We would like for you to take no more than five minutes to summarize your testimony, or to make any remark that you wish to make.

We will hold up a sign, to just let you know when you only have two minutes remaining, and when your testimony is up.

I am going to vary a little from the order listed on the paper. Since Dr. Fontana is our host, I am going to ask Dr. Fontana to testify first.

Again, Dr. Fontana, I would like to express my appreciation for your hosting of this hearing on such short notice, and to introduce Dr. Fontana, I would like to yield to my colleague, Congressman Biaggi.

STATEMENTS OF DR. VINCENT FONTANA, MEDICAL DIRECTOR AND PEDIATRICIAN-IN-CHIEF ON CHILD ABUSE AND NEGLECT FOR NEW YORK CITY; CESAR PERALES, COMMISSIONER OF SOCIAL SERVICES FOR NEW YORK STATE; JOANNE JOHNSONHERSHMAN, ASSISTANT DIRECTOR OF SOCIAL WORKERS, ST. LUKE'S HOSPITAL; DENIS WALCOTT, DIRECTOR OF HARLEM DOWLING CHILDREN SERVICE PROGRAM, PREVENTION AND TREATMENT OF ABUSED CHILDREN; AND DR. ANDREA SAVAGE, ASSISTANT PROFESSOR OF CHILD ABUSE TRAINING FOR CHILD ABUSE SOCIAL WORKERS, HUNTER COLLEGE

Mr. BIAGGI. I think I said it all about Dr. Fontana in my opening comments, and those of you who have been associated with child abuse problems in our nation don't need an introduction to Dr. Fontana. He is a paragon of the issue; he has been there long before so many of us, and his commitment has been unflagging, and he has been kind of an inspiration for my own participation. am sure he enjoys that role in the minds and hearts of many of us who have been concerned with the problem over the years, and we always look forward to hearing from Dr. Fontana.

Dr. FONTANA. Thank you very much, Congressman Biaggi, and Congressman Owens for the invitation.

Before going into formal remarks, I must say that many of the accomplishments in this nation, the state and the city have been due to the fact that we have had the support of our members of Congress such as Congressman Mario Biaggi, who I remember in the early 70's asking me up to the Hill to meet with Senator Humpherie, Senator Mondale, and Tip O'Neal, and trying to convince and "educate" the people at the head of our government that child abuse indeed was something to be dealt with. I can remember Tip O'Neal saying to me in those days, "Well, Doctor, I think I read something about child abuse in one of the magazines a few months ago," but that was the essence of what the remarks were. So it was Congressman Biaggi's support and leadership, at that time, that convinced people and the Congressmen on a high level, the President and Vice President at the time, that we needed something like the Treatment and Prevention Act of 1974. Those will be history; and Congressman Biaggi is a member of Congress who will be known as being the father of the child abuse legislation.

Mr. FONTANA. Mr. Chairman and Members of the Subcommittee, I wish to express my appreciation for inviting me to give testimony this morning. My remarks will not endear me to the National Center, but I do have a commitment in this area, and must take the risk of further alienation.

I would like to preface my remarks by stating at the outset that I did and do now support the original intent of Public Law 93-247. Through this law 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 Center. However, today we stand between the reality of our accomplishments 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 continues to bring undue suffering, death, physical and emotional damage to the children of our nation. Today in New York City alone, an average of two children a week are pronounced dead on arrival at New York City hospitals, while over 50,000 children are involved in reported cases of abuse and maltreatment. A conservative estimate that there are at least 4,000 children in this nation who die every year because of suspected maltreatment by their parents or caretakers is cause for grave concern. As a pediatrician, I know of no other disease that can cause the physical and emotional damage and fatalities that child maltreatment 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 continue to increase and is feeding into the crime and violence in our society. Those youngsters that assault, rob and murder-the juvenile suicides, the young drug addicts and alcoholics.

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 distorted values, disrespect for human life, and with drug addiction, alcoholism, assaults, armed robberies, murders and the other ills in the midst of which we live.

Unfortunately, in spite of the child abuse Prevention and Treatment Act of 1974, comprehensive treatment, rehabilitative and preventative services that would help abusive parents and their children has failed to keep pace with the increased incidence of child maltreatment in this country. This failure is caused by a number of factors. One of the major causes is rooted in the misplaced program priorities 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 recommendations to change the legislation so that it can be made more effective, especially when dealing with the states' commitment to child protection.

