STATEMENT OF DR. VINCENT FONTANA, MEDICAL DIRECTOR AND
PEDIATRICIAN-IN-CHIEF, NEW YORK FOUNDLING HOSPITAL,
CENTER FOR PARENT AND CHILD DEVELOPMENT, AND CHAIR-
MAN, MAYOR'S TASK FORCE OF THE CITY OF NEW YORK ON
CHILD ABUSE.

DR. FONTANA. Thank you very much for your kind remarks.

MR. BRADEMAS. Dr. Fontana, we are glad to see you again. I want
to echo the welcome you have just received from Mr. Biaggi.

I would note that we have ten other witnesses this morning in
three panels. I wonder, sir, if you could try to summarize your testi-
mony so as to enable us to put questions to you?

Dr. FONTANA. I will do that, Mr. Chairman.

There are certain facts that I think I could better state to the
committee through this statement, Mr. Chairman, and members of
the subcommittee. I wish to express my appreciation to you for in-
viting me to give testimony this morning. My remarks today prob-
ably will not endear me to OCD or the National Center but I do
have a commitment in this area and must take necessary risks.

I would like to preface my remarks by stating at the outset that
I did and do now support Public Law 93-247. Through this law and
the personal commitment the former chairman of the committee,
Vice President Mondale, and each subcommittee members, some
very positive results have become apparent since its passage in
1974: Recognition by our Federal Government of the seriousness of
the problem of child maltreatment; the establishment of a National
Center for Child Abuse and Neglect and the increased involvement
of State and city agencies and groups in the area of child abuse
that have been put into motion by grants awarded through the Cen-
ter. However, today we stand between the reality of our accomplish-
ments and our failures and much work remains to be done if this
act is to be truly effective in its purpose.

Child abuse and neglect continue to bring undue sneering, death,
physical and emotional damage to the children of our Nation. In
1976, in New York City alone an average of two children a week
were pronounced dead on arrival at New York hospitals, while over
30,000 children were involved in reported cases of abuse and mal-
treatment. A conservative estimate that there are at least 2,000
children in this Nation that die every year because of suspected
maltreatment by their parents or caretakers is cause for grave con-
cern. As a pediatrician, I know of no other disease that can cause
the physical and emotional damage and fatalities that child mal-
treatment causes and yet there are those that question whether we
are truly involved in an epidemic of child abuse in this country. My
answer is that we are involved in an epidemic of child abuse in this
country which is continuing to increase and is rapidly becoming an
accepted child rearing pattern in our society.

Child abuse is an ugly symptom of our times but it is more than
that, it is extricably linked with unbearable stress, with impossible
living conditions, with material and spiritual poverty, with dis-
torted values, disrespect to human life, and with drug addiction, al-
coholism, assaults, armed robberies, murders and the other ills in the
midst of which we live.

Unfortunately, in spite of the Child Abuse Prevention and Treat-
ment Act of 1974, comprehensive treatment, rehabilitative and pre-
ventive services that would help abusive parents and their children
have failed to keep pace with the increased incidence of child mal-
treatment in this country. This failure is caused by a number of
factors.

One of the major causes is rooted in the misplaced program priori-
ties presently existing in the National Center. I believe that future
successes in preventing and treating child abuse in this country will
depend on the approval by the Congress of some very positive rec-
ommendations to change the legislation so that it can be made more


29

effective especially when dealing with the States' commitment to
child protection.

It is a tragic fact that the National Center and Office of Child
Development; in the past, have established priorities which have
supported demonstration and training programs when the primary
need was to provide funding for preventive and rehabilitative serv-
ices for abusive parents. New York City, the child abuse capital of
this country, as well as it being the drug abuse capital, with its
80,000 reported cases of suspected child abuse and neglect in 1976 has
not received a single dollar of the tens of millions thus far expended.

Progress in attacking the root causes of child maltreatment in this
country does not lie in our public relations' firms or in model legisla-
tion or media commercialism. We must do away with the problem
of political opportunism when dealing with child abuse and move
toward a more comprehensive, well organized, supervised national
policy for children and their families under Public Law 98-947.

In spite of some positive happenings, the law has not been totally
effective in its implementation in a number of areas. There have been
indications that compromises and omissions, inadequacy of effort and
insufficient expertise at the Center and in the office of Child De-
velopment have allowed the expenditures of tight and limited dollars
to carry out needless research, collect information through additional,
unnecessary surveys and support conferences and education pro-
grams through so-called Federally funded demonstration projects.
Over the past year, I have been invited to speak at over a dozen
such education seminars.

The performance of the National Center is not being monitored
at the present time. While its mandate was clear, it has not proven
to be totally effective nor has it through its funding and fiscal re-
sponsibilities supported major services that could be models for
preventing and remedying the family problems that result in neglect,
abuse, exploitation and delinquency of our children.

