Serial child abuse

July 04, 2004

KEONNA EMMONS was shaken so hard that the toddler wound up hospitalized, in critical condition, with severe head injuries. Bernice Gilmore, the Baltimore woman who was caring for Keonna and pleaded guilty in June to assaulting her, had previously lost custody of her son for throwing him against a wall.

Keisha L. Carr, a depressed 23-year-old, broke the arms and legs of her eldest son, and within a year brutally killed the boy's infant brother. Sheila Avery lost custody of her son Travon because of neglect, and within a month of his return to her, she thrust the 5-year-old into a scalding bath, killing him. Five months after child-welfare workers took Sierra Swann's oldest child from her because of abuse and neglect, the runaway foster teen was charged with murdering her newborn twin daughters.

Serial abuse: It's happening time after time after time in Maryland. The pattern is not uncommon in domestic violence. It's proving to be no different here when the abuse -- or worse -- involves a parent and a child. And yet, shockingly, the state of Maryland appears to place no higher priority on families under its watch who have abuse in their past. And children are in danger of dying because of it.

It's critically important that child-welfare officials develop a process to flag and monitor potential serial abuse cases. In fact, a citizens oversight panel recommended in May that the state establish a triage system to assist special-needs cases; surely, repeat abuse would qualify. State officials cannot delay -- children's lives are at stake.

Abuse is rarely a one-time occurrence. Families in which a child has been abused continue to have children; they also are at risk. A drug-addicted mother, an alcoholic father compound the potential for harm.

Dr. Peter L. Beilenson, Baltimore's health commissioner and head of the city's child fatality review committee, says repeat abuse is a factor in the deaths of six to 12 children a year. But the problem is far greater: A recent federal audit of Maryland's child and family services found a recurrence of abuse and neglect in 8 percent of the estimated 3,000 cases in which a child is allowed to remain at home or with relatives. That exceeds the 6.1 percent rate expected by federal reviewers.

Dr. Beilenson and his committee have urged the state Department of Social Services to track women who have abused in the past to protect other children from injury in the future. But the agency would be hard-pressed to undertake that potentially life-saving step: The agency can't identify how many of its 12,000 cases involve previous abuse and neglect without hand-searching its records.

The problems of protecting children are not Maryland's alone. Not one state passed a 2004 federal audit that reviews the ability of social services agencies to protect and serve abused and neglected children. But why is the problem so prevalent? Political leadership, judicial discretion, financial resources, availability of services and public interest can improve or impede how states deal with these troubled and troubling families.

Baltimore social services workers tried to protect 18-month-old Alicia Cureton. The city Department of Social Services had been involved with the child since her birth. Diagnosed as drug-exposed, Alicia was put in a special foster care program. A Baltimore judge later placed her in the custody of her father -- over the objections of child protective service workers -- and ordered him not to leave the child alone with her mother, Monalisa Mackey. But the child's father maintained a relationship with Ms. Mackey.

On the afternoon of Feb. 28, Alicia was left with her mother and two siblings while her dad ran some errands. When medics were called to the house, Ms. Mackey claimed Alicia had fallen down 10 carpeted steps, police say. But the child had injuries that suggested something more terrible had occurred. And it had -- the medical examiner later ruled Alicia's death a homicide by asphyxiation. Ms. Mackey was charged with murder in Alicia's death; she has pleaded innocent to the charges.

Although police say they had no previous reports of child abuse against Ms. Mackey, the mother of eight had a long history with the social services agency. The department intervened with at least six of her other children, according to officials.

In state and congressional hearings, state Secretary of Human Resources Christopher J. McCabe has said that his workers can't act simply on the presumption that an abusive parent will abuse another child later. Perhaps. But child-welfare professionals will tell you that the best predictor of future behavior is past behavior. That's why the state must pay closer attention to families whose children have been abused in the past.

"If parents get services, we can reduce the risk of reoccurrence," says Dr. Allen Walker, a Johns Hopkins pediatrician and an expert on child abuse. "But it never goes away entirely."

When a child is removed from a parent because of abuse and neglect and placed in foster care, it is the responsibility of a foster care worker to refer parents for services, meet with them routinely and ensure contact between parent and child. But Maryland cannot be counted on to provide that kind of support. The same federal audit released June 9 found that the state was not "consistently effective" in assessing the needs of abused children and their parents and providing services to help safely reunite them.

Meanwhile, in too many cases, another child is born, and another. They can become the target of a parent's recklessness, anger, frustration. They remain helpless victims until they arrive at school with bruises. Or at the hospital with a broken nose. Or at the morgue.

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