Progress in attaching the root causes of child maltreatment in this country does not lie in our public relations' firms or in model legislation 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 93-247.

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 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 programs through so-called federally funded demonstration projects.

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 responsibilities 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. It seems to me that our efforts leading to increased identification and reporting are succeeding handsomely, but that our ability to support service delivery and treatment efforts is seriously lacking.

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 psychodynamic 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, monies could be more profitably used to make available these preventive and treatment child abuse services.

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.

The need to gather further data and conduct further research and to develop a clearinghouse is self-evident, 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 this 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. Fiscal support has been seriously lacking for these time-tested treatment services that protect children and help families.

The Child Abuse Prevention and Treatment Act requires the appointment of an Advisory Board on Child Abuse and Neglect which shall be composed of 15 members, representative of the nation at large. Pediatricians should be included in any advisory group af

fecting child health care. This advisory 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 review, approve, disapprove proposals submitted for funding. The presently existing grant-making policy by OCD is ineffective and politically biased. The advisory group could also, through exhaustive, non-biased evaluations, make available to all concerned what is being done with federal monies; 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 solving this tremendous problem that the National Center for Child Abuse and Neglect is conscious and aware of, a firm and clear statement of this law's intent and commitment to the children and families of our country.

Any national health financing plan, whether it be in the child abuse or infectious diseases, must include an effective peer review mechanism which is at the present time non-existent in the Center. Meaningful 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 designated to fund child abuse protective services in each state. The problem exists in every state; every state should be given the opportunity of caring for its children and their troubled parents. Investment of the federal 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 this legislation, 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, a healthy family unit is still the best and the most effective way to insure the physical, emotional and social health of our children and prevention of maltreatment.

It is most important to remember, in summarizing, that child abuse, again, is truly the crime of violence that we are seeing in our city streets, and as Congressman Biaggi mentioned, our prison systems are filled with the abused and unloved child, and this nation has to make a decision: Should we be putting more moneys in funding into preventative services for abused children and their families, or are we going to be spending more funding for building more prisons and more prisoners?

Thank you.

Mr. OWENS. Thank you very much.

Cesar Perales, Commissioner of Social Services for New York State.

Mr. PERALES. Thank you very much, Mr. Chairman. My thanks to you for the opportunity to share, thanks to New York State and both you and Mr. Biaggi for this afternoon's hearing, and a particular thank you to you, Mr. Chairman, for taking over your new responsibility of this Chair. I think you heard a sigh of relief in New York State when you took on these duties, and it's a relief that I think will be shared by other people throughout this country who sit as commissioners of state committees for social services, who have the very difficult responsibility of administering child preventative services, and overseeing them in their states.

Let me also thank the New York Foundling Hospital and Dr. Fontana for hosting this hearing. Most of us here today, I think, are aware of his long-standing leadership in this area. You may not know that he serves as a member of the New York State Citizens Task Force on Child Abuse and Neglect, which I co-chair with the first lady of this state, Matilda Cuomo, and we quite often rely on Dr. Fontana's advice and counsel.

Before addressing the question of the Act, I would like to discuss for a moment the wider issue of protecting children from abuse and maltreatment. To do this, I would attempt to convey the general magnitude of the problem in our state. In 1986, local child protective organization workers investigated nearly 96,000 reports of suspected child abuse and neglect that involved over 157,000 children in New York State. 47 percent of these reports came from New York State. In New York State, reports have gone up 49 percent in the last five years, and 155 percent in the last ten years.

I should point out that the incidence in child abuse reports is not a problem for our city. We are very much in line statistically with national trends in reporting. This is not to imply that New York City and New York State cannot do more, we must.

I do wish to be clear: This is a nationwide problem that needs national leadership.

Over the last five years, while child protective service reports in New York State have risen by almost 50 percent, the social services department and the largest federal programs supporting child abuse services have not even reflected increases in inflation during this period. At the same time, however, here in New York, state and local funding support has risen from $80 million to a projected $220 million in the next state fiscal year. While the amount of federal funding available under the CHEAP Act has remained limited, we have put these funds to the best use, developing special programs that have enhanced our ability to serve children and their families. In order for the state to continue these efforts, I urge the subcommittee's support for the reauthorization of the Act, at an increased funding. Toward that end, I would make the following recommendations:

First, the authorized funding level under the Act should be increased to $50 million, from the current level of 43.1 million. With these funds, I urge that monies now spent directly through federal contracts to universities and private consulting firms for demonstration and in other service projects, be shifted to the states. This