Nearly 13,000 children were taken under the wing of the state’s child welfare authorities last year to protect them from abuse or neglect, though the number of children in need of protection is thought to be much higher, representing what experts call a "hidden epidemic."
Fighting this epidemic are front-line officials in law enforcement, at the S.C. Department of Social Services and inside courtrooms, along with a myriad of about 30 non-governmental organizations and institutions across the state.
In Charleston and Berkeley counties, the front-line fighters rely heavily on one particular nonprofit: the Dee Norton Lowcountry Children’s Center.
The children’s center, in turn, collaborates with 35 organizations to provide care, including the Medical University of South Carolina, People Against Rape and the Charleston/Dorchester Mental Health Center.
Since 1991, the center has assisted 15,500 children and their families, striving to provide a "coordinated community response" to victims.
Each month the center addresses about 100 new allegations of child abuse, according to Development Coordinator Beverly Hutchison. Last year the center conducted 1,700 medical examinations and treated 1,115 children at a cost of about $1,300 per child.
Lately, "there has been a significant increase in kids referred for domestic violence and physical abuse," she said. "And, unfortunately, when there’s one form of abuse, there is very likely more than one form of abuse."
Hutchison said one factor likely is financial hardship. A bad economy and unemployment can increase stress levels inside the home and, too often, children end up on the receiving end, she said.
The children’s center’s annual budget of $2.3 million includes $800,000 that is earmarked for state training programs, leaving $1.5 million for normal operating expenses.
That budget covers two pediatricians with forensic training, two pediatric nurse practitioners, five therapists, a school liaison, three family advocates, three child advocates and a team of administrators.
Executive Director Libby Ralston said the center received early support from the Junior League of Charleston and the Charleston County Legislative Delegation, and was formed to improve the way children are treated by coordinating disparate and disconnected services.
Child abuse is traumatic enough without an excess of bureaucracy to contend with, she said.
Discovery is the first — and main — challenge, Ralston said. The only way to know about abuse is if the child admits it, but children are reluctant to talk about it. "And offenders don’t tell the truth," she said. "They lie more effectively than kids tell the truth."
The center had to develop a new language for use with children, and to use only mental health experts for interviews about abuse, she said. And it had to secure evidence that could be used in court.
Fifty-seven percent of the children seen at the center are victims of sexual abuse; 56 percent are female; 36 percent are age 6 and under; 44 percent are between the ages of 7 and 12; and 83 percent knew the offender prior to the abuse, according to the center.
Examples of children who visit the center include:
A 13-year-old girl sexually abused by a man in her family who was removed from the home after the girl told her teacher about the abuse. "He’s out of my home, but can you get him out of my head?" she asked the therapist.
A 12-year-old girl who was impregnated by her father.
A 5-year-old child who was regularly abused sexually by a 15-year-old brother.
How pervasive is the problem?
"It’s huge," Ralston said. "But we have no idea (how huge) because the problem isn’t counted. It isn’t a priority in terms of tracking it." Reported cases of child sexual abuse are perhaps only 10 percent of the total number, she said.
Her team is involved with the majority of Department of Social Services cases and works with 16 other child advocacy centers statewide that also provide consolidated services modeled in part after the children’s center, she said.
Anne Abel, director of the violence, intervention and prevention division at MUSC and a full-time collaborator with the center, said the cost to society of all types of child abuse is thought to be $284 million a day.
The epidemic leads to physical and mental health problems, poverty and crime. "It makes (victims) more prone to a huge array of very expensive diseases," she said.
A collaborative study by the Centers for Disease Control and Prevention and Kaiser Permanente, a managed care consortium, has highlighted the link between "adverse childhood events" and health and behavior outcomes later in life, Abel said.
Adverse events include the death of a parent, sexual abuse, drug use, physical and emotional abuse or neglect, family violence, incarceration and mental illness.
Children who experience four adverse events, as opposed to one, are up to 12 times more likely to contend with alcoholism, drug abuse, depression and suicide attempts; up to four times more likely to smoke; likely to have more than 50 sexual intercourse partners and greater instances of sexually transmitted disease; and one and a half times more likely to be physically inactive and severely obese.
Of these adverse events, abuse is encountered sooner or later "by every clinician who sees children," Abel said.
The children’s center hosts regular meetings with other service organizations to share information and "so we don’t feel alone," Ralston said. "This isn’t the kind of job you can do alone. You have to collaborate."
The center includes a sparsely furnished interview room that has two comfortable chairs and a whiteboard. Interviews are recorded. The medical examination room is equipped with a $27,000 colposcope that produces magnified images.
Trained counselors are on hand to conduct forensic interviews and provide ongoing treatment.
During a single week last month, the center’s staff conducted 33 new interviews and 20 treatment sessions. Despite the intervention of hundreds of experts throughout the state and the expenditure of millions of dollars, the epidemic of child abuse remains largely invisible to the public, Ralston said.
"We don’t want to believe these things happen," she said.
Reach Adam Parker at 937-5902 or email@example.com.