What we must talk about is love and
mothering. \Ve must accept the fact that
some people shouldn’t have children and
that it isnt necessary for everybody to huave a chiild. We must thuen recognize that where mothierimug is imuadequate, thiat we must sup-plemeuit. In our society it should be I)Ossi-ble to titrate mothering quite vell, and to supplement it where it is required.
The future is quite bright. We understand
the problem much better. We know, I
think, what to do. We will be able to
pre-dict quite well who is at risk and intervene
before anything goes wrong. Medically
speaking, we are about there. We have a
long way to go yet to coordinate the profes-sions of social work, law, and medicine but
I think a start is being made.
PANEL DISCUSSION
Dmu. FONTANA: Dr. Kempe, could your
surrogate mothuer program be successful in
New’ York?
Du. KEMPE: Absolutely. I will tell you
‘hat the’ do. They go to the home. They
generally start out hiaving some coffee in
the kitchen. Tiuen they go shopping, help
along, listen. They concentrate on the par-cuts. not on the child. They will take them
out for a meal. They will do what a good
neighbor will do. If they ask for a $50 loan, since they dont have $50 either, that is im-possii)le. If they want a dime, they will lend
a dime like a good neighbor would. They
send Christmas cards, birthday cards. They
do all the things that some social workers were told in school is unprofessional. They do w’Iuat the social worker in past
genera-tions did, whuich was care. They hand out
their telephone number. My bedside
tele-phomue number, my wife’s, and Dr. Steele’s are in the telephone book. \Ve get calls at 2 AM. \Ve think that is a good thing.
In this coiunection, when do you know’
that the child is safe to go home? We now
have gone through this several hundred
times amid not hiad a chiild rebattered. We
used to have a 30% rate. Tue child is safe
to go home:
1. \Vhemu the parents’ self-image has
im-proved. When they think better of
themselves. We can sense this by the
way they dress and when they have
any kind of social life.
2. When they see the child in niore posi-tive terms.
3. When they prove to us that they can
use lifelines in nuoments of stress and
they can use the telephone to call one
of these three telephone nunibers I
mentioned.
4. When on weekend visits they have
shown that they can handle the child
emotionally.
When these four things are done, the
child is ready to go home. That will be
be-tween three months and eight months.
When it isn’t done by eight months, it is
likely to he quite a long time.
Dii. FONTANA: Dr. Kempe, do you
sug-gest physical punishment in reasonable
de-grees for children, or is “spare the rod, spoil the child” out?
Dii. KEMPE: It depends on the mores of
our society. I think it will soon be out. Be-fore long, assault and battery will be just that even between parent and child.
DR. FONTANA: Judge Kehley, what
ser-vices are available to the Family Court in
making decisions with regard to an abused or neglected child? Is there any follow-up on a family after the child is returned?
JUDGE KELLEY: The services available are
those obtainable through the Probation
De-partment of our own court and also through
investigation by the Bureau of Child
Wel-fare. If it is an SPCC case, there has usually
been a good and thorough investigation
be-fore the petition is filed. This information is available to the judge. The judge can ask for more investigation at that point. As an ex-ample, if the judge desires additional
infor-ination before deciding on placement, the
judge can ask for a reevaluation of the
home.
SYMPOSIUM ON CHILD ABUSE 810
information that either public or private agencies caiu provide, then the decision will have to be the judge’s. If the judge wants a follow-up, thlat can be done very simply by returning a child, but putting the
respon-dents, which would he the parents on
pro-bation, with a requirement for report froni time to time.
Dii. FONTANA: Dr. Joyner, what do you
see as the role of tlue nurse in prevention of child abuse and aid to the parents?
Dii. JOYNEB: The nurse on the ward can
be invaluable in supplying information as
to the responsiveness of the child, how the child acts with pareiits, how’ often parents visit.
Public health nurses coumkl get imuvolved in the team effort of 1)0th time investigative phuase amid even (if they had time enough,
which I have never seen a public health
nurse yet huave) take over as surrogate
mother. I hope we will be able to get a
coterie of surrogate mothers. There are
cer-tain home conditions in New’ York where a
surrogate mother would not work. In our
last case the family had already been in and out of jail. %Ve rarely could see them since
every time somebody came to visit them,
they thought it was the police, so they went
down the fire escape. They were all drug
pushers as vehl as users. This included
hav-ing forcibly injected an 11-year-old with
heroin.
Such cases are fortunately rare. Most of
w’hiat Dr. Kemne propos1 would w’ork in
the majority of our cases, but not all of
them.
Dii. FONTANA: Mr. Cameron, how do you reconcile a statutory obligation to provide
for abused and neglected children and for
follow-through care as you discussed, with
the lack of resources presemutly available? Mit CAMERON: How’ (10 we reconcile anything today in light of thue realities of budget slashies? I think it is about time that we reestablished some of oim r priorities.
There is a lack of effective training for those asked to do the job. There is also
in-adequate support both within their own
agency and within time community. Dearth
of resources is part of the problem.
Dii. FONTANA: Dr. Kenupe, would you hike to give us your feelings on this ques-tion?
DR. KEMPE: I disagree to some extent. If
we wait for the money, we will wait
for-ever. I am satisfied thuat the resources in
this country have never i)een gathered
to-gether in any reasonable way to excite
peo-ple to do a proper job. I mean the old and
the very young.
