introduce? >> yes, thank you madam chair. thank you for your leadership and for holding this hearing on this very important issue. it is my pleasure to introduce aaron sullivan sutton, commissioner for children and families at the minnesota department of human services. as an attorney, social worker and instruct tour, ms. sutton has dedicated her career to public service and in her position she is responsible for developing policies and administering programs that promote child safety. she previously served as minnesota's director chose safety and permanency, where she oversaw adoption, foster care and other children's services. she also serves on the executive committee for the national association of child welfare at illustrators and as a past president of that organization.

in all, assistant commissioner sutton has spent nearly 30 years in the child welfare feeling i spent more than 20 years with the minnesota department of hamas services. thank you for your service and for all you do to keep minnesota's children safe. i look forward to hearing your testimony. >> we also want to welcome.or robert block of pediatrics, a respected organization as 60,000 pediatricians committed to improving shareholders whole. in addition to some talented pediatrics, he has an additional specialty in the child-abuse pediatrician, unique one, board-certified in this unique subspecialty. we thought it would help to get a clinical.

and from essentially the doctor either in the er or the doctor in the examining room, sometimes first here's a story we can benefit from their experience, both in prevention and intervention and protection and then also perhaps the one of these treatment things that will come out. we're so glad to have you. and i may want to recognize therese huizar. who is the executive director of the national children's alliance, which is the accrediting body for 700 child advocacy centers. remember, this is where it gets child-abuse of the comprehensive service from forensic interviews, which is different than a medical interview. but it did give medical evaluation for mental health

treatment. the senators and social service and the courts. she comes with a great deal of experience programming or dishonor us and is an international wreck last taxpayer. we really think it's great that you could come here and we look forward to your testimony and we look forward to advice and recommendations as you hear this hearing unfold. work with us so that we can not at the end of the day, not just feel good that we listen, but that we do good with what we've heard. so ms. sutton, one that you start. wilco two dr. block from the air. >> thank you, members of the committee. i am erin sullivan sutton, commissioner of family children services. i'm here today representing the

american public human services association and its affiliate at the national says niche in a public busker administrators as well as state of minnesota. we have learned a lot about preventing child abuse and neglect over the years and what interventions result in positive outcomes for children and their families. with your help we can do even better. i would've spent some time talking about the work we've done in minnesota and the work that we have done to recognize to state child protection systems. we talked about horrific crimes committed against children who come to the attention of child protective services online for a snack, but also to the thousands who are struggling to provide adequate care for the children that we have recognized the need to have a different response system to help them safely care for the system. our recommendation that all three areas. immigration services, mandatory requirements and chat busker finance reform. the conditions that led to the

development of the regional capital legislation in 1974 had changed significantly in the intervening years. 40 years ago the reality of parents or other children were underrecognized by public insistence of interventions were not prepared to respond. since then three or work in the work of state and local communities, there've been sustained efforts to educate the public and develop a child protection infrastructure to respond quickly to report of child abuse and neglect. one of the issues that we must address is the capacity of states to respond to the reports coming in a way that works for children and their families. although captain addresses treatment of children, doctors limited to support to fully carry out our requirements and does not adequately account for expenditures to each requirement. our basic state grant receives

$445,000 to help us develop an infrastructure for child protection. we very much appreciate that. however, support to recognize or state uses approximately $20 million simply to conduct assessments and reports of ill-treatment. in addition to assessments, it's absolutely imperative that we have the capacity to provide other services to children and parents, keeping children safe and well cared for. because of the total distribution of funds, public health childbirth regencies often have federal funding sources, state funding of local resources to provide the care and summit of a patchwork manner. 90% of all federal funds are used in child welfare for foster care or adoption assistance and the remaining 10% have prevention programs. the imbalance in offending structure indicates the need for a stronger federal role in providing adequate resources for preventing and teaching child-abuse neglect. in minnesota and the past decade

