" level of technical assistance to the states (again, though, not
an increase).

            But the real reason I write
is because of the broader problem created by exaggerating social ills. Cynics
might chalk up this latest report as yet another well-meaning effort to build
support for child-abuse programs. After all, goes the thinking, if the American
people believe that child maltreatment is a big problem, they might be willing
to spend more money on treatment and prevention programs. Richard Gelles, a
longtime leader in the field and author of The Book of David: How Preserving
Families Can Cost Children's Lives , says that he used to "go along" with
past exaggerations, but has come to appreciate the harm that they have
done.

            Exaggerating the severity of
cases is what columnist Charles Krauthammer has called "defining deviancy up."
The more it seems that such serious maltreatment is common, the less likely are
agencies to respond firmly. To put it bluntly, society can consider a tough
response to 150,000 serious cases a year--but 560,000 is an entirely different
matter, politically and programmatically.

            I have
worked in this field for almost 30 years--first as a young prosecutor in New
York City, later as the director of the HHS National Center on Child Abuse and
Neglect, and more recently as a trainer and consultant--and I know that child
abuse and child neglect are profound national problems. But, time after time I
have seen how such overstatements have made the problem seem too big to handle
or have distorted policy-making. I am afraid that Shalala's remarks will do the
same.

            
               Justice
Is a Bearded Lady
            

            According to "The Week/The Spin" posted
Friday, Oct. 11, "Gossip focused on Justice Scalia's new beard, the first
facial hair on the court in more than half a century."

            Well, I
know Sandra Day O'Connor and Ruth Bader Ginsberg don't. And I'm pretty sure
that Breyer, Souter, Stevens, Kennedy, and Rehnquist don't. But doesn't
Clarence Thomas have a mustache?

            
               --Tim
Carvell
            

            
               Mississippi
Yearning
            

            In his "Diary," Joe Queenan
describes the editors and reporters at the local Gannett-owned paper he reads:
"Having persuaded themselves that they are living and working in rural
Mississippi--which is where they all belong--the staff always seems amazed to
find that people like Ivan Boesky, Carl Icahn, Mariah Carey, or David Letterman
actually live in the same county as them."

            These
editors do not belong in "rural Mississippi." No one here would put up with
their awful writing. When I moved to Oxford, Miss., last winter to work in the
publications department of the University of Mississippi, I thought I would get
special treatment for being a wordsmith. Hell no. Telling people around here
that you are a writer is like telling a New Yorker that you are an actor and
expecting them to be impressed. This state has a lot to be ashamed of, but not
its writers. Bad analogy, Mr. Queenan. Instead, condemn your weak local editors
to Alabama, which is where they all belong.

            
               -- Gary Bridgman