Frank Ferro, Associate Chief of the Childrens Bureau, confirms
this fact. He states "It seems to me that our efforts leading to in-
creased identification and reporting are succeeding handsomely but
that our ability to support service delivery and treatment efforts is
seriously lacking.

For example, at Vanderbilt University Hospital, moneys have been
granted to support a study in Nashville, Tenn., by the Department
of Pediatrics to study the "Casual Factors in Neglect and Battering."
A grant of $173,000 given for one year. There is ample evidence of
the causes of abuse and neglect of children that can be readily found
in the medical literature and recent textbooks on the subject in the
pioneering studies of Kempe, Helfer, Fontana, Steele and Pollack.
There are volumes of testimony on the hearings of your subcommittee
in the years past that attest to the fact that information was and is
available concerning the psychodynamics of child abuse and the
variety of treatment and prevention modalities that have been found
effective in dealing with these children and their families. Certainly,
these monies could have been more profitably used to make available
these preventive and treatment child abuse services.

Mounds of practical information on child abuse and maltreatment
has been compiled by the American Humane Association under the
expert direction of Vincent de Francis. The American Humane As-


30

sociation has been dedicated to the specific purpose of assuring better
protection of the abused and neglected children through the dis-
semination of very prominent medical, social and legal information
on child protection.

This voluminous literature attests to the fact that we do have
today a good understanding of the causes of child abuse and how
to prevent and treat the problem.

Another example of misspent moneys, the Joseph A. Davies Con-
sultants, Inc., were given $306,539 for 1 year -- July 1, 1975 to June
30, 1975 -- for the provision of technical assistance in the develop-
ment of child abuse and neglect public awareness programs and
materials.

Joseph A. Davies Consultants called on me and my colleagues
in the field to learn what should be done to make the public more
aware of child abuse. They had no previous experience or expertise
whatsoever in the field of child abuse and therefore spent much time
and Federal money in visiting and securing information from the
experts, some of whom, incidentally, had not been granted assistance
by the national center when requesting moneys for support of their
work in the treatment and prevention of child abuse. The Joseph
Davies Corp. then proceeded to pump this information right back
into the areas around the country that gave them this information
in the first place.

To compound matters, further, this grant to Joseph A. Davies
Consultants was made during the time that discussions were under-
way with the National Committee of Child Abuse and the ad-
vertising council to carry out a nationwide awareness campaign on
child abuse.

As a member of the national committee, I participated in these
meetings and was acutely aware of Mr. Douglas Besharov's efforts to
have the national center coordinate its efforts with the advertising
council and the National Committee of Child Abuse, but to no avail.
Indeed, while these discussions were going on, the Joseph A. Davies
Consultants were pursuing their studies and research in the pro-
graming of a public campaign. Again an unnecessary expenditure of
hundreds of thousands of dollars by the center.

It is my feeling that this act was supposed to do more than just
collect statistics, fund research projects or support public relations
firms. It was designed to help the States in staffing, training, and
supporting programs that deal daily with child maltreatment. It
was supposed to help pay for centers where abused victims could be
treated and their families be rehabilitated. Yet HEW and the Na-
tional Center for Child Abuse and Neglect has granted public re-
lations firms millions of dollars to dream up advertising gimmicks
and perform incidence studies which will not bring us any closer
to eradicating this disease than we were before this law was passed.

Other examples wherein hundred of thousands of dollars have
been poorly expended under this law include a grant to study the
state of knowledge of child neglect, given to the University of
Georgia. Another to study the "Early Warning Signals of Serious
Neglect and Abuse" given to a School of Social Welfare -- in this
instance $252,000 given for a period of 1 year.


31

A huge grant was given to the Institute of Judicial Administra-
tion in New York City to study the revision of the 1962 model
Child Protective Services Act. During the period of time that this
study went on, meetings were held with the appointed National Ad-
visory Committee throughout the country at great expense for hotel
accommodations, travel and living expenses.

Literally thousands of pages of a variety of documents were sent
to members of the advisory committee throughout the year, such as
several drafts of the Model Act, a report of "Child Maltreatment
in Military Communities," a "Study of Child Abuse Reporting Prac-
tices and Services in Four States," "Guidelines for Legislation: a
National Survey of Attitudes of Selected Professionals Involved in
the Reporting of Child Abuse and Neglect" and a "Review of the
Literature" containing over 388 references.

This all culminated in the publication of a text by Sussman and
Cohen on the "Reporting of Child Abuse and Neglect -- Guidelines
for Legislation." All of this at a great cost to the Government. Hun-
dreds of thousands of dollars allocated to this project which created
a model bill without considering the many new innovative programs
which are presently being utilized and developed throughout this
country. This model bill and all its work is probably already anti-
quated and the moneys expended did little or nothing for the vic-
tims of the disease it is supposed to protect.