we have learned that by investing resources earlier and more flexible ways to meet individual needs of families, were able to keep children safe or sooner, reduce mistreatment and the need for out of home care. over the past decade, minnesota has made changes in how we address child maltreatment. the majority of our reports in minnesota are driven by poverty come mostly child treatment involving child neglect. we have learned that the situations are more responsive to services that help families address the needs and provide constant education and connections to community support rather than adversarial approaches to families. we need aggressive law enforcement interventions in situations of child endangerment and horrific crimes against children. however, we also know when he prevention and intervention efforts in minnesota to focus on engagement of families focused

on keeping children safely with their families whenever possible. minnesota has been a leader in the development of differential response. we retain a forensic investigation for reports alleging substantial child endangerment, but on minnesota more than 70% of our child reports receive an alternative families and this sets aside investigative activity and focuses on ensuring child safety by engaging the family and the services and resources they need to keep the children safe. they're structured assessments of safety rest and is connected with families and partnerships in those assessments form the basis of service delivery planning. a random clinical trial in minnesota follett outcomes for a period of five years from 2,002,005. using this approach were able to demonstrate children or made safer by quickly engaging parents and constructive conversations involving child

safety that results in lower child maltreatment reporting rates and decreased need for out of home placement, which is one outcome we did not expect to see. we saw the families and child welfare workers identify this approach is creating cooperation and greater satisfaction and we also learn that this approach to family assessment in a series of cases as much or costly in the long run. minnesota has used that experience to employ further strengthening family approaches in the subsequent years. from 2006 until 2010, introducing a number of programs we have seen a 10% reduction in child maltreatment reports in minnesota facility 24% reduction in the number of children reporting out of home places. in those communities where we have both early intervention services as well as the family assessment services, we have seen it after reduction in the need for reports coming in the

first instance. to assure greater well-being for children, federal and state law should invest in a variety of prevention and early intervention activities to support stable families. early intervention programs by child protection agencies have proven to be very effective. for example, minnesota parent support pilot programs in the practice of engaging families and providers for services to parents needing support before there is a need for child protection investigation. limits are identified as having at risk reporting to the agency and on that given day are not yet meeting criteria of maltreatment. if we intervened, they avail themselves of services and again we've made a difference in being able to prevent maltreatment from occurring. i recommendation and improvements to capping should be lined with reform efforts in both federal state by using

holistic approach that cuts across historical barriers such as departments, congressional committees or jurisdictions to provide an effect is, efficient service array that focuses on positive outcomes as well as accountability. and mentioned earlier the need for finance reform in the imbalance of federal funding for state to provide child welfare services. the recommendations on how to protect, preventing intervened moving forward. it is critical that congress and states work together to keep kids safe or sooner, particularly when we know who mayonnaise avarice kids are. in order to do that is the same flexibility to use federal funds in a manner that had needs of families coming to her attention. financing should promote flexibility while maintaining an appropriate framework for accountability. we need to be accountable for the work we are doing.

because nocturne has many causes stomach internet services needs to include a broader range of community-based emergency programs and support for families that provide treatment for children and promote the general well-being of children who come to our attention. importantly, we need to prevent the incidence of maltreatment as well as maltreatment and improve the conditions that lead to families being involved in the child welfare system. so we encourage you as you look at changes to also look at federal finance reform, particularly how federal 40 funds are used and are very limited and based on eligibility standards for parents from 1996. and also would encourage you to maintain or increase current levels. nowhere does not exempt from the sequestration under the budget. i'm also work to pressure congress to reduce funding. it is of paramount concern however that this committee to all that you can do to help

ensure that the sequestration occurs that programs are not reduced to a level where we can no longer adequately serve the most vulnerable children are your children at risk deserve better than to be placed in harms way for reduction of funding in these very limited resources are critical to our capacity to serve families. thank you. >> thank you free much for that really content rich testimony. we will go forward with our questions. dr. block the >> thank you, chairperson kolsky and children and families for inviting me to speak today on behalf of myself and the over 60,000 members of the american academy of pediatrics. the abridgment comments and hope you find value in my written testimony. one important point, not all children will become adult. but it is certainly true that

each adult was once a child. experiences and opportunities afforded to each of us in our early years of a long-term impact on our health and development and may create a substantial imprint on the adults that would one day become. in order to get the health and well-being of her entire society, we must not be children and their welfare as isolated individuals were assigned, but instead recognize children's physical and mental health must be addressed at the beginning of hope across the entire lake course. for this reason, i became interested in child maltreatment during residency training 40 years ago. throughout my experience evaluating child abuse cases and testifying in court on behalf of abused children, the question i am most frequently asked is, how can you do this work? the answer is, how can you not?

