Child abuse has drawn significant attention in Korea in recent years. In the wake of widespread media coverage regarding several children who died as a result of severe abuse, a new “Act on Special Cases Concerning the Punishment, etc., of Crimes of Child Abuse” was enacted on January 28, 2014, and became effective on September 29, 2014. The reporting rate on child abuse and neglect increased substantially after this but has still only reached approximately 20 percent, which is far lower than the rates in other developed countries, including the reporting rate in the United States of around 70 percent. Moreover, legal, social, and psychological services and support systems for the victims of child abuse are still limited.
As a child psychiatrist working with children, parents, and teachers, I’ve had many opportunities to hear about the psychological trauma of child abuse, the difficulties of mandatory reporters, and the limitations of the response system in Korea. I’m presently in Boston nearing the end of a sabbatical, and I’ve learned that Massachusetts invests heavily in child support and has one of the best child abuse response systems in the US. Moreover, with its abundance of medical and law schools, universities, colleges, and hospitals, the state has a long history of interdisciplinary approaches to child abuse. Dr. Robin Deutsch is a key person in this history. She worked in the Children and the Law program at the Massachusetts General Hospital Law and Psychiatry Service for 20 years and has devoted time to divorce custody evaluation and child abuse. In this interview, we discussed the differences in child support and child abuse response systems in Korea and Massachusetts.
Many viewers wondered why the mother and her partner’s abuse were not adequately addressed and why Hye-na was not protected despite the teachers being aware. In fact, many of them reported the abuse to the police, and the police visited Hye-na’s house several times.
Young children frequently deny that they are abused, sometimes because of fear of separation from their caregiver, sometimes because of fear of retribution, sometimes because of fear of the abuse becoming more severe. In those cases, how can we find evidence of child abuse? Do you have any system to protect children who were reported as child abuse victims but for whom the police or Child Protection Agency (CPA) have difficulty finding evidence of abuse?
Robin Deutsch: That’s quite a story! It’s really an interesting question because when kids are interviewed in their homes or in the presence of their parents, they’re much, much less likely to report. Where and by whom a child is interviewed is important. So we have lots of education about interviewing children away from their homes. Moreover, if the police are doing the interviewing and the police are not well trained, they will either use leading questions or they won’t be able to build rapport.
When you’re interviewing kids, if there’s any suspicion of child abuse, there are a number of things that you have to put in place. In Massachusetts, the Department of Child and Family Services (DCF)—our equivalent of your CPA—does the first round of interviewing. And it’s not always very effective. But when there is a suspicion of really severe physical or sexual abuse then we have Sexual Abuse Intervention Network (SAIN) interviews. These interviews happen when DCF sends the case to the district attorney, who may charge a person for perpetration of child abuse. The child is then interviewed by a trained person, and behind the one-way mirror are DCF, the police, the assistant district attorney, and any other related person. This is because we know that repeated interviewing of children by different people does not yield reliable or accurate results. So when the interviewer completes his or her interview and other people behind the mirror still have questions, they call in to the interviewer. So you have one person interviewing the child at a time. But one of the problems that we have is that the DCF is often totally overworked. They have much too large of a caseload and they sometimes miss things. But that being said, we know that interviewing a child outside of their home, away from their caregivers, is much more effective.
So even the very first interview is performed away from the kid’s home?
Not necessarily. It depends on the state. Sometimes DCF may first interview the child in their home. But never in the presence of a caregiver. Or at least they shouldn’t.
And being removed from the home for the first interview can be quite traumatic for a child. Particularly when they go in and take the child out of bed at 11 at night and put them in a foster home.
In Korea, in 86% of cases, the CPA worker, either with or without police, is the first person who interviews the child. But still in 14% of cases, the police go to the home and interview the suspected child abuse victim. Our agencies are understaffed too.
It’s a real problem. I was involved in training DCF workers for more than 15 years. And I found that we have to start with child development. I think you have to ground it in that before you get into the interviewing itself, and then the impact of trauma.
Yes, you’re right. Understanding child development is important to understanding children’s responses, behavior, and language.