In studying the report of the U.S. Department of Health, Educa-
tion, and Welfare to the President and Congress of the United
States on the implementation of Public Law 93-247, published in
August of 1975, the national center granted to Douglas Burninger,
Ph.D. of Herner and Co. of Washington, D.C. $494,014 to work to-
wards a clearinghouse on programs and summarization of research
on child abuse and neglect. At the same time, HEW's Interdepart-
mental Committee on Child Abuse and Neglect granted Vincent de
Francis of the American Humane Association $184,721 to establish a
national clearinghouse for child abuse and neglect. And in May of
1976, I received a letter from the Aspens Systems Corp., asking me
to participate in a technical advisory group to the Aspen Systems
Corp. in connection with a clearinghouse on child abuse and neglect
that was being sponsored by the National Center for Child Abuse
and Neglect office of child development. I find it very difficult to com-
prehend the awarding of such large moneys to a variety of groups
to carry out what appears to be similar program proposals.

Some of the other grants that have been awarded in the past that
cause great concern is one for $200,000 to Bert Associates, Inc., of
Bethesda, Md., to do the development of an evaluation system for
measuring cost effectiveness of protective services and then the same
Bert Associates received another grant for $107,117 to do a national
incidence study.

Last, but not least, awarding $271,246 to Parents' Anonymous of
Englewood, Calif. These moneys were used mainly to travel through-
out the United States: hotels and living expenses. A variety of pub-
lications advertising Parents' Anonymous also were subsidized by
the national center -- having little to do with any direct treatment of
children or parents. Some staff members of Parents' Anonymous


32

groups throughout this country have informed me of their concern
as to how these Federal moneys had been spent by the national group
in California.

The need to gather further data and conduct further research and
to develop a clearinghouse is self-evidence but it appears to me that
it is much more important first to make use of all available existing
information and experience that have been published by pioneers and
experts dealing with the problem on a day-by-day basis. It is the
basic information that should be further developed and supported.
Programs that have been proven to be effective in the treatment and
in rehabilitation of abusive parents such as those that are presently
functioning at centers in Denver, Boston, California, Michigan, and
New York should be supported.

Dr. Henry Kempe has submitted proposed amendments to Public
Law 93-247 which we have discussed. I completely support these
proposed amendments. I do have a copy of these proposed amend-
ments for the subcommittee and will therefore not discuss them in
detail. I support them in spite of the fact that in some instances these
changes would not deprive the National Center or HEW generally
of the authority to pursue already established policies since there
are many ways of skinning the cat.

I would like to add, however, that I think the last proposed amend-
ment, namely, that the Child Abuse Prevention and Treatment Act
require the appointment of an Advisory Board on Child Abuse and
Neglect which shall be composed of 15 members representative of
the Nation at large be given consideration. Pediatricians should be
included in any advisory group affecting child health care. This ad-
visory board of experts, I believe, will serve to pull together in an
intensive, critical manner the effectiveness of the National Center of
Child Abuse and Neglect in their funding of programs.

It should have the power to approve or disapprove of proposals
submitted for funding. The present grant policy in OCD is defective
and biased. The advisory group could also through exhaustive, non-
biased evaluation make available to all concerned what is being done
with Federal moneys; what is not being done; and what more can
be done.

By providing consultative expertise with regard to the essential
components and mandates of this law, one can be more hopeful
that we will be more effective and prudent in our future financial
expenditures. I pray that this will assure all of us involved in solv-
ing this tremendous problem that the National Center for Child
Abuse and Neglect is conscious and aware of a firm and clear state-
ment of this law's intent and commitment to the children and fam-
ilies of our country.

Any national health financing plan whether it be in child abuse
or infections diseases, must include an effective peer review mechan-
ism which is at the present time nonexistent in the Center. Mean-
ingfull accountability is critical and urgent to effective functioning
of the Center under the law. A firm base of operation is essential if
further progress is to be made in this area.

Congressional action is needed in mandating program support in
every State, allocating sufficient funds specifically designed tt fund
child abuse protective services in each State. The problem exists in


33

every State -- every State should be given the opportunity of caring
for its children and their troubled parents. Investment of the Fed-
eral dollar in the prevention and treatment of child abuse is not
only humanitarian but we have found it is also cost effective.

This subcommittee and the Congress in supporting this legisla-
tion has been and hopefully will continue to be especially responsive
to the needs of our most vulnerable, yet most valuable sector of our
society, namely, our children. We must underline and remember
that the proposed amendments and extension of this law must make
available visible support to the troubled American family. Despite
the changes in our society, the family unit is still the best and the
most effective way to insure the physical, emotional and social health
of our children and prevent their maltreatment.

Thank you, Mr. Chairman.


[A prepared statement by Dr. Fontana was also provided to the
committee]