we now recognize the child abuse and neglect not only damage an individual short-term health, but also alter a child's neurophysiology and long-term well-being. children who have suffered abuse or neglect may develop a variety of behavior and psychological issues, including combat disorders, decreased functioning and community impairments and emotional instability and posttraumatic stress disorder and others. the landmark adverse childhood experiences or studies. also demonstrated between childhood trauma and the presence of adult diseases, including heart disease, cancer, chronic lung disease and liver disease as well as unintended day, transmitted diseases and alcoholism. based on the study, childhood trauma may be the leading cause of poor health among adult in the united states. pediatricians are an excellent position to detect and prevent abuse because of their unique relationship with families and experience in child development.

pediatricians are trained to identify injuries and behavioral changes resulting from abuse or neglect and to understand the physician's role in treating or reporting abuse. however, there were inconsistencies with what is considered suspicious and sometimes limited understanding of the child abuse reporting process, even within the medical community. as president of the american academy of pediatrics, i can assure you provided the necessary specialized education and training to report abuse in a cloud in serve these children appropriately is embraced at the very highest levels of leadership within our organization. the academy respectfully submits the following recommendations. every one half to report maltreatment to proper authorities could support as you've heard and training is crucial and every adult has his or her responsibility to report

and to protect children who may be children of abuse. one common reason mandatory reporters do not report suspected abuse is fear of legal retribution. it was police captain of reauthorization did require secretary of health and human services to recommend potential changes needed to address this issue in the academy looks forward to that report. health care financing must provide payment to professions for the more complex and lengthy visit that are typical and very, very necessary for children who have been abused. in addition, child welfare workers and mental health confessionals are crucial to identifying treaty and preventing child abuse. it would be important for congress to take steps to support these professions and training programs. we have a new child-abuse pediatrics subspecialty, which

has the potential to expand the number of positions with expertise in this important field. more financial support is necessary to ensure every physician with interest and passion to pursue child-abuse pediatrics is able to do so. the aap has proposed the health child-abuse research education and services or health care network that serve as regional consortium centers of excellence to bring the medical profession into full partnership in the prevention and diagnosis, treatment and research about child abuse and neglect. funding and support for this network is needed. the federal government can create better coordination across agencies and increase funding for home visitation another unfunded -- underfunded programs. at the state level, child-abuse definitions reporting requirements and exemptions differ really good the report of

suspected or substantiated abuse in one state may not follow a child if he or she moves to another state, allowing neglect of children to slip through the cracks. more attention must be paid to interstate reporting and investigation. so as a pediatrician, a child-abuse specialists and father and grandfather, i will remind the committee that early experiences matter for the rest of our lives. every one of the sinister and has an application to insure every child in america has the opportunity to live free from fear from harm so that he or she will grow into a protective, happy adult. it's an honor to provide testimony on behalf of myself and i look forward to your questions. >> ms. huizar. >> thank you. thank you for what in this important subset appear in a on

the problem of child abuse. national children's alliance and the national association of credit and body for 750 children at b.c. centers. those centers serve more than 267,000 abuse children i shared. children's advocacy centers courtney to multidisciplinary team approach to the investigation, prosecution and treatment of childhood abuse. in so doing were close with law enforcement and prosecutors and protective services, victim advocates, medical and mental-health professionals. colleagues have spoken on the need for improved mechanism can i join them in their car before training for mandated reporters. recent events have asked why individuals to support child abuse. and we know what 95% of americans express deep concern about abuse, only one third contacted the authorities when actually confronted with the view. adults do not report because