Yes. In this state and in most states it’s called “termination of parental rights”. And depending on the jurisdiction, it’s either the juvenile court or the family court that hears those cases. Now in Massachusetts there are 14 factors that do not require the consent of a parent regarding the adoption. In other words, situations where a parents’ rights can be terminated. What we look at first and foremost is the fitness of the child’s parent. Those 14 factors are things like abandonment, abuse or neglect. Or when a child has been in another placement for at least six months and the child has formed a strong, positive bond with his or her substitute caretaker. But generally the DCF can’t bring that petition until the child has been in that placement for, I think, at least a year.
So if this teacher has run away with Hye-na and stayed with her for at least six months and formed a strong and good relationship, then can they be together?
Well, no. Because the fact that Su-jin ran away with Hye-na means she would never be considered. Because that would be kidnapping. Instead of kidnapping, she would have had to have been authorized as a foster care parent first. So the DCF would have placed her with Su-jin. And if they did that and Su-jin had taken care of her for at least six months and the parents were considered either not compliant with the DCF service plan, or weren’t getting the treatment they needed, weren’t responding to the requirements of DCF… It’s at that point, after a year, that they would be able to begin adoption proceedings.
Yes. She was actually accused of kidnapping in the drama. But she took care of Hye-na very carefully, and they had a very nice relationship. Su-jin was the first adult whom Hye-na could trust, in her entire life. It was a very complicated situation for the courts.
Our kids, unless they have committed offenses, go into foster homes. But the quality of foster homes varies. So there are some wonderful foster homes and wonderful foster parents, and there some where the kids get abused again. So foster parents have to go through rigorous screening. And they get paid.
Paid by the government?
Right, by the state. When they remove a child from the parents and put them in another place, it’s almost always in foster homes. But if you have a really behaviorally or emotionally disturbed child that can’t be contained, we have specialized foster homes. But when there aren’t enough specialized foster homes, there are times when those kids end up in some kind of a group home. Those are not shelters though, they are group homes.
Then the kids receive appropriate services. The DCF develops a service plan for each child and family when they’re removed. And the service plan may include mental health services, or medical services, or educational services, depending on what kind of abuse or neglect there has been. There also is a service plan for the parents. It may be for a substance abuse issue, it may be for anger management. And generally, but not always, they may also have supervised visitation between the biological parents and the children. Visitations are generally at a DCF office for an hour a week or less.
How long are they usually in a foster home?
The law is that kids are supposed to have a permanent placement by a year, which can be extended to 18 months. That means that they either go back to their parents or they’re freed for adoption. But it rarely works that way. Often kids are in foster homes for a number of years. And then, what often happens for some kids, is they’re in multiple foster homes. They go back to their parents, the parents slip again. They go back to another foster home. And often they’re not in the same foster home as the first time around. They’re usually first in the home in an emergency or a short term foster home. Then they go to another one. Then if that doesn’t work out they go to another one. So they can have multiple placements.
It’s not what we try to do. But sometimes due to a variety of circumstances that’s what happens. Other times kids are fortunate to be in one foster home, which ends up being a pre-adoptive home, where the foster parents also want to adopt the child. And those are really difficult court cases.
I had not heard about that. How long were they in the car?
About 20 minutes.
So was it really hot?
Well, it was October and 27-28 degrees Celsius. Actually it is not illegal in Korea, and not addressed in any laws. I absolutely agree that they are guilty. They shouldn’t have done that. But their kids who can’t speak English were separated from their parents and placed in shelters in a foreign country for several days. I think this could be more harmful to them. What do you think about this case?
Oh, this is so awful. So you know it’s like the immigrant families here. ICE (US Immigration and Customs Enforcement) will arrest a parent and send them to a detention center far away. And then the kids get placed someplace far away. It’s terrifying. I mean for children, the unknown, the not being able to understand not only the language but what happened. And depending on the age of the child, they can blame themselves. I mean I would imagine that this kind of treatment of children can be more traumatic than whatever the original event was.
And these things happened in the United States…
In most states, you cannot leave a child in a car, or a dog.
Even a dog?!
Well you can if it is not an extreme weather condition..
What is nice about the United States law is they provide very clear guidelines. In Massachusetts, leaving a child younger than ten alone at home alone is considered neglect. But in Korea we do not have those guidelines. So eight-year-old kids are frequently left alone at home. If we had clear guidelines and notified every parent, it would be better.
Absolutely. Clear guidelines, whatever they are. So everybody knows: these are rules.
So wait, you said you heard this from the teachers?
