The need for a prevention-oriented approach to child abuse is paramount. Yet too many of our resources are being directed to managing the emergencies that are the result of trauma, we continue to avoid dealing straight on with the source.

Imagine this situation

There is a person on the roof. That person is tossing ceramic plates off the rooftop, and they are shattering on the road below. It has become a public health problem; shattered plates everywhere. To deal with this problem, the city has employed many professionals to collect the pieces and bring them to special centers, like my center, the Post Ceramic Stress Center, where other highly trained professionals work hard every day to repair these shattered plates, with highly effective glues, all interestingly with three to five letter acronyms such as MST, IFP, DBT, CBT, TF-CBT, OCM, FST, IOP, PHP, SST, EMDR. In many cases, these professionals are able to repair these plates, even though they carry the scars of their fall. We are told that these repaired plates can be functional again, though they will always bear the memory of what happened to them.

More recently, scientists have become interested in the various ways that the plates have shattered, for they break in different ways, even though they were all thrown off the same roof. Applying the latest diagnostic criteria, they have identified ADHD plates, depressed plates, borderline plates, schizophrenic plates, oppositional-deviant plates, obsessive-compulsive plates, and manic plates. Scientists are making great strides in understanding how plates are made and what differences in the plates account for the ways that they break. Of great interest recently is understanding why some plates don’t break. These plates are called resilient plates. If scientists can discover what it is about the resilient plates that give them the extra strength to withstand being thrown from the roof, then perhaps we can someday make stronger plates!

Now you may ask me, “David, isn’t it mostly a matter of how the plates land, the luck of the fall, rather than something in the plates themselves?” And you would have a very interesting question indeed, but listen, we are learning a lot about the difference between resilient and shattered plates. For example, Xrays of these plates suggest that resilient plates may have a thicker ridge encircling the underside of the plate, it’s called the anterior locus ceramicus….

And I suppose you might interrupt me and say, “This science is all well and good, but has anyone thought to go up onto the roof and stop the person from throwing the plates off the roof in the first place!”

Well of course that has been considered, but there are too many people on the roof. When we have gone up there, no one admits to having thrown a plate. We don’t have the money to hire enough people to stay up on the roof and monitor all those people. We can only do what we can do, and we are doing a lot! Unfortunately we have to wait until the plate hits the ground before we can do something.

Well, okay, so I made this scenario up.

No one is on the roof throwing plates onto the street; scientists are not taking Xrays of resilient plates. But what I did not make up is that some people are in their homes and neglecting, beating, and sexually abusing their children, and currently we have to wait until a scream is heard, a bruise is noticed, or an absence from school is investigated. We do our best to respond, to provide resources, education, and treatment; we meet, we agonize.

Last week I sat in the waiting room of the DCF office in New Haven prior to a meeting, and in a short time, three workers came in each carrying a child: an infant, a one year old, and maybe a three year old; all bewildered, all clinging to this stranger whose job it is to scoop up a battered or abused child out of a harmful environment. How many are out there?

The Post Traumatic Stress Center where I work each day is two blocks from a house, which I pass by on my way to work: broken porch railing, unlocked door, where 16 people live, and drink and drug, and neglect the seven or so children there. My busy trauma center, our busy clinics and hospitals, waiting for the damage to reach intolerable levels, waiting for these children to be transferred down the street into our care. Why are we waiting for children to fall apart, for the plates to be shattered?

By waiting we have insured our failure.

Recently I consulted with a team from our local high school, presenting on this very issue. The vice principal politely asked, “So Dr. Johnson, your program sounds great, but do we need it? Everyday we have about 15 kids who blow out of class in a major disturbance. Our team handles these incidents generally very effectively. What value will your ideas bring?”

And I replied, “You deal effectively with the 15 kids who become upset each day, but not the 15 kids who will become upset tomorrow. As a result, until the end of time, you will have 15 upset kids every day. Understanding how highly stressed kids hold on the best they can, and identifying those kids near the breaking point, you can gradually reduce the number of kids who become upset each day.”

It may seem foolish in my example for the city to pay people to collect and repair broken plates, but in the field of trauma that is what we are doing. These measures are not enough. It is not sufficient for us to repeatedly “rededicate ourselves to the battle against child maltreatment.” We must deal with the person on the roof, that is, with the conditions that give rise to child maltreatment in the first place.

Indeed, how do people get on that roof, that edge of stability where one’s anger or sexual urges cannot be contained any longer and one hurls them toward those in immediate proximity who are weaker? Certainly poverty, mental illness, substance abuse, and prejudice are ladders onto that roof. But it is likely that the major way up, is to have been thrown off the roof oneself. Highly stressed people, when they break down, can in their turn harm others, particularly their children. Yet this vicious fact actually provides us with hope, for it means that if we can interrupt the actions of those on the roof now, in less than a generation, there will be far fewer people climbing up onto the roof.

What do we need to do?

We need early identification, which means that we must ask every child from as early on as possible, and certainly by kindergarten, on a regular basis, if they are being harmed.

I will address in future posts how we can most effectively intervene in this vicious cycle of perpetration and victimization.