they don't know the kinds of abuse and they worry what will happen when they do and because they don't know how to report. all these problems can be addressed by widespread training and public awareness campaign to 240 million americans adults who should be reporting abuse if they suspect it. and that is something uniquely the federal government's role to do, given the scale of that task. but we can't forget that perhaps the most important and concerning underreporting occurs among the most vulnerable. that is abuse children themselves. research tell us that only one third of adults who say they were abused as children ever told anyone. many children are reluctant to report the infinite thought must take the approach and children must be trained and body safety information and abuse

prevention. children's advocacy center said that the forefront forefront of that word, training nearly 400,000 schoolchildren last year. but this work must be extended and expanded to america's 17 million children. emma barriers report abuse are finally receiving well wanted attention, reducing these alone will not save children. improve child-abuse reporting must be paired with equally strong intervention in order for a abuse children to receive the hope in that they so desperately need. children's fantasy centers play a key role in that response. this model of comprehensive care has been proven to prove investigation while ensuring that abuse children receive needed medical in all the while saving on average $1000 per child abuse case. sadly, this effective response is not available to all of america's children. there are still more than 1000 copies for the u.s. and abuse

children have no access to the services. many of those in counties represented by states that serve on this committee. we call in congress to finish good work established a creation of the victims of child abuse that in 1990 by expanding services to america's children. unless someone thinks on primus to report in an intervention of child abuse are complicated or difficult to achieve in these tight budget times, it's important to be reminded that many are at the door at no cost. improved data collection about the scope of the problem, modify and confidentiality laws to encourage information sharing for those that investigate and treat child-abuse and the adoption of model protocols for civil and criminal case court nation take more political will and funds to achieve. finally, child abuse investigations erick a way to services for vick jones.

research tells us that the best long-term predictor of recovery views as a political outcome of the case. it is whether the child refused treatment and support. on treatment child abuse has terrible lifelong effects and the maladies that are result of the trauma of abuse. fortunately over the past decade and through the work of the national child germanic stress network, we now know a great deal about successfully treating trauma in children. evidence supported, focus treatment is remarkably affect that reducing trauma and child victims of helping them to begin to heal the return of who's a victim of abuse deserves access to it. children's abuse depend on proven treatments for recovery treatment in society having failed to protect children from abuse in the first place can certainly work to restore them

to wholeness after the fact. if we invest in the treatment outcome that will save ourselves from having to pay for the cost of their compromise physical and emotional health later. it is our collective responsibility to protect children from abuse. when that fails to report it and ensure that those receive services they need to heal and lead productive lives. the health and well-being of our great nation's children depend upon it and they certainly depend upon you, senators, as well. thank you. >> ms. huizar, let me follow up if they can to devise an effect to prevention and intervention strategies and to know how best to address resources. it is important that we know the full scope of the problem of abuse in children.

what is needed to improve the current data collection and reporting across child protective services and law enforcement to claim that data we need to make the right decisions? >> i'm so glad you asked that, senator byrd come in because this at the heart of understanding the abuse. currently they did it turn into a state child because intense data and that does not include information from law enforcement. in many states, line force and ideally individuals that investigate third-party abuse. that is abuse that occurs by individuals outside the family and of itself.

collect the data so that we have a fuller, richer understanding of the problem. >> thank you for that. ms. sutton, on the ground and working with kids who have been abused, can you talk more about the confidentiality restriction that capped a and hip both children to not to get the best of for the most informed assistance that they need? or do we have restrictions that don't allow the information sharing we need?