Yes. There was one girl who stood on the roof of the school saying, “I’m going to die.” Because her parents did not want to go to school, the school nurse had to stay with her and observe her, to prevent her from committing suicide while at school. After her shift, the nurse was extremely anxious about how the parents would take care of their child. In other cases, youth frequently cut their wrists and were in need of psychiatric treatment, but their parents refused to go to school or take them for a psychiatric evaluation.
If that would happen here, then the school would be a “mandated reporter”. Mandated reporters only have to have a suspicion—they don’t have to investigate or know—of abuse or neglect, and they must report it to DCF.
In Korea, the teachers, school personnel, and health care professionals are all mandated reporters, but even they do not fully understand the definitions of child abuse and neglect.
Because it’s neglect if you’re not attending to a child’s medical or psychiatric needs. So here, it would be screened in automatically, as neglect.
Right, but many teachers still do not know the exact definition of neglect, especially medical neglect. And sometimes they do not recognize that neglect as well as abuse should be reported. So when I talk with the teachers, I usually recommend they report the parents for neglect. Then the head of that district’s Child Protection Agency can request ‘parental authority’ from the family court.
… so then they can agree to the mental health treatment that this child needs?
Yes right. That is my recommendation. Also in general hospitals, I often hear from doctors and nurses about parents who do not agree to the necessary treatment for their kids, and leave the kids to die. In one case, a child was in ICU and whenever the mother came, she asked her child, “Aren’t you having difficulty? Isn’t it painful? I think you are in such big pain. I think it would be better for you to die.” In that instance, I recommended that the mother be reported.
We sometimes have cases like that with certain religions.
Same in Korea.
So there are some religions that do not believe in medical treatment. They think God should take care of it. When this happens in a hospital setting, the hospital legal team reports it to DCF and they go to court. DCF asks the court to order treatment for a child, particularly if they’re going to die or if it’s going to have long term consequences. It becomes a situation of parental rights and religious freedom versus the child’s rights. Generally, the courts order medical treatment.
In front of the kids?
… and force the kids to be on their side. There have been cases where the kid had to appear in court.
The kid had to? They still do?
Not these days. After divorce, many parents prohibit kids from meeting or contacting the other parent or just leave their kids without enough explanation. And also if the kid lives with one parent, there is not enough childcare infrastructure, so grandparents usually take care of the kids. And the grandparents usually criticize the other parent in front of the kids.
Yes, I can imagine.
And also many parents do not provide child support expenses on time.
In Massachusetts, in those case, the court orders wage garnishment. The parent who is supposed to pay child support, their wages are garnished and the money goes directly to the parent who takes care of a child.
Wow. Perfect! Your government has a wonderful system.
Another thing we have, in almost every state I think, is mandatory parent education in order to get divorced. This parent education is really limited. It’s like only four to six hours. But every parent has to go. And it doesn’t address the worst cases but it’s helpful to about 85 percent of cases where parents divorce and they have children. And it’s basically just how to keep your child out of the middle. How conflict is so bad for kids. That kind of thing. But then we’ve got that 10 to 15 per cent which are so difficult. They continue to fight, relitigate, blame and mistrust. It’s high conflict and high conflict usually also impacts parenting, so parenting is compromised. And sometimes we have what we call “alienation”.
In alienation the child resists contact with a parent, but not for valid and realistic reasons. It may be the rejected parent has some issues with discipline or the child was not as close to that parent. But basically one parent represents the other parent as really bad, really dangerous, really toxic, whatever it is, and then the kids align with that parent and refuse any access with the other. Often the extended family also gets involved and sometimes therapists and/or lawyers also align with one side. I actually think that when a parent actively tries to keep a child from the other parent without cause, it constitutes child abuse.
Yes. In Korea, most of the couples who divorce and have a child take one or two hours of mandatory parenting education.
For the extreme cases, the most difficult cases, we have high conflict parent programs. But there are very few in the country. There may be five in the whole country. So we educate the judges and attorneys, and the more we do parent education to keep parents from putting their kids in the middle, subjecting them to conflict and violence, the better chance there is of good adjustment for the kids.
That would keep someone from reporting!
It still happens. In the emergency room, when child abuse is suspected, the emergency care physician calls the police, and they come and yell. We still need much, much more education for the police.
