Children in danger

A child dies of a severe staph infection and his family is discovered living in squalor. A mother overmedicates her child. Police respond to a disturbance and discover sexual abuse and children living in a home piled with garbage.

All of those cases -- and more like them -- are part of the daily stream of work handled by the Missouri Children's Division, the courts, prosecutors and police.

Each has a different role to play in protecting children and sometimes the goals of each seem at odds. But many who work in the fields agree that the cases that receive public attention only sketch an outline of what is happening to children in the region.

Child welfare workers "handle the vast majority of cases and handle them without a serious criminal charge," Cape Girardeau County Prosecuting Attorney Morley Swingle said. "The cases that make it to the criminal courts are probably just the tip of the iceberg."

Circuit Judge Benjamin Lewis has seen both sides of the problem -- he was a lawyer working for the juvenile office and he sits in judgment of criminal cases. The cases he sees as a judge, he said, are just a small portion of the total picture.

"It would be amazing to someone who doesn't pay close attention," Lewis said of the workload for case workers.

The state Child Abuse and Neglect hotline receives a steady stream of calls from Southeast Missouri -- an average of more than four a day from just the three counties in the 32nd Judicial Circuit.

Many of those calls are baseless, sometimes the result of a spouse seeking revenge or leverage during a divorce. But more often, the calls show real abuse or neglect or bring to light factors that show the parents need help to improve their child's living conditions.

And the aim in almost every case -- including many where serious criminal charges are filed -- is to keep the parents and children together. Only the most serious crimes against children -- usually involving sexual abuse -- require the Missouri Children's Division to keep parents and children apart.

"Our goal from Day 1 is to reunite them with their family," said Lynne Cairns, director of the Missouri Children's Division office for the 32nd Circuit, which includes Bollinger, Perry and Cape Girardeau counties.

A call to the hotline sets in motion an investigation of conditions at a child's home. Depending on the allegations, children's division workers can take police along to determine if there is imminent danger. Only a police officer, juvenile officer or medical professional can decide to remove a child during the initial phase of the investigation.

But from that point forward, each case runs on parallel tracks of child protection and legal prosecution. High profile cases from the past year show how the two tracks for dealing with such cases work.

Where children died or were seriously injured -- such as the case of Ethan Patrick Williams, a Perry County boy who died of staph, or the young son of Holly Hency, who pleaded guilty to deliberately overmedicating her child -- the juvenile courts become responsible for the children.

In other cases -- such as that of Cedric Moore and Karen Clark, who kept six children living in filth on Pearl Street or Terri Duncan, who was with three children in a garbage-filled apartment on North Street -- children are returned to their parents within days.

"In general, keeping a dirty house is not a crime," Swingle said. "A crime does occur when the state can prove a child's health was put at risk."

The job of law enforcement and prosecutors is to punish the worst cases. The job of the Missouri Children's Division and the juvenile courts, on the other hand, is to heal a family's problems, if possible, Cairns said.

For example, less than 10 percent of hotline calls in Cape Girardeau County in 2004 resulted in findings that children had been abused or neglected. But for the children involved in 60 percent of those calls, case workers decided the family needed intervention.

Sometimes the help is as simple as assistance for the family to find better housing or work. Other times, the intervention is more serious, and the division forms a family support team to address multiple problems.

The first meeting of such a team is held within 24 hours of the opening of an investigation. With the parents, the investigators and juvenile court personnel, the concerns found at the home are discussed and issues identified, Cairns said.

A second meeting is held within 72 hours, with the goal to identify what must be done so parents can be reunited with their children, Cairn said.

"We talk about what the parents are doing right," she said. "And we are starting to develop a plan for change. We want the family to be part of telling us what they need."

When the key problems are the way the family lives -- such as in the case of filthy homes -- the goals are straightforward. The home must be cleaned or the conditions that make it unhealthy removed, Cairns said.

And when the children return home, she said, investigators make follow-up visits. If the parents keep their promises, the cases often end there.

Each hotline call receives an initial assessment, which determines how fast investigators act. For cases involving sexual abuse, severe physical abuse or a call from a hospital, investigators have three hours to respond.

For calls with any other allegations except educational neglect, investigators must make contact with the family within 24 hours. For educational neglect, the standard is a visit within three days.

"We see serious cases on an ongoing basis," Cairns said. "But I don't think it is by any means an epidemic."

When a potentially serious case is reported, Children's Division workers usually call on police to accompany them to the home. The conditions are shocking at times, said Det. Darren Estes of the Cape Girardeau Police Department.

"A person could drive themselves crazy thinking about what kids are dealing with on a daily basis," Estes said.

Police aren't responsible for deciding if a case requires criminal prosecutions, Estes said. They send the cases to prosecutors, who decide what charges to file and, as many cases have shown, whether to seek prison time or probation.

Almost all the child neglect cases involving filthy homes begin as felony cases. But Swingle's office has allowed parents to plead guilty to reduced charges when no actual, physical harm can be proven.

The difference, he said, is whether parents knowingly create a hazard or whether it is a matter of negligence. When parents are put on probation, they are usually required to work with family assistance programs for the entirety of their probationary period.

The rewards from such cases are healthy, well-cared-for children, Estes said. Too often, he said, officers return to the same homes again.

"I worry about those kids and I hope I don't see their names come across my desk again," he said. "I pray for their safety and hope they are going to be OK."

The day-in, day-out nature of the effort to protect children can take a toll on those involved. As a judge, Lewis said, he must follow the law and maintain an impartial stance. Judges are not advocates for either side, he said.

The law requires the courts to balance the interests of the child with the rights of the parents, two goals that are "in constant tension with each other," he said.

Each case usually is not a black-and-white decision, he said.

"Nobody has a crystal ball," Lewis said. "Children love bad parents, too. There aren't a lot of easy answers."

But keeping an impartial stance isn't the same as not caring about the outcome, he said. And the evidence can be chilling at times.

"Sometimes you just want to go home and hug your kids and not let them out of the house," Lewis said.