>> the confidentiality statutes are intended to protect identity people abused or neglected although there is provision that allows states to authorize disclosure to other entities that they need the information in order to do this work with children. i'm not sure how many states have gone to far surpass that. we also see issues with respect to hit the ensuring information back and forth between child protective service agencies, health care agencies, company l. achieve and for the bastion for the cares of difficulty getting information between education systems and child protection and other service providers that we absolutely need to be talking

together could sleep kit and it's our responsibility to make sure they have good education outcomes as well. >> thank you. i want to thank the chairman for designing the year and the way she did when we talked about detection of abuses and now treatments necessary and i hope everybody heard exactly what was said. we've got some stovepipes between law enforcement and child protective services and stovepipes within -- that limit our ability to share the vital medical information with those making decisions about intervention. i would suggest all of those contribute to maybe not the best decisions about prevention. so i hope the chair will work with me. i know she will issue a with other members to figure out where we can modify those possibly an out wait for all the

states to figure out how they can wait for those current requirements. i think the chair. >> excellent comments. senator casey. >> thank you, madam chair. dr., i'd like to ask a couple questions. one relates directly to your testimony. the first with regard to education and training. he made that a central part of your written testimony associate presentation. you also talk about the chronic underfunding of the child abuse and prevention and treatment act. so-called captcha. i'm looking at pages 18 and 19 of your written testimony about prevention. you go into some link providing

examples of strategies to implement a stronger prevention program. can you walk through some of those? >> yeah, senator, thank you. prevention is still an area that we are learning about as we go. sometimes by trial and error. it is difficult to collect evidence across broad populations to demonstrate a certain program works. i think in the area of child abuse which has been the focus of the hearing, we are trying to do two things. by week, everyone involved. but we are trying to educate children about the privacy of their minds and bodies, but more importantly since relying on them to protect themselves is not the way to go, we are trying to teach adults in two ways. number one, and make them aware this problem exists. one of our big problems is nobody must talk about child abuse or admit the society allows this to happen at the

rate it's happening. so we have it continue holding hearings to emphasize the fact that leaders recognize this is an issue not only for children, but as i mentioned for the adult they will become later on. we need to train adults to recognize that might be abuse and that requires some pretty careful education because we also need them to understand that is not abuse. as an oil, our member now at the end of every day my third grade teacher, ms. casino gave each of us a hug as for the classroom. that would be held and questioned today and yet her heart was in no way predatory or abusive. it was a signal and bodily touch do we know is part of communicating between adults and other adults as well as adults and children. so we need to define things that we don't mend up making mandatory porters report rings that are not abuse. how do we reach people to educate them about that is a major question. there are programs around the country aimed at anyone who will come to some sessions to

understand how this adults can protect children by some common sense things. for example, if you are the last teacher to leave the school of the afternoon after teacher conferences or a meeting and there is -- i don't want to pick on one person, so a janitor or coach or another teacher who is still in the building and there's a little girl sitting on the steps waiting for a late parrot to pick her up, it's a good idea not to leave the building and perhaps sit down next to her or help her call for assistance. that's assuming you're suspecting everyone around you is abusive. it just means that it's a good idea to be alert to possible situations. that's a long-winded answer, but would attack about prevention efforts with it for some things that were. and physical abuse one of our biggest problems is abusive head trauma and shaken baby syndrome and we know today. it the programs that if we can educate parents to the normalcy of their and they're crying to

the fact that they are not bad parents if their infant doesn't quiet when asked them to, that we can protect those babies from people losing their temper and inflicting harm on children. so that might give a couple examples. >> finally, with regard to the training you focus in particular on the mandated reporters. can you talk a little bit about that in the best approach their? one of the problems we have is not just the debate about who is a mandated reporter and whether that should be broadened. i think it should. but even mandated reporters not having enough training and experience. we ascribe experience and knowledge to expertise to not have the proper training. >> i come from the state of oklahoma that does have a mandatory reporting for everyone

phrase at the end result which mentions teachers, health professionals and others is mandatory porters and every other citizen. i think that's a good idea. on the other hand, it is important for us to acknowledge even among my fellow physicians we don't always report abuse the way it should be reported. some of the reasons for that are unique to us particularly in medical liability issues and now that is expanded into civil rights litigation. we got funny protection for reporters not only for making a report, the perhaps participating in the process later on process later on if the case goes on to prosecution or some other adjudication. we need to as i mentioned people understand what is child abuse? what does it look like? what does it sound like? what you do when you suspect it is happening? how could we work to her various disciplines to create interdisciplinary approach? when i talk to physicians, one

