Office of the Child Advocate 
3312 Northside Drive, Suite D-250 Macon, GA 31210 
478-757-2661 or 1-800-254-2064 www.gachildadvocate.org 
Meeting the Health and Educational Needs of Abused and Neglected Children 
By Tom C. Rawlings State Child Advocate for the Protection of Children 
One of the most disturbing cases I saw during my time as a juvenile court judge was the case of an 11-year-old boy I'll call Stan. Stan was a sweet child much of the time, but when he was acting out he was a handful. He had suffered physical abuse as a young child and had been through the child protective services system until placed with relatives. When I met him, he was attending a special "psychoeducational center" because he was so emotionally disturbed that he couldn't attend regular school. Even at the psycho-educational center, he sometimes had to be put in isolation when he lost control. He came to our court because his outbursts at school were so violent that the school knew not where to turn, and he arrived with a long list of diagnoses that I as a judge simply didn't understand. 
Unfortunately, Stan is like a lot of children who suffer neglect and abuse when they are young. According to a report prepared by New York's Commission on Justice for Children, 80% of foster children have at least one chronic medical condition, often as the result of pre-natal drug or alcohol abuse by their mothers. Half of foster children have significant learning deficits and developmental delays. Nearly half of foster children come into care with a mental health condition that needs serious intervention. 
To doctors and brain specialists, those statistics make sense. Think about a young child growing up in a violent or chronically stressful environment. Experts on brain development report that when a young child is exposed to such stress day in and day out, his or her brain will set its "regulation mechanisms" at the highest level. The child essentially operates in a state of constant fear. His brain loses its ability to take in subtle cues. If he is used to being yelled at constantly, he may not react to a normal tone of voice so he doesn't follow directions from teachers. Or he may overreact and see a friendly smile as a sneer, leading to a fight or a violent outburst. 
The result? These children often do poorly in school and get labeled as "behavior problems" early on. They are more likely to end up being sent to an alternative school setting with other children who have problematic behaviors. They are more likely to overreact and get into a fight or attack a teacher, which may land them in juvenile court. Studies show that child maltreatment is the greatest single risk factor for many bad outcomes, including involvement with the justice system, major psychiatric illnesses and substance abuse. Maybe that's why up to 40% of youths in juvenile detention have significant mental health problems. In other words, when you're dealing with children who have been traumatized, it's not just a matter of ensuring they are in a safe place and then moving on. These children often require ongoing counseling, healthcare, and special educational services. And without that consistent, ongoing treatment, you might find yourself 5 to 10 years after the abuse with another young Stan. 
Unfortunately, we adults sometimes forget that this ongoing care is essential for children who have suffered maltreatment. Like the rest of us, children are often good at hiding problems and trying to forget the abuse they suffered. So if you are teaching, caring for, or mentoring a child who has been through a tough time, make sure they are receiving the ongoing services they need. Here are some quick suggestions: 
 Make sure that all children who have suffered abuse and neglect receive a full mental and physical health evaluation and ongoing follow-ups. For children on Medicaid, federal law requires that these checkups be provided on a routine basis. 
 If a child has been referred to counseling, make sure the child completes it. And remember that even if the child receives counseling now, something may occur as the child reaches a different developmental stage that will re-trigger the traumatic feelings and the problems that accompany it. 
 Because victims of abuse and neglect often suffer developmental delays and learning difficulties, make sure the school regularly tests a child who seems to be having difficulty with behavior or learning issues. The child may qualify for individualized special educational services designed to help him or her succeed in school. 
 Encourage your schools to work in cooperation with families of children who are having behavioral problems. Many schools, including some in Georgia, are adopting a model of service known as "positive behavioral support" that can bring together families, teachers, counselors, and mental health professionals to ensure that children receive the care and help they need before their problems get out of hand. 
If you're having trouble with a child whose issues may result from maltreatment, there may be resources to help you obtain help for the child. Contact the Office of the Child Advocate at www.gachildadvocate.org for more information. You can also learn more about the health problems of foster children and about services for children with behavioral issues at the following websites: 
 The New York Permanent Judicial Commission on Justice For Children has helpful publications at www.nycourts.gov/ip/justiceforchildren/index.shtml 
 Learn more about Positive Behavioral Support at www.pbis.org  Visit the Children's Advocacy Centers of Georgia at www.cacga.org  Learn more about special education in Georgia at http://www.doe.k12.ga.us/ci_exceptional.aspx 
Tom Rawlings, Georgia's Child Advocate for the Protection of Children, was appointed by Governor Sonny Perdue to assure quality and efficiency in Georgia's child protective systems. The Office of Child Advocate is a resource for those interested in the welfare of our state's neglected and abused children. Tom can be reached at tom@gachildadvocate.org.