Among the old are people who are
vege-tatinq away in front of television sets who
could be used as resources for these
fami-lies. We are doing this. We are putting ba-bies that need fostering into homes for the aged, where four or five elderly ladies take
four-hour shifts nursing babies and give
more mothering than most babies can stand
as a matter of fact. The only probleni w’e’ve
had is that some babies don’t get enough
sleep.
We haven’t begun to really get at people who are able to give time. This is what this
is about. They have time, and they have
love. All you iueed are those two itenis.
We haven’t been willing as social
work-ers, as physicians, to hand over our sacred skills and our stethoscopes to lay people
be-cause we are afraid that somehow or other
it is going to devalue our money, our skill. It think it is all wrong. These human skills
people gave us because we had the lucky
break of having a loving mother and father.
W7e should put them to work. We have
done that in reading programs around the
country. You have a very elegant program
in parts of New York for remedial reading.
That same model would serve very well in
the area of child abuse.
In this country, churches are standimug
ab-solutely empty except for three or four
hours a week. They could all be used as day
care centers as sonic of them are. They
could be used as crisis nurseries. The man-power really is here.
Dii. FONTANA: It may be a little early to
make a judgment, but would anyone care to
predict whether the incidence of abuse will
811
ternus of cases reported there hasn’t been
any change yet. The incidence of
abandon-ment appears to be down at least 30%.
Dii. KEMPE: I think you would not be
able to shiow a great difference yet because abortion is still a middle- and upper-class
phenomenon. It is the poor who don’t get
aborted, who appear in court for child
abuse.
1)rm. FONTANA: Dr. Kempe, what do you
see as the most effective role for the visiting puhilic health nurse in attempting
preven-tion amid perhaps management of child
abuse in a suspicious home?
Dii. KEMPE: They do very well with us.
\Ve use them extensively. They are most
ideal to go into honies, because the public accepts the visiting nurse. She has an entree that very few physicians, social workers, or
the police ever have. We also often use
them as time parent surrogate if she can take on a few.
You cannot take on more than one or two
of these, not just because of time, because
of enuotional wear and tear. These people
wear you out. My wife, who is a very
long-suffering, able adult and child psychiatrist, tells me that in her practice, she cannot
tol-erate niore than one or two such clients.
That is also true for Dr. Steele and the rest
of us. In terms of emotional wear and tear
you are better off with just one client at a
time. You are going to have to use other
people to do the work.
I would add that nobody should ever
think that we will ever make these people
whole. I think it is naive for any of us, so-cial workers, psychiatrists, pediatricians, to believe so. It is ludicrous. The most you can hope for is that they will get one experience in trusting an adult, and that they will be-gin to behave differently around their
chil-dren. If you have modest goals using those
criteria you will do very well. If you are
aiming for mental health, you can forget that. They are too damaged.
JUDGE KELLEY: Dr. Kempe, I understand
that you are saying, you don’t make the
adult person whole, but do they finally get a glimmer of a feeling of affection?
Dim. KEMPE: Very often they do. And that
is how you make the decision as to when to
return the child to their full custody. When they begin to talk about the child in posi-tive terms, with some pleasure and some joy
as their own, and have a better image of
themselves, and when they have used
life-lines successfully, it is quite safe to send the child home.
Conversely, some never do, and you have
got to simply face that. Social workers by
and large cannot face the concept that they could fail, that there is no salvation. One of
the deep religious parts of social work is
that there is salvation.
Dii. FONTANA: Judge Kelley, are there any inservice educational programs concern-ing child abuse and neglect that the judges
of the Family Court can be exposed to?
JUDGE KELLEY: We have judicial
confer-ences fairly frequently and we have had
conferences on child abuse. Dr. Joyner has
joined us at one at the Bar Association last spring. Mr. Isaacs, who is a consultant to the
Judicial Conference on the Family Court,
has set up several conferences. Dr. Heifer
came to the court and spoke about what he
and Dr. Kempe have been doing. We have
been trying to keep the judges up to date.
DR. KEMPE: Judge Kelley, in Colorado at
least, one of our basic problems is that the
Welfare Department of some counties
es-sentially prejudges the cases. They decide which case will stand up in court, if I can use that in terms of physical evidence. They figure out what judge will do what.
They have arranged it so they can’t lose a
case because they bring to the judge only
one case in 20. The other 19 they try to
han-dle in-house, and among them we have had
some terrible disasters.
I wonder whether there isn’t something to be said for a child having his minute in court, even if it is just to the point that the judge says, “I think it is all right, all of you
agreeing to leave the child home.” I just
don’t like the idea that there is another
judge before you come on the picture who
is a 22-year-old social worker who has
SYMPOSIUM ON CHILD ABUSE 812
JUDGE KELLEY: We have done away with trying to pick your own judge. We haven’t,
however, been able to do anything to get a
person to bring a case to court if indeed the social worker thinks it won’t stand in court. And it would seem to me that the social worker should somehow, if there is any
doubt, leave the decision as to whether
there is a case or not to the court.
Dim. KEMPE: If the court uses only physi-cal evidence and will not use psychiatric
and psychiatric social workers’ evidence
and if the social worker isn’t treated well in court, as they are not sometimes, then I could see the social worker’s reluctance to
go.
My bias has been that the court is
soci-ety. The child should have his minute in