of the leading reasons that they have a suspicious case, they are not quick to report because they have concerns about the system. what will happen in their particular locale with children's protective services? availability in working the case. bubble happened with prosecution? and what will happen to them in terms of their time doubled taken not only indicate the report, but in the fond du lac. we can take care of that within the medical profession if we continue to need cheap to create the talent two medical schools and communities to help teach about that. we need to learn how to work together across disciplines. we are doing a good job of that right now in centers and are playing a legal rule and not, but we can do better. we need to have more opportunity to teach each other about what are disciplines are all about them we need to learn to hold each other accountable for a piece of the puzzle. >> thank you.

>> first of all, you want to thank all three of you for your testimony. you are cassation represent and recessional c. represent. i have about four questions. the first is about deterrence. i just need a short answer remiss because the answers will be longer policy questions. there is this hope that mandatory reporting acts as a deterrent to people who are predators, that if they feared discovery through others who would train them in or report them, that that acts as a deterrent or a chilling effect of abusive behavior. i wonder if they did demonstrates the mandatory reporting, which i happen to be an advocate of, actually as a deterrent. blushes go down. ms. sutton, what you think?

>> to be honest i never thought of the kidnappers did. i think all too often the predatory offenders that we are talking about are not thinking about and dated reporting. i do think mandated reporting over the years has provided a tremendous amount of education across our country's sli was first passed in 1974 and in that respect has made us all that much more aware of the abuse and neglect and hopefully that has resulted in the prevention as well. >> i think mandatory reporting by itself is not a primary determining, but it is a secondary deterrent. if we have people reporting that they suspect, we are going to avoid the second, third, fourth, 20 episodes, particularly in abuse, predators don't limit themselves to one victim losses in the family and they only have access to one victim. it's a yes or no. notice that a primary deterrent,

but it is important to get things stop before it gets even more out of hand. >> out completely concur with transcendence comments about that. >> the question is who should report. and we have kind of a consensus on the so-called mandate reporter reporting, but then what is the next circle out, although it to anybody who sees them thing, do some thing can see something, say something. there were contemplating and our legislative work, expanding reporting to everybody and masking states tend to develop legislation to implement that. do you think we should keep it limited? and do concentrated training? do you think we should expand it to everybody?

do you think we should include everybody, but do extensive education and training to those who need certification and licensing because of their access to a child? we have a core group of people. ms. sutton, what do you think? >> senator -- >> who do you think we should require to report? >> i think i tend to agree with testimony research. i like to know more about the states for everyone is required to report in minnesota we require certain professionals that encourage everyone to report. i am concerned about and see an increase in false reports as well as with the impact may be on the system and our capacity to respond. without an increase in the availability to respond to more reports, i would be concerned -- >> not get to the kids that

could be in danger. >> senator, i agree with your comments in with yours as well. we have a system already in child welfare that is totally overburden. have a daughter who survived four years as a permanency placer worker for chaucer care what should have been 24-ish was 53 with an on call that was constant, including a call issues on the turnpike from oklahoma city to tulsa a night of of her wedding rehearsal. but she had to respond to. we have to support these programs. we have at any given time, 50, 60, 70% of workers in the field in their first year of experience. even though invest in training them, if they can survive the system, we have not got a a good return on investments. we can encourage are going to be reporters, but do we have to shore up the system first and educate to minimize reports that really are your minimal kinds of

observations. >> so there is the required -- ms. sutton sexpot language, which was require a certain body or population, but then encourage the rest of the population on what to do. i think dr. block company made an important point. if you're going to do this work and those who are child protective workers, in some specialties such as yours, they themselves did not only education and training, but support because of what they see and experience to prevent burnout with the excessive burden of fear. i just recall for myself that if you proved and someone could die i mean, the fear of screwing up

the mountain professionals doing this air base is pretty significant. so tell me who you think should report and the support that needs to go to those charged with responsibilities. [inaudible] >> anyone can a professional contact which will fully required to do so. i think it is important to start retraining and then move on to expansion of reporting requirements as opposed to the other way around. in other words, if we spread the word about these things to the largest body, then you could pacemen based on research you do, other groups you might like to additionally be legally required to report. but in the absence of the research and training, i think those would be problematic.