In the US, the police are generally not the first people who come. DCF comes. The police may also come if they have to arrest somebody, but if they don’t have to arrest somebody, they won’t. And the name of whoever reports it is confidential. So even when you’re in court and discussing the report call from an emergency room, the name of the reporting person is crossed out. So the perpetrator never knows. They can guess, but they never actually know who the reporter is.
The US is a big country. In Massachusetts everything is very far apart. But Korea is a very small country with a small society. So even though our Act also states that the name of the reporter is confidential, most of the perpetrators can guess it. They complain about it, and sometimes get violent with the reporters. If it happens in a small outpatient clinic, the perpetrator comes to the clinic, and sits in front of the entrance and yells that the outpatient clinic owner, the doctor, shouldn’t see patients…
So in my program, the thing we do is call the person who we’re making the report on. Let me give you an example from last week. We called the mother in a divorce case and we said, “You know, you remember I told you I’m a mandated reporter. And yesterday you told me that you allowed the children to bring alcohol into your apartment and to have their friends over to have a party. I have no idea how DCF is going to respond. But because I’m a mandated reporter I have to report that. Would you like to be on the phone with me when I report it?” So you engage them. And then if they are on the phone with you, they can say, “Well, no I didn’t.” And that’s fine. You’re just making the report.
Two weeks ago there was another case, where the kids reported as part of a custody evaluation that the mother was hitting them pretty frequently. We don’t know how bad, we don’t know anything, but we’re a mandated reporter. So we called the mother. And we said, “You know we’re mandated reporters. We’ve heard that you’ve been hitting the kids and we have no idea if it’s true or not. We have no idea of the circumstances but because we’re mandated reporters we have to report it and DCF will investigate, not us. Would you like to be on the phone when we call them.
Yeah, that’s a nice idea: “I’m not sure if this is true or not.”
Yeah we don’t know if this is true. But it’s not our job to evaluate, to investigate, but it is our job to report it. We have to.
The way we discuss reports with parents is important. The other problem is the police officers and prosecutors ask doctors not only for the state of the child, but they request that doctors provide specific evidence of abuse, such as papers.
Why do they ask you to do that?!
I’m not sure. But it might be a lack of knowledge within the police or prosecutor’s office, or a lack of child abuse professionals. For example, there was one ER physician who reported a case of shaken baby syndrome. But he had to go to the police station several times and to the prosecutor’s office, and to go to court. The police officer and the prosecutors requested papers or documents showing that this case was shaken baby syndrome and that shaken baby syndrome is evidence of child abuse. And he said, if every case is like this…
… then I’m not reporting it anymore! So what you need is the CPA, the equivalent of our DCF, to be able to hire experts, because the reporter should not be responsible for this. You need separation of services, between report and investigation.
You’re right. Our National CPA just hired a lawyer. But I think that they have to hire a child psychiatrist.
They have to! It is about evaluation of mental health, risk, parenting.
Do you have any plans in place to prevent child abuse or support high risk parents?
We do not have a very good prevention plan. We have a better reaction plan—the DCF services that I was telling you about. Prevention is a real problem in this country as well. Did you know that in Sweden they have Policies supporting families at risk, including free counselling for parents, free parental cooperation talks offered by the Social Services in case of divorce or separation, free child and adolescent psychiatry and in home care of children. That’s what we need.
One of the things we do have is when there’s been a report of child abuse or neglect and the kids are not removed, we have in-home services provided by the DCF. They go into the home, they work with the parent and with the children. I don’t know how effective it is long term. But to me, having in-home wrap around services that are frequent enough makes sense. Addressing parenting issues, mental health issues, financial issues, social support (some of these people are so isolated), and we do have those services that actually come into the home. I am not familiar with the studies that show us how effective they are, but we do know there is higher engagement and attendance when services are in-home.
In my opinion we should start parenting courses in high school. We should also open our neighborhood schools and have ongoing parenting classes, with a child-care service. You just need money.
Yeah, money always matters.
The key of course, is the multidisciplinary nature. I think it is always useful when such an organization creates policies and procedures including roles, collaborations, timelines, and addresses issues of confidentiality and privilege. It may be useful for the Society to go further and develop guidelines for investigation, evaluation, and court hearings. Of course having a conference or think tank is the way to move these ideas forward.
Thank you so much for your wonderful suggestions.