(posted Wednesday, Oct. 23)
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 by20 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?
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