and i also think that any increase in expanding the circle of those legally required to report absolutely has to be paired with increased resources. increased resources for state and local one person sent most of my be prosecuted or investigated federally, increase resources in terms of treatment, in terms of medical treatment and mental health treatment in the services of children advocacy centers. >> that takes me to should investigate. if you're going to report, one of the things that emerges from reporting is the hesitancy of people to report because some people don't know where they go, the second they don't want to be mixed up or they think i really don't want to go to the cops about this. and i don't use that -- i use it and the best sense of the word. and i think u.s. professionals would agree the investigation that a child protect its service

worker does come at the inquiry that a physician or nurse practitioner does, et cetera, is very different than law enforcement. this gathering evidence for the commission of a crime, where you are trying to gather information for the protection of the child, two different things. so my question goes that if we had mandatory requirement, knowing the child abuse is a crime -- i don't minimize that. but should the first line of reporting the child protective services or should we go directly to the cops and the cops get the children to protective services? ms. sutton, you ran a pretty big agency. >> in minnesota, or that requires press reporting within 24 hours so an individual -- >> could you see what that is click >> papers can choose report to enforcement of child protection. they are required to report

within 24 hours a minute the allegation involves violation of a criminal statute commensurately what would happen if the joint investigation by law enforcement in the agency, the cops doing their role in the agency doing facts gathered to look at service plans and delivery. in certain circumstances, law-enforcement man chad protection not to do an assessment that there would be something that could interfere with the one person investigation. but they do go hand-in-hand. >> a few report come you choose which one you do, do you feel comfortable, therefore you know about. but then they talk to each other. because they are highly trained, we cannot forget that there's no cost and what we're we're talking about here. then they determine what is the best way to proceed in the interest of the child. is that the foremost question in mind? interest of the child or the interest in that case.

the interest in something called the case. >> the interest is in first assuring whether a child is safe. and once we can assure you chad two-phase is doing the investigation or assessment of what has occurred. and also for us, it was really distinguishing between the situations that may involve criminal attachments or children the situations where families are struggling to take care of children. having a punitive investigated approach was not serving as families well. so we needed to develop a balance of those so that we can respond most appropriately given the particular situation that came to our attention. >> in our center, we applaud the disciplines housed under one roof, including medicine and on the other components. so we are able -- >> is that where or usual and customary? >> i think it's becoming more

and more customary. they are limited in number. >> very true. the example i want to give this an optimal way to approach that because regardless of who has received a report, the report comes to the multidisciplinary team to see who should be doing that, including the children need for extensive evaluation, and investigation of what have you. so i think supporting interdisciplinary centers and interdisciplinary teams, whether they be housing communities might be a solution. >> i certainly agree that every child abuse case should he investigated by a multiple of multidisciplinary team. wayne and i was going to go on criminally with that as well as was going to protect the child and insurance simultaneously

they're getting treatment. i think tennessee has a nice hole in which in the way that child abuse reports come in, when they come in through cps can also press portents immediately to enforcement, the a-alpha for other children's advocacy for the state and tracking database. he enjoys the cases involve democrats. they don't see that within a day or two. it gives them the ability to call on horseback child protective services and say whatever happened to john smith? is that his command and it's one that should have been screaming to the advocacy center in we haven't seen a child yet. thursday's doing innovative things about that. what they brought in the response would be very helpful. >> well, we also have to think legislatively, are we talking about mandatory reporting,

encouraging reporting for child maltreatment because literally we talked about different categories. one is the klatch. now back in my day and from when i was discussing it with child protective agencies, the data says that the majority of people who come to the attention i miss not showing up in schools and don't seem like they've had a good meal. they will need to see a dentist lake we had, et cetera. and that's different what there's physical abuse, all things that show up either in the classroom, the battered child, dr. block spoke about the crying, shaking, et cetera. but then we called it the b.

