It's the pictures that I can't get out of mind. They are so horrible they will break your heart and make you mad all at once. I'm talking about the x-rays, scans and photographs that Amy Terreros and her team at Phoenix Children's Hospital use as their tools in the battle against child abuse. I can't forget the x-rays of a little boy whose caregiver brought him in to the emergency room because he supposedly choked on cereal and passed out.
Terreros, a pediatric nurse practitioner, and the pediatrician, Dr. Stephanie Zimmerman, didn't believe the story. Whenever a case comes into the hospital and abuse is suspected, Terreros' team is called in on a case. They work like detectives ordering medical tests and x-rays that will uncover the real story behind a child's injury. On this case the x-rays uncovered more broken bones; one arm fracture, then another.
"How could this child be functioning?" I asked Terreros and Dr. Zimmerman. Terreros told me that the child probably wasn't walking and then showed me the next x-ray. It showed a broken leg bone, and she said his other leg had been broken, too. In fact, this toddler had four broken bones all in different stages of healing. That was all I could take; tears sprang to my eyes. My cameraman Les Rose stopped shooting, and my producer Kristen Muller was also getting choked up. We're all three parents and these images are a harsh reality we don't see every day.
The team at Phoenix Children's sees it all the time but something has changed. They say they are getting even more cases due to the impact of the recession on families. Terreros has seen a 40 percent increase in the number of cases her team investigates compared to the same time last year. In the past two months Terreros has had two cases she directly connects to the economy. In one, the child was staying with dad, who had been laid off and had never before been in the role of primary care-giver. The child ended up in the emergency room with a broken bone.
According to Dr. Rachel Berger at Pittsburgh Children's Hospital, cases of shaken baby syndrome, when a baby is shaken so violently it can be permanently brain damaged or killed, have been on the rise lately.
Boston Children's Hospital usually takes in 1,500 cases of child abuse annually. Last year, that number increased to 1,800.
Seattle Children's Hospital says child abuses cases have gone up 30 percent. The recession, they believe is playing a role. In Beaufort, South Carolina, where unemployment in a five-county area is up 700 percent, child abuse cases have increased 64 percent over last year.
That's where we heard first hand about how financial frustration turns to abuse. A single mom didn't want to be identified but she admitted to abusing her kids. Her husband is in prison. She is trying to make ends at a low-paying job. She knows that if she tried to move there wouldn't be much opportunity for her elsewhere. The pressure is getting to her. She screams too much at the children, three girls and a young son. Her six-year-old daughter has been on the wrong end of much of her anger. The mom threw a hairbrush at her and gave her a black eye. She wrestled her to the ground of a parking lot when the girl was throwing a fit and someone called the police. She told the police she sometimes goes too far in disciplining the kids but she's at the end of her rope.
Luckily for her, she found a program called Hope Haven of the Lowcountry in Beaufort, S.C.
Her children are getting intense counseling while she receives help with parenting strategies and conflict-resolution techniques. The mother is getting the tools she needs to deal with her anger in other ways. Still, sometimes she hears the kids say, "Stay away from mom, she's not in a good mood," and that makes her worry about the long-term impact on her children.
Not all child abuse experts believe the economy is causing a spike. Carole Jenny of Hasbro Children's Hospital in Rhode Island says "I'm wondering if a lot of hospitals aren't doing better case finding."
The numbers may be anecdotal right now and the Federal Government's reporting lags behind so it can't verify a trend. Still, more and more children's hospitals are worried.
There is no denying that states have had to slash budgets and sometimes services that would treat and prevent child abuse. In Phoenix, where home values have dropped in half and entire neighborhoods look like ghost towns, the story gets worse. The state's budget has been slashed drastically, and 15 percent of the Children Protective Services budget had to be eliminated. As a result, 181 frontline case workers, who identify "at risk" families and work on preventing child abuse, lost their jobs. The budget cuts also mean low-level complaints will not be investigated. The remaining workers have to take work-week furloughs, cut back on cell phone use, and visit fewer families.
"It was a gut wrenching decision to make. Nobody wanted to make that decision but it was necessary," said Gary Arnold of the Arizona Department of Emergency Services.
What happens to those low level cases? How many become serious? They don't know the answer to that question at Arizona's Children Protective Services agency, but Amy Terreros of Phoenix Children's Hospital thinks she knows.
"A child is left in an unsafe situation and then they come in here, critically ill."