word, in the bad old, bruised, burns, broken initially comes into madness and in some way. and one is by reporting and then there's psychological. the child lock in the closet. there's no ethics of physical abuse or just other kinds of horrific things i don't want to elaborate on the you could give examples. and then there is abuse. and those are different things. ..

as simple as possible so people know what to report and where to report that. and don't parcel without but make sure people know they should report child neglect, physical abuse, sexual abuse, emotional injury and threatened injury which is what the captain on covered and then give the flexibility and the ability of the system working together and i mean that in the medical

community child and efficacy as well as protective child services to look at what is the most appropriate intervention based on the assessment of those individuals circumstances. that is one of the hardest lessons we learned in florida is one size did not fit all and we were creating war trauma by trying to do that so we needed to be much more individualized. >> one of the things pediatrician's be the free strongly in is the patient or family center medical home. not only the medical physician but other professionals working as a health care team are going to be able to see aberrations and development or physical appearance in a treasure whether it is under or over. so we have places like the medical home where we can do a lot of prevention and a lot of intervention before neglect,

emotional abuse come poor parenting. not every child has access to those homes particularly if they are supported by medicaid or are not in church whatsoever. but places like that where a children come regularly, schools for nexium will can be targets of training to identify behavioral issues that are not translated into this is a bad child but rather translated into we should look at what is happening in this child's life. >> i don't think we can ask them to be assessors of the responses that should happen. they make the report. i am in agreement keeping the reporting symbol and how they go about this and i think what happens after that interprets differential response is critically important for a simple we know while

differential response has been enormously beneficial and neglect cases and physical abuse cases not sexual abuse cases so that is something we should expect mandated a reporter to know and our job this child. >> i could sit and talk all day with you. i really want to thank each and every one of you being with us today. the work you do to protect and prevent child abuse, in the house and in the senate to those in the judiciary committee to develop a bipartisan legislative framework to address things we've discussed today. there are so many people wanted to submit testimony i will ask unanimous consent nine pieces of the testimony be submitted to

the record and again i want to thank warren who was here all day today and her advocacy every day and secretary sebelius, the baltimore child abuse center, the american psychological association, the committee for children, stop it now and in child welfare submitted their testimony. we are going to leave their record open for questions and the congress will be reassessing but upon the return we will be examining all of the proposals to see healthy move forward. listening to the four of you take a back many years ago to my own work. doctor you we and i began at just about the same time, and the body of knowledge that's

been developed in the financial expertise and all of the main site has been stunning. i fear that in the audience today women who believed in me and the work and they would be so pleased to year to come to protect our children a and cutting across the red tape. we survived new thinking and the protection of children. focus on the children, not the bureaucracy she trained and encouraged me to go to graduate school. those in america that arf sweating the details and how to do a great job and how they can

make sure children are safe and secure. as we have to put our sweat equity and come up with of the right policy. as we look forward to a conversation with you and thank you and say god bless you for what you do. god bless our children and protect them and god bless america. the committee is adjourned. and all will conversations [inaudible conversations]

[captioning performed by national captioning institute] >> several live events to tell you about this morning. house speaker john boehner will "e interviewed by "politico's white house correspondent on c- span2 at 8:45 a.m. eastern. on c-span 3 at 10:00, the house oversight and government reform committee will hear from the chairman and all the members of the nuclear regulatory commission about management and operations. in a few moments, today's headlines and your phone calls live on "washington journal." and the house will be in session for general speeches at 10:00 eastern with legislative business beginning at noon. today's agenda includes a bill that authorizes defense programs. and in about 45 minutes, we will talk about of the debate over extending the payroll tax cut. first, with republican senator tom coburn of oklahoma, a member tom coburn of oklahoma, a member of